Volume 10, Issue 20, June 7, 2018

CDC Science Clips: Volume 10, Issue 20, June 7, 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!

This week, Science Clips is pleased to collaborate with CDC Vital Signs by featuring scientific articles from the latest issue (www.cdc.gov/vitalsigns). The articles marked with an asterisk are general review articles which may be of particular interest to clinicians and public health professionals seeking background information in this area.

  1. CDC Vital Signs
    • Injury Prevention and Control – Suicide Prevention
      1. *2012 National strategy for suicide prevention: goals and objectives for actionCdc-pdfExternal
        Office of the Surgeon General , National Action Alliance for Suicide Prevention .
        Washington, DC: US Department of Health and Human Services, Office of the Surgeon General. 2012 .

        The National Strategy includes 13 goals and 60 objectives that have been updated to reflect advances in suicide prevention knowledge, research, and practice, as well as broader changes in society and health care delivery that have created new opportunities for suicide prevention.

      2. *Preventing suicide: a technical package of policy, programs, and practiceCdc-pdf
        Stone D, Holland K, Bartholow B, Crosby A, Davis S, Wilkins N.
        Atlanta, GA: US Department of Health and Human Services, CDC. 2017 .

        This technical package represents a select group of strategies based on the best available evidence to help communities and states sharpen their focus on prevention activities with the greatest potential to prevent suicide. These strategies include: strengthening economic supports; strengthening access and delivery of suicide care; creating protective environments; promoting connectedness; teaching coping and problem-solving skills; identifying and supporting people at risk; and lessening harms and preventing future risk. The strategies represented in this package include those with a focus on preventing the risk of suicide in the first place as well as approaches to lessen the immediate and long-term harms of suicidal behavior for individuals, families, communities, and society. The strategies in the technical package support the goals and objectives of the National Strategy for Suicide Prevention and the National Action Alliance for Suicide Prevention’s priority to strengthen community-based prevention. Commitment, cooperation, and leadership from numerous sectors, including public health, education, justice, health care, social services, business, labor, and government can bring about the successful implementation of this package.

      3. *Transforming communities: Key elements for the implementation of comprehensive community-based suicide preventionCdc-pdfExternal
        National Action Alliance for Suicide Prevention , Transforming Communities-Community-Based Suicide Prevention Priority Group .
        Washington, DC: Education Development Center, Inc.. 2017 .

        [No abstract]

      4. Comprehensive, integrated approaches to suicide prevention: practical guidanceExternal
        Caine ED, Reed J, Hindman J, Quinlan K.
        Inj Prev. 2018 Jun;24(Suppl 1):i38-i45.

        BACKGROUND: Efforts in the USA during the 21st century to stem the ever-rising tide of suicide and risk-related premature deaths, such as those caused by drug intoxications, have failed. Based primarily on identifying individuals with heightened risk nearing the precipice of death, these initiatives face fundamental obstacles that cannot be overcome readily. OBJECTIVE: This paper describes the step-by-step development of a comprehensive public health approach that seeks to integrate at the community level an array of programmatic efforts, which address upstream (distal) risk factors to alter life trajectories while also involving health systems and clinical providers who care for vulnerable, distressed individuals, many of whom have attempted suicide. CONCLUSION: Preventing suicide and related self-injury morbidity and mortality, and their antecedents, will require a systemic approach that builds on a societal commitment to save lives and collective actions that bring together diverse communities, service organisations, healthcare providers and governmental agencies and political leaders. This will require frank, data-based appraisals of burden that drive planning, programme development and implementation, rigorous evaluation and a willingness to try-fail-and-try-again until the tide has been turned.

      5. Increase in suicide in the United States, 1999-2014External
        Curtin SC, Warner M, Hedegaard H.
        NCHS Data Brief. 2016 Apr(241):1-8.

        KEY FINDINGS: Data from the National Vital Statistics System, Mortality *From 1999 through 2014, the age-adjusted suicide rate in the United States increased 24%, from 10.5 to 13.0 per 100,000 population, with the pace of increase greater after 2006. *Suicide rates increased from 1999 through 2014 for both males and females and for all ages 10-74. *The percent increase in suicide rates for females was greatest for those aged 10-14, and for males, those aged 45-64. *The most frequent suicide method in 2014 for males involved the use of firearms (55.4%), while poisoning was the most frequent method for females (34.1%). *Percentages of suicides attributable to suffocation increased for both sexes between 1999 and 2014.

      6. Suicide trends among and within urbanization levels by sex, race/ethnicity, age group, and mechanism of death – United States, 2001-2015External
        Ivey-Stephenson AZ, Crosby AE, Jack SP, Haileyesus T, Kresnow-Sedacca MJ.
        MMWR Surveill Summ. 2017 Oct 6;66(18):1-16.

        PROBLEM/CONDITION: Suicide is a public health problem and one of the top 10 leading causes of death in the United States. Substantial geographic variations in suicide rates exist, with suicides in rural areas occurring at much higher rates than those occurring in more urban areas. Understanding demographic trends and mechanisms of death among and within urbanization levels is important to developing and targeting future prevention efforts. REPORTING PERIOD: 2001-2015. DESCRIPTION OF SYSTEM: Mortality data from the National Vital Statistics System (NVSS) include demographic, geographic, and cause of death information derived from death certificates filed in the 50 states and the District of Columbia. NVSS was used to identify suicide deaths, defined by International Classification of Diseases, 10th Revision (ICD-10) underlying cause of death codes X60-X84, Y87.0, and U03. This report examines annual county level trends in suicide rates during 2001-2015 among and within urbanization levels by select demographics and mechanisms of death. Counties were collapsed into three urbanization levels using the 2006 National Center for Health Statistics classification scheme. RESULTS: Suicide rates increased across the three urbanization levels, with higher rates in nonmetropolitan/rural counties than in medium/small or large metropolitan counties. Each urbanization level experienced substantial annual rate changes at different times during the study period. Across urbanization levels, suicide rates were consistently highest for men and non-Hispanic American Indian/Alaska Natives compared with rates for women and other racial/ethnic groups; however, rates were highest for non-Hispanic whites in more metropolitan counties. Trends indicate that suicide rates for non-Hispanic blacks were lowest in nonmetropolitan/rural counties and highest in more urban counties. Increases in suicide rates occurred for all age groups across urbanization levels, with the highest rates for persons aged 35-64 years. For mechanism of death, greater increases in rates of suicide by firearms and hanging/suffocation occurred across all urbanization levels; rates of suicide by firearms in nonmetropolitan/rural counties were almost two times that of rates in larger metropolitan counties. INTERPRETATION: Suicide rates in nonmetropolitan/rural counties are consistently higher than suicide rates in metropolitan counties. These trends also are observed by sex, race/ethnicity, age group, and mechanism of death. PUBLIC HEALTH ACTION: Interventions to prevent suicides should be ongoing, particularly in rural areas. Comprehensive suicide prevention efforts might include leveraging protective factors and providing innovative prevention strategies that increase access to health care and mental health care in rural communities. In addition, distribution of socioeconomic factors varies in different communities and needs to be better understood in the context of suicide prevention.

      7. Mortality in the United States, 2016External
        Kochanek KD, Murphy S, Xu J, Arias E.
        NCHS Data Brief. 2017 Dec(293):1-8.

        This report presents final 2016 U.S. mortality data on deaths and death rates by demographic and medical characteristics. These data provide information on mortality patterns among U.S. residents by variables such as sex, race and ethnicity, and cause of death. Life expectancy estimates, age-specific death rates, age-adjusted death rates by race and ethnicity and sex, 10 leading causes of death, and 10 leading causes of infant death were analyzed by comparing 2016 and 2015 final data (1).

      8. Critical issues in psychological autopsy studiesExternal
        Pouliot L, De Leo D.
        Suicide Life Threat Behav. 2006 Oct;36(5):491-510.

        This paper reviews research based on the psychological autopsy (PA) method applied to the study of suicide. It evidences the presence of a number of methodological problems. Shortcomings concern sampling biases in the selection of control subjects, confounding influences of extraneous variables, and reliability of the assessment instruments. The absence of homogeneity among studies in the procedure employed, as well as the lack of defined guidelines for performing this type of inquiry are emphasized. Questions needing empirical investigation in the future are pointed out. It is concluded that the validity and reliability of findings emerging from the use of this method of investigation would benefit from a standardization of its application.

      9. Preventing suicide: a community engagement toolkit. Pilot version 1.0External
        World Health Organization .
        Geneva: World Health Organization. Licence: CC BY-NC-SA 3.0 IGO.. 2016 .

        Communities can play a critical role in suicide prevention. Facilitating community engagement in suicide prevention is an important task. The toolkit is a step-by-step guide for communities to engage in suicide prevention activities and have ownership of the process and keep efforts sustained. It is hoped that the pilot version will be used, after necessary adaptation, in many countries and contexts, so that the final product can be strengthened and become more effective and user-friendly.

      10. Risks to mental health: an overview of vulnerabilities and risk factorsCdc-pdfExternal
        World Health Organization .
        Geneva: World Health Organization. 2012 .

        [No abstract]

  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. Annual Report to the Nation on the Status of Cancer, part I: National cancer statisticsExternal
        Cronin KA, Lake AJ, Scott S, Sherman RL, Noone AM, Howlader N, Henley SJ, Anderson RN, Firth AU, Ma J, Kohler BA, Jemal A.
        Cancer. 2018 May 22.

        BACKGROUND: The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate to provide annual updates on cancer occurrence and trends in the United States. METHODS: Incidence data were obtained from the CDC-funded and NCI-funded population-based cancer registry programs and compiled by NAACCR. Data on cancer deaths were obtained from the National Center for Health Statistics National Vital Statistics System. Trends in age-standardized incidence and death rates for all cancers combined and for the leading cancer types by sex, race, and ethnicity were estimated by joinpoint analysis and expressed as the annual percent change. Stage distribution and 5-year survival by stage at diagnosis were calculated for breast cancer, colon and rectum (colorectal) cancer, lung and bronchus cancer, and melanoma of the skin. RESULTS: Overall cancer incidence rates from 2008 to 2014 decreased by 2.2% per year among men but were stable among women. Overall cancer death rates from 1999 to 2015 decreased by 1.8% per year among men and by 1.4% per year among women. Among men, incidence rates during the most recent 5-year period (2010-2014) decreased for 7 of the 17 most common cancer types, and death rates (2011-2015) decreased for 11 of the 18 most common types. Among women, incidence rates declined for 7 of the 18 most common cancers, and death rates declined for 14 of the 20 most common cancers. Death rates decreased for cancer sites, including lung and bronchus (men and women), colorectal (men and women), female breast, and prostate. Death rates increased for cancers of the liver (men and women); pancreas (men and women); brain and other nervous system (men and women); oral cavity and pharynx (men only); soft tissue, including heart (men only); nonmelanoma skin (men only); and uterus. Incidence and death rates were higher among men than among women for all racial and ethnic groups. For all cancer sites combined, black men and white women had the highest incidence rates compared with other racial groups, and black men and black women had the highest death rates compared with other racial groups. Non-Hispanic men and women had higher incidence and mortality rates than those of Hispanic ethnicity. Five-year survival for cases diagnosed from 2007 through 2013 ranged from 100% (stage I) to 26.5% (stage IV) for female breast cancer, from 88.1% (stage I) to 12.6% (stage IV) for colorectal cancer, from 55.1% (stage I) to 4.2% (stage IV) for lung and bronchus cancer, and from 99.5% (stage I) to 16% (stage IV) for melanoma of the skin. Among children, overall cancer incidence rates increased by 0.8% per year from 2010 to 2014, and overall cancer death rates decreased by 1.5% per year from 2011 to 2015. CONCLUSIONS: For all cancer sites combined, cancer incidence rates decreased among men but were stable among women. Overall, there continue to be significant declines in cancer death rates among both men and women. Differences in rates and trends by race and ethnic group remain. Progress in reducing cancer mortality has not occurred for all sites. Examining stage distribution and 5-year survival by stage highlights the potential benefits associated with early detection and treatment. Cancer 2018. (c) 2018 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

      2. BACKGROUND: Large reductions in diabetes complications have altered diabetes-related morbidity in the USA. It is unclear whether similar trends have occurred in causes of death. METHODS: Using data from the National Health Interview Survey Linked Mortality files from 1985 to 2015, we estimated age-specific death rates and proportional mortality from all causes, vascular causes, cancers, and non-vascular, non-cancer causes among US adults by diabetes status. FINDINGS: From 1988-94, to 2010-15, all-cause death rates declined by 20% every 10 years among US adults with diabetes (from 23.1 [95% CI 20.1-26.0] to 15.2 [14.6-15.8] per 1000 person-years), while death from vascular causes decreased 32% every 10 years (from 11.0 [9.2-12.2] to 5.2 [4.8-5.6] per 1000 person-years), deaths from cancers decreased 16% every 10 years (from 4.4 [3.2-5.5] to 3.0 [2.8-3.3] per 1000 person-years), and the rate of non-vascular, non-cancer deaths declined by 8% every 10 years (from 7.7 [6.3-9.2] to 7.1 [6.6-7.5]). Death rates also declined significantly among people without diagnosed diabetes for all four major mortality categories. However, the declines in death rates were significantly greater among people with diabetes for all-causes (pinteraction<0.0001), vascular causes (pinteraction=0.0214), and non-vascular, non-cancer causes (pinteration<0.0001), as differences in all-cause and vascular disease death between people with and without diabetes were reduced by about a half. Among people with diabetes, all-cause mortality rates declined most in men and adults aged 65-74 years of age, and there was no decline in death rates among adults aged 20-44 years. The different magnitude of changes in cause-specific mortality led to large changes in the proportional mortality. The proportion of total deaths among adults with diabetes from vascular causes declined from 47.8% (95% CI 38.9-58.8) in 1988-94 to 34.1% (31.4-37.1) in 2010-15; this decline was offset by large increases in the proportion of deaths from non-vascular, non-cancer causes, from 33.5% (26.7-42.1) to 46.5% (43.3-50.0). The proportion of deaths caused by cancer was relatively stable over time, ranging from 16% to 20%. INTERPRETATION: Declining rates of vascular disease mortality are leading to a diversification of forms of diabetes-related mortality with implications for clinical management, prevention, and disease monitoring. FUNDING: None.

