Issue 14, April 11, 2017

CDC Science Clips: Volume 9, Issue 14, April 11, 2017

Each Tuesday, to enhance awareness of emerging scientific knowledge, selected science clips will be posted here for the public health community. The focus is applied public health research and prevention science that has the capacity to improve health now.

  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 RSS Word feed
      • Estimated HIV inter-test interval among people at high risk for HIV infection in the U.SExternal
        An Q, Song R, Finlayson TJ, Wejnert C, Paz-Bailey G.
        Am J Prev Med. 2017 Mar 20.
        INTRODUCTION: Knowing the HIV testing frequency and its temporal changes are central to evaluate public adherence to HIV testing recommendations and performance of HIV prevention programs. This study intended to estimate the mean HIV inter-test interval (ITI) and monitor its trends among men who have sex with men (MSM); people who inject drugs (PWID); and high-risk heterosexuals (HRH). METHODS: Using National HIV Behavioral Surveillance data collected during 2008-2015, this analysis estimated the mean HIV ITI for each year by race/ethnicity and age among MSM, PWID, and HRH who reported the most recent HIV test date. Separate statistical models based on renewal process theory were fit using PROC NLIN with Newton-Raphson method. Estimated mean HIV ITI lengths were compared using the z-test. RESULTS: Estimated HIV ITI generally decreased in the past decade among MSM, PWID, and HRH who reported the most recent HIV test date. In most recent study years, estimated HIV ITI (in months) ranged from 5.8 to 12.5 among MSM, from 9.0 to 13.1 among PWID, and from 15.3 to 26.7 among HRH. Within each risk group, estimated HIV ITI was shortest among blacks and individuals aged 18-24 years. CONCLUSIONS: People at high risk for HIV infection who ever tested for HIV tested more frequently in the past decade. Most recently, MSM and PWID largely adhered to the Centers for Disease Control and Prevention’s HIV testing recommendations, but HRH tested less frequently. Identifying factors associated with infrequent testing among HRH may provide information for future HIV testing initiatives.

      • Applying clinical and public health research to prevent sexually transmitted infectionsExternal
        Truman BI.
        J Public Health Manag Pract. 2017 May/Jun;23(3):239-241.
        [No abstract]
    • Drug Safety RSS Word feed
      • Physician dispensing of oxycodone and other commonly used opioids, 2000-2015, United StatesExternal
        Mack KA, Jones CM, McClure RJ.
        Pain Med. 2017 Mar 15.
        Objective.: An average of 91 people in the United States die every day from an opioid-related overdose (including prescription opioids and heroin). The direct dispensing of opioids from health care practitioner offices has been linked to opioid-related harms. The objective of this study is to describe the changing nature of the volume of this type of prescribing at the state level. Methods.: This descriptive study examines the distribution of opioids by practitioners using 1999-2015 Automation of Reports and Consolidated Orders System data. Analyses were restricted to opioids distributed to practitioners. Amount distributed (morphine milligram equivalents [MMEs]) and number of practitioners are presented. Results.: Patterns of distribution to practitioners and the number of practitioners varied markedly by state and changed dramatically over time. Comparing 1999 with 2015, the MME distributed to dispensing practitioners decreased in 16 states and increased in 35. Most notable was the change in Florida, which saw a peak of 8.94 MMEs per 100,000 persons in 2010 (the highest distribution in all states in all years) and a low of 0.08 in 2013. Discussion.: This study presents the first state estimates of office-based dispensing of opioids. Increases in direct dispensing in recent years may indicate a need to monitor this practice and consider whether changes are needed. Using controlled substances data to identify high prescribers and dispensers of opioids, as well as examining overall state trends, is a foundational activity to informing the response to potentially high-risk clinical practices.

    • Environmental Health RSS Word feed
      • In vitro cytotoxicity assessment of a West Virginia chemical spill mixture involving 4-methylcyclohexanemethanol and propylene glycol phenyl etherExternal
        Han AA, Fabyanic EB, Miller JV, Prediger MS, Prince N, Mouch JA, Boyd J.
        Environ Monit Assess. 2017 Apr;189(4):190.
        Thousands of gallons of industrial chemicals, crude 4-methylcyclohexanemethanol (MCHM) and propylene glycol phenyl ether (PPh), leaked from industrial tanks into the Elk River in Charleston, West Virginia, USA, on January 9, 2014. A considerable number of people were reported to exhibit symptoms of chemical exposure and an estimated 300,000 residents were advised not to use or drink tap water. At the time of the spill, the existing toxicological data of the chemicals were limited for a full evaluation of the health risks, resulting in concern among those in the impacted regions. In this preliminary study, we assessed cell viability and plasma membrane degradation following a 24-h exposure to varying concentrations (0-1000 muM) of the two compounds, alone and in combination. Evaluation of different cell lines, HEK-293 (kidney), HepG2 (liver), H9c2 (heart), and GT1-7 (brain), provided insight regarding altered cellular responses in varying organ systems. Single exposure to MCHM or PPh did not affect cell viability, except at doses much higher than the estimated exposure levels. Certain co-exposures significantly reduced metabolic activity and increased plasma membrane degradation in GT1-7, HepG2, and H9c2 cells. These findings highlight the importance of examining co-exposures to fully understand the potential toxic effects.

    • Food Safety RSS Word feed
      • An updated review of ciguatera fish poisoning: Clinical, epidemiological, environmental, and public health managementExternal
        Friedman MA, Fernandez M, Backer LC, Dickey RW, Bernstein J, Schrank K, Kibler S, Stephan W, Gribble MO, Bienfang P, Bowen RE, Degrasse S, Flores Quintana HA, Loeffler CR, Weisman R, Blythe D, Berdalet E, Ayyar R, Clarkson-Townsend D, Swajian K, Benner R, Brewer T, Fleming LE.
        Mar Drugs. 2017 Mar 14;15(3).
        Ciguatera Fish Poisoning (CFP) is the most frequently reported seafood-toxin illness in the world. It causes substantial human health, social, and economic impacts. The illness produces a complex array of gastrointestinal, neurological and neuropsychological, and cardiovascular symptoms, which may last days, weeks, or months. This paper is a general review of CFP including the human health effects of exposure to ciguatoxins (CTXs), diagnosis, human pathophysiology of CFP, treatment, detection of CTXs in fish, epidemiology of the illness, global dimensions, prevention, future directions, and recommendations for clinicians and patients. It updates and expands upon the previous review of CFP published by Friedman et al. (2008) and addresses new insights and relevant emerging global themes such as climate and environmental change, international market issues, and socioeconomic impacts of CFP. It also provides a proposed universal case definition for CFP designed to account for the variability in symptom presentation across different geographic regions. Information that is important but unchanged since the previous review has been reiterated. This article is intended for a broad audience, including resource and fishery managers, commercial and recreational fishers, public health officials, medical professionals, and other interested parties.

    • Injury and Violence RSS Word feed
    • Laboratory Sciences RSS Word feed
      • Pathogenic events in a nonhuman primate model of oral poliovirus infection leading to paralytic poliomyelitisExternal
        Shen L, Chen CY, Huang D, Wang R, Zhang M, Qian L, Zhu Y, Zhang AZ, Yang E, Qaqish A, Chumakov K, Kouiavskaia D, Vignuzzi M, Nathanson N, Macadam AJ, Andino R, Kew O, Xu J, Chen ZW.
        J Virol. 2017 Mar 29.
        Despite a great deal of prior research, the early pathogenic events in natural oral poliovirus infection remain poorly defined. To establish a model for study, we infected 39 macaques by feeding single high doses of the virulent Mahoney strain of wild type 1 poliovirus. Doses ranging from107-109 TCID50 consistently infected all animals, and most monkeys receiving 108 or 109 TCID50 developed paralysis. There was no apparent difference in the susceptibility of the three macaque species (rhesus, cynomolgus, and bonnet) used. Virus excretion in stool and nasopharynges was consistently observed, with occasional viremia, and virus was isolated from tonsils, gut mucosa, and draining lymph nodes. Viral replication proteins were detected in both epithelial and lymphoid cell populations expressing CD155 in the tonsil and intestine, as well as in spinal cord neurons. Necrosis was observed in these three cell types, and viral replication in tonsil/gut was associated with histopathologic destruction and inflammation. The sustained response of neutralizing antibody correlated temporally with resolution of viremia and termination of virus shedding in oropharynges and feces. For the first time, this model demonstrates that early in the infectious process, poliovirus replication occurs in both epithelial cells (explaining virus shedding in the gastrointestinal tract) and lymphoid/monocytic cells in tonsils and Peyer’s patches (explaining viremia), consistent with previous studies of poliovirus pathogenesis in humans. Because this model recapitulates human poliovirus infection and poliomyelitis, it can be used to study polio pathogenesis, and to assess efficacy of candidate antiviral drugs and new vaccines. IMPORTANCE Early pathogenic events of poliovirus infection remain largely undefined, and there is a lack of animal models mimicking natural oral human infection leading to paralytic poliomyelitis. All of 39 macaques fed with single high doses ranging from 107-109 TCID50 Mahoney type 1 virus were infected, and most monkeys developed paralysis. Virus excretion in stool and nasopharynges was consistently observed, with occasional viremia; tonsil, mesentery lymph nodes and intestinal mucosa served as major target sites of viral replication. For the first time, this model demonstrates that early in the infectious process, poliovirus replication occurs in both epithelial cells (explaining virus shedding in the gastrointestinal tract) and lymphoid/monocytic cells in tonsils and Peyer’s patches (explaining viremia), thereby supplementing historical reconstructions of poliovirus pathogenesis. Because this model recapitulates human poliovirus infection and poliomyelitis, it can be used to study polio pathogenesis, candidate antiviral drugs, and the efficacy of new vaccines.

