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Li Y, Rivers J, Mathis S, Li Z, Chochua S, Metcalf BJ, Beall B, McGee L. Genomic cluster formation among invasive group A streptococcal infections in the USA: a whole-genome sequencing and population-based surveillance study. THE LANCET. MICROBE 2024:100927. [PMID: 39419051 DOI: 10.1016/s2666-5247(24)00169-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 10/19/2024]
Abstract
BACKGROUND Clusters of invasive group A streptococcal (iGAS) infection, linked to genomically closely related group A streptococcal (GAS) isolates (referred to as genomic clusters), pose public health threats, and are increasingly identified through whole-genome sequencing (WGS) analysis. In this study, we aimed to assess the risk of genomic cluster formation among iGAS cases not already part of existing genomic clusters. METHODS In this WGS and population-based surveillance study, we analysed iGAS case isolates from the Active Bacterial Core surveillance (ABCs), which is part of the US Centers for Disease Control and Prevention's Emerging Infections Program, in ten US states from Jan 1, 2015, to Dec 31, 2019. We included all residents in ABCs sites with iGAS infections meeting the case definition and excluded non-conforming GAS infections and cases with whole-genome assemblies of the isolate containing fewer than 1·5 million total bases or more than 150 contigs. For iGAS cases we collected basic demographics, underlying conditions, and risk factors for infection from medical records, and for isolates we included emm types, antimicrobial resistance, and presence of virulence-related genes. Two iGAS cases were defined as genomically clustered if their isolates differed by three or less single-nucleotide variants. An iGAS case not clustered with any previous cases at the time of detection, with a minimum trace-back time of 1 year, was defined as being at risk of cluster formation. We monitored each iGAS case at risk for a minimum of 1 year to identify any cluster formation event, defined as the detection of a subsequent iGAS case clustered with the case at risk. We used the Kaplan-Meier method to estimate the cumulative incidence of cluster formation events over time. We used Cox regression to assess associations between features of cases at risk upon detection and subsequent cluster formation. We developed a random survival forest machine-learning model based on a derivation cohort (random selection of 50% of cases at risk) to predict cluster formation risk. This model was validated using a validation cohort consisting of the remaining 50% of cases at risk. FINDINGS We identified 2764 iGAS cases at risk from 2016 to 2018, of which 656 (24%) formed genomic clusters by the end of 2019. Overall, the cumulative incidence of cluster formation was 0·057 (95% CI 0·048-0·066) at 30 days after detection, 0·12 (0·11-0·13) at 90 days after detection, and 0·16 (0·15-0·18) at 180 days after detection. A higher risk of cluster formation was associated with emm type (adjusted hazard ratio as compared with emm89 was 2·37 [95% CI 1·71-3·30] for emm1, 2·72 [1·82-4·06] for emm3, 2·28 [1·49-3·51] for emm6, 1·47 [1·05-2·06] for emm12, and 2·21 [1·38-3·56] for emm92), homelessness (1·42 [1·01-1·99]), injection drug use (2·08 [1·59-2·72]), residence in a long-term care facility (1·78 [1·29-2·45]), and the autumn-winter season (1·34 [1·14-1·57]) in multivariable Cox regression analysis. The machine-learning model stratified the validation cohort (n=1382) into groups at low (n=370), moderate (n=738), and high (n=274) risk. The 90-day risk of cluster formation was 0·03 (95% CI 0·01-0·05) for the group at low risk, 0·10 (0·08-0·13) for the group at moderate risk, and 0·21 (0·17-0·25) for the group at high risk. These results were consistent with the cross-validation outcomes in the derivation cohort. INTERPRETATION Using population-based surveillance data, we found that pathogen, host, and environment factors of iGAS cases were associated with increased likelihood of subsequent genomic cluster formation. Groups at high risk were consistently identified by a predictive model which could inform prevention strategies, although future work to refine the model, incorporating other potential risk factors such as host contact patterns and immunity to GAS, is needed to improve its predictive performance. FUNDING Centers for Disease Control and Prevention.
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Affiliation(s)
- Yuan Li
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Joy Rivers
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Sopio Chochua
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benjamin J Metcalf
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Lesley McGee
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Cowley ES, Chaves IZ, Osman F, Suen G, Anantharaman K, Hryckowian AJ. Determinants of Gastrointestinal Group B Streptococcus Carriage in Adults. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.17.553755. [PMID: 37645860 PMCID: PMC10462156 DOI: 10.1101/2023.08.17.553755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Streptococcus agalactiae (Group B Streptococcus, GBS) is a commensal Gram-positive bacterium found in the human gastrointestinal and urogenital tracts. Much of what is known about GBS relates to the diseases it causes in pregnant people and neonates. However, GBS is a common cause of disease in the general population with 90% of GBS mortality occurring in non-pregnant people. There are limited data about the predisposing factors for GBS and the reservoirs in the body. To gain an understanding of the determinants of gastrointestinal GBS carriage, we used stool samples and associated metadata to determine the prevalence and abundance of GBS in the gut microbiome of adults and find risk factors for GBS status. Methods We used 754 stool samples collected from adults in Wisconsin from 2016-2017 to test for the prevalence and abundance of GBS using a Taqman probe-based qPCR assay targeting two GBS-specific genes: cfp and sip. We compared the microbiome compositions of the stool samples by GBS status using 16S rRNA analysis. We compared associations with GBS status and 557 survey variables collected during sample acquisition (demographics, diet, overall health, and reproductive health) using univariate and multivariate analyses. Results We found 137/754 (18%) of participants had detectable GBS in their stool samples with a median abundance of 104 copies per nanogram of starting DNA. There was no difference in GBS status or abundance based on gender. Beta-diversity, Bray-Curtis and Unweighted UniFrac, was significantly different based on carrier status of the participant. Prior to p-value correction, 59/557 (10.6%) survey variables were significantly associated with GBS carrier status and 11/547 (2.0%) variables were significantly associated with abundance (p-value<0.05). After p-value correction, 2/547 (0.4%) variables were associated with GBS abundance: an increased abundance of GBS was associated with a decreased frequency since last dental checkup (p<0.001) and last dental cleaning (p<0.001). Increased GBS abundance was significantly associated with increased frequency of iron consumption (p=0.007) after p-value correction in multivariate models. Conclusions GBS is found in stool samples from adults in Wisconsin at similar frequencies as pregnant individuals screened with rectovaginal swabs. We did not find associations between risk factors historically associated with GBS in pregnant people, suggesting that risk factors for GBS carriage in pregnancy may differ from those in the general population. We found that frequency of iron consumption and dental hygiene are risk factors for GBS carriage in Wisconsin adults. Given that these variables were not assayed in previous GBS surveys, it is possible they also influence carriage in pregnant people. Taken together, this work serves as a foundation for future work in developing approaches to decrease GBS abundance in carriers.
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Affiliation(s)
- Elise S. Cowley
- Department of Bacteriology, University of Wisconsin-Madison
- Microbiology Doctoral Training Program, University of Wisconsin-Madison
| | - Ibrahim Zuniga Chaves
- Department of Bacteriology, University of Wisconsin-Madison
- Microbiology Doctoral Training Program, University of Wisconsin-Madison
| | - Fauzia Osman
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Garret Suen
- Department of Bacteriology, University of Wisconsin-Madison
| | | | - Andrew J. Hryckowian
- Department of Medical Microbiology & Immunology, University of Wisconsin-Madison
- Department of Medicine (Division of Gastroenterology & Hepatology), School of Medicine and Public Health, University of Wisconsin-Madison
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3
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Wiese AD, Mitchel E, Ndi D, Markus TM, Talbot HK, Schaffner W, Grijalva CG. Risk of Acute Myocardial Infarction Among Patients With Laboratory-Confirmed Invasive Pneumococcal Disease: A Self-Controlled Case Series Study. Clin Infect Dis 2023; 76:2171-2177. [PMID: 36751004 PMCID: PMC10273377 DOI: 10.1093/cid/ciad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/26/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) events have been reported among patients with certain viral and bacterial infections. Whether invasive pneumococcal disease (IPD) increases the risk of AMI remains unclear. We examined whether laboratory-confirmed IPD was associated with the risk of AMI. METHODS We conducted a self-controlled case series analysis among adult Tennessee residents with evidence of an AMI hospitalization (2003-2019). Patient follow-up started 1 year before the earliest AMI and continued through the date of death, 1 year after AMI, or study end (December 2019). Periods for AMI assessment included the 7 to 1 days before IPD specimen collection (pre-IPD detection), day 0 through day 7 after IPD specimen collection (current IPD), day 8 to 28 after IPD specimen collection (post-IPD), and a control period (all other follow-up). We used conditional Poisson regression to calculate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for each risk period compared with control periods using within-person comparisons. RESULTS We studied 324 patients hospitalized for AMI with laboratory-confirmed IPD within 1 year before or after the AMI hospitalization. The incidence of AMI was significantly higher during the pre-IPD detection (IRR, 10.29; 95% CI: 6.33-16.73) and the current IPD (IRR, 92.95; 95% CI: 72.17-119.71) periods but nonsignificantly elevated in the post-IPD risk period (IRR, 1.83; 95% CI: .86-3.91) compared with control periods. The AMI incidence was higher in the post-IPD control period (29 to 365 days after IPD; IRR, 2.95; 95% CI: 2.01-4.32). CONCLUSIONS Hospitalizations with AMI were strongly associated with laboratory-confirmed IPD.
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Affiliation(s)
- Andrew D Wiese
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ed Mitchel
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Danielle Ndi
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tiffanie M Markus
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - H Keipp Talbot
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William Schaffner
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Veteran Affairs TN Valley Health Care System, Nashville, TN, USA
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Oliver SE, Rubis AB, Soeters HM, Reingold A, Barnes M, Petit S, Farley MM, Harrison LH, Como-Sabetti K, Khanlian SA, Wester R, Thomas A, Schaffner W, Marjuki H, Wang X, Hariri S. Epidemiology of Invasive Nontypeable Haemophilus influenzae Disease-United States, 2008-2019. Clin Infect Dis 2023; 76:1889-1895. [PMID: 36722332 PMCID: PMC11320882 DOI: 10.1093/cid/ciad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Nontypeable Haemophilus influenzae (NTHi) is the most common cause of invasive H. influenzae disease in the United States (US). We evaluated the epidemiology of invasive NTHi disease in the US, including among pregnant women, infants, and people with human immunodeficiency virus (PWH). METHODS We used data from population- and laboratory-based surveillance for invasive H. influenzae disease conducted in 10 sites to estimate national incidence of NTHi, and to describe epidemiology in women of childbearing age, infants aged ≤30 days (neonates), and PWH living in the surveillance catchment areas. H. influenzae isolates were sent to the Centers for Disease Control and Prevention for species confirmation, serotyping, and whole genome sequencing of select isolates. RESULTS During 2008-2019, average annual NTHi incidence in the US was 1.3/100 000 population overall, 5.8/100 000 among children aged <1 year, and 10.2/100 000 among adults aged ≥80 years. Among 225 reported neonates with NTHi, 92% had a positive culture within the first week of life and 72% were preterm. NTHi risk was 23 times higher among preterm compared to term neonates, and 5.6 times higher in pregnant/postpartum compared to nonpregnant women. More than half of pregnant women with invasive NTHi had loss of pregnancy postinfection. Incidence among PWH aged ≥13 years was 9.5 cases per 100 000, compared to 1.1 cases per 100 000 for non-PWH (rate ratio, 8.3 [95% confidence interval, 7.1-9.7]; P < .0001). CONCLUSIONS NTHi causes substantial invasive disease, especially among older adults, pregnant/postpartum women, and neonates. Enhanced surveillance and evaluation of targeted interventions to prevent perinatal NTHi infections may be warranted.
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Affiliation(s)
- Sara E. Oliver
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - Amy B. Rubis
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - Heidi M. Soeters
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | | | - Meghan Barnes
- Colorado Department of Public Health and Environment, Denver, CO
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, CT
| | - Monica M. Farley
- Emory University School of Medicine and The Atlanta VA Medical Center, Atlanta, GA
| | - Lee H. Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | | | | | | | - Henju Marjuki
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - Susan Hariri
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA
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5
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Geurtsen J, de Been M, Weerdenburg E, Zomer A, McNally A, Poolman J. Genomics and pathotypes of the many faces of Escherichia coli. FEMS Microbiol Rev 2022; 46:fuac031. [PMID: 35749579 PMCID: PMC9629502 DOI: 10.1093/femsre/fuac031] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 06/22/2022] [Indexed: 01/09/2023] Open
Abstract
Escherichia coli is the most researched microbial organism in the world. Its varied impact on human health, consisting of commensalism, gastrointestinal disease, or extraintestinal pathologies, has generated a separation of the species into at least eleven pathotypes (also known as pathovars). These are broadly split into two groups, intestinal pathogenic E. coli (InPEC) and extraintestinal pathogenic E. coli (ExPEC). However, components of E. coli's infinite open accessory genome are horizontally transferred with substantial frequency, creating pathogenic hybrid strains that defy a clear pathotype designation. Here, we take a birds-eye view of the E. coli species, characterizing it from historical, clinical, and genetic perspectives. We examine the wide spectrum of human disease caused by E. coli, the genome content of the bacterium, and its propensity to acquire, exchange, and maintain antibiotic resistance genes and virulence traits. Our portrayal of the species also discusses elements that have shaped its overall population structure and summarizes the current state of vaccine development targeted at the most frequent E. coli pathovars. In our conclusions, we advocate streamlining efforts for clinical reporting of ExPEC, and emphasize the pathogenic potential that exists throughout the entire species.