      3. Risk of cancer death by comorbidity severity and use of adjuvant chemotherapy among women with locoregional breast cancerExternal
        Kimmick GG, Li X, Fleming ST, Sabatino SA, Wilson JF, Lipscomb J, Cress R, Bergom C, Anderson RT, Wu XC.
        J Geriatr Oncol. 2018 May;9(3):214-220.

        OBJECTIVES: To examine the associations of comorbidity and chemotherapy with breast cancer- and non-breast cancer-related death. MATERIALS AND METHODS: Included were women with invasive locoregional breast cancer diagnosed in 2004 from seven population-based cancer registries. Data were abstracted from medical records and verified with treating physicians when there were inconsistencies and missing information on cancer treatment. Comorbidity severity was quantified using the Adult Comorbidity Evaluation 27. Treatment guideline concordance was determined by comparing treatment received with the National Comprehensive Cancer Network guidelines. Kaplan-Meier method and multivariable Cox proportional hazards regressions were employed for statistical analyses. RESULTS: Of 5852 patients, 76% were under 70years old and 69% received guideline concordant adjuvant chemotherapy. Comorbidity was more prevalent in women age 70 and older (79% vs. 51%; p<0.001). After adjusting for tumor characteristics and treatment, severe comorbidity burden was associated with significantly higher cancer-related mortality in older patients (Hazard Ratio [HR]=2.38, 95% CI 1.08-5.24), but not in younger patients (HR=1.78, 95% CI 0.87-3.64). Among patients receiving guideline adjuvant chemotherapy, cancer-related mortality was significantly higher in older patients (HR=2.35, 95% CI 1.52-3.62), and those with severe comorbidity (HR=3.79, 95% CI 1.72-8.33). CONCLUSIONS: Findings suggest that, compared to women with no comorbidity, patients with breast cancer age 70 and older with severe comorbidity are at increased risk of dying from breast cancer, even after adjustment for adjuvant chemotherapy and other tumor and treatment differences. This information adds to risk-benefit discussions and emphasizes the need for further study of the role for adjuvant chemotherapy in these patient groups.

      4. Aspects of multicomponent integrated care promote sustained improvement in surrogate clinical outcomes: A systematic review and meta-analysisExternal
        Lim LL, Lau ES, Kong AP, Davies MJ, Levitt NS, Eliasson B, Aguilar-Salinas CA, Ning G, Seino Y, So WY, McGill M, Ogle GD, Orchard TJ, Clarke P, Holman RR, Gregg EW, Gagliardino JJ, Chan JC.
        Diabetes Care. 2018 Jun;41(6):1312-1320.

        OBJECTIVE: The implementation of the Chronic Care Model (CCM) improves health care quality. We examined the sustained effectiveness of multicomponent integrated care in type 2 diabetes. RESEARCH DESIGN AND METHODS: We searched PubMed and Ovid MEDLINE (January 2000-August 2016) and identified randomized controlled trials comprising two or more quality improvement strategies from two or more domains (health system, health care providers, or patients) lasting >/=12 months with one or more clinical outcomes. Two reviewers extracted data and appraised the reporting quality. RESULTS: In a meta-analysis of 181 trials (N = 135,112), random-effects modeling revealed pooled mean differences in HbA1c of -0.28% (95% CI -0.35 to -0.21) (-3.1 mmol/mol [-3.9 to -2.3]), in systolic blood pressure (SBP) of -2.3 mmHg (-3.1 to -1.4), in diastolic blood pressure (DBP) of -1.1 mmHg (-1.5 to -0.6), and in LDL cholesterol (LDL-C) of -0.14 mmol/L (-0.21 to -0.07), with greater effects in patients with LDL-C >/=3.4 mmol/L (-0.31 vs. -0.10 mmol/L for <3.4 mmol/L; Pdifference = 0.013), studies from Asia (HbA1c -0.51% vs. -0.23% for North America [-5.5 vs. -2.5 mmol/mol]; Pdifference = 0.046), and studies lasting >12 months (SBP -3.4 vs. -1.4 mmHg, Pdifference = 0.034; DBP -1.7 vs. -0.7 mmHg, Pdifference = 0.047; LDL-C -0.21 vs. -0.07 mmol/L for 12-month studies, Pdifference = 0.049). Patients with median age <60 years had greater HbA1c reduction (-0.35% vs. -0.18% for >/=60 years [-3.8 vs. -2.0 mmol/mol]; Pdifference = 0.029). Team change, patient education/self-management, and improved patient-provider communication had the largest effect sizes (0.28-0.36% [3.0-3.9 mmol/mol]). CONCLUSIONS: Despite the small effect size of multicomponent integrated care (in part attenuated by good background care), team-based care with better information flow may improve patient-provider communication and self-management in patients who are young, with suboptimal control, and in low-resource settings.

      5. Because conducting population-based oral health screening is resource intensive, oral health data at small-area levels (e.g., county-level) are not commonly available. We applied the multilevel logistic regression and poststratification method to estimate county-level prevalence of untreated dental caries among children aged 6-9years in the United States using data from the National Health and Nutrition Examination Survey (NHANES) 2005-2010 linked with various area-level data at census tract, county and state levels. We validated model-based national estimates against direct estimates from NHANES. We also compared model-based estimates with direct estimates from select State Oral Health Surveys (SOHS) at state and county levels. The model with individual-level covariates only and the model with individual-, census tract- and county-level covariates explained 7.2% and 96.3% respectively of overall county-level variation in untreated caries. Model-based county-level prevalence estimates ranged from 4.9% to 65.2% with median of 22.1%. The model-based national estimate (19.9%) matched the NHANES direct estimate (19.8%). We found significantly positive correlations between model-based estimates for 8-year-olds and direct estimates from the third-grade State Oral Health Surveys (SOHS) at state level for 34 states (Pearson coefficient: 0.54, P=0.001) and SOHS estimates at county level for 53 New York counties (Pearson coefficient: 0.38, P=0.006). This methodology could be a useful tool to characterize county-level disparities in untreated dental caries among children aged 6-9years and complement oral health surveillance to inform public health programs especially when local-level data are not available although the lack of external validation due to data unavailability should be acknowledged.

      6. Annual Report to the Nation on the Status of Cancer, part II: Recent changes in prostate cancer trends and disease characteristicsExternal
        Negoita S, Feuer EJ, Mariotto A, Cronin KA, Petkov VI, Hussey SK, Benard V, Henley SJ, Anderson RN, Fedewa S, Sherman RL, Kohler BA, Dearmon BJ, Lake AJ, Ma J, Richardson LC, Jemal A, Penberthy L.
        Cancer. 2018 May 22.

        BACKGROUND: Temporal trends in prostate cancer incidence and death rates have been attributed to changing patterns of screening and improved treatment (mortality only), among other factors. This study evaluated contemporary national-level trends and their relations with prostate-specific antigen (PSA) testing prevalence and explored trends in incidence according to disease characteristics with stage-specific, delay-adjusted rates. METHODS: Joinpoint regression was used to examine changes in delay-adjusted prostate cancer incidence rates from population-based US cancer registries from 2000 to 2014 by age categories, race, and disease characteristics, including stage, PSA, Gleason score, and clinical extension. In addition, the analysis included trends for prostate cancer mortality between 1975 and 2015 by race and the estimation of PSA testing prevalence between 1987 and 2005. The annual percent change was calculated for periods defined by significant trend change points. RESULTS: For all age groups, overall prostate cancer incidence rates declined approximately 6.5% per year from 2007. However, the incidence of distant-stage disease increased from 2010 to 2014. The incidence of disease according to higher PSA levels or Gleason scores at diagnosis did not increase. After years of significant decline (from 1993 to 2013), the overall prostate cancer mortality trend stabilized from 2013 to 2015. CONCLUSIONS: After a decline in PSA test usage, there has been an increased burden of late-stage disease, and the decline in prostate cancer mortality has leveled off. Cancer 2018. (c) 2018 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

      7. Trends in high-grade cervical cancer precursors in the human papillomavirus vaccine eraExternal
        Oakley F, Desouki MM, Pemmaraju M, Gargano JM, Markowitz LE, Steinau M, Unger ER, Zhu Y, Fadare O, Griffin MR.
        Am J Prev Med. 2018 May 16.

        INTRODUCTION: The 2006 introduction of human papillomavirus vaccine targeted against genotypes 6, 11, 16, and 18 should result in decreased cervical dysplasia in vaccinated women. However, new cervical cancer guidelines to increase screening intervals complicate interpretation of trends. The hypothesis is that cervical dysplasia would decrease only in young vaccine-eligible women, and not older women. METHODS: The authors identified Davidson County, Tennessee, women aged 18-39 years with cervical intraepithelial neoplasia (CIN) grade 2 or greater and adenocarcinoma in situ, denoted as CIN2+, through pathology reports from laboratories serving this population. Biopsy specimens for human papillomavirus genotyping were collected. Trends in CIN2+ rates and associated human papillomavirus genotypes, 2008 through 2013, were examined. RESULTS: The authors identified 2,031 women with CIN2+. Rates of CIN2+ fell from 188.9 to 58.7 per 100,000 women aged 18-20 years (annual percentage change= -24.2, 95% CI= -41.4, -2.1) and from 495.6 to 332.4 per 100,000 women aged 21-24 years (annual percentage change= -10.2%, 95% CI= -16.3, -3.4). There was no significant change in CIN2+ rates for women aged 25-29 or 30-39 years. In biopsy specimens from 1,319 of 2,031 (65%) women, at least one human papillomavirus genotype was identified in 1,270 (96%). The prevalence of at least one of four vaccine human papillomavirus genotypes (6, 11, 16, and 18) declined from 59% in 2008 to 52% in 2013 (p=0.003). CONCLUSIONS: Diagnosis of CIN2+ decreased in women aged 18-24 years, but not in older women. Both changes in screening and human papillomavirus vaccination could have contributed to the decline of CIN2+ in young women.

      8. Considering disability and health: Reflections on the Healthy People 2020 Midcourse ReviewExternal
        Sinclair LB, Fox MH, Jonas BS, Berry HG, Quatrano LA, McGowan AK, Peacock G.
        Disabil Health J. 2018 Apr 19.

        The Healthy People 2020 (HP2020) Midcourse Review (MCR) presents an opportunity for professionals in the disability and health field to contemplate preliminary progress toward achieving specific health objectives. The MCR showed notable progress in access to primary care, appropriate services for complex conditions associated with disability, expansion of health promotion programs focusing on disability, improving mental health, and reducing the unemployment rate among job seekers with disabilities. This commentary presents potential considerations, at least in part, for such progress including increased access to health care, greater awareness of appropriate services for complex conditions, and opportunities for societal participation. Additional considerations are provided to address the lack of progress in employment among this population — a somewhat different measure than that for unemployment. Continuing to monitor these objectives will help inform programs, policies, and practices that promote the health of people with disabilities as measured by HP2020.

      9. Factors associated with breast MRI use among women with a family history of breast cancerExternal
        White MC, Soman A, Weinberg CR, Rodriguez JL, Sabatino SA, Peipins LA, DeRoo L, Nichols HB, Hodgson ME, Sandler DP.
        Breast J. 2018 May 20.

        Although annual breast magnetic resonance imaging (MRI) is recommended for women at high risk for breast cancer as an adjunct to screening mammography, breast MRI use remains low. We examined factors associated with breast MRI use in a cohort of women with a family history of breast cancer but no personal cancer history. Study participants came from the Sister Study cohort, a nationwide, prospective study of women with at least 1 sister who had been diagnosed with breast cancer but who themselves had not ever had breast cancer (n = 17 894). Participants were surveyed on breast cancer beliefs, cancer worry, breast MRI use, provider communication, and genetic counseling and testing. Logistic regression was used to assess factors associated with having a breast MRI overall and for those at high risk. Breast MRI was reported by 16.1% and was more common among younger women and those with higher incomes. After adjustment for demographics, ever use of breast MRI was associated with actual and perceived risk. Odds ratios (OR) were 12.29 (95% CI, 8.85-17.06), 2.48 (95% CI, 2.27-2.71), and 2.50 (95% CI, 2.09-2.99) for positive BRCA1/2 test, lifetime breast cancer risk >/= 20%, and being told by a health care provider of higher risk, respectively. Women who believed they had much higher risk than others or had higher level of worry were twice as likely to have had breast MRI; OR = 2.23 (95% CI, 1.82-2.75) and OR = 1.76 (95% CI, 1.52-2.04). Patterns were similar among women at high risk. Breast cancer risk, provider communication, and personal beliefs were determinants of breast MRI use. To support shared decisions about the use of breast MRI, women could benefit from improved understanding of the chances of getting breast cancer and increased quality of provider communications.

    • Communicable Diseases
      1. Risk factors for group A streptococcus colonization during an outbreak among people experiencing homelessness in Anchorage, Alaska, 2017External
        Adebanjo T, Mosites E, Van Beneden CA, Onukwube J, Blum M, Harper M, Rudolph K, Frick A, Castrodale L, McLaughlin J, Bruce MG, Gounder P.
        Clin Infect Dis. 2018 May 18.