    • Maternal and Child Health RSS Word feed
      • Population-based pregnancy and birth defects surveillance in the era of Zika virus
        Gilboa SM, Mai CT, Shapiro-Mendoza CK, Cragan JD, Moore CA, Meaney-Delman DM, Jamieson DJ, Honein MA, Boyle CA.
        Birth Defects Research. 2017 ;109(5):372-378.
        Background: Zika virus is a newly recognized human teratogen; monitoring its impact on the birth prevalence of microcephaly and other adverse pregnancy outcomes will continue to be an urgent need in the United States and worldwide. Methods: When the Centers for Disease Control and Prevention (CDC) activated the Emergency Operations Center for the Zika virus outbreak response in January of 2016, public health leadership recognized that a joint, coordinated effort was required between activities focused on the effects of the infection among pregnant women and those focused on birth defects in fetuses and infants. Before the introduction of Zika virus in the Americas, population-based birth defects surveillance occurred independently of pregnancy surveillance activities. Results: The coordination of pregnancy surveillance and birth defects surveillance implemented through the CDC Zika virus response represents a paradigm shift. Conclusion: Coordination of these surveillance systems provides an opportunity to capture information from both a prospective and retrospective approach. This relatively modest investment in the public health infrastructure can continue to protect pregnant women and their infants during the ongoing response to Zika virus and in the next emergent threat to maternal and child health.

    • Parasitic Diseases RSS Word feed
      • Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settingsExternal
        Hopkins H, Bruxvoort KJ, Cairns ME, Chandler CI, Leurent B, Ansah EK, Baiden F, Baltzell KA, Bjorkman A, Burchett HE, Clarke SE, DiLiberto DD, Elfving K, Goodman C, Hansen KS, Kachur SP, et al .
        Bmj. 2017 Mar 29;356:j1054.
        Objectives To examine the impact of use of rapid diagnostic tests for malaria on prescribing of antimicrobials, specifically antibiotics, for acute febrile illness in Africa and Asia.Design Analysisof nine preselected linked and codesigned observational and randomised studies (eight cluster or individually randomised trials and one observational study).Setting Public and private healthcare settings, 2007-13, in Afghanistan, Cameroon, Ghana, Nigeria, Tanzania, and Uganda.Participants 522 480 children and adults with acute febrile illness.Interventions Rapid diagnostic tests for malaria.Main outcome measures Proportions of patients for whom an antibiotic was prescribed in trial groups who had undergone rapid diagnostic testing compared with controls and in patients with negative test results compared with patients with positive results. A secondary aim compared classes of antibiotics prescribed in different settings.Results Antibiotics were prescribed to 127 052/238 797 (53%) patients in control groups and 167 714/283 683 (59%) patients in intervention groups. Antibiotics were prescribed to 40% (35 505/89 719) of patients with a positive test result for malaria and to 69% (39 400/57 080) of those with a negative result. All but one study showed a trend toward more antibiotic prescribing in groups who underwent rapid diagnostic tests. Random effects meta-analysis of the trials showed that the overall risk of antibiotic prescription was 21% higher (95% confidence interval 7% to 36%) in intervention settings. In most intervention settings, patients with negative test results received more antibiotic prescriptions than patients with positive results for all the most commonly used classes: penicillins, trimethoprim-sulfamethoxazole (one exception), tetracyclines, and metronidazole.Conclusions Introduction of rapid diagnostic tests for malaria to reduce unnecessary use of antimalarials-a beneficial public health outcome-could drive up untargeted use of antibiotics. That 69% of patients were prescribed antibiotics when test results were negative probably represents overprescription.This included antibiotics from several classes, including those like metronidazole that are seldom appropriate for febrile illness, across varied clinical, health system, and epidemiological settings. It is often assumed that better disease specific diagnostics will reduce antimicrobial overuse, but they might simply shift it from one antimicrobial class to another. Current global implementation of malaria testing might increase untargeted antibiotic use and must be examined.

    • Reproductive Health RSS Word feed
    • Substance Use and Abuse RSS Word feed
      • Measuring PM2.5, ultrafine particles, air nicotine and wipe samples following the use of electronic cigarettesExternal
        Melstrom P, Koszowski B, Thanner MH, Hoh E, King B, Bunnell R, McAfee T.
        Nicotine Tob Res. 2017 Mar 09.
        Background: Few studies have examined the extent of inhalation or dermal contact among bystanders following short-term, secondhand e-cigarette exposure. Objective: Measure PM2.5 (particles <2.5 microns), UF (ultrafine particles <100nm), and nicotine in air and deposited on surfaces and clothing pre-/during/post- a short-term (two-hour) e-cigarette exposure. Methods: E-cigarettes were used ad libitum by three experienced users for two hours during two separate sessions (disposable e-cigarettes, then tank-style e-cigarettes, or “tanks”) in a 1858ft3 room. We recorded: uncorrected PM2.5 (using SidePak(R)); UF (using P-Trak(R)); air nicotine concentrations (using air samplers; SKC(R) XAD-4 canisters); ambient air exchange rate (using an air capture hood). Wipe samples were taken by wiping 100cm2 room surfaces pre- and post- both sessions, and clean cloth wipes were worn during the exposure and collected at the end. Results: Uncorrected PM2.5 and UF were higher (p<0.0001) during sessions than before or after. Median PM2.5 during exposure was higher using tanks (0.515mg/m3) than disposables (0.035mg/m3)(p<0.0001). Median UF during exposure was higher using disposables (31,200particles/cm3) than tanks (25,200particles/cm3)(p<0.0001). Median air nicotine levels were higher (p<0.05) during both sessions (disposables=0.697ng/L, tanks=1.833ng/L) than before (disposables=0.004ng/L, tanks=0.010ng/L) or after (disposables=0.115ng/L, tanks=0.147ng/L). Median accumulation rates of nicotine on surface samples were 2.1ng/100cm2/hr using disposables and 4.0ng/100cm2/hr using tanks; for cloth samples, it was 44.4ng/100cm2/hr using disposables and 69.6ng/100cm2/hr using tanks (p<0.01). Mean room ventilation rate was ~5 air changes per hour during both sessions. Conclusions: Short-term e-cigarette use can produce: elevated PM2.5; elevated UF; nicotine in the air; and accumulation of nicotine on surfaces and clothing. Implications: * Short-term indoor e-cigarette use produced accumulation of nicotine on surfaces and clothing, which could lead to dermal exposure to nicotine. * Short-term e-cigarette use produced elevated PM2.5 and ultrafine particles, which could lead to secondhand inhalation of these particles and any chemicals associated with them by bystanders. * We measured significant differences in PM2.5 and ultrafine particles between disposable e-cigarettes and tank-style e-cigarettes, suggesting a difference in the exposure profiles of e-cigarette products.

  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 RSS Word feed
      1. Arthritis and cognitive impairment in older adultsExternal
        Baker NA, Barbour KE, Helmick CG, Zack M, Al Snih S.
        Rheumatol Int. 2017 Mar 23.
        Adults aged 65 or older with arthritis may be at increased risk for cognitive impairment [cognitive impairment but not dementia (CIND) or dementia]. Studies have found associations between arthritis and cognition impairments; however, none have examined whether persons with arthritis develop cognitive impairments at higher rates than those without arthritis. Using data from the Health and Retirement Study, we estimated the prevalence of cognitive impairments in older adults with and without arthritis, and examined associations between arthritis status and cognitive impairments. We calculated incidence density ratios (IDRs) using generalized estimating equations to estimate associations between arthritis and cognitive impairments adjusting for age, sex, race/ethnicity, marital status, education, income, depression, obesity, smoking, the number of chronic conditions, physical activity, and birth cohort. The prevalence of CIND and dementia did not significantly differ between those with and without arthritis (CIND: 20.8%, 95% CI 19.7-21.9 vs. 18.3%, 95% CI 16.8-19.8; dementia: 5.2% 95% CI 4.6-5.8 vs. 5.1% 95% CI 4.3-5.9). After covariate control, older adults with arthritis did not differ significantly from those without arthritis for either cognitive outcome (CIND IDR: 1.6, 95% CI = 0.9-2.9; dementia IDR: 1.1, 95% CI = 0.4-3.3) and developed cognitive impairments at a similar rate to those without arthritis. Older adults with arthritis were not significantly more at risk to develop cognitive impairments and developed cognitive impairments at a similar rate as older adults without arthritis over 6 years.

      2. Estimating demand for and supply of pediatric preventive dental care for children and identifying dental care shortage areas, Georgia, 2015External
        Cao S, Gentili M, Griffin PM, Griffin SO, Harati P, Johnson B, Serban N, Tomar S.
        Public Health Rep. 2017 Jan 01:33354917699579.
        OBJECTIVES: Demand for dental care is expected to outpace supply through 2025. The objectives of this study were to determine the extent of pediatric dental care shortages in Georgia and to develop a general method for estimation that can be applied to other states. METHODS: We estimated supply and demand for pediatric preventive dental care for the 159 counties in Georgia in 2015. We compared pediatric preventive dental care shortage areas (where demand exceeded twice the supply) designated by our methods with dental health professional shortage areas designated by the Health Resources & Services Administration. We estimated caries risk from a multivariate analysis of National Health and Nutrition Examination Survey data and national census data. We estimated county-level demand based on the time needed to perform preventive dental care services and the proportion of time that dentists spend on pediatric preventive dental care services from the Medical Expenditure Panel Survey. RESULTS: Pediatric preventive dental care supply exceeded demand in Georgia in 75 counties: the average annual county-level pediatric preventive dental care demand was 16 866 hours, and the supply was 32 969 hours. We identified 41 counties as pediatric dental care shortage areas, 14 of which had not been designated by the Health Resources & Services Administration. CONCLUSIONS: Age- and service-specific information on dental care shortage areas could result in more efficient provider staffing and geographic targeting.

