Immune response after rabies vaccine in a kidney transplant recipient

A 48-year-old male kidney-transplant recipient was bitten by a rabid dog. His immunosuppressive treatment consisted of cyclosporine 60 mg b.i.d., mycophenolate mofetil (MMF) 250 mg t.i.d., and prednisone 5 mg. After wound care, he received 5 doses of purified vero cell rabies vaccine on days 0, 3, 7, 14, and 28, and human rabies immunoglobulin, according to international guidelines. Adequate levels of rabies virus neutralizing antibodies were observed after the administration of the third vaccine dose. However, a decrease of antibody titer was detected by day 28. Immunosuppressive medication was minimized, withdrawing MMF and reducing the dose of cyclosporine. Booster doses of the same vaccine were administered on days 38, 41, 45, 52, and 66. Adequate neutralizing antibody response was recovered during the ensuing 12 months, under reduced immunosuppression. Nineteen months after the incident, the patient remains with good graft function and is asymptomatic for rabies. It remains to be determined whether the attained immune response was either the result of the booster vaccinations or the reduction of immunosuppression alone. Nevertheless, such an outcome would have been possible only with the combined management strategy implemented.

Systematic Review of the Association between Lipoprotein-Associated Phospholipase A2 and Atherosclerosis

Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a novel inflammatory biomarker. Basic research has shown that Lp-PLA2 is involved in the pathogenesis of atherosclerosis. In the past decade, an increasing number of epidemiological studies have investigated the association of Lp-PLA2 with atherosclerosis, but its roles in the different stages of atherosclerosis are not established. By undertaking a systematic review of the epidemiological studies on the relationship between Lp-PLA2 and atherosclerotic cardiovascular disease (CVD)/subclinical atherosclerosis, we tried to evaluate the relationship between Lp-PLA2 and the different stages of atherosclerosis. MEDLINE, Cochrane Library, and National Knowledge Infrastructure (CNKI) were searched up to September 1st, 2011. The references in all the located articles were manually searched. Epidemiological studies on the association of Lp-PLA2 with CVD and subclinical atherosclerosis, with total CVD, coronary heart disease (CHD), stroke, and subclinical atherosclerosis as their observation endpoints or outcome variables, were included in this study. Studies which did not assess the hazard ratio (HR), relative risk (RR), or odds ratio (OR) of Lp-PLA2 or which did not adjust for other known risk factors were excluded. The general information, study design, sample size, outcome variables and their definitions, follow-up duration, Lp-PLA2 measurements, variables adjusted in the multivariate analysis and main results in the literatures were retrieved. Thirty-nine studies were enrolled in this systematic review. Thirty-three studies (49, 260 subjects) investigated the relationship between Lp-PLA2 and CVD, among which 31 showed that increased Lp-PLA2 is associated to high risk for incidence or mortality of CVD: HR/RR per 1 standard deviation (SD) increase = 1.17-1.40; RR for the highest as compared with the lowest quartile was 1.41-3.75 (1.8-2.5 in most studies). Six studies (four cross-sectional studies and two case-control studies, with an overall sample size of 5,537) explored the relationship between Lp-PLA2 and subclinical atherosclerosis; among them, two studies demonstrated that Lp-PLA2 was associated with coronary artery calcification in young adults and men. In conclusion, many epidemiological studies have demonstrated that Lp-PLA2 increases the risk of clinical CVD events. However, whether there is a similar association between Lp-PLA2 and subclinical atherosclerosis remains unclear. Whether Lp-PLA2 exerts its effect during the occurrence of clinical events promoted by unstable plaques or at the early stage of atherosclerosis needs to be clarified in further prospective studies.

Persistence of multiple illnesses in World Trade Center rescue and recovery workers: a cohort study

BACKGROUND

More than 50,000 people participated in the rescue and recovery work that followed the Sept 11, 2001 (9/11) attacks on the World Trade Center (WTC). Multiple health problems in these workers were reported in the early years after the disaster. We report incidence and prevalence rates of physical and mental health disorders during the 9 years since the attacks, examine their associations with occupational exposures, and quantify physical and mental health comorbidities.

METHODS

In this longitudinal study of a large cohort of WTC rescue and recovery workers, we gathered data from 27,449 participants in the WTC Screening, Monitoring, and Treatment Program. The study population included police officers, firefighters, construction workers, and municipal workers. We used the Kaplan-Meier procedure to estimate cumulative and annual incidence of physical disorders (asthma, sinusitis, and gastro-oesophageal reflux disease), mental health disorders (depression, post-traumatic stress disorder [PTSD], and panic disorder), and spirometric abnormalities. Incidence rates were assessed also by level of exposure (days worked at the WTC site and exposure to the dust cloud).

FINDINGS

9-year cumulative incidence of asthma was 27·6% (number at risk: 7027), sinusitis 42·3% (5870), and gastro-oesophageal reflux disease 39·3% (5650). In police officers, cumulative incidence of depression was 7·0% (number at risk: 3648), PTSD 9·3% (3761), and panic disorder 8·4% (3780). In other rescue and recovery workers, cumulative incidence of depression was 27·5% (number at risk: 4200), PTSD 31·9% (4342), and panic disorder 21·2% (4953). 9-year cumulative incidence for spirometric abnormalities was 41·8% (number at risk: 5769); three-quarters of these abnormalities were low forced vital capacity. Incidence of most disorders was highest in workers with greatest WTC exposure. Extensive comorbidity was reported within and between physical and mental health disorders.

INTERPRETATION

9 years after the 9/11 WTC attacks, rescue and recovery workers continue to have a substantial burden of physical and mental health problems. These findings emphasise the need for continued monitoring and treatment of the WTC rescue and recovery population.

FUNDING

Centers for Disease Control and Prevention and National Institute for Occupational Safety and Health.

Co-occurrence patterns of the dengue vector Aedes aegypti and Aedes mediovitattus, a dengue competent mosquito in Puerto Rico

Aedes aegypti is implicated in dengue transmission in tropical and subtropical urban areas around the world. Ae. aegypti populations are controlled through integrative vector management. However, the efficacy of vector control may be undermined by the presence of alternative, competent species. In Puerto Rico, a native mosquito, Ae. mediovittatus, is a competent dengue vector in laboratory settings and spatially overlaps with Ae. aegypti. It has been proposed that Ae. mediovittatus may act as a dengue reservoir during inter-epidemic periods, perpetuating endemic dengue transmission in rural Puerto Rico. Dengue transmission dynamics may therefore be influenced by the spatial overlap of Ae. mediovittatus, Ae. aegypti, dengue viruses, and humans. We take a landscape epidemiology approach to examine the association between landscape composition and configuration and the distribution of each of these Aedes species and their co-occurrence. We used remotely sensed imagery from a newly launched satellite to map landscape features at very high spatial resolution. We found that the distribution of Ae. aegypti is positively predicted by urban density and by the number of tree patches, Ae. mediovittatus is positively predicted by the number of tree patches, but negatively predicted by large contiguous urban areas, and both species are predicted by urban density and the number of tree patches. This analysis provides evidence that landscape composition and configuration is a surrogate for mosquito community composition, and suggests that mapping landscape structure can be used to inform vector control efforts as well as to inform urban planning.