        We identified risk factors for any emm-type group A streptococcal (GAS) colonization while investigating an invasive emm26.3 GAS outbreak among people experiencing homelessness in Alaska. Risk factors included upper extremity skin breakdown, sleeping outdoors, sharing blankets, and infrequent tooth brushing. Our results may help guide control efforts in future outbreaks.

      2. The influence of mobility among high-risk populations on HIV transmission in Western KenyaExternal
        Bershteyn A, Mutai KK, Akullian AN, Klein DJ, Jewell BL, Mwalili SM.
        Infectious Disease Modelling. 2018 01 Jan;3:97-106.

        Western Kenya suffers a highly endemic and also very heterogeneous epidemic of human immunodeficiency virus (HIV). Although female sex workers (FSW) and their male clients are known to be at high risk for HIV, HIV prevalence across regions in Western Kenya is not strongly correlated with the fraction of women engaged in commercial sex. An agent-based network model of HIV transmission, geographically stratified at the county level, was fit to the HIV epidemic, scale-up of interventions, and populations of FSW in Western Kenya under two assumptions about the potential mobility of FSW clients. In the first, all clients were assumed to be resident in the same geographies as their interactions with FSW. In the second, some clients were considered non-resident and engaged only in interactions with FSW, but not in longer-term non-FSW partnerships in these geographies. Under both assumptions, the model successfully reconciled disparate geographic patterns of FSW and HIV prevalence. Transmission patterns in the model suggest a greater role for FSW in local transmission when clients were resident to the counties, with 30.0% of local HIV transmissions attributable to current and former FSW and clients, compared to 21.9% when mobility of clients was included. Nonetheless, the overall epidemic drivers remained similar, with risky behavior in the general population dominating transmission in high-prevalence counties. Our modeling suggests that co-location of high-risk populations and generalized epidemics can further amplify the spread of HIV, but that large numbers of formal FSW and clients are not required to observe or mechanistically explain high HIV prevalence in the general population.

      3. Epidemiology of acute diarrhea caused by rotavirus in sentinel surveillance sites of Vietnam, 2012-2015External
        Huyen DT, Hong DT, Trung NT, Hoa TT, Oanh NK, Thang HV, Thao NT, Hung DM, Iijima M, Fox K, Grabovac V, Heffelfinger J, Batmunkh N, Anh DD.
        Vaccine. 2018 May 18.

        A prospective, multicentre study was conducted in four sentinel surveillance hospitals to assess the trend and epidemiology of acute diarrhea caused by Rotavirus in Vietnam. During the period 2012-2015, a total 8,889 children under 5years of age were enrolled in the surveillance, and 8689 stool samples were collected. Of these cases, Rotavirus was most common pathogen 46.7% (4054 cases); in which 26.6% (1117) rotavirus-positive stool samples were evaluated to identify genotypes. The proportion of rotavirus positive specimens decreased annually from 54.7% in 2012 to 36.6% in 2015. Rotavirus was detected year-round, but most rotavirus gastroenteritis cases (77.1%) occurred between December and May, corresponding to the rotavirus seasonality. It is found that the peaks varied by regions. Rotavirus positivities varied between the youngest and oldest age, but children 6-11months old (38.8%) and 12-23months old (38.4%) counted for most cases. A significant higher number of diarrhea within 24hours (8.3 times, 95%CI: 8.1-8.4 times) and higher proportion of severe dehydration (12.9%) in Rotavirus positive group than that in Rotavirus negative group (7.7 times, 95%CI: 7.6-7.9 times; and 9.7%, respectively). A downtrend of prevalence of G1P[8] was observed from 82% in 2013 to 15% in 2015. However, G2P[4] was found in 5% of samples in 2012, 9% in 2013, 36% in 2014, and 28% in 2015. Rotavirus infection is the most important cause of acute diarrhea among hospitalized children in Vietnam, and a rotavirus vaccination program for children may significantly reduce this disease.

      4. Evaluating previous antibiotic use as a risk factor for acute gastroenteritis among children in Davidson County, Tennessee, 2014-2015External
        Kolsin JM, Lopman BA, Payne DC, Wikswo ME, Dunn JR, Halasa NB, Hall AJ.
        J Pediatric Infect Dis Soc. 2018 May 19.

        Background: Epidemiologic studies that evaluate the relationship between previous antibiotic use and acute gastroenteritis (AGE) in the pediatric population are currently lacking. Methods: We analyzed inpatient and outpatient children with AGE and healthy controls from Vanderbilt University Medical Center between December 1, 2014, and November 30, 2015. The following 4 outcome groups were defined: overall AGE, norovirus-associated AGE, rotavirus-associated AGE, and nonnorovirus/nonrotavirus AGE. Multiple logistic regression was performed to evaluate the association between previous antibiotic use and the 4 AGE outcomes and with AGE severity. Results: Reported antibiotic use rates in the 3 months before illness onset were similar across the 4 AGE outcomes (overall AGE, 21%; norovirus-associated AGE, 23%; rotavirus-associated AGE, 28%; and nonnorovirus/nonrotavirus AGE, 22%) but were higher than that reported for healthy controls (9%). Compared with healthy controls, patients with AGE overall were 4.6 (95% confidence interval [CI], 1.8-11.4) times more likely to have reported antibiotic use in the 3 weeks before illness onset and 2.6 (95% CI, 1.7-4.1) times more likely to have reported antibiotic use within 3 months before illness onset. Similar results were found for the other specific AGE outcomes. For the overall AGE group, the odds of antibiotic use in the 3 months before illness onset was 3.5 (95% CI, 1.8-7.1) times higher for inpatients than for outpatients. Conclusions: Previous antibiotic use among children was associated with increased odds of AGE, irrespective of etiology, and this association was stronger with more recent antibiotic use. Previous antibiotic use was associated also with more severe AGE.

      5. Mycoplasma pneumoniae among children hospitalized with community-acquired pneumoniaExternal
        Kutty PK, Jain S, Taylor TH, Bramley AM, Diaz MH, Ampofo K, Arnold SR, Williams DJ, Edwards KM, McCullers JA, Pavia AT, Winchell JM, Schrag SJ, Hicks LA.
        Clin Infect Dis. 2018 May 17.

        Background: The burden and epidemiology of Mycoplasma pneumoniae (Mp) among U.S. children (<18 years) hospitalized with community-acquired pneumonia (CAP) are poorly understood. Methods: In the Etiology of Pneumonia in the Community (EPIC) study, we prospectively enrolled 2254 children hospitalized with radiographically-confirmed pneumonia from January 2010-June 2012 and tested nasopharyngeal/oropharyngeal swabs for Mp using real-time polymerase chain reaction (PCR). Clinical and epidemiological features of Mp-PCR-positive and -negative children were compared using logistic regression. Macrolide susceptibility was assessed by genotyping isolates. Results: In the EPIC study, 182(8%) children were Mp-PCR-positive (median age: 7 years); 12% required intensive care and 26% had pleural effusion. No in-hospital deaths occurred. Macrolide resistance was found in 6/169(4%) isolates. Of 178(98%) Mp-PCR-positive children tested for co-pathogens, 50(28%) had >/=1 co-pathogen detected. Variables significantly associated with higher odds of Mp detection included age {10-17 years [adjusted odds ratio (aOR): 7.9 (95% confidence interval (CI): 4.5-13.6)] and 5-9 years [aOR: 4.8 (CI: 2.9-7.8)] vs. 2-4 years}, outpatient antibiotics </=5 days pre-admission [aOR: 2.3 (CI: 1.5-3.4)], and co-pathogen detection [aOR: 2.1 (CI: 1.3-3.1)]. Clinical characteristics often seen included hilar lymphadenopathy, rales, headache, sore throat, and decreased breath sounds. Conclusions: Usually considered as a mild respiratory infection, M. pneumoniae was the most commonly detected bacteria among children >/=5 years hospitalized with CAP; one-quarter of whom had co-detections. Although associated with clinically non-specific symptoms, there was a need for intensive care support in some cases. M. pneumoniae should be included in the differential diagnosis for school-aged children hospitalized with CAP.

      6. Long-term liver disease, treatment, and mortality outcomes among 17,000 persons diagnosed with chronic hepatitis C virus infection: Current Chronic Hepatitis Cohort Study status and review of findingsExternal
        Moorman AC, Rupp LB, Gordon SC, Zhong Y, Xing J, Lu M, Boscarino JA, Schmidt MA, Daida YG, Teshale EH, Spradling PR, Holmberg SD.
        Infect Dis Clin North Am. 2018 Jun;32(2):253-268.

        Chronic Hepatitis Cohort Study (CHeCS) publications using data from “real-world” patients with hepatitis C virus (HCV) have described demographic disparities in access to care; rates of advanced liver disease, morbidity, and mortality (2.5%-3.5% per year during 2006-10, although only 19% of all CHeCS decedents, and just 30% of those with deaths attributed to liver disease, had HCV listed on death certificate); substantial comorbidities, such as diabetes, advanced liver fibrosis (29% prevalence), renal disease, and depression, and partial reversal of all these with successful antiviral therapy; patient risk behaviors; and use of noninvasive markers to assess liver disease.

      7. Rotavirus gastroenteritis surveillance in Azerbaijan, 2011-2016External
        Mursalova N, Shugayev N, Suleymanova J, Daniels DS, Wasley A, Cohen AL, Aliabadi N.
        Vaccine. 2018 May 18.

        INTRODUCTION: Rotavirus is a leading cause of acute gastroenteritis and mortality among children worldwide but data describing rotavirus disease in Azerbaijan are lacking. This analysis describes the rotavirus disease burden in Baku, the largest city in Azerbaijan. METHODS: We conducted active, prospective, sentinel hospital surveillance with laboratory confirmation for rotavirus among children under 5years of age hospitalized at a large pediatric hospital in Baku during 2011-2016. Children with bloody diarrhea, or prior use of antibiotics or intravenous fluids were excluded. The guardians of enrolled children completed a questionnaire documenting clinical and demographic information. A stool specimen was collected from each enrolled child. We report the number and proportion of rotavirus positive hospitalizations during the surveillance period and a clinical description of rotavirus-positive and rotavirus-negative children. RESULTS: From July 2011 through June 2016, 3139 children <5years of age were enrolled into the surveillance system. Of these, 523 (17%) were positive for rotavirus, varying from 13% to 21% by surveillance year, with a median of 16% over the surveillance period. Increase in rotavirus detections occurred during December-May. Most rotavirus infections (303/523; 58%) occurred in children aged 6-23months. CONCLUSION: Rotavirus is responsible for approximately 16% of annual hospital admissions for acute gastroenteritis in children <5years of age in Baku. This is lower than regional estimates. Exclusion of children with a history of antibiotic use or intravenous fluids may be accounting for this lower prevalence, and expansion of surveillance to include these groups could provide a more comprehensive picture of acute rotavirus gastroenteritis in Baku.

      8. Historical and current trends in the epidemiology of early syphilis in San Francisco, 1955-2016External
        Nguyen TQ, Kohn RP, Chew Ng R, Philip SS, Cohen SE.
        Sex Transm Dis. 2018 May 22.

        BACKGROUND: Seventeen years into a sustained epidemic, early syphilis (ES) rates in San Francisco (SF) are continuing to increase and the demographics of the affected population are changing. We provide a historical overview of ES in SF among men who have sex with men (MSM) and describe trends in the epidemiology and disease investigation outcomes. METHODS: We examined data from the SF Department of Public Health’s patient-based registry of integrated STD surveillance, clinical, and field investigation data to describe demographic and behavioral characteristics of ES cases, as well as outcomes of syphilis partner services. Chi-square tests were performed to examine categorical differences across time periods. Analysis of variance was used to examine differences in continuous variables. RESULTS: In 2016, 1095 ES cases were reported among males in SF, a 219% increase from the 343 cases identified 10 years ago. Between 1996-99 and 2010-16, an increasing proportion of ES cases were among MSM younger than 25 years, non-white, and HIV-negative (P<.05). A decreasing proportion of ES cases were assigned for Partner Services (PS), among whom a smaller proportion of reported sex partners were identified by name, resulting in an overall decline in the proportion of cases who had at least one named partner treated as a result of PS (Disease Investigation Rate) from 30.5 in 2000-2004 to 14.8 in 2010-2016. CONCLUSIONS: Syphilis case rates continue to increase in SF and the epidemic is expanding beyond a core population. Additional resources and innovative prevention approaches are needed to reduce the burden of syphilis among MSM.

      9. Individual and network factors associated with HIV care continuum outcomes among Nigerian MSM accessing healthcare servicesExternal
        Ramadhani HO, Ndembi N, Nowak RG, Ononaku U, Gwamna J, Orazulike I, Adebajo S, Crowell TA, Liu H, Baral SD, Ake J, Charurat ME.
        J Acquir Immune Defic Syndr. 2018 May 16.

        BACKGROUND: and setting: As data on the determinants of the HIV care continuum from key populations such as men who have sex with men (MSM) in resource-limited, settings (RLS) are limited, the study aimed to characterize HIV care continuum outcomes and assess individual and network barriers to progression through the HIV care continuum among MSM in Abuja and Lagos, Nigeria. METHODS: TRUST/RV368 study used respondent-driven-sampling to accrue MSM into community-based clinics in Nigeria. Participants received HIV testing at enrollment. HIV-infected participants were offered antiretroviral therapy (ART) with HIV RNA testing every three months (Abuja) or six months (Lagos). Multiple logistic regression models were used to calculate adjusted odds ratios for factors associated with each point in the HIV care continuum, including HIV testing, ART initiation, and six-month viral suppression. RESULTS: A total of 1506 MSM were recruited, 1178 (78.2%) tested for HIV and 369 (31.3%) were HIV positive newly diagnosed. Of these, 188 (50.1%) initiated ART, 136 (72.3%) completed six months and 96 (70.6%) were virally suppressed. Larger network size and stronger social network support were positively associated with HIV testing uptake. Factors associated with ART initiation were higher education and stronger social network support. Having stronger social network support was associated with increased odds of viral suppression at six months. CONCLUSIONS: Social determinants of health potentiated increased HIV Care Continuum outcomes. Integration of HIV prevention, HIV Counselling and Testing services and universal coverage of ART into a community-based clinic is critical in achieving better hig HIV Care Continuum outcomes.

