Issue 8, February 28, 2017

CDC Science Clips: Volume 9, Issue 8, February 28, 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 Ten Articles of the Week
    Selected by a senior CDC scientist from the standard sections listed below. The names of CDC authors are indicated in bold text.
    • Parasitic Diseases RSS Word feed
      1. Nodding syndrome may be an autoimmune reaction to the parasitic worm Onchocerca volvulusExternal
        Johnson TP, Tyagi R, Lee PR, Lee MH, Johnson KR, Kowalak J, Elkahloun A, Medynets M, Hategan A, Kubofcik J, Sejvar J, Ratto J, Bunga S, Makumbi I, Aceng JR, Nutman TB, Dowell SF, Nath A.
        Sci Transl Med. 2017 Feb 15;9(377).
        Nodding syndrome is an epileptic disorder of unknown etiology that occurs in children in East Africa. There is an epidemiological association with Onchocerca volvulus, the parasitic worm that causes onchocerciasis (river blindness), but there is limited evidence that the parasite itself is neuroinvasive. We hypothesized that nodding syndrome may be an autoimmune-mediated disease. Using protein chip methodology, we detected autoantibodies to leiomodin-1 more abundantly in patients with nodding syndrome compared to unaffected controls from the same village. Leiomodin-1 autoantibodies were found in both the sera and cerebrospinal fluid of patients with nodding syndrome. Leiomodin-1 was found to be expressed in mature and developing human neurons in vitro and was localized in mouse brain to the CA3 region of the hippocampus, Purkinje cells in the cerebellum, and cortical neurons, structures that also appear to be affected in patients with nodding syndrome. Antibodies targeting leiomodin-1 were neurotoxic in vitro, and leiomodin-1 antibodies purified from patients with nodding syndrome were cross-reactive with O. volvulus antigens. This study provides initial evidence supporting the hypothesis that nodding syndrome is an autoimmune epileptic disorder caused by molecular mimicry with O. volvulus antigens and suggests that patients may benefit from immunomodulatory therapies.

    • Chronic Diseases and Conditions RSS Word feed
      1. Is diabetes prevalence higher among HIV-infected individuals compared with the general population? Evidence from MMP and NHANES 2009-2010External
        Hernandez-Romieu AC, Garg S, Rosenberg ES, Thompson-Paul AM, Skarbinski J.
        BMJ Open Diabetes Res Care. 2017 ;5(1):e000304.
        BACKGROUND: Nationally representative estimates of diabetes mellitus (DM) prevalence among HIV-infected adults in the USA are lacking, and whether HIV-infected adults are at increased risk of DM compared with the general adult population remains controversial. METHODS: We used nationally representative survey (2009-2010) data from the Medical Monitoring Project (n=8610 HIV-infected adults) and the National Health and Nutrition Examination Survey (n=5604 general population adults) and fit logistic regression models to determine and compare weighted prevalences of DM between the two populations, and examine factors associated with DM among HIV-infected adults. RESULTS: DM prevalence among HIV-infected adults was 10.3% (95% CI 9.2% to 11.5%). DM prevalence was 3.8% (CI 1.8% to 5.8%) higher in HIV-infected adults compared with general population adults. HIV-infected subgroups, including women (prevalence difference 5.0%, CI 2.3% to 7.7%), individuals aged 20-44 (4.1%, CI 2.7% to 5.5%), and non-obese individuals (3.5%, CI 1.4% to 5.6%), had increased DM prevalence compared with general population adults. Factors associated with DM among HIV-infected adults included age, duration of HIV infection, geometric mean CD4 cell count, and obesity. CONCLUSIONS: 1 in 10 HIV-infected adults receiving medical care had DM. Although obesity contributes to DM risk among HIV-infected adults, comparisons to the general adult population suggest that DM among HIV-infected persons may develop at earlier ages and in the absence of obesity.

      2. Turning the curve on obesity prevalence among fifth graders in the los Angeles Unified School District, 2001-2013External
        Kamali A, Hameed H, Shih M, Simon P.
        Prev Chronic Dis. 2017 Feb 16;14:E16.
        INTRODUCTION: After multiple decades of increasing childhood obesity prevalence in the United States, findings from recent studies suggest that prevalence has leveled or is decreasing in some populations. However, demographic and socioeconomic disparities in prevalence remain and may be increasing. METHODS: To assess recent trends and disparities in childhood obesity prevalence in Los Angeles County, we analyzed data from 2001 through 2013 in fifth graders in the Los Angeles Unified School District (LAUSD). Obesity was defined as a body mass index at or above the 95th percentile for children of the same age and sex as compared with Centers for Disease Control and Prevention growth charts, on the basis of measured height and weight. Trends were examined by sex, race/ethnicity, and socioeconomic status (SES). SES was determined by using school-level data on the percentage of students participating in a free and reduced-price meal program. RESULTS: Obesity prevalence increased from 27.5% in 2001 to 31.6% in 2005, was stable from 2005 through 2010, and decreased from 31.6% in 2010 to 28.5% in 2013. Similar trajectories in prevalence were observed for all demographic and SES subgroups, although the decline in prevalence began earlier among whites and students attending schools in the highest SES group. Disparities in prevalence by race/ethnicity and SES were observed during the entire study period but narrowed slightly from 2010 through 2013. CONCLUSION: Although obesity prevalence among fifth graders in LAUSD declined from 2010 through 2013, prevalence remains higher than in 2001, and demographic and socioeconomic disparities in prevalence persist. Future interventions in the county should prioritize Latinos and students attending low SES schools.

    • Communicable Diseases RSS Word feed
      1. Measles in the United States since the millennium: Perils and progress in the postelimination eraExternal
        Schuchat A, Fiebelkorn AP, Bellini W.
        Microbiol Spectr. 2016 Apr;4(2).
        This article describes measles and measles vaccination, along with the challenges, successes, and progress in the postelimination era.

    • Environmental Health RSS Word feed
      1. Examples of applied public health through the work of the Epidemic Intelligence Service officers at CDC’s National Center for Environmental Health: 2006-2015External
        Carroll YI, Rashid FA, Falk H, Howley MM.
        Public Health Reviews. 2017 ;38(1).
        The Epidemic Intelligence Service officers (EISOs) at the National Center for Environmental Health (NCEH)/Agency for Toxic Substances and Disease Registry (ATSDR) respond to public health outbreaks, assist public health surveillance, and recommend public health actions. We summarize the breadth of work done by EISOs assigned to NCEH/ATSDR during 2006-2015. We used the Web of Science, Scopus, and PubMed databases to identify articles authored by the EISOs, number and types of epidemiologic assistance field investigations (Epi-AIDS), and interviewed NCEH/ATSDR programs with EISO assignees. The largest number of NCEH/ATSDR EISO publications (n = 61) and Epi-AIDS (n = 110) related to toxic chemicals (23 and 37, respectively), followed by natural disasters and those caused by humans (19 and 25, respectively), extreme temperature-related illness (9), and chronic diseases (8). The investigations raised awareness, identified risk factors and public health needs, and introduced better prevention and protection measures for human health. Through field investigations and other technical assistance, NCEH/ATSDR provided leadership and staff scientists to assist in the field, as well as knowledge transfer to local, state, territorial, and international health departments.

    • Genetics and Genomics RSS Word feed
      1. Whole genome sequencing of a large panel of contemporary Neisseria gonorrhoeae clinical isolates indicates that a wild-type mtrA gene is common: implications for inducible antimicrobial resistanceExternal
        Vidyaprakash E, Abrams AJ, Shafer WM, Trees DL.
        Antimicrob Agents Chemother. 2017 Feb 13.
        Previous studies have shown that the expression of the mtrCDE efflux pump operon is inducible at the transcriptional level in gonococci during incubation in sub-lethal concentrations of the nonionic detergent Triton X-100, which along with antibiotics, bile salts, progesterone and antimicrobial peptides, is a substrate of the MtrCDE efflux pump.

    • Health Disparities RSS Word feed
      1. Housing assistance programs and adult health in the United StatesExternal
        Fenelon A, Mayne P, Simon AE, Rossen LM, Helms V, Lloyd P, Sperling J, Steffen BL.
        Am J Public Health. 2017 Feb 16:e1-e8.
        OBJECTIVES: To examine whether access to housing assistance is associated with better health among low-income adults. METHODS: We used National Health Interview Survey data (1999-2012) linked to US Department of Housing and Urban Development (HUD) administrative records (1999-2014) to examine differences in reported fair or poor health and psychological distress. We used multivariable models to compare those currently receiving HUD housing assistance (public housing, housing choice vouchers, and multifamily housing) with those who will receive housing assistance within 2 years (the average duration of HUD waitlists) to account for selection into HUD assistance. RESULTS: We found reduced odds of fair or poor health for current public housing (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.57, 0.97) and multifamily housing (OR = 0.75; 95% CI = 0.60, 0.95) residents compared with future residents. Public housing residents also had reduced odds of psychological distress (OR = 0.59; 95% CI = 0.40, 0.86). These differences were not mediated by neighborhood-level characteristics, and we did not find any health benefits for current housing choice voucher recipients. CONCLUSIONS: Housing assistance is associated with improved health and psychological well-being for individuals entering public housing and multifamily housing programs. (Am J Public Health. Published online ahead of print February 16, 2017: e1-e8. doi:10.2105/AJPH.2016.303649).

    • Immunity and Immunization RSS Word feed
      1. Vaccine adverse events in a safety net healthcare system and a managed care organizationExternal
        Narwaney KJ, Breslin K, Ross CA, Shoup JA, Wain KF, Weintraub ES, McNeil MM, Hambidge SJ.
        Vaccine. 2017 Mar 01;35(9):1335-1340.
        BACKGROUND: The Institute of Medicine, in a 2013 report, recommended that the Vaccine Safety Datalink (VSD) expand collaborations to include more diversity in the study population. Kaiser Permanente Colorado (KPCO), an established VSD site, partnered with Denver Health (DH), an integrated safety net healthcare system, to demonstrate the feasibility of integrating DH data within the VSD. Prior to incorporating the data, we examined the identification of specific vaccine associated adverse events (VAEs) in these two distinct healthcare systems. METHODS: We conducted retrospective cohort analyses within KPCO and DH to compare select VAEs between the two populations. We examined the following associations between January 1, 2004 and December 31, 2013: Measles, Mumps, and Rubella (MMR) vaccine and febrile seizures in children 2years and younger, intussusception after rotavirus vaccine in infants 4-34weeks, syncope after adolescent vaccines (Tetanus, Diphtheria, acellular Pertussis; Meningococcal and Human Papillomavirus) in adolescents 13-17years and medically attended local reactions after pneumococcal polysaccharide (PPSV23) vaccine in adults 65years and older. Both sites used similar data procurement methods and chart review processes. RESULTS: For seizures after MMR vaccine (KPCO – 3.15vs. DH – 2.97/10,000 doses) and syncope after all adolescent vaccines (KPCO – 3.0vs. DH – 2.37/10,000 doses), the chart confirmed rates were comparable at the two sites. However, for medically attended local reactions after PPSV23, there were differences in chart confirmed rates between the sites (KPCO – 31.65vs. DH – 14.90/10,000 doses). For intussusception after rotavirus vaccine, the number of cases was too low to make a valid comparison (KPCO – 0vs. DH – 0.13/10,000 doses). CONCLUSION: We demonstrated that data on important targeted VAEs can be captured at DH and rates appear similar to those at KPCO. Work is ongoing on the optimal approach to assimilate DH data as a potential safety net healthcare system in the VSD.

    • Injury and Violence RSS Word feed
      1. A review of CDC’s Web-based Injury Statistics Query and Reporting System (WISQARS: Planning for the future of injury surveillanceExternal
        Ballesteros MF, Webb K, McClure RJ.
        J Safety Res. 2017 .
        Introduction: The Centers for Disease Control and Prevention (CDC) developed the Web-based Injury Statistics Query and Reporting System (WISQARSTM) to meet the data needs of injury practitioners. In 2015, CDC completed a Portfolio Review of this system to inform its future development. Methods: Evaluation questions addressed utilization, technology and innovation, data sources, and tools and training. Data were collected through environmental scans, a review of peer-reviewed and grey literature, a web search, and stakeholder interviews. Results: Review findings led to specific recommendations for each evaluation question. Response: CDC reviewed each recommendation and initiated several enhancements that will improve the ability of injury prevention practitioners to leverage these data, better make sense of query results, and incorporate findings and key messages into prevention practices.

