Volume 11, Issue 2, January 8, 2019

CDC Science Clips: Volume 11, Issue 2, January 8, 2019

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

  1. Top Articles of the Week

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

    The names of CDC authors are indicated in bold text.
    • Communicable Diseases
      • Evaluation of an HIV-related mortuary surveillance system – Nairobi, Kenya, two sites, 2015External
        Ali H, Kiama C, Muthoni L, Waruru A, Young PW, Zielinski-Gutierrez E, Waruiru W, Hark Lerode R, Kim AA, Swaminathan M, De Cock KM, Wamicwe J.
        MMWR Surveill Summ. 2018 Dec 21;67(14):1-12.

        PROBLEM/CONDITION: Use of human immunodeficiency virus (HIV)-mortality surveillance data can help public health officials monitor, evaluate, and improve HIV treatment programs. Many high-income countries have high-coverage civil registration and vital statistics (CRVS) systems linked to case-based HIV surveillance on which to base HIV mortality estimates. However, in the absence of comprehensive CRVS systems in low- and medium-income countries, such as Kenya, mortuary surveillance can be used to understand the occurrence of HIV infection among cadavers. In 2015, a pilot HIV-related mortuary surveillance system was implemented in the two largest mortuaries in Nairobi, Kenya. CDC conducted an evaluation to assess performance attributes and identify strengths and weaknesses of the surveillance system pilot. PERIOD COVERED: Data collection: January 29-March 3, 2015; evaluation: November 2015. DESCRIPTION OF THE SYSTEM: The surveillance system objectives were to determine HIV positivity among cadavers at two mortuary sites in Nairobi, Kenya, and to determine annual cause-specific and HIV-specific mortality rates among the cadavers. Cadavers of persons aged >/=15 years at death admitted to either mortuary during a 33-day period were included. Demographic information and place and time of death were entered into a surveillance register. Cardiac blood was collected using transthoracic aspiration, and blood specimens were tested for HIV in a central laboratory. Causes of death were abstracted from mortuary and hospital records. Of the 807 cadavers brought to the mortuaries, 610 (75.6%) had an HIV test result available. The overall unadjusted HIV-positivity rate was 19.5% (119/610), which differed significantly by sex (14.6% among men versus 29.5% among women). EVALUATION: The evaluation was conducted using CDC guidelines for evaluating public health surveillance systems. The attributes of simplicity, flexibility, data quality (completeness and validity), acceptability, sensitivity, predictive value positive, representativeness, timeliness, and stability were examined. The evaluation steps included review of the surveillance system documents, in-depth interviews with 20 key informants (surveillance system staff, including mortuary and laboratory staff, and stakeholders involved in funding or implementation), and review of the surveillance database. RESULTS AND INTERPRETATION: Implementation of the pilot mortuary surveillance system was complex because of extensive paperwork and the need to collect and process specimens outside of business hours. However, the flexibility of the system accommodated multiple changes during implementation, including changes in specimen collection techniques and data collection tools. Acceptability was initially low among the mortuary staff but increased after concerns regarding workload were resolved. Timeliness of specimen collection could not be measured because time of death was rarely documented. Completeness of data available from the system was generally high except for cause of death (46.5%). Although the two largest mortuaries in Nairobi were included, the surveillance system might not be representative of the Nairobi population. One of the mortuaries was affiliated with the national referral hospital and included cadavers of admitted patients, some deaths might have occurred outside Nairobi, and data were collected for only 1 month. PUBLIC HEALTH ACTIONS: Mortuary surveillance can provide data on HIV positivity among cadavers and HIV-related mortality, which are not available from other sources in most sub-Saharan African countries. Availability of these mortality data will help describe a country’s progress toward achieving epidemic control and achieving Joint United Nations Programme on HIV/AIDS 95-95-95 targets. To understand HIV mortality in high-prevalence regions, the mortuary surveillance system is being replicated in Western Kenya. Although a low-cost system, its sustainability depends on external funding because mortuary surveillance is not yet incorporated into the national AIDS strategic framework in Kenya.

    • Disease Reservoirs and Vectors
      • Antibody-mediated virus neutralization is not a universal mechanism of Marburg, Ebola or Sosuga virus clearance in Egyptian rousette batsExternal
        Schuh AJ, Amman BR, Sealy TK, Kainulainen MH, Chakrabarti AK, Guerrero LW, Nichol ST, Albarino CG, Towner JS.
        J Infect Dis. 2018 Dec 21.

        Although bats are increasingly being recognized as natural reservoir hosts of emerging zoonotic viruses, little is known about how they control and clear virus infection in the absence of clinical disease. Here, we test >50 convalescent sera from Egyptian rousette bats (ERBs) experimentally primed or prime-boosted with Marburg virus, Ebola virus or Sosuga virus for the presence of virus-specific neutralizing antibodies using infectious reporter viruses. After serum neutralization testing, we conclude that antibody-mediated virus neutralization does not contribute significantly to the control and clearance of Marburg virus, Ebola virus or Sosuga virus infection in ERBs.

    • Genetics and Genomics
      • Analysis of whole-genome sequences for the prediction of penicillin resistance and beta-lactamase activity in Bacillus anthracisExternal
        Gargis AS, McLaughlin HP, Conley AB, Lascols C, Michel PA, Gee JE, Marston CK, Kolton CB, Rodriguez RL, Hoffmaster AR, Weigel LM, Sue D.
        mSystems. 2018 Nov-Dec;3(6).

        Penicillin (PEN) is a low-cost option for anthrax treatment, but naturally occurring resistance has been reported. beta-Lactamase expression (bla1, bla2) in Bacillus anthracis is regulated by a sigma factor (SigP) and its cognate anti-sigma factor (RsiP). Mutations leading to truncation of RsiP were previously described as a basis for PEN resistance. Here, we analyze whole-genome sequencing (WGS) data and compare the chromosomal sigP-bla1 regions from 374 B. anthracis strains to determine the frequency of mutations, identify mutations associated with PEN resistance, and evaluate the usefulness of WGS for predicting PEN resistance. Few (3.5%) strains contained at least 1 of 11 different mutations in sigP, rsiP, or bla1. Nine of these mutations have not been previously associated with PEN resistance. Four strains showed PEN resistance (PEN-R) by conventional broth microdilution, including 1 strain with a novel frameshift in rsiP. One strain that carries the same rsiP frameshift mutation as that found previously in a PEN-R strain showed a PEN-susceptible (PEN-S) phenotype and exhibited decreased bla1 and bla2 transcription. An unexpectedly small colony size, a reduced growth rate, and undetectable beta-lactamase activity levels (culture supernatant and cell lysate) were observed in this PEN-S strain. Sequence analysis revealed mutations in genes associated with growth defects that may contribute to this phenotype. While B. anthracis rsiP mutations cannot be exclusively used to predict resistance, four of the five strains with rsiP mutations were PEN-R. Therefore, the B. anthracis sigP-bla1 region is a useful locus for WGS-based PEN resistance prediction, but phenotypic testing remains essential. IMPORTANCE Determination of antimicrobial susceptibility of B. anthracis is essential for the appropriate distribution of antimicrobial agents for postexposure prophylaxis (PEP) and treatment of anthrax. Analysis of WGS data allows for the rapid detection of mutations in antimicrobial resistance (AMR) genes in an isolate, but the presence of a mutation in an AMR gene does not always accurately predict resistance. As mutations in the anti-sigma factor RsiP have been previously associated with high-level penicillin resistance in a limited number of strains, we investigated WGS assemblies from 374 strains to determine the frequency of mutations and performed functional antimicrobial susceptibility testing. Of the five strains that contained mutations in rsiP, only four were PEN-R by functional antimicrobial susceptibility testing. We conclude that while sequence analysis of this region is useful for AMR prediction in B. anthracis, genetic analysis should not be used exclusively and phenotypic susceptibility testing remains essential.

    • Healthcare Associated Infections
    • Injury and Violence
      • Self-directed violence after medical emergency department visits among youthExternal
        Wang J, Xie H, Holland KM, Sumner SA, Balaji AB, David-Ferdon CF, Crosby AE.
        Am J Prev Med. 2018 Dec 11.

        INTRODUCTION: Identifying medical encounters that precede self-directed violence may allow for important prevention opportunities. This study examined the risk of self-directed violence after visiting the emergency department for a range of physical health conditions among youth. METHODS: This retrospective cohort study used 2012-2013 statewide emergency department data from six states. Among patients aged 15-29 years, the exposure group included 2,192,322 emergency department visits for 16 selected conditions, coded by whether visits for those conditions were the first, second, or third or later visit for that condition. Emergency department visits for a minor infection served as the reference group (n=149,163). A Cox proportional hazard model was used to assess the risk of a self-directed violence event within 6 months for each condition. Analyses were conducted in 2017. RESULTS: Overall, 8,489 (0.4%) of all patients visited the emergency department for self-directed violence over a 6-month period. Initial visits for epilepsy or seizures conveyed a markedly elevated hazard ratio for subsequent self-directed violence at 6.0 and 5.7, respectively (p<0.001). Initial visits for other conditions showed moderately elevated risk with hazard ratios primarily <2. Second visits for various pain symptoms, syncope, vomiting, or non-self-directed violence injury also had a 3- to 5-fold increase in hazard ratios for subsequent self-directed violence. Hazard ratios for third or later visit increased to 8.8 for back pain, 6.9 for headache, about 5 for abdominal pain, dental complaints, and non-self-directed violence injury (p<0.001). CONCLUSIONS: Young people presenting to the emergency department for certain medical conditions are at an increased risk of subsequent self-directed violence. An awareness of these patterns may help guide screening efforts for suicide prevention in clinical settings.

    • Laboratory Sciences
      • Pulmonary toxicity and lung tumorigenic potential of surrogate metal oxides in gas metal arc welding-stainless steel fume: Iron as a primary mediator versus chromium and nickelExternal
        Falcone LM, Erdely A, Salmen R, Keane M, Battelli L, Kodali V, Bowers L, Stefaniak AB, Kashon ML, Antonini JM, Zeidler-Erdely PC.
        PLoS One. 2018 ;13(12):e0209413.