The Centers for Disease Control and Prevention resting trap: a novel device for collecting resting mosquitoes

Commercially available wood-fiber pots used to collect resting mosquitoes were modified to improve sampling efficiency. The modified traps, called the Centers for Disease Control and Prevention resting traps, collected 16.0 and 5.2 times more adult Culex pipiens and Cx. tarsalis than the conventional wood-fiber pots. The resting trap increases the mean number of resting mosquitoes collected per trap-night and is useful for collecting blood-engorged mosquitoes.

World Trade Center disaster: assessment of responder occupations, work locations, and job tasks

BACKGROUND

To date there have been no comprehensive reports of the work performedby 9/11 World Trade Center responders.

METHODS

18,969 responders enrolled in the WTC Medical Monitoring and Treatment Program were used to describe workers’ pre-9/11 occupations, WTC work activities and locations from September 11, 2001 to June 2002.

RESULTS

The most common pre-9/11 occupation was protective services (47%); other common occupations included construction, telecommunications, transportation, and support services workers. 14% served as volunteers. Almost one-half began work on 9/11 and >80% reported working on or adjacent to the ‘‘pile’’ at Ground Zero. Initially,the most common activity was search and rescue but subsequently, the activities of most responders related to their pre-9/11 occupations. Other major activities included security; personnel support; buildings and grounds cleaning; and telecommunications repair.

CONCLUSIONS

The spatial, temporal, occupational, and task-related taxonomy reported here will aid the development of a job-exposure matrix, assist in assessment of disease risk, and improve planning and training for responders in future urban disasters.

Particle Collection Efficiency for Nylon Mesh Screens

Mesh screens composed of nylon fibers leave minimal residual ash and produce no significant spectral interference when ashed for spectrometric examination. These characteristics make nylon mesh screens attractive as a collection substrate for nanoparticles. A theoretical single-fiber efficiency expression developed for wire-mesh screens was evaluated for estimating the collection efficiency of submicrometer particles for nylon mesh screens. Pressure drop across the screens, the effect of particle morphology (spherical and highly fractal) on collection efficiency and single-fiber efficiency were evaluated experimentally for three pore sizes (60, 100 and 180 μm) at three flow rates (2.5, 4 and 6 Lpm). The pressure drop across the screens was found to increase linearly with superficial velocity. The collection efficiency of the screens was found to vary by less than 4% regardless of particle morphology. Single-fiber efficiency calculated from experimental data was in good agreement with that estimated from theory for particles between 40 and 150 nm but deviated from theory for particles outside this size range. New coefficients for the single-fiber efficiency model were identified that minimized the sum of square error (SSE) between the values estimated with the model and those determined experimentally. Compared to the original theory, the SSE calculated using the modified theory was at least one order of magnitude lower for all screens and flow rates with the exception of the 60-μm pore screens at 2.5 Lpm, where the decrease was threefold.

Time and distance barriers to mammography facilities in the Atlanta metropolitan area

To a great extent, research on geographic accessibility to mammography facilities has focused on urban-rural differences. Spatial accessibility within urban areas can nonetheless pose a challenge, especially for minorities and low-income urban residents who are more likely to depend on public transportation. To examine spatial and temporal accessibility to mammography facilities in the Atlanta metropolitan area by public and private transportation, we built a multimodal transportation network model including bus and rail routes, bus and rail stops, transfers, walk times, and wait times. Our analysis of travel times from the population-weighted centroids of the 282 census tracts in the 2-county area to the nearest facility found that the median public transportation time was almost 51 minutes. We further examined public transportation travel times by levels of household access to a private vehicle. Residents in tracts with the lowest household access to a private vehicle had the shortest travel times, suggesting that facilities were favorably located for women who have to use public transportation. However, census tracts with majority non-Hispanic black populations had the longest travel times for all levels of vehicle availability. Time to the nearest mammography facility would not pose a barrier to women who had access to a private vehicle. This study adds to the literature demonstrating differences in spatial accessibility to health services by race/ethnicity and socioeconomic characteristics. Ameliorating spatial inaccessibility represents an opportunity for intervention that operates at the population level.

[THE EMPIRICAL DISTINCTIVENESS OF WORK ENGAGEMENT AND WORKAHOLISM AMONG HOSPITAL NURSES IN JAPAN : THE EFFECT ON SLEEP QUALITY AND JOB PERFORMANCE]

OBJECTIVE

The aim of the present study is to demonstrate the distinctiveness of work engagement and workaholism by examining their relationships with sleep quality and job performance.

METHOD

A total of 447 nurses from 3 hospitals in Japan were surveyed using a self-administrated questionnaire including Utrecht Work Engagement Scale (UWES), the Dutch Workaholism Scale (DUWAS), questions on sleep quality (7 items) regarding (1) difficulty initiating sleep, (2) difficulty maintaining sleep, (3) early morning awakening, (4) dozing off or napping in daytime, (5) excessive daytime sleepiness at work, (6) difficulty awakening in the morning, and (7) tiredness awakening in the morning, and the World Health Organization Health Work Performance Questionnaire.

RESULTS

The Structural Equation Modeling showed that, work engagement was positively related to sleep quality and job performance whereas workaholism negatively to sleep quality and job performance.

CONCLUSION

The findings suggest that work engagement and workaholism are conceptually distinctive and that the former is positively and the latter is negatively related to well-being (i.e., good sleep quality and job performance).

Diabetes and tuberculosis, US National Health Interview Survey, 2000-2005

Blacks and Hispanics are disproportionately affected by diabetes, which may confound ethnic association with tuberculosis (TB). We analyzed 2000-2005 National Health Interview Survey data. We present adjusted odds ratios (aORs) and 99% confidence intervals (CIs) for the association of diabetes with history of TB disease, controlling for race/ethnicity and age. Diabetics had an aOR of 1.4 (99%CI 1.0-2.0) for history of TB, controlling for being foreign-born non-Hispanic (aOR 2.2, 99%CI 1.6-3.2), US-born Hispanic (aOR 2.1, 99%CI 1.4-3.2), age ≥65 years (aOR 2.0, 99%CI 1.5-2.6), and being Black (aOR 1.6, 99%CI 1.1-2.4). After controlling for race/ethnicity, self-identified diabetics had an increased aOR for history of TB.

Observed prevalence of congenital heart defects from a surveillance study in China

OBJECTIVES

The purpose of this study was to estimate the prevalence of major and minor congenital heart defects among fetuses and neonates using sonography in a general population of 4 areas surrounding Shanghai, China.

METHODS

Pregnant women were recruited between April 2004 and December 2005 in Jiaxing City, Suzhou City, Changshu County, and Haining County. All participants could have 3 sonographic examinations performed by specially trained physicians regardless of medical indication: a fetal sonographic screen and fetal echocardiography between 20 and 28 weeks' gestation and neonatal echocardiography. Diagnoses of congenital heart defects were made on the basis of review of all available scans by an international group of experts in pediatric cardiology. Prevalence rates were calculated per 1000 births.

