Volume 12, Issue 19, June 16, 2020

CDC Science Clips: Volume 12, Issue 19, June 16, 2020

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

  1. Top Articles of the Week
    Selected weekly by a senior CDC scientist from the standard sections listed below.
    The names of CDC authors are indicated in bold text.
    • Chronic Diseases and Conditions
      • Outcomes in Kawasaki disease patients with coronary artery abnormalities at admissionexternal icon
        Ae R, Abrams JY, Maddox RA, Schonberger LB, Nakamura Y, Kuwabara M, Makino N, Matsubara Y, Matsubara D, Kosami K, Sasahara T, Belay ED.
        Am Heart J. 2020 May 3;225:120-128.
        BACKGROUND: Previous studies demonstrated that coronary artery lesions (CALs) resulting from Kawasaki disease (KD) can improve over time. However, limited information is available on sub-acute outcomes of CALs detected at admission during KD illness. METHODS: The nationwide Japanese KD survey contained substantial information on KD patients with CALs detected at admission and who received standard IVIG treatment within 10 days of disease onset. Coronary outcomes were evaluated by changes in CALs from admission to the first assessment at 30 days from disease onset in three categories: improved, unchanged, and progressed. Ordinal logistic regression analysis was performed to evaluate factors associated with the outcomes. RESULTS: Of 2024 patients with CALs detected at admission, improved, unchanged, and progressed outcomes were found in 1548 (76.5%), 390 (19.3%), and 86 (4.2%), respectively. Over 80% of patients with coronary artery (CA) dilatations had improved outcome. Independent factors associated with worse outcomes were larger-size CALs (adjusted ORs [95% CIs]: CA aneurysm=5.13 [3.65-7.22] and giant CA aneurysms=7.49 [3.56-15.72] compared with CA dilatation, respectively), age>/=60 months (1.45 [1.08-1.94] compared with 12-59 months), recurrent KD (1.57 [1.07-2.29]), parental history of KD (2.23 [1.02-4.85]), and delayed admission (8-10 days from disease onset: 1.76 [1.21-2.57] compared with 1-4 days). CONCLUSIONS: KD patients with larger CALs, >/=60 months old, and with recurrent status or parental history may require more rigorous treatment. In addition, delayed admission may result in worse coronary outcome, indicating that prompt diagnosis and treatment are required.

    • Communicable Diseases
      • Social mixing and clinical features linked with transmission in a network of extensively drug-resistant tuberculosis cases in KwaZulu-Natal, South Africaexternal icon
        Nelson KN, Jenness SM, Mathema B, Lopman BA, Auld SC, Shah NS, Brust JC, Ismail N, Omar SV, Brown TS, Allana S, Campbell A, Moodley P, Mlisana K, Gandhi NR.
        Clin Infect Dis. 2020 May 23;70(11):2396-2402.
        BACKGROUND: Tuberculosis (TB) is the leading infectious cause of death globally, and drug-resistant TB strains pose a serious threat to controlling the global TB epidemic. The clinical features, locations, and social factors driving transmission in settings with high incidences of drug-resistant TB are poorly understood. METHODS: We measured a network of genomic links using Mycobacterium tuberculosis whole-genome sequences. RESULTS: Patients with 2-3 months of cough or who spent time in urban locations were more likely to be linked in the network, while patients with sputum smear-positive disease were less likely to be linked than those with smear-negative disease. Associations persisted using different thresholds to define genomic links and irrespective of assumptions about the direction of transmission. CONCLUSIONS: Identifying factors that lead to many transmissions, including contact with urban areas, can suggest settings instrumental in transmission and indicate optimal locations and groups to target with interventions.

      • A call for a global COVID-19 Neuro Research Coalitionexternal icon
        Winkler AS, Knauss S, Schmutzhard E, Leonardi M, Padovani A, Abd-Allah F, Charway-Felli A, Emmerich JV, Umapathi T, Satishchandra P, Hoo FK, Dalmau J, Oreja-Guevara C, Ferreira LB, Pfausler B, Michael B, Tagliavini F, Hoglinger G, Endres M, Klein C, Hemmer B, Correll W, Sejvar J, Solomon T.
        Lancet Neurol. 2020 Jun;19(6):482-484.

    • Environmental Health
      • Associations of perfluoroalkyl substances with incident natural menopause: the Study of Women's Health Across the Nationexternal icon
        Ding N, Harlow SD, Randolph JF, Calafat AM, Mukherjee B, Batterman S, Gold EB, Park SK.
        J Clin Endocrinol Metab. 2020 Jun 3.
        CONTEXT: Previous epidemiologic studies of per- and polyfluoroalkyl substances (PFAS) and menopausal timing conducted in cross-sectional settings were limited by reverse causation because PFAS serum concentrations increase after menopause. OBJECTIVES: To investigate associations between perfluoroalkyl substances and incident natural menopause. DESIGN AND SETTING: A prospective cohort of midlife women, the Study of Women's Health Across the Nation, 1999-2017. PARTICIPANTS: 1120 multi-racial/ethnic premenopausal women aged 45-56 years. METHODS: Serum concentrations of perfluoroalkyls were quantified by high performance liquid chromatography-isotope dilution-tandem mass spectrometry. Natural menopause was defined as the bleeding episode prior to at least 12 months of amenorrhea not due to surgery or hormone use. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Participants contributed 5466 person-years of follow-up, and 578 had incident natural menopause. Compared to the lowest tertile, women at the highest tertile of baseline serum concentrations had adjusted HR for natural menopause of 1.26 (95%CI: 1.02-1.57) for n-perfluorooctane sulfonic acid (n-PFOS) (Ptrend=0.03), 1.27 (95%CI: 1.01-1.59) for branched-PFOS (Ptrend=0.03), and 1.31 (95%CI: 1.04-1.65) for n-perfluorooctanoic acid (Ptrend=0.01). Women were classified into four clusters based on their overall PFAS concentrations as mixtures: low, low-medium, medium-high, and high. Compared to the low cluster, the high cluster had a HR of 1.63 (95% CI: 1.08-2.45), which is equivalent to 2.0 years earlier median time to natural menopause. CONCLUSION: This study suggests that select PFAS serum concentrations are associated with earlier natural menopause, a risk factor for adverse health outcomes in later life.

    • Food Safety
      • Food safety and invasive Cronobacter infections during early infancy, 1961-2018external icon
        Strysko J, Cope JR, Martin H, Tarr C, Hise K, Collier S, Bowen A.
        Emerg Infect Dis. 2020 May;26(5):857-65.
        Invasive Cronobacter infections among infants are associated with severe neurologic disabilities and death. Early Cronobacter reports typically featured hospitalized and preterm infants and recognized contaminated powdered infant formula (PIF) as a transmission vehicle. To clarify recent epidemiology, we reviewed all cases of bloodstream infection or meningitis among infants that were reported to the Centers for Disease Control and Prevention and in the literature (1961–2018; n = 183). Most infants were neonates (100/150 [67%]); 38% (42/112) died, and 79% (81/102) had reported recent PIF consumption. In the final quarter of the study period (2004–2018), case counts were significantly higher (global average 8.7 cases/year); among US cases, significantly higher proportions occurred among full-term (56% [27/48]) and nonhospitalized (78% [42/54]) infants. PIF contamination, most commonly from opened containers, was identified in 30% (21/71) of investigations. Our findings reaffirm the need to promote safer alternatives for infant feeding, particularly among neonates. Contaminated powdered infant formula from opened containers is the most commonly identified transmission vehicle. eng

    • Health Economics
      • Cost-effectiveness of risk-stratified colorectal cancer screening based on polygenic risk: Current status and future potentialexternal icon
        Naber SK, Kundu S, Kuntz KM, Dotson WD, Williams MS, Zauber AG, Calonge N, Zallen DT, Ganiats TG, Webber EM, Goddard KA, Henrikson NB, van Ballegooijen M, Janssens A, Lansdorp-Vogelaar I.
        JNCI Cancer Spectr. 2020 Feb;4(1):pkz086.
        BACKGROUND: Although uniform colonoscopy screening reduces colorectal cancer (CRC) mortality, risk-based screening may be more efficient. We investigated whether CRC screening based on polygenic risk is a cost-effective alternative to current uniform screening, and if not, under what conditions it would be. METHODS: The MISCAN-Colon model was used to simulate a hypothetical cohort of US 40-year-olds. Uniform screening was modeled as colonoscopy screening at ages 50, 60, and 70 years. For risk-stratified screening, individuals underwent polygenic testing with current and potential future discriminatory performance (area under the receiver-operating curve [AUC] of 0.60 and 0.65-0.80, respectively). Polygenic testing results were used to create risk groups, for which colonoscopy screening was optimized by varying the start age (40-60 years), end age (70-85 years), and interval (1-20 years). RESULTS: With current discriminatory performance, optimal screening ranged from once-only colonoscopy at age 60 years for the lowest-risk group to six colonoscopies at ages 40-80 years for the highest-risk group. While maintaining the same health benefits, risk-stratified screening increased costs by $59 per person. Risk-stratified screening could become cost-effective if the AUC value would increase beyond 0.65, the price per polygenic test would drop to less than $141, or risk-stratified screening would lead to a 5% increase in screening participation. CONCLUSIONS: Currently, CRC screening based on polygenic risk is unlikely to be cost-effective compared with uniform screening. This is expected to change with a greater than 0.05 increase in AUC value, a greater than 30% reduction in polygenic testing costs, or a greater than 5% increase in adherence with screening.