        In 2017, the International Agency for Research on Cancer classified welding fumes as “carcinogenic to humans” (Group 1). Both mild steel (MS) welding, where fumes lack carcinogenic chromium and nickel, and stainless steel (SS) increase lung cancer risk in welders; therefore, further research to better understand the toxicity of the individual metals is needed. The objectives were to (1) compare the pulmonary toxicity of chromium (as Cr(III) oxide [Cr2O3] and Cr (VI) calcium chromate [CaCrO4]), nickel [II] oxide (NiO), iron [III] oxide (Fe2O3), and gas metal arc welding-SS (GMAW-SS) fume; and (2) determine if these metal oxides can promote lung tumors. Lung tumor susceptible A/J mice (male, 4-5 weeks old) were exposed by oropharyngeal aspiration to vehicle, GMAW-SS fume (1.7 mg), or a low or high dose of surrogate metal oxides based on the respective weight percent of each metal in the fume: Cr2O3 + CaCrO4 (366 + 5 mug and 731 + 11 mug), NiO (141 and 281 mug), or Fe2O3 (1 and 2 mg). Bronchoalveolar lavage, histopathology, and lung/liver qPCR were done at 1, 7, 28, and 84 days post-aspiration. In a two-stage lung carcinogenesis model, mice were initiated with 3-methylcholanthrene (10 mug/g; intraperitoneal; 1x) or corn oil then exposed to metal oxides or vehicle (1 x/week for 5 weeks) by oropharyngeal aspiration. Lung tumors were counted at 30 weeks post-initiation. Results indicate the inflammatory potential of the metal oxides was Fe2O3 > Cr2O3 + CaCrO4 > NiO. Overall, the pneumotoxic effects were negligible for NiO, acute but not persistent for Cr2O3 + CaCrO4, and persistent for the Fe2O3 exposures. Fe2O3, but not Cr2O3 + CaCrO4 or NiO significantly promoted lung tumors. These results provide experimental evidence that Fe2O3 is an important mediator of welding fume toxicity and support epidemiological findings and the IARC classification.

    • Parasitic Diseases
      • Human direct skin feeding versus membrane feeding to assess the mosquitocidal efficacy of high-dose ivermectin (IVERMAL Trial)External
        Smit MR, Ochomo EO, Aljayyoussi G, Kwambai TK, Abong’o BO, Bousema T, Waterhouse D, Bayoh NM, Gimnig JE, Samuels AM, Desai MR, Phillips-Howard PA, Kariuki SK, Wang D, Ward SA, Ter Kuile FO.
        Clin Infect Dis. 2018 Dec 22.

        Background: Ivermectin is being considered for mass-drug-administration for malaria due to its ability to kill mosquitoes feeding on recently treated individuals. In a recent trial, 3-day courses of 300 and 600 mcg/kg/day were shown to kill Anopheles mosquitoes for at least 28 days post-treatment when fed patients’ venous blood using membrane-feeding-assays. Direct-skin-feeding on humans may lead to higher mosquito-mortality as ivermectin capillary-concentrations are higher. We compared mosquito-mortality following direct-skin- and membrane-feeding. Methods: We conducted a mosquito feeding study nested within a randomized, double-blind, placebo-controlled trial of 141 adults with uncomplicated malaria in Kenya comparing 3-day ivermectin 0 (n=46), 300 (n=48), or 600 mcg/kg/day (n=47), co-administered with dihydroartemisinin-piperaquine. On post-treatment day-7, direct-skin and membrane-feeding assays were conducted using laboratory-reared Anopheles gambiae s.s.. Mosquito survival was assessed daily for 28-days-post-feeding. Results: Between July-20-2015 and May-7-2016, 69 of 141 patients participated in both direct-skin- and membrane-feeding (placebo n=23, 300mcg/kg/day n=24, 600mcg/kg/day n=22). The 14-day-post-feeding mortality for mosquitoes fed on blood 7-days post-treatment from patients in both ivermectin arms pooled was similar with direct-skin-feeding (n=2,941 mosquitoes) versus membrane-feeding (n=7,380 mosquitoes): cumulative-mortality (RR=0.99, 0.95-1.03, p=0.69) and survival-time (HR=0.96, 0.91-1.02, p=0.19). Results were consistent by sex, body-mass-index, and across the range of ivermectin capillary concentrations studied (0.72-73.9 ng/mL). Conclusions: Direct-skin-feeding and membrane-feeding on day 7 resulted in similar mosquitocidal-effects of ivermectin across a wide range of drug-concentrations, suggesting that the mosquitocidal-effects seen with membrane-feeding accurately reflect those of natural-biting. Membrane-feeding, which is more patient-friendly and ethically acceptable, can likely reliably be used to assess ivermectin’s mosquitocidal-efficacy.

      • Time-of-flight secondary ion mass spectrometry (ToF-SIMS) analysis was used to qualitatively and quantitatively assess the distribution of permethrin insecticide on the surfaces and interiors of Olyset long-lasting insecticidal net (LLIN) fibers. Total insecticide content in LLINs has been established using many analytical methods. However, it is important to quantify the bioavailable portion residing on the fiber surfaces for incorporated LLINs. ToF-SIMS is a very surface sensitive technique and can directly image the spatial distribution of permethrin insecticide on the surface of Olyset fibers. Surface permethrin appeared as patchy deposits which were easily removed by acetone and reappeared after several days as interior permethrin migrated (bloomed) from the fiber interior. After a wash/incubation cycle, permethrin deposits were more diffuse and less concentrated than those on the as-received fibers. ToF-SIMS is particularly sensitive to detect the Cl- ion, which is the characteristic ion of permethrin. Ion implantation and quantification of dopants using SIMS is well established in the semiconductor industry. In this study, quantitative depth profiling was carried out using 35Cl- ion implantation to correlate secondary ion yield with permethrin concentration, yielding a limit of detection of 0.051 wt% for permethrin. In some cases, surface concentration differed greatly from the fiber interior (>1 mum below the surface). Two- and three-dimensional mapping of Cl at sub-micrometer resolution showed permethrin to be dissolved throughout the fiber, with about 2 vol% residing in disperse, high-concentration domains. This suggests that these fibers fall into the class of monolithic sustained-release devices. It is expected that ToF-SIMS can be a valuable tool to provide insight into the insecticide release behavior of other LLIN products, both current and future.

      • Evaluation of a single dose of azithromycin for trachoma in low-prevalence communitiesExternal
        Wilson N, Goodhew B, Mkocha H, Joseph K, Bandea C, Black C, Igietseme J, Munoz B, West SK, Lammie P, Kasubi M, Martin DL.
        Ophthalmic Epidemiol. 2018 Dec 13:1-6.

        PURPOSE: Trachoma, caused by repeated ocular infection with Chlamydia trachomatis, is the leading infectious cause of blindness worldwide and is targeted for elimination as a public health problem. We sought to determine whether a one-time azithromycin mass treatment would reduce trachomatous inflammation-follicular (TF) levels below the elimination threshold of 5% in communities with disease prevalence between 5 and 9.9%. METHODS: The study was conducted in 96 sub-village units (balozis) in the Kongwa district of Tanzania which were predicted from prior prevalence surveys to have TF between 5 and 9.9%. Balozis were randomly assigned to the intervention and control arms. The intervention arm received a single mass drug administration of azithromycin. At baseline and 12-month follow-up, ocular exams for trachoma, ocular swabs for detection of chlamydial DNA, and finger prick blood for analysis of anti-chlamydial antibody were taken. RESULTS: Comparison of baseline and 12-month follow-up showed no significant difference in the overall TF1-9 prevalence by balozi between control and treatment arms. In the treatment arm there was a significant reduction of ocular infection 12 months after treatment (p = 0.004) but no change in the control arm. No change in Pgp3-specific antibody responses were observed after treatment in the control or treatment arms. Anti-CT694 responses increased in both study arms (p = 0.009 for control arm and p = 0.04 for treatment arm). CONCLUSION: These data suggest that a single round of MDA may not be sufficient to decrease TF levels below 5% when TF1-9 is between 5 and 9.9% at baseline.

    • Zoonotic and Vectorborne Diseases
      • Duration of the presence of infectious Zika virus in semen and serumExternal
        Medina FA, Torres G, Acevedo J, Fonseca S, Casiano L, De Leon-Rodriguez CM, Santiago GA, Doyle K, Sharp TM, Alvarado LI, Paz-Bailey G, Munoz-Jordan JL.
        J Infect Dis. 2019 Jan 1;219(1):31-40.

        Zika virus (ZIKV) has recently caused a large epidemic in the Americas that is associated with birth defects. Although ZIKV is primarily transmitted by Aedes mosquitoes, ZIKV RNA is detectable in blood and semen of infected individuals for weeks or months, during which sexual and other modes of transmission are possible. However, viral RNA is usually detectable longer than infectious virus is present. We determined the frequency of isolation of infectious virus from semen and serum samples prospectively obtained from a cohort of patients in Puerto Rico. We confirmed isolation of infectious virus on the basis of a tissue culture cytopathic effect, an increase in virus genome copy equivalents (GCE), and positive results of immunofluorescence analysis; virus in infected cells was quantitated by flow cytometry. These criteria confirmed the presence of infectious virus in semen specimens from 8 of 97 patients for up to 38 days after initial detection when virus loads are >1.4 x 106 genome copy equivalents/mL. Two serum isolates were obtained from 296 patients. These findings can help guide important prevention guidelines for persons that may potentially be infectious and transmit ZIKV sexually.

  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. Drivers of international variation in prevalence of disabling low back pain: Findings from the Cultural and Psychosocial Influences on Disability studyExternal
        Coggon D, Ntani G, Palmer KT, Felli VE, Harari F, Quintana LA, Felknor SA, Rojas M, Cattrell A, Vargas-Prada S, Bonzini M, Solidaki E, Merisalu E, Habib RR, Sadeghian F, Kadir MM, Warnakulasuriya SS, Matsudaira K, Nyantumbu-Mkhize B, Kelsall HL, Harcombe H.
        Eur J Pain. 2019 Jan;23(1):35-45.

        BACKGROUND: Wide international variation in the prevalence of disabling low back pain (LBP) among working populations is not explained by known risk factors. It would be useful to know whether the drivers of this variation are specific to the spine or factors that predispose to musculoskeletal pain more generally. METHODS: Baseline information about musculoskeletal pain and risk factors was elicited from 11 710 participants aged 20-59 years, who were sampled from 45 occupational groups in 18 countries. Wider propensity to pain was characterized by the number of anatomical sites outside the low back that had been painful in the 12 months before baseline (‘pain propensity index’). After a mean interval of 14 months, 9055 participants (77.3%) provided follow-up data on disabling LBP in the past month. Baseline risk factors for disabling LBP at follow-up were assessed by random intercept Poisson regression. RESULTS: After allowance for other known and suspected risk factors, pain propensity showed the strongest association with disabling LBP (prevalence rate ratios up to 2.6, 95% CI: 2.2-3.1; population attributable fraction 39.8%). Across the 45 occupational groups, the prevalence of disabling LBP varied sevenfold (much more than within-country differences between nurses and office workers), and correlated with mean pain propensity index (r = 0.58). CONCLUSIONS: Within our study, major international variation in the prevalence of disabling LBP appeared to be driven largely by factors predisposing to musculoskeletal pain at multiple anatomical sites rather than by risk factors specific to the spine. SIGNIFICANCE: Our findings indicate that differences in general propensity to musculoskeletal pain are a major driver of large international variation in the prevalence of disabling low back pain among people of working age.