    • Zoonotic and Vectorborne Diseases RSS Word feed
      1. Persistence of Zika virus in body fluids – preliminary reportExternal
        Paz-Bailey G, Rosenberg ES, Doyle K, Munoz-Jordan J, Santiago GA, Klein L, Perez-Padilla J, Medina FA, Waterman SH, Gubern CG, Alvarado LI, Sharp TM.
        N Engl J Med. 2017 Feb 14.
        Background To estimate the frequency and duration of detectable Zika virus (ZIKV) RNA in human body fluids, we prospectively assessed a cohort of newly infected participants in Puerto Rico. Methods We evaluated samples obtained from 150 participants (including 55 men) in whom ZIKV RNA was detected on reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay in urine or blood in an enhanced arboviral clinical surveillance site. We collected serum, urine, saliva, semen, and vaginal secretions weekly for the first month and then at 2, 4, and 6 months. All specimens were tested by means of RT-PCR, and serum was tested with the use of anti-ZIKV IgM enzyme-linked immunosorbent assay. Among the participants with ZIKV RNA in any specimen at week 4, biweekly collection continued until all specimens tested negative. We used parametric Weibull regression models to estimate the time until the loss of ZIKV RNA detection in each body fluid and reported the findings in medians and 95th percentiles. Results The medians and 95th percentiles for the time until the loss of ZIKV RNA detection were 14 days (95% confidence interval [CI], 11 to 17) and 54 days (95% CI, 43 to 64), respectively, in serum; 8 days (95% CI, 6 to 10) and 39 days (95% CI, 31 to 47) in urine; and 34 days (95% CI, 28 to 41) and 81 days (95% CI, 64 to 98) in semen. Few participants had detectable ZIKV RNA in saliva or vaginal secretions. Conclusions The prolonged time until ZIKV RNA clearance in serum in this study may have implications for the diagnosis and prevention of ZIKV infection. Current sexual-prevention guidelines recommend that men use condoms or abstain from sex for 6 months after ZIKV exposure; in 95% of the men in this study, ZIKV RNA was cleared from semen after about 3 months. (Funded by the Centers for Disease Control and Prevention.).

  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. Implementing standardized performance indicators to improve hypertension control at both the population and healthcare organization levelsExternal
        Campbell N, Ordunez P, Jaffe MG, Orias M, DiPette DJ, Patel P, Khan N, Onuma O, Lackland DT.
        J Clin Hypertens (Greenwich). 2017 Feb 13.
        The ability to reliably evaluate the impact of interventions and changes in hypertension prevalence and control is critical if the burden of hypertension-related disease is to be reduced. Previously, a World Hypertension League Expert Committee made recommendations to standardize the reporting of population blood pressure surveys. We have added to those recommendations and also provide modified recommendations from a Pan American Health Organization expert meeting for “performance indicators” to be used to evaluate clinical practices. Core indicators for population surveys are recommended to include: (1) mean systolic blood pressure and (2) mean diastolic blood pressure, and the prevalences of: (3) hypertension, (4) awareness of hypertension, (5) drug-treated hypertension, and (6) drug-treated and controlled hypertension. Core indicators for clinical registries are recommended to include: (1) the prevalence of diagnosed hypertension and (2) the ratio of diagnosed hypertension to that expected by population surveys, and the prevalences of: (3) controlled hypertension, (4) lack of blood pressure measurement within a year in people diagnosed with hypertension, and (5) missed visits by people with hypertension. Definitions and additional indicators are provided. Widespread adoption of standardized population and clinical hypertension performance indicators could represent a major step forward in the effort to control hypertension.

      2. Self-management in epilepsy: Why and how you should incorporate self-management in your practiceExternal
        Helmers SL, Kobau R, Sajatovic M, Jobst BC, Privitera M, Devinsky O, Labiner D, Escoffery C, Begley CE, Shegog R, Pandey D, Fraser RT, Johnson EK, Thompson NJ, Horvath KJ.
        Epilepsy Behav. 2017 Feb 12.
        [No abstract]
      3. Hereditary breast and ovarian cancer: Risk assessment in minority women and provider knowledge gaps
        Paris NM, Gabram-Mendola SG, Kerber AS, O’Connor J, Crane BE, Martin ML, Traxler LB, Matthews R, Parker C, Webster R, Schmitt E, Meaney-Delman D, Nair N, Green VL, Bellcross CA.
        J Community Support Oncol. 2016 June;14(6):261-267.
        Background: The Georgia Breast Cancer Genomics Project identifed minority and underserved women at high risk for hereditary breast and ovarian cancer based on family history. Education, web-based screening, genetic counseling, and testing were provided in public health and primary care settings in accordance with evidence-based recommendations and guidelines. Objectives: To assess risk of hereditary breast and ovarian cancer (HBOC) among minority and underserved women, provide genetic services according to evidence-based guidelines, and evaluate provider knowledge of HBOC. Methods: The Georgia Department of Public Health established this project through a cooperative agreement with the Centers for Disease Control and Prevention. HBOC screening and genetic services were provided in 13 public health centers and federally qualifed health centers. Staff received training on genetics and risk assessment using the Breast Cancer Genetics Referral Screening Tool (B-RST). Providers and medical residents were surveyed on their knowledge of HBOC. Young women with breast cancer were surveyed on receipt of genetic services. Results: More than 5,400 women were successfully screened; 79% identifed as racial/ethnic minorities. 5% of women screened positive on the B-RST, which is consistent with HBOC prevalence; 79% agreed to follow up. 23% met criteria for increased risk of BRCA 1/2 mutation and received genetic counseling and testing. Surveys revealed profound gaps in knowledge among physicians and medical residents and lack of delivery of evidence-based genetic services to survivors. Conclusions: The genomics project demonstrated the effcacy of population-based screening to identify high-risk women before they receive a diagnosis of cancer. A high percentage of women who screened positive also completed genetic counseling and testing. Access to the benefts of HBOC management to prevent cancer and decrease mortality among minority and underserved women depends on improvements in knowledge of genetics and evidence-based practice by providers.

    • Communicable Diseases RSS Word feed
      1. Giardiasis diagnosis and treatment practices among commercially insured persons in the United StatesExternal
        Beer KD, Collier SA, Du F, Gargano JW.
        Clin Infect Dis. 2017 Feb 16.
        [No abstract]
      2. Update: Influenza activity – United States, October 2, 2016-February 4, 2017External
        Blanton L, Mustaquim D, Alabi N, Kniss K, Kramer N, Budd A, Garg S, Cummings CN, Fry AM, Bresee J, Sessions W, Garten R, Xu X, Elal AI, Gubareva L, Barnes J, Wentworth DE, Burns E, Katz J, Jernigan D, Brammer L.
        MMWR Morb Mortal Wkly Rep. 2017 Feb 17;66(6):159-166.
        This report summarizes U.S. influenza activity during October 2, 2016-February 4, 2017, and updates the previous summary. Influenza activity in the United States began to increase in mid-December, remained elevated through February 4, 2017, and is expected to continue for several more weeks. To date, influenza A (H3N2) viruses have predominated overall, but influenza A (H1N1)pdm09 and influenza B viruses have also been identified.

      3. Risk of end stage liver disease, hepatocellular carcinoma and liver-related death by fibrosis stage in the hepatitis C Alaska cohortExternal
        Bruden DJ, McMahon BJ, Townshend-Bulson L, Gounder P, Gove J, Plotnik J, Homan C, Hewitt A, Barbour Y, Spradling PR, Simons BC, McArdle S, Bruce M.
        Hepatology. 2017 Feb 13.
        Long-term prospective studies of the outcomes associated with HCV infection are rare and critical for assessing the potential impact of HCV treatment. Using liver biopsy as a start point, we looked at development of end stage liver disease (ESLD), hepatocellular carcinoma (HCC) and liver-related death (LRD) according to fibrosis stage, among a cohort of American Indian/Alaska Native persons in Alaska. Persons were classified as having no/mild (Ishak=0,1), moderate (Ishak=2), or severe (Ishak=3,4) fibrosis or cirrhosis (Ishak=5,6). We examined time until development of ESLD, HCC and LRD and report survival probabilities at 3, 5, 7 and 10-years. Of 407 persons, 39%(n = 150) had no/mild fibrosis, 32%(n = 131) had moderate fibrosis, 22%(n = 88) had severe fibrosis and 9%(n = 38) had cirrhosis. The average time of follow-up was 7.3 years. Within 5 years of biopsy, 1.7% (95% confidence interval (CI):0.4,6.8) of persons with none/mild fibrosis developed ESLD compared to 7.9% (CI:4.0,15.2), 16.4% (CI:9.6,27.2) and 49.0% (CI:33.0,67.7) with moderate, severe fibrosis, and cirrhosis, respectively (p<0.01). The 5-year outcome of HCC was 1.0% (CI:0.1,7.0), 1.0% (CI 0.1,6.6), 1.1% (CI:0.2,7.7) and 13.4% (CI:4.4,36.7) among persons with none/mild, moderate fibrosis, severe fibrosis and cirrhosis, respectively (p<0.01). Five years following biopsy, 0.0% (CI:0.0,14.8) of persons with none/mild fibrosis had suffered an LRD compared to 1.0% (CI:0.2,7.5) of persons with moderate fibrosis, 4.7% (CI:1.5,14.1) with severe fibrosis and 16.3% (CI:7.0,35.1) with cirrhosis (p<0.01). Conclusion For prevention of HCC, LRD and ESLD in the short-term, HCV therapy should target those with more than mild fibrosis. This article is protected by copyright. All rights reserved.

      4. First-line antiretroviral drug discontinuations in childrenExternal
        Fortuin-de Smidt M, de Waal R, Cohen K, Technau KG, Stinson K, Maartens G, Boulle A, Igumbor EU, Davies MA.
        PLoS One. 2017 ;12(2):e0169762.
        INTRODUCTION: There are a limited number of paediatric antiretroviral drug options. Characterising the long term safety and durability of different antiretrovirals in children is important to optimise management of HIV infected children and to determine the estimated need for alternative drugs in paediatric regimens. We describe first-line antiretroviral therapy (ART) durability and reasons for discontinuations in children at two South African ART programmes, where lopinavir/ritonavir has been recommended for children <3 years old since 2004, and abacavir replaced stavudine as the preferred nucleoside reverse transcriptase inhibitor in 2010. METHODS: We included children (<16 years at ART initiation) who initiated >/=3 antiretrovirals between 2004-2014 with >/=1 follow-up visit on ART. We estimated the incidence of first antiretroviral discontinuation using Kaplan-Meier analysis. We determined the reasons for antiretroviral discontinuations using competing risks analysis. We used Cox regression to identify factors associated with treatment-limiting toxicity. RESULTS: We included 3579 children with median follow-up duration of 41 months (IQR 14-72). At ART initiation, median age was 44 months (IQR 13-89) and median CD4 percent was 15% (IQR 9-21%). At three and five years on ART, 72% and 26% of children respectively remained on their initial regimen. By five years on ART, the most common reasons for discontinuations were toxicity (32%), treatment failure (18%), treatment simplification (5%), drug interactions (3%), and other or unspecified reasons (18%). The incidences of treatment limiting toxicity were 50.6 (95% CI 46.2-55.4), 1.6 (0.5-4.8), 2.0 (1.2-3.3), and 1.3 (0.6-2.8) per 1000 patient years for stavudine, abacavir, efavirenz and lopinavir/ritonavir respectively. CONCLUSIONS: While stavudine was associated with a high risk of treatment-limiting toxicity, abacavir, lopinavir/ritonavir and efavirenz were well-tolerated. This supports the World Health Organization recommendation to replace stavudine with abacavir or zidovudine in paediatric first-line ART regimens in order to improve paediatric first-line ART durability.

      5. Vibrio alginolyticus infections in the USA, 1988-2012External
        Jacobs Slifka KM, Newton AE, Mahon BE.
        Epidemiol Infect. 2017 Feb 16:1-9.
        Vibrio alginolyticus causes soft tissue and bloodstream infection; little systematically collected clinical and epidemiological information is available. In the USA, V. alginolyticus infections are reported to the Cholera and Other Vibrio Illness Surveillance system. Using data from 1988 to 2012, we categorised infections using specimen source and exposure history, analysed case characteristics, and calculated incidence rates using US Census Bureau data. Most (96%) of the 1331 V. alginolyticus infections were from coastal states. Infections of the skin and ear were most frequent (87%); ear infections occurred more commonly in children, lower extremity infections more commonly in older adults. Most (86%) infections involved water activity. Reported incidence of infections increased 12-fold over the study period, although the extent of diagnostic or surveillance bias is unclear. Prevention efforts should target waterborne transmission in coastal areas and provider education to promote more rapid diagnosis and prevent complications.

      6. Pneumococcal serotype 5 colonization prevalence among newly arrived unaccompanied children 1 year after an outbreak – Texas, 2015External
        Kobayashi M, Misegades L, Fleming-Dutra KE, Ahmed S, Gierke R, Nanduri S, Healy JM, Nguyen DT, da Gloria Carvalho M, Pimenta F, Waterman SH, Moore MR, Kim C, Whitney CG.
        Pediatr Infect Dis J. 2017 Feb;36(2):236-238.
        In 2014, an acute respiratory illness outbreak affected unaccompanied children from Central America entering the United States; 9% of 774 surveyed children were colonized with Streptococcus pneumoniae serotype 5. In our 2015 follow-up survey of 475 children, serotype 5 was not detected, and an interim recommendation to administer 13-valent pneumococcal conjugate vaccine to all unaccompanied children was discontinued.

      7. Emerging fungal infections in the Pacific Northwest: The unrecognized burden and geographic range of Cryptococcus gattii and Coccidioides immitisExternal
        Lockhart SR, McCotter OZ, Chiller TM.
        Microbiol Spectr. 2016 Jun;4(3).
        Both Cryptococcus gattii and Coccidioides can cause debilitating diseases if not identified early. It is imperative that clinicians recognize these diseases and begin treatment quickly when necessary. In order to have these two mycoses in their differential diagnosis, clinicians, microbiologists, and public health officials must be aware of the expanding geographic boundary in the case of Coccidioides immitis and the new emergence in the case of C. gattii. Accordingly, there is now mandatory reporting for cases of C. gattii and C. immitis in both Washington and Oregon, and the Centers for Disease Control and Prevention keeps a repository of available isolates. Through the One Health initiative, clinicians, veterinarians, and public health officials are collaborating to better understand the emergence and expanding geographic range of these extremely important fungal diseases.