    • Healthcare Associated Infections
    • Immunity and Immunization
      • Impact of the introduction of rotavirus vaccine on hospital admissions for diarrhea among children in Kenya: A controlled interrupted time-series analysisexternal icon
        Otieno GP, Bottomley C, Khagayi S, Adetifa I, Ngama M, Omore R, Ogwel B, Owor BE, Bigogo G, Ochieng JB, Onyango C, Juma J, Mwenda J, Tabu C, Tate JE, Addo Y, Britton T, Parashar UD, Breiman RF, Verani JR, Nokes DJ.
        Clin Infect Dis. 2020 May 23;70(11):2306-2313.
        BACKGROUND: Monovalent rotavirus vaccine, Rotarix (GlaxoSmithKline), was introduced in Kenya in July 2014 and is recommended to infants as oral doses at ages 6 and 10 weeks. A multisite study was established in 2 population-based surveillance sites to evaluate vaccine impact on the incidence of rotavirus-associated hospitalizations (RVHs). METHODS: Hospital-based surveillance was conducted from January 2010 to June 2017 for acute diarrhea hospitalizations among children aged <5 years in 2 health facilities in Kenya. A controlled interrupted time-series analysis was undertaken to compare RVH pre- and post-vaccine introduction using rotavirus-negative cases as a control series. The change in incidence post-vaccine introduction was estimated from a negative binomial model that adjusted for secular trend, seasonality, and multiple health worker industrial actions (strikes). RESULTS: Between January 2010 and June 2017 there were 1513 and 1652 diarrhea hospitalizations in Kilifi and Siaya; among those tested for rotavirus, 28% (315/1142) and 23% (197/877) were positive, respectively. There was a 57% (95% confidence interval [CI], 8-80%) reduction in RVHs observed in the first year post-vaccine introduction in Kilifi and a 59% (95% CI, 20-79%) reduction in Siaya. In the second year, RVHs decreased further at both sites, 80% (95% CI, 46-93%) reduction in Kilifi and 82% reduction in Siaya (95% CI. 61-92%); this reduction was sustained at both sites into the third year. CONCLUSIONS: A substantial reduction in RVHs and all-cause diarrhea was observed in 2 demographic surveillance sites in Kenya within 3 years of vaccine introduction.

    • Injury and Violence
      • The role of middle school sports involvement in understanding high school sexual violence perpetrationexternal icon
        Basile KC, Espelage DL, Ingram KM, Simon TR, Berrier FL.
        J Interpers Violence. 2020 Jun 2.
        A number of studies have examined the association between male involvement in sports and sexual violence (SV) perpetration, especially among college-age males. Less is known about the association between sports involvement and SV perpetration for adolescent males and females. To address this gap, the current study examined sports involvement in middle school (no sports, no/low contact, and high contact) among 1,561 students, who were then followed into high school and asked about the frequency of SV perpetration. Results from logistic regression models indicated that, even after controlling for mother's education, race/ethnicity, SV perpetration in middle school, and traditional beliefs about masculinity and substance use, middle school sports participation was significantly associated with risk of SV perpetration in high school. Compared with youth who reported no sports involvement in middle school, youth categorized as no/low contact sports involvement had greater odds of SV perpetration in high school. Sex differences emerged, revealing that no/low contact sports involvement was associated with SV perpetration for females and high contact sports involvement was associated with SV perpetration for males, compared with no sports involvement. These findings suggest potential opportunities to intervene in middle school to improve coaching practices, enhance respectful relationships, and modify athletes' norms, attitudes, and behaviors to reduce risk for SV perpetration in high school.

      • Traumatic brain injury-related emergency department visits among American Indian and Alaska Native persons - National Patient Information Reporting System, 2005-2014external icon
        Sarmiento K, Kennedy J, Daugherty J, Peterson AB, Evans ME, Haberling DL, Billie H.
        J Head Trauma Rehabil. 2020 May 27.
        OBJECTIVE: The American Indian/Alaska Native (AI/AN) population has a disproportionately high rate of traumatic brain injuries (TBIs). However, there is little known about incidence and common mechanisms of injury among AI/AN persons who seek care in an Indian Health Service (IHS) or tribally managed facility. METHODS: Using the IHS National Patient Information Reporting System, we assessed the incidence of TBI-related emergency department visits among AI/AN children and adults seen in IHS or tribally managed facilities over a 10-year period (2005-2014). RESULTS: There were 44 918 TBI-related emergency department visits during the study period. Males and persons aged 18 to 34 years and 75 years and older had the highest rates of TBI-related emergency department visits. Unintentional falls and assaults contributed to the highest number and proportion of TBI-related emergency department visits. The number and age-adjusted rate of emergency department visits for TBI were highest among persons living in the Southwest and Northern Plains when compared with other IHS regions. CONCLUSION: Thousands of AI/AN children and adults are seen each year in emergency departments for TBI and the numbers increased over the 10-year period examined. Evidence-based interventions to prevent TBI-related emergency department visits, such as programs to reduce the risk for older adult falls and assault, are warranted.

    • Physical Activity
      • Public health representation on active transportation bodies across US municipalitiesexternal icon
        Omura JD, Kochtitzky CS, Galuska DA, Fulton JE, Shah S, Carlson SA.
        J Public Health Manag Pract. 2020 Jun 1.
        CONTEXT: Municipal bodies such as planning or zoning commissions and active transportation advisory committees can influence decisions made by local governments that support physical activity through active transportation. Public health professionals are encouraged to participate in and inform these processes. However, the extent of such collaboration among US municipalities is currently unknown. OBJECTIVE: To estimate the prevalence of active transportation bodies among US municipalities and the proportion with a designated public health representative. DESIGN: A cross-sectional survey administered from May through September 2014. SETTING: Nationally representative sample of US municipalities with populations of 1000 or more people. PARTICIPANTS: Respondents were the city or town manager, planner, or person with similar responsibilities (N = 2018). MAIN OUTCOME MEASURES: The prevalence of planning or zoning commissions and active transportation advisory committees among municipalities and whether there was a designated public health representative on them. RESULTS: Approximately 90.9% of US municipalities have a planning or zoning commission, whereas only 6.5% of these commissions have a designated public health representative. In contrast, while 16.5% of US municipalities have an active transportation advisory committee, 22.4% of them have a designated public health representative. These active transportation bodies are less common among municipalities that are smaller, rural, located in the South, and where population educational attainment is lower. Overall, few US municipalities have a planning or zoning commission (5.9%) or an active transportation advisory committee (3.7%) that also has a designated public health representative. CONCLUSIONS: Approximately 9 in 10 US municipalities have a planning or zoning commission, whereas only 1 in 6 has an active transportation advisory committee. Public health representation on active transportation bodies across US municipalities is low. Increasing the adoption of active transportation advisory committees and ensuring a designated public health representative on active transportation bodies may help promote the development of activity-friendly communities across the United States.

    • Zoonotic and Vectorborne Diseases
      • Investigation of Heartland Virus Disease throughout the United States, 2013-2017external icon
        Staples JE, Pastula DM, Panella AJ, Rabe IB, Kosoy OI, Walker WL, Velez JO, Lambert AJ, Fischer M.
        Open Forum Infect Dis. 2020 May;7(5):ofaa125.
        Background: Heartland virus (HRTV) was first described as a human pathogen in 2012. From 2013 to 2017, the Centers for Disease Control and Prevention (CDC) implemented a national protocol to evaluate patients for HRTV disease, better define its geographic distribution, epidemiology, and clinical characteristics, and develop diagnostic assays for this novel virus. Methods: Individuals aged >/=12 years whose clinicians contacted state health departments or the CDC about testing for HRTV infections were screened for recent onset of fever with leukopenia and thrombocytopenia. A questionnaire was administered to collect data on demographics, risk factors, and signs and symptoms; blood samples were tested for the presence of HRTV RNA and neutralizing antibodies. Results: Of 85 individuals enrolled and tested, 16 (19%) had evidence of acute HRTV infection, 1 (1%) had past infection, and 68 (80%) had no infection. Patients with acute HRTV disease were residents of 7 states, 12 (75%) were male, and the median age (range) was 71 (43-80) years. Illness onset occurred from April to September. The majority reported fatigue, anorexia, nausea, headache, confusion, arthralgia, or myalgia. Fourteen (88%) cases were hospitalized; 2 (13%) died. Fourteen (88%) participants reported finding a tick on themselves in the 2 weeks before illness onset. HRTV-infected individuals were significantly older (P < .001) and more likely to report an attached tick (P = .03) than uninfected individuals. Conclusions: Health care providers should consider HRTV disease testing in patients with an acute febrile illness with either leukopenia or thrombocytopenia not explained by another condition or who were suspected to have a tickborne disease but did not improve following appropriate treatment.

  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. Is India's public health care system prepared for cervical cancer screening?: Evaluating facility readiness from the fourth round of the District Level Household and Facility Survey (DLHS-4)external icon
        Dhillon PK, Hallowell B, Agrawal S, Ghosh A, Yadav A, Van Dyne E, Senkomago V, Patel SA, Saraf D, Hariprasad R, Dumka N, Mehrotra R, Saraiya M.
        Prev Med. 2020 May 27:106147.
        India's cervical cancer screening was launched in 2016 and we evaluated baseline facility readiness using nationally representative data from the 2012-13 District Level Household and Facility Survey on 4 tiers of the public health care system - 18,367 sub-health centres (SHC's), 8540 primary health centres (PHC's), 4810 community health centres and 1540 district/sub-divisional hospitals. To evaluate facility readiness we used the Improving Data for Decision Making in Global Cervical Cancer Programmes toolkit on six domains - potential staffing, infrastructure, equipment and supplies, infection prevention, medicines and laboratory testing, and data management. Composite scores were created by summing responses within domains, standardizing scores across domains at each facility level, and averaging across districts/states. Overall, readiness scores were low for cervical cancer screening. At SHC's, the lowest scores were observed in 'infrastructure' (0.55) and 'infection prevention' (0.44), while PHC's had low 'potential staffing' scores (0.50) due to limited manpower to diagnose and treat (cryotherapy) potential cases. Scores were higher for tiers conducting diagnostic work-up and treatment/referral. The highest scores were in 'potential staffing' except for PHC's, while the lowest scores were in 'infection & prevention' and 'medicines and laboratory'. Goa and Maharashtra were consistently top 5 ranking states for readiness. Substantial heterogeneity in facility readiness for cervical cancer screening spans states and tiers of India's public healthcare system. Infrastructure and staffing are large barriers to screening at PHCs, which are crucial for referral of high-risk patients. Our results suggest focus areas in cervical cancer screening at the district level for policy makers.

