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Lopez AS, Kidd S, Yee E, Dooling K, Routh JA. Six- and 12-month functional outcomes among patients with confirmed acute flaccid myelitis (AFM) with onset in 2018, United States. J Pediatr Rehabil Med 2023; 16:391-400. [PMID: 37182848 PMCID: PMC11019776 DOI: 10.3233/prm-220054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
PURPOSE Acute flaccid myelitis (AFM), an uncommon but serious neurologic condition, primarily affects children, and can progress quickly to paralysis and respiratory failure. Data on long-term outcomes of patients with AFM are limited. This study reports on functional status through 12 months for AFM patients who became ill in 2018 in the United States. METHODS Health departments collected information on outcomes at 6 and 12 months after onset of AFM using a standardized form that asked patients or their parents/guardians about functional status. Analyses were restricted to confirmed cases. RESULTS Of the 238 confirmed AFM cases reported to CDC in 2018, 90 (38%) had assessments at 6 months, 82 (34%) at 12 months, and 49 (21%) at both 6 and 12 months. Among the 49 patients with data at both time points, the proportion of patients reporting significant or severe impairment at 6 months ranged from 2% to 59% depending on the outcome. Although proportions decreased by 12 months and ranged from 2% to 51%, most patients had some impairment at 12 months. No deaths were reported. CONCLUSION Six- and 12-month outcomes in patients with onset of AFM in 2018 span a wide range of functionality, particularly of upper and lower extremities. Importantly, improvement appears to occur over time in some patients.
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Affiliation(s)
- Adriana S Lopez
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah Kidd
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eileen Yee
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Janell A Routh
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Marin M, Leung JW, Lopez AS, Melgar M, Anderson TC, Curns AT, Dooling KL. 801. IDSA Featured Oral Abstract: 25 Years of Varicella Vaccination Program in the United States: Health Impact during 1995–2019. Open Forum Infect Dis 2022. [PMCID: PMC9752897 DOI: 10.1093/ofid/ofac492.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background In 1995, the United States was the first country to introduce universal childhood varicella vaccination. High vaccine coverage was attained among young children, ≥ 90% since 2007. In 2007, the policy was changed from 1-dose to a 2-dose program. We describe the impact of 25 years of the U.S. varicella vaccination program on varicella disease nationally. Methods We reviewed published data and analyzed overall and age-specific trends for rates from the pre-vaccine period (1990–1994) through 2019 for varicella incidence using National Notifiable Diseases Surveillance System data, hospitalizations using National Inpatient Sample data, and deaths using National Center for Health Statistics data. We present trends in persons aged < 50 years, which captures most varicella burden and avoids misclassified herpes zoster in older people. Outbreak (≥ 5 varicella cases epidemiologically linked) characteristics were assessed for 1995–2019 and were informed by published data and analysis of surveillance data reported to CDC. Results Within the 10 years of the 1-dose program, varicella incidence, hospitalization, and mortality rates declined dramatically (71%–90%) vs. pre-vaccine. However, limited transmission continued in school settings which informed the change to a 2-dose policy. By 2019, declines reached > 97% for incidence and 94% and 97% for hospitalizations and deaths, respectively. The greatest decline occurred among persons aged < 20 years, born during the varicella vaccination program, with 99%, 97%, and > 99% reduction in incidence, hospitalizations, and deaths, respectively. The 2-dose program further reduced the number, size, and duration of outbreaks vs. the 1-dose program; over the entire program, the proportion of outbreaks with < 10 cases increased from 28% to 73%. Conclusion The varicella vaccination program significantly reduced varicella morbidity and mortality in the U.S. Twenty-five years into the program, pediatric varicella hospitalization has become a rare event and varicella deaths in persons aged < 20 years are practically eliminated in the U.S. Annually, > 3.8 million cases, 10,500 hospitalizations, and 100 deaths from varicella are now prevented in the United States due to the varicella vaccination program. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
- Mona Marin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica W Leung
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Michael Melgar
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tara C Anderson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aaron T Curns
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Marin M, Leung J, Anderson TC, Lopez AS. Monitoring Varicella Vaccine Impact on Varicella Incidence in the United States: Surveillance Challenges and Changing Epidemiology, 1995-2019. J Infect Dis 2022; 226:S392-S399. [PMID: 36265855 DOI: 10.1093/infdis/jiac221] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Surveillance is critical for monitoring vaccine impact. Varicella surveillance challenges predated varicella vaccine US licensure in 1995. Several interim steps were needed before case-based surveillance could be established in most states, and both active and passive surveillance was needed to document the vaccination program's impact on varicella incidence. By the end of the 1-dose program in 2005, incidence had declined 90% in the active surveillance areas, with significant declines occurring in all age groups within 5 years of program implementation. Additional declines occurred during the 2-dose program leading to >97% decline in incidence over the 25 years of program implementation through 2019, based on data from 4 states with continuous passive reporting. Surveillance showed that declines were highest among children and adolescents covered by the routine vaccination recommendations but occurred in all age groups. Although surveillance systems changed and were adapted to reflect evolving epidemiology, data consistently demonstrated decreasing varicella incidence following the vaccination program implementation. The vaccination program dramatically decreased virus circulation and increased community protection. Continued and improved varicella surveillance is needed to accurately monitor disease epidemiology and further guide prevention efforts.
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Affiliation(s)
- Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tara C Anderson
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adriana S Lopez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Abstract
We describe the changing epidemiology of varicella outbreaks informed by past and current active and passive surveillance in the United States by reviewing data published during 1995-2015 and analyzing new data from 2016 to 2019. Varicella outbreaks were defined as ≥5 varicella cases within 1 setting and ≥1 incubation period. During the 1-dose varicella vaccination program (1995‒2006), the number of varicella outbreaks declined by 80% (2003-2006 vs 1995-1998) in 1 active surveillance area where vaccination coverage reached 90.5% in 2006. During the 2-dose program, in 7 states with consistent reporting to the Centers for Disease Control and Prevention, the number of outbreaks declined by 82% (2016-2019 vs 2005-2006). Over the entire program (1995-2019), outbreak size and duration declined from a median of 15 cases/outbreak and 45 days duration to 7 cases and 30 days duration. The proportion of outbreaks with <10 cases increased from 28% to 73%. During 2016‒2019, most (79%) outbreak cases occurred among unvaccinated or partially vaccinated persons eligible for second-dose vaccination, highlighting the potential for further varicella control.