      8. Invasive infections with nontyphoidal Salmonella in sub-Saharan AfricaExternal
        Mahon BE, Fields PI.
        Microbiol Spectr. 2016 Jun;4(3).
        Invasive nontyphoidal Salmonella (NTS) infections in Africa cause an enormous burden of illness. These infections are often devastating, with mortality estimated at 20%, even with appropriate antimicrobial therapy. Two major groups-young children and HIV-infected adults-suffer the great majority of these infections. In children, younger age itself, as well as malaria, malnutrition, and HIV infection, are prominent risk factors. In adults, HIV infection is by far the most important risk factor. The most common serotypes in invasive infections are Salmonella enterica serotypes Typhimurium and Enteritidis. In recent years, a specific strain of Salmonella Typhimurium, multilocus sequence type 313, has caused epidemics of invasive disease. Little is known about risk factors for exposure to NTS, making the design of rational interventions to decrease exposure difficult. Antimicrobial therapy is critically important for treatment of invasive NTS infections. Thus, the emergence and spread of resistance to agents commonly used for treatment of invasive NTS infection, now including third-generation cephalosporins, is an ominous development. Already, many invasive NTS infections are essentially untreatable in many health care facilities in sub-Saharan Africa. Several candidate vaccines are in early development and, if safe and effective, could be promising. Interventions to prevent exposure to NTS (e.g., improved sanitation), to prevent the occurrence of disease if exposure does occur (e.g., vaccination, malaria control), and to prevent severe disease and death in those who become ill (e.g., preserving antimicrobial effectiveness) are all important in reducing the toll of invasive NTS disease in sub-Saharan Africa.

      9. Incidence of invasive salmonella disease in sub-Saharan Africa: a multicentre population-based surveillance studyExternal
        Marks F, von Kalckreuth V, Aaby P, Adu-Sarkodie Y, El Tayeb MA, Ali M, Aseffa A, Baker S, Biggs HM, Bjerregaard-Andersen M, Breiman RF, Campbell JI, Cosmas L, Crump JA, Espinoza LM, Deerin JF, Dekker DM, Fields BS, Gasmelseed N, Hertz JT, Van Minh Hoang N, Im J, Jaeger A, Jeon HJ, Kabore LP, Keddy KH, Konings F, Krumkamp R, Ley B, Lofberg SV, May J, Meyer CG, Mintz ED, et al .
        Lancet Glob Health. 2017 Mar;5(3):e310-e323.
        BACKGROUND: Available incidence data for invasive salmonella disease in sub-Saharan Africa are scarce. Standardised, multicountry data are required to better understand the nature and burden of disease in Africa. We aimed to measure the adjusted incidence estimates of typhoid fever and invasive non-typhoidal salmonella (iNTS) disease in sub-Saharan Africa, and the antimicrobial susceptibility profiles of the causative agents. METHODS: We established a systematic, standardised surveillance of blood culture-based febrile illness in 13 African sentinel sites with previous reports of typhoid fever: Burkina Faso (two sites), Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar (two sites), Senegal, South Africa, Sudan, and Tanzania (two sites). We used census data and health-care records to define study catchment areas and populations. Eligible participants were either inpatients or outpatients who resided within the catchment area and presented with tympanic (>/=38.0 degrees C) or axillary temperature (>/=37.5 degrees C). Inpatients with a reported history of fever for 72 h or longer were excluded. We also implemented a health-care utilisation survey in a sample of households randomly selected from each study area to investigate health-seeking behaviour in cases of self-reported fever lasting less than 3 days. Typhoid fever and iNTS disease incidences were corrected for health-care-seeking behaviour and recruitment. FINDINGS: Between March 1, 2010, and Jan 31, 2014, 135 Salmonella enterica serotype Typhi (S Typhi) and 94 iNTS isolates were cultured from the blood of 13 431 febrile patients. Salmonella spp accounted for 33% or more of all bacterial pathogens at nine sites. The adjusted incidence rate (AIR) of S Typhi per 100 000 person-years of observation ranged from 0 (95% CI 0-0) in Sudan to 383 (274-535) at one site in Burkina Faso; the AIR of iNTS ranged from 0 in Sudan, Ethiopia, Madagascar (Isotry site), and South Africa to 237 (178-316) at the second site in Burkina Faso. The AIR of iNTS and typhoid fever in individuals younger than 15 years old was typically higher than in those aged 15 years or older. Multidrug-resistant S Typhi was isolated in Ghana, Kenya, and Tanzania (both sites combined), and multidrug-resistant iNTS was isolated in Burkina Faso (both sites combined), Ghana, Kenya, and Guinea-Bissau. INTERPRETATION: Typhoid fever and iNTS disease are major causes of invasive bacterial febrile illness in the sampled locations, most commonly affecting children in both low and high population density settings. The development of iNTS vaccines and the introduction of S Typhi conjugate vaccines should be considered for high-incidence settings, such as those identified in this study. FUNDING: Bill & Melinda Gates Foundation.

      10. Correlation of adherence by pill count, self-report, MEMS and plasma drug levels to treatment response among women receiving ARV therapy for PMTCT in KenyaExternal
        Mudhune V, Gvetadze R, Girde S, Ndivo R, Angira F, Zeh C, Thomas T, Lecher SL.
        AIDS Behav. 2017 Feb 14.
        Success of antiretroviral therapy depends on adherence to effective treatment. We evaluated four adherence methods and their correlation with immunological and virologic response among women receiving PMTCT. Univariable and multivariable analyses were used to assess how adherence by pill count (n = 463), self-report (n = 463), MEMS (n = 129) and plasma drug level (n = 89) was associated with viral load suppression within a 6 months period. Longitudinal analysis was performed to determine the correlation of CD4 cell count with each measure of adherence. For all measures of adherence, sustained viral suppression was less likely for participants in the lowest category of adherence. Although CD4 cell count increased substantially over time, there was no significant association with adherence by the methods. Multiple strategies can be used successfully to monitor treatment adherence. Persons with >/=95% adherence by any method used in this study were more likely to have a favorable treatment outcome.

      11. Notes from the field: Ongoing cholera epidemic – Tanzania, 2015-2016External
        Narra R, Maeda JM, Temba H, Mghamba J, Nyanga A, Greiner AL, Bakari M, Beer KD, Chae SR, Curran KG, Eidex RB, Gibson JJ, Handzel T, Kiberiti SJ, Kishimba RS, Lukupulo H, Malibiche T, Massa K, Massay AE, McCrickard LS, McHau GJ, Mmbaga V, Mohamed AA, Mwakapeje ER, Nestory E, Newton AE, Oyugi E, Rajasingham A, Roland ME, Rusibamayila N, Sembuche S, Urio LJ, Walker TA, Wang A, Quick RE.
        MMWR Morb Mortal Wkly Rep. 2017 Feb 17;66(6):177-178.
        [No abstract]
      12. Middle East Respiratory Syndrome (MERS)External
        Rasmussen SA, Watson AK, Swerdlow DL.
        Microbiol Spectr. 2016 Jun;4(3).
        Since the identification of the first patients with Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, over 1,600 cases have been reported as of February 2016. Most cases have occurred in Saudi Arabia or in other countries on or near the Arabian Peninsula, but travel-associated cases have also been seen in countries outside the Arabian Peninsula. MERS-CoV causes a severe respiratory illness in many patients, with a case fatality rate as high as 40%, although when contacts are investigated, a significant proportion of patients are asymptomatic or only have mild symptoms. At this time, no vaccines or treatments are available. Epidemiological and other data suggest that the source of most primary cases is exposure to camels. Person-to-person transmission occurs in household and health care settings, although sustained and efficient person-to-person transmission has not been observed. Strict adherence to infection control recommendations has been associated with control of previous outbreaks. Vigilance is needed because genomic changes in MERS-CoV could result in increased transmissibility, similar to what was seen in severe acute respiratory syndrome coronavirus (SARS-CoV).

      13. Estimating false-recent classification for the limiting-antigen avidity EIA and BED-capture enzyme immunoassay in Vietnam: Implications for HIV-1 incidence estimatesExternal
        Shah NS, Duong YT, Le LV, Tuan NA, Parekh B, Ha HT, Pham QD, Cuc CT, Dobbs T, Tram TH, Lien TT, Wagar N, Yang C, Martin A, Wolfe MI, Nguyen HT, Kim AA.
        AIDS Res Hum Retroviruses. 2017 Feb 14.
        BACKGROUND: Laboratory tests that can distinguish recent from long-term HIV infection are used to estimate HIV incidence in a population but can potentially misclassify a proportion of long-term HIV infections as recent. Correct application of an assay requires determination of the proportion false recents (PFR) as part of the assay characterization and for calculating HIV incidence in a local population using a HIV incidence assay. METHODS: From April 2009 to December 2010, blood specimens were collected from HIV-infected individuals attending 9 outpatient clinics (OPCs) in Vietnam (4 from northern and 5 from southern Vietnam). Participants were living with HIV for >/=1 year and reported no antiretroviral drug (ARV) treatment. Basic demographic data and clinical information were collected. Specimens were tested with the BED capture enzyme immunoassay (BED-CEIA) and the Limiting-antigen (LAg)-Avidity EIA. PFR was estimated by dividing the number of specimens classified as recent by the total number of specimens; 95% confidence intervals (CI) were calculated. Specimens that tested recent had viral load testing performed. RESULTS: Among 1,813 specimens (north, n= 942 and south, n = 871), the LAg-Avidity EIA PFR was 1.7% (CI 1.2-2.4) and differed by region [north 2.7% (CI 1.8, 3.9) versus south 0.7% (CI 0.3, 1.5); p=0.002]. The BED-CEIA PFR was 2.3% (CI 1.7, 3.0) and varied by region [north 3.4% (CI: 2.4, 4.7) versus south 1.0% (CI 0.5, 1.2), p<0.001]. Excluding specimens with an undetectable VL, the LAg-Avidity EIA PFR was 1.2% (CI: 0.8, 1.9) and the BED-CEIA PFR was 1.7% (CI: 1.2, 2.4). CONCLUSIONS: The LAg-Avidity EIA PFR was lower than the BED-CEIA PFR. After excluding specimens with an undetectable VL, the PFR for both assays was similar. A low PFR should facilitate the implementation of the LAg-Avidity EIA for cross-sectional incidence estimates in Vietnam.

      14. An evaluation of Mpowerment on Individual-level HIV risk behavior, testing, and psychosocial factors among young MSM of color: The Monitoring and Evaluation of MP (MEM) ProjectExternal
        Shelley G, Williams W, Uhl G, Hoyte T, Eke A, Wright C, Rebchook G, Pollack L, Bell K, Wang Y, Cheng Q, Kegeles SM.
        AIDS Educ Prev. 2017 Feb;29(1):24-37.
        Young men who have sex with men (MSM) of color are at increased risk for HIV infection. Mpowerment (MP) is an intervention designed to reduce risky sexual behavior and increase HIV testing among young MSM ages 18-29. From 2009 to 2012, three community-based organizations with support from the U.S. Centers for Disease Control and Prevention evaluated MP among N = 298 participants. Following a repeated measures design, data from 3- and 6-month follow-ups were compared to baseline. HIV testing and self-efficacy for safer sex increased at both follow-up time points; self-acceptance as an MSM was higher at follow-up 2. Condomless anal/vaginal sex was lower at follow-up 1 only. Frequency of exchange of safer sex messages among gay/bisexual/transgender friends was lower at follow-up 1, but similar to baseline at follow-up 2. Exposure to MP was associated with improved perceived positive social norms about safer sex and safer sex messages among gay/bisexual/transgender friends.

      15. Seasonal, geographic, and temporal trends of emm clusters associated with invasive group A streptococcal infections in US multistate surveillanceExternal
        Smeesters PR, Laho D, Beall B, Steer AC, Van Beneden CA.
        Clin Infect Dis. 2017 Feb 10.
        [No abstract]
      16. Effect of postnatal HIV treatment on clinical mastitis and breast inflammation in HIV-infected breast-feeding womenExternal
        Zadrozny S, Westreich D, Hudgens MG, Chasela C, Jamieson DJ, Martinson F, Zimba C, Tegha G, Hoffman I, Miller WC, Pence BW, King CC, Kourtis AP, Msungama W, van der Horst C.
        Paediatr Perinat Epidemiol. 2017 Feb 16.
        BACKGROUND: The relationship between mastitis and antiretroviral therapy among HIV-positive, breast-feeding women is unclear. METHODS: In the Breastfeeding, Antiretrovirals, and Nutrition (BAN) study, conducted in Lilongwe, Malawi, 2369 mother-infant pairs were randomized to a nutritional supplement group and to one of three treatment groups: maternal antiretroviral therapy (ART), infant nevirapine (NVP) or standard of care for 24 weeks of exclusive breast-feeding and 4 weeks of weaning. Among 1472 HIV-infected women who delivered live infants between 2004 and 2007, we estimated cumulative incidence functions and sub-distribution hazard ratios (HR) of mastitis or breast inflammation comparing women in maternal ART (n = 487) or infant nevirapine (n = 492) groups to the standard of care (n = 493). Nutritional supplement groups (743 took, 729 did not) were also compared. RESULTS: Through 28-weeks post-partum, 102 of 1472 women experienced at least one occurrence of mastitis or breast inflammation. The 28-week risk was higher for maternal ART (risk difference (RD) 4.5, 95% confidence interval (CI) 0.9, 8.1) and infant NVP (RD 3.6, 95% CI 0.3, 6.9) compared to standard of care. The hazard of late-appearing mastitis or breast inflammation (from week 5-28) was also higher for maternal ART (HR 6.7, 95% CI 2.0, 22.6) and infant NVP (HR 5.1, 95% CI 1.5, 17. 5) compared to the standard of care. CONCLUSIONS: Mastitis or breast inflammation while breast-feeding is a possible side effect for women taking prophylactic ART and women whose infants take NVP, warranting additional research in the context of postnatal HIV transmission.