      10. Mental health and retention in HIV care: A systematic review and meta-analysisExternal
        Rooks-Peck CR, Adegbite AH, Wichser ME, Ramshaw R, Mullins MM, Higa D, Sipe TA.
        Health Psychol. 2018 Jun;37(6):574-585.

        OBJECTIVE: Mental health (MH) diagnoses, which are prevalent among persons living with HIV infection, might be linked to failed retention in HIV care. This review synthesized the quantitative evidence regarding associations between MH diagnoses or symptoms and retention in HIV care, as well as determined if MH service utilization (MHSU) is associated with improved retention in HIV care. METHOD: A comprehensive search of the Centers for Disease Control and Prevention’s HIV/AIDS Prevention Research Synthesis database of electronic (e.g., MEDLINE, EMBASE, PsycINFO) and manual searches was conducted to identify relevant studies published during January 2002-August 2017. Effect estimates from individual studies were pooled by using random-effects meta-analysis, and a moderator analysis was conducted. RESULTS: Forty-five studies, involving approximately 57,334 participants in total, met the inclusion criteria: 39 examined MH diagnoses or symptoms, and 14 examined MHSU. Overall, a significant association existed between MH diagnoses or symptoms, and lower odds of being retained in HIV care (odds ratio, OR = 0.94; 95% confidence interval [CI] [0.90, 0.99]). Health insurance status (beta = 0.004; Z = 3.47; p = .001) significantly modified the association between MH diagnoses or symptoms and retention in HIV care. In addition, MHSU was associated with an increased odds of being retained in HIV care (OR = 1.84; 95% CI [1.45, 2.33]). CONCLUSIONS: Results indicate that MH diagnoses or symptoms are a barrier to retention in HIV care and emphasize the importance of providing MH treatment to HIV patients in need. (PsycINFO Database Record

      11. Missed opportunities to prescribe preexposure prophylaxis in South Carolina, 2013-2016External
        Smith DK, Chang MH, Duffus WA, Okoye S, Weissman S.
        Clin Infect Dis. 2018 May 22.

        Introduction: Expanding use of preexposure prophylaxis (PrEP) in ways that address current racial/ethnic disparities is an important HIV prevention goal. We investigated missed opportunities to provide PrEP during healthcare visits occurring prior to HIV infection. Methods: This retrospective cohort study linked South Carolina HIV case surveillance data to 3 statewide healthcare databases. Characteristics of patients, health care visits and providers, sexually transmitted diseases (STD), and other diagnoses, were assessed for medical encounters occurring before an initial HIV diagnosis. Adjusted odds ratios were used to identify correlates of missed opportunities for PrEP provision. Results: Of 885 persons newly diagnosed during the study period, 586 (66%) had 4,029 visits to a health care facility prior to their HIV diagnosis (mean of 6.9 visits) with missed opportunities for provision of PrEP. Emergency medicine trained clinicians conducted (61%) and primary care clinicians (family practice or internal medicine) conducted. 10% of visits. 42% of visits were by persons who were uninsured or self-paid, 36% had public insurance, and 18% had commercial insurance In multivariable analyses, being female, African American, or < 30 years of age were statistically significant predictors of having prior health care visits. Among persons at least one health care visit prior to their HIV diagnosis, 28.5% had a diagnosis of gonorrhea, syphilis, or chlamydia at any visit. Conclusion: Healthcare visits occurring among persons who would benefit from provision of PrEP, especially persons with diagnosed STDs, should be leveraged to increase use of PrEP and reduce the risk of HIV acquisition.

      12. Despite the high HIV incidence and prevalence among black men who have sex with men (BMSM), little research has examined partner characteristics, partner seeking venue, sexual position, substance use, and sexual risk behavior at the sex event-level among BMSM. Using the baseline data from a multi-site study of 807 BMSM stratified by their HIV status, the goal of this study was to conduct a detailed event-level analysis of 1577 male anal sex events to assess the factors associated with condomless anal intercourse (CLAI) with a HIV-discordant or HIV status-unknown partner. We found CLAI with an HIV-discordant or unknown HIV status partner among HIV-negative BMSM was negatively associated with having sex with a main partner, and was positively associated with taking both receptive and insertive sexual positions during sex. As compared to a sex partner met at bar, night club or dance club, HIV-positive BMSM were less likely to engage in CLAI with HIV-discordant and unknown HIV status partner met at party or friend’s house or at community organizations. HIV-positive BMSM had lower odds of engaging in CLAI with HIV-discordant and unknown HIV status partner if they had insertive sexual position or both receptive and insertive sexual positions. These results underscore the importance of delineating unique sex event-level factors associated with sexual risk behavior depending on individuals’ HIV status. Our findings suggest event-level partner characteristics, sexual position, and partner seeking venues may contribute to disparities in HIV incidence.

    • Community Health Services
      1. Using the social-ecological model to improve access to care for adolescents and young adultsExternal
        Harper CR, Steiner RJ, Brookmeyer KA.
        J Adolesc Health. 2018 Jun;62(6):641-642.

        [No abstract]

    • Disease Reservoirs and Vectors
      1. Generation of a Lineage II Powassan Virus (Deer Tick Virus) cDNA clone: Assessment of flaviviral genetic determinants of tick and mosquito vector competenceExternal
        Kenney JL, Anishchenko M, Hermance M, Romo H, Chen CI, Thangamani S, Brault AC.
        Vector Borne Zoonotic Dis. 2018 May 21.

        The Flavivirus genus comprises a diverse group of viruses that utilize a wide range of vertebrate hosts and arthropod vectors. The genus includes viruses that are transmitted solely by mosquitoes or vertebrate hosts as well as viruses that alternate transmission between mosquitoes or ticks and vertebrates. Nevertheless, the viral genetic determinants that dictate these unique flaviviral host and vector specificities have been poorly characterized. In this report, a cDNA clone of a flavivirus that is transmitted between ticks and vertebrates (Powassan lineage II, deer tick virus [DTV]) was generated and chimeric viruses between the mosquito/vertebrate flavivirus, West Nile virus (WNV), were constructed. These chimeric viruses expressed the prM and E genes of either WNV or DTV in the heterologous nonstructural (NS) backbone. Recombinant chimeric viruses rescued from cDNAs were characterized for their capacity to grow in vertebrate and arthropod (mosquito and tick) cells as well as for in vivo vector competence in mosquitoes and ticks. Results demonstrated that the NS elements were insufficient to impart the complete mosquito or tick growth phenotypes of parental viruses; however, these NS genetic elements did contribute to a 100- and 100,000-fold increase in viral growth in vitro in tick and mosquito cells, respectively. Mosquito competence was observed only with parental WNV, while infection and transmission potential by ticks were observed with both DTV and WNV-prME/DTV chimeric viruses. These data indicate that NS genetic elements play a significant, but not exclusive, role for vector usage of mosquito- and tick-borne flaviviruses.

      2. Increases in the competitive fitness of West Nile virus isolates after introduction into CaliforniaExternal
        Worwa G, Hutton AA, Frey M, Duggal NK, Brault AC, Reisen WK.
        Virology. 2018 Jan 15;514:170-181.

        To investigate the phenotypic evolution of West Nile virus (WNV) in California, we competed sixteen isolates made during 2007-08 against COAV997-5nt, a genetically marked clone from the founding 2003 California isolate COAV997-2003. Using in vivo fitness competitions in House Finches (HOFI) and Culex tarsalis mosquitoes, we found that the majority of WNV WN02 and SW03 genotype isolates exhibited elevated replicative fitness in both hosts compared to COAV997-5nt. Increased replicative capacity in HOFIs was not associated with increased mortality, indicating that these isolates had not gained avian virulence. One WN02 isolate from Coachella Valley, a region geographically close to the isolation of COAV997, showed neutral fitness in HOFIs and reduced fitness in Cx. tarsalis. Two isolates from Kern County and Sacramento/Yolo County out-competed COAV997-nt in HOFIs, but were transmitted less efficiently by Cx. tarsalis. Competition demonstrated neutral or increased fitness that appeared independent of both WN02 and SW03 genotypes.

    • Environmental Health
      1. Associations between prenatal and childhood PBDE exposure and early adolescent visual, verbal and working memoryExternal
        Cowell WJ, Margolis A, Rauh VA, Sjodin A, Jones R, Wang Y, Garcia W, Perera F, Wang S, Herbstman JB.
        Environ Int. 2018 May 19;118:9-16.

        BACKGROUND: Prenatal and childhood exposure to polybrominated diphenyl ether (PBDE) flame retardants has been inversely associated with cognitive performance, however, few studies have measured PBDE concentrations in samples collected during both prenatal and postnatal periods. METHODS: We examined prenatal (cord) and childhood (ages 2, 3, 5, 7 and 9years) plasma PBDE concentrations in relation to memory outcomes assessed between the ages of 9 and 14years. The study sample includes a subset (n=212) of the African American and Dominican children enrolled in the Columbia Center for Children’s Environmental Health Mothers and Newborns birth cohort. We used multivariable linear regression to examine associations between continuous log10-transformed PBDE concentrations and performance on tests of visual, verbal and working memory in age-stratified models. We additionally used latent class growth analysis to estimate trajectories of exposure across early life, which we analyzed as a categorical variable in relation to memory outcomes. We examined interactions between PBDE exposure and sex using cross-product terms. RESULTS: Associations between prenatal exposure and working memory significantly varied by sex (p-interaction=0.02), with inverse relations observed only among girls (i.e. betaBDE-47=-7.55, 95% CI: -13.84, -1.24). Children with sustained high concentrations of BDEs-47, 99 or 100 across childhood scored approximately 5-8 standard score points lower on tests of visual memory. Children with PBDE plasma concentrations that peaked during toddler years performed better on verbal domains, however, these associations were not statistically significant. CONCLUSIONS: Exposure to PBDEs during both prenatal and postnatal periods may disrupt memory domains in early adolescence. These findings contribute to a substantial body of evidence supporting the developmental neurotoxicity of PBDEs and underscore the need to reduce exposure among pregnant women and children.

      2. Polybrominated diphenyl ether (PBDE) exposures and thyroid hormones in children at age 3 yearsExternal
        Vuong AM, Braun JM, Webster GM, Thomas Zoeller R, Hoofnagle AN, Sjodin A, Yolton K, Lanphear BP, Chen A.
        Environ Int. 2018 May 19;117:339-347.

        BACKGROUND: Polybrominated diphenyl ethers (PBDEs) reduce serum thyroid hormone concentrations in animal studies, but few studies have examined the impact of early-life PBDE exposures on thyroid hormone disruption in childhood. METHODS: We used data from 162 mother-child pairs from the Health Outcomes and Measures of the Environment Study (2003-2006, Cincinnati, OH). We measured PBDEs in maternal serum at 16+/-3weeks gestation and in child serum at 1-3years. Thyroid hormones were measured in serum at 3years. We used multiple informant models to investigate associations between prenatal and early-life PBDE exposures and thyroid hormone levels at age 3years. RESULTS: Prenatal PBDEs were associated with decreased thyroid stimulating hormone (TSH) levels at age 3years. A 10-fold increase in prenatal summation operatorPBDEs (BDE-28, -47, -99, -100, and -153) was associated with a 27.6% decrease (95% CI -40.8%, -11.3%) in TSH. A ten-fold increase in prenatal summation operatorPBDEs was associated with a 0.25pg/mL (0.07, 0.43) increase in free triiodothyronine (FT3). Child sex modified associations between prenatal PBDEs and thyroid hormones, with significant decrements in TSH among females and decreased free T4 (FT4) in males. Prenatal summation operatorPBDEs were not associated with TT4, FT4, or total T3. CONCLUSIONS: These findings suggest an inverse relationship between prenatal summation operatorPBDEs and TSH at 3years. Associations may be sexually dimorphic, with an inverse relationship between prenatal BDE-47 and -99 and TSH in females and null associations among males.

    • Genetics and Genomics
      1. Draft genome sequences for a diverse set of isolates from 10 Neisseria speciesExternal
        Nichols M, Topaz N, Wang X, Wang X, Boxrud D.
        Genome Announc. 2018 May 17;6(20).

        Neisseria is a diverse genus that includes commensal and pathogenic species that pose a public health threat. While the pathogenic species have been studied extensively, many of the commensals have limited genomic information available. Here, we present draft genome sequences for a diverse set of 37 isolates from 10 Neisseria species.

    • Global Health
      1. Enabling clinicians to easily find location-based travel health recommendations-is innovation needed?External
        Lash RR, Walker AT, Lee CV, LaRocque R, Rao SR, Ryan ET, Brunette G, Holton K, Sotir MJ.
        J Travel Med. 2018 Jan 1;25(1).