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Affiliation(s)
- Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Adriana S. Lopez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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Marin M, Lopez AS, Melgar M, Dooling K, Curns AT, Leung J. Decline in Severe Varicella Disease During the United States Varicella Vaccination Program: Hospitalizations and Deaths, 1990-2019. J Infect Dis 2022; 226:S407-S415. [PMID: 36265852 PMCID: PMC10406340 DOI: 10.1093/infdis/jiac242] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
To describe the impact of the US varicella vaccination program on severe varicella outcomes, we analyzed varicella hospitalizations using the National Inpatient Sample 1993-2019 and varicella deaths using the National Center for Health Statistics data 1990-2019. Over 25 years of vaccination program (1995-2019), varicella hospitalizations, and deaths declined 94% and 97%, respectively, among persons aged <50 years. Most of the decline (∼90%) occurred during the 1-dose period (through 2006/2007) by attaining and maintaining high vaccination coverage; additional declines occurred during the 2-dose period, especially in the age groups covered by the 2-dose recommendation. The greatest decline for both hospitalizations and deaths (97% and >99%, respectively) was among persons aged <20 years, born during the varicella vaccination program. In the <20 age group, varicella hospitalization has become a rare event, and varicella deaths have been practically eliminated in the United States. A total of >10 500 varicella hospitalizations and 100 varicella deaths are now prevented annually in the United States as a direct result of vaccination and reduction in varicella-zoster virus circulation.
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Affiliation(s)
- Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adriana S Lopez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael Melgar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathleen Dooling
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aaron T Curns
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Kidd S, Yee E, English R, Rogers S, Emery B, Getachew H, Routh JA, Lopez AS. National Surveillance for Acute Flaccid Myelitis - United States, 2018-2020. MMWR Morb Mortal Wkly Rep 2021; 70:1534-1538. [PMID: 34735423 PMCID: PMC8568096 DOI: 10.15585/mmwr.mm7044a2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Acute flaccid myelitis (AFM), a recognized complication of certain viral infections, is a serious neurologic condition that predominantly affects previously healthy children and can progress rapidly, leading to respiratory insufficiency and permanent paralysis. After national AFM surveillance began in 2014, peaks in AFM cases were observed in the United States in 2014, 2016, and 2018 (1). On the basis of this biennial pattern, an increase in AFM was anticipated in 2020. To describe the epidemiology of confirmed AFM cases since 2018, demographic, clinical, and laboratory information collected as part of national AFM surveillance was reviewed. In 2018, a total of 238 confirmed AFM cases were reported to CDC, compared with 47 cases in 2019 and 32 in 2020. Enterovirus D68 (EV-D68) was detected in specimens from 37 cases reported in 2018, one case in 2019 and none in 2020. Compared with 2018, cases reported during 2019-2020 occurred in older children and were less frequently associated with upper limb involvement, febrile or respiratory prodromal illness, or cerebrospinal fluid (CSF) pleocytosis. These findings suggest that the etiologies of AFM in 2019 and 2020 differed from those in 2018. The absence of an increase in cases in 2020 reflects a deviation from the previously observed biennial pattern, and it is unclear when the next increase in AFM should be expected. Clinicians should continue to maintain vigilance and suspect AFM in any child with acute flaccid limb weakness, particularly in the setting of recent febrile or respiratory illness.
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Schubert RD, Hawes IA, Ramachandran PS, Ramesh A, Crawford ED, Pak JE, Wu W, Cheung CK, O'Donovan BD, Tato CM, Lyden A, Tan M, Sit R, Sowa GM, Sample HA, Zorn KC, Banerji D, Khan LM, Bove R, Hauser SL, Gelfand AA, Johnson-Kerner BL, Nash K, Krishnamoorthy KS, Chitnis T, Ding JZ, McMillan HJ, Chiu CY, Briggs B, Glaser CA, Yen C, Chu V, Wadford DA, Dominguez SR, Ng TFF, Marine RL, Lopez AS, Nix WA, Soldatos A, Gorman MP, Benson L, Messacar K, Konopka-Anstadt JL, Oberste MS, DeRisi JL, Wilson MR. Author Correction: Pan-viral serology implicates enteroviruses in acute flaccid myelitis. Nat Med 2021; 27:1849. [PMID: 34548659 DOI: 10.1038/s41591-021-01429-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ryan D Schubert
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Isobel A Hawes
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Prashanth S Ramachandran
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Akshaya Ramesh
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Emily D Crawford
- Chan Zuckerberg Biohub, San Francisco, CA, USA.,Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
| | - John E Pak
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Wesley Wu
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | | | - Brian D O'Donovan
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Amy Lyden
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | | | - Rene Sit
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Gavin M Sowa
- School of Medicine, University of California, San Francisc, San Francisco, CA, USA
| | - Hannah A Sample
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Kelsey C Zorn
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Debarko Banerji
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Lillian M Khan
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Riley Bove
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Stephen L Hauser
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Amy A Gelfand
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Bethany L Johnson-Kerner
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kendall Nash
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | | | - Tanuja Chitnis
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Joy Z Ding
- Division of Neurology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Hugh J McMillan
- Division of Neurology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Charles Y Chiu
- Department of Laboratory Medicine and Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - Benjamin Briggs
- Department of Pediatrics, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - Carol A Glaser
- Department of Pediatric Infectious Diseases, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Cynthia Yen
- Division of Communicable Disease Control, California Department of Public Health, Richmond, CA, USA
| | - Victoria Chu
- Division of Communicable Disease Control, California Department of Public Health, Richmond, CA, USA
| | - Debra A Wadford
- Division of Communicable Disease Control, California Department of Public Health, Richmond, CA, USA
| | - Samuel R Dominguez
- Children's Hospital Colorado and Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Terry Fei Fan Ng
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel L Marine
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adriana S Lopez
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - W Allan Nix
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ariane Soldatos
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Mark P Gorman
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Leslie Benson
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Kevin Messacar
- Children's Hospital Colorado and Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - M Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joseph L DeRisi