    • Disease Reservoirs and Vectors RSS Word feed
      1. Prevalence and phylogenetic analysis of Bartonella species of wild carnivores and their fleas in northwestern MexicoExternal
        Lopez-Perez AM, Osikowicz L, Bai Y, Montenieri J, Rubio A, Moreno K, Gage K, Suzan G, Kosoy M.
        Ecohealth. 2017 Feb 14.
        The host-parasite-vector relationship of Bartonella spp. system in wild carnivores and their fleas from northwestern Mexico was investigated. Sixty-six carnivores belonging to eight species were sampled, and 285 fleas belonging to three species were collected during spring (April-May) and fall (October-November) seasons. We detected Bartonella species in 7 carnivores (10.6%) and 27 fleas (9.5%) through either blood culture or PCR. Of the 27 Bartonella-positive fleas, twenty-two were Pulex simulans, three were Pulex irritans and one was Echidnophaga gallinacea. The gltA gene and ITS region sequences alignment revealed six and eight genetic variants of Bartonella spp., respectively. These variants were clustered into Bartonella rochalimae, Bartonella vinsonii subsp. berkhoffii and another genotype, which likely represents a novel species of Bartonella spp. Although experimental infection studies are required to prove the vector role of P. simulans, our results suggest that this flea may play an important role in the Bartonella transmission. The results indicated possible host-specific relationships between Bartonella genotypes and the families of the carnivores, but further studies are needed to verify this finding. The presence of zoonotic species of Bartonella spp. in wild carnivores raises the issue of their potential risk for humans in fragmented ecosystems.

      2. Modelling filovirus maintenance in nature by experimental transmission of Marburg virus between Egyptian rousette batsExternal
        Schuh AJ, Amman BR, Jones ME, Sealy TK, Uebelhoer LS, Spengler JR, Martin BE, Coleman-McCray JA, Nichol ST, Towner JS.
        Nat Commun. 2017 Feb 13;8:14446.
        The Egyptian rousette bat (ERB) is a natural reservoir host for Marburg virus (MARV); however, the mechanisms by which MARV is transmitted bat-to-bat and to other animals are unclear. Here we co-house MARV-inoculated donor ERBs with naive contact ERBs. MARV shedding is detected in oral, rectal and urine specimens from inoculated bats from 5-19 days post infection. Simultaneously, MARV is detected in oral specimens from contact bats, indicating oral exposure to the virus. In the late study phase, we provide evidence that MARV can be horizontally transmitted from inoculated to contact ERBs by finding MARV RNA in blood and oral specimens from contact bats, followed by MARV IgG antibodies in these same bats. This study demonstrates that MARV can be horizontally transmitted from inoculated to contact ERBs, thereby providing a model for filovirus maintenance in its natural reservoir host and a potential mechanism for virus spillover to other animals.

    • Genetics and Genomics RSS Word feed
      1. Comparative genomic analysis of the IId subtype family of Cryptosporidium parvumExternal
        Feng Y, Li N, Roellig DM, Kelley A, Liu G, Amer S, Tang K, Zhang L, Xiao L.
        Int J Parasitol. 2017 Feb 10.
        Host adaptation is known to occur in Cryptosporidium parvum, with IIa and IId subtype families preferentially infecting calves and lambs, respectively. To improve our understanding of the genetic basis of host adaptation in Cryptosporidium parvum, we sequenced the genomes of two IId specimens and one IIa specimen from China and Egypt using the Illumina technique and compared them with the published IIa IOWA genome. Sequence data were obtained for >99.3% of the expected genome. Comparative genomic analysis identified differences in numbers of three subtelomeric gene families between sequenced genomes and the reference genome, including those encoding SKSR secretory proteins, the MEDLE family of secretory proteins, and insulinase-like proteases. These gene gains and losses compared with the reference genome were confirmed by PCR analysis. Altogether, 5,191-5,766 single nucleotide variants were seen between genomes sequenced in this study and the reference genome, with most SNVs occurring in subtelomeric regions of chromosomes 1, 4, and 6. The most highly polymorphic genes between IIa and IId encode mainly invasion-associated and immunodominant mucin proteins, and other families of secretory proteins. Further studies are needed to verify the biological significance of these genomic differences.

      2. First full draft genome sequence of Plasmodium brasilianumExternal
        Talundzic E, Ravishankar S, Nayak V, Patel DS, Olsen C, Sheth M, Batra D, Loparev V, Vannberg FO, Udhayakumar V, Barnwell JW.
        Genome Announc. 2017 Feb 09;5(6).
        Plasmodium malariae is a protozoan parasite that can cause human malaria. The simian parasite Plasmodium brasilianum infects New World monkeys from Latin America and is morphologically indistinguishable from P. malariae Here, we report the first full draft genome sequence for P. brasilianum.

    • Health Economics RSS Word feed
      1. Costs of colorectal cancer screening provision in CDC’s colorectal cancer control program: Comparisons of colonoscopy and FOBT/FIT based screeningExternal
        Subramanian S, Tangka FK, Hoover S, Royalty J, DeGroff A, Joseph D.
        Eval Program Plann. 2017 Feb 07.
        We assess annual costs of screening provision activities implemented by 23 of the Centers for Disease Control and Prevention’s Colorectal Cancer Control Program (CRCCP) grantees and report differences in costs between colonoscopy and FOBT/FIT-based screening programs. We analysed annual cost data for the first three year of the CRCCP (July 2009-June 2011) for each screening provision activity and categorized them into clinical and non-clinical screening provision activities. The largest cost components for both colonoscopy and FOBT/FIT-based programs were screening and diagnostic services, program management, and data collection and tracking. During the first 3 years of the CRCCP, the average annual clinical cost for screening and diagnostic services per person served was $1150 for colonoscopy programs, compared to $304 for FIT/FOBT-based programs. Overall, FOBT/FIT-based programs appear to have slightly higher non-clinical costs per person served (average $1018; median $838) than colonoscopy programs (average $980; median $686). Colonoscopy-based CRCCP programs have higher clinical costs than FOBT/FIT-based programs during the 3-year study timeframe (translating into fewer people screened). Non-clinical costs for both approaches are similar and substantial. Future studies of the cost-effectiveness of colorectal cancer screening initiatives should consider both clinical and non-clinical costs.

      2. Preventing deaths and injuries from house fires: a cost-benefit analysis of a community-based smoke alarm installation programmeExternal
        Yellman MA, Peterson C, McCoy MA, Stephens-Stidham S, Caton E, Barnard JJ, Padgett TO, Florence C, Istre GR.
        Inj Prev. 2017 Feb 09.
        BACKGROUND: Operation Installation (OI), a community-based smoke alarm installation programme in Dallas, Texas, targets houses in high-risk urban census tracts. Residents of houses that received OI installation (or programme houses) had 68% fewer medically treated house fire injuries (non-fatal and fatal) compared with residents of non-programme houses over an average of 5.2 years of follow-up during an effectiveness evaluation conducted from 2001 to 2011. OBJECTIVE: To estimate the cost-benefit of OI. METHODS: A mathematical model incorporated programme cost and effectiveness data as directly observed in OI. The estimated cost per smoke alarm installed was based on a retrospective analysis of OI expenditures from administrative records, 2006-2011. Injury incidence assumptions for a population that had the OI programme compared with the same population without the OI programme was based on the previous OI effectiveness study, 2001-2011. Unit costs for medical care and lost productivity associated with fire injuries were from a national public database. RESULTS: From a combined payers’ perspective limited to direct programme and medical costs, the estimated incremental cost per fire injury averted through the OI installation programme was $128,800 (2013 US$). When a conservative estimate of lost productivity among victims was included, the incremental cost per fire injury averted was negative, suggesting long-term cost savings from the programme. The OI programme from 2001 to 2011 resulted in an estimated net savings of $3.8 million, or a $3.21 return on investment for every dollar spent on the programme using a societal cost perspective. CONCLUSIONS: Community smoke alarm installation programmes could be cost-beneficial in high-fire-risk neighbourhoods.

    • Immunity and Immunization RSS Word feed
      1. Interim estimates of 2016-17 seasonal influenza vaccine effectiveness – United States, February 2017External
        Flannery B, Chung JR, Thaker SN, Monto AS, Martin ET, Belongia EA, McLean HQ, Gaglani M, Murthy K, Zimmerman RK, Nowalk MP, Jackson ML, Jackson LA, Foust A, Sessions W, Berman L, Spencer S, Fry AM.
        MMWR Morb Mortal Wkly Rep. 2017 Feb 17;66(6):167-171.
        In the United States, annual vaccination against seasonal influenza is recommended for all persons aged >/=6 months. Each influenza season since 2004-05, CDC has estimated the effectiveness of seasonal influenza vaccine to prevent influenza-associated, medically attended, acute respiratory illness (ARI). This report uses data, as of February 4, 2017, from 3,144 children and adults enrolled in the U.S. Influenza Vaccine Effectiveness Network (U.S. Flu VE Network) during November 28, 2016-February 4, 2017, to estimate an interim adjusted effectiveness of seasonal influenza vaccine for preventing laboratory-confirmed influenza virus infection associated with medically attended ARI. During this period, overall vaccine effectiveness (VE) (adjusted for study site, age group, sex, race/ethnicity, self-rated general health, and days from illness onset to enrollment) against influenza A and influenza B virus infection associated with medically attended ARI was 48% (95% confidence interval [CI] = 37%-57%). Most influenza infections were caused by A (H3N2) viruses. VE was estimated to be 43% (CI = 29%-54%) against illness caused by influenza A (H3N2) virus and 73% (CI = 54%-84%) against influenza B virus. These interim VE estimates indicate that influenza vaccination reduced the risk for outpatient medical visits by almost half. Because influenza activity remains elevated (2), CDC and the Advisory Committee on Immunization Practices recommend that annual influenza vaccination efforts continue as long as influenza viruses are circulating. Vaccination with 2016-17 influenza vaccines will reduce the number of infections with most currently circulating influenza viruses. Persons aged >/=6 months who have not yet been vaccinated this season should be vaccinated as soon as possible.

      2. Vial usage, device dead space, vaccine wastage, and dose accuracy of intradermal delivery devices for inactivated poliovirus vaccine (IPV)External
        Jarrahian C, Rein-Weston A, Saxon G, Creelman B, Kachmarik G, Anand A, Zehrung D.
        Vaccine. 2017 Feb 08.
        INTRODUCTION: Intradermal delivery of a fractional dose of inactivated poliovirus vaccine (IPV) offers potential benefits compared to intramuscular (IM) delivery, including possible cost reductions and easing of IPV supply shortages. Objectives of this study were to assess intradermal delivery devices for dead space, wastage generated by the filling process, dose accuracy, and total number of doses that can be delivered per vial. METHODS: Devices tested included syringes with staked (fixed) needles (autodisable syringes and syringes used with intradermal adapters), a luer-slip needle and syringe, a mini-needle syringe, a hollow microneedle device, and disposable-syringe jet injectors with their associated filling adapters. Each device was used to withdraw 0.1-mL fractional doses from single-dose IM glass vials which were then ejected into a beaker. Both vial and device were weighed before and after filling and again after expulsion of liquid to record change in volume at each stage of the process. Data were used to calculate the number of doses that could potentially be obtained from multidose vials. RESULTS: Results show wide variability in dead space, dose accuracy, overall wastage, and total number of doses that can be obtained per vial among intradermal delivery devices. Syringes with staked needles had relatively low dead space and low overall wastage, and could achieve a greater number of doses per vial compared to syringes with a detachable luer-slip needle. Of the disposable-syringe jet injectors tested, one was comparable to syringes with staked needles. DISCUSSION: If intradermal delivery of IPV is introduced, selection of an intradermal delivery device can have a substantial impact on vaccine wasted during administration, and thus on the required quantity of vaccine that needs to be purchased. An ideal intradermal delivery device should be not only safe, reliable, accurate, and acceptable to users and vaccine recipients, but should also have low dead space, high dose accuracy, and low overall wastage to maximize the potential number of doses that can be withdrawn and delivered.