RESULTS

Among 4006 scanned fetuses and neonates, there were 75 congenital heart defects, including 12 major defects. The observed prevalence for all congenital heart defects was 18.7 (95% confidence interval, 14.8-23.5) per 1000 births, and the prevalence for major defects was 3.0 (95% confidence interval, 1.6-5.2) per 1000 births. The most common defects were ventricular septal defects (n = 47 [62.7%]), atrial septal defects (n = 14 [18.7%]), tetralogy of Fallot (n = 4 [5.3%]), and hypoplastic left heart syndrome (n = 3 [4.0%]).

CONCLUSIONS

The prevalence of all congenital heart defects in the 4 areas of China studied was higher than that reported in other countries, with ventricular septal defects being the most frequent defects. Our data likely reflect a better estimate of the total prevalence of congenital heart defects in China than reported previously.

Use of dietary fluoride supplements by children living in Berlin, Germany, may have a dose-response preventive effect against dental caries, regardless of their use of fluoridated salt

PURPOSE/QUESTION

To assess benefits (caries prevention) and risks (dental fluorosis) of using dietary fluoride supplements (referred as “fluoride tablets” in the article) among children consuming fluoridated salt in a district of Berlin, Germany.

SOURCE OF FUNDING

Information not available. The authors acknowledged the cooperation of the Public Dental Services of the Steglitz-Zehlendorf district in Berlin

TYPE OF STUDY/DESIGN

Retrospective cohort study

LEVEL OF EVIDENCE

Level 2: Limited-quality, patient-oriented evidence

STRENGTH OF RECOMMENDATION GRADE

Not applicable

Mosquito (Diptera: Culicidae) bloodmeal sources during a period of West Nile virus transmission in Puerto Rico

Host bloodmeals of indigenous Caribbean mosquitoes have not been studied previously. We identified vertebrate DNA in 90 blood-engorged mosquitoes belonging to four genera (Aedes, Culex, Deinocerites, and Uranotaenia) and 12 species that were collected in Puerto Rico within a geographic and temporal focus of West Nile virus transmission in 2007. It was found that 62 (68.8%) bloodmeals were from reptiles, 18 (20.0%) from birds, and 10 (11.1%) from mammals. Only one bloodmeal of 18 derived from Culex (Culex) species was passerine, suggesting a preference for nonpasserine birds and other vertebrates (i.e., reptiles) among the candidate WNV vectors. We interpret the results with respect to vectorial capacity for West Nile virus, an emerging arbovirus throughout the Caribbean Basin.

Predictors of hepatitis A vaccination among young children in the United States

We analysed data from the 2009 National Immunization Survey to determine potential predictors of hepatitis A vaccination coverage among children aged 19-35 months. Overall national coverage was 75% for ≥1 dose. Residence in a state with hepatitis A vaccination recommendations prior to 2006, or in a metropolitan statistical area within such state, or being a minority child were among the variables independently associated with higher vaccination coverage. While hepatitis A vaccination coverage has improved since nationwide routine childhood vaccination began in 2006, coverage remains lower than that for other recommended childhood vaccines.

Estimated effects of the National Breast and Cervical Cancer Early Detection Program on breast cancer mortality

BACKGROUND

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides breast cancer screening to medically underserved, low-income women aged 40-64 years. No study has evaluated NBCCEDP's effect on breast cancer mortality.

PURPOSE

This study estimates life-years saved by NBCCEDP breast cancer screening compared with screening in the absence of NBCCEDP and with no screening.

METHODS

A breast cancer simulation model based on existing Cancer Intervention and Surveillance Modeling Network models was constructed. The screening module from these models was modified to reflect screening frequency for NBCCEDP participants. Screening data for uninsured women represented what would have happened without the program. Separate simulations were performed for women who received NBCCEDP (Program) screening, women who potentially received screening without the program (No Program), and women who received no screening (No Screening). The impact of NBCCEDP was estimated as the difference in life-years between the Program and No Program, and the Program and No Screening scenarios. The analysis was performed in 2008-2009.

RESULTS

Among 1.8 million women who were screened between 1991 and 2006, the Program saved 100,800 life-years compared with No Program and 369,000 life-years compared with No Screening. Per woman screened, the Program saved 0.056 life-years (95% CI=0.031, 0.081) compared with No Program and 0.206 life-years (95% CI=0.177, 0.234) compared with No Screening. Per woman with invasive breast cancer and screen-detected invasive cancer, the Program saved 0.41 and 0.71 life-years, respectively, compared with No Program.

CONCLUSIONS

These estimates suggest that NBCCEDP breast cancer screening has reduced mortality among medically uninsured and underinsured low-income women.

Patients diagnosed with tuberculosis at death or who died during therapy: association with the human immunodeficiency virus

OBJECTIVES

To describe trends and risk factors for tuberculosis (TB) mortality.

DESIGN

We calculated trends, identified patient characteristics associated with TB diagnosis at death or death during TB treatment, and described diagnostic procedures using the United States National TB Surveillance System for 1997-2005.

RESULTS

Human immunodeficiency virus (HIV) infected TB patients had an adjusted odds ratio (aOR) of 4-11 for TB diagnosis at death (foreign-born non-Whites, aOR = 11) and of 3-19 for death during TB treatment vs. non-HIV-infected patients. Odds increased by age. Hispanic males had an aOR of 2 for TB diagnosis at death compared with female non-Hispanics. Multidrug-resistant TB (MDR-TB) patients had a three times greater aOR of death during treatment than non-MDR patients. American Indians, Black females, residents in long-term care facilities, US-born patients, and non-HIV-infected homeless persons aged 25-44 years each had an aOR of 2 for mortality during treatment; 86% of pulmonary patients diagnosed at death had a chest radiograph, but 34% had no sputum smear or culture reported.

CONCLUSION

During 1997-2005, controlling for age, HIV remained the characteristic with the greatest aOR for TB diagnosis at death or death during TB therapy. Race/ethnicity, country of birth and homelessness further increased the adjusted odds of death. Results show possible missed opportunities for TB diagnosis prior to death.

New gene variants associated with venous thrombosis: a replication study in White and Black Americans

BACKGROUND

We evaluated 10 single-nucleotide polymorphisms (SNPs) identified in three European case-control studies as risk factors for venous thrombosis.

OBJECTIVES

We sought to replicate the positive findings from this report among Whites and to evaluate the association of these SNPs with venous thrombosis for the first time among Blacks.

PATIENT/METHODS

These SNPs were evaluated in a case-control study of deep vein thrombosis and pulmonary embolism that included 1076 cases and 1239 controls. About 50% of subjects were African Americans. We measured plasma factor (F) XI on a subset of subjects.

RESULTS

Among Whites, positive findings for rs13146272 in the CYP4V2 gene, for rs3087505 in the KLKB1 gene and for rs3756008 and rs2036914 in the F11 gene were found. We did not find significant associations for rs2227589 in the SERPINC1 gene and for rs1613662 in the GP6 gene. Among Blacks, rs2036914 in F11 and rs670659 in RGS7 were related to venous thrombosis, but the study had limited statistical power for many SNPs. Among Blacks, plasma FXI was related to two SNPs and the OR relating to the 90th percentile of the control distribution of plasma FXI was 2.6 (95% CI, 1.4, 5.0).