- Chan Zuckerberg Biohub, San Francisco, CA, USA.,Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Michael R Wilson
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA. .,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
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Fields VL, Kiphibane T, Eason JT, Hafoka SF, Lopez AS, Schwartz A, Henry A, Tran CH, Tate JE, Kirking HL, Laws RL, Venkatappa T, Mosites E, Montgomery MP. Assessment of contact tracing for COVID-19 among people experiencing homelessness, Salt Lake County Health Department, March-May 2020. Ann Epidemiol 2021; 59:50-55. [PMID: 33894384 PMCID: PMC8061086 DOI: 10.1016/j.annepidem.2021.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/02/2021] [Accepted: 04/14/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Contact tracing is intended to reduce the spread of coronavirus disease 2019 (COVID-19), but it is difficult to conduct among people who live in congregate settings, including people experiencing homelessness (PEH). This analysis compares person-based contact tracing among two populations in Salt Lake County, Utah, from March-May 2020. METHODS All laboratory-confirmed positive cases among PEH (n = 169) and documented in Utah's surveillance system were included in this analysis. The general population comparison group (n = 163) were systematically selected from all laboratory-confirmed cases identified during the same period. RESULTS Ninety-three PEH cases (55%) were interviewed compared to 163 (100%) cases among the general population (P < .0001). PEH were more likely to be lost to follow-up at end of isolation (14.2%) versus the general population (0%; P-value < .0001) and provided fewer contacts per case (0.3) than the general population (4.7) (P-value < .0001). Contacts of PEH were more often unreachable (13.0% vs. 7.1%; P-value < .0001). CONCLUSIONS These findings suggest that contact tracing among PEH should include a location-based approach, along with a person-based approach when resources allow, due to challenges in identifying, locating, and reaching cases among PEH and their contacts through person-based contact tracing efforts alone.
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Affiliation(s)
| | | | | | | | | | - Amy Schwartz
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Ankita Henry
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Cuc H Tran
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | | - Emily Mosites
- Centers for Disease Control and Prevention, Atlanta, GA
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Lopez AS, Hill M, Antezano J, Vilven D, Rutner T, Bogdanow L, Claflin C, Kracalik IT, Fields VL, Dunn A, Tate JE, Kirking HL, Kiphibane T, Risk I, Tran CH. Transmission Dynamics of COVID-19 Outbreaks Associated with Child Care Facilities - Salt Lake City, Utah, April-July 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1319-1323. [PMID: 32941418 PMCID: PMC7498176 DOI: 10.15585/mmwr.mm6937e3] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Acute flaccid myelitis (AFM) is a serious neurologic condition that causes limb weakness or paralysis in previously healthy children. Since clusters of cases were first reported in 2014, nationwide surveillance has demonstrated sharp increases in AFM cases in the United States every 2 years, most occurring during late summer and early fall. Given this current biennial pattern, another peak AFM season is expected during fall 2020 in the United States. Scientific understanding of the etiology and the factors driving the biennial increases in AFM has advanced rapidly in the past few years, although areas of uncertainty remain. The Centers for Disease Control and Prevention and AFM partners are focused on answering key questions about AFM epidemiology and mechanisms of disease. This article summarizes the current understanding of AFM etiology and outlines priorities for surveillance and research as we prepare for a likely surge in cases in 2020.
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Messacar K, Spence-Davizon E, Osborne C, Press C, Schreiner TL, Martin J, Messer R, Maloney J, Burakoff A, Barnes M, Rogers S, Lopez AS, Routh J, Gerber SI, Oberste MS, Nix WA, Abzug MJ, Tyler KL, Herlihy R, Dominguez SR. Clinical characteristics of enterovirus A71 neurological disease during an outbreak in children in Colorado, USA, in 2018: an observational cohort study. Lancet Infect Dis 2019; 20:230-239. [PMID: 31859216 DOI: 10.1016/s1473-3099(19)30632-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/15/2019] [Accepted: 10/22/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND In May, 2018, Children's Hospital Colorado noted an outbreak of enterovirus A71 (EV-A71) neurological disease. We aimed to characterise the clinical features of EV-A71 neurological disease during this outbreak. METHODS In this retrospective observational cohort study, children (younger than 18 years) who presented to Children's Hospital Colorado (Aurora, CO, USA) between March 1 and November 30, 2018, with neurological disease (defined by non-mutually exclusive criteria, including meningitis, encephalitis, acute flaccid myelitis, and seizures) and enterovirus detected from any biological specimen were eligible for study inclusion. The clinical characteristics of children with neurological disease associated with EV-A71 were compared with those of children with neurological disease associated with other enteroviruses during the same period. To explore the differences in clinical presentation of acute flaccid myelitis, we also used a subgroup analysis to compare clinical findings in children with EV-A71-associated acute flaccid myelitis during the study period with these findings in those with enterovirus D68 (EV-D68)-associated acute flaccid myelitis at the same hospital between 2013 and 2018. FINDINGS Between March 10 and Nov 10, 2018, 74 children presenting to Children's Hospital Colorado were found to have enterovirus neurological disease; EV-A71 was identified in 43 (58%) of these children. The median age of the children with EV-A71 neurological disease was 22·7 months (IQR 4·0-31·9), and most of these children were male (34 [79%] children). 40 (93%) children with EV-A71 neurological disease had findings suggestive of meningitis, 31 (72%) children showed evidence of encephalitis, and ten (23%) children met our case definition of acute flaccid myelitis. All children with EV-A71 disease had fever and 18 (42%) children had hand, foot, or mouth lesions at or before neurological onset. Children with EV-A71 disease were best differentiated from those with other enteroviruses (n=31) by the neurological findings of myoclonus, ataxia, weakness, and autonomic instability. Of the specimens collected from children with EV-A71, this enterovirus was detected in 94% of rectal, 79% of oropharyngeal, 56% of nasopharyngeal, and 20% of cerebrospinal fluid specimens. 39 (93%) of 42 children with EV-A71 neurological disease who could be followed up showed complete recovery by 1-2 months. Compared with children with EV-D68-associated acute flaccid myelitis, children with EV-A71-associated acute flaccid myelitis were younger, showed neurological onset earlier after prodromal symptom onset, had milder weakness, showed more rapid improvement, and were more likely to completely recover. INTERPRETATION This outbreak of EV-A71 neurological disease, the largest reported in the Americas, was characterised by fever, myoclonus, ataxia, weakness, autonomic instability, and full recovery in most patients. Because EV-A71 epidemiology outside of Asia remains difficult to predict, identification of future outbreaks will be aided by prompt recognition of these distinct clinical findings, testing of non-sterile and sterile site specimens, and enhanced enterovirus surveillance. FUNDING None.