        Background: The types of place names and the level of geographic detail that patients report to clinicians regarding their intended travel itineraries vary. The reported place names may not match those in published travel health recommendations, making traveler-specific recommendations potentially difficult and time-consuming to identify. Most published recommendations are at the country level; however, subnational recommendations exist when documented disease risk varies within a country, as for malaria and yellow fever. Knowing the types of place names reported during consultations would be valuable for developing more efficient ways of searching and identifying recommendations, hence we inventoried these descriptors and identified patterns in their usage. Methods: The data analyzed were previously collected individual travel itineraries from pretravel consultations performed at Global TravEpiNet (GTEN) travel clinic sites. We selected a clinic-stratified random sample of records from 18 GTEN clinics that contained responses to an open-ended question describing itineraries. We extracted and classified place names into nine types and analyzed patterns relative to common travel-related demographic variables. Results: From the 1756 itineraries sampled, 1570 (89%) included one or more place names, totaling 3366 place names. The frequency of different types of place names varied considerably: 2119 (63%) populated place, 336 (10%) tourist destination, 283 (8%) physical geographic area, 206 (6%) vague subnational area, 163 (5%) state, 153 (5%) country, 48 (1%) county, 12 (1%) undefined. Conclusions: The types of place names used by travelers to describe travel itineraries during pretravel consultations were often different from the ones referenced in travel health recommendations. This discrepancy means that clinicians must use additional maps, atlases or online search tools to cross-reference the place names given to the available recommendations. Developing new clinical tools that use geographic information systems technology would make it easier and faster for clinicians to find applicable recommendations for travelers.

    • Healthcare Associated Infections
      1. Molecular epidemiology of Candida auris in Colombia reveals a highly-related, country-wide colonization with regional patterns in Amphotericin B resistanceExternal
        Escandon P, Chow NA, Caceres DH, Gade L, Berkow EL, Armstrong P, Rivera S, Misas E, Duarte C, Moulton-Meissner H, Welsh RM, Parra C, Pescador LA, Villalobos N, Salcedo S, Berrio I, Varon C, Espinosa-Bode A, Lockhart SR, Jackson BR, Litvintseva AP, Beltran M, Chiller TM.
        Clin Infect Dis. 2018 May 16.

        Background: Candida auris is a multidrug-resistant yeast associated with hospital outbreaks worldwide. During 2015-2016, multiple outbreaks were reported in Colombia. We aimed to understand the extent of contamination in healthcare settings and to characterize the molecular epidemiology of C. auris in Colombia. Methods: We sampled patients, patient contacts, healthcare workers, and the environment in four hospitals with recent C. auris outbreaks. Using standardized protocols, people were swabbed at different body sites. Patient and procedure rooms were sectioned into four zones and surfaces were swabbed. We performed whole-genome sequencing (WGS) and antifungal susceptibility testing (AFST) on all isolates. Results: Seven (41%) of the 17 people swabbed were found to be colonized. C. auris was isolated from 37/322 (12%) environmental samples. These were collected from a variety of items in all four zones. WGS and AFST revealed that although isolates were similar throughout the country, isolates from the northern region were genetically distinct and more resistant to amphotericin B (AmB) than the isolates from central Colombia. Four novel non-synonymous mutations were found to be significantly associated with AmB resistance. Conclusions: Our results show that extensive C. auris contamination can occur and highlight the importance of adherence to appropriate infection control practices and disinfection strategies. Observed genetic diversity supports healthcare transmission and a recent expansion of C. auris within Colombia with divergent AmB susceptibility.

      2. A prolonged and large outbreak of invasive group A streptococcal disease within a nursing home: repeated intra-facility transmission of a single strainExternal
        Nanduri SA, Metcalf BJ, Arwady MA, Edens C, Lavin MA, Morgan J, Clegg W, Beron A, Albertson JP, Link-Gelles R, Ogundimu A, Gold J, Jackson D, Chochua S, Stone N, Van Beneden C, Fleming-Dutra K, Beall B.
        Clin Microbiol Infect. 2018 May 18.

        OBJECTIVES: Multiple invasive group A streptococcal (GAS) infections were reported to public health by a skilled nursing facility (Facility A) in Illinois between May 2014 and August 2016. Cases continued despite interventions including antibiotic prophylaxis for all residents and staff. Two other geographically close facilities reported contemporaneous outbreaks of GAS. We investigated potential reasons for ongoing transmission. METHODS: We obtained epidemiologic data from chart review of cases and review of facility and public health records from previous investigations into the outbreak. Infection control practices at Facility A were observed and evaluated. Whole genome sequencing (WGS) followed by phylogenetic analysis was performed on available isolates from the 3 facilities. RESULTS: From 2014-2016, 19 invasive and 60 non-invasive GAS infections were identified at Facility A occurring in 3 clusters. Infection control evaluations during clusters 2 and 3 identified hand hygiene compliance rates of 14-25%, appropriate PPE use in only 33% of observed instances, and deficient wound care practices. GAS isolates from residents and staff of all three facilities were subtype emm89.0; on phylogenetic analysis, Facility-A isolates were monophyletic and distinct. CONCLUSIONS: Inadequate infection control and improper wound care practices likely led to this 28-month long outbreak of severe infections in a skilled nursing facility. WGS and phylogenetic analysis suggested that intra-facility transmission of a single highly transmissible GAS strain was responsible for the outbreak in Facility A. Integration of genomic epidemiology tools with traditional epidemiology and infection control assessments was helpful in investigation of a facility-wide outbreak.

    • Immunity and Immunization
      1. Global rotavirus vaccine introductions and coverage: 2006 – 2016External
        Abou-Nader A, Sauer M, Steele AD, Tate JE, Atherly D, Parashar UD, Santosham M, Nelson EA.
        Hum Vaccin Immunother. 2018 May 22:1-40.

        An estimated 215,000 children died of rotavirus infections in 2013, accounting for 37% of diarrhea-related deaths worldwide, 92% of which occurred in low and lower-middle income countries. Since 2009 the World Health Organization (WHO) recommends the use of rotavirus vaccines in all national immunization programs. This review compares rotavirus vaccine (RV) introductions and vaccine coverage by region, country income status and Gavi-eligibility from 2006-2016. Gross National Income data from the World Bank and surviving infant population from United Nations Population Division was obtained for 2016. Data from WHO were collected on rotavirus vaccine coverage, national immunization schedules, and new vaccine introductions for 2016 while estimated rotavirus deaths were collected for 2013, the last year of available WHO data. As of December 2016, the majority of countries (57%, 110/194) had not introduced universal rotavirus vaccine despite WHO’s 2009 recommendation to do so. Countries in the WHO African region had the greatest proportion of introductions (37%, 31/84) by December 2016 and a great majority of these (77%, 24/31) were supported by new vaccine introduction (NVI) grants from Gavi. Almost half (48%) of global introductions were in low and lower-middle income Gavi-eligible and Gavi-graduating countries. Conversely, countries in the Southeast Asia WHO region and those not eligible for Gavi NVI support have been slow to introduce rotavirus vaccine. High-income countries, on average, had poorer rotavirus vaccine coverage compared to low and lower-middle income countries. The over-representation of African countries within the Gavi subset and high estimated rotavirus deaths in these African countries, likely explains why introduction efforts have been focused in this region. While much progress has been made with the integration and implementation of rotavirus vaccine into national immunization programs, 110 countries representing 69% of the global birth cohort had yet to introduce the vaccine by December 2016.

      2. Rotavirus commonly causes diarrhea but can also cause seizures. Analysis of insurance claims for 1,773,295 US children with 2950 recorded seizures found that, compared to rotavirus-unvaccinated children, seizure hospitalization risk was reduced by 24% (95% confidence interval [CI], 13% – 33%) and 14% (95%CI, 0% – 26%) among fully and partially rotavirus-vaccinated children, respectively.

      3. Lessons learned in clinical trial communication during an Ebola outbreak: The implementation of STRIVEExternal
        Callis A, Carter VM, Ramakrishnan A, Albert AP, Conteh L, Barrie AA, Fahnbulleh L, Koroma MM, Saidu S, Williams O, Samai M.
        J Infect Dis. 2018 May 18;217(suppl_1):S40-s47.

        Clinical Trials Registration: ClinicalTrials.gov [NCT02378753] and Pan African Clinical Trials Registry [PACTR201502001037220].

      4. Implementing a multisite clinical trial in the midst of an Ebola outbreak: Lessons learned from the Sierra Leone Trial to Introduce a Vaccine against EbolaExternal
        Carter RJ, Idriss A, Widdowson MA, Samai M, Schrag SJ, Legardy-Williams JK, Estivariz CF, Callis A, Carr W, Webber W, Fischer ME, Hadler S, Sahr F, Thompson M, Greby SM, Edem-Hotah J, Momoh RM, McDonald W, Gee JM, Kallon AF, Spencer-Walters D, Bresee JS, Cohn A, Hersey S, Gibson L, Schuchat A, Seward JF.
        J Infect Dis. 2018 May 18;217(suppl_1):S16-s23.

        The Sierra Leone Trial to Introduce a Vaccine against Ebola (STRIVE), a phase 2/3 trial of investigational rVSVG-ZEBOV-GP vaccine, was conducted during an unprecedented Ebola epidemic. More than 8600 eligible healthcare and frontline response workers were individually randomized to immediate (within 7 days) or deferred (within 18-24 weeks) vaccination and followed for 6 months after vaccination for serious adverse events and Ebola virus infection. Key challenges included limited infrastructure to support trial activities, unreliable electricity, and staff with limited clinical trial experience. Study staff made substantial infrastructure investments, including renovation of enrollment sites, laboratories, and government cold chain facilities, and imported equipment to store and transport vaccine at </=-60oC. STRIVE built capacity by providing didactic and practical research training to >350 staff, which was reinforced with daily review and feedback meetings. The operational challenges of safety follow-up were addressed by issuing mobile telephones to participants, making home visits, and establishing a nurse triage hotline. Before the Ebola outbreak, Sierra Leone had limited infrastructure and staff to conduct clinical trials. Without interfering with the outbreak response, STRIVE responded to an urgent need and helped build this capacity. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov [NCT02378753] and Pan African Clinical Trials Registry [PACTR201502001037220].

      5. Participant retention in a randomized clinical trial in an outbreak setting: Lessons from the Sierra Leone Trial to Introduce a Vaccine Against Ebola (STRIVE)External
        Carter RJ, Senesi RG, Dawson P, Gassama I, Kargbo SA, Petrie CR, Rogers MH, Samai M, Luman ET.
        J Infect Dis. 2018 May 18;217(suppl_1):S65-s74.

        Clinical Trials Registration: ClinicalTrials.gov [NCT02378753] and Pan African Clinical Trials Registry [PACTR201502001037220].

      6. Clinical surveillance and evaluation of suspected Ebola cases in a vaccine trial during an Ebola epidemic: The Sierra Leone Trial to Introduce a Vaccine Against EbolaExternal
        Conteh MA, Goldstein ST, Wurie HR, Gidudu J, Lisk DR, Carter RJ, Seward JF, Hampton LM, Wang D, Andersen LE, Arvay M, Schrag SJ, Dawson P, Fombah AE, Petrie CR, Feikin DR, Russell JB, Lindblad R, Kargbo SA, Samai M, Mahon BE.
        J Infect Dis. 2018 May 18;217(suppl_1):S33-s39.

        Clinical Trials Registration: ClinicalTrials.gov [NCT02378753] and Pan African Clinical Trials Registry [PACTR201502001037220].

      7. Utilizing nurses to staff an Ebola vaccine clinical trial in Sierra Leone during the Ebola outbreakExternal
        Edem-Hotah J, McDonald W, Abu PM, Luman ET, Carter RJ, Koker A, Goldstein ST.
        J Infect Dis. 2018 May 18;217(suppl_1):S60-s64.

        Clinical Trials Registration: ClinicalTrials.gov [NCT02378753] and Pan African Clinical Trials Registry [PACTR201502001037220].

      8. Health conditions in an adult population in Sierra Leone: Data reported from the Sierra Leone Trial to Introduce a Vaccine Against Ebola (STRIVE)External
        Fombah AE, Goldstein ST, Jarrett OD, Jalloh MI, El-Khorazaty J, Lisk DR, Legardy-Williams J, Pratt DA, George PM, Russell JB, Schrag SJ, Dawson P, Deen GF, Carr W, Lindblad R, James F, Bah MM, Yillia JF, Sandy JD, Turay PE, Conteh MA, Slutsker L, Mahon BE, Samai M, Seward JF.
        J Infect Dis. 2018 May 18;217(suppl_1):S75-s80.

        Clinical Trials Registration: ClinicalTrials.gov [NCT02378753] and Pan African Clinical Trials Registry [PACTR201502001037220].

      9. Monitoring serious adverse events in the Sierra Leone Trial to Introduce a Vaccine Against EbolaExternal
        Jarrett OD, Seward JF, Fombah AE, Lindblad R, Jalloh MI, El-Khorazaty J, Dawson P, Burton D, Zucker J, Carr W, Bah MM, Deen GF, George PM, James F, Lisk DR, Pratt D, Russell JB, Sandy JD, Turay P, Hamel MJ, Schrag SJ, Walker RE, Samai M, Goldstein ST.
        J Infect Dis. 2018 May 18;217(suppl_1):S24-s32.

        Clinical Trials Registration: ClinicalTrials.gov [NCT02378753] and Pan African Clinical Trials Registry [PACTR201502001037220].

      10. A comparative cost analysis of the Vaccination Program for US-bound RefugeesExternal
        Joo H, Maskery B, Mitchell T, Leidner A, Klosovsky A, Weinberg M.
        Vaccine. 2018 May 11;36(20):2896-2901.

