Volume 11, Issue 8, February 19, 2019

CDC Science Clips: Volume 11, Issue 8, February 19, 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
      • Epidemiology of perinatal HIV transmission in the United States in the era of its eliminationExternal
        Nesheim SR, FitzHarris LF, Gray KM, Lampe MA.
        Pediatr Infect Dis J. 2019 Feb 4.
        The number of infants with HIV born in the United States has decreased for years, approaching the Centers for Disease Control and Prevention’s incidence goal for eliminating perinatal HIV transmission. We reviewed recent literature on perinatal HIV in the United States. Among perinatally HIV-exposed infants (whose mothers have HIV, without regard to infants’ HIV diagnosis), prenatal and natal antiretroviral use has increased, maternal HIV infection is more frequently diagnosed prior to pregnancy, and breastfeeding is uncommon. In contrast, mothers of infants with HIV are tested at a lower rate for HIV, receive prenatal care less often, receive antiretrovirals (prenatal and natal) less often, and breastfeed more often. The incidence of perinatal HIV remains 5 times as high among black than white infants. The annual number of births to women with HIV was estimated last for 2006 (8,700), but has likely decreased. The numbers of women of childbearing age living with HIV and HIV diagnoses have decreased. The estimated time from HIV infection to diagnosis remains long among women and men who acquired HIV heterosexually. It is important to review the epidemiology and to continue monitoring outcomes and other health indicators for reproductive age adults living with HIV and their infants.

    • Disaster Control and Emergency Services
      • REDCap for biocontainment worker symptom monitoringExternal
        O’Keefe AL, Buss BF, Koirala S, Gleason MX, Mudgapalli A, Schwedhelm S.
        Health Secur. 2019 Feb 6.
        The Ebola epidemic of 2014 demonstrated that outbreaks of high-consequence infectious diseases, even in remote parts of the world, can affect communities anywhere in the developed world and that every healthcare facility must be prepared to identify, isolate, and provide care for infected patients. The Nebraska Biocontainment Unit (NBU), located at Nebraska Medicine in Omaha, Nebraska, cared for 3 American citizens exposed in West Africa and confirmed with Ebola virus disease (EVD). Symptom monitoring of healthcare workers caring for these patients was implemented, which included twice daily contact to document the absence or presence of signs of fever or illness. This article describes the symptom monitoring experience of the NBU and local and state public health agencies. Based on lessons learned from that experience, we sought a more efficient solution to meet the needs of both the healthcare facility and public health authorities. REDCap, an open-source application used commonly by academic health centers, was used to develop an inexpensive symptom monitoring application that could reduce the burden of managing these activities, thus freeing up valuable time. Our pilot activities demonstrated that this novel use of REDCap holds promise for minimizing costs and resource demands associated with symptom monitoring while offering a more user-friendly experience for people being monitored and the officials managing the response.

    • Health Disparities
      • Racial/ethnic disparities in mortality: Contributions and variations by rurality in the United States, 2012-2015External
        Hall JE, Moonesinghe R, Bouye K, Penman-Aguilar A.
        Int J Environ Res Public Health. 2019 Feb 2;16(3).
        The value of disaggregating non-metropolitan and metropolitan area deaths in illustrating place-based health effects is evident. However, how place interacts with characteristics such as race/ethnicity has been less firmly established. This study compared socioeconomic characteristics and age-adjusted mortality rates by race/ethnicity in six rurality designations and assessed the contributions of mortality rate disparities between non-Hispanic blacks (NHBs) and non-Hispanic whites (NHWs) in each designation to national disparities. Compared to NHWs, age-adjusted mortality rates for: (1) NHBs were higher for all causes (combined), heart disease, malignant neoplasms, and cerebrovascular disease; (2) American Indian and Alaska Natives were significantly higher for all causes in rural areas; (3) Asian Pacific islanders and Hispanics were either lower or not significantly different in all areas for all causes combined and all leading causes of death examined. The largest contribution to the U.S. disparity in mortality rates between NHBs and NHWs originated from large central metropolitan areas. Place-based variations in mortality rates and disparities may reflect resource, and access inequities that are often greater and have greater health consequences for some racial/ethnic populations than others. Tailored, systems level actions may help eliminate mortality disparities existing at intersections between race/ethnicity and place.

      • Racial and ethnic estimates of Alzheimer’s disease and related dementias in the United States (2015-2060) in adults aged >/=65 yearsExternal
        Matthews KA, Xu W, Gaglioti AH, Holt JB, Croft JB, Mack D, McGuire LC.
        Alzheimers Dement. 2019 Jan;15(1):17-24.
        INTRODUCTION: Alzheimer’s disease and related dementias (ADRD) cause a high burden of morbidity and mortality in the United States. Age, race, and ethnicity are important risk factors for ADRD. METHODS: We estimated the future US burden of ADRD by age, sex, and race and ethnicity by applying subgroup-specific prevalence among Medicare Fee-for-Service beneficiaries aged >/=65 years in 2014 to subgroup-specific population estimates for 2014 and population projection data from the US Census Bureau for 2015 to 2060. RESULTS: The burden of ADRD in 2014 was an estimated 5.0 million adults aged >/=65 years or 1.6% of the population, and there are significant disparities in ADRD prevalence among population subgroups defined by race and ethnicity. ADRD burden will double to 3.3% by 2060 when 13.9 million Americans are projected to have the disease. DISCUSSION: These estimates can be used to guide planning and interventions related to caring for the ADRD population and supporting caregivers.

    • Immunity and Immunization
      • OBJECTIVES: Influenza vaccination of healthcare personnel working in long-term care (LTC) facilities can reduce influenza-related morbidity and mortality among healthcare personnel and among resident populations who are at increased risk for complications from influenza and who may respond poorly to vaccination. The objective of this study was to investigate workplace interventions and healthcare personnel vaccination-related attitudes associated with higher influenza vaccination coverage among healthcare personnel working in LTC facilities. SETTING AND PARTICIPANTS: Data were obtained from an online survey of healthcare personnel conducted in April 2016 among a nonprobability sample of 2258 healthcare personnel recruited from 2 preexisting national opt-in Internet panels. Respondents were asked about influenza vaccination status, workplace vaccination policies and interventions, and their attitudes toward vaccination. Analyses were restricted to the 332 healthcare personnel who worked in nursing homes, assisted living facilities, or other LTC facilities. MEASURES: Logistic regression models were used to assess the independent associations between each workplace intervention and higher influenza vaccination coverage compared with referent levels, controlling for occupation, age, and race/ethnicity. Prevalence ratios were calculated under the assumption of simple random sampling. RESULTS: Approximately 77% of healthcare personnel working in LTC facilities reported receiving influenza vaccination in the 20152016 influenza season. Influenza vaccination was independently associated with an employer vaccination requirement (prevalence ratio (PR) [95% confidence interval] = 1.28 [1.11, 1.47]), being offered free onsite vaccination (PR = 1.20 [1.04, 1.39]), and employers publicizing vaccination coverage level to employees (PR = 1.24 [1.09, 1.41]). Vaccination was most highly associated with a combination of 3 or more workplace interventions. Most healthcare personnel working in LTC facilities reported positive attitudes toward the safety and effectiveness of influenza vaccination. CONCLUSIONS/IMPLICATIONS: Implementing employer vaccination interventions in LTC facilities, including employer vaccination requirements and free on-site influenza vaccination that is actively promoted, could increase influenza vaccination among healthcare personnel.

    • Laboratory Sciences
      • Optimization of a rapid test for antibodies to the Chlamydia trachomatis antigen Pgp3External
        Gwyn S, Mkocha H, Randall JM, Kasubi M, Martin DL.
        Diagn Microbiol Infect Dis. 2018 Nov 10.
        Serological surveillance for trachoma could allow monitoring of transmission levels in areas that have achieved elimination targets. Platforms that allow testing in basic laboratories or testing of easy-to-manage samples such as dried blood spots would contribute to the feasibility of serologic testing. Blood from 506 1-12-year-olds in 2 villages in Kongwa district, Tanzania, was tested for antibodies against the antigen Pgp3. Whole blood, plasma, and dried blood spots (DBS) were tested in lab and field settings using a cassette-enclosed Pgp3 lateral flow assay (LFA-cassette) and a pared-back “dipstick” assay (LFA-dipstick). DBS were also tested with a bead-based multiplex assay (MBA). There was no significant difference in antibody positivity between the MBA and either LFA format (ranging from 42.5% to 48.4%). Interrater agreement between an expert rater and 3 different raters in field and lab settings was uniformly good, with Cohen’s kappa >0.81 in all cases.