    • Laboratory Sciences RSS Word feed
      1. Development and validation of a high-throughput online solid phase extraction – liquid chromatography – tandem mass spectrometry method for the detection of gonyautoxins1&4 and gonyautoxins2&3 in human urineExternal
        Coleman R, Lemire SW, Bragg W, Garrett A, Ojeda-Torres G, Wharton R, Hamelin E, Thomas J, Johnson RC.
        Biomed Chromatogr. 2017 Feb 10.
        Paralytic shellfish toxins (PSTs), including gonyautoxins and saxitoxins, are produced by multiple species of microalgae and dinoflagellates, and are bioaccumulated by shellfish and other animals. Human exposure to PSTs typically occurs through ingestion of recreationally-harvested contaminated shellfish and results in non-specific symptomology. Confirmation of exposure to PSTs has often relied on the measurement of saxitoxin, the most toxic congener; however, gonyautoxins (GTXs), the sulfated carbamate derivatives of saxitoxin, may be present in shellfish at higher concentrations. To improve identification of PST exposures, our group has developed an online solid phase extraction hydrophilic interaction liquid chromatography (HILIC) method to identify GTX1-4 in human urine with tandem mass spectrometry. The reportable range varied for each analyte, with all falling within 0.899 and 250 ng/mL in urine with precision <15% and >85% accuracy as determined for all quality control samples. This new online method quantitates GTX1-4 following exposures to PSTs, supporting the work of public health authorities.

      2. Frequent Zika virus sexual transmission and prolonged viral RNA shedding in an immunodeficient mouse modelExternal
        Duggal NK, Ritter JM, Pestorius SE, Zaki SR, Davis BS, Chang GJ, Bowen RA, Brault AC.
        Cell Rep. 2017 Feb 14;18(7):1751-1760.
        Circulation of Zika virus (ZIKV) was first identified in the Western hemisphere in late 2014. Primarily transmitted through mosquito bite, ZIKV can also be transmitted through sex and from mother to fetus, and maternal ZIKV infection has been associated with fetal malformations. We assessed immunodeficient AG129 mice for their capacity to shed ZIKV in semen and to infect female mice via sexual transmission. Infectious virus was detected in semen between 7 and 21 days post-inoculation, and ZIKV RNA was detected in semen through 58 days post-inoculation. During mating, 73% of infected males transmitted ZIKV to uninfected females, and 50% of females became infected, with evidence of fetal infection in resulting pregnancies. Semen from vasectomized mice contained significantly lower levels of infectious virus, though sexual transmission still occurred. This model provides a platform for studying the kinetics of ZIKV sexual transmission and prolonged RNA shedding also observed in human semen.

      3. Evaluation of fluidized bed asbestos segregator to determine erionite in soil
        Farcas D, Harper M, Januch JW, Jacobs TA, Sarkisian K, Stetler LD, Schwegler-Berry D.
        Environ Earth Sci. 2017 ;76(3).
        Three sets of soil samples were collected by the National Institute for Occupational Safety and Health and one set by South Dakota School of Mines & Technology from in and around the Slim Buttes Land Unit of the Sioux Ranger District of the Custer-Gallatin National Forest in the northwest of South Dakota. The rocks forming the Slim Buttes are sedimentary clays, sands and gravels including re-worked volcanic ash-falls in which the zeolite mineral erionite has crystallized during diagenesis in a fibrous form or morphology similar to that of asbestos. The samples were prepared using the fluidized bed asbestos segregator (FBAS) and analyzed by phase contrast microscopy (PCM) or transmission electron microscopy to detect the presence of mineral fibers. FBAS-PCM results compared to semi-quantitative polarized light microscopy (PLM) and X-ray diffraction analysis indicated a recovery of approximately 1% and a linear relationship that likely can be extrapolated to concentrations well below the 1% detection limit of PLM. There were small variations between a PCM count of 10 fibers to a count of 100 fibers (or a maximum of 200 microscopic fields of view), which indicates the possibility of rapid turnaround of results. Although the four sets of samples examined in this work were collected by slightly different techniques, some tentative conclusions can be drawn about the distribution of erionite in soils. Erionite was detected in almost every soil sample, even those taken several miles from the outcrop, but without any distribution indicating recent transportation from the current volcaniclastic sediment outcrops. Removal of more extensive volcaniclastic sediments through erosion may have resulted in remnant material in soils, including erionite crystals, but this possibility requires further study. Although we have demonstrated that erionite in soils can be detected through FBAS-PCM, we have not attempted to correlate those results with human inhalation exposure through activity-based sampling, and thus, any risk inherent in working these soils is unknown.

      4. Combatting global infectious diseases: A network effect of specimen referral systemsExternal
        Fonjungo PN, Alemnji GA, Kebede Y, Opio A, Mwangi C, Spira TJ, Beard RS, Nkengasong JN.
        Clin Infect Dis. 2017 Feb 13.
        [No abstract]
      5. Herpes simplex virus and varicella – zoster virusExternal
        Levin MJ, Weinberg A, Schmid DS.
        Microbiol Spectr. 2016 Jun;4(3).
        The most common specimens from immunocompromised patients that are analyzed for detection of herpes simplex virus (HSV) or varicella-zoster virus (VZV) are from skin lesions. Many types of assays are applicable to these samples, but some, such as virus isolation and direct fluorescent antibody testing, are useful only in the early phases of the lesions. In contrast, nucleic acid (NA) detection methods, which generally have superior sensitivity and specificity, can be applied to skin lesions at any stage of progression. NA methods are also the best choice, and sometimes the only choice, for detecting HSV or VZV in blood, cerebrospinal fluid, aqueous or vitreous humor, and from mucosal surfaces. NA methods provide the best performance when reliability and speed (within 24 hours) are considered together. They readily distinguish the type of HSV detected or the source of VZV detected (wild type or vaccine strain). Nucleic acid detection methods are constantly being improved with respect to speed and ease of performance. Broader applications are under study, such as the use of quantitative results of viral load for prognosis and to assess the efficacy of antiviral therapy.

      6. Novel multiplex assay platforms to detect influenza A hemagglutinin subtype specific antibody responses for high-throughput and in-field applicationsExternal
        Li ZN, Trost JF, Weber KM, LeMasters EH, Nasreen S, Esfandiari J, Gunasekera AH, McCausland M, Sturm-Ramirez K, Wrammert J, Gregory S, Veguilla V, Stevens J, Miller JD, Katz JM, Levine MZ.
        Influenza Other Respir Viruses. 2017 Feb 16.
        BACKGROUND: Detections of influenza A subtype specific antibody responses are often complicated by the presence of cross-reactive antibodies. We developed two novel multiplex platforms for antibody detection. The multiplexed magnetic fluorescence microsphere immunoassay (MAGPIX) is a high throughput laboratory-based assay. Chembio Dual Path Platform (DPP) is a portable and rapid test that could be used in the field. METHODS: Twelve recombinant globular head domain hemagglutinin (GH HA1) antigens from A(H1N1)pdm09 (pH1N1), A(H2N2), A(H3N2), A(H5N1), A(H7N9), A(H9N2), A(H13N9), B/Victoria lineage, B/Yamagata lineage viruses, and protein A control were used. Human sera from U.S. residents either vaccinated (with H5N1 or pH1N1) or infected with pH1N1 influenza viruses, and sera from live bird market workers in Bangladesh (BDPW) were evaluated. GH HA1 antigens and serum adsorption using full ectodomain recombinant hemagglutinins from A(H1N1) and A(H3N2) were introduced into the platforms to reduce cross-reactivity. RESULTS: Serum adsorption reduced cross-reactivity to novel subtype HAs. Compared to traditional hemagglutination inhibition or microneutralization assays, when serum adsorption and the highest fold rise in signals were used to determine positivity, the correct subtype-specific responses were identified in 86% to 100% of U.S. residents exposed to influenza antigens through vaccination or infection (N=49). For detection of H5N1 specific antibodies in sera collected from BDPW, H5 sensitivity was 100% (6/6) for MAGPIX, 83% (5/6) for DPP; H5 specificity was 100% (15/15) and cross-reactivity against other subtype was 0% (0/6) for both platforms. CONCLUSION: MAGPIX and DPP platforms can be utilized for high-throughput and in-field detection of novel influenza virus infections.

      7. Evaluation of multiplex assay platforms for detection of influenza hemagglutinin subtype specific antibody responsesExternal
        Li ZN, Weber KM, Limmer RA, Horne BJ, Stevens J, Schwerzmann J, Wrammert J, McCausland M, Phipps AJ, Hancock K, Jernigan DB, Levine M, Katz JM, Miller JD.
        J Virol Methods. 2017 Jan 17;243:61-67.
        Influenza hemagglutination inhibition (HI) and virus microneutralization assays (MN) are widely used for seroprevalence studies. However, these assays have limited field portability and are difficult to fully automate for high throughput laboratory testing. To address these issues, three multiplex influenza subtype-specific antibody detection assays were developed using recombinant hemagglutinin antigens in combination with Chembio, Luminex(R), and ForteBio(R) platforms. Assay sensitivity, specificity, and subtype cross-reactivity were evaluated using a panel of well characterized human sera. Compared to the traditional HI, assay sensitivity ranged from 87% to 92% and assay specificity in sera collected from unexposed persons ranged from 65% to 100% across the platforms. High assay specificity (86-100%) for A(H5N1) rHA was achieved for sera from exposed or unexposed to hetorosubtype influenza HAs. In contrast, assay specificity for A(H1N1)pdm09 rHA using sera collected from A/Vietnam/1204/2004 (H5N1) vaccinees in 2008 was low (22-30%) in all platforms. Although cross-reactivity against rHA subtype proteins was observed in each assay platform, the correct subtype specific responses were identified 78%-94% of the time when paired samples were available for analysis. These results show that high throughput and portable multiplex assays that incorporate rHA can be used to identify influenza subtype specific infections.

      8. Establishment and use of epidemiological cutoff values for molds and yeasts using the Clinical and Laboratory Standards Institute M57 standardExternal
        Lockhart SR, Ghannoum MA, Alexander BD.
        J Clin Microbiol. 2017 Feb 15.
        Breakpoints are used to predict whether an antifungal agent will be clinically effective against a particular fungal isolate. They are based on a combination of MIC values, pharmacokinetic/pharmacodynamic values and clinical outcome data. For many fungus/antifungal combinations this data will never be available. For these combinations Epidemiological Cutoff Values (ECVs) provide a methodology to categorize isolates as either wild type or non-wild type. This review defines ECVs, explains how they are generated using the CLSI methodology in standard M57, and describes how they can be used in clinical practice.

      9. The maturation state of the auditory nerve and brainstem in rats exposed to lead acetate and supplemented with ferrous sulfate
        Zucki F, Morata TC, Duarte JL, Ferreira MC, Salgado MH, Alvarenga KF.
        Braz J Otorhinolaryngol. 2017 .
        Introduction The literature has reported the association between lead and auditory effects, based on clinical and experimental studies. However, there is no consensus regarding the effects of lead in the auditory system, or its correlation with the concentration of the metal in the blood. Objective To investigate the maturation state of the auditory system, specifically the auditory nerve and brainstem, in rats exposed to lead acetate and supplemented with ferrous sulfate. Methods 30 weanling male rats (Rattus norvegicus, Wistar) were distributed into six groups of five animals each and exposed to one of two concentrations of lead acetate (100 or 400 mg/L) and supplemented with ferrous sulfate (20 mg/kg). The maturation state of the auditory nerve and brainstem was analyzed using Brainstem Auditory Evoked Potential before and after lead exposure. The concentration of lead in blood and brainstem was analyzed using Inductively Coupled Plasma-Mass Spectrometry. Results We verified that the concentration of Pb in blood and in brainstem presented a high correlation (r = 0.951; p < 0.0001). Both concentrations of lead acetate affected the maturation state of the auditory system, being the maturation slower in the regions corresponding to portion of the auditory nerve (wave I) and cochlear nuclei (wave II). The ferrous sulfate supplementation reduced significantly the concentration of lead in blood and brainstem for the group exposed to the lowest concentration of lead (100 mg/L), but not for the group exposed to the higher concentration (400 mg/L). Conclusion This study indicate that the lead acetate can have deleterious effects on the maturation of the auditory nerve and brainstem (cochlear nucleus region), as detected by the Brainstem Auditory Evoked Potentials, and the ferrous sulphate can partially amend this effect.

    • Maternal and Child Health RSS Word feed
      1. Impact of the integration of water treatment, hygiene, nutrition, and clean delivery interventions on maternal health service useExternal
        Fagerli K, O’Connor K, Kim S, Kelley M, Odhiambo A, Faith S, Otieno R, Nygren B, Kamb M, Quick R.
        Am J Trop Med Hyg. 2017 Feb 13.
        Reducing barriers associated with maternal health service use, household water treatment, and improved hygiene is important for maternal and neonatal health outcomes. We surveyed a sample of 201 pregnant women who participated in a clinic-based intervention in Kenya to increase maternal health service use and improve household hygiene and nutrition through the distribution of water treatment products, soap, protein-fortified flour, and clean delivery kits. From multivariable logistic regression analyses, the adjusted odds of >/= 4 antenatal care (ANC4+) visits (odds ratio [OR] = 3.0, 95% confidence interval [CI] = 1.9-4.5), health facility delivery (OR = 5.3, 95% CI = 3.4-8.3), and any postnatal care visit (OR = 2.8, 95% CI = 1.9-4.2) were higher at follow-up than at baseline, adjusting for demographic factors. Women who completed primary school had higher odds of ANC4+ visits (OR = 1.8, 95% CI = 1.1-2.9) and health facility delivery (OR = 4.2, 95% CI = 2.5-7.1) than women with less education. For women who lived </= 2.5 km from the health facility, the estimated odds of health facility delivery (OR = 2.4, 95% CI = 1.5-4.1) and postnatal care visit (OR = 1.6, 95% CI = 1.0-2.6) were higher than for those who lived > 2.5 km away. Compared with baseline, a higher percentage of survey participants at follow-up were able to demonstrate proper handwashing (P = 0.001); water treatment behavior did not change. This evaluation suggested that hygiene, nutritional, clean delivery incentives, higher education level, and geographical contiguity to health facility were associated with increased use of maternal health services by pregnant women.