        BACKGROUND: Vaccination Program for US-bound Refugees (VPR) currently provides one or two doses of some age-specific Advisory Committee on Immunization Practices (ACIP)-recommended vaccines to US-bound refugees prior to departure. METHODS: We quantified and compared the full vaccination costs for refugees using two scenarios: (1) the baseline of no VPR and (2) the current situation with VPR. Under the first scenario, refugees would be fully vaccinated after arrival in the United States. For the second scenario, refugees would receive one or two doses of selected vaccines before departure and complete the recommended vaccination schedule after arrival in the United States. We evaluated costs for the full vaccination schedule and for the subset of vaccines provided by VPR by four age-stratified groups; all costs were reported in 2015 US dollars. We performed one-way and probabilistic sensitivity analyses and break-even analyses to evaluate the robustness of results. RESULTS: Vaccination costs with the VPR scenario were lower than costs of the scenario without the VPR for refugees in all examined age groups. Net cost savings per person associated with the VPR were ranged from $225.93 with estimated Refugee Medical Assistance (RMA) or Medicaid payments for domestic costs to $498.42 with estimated private sector payments. Limiting the analyses to only the vaccines included in VPR, the average costs per person were 56% less for the VPR scenario with RMA/Medicaid payments. Net cost savings with the VPR scenario were sensitive to inputs for vaccination costs, domestic vaccine coverage rates, and revaccination rates, but the VPR scenario was cost savings across a range of plausible parameter estimates. CONCLUSIONS: VPR is a cost-saving program that would also reduce the risk of refugees arriving while infected with a vaccine preventable disease.

      11. Rapid establishment of a cold chain capacity of -60 degrees C or colder for the STRIVE Ebola Vaccine Trial During the Ebola Outbreak in Sierra LeoneExternal
        Jusu MO, Glauser G, Seward JF, Bawoh M, Tempel J, Friend M, Littlefield D, Lahai M, Jalloh HM, Sesay AB, Caulker AF, Samai M, Thomas V, Farrell N, Widdowson MA.
        J Infect Dis. 2018 May 18;217(suppl_1):S48-s55.

        Clinical Trials Registration: ClinicalTrials.gov [NCT02378753] and Pan African Clinical Trials Registry [PACTR201502001037220].

      12. Operationalizing international regulatory standards in a limited-resource setting during an epidemic: The Sierra Leone Trial to Introduce a Vaccine Against Ebola (STRIVE) experienceExternal
        Kabineh AK, Carr W, Motevalli M, Legardy-Williams J, Vincent W, Mahon BE, Samai M.
        J Infect Dis. 2018 May 18;217(suppl_1):S56-s59.

        Clinical Trials Registration: ClinicalTrials.gov [NCT02378753] and Pan African Clinical Trials Registry [PACTR201502001037220].

      13. Lymphoid tissue fibrosis is associated with impaired vaccine responsesExternal
        Kityo C, Makamdop KN, Rothenberger M, Chipman JG, Hoskuldsson T, Beilman GJ, Grzywacz B, Mugyenyi P, Ssali F, Akondy RS, Anderson J, Schmidt TE, Reimann T, Callisto SP, Schoephoerster J, Schuster J, Muloma P, Ssengendo P, Moysi E, Petrovas C, Lanciotti R, Zhang L, Arevalo MT, Rodriguez B, Ross TM, Trautmann L, Sekaly RP, Lederman MM, Koup RA, Ahmed R, Reilly C, Douek DC, Schacker TW.
        J Clin Invest. 2018 May 21.

        Vaccine responses vary by geographic location. We have previously described how HIV-associated inflammation leads to fibrosis of secondary lymph nodes (LNs) and T cell depletion. We hypothesized that other infections may cause LN inflammation and fibrosis, in a process similar to that seen in HIV infection, which may lead to T cell depletion and affect vaccine responses. We studied LNs of individuals from Kampala, Uganda, before and after yellow fever vaccination (YFV) and found fibrosis in LNs that was similar to that seen in HIV infection. We found blunted antibody responses to YFV that correlated to the amount of LN fibrosis and loss of T cells, including T follicular helper cells. These data suggest that LN fibrosis is not limited to HIV infection and may be associated with impaired immunologic responses to vaccines. This may have an impact on vaccine development, especially for infectious diseases prevalent in the developing world.

      14. The Sierra Leone Trial to Introduce a Vaccine Against Ebola: An evaluation of rVSVG-ZEBOV-GP vaccine tolerability and safety during the West Africa Ebola outbreakExternal
        Samai M, Seward JF, Goldstein ST, Mahon BE, Lisk DR, Widdowson MA, Jalloh MI, Schrag SJ, Idriss A, Carter RJ, Dawson P, Kargbo SA, Leigh B, Bawoh M, Legardy-Williams J, Deen G, Carr W, Callis A, Lindblad R, Russell JB, Petrie CR, Fombah AE, Kargbo B, McDonald W, Jarrett OD, Walker RE, Gargiullo P, Bash-Taqi D, Gibson L, Fofanah AB, Schuchat A.
        J Infect Dis. 2018 May 18;217(suppl_1):S6-s15.

        Clinical Trials Registration: ClinicalTrials.gov [NCT02378753] and Pan African Clinical Trials Registry [PACTR201502001037220].

      15. Comment: The Sierra Leone Trial to Introduce a Vaccine Against Ebola (STRIVE)External
        Schuchat A, Seward JF, Goldstein ST, Mahon BE.
        J Infect Dis. 2018 May 18;217(suppl_1):S1-s5.

        [No abstract]

    • Injury and Violence
      1. Ability of crime, demographic and business data to forecast areas of increased violenceExternal
        Bowen DA, Mercer Kollar LM, Wu DT, Fraser DA, Flood CE, Moore JC, Mays EW, Sumner SA.
        Int J Inj Contr Saf Promot. 2018 May 24:1-6.

        Identifying geographic areas and time periods of increased violence is of considerable importance in prevention planning. This study compared the performance of multiple data sources to prospectively forecast areas of increased interpersonal violence. We used 2011-2014 data from a large metropolitan county on interpersonal violence (homicide, assault, rape and robbery) and forecasted violence at the level of census block-groups and over a one-month moving time window. Inputs to a Random Forest model included historical crime records from the police department, demographic data from the US Census Bureau, and administrative data on licensed businesses. Among 279 block groups, a model utilizing all data sources was found to prospectively improve the identification of the top 5% most violent block-group months (positive predictive value = 52.1%; negative predictive value = 97.5%; sensitivity = 43.4%; specificity = 98.2%). Predictive modelling with simple inputs can help communities more efficiently focus violence prevention resources geographically.

      2. Short-term lost productivity per victim: Intimate partner violence, sexual violence, or stalkingExternal
        Peterson C, Liu Y, Kresnow MJ, Florence C, Merrick MT, DeGue S, Lokey CN.
        Am J Prev Med. 2018 May 15.

        INTRODUCTION: The purpose of this study is to estimate victims’ lifetime short-term lost productivity because of intimate partner violence, sexual violence, or stalking. METHODS: U.S. nationally representative data from the 2012 National Intimate Partner and Sexual Violence Survey were used to estimate a regression-adjusted average per victim (female and male) and total population number of cumulative short-term lost work and school days (or lost productivity) because of victimizations over victims’ lifetimes. Victims’ lost productivity was valued using a U.S. daily production estimate. Analysis was conducted in 2017. RESULTS: Non-institutionalized adults with some lifetime exposure to intimate partner violence, sexual violence, or stalking (n=6,718 respondents; survey-weighted n=130,795,789) reported nearly 741 million lost productive days because of victimizations by an average of 2.5 perpetrators per victim. The adjusted per victim average was 4.9 (95% CI=3.9, 5.9) days, controlling for victim, perpetrator, and violence type factors. The estimated societal cost of this short-term lost productivity was $730 per victim, or $110 billion across the lifetimes of all victims (2016 USD). Factors associated with victims having a higher number of lost days included a higher number of perpetrators and being female, as well as sexual violence, physical violence, or stalking victimization by an intimate partner perpetrator, stalking victimization by an acquaintance perpetrator, and sexual violence or stalking victimization by a family member perpetrator. CONCLUSIONS: Short-term lost productivity represents a minimum economic valuation of the immediate negative effects of intimate partner violence, sexual violence, and stalking. Victims’ lost productivity affects family members, colleagues, and employers.

      3. County-level trends in suicide rates in the U.S., 2005-2015External
        Rossen LM, Hedegaard H, Khan D, Warner M.
        Am J Prev Med. 2018 May 8.

        INTRODUCTION: Understanding the geographic patterns of suicide can help inform targeted prevention efforts. Although state-level variation in age-adjusted suicide rates has been well documented, trends at the county-level have been largely unexplored. This study uses small area estimation to produce stable county-level estimates of suicide rates to examine geographic, temporal, and urban-rural patterns in suicide from 2005 to 2015. METHODS: Using National Vital Statistics Underlying Cause of Death Files (2005-2015), hierarchical Bayesian models were used to estimate suicide rates for 3,140 counties. Model-based suicide rate estimates were mapped to explore geographic and temporal patterns and examine urban-rural differences. Analyses were conducted in 2016-2017. RESULTS: Posterior predicted mean county-level suicide rates increased by >10% from 2005 to 2015 for 99% of counties in the U.S., with 87% of counties showing increases of >20%. Counties with the highest model-based suicide rates were consistently located across the western and northwestern U.S., with the exception of southern California and parts of Washington. Compared with more urban counties, more rural counties had the highest estimated suicide rates from 2005 to 2015, and also the largest increases over time. CONCLUSIONS: Mapping county-level suicide rates provides greater granularity in describing geographic patterns of suicide and contributes to a better understanding of changes in suicide rates over time. Findings may inform more targeted prevention efforts as well as future research on community-level risk and protective factors related to suicide mortality.

      4. [No abstract]

      5. The timing of suicide in 18 United State states from 2003-2014External
        Tian N, Zack M, Fowler KA, Hesdorffer DC.
        Arch Suicide Res. 2018 May 23:1-21.

        OBJECTIVES: We investigated suicide timing over different time periods by age, sex and race/ethnicity. METHODS: 122,107 suicide deaths were identified from the population-based U.S. National Violent Death Reporting System in 18 U.S. States from 2003 through 2014. RESULTS: Suicides significantly increased (p < 0.05) from March to peak in September before falling, the first week of the month, and early in the week. Suicides also significantly increased (p < 0.05) in the morning, mainly peaking during the afternoon, although suicides in adolescents peaked in the evening and in those 65 years and older peaked in the morning. CONCLUSIONS: Comprehensive prevention efforts should focus on those at overall increased suicide risk and at peaks of high suicide frequency, especially among those vulnerable subgroups.

      6. Injury prevention: achieving population-level changeExternal
        Wilkins N, McClure RJ, Mack K.
        Inj Prev. 2018 Jun;24(Suppl 1):i1-i2.

        [No abstract]

    • Laboratory Sciences
      1. Efficacy of vaginally administered gel containing emtricitabine and tenofovir against repeated rectal SHIV exposures in macaquesExternal
        Dobard CW, Makarova N, West-Deadwyler R, Taylor A, Dinh C, Martin A, Lipscomb J, Mitchell J, Khalil G, Garcia-Lerma G, Heneine W.
        J Infect Dis. 2018 May 21.

        Vaginal microbicides containing antiretrovirals (ARV) have shown to prevent vaginally acquired HIV but these products may not protect women who engage in anal sex. Intravaginal dosing with ARVs have shown to result in drug exposures in rectal tissues, thus raising the possibility of dual compartment protection. To test this concept, we investigated whether intravaginal dosing with emtricitabine (FTC)-tenofovir (TFV) gel, which fully protected macaques against repeated vaginal exposures to simian human immunodeficiency virus (SHIV), protects against rectal SHIV exposures. Pharmacokinetic (PK) studies revealed rapid distribution of FTC and TFV to rectal tissues and luminal fluids, albeit at concentrations 1-2 log10 lower than those in the vaginal compartment. Efficacy measurements against repeated rectal SHIV challenges demonstrated a 4.5-fold reduction in risk of infection in macaques that received intravaginal FTC/TFV compared to placebo gel (p=0.047; log-rank test). These data support the concept of dual compartment protection by vaginal dosing and warrants developing ARV-based vaginal products with improved bidirectional dosing.

      2. The systemic toxicity of heavy metal mixtures in ratsExternal
        Fiati Kenston SS, Su H, Li Z, Kong L, Wang Y, Song X, Gu Y, Barber T, Aldinger J, Hua Q, Li Z, Ding M, Zhao J, Lin X.
        Toxicology Research. 2018 ;7(3):396-407.

        To explore the health effects of multi-heavy metal exposure, Sprague Dawley (SD) rats were orally given one dose of heavy metal mixtures (HMMs). The eight most common detectable heavy metals in Ningbo area are zinc (Zn), copper (Cu), manganese (Mn), chromium (Cr), nickel (Ni), cadmium (Cd), lead (Pb) and mercury (Hg). In this study, mixtures of these eight heavy metals were prepared using the compounds zinc sulfate heptahydrate, cupric sulfate, manganese dichloride, potassium dichromate, nickel dichloride, cadmium dichloride, lead acetate, and methyl mercury chloride with ion mass proportions of 1070.0, 312.6, 173.1, 82.6, 30.0, 13.3, 6.6, and 1.0, respectively. The rats were randomly divided into four groups. Beside the control group, each rat received a corresponding dose of HMMs 215, 464 or 1000 mg per kg body weight (bwt), respectively. The rats were observed for 4 weeks. During the last week of observation, the Morris water maze test was used to investigate spatial learning and memory in the treated rats. The rats were exsanguinated under complete chloral hydrate anesthesia and organ coefficients were measured. Biochemical tests of blood and serum samples were carried out. The results showed abnormalities in the hematological system, decreased renal function, hepatic injury and disturbances in the electrolyte balance of the rats treated with a high dose of HMMs. Death of some rats was also observed. This paper analyzed how a one-time high dose oral administration of HMMs induced systemic toxicity.