      2. Screening and referral for childhood obesity: Adherence to the U.S. Preventive Services Task Force RecommendationExternal
        Imoisili OE, Goodman AB, Dooyema CA, Harrison MR, Belay B, Park S.
        Am J Prev Med. 2018 Dec 11.

        INTRODUCTION: The U.S. Preventive Services Task Force recommends clinicians screen children aged 6 years or older for obesity and offer or refer children with obesity to intensive weight management programs. This study explores clinician awareness of weight management programs meeting the recommendation, adherence to the recommendation of screening and referral, and associations between provider and practice characteristics and weight management program referrals. METHODS: This cross-sectional study used data from the DocStyles survey 2017, a web-based panel survey, analyzed in 2017. Among 1,023 clinicians who see pediatric patients, this study examined clinician awareness of weight management programs in their communities that met the recommendation, practice of screening for childhood obesity, and referral to weight management programs. Multivariable logistic regression estimated associations between the demographic and practice characteristics of clinicians and weight management program referrals. RESULTS: Only 24.6% of surveyed clinicians were aware of a weight management program that met the U.S. Preventive Services Task Force recommendation in their community; of those aware, 88.9% referred patients to these weight management programs. Most (83.6%) clinicians screened children for obesity in >/=75% of visits. Overall, 53.5% of clinicians provided referrals to weight management programs. Referral was higher among female clinicians and clinicians serving mostly middle-income patients. Providers without teaching hospital privileges had lower odds of referral. CONCLUSIONS: Adherence to clinical recommendations is essential to curbing the childhood obesity epidemic. Only one in four surveyed clinicians were aware of weight management programs in their community meeting U.S. Preventive Services Task Force criteria. Half of clinicians referred pediatric patients with obesity to a weight management program. Results suggest efforts are needed to increase awareness of, and referral to, weight management programs meeting the recommendation.

      3. Trends in incidence of ESKD in people with type 1 and type 2 diabetes in Australia, 2002-2013External
        Koye DN, Magliano DJ, Reid CM, Pavkov ME, Chadban SJ, McDonald SP, Polkinghorne KR, White S, Paul C, Shaw JE.
        Am J Kidney Dis. 2018 Dec 14.

        RATIONALE & OBJECTIVE: The number of people with diabetes and end-stage kidney disease (ESKD) is increasing worldwide, but it is unknown whether this indicates an increasing risk for ESKD in people with diabetes. We examined temporal trends in the incidence of ESKD within the Australian population with diabetes from 2002 to 2013. STUDY DESIGN: Follow-up study using a national health care services registry. SETTING & PARTICIPANTS: Registrants with type 1 or type 2 diabetes in Australia’s National Diabetes Services Scheme (NDSS). PREDICTORS: Age, sex, indigenous status, diabetes type, and calendar year. OUTCOME: Incidence of ESKD (dialysis or kidney transplantation) or death ascertained using the Australian and New Zealand Dialysis and Transplant Registry and the Australian national death index. ANALYTICAL APPROACH: NDSS registrants were followed up from 2002 or date of registration until onset of ESKD, death, or December 31, 2013. The incidence of ESKD in type 1 diabetes was calculated only in those younger than 55 years. RESULTS: Among 1,375,877 registrants between 2002 and 2013, a total of 9,977 experienced incident ESKD, representing an overall incidence of ESKD in people with diabetes of 10.0 (95% CI, 9.8-10.2) per 10,000 person-years. Among those with type 1 diabetes, the age-standardized annual incidence was stable during the study period. Among those with type 2 diabetes, the incidence increased in nonindigenous people (annual percentage change, 2.2%; 95% CI, 0.4%-4.1%) with the greatest increases in those younger than 50 and those older than 80 years. No significant change over time was observed in indigenous people, although the adjusted incident rate ratio for indigenous versus nonindigenous was 4.03 (95% CI, 3.68-4.41). LIMITATIONS: Lack of covariates such as comorbid conditions, medication use, measures of quality of care, and baseline kidney function. CONCLUSIONS: The age-standardized annual incidence of ESKD increased in Australia from 2002 to 2013 for nonindigenous people with type 2 diabetes but was stable for people with type 1 diabetes. Efforts to prevent the development of ESKD, especially among indigenous Australians and those with early-onset type 2 diabetes, are warranted.

      4. Gender difference in clinical conditions among hospitalized adults with myotonic dystrophyExternal
        Ouyang L, Wang Y, Valdez R, Johnson N, Gutmann L, Street N, Bolen J.
        Muscle Nerve. 2018 Dec 21.

        INTRODUCTION: This study examines gender differences in adult hospitalizations with myotonic dystrophy (DM). METHODS: From the Nationwide Inpatient Sample (NIS) 2010-2014, we identified 1,891 adult hospitalizations with a DM diagnosis and constructed a comparison group of hospitalizations without DM using propensity score matching. We calculated relative risk by gender for 44 clinical diagnoses that each accounted for at least 5% of DM hospitalizations. RESULTS: Hospitalizations with DM were longer (4.8 vs. 4.1 days, P<.0001) and more costly ($13,241 vs. $11,458, P<.001) than those without DM. More than half (25 of 44) of the conditions co-occurring with DM hospitalizations did not differ in their relative risks by gender. For those that differed by gender, only five were specific to DM, compared with hospitalizations without DM. DISCUSSION: The results highlight the importance of comprehensive and coordinated care for DM rather than gender-oriented care in the inpatient setting. This article is protected by copyright. All rights reserved.

    • Communicable Diseases
      1. BACKGROUND: Calculating national rates of HIV diagnosis, incidence, and prevalence can quantify disease burden and is important for planning and evaluating programs. We calculated HIV rates among men who have sex with men (MSM), persons who inject drugs (PWID), and heterosexuals in 2010 and 2015. METHODS: We used proportion estimates of the United States population classified as MSM, PWID, and heterosexuals along with census data to calculate the population sizes which were used as the denominators for calculating HIV rates. The numerators (HIV diagnosis, incidence, and prevalence) were based on data submitted to the National HIV Surveillance System through June 2017. RESULTS: The estimated HIV diagnosis and incidence rates in 2015 were 574.7 and 583.6 per 100,000 MSM; 34.3 and 32.7 per 100,000 PWID; and 4.1 and 3.8 per 100,000 heterosexuals. The estimated HIV prevalence in 2015 was 12,372.9 per 100,000 MSM; 1,937.2 per 100,000 PWID; and 126.7 per 100,000 heterosexuals. The HIV diagnosis rates decreased from 2010 to 2015 in all three transmission categories. Blacks had the highest HIV diagnosis rates at both time points. The HIV incidence rates decreased among white MSM, MSM aged 13-24 years, PWID overall, and male and female heterosexuals; however, it increased among MSM aged 25-34 years. CONCLUSIONS: The estimated HIV diagnosis and HIV infection rates decreased for several transmission categories as well as race/ethnicity and age subgroups. MSM continue to be disproportionately affected. Disparities remain and have widened for some groups. Efforts are needed to strengthen prevention, care, and supportive services for all persons with HIV infection.

      2. Distinct evolutionary patterns of Neisseria meningitidis serogroup B disease outbreaks at two universities in the USAExternal
        Hao L, Holden MT, Wang X, Andrew L, Wellnitz S, Hu F, Whaley M, Sammons S, Knipe K, Frace M, McNamara LA, Liberator P, Anderson AS.
        Microb Genom. 2018 Apr;4(4).

        Neisseria meningitidis serogroup B (MnB) was responsible for two independent meningococcal disease outbreaks at universities in the USA during 2013. The first at University A in New Jersey included nine confirmed cases reported between March 2013 and March 2014. The second outbreak occurred at University B in California, with four confirmed cases during November 2013. The public health response to these outbreaks included the approval and deployment of a serogroup B meningococcal vaccine that was not yet licensed in the USA. This study investigated the use of whole-genome sequencing(WGS) to examine the genetic profile of the disease-causing outbreak isolates at each university. Comparative WGS revealed differences in evolutionary patterns between the two disease outbreaks. The University A outbreak isolates were very closely related, with differences primarily attributed to single nucleotide polymorphisms/insertion-deletion (SNP/indel) events. In contrast, the University B outbreak isolates segregated into two phylogenetic clades, differing in large part due to recombination events covering extensive regions (>30 kb) of the genome including virulence factors. This high-resolution comparison of two meningococcal disease outbreaks further demonstrates the genetic complexity of meningococcal bacteria as related to evolution and disease virulence.

      3. HIV risk associated with serum medroxyprogesterone acetate (MPA) levels among women in East and southern Africa: a case-control studyExternal
        Heffron R, Stalter R, Pyra M, Nanda K, Erikson DW, Hladik F, Blue SW, Davis NL, Mugo N, Kourtis AP, Lingappa JR, Baeten JM.
        Aids. 2018 Dec 21.

        BACKGROUND: Some observational studies have found increased HIV risk associated with self-reported use of injectable depot medroxyprogesterone acetate (DMPA). Testing blood samples for MPA, the progestin in DMPA, permits validation of self-reported data and exploration of whether potential HIV risk is correlated with MPA levels, which are highest soon after injection. METHODS: We conducted a case-control study testing archived serum from women who participated in three longitudinal studies of HIV prevention in East and southern Africa. Case samples, from women who acquired HIV, were from visits that occurred at or immediately prior to the first evidence of HIV infection. Secondary analyses restricted to case samples collected within 15 and 30 days of the estimated date of HIV infection. Matched control samples were from women who remained HIV-uninfected. We used multivariable conditional logistic regression to compare exogenous hormone levels, quantified through mass spectrometry, among cases and controls. RESULTS: When restricted to cases with samples collected within </=15 days of estimated date of HIV infection, MPA detection was more frequent among women who acquired HIV (adjusted odds ratio [AOR] = 2.75, 95% confidence interval [CI] 1.22-6.19). In this subset, the increase in HIV risk was only among samples with MPA detected at a low level of 0.02-0.50ng/ml: 36.7% of cases and 9.4% of controls, AOR = 6.03, 95% CI 2.50-14.54. CONCLUSIONS: Detection of MPA at low levels close to the estimated time of HIV acquisition was significantly more frequent among women who acquired HIV. Studies are needed that explore biological mechanisms elicited by any MPA level and HIV risk.