CONCLUSIONS

Our study supports the finding that genetic variants in the F11 gene are risk factors for venous thrombosis among both Whites and Blacks, although the findings in Blacks require confirmation. A meta-analysis of five case-control studies indicates that rs2227589 in the SERPINC1 gene, rs13146272 in the CYP4V2 gene and rs1613662 in the GP6 gene are risk factors for venous thrombosis among Whites.

Association of perceived stress with sleep duration and sleep quality in police officers

The objective was to investigate associations ofperceived stress with sleep duration and quality among 430 police officers. Perceived stress was assessed using the perceived stress scale. Sleep duration and quality were assessed using the Pittsburg sleep quality index questionnaire. Mean hours of sleep were determined across quartiles of perceived stress using ANOVA/ANCOVA. Logistic regression was used to obtain odds ratios and 95% confidence intervals for poor sleep quality across perceived stress quartiles. Mean age was 42.1 years. Perceived stress was inversely associated with sleep duration among certain groups: men (p = 0.004), higher-ranked officers (p = 0.002), those with higher depressive symptoms (p 0.097), no military experience (p = 0.006), and higher workload (p = 0.003). Gender, police rank, depressive symptoms, and workload each significantly modified the association between stress and sleep duration. Prevalence of poor sleep quality increased with higher levels of perceived stress; the trend was significant among men only (p < 0.0001), and gender significantly modified this association (interaction p = 0.015). Compared to those in the first quartile of perceived stress, women in the fourth quartile were almost four times and men almost six times more likely to have poor sleep quality. Perceived stress was inversely associated with sleep duration and positively associated with poor sleep quality.

Neurotoxicity following acute inhalation exposure to the oil dispersant COREXIT EC9500A

Consequent to the 2010 Deepwater Horizon oil spill in the Gulf of Mexico, there is an emergent concern about the short- and long-term adverse health effects of exposure to crude oil, weathered-oil products, and oil dispersants among the workforce employed to contain and clean up the spill. Oil dispersants typically comprise of a mixture of solvents and surfactants that break down floating oil to micrometer-sized droplets within the water column, thus preventing it from reaching the shorelines. As dispersants are generally sprayed from the air, workers are at risk for exposure primarily via inhalation. Such inhaled fractions might potentially permeate or translocate to the brain via olfactory or systemic circulation, producing central nervous system (CNS) abnormalities. To determine whether oil dispersants pose a neurological risk, male Sprague-Dawley rats were exposed by whole-body inhalation exposure to a model oil dispersant, COREXIT EC9500A (CE; approximately 27 mg/m(3) × 5 h/d × 1 d), and various molecular indices of neural dysfunction were evaluated in discrete brain areas, at 1 or 7 d postexposure. Exposure to CE produced partial loss of olfactory marker protein in the olfactory bulb. CE also reduced tyrosine hydroxylase protein content in the striatum. Further, CE altered the levels of various synaptic and neuronal intermediate filament proteins in specific brain areas. Reactive astrogliosis, as evidenced by increased expression of glial fibrillary acidic protein, was observed in the hippocampus and frontal cortex following exposure to CE. Collectively, these findings are suggestive of disruptions in olfactory signal transduction, axonal function, and synaptic vesicle fusion, events that potentially result in an imbalance in neurotransmitter signaling. Whether such acute molecular aberrations might persist and produce chronic neurological deficits remains to be ascertained.

A computer-controlled whole-body inhalation exposure system for the oil dispersant COREXIT EC9500A

An automated whole-body inhalation exposure system capable of exposing 12 individually housed rats was designed to examine the potential adverse health effects of the oil dispersant COREXIT EC9500A, used extensively during the Deepwater Horizon oil spill. A computer-controlled syringe pump injected the COREXIT EC9500A into an atomizer where droplets and vapor were formed and mixed with diluent air. The aerosolized COREXIT EC9500A was passed into a customized exposure chamber where a calibrated light-scattering instrument estimated the real-time particle mass concentration of the aerosol in the chamber. Software feedback loops controlled the chamber aerosol concentration and pressure throughout each exposure. The particle size distribution of the dispersant aerosol was measured and shown to have a count median aerodynamic diameter of 285 nm with a geometric standard deviation of 1.7. The total chamber concentration (particulate + vapor) was determined using a modification of the acidified methylene blue spectrophotometric assay for anionic surfactants. Tests were conducted to show the effectiveness of closed loop control of chamber concentration and to verify chamber concentration homogeneity. Five automated 5-h animal exposures were performed that produced controlled and consistent COREXIT EC9500A concentrations (27.1 ± 2.9 mg/m(3), mean ± SD).

Secondhand smoke concentrations in hospitality venues in the Pacific Basin: findings from American Samoa, Commonwealth of the Northern Mariana Islands, and Guam

INTRODUCTION

Secondhand smoke (SHS) from burning tobacco products causes disease and premature death among nonsmokers. Although the number of laws prohibiting smoking in indoor public places continues to increase, millions of nonsmokers in the United States (US) and its territories remain exposed to SHS. This study assessed indoor air pollution from SHS in hospitality venues in three US Pacific Basin territories.

METHODS

Air monitors were used to assess PM2.5, an environmental marker for SHS, in 19 smoke-permitted and 18 smoke- free bars and restaurants in American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), and Guam. Observational logs were used to record smoking and other sources of air pollution. Differences in average PM2.5 concentrations were determined using bivariate statistics.

RESULTS

The average PM2.5 level in venues where smoking was always permitted [arithmetic mean (AM)=299.98 μg/m3; geometric mean (GM)=200.39 μg/ m3] was significantly higher (p<0.001) than smoke-free venues [AM=8.33 μg/m3; GM=6.14 μg/m3]. In venues where smoking was allowed only during certain times, the average level outside these times [AM=42.10 μg/m3; GM=41.87 μg/m3] was also significantly higher (p<0.001) than smoke-free venues.

CONCLUSIONS

Employees and patrons of smoke-permitted bars and restaurants are exposed to dangerous levels of air pollution from SHS, even during periods when active smoking is not occurring. Prohibiting smoking in all public indoor areas, irrespective of the venue type or time of day, is the only way to fully protect nonsmokers from SHS exposure in these environments.

Overview of methods in economic analyses of behavioral interventions to promote oral health

BACKGROUND

Broad adoption of interventions that prove effective in randomized clinical trials or comparative effectiveness research may depend to a great extent on their costs and cost-effectiveness (CE). Many studies of behavioral health interventions for oral health promotion and disease prevention lack robust economic assessments of costs and CE.

OBJECTIVE

To describe methodologies employed to assess intervention costs, potential savings, net costs, CE, and the financial sustainability of behavioral health interventions to promote oral health.