    • Communicable Diseases
      1. Blood transfusion safety in the country of Georgia: collateral benefit from a national hepatitis C elimination programexternal icon
        Bloch EM, Kipiani E, Shadaker S, Alkhazashvili M, Gvinjilia L, Kuchuloria T, Chitadze N, Keating SM, Gamkrelidze A, Turdziladze A, Getia V, Nasrullah M, Averhoff F, Izoria M, Skaggs B.
        Transfusion. 2020 .
        BACKGROUND: In April 2015, the government of Georgia (country) initiated the worldʼs first national hepatitis C elimination program. An analysis of blood donor infectious screening data was conducted to inform a strategic plan to advance blood transfusion safety in Georgia. STUDY DESIGN AND METHODS: Descriptive analysis of blood donation records (2015-2017) was performed to elucidate differences in demographics, donor type, remuneration status, and seroprevalence for infectious markers (hepatitis C virus antibody [anti-HCV], human immunodeficiency virus [HIV], hepatitis B virus surface antigen [HBsAg], and Treponema pallidum). For regression analysis, final models included all variables associated with the outcome in bivariate analysis (chi-square) with a p value of less than 0.05. RESULTS: During 2015 to 2017, there were 251,428 donations in Georgia, representing 112,093 unique donors; 68.5% were from male donors, and 51.2% of donors were paid or replacement (friends or family of intended recipient). The overall seroprevalence significantly declined from 2015 to 2017 for anti-HCV (2.3%-1.4%), HBsAg (1.5%-1.1%), and T. pallidum (1.1%-0.7%) [p < 0.0001]; the decline was not significant for HIV (0.2%-0.1%). Only 41.0% of anti-HCV seropositive donors underwent additional testing to confirm viremia. Infectious marker seroprevalence varied by age, sex, and geography. In multivariable analysis, first-time and paid donor status were associated with seropositivity for all four infectious markers. CONCLUSION: A decline during the study period in infectious markers suggests improvement in blood safety in Georgia. Areas that need further improvement are donor recruitment, standardization of screening and diagnostic follow-up, quality assurance, and posttransfusion surveillance.

      2. Filling the gaps in the Peruvian care continuum for HIV-infected pregnant mothers: a case-control study in metropolitan Lima-Callao, Peruexternal icon
        Byelca H, Ken K, Bayer AM, Condor DF, Patricia S, Carcamo CP, Aral SO, Blanchard JF, Garcia PJ.
        Int J STD AIDS. 2020 Jun 2.
        Mother-to-child transmission of HIV (MTCT) accounts for a significant proportion of new HIV infections in Peru. The purpose of this case-control study was to examine maternal and infant factors associated with MTCT in Peru from 2015 to 2016. For each biologically confirmed case infant, we randomly selected four birth year- and birth hospital-matched controls from five hospitals in Lima-Callao. Maternal and infant information were gathered from medical records. Simple conditional logistic regression was utilized to examine possible maternal and infant characteristics associated with MTCT. The rate of MTCT was 6.9% in 2015 and 2.7% in 2016. A total of 63 matched controls were identified for 18 cases. Protective factors included higher number of prenatal visits (odds ratio [OR]: 0.72; 95% confidence interval [CI]: 0.55-0.94, p = 0.012) and having more children (OR: 0.10, 95% CI: 0.01-0.79, p = 0.029). Risk factors included later maternal diagnosis (OR: 1.19; 95% CI: 1.06-1.34; p = 0.001) and greater viral load at the time of maternal diagnosis (OR: 1.05; 95% CI: 1.01-1.10; p = 0.022). Our study highlights the importance of targeting early and continued prenatal care as specific areas to target to prevent gaps in the HIV treatment cascade for pregnant HIV-infected women. These strategies can ensure early screening and initiation of antiretroviral therapy to reduce MTCT rates.

      3. On the benefits of flattening the curve: A perspectiveexternal icon
        Feng Z, Glasser JW, Hill AN.
        Math Biosci. 2020 May 27;326:108389.
        The many variations on a graphic illustrating the impact of non-pharmaceutical measures to mitigate pandemic influenza that have appeared in recent news reports about COVID-19 suggest a need to better explain the mechanism by which social distancing reduces the spread of infectious diseases. And some reports understate one benefit of reducing the frequency or proximity of interpersonal encounters, a reduction in the total number of infections. In hopes that understanding will increase compliance, we describe how social distancing (a) reduces the peak incidence of infections, (b) delays the occurrence of this peak, and (c) reduces the total number of infections during epidemics. In view of the extraordinary efforts underway to identify existing medications that are active against SARS-CoV-2 and to develop new antiviral drugs, vaccines and antibody therapies, any of which may have community-level effects, we also describe how pharmaceutical interventions affect transmission.

      4. Knowledge and practices regarding safe household cleaning and disinfection for COVID-19 prevention - United States, May 2020external icon
        Gharpure R, Hunter CM, Schnall AH, Barrett CE, Kirby AE, Kunz J, Berling K, Mercante JW, Murphy JL, Garcia-Williams AG.
        MMWR Morb Mortal Wkly Rep. 2020 Jun 12;69(23):705-709.
        A recent report described a sharp increase in calls to poison centers related to exposures to cleaners and disinfectants since the onset of the coronavirus disease 2019 (COVID-19) pandemic (1). However, data describing cleaning and disinfection practices within household settings in the United States are limited, particularly concerning those practices intended to prevent transmission of SARS-CoV-2, the virus that causes COVID-19. To provide contextual and behavioral insight into the reported increase in poison center calls and to inform timely and relevant prevention strategies, an opt-in Internet panel survey of 502 U.S. adults was conducted in May 2020 to characterize knowledge and practices regarding household cleaning and disinfection during the COVID-19 pandemic. Knowledge gaps were identified in several areas, including safe preparation of cleaning and disinfectant solutions, use of recommended personal protective equipment when using cleaners and disinfectants, and safe storage of hand sanitizers, cleaners, and disinfectants. Thirty-nine percent of respondents reported engaging in nonrecommended high-risk practices with the intent of preventing SARS-CoV-2 transmission, such as washing food products with bleach, applying household cleaning or disinfectant products to bare skin, and intentionally inhaling or ingesting these products. Respondents who engaged in high-risk practices more frequently reported an adverse health effect that they believed was a result of using cleaners or disinfectants than did those who did not report engaging in these practices. Public messaging should continue to emphasize evidence-based, safe practices such as hand hygiene and recommended cleaning and disinfection of high-touch surfaces to prevent transmission of SARS-CoV-2 in household settings (2). Messaging should also emphasize avoidance of high-risk practices such as unsafe preparation of cleaning and disinfectant solutions, use of bleach on food products, application of household cleaning and disinfectant products to skin, and inhalation or ingestion of cleaners and disinfectants.

      5. Impact of the COVID-19 pandemic on emergency department visits - United States, January 1, 2019-May 30, 2020external icon
        Hartnett KP, Kite-Powell A, DeVies J, Coletta MA, Boehmer TK, Adjemian J, Gundlapalli AV.
        MMWR Morb Mortal Wkly Rep. 2020 Jun 12;69(23):699-704.
        On March 13, 2020, the United States declared a national emergency to combat coronavirus disease 2019 (COVID-19). As the number of persons hospitalized with COVID-19 increased, early reports from Austria (1), Hong Kong (2), Italy (3), and California (4) suggested sharp drops in the numbers of persons seeking emergency medical care for other reasons. To quantify the effect of COVID-19 on U.S. emergency department (ED) visits, CDC compared the volume of ED visits during four weeks early in the pandemic March 29-April 25, 2020 (weeks 14 to 17; the early pandemic period) to that during March 31-April 27, 2019 (the comparison period). During the early pandemic period, the total number of U.S. ED visits was 42% lower than during the same period a year earlier, with the largest declines in visits in persons aged </=14 years, females, and the Northeast region. Health messages that reinforce the importance of immediately seeking care for symptoms of serious conditions, such as myocardial infarction, are needed. To minimize SARS-CoV-2, the virus that causes COVID-19, transmission risk and address public concerns about visiting the ED during the pandemic, CDC recommends continued use of virtual visits and triage help lines and adherence to CDC infection control guidance.

      6. Adverse outcomes in pregnant women hospitalized with respiratory syncytial virus infection: A case-seriesexternal icon
        Hause AM, Panagiotakopoulos L, Weintraub E, Sy LS, Glenn SC, Tseng HF, McNeil MM.
        Clin Infect Dis. 2020 Jun 2.
        We identified 10 women hospitalized with RSV infection during pregnancy. Diagnoses included pneumonia/atelectasis (five), respiratory failure (two), and sepsis (two). Six had obstetrical complications during hospitalization, including one induced preterm birth. One required intensive care unit admission and mechanical ventilation. Four infants had complications at birth.

      7. SARS-CoV-2 infections and serologic responses from a sample of U.S. Navy service members - USS Theodore Roosevelt, April 2020external icon
        Payne DC, Smith-Jeffcoat SE, Nowak G, Chukwuma U, Geibe JR, Hawkins RJ, Johnson JA, Thornburg NJ, Schiffer J, Weiner Z, Bankamp B, Bowen MD, MacNeil A, Patel MR, Deussing E, CDC COVID-19 Surge Laboratory Group , Gillingham BL.
        MMWR Morb Mortal Wkly Rep. 2020 Jun 12;69(23):714-721.
        Compared with the volume of data on coronavirus disease 2019 (COVID-19) outbreaks among older adults, relatively few data are available concerning COVID-19 in younger, healthy persons in the United States (1,2). In late March 2020, the aircraft carrier USS Theodore Roosevelt arrived at port in Guam after numerous U.S. service members onboard developed COVID-19. In April, the U.S. Navy and CDC investigated this outbreak, and the demographic, epidemiologic, and laboratory findings among a convenience sample of 382 service members serving aboard the aircraft carrier are reported in this study. The outbreak was characterized by widespread transmission with relatively mild symptoms and asymptomatic infection among this sample of mostly young, healthy adults with close, congregate exposures. Service members who reported taking preventive measures had a lower infection rate than did those who did not report taking these measures (e.g., wearing a face covering, 55.8% versus 80.8%; avoiding common areas, 53.8% versus 67.5%; and observing social distancing, 54.7% versus 70.0%, respectively). The presence of neutralizing antibodies, which represent antibodies that inhibit SARS-CoV-2, among the majority (59.2%) of those with antibody responses is a promising indicator of at least short-term immunity. This report improves the understanding of COVID-19 in the U.S. military and among young adults in congregate settings and reinforces the importance of preventive measures to lower risk for infection in similar environments.