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Affiliation(s)
- Kevin Messacar
- Section of Infectious Diseases, School of Medicine, University of Colorado, Aurora, CO, USA; Children's Hospital Colorado, Aurora, CO, USA.
| | | | - Christina Osborne
- Section of Infectious Diseases, School of Medicine, University of Colorado, Aurora, CO, USA; Children's Hospital Colorado, Aurora, CO, USA
| | - Craig Press
- Section of Child Neurology, School of Medicine, University of Colorado, Aurora, CO, USA; Children's Hospital Colorado, Aurora, CO, USA
| | - Teri L Schreiner
- Section of Child Neurology, School of Medicine, University of Colorado, Aurora, CO, USA; Children's Hospital Colorado, Aurora, CO, USA
| | - Jan Martin
- Section of Child Neurology, School of Medicine, University of Colorado, Aurora, CO, USA; Children's Hospital Colorado, Aurora, CO, USA
| | - Ricka Messer
- Section of Child Neurology, School of Medicine, University of Colorado, Aurora, CO, USA; Children's Hospital Colorado, Aurora, CO, USA
| | - John Maloney
- Section of Radiology, School of Medicine, University of Colorado, Aurora, CO, USA; Children's Hospital Colorado, Aurora, CO, USA
| | - Alexis Burakoff
- Colorado Department of Public Health and the Environment, Denver, CO, USA; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Meghan Barnes
- Colorado Department of Public Health and the Environment, Denver, CO, USA
| | - Shannon Rogers
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adriana S Lopez
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janell Routh
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan I Gerber
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - W Allan Nix
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark J Abzug
- Section of Infectious Diseases, School of Medicine, University of Colorado, Aurora, CO, USA; Children's Hospital Colorado, Aurora, CO, USA
| | - Kenneth L Tyler
- Department of Pediatrics and Department of Neurology, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Rachel Herlihy
- Colorado Department of Public Health and the Environment, Denver, CO, USA
| | - Samuel R Dominguez
- Section of Infectious Diseases, School of Medicine, University of Colorado, Aurora, CO, USA; Children's Hospital Colorado, Aurora, CO, USA
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Schubert RD, Hawes IA, Ramachandran PS, Ramesh A, Crawford ED, Pak JE, Wu W, Cheung CK, O'Donovan BD, Tato CM, Lyden A, Tan M, Sit R, Sowa GA, Sample HA, Zorn KC, Banerji D, Khan LM, Bove R, Hauser SL, Gelfand AA, Johnson-Kerner BL, Nash K, Krishnamoorthy KS, Chitnis T, Ding JZ, McMillan HJ, Chiu CY, Briggs B, Glaser CA, Yen C, Chu V, Wadford DA, Dominguez SR, Ng TFF, Marine RL, Lopez AS, Nix WA, Soldatos A, Gorman MP, Benson L, Messacar K, Konopka-Anstadt JL, Oberste MS, DeRisi JL, Wilson MR. Pan-viral serology implicates enteroviruses in acute flaccid myelitis. Nat Med 2019; 25:1748-1752. [PMID: 31636453 PMCID: PMC6858576 DOI: 10.1038/s41591-019-0613-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/13/2019] [Indexed: 11/26/2022]
Abstract
Since 2012, the United States has experienced a biennial spike in pediatric acute flaccid myelitis (AFM).1–6 Epidemiologic evidence suggests non-polio enteroviruses (EVs) are a potential etiology, yet EV RNA is rarely detected in cerebrospinal fluid (CSF).2 We interrogated CSF from children with AFM (n=42) and pediatric other neurologic disease controls (n=58) for intrathecal anti-viral antibodies using a phage display library expressing 481,966 overlapping peptides derived from all known vertebrate and arboviruses (VirScan). We also performed metagenomic next-generation sequencing (mNGS) of AFM CSF RNA (n=20 cases), both unbiased and with targeted enrichment for EVs. Using VirScan, the only viral family significantly enriched by the CSF of AFM cases relative to controls was Picornaviridae, with the most enriched Picornaviridae peptides belonging to the genus Enterovirus (n=29/42 cases versus 4/58 controls). EV VP1 ELISA confirmed this finding (n=22/26 cases versus 7/50 controls). mNGS did not detect additional EV RNA. Despite rare detection of EV RNA, pan-viral serology identified frequently high levels of CSF EV-specific antibodies in AFM compared to controls, providing further evidence for a causal role of non-polio EVs in AFM.