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Affiliation(s)
- Jeroen Geurtsen
- Janssen Vaccines and Prevention B.V., 2333 Leiden, the Netherlands
| | - Mark de Been
- Janssen Vaccines and Prevention B.V., 2333 Leiden, the Netherlands
| | | | - Aldert Zomer
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, 3584 Utrecht, the Netherlands
| | - Alan McNally
- Institute of Microbiology and Infection, College of Medical and Dental Sciences, University of Birmingham, B15 2TT Birmingham, United Kingdom
| | - Jan Poolman
- Janssen Vaccines and Prevention B.V., 2333 Leiden, the Netherlands
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6
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Miller KM, Lamagni T, Cherian T, Cannon JW, Parks T, Adegbola RA, Pickering J, Barnett T, Engel ME, Manning L, Bowen AC, Carapetis JR, Moore HC, Barth DD, Kaslow DC, Van Beneden CA. Standardization of Epidemiological Surveillance of Invasive Group A Streptococcal Infections. Open Forum Infect Dis 2022; 9:S31-S40. [PMID: 36128405 PMCID: PMC9474937 DOI: 10.1093/ofid/ofac281] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/13/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Invasive group A streptococcal (Strep A) infections occur when Streptococcus pyogenes, also known as beta-hemolytic group A Streptococcus, invades a normally sterile site in the body. This article provides guidelines for establishing surveillance for invasive Strep A infections. The primary objective of invasive Strep A surveillance is to monitor trends in rates of infection and determine the demographic and clinical characteristics of patients with laboratory-confirmed invasive Strep A infection, the age- and sex-specific incidence in the population of a defined geographic area, trends in risk factors, and the mortality rates and rates of nonfatal sequelae caused by invasive Strep A infections.
This article includes clinical descriptions followed by case definitions, based on clinical and laboratory evidence, and case classifications (confirmed or probable, if applicable) for invasive Strep A infections and for 3 Strep A syndromes: streptococcal toxic shock syndrome, necrotizing fasciitis, and pregnancy-associated Strep A infection.
Considerations of the type of surveillance are also presented, noting that most people who have invasive Strep A infections will present to hospital and that invasive Strep A is a notifiable disease in some countries. Minimal surveillance necessary for invasive Strep A infection is facility-based, passive surveillance. A resource-intensive but more informative approach is active case finding of laboratory-confirmed Strep A invasive infections among a large (eg, state-wide) and well defined population.
Participant eligibility, surveillance population, and additional surveillance components such as the use of International Classification of Disease diagnosis codes, follow-up, period of surveillance, seasonality, and sample size are discussed. Finally, the core data elements to be collected on case report forms are presented.
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Affiliation(s)
- Kate M Miller
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
| | | | | | - Jeffrey W Cannon
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA
| | - Tom Parks
- Department of Infectious Disease, Imperial College London, Hammersmith Hospital , London , United Kingdom
| | | | - Janessa Pickering
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
| | - Tim Barnett
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
| | - Mark E Engel
- AFROStrep Research Initiative, Department of Medicine, University of Cape Town , Cape Town , South Africa
| | - Laurens Manning
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Infectious Diseases Department, Fiona Stanley Hospital , Perth, Western Australia , Australia
- Medical School, University of Western Australia , Perth, Western Australia , Australia
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Perth Children’s Hospital , Nedlands, Western Australia
- Faculty of Health and Medicine, University of Western Australia , Nedlands, Western Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Faculty of Health and Medicine, University of Western Australia , Nedlands, Western Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
| | - Dylan D Barth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Faculty of Health and Medicine, University of Western Australia , Nedlands, Western Australia
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7
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Miller KM, Van Beneden C, McDonald M, Hla TK, Wong W, Pedgrift H, Kaslow DC, Cherian T, Carapetis JR, Scheel A, Seale A, Bowen AC, Moore HC, Lamagni T, Rodriguez-Iturbe B. Standardization of Epidemiological Surveillance of Acute Poststreptococcal Glomerulonephritis . Open Forum Infect Dis 2022; 9:S57-S64. [PMID: 36128411 PMCID: PMC9474944 DOI: 10.1093/ofid/ofac346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/12/2022] [Indexed: 11/22/2022] Open
Abstract
Acute poststreptococcal glomerulonephritis (APSGN) is an immune complex-induced glomerulonephritis that develops as a sequela of streptococcal infections. This article provides guidelines for the surveillance of APSGN due to group A Streptococcus (Strep A). The primary objectives of APSGN surveillance are to monitor trends in age- and sex-specific incidence, describe the demographic and clinical characteristics of patients with APSGN, document accompanying risk factors, then monitor trends in frequency of complications, illness duration, hospitalization rates, and mortality. This document provides surveillance case definitions for APSGN, including clinical and subclinical APSGN based on clinical and laboratory evidence. It also details case classifications that can be used to differentiate between confirmed and probable cases, and it discusses the current investigations used to provide evidence of antecedent Strep A infection. The type of surveillance recommended depends on the burden of APSGN in the community and the objectives of surveillance. Strategies for minimal surveillance and enhanced surveillance of APSGN are provided. Furthermore, a discussion covers the surveillance population and additional APSGN-specific surveillance considerations such as contact testing, active follow up of cases and contacts, frequency of reporting, surveillance visits, period of surveillance, and community engagement. Finally, the document presents core data elements to be collected on case report forms, along with guidance for documenting the course and severity of APSGN.
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Affiliation(s)
- Kate M Miller
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | | | | | - Thel K Hla
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - William Wong
- Starship Children’s Hospital, Auckland, New Zealand
| | | | | | | | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Amy Scheel
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anna Seale
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- University of Warwick, Coventry, United Kingdom
- UK Health Security Agency, London, United Kingdom
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
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Potts CC, Rodriguez-Rivera LD, Retchless AC, Buono SA, Chen AT, Marjuki H, Blain AE, Wang X. Antimicrobial Susceptibility Survey of Invasive Haemophilus influenzae in the United States in 2016. Microbiol Spectr 2022; 10:e0257921. [PMID: 35536039 PMCID: PMC9241922 DOI: 10.1128/spectrum.02579-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/19/2022] [Indexed: 11/20/2022] Open
Abstract
Antibiotics are important for the treatment and prevention of invasive Haemophilus influenzae disease. Reduced susceptibility to clinically relevant drugs, except ampicillin, has been uncommon in the United States. Susceptibility of 700 invasive H. influenzae isolates, collected through population-based surveillance during 2016, was assessed for 15 antibiotics using broth microdilution, according to the CLSI guidelines; a subset of 104 isolates were also assessed for rifampin susceptibility using Etest. Genomes were sequenced to identify genes and mutations known to be associated with reduced susceptibility to clinically relevant drugs. A total of 508 (72.6%) had reduced susceptibility to at least one antibiotic and more than half of the isolates exhibited reduced susceptibility to only one (33.6%) or two (21.6%) antibiotic classes. All tested isolates were susceptible to rifampin, a chemoprophylaxis agent, and <1% (n = 3) of isolates had reduced susceptibility to third generation cephalosporins, which are recommended for invasive disease treatment. In contrast, ampicillin resistance was more common (28.1%) and predominantly associated with the detection of a β-lactamase gene; 26.2% of isolates in the collection contained either a TEM-1 or ROB-1 β-lactamase gene, including 88.8% of ampicillin-resistant isolates. β-lactamase negative ampicillin-resistant (BLNAR) isolates were less common and associated with ftsI mutations; resistance to amoxicillin-clavulanate was detected in <2% (n = 13) of isolates. The proportion of reduced susceptibility observed was higher among nontypeable H. influenzae and serotype e than other serotypes. US invasive H. influenzae isolates remain predominantly susceptible to clinically relevant antibiotics except ampicillin, and BLNAR isolates remain uncommon. IMPORTANCE Antibiotics play an important role for the treatment and prevention of invasive Haemophilus influenzae disease. Antimicrobial resistance survey of invasive H. influenzae isolates collected in 2016 showed that the US H. influenzae population remained susceptible to clinically relevant antibiotics, except for ampicillin. Detection of approximately a quarter ampicillin-resistant and β-lactamase containing strains demonstrates that resistance mechanisms can be acquired and sustained within the H. influenzae population, highlighting the continued importance of antimicrobial resistance surveillance for H. influenzae to monitor susceptibility trends and mechanisms of resistance.
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Affiliation(s)
- Caelin C. Potts
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lorraine D. Rodriguez-Rivera
- Weems Design Studio, Inc., Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- IHRC, Inc., Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adam C. Retchless
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sean A. Buono
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexander T. Chen
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Henju Marjuki
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy E. Blain
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Xin Wang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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9
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Kobayashi M, Matanock A, Xing W, Adih WK, Li J, Gierke R, Almendares O, Reingold A, Alden N, Petit S, Farley MM, Harrison LH, Holtzman C, Baumbach J, Thomas A, Schaffner W, McGee L, Pilishvili T. Impact of 13-Valent Pneumococcal Conjugate Vaccine on Invasive Pneumococcal Disease Among Adults With HIV-United States, 2008-2018. J Acquir Immune Defic Syndr 2022; 90:6-14. [PMID: 35384920 PMCID: PMC9009407 DOI: 10.1097/qai.0000000000002916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND People with HIV (PWH) are at increased risk for invasive pneumococcal disease (IPD). Thirteen-valent pneumococcal conjugate vaccine (PCV13) was recommended for use in US children in 2010 and for PWH aged 19 years or older in 2012. We evaluated the population-level impact of PCV13 on IPD among PWH and non-PWH aged 19 years or older. METHODS We identified IPD cases from 2008 to 2018 through the Active Bacterial Core surveillance platform. We estimated IPD incidence using the National HIV Surveillance System and US Census Bureau data. We measured percent changes in IPD incidence from 2008 to 2009 to 2017-2018 by HIV status, age group, and vaccine serotype group, including serotypes in recently licensed 15-valent (PCV15) and 20-valent (PCV20) PCVs. RESULTS In 2008-2009 and 2017-2018, 8.4% (552/6548) and 8.0% (416/5169) of adult IPD cases were among PWH, respectively. Compared with non-PWH, a larger proportion of IPD cases among PWH were in adults aged 19-64 years (94.7%-97.4% vs. 56.0%-60.1%) and non-Hispanic Black people (62.5%-73.0% vs. 16.7%-19.2%). Overall and PCV13-type IPD incidence in PWH declined by 40.3% (95% confidence interval: -47.7 to -32.3) and 72.5% (95% confidence interval: -78.8 to -65.6), respectively. In 2017-2018, IPD incidence was 16.8 (overall) and 12.6 (PCV13 type) times higher in PWH compared with non-PWH; PCV13, PCV15/non-PCV13, and PCV20/non-PCV15 serotypes comprised 21.5%, 11.2%, and 16.5% of IPD in PWH, respectively. CONCLUSIONS Despite reductions post-PCV13 introduction, IPD incidence among PWH remained substantially higher than among non-PWH. Higher-valent PCVs provide opportunities to reduce remaining IPD burden in PWH.
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Affiliation(s)
- Miwako Kobayashi
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Almea Matanock
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Wei Xing
- Weems Design Studio Inc, Decatur, GA
| | - William K Adih
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jianmin Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ryan Gierke
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Olivia Almendares
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Arthur Reingold
- Berkeley School of Public Health, University of California, Berkeley, CA
| | - Nisha Alden
- Colorado Department of Public Health and Environment, Denver, CO
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, CT
| | - Monica M Farley
- Department of Medicine, Emory University School of Medicine and the Atlanta VA Medical Center, GA
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Ann Thomas
- Oregon Department of Human Services, Portland, OR; and
| | - William Schaffner
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN
| | - Lesley McGee
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tamara Pilishvili
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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10
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Weston EJ, Heidenga BL, Farley MM, Tunali A, D'Angelo MT, Moore A, Workowski K, Raphael BH, Weinstock H, Torrone E. Surveillance for Disseminated Gonococcal Infections, Active Bacterial Core surveillance (ABCs) - United States, 2015-2019. Clin Infect Dis 2022; 75:953-958. [PMID: 35090024 DOI: 10.1093/cid/ciac052] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Disseminated gonococcal infections (DGI) are thought to be uncommon; surveillance is limited and case reports are analyzed retrospectively or in case clusters. We describe the population-level burden of culture-confirmed DGI through the Active Bacterial Core surveillance (ABCs) system. METHODS During 2015-2016, retrospective surveillance was conducted among residents in two ABCs areas and prospectively in three ABCs areas during 2017-2019. A DGI case was defined as isolation of Neisseria gonorrhoeae (Ng) from a normally sterile site. A case report form was completed for each case and antimicrobial susceptibility testing (AST) was performed on available isolates. RESULTS During 2015-2019, 77 DGI cases were identified (~a rate of 0.13 cases per 100,000 population) and accounted for 0.06% of all reported gonorrhea cases in the three surveillance areas. Most DGI cases were male (64%), non-Hispanic Black (68%), and ranged from 16-67 years; blood (55%) and joint (40%) were the most common sterile sites. Among 29 isolates with AST results during 2017-2019, all were susceptible to ceftriaxone. CONCLUSIONS DGI is an infrequent complication of Ng; since Ng can quickly develop antimicrobial resistance, continued DGI surveillance, including monitoring trends in antimicrobial susceptibility, could help inform DGI treatment recommendations.