      8. Screening and linkage to care for hepatitis C among inpatients in Georgia's national hospital screening programexternal icon
        Shadaker S, Nasrullah M, Gamkrelidze A, Ray J, Gvinjilia L, Kuchuloria T, Butsashvili M, Getia V, Metreveli D, Tsereteli M, Tsertsvadze T, Link-Gelles R, Millman AJ, Turdziladze A, Averhoff F.
        Prev Med. 2020 May 27;138:106153.
        The country of Georgia initiated an ambitious national hepatitis C elimination program. To facilitate elimination, a national hospital hepatitis C screening program was launched in November 2016, offering all inpatients screening for HCV infection. This analysis assesses the effectiveness of the first year of the screening program to identify HCV-infected persons and link them to care. Data from Georgia's electronic Health Management Information System and ELIMINATION-C treatment database were analyzed for patients aged >/=18 years hospitalized from November 1, 2016 to October 31, 2017. We described patient characteristics and screening results and compared linked-to-care patients to those not linked to care, defined as having a test for viremia following an HCV antibody (anti-HCV) positive hospital screening. Of 291,975 adult inpatients, 252,848 (86.6%) were screened. Of them, 4.9% tested positive, with a high of 17.4% among males aged 40-49. Overall, 19.8% of anti-HCV+ patients were linked to care, which differed by sex (20.6% for males vs. 18.4% for females; p = .019), age (23.9% for age 50-59 years vs. 10.7% for age >/= 70 years; p < .0001), and length of hospitalization (21.8% among patients hospitalized for 1 day vs. 16.1% for those hospitalized 11+ days; p = .023). Redundant screening is a challenge; 15.6% of patients were screened multiple times and 27.6% of anti-HCV+ patients had a prior viremia test. This evaluation demonstrates that hospital-based screening programs can identify large numbers of anti-HCV+ persons, supporting hepatitis C elimination. However, low linkage-to-care rates underscore the need for screening programs to be coupled with effective linkage strategies.

      9. OBJECTIVES: People living with human immunodeficiency virus (HIV) have an increased risk of other infections, including viral hepatitis, which can complicate the treatment and progression of the disease. We sought to characterize Alabama cases of HIV co-infected with hepatitis C virus or hepatitis B virus. METHODS: Using surveillance data, we defined co-infection as a person identified as having hepatitis C or hepatitis B and HIV during 2007-2016. We compared demographics, outcomes, and risk factors for co-infected versus monoinfected individuals with HIV. We mapped co-infected individuals' distribution. RESULTS: Of 5824 people with HIV, 259 (4.4%) were co-infected with hepatitis C (antibody or RNA positive) and 145 (2.5%) with hepatitis B (surface antigen, e antigen, or DNA positive) during 2007-2016. Individuals with HIV and hepatitis C had a greater odds of injection drug use (adjusted odds ratio 9.7; 95% confidence interval 6.0-15.5). Individuals with HIV and hepatitis B had a greater odds of male-to-male sexual contact (adjusted odds ratio 1.7; 95% confidence interval 1.1-2.6). Co-infection was greater in urban public health districts. CONCLUSIONS: We identified risk behaviors among Alabama populations associated with increased odds for HIV and viral hepatitis co-infection. Outreach, prevention, testing, and treatment resources can be targeted to these populations.

      10. Notes from the field: Measles outbreak on an army post and a neighboring community - El Paso, Texas, July-September 2019external icon
        Vance J, Gonzalez F, Estrada E, Ocaranza HI, Clemmons N, Palacios V.
        MMWR Morb Mortal Wkly Rep. 2020 Jun 12;69(23):722-723.

    • Disaster Control and Emergency Services
      1. Planning for epidemics and pandemics: assessing the potential impact of extended use and reuse strategies on respirator usage rates to support supply-and-demand planning effortsexternal icon
        Yorio PL, Fisher EM, Kilinc-Balci FS, Rottach D, Harney J, Seaton M, Dahm MM, Niemeier T.
        J Int Soc Respir Prot. 2020 Apr;37(1):52-60.
        During epidemics and pandemics healthcare personnel (HCP) are on the front line of disease containment and mitigation. Personal protective equipment (PPE), such as NIOSH-approved N95 filtering facepiece respirators (FFRs), serve an important role in minimizing HCP risks and are in high demand during public health emergencies. Because PPE demand can exceed supply, various public health strategies have been developed to reduce the rate of PPE consumption as supply dwindles. Extended use and limited reuse of N95 FFRs are strategies advocated by many governmental agencies used to increase the number of times a device can be used. Increased use of respirators designed for reuse-such as powered air-purifying respirators (PAPRs) and elastomeric half-mask and full facepiece air-purifying respirators- is another option designed to reduce the continuous need for new devices as the daily need for respirator use increases. Together, these strategies are designed to reduce the number of PPE units that must be discarded daily and, therefore, extend the longevity of available supply. The purpose of this paper is to theoretically estimate the impact of extended use and limited reuse strategies for N95 FFRs and the increased use of reusable respirator options on PPE consumed. The results suggest that a considerable reduction in PPE consumption would result from extended use and limited reuse of N95 FFRs and the increased use of respirators designed for reuse; however, the practical benefits must be balanced with the risks and economic costs. In addition, extended use and reuse strategies must be accompanied by proper procedures to reduce risk. The study is designed to support epidemic and pandemic PPE supply and demand planning efforts.

    • Environmental Health
      1. This review utilizes the robust database of literature contained in toxicological profiles developed by the Agency for Toxic Substances and Disease Registry. The aim was to use this database to identify developmental toxicity studies reporting alterations in hormone levels in the developing fetus and offspring and identify windows of sensitivity. We identified 74 oral exposure studies in rats that provided relevant information on 30 chemicals from 21 profiles. Most studies located provided information on thyroid hormones, with fewer studies on anterior pituitary, adrenal medulla, ovaries, and testes. No studies pertaining to hormones of the posterior pituitary, pancreas, or adrenal cortex were located. The results demonstrate that development of the endocrine system may be affected by exposure to environmental contaminants at many different points, including gestational and/or lactational exposure. Moreover, this review demonstrates the need for more developmental toxicity studies focused on the endocrine system and specifically alterations in hormone levels.

      2. Associations of per- and polyfluoroalkyl substances (PFAS) with glucose tolerance during pregnancy in Project Vivaexternal icon
        Preston EV, Rifas-Shiman SL, Hivert MF, Zota AR, Sagiv SK, Calafat AM, Oken E, James-Todd T.
        J Clin Endocrinol Metab. 2020 Jun 1.
        CONTEXT: Per- and polyfluoroalkyl substances (PFAS) exposure may alter glucose homeostasis. Research on PFAS exposure and glucose tolerance during pregnancy is limited. OBJECTIVE: Estimate associations between first trimester plasma PFAS concentrations and glucose tolerance assessed in late second pregnancy trimester. DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOME MEASURES: Pregnant women (n=1,540) enrolled in Project Viva in 1999-2002 provided first trimester plasma samples analyzed for eight PFAS. At ~28 weeks gestation, women completed 1-hr non-fasting, 50-g oral glucose challenge tests (GCT); if abnormal, women completed subsequent 3-hour oral glucose tolerance tests (OGTT) to screen for gestational diabetes mellitus (GDM). We assessed both continuous GCT glucose levels and four categories of glucose tolerance [normal glycemia (reference), isolated hyperglycemia, impaired glucose tolerance, GDM]. We used multinomial logistic regression to estimate associations of PFAS with glucose tolerance categories. We used multivariable linear regression and Bayesian kernel machine regression (BKMR) to assess individual and joint effects of PFAS on continuous GCT glucose levels, respectively. We evaluated effect modification by maternal age and race/ethnicity. RESULTS: PFAS were not associated with glucose tolerance categories. In BKMR analyses, we observed a positive association between ln-perfluorooctane sulfonate (PFOS) and glucose levels (Delta25th to 75th percentile: 6.2 mg/dL, 95% credible interval: 1.1, 11.3) and an inverse-U shaped association between 2-(N-perfluorooctane sulfonamide) acetate (MeFOSAA) and glucose levels. Individual linear regression results were similar. We found suggestive evidence that associations varied by age and racial/ethnic group. CONCLUSION: Certain PFAS may alter glucose homeostasis during pregnancy, but may not be associated with overt GDM.