      3. Colon cancer screening among patients receiving dialysis in the United States: Are we choosing wisely?External
        Carlos CA, McCulloch CE, Hsu CY, Grimes B, Pavkov ME, Burrows NR, Shahinian VB, Saran R, Powe NR, Johansen KL.
        J Am Soc Nephrol. 2017 Mar 23.
        The American Society of Nephrology recommends against routine cancer screening among asymptomatic patients receiving maintenance dialysis on the basis of limited survival benefit. To determine the frequency of colorectal cancer screening among patients on dialysis and the extent to which screening tests were targeted toward patients at lower risk of death and higher likelihood of receiving a kidney transplant, we performed a cohort study of 469,574 Medicare beneficiaries ages >/=50 years old who received dialysis between January 1, 2007 and September 30, 2012. We examined colorectal cancer screening tests according to quartiles of risk of mortality and kidney transplant on the basis of multivariable Cox modeling. Over a median follow-up of 1.5 years, 11.6% of patients received a colon cancer screening test (57.9 tests per 1000 person-years). Incidence rates of colonoscopy, flexible sigmoidoscopy, and fecal occult blood test were 27.9, 0.6, and 29.5 per 1000 person-years, respectively. Patients in the lowest quartile of mortality risk were more likely to be screened than those in the highest quartile (hazard ratio, 1.53; 95% confidence interval, 1.49 to 1.57; 65.1 versus 46.4 tests per 1000 person-years, respectively), amounting to a 33% higher rate of testing. Additionally, compared with patients least likely to receive a transplant, patients most likely to receive a transplant were more likely to be screened (hazard ratio, 1.68; 95% confidence interval, 1.64 to 1.73). Colon cancer screening is being targeted toward patients on dialysis at lowest risk of mortality and highest likelihood of transplantation, but absolute rates are high, suggesting overscreening.

    • Communicable Diseases RSS Word feed
      1. Adverse event profile of a mature voluntary medical male circumcision programme performing PrePex and surgical procedures in Zimbabwe
        Bochner AF, Feldacker C, Makunike B, Holec M, Murenje V, Stepaniak A, Xaba S, Balachandra S, Tshimanga M, Chitimbire VT, Barnhart S.
        J Int AIDS Soc. 2017 21 Feb;20 (1).
        Introduction: The frequency of adverse events (AEs) is a widely used indicator of voluntary medical male circumcision (VMMC) programme quality. Though over 11.7 million male circumcisions (MCs) have been performed, little published data exists on the profile of AEs from mature, large-scale programmes. No published data exists on routine implementation of PrePex, a device-based MC method. Methods: The ZAZIC Consortium began implementing VMMC in Zimbabwe in 2013, supporting services at 36 facilities. Aggregate data on VMMC outputs are collected monthly from each facility. Detailed forms are completed describing the profile of each moderate and severe AE. Bivariate and multivariable analyses were conducted using log-binomial regression models. Results: From October 2014 through September 2015, 44,868 clients were circumcised with 156 clients experiencing a moderate or severe AE. 96.2% of clients had a follow-up visit within 14 days of their procedure. AEs were uncommon, with 0.3% (116/41,416) of surgical and 1.2% (40/3,452) of PrePex clients experiencing a moderate or severe AE. After adjusting for VMMC site, we found that PrePex was associated with a 3.29-fold (95% CI: 1.78-6.06) increased risk of experiencing an AE compared to surgical procedures. Device displacements, when the PrePex device is intentionally or accidentally dislodged during the 7-day placement period, accounted for 70% of PrePex AEs. The majority of device displacements were intentional self-removals. Overall, infection was the most common AE among VMMC clients. Compared to clients aged 20 and above, clients aged 10-14 were 3.07-fold (95% CI: 1.36-6.91) more likely to experience an infection and clients aged 15-19 were 1.80-fold (95% CI: 0.82-3.92) more likely to experience an infection, adjusted for site. Conclusions: This exploratory analysis found that clients receiving PrePex were more likely to experience an AE than surgical circumcision clients. This is largely attributable to the occurrence of device displacements, which require prompt access to corrective surgical MC procedures as part of their clinical management. Most device displacements were self-removals which are preventable if client behaviour could be modified through counselling interventions. We also found that infection after MC is more common among younger clients, who may benefit from additional counselling or increased parental involvement.

      2. An electronic health record-based intervention to promote hepatitis C virus testing among adults born between 1945 and 1965: A cluster-randomized trialExternal
        Federman AD, Kil N, Kannry J, Andreopolous E, Toribio W, Lyons J, Singer M, Yartel A, Smith BD, Rein DB, Krauskopf K.
        Med Care. 2017 Mar 10.
        BACKGROUND: The Centers for Disease Control and Prevention (CDC) recommends one-time hepatitis C virus (HCV) antibody testing for “Birth Cohort” adults born during 1945-1965. OBJECTIVE: To examine the impact of an electronic health record (EHR)-embedded best practice alert (BPA) for HCV testing among Birth Cohort adults. DESIGN: Cluster-randomized trial was conducted from April 29, 2013 to March 29, 2014. SUBJECTS AND SETTING: Ten community and hospital-based primary care practices. Participants were attending physicians and medical residents during 25,620 study-eligible visits. INTERVENTION: Physicians in all practices received a brief introduction to the CDC testing recommendations. At visits for eligible patients at intervention sites, physicians received a BPA through the EHR to order HCV testing or medical assistants were prompted to post a testing order for the physician. Physicians in control sites did not receive the BPA. MAIN OUTCOMES: HCV testing; the incidence of HCV antibody positive tests was a secondary outcome. RESULTS: Testing rates were greater among Birth Cohort patients in intervention sites (20.2% vs. 1.8%, P<0.0001) and the odds of testing were greater in intervention sites after controlling for imbalances of patient and visit characteristics between comparison groups [odds ratio (OR), 9.0; 95% confidence interval, 7.6-10.7). The adjusted OR of identifying HCV antibody positive patients was also greater in intervention sites (OR, 2.1; 95% confidence interval, 1.3-11.2). CONCLUSIONS: An EHR-embedded BPA markedly increased HCV testing among Birth Cohort patients, but the majority of eligible patients did not receive testing indicating a need for more effective methods to promote uptake.

      3. Effects of brief messages about antiretroviral therapy and condom use benefits among black and Latino MSM in three US citiesExternal
        Herbst JH, Mansergh G, Pitts N, Denson D, Mimiaga MJ, Holman J.
        J Homosex. 2017 Mar 27.
        This pilot study examined effects of HIV prevention messages about self and partner benefits of antiretroviral therapy (ART) and condom effectiveness on increased intentions for behavior change. Data were from Messages4Men, a study examining prevention messages among 320 HIV-positive and 605 HIV-negative black and Latino MSM. Men completed a computer-based assessment after message exposure, and multivariable models controlled for risky sex and demographics. A majority of HIV-positive men reported increased intentions for ART use; 22% reported partner benefit information was new. HIV-positive men with a detectable viral load had significantly greater adjusted odds of reporting intentions for ART use. Over half of HIV-negative MSM reported ART benefit information was new, and 88% reported increased intentions to discuss ART use with infected partners. Black MSM anticipated they would increase condom use in response to the self and partner benefit messages. Tailored messages on benefits of ART are needed for MSM.

      4. Clinical and microbiological features of invasive nontyphoidal Salmonella associated with HIV-infected patients, Gauteng Province, South AfricaExternal
        Keddy KH, Musekiwa A, Sooka A, Karstaedt A, Nana T, Seetharam S, Nchabaleng M, Lekalakala R, Angulo FJ, Klugman KP.
        Medicine (Baltimore). 2017 Mar;96(13):e6448.
        The aim of this study was to define factors associated with HIV-infected versus uninfected patients with invasive nontyphoidal Salmonella (iNTS) and factors associated with mortality, which are inadequately described in Africa.Laboratory-based surveillance for iNTS was undertaken. At selected sentinel sites, clinical data (age, sex, HIV status, severity of illness, and outcome) were collected.Surveillance was conducted in Gauteng, South Africa, from 2003 to 2013. Clinical and microbiological differences between HIV-infected and uninfected patients were defined and risk factors for mortality established.Of 4886 iNTS infections in Gauteng from 2003 to 2013, 3106 (63.5%) were diagnosed at sentinel sites. Among persons with iNTS infections, more HIV-infected persons were aged >/=5 years (chi = 417.6; P < 0.001) and more HIV-infected children were malnourished (chi = 5.8; P = 0.02). Although 760 (30.6%) patients died, mortality decreased between 2003 [97/263 (36.9%)] and 2013 [926/120 (21.7%)]. On univariate analysis, mortality was associated with patients aged 25 to 49 years [odds ratio (OR) = 2.2; 95% confidence interval (CI) = 1.7-2.7; P < 0.001 and >/=50 years (OR = 3.0; 95% CI = 2.2-4.1; P < 0.001) compared with children < 5 years, HIV-infected patients (OR = 2.4; 95% CI = 1.7-3.4; P < 0.001), and severe illness (OR = 5.4; 95% CI = 3.6-8.1; P < 0.001). On multivariate analysis, mortality was associated with patients aged >/=50 years [adjusted OR (AOR) = 3.6, 95% CI = 2.1-6.1, P < 0.001] and severe illness (AOR = 6.3; 95% CI = 3.8-10.5; P < 0.001).Mortality due to iNTS in Gauteng remains high primarily due to disease severity. Interventions must be aimed at predisposing conditions, including HIV, other immune-suppressive conditions, and malignancy.

      5. Clostridium difficile infection in returning travellersExternal
        Michal Stevens A, Esposito DH, Stoney RJ, Hamer DH, Flores-Figueroa J, Bottieau E, Connor BA, Gkrania-Klotsas E, Goorhuis A, Hynes NA, Libman M, Lopez-Velez R, McCarthy AE, von Sonnenburg F, Schwartz E, van Genderen PJ, Scott Benson L, Leung DT.
        J Travel Med. 2017 May 01;24(3).
        Background: There is increasing recognition of the contribution of community-acquired cases to the global burden of Clostridium difficile infection (CDI). The epidemiology of CDI among international travellers is poorly understood, and factors associated with international travel, such as antibiotic use and changes in gut microbiota, could potentially put travellers at higher risk. Methods: We summarized demographic, travel-associated and geographic characteristics of travellers with CDI in the GeoSentinel database from 1997 to 2015. We also surveyed GeoSentinel sites to compare various testing indications, approaches, and diagnostic modalities. Results: We identified 260 GeoSentinel records, including 187 that satisfied criteria for analysis (confirmed cases in non-immigrant travellers aged >2 years, seen <12 weeks post-travel). CDI was reported in all age groups and in travellers to all world regions; the largest proportions of cases having destinations in Asia (31%), Central/South America or the Caribbean (30%) and Africa (24%). Our site survey revealed substantial heterogeneity of testing approaches between sites; the most commonly used test was the C. difficile toxin gene PCR. Conclusions: CDI is encountered in returning international travellers, although there is considerable variability in testing practices. These data underscore the importance of awareness of C. difficile as a potential cause of travel-associated diarrhoea.