METHODS

We provide an overview of terminology and strategies for conducting economic evaluations of behavioral interventions to improve oral health based on the recommendations of the Panel of Cost-Effectiveness in Health and Medicine. To illustrate these approaches, we summarize methodologies and findings from a limited number of published studies. The strategies include methods for assessing intervention costs, potential savings, net costs, CE, and financial sustainability from various perspectives (e.g., health-care provider, health system, health payer, employer, society). Statistical methods for estimating short-term and long-term economic outcomes and for examining the sensitivity of economic outcomes to cost parameters are described.

DISCUSSION

Through the use of established protocols for evaluating costs and savings, it is possible to assess and compare intervention costs, net costs, CE, and financial sustainability. The addition of economic outcomes to outcomes reflecting effectiveness, appropriateness, acceptability, and organizational sustainability strengthens evaluations of oral health interventions and increases the potential that those found to be successful in research settings will be disseminated more broadly.

Associations between police officer stress and the metabolic syndrome

The purpose of this study was to examine the association of police officer stress with metabolic syndrome (MetSyn) and its individual components. Participants included 288 men and 102 women from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study. Police stress was measured using the Spielberger police stress survey. MetSyn was defined using 2005 guidelines. Results were stratified by gender ANCOVA was used to describe differences in number of MetSyn components across police stress categories after adjusting for age and smoking status. Logistic regression was used to calculate odds ratios for having each MetSyn component by increased police stress levels. The multivariate-adjusted number of MetSyn components increased significantly in women across tertiles of the three perceived stress subscales, and administrative and organizational pressure and lack of support indices for the previous month. No association was found among male officers. Abdominal obesity and reduced high density lipoprotein cholesterol (HDL-C) were consistently associated with police stress in women. Police stress, particularly organizational pressure and lack of support, was associated with MetSyn among female but not male police officers. Given the stress of policing and the adverse cardiovascular disease (CVD) risk factors prevalent among police officers, exploring the association between specific types of police stress and subclinical CVD is important.

Cancer incidence among police officers in a U.S. northeast region: 1976-2006

Police officers are exposed to occupational hazards which may put them at increased risk of cancer We examined the incidence of cancer in a cohort of 2234 white-male police officers in Buffalo, New York. The study population was followed for 31 years (1976-2006). The incidence of cancer, ascertained using a population-based tumor registry, was compared with 9 US regions using the Surveillance Epidemiology and End Results (SEER) program data. Four hundred and six officers (18.2%) developed cancer between 1976 and 2006. The risk of overall cancer among police officers was found to be similar to the general white-male population (standardized incidence ratio [SIR] = 0.94, 95%, confidence interval [CI] = 0.85-1.03). An elevated risk of Hodgkin's lymphoma was observed relative to the general population (SIR = 3.34, 95%, CI = 1.22-7.26). The risk of brain cancer, although only slightly elevated relative to the general population (SIR = 1.61, 95%, CI = 0.73-3.05), was significantly increased with 30 years or more of service (SIR = 2.92, 95%, CI = 1.07-6.36). Incidence ratios were significantly lower than expected for skin and bladder cancer Police officers were at increased risk of Hodgkin's lymphoma overall and of brain cancer after 30 years of service.

Health disparities in police officers: comparisons to the U.S. general population

Police officers have one of the poorest cardiovascular disease (C'D) health profiles of any occupation. The goal of this study was to determine if police officers in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study (between 2004 and 2009) had a more adverse CV profile than the general US. employed population. Nearly one-half (46.9%) of the officers worked a non-day shift compared to 9% of U.S. workers. The percent of officers with depression was nearly double (12.0% vs. 6.8%) and officers were nearly four times more likely to sleep less than six hours in a 24-hour period than the general population (33.0% vs. 8.0%). A higher percentage of officers were obese (40.5% vs. 32.1%), had the metabolic syndrome (26.7% vs. 18.7%), and had higher mean serum total cholesterol levels (200.8 mg/dL vs. 193.2 mg/dL) than the comparison employed populations. In addition to having higher levels of traditional CVD risk factors, police officers had higher levels of non-traditional CVD risk factors. These findings highlight the need for expanding the definition of a health disparity to include occupation. Future studies should expand this comparison to additional traditional and non-traditional CVD risk factors and to other occupational groups.

Using a statistical process control chart during the quality assessment of cancer registry data

Statistical process control (SPC) charts may be used to detect acute variations in the data while simultaneously evaluating unforeseen aberrations that may warrant further investigation by the data user. Using cancer stage data captured by the Summary Stage 2000 (SS2000) variable, we sought to present a brief report highlighting the utility of the SPC chart during the quality assessment of cancer registry data. Using a county-level caseload for the diagnosis period of 2001-2004 (n=25,648), we found the overall variation of the SS2000 variable to be in control during diagnosis years of 2001 and 2002, exceeded the lower control limit (LCL) in 2003, and exceeded the upper control limit (UCL) in 2004; in situ/localized stages were in control throughout the diagnosis period, regional stage exceeded UCL in 2004, and distant stage exceeded the LCL in 2001 and the UCL in 2004. Our application of the SPC chart with cancer registry data illustrates that the SPC chart may serve as a readily available and timely tool for identifying areas of concern during the data collection and quality assessment of central cancer registry data.

Neurotoxicity following acute inhalation exposure to the oil dispersant COREXIT EC9500A

Consequent to the 2010 Deepwater Horizon oil spill in the Gulf of Mexico, there is an emergent concern about the short- and long-term adverse health effects of exposure to crude oil, weathered-oil products, and oil dispersants among the workforce employed to contain and clean up the spill. Oil dispersants typically comprise of a mixture of solvents and surfactants that break down floating oil to micrometer-sized droplets within the water column, thus preventing it from reaching the shorelines. As dispersants are generally sprayed from the air, workers are at risk for exposure primarily via inhalation. Such inhaled fractions might potentially permeate or translocate to the brain via olfactory or systemic circulation, producing central nervous system (CNS) abnormalities. To determine whether oil dispersants pose a neurological risk, male Sprague-Dawley rats were exposed by whole-body inhalation exposure to a model oil dispersant, COREXIT EC9500A (CE; approximately 27 mg/m(3) × 5 h/d × 1 d), and various molecular indices of neural dysfunction were evaluated in discrete brain areas, at 1 or 7 d postexposure. Exposure to CE produced partial loss of olfactory marker protein in the olfactory bulb. CE also reduced tyrosine hydroxylase protein content in the striatum. Further, CE altered the levels of various synaptic and neuronal intermediate filament proteins in specific brain areas. Reactive astrogliosis, as evidenced by increased expression of glial fibrillary acidic protein, was observed in the hippocampus and frontal cortex following exposure to CE. Collectively, these findings are suggestive of disruptions in olfactory signal transduction, axonal function, and synaptic vesicle fusion, events that potentially result in an imbalance in neurotransmitter signaling. Whether such acute molecular aberrations might persist and produce chronic neurological deficits remains to be ascertained.