      • In vitro antiviral activity of new oxazoline derivatives as potent poliovirus inhibitorsExternal
        Madia VN, Messore A, Pescatori L, Saccoliti F, Tudino V, De Leo A, Scipione L, Fiore L, Rhoden E, Manetti F, Oberste MS, Di Santo R, Costi R.
        J Med Chem. 2018 Dec 18.
        The final stages of polio eradication are proving more difficult than the early phases, and the development of effective drugs and treatments is considered a priority; thus, the research is ongoing. A screening of our in-house chemical library against poliovirus Sabin strains led to the identification of compounds 5 and 6 as hits active at submicromolar concentrations. Derivatives of these compounds were synthesized as a preliminary structure-activity-relationship study. Among them, 7 and 11 were highly active against poliovirus Sabin 1-3. Compound 11 was also very potent against a large panel of wild and vaccine-derived polioviruses. Time-of-addition experiments suggest that 5 and 7 could be active at an early stage of viral replication, whereas 11 was active at same concentration at all stages of viral replication. A ligand-based approach was applied to find the common structural features shared by the new compounds and already-known poliovirus inhibitors.

    • Mining
      • Developing a virtual reality environment for mining researchExternal
        Bellanca JL, Orr TJ, Helfrich WJ, Macdonald B, Navoyski J, Demich B.
        Mining, Metallurgy & Exploration. 2019 2019/01/14.
        Recent advances in computing, rendering, and display technologies have generated increased accessibility for virtual reality (VR). VR allows the creation of dynamic, high-fidelity environments to simulate dangerous situations, test conditions, and visualize concepts. Consequently, numerous products have been developed, but many of these are limited in scope. Therefore, the National Institute for Occupational Safety and Health researchers developed a VR framework, called VR Mine, to rapidly create an underground mine for human data collection, simulation, visualization, and training. This paper describes the features of VR Mine using self-escape and proximity detection as case studies. Features include mine generation, simulated networks, proximity detection systems, and the integration and visualization of real-time ventilation models.

    • Physical Activity
      • Leisure time and transportation walking among adults with and without arthritis in the United States, 2010External
        Hootman JM, Theis KA, Barbour KE, Paul P, Carlson SA.
        Arthritis Care Res (Hoboken). 2019 Feb;71(2):178-188.
        OBJECTIVE: Walking is a joint-friendly activity for adults with arthritis. The aim of this study was to estimate, among adults with arthritis, the prevalence of leisure and transportation walking overall (by arthritis status and by sociodemographic and health characteristics), the number of total minutes walking per week in each domain, and the distributions of walking bout length (i.e., short periods of activity) in minutes. METHODS: Data were obtained from the 2010 National Health Interview Survey. Prevalence estimates (percentages and 95% confidence intervals [95% CIs]) of leisure and transportation walking in the past 7 days and walking bout times were calculated (in minutes), as were multivariable Poisson regression models, which account for the complex sample design. RESULTS: Prevalence of leisure walking was 45.9% (95% CI 44.2-47.6) for adults with arthritis versus 51.9% (95% CI 50.9-52.9) for those without. Transportation walking prevalence was 23.0% (95% CI 21.7-24.4) for adults with arthritis versus 32.0% (95% CI 31.0-33.0) for those without. The total time of leisure walking per week did not differ in adults with arthritis compared to those without (77.3 versus 78.3 minutes, respectively; P = 0.62), while total time of transportation walking did differ (49.8 versus 58.1 minutes, respectively; P = 0.03). The most common walking bout length differed between leisure (26-40 minutes) and transportation (10-15 minutes) walking, but not by arthritis status. In separate adjusted multivariable models, obesity was consistently negatively associated with both walking outcomes, and being physically active was positively associated with both; lower extremity joint pain was not associated. CONCLUSION: By adding short bouts, leisure and transportation walking could be adopted by large proportions of adults with arthritis. Existing evidence-based programs can help increase physical activity.

    • Zoonotic and Vectorborne Diseases
      • Clinical presentation of pregnant women in isolation units for Ebola virus disease in Sierra Leone, 2014External
        Mpofu JJ, Soud F, Lyman M, Koroma AP, Morof D, Ellington S, Kargbo SS, Callaghan W.
        Int J Gynaecol Obstet. 2019 Feb 1.
        OBJECTIVES: To examine Ebola virus disease (EVD) symptom prevalence and EVD status among pregnant women in Ebola isolation units in Sierra Leone. METHODS: In an observational study, data were obtained for pregnant women admitted to Ebola isolation units across four districts in Sierra Leone from June 29, 2014, to December 20, 2014. Women were admitted to isolation units if they had suspected EVD exposures or fever (temperature >38 degrees C) and three or more self-reported symptoms suggestive of EVD. Associations were examined between EVD status and each symptom using chi(2) tests and logistic regression adjusting for age/labor status. RESULTS: Of 176 pregnant women isolated, 55 (32.5%) tested positive for EVD. Using logistic regression models adjusted for age, EVD-positive women were significantly more likely to have fever, self-reported fatigue/weakness, nausea/vomiting, headache, muscle/joint pain, chest pain, vaginal bleeding, unexplained bleeding, or sore throat upon admission. In models adjusted for age/labor, only women with fever or vaginal bleeding upon admission were significantly more likely to be EVD-positive. CONCLUSIONS: Several EVD symptoms and complications increased the odds of testing EVD-positive; some of these were also signs and symptoms of labor/pregnancy complications. The study results highlight the need to refine screening for pregnant women with EVD. This article is protected by copyright. All rights reserved.

  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. Life course socioeconomic position, allostatic load, and incidence of type 2 diabetes among African American adults: The Jackson Heart Study, 2000-04 to 2012External
        Beckles GL, McKeever Bullard K, Saydah S, Imperatore G, Loustalot F, Correa A.
        Ethn Dis. 2019 Winter;29(1):39-46.
        Objective: We examined whether life course socioeconomic position (SEP) was associated with incidence of type 2 diabetes (t2DM) among African Americans. Design: Secondary analysis of data from the Jackson Heart Study, 2000-04 to 2012, using Cox proportional hazard regression to estimate hazard ratios (HR) with 95% CI for t2DM incidence by measures of life course SEP. Participants: Sample of 4,012 nondiabetic adults aged 25-84 years at baseline. Outcome Measure: Incident t2DM identified by self-report, hemoglobin A1c >/=6.5%, fasting plasma glucose >/=126 mg/dL, or use of diabetes medication. Results: During 7.9 years of follow-up, 486 participants developed t2DM (incidence rate 15.2/1000 person-years, 95% CI: 13.9-16.6). Among women, but not men, childhood SEP was inversely associated with t2DM incidence (HR=.97, 95% CI: .94-.99) but was no longer associated with adjustment for adult SEP or t2DM risk factors. Upward SEP mobility increased the hazard for t2DM incidence (adjusted HR=1.52, 95% CI: 1.05-2.21) among women only. Life course allostatic load (AL) did not explain the SEP-t2DM association in either sex. Conclusions: Childhood SEP and upward social mobility may influence t2DM incidence in African American women but not in men.

      2. Onchocerciasis associated epilepsy – A question of causalityExternal
        Cantey PT, Sejvar J.
        Int J Infect Dis. 2019 Feb;79:185-186.