      6. Tuberculin skin test and interferon-gamma release assay use among privately insured persons in the United StatesExternal
        Owusu-Edusei K, Stockbridge EL, Winston CA, Kolasa M, Miramontes R.
        Int J Tuberc Lung Dis. 2017 Mar 28.
        OBJECTIVE: To describe tuberculin skin test (TST) and interferon-gamma release assay (IGRA) (i.e., QuantiFERON-TB and T-SPOT.TB [T-SPOT]) use among privately insured persons in the United States over a 15-year period. METHODS: We used current procedural terminology (CPT) codes for the TST and IGRAs to extract out-patient claims (2000-2014) and determined usage (claims/100,000). The chi2 test for trend in proportions was used to describe usage trends for select periods. RESULTS: The TST was the dominant (>80%) test in each year. Publication of guidelines preceded the assignment of QFT and T-SPOT CPT codes by 1 year (2006 for QFT; 2011 for T-SPOT). QFT usage was higher (P < 0.01) than T-SPOT in each year. The average annual increase in the use of QFT was higher than that of T-SPOT (35 vs. 3.8/100,000), and more so when the analytic period was 2011-2014 (65 vs. 38/100,000). However, during that 4-year period (2011-2014), TST use trended downward, with an average annual decrease of 28/100,000. The annual proportion of enrollees tested ranged from 1.1% to 1.5%. CONCLUSIONS: These results suggest a gradual shift from the use of the TST to the newer IGRAs. Future studies can assess the extent, if any, to which the shift from the use of the TST to IGRAs evolved over time.

      7. Evaluation of automated molecular testing rollout for tuberculosis diagnosis using routinely collected surveillance data – Uganda, 2012-2015External
        Scott C, Walusimbi S, Kirenga B, Joloba M, Winters M, Abdunoor N, Bain R, Alexander H, Shinnick T, Toney S, Odeke R, Mwangi C, Birabwa E, Dejene S, Mugabe F, YaDiul M, Cavanaugh JS.
        MMWR Morb Mortal Wkly Rep. 2017 Mar 31;66(12):339-342.
        In 2012, Uganda introduced the use of GeneXpert MTB/RIF (Cepheid, Sunnyvale CA), a sensitive, automated, real-time polymerase chain reaction-based platform for tuberculosis (TB) diagnosis, for programmatic use among children, adults with presumptive human immunodeficiency virus (HIV)-associated TB, and symptomatic persons at risk for rifampicin (RIF)-resistant TB. The effect of using the platform’s Xpert MTB/RIF assay on TB care and control was assessed using routinely collected programmatic data; in addition, a retrospective review of district quarterly summaries using abstracted TB register data from purposively selected facilities in the capital city of Kampala was conducted. Case notification rates were calculated and nonparametric statistical methods were used for analysis. No statistically significant differences were observed in case notification rates before and after the Xpert MTB/RIF assay became available, although four of 10 districts demonstrated a statistically significant difference in bacteriologically confirmed TB. Once the GeneXpert MTB/RIF platform is established and refined, a more comprehensive evaluation should be conducted.

      8. Diagnosing acute HIV infection: The performance of quantitative HIV-1 RNA testing (viral load) in the 2014 laboratory testing algorithmExternal
        Wu H, Cohen SE, Westheimer E, Gay CL, Hall L, Rose C, Hightow-Weidman LB, Gose S, Fu J, Peters PJ.
        J Clin Virol. 2017 Feb 15.
        New recommendations for laboratory diagnosis of HIV infection in the United States were published in 2014. The updated testing algorithm includes a qualitative HIV-1 RNA assay to resolve discordant immunoassay results and to identify acute HIV-1 infection (AHI). The qualitative HIV-1 RNA assay is not widely available; therefore, we evaluated the performance of a more widely available quantitative HIV-1 RNA assay, viral load, for diagnosing AHI. We determined that quantitative viral loads consistently distinguished AHI from a false-positive immunoassay result. Among 100 study participants with AHI and a viral load result, the estimated geometric mean viral load was 1,377,793 copies/mL.

    • Disease Reservoirs and Vectors RSS Word feed
      1. Elucidating transmission dynamics and host-parasite-vector relationships for rodent-borne Bartonella spp. in MadagascarExternal
        Brook CE, Bai Y, Yu EO, Ranaivoson HC, Shin H, Dobson AP, Metcalf CJ, Kosoy MY, Dittmar K.
        Epidemics. 2017 Mar 16.
        Bartonella spp. are erythrocytic bacteria transmitted via arthropod vectors, which infect a broad range of vertebrate hosts, including humans. We investigated transmission dynamics and host-parasite-vector relationships for potentially zoonotic Bartonella spp. in invasive Rattus rattus hosts and associated arthropod ectoparasites in Madagascar. We identified five distinct species of Bartonella (B. elizabethae 1, B. elizabethae 2, B. phoceensis 1, B. rattimassiliensis 1, and B. tribocorum 1) infecting R. rattus rodents and their ectoparasites. We fit standard epidemiological models to species-specific age-prevalence data for the four Bartonella spp. with sufficient data, thus quantifying age-structured force of infection. Known zoonotic agents, B. elizabethae 1 and 2, were best described by models exhibiting high forces of infection in early age class individuals and allowing for recovery from infection, while B. phoceensis 1 and B. rattimassiliensis 1 were best fit by models of lifelong infection without recovery and substantially lower forces of infection. Nested sequences of B. elizabethae 1 and 2 were recovered from rodent hosts and their Synopsyllus fonquerniei and Xenopsylla cheopsis fleas, with a particularly high prevalence in the outdoor-dwelling, highland-endemic S. fonquerniei. These findings expand on force of infection analyses to elucidate the ecological niche of the zoonotic Bartonella elizabethae complex in Madagascar, hinting at a potential vector role for S. fonquerniei. Our analyses underscore the uniqueness of such ecologies for Bartonella species, which pose a variable range of potential zoonotic threats.

    • Drug Safety RSS Word feed
      1. Methadone prescribing and overdose and the association with Medicaid preferred drug list policies – United States, 2007-2014External
        Faul M, Bohm M, Alexander C.
        MMWR Morb Mortal Wkly Rep. 2017 Mar 31;66(12):320-323.
        Drug overdose is a leading cause of injury death in the United States; 47,055 fatal drug overdoses were reported in 2014, a 6.5% increase from the previous year (1), driven by opioid use disorder (2,3). Methadone is an opioid prescribed for pain management and is also provided through opioid treatment programs to treat opioid use disorders. Because methadone might remain in a person’s system long after the pain-relieving benefits have been exhausted, it can cause slow or shallow breathing and dangerous changes in heartbeat that might not be perceived by the patient (4,5). In December 2006, the Food and Drug Administration issued a Public Health Advisory that alerted health care professionals to reports of death and life-threatening adverse events, such as respiratory depression and cardiac arrhythmias, in patients receiving methadone (4); in January 2008, a voluntary manufacturer restriction limited distribution of the 40 mg formulation of methadone. CDC analyzed state mortality and health care data and preferred drug list (PDL) policies to 1) compare the percentage of deaths involving methadone with the rate of prescribing methadone for pain, 2) characterize variation in methadone prescribing among payers and states, and 3) assess whether an association existed between state Medicaid reimbursement PDL policies and methadone overdose rates. The analyses found that, from 2007 to 2014, large declines in methadone-related overdose deaths occurred. Prescriptions for methadone accounted for 0.85% of all opioid prescriptions for pain in the commercially insured population and 1.1% in the Medicaid population. In addition, an association was observed between Medicaid PDLs requiring prior authorization for methadone and lower rates of methadone overdose among Medicaid enrollees. PDL policies requiring prior authorization might help to reduce the number of methadone overdoses.

    • Environmental Health RSS Word feed
      1. Urinary concentrations of insecticide and herbicide metabolites among pregnant women in rural Ghana: A pilot studyExternal
        Wylie BJ, Ae-Ngibise KA, Boamah EA, Mujtaba M, Messerlian C, Hauser R, Coull B, Calafat AM, Jack D, Kinney PL, Whyatt R, Owusu-Agyei S, Asante KP.
        Int J Environ Res Public Health. 2017 Mar 29;14(4).
        Use of pesticides by households in rural Ghana is common for residential pest control, agricultural use, and for the reduction of vectors carrying disease. However, few data are available about exposure to pesticides among this population. Our objective was to quantify urinary concentrations of metabolites of organophosphate (OP), pyrethroid, and select herbicides during pregnancy, and to explore exposure determinants. In 2014, 17 pregnant women from rural Ghana were surveyed about household pesticide use and provided weekly first morning urine voids during three visits (n = 51 samples). A total of 90.1% (46/51) of samples had detectable OP metabolites [geometric mean, GM (95% CI): 3,5,6-trichloro-2-pyridinol 0.54 microg/L (0.36-0.81), para-nitrophenol 0.71 microg/L (0.51-1.00)], 75.5% (37/49) had detectable pyrethroid metabolites [GM: 3-phenoxybenzoic acid 0.23 microg/L (0.17, 0.32)], and 70.5% (36/51) had detectable 2,4-dichlorophenoxyacetic acid levels, a herbicide [GM: 0.46 microg/L (0.29-0.73)]. Concentrations of para-nitrophenol and 2,4-dichlorophenoxyacetic acid in Ghanaian pregnant women appear higher when compared to nonpregnant reproductive-aged women in a reference U.S. POPULATION: Larger studies are necessary to more fully explore predictors of exposure in this population.