      3. Collection and extraction of occupational air samples for analysis of fungal DNAExternal
        Lemons AR, Lindsley WG, Green BJ.
        J Vis Exp. 2018 May 2(135).

        Traditional methods of identifying fungal exposures in occupational environments, such as culture and microscopy-based approaches, have several limitations that have resulted in the exclusion of many species. Advances in the field over the last two decades have led occupational health researchers to turn to molecular-based approaches for identifying fungal hazards. These methods have resulted in the detection of many species within indoor and occupational environments that have not been detected using traditional methods. This protocol details an approach for determining fungal diversity within air samples through genomic DNA extraction, amplification, sequencing, and taxonomic identification of fungal internal transcribed spacer (ITS) regions. ITS sequencing results in the detection of many fungal species that are either not detected or difficult to identify to species level using culture or microscopy. While these methods do not provide quantitative measures of fungal burden, they offer a new approach to hazard identification and can be used to determine overall species richness and diversity within an occupational environment.

      4. Microvascular dysfunction following multi-walled carbon nanotube exposure is mediated by thrombospondin-1 receptor CD47External
        Mandler WK, Nurkiewicz TR, Porter DW, Kelley EE, Olfert IM.
        Toxicol Sci. 2018 May 21.

        Pulmonary exposure to multi-walled carbon nanotubes (MWCNT) disrupts peripheral microvascular function. Thrombospondin-1 (TSP-1) is highly expressed during lung injury and has been shown to alter microvascular reactivity. It is unclear exactly how TSP-1 exerts effects on vascular function, but we hypothesized that the TSP-1 receptor CD47 may mediate changes in vasodilation.Wildtype (WT) or CD47 knockout (CD47 KO) C57B6/J-background animals were exposed to 50 microg of MWCNT or saline control via pharyngeal aspiration. Twenty-four hours post-exposure, intravital microscopy was performed to assess arteriolar dilation and venular leukocyte adhesion and rolling. To assess tissue redox status, electron paramagnetic resonance and NOx measurements were performed, while inflammatory biomarkers were measured via multiplex assay.Vasodilation was impaired in the WT+MWCNT group compared to control (57+/-9% vs 90+/-2% relaxation), while CD47 KO animals showed no impairment (108+/-8% relaxation). Venular leukocyte adhesion and rolling increased by > 2-fold, while the CD47 KO group showed no change. Application of the antioxidant apocynin rescued normal leukocyte activity in the WT+MWCNT group. Lung and plasma NOx were reduced in the WT+MWCNT group by 47% and 32%, respectively, while the CD47 KO groups were unchanged from control. Some inflammatory cytokines were increased in the CD47+MWCNT group only.In conclusion, TSP-1 is an important ligand mediating MWCNT-induced microvascular dysfunction, and CD47 is a component of this dysregulation. CD47 activation likely disrupts nitric oxide (*NO) signaling and promotes leukocyte-endothelial interactions. Impaired *NO production, signaling, and bioavailability is linked to a variety of cardiovascular diseases in which TSP-1/CD47 may play an important role.

      5. A comparison of total inward leakage measured using sodium chloride (NaCl) and corn oil aerosol methods for air-purifying respiratorsExternal
        Rengasamy S, Zhuang Z, Niezgoda G, Walbert G, Lawrence R, Boutin B, Hudnall J, Monaghan WP, Bergman M, Miller C, Harris J, Coffey C.
        J Occup Environ Hyg. 2018 May 21:1-34.

        The International Organization for Standardization (ISO) standard 16900-1:2014 specifies the use of sodium chloride (NaCl) and corn oil aerosols, and sulfur hexafluoride gas for measuring total inward leakage (TIL). However, a comparison of TIL between different agents is lacking. The objective of this study was to measure and compare TIL for respirators using corn oil and NaCl aerosols. TIL was measured with 10 subjects donning two models of filtering facepiece respirators (FFRs) including FFP1, N95, P100, and elastomeric half-mask respirators (ERs) in NaCl and corn oil aerosol test chambers, using continuous sampling methods. After fit testing with a PortaCount (TSI, St. Paul, MN) using the Occupational Safety and Health Administration (OSHA) protocol, five subjects were tested in the NaCl chamber first and then in the corn oil chamber, while other subjects tested in the reverse order. TIL was measured as a ratio of mass-based aerosol concentrations in-mask to the test chamber, while the subjects performed ISO 16900-1-defined exercises. The concentration of NaCl aerosol was measured using two flame photometers, and corn oil aerosol was measured with one light scattering photometer. The same instruments were used to measure filter penetration in both chambers using a Plexiglas(R) setup. The size distribution of aerosols was determined using a scanning mobility particle sizer and charge was measured with an electrometer. Filter efficiency was measured using an 8130 Automated Filter Tester (TSI). Results showed the geometric mean TIL for corn oil aerosol for one model each of all respirator categories, except P100, were significantly (p<0.05) greater than for NaCl aerosol. Filter penetration in the two test chambers showed a trend similar to TIL. The count median diameter was approximately 82 nm for NaCl and approximately 200 nm for corn oil aerosols. The net positive charge for NaCl aerosol was relatively larger. Both fit factor and filter efficiency influence TIL measurement. Overall, TIL determination with aerosols of different size distributions and charges using different methodologies may produce dissimilar results.

      6. This study compared the performance of the following field portable aerosol instrument sets to performance of the reference Scanning Mobility Particle Sizer (SMPS): the handheld CPC-3007, the portable aerosol mobility spectrometer (PAMS), the NanoScan scanning mobility particle sizer (NanoScan SMPS) combined with an optical particle sizer (OPS). Tests were conducted with monodispersed and polydispersed aerosols. Monodispersed aerosols were controlled at the approximate concentration of 1 x 105 particles cm-3 and four monodispersed particle sizes of 30, 60, 100, and 300 nm were selected and classified for the monodispersed aerosol test, while three different steady-state concentration levels (low, medium, and high: ~8 x 103, 5 x 104, and 1 x 105 particles cm-3, respectively) were selected for the polydispersed aerosol test. For all four monodispersed aerosol sizes, particle concentrations measured with the NanoScan SMPS were within 13% of those measured with the reference SMPS. Particle concentrations measured with the PAMS were within 25% of those measured with the reference SMPS. Concentrations measured with the handheld condensation particle counter were within 30% of those measured with the reference SMPS. For the polydispersed aerosols, the particle sizes and concentrations measured with the NanoScan-OPS compared most favorably with those measured with the reference SMPS for three different concentration levels of low, medium, and high (concentration deviations </=10% for all three concentration levels; deviations of particle size </=4%). Although the particle-size comparability between the PAMS and the reference SMPS was quite reasonable with the deviations within 10%, the polydispersed particle concentrations measured with the PAMS were within 36% of those measured with the reference SMPS. The results of this evaluation will be useful for selecting a suitable portable device for our next workplace study phase of respiratory protection assessment. This study also provided the advantages and limitations of each individual portable instrument and therefore results from this study can be used by industrial hygienists and safety professionals, with appropriate caution, when selecting a suitable portable instrument for aerosol particle measurement in nanotechnology workplaces.

    • Maternal and Child Health
      1. A systematic review of part C early identification studiesExternal
        Barger B, Rice C, Simmons CA, Wolf R.
        Topics Early Child Spec Educ. 2018 May;38(1):4-16.

        Authors conducted a systematic literature review on early identification steps leading at-risk young children to connect with Part C services. Authors classified data collection settings as primary (settings for general population) or specialized (settings for children at risk of developmental delay) and according to the phases of early identification in the study: (a) original population of children aged 0 to 6 years who had received Part C services, (b) screening and/or referral and/or developmental assessment from 0 through age 2 years, and (c) were deemed eligible and/or received Part C services. Authors identified 43 articles including at least two phases of the early identification process. The literature about connecting children to Part C early intervention (EI) is sparse and fragmented; few studies document the full process from community monitoring to service receipt. Results indicate opportunities for development of systems to better track and improve the identification of young children in need of EI.

      2. Trends in maternity care practice skin-to-skin contact indicators: United States, 2007-2015External
        Boundy EO, Perrine CG, Barrera CM, Li R, Hamner HC.
        Breastfeed Med. 2018 May 21.

        BACKGROUND: Mother-infant skin-to-skin contact (SSC) immediately after birth helps transition infants to the post-uterine environment and increases the likelihood of breastfeeding initiation and duration. This study examines trends in U.S. maternity practices related to SSC, and variations by facility demographics. METHODS: Data were from the Maternity Practices in Infant Nutrition and Care (mPINC) surveys (2007-2015), a biennial assessment of all U.S. maternity facilities. Facilities reported how often patients were encouraged to practice mother-infant SSC for >/=30 minutes within 1 hour of uncomplicated vaginal birth and 2 hours of uncomplicated cesarean birth, and how often routine infant procedures are performed while in SSC. We calculated the percentage of maternity facilities reporting these indicators for >/=90% of patients across the United States for each survey year. Estimates by facility characteristics (size, type, and state) were calculated for 2015 only. RESULTS: The percentage of facilities reporting “Most (>/=90%)” women, which were encouraged to practice early SSC, increased from 2007 to 2015 following both vaginal (40.4% to 83.0%) and cesarean (29.3% to 69.9%) births. The percentage of facilities reporting routine infant procedures were performed “Almost always (>/=90%),” while mother and infant were SSC increased from 16.6% to 49.5% (2007 to 2015) for vaginal births and from 2.2% to 10.7% (2009 to 2015) for cesarean births. Variations in SSC practice by facility type, size, and state were noted. CONCLUSIONS: Significant progress has been made in increasing hospital encouragement of early SSC for both vaginal and cesarean births. Continued efforts to support evidence-based maternity practices are needed.

    • Nutritional Sciences
      1. Best practices for financial sustainability of healthy food service guidelines in hospital cafeteriasExternal
        Jilcott Pitts S, Schwartz B, Graham J, Warnock AL, Mojica A, Marziale E, Harris D.
        Prev Chronic Dis. 2018 May 17;15:E58.

        In February and March 2017 we examined barriers and facilitators to financial sustainability of healthy food service guidelines and synthesized best practices for financial sustainability in retail operations. We conducted qualitative, in-depth interviews with 8 hospital food service directors to learn more about barriers and facilitators to financial sustainability of healthy food service guidelines in retail food service operations. Analysts organized themes around headers in the interview guide and also made note of emerging themes not in the original guide. They used the code occurrence and co-occurrence features in Dedoose version 7.0.23 (SocioCultural Research Consultants) independently to analyze patterns across the interviews and to pull illustrative quotes for analysis. Two overarching themes emerged, related to 1) the demand for and sales of healthy foods and beverages, and 2) the production and supply of healthy foods and beverages. Our study provides insights into how hospital food service directors can maximize revenue and remain financially viable while selling healthier options in on-site dining facilities.

    • Occupational Safety and Health
      1. The rate at which chemicals are introduced into commerce continues to outpace the development of authoritative occupational exposure limits. Occupational exposure banding is a tool that empowers and enables occupational hygienists to address unregulated chemicals. An occupational exposure band is not meant to replace an OEL; rather, it serves as a starting point to inform risk management decisions. Given the utility of an OEB, more occupational hygiene professionals are embracing the proposed NIOSH occupational exposure banding tool and using the occupational exposure banding process to guide their risk management decisions for chemicals without OELs. Occupational exposure banding, also known as hazard banding, is a process intended to quickly and accurately assign chemicals to specific categories (bands) that correspond to a range of exposure concentrations. These bands are assigned on the basis of a chemical’s toxicological potency and the adverse health effects associated with exposure to the chemical. The output of this process is an OEB. The pharmaceutical sector and some major chemical companies have used occupational exposure banding over the past several decades to establish exposure control limits or ranges for new or existing chemicals that lack formal OELs.

      2. Framework for considering productive aging and workExternal
        Schulte PA, Grosch J, Scholl JC, Tamers SL.
        J Occup Environ Med. 2018 May;60(5):440-448.

        OBJECTIVES: The U.S. population is experiencing a demographic transition resulting in an aging workforce. The objective of this article is to elucidate and expand an approach to keep that workforce safe, healthy, and productive. METHODS: This article elucidates the framework for the National Center for Productive Aging at Work of the National Institute for Occupational Safety and Health. Subject matter experts used a snowball method to review published literature to substantiate elements in the framework. RESULTS: Evidence-based literature supports a productive aging framework for the workforce involving the following elements: 1) life span perspective; 2) comprehensive and integrated approaches to occupational safety and health; 3) emphasis on positive outcomes for both workers and organizations; and 4) supportive work culture for multigenerational issues. CONCLUSION: The productive aging framework provides a foundational and comprehensive approach for addressing the aging workforce.

      3. OBJECTIVE: To examine the association of the cortisol awakening response (CAR) with change in brachial artery flow-mediated dilation (FMD%) in police officers over a seven-year period. METHODS: Baseline CAR was obtained from four saliva samples taken fifteen minutes apart immediately after awakening. Analysis of covariance was used to compare the change in FMD% (FMD%Follow-up-FMD%Baseline) across tertiles of area under the cortisol curve with respect to increase (AUCI). Regression analysis was use to assess trend. RESULTS: Officers (n = 172; 81% men) had a mean +/- SD age of 41 +/- 7.6 years. Men in the lowest AUCI tertile (i.e., atypical waking cortisol pattern) had a significantly larger seven-year mean decline in FMD% (mean +/- SE: -2.56 +/- 0.64) compared to men in the highest tertile (-0.89 +/- 0.69) (p = 0.0087). CONCLUSION: An awakening cortisol AUCI predicted worsening of FMD% approximately seven years later among male officers.