      4. The fraction of rhinovirus detections attributable to mild and severe respiratory illness in a high HIV-prevalence setting, South Africa, 2013-2015External
        Hellferscee O, Treurnicht FK, Walaza S, du Plessis M, von Gottberg A, Wolter N, Moyes J, Dawood H, Variava E, Pretorius M, Venter M, Cohen C, Tempia S.
        J Infect Dis. 2018 Dec 22.

        Background: The association of rhinoviruses (RV) detection to illness is poorly understood. Methods: We enrolled case-patients hospitalized with severe respiratory illness (SRI) at two hospitals and outpatients with influenza-like-illness (ILI) and asymptomatic individuals (controls) from two affiliated clinics during 2013-2015. We compared the RV prevalence among ILI and SRI cases to those of controls stratified by HIV-serostatus using penalized logistic regression. All analyses were adjusted for underlying medical conditions and viral coinfections. The attributable fraction (AF) was calculated from the adjusted odds ratio (aOR) using the following formula: (aOR-1)/aOR*100. Results: During 2013-2015 RV was detected in 17.4% (368/2120), 26.8% (979/3654) and 23.0% (1003/4360) of controls, ILI and SRI cases, respectively. The RV attributable fraction (AF) was statistically significant among children aged <5 years (ILI:44.6%; 95% CI: 30.7%-55.7% and SRI:50.3%; 95% CI: 38.6%-59.9%; p<0.001) and individuals aged >/=5 years (ILI:62.9%; 95% CI: 54.4%-69.8% and SRI:51.3%; 95% CI: 38.7%-61.3%; p<0.001) as well as among HIV-infected (ILI:59.9%; 95% CI: 45.8%-70.3% and SRI 39.8%; 95% CI: 22.3%-53.3%; p<0.001) and HIV-uninfected (ILI:53.6%; 95% CI: 44.7%-61.1% and SRI:55.3%; 95% CI: 45.6%-63.2%; p<0.001) individuals. Conclusions: Although rhinoviruses detection was common among controls, it was also associated with a substantial proportion of clinical illness across age groups, irrespective of HIV status.

      5. An intensive, active surveillance reveals continuous invasion and high diversity of rhinovirus in householdsExternal
        Kamau E, Onyango CO, Otieno GP, Kiyuka PK, Agoti CN, Medley GF, Cane PA, Nokes DJ, Munywoki PK.
        J Infect Dis. 2018 Dec 20.

        We report on infection patterns in 5 households (78 participants) delineating the natural history of human rhinovirus (HRV). Nasopharyngeal collections were obtained every 3-4 days irrespective of symptoms, over a 6-month period, with molecular screening for HRV and typing by sequencing VP4/VP2 junction. Overall, 311/3468 (8.9%) collections were HRV positive: 256 were classified into 3 species: 104 (40.6%) HRV-A; 14 (5.5%) HRV-B, and 138 (53.9%) HRV-C. Twenty-six known HRV types (13 HRV-A, 3 HRV-B, and 10 HRV-C) were identified (A75, C1, and C35 being most frequent). We observed continuous invasion and temporal clustering of HRV types in households (range 5-13 over 6 months). Intrahousehold transmission was independent of clinical status but influenced by age. Most (89.0%) of HRV infection episodes were limited to <14 days. Individual repeat infections were frequent (range 1-7 over 6 months), decreasing with age, and almost invariably heterotypic, indicative of lasting type-specific immunity and low cross-type protection.

      6. Who interacts with whom? Social mixing insights from a rural population in IndiaExternal
        Kumar S, Gosain M, Sharma H, Swetts E, Amarchand R, Kumar R, Lafond KE, Dawood FS, Jain S, Widdowson MA, Read JM, Krishnan A.
        PLoS One. 2018 ;13(12):e0209039.

        Acute lower respiratory infections (ALRI) are a leading cause of morbidity and mortality globally, with most ALRI deaths occurring in children in developing countries. Computational models can be used to test the efficacy of respiratory infection prevention interventions, but require data on social mixing patterns, which are sparse in developing countries. We describe social mixing patterns among a rural community in northern India. During October 2015-February 2016, trained field workers conducted cross-sectional face-to-face standardized surveys in a convenience sample of 330 households in Faridabad District, Haryana State, India. Respondents were asked about the number, duration, and setting of social interactions during the previous 24 hours. Responses were compared by age and gender. Among the 3083 residents who were approached, 2943 (96%) participated, of whom 51% were male and the median age was 22 years (interquartile range (IQR) 9-37). Respondents reported contact (defined as having had a face-to-face conversation within 3 feet, which may or may not have included physical contact) with a median of 17 (IQR 12-25) people during the preceding 24 hours. Median total contact time per person was 36 person-hours (IQR 26-52). Female older children and adults had significantly fewer contacts than males of similar age (Kruskal-Wallis chi2 = 226.59, p<0.001), but spent a longer duration in contact with young children (Kruskal-Wallis chi2 = 27.26, p<0.001), suggesting a potentially complex pattern of differential risk of infection between genders. After controlling for household size and day of the week, respondent age was significantly associated with number and duration of contacts. These findings can be used to model the impact of interventions to reduce lower respiratory tract infections in India.

      7. Implementing the package of CDC and WHO recommended linkage services: Methods, outcomes, and costs of the Bukoba Tanzania Combination Prevention Evaluation peer-delivered, linkage case management program, 2014-2017External
        MacKellar D, Maruyama H, Rwabiyago OE, Steiner C, Cham H, Msumi O, Weber R, Kundi G, Suraratdecha C, Mengistu T, Byrd J, Pals S, Churi E, Madevu-Matson C, Kazaura K, Morales F, Rutachunzibwa T, Justman J, Rwebembera A.
        PLoS One. 2018 ;13(12):e0208919.

        Although several studies have evaluated one or more linkage services to improve early enrollment in HIV care in Tanzania, none have evaluated the package of linkage services recommended by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). We describe the uptake of each component of the CDC/WHO recommended package of linkage services, and early enrollment in HIV care and antiretroviral therapy (ART) initiation among persons with HIV who participated in a peer-delivered, linkage case management (LCM) program implemented in Bukoba, Tanzania, October 2014 -May 2017. Of 4206 participants (88% newly HIV diagnosed), most received recommended services including counseling on the importance of early enrollment in care and ART (100%); escort by foot or car to an HIV care and treatment clinic (CTC) (83%); treatment navigation at a CTC (94%); telephone support and appointment reminders (77% among clients with cellphones); and counseling on HIV-status disclosure and partner/family testing (77%), and on barriers to care (69%). During three periods with different ART-eligibility thresholds [CD4<350 (Oct 2014 -Dec 2015, n = 2233), CD4</=500 (Jan 2016 -Sept 2016, n = 1221), and Test & Start (Oct 2016 -May 2017, n = 752)], 90%, 96%, and 97% of clients enrolled in HIV care, and 47%, 67%, and 86% of clients initiated ART, respectively, within three months of diagnosis. Of 463 LCM clients who participated in the last three months of the rollout of Test & Start, 91% initiated ART. Estimated per-client cost was $44 United States dollars (USD) for delivering LCM services in communities and facilities overall, and $18 USD for a facility-only model with task shifting. Well accepted by persons with HIV, peer-delivered LCM services recommended by CDC and WHO can achieve near universal early ART initiation in the Test & Start era at modest cost and should be considered for implementation in facilities and communities experiencing <90% early enrollment in ART care.

      8. BACKGROUND: HIV pre-exposure prophylaxis (PrEP) is efficacious; however, many men who have sex with men (MSM) (especially racial/ethnic minorities) are still unaware of and underuse it. METHODS: The 2014 Messages4Men Study focuses on black and Hispanic/Latino MSM in Chicago, Fort Lauderdale, and Kansas City (n = 937). Brief (2-3 sentence) messages were tested: a PrEP message tailored for HIV-uninfected MSM (n = 607) and a PrEP message tailored for HIV-infected MSM (n = 330). After reading the message, participants reported believability and awareness, and intent to use PrEP and condoms. Analyses consisted of bivariate and multivariable approaches. RESULTS: Among HIV-uninfected MSM, black (vs Hispanic/Latino) MSM indicated greater intentions to use PrEP (81% vs 70% respectively, P < 0.05); 72% overall had similar intentions to use condoms after hearing a PrEP message. PrEP information was new (63%) and believable (80%), with no racial/ethnic differences (P > 0.05). In multivariable analysis, men who reported recent condomless anal sex were less likely to report that the PrEP message enhanced their intent to use condoms in the future. DISCUSSION: Several years into the availability of PrEP, black and Hispanic/Latino MSM continue to be unaware of PrEP and its benefits, although information is largely believable once provided. The HIV prevention field should be prepared to incorporate new information about HIV prevention options into brief messages delivered through technology and social media.

      9. Field evaluation of near point of care Cepheid GeneXpert HIV-1 Qual for early infant diagnosisExternal
        Opollo VS, Nikuze A, Ben-Farhat J, Anyango E, Humwa F, Oyaro B, Wanjala S, Omwoyo W, Majiwa M, Akelo V, Zeh C, Maman D.
        PLoS One. 2018 ;13(12):e0209778.

        BACKGROUND: Access to point-of-care HIV testing shortens turn-around times, time to diagnosis and reduces loss to follow-up hence minimizing barriers to early linkage to care and treatment among HIV infected infants. Currently samples for early infant HIV diagnosis are sent to centralized testing facilities which are few and located only at specific regions in Kenya. However, there are Point of Care (POC) early infant diagnosis [EID] technologies elsewhere such as SAMBA and ALERE-Q that are yet to be evaluated in Kenya despite the urgent need for data to inform policy formulation regarding EID. The Cepheid GeneXpert HIV-1 Qual (GeneXpert) technology for POC EID offers a great opportunity to minimize HIV associated morbidity, mortality and loss to follow-up through decentralization of early infant HIV testing to the clinics. This technology also allows for same-day results thus facilitating prompt linkage to care. METHODS: We evaluated the GeneXpert HIV Qual EID POC in Homabay County against the standard of care platform, Roche CAP/CTM HIV-1 qualitative PCR, using dried blood spots (DBS). Between February-July 2016, DBS samples were collected from HIV exposed children <18 months of age enrolled in a cross-sectional study. Samples were collected by qualified nurse counselors, and were tested by trained technicians using field based GeneXpert and conventional laboratory based Roche CAP/CTM HIV-1 qualitative PCR. Sensitivity and specificity were determined. RESULTS: Overall, 3,814 mother/infant pairs were included in the study, out of which 921 infants were HIV exposed as per the mothers’ HIV status and based on the infant’s HIV rapid test. A total of 969 PCR tests were performed, out of which 30 (3.3%) infants were concordantly positive using both platforms. GeneXpert HIV-1 Qual yielded a sensitivity of 94.1% and specificity of 99.8% with an overall error rate of 0.7%. CONCLUSION: Our findings show that GeneXpert HIV-1 Qual performs well compared to CAP/CTM using DBS samples, suggesting that this technology may be adopted in decentralized laboratories as a near POC device. It may contribute to prompt diagnosis of HIV exposed infants hence enabling early linkage to care, thus advancing further gains in EID.