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Affiliation(s)
- Emily J Weston
- Division of STD Prevention (DSTDP) National Center for HIV/AIDS, Viral Hepatitis, STDs, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Monica M Farley
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, United States.,Atlanta VA Medical Center, Atlanta, GA, United States
| | - Amy Tunali
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, United States.,Atlanta VA Medical Center, Atlanta, GA, United States
| | | | - Ashley Moore
- Georgia Department of Public Health, Atlanta, GA, United States
| | - Kimberly Workowski
- Division of STD Prevention (DSTDP) National Center for HIV/AIDS, Viral Hepatitis, STDs, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, United States.,Emory University School of Medicine, Department of Medicine, Atlanta, GA, United States
| | - Brian H Raphael
- Division of STD Prevention (DSTDP) National Center for HIV/AIDS, Viral Hepatitis, STDs, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Hillard Weinstock
- Division of STD Prevention (DSTDP) National Center for HIV/AIDS, Viral Hepatitis, STDs, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Elizabeth Torrone
- Division of STD Prevention (DSTDP) National Center for HIV/AIDS, Viral Hepatitis, STDs, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, United States
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11
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Tsou PY, Yo CH, Hsein YC, Yungtum G, Hsu WT, Chung JY, Su KY, Chang A, Chang IJ, Lee CC. Temporal Trends in the Microbiological Characteristics of Sepsis in the United States: A Population Based Study. J Intensive Care Med 2021; 37:936-945. [PMID: 34787474 DOI: 10.1177/08850666211053778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Epidemiologic studies are needed for monitoring population-level trends in sepsis. This study examines sepsis-causing microorganisms from 2006 to 2014 in the United States using data from the Nationwide Inpatient Sample database. METHODS 7 860 686 adults hospitalized with sepsis were identified using a validated ICD-9 coding approach. Associated microorganisms were identified by ICD-9 code and classified by major groups (Gram-positive, Gram-negative, fungi, anaerobes) and specific species for analysis of their incidence and mortality. RESULTS The rate of sepsis incidence has increased for all four major categories of pathogens, while the mortality rate decreased. In 2014, Gram-negative pathogens had a higher incidence than Gram-positives. Anaerobes increased the fastest with an average annual increase of 20.17% (p < 0.001). Fungi had the highest mortality (19.28%) and the slowest annual decrease of mortality (-2.31%, p = 0.006) in 2013, while anaerobic sepsis had the highest hazard of mortality (adjusted HR 1.60, 95% CI 1.53-1.66). CONCLUSIONS Gram-negative pathogens have replaced Gram-positives as the leading cause of sepsis in the United States in 2014 during the study period (2006-2014). The incidence of anaerobic sepsis has an annual increase of 20%, while the mortality of fungal sepsis has not decreased at the same rate as other microorganisms. These findings should inform the diagnosis and management of septic patients, as well as the implementation of public health programs.
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Affiliation(s)
| | - Chia-Hung Yo
- 46608FarEastern Memorial Hospital, New Taipei City, Taiwan
| | - Yenh-Chen Hsein
- 37999National Taiwan University Yunlin Branch, Douliou, Taiwan
| | - Gregory Yungtum
- 12321Warren Alpert Medical School of Brown University, RI, USA
| | - Wan-Ting Hsu
- 1857Harvard Chan School of Public Health, Boston, MA, USA
| | | | - Ke-Ying Su
- 38006National Taiwan University Hospital, Taipei, Taiwan
| | | | - I-Jing Chang
- 63474Taipei Medical University Hospital, Taipei, Taiwan
| | - Chien-Chang Lee
- 38006National Taiwan University Hospital, Taipei, Taiwan.,Stanford University, Palo Alto, CA, USA.,38006National Taiwan University Hospital, Taiwan
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12
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Brown NE, Blain AE, Burzlaff K, Harrison LH, Petit S, Schaffner W, Smelser C, Thomas A, Triden L, Watt JP, Pondo T, Whaley MJ, Hu F, Wang X, Oliver S, Soeters HM. Racial Disparities in Invasive Haemophilus influenzae Disease-United States, 2008-2017. Clin Infect Dis 2021; 73:1617-1624. [PMID: 33993217 PMCID: PMC11307574 DOI: 10.1093/cid/ciab449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since the introduction of Haemophilus influenzae serotype b (Hib) conjugate vaccines in the United States, invasive H. influenzae disease epidemiology has changed, and racial disparities have not been recently described. METHODS Active population- and laboratory-based surveillance for H. influenzae was conducted through Active Bacterial Core surveillance at 10 US sites. Data from 2008-2017 were used to estimate projected nationwide annual incidence, as cases per 100 000. RESULTS During 2008-2017, Active Bacterial Core surveillance identified 7379 H. influenzae cases. Of 6705 patients (90.9%) with reported race, 76.2% were White, 18.6% were Black, 2.8% were Asian/Pacific Islander, and 2.4% were American Indian or Alaska Native (AI/AN). The nationwide annual incidence was 1.8 cases/100 000. By race, incidence was highest among AI/AN populations (3.1) and lowest among Asian/Pacific Islander populations (0.8). Nontypeable H. influenzae caused the largest incidence within all races (1.3), with no striking disparities identified. Among AI/AN children aged <5 years, incidence of H. influenzae serotype a (Hia) was 16.7 times higher and Hib incidence was 22.4 times higher than among White children. Although Hia incidence was lower among White and Black populations than among AI/AN populations, Hia incidence increased 13.6% annually among White children and 40.4% annually among Black children aged <5 years. CONCLUSIONS While nontypeable H. influenzae causes the largest H. influenzae burden overall, AI/AN populations experience disproportionately high rates of Hia and Hib, with the greatest disparity among AI/AN children aged <5 years. Prevention tools are needed to reduce disparities affecting AI/AN children and address increasing Hia incidence in other communities.
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Affiliation(s)
- Nicole E. Brown
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, United States
- Epidemic Intelligence Service, CDC, Atlanta, GA, United States
| | - Amy E. Blain
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, United States
| | - Kari Burzlaff
- New York State Department of Health, Albany, NY, United States
| | - Lee H. Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, CT, United States
| | - William Schaffner
- Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Chad Smelser
- New Mexico Department of Health, Santa Fe, NM, United States
| | - Ann Thomas
- Oregon Health Authority, Portland, OR, United States
| | - Lori Triden
- Minnesota Department of Health, St. Paul, MN, United States
| | - James P. Watt
- California Department of Public Health, Richmond, CA, United States
| | - Tracy Pondo
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, United States
| | - Melissa J. Whaley
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, United States
| | - Fang Hu
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, United States
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, United States
| | - Sara Oliver
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, United States
| | - Heidi M. Soeters
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, United States
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13
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Hertz JT, Madut DB, Rubach MP, William G, Crump JA, Galson SW, Maro VP, Bloomfield GS, Limkakeng AT, Temu G, Thielman NM, Sakita FM. Incidence of Acute Myocardial Infarction in Northern Tanzania: A Modeling Approach Within a Prospective Observational Study. J Am Heart Assoc 2021; 10:e021004. [PMID: 34320841 PMCID: PMC8475708 DOI: 10.1161/jaha.121.021004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Rigorous incidence data for acute myocardial infarction (AMI) in sub‐Saharan Africa are lacking. Consequently, modeling studies based on limited data have suggested that the burden of AMI and AMI‐associated mortality in sub‐Saharan Africa is lower than in other world regions. Methods and Results We estimated the incidence of AMI in northern Tanzania in 2019 by integrating data from a prospective surveillance study (681 participants) and a community survey of healthcare‐seeking behavior (718 participants). In the surveillance study, adults presenting to an emergency department with chest pain or shortness of breath were screened for AMI with ECG and troponin testing. AMI was defined by the Fourth Universal Definition of AMI criteria. Mortality was assessed 30 days following enrollment via in‐person or telephone interviews. In the cluster‐based community survey, adults in northern Tanzania were asked where they would present for chest pain or shortness of breath. Multipliers were applied to account for AMI cases that would have been missed by our surveillance methods. The estimated annual incidence of AMI was 172 (207 among men and 139 among women) cases per 100 000 people. The age‐standardized annual incidence was 211 (263 among men and 170 among women) per 100 000 people. The estimated annual incidence of AMI‐associated mortality was 87 deaths per 100 000 people, and the age‐standardized annual incidence was 102 deaths per 100 000 people. Conclusions The incidence of AMI and AMI‐associated mortality in northern Tanzania is much higher than previously estimated and similar to that observed in high‐income countries.
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Affiliation(s)
- Julian T Hertz
- Duke University School of Medicine Durham NC.,Duke Global Health Institute Durham NC
| | | | - Matthew P Rubach
- Duke University School of Medicine Durham NC.,Duke Global Health Institute Durham NC
| | | | - John A Crump
- Otago Global Health Institute Dunedin New Zealand
| | | | | | - Gerald S Bloomfield
- Duke University School of Medicine Durham NC.,Duke Global Health Institute Durham NC
| | | | - Gloria Temu
- Kilimanjaro Christian Medical Centre Moshi Tanzania
| | - Nathan M Thielman
- Duke University School of Medicine Durham NC.,Duke Global Health Institute Durham NC
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14
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Soeters HM, Oliver SE, Plumb ID, Blain AE, Zulz T, Simons BC, Barnes M, Farley MM, Harrison LH, Lynfield R, Massay S, McLaughlin J, Muse AG, Petit S, Schaffner W, Thomas A, Torres S, Watt J, Pondo T, Whaley MJ, Hu F, Wang X, Briere EC, Bruce MG. Epidemiology of Invasive Haemophilus influenzae Serotype a Disease-United States, 2008-2017. Clin Infect Dis 2021; 73:e371-e379. [PMID: 32589699 PMCID: PMC9628811 DOI: 10.1093/cid/ciaa875] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/19/2020] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Haemophilus influenzae serotype a (Hia) can cause invasive disease similar to serotype b; no Hia vaccine is available. We describe the epidemiology of invasive Hia disease in the United States overall and specifically in Alaska during 2008-2017. METHODS Active population- and laboratory-based surveillance for invasive Hia disease was conducted through Active Bacterial Core surveillance sites and from Alaska statewide invasive bacterial disease surveillance. Sterile-site isolates were serotyped via slide agglutination or real-time polymerase chain reaction. Incidences in cases per 100 000 were calculated. RESULTS From 2008 to 2017, an estimated average of 306 invasive Hia disease cases occurred annually in the United States (estimated annual incidence: 0.10); incidence increased by an average of 11.1% annually. Overall, 42.7% of cases were in children aged <5 years (incidence: 0.64), with highest incidence among children aged <1 year (1.60). Case fatality was 7.8% overall and was highest among adults aged ≥65 years (15.1%). Among children aged <5 years, the incidence was 17 times higher among American Indian and Alaska Native (AI/AN) children (8.29) than among children of all other races combined (0.49). In Alaska, incidences among all ages (0.68) and among children aged <1 year (24.73) were nearly 6 and 14 times higher, respectively, than corresponding US incidences. Case fatality in Alaska was 10.2%, and the vast majority (93.9%) of cases occurred among AI/AN. CONCLUSIONS Incidence of invasive Hia disease has increased since 2008, with the highest burden among AI/AN children. These data can inform prevention strategies, including Hia vaccine development.
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Affiliation(s)
- Heidi M. Soeters
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Sara E. Oliver
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Ian D. Plumb
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Amy E. Blain
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Tammy Zulz
- Arctic Investigations Program, CDC, Anchorage, AK, USA
| | | | - Meghan Barnes
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Monica M. Farley
- Emory University School of Medicine and The Atlanta VA Medical Center, Atlanta, GA, USA
| | - Lee H. Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Susan Petit
- Connecticut Department of Public Health, Hartford, CT, USA
| | | | - Ann Thomas
- Oregon Health Authority, Portland, OR, USA
| | | | - James Watt
- California Department of Public Health, Richmond, CA, USA
| | - Tracy Pondo
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Fang Hu
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Xin Wang
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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15
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Hunter CM, Salandy SW, Smith JC, Edens C, Hubbard B. Racial Disparities in Incidence of Legionnaires' Disease and Social Determinants of Health: A Narrative Review. Public Health Rep 2021; 137:660-671. [PMID: 34185609 DOI: 10.1177/00333549211026781] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Racial and socioeconomic disparities in the incidence of Legionnaires' disease have been documented for the past 2 decades; however, the social determinants of health (SDH) that contribute to these disparities are not well studied. The objective of this narrative review was to characterize SDH to inform efforts to reduce disparities in the incidence of Legionnaires' disease. METHODS We conducted a narrative review of articles published from January 1979 through October 2019 that focused on disparities in the incidence of Legionnaires' disease and pneumonia (inclusive of bacterial pneumonia and/or community-acquired pneumonia) among adults and children (excluding articles that were limited to people aged <18 years). We identified 220 articles, of which 19 met our criteria: original research, published in English, and examined Legionnaires' disease or pneumonia, health disparities, and SDH. We organized findings using the Healthy People 2030 SDH domains: economic stability, education access and quality, social and community context, health care access and quality, and neighborhood and built environment. RESULTS Of the 19 articles reviewed, multiple articles examined disparities in incidence of Legionnaires' disease and pneumonia related to economic stability/income (n = 13) and comorbidities (n = 10), and fewer articles incorporated SDH variables related to education (n = 3), social support (none), health care access (n = 1), and neighborhood and built environment (n = 6) in their analyses. CONCLUSIONS Neighborhood and built-environment factors such as housing, drinking water infrastructure, and pollutant exposures represent critical partnership and research opportunities. More research that incorporates SDH and multilevel, cross-sector interventions is needed to address disparities in Legionnaires' disease incidence.