Perinatal transmission of dengue virus in Puerto Rico: a case report

We report a laboratory confirmed case of vertical transmission of dengue in a mother-child pair in the eastern part of Puerto Rico. The clinical course of the pregnant female suggested a GBS infection, but laboratory tests confirmed it was dengue infection, one week after delivery. The male infant was healthy at birth, but one week after birth developed clinical complications related to vertical transmission of dengue. This report targets physicians in dengue endemic countries like Puerto Rico to be aware of the possibility of vertical transmission of dengue in symptomatic pregnant patients, especially around the time of delivery.

Parents' Death and its Implications for Child Survival

Reduction of child mortality is a global public health priority. Parents can play an important role in reducing child mortality. The inability of one or both parents to care for their children due to death, illness, divorce or separation increases the risk of death of their children. There is increasing evidence that the health, education, and socioeconomic status of mothers and fathers have significant impact on the health and survival of their children. We conducted a literature review to explore the impact of the death of parents on the survival and wellbeing of their children and the mechanisms through which this impact is mediated. Studies have generally concluded that the death of a mother significantly increased the risk of death of her children, especially during the early years; the effect continues but is significantly reduced with increasing age through the age of 15 years. The effect of the loss of a father had less impact than the effect of losing a mother although it too had negative consequences for the survival prospect of the child. A mother's health, education, socioeconomic status, fertility behavior, environmental health conditions, nutritional status and infant feeding, and the use of health services all play an important role in the level of risk of death of her children. Efforts to achieve the Millennium Development Goal No. 4 of reducing children's under-5 mortality in developing countries by two thirds by 2015 should include promoting the health and education of women.

Is suicide higher among separated/retired police officers? an epidemiological investigation

It is often assumed that separated or retired officers are at increased risk for suicide. The goal of this study was to compare police suicide rates between currently working and separated/retired officers. A 55-year retrospective mortality police cohort was utilized consisting of 3228 officers who worked between January 1, 1950 and December 31, 2005. Poisson regression and survival analysis were used for comparisons. Adjusted for age and years of service, suicide rates were 8.4 (95% CI = 3.8-18.7) times higher in working officers vs. separated/retired officers (110.5 vs. 13.1 per 100,000 person-years respectively). Survival time to suicide was significantly lower (p < 0.0001) for current working officers, suggesting suicide in a significantly shorter time span. Previous research indicates that the majority of suicides in working officers occur in the five years just prior to retirement eligibility, suggesting a period of decision anxiety. Results suggest a higher risk of suicide among working compared to separated/retired officers. However, the need for suicide prevention efforts remains important among both active and retired police officers.

Examination of a miniaturized funnel trap for Aedes aegypti (Diptera: Culicidae) larval sampling

Funnel traps are often used to sample for the presence of Aedes aegypti (L.) (Diptera: Culicidae) larvae in subterranean aquatic habitats. These traps are generally > or = 15 cm in diameter, making them impractical for use in subterranean sites that have narrow (10-cm) access ports, such as those in standard-sized septic tanks. Recent research indicates septic tanks may be important habitats for Ae. aegypti in Puerto Rico and the Caribbean. To sample mosquito larval populations in these sites, a miniaturized funnel trap was necessary. This project describes the use of a smaller funnel trap for sampling larval populations. The effects of larval instar (third and fourth) and population density on trap efficacy also are examined. The trap detected larval presence 83% of the time at a larval density of 0.011 larvae per cm(2) and 100% of the time at densities > or = 0.022 larvae per cm(2). There was a significant trend of increasing percentage of recaptured larvae with higher larval population densities. Although the miniaturized funnel trap is less sensitive at detecting larval presence in low population densities, it may be useful for sampling aquatic environments with restricted access or shallow water, particularly in domestic septic tanks.

Variability of urinary concentrations of polycyclic aromatic hydrocarbon metabolite in general population and comparison of spot, first-morning, and 24-h void sampling

Urinary mono-hydroxy polycyclic aromatic hydrocarbons (OH-PAHs) are commonly used in biomonitoring to assess exposure to polycyclic aromatic hydrocarbons (PAHs). Similar to other biologically non-persistent chemicals, OH-PAHs have relatively short biological half-lives (4.4-35 h). Little information is available on their variability in urinary concentrations over time in non-occupationally exposed subjects. This study was designed to (i) examine the variability of nine urinary OH-PAH metabolite concentrations over time and (ii) calculate sample size requirements for future epidemiological studies on the basis of spot urine, first-morning void, and 24-h void sampling. Individual urine samples (n=427) were collected during 1 week from 8 non-occupationally exposed adults. We recorded the time and volume of each urine excretion, dietary details, and driving activities of the participants. Within subjects, the coefficients of variation (CVs) for the wet-weight concentration of OH-PAHs in all samples ranged from 45% to 297%; creatinine adjustment reduced the CV to 19-288% (P<0.001; paired t-test). The simulated 24-h void concentrations were the least variable measure, with CVs ranging from 13% to 182% for the 9 OH-PAHs. Within-day variability contributed on average 84%, and between-day variability accounted for 16% of the total variance of 1-hydroxypyrene (1-PYR). Intraclass correlation coefficients of 1-PYR levels were 0.55 for spot urine samples, 0.65 [corrected] for first-morning voids, and 0.77 [corrected] for 24-h voids, indicating a high degree of correlation between urine measurements collected from the same subject over time. Sample size calculations were performed to estimate the number of subjects required for detecting differences in the geometric mean at a statistical power of 80% for spot urine, first-morning, and 24-h void sampling. These data will aid in the design of future studies of PAHs and possibly other biologically non-persistent chemicals and in the interpretation of their analytical results.

Cytomegalovirus seroprevalence in the United States: the national health and nutrition examination surveys, 1988-2004

BACKGROUND. Congenital cytomegalovirus (CMV) infection causes permanent disabilities in more than 5500 children each year in the United States. The likelihood of congenital infection and disability is highest for infants whose mothers were CMV seronegative before conception and who acquire infection during pregnancy. METHODS. To provide a current, nationally representative estimate of the seroprevalence of CMV in the United States and to investigate trends in CMV infection, serum samples from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 were tested for CMV-specific immunoglobulin G antibody, and results were compared with those from NHANES III (1988-1994). Individuals aged 6-49 years (21,639 for NHANES III and 15,310 for NHANES 1999-2004) were included. RESULTS. For NHANES 1999-2004, the overall age-adjusted CMV seroprevalence was 50.4%. CMV seroprevalence was higher among non-Hispanic black and Mexican American children compared with non-Hispanic white children and increased more quickly in subsequent age groups. CMV seropositivity was independently associated with older age, female sex, foreign birthplace, low household income, high household crowding, and low household education. Compared with NHANES 1988-1994, the overall age-adjusted CMV seroprevalence for NHANES 1999-2004 was not significantly different. CONCLUSIONS. Many women of reproductive age in the United States are still at risk of primary CMV infection during pregnancy. There is an urgent need for vaccine development and other interventions to prevent and treat congenital CMV. The substantial disparities in CMV risk among seronegative women suggest that prevention strategies should include an emphasis on reaching racial or ethnic minorities and women of low socioeconomic status.