    • Genetics and Genomics RSS Word feed
      1. Evolutionary dynamics of pathoadaptation revealed by three independent acquisitions of the VirB/D4 type IV secretion system in BartonellaExternal
        Harms A, Segers FH, Quebatte M, Mistl C, Manfredi P, Korner J, Chomel BB, Kosoy M, Maruyama S, Engel P, Dehio C.
        Genome Biol Evol. 2017 Mar 07.
        The alpha-proteobacterial genus Bartonella comprises a group of ubiquitous mammalian pathogens that are studied as a model for the evolution of bacterial pathogenesis. Vast abundance of two particular phylogenetic lineages of Bartonella had been linked to enhanced host adaptability enabled by lineage-specific acquisition of a VirB/D4 type IV secretion system (T4SS) and parallel evolution of complex effector repertoires. However, the limited availability of genome sequences from one of those lineages as well as other, remote branches of Bartonella has so far hampered comprehensive understanding of how the VirB/D4 T4SS and its effectors called Beps have shaped Bartonella evolution. Here, we report the discovery of a third repertoire of Beps associated with the VirB/D4 T4SS of B. ancashensis, a novel human pathogen that lacks any signs of host adaptability and is only distantly related to the two species-rich lineages encoding a VirB/D4 T4SS. Furthermore, sequencing of ten new Bartonella isolates from under-sampled lineages enabled combined in silico analyses and wet lab experiments that suggest several parallel layers of functional diversification during evolution of the three Bep repertoires from a single ancestral effector. Our analyses show that the Beps of B. ancashensis share many features with the two other repertoires, but may represent a more ancestral state that has not yet unleashed the adaptive potential of such an effector set. We anticipate that the effectors of B. ancashensis will enable future studies to dissect the evolutionary history of Bartonella effectors and help unraveling the evolutionary forces underlying bacterial host adaptation.

      2. A comparative analysis of the Lyve-SET phylogenomics pipeline for genomic epidemiology of foodborne pathogensExternal
        Katz LS, Griswold T, Williams-Newkirk AJ, Wagner D, Petkau A, Sieffert C, Van Domselaar G, Deng X, Carleton HA.
        Front Microbiol. 2017 ;8:375.
        Modern epidemiology of foodborne bacterial pathogens in industrialized countries relies increasingly on whole genome sequencing (WGS) techniques. As opposed to profiling techniques such as pulsed-field gel electrophoresis, WGS requires a variety of computational methods. Since 2013, United States agencies responsible for food safety including the CDC, FDA, and USDA, have been performing whole-genome sequencing (WGS) on all Listeria monocytogenes found in clinical, food, and environmental samples. Each year, more genomes of other foodborne pathogens such as Escherichia coli, Campylobacter jejuni, and Salmonella enterica are being sequenced. Comparing thousands of genomes across an entire species requires a fast method with coarse resolution; however, capturing the fine details of highly related isolates requires a computationally heavy and sophisticated algorithm. Most L. monocytogenes investigations employing WGS depend on being able to identify an outbreak clade whose inter-genomic distances are less than an empirically determined threshold. When the difference between a few single nucleotide polymorphisms (SNPs) can help distinguish between genomes that are likely outbreak-associated and those that are less likely to be associated, we require a fine-resolution method. To achieve this level of resolution, we have developed Lyve-SET, a high-quality SNP pipeline. We evaluated Lyve-SET by retrospectively investigating 12 outbreak data sets along with four other SNP pipelines that have been used in outbreak investigation or similar scenarios. To compare these pipelines, several distance and phylogeny-based comparison methods were applied, which collectively showed that multiple pipelines were able to identify most outbreak clusters and strains. Currently in the US PulseNet system, whole genome multi-locus sequence typing (wgMLST) is the preferred primary method for foodborne WGS cluster detection and outbreak investigation due to its ability to name standardized genomic profiles, its central database, and its ability to be run in a graphical user interface. However, creating a functional wgMLST scheme requires extended up-front development and subject-matter expertise. When a scheme does not exist or when the highest resolution is needed, SNP analysis is used. Using three Listeria outbreak data sets, we demonstrated the concordance between Lyve-SET SNP typing and wgMLST. Availability: Lyve-SET can be found at

    • Health Disparities RSS Word feed
      1. Advancing understanding of the sustainability of lay health advisor (LHA) programs for African-American women in community settingsExternal
        Shelton RC, Charles TA, Dunston SK, Jandorf L, Erwin DO.
        Transl Behav Med. 2017 Mar 23.
        Lay health advisor (LHA) programs have made strong contributions towards the elimination of health disparities and are increasingly being implemented to promote health and prevent disease. Developed in collaboration with African-American survivors, the National Witness Project (NWP) is an evidence-based, community-led LHA program that improves cancer screening among African-American women. NWP has been successfully disseminated, replicated, and implemented nationally in over 40 sites in 22 states in diverse community settings, reaching over 15,000 women annually. We sought to advance understanding of barriers and facilitators to the long-term implementation and sustainability of LHA programs in community settings from the viewpoint of the LHAs, as well as the broader impact of the program on African-American communities and LHAs. In the context of a mixed-methods study, in-depth telephone interviews were conducted among 76 African-American LHAs at eight NWP sites at baseline and 12-18 months later, between 2010 and 2013. Qualitative data provides insight into inner and outer contextual factors (e.g., community partnerships, site leadership, funding), implementation processes (e.g., training), as well as characteristics of the intervention (e.g., perceived need and fit in African-American community) and LHAs (e.g., motivations, burnout) that are perceived to impact the continued implementation and sustainability of NWP. Factors at the contextual levels and related to motivations of LHAs are critical to the sustainability of LHA programs. We discuss how findings are used to inform (1) the development of the LHA Sustainability Framework and (2) strategies to support the continued implementation and sustainability of evidence-based LHA interventions in community settings.

    • Healthcare Associated Infections RSS Word feed
      1. Detection, reporting, and treatment of hepatitis C infections among hemodialysis patientsExternal
        Collier MG, Nguyen DB, Patel PR, Moorman AC.
        Infect Control Hosp Epidemiol. 2017 Apr;38(4):493-494.
        [No abstract]
    • Immunity and Immunization RSS Word feed
      1. Re: “Invited commentary: Beware the test-negative design”External
        Ferdinands JM, Foppa IM, Fry AM, Flannery BL, Belongia EA, Jackson ML.
        Am J Epidemiol. 2017 Mar 01:1.
        [No abstract]
      2. Intussusception cases among children admitted to referral hospitals in Kenya, 2002-2013: Implications for monitoring postlicensure safety of rotavirus vaccines in AfricaExternal
        Omore R, Osawa F, Musia J, Rha B, Ismail A, Kiulia NM, Moke F, Vulule J, Wainaina AM, Tole J, Machoki SM, Nuorti JP, Breiman RF, Parashar UD, Montgomery JM, Tate JE.
        J Pediatric Infect Dis Soc. 2016 Dec;5(4):465-469.
        To describe the epidemiology of intussusception before introduction of the rotavirus vaccine, we reviewed the records of 280 patients younger than 5 years who were hospitalized in Kenya between 2002 and 2013. The patients who died (18 [6.4%]) had sought care later after symptom onset than the patients who survived (median, 5 vs 3 days, respectively; P = .04). Seeking prompt care may improve therapeutic outcomes.

      3. Notes from the field: Adverse events following a mass yellow fever immunization campaign – Kongo Central Province, Democratic Republic of the Congo, September 2016External
        Otshudiema JO, Ndakala NG, Loko ML, Mawanda EK, Tshapenda GP, Kimfuta JM, Gueye AS, Dee J, Philen RM, Giese C, Murrill CS, Arthur RR, Kebela BI.
        MMWR Morb Mortal Wkly Rep. 2017 Mar 31;66(12):343-344.
        [No abstract]
      4. Arm paralysis after routine childhood vaccinations: Application of advanced molecular methods to the causality assessment of an adverse event after immunizationExternal
        Shaw J, Halsey NA, Weinberg A, Schmid DS, George KS, Weldon WC, Jordan M, Bryant PW, LaRussa PS, Bradshaw DY, Harrington T, Gershon A.
        J Pediatric Infect Dis Soc. 2017 Jan 25.
        Post-licensure surveillance for adverse events following immunizations (AEFI) can identify rare complications of vaccinations and rigorous vaccine adverse event causality assessments can help to identify possible causal relationships. We report the development of arm paralysis after varicella vaccination in a 1-year-old child. Paralysis was initially presumed to be due to vOka because of the temporal relationship between vaccination and onset of arm weakness; however, molecular studies identified wild-type varicella zoster virus VZV (WT-VZV) in the CSF, leading the authors to conclude that WT-VZV was the probable cause. This case illustrates the complexity of assessing AEFI causality, and the importance of careful and complete evaluations when determining the most likely cause of an AEFI.

      5. Cognitive testing to evaluate revisions to the Vaccine Adverse Event Reporting System (VAERS) reporting formExternal
        Suragh TA, Miller ER, Hibbs BF, Winiecki SK, Zinderman C, Shimabukuro TT.
        Vaccine. 2017 Mar 25.
        INTRODUCTION: The Vaccine Adverse Event Reporting System (VAERS) is the spontaneous (passive) reporting system CDC and FDA use to monitor vaccine safety. We used cognitive testing to evaluate proposed revisions to the current VAERS form. METHODS: We conducted in-person cognitive interviews with 22 volunteers to evaluate proposed revisions in a prototype VAERS 2.0 form (new VAERS form). We analyzed data using thematic analysis. RESULTS: Repeating themes included preferences for: brevity, simplicity and clarity; features to minimize time requirements and facilitate ease of completion; logical ordering of questions by topic and importance; and visual cues like color-coded highlighting. Interviews identified instances of discordance between the intended meaning questions (from the perspective of CDC and FDA) and interpretation by volunteers. CONCLUSIONS: Cognitive testing yielded useful information to guide further revisions of the VAERS form. Cognitive testing can be an effective tool for public health programs interested in developing surveys and reporting forms.