        [No abstract]

      3. Sustained virological response does not improve long-term glycaemic control in patients with type 2 diabetes and chronic hepatitis CExternal
        Li J, Gordon SC, Rupp LB, Zhang T, Trudeau S, Holmberg SD, Moorman AC, Spradling PR, Teshale EH, Boscarino JA, Schmidt MA, Daida YG, Lu M.
        Liver Int. 2018 Dec 20.
        BACKGROUND: Sustained virological response to treatment for chronic hepatitis C virus may improve short-term glucose control among patients with type 2 diabetes, but the long-term impact remains largely unknown. We used data from the Chronic Hepatitis Cohort Study to investigate the impact of sustained virological response on long-term trends in haemoglobin A1c in patients with type 2 diabetes. METHODS: “Index date” was defined as the date of treatment initiation (treated patients) or hepatitis C virus diagnosis (untreated patients). To address treatment selection bias, we used a propensity score approach. We used a piecewise, linear spline, mixed-effects model to evaluate changes in haemoglobin A1c over a 5-year period. RESULTS: Our sample included 384 hepatitis C virus patients with type 2 diabetes (192 untreated, 192 treated, with sustained virological response or treatment failure). After adjusting for body mass index, haemoglobin A1c was stable among untreated and treatment failure patients. In sustained virological response patients, Hb1Ac trajectories evolved in three phases: (a) index through 6 months post-index, average haemoglobin A1c decreased significantly from 7.7% to 5.4% per 90 days (P < 0.001); (b) 6-30 months post-index, haemoglobin A1c rebounded at a rate of 1.5% every 90 days (P = 0.003); and (c) from 30 months onward, haemoglobin A1c stabilized at an average level of 7.9 (P-value = 0.34). Results from an analysis restricted to patients receiving direct-acting antivirals were consistent with the main findings. CONCLUSION: Successful hepatitis C virus treatment among patients with type 2 diabetes significantly reduces HbA1c shortly after treatment, but these decreases are not sustained long-term. Less than three years after sustained virological response, haemoglobin A1c rebounds to levels similar to untreated/treatment failure patients, and higher than recommended for type 2 diabetic maintenance.

      4. A longitudinal study of sexual function in women with newly diagnosed inflammatory bowel diseaseExternal
        Shmidt E, Suarez-Farinas M, Mallette M, Moniz H, Bright R, Shah SA, Merrick M, Shapiro J, Xu F, Sands B, Saha S.
        Inflamm Bowel Dis. 2019 Feb 6.
        Background: The literature provides conflicting data on sexual function in women with inflammatory bowel disease (IBD). We aim to describe sexual function at baseline and over time in a prospective inception cohort of adult women with IBD. Methods: Women age 18 years or older enrolled in the Ocean State Crohn’s & Colitis Area Registry (OSCCAR) with 2 years of prospective follow-up were included in the study. All subjects were enrolled within 1 year of IBD diagnosis. Female sexual function was assessed using the Female Sexual Function Index (FSFI). Linear mixed effects models were used to assess changes in FSFI by various demographic and clinical factors. Results: One hundred sixteen of 130 eligible women (89%) were included in the study. Ninety-seven percent of women had sexual dysfunction, defined as an FSFI score of <26.55, with a baseline mean FSFI score (SD) of 16.4 (8.4) overall (15.5 [8.6] in Crohn’s disease, 17.4 [8.1] in UC, P = 0.22). Despite improvement in overall disease activity, there was no significant change in the FSFI score or individual domain scores over the entire 2-year study period. Among all women with IBD, older age, nonsingle marital status, lower Short Form Health Survey (SF-36) Physical Component Summary score, and the use of biologics were independent risk factors for sexual dysfunction. Conclusions: Almost all women experienced sexual dysfunction that did not improve over time despite improvement in overall disease activity. Future studies are warranted to identify underlying mechanisms that explain the associations between demographic and clinical factors and sexual dysfunction among newly diagnosed women. 10.1093/ibd/izy397_videoizy397_video5999187279001.

    • Communicable Diseases
      1. [No abstract]

      2. Strengthening rural states’ capacity to prepare for and respond to emerging infectious diseases, 2013-2015External
        Santibanez S, Bellis KS, Bay A, Chung CL, Bradley K, Gibson D, Shultz A.
        South Med J. 2019 Feb;112(2):101-105.

        [No abstract]

    • Disaster Control and Emergency Services
      1. Evaluating promising investigational medical countermeasures: Recommendations in the absence of guidelinesExternal
        Bhadelia N, Sauer L, Cieslak TJ, Davey RT, McLellan S, Uyeki TM, Kortepeter MG.
        Health Secur. 2019 Feb 6.
        Emerging and re-emerging infectious diseases pose growing global public health threats. However, research on and development of medical countermeasures (MCMs) for such pathogens is limited by the sporadic and unpredictable nature of outbreaks, lack of financial incentive for pharmaceutical companies to develop interventions for many of the diseases, lack of clinical research capacity in areas where these diseases are endemic, and the ethical dilemmas related to conducting scientific research in humanitarian emergencies. Hence, clinicians providing care for patients with emerging diseases are often faced with making clinical decisions about the safety and effectiveness of experimental MCMs, based on limited or no human safety, preclinical, or even earlier product research or historical data, for compassionate use. Such decisions can have immense impact on current and subsequent patients, the public health response, and success of future clinical trials. We highlight these dilemmas and underscore the need to proactively set up procedures that allow early and ethical deployment of MCMs as part of clinical trials. When clinical trials remain difficult to deploy, we present several suggestions of how compassionate use of off-label and unlicensed MCMs can be made more informed and ethical. We highlight several collaborations seeking to address these gaps in data and procedures to inform future clinical and public health decision making.

    • Disease Reservoirs and Vectors
      1. Comparative fitness of West Nile virus isolated during California epidemicsExternal
        Worwa G, Hutton AA, Brault AC, Reisen WK.
        PLoS Negl Trop Dis. 2019 Feb 4;13(2):e0007135.
        West Nile virus (WNV) has been circulating in California since its first detection in 2003, causing repeated outbreaks affecting public, wildlife and veterinary health. Epidemics of WNV are difficult to predict due to the multitude of factors influencing transmission dynamics among avian and mosquito hosts. Typically, high levels of WNV amplification are required for outbreaks to occur, and therefore associated viral strains may exhibit enhanced virulence and mortality in competent bird species resulting in increased mosquito infection prevalence. In our previous study, most WNV isolates made from California during 2007-08 showed increased fitness when competed in House Finches (HOFI, Haemorhous mexicanus) and Culex tarsalis Coquillett mosquitoes against COAV997-5nt, a genetically marked recombinant virus derived from a 2003 California strain. Herein, we evaluated the competitive fitness of WNV strains isolated during California epidemics in 2004, 2005, 2007, 2011 and 2012 against COAV997-5nt. These outbreak isolates did not produce elevated mortality in HOFIs, but replicated more efficiently than did COAV997-5nt based on quantification of WNV RNA copies in sera, thereby demonstrating increased competitive fitness. Oral co-infections in Cx. tarsalis resulted in similar virus-specific infection and transmission rates, indicating that outbreak isolates did not have a fitness advantage over COAV997-5nt. Collectively, WNV isolates from outbreaks demonstrated relatively greater avian, but not vector, replicative fitness compared to COAV997-5nt, similar to previously characterized non-outbreak isolates of WNV. Our results indicated that ecological rather than viral factors may facilitate WNV amplification to outbreak levels, but monitoring viral phenotypes through competitive fitness studies may provide insight into altered replication and transmission potential among emerging WNV strains.