Secondary syphilis in cali, Colombia: new concepts in disease pathogenesis

Venereal syphilis is a multi-stage, sexually transmitted disease caused by the spirochetal bacterium Treponema pallidum (Tp). Herein we describe a cohort of 57 patients (age 18-68 years) with secondary syphilis (SS) identified through a network of public sector primary health care providers in Cali, Colombia. To be eligible for participation, study subjects were required to have cutaneous lesions consistent with SS, a reactive Rapid Plasma Reagin test (RPR-titer > or = 1 : 4), and a confirmatory treponemal test (Fluorescent Treponemal Antibody Absorption test- FTA-ABS). Most subjects enrolled were women (64.9%), predominantly Afro-Colombian (38.6%) or mestizo (56.1%), and all were of low socio-economic status. Three (5.3%) subjects were newly diagnosed with HIV infection at study entry. The duration of signs and symptoms in most patients (53.6%) was less than 30 days; however, some patients reported being symptomatic for several months (range 5-240 days). The typical palmar and plantar exanthem of SS was the most common dermal manifestation (63%), followed by diffuse hypo- or hyperpigmented macules and papules on the trunk, abdomen and extremities. Three patients had patchy alopecia. Whole blood (WB) samples and punch biopsy material from a subset of SS patients were assayed for the presence of Tp DNA polymerase I gene (polA) target by real-time qualitative and quantitative PCR methods. Twelve (46%) of the 26 WB samples studied had quantifiable Tp DNA (ranging between 194.9 and 1954.2 Tp polA copies/ml blood) and seven (64%) were positive when WB DNA was extracted within 24 hours of collection. Tp DNA was also present in 8/12 (66%) skin biopsies available for testing. Strain typing analysis was attempted in all skin and WB samples with detectable Tp DNA. Using arp repeat size analysis and tpr RFLP patterns four different strain types were identified (14d, 16d, 13d and 22a). None of the WB samples had sufficient DNA for typing. The clinical and microbiologic observations presented herein, together with recent Cali syphilis seroprevalence data, provide additional evidence that venereal syphilis is highly endemic in this region of Colombia, thus underscoring the need for health care providers in the region to be acutely aware of the clinical manifestations of SS. This study also provides, for the first time, quantitative evidence that a significant proportion of untreated SS patients have substantial numbers of circulating spirochetes. How Tp is able to persist in the blood and skin of SS patients, despite the known presence of circulating treponemal opsonizing antibodies and the robust pro-inflammatory cellular immune responses characteristic of this stage of the disease, is not fully understood and requires further study.

Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States

CONTEXT

Early data on pandemic 2009 influenza A(H1N1) suggest pregnant women are at increased risk of hospitalization and death.

OBJECTIVE

To describe the severity of 2009 influenza A(H1N1) illness and the association with early antiviral treatment among pregnant women in the United States.

DESIGN, SETTING, AND PATIENTS

Surveillance of 2009 influenza A(H1N1) in pregnant women reported to the Centers for Disease Control and Prevention (CDC) with symptom onset from April through December 2009.

MAIN OUTCOME MEASURES

Severity of illness (hospitalizations, intensive care unit [ICU] admissions, and deaths) due to 2009 influenza A(H1N1) among pregnant women, stratified by timing of antiviral treatment and pregnancy trimester at symptom onset.

RESULTS

We received reports on 788 pregnant women in the United States with 2009 influenza A(H1N1) with symptom onset from April through August 2009. Among those, 30 died (5% of all reported 2009 influenza A[H1N1] influenza deaths in this period). Among 509 hospitalized women, 115 (22.6%) were admitted to an ICU. Pregnant women with treatment more than 4 days after symptom onset were more likely to be admitted to an ICU (56.9% vs 9.4%; relative risk [RR], 6.0; 95% confidence interval [CI], 3.5-10.6) than those treated within 2 days after symptom onset. Only 1 death occurred in a patient who received treatment within 2 days of symptom onset. Updating these data with the CDC's continued surveillance of ICU admissions and deaths among pregnant women with symptom onset through December 31, 2009, identified an additional 165 women for a total of 280 women who were admitted to ICUs, 56 of whom died. Among the deaths, 4 occurred in the first trimester (7.1%), 15 in the second (26.8%), and 36 in the third (64.3%);

CONCLUSIONS

Pregnant women had a disproportionately high risk of mortality due to 2009 influenza A(H1N1). Among pregnant women with 2009 influenza A(H1N1) influenza reported to the CDC, early antiviral treatment appeared to be associated with fewer admissions to an ICU and fewer deaths.

Syphilis outbreak among American Indians - Arizona, 2007-2009

On January 25, 2007, an Indian Health Service (IHS) unit notified the Arizona Department of Health Services (ADHS) of five symptomatic syphilis cases (i.e., primary or secondary syphilis) that had occurred in members of a Southwest Indian Nation during the previous 6 months. By mid-April, three more cases had been identified. On April 18, 2007, the tribe declared an outbreak of syphilis and subsequently requested public health assistance from county, state, and federal agencies. On July 10, an enhanced, coordinated multiagency response to the outbreak began, involving tribal and Pima County health departments, IHS, ADHS, and CDC. This report summarizes the enhanced outbreak response, which identified a total of 106 cases of syphilis with onset from January 2007 to June 2009, including six congenital cases (two of them stillbirths). Initial communication gaps led to delays in response to this outbreak, but communication was improved through the formation of an outbreak response group that included members from county, state, and tribal health departments and IHS. For similar outbreaks in American Indian tribes, where various public health jurisdictions exist and often have concurrent responsibilities, formation of an outbreak response group can improve control efforts.

Non-cigarette tobacco use among women and adverse pregnancy outcomes

Although cigarette smoking remains the most prevalent form of tobacco use in girls and in women of reproductive age globally, use of non-cigarette forms of tobacco is prevalent or gaining in popularity in many parts of the world, especially in low- and middle-income countries. Sparse but growing evidence suggests that the use of some non-cigarette tobacco products during pregnancy increases the risk of adverse pregnancy outcomes. In this paper we review the literature on the prevalence of non-cigarette tobacco product use in pregnant women and in women of reproductive age in high-, middle-, and low-income countries and the evidence that maternal use of these products during pregnancy has adverse health effects. In addition, we communicate findings from an international group of perinatal and tobacco experts that was convened to establish research priorities concerning the use of non-cigarette tobacco products during pregnancy. The working group concluded that attempts to develop a public health response to non-cigarette tobacco use in women are hindered by a lack of data on the epidemiology of use in many parts of the world and by our limited understanding of the type and magnitude of the health effects of these products. We highlight research gaps and provide recommendations for a global research agenda.