      10. Phylogenetic methods inconsistently predict direction of HIV transmission among heterosexual pairs in the HPTN052 cohortExternal
        Rose R, Hall M, Redd AD, Lamers S, Barbier AE, Porcella SF, Hudelson SE, Piwowar-Manning E, McCauley M, Gamble T, Wilson EA, Kumwenda J, Hosseinipour MC, Hakim JG, Kumarasamy N, Chariyalertsak S, Pilotto JH, Grinsztejn B, Mills LA, Makhema J, Santos BR, Chen YQ, Quinn TC, Fraser C, Cohen MS, Eshleman SH, Laeyendecker O.
        J Infect Dis. 2018 Dec 24.

        Background: We evaluated use of phylogenetic methods to predict the direction of HIV transmission. Methods: For 33 index-partner pairs with genetically-linked infection, samples were collected from partners and indexes close to time of partners’ seroconversion (SC); 31 indexes also had an earlier sample. Phylogenies were inferred using env next-generation sequences (one tree per pair/subtype). Direction of transmission (DoT) predicted from each tree was classified as correct or incorrect based on which sequences (index or partner) were closest to the root. DoT was also assessed using maximum-parsimony to infer ancestral node states for 100 bootstrap trees. Results: DoT was predicted correctly for both single pair and subtype-specific trees in 22 pairs (67%) using SC samples and 23 pairs (74%) using early index samples. DoT was predicted incorrectly for four pairs (15%) using SC or early index samples. In the bootstrap analysis, DoT was predicted correctly for 18 pairs (55%) using SC samples and 24 pairs (73%) using early index samples. DoT was predicted incorrectly for seven pairs (21%) using SC samples and four pairs (13%) using early index samples. Conclusions: Phylogenetic methods based solely on tree topology of HIV env sequences, particularly without consideration of phylogenetic uncertainty, may be insufficient for determining DoT.

      11. Epidemiological features and spatial clusters of hand, foot, and mouth disease in Qinghai Province, China, 2009-2015External
        Xu L, Shi Y, Rainey JJ, Zhang Z, Zhang H, Zhao J, Li Y, Rao H, Li Y, Liao Q, Ma Y.
        BMC Infect Dis. 2018 Dec 5;18(1):624.

        BACKGROUND: Hand, Foot, and Mouth Disease (HFMD) is most frequently caused by Enterovirus71 (EV-A71) or Coxsackie virus A16 (CV-A16), infants and young children are at greatest risk. Describing the epidemiology of HFMD can help develop and better target interventions, including the use of pediatric EV-A71 vaccination. METHODS: We obtained data from the national surveillance system for HFMD cases with onset dates from 2009 to 2015. We defined probable cases as patient with skin papular or vesicular rashes on the hands, feet, mouth, or buttocks and confirmed cases as patients with the above symptoms along with laboratory-based enterovirus detection. We generated overall and age-specific annual incidence rates and described the temporal variability and seasonality of HFMD in Qinghai Province. We identified spatial clustering of HFMD incidence at the county level using the Local Indicator of Spatial Associationand an alpha level of 0.05. RESULTS: During the study period, 14,480 HFMD probable or confirmed cases were reported in Qinghai Province. Of the 2158 (14.9%) with laboratory confirmation, 924 (42.6%) were caused by CV-A16 and 830 (38.2%) were caused by EV-A71. The majority (89%) of all case-patients were </= 5 years of age and male (61.5%). The overall mean annual HFMD incidence rate was 36.4 cases per 100,000 populations, while the incidence rate for children </=5 years of age was 379.5 cases per 100,000. Case reports peaked during the months of May through July. HFMD was predominantly caused by EV-A71, except in 2010 and 2014 when CV-A16 was the predominant causative agent. High incidence rates of HFMD were clustered (Moran’s I = 0.59, P < 0.05) in the eastern region of the province. CONCLUSION: HFMD remains an important cause of childhood disease in Qinghai Province, occurring in an acyclical pattern of increased incidence, primarily due to CV-A16 circulation every three years. Incidence is also seasonal and tends to spatially cluster in the eastern region of the province. Since approximately 40% of confirmed HFMD cases were due to EV-A71, EV-A71 vaccination is likely to have a positive impact on the HFMD disease burden. Routine analysis of local surveillance data is crucial for describing disease occurrence and changes in etiology.

    • Disease Reservoirs and Vectors
      1. A survey of the mosquitoes of kosrae state, federated states of MICRONESIA, 2016External
        Rose DA, Godsey MS, Faraji A, Ostrum EM, Savage HM.
        J Am Mosq Control Assoc. 2018 ;34(2):143-146.

        [No abstract]

    • Drug Safety
      1. INTRODUCTION: Unintentional medication ingestions by young children lead to nearly 60,000 emergency department visits annually; 15% involve oral liquid medications. Safety packaging improvements have been shown to limit liquid medication ingestions. Estimated rates of emergency department visits for pediatric ingestions by product were calculated to help target interventions. METHODS: Frequencies and rates of emergency department visits for unintentional pediatric ingestions were estimated using adverse event data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project and retail sales/pharmacy dispensing data from Information Resources, Inc. and QuintilesIMS (collected 2012-2015; analyzed 2017). Rates of emergency department visits for ingestions of over-the-counter liquid medications were compared with those for prescription solid medications. RESULTS: From the results of 568 cases, an estimated 6,427 emergency department visits (95% CI=4,907, 7,948) were made annually after a child aged <6 years accessed one of the four most commonly implicated over-the-counter liquid medications without caregiver oversight. Nearly two thirds (63.8%) of these visits were made by children aged </=2 years and 9.0% resulted in hospitalization. Acetaminophen was the most commonly implicated over-the-counter liquid medication (2,515 estimated emergency department visits annually). Rates of emergency department visits for liquid diphenhydramine and acetaminophen ingestions (8.1 and 7.4 emergency department visits per 100,000 bottles sold) were higher than rates for other common over-the-counter liquids and comparable to high-rate prescription solid medications (clonidine and buprenorphine/naloxone: 11.1 and 10.5 emergency department visits per 100,000 dispensed prescriptions, respectively). CONCLUSIONS: Product-specific rates of emergency department visits for unintentional ingestions can help prioritize preventive interventions, such as enhancing safety packaging with flow restrictors.

    • Genetics and Genomics
      1. Draft genome sequence of French Guiana Leishmania (Viannia) guyanensis strain 204-365, assembled using long readsExternal
        Batra D, Lin W, Rowe LA, Sheth M, Zheng Y, Loparev V, de Almeida M.
        Microbiol Resour Announc. 2018 Dec;7(23).

        We present here the draft genome sequence for Leishmania (Viannia) guyanensis. The isolate was obtained from a clinical case of cutaneous leishmaniasis in French Guiana. Genomic DNA was sequenced using PacBio and MiSeq platforms.

      2. Genotypic differences between strains of the opportunistic pathogen Corynebacterium bovis isolated from humans, cows, and rodentsExternal
        Cheleuitte-Nieves C, Gulvik CA, McQuiston JR, Humrighouse BW, Bell ME, Villarma A, Fischetti VA, Westblade LF, Lipman NS.
        PLoS One. 2018 ;13(12):e0209231.

        Corynebacterium bovis is an opportunistic bacterial pathogen shown to cause eye and prosthetic joint infections as well as abscesses in humans, mastitis in dairy cattle, and skin disease in laboratory mice and rats. Little is known about the genetic characteristics and genomic diversity of C. bovis because only a single draft genome is available for the species. The overall aim of this study was to sequence and compare the genome of C. bovis isolates obtained from different species, locations, and time points. Whole-genome sequencing was conducted on 20 C. bovis isolates (six human, four bovine, nine mouse and one rat) using the Illumina MiSeq platform and submitted to various comparative analysis tools. Sequencing generated high-quality contigs (over 2.53 Mbp) that were comparable to the only reported assembly using C. bovis DSM 20582T (97.8 +/- 0.36% completeness). The number of protein-coding DNA sequences (2,174 +/- 12.4) was similar among all isolates. A Corynebacterium genus neighbor-joining tree was created, which revealed Corynebacterium falsenii as the nearest neighbor to C. bovis (95.87% similarity), although the reciprocal comparison shows Corynebacterium jeikeium as closest neighbor to C. falsenii. Interestingly, the average nucleotide identity demonstrated that the C. bovis isolates clustered by host, with human and bovine isolates clustering together, and the mouse and rat isolates forming a separate group. The average number of genomic islands and putative virulence factors were significantly higher (p<0.001) in the mouse and rat isolates as compared to human/bovine isolates. Corynebacterium bovis’ pan-genome contained a total of 3,067 genes of which 1,354 represented core genes. The known core genes of all isolates were primarily related to ”metabolism” and ”information storage/processing.” However, most genes were classified as ”function unknown” or “unclassified”. Surprisingly, no intact prophages were found in any isolate; however, almost all isolates had at least one complete CRISPR-Cas system.

      3. Cancer communication research in the era of genomics and precision medicine: a scoping reviewExternal
        Kaphingst KA, Peterson E, Zhao J, Gaysynsky A, Elrick A, Hong SJ, Krakow M, Pokharel M, Ratcliff CL, Klein WM, Khoury MJ, Chou WS.
        Genet Med. 2018 Dec 21.

        Effective use of genetic and genomic data in cancer prevention and treatment depends on adequate communication with patients and the public. Although relevant empirical work has emerged, the scope and outcomes of this communication research have not been characterized. We conducted a comprehensive scoping review of recent published research (2010-2017) on communication of cancer-related genetic and genomic testing (CGT) information. Searches in six databases revealed 9243 unique records; 513 papers were included. Most papers utilized an observational quantitative design; fewer utilized an experimental design. More attention has been paid to outcomes of CGT results disclosure than to decision making regarding CGT uptake or the process of results disclosure. Psychosocial outcomes were most common across studies. This literature has a strong focus on BRCA1/2, with few papers focused on Lynch syndrome or next-generation technologies. Women, Caucasians, older adults, and those of higher socioeconomic status were overrepresented. Research gaps identified include the need for studies on the process of CGT communication; examining behavioral, decision making, and communication outcomes; and inclusion of diverse populations. Addressing these gaps can help improve the use of genomics in cancer control and reduce disparities in access to and use of CGT.