      2. Perceived quality of life among caregivers of children with a childhood-onset dystrophinopathy: a double ABCX model of caregiver stressors and perceived resourcesExternal
        Frishman N, Conway KC, Andrews J, Oleson J, Mathews K, Ciafaloni E, Oleszek J, Lamb M, Matthews D, Paramsothy P, McKirgan L, Romitti P.
        Health Qual Life Outcomes. 2017 Feb 10;15(1):33.
        BACKGROUND: Duchenne and Becker muscular dystrophies, collectively referred to as dystrophinopathies, are recessive X-linked disorders characterized by progressive muscle weakness and ultimately cardiac and respiratory failure. Immediate family members are often primary caregivers of individuals with a dystrophinopathy. METHODS: We explored the impact of this role by inviting primary caregivers (n = 209) of males diagnosed with childhood-onset dystrophinopathy who were identified by the Muscular Dystrophy Surveillance, Tracking, and Research Network (MD STARnet) to complete a mailed questionnaire measuring perceived social support and stress, spirituality, and family quality of life (FQoL). Bivariate and multivariate analyses examined associations between study variables using the Double ABCX model as an analytic framework. RESULTS: Higher stressor pile-up was associated with lower perceived social support (r = -0.29, p < .001), availability of supportive family (r = -0.30, p < .001) or non-family (r = -0.19, p < .01) relationships, and higher perceived stress (r = 0.33, p < .001); but not with spirituality (r = -0.14, p > 0.05). FQoL was positively associated with all support measures (correlations ranged from: 0.25 to 0.58, p-values 0.01-0.001) and negatively associated with perceived stress and control (r = -0.49, p < .001). The association between stressor pile-up and FQoL was completely mediated through global perceived social support, supportive family relationships, and perceived stress and control; supportive non-family relationships did not remain statistically significant after controlling for other mediators. CONCLUSIONS: Findings suggest caregiver adaptation to a dystrophinopathy diagnosis can be optimized by increased perceived control, supporting family resources, and creation of a healthy family identity. Our findings will help identify areas for family intervention and guide clinicians in identifying resources that minimize stress and maximize family adaptation.

      3. Gross motor development in children aged 3-5 years, United States 2012External
        Kit BK, Akinbami LJ, Isfahani NS, Ulrich DA.
        Matern Child Health J. 2017 Feb 14.
        Objective Gross motor development in early childhood is important in fostering greater interaction with the environment. The purpose of this study is to describe gross motor skills among US children aged 3-5 years using the Test of Gross Motor Development (TGMD-2). Methods We used 2012 NHANES National Youth Fitness Survey (NNYFS) data, which included TGMD-2 scores obtained according to an established protocol. Outcome measures included locomotor and object control raw and age-standardized scores. Means and standard errors were calculated for demographic and weight status with SUDAAN using sample weights to calculate nationally representative estimates, and survey design variables to account for the complex sampling methods. Results The sample included 339 children aged 3-5 years. As expected, locomotor and object control raw scores increased with age. Overall mean standardized scores for locomotor and object control were similar to the mean value previously determined using a normative sample. Girls had a higher mean locomotor, but not mean object control, standardized score than boys (p < 0.05). However, the mean locomotor standardized scores for both boys and girls fell into the range categorized as “average.” There were no other differences by age, race/Hispanic origin, weight status, or income in either of the subtest standardized scores (p > 0.05). Conclusions In a nationally representative sample of US children aged 3-5 years, TGMD-2 mean locomotor and object control standardized scores were similar to the established mean. These results suggest that standardized gross motor development among young children generally did not differ by demographic or weight status.

      4. Trends in postpartum depressive symptoms – 27 states, 2004, 2008, and 2012External
        Ko JY, Rockhill KM, Tong VT, Morrow B, Farr SL.
        MMWR Morb Mortal Wkly Rep. 2017 Feb 17;66(6):153-158.
        Postpartum depression is common and associated with adverse infant and maternal outcomes (e.g., lower breastfeeding initiation and duration and poor maternal and infant bonding) (1-3). A developmental Healthy People 2020 objective is to decrease the proportion of women delivering a live birth who experience postpartum depressive symptoms (PDS).* To provide a baseline for this objective, CDC sought to describe self-reported PDS overall, by reporting state, and by selected sociodemographic factors, using 2004, 2008, and 2012 data from the Pregnancy Risk Assessment Monitoring System (PRAMS). A decline in the prevalence of PDS was observed from 2004 (14.8%) to 2012 (9.8%) among 13 states with data for all three periods (p<0.01). Statistically significant (p<0.05) declines in PDS prevalence were observed for eight states, and no significant changes were observed for five states. In 2012, the overall PDS prevalence was 11.5% for 27 states and ranged from 8.0% (Georgia) to 20.1% (Arkansas). By selected characteristics, PDS prevalence was highest among new mothers who 1) were aged </=19 years or 20-24 years, 2) were of American Indian/Alaska Native or Asian/Pacific Islander race/ethnicity, 3) had </=12 years of education, 4) were unmarried, 5) were postpartum smokers, 6) had three or more stressful life events in the year before birth, 7) gave birth to term, low-birthweight infants, and 8) had infants requiring neonatal intensive care unit admission at birth. Although the study did not investigate reasons for the decline, better recognition of risk factors for depression and improved screening and treatment before and during pregnancy, including increased use of antidepressants, might have contributed to the decline. However, more efforts are needed to reduce PDS prevalence in certain states and subpopulations of women. Ongoing surveillance and activities to promote appropriate screening, referral, and treatment are needed to reduce PDS among U.S. women.

      5. Prophylaxis usage, bleeding rates and joint outcomes of hemophilia 1999 – 2010: a surveillance projectExternal
        Manco-Johnson MJ, Soucie JM, Gill JC.
        Blood. 2017 Feb 09.
        This analysis of the United States Hemophilia Treatment Center Network and the Centers for Disease Control and Prevention surveillance registry assessed trends in prophylaxis use and its impact on key indicators of arthropathy across the life span among participants with severe hemophilia A. Data on demographics, clinical characteristics and outcomes were collected prospectively between 1999 and 2010 at annual clinical visits to 134 hemophilia treatment centers. Trends in treatment and outcomes were evaluated using cross-sectional and longitudinal analyses. Data analyzed included 26,614 visits for 6,196 males, mean age at first registry visit 17.7 years, median 14, range 2 to 69. During this time, prophylaxis use increased from 31% to 59% overall, with 75% of children and youths less than 20 years on prophylaxis by 2010. On cross-sectional analysis bleeding rates decreased dramatically for the entire population (p< 0.001) in parallel with increased prophylaxis usage, possibly as frequent bleeders adopted prophylaxis. Joint bleeding decreased proportionately with prophylaxis (22%) and non-prophylaxis (23%); target joints decreased more with prophylaxis (80% vs. 61%). Joint, total and target joint bleeding on prophylaxis were 33%, 41% and 27%, respectively, compared to non-prophylaxis. On longitudinal analysis of individuals over time, prophylaxis predicted decreased bleeding at any age (p < 0.001), but only prophylaxis initiation prior to age 4 years and non-obesity predicted preservation of joint motion (p<0.001 for each). Using a national registry care providers in a specialized health care network for a rare disorder were able to detect and track trends in outcomes over time.

      6. Adapting an autism screening tool for use in the DeKalb County Refugee Pediatric ClinicExternal
        McClure C, Reines S, Suchdev PS, Oladele A, Goodman AB.
        J Immigr Minor Health. 2017 Feb 14.
        BACKGROUND: Minimal literature exists regarding Autism Spectrum Disorder (ASD) among refugee children in the United States. Reliable ASD screening tools, such as the M-CHAT-R/F, have yet to be culturally adapted and translated into some languages spoken in the homes of these children. METHODS: Pediatric refugee patients (n = 13) of caregivers of Bhutanese (Nepali-speaking) descent were screened using a newly translated Nepali M-CHAT-R/F. The M-CHAT-R/F was adapted based on feedback from Bhutanese caregivers and interpreter expertise. Qualitative interviews regarding caregiver awareness of ASD were conducted. RESULTS: Caregivers understood the majority of M-CHAT-R/F items (91%). Four items required revision. Interviews revealed minimal awareness among Bhutanese caregivers regarding ASD or child development. DISCUSSION: The M-CHAT-R/F was adapted into Nepali using a combination of translation protocols, and is publicly available for clinical use. Future validation studies are needed which will aid in clinical screening for and epidemiologic research of ASD in this population.

    • Nutritional Sciences RSS Word feed
      1. A comparison of concentrations of sodium and related nutrients (potassium, total dietary fiber, total and saturated fat, and total sugar) in private-label and national brands of popular, sodium-contributing, commercially packaged foods in the United StatesExternal
        Ahuja JK, Pehrsson PR, Cogswell M.
        J Acad Nutr Diet. 2017 Feb 03.
        BACKGROUND: Private-label brands account for about one in four foods sold in US supermarkets. They provide value to consumers due to their low cost. We know of no US studies comparing the nutrition content of private-label products with corresponding national brand products. OBJECTIVE: The objective was to compare concentrations of sodium and related nutrients (potassium, total dietary fiber, total and saturated fat, and total sugar) in popular sodium-contributing, commercially packaged foods by brand type (national or private-label brand). DESIGN: During 2010 to 2014, the Nutrient Data Laboratory of the US Department of Agriculture obtained 1,706 samples of private-label and national brand products from up to 12 locations nationwide and chemically analyzed 937 composites for sodium and related nutrients. The samples came from 61 sodium-contributing, commercially packaged food products for which both private-label and national brands were among the top 75% to 80% of brands for US unit sales. In this post hoc comparative analysis, the authors assigned a variable brand type (national or private label) to each composite and determined mean nutrient contents by brand type overall and by food product and type. STATISTICAL ANALYSES PERFORMED: The authors tested for significant differences (P<0.05) by brand type using independent sample t tests or Mann-Whitney U tests when appropriate. RESULTS: Overall for all foods sampled, differences between brand types were not statistically significant for any of the nutrients studied. However, differences in both directions exist for a few individual food products and food categories. CONCLUSIONS: Concentrations of sodium and related nutrients (potassium, total dietary fiber, total and saturated fat, and total sugar) do not differ systematically between private-label and national brands, suggesting that brand type is not a consideration for nutritional quality of foods in the United States. The study data provide public health officials with baseline nutrient content by brand type to help focus US sodium-reduction efforts.

      2. Sodium intake among US school-aged children: National Health and Nutrition Examination Survey, 2011-2012External
        Quader ZS, Gillespie C, Sliwa SA, Ahuja JK, Burdg JP, Moshfegh A, Pehrsson PR, Gunn JP, Mugavero K, Cogswell ME.
        J Acad Nutr Diet. 2017 Jan;117(1):39-47.e5.
        BACKGROUND: Identifying current major dietary sources of sodium can enhance strategies to reduce excess sodium intake, which occurs among 90% of US school-aged children. OBJECTIVE: To describe major food sources, places obtained, and eating occasions contributing to sodium intake among US school-aged children. DESIGN: Cross-sectional analysis of data from the 2011-2012 National Health and Nutrition Examination Survey. PARTICIPANTS/SETTING: A nationally representative sample of 2,142 US children aged 6 to 18 years who completed a 24-hour dietary recall. MAIN OUTCOME MEASURES: Population proportions of sodium intake from major food categories, places, and eating occasions. STATISTICAL ANALYSES PERFORMED: Statistical analyses accounted for the complex survey design and sampling. Wald F tests and t tests were used to examine differences between subgroups. RESULTS: Average daily sodium intake was highest among adolescents aged 14 to 18 years (3,565+/-120 mg), lowest among girls (2,919+/-74 mg). Little variation was seen in average intakes or the top five sodium contributors by sociodemographic characteristics or weight status. Ten food categories contributed to almost half (48%) of US school-aged children’s sodium intake, and included pizza, Mexican-mixed dishes, sandwiches, breads, cold cuts, soups, savory snacks, cheese, plain milk, and poultry. More than 80 food categories contributed to the other half of children’s sodium intake. Foods obtained from stores contributed 58% of sodium intake, fast-food/pizza restaurants contributed 16%, and school cafeterias contributed 10%. Thirty-nine percent of sodium intake was consumed at dinner, 31% at lunch, 16% from snacks, and 14% at breakfast. CONCLUSIONS: With the exception of plain milk, which naturally contains sodium, the top 10 food categories contributing to US schoolchildren’s sodium intake during 2011-2012 comprised foods in which sodium is added during processing or preparation. Sodium is consumed throughout the day from multiple foods and locations, highlighting the importance of sodium reduction across the US food supply.