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Affiliation(s)
- Ryan D Schubert
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Isobel A Hawes
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Prashanth S Ramachandran
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Akshaya Ramesh
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Emily D Crawford
- Chan Zuckerberg Biohub, San Francisco, CA, USA.,Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
| | - John E Pak
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Wesley Wu
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | | | - Brian D O'Donovan
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Amy Lyden
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | | | - Rene Sit
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Gavin A Sowa
- School of Medicine, University of California, San Francisc, San Francisco, CA, USA
| | - Hannah A Sample
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Kelsey C Zorn
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Debarko Banerji
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Lillian M Khan
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Riley Bove
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Stephen L Hauser
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Amy A Gelfand
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Bethany L Johnson-Kerner
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kendall Nash
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | | | - Tanuja Chitnis
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Joy Z Ding
- Division of Neurology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Hugh J McMillan
- Division of Neurology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Charles Y Chiu
- Department of Laboratory Medicine and Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - Benjamin Briggs
- Department of Pediatrics, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - Carol A Glaser
- Department of Pediatric Infectious Diseases, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Cynthia Yen
- Division of Communicable Disease Control, California Department of Public Health, Richmond, CA, USA
| | - Victoria Chu
- Division of Communicable Disease Control, California Department of Public Health, Richmond, CA, USA
| | - Debra A Wadford
- Division of Communicable Disease Control, California Department of Public Health, Richmond, CA, USA
| | - Samuel R Dominguez
- Children's Hospital Colorado and Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Terry Fei Fan Ng
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel L Marine
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adriana S Lopez
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - W Allan Nix
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ariane Soldatos
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Mark P Gorman
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Leslie Benson
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Kevin Messacar
- Children's Hospital Colorado and Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - M Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joseph L DeRisi
- Chan Zuckerberg Biohub, San Francisco, CA, USA.,Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Michael R Wilson
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA. .,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
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Leung J, McCollum AM, Radford K, Hughes C, Lopez AS, Guagliardo SAJ, Nguete B, Likafi T, Kabamba J, Malekani J, Shongo Lushima R, Pukuta E, Karhemere S, Muyembe Tamfum JJ, Reynolds MG, Wemakoy Okitolonda E, Schmid DS, Marin M. Varicella in Tshuapa Province, Democratic Republic of Congo, 2009-2014. Trop Med Int Health 2019; 24:839-848. [PMID: 31062445 PMCID: PMC8786670 DOI: 10.1111/tmi.13243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe varicella cases in Tshuapa Province of the Democratic Republic of the Congo identified during monkeypox surveillance. METHODS Demographic, clinical and epidemiological data were collected from each suspected monkeypox case 2009-2014. Samples were tested by PCR for both Orthopoxviruses and varicella-zoster virus (VZV); a subset of VZV-positive samples was genotyped. We defined a varicella case as a rash illness with laboratory-confirmed VZV. RESULTS There were 366 varicella cases were identified; 66% were ≤19 years old. Most patients had non-typical varicella rash with lesions reported as the same size and stage of evolution (86%), deep and profound (91%), on palms of hands and/or soles of feet (86%) and not itchy (49%). Many had non-typical signs and symptoms, such as lymphadenopathy (70%) and sensitivity to light (23%). A higher proportion of persons aged ≥20 years than persons aged ≤19 years had ≥50 lesions (79% vs. 65%, P = 0.007) and were bedridden (15% vs. 9%, P = 0.056). All VZV isolates genotyped from 79 varicella cases were clade 5. During the surveillance period, one possible VZV-related death occurred in a 7-year-old child. CONCLUSIONS A large proportion of patients presented with non-typical varicella rash and clinical signs and symptoms, highlighting challenges identifying varicella in an area with endemic monkeypox. Continued surveillance and laboratory diagnosis will help in rapid identification and control of both monkeypox and varicella and improve our understanding of varicella epidemiology in Africa.
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Affiliation(s)
- Jessica Leung
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Atlanta GA USA
| | - Andrea M. McCollum
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta GA USA
| | - Kay Radford
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Atlanta GA USA
| | - Christine Hughes
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta GA USA
| | - Adriana S Lopez
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Atlanta GA USA
| | - Sarah Anne J. Guagliardo
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta GA USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, United States
| | - Beatrice Nguete
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Toutou Likafi
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Joelle Kabamba
- U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | - Jean Malekani
- University of Kinshasa, Department of Biology, Kinshasa, Democratic Republic of Congo
| | | | - Elisabeth Pukuta
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Stomy Karhemere
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | | | - Mary G. Reynolds
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta GA USA
| | | | - D Scott Schmid
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Atlanta GA USA
| | - Mona Marin
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Atlanta GA USA
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14
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Lopez AS, LaClair B, Buttery V, Zhang Y, Rosen J, Taggert E, Robinson S, Davis M, Waters C, Thomas CA, Rodriguez C, Thomas E, Tuttle J, Brantley T, Perella D, Del Rosario M, Marin M. Varicella Outbreak Surveillance in Schools in Sentinel Jurisdictions, 2012-2015. J Pediatric Infect Dis Soc 2019. [PMID: 29522133 DOI: 10.1093/jpids/piy010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In 2007, a routine second dose of varicella vaccine was recommended in the United States for children aged 4 to 6 years to better control varicella-zoster virus circulation and outbreaks. Sentinel varicella outbreak surveillance was established to assess feasibility of surveillance and describe outbreaks that are occurring. METHODS Through the Centers for Disease Control and Prevention Epidemiology Laboratory Capacity funding, health departments conducted active surveillance for varicella outbreaks in schools from 2012 to 2015. Outbreaks of varicella were defined as ≥5 cases in a school within at least 1 incubation period (21 days). School nurses, healthcare providers, or laboratories reported cases and outbreaks of varicella to health departments; demographic, vaccination, and clinical data were collected. RESULTS Georgia, Houston, Maine, Minnesota, New York City, and Philadelphia participated in all 3 years; Puerto Rico and West Virginia participated in 2012 to 2013; and Kansas and Arkansas participated in 2014 to 2015. Twenty-nine outbreaks including 262 cases were reported. The median size of the outbreaks was 7 cases (range, 5-31 cases), and the median duration was 31 days (range, 4-100 days). Of the case-patients associated with larger outbreaks (≥8 cases), 55.4% were unvaccinated, and 15.7% and 18.1% had received 1 or 2 doses of vaccine, respectively. In small outbreaks (5-7 cases), 33.3% of case-patients were unvaccinated, and 16.7% and 38.5% had received 1 or 2 doses of vaccine, respectively. CONCLUSIONS The majority of cases associated with outbreaks occurred in undervaccinated children (unvaccinated and 1-dose vaccine recipients). Outbreaks with a greater proportion of 2-dose vaccine recipients were smaller. Varicella outbreak surveillance is feasible, and continued monitoring of outbreaks remains important for describing the epidemiology of varicella during the 2-dose varicella vaccination program.