    • Health Disparities
      1. Changing rate orders of race-gender heart disease death rates: An exploration of county-level race-gender disparitiesExternal
        Vaughan AS, Quick H, Schieb L, Kramer MR, Taylor HA, Casper M.
        SSM Popul Health. 2019 Apr;7:100334.

        A holistic view of racial and gender disparities that simultaneously compares multiple groups can suggest associated underlying contextual factors. Therefore, to more comprehensively understand temporal changes in combined racial and gender disparities, we examine variations in the orders of county-level race-gender specific heart disease death rates by age group from 1973-2015. We estimated county-level heart disease death rates by race, gender, and age group (35-44, 45-54, 55-64, 65-74, 75-84, >/= 85, and >/= 35) from the National Vital Statistics System of the National Center for Health Statistics from 1973-2015. We then ordered these rates from lowest to highest for each county and year. The predominant national rate order (i.e., white women (WW) < black women (BW) < white men (WM) < black men (BM)) was most common in younger age groups. Inverted rates for black women and white men (WW<WM<BW<BM) was observed nationally only for ages 35-44, but was observed in at least some counties for all age groups < 75. From 1973 through 1979, national rates for black men aged >/= 35 were lower than those for white men. This national observation was found in a minority of counties, primarily among ages 55-64 and 65-74. The observed rates orders and their differences over time and place suggest that social and economic forces may be driving trends in heart disease mortality. Learning more about the places and times that deviate from the predominant rate order can further inform our understanding of these macro-level drivers of heart disease mortality trends.

    • Health Economics
      1. Consumption displacement in households with noncommunicable diseases in BangladeshExternal
        Datta BK, Husain MJ, Fatehin S, Kostova D.
        PLoS One. 2018 ;13(12).

        The economic burden of noncommunicable diseases (NCDs), including treatment costs and income and productivity losses, is a growing concern in developing countries, where NCD medical expenditure may offset consumption of other essential commodities. This study examines the role of NCDs in household resource allocation in Bangladesh. We use the Bangladesh Household Income and Expenditure Survey (HIES) 2010 to obtain expenditure data on 11 household expenditure categories and 12 food expenditure sub-categories for 12,240 households. Household NCD status was determined through self-report of at least one of the six major NCDs within the household-heart disease, hypertension, diabetes, kidney diseases, asthma, and cancer. We estimated unadjusted and regression-adjusted differences in household expenditure shares between NCD and non-NCD households. We further investigated how consumption of different food sub-categories is related to NCD status, distinguishing between household economic levels. The medical expenditure share was estimated to be 59% higher for NCD households than non-NCD households, and NCD households had lower expenditure shares on food, clothing, hygiene, and energy. Regression results indicated that presence of NCDs was associated with lower relative expenditure on clothing and housing in all economic subgroups, and with lower expenditure on food among marginally poor households. Having an NCD was significantly associated with higher household spending on tobacco and higher-calorie foods such as sugar, beverages, meat, dairy, and fruit, and with lower spending on fish, vegetables, and legumes. The findings indicate a link between NCDs and the possibility of adverse economic effects on the household by highlighting the potential displacement effect on household consumption that might occur through higher medical expenditure and lower spending on essentials. The findings might also point to a need for raising awareness about the link between NCDs and diet in Bangladesh.

    • Healthcare Associated Infections
      1. Investigation of a cluster of Sphingomonas koreensis infectionsExternal
        Johnson RC, Deming C, Conlan S, Zellmer CJ, Michelin AV, Lee-Lin S, Thomas PJ, Park M, Weingarten RA, Less J, Dekker JP, Frank KM, Musser KA, McQuiston JR, Henderson DK, Lau AF, Palmore TN, Segre JA.
        N Engl J Med. 2018 Dec 27;379(26):2529-2539.

        BACKGROUND: Plumbing systems are an infrequent but known reservoir for opportunistic microbial pathogens that can infect hospitalized patients. In 2016, a cluster of clinical sphingomonas infections prompted an investigation. METHODS: We performed whole-genome DNA sequencing on clinical isolates of multidrug-resistant Sphingomonas koreensis identified from 2006 through 2016 at the National Institutes of Health (NIH) Clinical Center. We cultured S. koreensis from the sinks in patient rooms and performed both whole-genome and shotgun metagenomic sequencing to identify a reservoir within the infrastructure of the hospital. These isolates were compared with clinical and environmental S. koreensis isolates obtained from other institutions. RESULTS: The investigation showed that two isolates of S. koreensis obtained from the six patients identified in the 2016 cluster were unrelated, but four isolates shared more than 99.92% genetic similarity and were resistant to multiple antibiotic agents. Retrospective analysis of banked clinical isolates of sphingomonas from the NIH Clinical Center revealed the intermittent recovery of a clonal strain over the past decade. Unique single-nucleotide variants identified in strains of S. koreensis elucidated the existence of a reservoir in the hospital plumbing. Clinical S. koreensis isolates from other facilities were genetically distinct from the NIH isolates. Hospital remediation strategies were guided by results of microbiologic culturing and fine-scale genomic analyses. CONCLUSIONS: This genomic and epidemiologic investigation suggests that S. koreensis is an opportunistic human pathogen that both persisted in the NIH Clinical Center infrastructure across time and space and caused health care-associated infections. (Funded by the NIH Intramural Research Programs.).

    • Immunity and Immunization
      1. Monovalent rotavirus vaccine effectiveness against rotavirus hospitalizations among children in ZimbabweExternal
        Mujuru HA, Burnett E, Nathoo KJ, Ticklay I, Gonah NA, Mukaratirwa A, Berejena C, Manangazira P, Rupfutse M, Weldegebriel GG, Mwenda JM, Yen C, Parashar UD, Tate JE.
        Clin Infect Dis. 2018 Dec 23.

        Background: Rotavirus is a leading cause of mortality among children <5 years old. Zimbabwe introduced rotavirus vaccine in May 2014. We evaluated monovalent rotavirus vaccine effectiveness (VE) under conditions of routine use at two surveillance sites in Harare, Zimbabwe. Methods: Children <5 years of age hospitalized or treated in the accident and emergency department (A&E) for acute watery diarrhea were enrolled for routine surveillance. Copies of vaccination cards were collected and reviewed to document the vaccination status of enrolled children. Among children age-eligible to receive rotavirus vaccine, we estimated VE, calculated as 1-odds ratio, using a test-negative case-control design. Results: We included 903 rotavirus positive cases and 2,685 rotavirus negative controls in the analysis; 99% had verified vaccination status. Rotavirus positive children had more severe diarrhea than rotavirus negative children; 61% of cases and 46% of controls had a Vesikari score >/=11 (p<0.01). Among cases, 31% were stunted for their age; 37% of controls were stunted (p<0.01). Among children 6-11 months old, adjusted 2-dose VE against hospitalization or treatment in A&E due to rotavirus of any severity was 61% (95%CI: 21, 81) and 68% (95%CI: 13, 88) against severe rotavirus disease. Stratified by nutritional status, adjusted VE was 45% (95%CI: -148, 88) among stunted infants and 71% (95%CI: 29, 88) among infants with a normal height-for-age. Conclusion : onovalent rotavirus vaccine is effective in preventing hospitalizations due to severe rotavirus diarrhea among infants in Zimbabwe providing additional evidence for countries considering rotavirus vaccine introduction that live, oral rotavirus vaccines are effective in high child mortality settings.

      2. Effectiveness of ten-valent pneumococcal conjugate vaccine against vaccine type invasive pneumococcal disease in PakistanExternal
        Riaz A, Mohiuddin S, Husain S, Yousafzai MT, Muhammad S, Kabir F, Ur Rehman N, Mirza W, Salam B, Nadeem N, Pardhan K, Khan KM, Raza SJ, Arif F, Iqbal K, Zuberi HK, Whitney CG, Omer SB, Zaidi AK, Ali A.
        Int J Infect Dis. 2018 Dec 18.

        OBJECTIVE: To assess PCV10 effectiveness against invasive pneumococcal disease (IPD) due to vaccine serotypes of Streptococcus pneumoniae (Sp) post introduction of vaccine in routine immunization program of Pakistan. METHODS: A matched case-control study was conducted at 16 hospitals in Sindh Province, Pakistan. Children <5years of age (eligible to receive PCV10) who presented with radiographic confirmed pneumonia and/or meningitis were enrolled as cases. PCR for Lyt A gene was conducted on blood (for radiographic pneumonia) and cerebrospinal fluid (for meningitis) samples to detect Sp. The proportion of IPD due to vaccine serotypes (including vaccine-related serogroups) was determined through serial multiplex PCR. For each case, at least five controls were enrolled from children hospitalized at the same institution, matched on age, district, and season. RESULTS: From 92 IPD cases enrolled during July 2013-March 2017, 24 cases (26.0%) were vaccine serotypes. Most case (87.5% of 24) and control (66.4% of 134) children had not received any PCV10 doses. Estimated effectiveness for PCV10 against vaccine type IPD was 72.7% (CI -7.2 to 92.6%) with at least one dose, 78.8% (CI -11.9 to 96.0%) for at least two doses and 81.9% (CI -55.7 to 97.9%) for all three doses of vaccine. INTERPRETATION: The VE point estimates for PCV10 were high and increased with increasing number of doses. However, VE estimates did not reach statistical significance, possibly due to low power. The findings indicate likely impact of vaccine in reducing burden of vaccine type IPD if vaccine uptake can be improved.

    • Injury and Violence
      1. An evaluation of welfare and child welfare system integration on rates of child maltreatment in ColoradoCdc-pdfExternal
        Latzman NE, Lokey C, Lesesne CA, Klevens J, Cheung K, Condron S, Garraza LG.
        Child Youth Serv Rev. 2019 ;96:386-395.

        [No abstract]

      2. Traditional and cyber bullying and sexual harassment: A longitudinal assessment of risk and protective factorsExternal
        Leemis RW, Espelage DL, Basile KC, Mercer Kollar LM, Davis JP.
        Aggress Behav. 2018 Dec 21.