    • Epidemiology and Surveillance
      1. An evaluation of syndromic surveillance-related practices among selected state and local health agenciesexternal icon
        Romano S, Yusuf H, Davis C, Thomas MJ, Grigorescu V.
        J Public Health Manag Pract. 2020 Jun 2.
        CONTEXT: Syndromic surveillance consists of the systematic collection and use of near real-time data about health-related events for situational awareness and public health action. As syndromic surveillance programs continue to adopt new technologies and expand, it is valuable to evaluate these syndromic surveillance systems and practices to ensure that they meet public health needs. OBJECTIVE: This assessment's aim is to provide recent information about syndromic surveillance systems and practice characteristics among a group of state and local health departments. DESIGN/SETTING: Information was obtained between November 2017 and June 2018 through a telephone survey using an Office of Management and Budget-approved standardized data collection tool. Participants were syndromic surveillance staff from each of 31 state and local health departments participating in the National Syndromic Surveillance Program funded by the Centers for Disease Control and Prevention. Questions included jurisdictional experience, data sources and analysis systems used, syndromic system data processing characteristics, data quality verification procedures, and surveillance activities conducted with syndromic data. MEASURES: Practice-specific information such as types of systems and data sources used for syndromic surveillance, data quality monitoring, and uses of data for public health situational awareness (eg, investigating occurrences of or trends in diseases). RESULTS: The survey analysis revealed a wide range of experiences with syndromic surveillance. Participants reported the receipt of data daily or more frequently. Emergency department data were the primary data source; however, other data sources are being integrated into these systems. All health departments routinely monitored data quality. Syndromes of highest priority across the respondents for health events monitoring were influenza-like illness and drug-related syndromes. However, a wide variety of syndromes were reported as priorities across the health departments. CONCLUSION: Overall, syndromic surveillance was relevantly integrated into the public health surveillance infrastructure. The near real-time nature of the data and its flexibility to monitor different types of health-related issues make it especially useful for public health practitioners. Despite these advances, syndromic surveillance capacity, locally and nationally, must continue to evolve and progress should be monitored to ensure that syndromic surveillance systems and data are optimally able to meet jurisdictional needs.

    • Healthcare Associated Infections
      1. Unsafe water, sanitation, and hygiene (WASH) conditions in healthcare facilities (HCFs) can increase the risk of disease transmission, yet WASH coverage is inadequate in HCFs in most low-and middle-income countries. In September 2017, we conducted a baseline survey ofWASH coverage in 100 HCFs in three rural Tanzanian districts. Based on needs calculated from the baseline, we distributed handwashing and drinking water stations, soap, and chlorine solution; we repeated the survey 10 months later. The intervention improved coverage with handwashing stations (82% vs. 100%, p < 0.0001), handwashing stations with water (59% vs. 96%, p < 0.0001), handwashing stations with soap and water (19% vs. 46%, p < 0.0001), and handwashing stations with soap and water within 5 m of latrines (26% vs. 53%, p < 0.0001). Coverage of drinking water stations increased from 34% to 100% (p < 0.0001) HCFs with at least one drinking water station with free chlorine residual (FCR) > 0.2mg/ml increased from 6% to 36% (p < 0.0001), and in a sample of HCFs, detectable E. coli in stored drinking water samples decreased from 46% to 5% (p < 0.001). Although the program increased access to handwashing stations, drinking water stations, and safe drinking water in HCFs in rural Tanzania, modest increases in soap availability and water treatment highlighted persistent challenges.

      2. Development and application of a core genome multilocus sequence typing scheme for the healthcare-associated pathogen Pseudomonas aeruginosaexternal icon
        Stanton RA, McAllister G, Daniels JB, Breaker E, Vlachos N, Gable P, Moulton-Meissner H, Halpin AL.
        J Clin Microbiol. 2020 Jun 3.
        Pseudomonas aeruginosa is an opportunistic human pathogen that frequently causes healthcare-associated infections (HAIs). Due to its metabolic diversity and ability to form biofilms, this gram negative, non-fermenter can persist in the healthcare environment, which can lead to prolonged HAI outbreaks. We describe the creation of a core genome MLST (cgMLST) scheme to provide a stable platform for the rapid comparison of P. aeruginosa isolates using whole genome sequencing (WGS) data. We used a diverse set of 58 complete P. aeruginosa genomes to curate a set of 4400 core genes found in each isolate, representing approximately 65% of the average genome size. We then expanded the alleles for each gene using 1991 contig-level genome sequences. The scheme was used to analyze genomes from four historical HAI outbreaks to compare the phylogenies generated using cgMLST to those of other means (traditional MLST, PFGE, and SNV analysis). The cgMLST scheme provides sufficient resolution for analyzing individual outbreaks, as well as the stability for comparisons across a variety of isolates encountered in surveillance studies, making it a valuable tool for the rapid analysis of P. aeruginosa genomes.

      3. Prescriber perceptions of fluoroquinolones, extended-spectrum cephalosporins, and Clostridioides difficile infectionexternal icon
        Szymczak JE, Muller BM, Shakamuri NS, Hamilton KW, Gerber JS, Laguio-Vila M, Dumyati GK, Fridkin SK, Guh AY, Reddy SC, Lautenbach E.
        Infect Control Hosp Epidemiol. 2020 May 29:1-7.
        BACKGROUND: Fluoroquinolones (FQs) and extended-spectrum cephalosporins (ESCs) are associated with higher risk of Clostridioides difficile infection (CDI). Decreasing the unnecessary use of FQs and ESCs is a goal of antimicrobial stewardship. Understanding how prescribers perceive the risks and benefits of FQs and ESCs is needed. METHODS: We conducted interviews with clinicians from 4 hospitals. Interviews elicited respondent perceptions about the risk of ESCs, FQs, and CDI. Interviews were audio recorded, transcribed, and analyzed using a flexible coding approach. RESULTS: Interviews were conducted with 64 respondents (38 physicians, 7 nurses, 6 advance practice providers, and 13 pharmacists). ESCs and FQs were perceived to have many benefits, including infrequent dosing, breadth of coverage, and greater patient adherence after hospital discharge. Prescribers stated that it was easy to make decisions about these drugs, so they were especially appealing to use in the context of time pressures. They described having difficulty discontinuing these drugs when prescribed by others due to inertia and fear. Prescribers were skeptical about targeting specific drugs as a stewardship approach and felt that the risk of a negative outcome from under treatment of a suspected bacterial infection was a higher priority than the prevention of CDI. CONCLUSIONS: Prescribers in this study perceived many advantages to using ESCs and FQs, especially under conditions of time pressure and uncertainty. In making decisions about these drugs, prescribers balance risk and benefit, and they believed that the risk of CDI was acceptable in compared with the risk of undertreatment.

    • Immunity and Immunization
      1. Seroprevalence of chronic hepatitis B virus infection and immunity to measles, rubella, tetanus and diphtheria among schoolchildren aged 6-7 years old in the Solomon Islands, 2016external icon
        Breakwell L, Anga J, Cooley G, Ropiti L, Gwyn S, Wannemuehler K, Woodring J, Ogaoga D, Martin D, Patel M, Tohme RA.
        Vaccine. 2020 May 27.
        The Western Pacific Region (WPR) established a goal to decrease chronic hepatitis B virus (HBV) infection among children to <1% and to achieve >/=95% hepatitis B vaccine birth dose (HepB-BD) and >/=95% three-dose (HepB3) coverage by 2017. In 2016, we conducted a national serosurvey in the Solomon Islands among 6-7-year-old school children to assess progress towards the control goal and immunity to measles, rubella, tetanus and diphtheria. Eighty schools were selected systematically proportional to their 6-7-year-old population; all 6-7-year-olds were enrolled. We collected basic demographic information and vaccination history. Children were tested for HBV surface antigen (HBsAg) using a rapid test, and for immunity to measles, rubella, tetanus, and diphtheria using a multiplex bead assay. In total, 1,249 out of 1,492 children (84%) were enrolled, among whom 1,169 (94%) underwent HBsAg testing and 1,156 (93%) provided dried blood spots. Almost 80% (n = 982) of enrolled children had vaccination cards, among whom 59% (n = 584) received a timely HepB-BD (within 24 hours of birth), 95% (n = 932) received HepB3, and >90% received vaccines for diphtheria, tetanus, and measles (rubella vaccine was not available at the time). HBsAg prevalence was 3.1% (95% confidence interval (CI): 2.0%-4.9%), with 55% of identified cases from one province. Among 982 children with vaccination cards, HBsAg prevalence was higher among children who had not received a timely HepB-BD and at least two HepB doses compared to those who had (4% vs. 2%). Of 1,156 tested children, immunoprotection estimates were 99% (95% CI: 98%-99%) for measles, 99% (95% CI: 97%-100%) for rubella, 85% (95% CI: 83%-87%) for tetanus, and 51% (95% CI: 47%-55%) for diphtheria. Improving timely HepB-BD coverage and maintaining high HepB3 coverage could help Solomon Islands reach the regional HBV control goal. Low immunity to tetanus and diphtheria suggests the need to introduce booster doses to ensure long-term protection.

    • Laboratory Sciences
      1. Evaluation of a new criterion for detecting prion disease with diffusion magnetic resonance imagingexternal icon
        Bizzi A, Pascuzzo R, Blevins J, Grisoli M, Lodi R, Moscatelli ME, Castelli G, Cohen ML, Schonberger LB, Foutz A, Safar JG, Appleby BS, Gambetti P.
        JAMA Neurol. 2020 Jun 1.
        Importance: Early diagnosis is a requirement for future treatment of prion diseases. Magnetic resonance imaging (MRI) with diffusion-weighted images and improved real-time quaking-induced conversion (RT-QuIC) in cerebrospinal fluid (CSF) have emerged as reliable tests. Objectives: To assess the sensitivity and specificity of diffusion MRI for the diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) with a new criterion (index test) of at least 1 positive brain region among the cortex of the frontal, parietal, temporal, and occipital lobes; the caudate; the putamen; and the thalamus. Design, Setting, and Participants: This diagnostic study with a prospective and a retrospective arm was performed from January 1, 2003, to October 31, 2018. MRIs were collected from 1387 patients with suspected sCJD consecutively referred to the National Prion Disease Pathology Surveillance Center as part of a consultation service. Intervention: Magnetic resonance imaging. Four neuroradiologists blinded to the diagnosis scored the MRIs of 200 randomly selected patients. One neuroradiologist scored the MRIs of all patients. Main Outcomes and Measures: Sensitivity and specificity of the index test compared with currently used criteria and CSF diagnostic (improved RT-QuIC, 14-3-3, and tau CSF tests). Results: A total of 872 patients matched the inclusion criteria (diffusion MRI and autopsy-confirmed diagnosis), with 619 having sCJD, 102 having other prion diseases, and 151 having nonprion disease. The primary analysis included 200 patients (mean [SD] age, 63.6 [12.9] years; 100 [50.0%] male). Sensitivity of the index test of 4 neuroradiologists was 90% to 95% and superior to sensitivity of current MRI criteria (69%-76%), whereas specificity was 90% to 100% and unchanged. Interrater reliability of the 4 neuroradiologists was high (kappa = 0.81), and individual intrarater reliability was excellent (kappa >/=0.87). The sensitivity of the index test of 1 neuroradiologist for 770 patients was 92.1% (95% CI, 89.7%-94.1%) and the specificity was 97.4% (95% CI, 93.4%-99.3%) compared with a sensitivity of 69.8% (95% CI, 66.0%-73.4%; P < .001) and a specificity of 98.0% (95% CI, 94.3%-99.6%; P > .99) according to the current criteria. For 88 patients, index test sensitivity (94.9%; 95% CI, 87.5%-98.6%) and specificity (100%; 95% CI, 66.4%-100%) were similar to those of improved RT-QuIC (86.1% [95% CI, 76.5%-92.8%] and 100% [95% CI, 66.4%-100%], respectively). Lower specificities were found for 14-3-3 and tau CSF tests in 452 patients. Conclusions and Relevance: In this study, the diagnostic performance of diffusion MRI with the new criterion was superior to that of current standard criteria and similar to that of improved RT-QuIC. These results may have important clinical implications because MRI is noninvasive and typically prescribed at disease presentation.