    • Environmental Health
      1. Integrating childhood and adult blood lead surveillance to improve identification and intervention effortsExternal
        Egan KB, Tsai RJ, Chuke SO.
        J Public Health Manag Pract. 2019 Jan/Feb;25 Suppl 1, Lead Poisoning Prevention:S98-s104.
        The Centers for Disease Control and Prevention (CDC) collects information on blood lead levels (BLLs) in the United States through the Childhood Blood Lead Surveillance (CBLS) system (<16 years of age) and the Adult Blood Lead Epidemiology and Surveillance (ABLES) program (>/=16 years of age). While both of these state-based national programs share the mutual goal of monitoring and reducing lead exposure in the US population, blood lead data for children and adults are maintained in separate data collection systems. This limits the ability to fully describe lead exposure in the US population across these 2 distinct population groups from sources such as take-home and maternal-child lead exposure. In addition, at the state level, having a unified system to collect, maintain, and analyze child and adult blood lead data provides a more efficient use of limited resources. Based on feedback from state partners, CDC is working to integrate CBLS and ABLES data collection systems at the national level. Several states have developed or are developing an integrated child and adult blood lead data collection system. We highlight efforts undertaken in Wisconsin, Minnesota, North Carolina, Iowa, and Oregon to investigate workplace and take-home lead exposure. Integrating blood lead surveillance data at the national level will enhance CDC’s ability to monitor sources of lead exposure from both the home and work environments including paint, water, soil, dust, consumer products, and lead-related industries. Together, an integrated child and adult blood lead surveillance system will offer a coordinated, comprehensive, and systematic public health approach to the surveillance and monitoring of reported BLLs across the US population.

      2. Lead poisoning prevention: The unfinished agendaExternal
        Ettinger AS, Ruckart PZ, Dignam T.
        J Public Health Manag Pract. 2019 Jan/Feb;25 Suppl 1, Lead Poisoning Prevention:S1-s2.

        [No abstract]

      3. ExpoQual: Evaluating measured and modeled human exposure dataExternal
        LaKind JS, O’Mahony C, Armstrong T, Tibaldi R, Blount BC, Naiman DQ.
        Environ Res. 2019 Jan 25;171:302-312.
        Recent rapid technological advances are producing exposure data sets for which there are no available data quality assessment tools. At the same time, regulatory agencies are moving in the direction of data quality assessment for environmental risk assessment and decision-making. A transparent and systematic approach to evaluating exposure data will aid in those efforts. Any approach to assessing data quality must consider the level of quality needed for the ultimate use of the data. While various fields have developed approaches to assess data quality, there is as yet no general, user-friendly approach to assess both measured and modeled data in the context of a fit-for-purpose risk assessment. Here we describe ExpoQual, an instrument developed for this purpose which applies recognized parameters and exposure data quality elements from existing approaches for assessing exposure data quality. Broad data streams such as quantitative measured and modeled human exposure data as well as newer and developing approaches can be evaluated. The key strength of ExpoQual is that it facilitates a structured, reproducible and transparent approach to exposure data quality evaluation and provides for an explicit fit-for-purpose determination. ExpoQual was designed to minimize subjectivity and to include transparency in aspects based on professional judgment. ExpoQual is freely available on-line for testing and user feedback (

      4. Response to the US FDA LeadCare Testing Systems Recall and CDC Health AlertExternal
        Mason J, Ortiz D, Pappas S, Quigley S, Yendell S, Ettinger AS.
        J Public Health Manag Pract. 2019 Jan/Feb;25 Suppl 1, Lead Poisoning Prevention:S91-s97.
        On May 17, 2017, the Food and Drug Administration issued a safety recall for the Magellan Diagnostics’ LeadCare Testing Systems due to the potential for inaccurately low blood lead test results when used with venous blood samples. Concurrently, the Centers for Disease Control and Prevention (CDC) issued a health alert with retesting recommendations for specific high-risk populations. The purpose of the CDC retesting recommendations was to help identify high-risk individuals so that those potentially impacted by falsely low test results could be retested and receive appropriate follow-up care. The CDC’s Lead Poisoning Prevention Program sought to understand how the recall and recommendations impacted state and local public health agencies. Childhood lead poisoning prevention programs (CLPPPs) in state and local public health agencies collect blood lead test results for children and had a lead role in identifying children for retesting. Case studies are presented that highlight the experiences of 4 state CLPPPs in responding to the recall and recommendations. Collectively, the case studies point to several lessons learned, including the importance of (1) having a well-functioning surveillance system in place prior to a serious incident; (2) having a clear understanding of the roles partners play in the continuum of care for children potentially exposed to lead; and (3) ensuring effective communications with all staff, both internal and external, to public health agencies that have a role in responding to a serious incident. The ability to respond to public health emergencies or other serious incidents takes the combined effort of federal, state, and local public health agencies as well as others in the health care delivery system. The CDC will continue to support state and local lead poisoning prevention programs so that they have the information and tools they need to address and prevent the health effects of lead exposures in communities.

      5. Childhood lead poisoning: A perpetual environmental justice issue?External
        Whitehead LS, Buchanan SD.
        J Public Health Manag Pract. 2019 Jan/Feb;25 Suppl 1, Lead Poisoning Prevention:S115-s120.
        As the amount of lead in the environment has significantly decreased with the removal of lead in gasoline and paint, the United States has made great strides in preventing lead poisoning or reducing levels of lead in young children’s blood. Even so, lead exposure is not equal for all children-low-income and minority children continue to bear a disproportionate burden of exposure primarily through contact with deteriorating lead-based paint from older housing and potentially through drinking contaminated water resulting from failing leaded pipes, as evidenced by the recent events in Flint, Michigan. These facts suggest that childhood lead poisoning is an environmental justice issue worthy of public health consideration and action; “environmental justice” is focused on identifying and addressing disproportionately high and adverse effects of environmental hazards on low-income and minority communities. The question remains, however, as to whether addressing the quality-of-life “risk” factors associated with lead poisoning might eventually lead to reduction in exposure, as well as potentially resulting in adverse health effects. Utilizing an environmental justice framework and examining this issue through a multidimensional environmental justice lens, we contemplated the quality-of-life factors that may essentially predispose minority children and their families to lead poisoning. Specifically, we examined American Community Survey data (2012-2016) focused on comparing race/ethnicity with other sociodemographic variables known to be associated with risks for childhood lead poisoning. The results provide thought-provoking context for making progress toward eliminating lead poisoning as a major environmental justice concern.

    • Genetics and Genomics
      1. Draft genome sequence of a Clostridium botulinum isolate from Thailand harboring the subtype bont/B8 geneExternal
        Halpin JL, Wangroongsarb P, Jittaprasartsin C, Dykes JK, Luquez C.
        Microbiol Resour Announc. 2019 Jan;8(5).
        In 2010, a Clostridium botulinum type B isolate was recovered from fermented soybeans during a foodborne botulism investigation. Molecular investigation of the botulinum neurotoxin (bont) gene operon determined that the sequence was a new subtype, denoted B8. Here, we describe the draft whole-genome sequence of the organism.

      2. Precision medicine vs preventive medicineExternal
        Khoury MJ.
        Jama. 2019 Jan 29;321(4):406.

        [No abstract]

    • Health Behavior and Risk
      1. Multiple psychosocial health problems and sexual risk among African American females in juvenile detention: A cross-sectional studyExternal
        Fasula AM, Gray SC, Vereen R, Carry M, Sales JM, Abad N, Brown JL, Swartzendruber A, Gelaude DJ.
        Child Youth Serv Rev. 2018 May;88:74-80.
        Objectives: African American girls in juvenile detention are disproportionately affected by sexually transmitted diseases (STDs) and other psychosocial health problems, yet few studies have examined associations between experiencing multiple psychosocial health problems and sexual risk behaviors and STD diagnosis. Method: The study included 188 detained African American girls aged 13-17 years. We conducted three sets of logistic regressions. First, bivariate analyses assessed associations among seven psychosocial factors (substance use disorder; depression; post-traumatic stress disorder [PTSD]; emotional abuse; pregnancy coercion; physical abuse; and sexual abuse) and four outcomes (early sexual initiation; condomless sex; multiple sexual partners; self-reported STD) to examine their interrelationships. Second, we examined associations between experiencing multiple psychosocial factors and outcomes. Third, psychosocial factors were categorized into four domains: substance use disorder; mental health (depression, PTSD); psychological abuse (emotional abuse, pregnancy coercion); and violence (physical abuse, sexual abuse) and included as independent associations with each outcome to assess their relative importance. Results: Multiple interrelationships among psychosocial factors and outcomes were identified. An increase of one psychosocial health problem was associated with an 18% to 27% increased odds of sexual risk behaviors or a previous STD diagnosis. Reporting violence was associated with increased odds of having multiple partners (odds ratio = 3.31; confidence interval = 1.57-6.97), and experiencing psychological abuse was associated with increased odds of reporting an STD diagnosis (odds ratio = 3.95; confidence interval = 1.62-9.63). Conclusion: Multiple psychosocial health problems, particularly psychological abuse and violence, are associated with sexual risk and STDs in this vulnerable population.