        Adolescents engage in bullying and sexual harassment perpetration both in-person and online. Yet, little is known about the overlap of traditional (in-person) and cyber bullying and sexual harassment perpetration. The present study assessed the co-occurrence of these forms of aggression in high school and identified middle school predictors based on participants’ perceptions of factors across the social ecology. Racially diverse middle and high school students (n = 3549) were surveyed over four time points from Spring 2008 to Spring 2013. A latent class analysis was used to identify classes of individuals according to endorsement of traditional and cyber bullying and sexual harassment items in high school. Four classes were identified: (1) high all, consisting of traditional and cyber bullying and sexual harassment perpetration (n = 227); (2) traditional bullying perpetration (n = 604); (3) traditional and cyber bullying perpetration (n = 450); and (4) low all (n = 1,261). Students who reported high levels of anger, self-esteem, empathy, pornographic exposure, and traditional masculinity (individual level), lower levels of social support and parental monitoring (relational level), and higher levels of school belonging (community level) had increased odds of being in the high all class when compared to the other classes. Given the co-occurrence of traditional and cyber bullying and sexual harassment, prevention programming that addresses both forms of aggression across traditional and online contexts may be beneficial. This study also suggests the importance of comprehensive prevention efforts that incorporate approaches at the different ecological levels, such as teaching adolescents healthy emotional and interpersonal skills, and engaging parents in prevention.

    • Laboratory Sciences
      1. Clinical and molecular features of feline foamy virus and feline leukemia virus co-infection in naturally-infected catsExternal
        Cavalcante LT, Muniz CP, Jia H, Augusto AM, Troccoli F, Medeiros SO, Dias CG, Switzer WM, Soares MA, Santos AF.
        Viruses. 2018 Dec 11;10(12).

        Feline foamy virus (FFV) and feline leukemia virus (FeLV) belong to the Retroviridae family. While disease has not been reported for FFV infection, FeLV infection can cause anemia and immunosuppression (progressive infection). Co-infection with FFV/FeLV allows evaluation of the pathogenic potential and epidemiology of FFV infection in cats with FeLV pathology. Blood and buccal swab samples from 81 cats were collected in Rio de Janeiro. Plasma was serologically tested for FeLV. DNA extracted from peripheral blood mononuclear cells and buccal swabs was used to PCR detect FFV and FeLV. A qPCR was developed to detect and measure FFV proviral loads (pVLs) in cats. FeLV qPCR was performed using previous methods. The median log10 pVL of FFV mono-infected individuals was lower than found in FFV/FeLV co-infected cats in buccal swabs (p = 0.003). We found 78% of cats had detectable buccal FFV DNA in FFV mono-infected and FFV co-infected FeLV-progressive cats, while in FeLV-regressive cats (those without signs of disease) 22% of cats had detectable buccal FFV DNA (p = 0.004). Our results suggest that regressive FeLV infection may reduce FFV saliva transmission, the main mode of FV transmission. We did not find evidence of differences in pathogenicity in FFV mono- and -dually infected cats. In summary, we show that FVs may interact with FeLV within the same host. Our study supports the utility of cats naturally co-infected with retroviruses as a model to investigate the impact of FV on immunocompromised mammalian hosts.

      2. Development, validation and integration of in silico models to identify androgen active chemicalsExternal
        Manganelli S, Roncaglioni A, Mansouri K, Judson RS, Benfenati E, Manganaro A, Ruiz P.
        Chemosphere. 2018 Dec 19;220:204-215.

        Humans are exposed to large numbers of environmental chemicals, some of which potentially interfere with the endocrine system. The identification of potential endocrine disrupting chemicals (EDCs) has gained increasing priority in the assessment of environmental hazards. The U.S. Environmental Protection Agency (U.S. EPA) has developed the Endocrine Disruptor Screening Program (EDSP) which aims to prioritize and screen potential EDCs. The Toxicity Forecaster (ToxCast) program has generated data using in vitro high-throughput screening (HTS) assays measuring activity of chemicals at multiple points along the androgen receptor (AR) activity pathway. In the present study, using a large and diverse data set of 1667 chemicals provided by the U.S. EPA from the combined ToxCast AR assays in the framework of the Collaborative Modeling Project for Androgen Receptor Activity (CoMPARA). Two models were built using ADMET Predictor; one is based on Artificial Neural Networks (ANNs) technology and the other uses a Support Vector Machine (SVM) algorithm; one model is a Decision Tree (DT) developed in R; and two models make use of differently combined sets of structural alerts (SAs) automatically extracted by SARpy. We used two strategies to integrate predictions from single models; one is based on a majority vote approach and the other on prediction convergence. These strategies led to enhanced statistical performance in most cases. Moreover, the majority vote approach improved prediction coverage when one or more single models were not able to provide any estimations. This study integrates multiple in silico approaches as a virtual screening tool for use in risk assessment of endocrine disrupting chemicals.

    • Maternal and Child Health
      1. Maternal pre-pregnancy body mass index and gestational weight gain in relation to autism spectrum disorder and other developmental disorders in offspringExternal
        Windham GC, Anderson M, Lyall K, Daniels JL, Kral TV, Croen LA, Levy SE, Bradley CB, Cordero C, Young L, Schieve LA.
        Autism Res. 2018 Dec 21.

        Most prior studies examining maternal pre-pregnancy body mass index (BMI) in relation to offspring autism spectrum disorders (ASD) have reported an association, though findings are not uniform and few have also examined gestational weight gain (GWG). Therefore, we examined both in the Study to Explore Early Development, a multi-site case-control study of children born in 2003-2006. Children identified from clinics, schools, and birth certificates were enrolled at ages 2-5 year and using standardized developmental evaluations, classified as: ASD, other developmental delays (DD), or population-based controls. Maternal height, weight, and GWG were self-reported during the telephone interview. Three primary weight risk factors were examined: (a) Pre-pregnancy BMI, classified as underweight to obese, (b) GWG continuous and categorized as quintiles, and (c) Institute of Medicine clinical weight-gain recommendations. Odds ratios adjusted (AOR) for sociodemographic and prenatal factors were calculated among term singletons, comparing the ASD (n = 540) or DD (n = 720) groups to the control group (n = 776). The AOR of ASD and maternal obesity was 1.37 (95%CI 0.98-1.92). Associations with higher GWG were stronger (Quintile5 vs. Quintile3 AOR = 1.58, 95%CI 1.08-2.31), and particularly so among overweight/obese women (AOR = 1.90, 95%CI 0.98-3.68). DD was associated with maternal overweight and obesity (obesity AOR = 1.48, 95%CI 1.08-2.02), but not with total GWG or clinical recommendations. High maternal BMI and GWG are risk factors for other pregnancy and child outcomes, and our results suggest they may also represent modifiable risk factors for neurodevelopmental outcomes. Autism Res 2018. (c) 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: In a large, national study, we found that children with autism were more likely than unaffected children to have mothers with higher weight gain during pregnancy; risk of autism may be even stronger if mothers were also overweight before pregnancy. Children with other developmental delays were more likely to have mothers who were overweight or obese before pregnancy, but not who gained more weight during pregnancy. Overweight and weight gain may represent factors that could be modified.

    • Nutritional Sciences
      1. We examined associations between sugar-sweetened beverage (SSB) intake – a chronic disease risk factor – and characteristics of 75,029 adults (>/=18 y) in 9 states by using 2016 Behavioral Risk Factor Surveillance System (BRFSS) data. We used multinomial logistic regression to estimate adjusted odds ratios for SSB intake categorized as none (reference), fewer than 1 time per day, and 1 or more times per day, by sociodemographic and behavioral characteristics. Overall, 32.1% of respondents drank SSBs 1 or more times per day. We found higher odds for 1 or more times per day among younger respondents, men, Hispanic and non-Hispanic black respondents, current smokers, respondents residing in nonmetropolitan counties, employed respondents, and those with less than high school education, obesity, and no physical activity. Our findings can inform the targeting of efforts to reduce SSB consumption.

    • Occupational Safety and Health
      1. BACKGROUND: After Campylobacter infection was reported in a contract construction worker (contractor) at a chicken processing facility, we described the illness and determined illness associations with workforce exposure. METHODS: Case finding was conducted by reportable disease surveillance and contractor interviews. A case was defined as either diarrhea and fever, or diarrhea lasting >/=3 days during January-September, 2016. RESULTS: Fourteen cases were identified among 74 contractors interviewed; four were laboratory-confirmed (two Campylobacter, two Salmonella). Cases were more likely to perform electrical work (odds ratio [OR] 10.4, P < 0.001), take breaks in unofficial areas (OR 6.4, P = 0.01), bring drinks into work areas (OR 4.2, P = 0.02), and have contact with poultry fluids (OR 6.4, P = 0.03). Only 23 (31%) contractors reported infectious disease prevention training. CONCLUSIONS: This outbreak emphasizes the importance of training contractors for all potential hazards. Host employers and staffing agencies share responsibility for contractor safety.

      2. Structure and control of healthy worker effects in studies of pregnancy outcomesExternal
        Johnson CY, Rocheleau CM, Grajewski B, Howards PP.
        Am J Epidemiol. 2018 Dec 21.

        Much of the healthy worker effect literature focuses on studies of chronic disease and mortality; however, when studying pregnancy outcomes, these effects might differ because of the short, defined risk periods of most pregnancy outcomes. Three pregnancy-specific healthy worker effects have also been described, but the structure of these effects have not yet been investigated when occupational exposure, and not employment status, is the exposure of interest. We used directed acyclic graphs to examine healthy worker effects in studies of occupational exposures and pregnancy outcomes: healthy hire effect, healthy worker survivor effect, desperation/privilege effect (differential workforce re-entry after pregnancy), reproductively unhealthy worker effect (women with live births leave the workforce, women with non-live births do not), and insecure pregnancy effect (women with adverse pregnancy outcomes reduce exposures in subsequent pregnancies). Given our assumptions, healthy hire effect, desperation/privilege effect, reproductively unhealthy worker effect, and insecure pregnancy effect resulted from confounding that can be addressed if measured confounders, such as employment status, are available. Presence of healthy worker survivor effect, however, varied by study design. Different types of healthy worker effects can be present in studies of occupational exposures and pregnancy outcomes, and many of them are easily addressed analytically.

      3. Health effects associated with occupational exposure to hand-arm or whole body vibrationExternal
        Krajnak K.
        J Toxicol Environ Health B Crit Rev. 2018 Dec 25:1-15.