      2. How ISG15 combats viral infectionexternal icon
        Freitas BT, Scholte FE, Bergeron E, Pegan SD.
        Virus Res. 2020 May 31:198036.
        Interferon (IFN)-stimulated gene product 15 (ISG15) is a ubiquitin-like protein critical for the control of microbial infections. ISG15 appears to serve a wide variety of functions, which regulate multiple cellular responses contributing to the development of an antiviral state. ISG15 is a versatile molecule directly modulating both host and virus protein function which regulate many signaling pathways, including its own synthesis. Here we review the various roles ISG15 plays in the antiviral immune response, and examine the mechanisms by which viruses attempt to mitigate or exploit ISG15 activity.

      3. Detection of Clostridioides difficile by real-time PCR in young children does not predict diseaseexternal icon
        Pahud BA, Hassan F, Harrison CJ, Halasa NB, Chappell JD, Englund JA, Klein EJ, Szilagyi PG, Weinberg GA, Sherman AK, Polage C, Wikswo ME, McDonald LC, Payne DC, Selvarangan R.
        Hosp Pediatr. 2020 Jun 1.
        OBJECTIVES: Diagnosing Clostridioides difficile infections in young children with high asymptomatic colonization is challenging. We compared the frequency of C difficile detection by polymerase chain reaction (PCR) in healthy control (HC) children with those with acute gastroenteritis (AGE) and evaluated fecal-lactoferrin and organism load as possible indicators of true C difficile infection disease. METHODS: Stool was collected from children <2 years old with AGE and from HCs. C difficile was detected by real-time PCR, and lactoferrin was measured by enzyme-linked immunosorbent assay. Clinical data were obtained via interviews and chart review. Mann-Whitney U test and chi(2) tests were used for group comparisons. RESULTS: Of 524 stools collected from 524 children (250 with AGE, 274 HCs), C difficile was detected less in children with AGE (14%, 36 of 250) than in HCs (28%, 76 of 274) stools (P < .0001). Among infants <1 year old (n = 297), C difficile was detected in 18% of children with AGE versus 32% of HCs (P < .005), and among children 1 to 2 years old (n = 227), C difficile was detected in 10% of children with AGE versus 21% of HCs (P < .02). There was no significant difference in C difficile PCR cycle threshold values between children with AGE and HCs or lactoferrin levels in C difficile PCR-positive versus -negative stools. CONCLUSIONS: HC children <2 years of age had higher rates of C difficile detection by PCR than children with AGE; C difficile detection by real-time PCR alone is not a reliable means to diagnose C difficile disease in children <2 years old.

      4. Expert opinion on verification of antimicrobial susceptibility testsexternal icon
        Patel JB, Thomson RB, Alby K, Babady E, Culbreath K, Galas MF, Lockhart SR, Lubbers BV, Morgan M, Richter SS, Sharp S, Shawar RM, Cardenas AM, Esparza G, Hubbard N, Papich MG, Schuetz AN.
        J Clin Microbiol. 2020 Jun 3.
        On behalf of the Clinical and Laboratory Standards Institute (CLSI), the Expert Panel on Microbiology would like to respond to the recent commentary by Kirby and colleagues voicing concerns related to verification of commercial antimicrobial susceptibility testing (AST) for new drugs that are introduced into the clinical laboratory (1).....

      5. Fatal abrin poisoning by injectionexternal icon
        Rinner GR, Watkins SA, Shirazi FM, Fernandez MC, Hess G, Mihalic J, Runcorn S, Waddell V, Ritter J, Reagan-Steiner S, Thomas J, Yip L, Walter FG.
        Clin Toxicol (Phila). 2020 Jun 1:1-3.
        Abrin is a toxin of public health concern due to its lethality, lack of antidote, and potential for use as a bioterrorism agent. Possible routes of exposure include ingestion, inhalation, and injection. Onset of symptoms is often delayed, even in severe cases. In fatal cases, death occurs from multi-organ failure. We describe the clinical course, laboratory, and pathologic findings in a case of fatal human poisoning associated with abrin injection. The Abrus precatorius seeds in this case were obtained via the internet. The Centers for Disease Control and Prevention's Laboratory Response Network detected abrine in the urine confirming abrin exposure in this fatal poisoning.

      6. Update: proposed reference sequences for subtypes of hepatitis E virus (species Orthohepevirus A)external icon
        Smith DB, Izopet J, Nicot F, Simmonds P, Jameel S, Meng XJ, Norder H, Okamoto H, van der Poel WH, Reuter G, Purdy MA.
        J Gen Virol. 2020 May 29.
        In this recommendation, we update our 2016 table of reference sequences of subtypes of hepatitis E virus (HEV; species Orthohepevirus A, family Hepeviridae) for which complete genome sequences are available (Smith et al., 2016). This takes into account subsequent publications describing novel viruses and additional proposals for subtype names; there are now eight genotypes and 36 subtypes. Although it remains difficult to define strict criteria for distinguishing between virus subtypes, and is not within the remit of the International Committee on Taxonomy of Viruses (ICTV), the use of agreed reference sequences will bring clarity and stability to researchers, epidemiologists and clinicians working with HEV.

      7. Development of an RNA strand-specific hybridization assay to differentiate replicating versus nonreplicating influenza A virusesexternal icon
        Yang G, Hodges EN, Winter J, Zanders N, Shcherbik S, Bousse T, Murray JR, Muraduzzaman AK, Rahman M, Alamgir AS, Flora MS, Blanton L, Barnes JR, Wentworth DE, Davis CT.
        J Clin Microbiol. 2020 May 26;58(6).
        Replication of influenza A virus (IAV) from negative-sense viral RNA (vRNA) requires the generation of positive-sense RNA (+RNA). Most molecular assays, such as conventional real-time reverse transcriptase PCR (rRT-PCR), detect total RNA in a sample without differentiating vRNA from +RNA. These assays are not designed to distinguish IAV infection versus exposure of an individual to an environment enriched with IAVs but wherein no viral replication occurs. We therefore developed a strand-specific hybridization (SSH) assay that differentiates between vRNA and +RNA and quantifies relative levels of each RNA species. The SSH assay exhibited a linearity of 7 logs with a lower limit of detection of 6.0 × 10(2) copies of molecules per reaction. No signal was detected in samples with a high load of nontarget template or influenza B virus, demonstrating assay specificity. IAV +RNA was detected 2 to 4 h postinoculation of MDCK cells, whereas synthesis of cold-adapted IAV +RNA was significantly impaired at 37°C. The SSH assay was then used to test IAV rRT-PCR positive nasopharyngeal specimens collected from individuals exposed to IAV at swine exhibitions (n = 7) or while working at live bird markets (n = 2). The SSH assay was able to differentiate vRNA and +RNA in samples collected from infected, symptomatic individuals versus individuals who were exposed to IAV in the environment but had no active viral replication. Data generated with this technique, especially when coupled with clinical data and assessment of seroconversion, will facilitate differentiation of actual IAV infection with replicating virus versus individuals exposed to high levels of environmental contamination but without virus infection.

    • Occupational Safety and Health
      1. Trends in pneumoconiosis deaths - United States, 1999-2018external icon
        Bell JL, Mazurek JM.
        MMWR Morb Mortal Wkly Rep. 2020 Jun 12;69(23):693-698.
        Pneumoconioses are preventable occupational lung diseases caused by inhaling dust particles such as coal dust or different types of mineral dusts (1). To assess recent trends in deaths associated with pneumoconiosis, CDC analyzed multiple cause-of-death data*(,)(dagger) for decedents aged >/=15 years for the years 1999-2018, and industry and occupation data collected from 26 states( section sign) for the years 1999, 2003, 2004, and 2007-2013. During 1999-2018, pneumoconiosis deaths decreased by 40.4%, with the exception of pneumoconiosis attributed to other inorganic dusts (e.g., aluminum, bauxite, beryllium, iron, and tin oxide), which increased significantly (p-value for time trend <0.05). The largest observed decreases in pneumoconiosis deaths were for those associated with coal workers' pneumoconiosis (69.6%) and silicosis (53.0%). Asbestosis was the most frequently reported pneumoconiosis and was associated with working in the construction industry. The ongoing occurrence of deaths associated with pneumoconiosis underscores the importance of occupational dust exposure reduction, early case detection, and continued surveillance to monitor trends.