    • Immunity and Immunization
      1. Recommended Adult Immunization Schedule, United States, 2019External
        Kim DK, Hunter P.
        Ann Intern Med. 2019 Feb 5;170(3):182-92.

        [No abstract]

      2. Antibodies against egg- and cell-grown influenza A(H3N2) viruses in adults hospitalized during the 2017-2018 seasonExternal
        Levine MZ, Martin ET, Petrie JG, Lauring AS, Holiday C, Jefferson S, Fitzsimmons WJ, Johnson E, Ferdinands JM, Monto AS.
        J Infect Dis. 2019 Feb 4.
        Background: Influenza vaccine effectiveness was low in 2017-2018, yet circulating A(H3N2) viruses were antigenically similar to cell-grown vaccine strains. Notably, most influenza vaccines are egg-propagated. Methods: Serum was collected shortly after illness onset from 15 A(H3N2) infected cases and 15 uninfected hospitalized adults. Geometric mean titers against egg- and cell-grown A/Hong Kong/4801/2014 A(H3N2) vaccine strains and representative circulating viruses (including A/Washington/16/2017) were determined by microneutralization (MN). Independent effects of strain-specific titers on susceptibility were estimated by logistic regression. Results: MN titers against egg-A/Hong Kong were significantly higher among vaccinated individuals (173 vs 41; p=0.01). In unadjusted models, a 2-fold increase in titers against egg-A/Hong Kong was not significantly protective (29% reduction; p=0.09), but a similar increase in cell-A/Washington titer (3C.2a2) was protective (60% reduction; p=0.02). Higher egg-A/Hong Kong titers were not significantly associated with infection, when adjusted for titers against A/Washington (15% reduction; p=0.61). A 54% reduction of odds of infection was observed with a 2-fold increase in A/Washington (not significant), adjusted for egg-A/Hong Kong titer. Conclusion: Individuals vaccinated in 2017-2018 had high antibody titers against the egg-adapted vaccine strain and lower titers against circulating viruses. Titers against circulating, but not egg-adapted strains, were correlated with protection.

      3. Effects of influenza vaccination in the United States during the 2017-2018 influenza seasonExternal
        Rolfes MA, Flannery B, Chung J, O’Halloran A, Garg S, Belongia EA, Gaglani M, Zimmerman R, Jackson ML, Monto AS, Alden NB, Anderson E, Bennett NM, Billing L, Eckel S, Kirley PD, Lynfield R, Monroe ML, Spencer M, Spina N, Talbot HK, Thomas A, Torres S, Yousey-Hindes K, Singleton J, Patel M, Reed C, Fry AM.
        Clin Infect Dis. 2019 Feb 2.
        Background: The severity of the 2017-2018 influenza season in the U.S. was high with influenza A(H3N2) viruses predominating. We report influenza vaccine effectiveness (VE) and estimate the number of vaccine prevented influenza-associated illnesses, medical visits, hospitalizations, and deaths for the 2017-2018 influenza season. Methods: We used national age-specific estimates of 2017-2018 influenza vaccine coverage and disease burden. We estimated VE, and 95% confidence intervals (CI), against medically-attended RT-PCR confirmed influenza virus infection, in the ambulatory setting, using a test-negative design. We estimated influenza type/subtype-specific burden using multipliers applied to population-based rates of influenza-associated hospitalizations. We used a compartmental model to estimate numbers, with 95% credible intervals (CrI), of influenza-associated outcomes prevented by vaccination. Results: The VE against outpatient medically-attended, laboratory-confirmed influenza was 38% (95% CI: 31-43%) including 22% (95% CI: 12-31%) against influenza A(H3N2), 62% (95% CI: 50-71%) against influenza A(H1N1)pdm09, and 50% (95% CI: 41-57%) against influenza B. We estimated that influenza vaccination prevented 7.1 million (95% CrI: 5.4 million-9.3 million) illnesses, 3.7 million (95% CrI: 2.8 million-4.9 million) medical visits, 109,000 (95% CrI: 39,000-231,000) hospitalizations, and 8,000 (95% CrI: 1,100-21,000) deaths. Vaccination prevented 10% of expected hospitalizations overall and 41% among young children (6 months-4 years). Conclusions: Despite 38% VE, influenza vaccination reduced a substantial burden of influenza-associated illness, medical visits, hospitalizations, and deaths in the U.S. during the 2017-2018 season. Our results demonstrate the benefit of current influenza vaccination and the need for improved vaccines.

    • Laboratory Sciences
      1. Maternal titanium dioxide nanomaterial inhalation exposure compromises placental hemodynamicsExternal
        Abukabda AB, Bowdridge EC, McBride CR, Batchelor TP, Goldsmith WT, Garner KL, Friend S, Nurkiewicz TR.
        Toxicol Appl Pharmacol. 2019 Jan 31.
        The fetal consequences of gestational engineered nanomaterial (ENM) exposure are unclear. The placenta is a barrier protecting the fetus and allowing transfer of substances from the maternal circulation. The purpose of this study was to determine the effects of maternal pulmonary titanium dioxide nanoparticle (nano-TiO2) exposure on the placenta and umbilical vascular reactivity. We hypothesized that pulmonary nano-TiO2 inhalation exposure increases placental vascular resistance and impairs umbilical vascular responsiveness. Pregnant Sprague-Dawley rats were exposed via whole-body inhalation to nano-TiO2 with an aerodynamic diameter of 188+/-0.36nm. On gestational day (GD) 11, rats began inhalation exposures (6h/exposure). Daily lung deposition was 87.5+/-2.7mug. Animals were exposed for 6days for a cumulative lung burden of 525+/-16mug. On GD 20, placentas, umbilical artery and vein were isolated, cannulated, and treated with acetylcholine (ACh), angiotensin II (ANGII), S-nitroso-N-acetyl-DL-penicillamine (SNAP), or calcium-free superfusate (Ca(2+)-free). Mean outflow pressure was measured in placental units. ACh increased outflow pressure to 53+/-5mmHg in sham-controls but only to 35+/-4mmHg in exposed subjects. ANGII decreased outflow pressure in placentas from exposed animals (17+/-7mmHg) compared to sham-controls (31+/-6mmHg). Ca(2+)-free superfusate yielded maximal outflow pressures in sham-control (63+/-5mmHg) and exposed (30+/-10mmHg) rats. Umbilical artery endothelium-dependent dilation was decreased in nano-TiO2 exposed fetuses (30+/-9%) compared to sham-controls (58+/-6%), but ANGII sensitivity was increased (-79+/-20% vs -36+/-10%). These results indicate that maternal gestational pulmonary nano-TiO2 exposure increases placental vascular resistance and impairs umbilical vascular reactivity.