    • Occupational Safety and Health – Mining
      1. An analysis of injuries to front-end loader operators during ingress and egressExternal
        Nasarwanji MF, Pollard J, Porter W.
        Int J Ind Ergon. 2018 May;65:84-92.

        Slips, trips, and falls from mobile mining equipment have been documented for decades. However, little research has been conducted to determine the events precipitating these incidents during ingress or egress. This study examined slips, trips, and falls sustained during ingress or egress from front-end loaders to determine the frequencies of factors that may contribute to injuries. Non-fatal injuries, when getting on or off of front-end wheel loaders specifically, were identified, coded, and analyzed from the Mine Safety and Health Administration’s accidents, injuries, and illnesses database. Overall trends, events that precipitated the injury, injuries sustained, contributing factors, location of the individual, and equipment characteristics were analyzed. More incidents occurred during egress (63%); and egress is believed to be more hazardous than ingress. Foot slips were the most common event that precipitated the incident and the leading cause of these was contaminants on the equipment. Misstep, loss of footing, and step on/in related incidents were more common during egress and are likely due to the operator’s reduced visibility when descending a ladder facing the equipment, limiting their ability to detect hazards. Egress also makes an operator less capable of avoiding unsafe ground conditions as indicated by the significant number of step on/in injuries occurring on the ground during egress. Most of the front-end loaders associated with the incidents were found to have bottom rungs with flexible rails, which may also increase fall risk during egress due to inconsistent rung heights and lengthy transition areas from the ground, through the flexible-railed rungs, to the rungs with rigid rails. Recommendations are provided to reduce the risk for slips, trips, and falls from mobile mining equipment.

    • Reproductive Health
      1. Access to long-acting reversible contraception among US publicly funded health centersExternal
        Bornstein M, Carter M, Zapata L, Gavin L, Moskosky S.
        Contraception. 2018 May;97(5):405-410.

        OBJECTIVES: Access to a full range of contraceptive methods, including long-acting reversible contraception (LARC), is central to providing quality family planning services. We describe health center-related factors associated with LARC availability, including staff training in LARC insertion/removal and approaches to offering LARC, whether onsite or through referral. STUDY DESIGN: We analyzed nationally representative survey data collected during 2013-2014 from administrators of publicly funded U.S. health centers that offered family planning. The response rate was 49.3% (n=1615). In addition to descriptive statistics, we used multivariable logistic regression to identify health center characteristics associated with offering both IUDs and implants onsite. RESULTS: Two-thirds (64%) of health centers had staff trained in all three LARC types (hormonal IUD, copper IUD, implant); 21% had no staff trained in any of those contraceptive methods. Half of health centers (52%) offered IUDs (any type) and implants onsite. After onsite provision, informal referral arrangements were the most common way LARC methods were offered. In adjusted analyses, Planned Parenthood (AOR=9.49) and hospital-based (AOR=2.35) health centers had increased odds of offering IUDs (any type) and implants onsite, compared to Health Departments, as did Title X-funded (AOR=1.55) compared to non-Title X-funded health centers and centers serving a larger volume of family planning clients. Centers serving mostly rural areas compared to those serving urbans areas had lower odds (AOR 0.60) of offering IUD (any type) and implants. CONCLUSIONS: Variation in LARC access remains among publicly funded health centers. In particular, Health Departments and rural health centers have relatively low LARC provision. IMPLICATIONS: For more women to be offered a full range of contraceptive methods, additional efforts should be made to increase availability of LARC in publicly-funded health centers, such as addressing provider training gaps, improving referrals mechanisms, and other efforts to strengthen the health care system.

      2. Dissemination and use of WHO family planning guidance and tools: a qualitative assessmentExternal
        Kraft JM, Oduyebo T, Jatlaoui TC, Curtis KM, Whiteman MK, Zapata LB, Gaffield ME.
        Health Res Policy Syst. 2018 May 22;16(1):42.

        BACKGROUND: As countries continue to improve their family planning (FP) programmes, they may draw on WHO’s evidence-based FP guidance and tools (i.e. materials) that support the provision of quality FP services. METHODS: To better understand the use and perceived impact of the materials and ways to strengthen their use by countries, we conducted qualitative interviews with WHO regional advisors, and with stakeholders in Ethiopia and Senegal who use WHO materials. RESULTS: WHO uses a multi-faceted strategy to directly and indirectly disseminate materials to country-level decision-makers. The materials are used to develop national family planning guidelines, protocols and training curricula. Participants reported that they trust the WHO materials because they are evidence based, and that they adapt materials to the country context (e.g. remove content on methods not available in the country). The main barrier to the use of national materials is resource constraints. CONCLUSIONS: Although the system and processes for dissemination work, improvements might contribute to increased use of the materials. For example, providers may benefit from additional guidance on how to counsel women with characteristics or medical conditions where contraceptive method eligibility criteria do not clearly rule in or rule out a method.

      3. In vitro fertilization, interpregnancy interval, and risk of adverse perinatal outcomesExternal
        Palmsten K, Homer MV, Zhang Y, Crawford S, Kirby RS, Copeland G, Chambers CD, Kissin DM, Su HI.
        Fertil Steril. 2018 May;109(5):840-848.e1.

        OBJECTIVE: To compare associations between interpregnancy intervals (IPIs) and adverse perinatal outcomes in deliveries following IVF with deliveries following spontaneous conception or other (non-IVF) fertility treatments. DESIGN: Cohort using linked birth certificate and assisted reproductive technology surveillance data from Massachusetts and Michigan. SETTING: Not applicable. PATIENT(S): 1,225,718 deliveries. INTERVENTION(S): None. MAIN OUTCOMES MEASURE(S): We assessed associations between IPI and preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) according to live birth or nonlive pregnancy outcome in the previous pregnancy. RESULT(S): In IVF deliveries following previous live birth, risk of PTB was 22.2% for IPI 12 to <24 months (reference); risk of PTB was higher for IPI <12 months (adjusted relative risk [aRR] 1.24, 95% confidence interval [CI] 1.09-1.41) and IPI >/=60 months (aRR 1.12, 95% CI 1.00-1.26). In non-IVF deliveries following live birth, risk of PTB was 6.4% for IPI 12 to <24 months (reference); risk of PTB was higher for IPI <12 and >/=60 months (aRR 1.19, 95% CI 1.16-1.21, for both). In both populations, U-shaped or approximately U-shaped associations were observed for SGA and LBW, although the association of IPI <12 months and SGA was not significant in IVF deliveries. In IVF and non-IVF deliveries following nonlive pregnancy outcome, IPI <12 months was not associated with increased risk of PTB, LBW, or SGA, but IPI >/=60 months was associated with significant increased risk of those outcomes in non-IVF deliveries. CONCLUSION(S): Following live births, IPIs <12 or >/=60 months were associated with higher risks of most adverse perinatal outcomes in both IVF and non-IVF deliveries.

    • Social and Behavioral Sciences
      1. INTRODUCTION: Schools are in a unique position to meet the mental and behavioral health needs of children and adolescents because approximately 95% of young people aged 7-17 years attend school. Little is known, however, about policies related to counseling, psychological, and social services staffing in school districts. This study analyzed the prevalence of such policies in public school districts in the U.S. METHODS: Data from four cycles (2000, 2006, 2012, and 2016) of the School Health Policies and Practices Study, a national survey periodically conducted to assess policies and practices for ten components of school health, were analyzed in 2017. The survey collected data related to counseling, psychological, and social services among nationally representative samples of school districts using online or mailed questionnaires. Sampled districts identified respondents responsible for or most knowledgeable about the content of each questionnaire. RESULTS: The percentage of districts with a district-level counseling, psychological, and social services coordinator increased significantly from 62.6% in 2000 to 79.5% in 2016. In 2016, 56.3% of districts required each school to have someone to coordinate counseling, psychological, and social services at the school. Fewer districts required schools at each level to have a specified ratio of counselors to students (16.2% for elementary schools, 16.8% for middle schools, and 19.8% for high schools), and the percentage of districts with these requirements has decreased significantly since 2012. CONCLUSIONS: Increases in the prevalence of district-level staffing policies could help increase the quantity and quality of counseling, psychological, and social services staff in schools nationwide, which in turn could improve mental and behavioral health outcomes for students. SUPPLEMENT INFORMATION: This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

    • Zoonotic and Vectorborne Diseases
      1. Cost-effectiveness of dog rabies vaccination programs in East AfricaExternal
        Borse RH, Atkins CY, Gambhir M, Undurraga EA, Blanton JD, Kahn EB, Dyer JL, Rupprecht CE, Meltzer MI.
        PLoS Negl Trop Dis. 2018 May 23;12(5):e0006490.

        BACKGROUND: Dog rabies annually causes 24,000-70,000 deaths globally. We built a spreadsheet tool, RabiesEcon, to aid public health officials to estimate the cost-effectiveness of dog rabies vaccination programs in East Africa. METHODS: RabiesEcon uses a mathematical model of dog-dog and dog-human rabies transmission to estimate dog rabies cases averted, the cost per human rabies death averted and cost per year of life gained (YLG) due to dog vaccination programs (US 2015 dollars). We used an East African human population of 1 million (approximately 2/3 living in urban setting, 1/3 rural). We considered, using data from the literature, three vaccination options; no vaccination, annual vaccination of 50% of dogs and 20% of dogs vaccinated semi-annually. We assessed 2 transmission scenarios: low (1.2 dogs infected per infectious dog) and high (1.7 dogs infected). We also examined the impact of annually vaccinating 70% of all dogs (World Health Organization recommendation for dog rabies elimination). RESULTS: Without dog vaccination, over 10 years there would a total of be approximately 44,000-65,000 rabid dogs and 2,100-2,900 human deaths. Annually vaccinating 50% of dogs results in 10-year reductions of 97% and 75% in rabid dogs (low and high transmissions scenarios, respectively), approximately 2,000-1,600 human deaths averted, and an undiscounted cost-effectiveness of $451-$385 per life saved. Semi-annual vaccination of 20% of dogs results in in 10-year reductions of 94% and 78% in rabid dogs, and approximately 2,000-1,900 human deaths averted, and cost $404-$305 per life saved. In the low transmission scenario, vaccinating either 50% or 70% of dogs eliminated dog rabies. Results were most sensitive to dog birth rate and the initial rate of dog-to-dog transmission (Ro). CONCLUSIONS: Dog rabies vaccination programs can control, and potentially eliminate, dog rabies. The frequency and coverage of vaccination programs, along with the level of dog rabies transmission, can affect the cost-effectiveness of such programs. RabiesEcon can aid both the planning and assessment of dog rabies vaccination programs.

      2. Antigenically diverse swine origin H1N1 variant influenza viruses exhibit differential ferret pathogenesis and transmission phenotypesExternal
        Pulit-Penaloza JA, Jones J, Sun X, Jang Y, Thor S, Belser JA, Zanders N, Creager HM, Ridenour C, Wang L, Stark TJ, Garten R, Chen LM, Barnes J, Tumpey TM, Wentworth DE, Maines TR, Davis CT.
        J Virol. 2018 Jun 1;92(11).

        Influenza A(H1) viruses circulating in swine represent an emerging virus threat, as zoonotic infections occur sporadically following exposure to swine. A fatal infection caused by an H1N1 variant (H1N1v) virus was detected in a patient with reported exposure to swine and who presented with pneumonia, respiratory failure, and cardiac arrest. To understand the genetic and phenotypic characteristics of the virus, genome sequence analysis, antigenic characterization, and ferret pathogenesis and transmissibility experiments were performed. Antigenic analysis of the virus isolated from the fatal case, A/Ohio/09/2015, demonstrated significant antigenic drift away from the classical swine H1N1 variant viruses and H1N1 pandemic 2009 viruses. A substitution in the H1 hemagglutinin (G155E) was identified that likely impacted antigenicity, and reverse genetics was employed to understand the molecular mechanism of antibody escape. Reversion of the substitution to 155G, in a reverse genetics A/Ohio/09/2015 virus, showed that this residue was central to the loss of hemagglutination inhibition by ferret antisera raised against a prototypical H1N1 pandemic 2009 virus (A/California/07/2009), as well as gamma lineage classical swine H1N1 viruses, demonstrating the importance of this residue for antibody recognition of this H1 lineage. When analyzed in the ferret model, A/Ohio/09/2015 and another H1N1v virus, A/Iowa/39/2015, as well as A/California/07/2009, replicated efficiently in the respiratory tract of ferrets. The two H1N1v viruses transmitted efficiently among cohoused ferrets, but respiratory droplet transmission studies showed that A/California/07/2009 transmitted through the air more efficiently. Preexisting immunity to A/California/07/2009 did not fully protect ferrets from challenge with A/Ohio/09/2015.IMPORTANCE Human infections with classical swine influenza A(H1N1) viruses that circulate in pigs continue to occur in the United States following exposure to swine. To understand the genetic and virologic characteristics of a virus (A/Ohio/09/2015) associated with a fatal infection and a virus associated with a nonfatal infection (A/Iowa/39/2015), we performed genome sequence analysis, antigenic testing, and pathogenicity and transmission studies in a ferret model. Reverse genetics was employed to identify a single antigenic site substitution (HA G155E) responsible for antigenic variation of A/Ohio/09/2015 compared to related classical swine influenza A(H1N1) viruses. Ferrets with preexisting immunity to the pandemic A(H1N1) virus were challenged with A/Ohio/09/2015, demonstrating decreased protection. These data illustrate the potential for currently circulating swine influenza viruses to infect and cause illness in humans with preexisting immunity to H1N1 pandemic 2009 viruses and a need for ongoing risk assessment and development of candidate vaccine viruses for improved pandemic preparedness.

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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