    • Occupational Safety and Health RSS Word feed
      1. Examining temporal effects on cancer risk in the international nuclear workers’ studyExternal
        Daniels RD, Bertke SJ, Richardson DB, Cardis E, Gillies M, O’Hagan JA, Haylock R, Laurier D, Leuraud K, Moissonnier M, Thierry-Chef I, Kesminiene A, Schubauer-Berigan MK.
        Int J Cancer. 2017 Mar 15;140(6):1260-1269.
        The paper continues the series of publications from the International Nuclear Workers Study cohort that comprises 308,297 workers from France, the United Kingdom and the United States, providing 8.2 million person-years of observation from a combined follow-up period (at earliest 1944 to at latest 2005). These workers’ external radiation exposures were primarily to photons, resulting in an estimated average career absorbed dose to the colon of 17.4 milligray. The association between cumulative ionizing radiation dose and cancer mortality was evaluated in general relative risk models that describe modification of the excess relative risk (ERR) per gray (Gy) by time since exposure and age at exposure. Methods analogous to a nested-case control study using conditional logistic regression of sampled risks sets were used. Outcomes included: all solid cancers, lung cancer, leukemias excluding chronic lymphocytic, acute myeloid leukemia, chronic myeloid leukemia, multiple myeloma, Hodgkin lymphoma and non-Hodgkin lymphoma. Significant risk heterogeneity was evident in chronic myeloid leukemia with time since exposure, where we observed increased ERR per Gy estimates shortly after exposure (2-10 year) and again later (20-30 years). We observed delayed effects for acute myeloid leukemia although estimates were not statistically significant. Solid cancer excess risk was restricted to exposure at age 35+ years and also diminished for exposure 30 years prior to attained age. Persistent or late effects suggest additional follow-up may inform on lifetime risks. However, cautious interpretation of results is needed due to analytical limitations and a lack of confirmatory results from other studies.

      2. Radon in US workplaces: A reviewExternal
        Daniels RD, Schubauer-Berigan MK.
        Radiat Prot Dosimetry. 2017 Feb 16:1-9.
        [No abstract]
      3. Risk of work injury among adolescent students from single and partnered parent familiesExternal
        Wong IS, Breslin FC.
        Am J Ind Med. 2017 Mar;60(3):285-294.
        BACKGROUND: Parental involvement in keeping their children safe at work has been examined in a handful of studies, with mixed results. Evidence has suggested that non-work injury risk is higher among children from single-parent families, but little is known about their risk for work-related injuries. METHODS: Five survey cycles of the Canadian Community Health Survey were pooled to create a nationally representative sample of employed 15-19-year old students (N = 16,620). Multivariable logistic regression estimated the association between family status and work injury. RESULTS: Risk of work-related repetitive strains (OR:1.24, 95%CI: 0.69-2.22) did not differ by family type. However, children of single parents were less likely to sustain a work injury receiving immediate medical care (OR:0.43, 95%CI: 0.19-0.96). CONCLUSION: Despite advantages and disadvantages related to family types, there is no evidence that work-related injury risk among adolescents from single parent families is greater than that of partnered-parent families. Am. J. Ind. Med. 60:285-294, 2017.

    • Parasitic Diseases RSS Word feed
      1. Analysing trends and forecasting malaria epidemics in Madagascar using a sentinel surveillance network: a web-based applicationExternal
        Girond F, Randrianasolo L, Randriamampionona L, Rakotomanana F, Randrianarivelojosia M, Ratsitorahina M, Brou TY, Herbreteau V, Mangeas M, Zigiumugabe S, Hedje J, Rogier C, Piola P.
        Malar J. 2017 Feb 13;16(1):72.
        BACKGROUND: The use of a malaria early warning system (MEWS) to trigger prompt public health interventions is a key step in adding value to the epidemiological data routinely collected by sentinel surveillance systems. METHODS: This study describes a system using various epidemic thresholds and a forecasting component with the support of new technologies to improve the performance of a sentinel MEWS. Malaria-related data from 21 sentinel sites collected by Short Message Service are automatically analysed to detect malaria trends and malaria outbreak alerts with automated feedback reports. RESULTS: Roll Back Malaria partners can, through a user-friendly web-based tool, visualize potential outbreaks and generate a forecasting model. The system already demonstrated its ability to detect malaria outbreaks in Madagascar in 2014. CONCLUSION: This approach aims to maximize the usefulness of a sentinel surveillance system to predict and detect epidemics in limited-resource environments.

      2. Partnering for impact: Integrated transmission assessment surveys for lymphatic filariasis, soil transmitted helminths and malaria in HaitiExternal
        Knipes AK, Lemoine JF, Monestime F, Fayette CR, Direny AN, Desir L, Beau de Rochars VE, Streit TG, Renneker K, Chu BK, Chang MA, Mace KE, Won KY, Lammie PJ.
        PLoS Negl Trop Dis. 2017 Feb 16;11(2):e0005387.
        BACKGROUND: Since 2001, Haiti’s National Program for the Elimination of Lymphatic Filariasis (NPELF) has worked to reduce the transmission of LF through annual mass drug administration with diethylcarbamazine and albendazole. The NPELF reached full national coverage with MDA for LF in 2012, and by 2014, a total of 14 evaluation units (48 communes) had met WHO eligibility criteria to conduct LF transmission assessment surveys (TAS) to determine whether prevalence had been reduced to below a threshold, such that transmission is assumed to be no longer sustainable. Haiti is also endemic for malaria and many communities suffer a high burden of soil transmitted helminths (STH). Heeding the call from WHO for integration of neglected tropical diseases (NTD) activities, Haiti’s NPELF worked with the national malaria control program (NMCP) and with partners to develop an integrated TAS (LF-STH-malaria) to include assessments for malaria and STH. METHODOLOGY/PRINCIPLE FINDINGS: The aim of this study was to evaluate the feasibility of using TAS surveys for LF as a platform to collect information about STH and malaria. Between November 2014 and June 2015, TAS were conducted in 14 evaluation units (EUs) including 1 TAS (LF-only), 1 TAS-STH-malaria, and 12 TAS-malaria, with a total of 16,655 children tested for LF, 14,795 tested for malaria, and 298 tested for STH. In all, 12 of the 14 EUs passed the LF TAS, allowing the program to stop MDA for LF in 44 communes. The EU where children were also tested for STH will require annual school-based treatment for STH to maintain reduced STH levels. Finally, only 12 of 14,795 children tested positive for malaria by RDT in 38 communes. CONCLUSIONS/SIGNIFICANCE: Haiti’s 2014-2015 Integrated TAS surveys provide evidence of the feasibility of using the LF TAS as a platform for integration of assessments for STH and or malaria.

      3. Bead-based immunoassay allows sub-picogram detection of histidine-rich protein 2 from Plasmodium falciparum and estimates reliability of malaria rapid diagnostic testsExternal
        Rogier E, Plucinski M, Lucchi N, Mace K, Chang M, Lemoine JF, Candrinho B, Colborn J, Dimbu R, Fortes F, Udhayakumar V, Barnwell J.
        PLoS One. 2017 ;12(2):e0172139.
        Detection of histidine-rich protein 2 (HRP2) from the malaria parasite Plasmodium falciparum provides evidence for active or recent infection, and is utilized for both diagnostic and surveillance purposes, but current laboratory immunoassays for HRP2 are hindered by low sensitivities and high costs. Here we present a new HRP2 immunoassay based on antigen capture through a bead-based system capable of detecting HRP2 at sub-picogram levels. The assay is highly specific and cost-effective, allowing fast processing and screening of large numbers of samples. We utilized the assay to assess results of HRP2-based rapid diagnostic tests (RDTs) in different P. falciparum transmission settings, generating estimates for true performance in the field. Through this method of external validation, HRP2 RDTs were found to perform well in the high-endemic areas of Mozambique and Angola with 86.4% and 73.9% of persons with HRP2 in their blood testing positive by RDTs, respectively, and false-positive rates of 4.3% and 0.5%. However, in the low-endemic setting of Haiti, only 14.5% of persons found to be HRP2 positive by the bead assay were RDT positive. Additionally, 62.5% of Haitians showing a positive RDT test had no detectable HRP2 by the bead assay, likely indicating that these were false positive tests. In addition to RDT validation, HRP2 biomass was assessed for the populations in these different settings, and may provide an additional metric by which to estimate P. falciparum transmission intensity and measure the impact of interventions.

    • Program Evaluation RSS Word feed
      1. Improving community readiness for change through coalition capacity building: Evidence from a multisite intervention
        Anderson-Carpenter KD, Watson-Thompson J, Jones MD, Chaney L.
        J Community Psychol. 2017 .
        Often, community coalitions are facilitators of community-level changes when addressing underage drinking. Although studies have shown that enhancing coalition capacity is related to improved internal functioning, the relationship between enhanced capacity and community readiness for change is not well established. The present study used a pretest-posttest design to examine whether enhancing coalition capacity through training and technical assistance was associated with improved community readiness and coalition-facilitated community-level changes. Seven Kansas communities engaged in an intensive capacity building intervention through implementation of the Strategic Prevention Framework. The results indicated strong correlations between increased coalition capacity, changes in community readiness stages, and the number of community changes facilitated. The results suggest that strengthening coalition capacity through training and technical assistance may improve community readiness for change and enable the implementation of community-wide program and environmental changes.

    • Public Health Leadership and Management RSS Word feed
      1. Careers in virology: Working at the Centers for Disease Control and PreventionExternal
        Konopka-Anstadt JL, Burns CC.
        J Virol. 2017 Feb 15.
        As non-academic careers in science have become less and less “alternative,” one field that has consistently attracted early-career virologists is public health research. The desire to make tangible contributions towards public health needs and better protect the public from infectious disease often motivate the transition. In this Career Gem, two academically-trained virologists offer insights into pursuing a research career in public health at the Centers for Disease Control and Prevention.

    • Reproductive Health RSS Word feed
      1. Risks factors and treatment use related to infertility and impaired fecundity among reproductive-aged womenExternal
        Crawford S, Smith RA, Kuwabara SA, Grigorescu V.
        J Womens Health (Larchmt). 2017 Feb 10.
        INTRODUCTION: Population-level data on infertility and impaired fecundity are sparse. We explored the use of self-reported information provided by reproductive-aged women participating in the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS). MATERIALS AND METHODS: Three out of 12 questions on reproductive history, family planning, and infertility that seven states included in the 2013 BRFSS were used for this study. In addition to descriptive statistics, we used multinomial logistic regression to identify factors associated with ever experiencing infertility only, difficulty staying pregnant only, and neither infertility nor difficulty staying pregnant. We also explored the association between healthcare coverage and type of treatment received among women ever experiencing infertility only or difficulty staying pregnant only. RESULTS: Compared with women reporting having never experienced either infertility or difficulty staying pregnant, women who reported ever experiencing difficulty staying pregnant only were significantly more likely to report a history of depressive disorders and smoking (adjusted odds ratio [aOR] = 1.69, 95% confidence interval [CI] = 1.07-2.68 and aOR = 1.98, 95% CI = 1.22-3.20, respectively). Women who ever experienced infertility only were also more likely to report a history of depressive disorders (aOR = 2.02, 95% CI = 1.14-3.59), but less likely to report healthcare coverage (aOR = 0.26, 95% CI = 0.14-0.46). Only 18.9% (95% CI = 11.4-29.9) of women who ever experienced difficulty staying pregnant only reported seeking infertility treatment compared with 49.6% (95% CI = 34.9-64.4) of women who ever experienced infertility only. CONCLUSIONS: Ongoing public health surveillance systems of state-specific self-reported data, such as BRFSS, provide the opportunity to explore preventable risk factors and treatment use related to infertility and impaired fecundity.

    • Substance Use and Abuse RSS Word feed
      1. Cigarette smoking and adverse health outcomes among adults receiving federal housing assistanceExternal
        Helms VE, King BA, Ashley PJ.
        Prev Med. 2017 Feb 09.
        Cigarette smoking is higher among low-income adults and individuals who reside in federally assisted housing are particularly susceptible to the adverse effects of smoking and secondhand smoke exposure. This study assessed smoking-related behaviors and health outcomes among U.S. adults who received federal housing assistance during 2006-2012. National Health Interview Survey data linked with administrative data from the U.S. Department of Housing and Urban Development were analyzed; 5218 HUD-assisted adults were assessed. Demographic characteristics associated with smoking, including frequency and consumption, were assessed among adult cigarette smokers. Fourteen adverse health outcomes were examined among cigarette smoking and nonsmoking adults. One-third (33.6%) of HUD-assisted adults were current cigarette smokers. Smoking prevalence was highest among adults aged 25-44 (42.5%), non-Hispanic whites (39.5%), and adults who resided in households with children (37.5%). Half attempted to quit in the past year; 82.1% were daily smokers; and, 35.8% of daily smokers reported smoking 20+ cigarettes a day. Multivariable analyses revealed that compared to nonsmokers, cigarette smokers had increased likelihood of reporting fair or poor health (95% CI: 1.04-1.52), chronic obstructive pulmonary disease (CI: 1.87-3.06), disability (CI: 1.25-1.83), asthma (CI: 1.02-1.55), serious psychological distress (CI: 1.39-2.52), >1 emergency room visit in the past year (CI: 1.09-1.56), and >/=10 work loss days in the past year (CI: 1.15-3.06). Adults who receive housing assistance represent an at-risk population for adverse health outcomes associated with smoking and secondhand smoke. Housing assistance programs provide a valuable platform for the implementation of evidence-based tobacco prevention and control measures, including smokefree policies.