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Affiliation(s)
- Candis M Hunter
- 1242 Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Simone W Salandy
- 1242 Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica C Smith
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Chris Edens
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brian Hubbard
- 1242 Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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16
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Retchless AC, Chen A, Chang HY, Blain AE, McNamara LA, Mustapha MM, Harrison LH, Wang X. Using Neisseria meningitidis genomic diversity to inform outbreak strain identification. PLoS Pathog 2021; 17:e1009586. [PMID: 34003852 PMCID: PMC8177650 DOI: 10.1371/journal.ppat.1009586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 06/04/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022] Open
Abstract
Meningococcal disease is a life-threatening illness caused by the human-restricted bacterium Neisseria meningitidis. Outbreaks in the USA involve at least two cases in an organization or community caused by the same serogroup within three months. Genome comparisons, including phylogenetic analysis and quantification of genome distances can provide confirmatory evidence of pathogen transmission during an outbreak. Interpreting genome distances depends on understanding their distribution both among isolates from outbreaks and among those not from outbreaks. Here, we identify outbreak strains based on phylogenetic relationships among 141 N. meningitidis isolates collected from 28 outbreaks in the USA during 2010-2017 and 1516 non-outbreak isolates collected through contemporaneous meningococcal surveillance. We show that genome distance thresholds based on the maximum SNPs and allele distances among isolates in the phylogenetically defined outbreak strains are sufficient to separate most pairs of non-outbreak isolates into separate strains. Non-outbreak isolate pairs that could not be distinguished from each other based on genetic distances were concentrated in the clonal complexes CC11, CC103, and CC32. Within each of these clonal complexes, phylodynamic analysis identified a group of isolates with extremely low diversity, collected over several years and multiple states. Clusters of isolates with low genetic diversity could indicate increased pathogen transmission, potentially resulting in local outbreaks or nationwide clonal expansions.
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Affiliation(s)
- Adam C. Retchless
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alex Chen
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - How-Yi Chang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amy E. Blain
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lucy A. McNamara
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mustapha M. Mustapha
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Lee H. Harrison
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Xin Wang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
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17
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McGee L, Chochua S, Li Z, Mathis S, Rivers J, Metcalf B, Ryan A, Alden N, Farley MM, Harrison LH, Snippes Vagnone P, Lynfield R, Smelser C, Muse A, Thomas AR, Schrag S, Beall BW. Multistate, Population-Based Distributions of Candidate Vaccine Targets, Clonal Complexes, and Resistance Features of Invasive Group B Streptococci Within the United States, 2015-2017. Clin Infect Dis 2021; 72:1004-1013. [PMID: 32060499 DOI: 10.1093/cid/ciaa151] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/13/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Group B Streptococcus (GBS) is a leading cause of neonatal sepsis and meningitis and an important cause of invasive infections in pregnant and nonpregnant adults. Vaccines targeting capsule polysaccharides and common proteins are under development. METHODS Using whole genome sequencing, a validated bioinformatics pipeline, and targeted antimicrobial susceptibility testing, we characterized 6340 invasive GBS isolates recovered during 2015-2017 through population-based Active Bacterial Core surveillance (ABCs) in 8 states. RESULTS Six serotypes accounted for 98.4% of isolates (21.8% Ia, 17.6% V, 17.1% II, 15.6% III, 14.5% Ib, 11.8% IV). Most (94.2%) isolates were in 11 clonal complexes (CCs) comprised of multilocus sequence types identical or closely related to sequence types 1, 8, 12, 17, 19, 22, 23, 28, 88, 452, and 459. Fifty-four isolates (0.87%) had point mutations within pbp2x associated with nonsusceptibility to 1 or more β-lactam antibiotics. Genes conferring resistance to macrolides and/or lincosamides were found in 56% of isolates; 85.2% of isolates had tetracycline resistance genes. Two isolates carrying vanG were vancomycin nonsusceptible (minimum inhibitory concentration = 2 µg/mL). Nearly all isolates possessed capsule genes, 1-2 of the 3 main pilus gene clusters, and 1 of 4 homologous alpha/Rib family determinants. Presence of the hvgA virulence gene was primarily restricted to serotype III/CC17 isolates (465 isolates), but 8 exceptions (7 IV/CC452 and 1 IV/CC17) were observed. CONCLUSIONS This first comprehensive, population-based quantitation of strain features in the United States suggests that current vaccine candidates should have good coverage. The β-lactams remain appropriate for first-line treatment and prophylaxis, but emergence of nonsusceptibility warrants ongoing monitoring.
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Affiliation(s)
- Lesley McGee
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sopio Chochua
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zhongya Li
- IHRC Inc, Contractor to Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Saundra Mathis
- IHRC Inc, Contractor to Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joy Rivers
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Benjamin Metcalf
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison Ryan
- California Emerging Infections Program, Oakland, California, USA
| | - Nisha Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Monica M Farley
- Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Ruth Lynfield
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Chad Smelser
- New Mexico Department of Public Health, Santa Fe, New Mexico, USA
| | - Alison Muse
- New York State Department of Health, Albany, New York, USA
| | - Ann R Thomas
- Oregon Department of Human Services, Portland, Oregon, USA
| | - Stephanie Schrag
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bernard W Beall
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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18
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Potts CC, Retchless AC, McNamara LA, Marasini D, Reese N, Swint S, Hu F, Sharma S, Blain AE, Lonsway D, Karlsson M, Hariri S, Fox LM, Wang X. Acquisition of ciprofloxacin resistance among an expanding clade of β-lactamase positive, serogroup Y Neisseria meningitidis in the United States. Clin Infect Dis 2021; 73:1185-1193. [PMID: 33900407 DOI: 10.1093/cid/ciab358] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Penicillin and ciprofloxacin are important for invasive meningococcal disease (IMD) management and prevention. IMD cases caused by penicillin- and ciprofloxacin-resistant Neisseria meningitidis containing a ROB-1 β-lactamase gene (blaROB-1) and a mutated DNA gyrase gene (gyrA), have been recently reported in the USA. METHODS We examined 2097 meningococcal genomes collected through US population-based surveillance from January 2011-February 2020 to identify IMD cases caused by strains with blaROB-1 or gyrA-mediated resistance. Antimicrobial resistance was confirmed phenotypically. The US isolate genomes were compared to non-US isolate genomes containing blaROB-1. Interspecies transfer of ciprofloxacin resistance was assessed by comparing gyrA among Neisseria species. RESULTS Eleven penicillin- and ciprofloxacin-resistant isolates were identified after December 2018; all were serogroup Y, sequence type 3587, clonal complex (CC) 23, and contained blaROB-1 and a T91I-containing gyrA allele. An additional 22 penicillin-resistant, blaROB-1-containing US isolates with wild-type gyrA were identified from 2013-2020. All 33 blaROB-1-containing isolates formed a single clade, along with 12 blaROB-1-containing isolates from six other countries. Two-thirds of blaROB-1-containing US isolates were from Hispanic individuals. Twelve additional ciprofloxacin-resistant isolates with gyrA T91 mutations were identified. Ciprofloxacin-resistant isolates belonged to six CCs and contained 10 unique gyrA alleles; seven were similar or identical to alleles from N. lactamica or N. gonorrhoeae. CONCLUSIONS Recent IMD cases caused by a dual resistant serogroup Y suggest changing antimicrobial resistance patterns in the USA. The emerging dual-resistance is due to acquisition of ciprofloxacin resistance by β-lactamase-containing N. meningitidis. Routine antimicrobial resistance surveillance will effectively monitor resistance changes and spread.
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Affiliation(s)
- Caelin C Potts
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adam C Retchless
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lucy A McNamara
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daya Marasini
- Weems Design Studio, Inc., Contractor to Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Natashia Reese
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephanie Swint
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fang Hu
- IHRC, Inc., Contractor to Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Shalabh Sharma
- IHRC, Inc., Contractor to Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Amy E Blain
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David Lonsway
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Karlsson
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan Hariri
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - LeAnne M Fox
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xin Wang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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19
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Rossow JA, Gharpure R, Brennan J, Relan P, Williams SR, Vallabhaneni S, Jackson BR, Graber CR, Hillis SR, Schaffner W, Dunn JR, Jones TF. Injection Drug Use-Associated Candidemia: Incidence, Clinical Features, and Outcomes, East Tennessee, 2014-2018. J Infect Dis 2021; 222:S442-S450. [PMID: 32877559 DOI: 10.1093/infdis/jiaa024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Injection drug use (IDU) is an established but uncommon risk factor for candidemia. Surveillance for candidemia is conducted in East Tennessee, an area heavily impacted by the opioid crisis and IDU. We evaluated IDU-associated candidemia to characterize the epidemiology and estimate the burden. METHODS We assessed the proportion of candidemia cases related to IDU during January 1, 2014-September 30, 2018, estimated candidemia incidence in the overall population and among persons who inject drugs (PWID), and reviewed medical records to compare clinical features and outcomes among IDU-associated and non-IDU candidemia cases. RESULTS The proportion of IDU-associated candidemia cases in East Tennessee increased from 6.1% in 2014 to 14.5% in 2018. Overall candidemia incidence in East Tennessee was 13.5/100 000, and incidence among PWID was 402-1895/100 000. Injection drug use-associated cases were younger (median age, 34.5 vs 60 years) and more frequently had endocarditis (39% vs 3%). All-cause 30-day mortality was 8% among IDU-associated cases versus 25% among non-IDU cases. CONCLUSIONS A growing proportion of candidemia in East Tennessee is associated with IDU, posing an additional burden from the opioid crisis. The lower mortality among IDU-associated cases likely reflects in part the younger demographic; however, Candida endocarditis seen among approximately 40% underscores the seriousness of the infection and need for prevention.
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Affiliation(s)
- John A Rossow
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Radhika Gharpure
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julia Brennan
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Tennessee Department of Health, Nashville, Tennessee, USA
| | - Pryanka Relan
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sabrina R Williams
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Snigdha Vallabhaneni
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan R Jackson
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caroline R Graber
- Tennessee Department of Health, Nashville, Tennessee, USA.,Tennessee Emerging Infections Program, Nashville, Tennessee, USA.,Vanderbilt University School of Medicine, Department of Health Policy, Nashville, Tennessee, USA
| | - Sherry R Hillis
- Tennessee Emerging Infections Program, Nashville, Tennessee, USA.,Vanderbilt University Medical Center, Nashville, Tennesse, USA
| | | | - John R Dunn
- Tennessee Department of Health, Nashville, Tennessee, USA
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20
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Kobayashi M, McGee L, Chochua S, Apostol M, Alden NB, Farley MM, Harrison LH, Lynfield R, Vagnone PS, Smelser C, Muse A, Thomas AR, Deng L, Metcalf BJ, Beall BW, Schrag SJ. Low but Increasing Prevalence of Reduced Beta-lactam Susceptibility Among Invasive Group B Streptococcal Isolates, US Population-Based Surveillance, 1998-2018. Open Forum Infect Dis 2021; 8:ofaa634. [PMID: 33553474 PMCID: PMC7850125 DOI: 10.1093/ofid/ofaa634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/16/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Invasive group B Streptococcus (iGBS) isolates with mutations in the pbp2x gene that encodes penicillin binding protein 2x can have reduced beta-lactam susceptibility (RBLS) when susceptible by Clinical and Laboratory Standards Institute (CLSI) criteria. We assessed the emergence and characteristics of RBLS strains in US iGBS isolates. METHODS We analyzed iGBS isolates from 8 multistate population-based surveillance sites from 1998 to 2018. During 1998-2014, phenotypic antimicrobial susceptibility was determined by broth microdilution; criteria for 6 antibiotics were used to identify RBLS, followed by whole-genome sequencing (WGS). WGS for all isolates was added in 2015; we used phenotypic and genotypic results of >2000 isolates to validate phenotypic RBLS criteria and genotypic predictions. Since 2016, WGS has been used to screen for RBLS with broth microdilution confirmation of predicted RBLS isolates. RESULTS Of 28 269 iGBS isolates, 28 (0.1%) were nonsusceptible by CLSI criteria; 137 (0.5%) met RBLS criteria. RBLS isolates were detected in all Active Bacterial Core surveillance sites. The RBLS proportion increased, especially since 2013 (odds ratio, 1.17; 95% CI, 1.03-1.32); the proportion that were nonsusceptible remained stable. CONCLUSIONS The RBSL proportion was low but increasing among US iGBS isolates. Ongoing monitoring is needed to detect emerging threats to prevention and treatment of GBS infections.
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Affiliation(s)
- Miwako Kobayashi
- Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lesley McGee
- Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sopio Chochua
- Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mirasol Apostol
- California Emerging Infections Program, Oakland, California, USA
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Monica M Farley
- Emory University School of Medicine and the Atlanta VA Medical Center, Atlanta, Georgia, USA
| | - Lee H Harrison
- University of Pittsburgh Department of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ruth Lynfield
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | | | - Chad Smelser
- New Mexico Department of Health, Santa Fe, New Mexico, USA
| | - Alison Muse
- New York State Department of Health, Albany, New York, USA
| | - Ann R Thomas
- Oregon Public Health Division, Portland, Oregon, USA
| | - Li Deng
- Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Benjamin J Metcalf
- Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bernard W Beall
- Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephanie J Schrag
- Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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21
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Raman R, Brennan J, Ndi D, Sloan C, Markus TM, Schaffner W, Talbot HK. Marked Reduction of Socioeconomic and Racial Disparities in Invasive Pneumococcal Disease Associated With Conjugate Pneumococcal Vaccines. J Infect Dis 2020; 223:1250-1259. [PMID: 32780860 DOI: 10.1093/infdis/jiaa515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND It is not known whether reductions in socioeconomic and racial disparities in incidence of invasive pneumococcal disease (defined as the isolation of Streptococcus pneumoniae from a normally sterile body site) noted after pneumococcal conjugate vaccine (PCV) introduction have been sustained. METHODS Individual-level data collected from 20 Tennessee counties participating in Active Bacterial Core surveillance over 19 years were linked to neighborhood-level socioeconomic factors. Incidence rates were analyzed across 3 periods-pre-7-valent PCV (pre-PCV7; 1998-1999), pre-13-valent PCV (pre-PCV13; 2001-2009), and post-PCV13 (2011-2016)-by socioeconomic factors. RESULTS A total of 8491 cases of invasive pneumococcal disease were identified. Incidence for invasive pneumococcal disease decreased from 22.9 (1998-1999) to 17.9 (2001-2009) to 12.7 (2011-2016) cases per 100 000 person-years. Post-PCV13 incidence (95% confidence interval [CI]) of PCV13-serotype disease in high- and low-poverty neighborhoods was 3.1 (2.7-3.5) and 1.4 (1.0-1.8), respectively, compared with pre-PCV7 incidence of 17.8 (15.7-19.9) and 6.4 (4.9-7.9). Before PCV introduction, incidence (95% CI) of PCV13-serotype disease was higher in blacks than whites (17.3 [15.1-19.5] vs 11.8 [10.6-13.0], respectively); after introduction, PCV13-type disease incidence was greatly reduced in both groups (white: 2.7 [2.4-3.0]; black: 2.2 [1.8-2.6]). CONCLUSIONS Introduction of PCV13 was associated with substantial reductions in overall incidence and socioeconomic and racial disparities in PCV13-serotype incidence.