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Affiliation(s)
- Adriana S Lopez
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Jennifer Rosen
- New York City Department of Health and Mental Hygiene, New York
| | | | - Sara Robinson
- Maine Department of Health and Human Services, Augusta
| | - Mychal Davis
- Kansas Department of Health and Environment, Topeka
| | | | - Carrie A Thomas
- West Virginia Department of Health and Human Services, Charleston
| | | | | | | | - Tamara Brantley
- New York City Department of Health and Mental Hygiene, New York
| | - Dana Perella
- Philadelphia Department of Public Health, Pennsylvania
| | | | - Mona Marin
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Kujawski SA, Midgley CM, Rha B, Lively JY, Nix WA, Curns AT, Payne DC, Englund JA, Boom JA, Williams JV, Weinberg GA, Staat MA, Selvarangan R, Halasa NB, Klein EJ, Sahni LC, Michaels MG, Shelley L, McNeal M, Harrison CJ, Stewart LS, Lopez AS, Routh JA, Patel M, Oberste MS, Watson JT, Gerber SI. Enterovirus D68-Associated Acute Respiratory Illness - New Vaccine Surveillance Network, United States, July-October, 2017 and 2018. MMWR Morb Mortal Wkly Rep 2019; 68:277-280. [PMID: 30921299 PMCID: PMC6448985 DOI: 10.15585/mmwr.mm6812a1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the fall of 2014, an outbreak of enterovirus D68 (EV-D68)-associated acute respiratory illness (ARI) occurred in the United States (1,2); before 2014, EV-D68 was rarely reported to CDC (2,3). In the United States, reported EV-D68 detections typically peak during late summer and early fall (3). EV-D68 epidemiology is not fully understood because testing in clinical settings seldom has been available and detections are not notifiable to CDC. To better understand EV-D68 epidemiology, CDC recently established active, prospective EV-D68 surveillance among pediatric patients at seven U.S. medical centers through the New Vaccine Surveillance Network (NVSN) (4). This report details a preliminary characterization of EV-D68 testing and detections among emergency department (ED) and hospitalized patients with ARI at all NVSN sites during July 1-October 31, 2017, and the same period in 2018. Among patients with ARI who were tested, EV-D68 was detected in two patients (0.8%) in 2017 and 358 (13.9%) in 2018. Continued active, prospective surveillance of EV-D68-associated ARI is needed to better understand EV-D68 epidemiology in the United States.
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16
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Messacar K, Burakoff A, Nix WA, Rogers S, Lopez AS, Oberste MS, Gerber SI, Spence-Davizon E, Herlihy R, Dominguez S. LB8. Outbreak of Enterovirus A71 Neurologic Disease in Children—Colorado, 2018. Open Forum Infect Dis 2018. [PMCID: PMC6253202 DOI: 10.1093/ofid/ofy229.2182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
- Kevin Messacar
- Pediatric Infectious Diseases and Hospital Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Alexis Burakoff
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William A Nix
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, Atlanta, Georgia
| | - Shannon Rogers
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adriana S Lopez
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M Steve Oberste
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Rachel Herlihy
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Samuel Dominguez
- Pediatrics, University of Colorado and The Children’s Hospital, Aurora, Colorado
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17
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Clemmons N, Lee A, Lopez AS, Marlow M, Marin M, Patel M. 658. Trends in Mumps Cases and Incidence, United States, January 2016‒April 2018. Open Forum Infect Dis 2018. [PMCID: PMC6253305 DOI: 10.1093/ofid/ofy210.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Since 2012, there has been a steady increase in the number of reported mumps cases and outbreaks in the United States, primarily affecting young, two-dose vaccinated adults. We analyzed epidemiologic characteristics of mumps cases reported nationally from 2016 to 2018. Methods We included confirmed and probable mumps cases transmitted from January 2016 to April 2018 by 52 health department jurisdictions (50 states, DC and NYC) that report cases to the National Notifiable Diseases Surveillance System (NNDSS). We calculated overall and age-specific incidence rates (IR) by dividing the annual number of mumps cases by the corresponding US Census Bureau’s Bridged Race population estimates. Cases were reported as outbreak-related or non-related in NNDSS by the submitting jurisdiction. Results Between January 1, 2016–April 21, 2018, 13,348 mumps cases (n = 6,369 in 2016, n = 6,056 in 2017 and n = 923 in 2018) were reported to NNDSS. IRs were 20, 19, and 2.9/million population in 2016, 2017, and January–April 2018, respectively. Young adults (18–22 years) had the highest IR: 88, 76, and 7.3/million population in 2016, 2017, and 2018, respectively. During January–April timeframe, 348 more cases were reported in 2016 (IR = 3.8/million) and almost four times as many cases were reported in 2017 (n = 3,376, IR = 10.5/million) compared with 2018 (P < 0.0001). The number of jurisdictions that reported cases in the first 4 months of each year was 39, 44, and 47 in 2016, 2017, and 2018, respectively. During the same timeframe, the number of outbreak-related cases reported was lower in 2018 (n = 523) vs. 2017 (n = 2,350) and 2016 (n = 1,271) (P < 0.0001), and the number of jurisdictions reporting outbreak-related cases was lower in 2018 (n = 16) vs. 2017 (n = 32, P = 0.002) and 2016 (n = 22, P = 0.23). Conclusion Preliminary data suggest that the overall and outbreak-related mumps cases may be decreasing in 2018 after 2 years of increased reports. However, the number of jurisdictions reporting mumps cases has not decreased. Thorough investigations of sporadic cases may lead to improved identification of epidemiologic linkages and earlier identification of outbreaks. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Nakia Clemmons
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adria Lee
- Ihrc, Inc., Contracting Agency to the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adriana S Lopez
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Manisha Patel
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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18
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McKay SL, Lee AD, Lopez AS, Nix WA, Dooling KL, Keaton AA, Spence-Davizon E, Herlihy R, Clark TA, Hopkins SE, Pastula DM, Sejvar J, Oberste MS, Pallansch MA, Patel M, Routh JA. Increase in Acute Flaccid Myelitis - United States, 2018. MMWR Morb Mortal Wkly Rep 2018; 67:1273-1275. [PMID: 30439867 PMCID: PMC6290805 DOI: 10.15585/mmwr.mm6745e1] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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19
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Rice ME, Bannerman M, Marin M, Lopez AS, Lewis MM, Stamatakis CE, Regan JJ. Maritime varicella illness and death reporting, U.S., 2010-2015. Travel Med Infect Dis 2018; 23:27-33. [PMID: 29621623 PMCID: PMC6624850 DOI: 10.1016/j.tmaid.2018.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/22/2018] [Accepted: 04/01/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ships destined for, or departing from, U.S. ports of entry must report certain signs and symptoms of potentially communicable diseases of public health interest among travelers to the Division of Global Migration and Quarantine (DGMQ) at the Centers for Disease Control and Prevention. METHODS We reviewed ships' varicella case and outbreak reports from January 2010 through December 2015. RESULTS DGMQ received 967 reports of varicella and 13 reports of herpes zoster. Most varicella case-patients were 20-49 years of age (84.7%, 472/557) and were cruise ship crew members (78.4%, 758/967). Most often, cruise ship crew member case-patients were born in or held passports from Indonesia (21.7%, 80/369), Philippines (17.6%, 65/369), or India (17.3%, 64/369). Ninety-nine varicella outbreaks were reported, including 439 varicella cases and one herpes zoster case; 97 (98.0%) outbreaks occurred on cruise ships, and 90.2% of associated cases were among crew members (397/440). Most varicella cases were in crew members, who are adults often from tropical regions where varicella immunity is acquired later in childhood or young adulthood or without varicella vaccination programs. CONCLUSION Varicella vaccination as appropriate for susceptible travelers, particularly crew members, before maritime travel may decrease risk of varicella infection and prevent outbreaks on ships.