      2. Utilization of smoking cessation medication benefits among Medicaid fee-for-service enrollees 1999-2008External
        Kahende J, Malarcher A, England L, Zhang L, Mowery P, Xu X, Sevilimedu V, Rolle I.
        PLoS One. 2017 ;12(2):e0170381.
        OBJECTIVE: To assess state coverage and utilization of Medicaid smoking cessation medication benefits among fee-for-service enrollees who smoked cigarettes. METHODS: We used the linked National Health Interview Survey (survey years 1995, 1997-2005) and the Medicaid Analytic eXtract files (1999-2008) to assess utilization of smoking cessation medication benefits among 5,982 cigarette smokers aged 18-64 years enrolled in Medicaid fee-for-service whose state Medicaid insurance covered at least one cessation medication. We excluded visits during pregnancy, and those covered by managed care or under dual enrollment (Medicaid and Medicare). Multivariate logistic regression was used to determine correlates of cessation medication benefit utilization among Medicaid fee-for-service enrollees, including measures of drug coverage (comprehensive cessation medication coverage, number of medications in state benefit, varenicline coverage), individual-level demographics at NHIS interview, age at Medicaid enrollment, and state-level cigarette excise taxes, statewide smoke-free laws, and per-capita tobacco control funding. RESULTS: In 1999, the percent of smokers with >/=1 medication claims was 5.7% in the 30 states that covered at least one Food and Drug Administration (FDA)-approved cessation medication; this increased to 9.9% in 2008 in the 44 states that covered at least one FDA-approved medication (p<0.01). Cessation medication utilization was greater among older individuals (>/= 25 years), females, non-Hispanic whites, and those with higher educational attainment. Comprehensive coverage, the number of smoking cessation medications covered and varenicline coverage were all positively associated with utilization; cigarette excise tax and per-capita tobacco control funding were also positively associated with utilization. CONCLUSIONS: Utilization of medication benefits among fee-for-service Medicaid enrollees increased from 1999-2008 and varied by individual and state-level characteristics. Given that the Affordable Care Act bars state Medicaid programs from excluding any FDA-approved cessation medications from coverage as of January 2014, monitoring Medicaid cessation medication claims may be beneficial for informing efforts to increase utilization and maximize smoking cessation.

    • Veterinary Medicine RSS Word feed
      1. Endemic infection of stranded southern sea otters (Enhydra lutris nereis) with novel parvovirus, polyomavirus, and adenovirusExternal
        Siqueira JD, Ng T, Miller M, Li L, Deng X, Dodd E, Batac F, Delwart E.
        J Wildl Dis. 2017 Feb 13.
        Over the past century, the southern sea otter (SSO; Enhydra lutris nereis) population has been slowly recovering from near extinction due to overharvest. The SSO is a threatened species under federal law and a fully protected species under California law. Through a multiagency collaborative program, stranded animals are rehabilitated and released, while deceased animals are necropsied and tissues are cryopreserved to facilitate scientific study. Here, we processed archival tissues to enrich particle-associated viral nucleic acids, which we randomly amplified and deeply sequenced to identify viral genomes through sequence similarities. Anelloviruses and endogenous retroviral sequences made up over 50% of observed viral sequences. Polyomavirus, parvovirus, and adenovirus sequences made up most of the remaining reads. We characterized and phylogenetically analyzed the full genome of sea otter (SO) polyomavirus 1 and the complete coding sequence of SO parvovirus 1 and found that the closest known viruses infect primates and domestic pigs ( Sus scrofa domesticus), respectively. We tested archived tissues from 69 stranded SO necropsied over 14 yr (2000-13) by PCR. Polyomavirus, parvovirus, and adenovirus infections were detected in 51, 61, and 29% of examined animals, respectively, with no significant increase in frequency over time, suggesting endemic infection. We found that 80% of tested SSO were infected with at least one of the three DNA viruses, whose tissue distribution we determined in 261 tissue samples. Parvovirus DNA was most frequently detected in mesenteric lymph node, polyomavirus DNA in spleen, and adenovirus DNA in multiple tissues (spleen, retropharyngeal and mesenteric lymph node, lung, and liver). This study describes the virome in tissues of a threatened species and shows that stranded SSO are frequently infected with multiple viruses, warranting future research to investigate associations between these infections and observed lesions.

    • Zoonotic and Vectorborne Diseases RSS Word feed
      1. Prevalence and clinical presentation of Rickettsia, Coxiella, Leptospira, Bartonella and chikungunya virus infections among hospital-based febrile patients from December 2008 to November 2009 in BangladeshExternal
        Faruque LI, Zaman RU, Gurley ES, Massung RF, Alamgir AS, Galloway RL, Powers AM, Bai Y, Kosoy M, Nicholson WL, Rahman M, Luby SP.
        BMC Infect Dis. 2017 Feb 13;17(1):141.
        BACKGROUND: We conducted a study to identify Rickettsia, Coxiella, Leptospira, Bartonella, and Chikungunya virus infections among febrile patients presenting at hospitals in Bangladesh. METHODS: We collected blood samples from patients at six tertiary hospitals from December 2008 to November 2009 and performed laboratory tests at the United States Centers for Disease Control and Prevention (CDC). RESULTS: Out of 720 enrolled patients, 263 (37%) were infected with Rickettsia; 132 patients had immunofluorescence antibody titer >64 against spotted fever, 63 patients against scrub typhus fever and 10 patients against typhus fever. Ten patients were identified with Coxiella. We isolated Leptospira from two patients and Bartonella from one patient. Ten patients had antibodies against Chikungunya virus. The proportion of patients who died was higher with rickettsial fever (5%) compared to those without a diagnosis of rickettsial infection (2%). None of the patients were initially diagnosed with rickettsial fever. CONCLUSIONS: Rickettsial infections are frequent yet under-recognized cause of febrile illness in Bangladesh. Clinical guidelines should be revised so that local clinicians can diagnose rickettsial infections and provide appropriate drug treatment.

      2. Transmission of Zika Virus – Haiti, October 12, 2015-September 10, 2016External
        Journel I, Andrecy LL, Metellus D, Pierre JS, Faublas RM, Juin S, Dismer AM, Fitter DL, Neptune D, Laraque MJ, Corvil S, Pierre M, Buteau J, Lafontant D, Patel R, Lemoine JF, Lowrance DW, Charles M, Boncy J, Adrien P.
        MMWR Morb Mortal Wkly Rep. 2017 Feb 17;66(6):172-176.
        Zika virus disease is caused by infection with a flavivirus with broad geographic distribution and is most frequently transmitted by the bite of an infected mosquito. The disease was first identified in the World Health Organization’s Region of the Americas in 2015 and was followed by a surge in reported cases of congenital microcephaly in Brazil; Zika virus disease rapidly spread to the rest of the region and the Caribbean, including Haiti. Infection with the virus is associated with adverse fetal outcomes and rare neurologic complications in adults. The magnitude of public health issues associated with Zika virus led the World Health Organization to declare the Zika virus outbreak a Public Health Emergency of International Concern on February 1, 2016 (2). Because many persons with mild Zika virus disease are asymptomatic and might not seek care, it is difficult to estimate the actual incidence of Zika virus infection. During October 12, 2015-September 10, 2016, the Haitian Ministry of Public Health and Population (Ministere de la Sante Publique et de la Population [MSPP]) detected 3,036 suspected cases of Zika virus infection in the general population, 22 suspected cases of Zika virus disease among pregnant women, 13 suspected cases of Guillain-Barre syndrome (GBS), and 29 suspected cases of Zika-associated congenital microcephaly. Nineteen (0.6%) patients with suspected Zika virus disease, residing in Ouest (10 patients), Artibonite (six), and Centre (three) administrative departments, have been confirmed by laboratory testing, including two among pregnant women and 17 in the general population. Ongoing laboratory-enhanced surveillance to monitor Zika virus disease in Haiti is important to understanding the outbreak and ensuring effective response activities.

      3. Presumptive risk factors for monkeypox in rural communities in the Democratic Republic of the CongoExternal
        Quiner CA, Moses C, Monroe BP, Nakazawa Y, Doty JB, Hughes CM, McCollum AM, Ibata S, Malekani J, Okitolonda E, Carroll DS, Reynolds MG.
        PLoS One. 2017 ;12(2):e0168664.
        Monkeypox virus (MPXV), a close relative of Variola virus, is a zoonotic virus with an unknown reservoir. Interaction with infected wildlife, bites from peri-domestic animals, and bushmeat hunting are hypothesized routes of infection from wildlife to humans. Using a Risk Questionnaire, performed in monkeypox-affected areas of rural Democratic Republic of the Congo, we describe the lifestyles and demographics associated with presumptive risk factors for MPXV infection. We generated two indices to assess risk: Household Materials Index (HMI), a proxy for socioeconomic status of households and Risk Activity Index (RAI), which describes presumptive risk for animal-to-human transmission of MPXV. Based on participant self-reported activity patterns, we found that people in this population are more likely to visit the forest than a market to fulfill material needs, and that the reported occupation is limited in describing behavior of individuals may participate. Being bitten by rodents in the home was commonly reported, and this was significantly associated with a low HMI. The highest scoring RAI sub-groups were ‘hunters’ and males aged >/= 18 years; however, several activities involving MPXV-implicated animals were distributed across all sub-groups. The current analysis may be useful in identifying at-risk groups and help to direct education, outreach and prevention efforts more efficiently.

      4. West Nile Virus infectionExternal
        Sejvar JJ.
        Microbiol Spectr. 2016 Jun;4(3).
        Although long recognized as a human pathogen, West Nile virus (WNV) emerged as a significant public health problem following its introduction and spread across North America. Subsequent years have seen a greater understanding of all aspects of this viral infection. The North American epidemic resulted in a further understanding of the virology, pathogenesis, clinical features, and epidemiology of WNV infection. Approximately 80% of human WNV infections are asymptomatic. Most symptomatic people experience an acute systemic febrile illness; less than 1% of infected people develop neuroinvasive disease, which typically manifests as meningitis, encephalitis, or anterior myelitis resulting in acute flaccid paralysis. Older age is associated with more severe illness and higher mortality; other risk factors for poor outcome have been challenging to identify. In addition to natural infection through mosquito bites, transfusion- and organ transplant-associated infections have occurred. Since there is no definitive treatment for WNV infection, protection from mosquito bites and other preventative measures are critical. WNV has reached an endemic pattern in North America, but the future epidemiologic pattern is uncertain.

      5. Relative analytical sensitivity of donor nucleic acid amplification technology screening and diagnostic real-time polymerase chain reaction assays for detection of Zika virus RNAExternal
        Stone M, Lanteri MC, Bakkour S, Deng X, Galel SA, Linnen JM, Munoz-Jordan JL, Lanciotti RS, Rios M, Gallian P, Musso D, Levi JE, Sabino EC, Coffey LL, Busch MP.
        Transfusion. 2017 Feb 14.
        BACKGROUND: Zika virus (ZIKV) has spread rapidly in the Pacific and throughout the Americas and is associated with severe congenital and adult neurologic outcomes. Nucleic acid amplification technology (NAT) assays were developed for diagnostic applications and for blood donor screening on high-throughput NAT systems. We distributed blinded panels to compare the analytical performance of blood screening relative to diagnostic NAT assays. STUDY DESIGN AND METHODS: A 25-member, coded panel (11 half-log dilutions of a 2013 French Polynesia ZIKV isolate and 2015 Brazilian donor plasma implicated in transfusion transmission, and 3 negative controls) was sent to 11 laboratories that performed 17 assays with 2 to 12 replicates per panel member. Results were analyzed for the percentage reactivity at each dilution and by probit analysis to estimate the 50% and 95% limits of detection (LOD50 and LOD95 , respectively). RESULTS: Donor-screening NAT assays that process approximately 500 microL of plasma into amplification reactions were comparable in sensitivity (LOD50 and LOD95 , 2.5 and 15-18 copies/mL) and were approximately 10-fold to 100-fold more sensitive than research laboratory-developed and diagnostic reverse transcriptase-polymerase chain reaction tests that process from 10 to 30 microL of plasma per amplification. Increasing sample input volume assayed with the Centers for Disease Control and Prevention reverse transcriptase-polymerase chain reaction assays increased the LODs by 10-fold to 30-fold. CONCLUSIONS: Blood donor-screening ZIKV NAT assays demonstrate similar excellent sensitivities to assays currently used for screening for transfusion-transmitted viruses and are substantially more sensitive than most other laboratory-developed and diagnostic ZIKV reverse transcriptase-polymerase chain reaction assays. Enhancing sensitivities of laboratory-developed and diagnostic assays may be achievable by increasing sample input.

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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