      2. [No abstract]

      3. miRNA-378a as a key regulator of cardiovascular health following engineered nanomaterial inhalation exposureExternal
        Hathaway QA, Durr AJ, Shepherd DL, Pinti MV, Brandebura AN, Nichols CE, Kunovac A, Goldsmith WT, Friend SA, Abukabda AB, Fink GK, Nurkiewicz TR, Hollander JM.
        Nanotoxicology. 2019 Feb 1:1-20.
        Nano-titanium dioxide (nano-TiO2), though one of the most utilized and produced engineered nanomaterials (ENMs), diminishes cardiovascular function through dysregulation of metabolism and mitochondrial bioenergetics following inhalation exposure. The molecular mechanisms governing this cardiac dysfunction remain largely unknown. The purpose of this study was to elucidate molecular mediators that connect nano-TiO2 exposure with impaired cardiac function. Specifically, we were interested in the role of microRNA (miRNA) expression in the resulting dysfunction. Not only are miRNA global regulators of gene expression, but also miRNA-based therapeutics provide a realistic treatment modality. Wild type and MiRNA-378a knockout mice were exposed to nano-TiO2 with an aerodynamic diameter of 182 +/- 1.70 nm and a mass concentration of 11.09 mg/m(3) for 4 h. Cardiac function, utilizing the Vevo 2100 Imaging System, electron transport chain complex activities, and mitochondrial respiration assessed cardiac and mitochondrial function. Immunoblotting and qPCR examined molecular targets of miRNA-378a. MiRNA-378a-3p expression was increased 48 h post inhalation exposure to nano-TiO2. Knockout of miRNA-378a preserved cardiac function following exposure as revealed by preserved E/A ratio and E/SR ratio. In knockout animals, complex I, III, and IV activities ( approximately 2- to 6-fold) and fatty acid respiration ( approximately 5-fold) were significantly increased. MiRNA-378a regulated proteins involved in mitochondrial fusion, transcription, and fatty acid metabolism. MiRNA-378a-3p acts as a negative regulator of mitochondrial metabolic and biogenesis pathways. MiRNA-378a knockout animals provide a protective effect against nano-TiO2 inhalation exposure by altering mitochondrial structure and function. This is the first study to manipulate a miRNA to attenuate the effects of ENM exposure.

      4. Development and evaluation of a multiplexed immunoassay for simultaneous detection of serum IgG antibodies to six human coronavirusesExternal
        Trivedi SU, Miao C, Sanchez JE, Caidi H, Tamin A, Haynes L, Thornburg NJ.
        Sci Rep. 2019 Feb 4;9(1):1390.
        Known human coronaviruses (hCoV) usually cause mild to moderate upper-respiratory tract illnesses, except SARS-CoV and MERS-CoV, which, in addition to mild illness can also be associated with severe respiratory diseases and high mortality rates. Well-characterized multiplexed serologic assays are needed to aid in rapid detection and surveillance of hCoVs. The present study describes development and evaluation of a multiplexed magnetic microsphere immunoassay (MMIA) to simultaneously detect immunoglobulin G (IgG) antibodies specific for recombinant nucleocapsid proteins (recN) from hCoVs 229E, NL63, OC43, HKU1, SARS-CoV, and MERS-CoV. We used paired human sera to screen for IgG with reactivity against six hCoVs to determine assay sensitivity, specificity and reproducibility. We found no signal interference between monoplex and multiplex assay formats (R(2) range = 0.87-0.97). Screening of paired human sera using MMIA, resulted in 92 of 106 (sensitivity: 86%) as positive and 68 of 80 (specificity: 84%) as negative. This study serves as a proof of concept that it is feasible to develop and use a multiplexed microsphere immunoassay as a next generation screening tool for use in large scale seroprevalence studies of hCoVs.

    • Maternal and Child Health
      1. Prevalence of cerebral palsy, intellectual disability, hearing loss, and blindness, National Health Interview Survey, 2009-2016External
        McGuire DO, Tian LH, Yeargin-Allsopp M, Dowling NF, Christensen DL.
        Disabil Health J. 2019 Jan 23.
        BACKGROUND: Developmental disabilities are present in a significant proportion of US children. Surveillance of developmental disabilities is crucial for monitoring population trends, guiding research into risk factors, and informing resource allocation. OBJECTIVE/HYPOTHESIS: We examined overall prevalence, prevalence by demographic characteristics, and trends over time for cerebral palsy (CP), intellectual disability (ID), moderate to severe hearing loss (MSHL), and blindness. METHODS: Data from the 2009-2016 National Health Interview Survey (NHIS) were analyzed for children 3-17 years of age. Question wording was consistent over time except for ID, which changed in 2011 to replace the term “mental retardation.” Demographic differences and linear trends (over three time periods) were assessed by Chi-square tests and Wald-F tests. RESULTS: Prevalence estimates per 1000 children ages 3-17 years for CP, ID, MSHL, and blindness were 3.2 (95% CI: 2.7, 3.7), 11.1 (95% CI: 10.2, 12.1), 6.4 (95% CI: 5.6, 7.2), and 1.6 (95% CI: 1.3, 2.0), respectively. Disability prevalence was higher for children with low birthweight and from families of lower parental education, income </=200% of federal poverty level, and public insurance. Older children had higher ID prevalence; boys had significantly higher CP and ID prevalences. Only ID demonstrated a significantly increased trend over time (p=0.0002). CONCLUSIONS: We provide nationally representative prevalence estimates for four developmental disabilities; recent estimates are comparable to those from records-based studies. Prevalences were stable except for ID, which increased after 2010, coincident with the questionnaire change. A substantial number of US children continue to have these disabilities and service needs.

      2. A description of the educational setting among individuals with fragile X syndromeExternal
        Nash R, Riley C, Paramsothy P, Gilbertson K, Raspa M, Wheeler A, Dziuban EJ, Peacock G.
        Am J Intellect Dev Disabil. 2019 Jan;124(1):57-76.
        Children with fragile X syndrome (FXS) display wide-ranging intellectual and behavioral abilities that affect daily life. We describe the educational setting of students with FXS and assess the relationships between school setting, co-occurring conditions, and functional ability using a national survey sample ( n = 982). The majority of students with FXS in this sample have formal individualized education plans, spend part of the day outside regular classrooms, and receive modifications when in a regular classroom. Males with FXS and certain co-occurring conditions (autism, aggression, and self-injurious behavior) are more likely to spend the entire day outside regular classrooms, compared to males without these co-occurring conditions. Students who spend more time in regular classrooms are more likely to perform functional tasks without help.

    • Mining
      1. Mineworkers’ perceptions of mobile proximity detection systemsExternal
        Bellanca JL, Swanson LR, Helton J, McNinch M.
        Mining, Metallurgy & Exploration. 2019 2019/01/25.
        Accident data indicates that mobile haulage poses a significant pinning, crushing, and striking risk. Proximity detection systems (PDSs) have the potential to protect mineworkers from these risks. However, unintended consequences of mobile PDSs can undermine the safety benefit they provide. Soliciting iterative user input can improve the design process. Users help provide a critical understanding of how mobile PDSs may hinder normal operation and endanger mineworkers. Researchers explored users’ perspectives by conducting interviews with mineworkers from seven mines that have installed mobile PDSs on some of their haulage equipment. Mineworkers reported that mobile PDSs affect loading, tramming, section setup, maintenance, and general work on the section. Mineworkers discussed the operational effects and increased burden, exposure, and risk. Mineworkers also suggested that improved task compatibility, training, logistics, and PDS performance might help address some of these identified issues. This paper also gives additional insights into mobile PDS design and implementation.

    • Nutritional Sciences
      1. A report of activities related to the Dietary Reference Intakes from the Joint Canada-US Dietary Reference Intakes Working GroupExternal
        MacFarlane AJ, Cogswell ME, de Jesus JM, Greene-Finestone LS, Klurfeld DM, Lynch CJ, Regan K, Yamini S.
        Am J Clin Nutr. 2019 Feb 5.
        The governments of the United States and Canada have jointly undertaken the development of the Dietary Reference Intakes (DRIs) since the mid-1990s. The Federal DRI committees from each country work collaboratively to identify DRI needs, prioritize nutrient reviews, advance work to resolve methodological issues that is necessary for new reviews, and sponsor DRI-related committees through the National Academies of Sciences, Engineering and Medicine. In recent years, the Joint Canada-US DRI Working Group, consisting of members from both Federal DRI committees, developed an open and transparent nomination process for prioritizing nutrients for DRI review, by which sodium, the omega-3 (n-3) fatty acids, vitamin E, and magnesium were identified. In addition, discussions during the nutrient nomination process prompted the Federal DRI committees to address previously identified issues related to the use of chronic disease endpoints when setting DRIs. The development of guiding principles for setting DRIs based on chronic disease risk reduction will be applied for the first time during the DRI review of sodium and potassium. In summary, the US and Canadian governments have worked collaboratively to adapt our approach to prioritizing nutrients for DRI review and to broaden the scope of the DRIs to better incorporate the concept of chronic disease risk reduction in order to improve public health.