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Affiliation(s)
- Rameela Raman
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Julia Brennan
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Tennessee Department of Health, Nashville, Tennessee, USA
| | - Danielle Ndi
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
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22
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Bozio CH, Blain A, Edge K, Farley MM, Harrison LH, Poissant T, Schaffner W, Scheuer T, Torres S, Triden L, Briere E, Oliver SE. Clinical characteristics and adverse clinical outcomes of invasive Haemophilus influenzae serotype a cases - United States, 2011-2015. Clin Infect Dis 2020; 73:e3670-e3676. [PMID: 32668450 DOI: 10.1093/cid/ciaa990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Incidence of invasive disease due to H. influenzae serotype a (Hia) increased an average of 13% annually from 2002-2015. We described clinical characteristics and adverse clinical outcomes of U.S. invasive Hia cases detected through multi-state surveillance during 2011-2015. METHODS Medical record data were abstracted for cases reported in eight jurisdictions conducting active population- and laboratory-based surveillance for invasive Hia disease across the United States. Isolates from sterile sites were serotyped by real-time polymerase chain reaction. Adverse clinical outcomes were defined as any possible complication of meningitis, bacteremic pneumonia, or bacteremia (including hearing loss, developmental delay, and speech delay, but excluding death), and were assessed at hospital discharge and one-year post-disease onset. RESULTS During 2011-2015, 190 Hia cases were reported to the eight participating sites; 169 (88.9%) had data abstracted. Many patients were aged <5 years (42.6%) or ≥65 years (20.7%). Meningitis was the most common clinical presentation among <1 year olds (71.4%); bacteremic pneumonia was the most common presentation among persons aged ≥50 years (78.7%). Overall, 95.9% of patients were hospitalized: among those hospitalized, 47.5% were admitted to an intensive care unit, and 6.2% died during hospitalization. At hospital discharge and one-year post-disease onset, adverse outcomes were identified in 17.7% and 17.8% of patients overall, and in 43.9% and 48.5% of patients with meningitis (primarily children). CONCLUSIONS Hia infection can cause severe disease requiring hospitalization and may also cause short- and long-term adverse clinical outcomes, especially among children. Novel vaccines could prevent morbidity and mortality.
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Affiliation(s)
- Catherine H Bozio
- Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA.,National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - Amy Blain
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - Karen Edge
- Colorado Department of Public Health and Environment, Colorado
| | - Monica M Farley
- Emory University School of Medicine, Atlanta, GA.,Atlanta VA Medical Center, Atlanta, GA
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Tara Scheuer
- California Emerging Infections Program, Oakland, CA
| | | | - Lori Triden
- Minnesota Department of Health, St. Paul, MN
| | - Elizabeth Briere
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - Sara E Oliver
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA
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23
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Bacterial and fungal pathogens isolated from patients with bloodstream infection: frequency of occurrence and antimicrobial susceptibility patterns from the SENTRY Antimicrobial Surveillance Program (2012–2017). Diagn Microbiol Infect Dis 2020; 97:115016. [DOI: 10.1016/j.diagmicrobio.2020.115016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/04/2020] [Accepted: 02/08/2020] [Indexed: 11/19/2022]
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24
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Gebretsadik T, Cooper WO, Ouyang L, Thibadeau J, Markus T, Cook J, Tesfaye S, Mitchel EF, Newsome K, Carroll KN. Rates of hospitalization for urinary tract infections among medicaid-insured individuals by spina bifida status, Tennessee 2005-2013. Disabil Health J 2020; 13:100920. [PMID: 32402791 DOI: 10.1016/j.dhjo.2020.100920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Individuals with spina bifida are at increased risk for urinary tract infection (UTI), however there are few population-based investigations of the burden of UTI hospitalizations. OBJECTIVE We assessed rates and risk factors for UTI hospitalization in individuals with and without spina bifida. METHODS We conducted a retrospective cohort study to estimate rates of UTI hospitalization by spina bifida status. We included individuals enrolled in Tennessee Medicaid who lived in one of the Emerging Infections Program's Active Bacterial Surveillance counties between 2005 and 2013. Spina bifida was primarily defined and UTI hospitalizations were identified using International Classification of Diseases, Ninth Revision diagnoses. We also studied a subset without specific health conditions potentially associated with UTI. We used Poisson regression to calculate rate ratios (RR) of UTIs for individuals with versus without spina bifida, adjusting for race, sex and age group. RESULTS Over the 9-years, 1,239,362 individuals were included and 2,493 met criteria for spina bifida. Individuals with spina bifida had over a four-fold increased rate of UTI hospitalization than those without spina bifida-in the overall study population and in the subset without specific, high-risk conditions (adjusted rate ratios: 4.41, 95% confidence intervals: 3.03, 6.43) and (4.87, 95% CI: 2.99, 7.92), respectively. We detected differences in rates of UTI hospitalization by race and sex in individuals without spina bifida that were not seen among individuals with spina bifida. CONCLUSIONS Individuals with spina bifida had increased rates of UTI hospitalizations, and associated demographic patterns differed from those without spina bifida.
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Affiliation(s)
- Tebeb Gebretsadik
- Department of Biostatistics, 2525 West End, Suite, 1100, Vanderbilt School of Medicine, Nashville, TN, USA
| | - William O Cooper
- Division of General Pediatrics, Department of Pediatrics, 2146, Belcourt Ave., Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lijing Ouyang
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Judy Thibadeau
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tiffanie Markus
- Department of Health Policy, 2525 West End Ave., Suite 1200, 1275, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica Cook
- Division of General Pediatrics, Department of Pediatrics, 2146, Belcourt Ave., Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah Tesfaye
- Division of General Pediatrics, Department of Pediatrics, 2146, Belcourt Ave., Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edward F Mitchel
- Department of Health Policy, 2525 West End Ave., Suite 1200, 1275, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kimberly Newsome
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kecia N Carroll
- Division of General Pediatrics, Department of Pediatrics, 2146, Belcourt Ave., Vanderbilt University Medical Center, Nashville, TN, USA.
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25
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Adebanjo TA, Pondo T, Yankey D, Hill HA, Gierke R, Apostol M, Barnes M, Petit S, Farley M, Harrison LH, Holtzman C, Baumbach J, Bennett N, McGuire S, Thomas A, Schaffner W, Beall B, Whitney CG, Pilishvili T. Pneumococcal Conjugate Vaccine Breakthrough Infections: 2001-2016. Pediatrics 2020; 145:peds.2019-0836. [PMID: 32054822 PMCID: PMC7055927 DOI: 10.1542/peds.2019-0836] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Most countries use 3-dose pneumococcal conjugate vaccine (PCV) schedules; a 4-dose (3 primary and 1 booster) schedule is licensed for US infants. We evaluated the invasive pneumococcal disease (IPD) breakthrough infection incidence in children receiving 2 vs 3 primary PCV doses with and without booster doses (2 + 1 vs 3 + 1; 2 + 0 vs 3 + 0). METHODS We used 2001-2016 Active Bacterial Core surveillance data to identify breakthrough infections (vaccine-type IPD in children receiving ≥1 7-valent pneumococcal conjugate vaccine [PCV7] or 13-valent pneumococcal conjugate vaccine [PCV13] dose) among children aged <5 years. We estimated schedule-specific IPD incidence rates (IRs) per 100 000 person-years and compared incidence by schedule (2 + 1 vs 3 + 1; 2 + 0 vs 3 + 0) using rate differences (RDs) and incidence rate ratios. RESULTS We identified 71 PCV7 and 49 PCV13 breakthrough infections among children receiving a schedule of interest. PCV13 breakthrough infection rates were higher in children aged <1 year receiving the 2 + 0 (IR: 7.8) vs 3 + 0 (IR: 0.6) schedule (incidence rate ratio: 12.9; 95% confidence interval: 4.1-40.4); PCV7 results were similar. Differences in PCV13 breakthrough infection rates by schedule in children aged <1 year were larger in 2010-2011 (2 + 0 IR: 18.6; 3 + 0 IR: 1.4; RD: 16.6) vs 2012-2016 (2 + 0 IR: 3.6; 3 + 0 IR: 0.2; RD: 3.4). No differences between schedules were detected in children aged ≥1 year for PCV13 breakthrough infections. CONCLUSIONS Fewer PCV breakthrough infections occurred in the first year of life with 3 primary doses. Differences in breakthrough infection rates by schedule decreased as vaccine serotypes decreased in circulation.
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Affiliation(s)
- Tolulope A. Adebanjo
- Epidemic Intelligence Service and,National Center for Immunization and Respiratory
Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - David Yankey
- National Center for Immunization and Respiratory
Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Holly A. Hill
- National Center for Immunization and Respiratory
Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Meghan Barnes
- Colorado Department of Public Health and Environment,
Denver, Colorado
| | - Susan Petit
- Connecticut Department of Public Health, Hartford,
Connecticut
| | - Monica Farley
- School of Medicine, Emory University and Atlanta
Department of Veterans Affairs Medical Center, Atlanta, Georgia
| | - Lee H. Harrison
- Bloomberg School of Public Health, Johns Hopkins
University, Baltimore, Maryland
| | | | - Joan Baumbach
- New Mexico Department of Health, Santa Fe, New
Mexico
| | - Nancy Bennett
- School of Medicine and Dentistry, University of
Rochester, Rochester, New York
| | | | - Ann Thomas
- Oregon Public Health Division, Portland, Oregon;
and
| | | | - Bernard Beall
- National Center for Immunization and Respiratory
Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cynthia G. Whitney
- National Center for Immunization and Respiratory
Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tamara Pilishvili
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
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26
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Collins LF, Havers FP, Tunali A, Thomas S, Clennon JA, Wiley Z, Tobin-D’Angelo M, Parrott T, Read TD, Satola SW, Petit RA, Farley MM. Invasive Nontypeable Haemophilus influenzae Infection Among Adults With HIV in Metropolitan Atlanta, Georgia, 2008-2018. JAMA 2019; 322:2399-2410. [PMID: 31860046 PMCID: PMC6990662 DOI: 10.1001/jama.2019.18800] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE Invasive nontypeable Haemophilus influenzae (NTHi) infection among adults is typically associated with bacteremic pneumonia. Nontypeable H influenzae is genetically diverse and clusters of infection are uncommon. OBJECTIVE To evaluate an increase in invasive NTHi infection from 2017-2018 among HIV-infected men who have sex with men in metropolitan Atlanta, Georgia. DESIGN, SETTING, AND PARTICIPANTS A population-based surveillance study with a cohort substudy and descriptive epidemiological analysis identified adults aged 18 years or older with invasive NTHi infection (isolation of NTHi from a normally sterile site) between January 1, 2008, and December 31, 2018 (final date of follow-up). EXPOSURES Time period, HIV status, and genetic relatedness (ie, cluster status) of available NTHi isolates. MAIN OUTCOMES AND MEASURES The primary outcome was incidence of invasive NTHi infection (from 2008-2016 and 2017-2018) among persons with HIV and compared with NTHi infection from 2008-2018 among those without HIV. The secondary outcomes were assessed among those aged 18 to 55 years with invasive NTHi infection and included epidemiological, clinical, and geographic comparisons by cluster status. RESULTS Among 553 adults with invasive NTHi infection (median age, 66 years [Q1-Q3, 48-78 years]; 52% male; and 38% black), 60 cases occurred among persons with HIV. Incidence of invasive NTHi infection from 2017-2018 among persons with HIV (41.7 cases per 100 000) was significantly greater than from 2008-2016 among those with HIV (9.6 per 100 000; P < .001) and from 2008-2018 among those without HIV (1.1 per 100 000; P < .001). Among adults aged 18 to 55 years with invasive NTHi infections from 2017-2018 (n = 179), persons with HIV (n = 31) were significantly more likely than those from 2008-2018 without HIV (n = 124) to be male (94% vs 49%, respectively; P < .001), black (100% vs 53%; P < .001), and have septic arthritis (35% vs 1%; P < .001). Persons with HIV who had invasive NTHi infection from 2017-2018 (n = 31) were more likely than persons with HIV who had invasive NTHi infection from 2008-2016 (n = 24) to have septic arthritis (35% vs 4%, respectively; P = .01). Pulsed-field gel electrophoresis of 174 of 179 NTHi isolates from 18- to 55-year-olds identified 2 genetically distinct clonal groups: cluster 1 (C1; n = 24) and cluster 2 (C2; n = 23). Whole-genome sequencing confirmed 2 clonal lineages of NTHi infection and revealed all C1 isolates (but none of the C2 isolates) carried IS1016 (an insertion sequence associated with H influenzae capsule genes). Persons with HIV were significantly more likely to have C1 or C2 invasive NTHi infection from 2017-2018 (28/31 [90%]) compared with from 2008-2016 among persons with HIV (10/24 [42%]; P < .001) and compared with from 2008-2018 among those without HIV (9/119 [8%]; P < .001). Among persons with C1 or C2 invasive NTHi infection who had HIV (n = 38) (median age, 34.5 years; 100% male; 100% black; 82% men who have sex with men), 32 (84%) lived in 2 urban counties and an area of significant spatial aggregation was identified compared with those without C1 or C2 invasive NTHi infection. CONCLUSIONS AND RELEVANCE Among persons with HIV in Atlanta, the incidence of invasive nontypeable H influenzae infection increased significantly from 2017-2018 compared with 2008-2016. Two unique but genetically related clonal strains were identified and were associated with septic arthritis among black men who have sex with men and who lived in geographic proximity.