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Affiliation(s)
- Marion E Rice
- Division of Global Migration and Quarantine (DGMQ), Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA 30329-4018, United States; Emory University, Rollins School of Public Health, Atlanta, GA, United States.
| | | | - Mona Marin
- Division of Viral Diseases (DVD), CDC, 1600 Clifton Road NE, Atlanta, GA 30329-4018, United States.
| | - Adriana S Lopez
- Division of Viral Diseases (DVD), CDC, 1600 Clifton Road NE, Atlanta, GA 30329-4018, United States.
| | - Melissa M Lewis
- Division of Global Migration and Quarantine (DGMQ), Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA 30329-4018, United States.
| | - Caroline E Stamatakis
- Division of Global Migration and Quarantine (DGMQ), Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA 30329-4018, United States; Council of State and Territorial Epidemiologists, Atlanta, GA, USA.
| | - Joanna J Regan
- Division of Global Migration and Quarantine (DGMQ), Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA 30329-4018, United States.
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20
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Lopez AS, Lanzieri TM, Claussen AH, Vinson SS, Turcich MR, Iovino IR, Voigt RG, Caviness AC, Miller JA, Williamson WD, Hales CM, Bialek SR, Demmler-Harrison G. Intelligence and Academic Achievement With Asymptomatic Congenital Cytomegalovirus Infection. Pediatrics 2017; 140:peds.2017-1517. [PMID: 29066580 PMCID: PMC5654402 DOI: 10.1542/peds.2017-1517] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine intelligence, language, and academic achievement through 18 years of age among children with congenital cytomegalovirus infection identified through hospital-based newborn screening who were asymptomatic at birth compared with uninfected infants. METHODS We used growth curve modeling to analyze trends in IQ (full-scale, verbal, and nonverbal intelligence), receptive and expressive vocabulary, and academic achievement in math and reading. Separate models were fit for each outcome, modeling the change in overall scores with increasing age for patients with normal hearing (n = 78) or with sensorineural hearing loss (SNHL) diagnosed by 2 years of age (n = 11) and controls (n = 40). RESULTS Patients with SNHL had full-scale intelligence and receptive vocabulary scores that were 7.0 and 13.1 points lower, respectively, compared with controls, but no significant differences were noted in these scores among patients with normal hearing and controls. No significant differences were noted in scores for verbal and nonverbal intelligence, expressive vocabulary, and academic achievement in math and reading among patients with normal hearing or with SNHL and controls. CONCLUSIONS Infants with asymptomatic congenital cytomegalovirus infection identified through newborn screening with normal hearing by age 2 years do not appear to have differences in IQ, vocabulary or academic achievement scores during childhood, or adolescence compared with uninfected children.
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Affiliation(s)
| | | | - Angelika H. Claussen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sherry S. Vinson
- Texas Children’s Hospital, Houston, Texas;,Baylor College of Medicine, Houston, Texas; and
| | - Marie R. Turcich
- Texas Children’s Hospital, Houston, Texas;,Baylor College of Medicine, Houston, Texas; and
| | - Isabella R. Iovino
- Texas Children’s Hospital, Houston, Texas;,Baylor College of Medicine, Houston, Texas; and
| | - Robert G. Voigt
- Texas Children’s Hospital, Houston, Texas;,Baylor College of Medicine, Houston, Texas; and
| | | | - Jerry A. Miller
- Texas Children’s Hospital, Houston, Texas;,P3S Corporation, San Antonio, Texas
| | | | - Craig M. Hales
- National Center for Immunization and Respiratory Diseases, and
| | | | - Gail Demmler-Harrison
- Texas Children’s Hospital, Houston, Texas;,Baylor College of Medicine, Houston, Texas; and
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Leung J, Reagan-Steiner S, Lopez AS, Jeyarajah J, Marin M. Varicella Vaccination Coverage among Adolescents Ages 13–17 Years, United States, National Immunization Survey, 2007–2014. Open Forum Infect Dis 2017. [PMCID: PMC5631782 DOI: 10.1093/ofid/ofx163.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Varicella is typically a self-limiting disease but it can be more severe in adolescents and adults. In 2007, 2-doses of varicella vaccine were routinely recommended for children, with a catch-up second dose for persons who received 1 prior dose.