      2. Work hours and cognitive function: The Multi-Ethnic Study of Atherosclerosisexternal icon
        Charles LE, Fekedulegn D, Burchfiel CM, Fujishiro K, Al Hazzouri AZ, Fitzpatrick AL, Rapp SR.
        Saf Health Work. 2020 .
        Background: Cognitive impairment is a public health burden. Our objective was to investigate associations between work hours and cognitive function. Methods: Multi-Ethnic Study of Atherosclerosis (MESA) participants (n = 2,497; 50.7% men; age range 44–84 years) reported hours per week worked in all jobs in Exams 1 (2000–2002), 2 (2002–2004), 3 (2004–2005), and 5 (2010–2011). Cognitive function was assessed (Exam 5) using the Cognitive Abilities Screening Instrument (version 2), a measure of global cognitive functioning; the Digit Symbol Coding, a measure of processing speed; and the Digit Span test, a measure of attention and working memory. We used a prospective approach and linear regression to assess associations for every 10 hours of work. Results: Among all participants, associations of hours worked with cognitive function of any type were not statistically significant. In occupation-stratified analyses (interaction p = 0.051), longer work hours were associated with poorer global cognitive function among Sales/Office and blue-collar workers, after adjustment for age, sex, physical activity, body mass index, race/ethnicity, educational level, annual income, history of heart attack, diabetes, apolipoprotein E-epsilon 4 allele (ApoE4) status, birth-place, number of years in the United States, language spoken at MESA Exam 1, and work hours at Exam 5 (β = –0.55, 95% CI = –0.99, –0.09) and (β = –0.80, –1.51, –0.09), respectively. In occupation-stratified analyses (interaction p = 0.040), we also observed an inverse association with processing speed among blue-collar workers (adjusted β = –0.80, –1.52, –0.07). Sex, race/ethnicity, and ApoE4 did not significantly modify associations between work hours and cognitive function. Conclusion: Weak inverse associations were observed between work hours and cognitive function among Sales/Office and blue-collar workers.

      3. OBJECTIVES: To improve exposure estimates and reexamine exposure-response relationships between cumulative styrene exposure and cancer mortality in a previously studied cohort of US boatbuilders exposed between 1959 and 1978 and followed through 2016. METHODS: Cumulative styrene exposure was estimated from work assignments and air-sampling data. Exposure-response relationships between styrene and select cancers were examined in Cox proportional hazards models matched on attained age, sex, race, birth cohort and employment duration. Models adjusted for socioeconomic status (SES). Exposures were lagged 10 years or by a period maximising the likelihood. HRs included 95% profile-likelihood CIs. Actuarial methods were used to estimate the styrene exposure corresponding to 10(-4) extra lifetime risk. RESULTS: The cohort (n= 5163) contributed 201 951 person-years. Exposures were right-skewed, with mean and median of 31 and 5.7 ppm-years, respectively. Positive, monotonic exposure-response associations were evident for leukaemia (HR at 50 ppm-years styrene = 1.46; 95% CI 1.04 to 1.97) and bladder cancer (HR at 50 ppm-years styrene =1.64; 95% CI 1.14 to 2.33). There was no evidence of confounding by SES. A working lifetime exposure to 0.05 ppm styrene corresponded to one extra leukaemia death per 10 000 workers. CONCLUSIONS: The study contributes evidence of exposure-response associations between cumulative styrene exposure and cancer. Simple risk projections at current exposure levels indicate a need for formal risk assessment. Future recommendations on worker protection would benefit from additional research clarifying cancer risks from styrene exposure.

      4. Persistent and emerging hazards contributing to work-related fatalities in Alaskaexternal icon
        Lucas D, Fitzgerald E, Case S, O'Connor M, Syron L.
        Am J Ind Med. 2020 Jun 1.
        BACKGROUND: Workers in Alaska have an elevated risk of dying on the job compared to workers in the rest of the United States. The purpose of this study was to measure and describe the trend in fatalities during the 15-year period 2004 to 2018, and to identify lingering and emerging hazards that result in fatalities. METHODS: Data on fatal work-related injuries in Alaska during 2004 to 2018 were obtained from the Alaska Occupational Injury Surveillance System. Descriptive statistics were calculated to identify fatality characteristics. Fatality rates were expressed as the number of deaths per 100 000 workers, and Poisson regression was used to measure the trend during the study period. RESULTS: During 2004 to 2018, there were 517 work-related fatalities in Alaska. The average annual risk of fatalities during the 15-year period was 9.6 per 100 000 workers, with no significant trend. The leading events or exposures resulting in fatal injuries to workers in Alaska during 2004 to 2018 were water vehicle incidents (145, 28.0%), aircraft incidents (105, 20.3%), and suicides (46, 8.9%). The number of suicides and homicides at work increased substantially during the 15-year period. CONCLUSIONS: While deaths due to water vehicle incidents have substantially decreased, they still represent a major component of Alaska's work-related fatality profile. Aviation safety continues to be an area of concern in Alaska. Unintentional drug overdoses at work, as well as workplace violence in the form of suicides and homicides, represent emerging issues that need the attention of Alaskan occupational safety stakeholders. These findings can inform and direct fatality prevention research and practice.

    • Occupational Safety and Health - Mining
      1. The environmental risks associated with casing deformation in unconventional (shale) gas wells positioned in abutment pillars of longwall mines is a concern to many in the mining and gas well industry. With the recent interest in shale exploration and the proximity to longwall mining in Southwestern Pennsylvania, the risk to mine workers could be catastrophic as fractures in surrounding strata create pathways for transport of leaked gases. Hence, this research by the National Institute for Occupational Safety and Health (NIOSH) presents an analytical model of the gas transport through fractures in a low permeable stratum. The derived equations are used to conduct parametric studies of specific transport conditions to understand the influence of stratum geology, fracture lengths, and the leaked gas properties on subsurface transport. The results indicated that the prediction that the subsurface gas flux decreases with an increase in fracture length is specifically for a non-gassy stratum. The sub-transport trend could be significantly impacted by the stratum gas generation rate within specific fracture lengths, which emphasized the importance of the stratum geology. These findings provide new insights for improved understanding of subsurface gas transport to ensure mine safety.

      2. Background: Analyzing health risk factors among current workers by industry and occupation (IO) provides information on disparities between worker groups, especially when comparing workers within manual labor occupations. Mining and oil and gas extraction (OGE) are unique industries with different work environments that could affect health risk factors. The study objective was to compare the prevalence of health risk factors of miners, OGE, other manual labor, and nonmanual labor workers. Methods: The Behavioral Risk Factor Surveillance System's IO module was analyzed for years 2013-2017 to compare prevalences of excessive alcohol use, smoking, smokeless tobacco use, seat belt use, inadequate sleep, and obesity among four worker groups. National Health Interview Survey IO codes were used to categorize miners, OGE, other manual labor, and nonmanual labor workers. Findings: Miners and OGE workers had higher prevalence estimates than both nonmanual and manual labor workers for all health risk factors except current smoking. Both miners and OGE workers were significantly more likely than other manual labor workers to report smokeless tobacco use and not always wearing seatbelts. Compared with other manual labor workers, OGE workers were significantly more likely to report obesity, and miners were significantly more likely to report inadequate sleep. Conclusion/Application to Practice: Prevalence of most health risk factors differed among miners, OGE, other manual labor, and nonmanual labor workers. These differences could lead to disparities in health outcomes. Occupational health professionals in mining and OGE can use this information to inform and target integrated wellness and health and safety programs.

    • Parasitic Diseases
      1. Malaria and parasitic neglected tropical diseases: Potential syndemics with COVID-19?external icon
        Gutman JR, Lucchi NW, Cantey PT, Steinhardt LC, Samuels AM, Kamb ML, Kapella BK, McElroy PD, Udhayakumar V, Lindblade KA.
        Am J Trop Med Hyg. 2020 Jun 1.
        The COVID-19 pandemic, caused by SARS-CoV-2, have surpassed 5 million cases globally. Current models suggest that low- and middle-income countries (LMICs) will have a similar incidence but substantially lower mortality rate than high-income countries. However, malaria and neglected tropical diseases (NTDs) are prevalent in LMICs, and coinfections are likely. Both malaria and parasitic NTDs can alter immunologic responses to other infectious agents. Malaria can induce a cytokine storm and pro-coagulant state similar to that seen in severe COVID-19. Consequently, coinfections with malaria parasites and SARS-CoV-2 could result in substantially worse outcomes than mono-infections with either pathogen, and could shift the age pattern of severe COVID-19 to younger age-groups. Enhancing surveillance platforms could provide signals that indicate whether malaria, NTDs, and COVID-19 are syndemics (synergistic epidemics). Based on the prevalence of malaria and NTDs in specific localities, efforts to characterize COVID-19 in LMICs could be expanded by adding testing for malaria and NTDs. Such additional testing would allow the determination of the rates of coinfection and comparison of severity of outcomes by infection status, greatly improving the understanding of the epidemiology of COVID-19 in LMICs and potentially helping to mitigate its impact.

      2. Artemether-lumefantrine efficacy for the treatment of uncomplicated Plasmodium falciparum malaria in Choco, Colombia after 8 years as first-line treatmentexternal icon
        Olivera MJ, Guerra AP, Cortes LJ, Horth RZ, Padilla J, Novoa J, Ade MP, Ljolje D, Lucchi NW, Marquiño W, Renteria M, Yurgaky W, Macedo de Oliveira A.
        Am J Trop Med Hyg. 2020 May;102(5):1056-1063.
        Artemether-lumefantrine (AL) is the first-line treatment for uncomplicated Plasmodium falciparum infection in Colombia. To assess AL efficacy for uncomplicated falciparum malaria in Quibdo, Choco, Colombia, we conducted a 28-day therapeutic efficacy study (TES) following the WHO guidelines. From July 2018 to February 2019, febrile patients aged 5-65 years with microscopy-confirmed P. falciparum mono-infection and asexual parasite density of 250-100,000 parasites/µL were enrolled and treated with a supervised 3-day course of AL. The primary endpoint was adequate clinical and parasitological response (ACPR) on day 28. We attempted to use polymerase chain reaction (PCR) genotyping to differentiate reinfection and recrudescence, and conducted genetic testing for antimalarial resistance-associated genes. Eighty-eight patients consented and were enrolled; four were lost to follow-up or missed treatment doses. Therefore, 84 (95.5%) participants reached a valid endpoint: treatment failure or ACPR. No patient remained microscopy positive for malaria on day 3, evidence of delayed parasite clearance and artemisinin resistance. One patient had recurrent infection (12 parasites/µL) on day 28. Uncorrected ACPR rate was 98.8% (83/84) (95% CI: 93.5-100%). The recurrent infection sample did not amplify during molecular testing, giving a PCR-corrected ACPR of 100% (83/83) (95% CI: 95.7-100%). No P. falciparum kelch 13 polymorphisms associated with artemisinin resistance were identified. Our results support high AL efficacy for falciparum malaria in Choco. Because of the time required to conduct TESs in low-endemic settings, it is important to consider complementary alternatives to monitor antimalarial efficacy and resistance.