Centers for Disease Control and Prevention (CDC). Update: novel influenza A (H1N1) virus infection - Mexico, March-May, 2009

On April 12, 2009, Mexico responded to a request for verification by the World Health Organization (WHO) of an outbreak of acute respiratory illness in the small community of La Gloria, Veracruz. During April 15-17, the Mexico Ministry of Health received informal notification of clusters of rapidly progressive severe pneumonia occurring mostly in Distrito Federal (metropolitan Mexico City) and San Luis Potosi. In response, on April 17, Mexico intensified national surveillance for acute respiratory illness and pneumonia. During April 22-24, novel influenza A (H1N1) virus infection, previously identified in two children in the United States, was confirmed in several patients. This report updates a previous report on the outbreak in Mexico and summarizes public health actions taken to date by Mexico to monitor and control the outbreak. During March 1-May 29, national surveillance identified 41,998 persons with acute respiratory illness; specimens from 25,127 (59.8%) patients were tested, of which 5,337 (21.2%) were positive for novel influenza A (H1N1) virus infection by real-time reverse transcription--polymerase chain reaction (rRT-PCR). As of May 29, 97 patients with laboratory-confirmed infection had died. Epidemiologic evidence to date suggests that the outbreak likely peaked nationally in late April, although localized cases continue to be identified.

Measles outbreak in South Africa, 2003-2005

OBJECTIVES

Measles was virtually eliminated in South Africa following control activities in 1996/7. However, from July 2003 to November 2005, 1676 laboratory-confirmed measles cases were reported in South Africa. We investigated the outbreak's cause and the role of HIV.

DESIGN

We traced laboratory-confirmed case-patients residing in the Johannesburg metropolitan (JBM) and O. R. Tambo districts. We interviewed laboratory--or epidemiologically confirmed case-patients or their caregivers to determine vaccination status and, in JBM, HIV status. We calculated vaccine effectiveness using the screening method.

SETTING

Household survey in JBM and O. R. Tambo districts. Outcome measures. Vaccine effectiveness, case-fatality rate, and hospitalisations.

RESULTS

In JBM, 109 case-patients were investigated. Of the 57 case-patients eligible for immunisation, 27 (47.4%) were vaccinated. Fourteen (12.8%) case-patients were HIV infected, 46 (42.2%) were HIV uninfected, and 49 (45.0%) had unknown HIV status. Among children aged 12-59 months, vaccine effectiveness was 85% (95% confidence interval (CI): 63, 94) for all children, 63% for HIV infected, 75% for HIV uninfected, and 96% for children with unknown HIV status. (Confidence intervals were not calculated for sub-groups owing to small sample size.) In O. R. Tambo district, 157 case-patients were investigated. Among the 138 case-patients eligible for immunisation, 41 (29.7%) were vaccinated. Vaccine effectiveness was 89% (95% CI 77, 95).

CONCLUSIONS

The outbreak's primary cause was failure to vaccinate enough of the population to prevent endemic measles transmission. Although vaccine effectiveness might have been lower in HIV-infected than in uninfected children, population vaccine effectiveness remained high.

Filtration Performance of FDA-Cleared Surgical Masks

Ashortage of NIOSH-approved respirators is predicted during an influenza pandemic and other infectious disease outbreaks. Healthcare workers may use surgical masks instead of respirators due to non-availability and for economical reasons. This study investigated the filtration performance of surgical masks for a wide size range of submicron particles including the sizes of many viruses. Five models of FDA-cleared surgical masks were tested for room air particle penetrations at constant and cyclic flow conditions. Penetrations of polydisperse NaCl aerosols (75±20 nm, count median diameter), monodisperse NaCl aerosols (20-400 nm range) and particles in the 20-1000 nm range were measured at 30 and 85 liters/min. Filtration performance of surgical masks varied widely for room air particles at constant flow and correlated with the penetration levels measured under cyclic flow conditions. Room air particle penetration levels were comparable to polydisperse and monodisperse aerosol penetrations at 30 and 85 liters/minute. Filtration performance of FDA-cleared surgical masks varied widely for room air particles, and monodisperse and polydisperse aerosols. The results suggest that not all FDA-cleared surgical masks will provide similar levels of protection to wearers against infectious aerosols in the size range of many viruses.

Transmission of atypical varicella-zoster virus infections involving palm and sole manifestations in an area with monkeypox endemicity

During a suspected monkeypox outbreak in the Republic of Congo, we documented transmission of varicella-zoster virus (VZV) infection with palm and sole manifestations among 5 family members. Genotyping results confirmed the VZV strain European E2, a genotype not previously reported in Africa. VZV with palm and sole involvement should be considered when differentiating a monkeypox diagnosis.

Knowledge, attitudes and risk perceptions about tuberculosis: US National Health Interview Survey

BACKGROUND

Tuberculosis (TB) disproportionately affects the human immunodeficiency virus (HIV) infected, foreign-born, Black, Hispanic, American Indian/Alaska Native, Asian, homeless, incarcerated, alcoholic, diabetic or cancer patients, male, those aged >44 years, smokers and poor persons.

METHODS

We present TB knowledge, attitudes and risk perceptions overall and for those experiencing TB disparities from the 2000-2005 US National Health Interview Survey (NHIS).

RESULTS

A total of 32% of respondents said TB is curable; 44% correctly recognized that TB is transmitted by air. Persons with less knowledge about TB transmission were aged 18-24 years, alcohol abusers, educated <12 years, Hispanics or males. Persons less likely to say TB is curable were aged 18-44 years, smokers, HIV-tested, uninsured, alcohol abusers or homeless/incarcerated. Only 28% of foreign-born persons from Mexico/Central America/the Caribbean said TB was curable.

CONCLUSIONS

Knowledge about TB transmission and curability was low among a representative US population. Renewed TB educational efforts are needed for all populations, but should be targeted to populations disproportionately affected, especially those who are HIV-infected, homeless/incarcerated, Black, alcohol abusers, uninsured or born in Mexico/Central America/the Caribbean.

Challenges in routine implementation and quality control of rapid diagnostic tests for malaria--Rufiji District, Tanzania

Rapid diagnostic tests (RDTs) represent an alternative to microscopy for malaria diagnosis and have shown high sensitivity and specificity in a variety of study settings. Current World Health Organization (WHO) guidelines for quality control of RDTs provide detailed instructions on pre-field testing, but offer little guidance for quality assurance once RDTs are deployed in health facilities. From September 2006 to April 2007, we introduced a histidine-rich protein II (HRP2)-based RDT (Paracheck) for suspected malaria cases five years of age and older in nine health facilities in Rufiji District, Tanzania, to assess sensitivity and specificity of RDTs in routine use at rural health facilities. Thick blood smears were collected for all patients tested with RDTs and stained and read by laboratory personnel in each facility. Thick smears were subsequently reviewed by a reference microscopist to determine RDT sensitivity and specificity. In all nine health facilities, there were significant problems with the quality of staining and microscopy. Sensitivity and specificity of RDTs were difficult to assess given the poor quality of routine blood smear staining. Mean operational sensitivity of RDTs based on reference microscopy was 64.8%, but varied greatly by health facility, range 18.8-85.9%. Sensitivity of RDTs increased with increasing parasite density. Specificity remained high at 87.8% despite relatively poor slide quality. Institution of quality control of RDTs based on poor quality blood smear staining may impede reliable measurement of sensitivity and specificity and undermine confidence in the new diagnostic. There is an urgent need for the development of alternative quality control procedures for rapid diagnostic tests that can be performed at the facility level.