    • Laboratory Sciences RSS Word feed
      1. Rapid ascent from zero quality to international organization for standardization accreditation : A case study of Hai Duong Preventive Medicine Center in Vietnam, 2012-2013External
        Duong CN, Bond KB, Carvalho H, Thi Thu HB, Nguyen T, Rush T.
        Am J Clin Pathol. 2017 Mar 15.
        Objectives: In 2012, the Vietnam Ministry of Health sought to improve the quality of health laboratories by introducing international quality standards. Methods: Strengthening Laboratory Management Toward Accreditation (SLMTA), a year-long, structured, quality improvement curriculum (including projects and mentorship) was piloted in 12 laboratories. Progress was measured using a standardized audit tool (Stepwise Laboratory Quality Improvement Process Towards Accreditation). Results: All 12 pilot laboratories (a mix of hospital and public health) demonstrated improvement; median scores rose from 44% to 78% compliance. The public health laboratory in Hai Duong Province entered the program with the lowest score of the group (28%) yet concluded with the highest score (86%). Five months after the completion of the program, without any additional external support, they were accredited. Laboratory management/staff describe factors key to their success: support from the facility senior management, how-to guidance provided by SLMTA, support from the site mentor, and strong commitment of laboratory staff. Conclusions: Hai Duong preventive medical center is one of only a handful of laboratories to reach accreditation after participation in SLMTA and the only laboratory to do so without additional support. Due to the success seen in Hai Duong and other pilot laboratories, Vietnam has expanded the use of SLMTA.

      2. Guidelines for validation of next-generation sequencing-based oncology panels: A joint consensus recommendation of the Association for Molecular Pathology and College of American PathologistsExternal
        Jennings LJ, Arcila ME, Corless C, Kamel-Reid S, Lubin IM, Pfeifer J, Temple-Smolkin RL, Voelkerding KV, Nikiforova MN.
        J Mol Diagn. 2017 Mar 21.
        Next-generation sequencing (NGS) methods for cancer testing have been rapidly adopted by clinical laboratories. To establish analytical validation best practice guidelines for NGS gene panel testing of somatic variants, a working group was convened by the Association of Molecular Pathology with liaison representation from the College of American Pathologists. These joint consensus recommendations address NGS test development, optimization, and validation, including recommendations on panel content selection and rationale for optimization and familiarization phase conducted before test validation; utilization of reference cell lines and reference materials for evaluation of assay performance; determining of positive percentage agreement and positive predictive value for each variant type; and requirements for minimal depth of coverage and minimum number of samples that should be used to establish test performance characteristics. The recommendations emphasize the role of laboratory director in using an error-based approach that identifies potential sources of errors that may occur throughout the analytical process and addressing these potential errors through test design, method validation, or quality controls so that no harm comes to the patient. The recommendations contained herein are intended to assist clinical laboratories with the validation and ongoing monitoring of NGS testing for detection of somatic variants and to ensure high quality of sequencing results.

      3. Re-imagining the future of diagnosis of neglected tropical diseasesExternal
        Peeling RW, Boeras DI, Nkengasong J.
        Comput Struct Biotechnol J. 2017 ;15:271-274.
        Neglected Tropical Diseases (NTDs) affect an estimated 1 billion people in 149 countries. The World Health Organization (WHO) prioritised 17 NTDs for control and elimination by 2020 and defined a Road Map to help countries reach these goals. Improved diagnostics for NTDs are essential for guiding treatment strategies at different thresholds of control, interruption of transmission, elimination and post-elimination surveillance. While substantial progress has been made in the last decade with chemotherapy, the same cannot be said of diagnostics, largely due to the perceived lack of a commercially viable market for NTD diagnostics. New sample in-answer out nucleic acid amplification technologies that can be performed at the point-of-care offer improved performance over current technologies and the potential to test for multiple pathogens using a single specimen. Finding commonalities for different NTDs in terms of geographic overlap, sentinel populations and treatment strategy will allow NTD programs to leverage these innovations to build cost-effective multiplex surveillance platforms. Connectivity solutions linking data from diagnostic laboratories and POC test readers/devices provide opportunities for automated surveillance systems to make health systems more efficient, improving patient outcomes and assessing impact of interventions in real time. New models of public-private product development partnerships are critical in leveraging diagnostic innovation in other priority area for better diagnosis, control and elimination of NTDs.

      4. Does acute normobaric hypoxia induce anapyrexia in adult humans?External
        Seo Y, Gerhart HD, Vaughan J, Kim JH, Glickman EL.
        High Alt Med Biol. 2017 Mar 27.
        Seo, Yongsuk, Hayden D. Gerhart, Jeremiah Vaughan, Jung-Hyun Kim, and Ellen L. Glickman. Does acute normobaric hypoxia induce anapyrexia in adult humans? High Alt Med Biol 00:000-000, 2017.-Exposure to hypoxia is known to induce a reduction in core body temperature as a protective mechanism, which has been shown in both animals and humans. The purpose of this study was to test if acute exposure to normobaric hypoxia (NH) induces anapyrexia in adult humans in association with decreased peripheral oxygen saturation (SpO2). Ten healthy male subjects were seated in atmospheres of normobaric normoxia 21% (NN21), NH 17% (NH17), and 13% (NH13) O2 for 60 minutes in a counterbalanced manner. Rectal temperature (Tre) was continuously monitored together with the quantification of metabolic heat production (MHP) and body heat storage (S). Baseline physiological measurements showed no differences between the three conditions. SpO2 was significantly decreased in NH17 and NH13 compared with NN21 (p </= 0.001). Tre decreased following 60 minutes of resting in all conditions, but, independent of the conditions, showed no association between Tre and levels of hypoxic SpO2. There was also no significant difference in either MHP or S between conditions. The present results showed no evidence of hypoxia-induced anapyrexia in adult humans during 1 hour of resting after exposure to NH either at 13% or 17% O2.

    • Maternal and Child Health RSS Word feed
      1. Monitoring the World Health Organization global target 2025 for exclusive breastfeedingExternal
        Gupta PM, Perrine CG, Chen J, Elam-Evans LD, Flores-Ayala R.
        J Hum Lact. 2017 Mar 01:890334417693210.
        BACKGROUND: Exclusive breastfeeding under 6 months, calculated from a single 24-hour recall among mothers of children 0 to 5 months of age, is a World Health Organization (WHO) indicator used to monitor progress on the 2025 global breastfeeding target. Many upper-middle-income and high-income countries, including the United States, do not have estimates for this indicator. Research aim: To describe the prevalence of exclusive breastfeeding under 6 months in the United States. METHODS: We used a single 24-hour dietary recall from the National Health and Nutrition Examination Survey 2009-2012 to calculate the prevalence of exclusive breastfeeding under 6 months. We discuss our results in the context of routine breastfeeding surveillance, which is reported from a national survey with different methodology. RESULTS: Among children younger than 6 months, 24.4%, 95% confidence interval [17.6, 31.1], were exclusively breastfed the previous day. CONCLUSION: To our knowledge, this is the first estimate of the WHO indicator of exclusive breastfeeding under 6 months for the United States. This study supports the global surveillance and data strategy for reporting to the WHO on the 2025 target for exclusive breastfeeding.

      2. Brief report: Estimated prevalence of a community diagnosis of autism spectrum disorder by age 4 years in children from selected areas in the United States in 2010: Evaluation of birth cohort effectsExternal
        Soke GN, Maenner MJ, Christensen D, Kurzius-Spencer M, Schieve LA.
        J Autism Dev Disord. 2017 Mar 24.
        We compared early-diagnosed autism spectrum disorder (ASD) (defined as diagnosis by age 4 years) between the 2002 and 2006 birth cohorts, in five sites of the Autism and Developmental Disabilities Monitoring Network. In the 2002 cohort, the prevalence/1000 of early-diagnosed ASD was half the 8-year-old prevalence (7.2 vs. 14.7, prevalence ratio [PR] 0.5 [0.4-0.6]). Overall, the prevalence of early-diagnosed ASD did not differ between birth cohorts (PR 1.1 [0.9-1.3]). However, in three sites with complete case ascertainment, the prevalence of early-diagnosed ASD was higher for those born in 2006 versus 2002 (PR 1.3 [1.1-1.5]), suggesting possible improvement in early identification. The lack of change in two sites may reflect less complete case ascertainment. Studies in more recent cohorts are needed.

    • Nutritional Sciences RSS Word feed
      1. Sodium intake among persons aged >/=2 years – United States, 2013-2014External
        Quader ZS, Zhao L, Gillespie C, Cogswell ME, Terry AL, Moshfegh A, Rhodes D.
        MMWR Morb Mortal Wkly Rep. 2017 Mar 31;66(12):324-238.
        High sodium consumption can increase hypertension, a major risk factor for cardiovascular diseases (1). Reducing sodium intake can lower blood pressure, and sodium reduction in the U.S. population of 40% over 10 years might save at least 280,000 lives (2). Average sodium intake in the United States remains in excess of Healthy People 2020 objectives,* and monitoring sources of sodium in the U.S. population can help focus sodium reduction measures (3,4). Data from 2013-2014 What We Eat in America (WWEIA), the dietary intake portion of the National Health and Nutrition Examination Survey (NHANES),dagger were analyzed to determine the ranked percentage sodium contribution of selected food categories and sources of sodium intake from all reported foods and beverages, both overall and by demographic subgroups. These latest data include updated food codes and separate estimates for intake among non-Hispanic Asians. section sign In 2013-2014, 70% of dietary sodium consumed by persons in the United States came from 25 food categories; breads were the top contributor, accounting for 6% of sodium consumed. A majority of sodium consumed was from food obtained at stores; however, sodium density (mg/1,000 kcal) was highest in food obtained at restaurants. A variety of commonly consumed foods contributes to U.S. sodium intake, emphasizing the importance of sodium reduction across the food supply (4).