    • Public Health Leadership and Management
      1. Community health worker initiatives: An approach to design and measurementexternal icon
        Jayapaul-Philip B, Shantharam SS, Moeti R, Kumar GS, Barbero C, Rohan EA, Mensa-Wilmot Y, Soler R.
        J Public Health Manag Pract. 2020 Jun 1.
        CONTEXT: The Centers for Disease Control and Prevention supports the engagement of community health workers (CHWs) to help vulnerable populations achieve optimum health through a variety of initiatives implemented in several organizational units. PROGRAM: This article provides a unified and comprehensive logic model for these initiatives that also serves as a common framework for monitoring and evaluation. IMPLEMENTATION: We developed a logic model to fully describe the levels of effort needed to effectively and sustainably engage CHWs. We mapped monitoring and evaluation metrics currently used by federally funded organizations to the logic model to assess the extent to which measurement and evaluation are aligned to programmatic efforts. EVALUATION: We found that the largest proportion of monitoring and evaluation metrics (61%) currently used maps to the "CHW intervention level" of the logic model, a smaller proportion (37%) maps to the "health system and community organizational level," and a minimal proportion (3%) to the "statewide infrastructure level." DISCUSSION: Organizations engaging CHWs can use the logic model to guide the design as well as performance measurement and evaluation of their CHW initiatives.

    • Substance Use and Abuse
      1. INTRODUCTION: Rates of opioid overdose (OD) have risen to unprecedented numbers and more than half of incarcerated individuals meet the criteria for substance use disorder, placing them at high risk. This review describes the relationship between incarceration history and OD. METHODS: A scoping review was conducted and criteria for inclusion were: set in North America, published in English, and non-experimental study of formerly incarcerated individuals. Due to inconsistent definitions of opioid OD, we included all studies examining OD where opioids were mentioned. RESULTS: The 18 included studies were all published in 2001 or later. Four associations between incarceration history and OD were identified: (1) six studies assessed incarceration history as a risk factor for OD and four found a significantly higher risk of OD among individuals with a history of incarceration compared to those without; (2) nine studies examined the rate of OD compared to the general population: eight found a significantly higher risk of fatal OD among those with a history of incarceration and three documented the highest risk of death immediately following release; (3) six studies found demographic, substance use and mental health, and incarceration-related risk factors for OD among formerly incarcerated individuals; and (4) four studies assessed the proportion of deaths due to OD and found a range from 5 % to 57 % among formerly incarcerated individuals. DISCUSSION: Findings support the growing call for large-scale implementation of evidence-based OD prevention interventions in correctional settings and among justice-involved populations to reduce OD burden in this high-risk population.

    • Veterinary Medicine
      1. First reported cases of SARS-CoV-2 infection in companion animals - New York, March-April 2020external icon
        Newman A, Smith D, Ghai RR, Wallace RM, Torchetti MK, Loiacono C, Murrell LS, Carpenter A, Moroff S, Rooney JA, Barton Behravesh C.
        MMWR Morb Mortal Wkly Rep. 2020 Jun 12;69(23):710-713.
        On April 22, CDC and the U.S. Department of Agriculture (USDA) reported cases of two domestic cats with confirmed infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). These are the first reported companion animals (including pets and service animals) with SARS-CoV-2 infection in the United States, and among the first findings of SARS-CoV-2 symptomatic companion animals reported worldwide. These feline cases originated from separate households and were epidemiologically linked to suspected or confirmed human COVID-19 cases in their respective households. Notification of presumptive positive animal test results triggered a One Health* investigation by state and federal partners, who determined that no further transmission events to other animals or persons had occurred. Both cats fully recovered. Although there is currently no evidence that animals play a substantial role in spreading COVID-19, CDC advises persons with suspected or confirmed COVID-19 to restrict contact with animals during their illness and to monitor any animals with confirmed SARS-CoV-2 infection and separate them from other persons and animals at home (1).

    • Zoonotic and Vectorborne Diseases
      1. Ensuring ethical data access: the Sierra Leone Ebola Database (SLED) modelexternal icon
        Gorina Y, Redd JT, Hersey S, Jambai A, Meyer P, Kamara AS, Kamara A, Harding JD, Bangura B, Kamara MA.
        Ann Epidemiol. 2020 ;46:1-4.
        Purpose: Organizations responding to the 2014–2016 Ebola epidemic in Sierra Leone collected information from multiple sources and kept it in separate databases, including distinct data systems for Ebola hot line calls, patient information collected by field surveillance officers, laboratory testing results, clinical information from Ebola treatment and isolation facilities, and burial team records. Methods: After the conclusion of the epidemic, the Sierra Leone Ministry of Health and Sanitation and the U.S. Centers for Disease Control and Prevention partnered to collect these disparate records and consolidate them in the Sierra Leone Ebola Database. Results: The Sierra Leone Ebola Database data are providing a lasting resource for postepidemic data analysis and epidemiologic research, including identifying best strategies in outbreak response, and are used to help families locate the graves of family members who died during the epidemic. Conclusion: This report describes the Ministry of Health and Sanitation and Centers for Disease Control and Prevention processes to safeguard Ebola records while making the data available for public health research.

      2. Seoul virus infection and spread in US home-based ratteries-rat and human testing results from a multistate outbreak investigationexternal icon
        Knust B, Brown S, de St Maurice A, Whitmer S, Koske SE, Ervin E, Patel K, Graziano J, Morales-Betoulle ME, House J, Cannon D, Kerins J, Holzbauer S, Austin C, Gibbons-Burgener S, Colton L, Dunn J, Zufan S, Choi MJ, Davis WR, Chiang CF, Manning CR, Roesch L, Shoemaker T, Purpura L, McQuiston J, Peterson D, Radcliffe R, Garvey A, Christel E, Morgan L, Scheftel J, Kazmierczak J, Klena JD, Nichol ST, Rollin PE.
        J Infect Dis. 2020 Jun 2.
        BACKGROUND: During 2017, a multi-state outbreak investigation occurred following the confirmation of Seoul virus (SEOV) infections in people and pet rats. A total of 147 humans and 897 rats were tested. METHODS: In addition to IgG and IgM serology and traditional RT-PCR, novel quantitative RT-PCR primers/probe were developed, and whole genome sequencing was performed. RESULTS: Seventeen people had SEOV IgM, indicating recent infection; seven reported symptoms and three were hospitalized. All patients recovered. Thirty-one facilities in 11 US states had SEOV infection, and among those with >/=10 rats tested, rat IgG prevalence ranged 2-70% and SEOV RT-PCR positivity ranged 0-70%. Human lab-confirmed cases were significantly associated with rat IgG positivity and RT-PCR positivity (p=0.03 and p=0.006, respectively). Genomic sequencing identified >99.5% homology between SEOV sequences in this outbreak, and these were >99% identical to SEOV associated with previous pet rat infections in England, the Netherlands, and France. Frequent trade of rats between home-based ratteries contributed to transmission of SEOV between facilities. CONCLUSIONS: Pet rat owners, breeders, and the healthcare and public health community should be aware and take steps to prevent SEOV transmission in pet rats and to humans. Biosecurity measures and diagnostic testing can prevent further infections.

      3. Neurodevelopmental findings in children 20-30 months of age with postnatal Zika infection at 1-12 months of age, Colombia, September-November 2017external icon
        Pacheco O, Newton SM, Daza M, Cates JE, Reales JA, Burkel VK, Mercado M, Godfred-Cato S, Gonzalez M, Anderson KN, Woodworth KR, Valencia D, Tong VT, Gilboa SM, Osorio MB, Rodriguez DY, Prieto-Alvarado FE, Moore CA, Honein MA, Ospina Martinez ML.
        Paediatr Perinat Epidemiol. 2020 Jun 2.
        BACKGROUND: Zika virus (ZIKV) infection during pregnancy can cause infant brain and eye abnormalities and has been associated with adverse neurodevelopmental outcomes in exposed infants. Evidence is limited on ZIKV's effects on children infected postnatally within the first year of life. OBJECTIVE: To determine whether any adverse neurodevelopmental outcomes occurred in early childhood for children infected postnatally with ZIKV during infancy, given the neurotoxicity of ZIKV infection and the rapid brain development that occurs in infancy and early childhood. METHODS: The Colombia Instituto Nacional de Salud (INS) conducted health and developmental screenings between September and November 2017 to evaluate 60 children at ages 20-30 months who had laboratory-confirmed symptomatic postnatal ZIKV infection at ages 1-12 months. We examined the frequency of adverse neurologic, hearing, eye, and developmental outcomes as well as the relationship between age at Zika symptom onset and developmental outcomes. RESULTS: Nine of the 60 (15.0%) children had adverse outcomes on the neurologic, hearing, or eye examination. Six of the 47 (12.8%) children without these adverse findings, and who received a valid developmental screening, had an alert score in the hearing-language domain which signals the need for additional developmental evaluation. CONCLUSION: Neurologic, hearing, eye, and developmental findings suggest reassuring results. Since the full spectrum of neurodevelopmental outcomes in children postnatally infected with ZIKV remains unknown, routine paediatric care is advised to monitor the development of these children to ensure early identification of any adverse neurodevelopmental outcomes.

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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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