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Affiliation(s)
- Lauren F. Collins
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
| | - Fiona P. Havers
- Division of Bacterial Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
- Atlanta VA Medical Center, Decatur, Georgia
| | - Amy Tunali
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
| | - Stephanie Thomas
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
| | - Julie A. Clennon
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Zanthia Wiley
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Melissa Tobin-D’Angelo
- Georgia Emerging Infections Program, Atlanta
- Georgia Department of Public Health, Atlanta
| | - Tonia Parrott
- Georgia Emerging Infections Program, Atlanta
- Georgia Department of Public Health, Atlanta
| | - Timothy D. Read
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
| | - Sarah W. Satola
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
| | - Robert A. Petit
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
| | - Monica M. Farley
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
- Atlanta VA Medical Center, Decatur, Georgia
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Tirone C, Pezza L, Paladini A, Tana M, Aurilia C, Lio A, D'Ippolito S, Tersigni C, Posteraro B, Sanguinetti M, Di Simone N, Vento G. Gut and Lung Microbiota in Preterm Infants: Immunological Modulation and Implication in Neonatal Outcomes. Front Immunol 2019; 10:2910. [PMID: 31921169 PMCID: PMC6920179 DOI: 10.3389/fimmu.2019.02910] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/27/2019] [Indexed: 12/23/2022] Open
Abstract
In recent years, an aberrant gastrointestinal colonization has been found to be associated with an higher risk for postnatal sepsis, necrotizing enterocolitis (NEC) and growth impairment in preterm infants. As a consequence, the reasons of intestinal dysbiosis in this population of newborns have increasingly become an object of interest. The presence of a link between the gut and lung microbiome's development (gut-lung axis) is emerging, and more data show as a gut-brain cross talking mediated by an inflammatory milieu, may affect the immunity system and influence neonatal outcomes. A revision of the studies which examined gut and lung microbiota in preterm infants and a qualitative analysis of data about characteristic patterns and related outcomes in terms of risk of growing impairment, Necrotizing Enterocolitis (NEC), Bronchopulmonary Dysplasia (BPD), and sepsis have been performed. Microbiota take part in the establishment of the gut barrier and many data suggest its immune-modulator role. Furthermore, the development of the gut and lung microbiome (gut-lung axis) appear to be connected and able to lead to abnormal inflammatory responses which have a key role in the pathogenesis of BPD. Dysbiosis and the gut predominance of facultative anaerobes appear to be crucial to the pathogenesis and subsequently to the prevention of such diseases.
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Affiliation(s)
- Chiara Tirone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. di Neonatologia, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Clinica Pediatrica, Rome, Italy
| | - Lucilla Pezza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. di Neonatologia, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Clinica Pediatrica, Rome, Italy
| | - Angela Paladini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. di Neonatologia, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Clinica Pediatrica, Rome, Italy
| | - Milena Tana
- Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. di Neonatologia, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Clinica Pediatrica, Rome, Italy
| | - Claudia Aurilia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. di Neonatologia, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Clinica Pediatrica, Rome, Italy
| | - Alessandra Lio
- Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. di Neonatologia, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Clinica Pediatrica, Rome, Italy
| | - Silvia D'Ippolito
- Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. di Ostetricia e Patologia Ostetrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Chiara Tersigni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. di Ostetricia e Patologia Ostetrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Brunella Posteraro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy.,Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Sanguinetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy.,Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicoletta Di Simone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. di Ostetricia e Patologia Ostetrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Giovanni Vento
- Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. di Neonatologia, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Clinica Pediatrica, Rome, Italy
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Multistate population and whole genome sequence-based strain surveillance of invasive pneumococci recovered in the USA during 2017. Clin Microbiol Infect 2019; 26:512.e1-512.e10. [PMID: 31536818 DOI: 10.1016/j.cmi.2019.09.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/16/2019] [Accepted: 09/07/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We aimed to provide population-based and whole-genome sequence (WGS) -based characterization of invasive pneumococcal disease isolates collected from multistate surveillance in the USA during 2017. METHODS We obtained short-read WGS from 2881 isolates with associated bioinformatics pipeline strain feature predictions. For quality control, capsular serotypes and antimicrobial MICs were also obtained conventionally from 442 isolates. Annotated WGS were provided (inclusive of serotypes, MICs, multilocus sequence types, pilus type(s)) from 2723 isolates. For 158 isolates with suboptimal WGS, antimicrobial MICs were obtained conventionally. RESULTS There were 127 isolates from children <5 years of age and 2754 isolates from those ≥5 years old in 2017. One of 43 different serotypes was predicted for 2877 of the 2881 isolates. Serotypes in the 13-valent conjugate vaccine together with 6C (PCV13+6C) accounted for 816 (28.3%) isolates, with PCV13 serotype 3 being the most common serotype overall. Non-PCV13-6C- serotypes accounted for 2065 (71.7%) isolates, comprising 96 (75.6%) isolates from children < 5 years old and 1969 (61.4%) isolates from those aged ≥5 years. Of 36 different categories of recently emerged serotype-switch variants, three showed marked increases relative to 2015-2016 in that the number from 2017 surpassed the number from 2015-2016 combined. Two of these included antimicrobial-resistant serotype 11A and 35B serotype-switch variants of the ST156 clonal complex. CONCLUSIONS PCV13+6C strains are still identified in 2017 but non-PCV13-type strains impose a considerable burden. This well-annotated year 2017 WGS/strain data set will prove useful for a broad variety of analyses and improved our understanding of invasive pneumococcal disease-causing strains in the post-PCV13 era.
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Francois Watkins LK, McGee L, Schrag SJ, Beall B, Jain JH, Pondo T, Farley MM, Harrison LH, Zansky SM, Baumbach J, Lynfield R, Snippes Vagnone P, Miller LA, Schaffner W, Thomas AR, Watt JP, Petit S, Langley GE. Epidemiology of Invasive Group B Streptococcal Infections Among Nonpregnant Adults in the United States, 2008-2016. JAMA Intern Med 2019; 179:479-488. [PMID: 30776079 PMCID: PMC6450309 DOI: 10.1001/jamainternmed.2018.7269] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 10/26/2018] [Indexed: 12/17/2022]
Abstract
Importance Group B Streptococcus (GBS) is an important cause of invasive bacterial disease. Previous studies have shown a substantial and increasing burden of GBS infections among nonpregnant adults, particularly older adults and those with underlying medical conditions. Objective To update trends of invasive GBS disease among US adults using population-based surveillance data. Design, Setting, and Participants In this population-based surveillance study, a case was defined as isolation of GBS from a sterile site between January 1, 2008, and December 31, 2016. Demographic and clinical data were abstracted from medical records. Rates were calculated using US Census data. Antimicrobial susceptibility testing and serotyping were performed on a subset of isolates. Case patients were residents of 1 of 10 catchment areas of the Active Bacterial Core surveillance (ABCs) network, representing approximately 11.5% of the US adult population. Patients were included in the study if they were nonpregnant, were 18 years or older, were residents of an ABCs catchment site, and had a positive GBS culture from a normally sterile body site. Main Outcomes and Measures Trends in GBS cases overall and by demographic characteristics (sex, age, and race), underlying clinical conditions of patients, and isolate characteristics are described. Results The ABCs network detected 21 250 patients with invasive GBS among nonpregnant adults from 2008 through 2016. The GBS incidence in this population increased from 8.1 cases per 100 000 population in 2008 to 10.9 in 2016 (P = .002 for trend). There were 3146 cases reported in 2016 (59% male; median age, 64 years; age range, 18-103 years). The GBS incidence was higher among men than women and among blacks than whites and increased with age. Projected to the US population, an estimated 27 729 cases of invasive disease and 1541 deaths occurred in the United States in 2016. Ninety-five percent of cases in 2016 occurred in someone with at least 1 underlying condition, most commonly obesity (53.9%) and diabetes (53.4%). Resistance to clindamycin increased from 37.0% of isolates in 2011 to 43.2% in 2016 (P = .02). Serotypes Ia, Ib, II, III, and V accounted for 86.4% of isolates in 2016; serotype IV increased from 4.7% in 2008 to 11.3% in 2016 (P < .001 for trend). Conclusions and Relevance The public health burden of invasive GBS disease among nonpregnant adults is substantial and continues to increase. Chronic diseases, such as obesity and diabetes, may contribute.
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Affiliation(s)
- Louise K. Francois Watkins
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lesley McGee
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie J. Schrag
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bernard Beall
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Hudson Jain
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tracy Pondo
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Monica M. Farley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Lee H. Harrison
- Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | - Lisa A. Miller
- Colorado School of Public Health, University of Colorado Denver, Aurora
- Colorado Department of Public Health and Environment, Denver
| | | | | | | | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | - Gayle E. Langley
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Sader HS, Rhomberg PR, Fuhrmeister AS, Mendes RE, Flamm RK, Jones RN. Antimicrobial Resistance Surveillance and New Drug Development. Open Forum Infect Dis 2019; 6:S5-S13. [PMID: 30895210 PMCID: PMC6419994 DOI: 10.1093/ofid/ofy345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Surveillance represents an important informational tool for planning actions to monitor emerging antimicrobial resistance. Antimicrobial resistance surveillance (ARS) programs may have many different designs and can be grouped in 2 major categories based on their main objectives: (1) public health ARS programs and (2) industry-sponsored/product-oriented ARS programs. In general, public health ARS programs predominantly focus on health care and infection control, whereas industry ARS programs focus on an investigational or recently approved molecule(s). We reviewed the main characteristics of industry ARS programs and how these programs contribute to new drug development. Industry ARS programs are generally performed to comply with requirements from regulatory agencies responsible for commercial approval of antimicrobial agents, such as the US Food and Drug Administration, European Medicines Agency, and others. In contrast to public health ARS programs, which typically collect health care and diverse clinical data, industry ARS programs frequently collect the pathogens and perform the testing in a central laboratory setting. Global ARS programs with centralized testing play an important role in new antibacterial and antifungal drug development by providing information on the emergence and dissemination of resistant organisms, clones, and resistance determinants. Organisms collected by large ARS programs are extremely valuable to evaluate the potential of new agents and to calibrate susceptibility tests once a drug is approved for clinical use. These programs also can provide early evaluations of spectrum of activity and postmarketing trends required by regulatory agencies, and the programs may help drug companies to select appropriate dosing regimens and the appropriate geographic regions in which to perform clinical trials. Furthermore, these surveillance programs provide useful information on the potency and spectrum of new antimicrobial agents against indications and organisms in which clinicians have little or no experience. In summary, large ARS programs, such as the SENTRY Antimicrobial Surveillance Program, contribute key data for new drug development.
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Nanduri SA, Petit S, Smelser C, Apostol M, Alden NB, Harrison LH, Lynfield R, Vagnone PS, Burzlaff K, Spina NL, Dufort EM, Schaffner W, Thomas AR, Farley MM, Jain JH, Pondo T, McGee L, Beall BW, Schrag SJ. Epidemiology of Invasive Early-Onset and Late-Onset Group B Streptococcal Disease in the United States, 2006 to 2015: Multistate Laboratory and Population-Based Surveillance. JAMA Pediatr 2019; 173:224-233. [PMID: 30640366 PMCID: PMC6439883 DOI: 10.1001/jamapediatrics.2018.4826] [Citation(s) in RCA: 230] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Invasive disease owing to group B Streptococcus (GBS) remains an important cause of illness and death among infants younger than 90 days in the United States, despite declines in early-onset disease (EOD; with onset at 0-6 days of life) that are attributed to intrapartum antibiotic prophylaxis (IAP). Maternal vaccines to prevent infant GBS disease are currently under development. OBJECTIVE To describe incidence rates, case characteristics, antimicrobial resistance, and serotype distribution of EOD and late-onset disease (LOD; with onset at 7-89 days of life) in the United States from 2006 to 2015 to inform IAP guidelines and vaccine development. DESIGN, SETTING, AND PARTICIPANTS This study used active population-based and laboratory-based surveillance for invasive GBS disease conducted through Active Bacterial Core surveillance in selected counties of 10 states across the United States. Residents of Active Bacterial Core surveillance areas who were younger than 90 days and had invasive GBS disease in 2006 to 2015 were included. Data were analyzed from December 2017 to April 2018. EXPOSURES Group B Streptococcus isolated from a normally sterile site. MAIN OUTCOMES AND MEASURES Early-onset disease and LOD incidence rates and associated GBS serotypes and antimicrobial resistance. RESULTS The Active Bacterial Core surveillance program identified 1277 cases of EOD and 1387 cases of LOD. From 2006 to 2015, EOD incidence declined significantly from 0.37 to 0.23 per 1000 live births (P < .001), and LOD rates remained stable (mean, 0.31 per 1000 live births). Among the mothers of 1277 infants with EOD, 617 (48.3%) had no indications for IAP and did not receive it, and 278 (21.8%) failed to receive IAP despite having indications. Serotype data were available for 1743 of 1897 patients (91.3%) from 7 sites that collect GBS isolates. Among patients with EOD, serotypes Ia (242 [27.3%]) and III (242 [27.3%]) were most common. Among patients with LOD, serotype III was most common (481 [56.2%]), and this increased from 2006 to 2015 from 0.12 to 0.20 cases per 1000 live births (P < .001). Serotype IV caused 53 cases (6.2%) of EOD and LOD combined. The 6 most common serotypes (Ia, Ib, II, III, IV, and V) caused 881 EOD cases (99.3%) and 853 LOD cases (99.7%). No β-lactam resistance was identified; 359 isolates (20.8%) tested showed constitutive clindamycin resistance. In 2015, an estimated 840 EOD cases and 1265 LOD cases occurred nationally. CONCLUSIONS AND RELEVANCE The rates of LOD among US infants are now higher than EOD rates. Combined with addressing IAP implementation gaps, an effective vaccine covering the most common serotypes might further reduce EOD rates and help prevent LOD, for which there is no current public health intervention.