    • Occupational Safety and Health
      1. Background: Recent cross-sectional epidemiologic studies have examined the association between human health effects and carbon nanotube and nanofiber (CNT/F) workplace exposures. However, due to the latency of many health effects of interest, cohort studies with sufficient follow-up will likely be needed. The objective of this study was to identify workplace determinants that contribute to exposure and develop predictive models to estimate CNT/F exposures for future use in epidemiologic studies. Methods: Exposure measurements were compiled from 15 unique facilities for the metrics of elemental carbon (EC) mass at both the respirable and inhalable aerosol size fractions as well as a quantitative analysis performed by transmission electron microscopy (TEM). These metrics served as the dependent variables in model development. Repeated personal samples were collected from most of the 127 CNT/F worker participants for 252 total observations. Determinants were categorized as company-level or worker-level and used to describe the exposure relationship within the dependent variables. The influence of determinants on variance components was explored using mixed linear models that utilized a backwards stepwise selection process with a lowering of the AIC for model determinant selection. Additional ridge regression models were created that examined predictive performance with and without all two-way interactions. Cross-validation was performed on each model to evaluate the generalizability of its predictive capabilities while predictive performance was evaluated according to the corresponding R2 value and root mean square error (RMSE). Results: Determinants at the company-level that increased exposure included an inadequate or semi-adequate engineering control rating, increasing average CNT/F diameter/length, daily quantities of material handled from 101 g to >1 kg and >1 kg, the use of CNF materials, the industry type of hybrid producer/user, and the expert assessment of a high exposure potential. Worker-level determinants associated with higher exposure included handling the dry-powdered form of CNT/F, handling daily quantities of material >1 kg, direct/indirect exposure, having the job title of engineer, using a respirator, using a ventilated or unventilated enclosure, and the job task of powder handling. The mixed linear models explained >60% of the total variance when using all company- and worker-level determinants to create the three exposure models. The cross-validated RMSE values for each of the three mixed models ranged from 2.50 to 4.23. Meanwhile, the ridge regression models, without all two-way interactions, estimated cross-validated RMSE values of 2.85, 2.23, and 2.76 for the predictive models of inhalable EC, respirable EC, and TEM, respectively. Conclusions: The ridge regression models demonstrated the best performance for predicting exposures to CNT/F for each exposure metric, although they only provided a modest predictive capability. Therefore, it was concluded that the models alone would not be adequate in predicting workplace exposures and would need to be integrated with other methods.

      2. Activity modification in heat: critical assessment of guidelines across athletic, occupational, and military settings in the USAExternal
        Hosokawa Y, Casa DJ, Trtanj JM, Belval LN, Deuster PA, Giltz SM, Grundstein AJ, Hawkins MD, Huggins RA, Jacklitsch B, Jardine JF, Jones H, Kazman JB, Reynolds ME, Stearns RL, Vanos JK, Williams AL, Williams WJ.
        Int J Biometeorol. 2019 Feb 2.
        Exertional heat illness (EHI) risk is a serious concern among athletes, laborers, and warfighters. US Governing organizations have established various activity modification guidelines (AMGs) and other risk mitigation plans to help ensure the health and safety of their workers. The extent of metabolic heat production and heat gain that ensue from their work are the core reasons for EHI in the aforementioned population. Therefore, the major focus of AMGs in all settings is to modulate the work intensity and duration with additional modification in adjustable extrinsic risk factors (e.g., clothing, equipment) and intrinsic risk factors (e.g., heat acclimatization, fitness, hydration status). Future studies should continue to integrate more physiological (e.g., valid body fluid balance, internal body temperature) and biometeorological factors (e.g., cumulative heat stress) to the existing heat risk assessment models to reduce the assumptions and limitations in them. Future interagency collaboration to advance heat mitigation plans among physically active population is desired to maximize the existing resources and data to facilitate advancement in AMGs for environmental heat.

    • Occupational Safety and Health – Mining
      1. A test method for evaluating the thermal environment of underground coal mine refuge alternativesExternal
        Yantek DS, Yan L, Damiano NW, Reyes MA, Srednicki JR.
        Int J Min Sci Technol. 2019 .
        Since 2009, the Mine Safety and Health Administration (MSHA) has required mines to install refuge alternatives (RAs) in underground coal mines. One of the biggest concerns with occupied RAs is the possible severity of the resulting thermal environment. In 30 CFR 7.504, the maximum allowable apparent temperature (AT) for an occupied RA is specified as 35C (95F). Manufacturers must conduct heat/humidity tests to demonstrate that their RAs meet the 35C (95F) AT limit. For these tests, heat input devices are used to input the metabolic heat of actual miners. A wide variety of test methods, sensors, and heat input devices could be used when conducting such tests. Since 2012, the National Institute for Occupational Safety and Health (NIOSH) has conducted over thirty 96-hour heat/humidity tests on four different RAs. This paper discusses the test equipment and procedures used during these investigations. This information is useful for RA manufacturers conducting RA heat/humidity tests, for other researchers investigating RA heat/humidity buildup, and for those who need to assess the thermal environment of any confined space where people may be trapped or are seeking refuge.

    • Parasitic Diseases
      1. [No abstract]

      2. Schistosomiasis is associated with incident HIV transmission and death in ZambiaExternal
        Wall KM, Kilembe W, Vwalika B, Dinh C, Livingston P, Lee YM, Lakhi S, Boeras D, Naw HK, Brill I, Chomba E, Sharkey T, Parker R, Shutes E, Tichacek A, Secor WE, Allen S.
        PLoS Negl Trop Dis. 2018 Dec;12(12):e0006902.
        BACKGROUND: We examined relationships between schistosome infection, HIV transmission or acquisition, and all-cause death. METHODS: We retrospectively tested baseline sera from a heterosexual HIV-discordant couple cohort in Lusaka, Zambia with follow-up from 1994-2012 in a nested case-control design. Schistosome-specific antibody levels were measured by ELISA. Associations between baseline antibody response to schistosome antigens and incident HIV transmission, acquisition, and all-cause death stratified by gender and HIV status were assessed. In a subset of HIV- women and HIV+ men, we performed immunoblots to evaluate associations between Schistosoma haematobium or Schistosoma mansoni infection history and HIV incidence. RESULTS: Of 2,145 individuals, 59% had positive baseline schistosome-specific antibody responses. In HIV+ women and men, baseline schistosome-specific antibodies were associated with HIV transmission to partners (adjusted hazard ratio [aHR] = 1.8, p<0.005 and aHR = 1.4, p<0.05, respectively) and death in HIV+ women (aHR = 2.2, p<0.001). In 250 HIV- women, presence of S. haematobium-specific antibodies was associated with increased risk of HIV acquisition (aHR = 1.4, p<0.05). CONCLUSION: Schistosome infections were associated with increased transmission of HIV from both sexes, acquisition of HIV in women, and increased progression to death in HIV+ women. Establishing effective prevention and treatment strategies for schistosomiasis, including in urban adults, may reduce HIV incidence and death in HIV+ persons living in endemic areas.

    • Public Health Leadership and Management
      1. Public Health Workforce 3.0: Recent progress and what’s on the horizon to achieve the 21st-century workforceExternal
        Glynn MK, Jenkins ML, Ramsey C, Simone PM.
        J Public Health Manag Pract. 2019 Mar/Apr;25 Suppl 2, Public Health Workforce Interests and Needs Survey 2017:S6-s9.