    • Occupational Safety and Health RSS Word feed
      1. Association of respiratory symptoms and asthma with occupational exposures: findings from a population-based cross-sectional survey in Telemark, NorwayExternal
        Abrahamsen R, Fell AK, Svendsen MV, Andersson E, Toren K, Henneberger PK, Kongerud J.
        BMJ Open. 2017 Mar 22;7(3):e014018.
        OBJECTIVES: The aim of this study was to estimate the prevalence of respiratory symptoms and physician-diagnosed asthma and assess the impact of current occupational exposure. DESIGN: Cross-sectional analyses of the prevalence of self-reported respiratory health and association with current occupational exposure in a random sample of the general population in Telemark County, Norway. SETTINGS: In 2013, a self-administered questionnaire was mailed to a random sample of the general population, aged 16-50, in Telemark, Norway. The overall response rate was 33%, comprising 16 099 responders. OUTCOME MEASURES: The prevalence for respiratory symptoms and asthma, and OR of respiratory symptoms and asthma for occupational groups and exposures were calculated. Occupational exposures were assessed using self-reported exposure and an asthma-specific job-exposure matrix (JEM). RESULTS: The prevalence of physician-diagnosed asthma was 11.5%. For the occupational groups, the category with agriculture/fishery workers and craft/related trade workers was associated with wheezing and asthma attack in the past 12 months, showing OR 1.3 (1.1 to 1.6) and 1.9 (1.2 to 2.8), respectively. The group including technicians and associated professionals was also associated with wheezing OR 1.2 (1.0 to 1.3) and asthma attack OR 1.4 (1.1 to 1.9). The JEM data show that exposure to flour was associated with wheezing OR 3.2 (1.4 to 7.3) and woken with dyspnoea OR 3.5 (1.3 to 9.5), whereas exposures to diisocyanates, welding/soldering fumes and exposure to vehicle/motor exhaust were associated with dyspnoea OR 2.9 (1.5 to 5.7), 3.2 (1.6 to 6.4) and 1.4 (1.0 to 1.8), respectively. CONCLUSIONS: The observed prevalence of physician-diagnosed asthma was 11.5%. The ‘manual’ occupations were associated with respiratory symptoms. Occupational exposure to flour, diisocyanates, welding/soldering fumes and vehicle/motor exhaust was associated with respiratory symptoms in the past 12 months and use of asthma medication. However, prospective data are needed to confirm the observed associations.

      2. Effects of organizational safety practices and perceived safety climate on PPE usage, engineering controls, and adverse events involving liquid antineoplastic drugs among nursesExternal
        DeJoy DM, Smith TD, Woldu H, Dyal MA, Steege AL, Boiano JM.
        J Occup Environ Hyg. 2017 Mar 22.
        PURPOSE: Antineoplastic drugs pose risks to the healthcare workers who handle them. This fact notwithstanding, adherence to safe handing guidelines remains inconsistent and often poor. This study examined the effects of pertinent organizational safety practices and perceived safety climate on the use of personal protective equipment, engineering controls, and adverse events (spill/leak or skin contact) involving liquid antineoplastic drugs Method: Data for this study came from the 2011 National Institute for Occupational Safety and Health (NIOSH) Health and Safety Practices Survey of Healthcare Workers which included a sample of approximately 1,800 nurses who had administered liquid antineoplastic drugs during the past seven days. Regression modeling was used to examine predictors of personal protective equipment use, engineering controls, and adverse events involving antineoplastic drugs. RESULTS: Approximately 14% of nurses reported experiencing an adverse event while administering antineoplastic drugs during the previous week. Usage of recommended engineering controls and personal protective equipment was quite variable. Usage of both was better in non-profit and government settings, when workers were more familiar with safe handling guidelines, and when perceived management commitment to safety was higher. Usage was poorer in the absence of specific safety handling procedures. The odds of adverse events increased with number of antineoplastic drugs treatments and when antineoplastic drugs were administered more days of the week. The odds of such events was significantly lower when the use of engineering controls and personal protective equipment was greater and when more precautionary measures were in place. Greater levels of management commitment to safety and perceived risk were also related to lower odds of adverse events. CONCLUSIONS: These results point to the value of implementing a comprehensive health and safety program that utilizes available hazard controls and effectively communicates and demonstrates the importance of safe handling practices. Such actions also contribute to creating a positive safety climate.

      3. Lifetime allergic rhinitis prevalence among US primary farm operators: findings from the 2011 Farm and Ranch Safety surveyExternal
        Mazurek JM, Henneberger PK.
        Int Arch Occup Environ Health. 2017 Mar 24.
        PURPOSE: Allergic rhinitis is associated with decreased quality of life, and reduced workplace performance and productivity. This study investigated the prevalence of lifetime allergic rhinitis and factors associated with allergic rhinitis among US primary farm operators. METHODS: The 2011 Farm and Ranch Safety Survey data collected from 11,210 active farm operators were analyzed. Survey respondents were determined to have lifetime allergic rhinitis based on a “yes” response to the question: “Have you ever been told by a doctor, nurse, or other health professional that you had hay fever, seasonal allergies, or allergic rhinitis?” Data were weighted to produce nationally representative estimates. RESULTS: An estimated 30.8% of the 2.1 million active farm operators had lifetime allergic rhinitis in 2011. The allergic rhinitis prevalence varied by demographic and farm characteristics. Farm operators with allergic rhinitis were 1.38 (95% CI 1.22-1.56) times more likely to be exposed to pesticides compared with operators with no allergic rhinitis. The association with pesticide exposure for allergic rhinitis and current asthma, and allergic rhinitis alone was statistically significant and greater than that for current asthma alone. CONCLUSION: Certain groups of farm operators may be at increased risk of allergic rhinitis. Studies should further investigate the association of allergic rhinitis with specific pesticide exposure.

      4. Deaths from non-malignant respiratory disease in styrene-exposed workers: Does obliterative bronchiolitis contribute to mortality?External
        Nett RJ, Edwards NT, Ruder AM, Bertke SJ, Keumala I, Cox-Ganser J, Cummings KJ.
        Ann Am Thorac Soc. 2017 Mar 27.
        [No abstract]
      5. Berkson error adjustment and other exposure surrogates in occupational case-control studies, with application to the Canadian INTEROCC studyExternal
        Oraby T, Sivaganesan S, Bowman JD, Kincl L, Richardson L, McBride M, Siemiatycki J, Cardis E, Krewski D.
        J Expo Sci Environ Epidemiol. 2017 Mar 29.
        Many epidemiological studies assessing the relationship between exposure and disease are carried out without data on individual exposures. When this barrier is encountered in occupational studies, the subject exposures are often evaluated with a job-exposure matrix (JEM), which consists of mean exposure for occupational categories measured on a comparable group of workers. One of the objectives of the seven-country case-control study of occupational exposure and brain cancer risk, INTEROCC, was to investigate the relationship of occupational exposure to electromagnetic fields (EMF) in different frequency ranges and brain cancer risk. In this paper, we use the Canadian data from INTEROCC to estimate the odds of developing brain tumours due to occupational exposure to EMF. The first step was to find the best EMF exposure surrogate among the arithmetic mean, the geometric mean, and the mean of log-normal exposure distribution for each occupation in the JEM, in comparison to Berkson error adjustments via numerical approximation of the likelihood function. Contrary to previous studies of Berkson errors in JEMs, we found that the geometric mean was the best exposure surrogate. This analysis provided no evidence that cumulative lifetime exposure to extremely low frequency magnetic fields increases brain cancer risk, a finding consistent with other recent epidemiological studies.Journal of Exposure Science and Environmental Epidemiology advance online publication, 29 March 2017; doi:10.1038/jes.2017.2.

    • Parasitic Diseases RSS Word feed
      1. Skin snips have no role in programmatic evaluations for onchocerciasis elimination: a reply to Bottomley et alExternal
        Eberhard ML, Cupp EW, Katholi CR, Richards FO, Unnasch TR.
        Parasit Vectors. 2017 Mar 23;10(1):154.
        A critique of the recommendation that skin snips be used for post-MDA surveillance of formerly endemic onchocerciasis areas is provided. After considering several fundamental aspects of the use of this methodology within the context of prolonged mass distribution of ivermectin, we argue that skin-snipping has no value for monitoring onchocerciasis elimination programs.

    • Reproductive Health RSS Word feed
      1. Contraception for women with multiple sclerosis: Guidance for healthcare providersExternal
        Houtchens MK, Zapata LB, Curtis KM, Whiteman MK.
        Mult Scler. 2017 Mar 01:1352458517701314.
        Family planning is essential for any comprehensive treatment plan for women of reproductive age with multiple sclerosis (MS), including counseling on using effective contraception to optimally time desired and prevent unintended pregnancies. This topical review summarizes the first evidence-based recommendations on contraception safety for women with MS. In 2016, evidence-based recommendations for contraceptive use by women with MS were included in US Medical Eligibility Criteria for Contraceptive Use. They were developed after review of published scientific evidence on contraception safety and consultation with experts. We summarize and expand on the main conclusions of the Centers for Disease Control and Prevention guidance. Most contraceptive methods appear based on current evidence to be safe for women with MS. The only restriction is use of combined hormonal contraceptives among women with MS with prolonged immobility because of concerns about possible venous thromboembolism. Disease-modifying therapies (DMTs) do not appear to decrease the effectiveness of hormonal contraception although formal drug-drug interaction studies are limited. Neurologists can help women with MS make contraceptive choices that factor their level of disability, immobility, and medication use. For women with MS taking potentially teratogenic medications, highly effective methods that are long-acting (e.g. intrauterine devices, implants) might be the best option.