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Affiliation(s)
| | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | - Chad Smelser
- New Mexico Department of Public Health, Santa Fe
| | | | - Nisha B. Alden
- Colorado Department of Public Health and Environment, Denver
| | - Lee H. Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | | | | | - Monica M. Farley
- Emory University School of Medicine, Atlanta, Georgia,Atlanta VA Medical Center, Atlanta, Georgia
| | - Jennifer H. Jain
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tracy Pondo
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lesley McGee
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bernard W. Beall
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie J. Schrag
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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32
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Fuhrmeister AS, Jones RN. The Importance of Antimicrobial Resistance Monitoring Worldwide and the Origins of SENTRY Antimicrobial Surveillance Program. Open Forum Infect Dis 2019; 6:S1-S4. [PMID: 30895209 PMCID: PMC6419910 DOI: 10.1093/ofid/ofy346] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The origins of how and why the SENTRY Antimicrobial Surveillance Program was created are briefly described, with additional details on how the isolates are collected and tested as well as the important uses of the data in monitoring antimicrobial resistance and drug development.
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33
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Soeters HM, Blain A, Pondo T, Doman B, Farley MM, Harrison LH, Lynfield R, Miller L, Petit S, Reingold A, Schaffner W, Thomas A, Zansky SM, Wang X, Briere EC. Current Epidemiology and Trends in Invasive Haemophilus influenzae Disease-United States, 2009-2015. Clin Infect Dis 2018; 67:881-889. [PMID: 29509834 PMCID: PMC6181225 DOI: 10.1093/cid/ciy187] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/01/2018] [Indexed: 01/15/2023] Open
Abstract
Background Following Haemophilus influenzae serotype b (Hib) conjugate vaccine introduction in the 1980s, Hib disease in young children dramatically decreased, and epidemiology of invasive H. influenzae changed. Methods Active surveillance for invasive H. influenzae disease was conducted through Active Bacterial Core surveillance sites. Incidence rates were directly standardized to the age and race distribution of the US population. Results During 2009-2015, the estimated mean annual incidence of invasive H. influenzae disease was 1.70 cases per 100000 population. Incidence was highest among adults aged ≥65 years (6.30) and children aged <1 year (8.45); many cases in infants aged <1 year occurred during the first month of life in preterm or low-birth-weight infants. Among children aged <5 years (incidence: 2.84), incidence was substantially higher in American Indian and Alaska Natives AI/AN (15.19) than in all other races (2.62). Overall, 14.5% of cases were fatal; case fatality was highest among adults aged ≥65 years (20%). Nontypeable H. influenzae had the highest incidence (1.22) and case fatality (16%), as compared with Hib (0.03; 4%) and non-b encapsulated serotypes (0.45; 11%). Compared with 2002-2008, the estimated incidence of invasive H. influenzae disease increased by 16%, driven by increases in disease caused by serotype a and nontypeable strains. Conclusions Invasive H. influenzae disease has increased, particularly due to nontypeable strains and serotype a. A considerable burden of invasive H. influenzae disease affects the oldest and youngest age groups, particularly AI/AN children. These data can inform prevention strategies, including vaccine development.
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Affiliation(s)
- Heidi M Soeters
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy Blain
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tracy Pondo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Monica M Farley
- Emory University School of Medicine, Georgia
- Atlanta Veterans Affairs Medical Center, Georgia
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Lisa Miller
- University of Colorado School of Public Health, Denver
| | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | | | | | | | | | - Xin Wang
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth C Briere
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Potts CC, Joseph SJ, Chang HY, Chen A, Vuong J, Hu F, Jenkins LT, Schmink S, Blain A, MacNeil JR, Harrison LH, Wang X. Population structure of invasive Neisseria meningitidis in the United States, 2011-15. J Infect 2018; 77:427-434. [PMID: 29964139 DOI: 10.1016/j.jinf.2018.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/06/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Meningococcal conjugate vaccines (MenACWY) were licensed in the United States in 2005. We assessed the population structure of invasive Neisseria meningitidis (Nm) ten years after recommended use of MenACWY among adolescents. METHODS Meningococcal isolates obtained through Active Bacterial Core surveillance (ABCs) from 2000-05, 2006-10, and 2011-15 underwent whole genome or Sanger sequencing. Genome phylogenies were completed using maximum likelihood methods; and distribution of multilocus sequence typing (MLST) sequence type (ST) and clonal complex (CC), and PorA and FetA types were assessed. RESULTS Prevalent serogroups (B, C, Y and W), CCs, and PorA and FetA types were detected in all three time periods, but dynamic changes were observed. The proportion of serogroup W CC11 isolates increased in 2011-15 and were most related to South American strains. Changes in CC distribution were also observed in serogroup C and serogroup Y. Phylogenetic analysis showed that U.S. serogroup W CC11s are closely related to a subset of U.S. serogroup C isolates; combined global analysis demonstrated that some CCs, including CC11, exhibit regional clustering. CONCLUSIONS Overall, the Nm population structure has remained stable after MenACWY introduction. Dynamic changes in genotypes, unlikely related to vaccination, also occurred, highlighting the need for continued whole genome-based surveillance.
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Affiliation(s)
- Caelin C Potts
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Sandeep J Joseph
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - How-Yi Chang
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Alexander Chen
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Jeni Vuong
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Fang Hu
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Laurel T Jenkins
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Susanna Schmink
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Amy Blain
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Jessica R MacNeil
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xin Wang
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA.
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Pitts SI, Maruthur NM, Langley GE, Pondo T, Shutt KA, Hollick R, Schrag SJ, Thomas A, Nichols M, Farley M, Watt JP, Miller L, Schaffner W, Holtzman C, Harrison LH. Obesity, Diabetes, and the Risk of Invasive Group B Streptococcal Disease in Nonpregnant Adults in the United States. Open Forum Infect Dis 2018; 5:ofy030. [PMID: 29977953 PMCID: PMC6016410 DOI: 10.1093/ofid/ofy030] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/22/2017] [Accepted: 04/24/2018] [Indexed: 02/06/2023] Open
Abstract
Background Rates of invasive group B Streptococcus (GBS) disease, obesity, and diabetes have increased in US adults. We hypothesized that obesity would be independently associated with an increased risk of invasive GBS disease. Methods We identified adults with invasive GBS disease within Active Bacterial Core surveillance during 2010–2012 and used population estimates from the Behavioral Risk Factor Surveillance System to calculate invasive GBS incidence rates. We estimated relative risks (RRs) of invasive GBS using Poisson analysis with offset denominators, with obesity categorized as class I/II (body mass index [BMI] = 30–39.9 kg/m2) and class III (BMI ≥ 40.0 kg/m2). Results In multivariable analysis of 4281 cases, the adjusted RRs of invasive GBS disease were increased for obesity (class I/II: RR, 1.52; 95% confidence interval [CI], 1.14–2.02; and class III: RR, 4.87; 95% CI, 3.50–6.77; reference overweight) and diabetes (RR, 6.04; 95% CI, 4.77–7.65). The adjusted RR associated with class III obesity was 3-fold among persons with diabetes (95% CI, 1.38–6.61) and nearly 9-fold among persons without diabetes (95% CI, 6.41–12.46), compared with overweight. The adjusted RRs associated with diabetes varied by age and BMI, with the highest RR in young populations without obesity. Population attributable risks of invasive GBS disease were 27.2% for obesity and 40.1% for diabetes. Conclusions Obesity and diabetes were associated with substantially increased risk of infection from invasive GBS. Given the population attributable risks of obesity and diabetes, interventions that reduce the prevalence of these conditions would likely reduce the burden of invasive GBS infection.
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Affiliation(s)
- Samantha I Pitts
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nisa M Maruthur
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Gayle E Langley
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tracy Pondo
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen A Shutt
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rosemary Hollick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stephanie J Schrag
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ann Thomas
- Oregon Public Health Division, Portland, Oregon
| | - Megin Nichols
- New Mexico Department of Public Health, Santa Fe, New Mexico
| | | | - James P Watt
- California Department of Public Health, Richmond, California
| | - Lisa Miller
- University of Colorado School of Public Health, Aurora, Colorado
| | | | | | - Lee H Harrison
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Association of bacterial genotypes and epidemiological features with treatment failure in hemodialysis patients with methicillin-resistant Staphylococcus aureus bacteremia. PLoS One 2018; 13:e0198486. [PMID: 29864149 PMCID: PMC5986133 DOI: 10.1371/journal.pone.0198486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/18/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Methicillin-resistant Staphylococcus aureus (MRSA) infections in the hemodialysis (HD) population are epidemiologically classified as healthcare-associated infections. The data about the clinical impact and bacterial characteristics of hospital-onset (HO)- and community-onset (CO)-MRSA in HD patients are scarce. The current study analyzed the difference in the clinical and molecular characteristics of HO-MRSA and CO-MRSA. METHODS We performed a retrospective review and molecular analysis of clinical isolates from 106 HD patients with MRSA bacteremia from 2009 to 2014. CA genotypes were defined as isolates carrying the SCCmec type IV or V, and HA genotypes were defined as isolates harboring SCCmec type I, II, or III. RESULTS CO-MRSA infections occurred in 76 patients, and 30 patients had HO-MRSA infections. There was no significant difference in the treatment failure rates between patients with CO-MRSA infections and those with HO-MRSA infections. CA genotypes were associated with less treatment failure (odds ratio [OR]: 0.18; 95% confidence interval [95% CI], 0.07-0.49; p = 0.001). For isolates with a vancomycin minimum inhibitory concentration (MIC) < 1.5 mg/L, the multivariate analysis revealed that HA genotypes and cuffed tunneled catheter use were associated with treatment failure. For isolates with a vancomycin MIC ≥1.5 mg/L, the only risk factor for treatment failure was a higher Pitt score (OR: 1.76; 95% CI, 1.02-3.05; p = 0.043). CONCLUSION CA genotypes, but not the epidemiological classification of CO-MRSA, impacted the clinical outcome of MRSA bacteremia in the HD population.
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Nanduri SA, Metcalf BJ, Arwady MA, Edens C, Lavin MA, Morgan J, Clegg W, Beron A, Albertson JP, Link-Gelles R, Ogundimu A, Gold J, Jackson D, Chochua S, Stone N, Van Beneden C, Fleming-Dutra K, Beall B. Prolonged and large outbreak of invasive group A Streptococcus disease within a nursing home: repeated intrafacility transmission of a single strain. Clin Microbiol Infect 2018; 25:248.e1-248.e7. [PMID: 29783026 DOI: 10.1016/j.cmi.2018.04.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/19/2018] [Accepted: 04/30/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Multiple invasive group A Streptococcus (GAS) infections were reported to public health by a skilled nursing facility (facility A) in Illinois between May 2014 and August 2016. Cases continued despite interventions including antibiotic prophylaxis for all residents and staff. Two other geographically close facilities reported contemporaneous outbreaks of GAS. We investigated potential reasons for ongoing transmission. METHODS We obtained epidemiologic data from chart review of cases and review of facility and public health records from previous investigations into the outbreak. Infection control practices at facility A were observed and evaluated. Whole genome sequencing followed by phylogenetic analysis was performed on available isolates from the three facilities. RESULTS From 2014 to 2016, 19 invasive and 60 noninvasive GAS infections were identified at facility A occurring in three clusters. Infection control evaluations during clusters 2 and 3 identified hand hygiene compliance rates of 14% to 25%, appropriate personal protective equipment use in only 33% of observed instances, and deficient wound-care practices. GAS isolates from residents and staff of all three facilities were subtype emm89.0; on phylogenetic analysis, facility A isolates were monophyletic and distinct. CONCLUSIONS Inadequate infection control and improper wound-care practices likely led to this 28-month-long outbreak of severe infections in a skilled nursing facility. Whole genome sequencing and phylogenetic analysis suggested that intrafacility transmission of a single highly transmissible GAS strain was responsible for the outbreak in facility A. Integration of genomic epidemiology tools with traditional epidemiology and infection control assessments was helpful in investigation of a facility-wide outbreak.