        Workers in a number of different occupational sectors are exposed to workplace vibration on a daily basis. This exposure may arise through the use of powered-hand tools or hand-transmitted vibration (HTV). Workers might also be exposed to whole body vibration (WBV) by driving delivery vehicles, earth moving equipment, or through use of tools that generate vibration at low dominant frequencies and high amplitudes, such as jackhammers. Occupational exposure to vibration has been associated with an increased risk of musculoskeletal pain in the back, neck, hands, shoulders, and hips. Occupational exposure may also contribute to the development of peripheral and cardiovascular disorders and gastrointestinal problems. In addition, there are more recent data suggesting that occupational exposure to vibration may enhance the risk of developing certain cancers. The aim of this review is to provide an assessment of the occupations where exposure to vibration is most prevalent, and a description of the adverse health effects associated with occupational exposure to vibration. This review will examine (1) various experimental methods used to measure and describe the characteristics of vibration generated by various tools and vehicles, (2) the etiology of vibration-induced disorders, and (3) how these data were employed to assess and improve intervention strategies and equipment that reduces the transmission of vibration to the body. Finally, there is a discussion of the research gaps that need to be investigated to further reduction in the incidence of vibration-induced illnesses and injuries.

      4. Occupational physical activity and coronary heart disease in Women’s Health Initiative Observational StudyExternal
        Wang C, De Roos AJ, Fujishiro K, Allison MA, Wallace R, Seguin RA, Nassir R, Michael YL.
        J Gerontol A Biol Sci Med Sci. 2018 Dec 24.

        Background: Women comprise nearly half of the labor force in our society, but the impact of the occupational psychical activity on women’s heart health in later life was unclear. We conducted a case-cohort study to assess the association of occupational physical activity, alone and jointly with leisure-time physical activity, and risk of coronary heart disease (CHD). Method: We included women enrolled in Women’s Health Initiative Observational Study who provided an occupational history at baseline and were followed until 2013 for the first occurrence of myocardial infarction or CHD death (mean age+/-SD=63.4+/-7.2). 5,243 women free of CHD at baseline were randomly selected into a subcohort and 3,421 CHD events were adjudicated during follow-up. Through linkage of Standard Occupational Classification codes to the Occupational Information Network, we assessed cumulative and most recent exposure of occupational physical activity (OPA). Leisure time physical activity (LTPA) was assessed through WHI’s physical activity questionnaire. Weighted Cox proportional hazard models were used to evaluate CHD risk. Results: After adjustment for demographic and socio-economic factors, levels of OPA were not associated with CHD risk. Compared to women with low OPA and high LTPA, women with moderate to high cumulative OPA and low LTPA had relative high CHD risk (HR: 1.54, 95% CI: 1.26, 1.88 for moderate OPA and HR: 1.46. 95% CI: 1.20, 1.78 for high OPA). Discussion: Results from this study suggest no overall association between lifetime OPA and CHD risk in women, but the impact of OPA varies by LTPA levels.

    • Parasitic Diseases
      1. The utility of serology for elimination surveillance of trachomaExternal
        Pinsent A, Solomon AW, Bailey RL, Bid R, Cama A, Dean D, Goodhew B, Gwyn SE, Jack KR, Kandel RP, Kama M, Massae P, Macleod C, Mabey DC, Migchelsen S, Muller A, Sandi F, Sokana O, Taoaba R, Tekeraoi R, Martin DL, White MT.
        Nat Commun. 2018 Dec 21;9(1):5444.

        Robust surveillance methods are needed for trachoma control and recrudescence monitoring, but existing methods have limitations. Here, we analyse data from nine trachoma-endemic populations and provide operational thresholds for interpretation of serological data in low-transmission and post-elimination settings. Analyses with sero-catalytic and antibody acquisition models provide insights into transmission history within each population. To accurately estimate sero-conversion rates (SCR) for trachoma in populations with high-seroprevalence in adults, the model accounts for secondary exposure to Chlamydia trachomatis due to urogenital infection. We estimate the population half-life of sero-reversion for anti-Pgp3 antibodies to be 26 (95% credible interval (CrI): 21-34) years. We show SCRs below 0.015 (95% confidence interval (CI): 0.0-0.049) per year correspond to a prevalence of trachomatous inflammation-follicular below 5%, the current threshold for elimination of active trachoma as a public health problem. As global trachoma prevalence declines, we may need cross-sectional serological survey data to inform programmatic decisions.

    • Program Evaluation
      1. [No abstract]

    • Substance Use and Abuse
      1. Enhanced enforcement of laws to reduce alcohol overservice among licensed establishments in New Mexico, 2004-2008External
        Tomedi LE, Roeber J, Xuan Z, Kanny D, Brewer RD, Naimi TS.
        Prev Chronic Dis. 2018 Dec 6;15:E151.

        Limited information exists about the effectiveness of interventions to enforce laws prohibiting alcohol sales to intoxicated patrons in licensed establishments. New Mexico Behavioral Risk Factor Surveillance System data were used to evaluate an intervention on binge drinking intensity in licensed (eg, bars) versus unlicensed (eg, homes) locations. The proportion of binge drinkers in licensed locations who consumed 8 or more drinks on a binge drinking occasion decreased from 42.1% in 2004-2005 to 22.6% in 2007-2008 (adjusted odds ratio, 0.4; 95% confidence interval, 0.2-0.9), while the proportion in unlicensed locations was essentially unchanged. Enhanced enforcement of overservice laws may reduce excessive drinking in licensed establishments.

    • Zoonotic and Vectorborne Diseases
      1. Rabies surveillance in the United States during 2017External
        Ma X, Monroe BP, Cleaton JM, Orciari LA, Li Y, Kirby JD, Chipman RB, Petersen BW, Wallace RM, Blanton JD.
        J Am Vet Med Assoc. 2018 15 Dec;253(12):1555-1568.

        OBJECTIVE To describe rabies and rabies-related events occurring during 2017 in the United States. DESIGN Cross-sectional analysis of passive surveillance data. ANIMALS All animals submitted for laboratory diagnosis of rabies in the United States during 2017. PROCEDURES State and territorial public health departments provided data on animals submitted for rabies testing in 2017. Data were analyzed temporally and geographically to assess trends in domestic and sylvatic animal rabies cases. RESULTS During 2017, 52 jurisdictions reported 4,454 rabid animals to the CDC, representing a 9.3% decrease from the 4,910 rabid animals reported in 2016. Of the 4,454 cases of animal rabies, 4,055 (91.0%) involved wildlife species. Relative contributions by the major animal groups were as follows: 1,433 (32.2%) bats, 1,275 (28.6%) raccoons, 939 (21.1%) skunks, 314 (7.0%) foxes, 276 (6.2%) cats, 62 (1.4%) dogs, and 36 (0.8%) cattle. There was a 0.4% increase in the number of samples submitted for testing in 2017, compared with the number submitted in 2016. Two human rabies deaths were reported in 2017, compared with none in 2016. CONCLUSIONS AND CLINICAL RELEVANCE The overall number of reported cases of animal rabies has decreased over time. Laboratory testing of animals suspected to be rabid remains a critical public health function and continues to be a cost-effective method to directly influence human rabies postexposure prophylaxis recommendations.

      2. Implementation and Evaluation of Guillain-Barre Syndrome Surveillance in Puerto Rico during the 2016 Zika Virus EpidemicExternal
        Major CG, Dirlikov E, Medina NA, Lugo-Robles R, Matos D, Munoz-Jordan J, Colon-Sanchez C, Garcia-Negron M, Olivero-Segarra M, Malave-Gonzalez G, Thomas DL, Luciano CA, Waterman SH, Sejvar J, Sharp TM, Rivera-Garcia B.
        P R Health Sci J. 2018 Dec;37(Special Issue):S85-s92.

        OBJECTIVE: Guillain-Barre syndrome (GBS) is an uncommon autoimmune disorder that follows infection or vaccination, and increased incidence has been reported during Zika virus (ZIKV) transmission. During the 2016 ZIKV epidemic, the Puerto Rico Department of Health (PRDH) implemented the Enhanced GBS Surveillance System (EGBSSS). Here, we describe EGBSSS implementation and evaluate completeness, validity, and timeliness. METHODS: GBS cases were identified using passive surveillance and discharge diagnostic code for GBS. Completeness was evaluated by capture-recapture methods. Sensitivity and positive predictive value (PPV) for confirmed GBS cases were calculated for both case identification methods. Median time to completion of key time steps were compared by quarter (Q1-4) and hospital size. RESULTS: A total of 122 confirmed GBS cases with onset of neurologic illness in 2016 were identified. Capture-recapture methodology estimated that four confirmed GBS cases were missed by both identification methods. Identification of cases by diagnostic code had a higher sensitivity than passive surveillance (89% vs. 80%), but a lower PPV (60% vs. 72%). There was a significant decrease from Q1 to Q3 in median time from hospital admission to case reporting (11 days vs. 2 days, p = 0.032) and from Q2 to Q3 in median time from specimen receipt to arbovirus laboratory test reporting (35 days vs. 26 days, p = 0.004). CONCLUSION: EGBSSS provided complete, valid, and increasingly timely surveillance data, which guided public health action and supported healthcare providers during the ZIKV epidemic. This evaluation provides programmatic lessons for GBS surveillance and emergency response surveillance.

      3. Human rabies postexposure prophylaxis knowledge and retention among health professionals by using an online continuing education module: Arizona, 2012 to 2015External
        Venkat H, Matthews J, Narang J, Sunenshine R, Adams LE, Bunko AM, White JR, Levy C, Sylvester T.
        Pedagogy Health Promot. 2018 ;2018.

        Rabies postexposure prophylaxis (PEP) is administered for rabies prevention after a human exposure to a potentially rabid animal, such as a bite. Previous studies have reported that rabies PEP is often inappropriately administered. Health professional education was proposed as one potential solution to address inappropriate PEP use. We assessed baseline knowledge, knowledge gain, and knowledge retention among health professionals in Arizona of rabies epidemiology and appropriate PEP administration. Maricopa County Department of Public Health created an online rabies PEP continuing education module and measured knowledge before and after module completion using a 10-question test. The same test was administered three times (pretest, posttest, and retention test at >/=3 months). To assess knowledge gain and retention, we compared median scores using nonparametric methods. A total of 302 respondents completed the pretest (median score, 60%) and posttest (median score, 90%; p < .001); 98 respondents completed all three tests with median scores 60% (pretest), 90% (posttest, p < .01), and 80% (retention test and compared with pretest, p < .01). Sixty-nine (70%) respondents improved their pretest to retention test score by a mean of 2.4 points out of a total 10 points (median: 2 points; range: -5 to 7 points). Only 48% of pretest respondents correctly answered that PEP should not be administered immediately to anyone bitten by a healthy dog. However, 81% and 70% answered correctly on the posttest (p < .0001) and retention test (p = .002), respectively. Respondents demonstrated rabies epidemiology and PEP knowledge gain and >/=3-month knowledge retention after completing the online continuing education module.

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Page last reviewed: January 31, 2019