        [No abstract]

    • Reproductive Health
      1. Preterm birth and small size for gestational age in singleton, in vitro fertilization births using donor oocytesExternal
        Boulet SL, Kawwass JF, Crawford S, Davies MJ, Kissin DM.
        Am J Epidemiol. 2018 Aug 1;187(8):1642-1650.
        We used 2006-2015 US National Assisted Reproductive Technology Surveillance System data to compare preterm birth and fetal growth for liveborn singletons (24-42 weeks’ gestation) following in vitro fertilization with donor versus autologous oocytes. Using binary and multinomial logistic regression, we computed adjusted odds ratios and 95% confidence intervals for associations between use of donor oocytes and preterm delivery, being small for gestational age (SGA), and being large for gestational age (LGA), stratified by fresh and thawed embryo status and accounting for maternal characteristics and year of birth. There were 204,855 singleton births from fresh embryo transfers and 106,077 from thawed embryo transfers. Among fresh embryo transfers, donor oocyte births had higher odds of being preterm (adjusted odd ratio (aOR) = 1.32, 95% confidence interval (CI): 1.27, 1.38) or LGA (aOR = 1.27, 95% CI: 1.21, 1.33) but lower odds of being SGA (aOR = 0.81, 95% CI: 0.77, 0.85). Among thawed embryo transfers, donor oocyte births had higher odds of being preterm (aOR = 1.57, 95% CI: 1.48, 1.65) or SGA (aOR = 1.22, 95% CI: 1.14, 1.31) but lower odds of being LGA (aOR = 0.87, 95% CI: 0.82, 0.92). Use of donor oocytes was associated with increased odds of preterm delivery irrespective of embryo status; odds of being SGA were increased for donor versus autologous oocyte births among thawed embryo transfers only.

    • Substance Use and Abuse
      1. Does the association between substance use and sexual risk behaviors among high school students vary by sexual identity?External
        Clayton HB, Andrzejewski J, Johns M, Lowry R, Ashley C.
        Addict Behav. 2019 Jan 17;93:122-128.
        OBJECTIVE: Limited information exists on whether associations between substance use behaviors (SUBs) and sexual risk behaviors (SRBs) vary by sexual identity. METHODS: Data from the 2015 national Youth Risk Behavior Survey (n=15,624), were analyzed to assess associations between SUBs (cigarette smoking, alcohol use, binge drinking, marijuana use, prescription drug misuse, injection drug use, illicit drug use) and SRBs (sexual activity, number of partners, condom use). Logistic regression models calculated adjusted prevalence ratios (aPR), stratified by sexual identity, and interaction effects for sexual identity were introduced to models to determine if associations varied by sexual identity. RESULTS: All SUBs had significant associations with current sexual activity and 4+ sexual partners for both heterosexual and LGB students. No condom use during last sexual intercourse was significantly associated with all SUBs except alcohol use among heterosexual students, while no condom use was only significantly associated with injection drug use among LGB students. Associations between current sexual activity and SUBs were significantly stronger among heterosexual compared to LGB students for smoking (aPR=2.39;95% CI:2.15,2.65 vs aPR=1.49;95% CI:1.14,1.95), marijuana use (2.41;2.15,2.71 vs 1.86;1.58,2.19) and prescription drug misuse (2.10;1.93,2.28 vs 1.60;1.28,2.00). Associations between no condom use and SUBs were significantly stronger for heterosexual compared to LGB students only for smoking (1.32;1.16,1.50 vs 0.96;0.73,1.25) and marijuana use (1.22;1.07,1.38 vs 0.90;0.72,1.12). CONCLUSIONS: The relationship between most SUBs and SRBs did not vary significantly by sexual identity. These findings underscore the importance coordinating school-based programs to prevent substance use and promote sexual health.

      2. OBJECTIVES:: In Colorado, legalization of recreational marijuana in 2014 increased public access to marijuana and might also have led to an increase in emergency department (ED) visits. We examined the validity of using syndromic surveillance data to detect marijuana-associated ED visits by comparing the performance of surveillance queries with physician-reviewed medical records. METHODS:: We developed queries of combinations of marijuana-specific International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes or keywords. We applied these queries to ED visit data submitted through the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) syndromic surveillance system at 3 hospitals during 2016-2017. One physician reviewed the medical records of ED visits identified by >/=1 query and calculated the positive predictive value (PPV) of each query. We defined cases of acute adverse effects of marijuana (AAEM) as determined by the ED provider’s clinical impression during the visit. RESULTS:: Of 44 942 total ED visits, ESSENCE queries detected 453 (1%) as potential AAEM cases; a review of 422 (93%) medical records identified 188 (45%) true AAEM cases. Queries using ICD-10 diagnostic codes or keywords in the triage note identified all true AAEM cases; PPV varied by hospital from 36% to 64%. Of the 188 true AAEM cases, 109 (58%) were among men and 178 (95%) reported intentional use of marijuana. Compared with noncases of AAEM, cases were significantly more likely to be among non-Colorado residents than among Colorado residents and were significantly more likely to report edible marijuana use rather than smoked marijuana use ( P < .001). CONCLUSIONS:: ICD-10 diagnostic codes and triage note keyword queries in ESSENCE, validated by medical record review, can be used to track ED visits for AAEM.

      3. Determination of humectants in tobacco filler by high performance chromatography/single quadrupole mass spectrometryExternal
        Xizheng Y, Valentin-Blasini L, Watson C, Cardenas RB.
        Beitrage zur Tabakforschung International/ Contributions to Tobacco Research. 2018 ;28(4):170-178.
        Glycerol, and 1,2-propylene glycol are the humectants most commonly used by the tobacco industry. They are found in a variety of tobacco products and are often present at high levels ( 2-5 % w/w). While humectants are generally considered safe, they may serve as precursors in the formation of harmful carbonyl compounds. A selective, precise, and sensitive method for the quantification of several humectants in cigarette filler was developed. The method’s sample clean-up is a two-step process consisting of a mechanical extraction, followed by solid phase extraction. Individual humectants are separated, identified, and measured using liquid chromatography coupled to a single quadrupole mass spectrometer as the detector (LC/MS). Detection limits were 0.105, 0.575, and 0.039 mg/cigarette for glycerol, 1,2-propylene glycol and triethylene glycol, respectively. The quantification range for these analytes was 0.4-75.0 mg/cigarette. Twenty-seven brands of domestic commercial cigarettes were evaluated to assess typical levels of humectants in the tobacco filler.

    • Zoonotic and Vectorborne Diseases
      1. Rabies post-exposure prophylaxis initiation and adherence among patients in Vietnam, 2014-2016External
        Tran CH, Afriyie DO, Pham TN, Otsu S, Urabe M, Dang AD, Tran HG, Nguyen HV, Le HT, Nguyen HT.
        Vaccine. 2019 Feb 2.
        BACKGROUND: Adhering to post-exposure prophylaxis (PEP): wound treatment, vaccine, and rabies immunoglobulin (RIG) is a crucial step in preventing rabies mortality. When PEP is widely available, a lack of adherence to the recommended treatment guidelines can also lead to death. Our objective was to understand characteristics associated with adherence to the vaccine regimen and RIG in Vietnam. METHODS: We obtained individual-level data on PEP adherence from registries at 10 sites located in five provinces. From these registries, we extracted epidemiologic characteristics of patients including the timing of PEP initiation and completion. We used descriptive analyses and logistic regression to examine patient characteristics associated with initiation and completion of RIG and vaccine. Based on reported rabies mortality, the government defined provincial rabies burden as medium-burden (<5 and >2 deaths) and high-burden (>/=5 deaths). RESULTS: During 2014-2016, 15,646 patients received PEP in our study. Among 14,296 vaccinated patients, only 41.4% (5847) completed their five-dose intramuscular (IM) injections and 81.6% (133) of patients completed their eight-dose intradermal (ID) injections. Approximately 26% of patients received RIG. Patient characteristics associated with vaccine completion were females (44%), <15years of age (44%), category 1 exposure (68%, bite location on leg (46%), bite from bat (56%), bite from a healthy animal (45%), high-burden province (86%), and district preventive center (49%). Disparities were revealed among provinces, with high-burden provinces having highest (86%) and lowest (7%) vaccine completion rates. CONCLUSIONS AND RELEVANCE: Vietnam has made tremendous progress towards reducing the burden of rabies. However, despite the wide availability of PEP, we found relatively low rates of vaccine completion. Our findings suggest provider training and patient education is needed to ensure appropriate treatment is completed. Moreover, our data suggest changes to information reported through the national surveillance system for monitoring good clinical practice for rabies prevention and control.

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

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