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Affiliation(s)
- S A Nanduri
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - B J Metcalf
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M A Arwady
- Chicago Department of Public Health, Chicago, IL, USA
| | - C Edens
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M A Lavin
- Lavin Consulting LLC, San Francisco, CA, USA
| | - J Morgan
- Illinois Department of Public Health, Springfield, IL, USA
| | - W Clegg
- Chicago Department of Public Health, Chicago, IL, USA
| | - A Beron
- Illinois Department of Public Health, Springfield, IL, USA
| | - J P Albertson
- Illinois Department of Public Health, Springfield, IL, USA
| | - R Link-Gelles
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - A Ogundimu
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J Gold
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - D Jackson
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - S Chochua
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - N Stone
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - C Van Beneden
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - K Fleming-Dutra
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - B Beall
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Kolter J, Henneke P. Codevelopment of Microbiota and Innate Immunity and the Risk for Group B Streptococcal Disease. Front Immunol 2017; 8:1497. [PMID: 29209311 PMCID: PMC5701622 DOI: 10.3389/fimmu.2017.01497] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 10/24/2017] [Indexed: 12/14/2022] Open
Abstract
The pathogenesis of neonatal late-onset sepsis (LOD), which manifests between the third day and the third month of life, remains poorly understood. Group B Streptococcus (GBS) is the most important cause of LOD in infants without underlying diseases or prematurity and the third most frequent cause of meningitis in the Western world. On the other hand, GBS is a common intestinal colonizer in infants. Accordingly, despite its adaption to the human lower gastrointestinal tract, GBS has retained its potential virulence and its transition from a commensal to a dangerous pathogen is unpredictable in the individual. Several cellular innate immune mechanisms, in particular Toll-like receptors, the inflammasome and the cGAS pathway, are engaged by GBS effectors like nucleic acids. These are likely to impact on the GBS-specific host resistance. Given the long evolution of streptococci as a normal constituent of the human microbiota, the emergence of GBS as the dominant neonatal sepsis cause just about 50 years ago is remarkable. It appears that intensive usage of tetracycline starting in the 1940s has been a selection advantage for the currently dominant GBS clones with superior adhesive and invasive properties. The historical replacement of Group A by Group B streptococci as a leading neonatal pathogen and the higher frequency of other β-hemolytic streptococci in areas with low GBS prevalence suggests the existence of a confined streptococcal niche, where locally competing streptococcal species are subject to environmental and immunological selection pressure. Thus, it seems pivotal to resolve neonatal innate immunity at mucous surfaces and its impact on microbiome composition and quality, i.e., genetic heterogeneity and metabolism, at the microanatomical level. Then, designer pro- and prebiotics, such as attenuated strains of GBS, and oligonucleotide priming of mucosal immunity may unfold their potential and facilitate adaptation of potentially hazardous streptococci as part of a beneficial local microbiome, which is stabilized by mucocutaneous innate immunity.
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Affiliation(s)
- Julia Kolter
- Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Philipp Henneke
- Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Pediatrics and Adolescent Medicine, Medical Center - University of Freiburg, Freiburg, Germany
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Cost-effectiveness of a potential group B streptococcal vaccine for pregnant women in the United States. Vaccine 2017; 35:6238-6247. [PMID: 28951085 DOI: 10.1016/j.vaccine.2017.08.085] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/07/2017] [Accepted: 08/29/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND In the U.S., intrapartum antibiotic prophylaxis (IAP) for pregnant women colonized with group B streptococcus (GBS) has reduced GBS disease in the first week of life (early-onset/EOGBS). Nonetheless, GBS remains a leading cause of neonatal sepsis, including 1000 late-onset (LOGBS) cases annually. A maternal vaccine under development could prevent EOGBS and LOGBS. METHODS Using a decision-analytic model, we compared the public health impact, costs, and cost-effectiveness of five strategies to prevent GBS disease in infants: (1) no prevention; (2) currently recommended screening/IAP; (3) maternal GBS immunization; (4) maternal immunization with IAP when indicated for unimmunized women; (5) maternal immunization plus screening/IAP for all women. We modeled a pentavalent vaccine covering serotypes 1a, 1b, II, III, and V, which cause almost all GBS disease. RESULTS In the base case, screening/IAP alone prevents 46% of EOGBS compared to no prevention, at a cost of $70,275 per quality-adjusted life-year (QALY) from a healthcare and $51,249/QALY from a societal perspective (2013 US$). At coverage rates typical of maternal vaccines in the U.S., a pentavalent vaccine alone would not prevent as much disease as screening/IAP until its efficacy approached 90%, but would cost less per QALY. At vaccine efficacy of ≥70%, maternal immunization together with IAP for unimmunized women would prevent more disease than screening/IAP, at a similar cost/QALY. CONCLUSIONS GBS maternal immunization, with IAP as indicated for unvaccinated women, could be an attractive alternative to screening/IAP if a pentavalent vaccine is sufficiently effective. Coverage, typically low for maternal vaccines, is key to the vaccine's public health impact.
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Shen AK, Tsai AY, Birkhead GS. A review of policy, practices, and players governing and involved in the United States vaccine and immunization enterprise. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2017. [DOI: 10.1108/ijhg-05-2017-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to outline the organization and governance of the US vaccine and immunization enterprise. It describes the major components of the US system including the various relationships between major federal government entities, stakeholders, and advisory committees that inform government policymaking at various points in the system.
Design/methodology/approach
The authors describe the complex interdependent network of partners that engage in a wide range of activities such as disease surveillance, research, vaccine development, regulatory licensure, practice recommendations, financing, service delivery, communications, and post-licensure monitoring.
Findings
The US system of governance is highly participatory and focuses on a transparent and open engagement, with input from a wide range of partners to inform decision-making. This collaborative framework allows many inputs to be heard and helps support the US vaccine and immunization system as it evolves to meet the continued public health needs in the USA through the optimal use of safe and effective vaccines.
Originality/value
This is an invited article on the US vaccine and immunization enterprise. The development and availability of vaccines in the USA has had profound impact on mortality and morbidity and public health (Centers for Disease Control and Prevention, 2011). The success of this enterprise is a result of a blended public and private sector system with partnerships at the federal, state, and local levels of government to optimize the use of safe and effective vaccines. Governance structures have been established to support the interaction and decision-making among the federal and non-federal actors toward the common goal of controlling and preventing infectious diseases.
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Isturiz R, Sings HL, Hilton B, Arguedas A, Reinert RR, Jodar L. Streptococcus pneumoniae serotype 19A: worldwide epidemiology. Expert Rev Vaccines 2017; 16:1007-1027. [DOI: 10.1080/14760584.2017.1362339] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Groseclose SL, Buckeridge DL. Public Health Surveillance Systems: Recent Advances in Their Use and Evaluation. Annu Rev Public Health 2017; 38:57-79. [DOI: 10.1146/annurev-publhealth-031816-044348] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Surveillance is critical for improving population health. Public health surveillance systems generate information that drives action, and the data must be of sufficient quality and with a resolution and timeliness that matches objectives. In the context of scientific advances in public health surveillance, changing health care and public health environments, and rapidly evolving technologies, the aim of this article is to review public health surveillance systems. We consider their current use to increase the efficiency and effectiveness of the public health system, the role of system stakeholders, the analysis and interpretation of surveillance data, approaches to system monitoring and evaluation, and opportunities for future advances in terms of increased scientific rigor, outcomes-focused research, and health informatics.
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Affiliation(s)
- Samuel L. Groseclose
- Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia 30329
| | - David L. Buckeridge
- Surveillance Lab, McGill Clinical and Health Informatics, Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada H3A 1A3
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Stoll BJ. Early-Onset Neonatal Sepsis: A Continuing Problem in Need of Novel Prevention Strategies. Pediatrics 2016; 138:peds.2016-3038. [PMID: 27940736 DOI: 10.1542/peds.2016-3038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Barbara J Stoll
- H. Wayne Hightower Distinguished Professor in the Medical Sciences and Dean, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
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Nelson GE, Pondo T, Toews KA, Farley MM, Lindegren ML, Lynfield R, Aragon D, Zansky SM, Watt JP, Cieslak PR, Angeles K, Harrison LH, Petit S, Beall B, Van Beneden CA. Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005-2012. Clin Infect Dis 2016. [PMID: 27105747 DOI: 10.1093/cid/ciw248)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Invasive group A Streptococcus (GAS) infections are associated with significant morbidity and mortality rates. We report the epidemiology and trends of invasive GAS over 8 years of surveillance. METHODS From January 2005 through December 2012, we collected data from the Centers for Disease Control and Prevention's Active Bacterial Core surveillance, a population-based network of 10 geographically diverse US sites (2012 population, 32.8 million). We defined invasive GAS as isolation of GAS from a normally sterile site or from a wound in a patient with necrotizing fasciitis (NF) or streptococcal toxic shock syndrome (STSS). Available isolates were emm typed. We calculated rates and made age- and race-adjusted national projections using census data. RESULTS We identified 9557 cases (3.8 cases per 100 000 persons per year) with 1116 deaths (case-fatality rate, 11.7%). The case-fatality rates for septic shock, STSS, and NF were 45%, 38%, and 29%, respectively. The annual incidence was highest among persons aged ≥65 years (9.4/100 000) or <1 year (5.3) and among blacks (4.7/100 000). National rates remained steady over 8 years of surveillance. Factors independently associated with death included increasing age, residence in a nursing home, recent surgery, septic shock, NF, meningitis, isolated bacteremia, pneumonia, emm type 1 or 3, and underlying chronic illness or immunosuppression. An estimated 10 649-13 434 cases of invasive GAS infections occur in the United States annually, resulting in 1136-1607 deaths. In a 30-valent M-protein vaccine, emm types accounted for 91% of isolates. CONCLUSIONS The burden of invasive GAS infection in the United States remains substantial. Vaccines under development could have a considerable public health impact.
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Affiliation(s)
- George E Nelson
- Epidemic Intelligence Service National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Vanderbilt University, Nashville, Tennessee
| | - Tracy Pondo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Karrie-Ann Toews
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Monica M Farley
- Emory University School of Medicine and the VA Medical Center, Atlanta, Georgia
| | | | | | - Deborah Aragon
- Colorado Department of Public Health and Environment, Denver
| | | | - James P Watt
- California Department of Public Health, Richmond
| | | | - Kathy Angeles
- New Mexico Emerging Infections Program, University of New Mexico, Las Cruces
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | - Bernard Beall
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Chris A Van Beneden
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
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Tillotson GS. Where in the world? The role of geography in antibiotic resistance and the potential impact in pulmonary infections. Postgrad Med 2016; 128:449-50. [PMID: 27149001 DOI: 10.1080/00325481.2016.1185375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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46
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Moore MR, Whitney CG. Use of Pneumococcal Disease Epidemiology to Set Policy and Prevent Disease during 20 Years of the Emerging Infections Program. Emerg Infect Dis 2016; 21:1551-6. [PMID: 26291238 PMCID: PMC4550168 DOI: 10.3201/eid2109.150395] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This program has been a flexible platform for following trends of this disease and evaluating vaccine effectiveness. Two decades ago, the Emerging Infections Program of the US Centers for Disease Control and Prevention implemented what seemed like a simple yet novel idea: a population- and laboratory-based surveillance system designed to identify and characterize invasive bacterial infections, including those caused by Streptococcus pneumoniae. This system, known as Active Bacterial Core surveillance, has since served as a flexible platform for following trends in invasive pneumococcal disease and studying vaccination as the most effective method for prevention. We report the contributions of Active Bacterial Core surveillance to every pneumococcal vaccine policy decision in the United States during the past 20 years.
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Pinner RW, Lynfield R, Hadler JL, Schaffner W, Farley MM, Frank ME, Schuchat A. Cultivation of an Adaptive Domestic Network for Surveillance and Evaluation of Emerging Infections. Emerg Infect Dis 2016; 21:1499-509. [PMID: 26289824 PMCID: PMC4550162 DOI: 10.3201/eid2109.150619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Accomplishments of this program have provided numerous dividends and might benefit areas outside infectious diseases.
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48
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Nelson GE, Pondo T, Toews KA, Farley MM, Lindegren ML, Lynfield R, Aragon D, Zansky SM, Watt JP, Cieslak PR, Angeles K, Harrison LH, Petit S, Beall B, Van Beneden CA. Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005-2012. Clin Infect Dis 2016; 63:478-86. [PMID: 27105747 DOI: 10.1093/cid/ciw248] [Citation(s) in RCA: 261] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/14/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Invasive group A Streptococcus (GAS) infections are associated with significant morbidity and mortality rates. We report the epidemiology and trends of invasive GAS over 8 years of surveillance. METHODS From January 2005 through December 2012, we collected data from the Centers for Disease Control and Prevention's Active Bacterial Core surveillance, a population-based network of 10 geographically diverse US sites (2012 population, 32.8 million). We defined invasive GAS as isolation of GAS from a normally sterile site or from a wound in a patient with necrotizing fasciitis (NF) or streptococcal toxic shock syndrome (STSS). Available isolates were emm typed. We calculated rates and made age- and race-adjusted national projections using census data. RESULTS We identified 9557 cases (3.8 cases per 100 000 persons per year) with 1116 deaths (case-fatality rate, 11.7%). The case-fatality rates for septic shock, STSS, and NF were 45%, 38%, and 29%, respectively. The annual incidence was highest among persons aged ≥65 years (9.4/100 000) or <1 year (5.3) and among blacks (4.7/100 000). National rates remained steady over 8 years of surveillance. Factors independently associated with death included increasing age, residence in a nursing home, recent surgery, septic shock, NF, meningitis, isolated bacteremia, pneumonia, emm type 1 or 3, and underlying chronic illness or immunosuppression. An estimated 10 649-13 434 cases of invasive GAS infections occur in the United States annually, resulting in 1136-1607 deaths. In a 30-valent M-protein vaccine, emm types accounted for 91% of isolates. CONCLUSIONS The burden of invasive GAS infection in the United States remains substantial. Vaccines under development could have a considerable public health impact.
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Affiliation(s)
- George E Nelson
- Epidemic Intelligence Service National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Vanderbilt University, Nashville, Tennessee
| | - Tracy Pondo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Karrie-Ann Toews
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Monica M Farley
- Emory University School of Medicine and the VA Medical Center, Atlanta, Georgia
| | | | | | - Deborah Aragon
- Colorado Department of Public Health and Environment, Denver
| | | | - James P Watt
- California Department of Public Health, Richmond
| | | | - Kathy Angeles
- New Mexico Emerging Infections Program, University of New Mexico, Las Cruces
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | - Bernard Beall
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Chris A Van Beneden
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
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Invasive disease due to Haemophilus influenzae type A in children in Canada's north: A priority for prevention. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2016; 26:291-2. [PMID: 26744583 PMCID: PMC4692295 DOI: 10.1155/2015/613820] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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