    • Social and Behavioral Sciences RSS Word feed
      1. Validity of self-reported concentration and memory problems: Relationship with neuropsychological assessment and depressionExternal
        Bowler RM, Adams SW, Schwarzer R, Gocheva VV, Roels HA, Kim Y, Kircos CL, Wright CW, Colledge M, Bollweg G, Lobdell DT.
        J Clin Exp Neuropsychol. 2017 Mar 29:1-11.
        BACKGROUND: This study investigated the validity of self-reported concentration and memory problems (CMP) in residents environmentally exposed to manganese (Mn). METHOD: Self-report of CMP from a health questionnaire (HQ) and the Symptom Checklist-90-Revised (SCL-90-R) was compared to neuropsychological assessment (Trails A&B; Digit Span; Digit Symbol; Similarities; Auditory Consonant Trigrams, ACT; NAB Memory; Rey-Osterrieth, Rey-O, Delayed). Participants included 146 residents from Ohio exposed to air-Mn, with a modeled average concentration of 0.55 microg m-3 (range = 0.01-4.58). RESULTS: Residents were primarily White (94.5%), aged 30-64 years (M = 51.24), with a minimum of 10 years of residence (range = 10-64). Ninety-four (65.3%) participants reported concentration problems, and 107 residents (73.3%) reported memory problems. More participants endorsed CMP on the SCL-90-R than on the HQ. The prevalence of self-reported CMP was higher for women than for men (88.4% vs. 68.3%). Point-biserial and Pearson’s correlations between self-reported CMP and neuropsychological test scores were nonsignificant and weak for both the HQ (rpb = -.20 to rpb = .04) and the SCL-90-R (r = -.12 to r = .007). Greater levels of depression, anxiety, and female sex predicted having more self-reported CMP on both the HQ and the SCL-90-R. Air-Mn and blood-Mn were not associated with self-reported CMP. Residential distance from the Mn source accounted for a small proportion of variance (sr2 = .04), although depression remained the largest predictor (sr2 = .21). CONCLUSION: These results indicate that self-report of CMP in Mn-exposed residents appear to be invalid when compared to neuropsychological test scores. The participants’ misperception of having CMP is associated with less education and higher levels of depression. Neuropsychological assessment is recommended to attain valid results.

    • Substance Use and Abuse RSS Word feed
      1. Screening for excessive alcohol use and brief counseling of adults – 17 states and the District of Columbia, 2014External
        McKnight-Eily LR, Okoro CA, Mejia R, Denny CH, Higgins-Biddle J, Hungerford D, Kanny D, Sniezek JE.
        MMWR Morb Mortal Wkly Rep. 2017 Mar 31;66(12):313-319.
        Excessive and/or risky alcohol use resulted in $249 billion in economic costs in 2010 (1) and >88,000 deaths in the United States every year from 2006 to 2010 (2). It is associated with birth defects and disabilities (e.g., fetal alcohol spectrum disorders [FASDs]), increases in chronic diseases (e.g., heart disease and breast cancer), and injuries and violence (e.g., motor vehicle crashes, suicide, and homicide).dagger Since 2004, the U.S. Preventive Services Task Force (USPSTF) has recommended alcohol misuse screening and brief counseling (also known as alcohol screening and brief intervention or ASBI) for adults aged >/=18 years (3). section sign Among adults, ASBI reduces episodes of binge-level consumption, reduces weekly alcohol consumption, and increases compliance with recommended drinking limits in those who have an intervention in comparison to those who do not (3). A recent study suggested that health care providers rarely talk with patients about alcohol use (4). To estimate the prevalence of U.S. adults who reported receiving elements of ASBI, CDC analyzed 2014 Behavioral Risk Factor Surveillance System (BRFSS) data from 17 states paragraph sign and the District of Columbia (DC). Weighted crude and age-standardized overall and state-level prevalence estimates were calculated by selected drinking patterns and demographic characteristics. Overall, 77.7% of adults (age-standardized estimate) reported being asked about alcohol use by a health professional in person or on a form during a checkup, but only 32.9% reported being asked about binge-level alcohol consumption (3). Among binge drinkers, only 37.2% reported being asked about alcohol use and advised about the harms of drinking too much, and only 18.1% reported being asked about alcohol use and advised to reduce or quit drinking. Widespread implementation of ASBI and other evidence-based interventions could help reduce excessive alcohol use in adults and related harms.

      2. Increase in drug overdose deaths involving fentanyl – Rhode Island, January 2012-March 2014External
        Mercado MC, Sumner SA, Spelke MB, Bohm MK, Sugerman DE, Stanley C.
        Pain Med. 2017 Mar 06.
        Objective: This study identified sociodemographic, substance use, and multiple opioid prescriber and dispenser risk factors among drug overdose decedents in Rhode Island, in response to an increase in overdose deaths (ODs) involving fentanyl. Methods: This cross-sectional investigation comprised all ODs reviewed by Rhode Island’s Office of the State Medical Examiners (OSME) during January 2012 to March 2014. Data for 536 decedents were abstracted from OSME’s charts, death certificates, toxicology reports, and Prescription Monitoring Program (PMP) databases. Decedents whose cause of death involved illicit fentanyl (N = 69) were compared with decedents whose causes of death did not involve fentanyl (other drug decedents; N = 467). Results: Illicit-fentanyl decedents were younger than other drug decedents ( P = 0.005). While more other-drug decedents than illicit fentanyl decedents had postmortem toxicological evidence of consuming heroin (31.9% vs 19.8%, P < 0.001) and various pharmaceutical substances ( P = 0.002-0.027), third party reports indicated more recent heroin use among illicit fentanyl decedents (62.3% vs 45.6%, P = 0.002). Approximately 35% of decedents filled an opioid prescription within 90 days of death; of these, one-third had a mean daily dosage greater than 100 morphine milligram equivalents (MME/day). Most decedents’ opioid prescriptions were filled at one to two dispensers (83.9%) and written by one to two prescribers (75.8%). Notably, 29.2% of illicit fentanyl and 10.5% of other drug decedents filled prescriptions for buprenorphine, which is used to treat opioid use disorders. Conclusions: Illicit-fentanyl deaths frequently involved other illicit drugs (e.g., cocaine, heroin). The proportion of all decedents acquiring greater than 100 MME/day prescription dosages written and/or filled by few prescribers and dispensers is concerning. To protect patients, prescribers and dispensers should review PMP records and substance abuse history prior to providing opioids.

    • Zoonotic and Vectorborne Diseases RSS Word feed
      1. Zika virus transmission – region of the Americas, May 15, 2015-December 15, 2016External
        Ikejezie J, Shapiro CN, Kim J, Chiu M, Almiron M, Ugarte C, Espinal MA, Aldighieri S.
        MMWR Morb Mortal Wkly Rep. 2017 Mar 31;66(12):329-334.
        Zika virus, a mosquito-borne flavivirus that can cause rash with fever, emerged in the Region of the Americas on Easter Island, Chile, in 2014 and in northeast Brazil in 2015 (1). In response, in May 2015, the Pan American Health Organization (PAHO), which serves as the Regional Office of the Americas for the World Health Organization (WHO), issued recommendations to enhance surveillance for Zika virus. Subsequently, Brazilian investigators reported Guillain-Barre syndrome (GBS), which had been previously recognized among some patients with Zika virus disease, and identified an association between Zika virus infection during pregnancy and congenital microcephaly (2). On February 1, 2016, WHO declared Zika virus-related microcephaly clusters and other neurologic disorders a Public Health Emergency of International Concern.* In March 2016, PAHO developed case definitions and surveillance guidance for Zika virus disease and associated complications (3). Analysis of reports submitted to PAHO by countries in the region or published in national epidemiologic bulletins revealed that Zika virus transmission had extended to 48 countries and territories in the Region of the Americas by late 2016. Reported Zika virus disease cases peaked at different times in different areas during 2016. Because of ongoing transmission and the risk for recurrence of large outbreaks, response efforts, including surveillance for Zika virus disease and its complications, and vector control and other prevention activities, need to be maintained.

      2. Decision making in the face of uncertainty: the challenge of emerging infectious diseasesExternal
        Marks PW, Petersen LR.
        Transfusion. 2017 Mar;57(3pt2):723-728.
        [No abstract]
      3. Yellow Fever Outbreak – Kongo Central Province, Democratic Republic of the Congo, August 2016External
        Otshudiema JO, Ndakala NG, Mawanda EK, Tshapenda GP, Kimfuta JM, Nsibu LN, Gueye AS, Dee J, Philen RM, Giese C, Murrill CS, Arthur RR, Kebela BI.
        MMWR Morb Mortal Wkly Rep. 2017 Mar 31;66(12):335-338.
        On April 23, 2016, the Democratic Republic of the Congo’s (DRC’s) Ministry of Health declared a yellow fever outbreak. As of May 24, 2016, approximately 90% of suspected yellow fever cases (n = 459) and deaths (45) were reported in a single province, Kongo Central Province, that borders Angola, where a large yellow fever outbreak had begun in December 2015. Two yellow fever mass vaccination campaigns were conducted in Kongo Central Province during May 25-June 7, 2016 and August 17-28, 2016. In June 2016, the DRC Ministry of Health requested assistance from CDC to control the outbreak. As of August 18, 2016, a total of 410 suspected yellow fever cases and 42 deaths were reported in Kongo Central Province. Thirty seven of the 393 specimens tested in the laboratory were confirmed as positive for yellow fever virus (local outbreak threshold is one laboratory-confirmed case of yellow fever). Although not well-documented for this outbreak, malaria, viral hepatitis, and typhoid fever are common differential diagnoses among suspected yellow fever cases in this region. Other possible diagnoses include Zika, West Nile, or dengue viruses; however, no laboratory-confirmed cases of these viruses were reported. Thirty five of the 37 cases of yellow fever were imported from Angola. Two-thirds of confirmed cases occurred in persons who crossed the DRC-Angola border at one market city on the DRC side, where </=40,000 travelers cross the border each week on market day. Strategies to improve coordination between health surveillance and cross-border trade activities at land borders and to enhance laboratory and case-based surveillance and health border screening capacity are needed to prevent and control future yellow fever outbreaks.

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

Page last reviewed: January 31, 2019