Methods
We used 2007–2014 NIS-Teen data to examine trends in ≥2 dose varicella vaccination coverage and proportions of adolescents with/without evidence of immunity to varicella. Evidence of immunity included receipt of ≥2 doses of varicella vaccine or varicella disease history. Additionally, using 2014 data, we assessed characteristics of ≥2 dose varicella vaccination coverage: 1) factors associated with ≥2 dose vaccination, 2) timing of receipt of second dose and 3) missed opportunities for second dose vaccination among adolescents who had received 1 prior dose of varicella vaccine.
Results
During 2007–2014, the proportion of adolescents with ≥2 doses of varicella vaccine increased from 8.3% to 66.9% in 13–15 year olds, and from 3.6% to 56.7% in 16–17 year olds. The proportion of adolescents with evidence of varicella immunity also increased for both age groups, from 68.0% to 84.1% in 13–15 year olds and from 78.6% to 83.4% in 16–17 year olds. Among adolescents who received ≥2 doses of varicella vaccine by 2014, a higher proportion of 13–15 year olds received their second dose at 4–6 years compared with 16–17 year olds (13.4% vs. 3.2%). Factors significantly associated with lower ≥2 dose coverage included non-Hispanic White race/ethnicity; rural residence; living at >133% of the income-to-poverty ratio; no 11- to 12-year well-child visit; not receiving an adolescent vaccine; and residence in a state with no 2-dose immunization school entry requirement. Among the 2,478 adolescents who received only 1-dose of varicella vaccine, 77.1% (1,922) had at least 1 missed opportunity to receive their second dose; potentially 2-dose coverage could have increased from 79.5% to 94.8%.
Conclusion
The ≥2-dose varicella vaccination coverage and the proportion of adolescents with evidence of immunity to varicella increased during 2007 to 2014, though 16% lacked evidence of immunity in 2014. Though catch-up campaigns have succeeded, decreasing missed vaccination opportunities will help with further improvement.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Jessica Leung
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Adriana S Lopez
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Mona Marin
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Varan AK, Lederman ER, Stous SS, Elson D, Freiman JL, Marin M, Lopez AS, Stauffer WM, Joseph RH, Waterman SH. Serological Susceptibility to Varicella Among U.S. Immigration and Customs Enforcement Detainees. J Correct Health Care 2017; 24:84-95. [PMID: 28945148 DOI: 10.1177/1078345817727287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
U.S. Immigration and Customs Enforcement (ICE) is responsible for detaining unauthorized aliens during immigration proceedings. During 2014 to 2015, adult ICE detainees at a California facility were invited to complete a survey concerning self-reported varicella history and risk factors. Participants underwent serological testing for varicella-zoster virus (VZV) IgG; susceptible individuals were offered varicella vaccination. Among 400 detainees with available serology results, 48 (12%) were susceptible to varicella. Self-reported varicella history was negatively associated with susceptibility (adjusted odds ratio = 0.16; 95% confidence interval [0.07, 0.35]). Among 196 detainees reporting a positive history, 95% had VZV IgG levels suggestive of varicella immunity. Among 44 susceptible detainees offered vaccination, 86% accepted. Given relatively high varicella susceptibility, targeted screening and vaccination among ICE detainees lacking a positive history might reduce varicella transmission risks.
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Affiliation(s)
- Aiden K Varan
- 1 CDC/CSTE Applied Epidemiology Fellowship Program, Atlanta, GA, USA.,2 Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, San Diego, CA, USA.,3 County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Edith R Lederman
- 4 Immigration and Customs Enforcement Health Service Corps, San Diego, CA, USA
| | - Shanon S Stous
- 4 Immigration and Customs Enforcement Health Service Corps, San Diego, CA, USA
| | - Diana Elson
- 5 Immigration and Customs Enforcement Health Service Corps, Washington, DC, USA
| | - Jennifer L Freiman
- 5 Immigration and Customs Enforcement Health Service Corps, Washington, DC, USA
| | - Mona Marin
- 6 Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA
| | - Adriana S Lopez
- 6 Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA
| | - William M Stauffer
- 7 Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA.,8 Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Rachael H Joseph
- 7 Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephen H Waterman
- 9 Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
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Marin M, Lopez AS, Leung J, Schmid DS, Harpaz R. Varicella Vaccination in the United States: Two Decades of Experience With Program Implementation. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mona Marin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jessica Leung
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - D. Scott Schmid
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rafael Harpaz
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Lopez AS, Zhang J, Marin M. Epidemiology of Varicella During the 2-Dose Varicella Vaccination Program - United States, 2005-2014. MMWR Morb Mortal Wkly Rep 2016; 65:902-5. [PMID: 27584717 DOI: 10.15585/mmwr.mm6534a4] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Before availability of varicella vaccine in the United States, an estimated 4 million varicella cases, 11,000-13,500 varicella-related hospitalizations, and 100-150 varicella-related deaths occurred annually. The varicella vaccination program was implemented in the United States in 1996 as a 1-dose routine childhood program. Based on data from two varicella active surveillance sites, the varicella vaccination program led to 90% decline in incidence over the next decade (1). However, because of continued varicella outbreaks, a routine 2-dose schedule (at ages 12-15 months and 4-6 years) was recommended and has been in place since 2006 (2). The declines in incidence (1,3-6) made it feasible for states to implement varicella case-based surveillance and to report varicella data to CDC through the National Notifiable Diseases Surveillance System (NNDSS). State data have become the primary source for monitoring trends in varicella incidence nationally (7). Using NNDSS data, CDC previously reported nationwide declines in varicella incidence of 72% from the end of the 1-dose to the early years of the 2-dose varicella vaccination program (2006-2010) (7). This report updates varicella incidence trends to include the most recent years in the 2-dose varicella vaccination program. Between the period 2005-2006 (before the 2-dose recommendation) and 2013-2014, overall varicella incidence declined 84.6%, with the largest declines reported in children aged 5-9 years (89.3%) and 10-14 years (84.8%). The availability of varicella-specific data varied over time. During the last 2 years examined (2013 and 2014), completeness of reporting of two critical variables monitored by CDC, vaccination status (receipt of at least 1 dose of varicella vaccine) of cases and severity of disease based on number of lesions, were 54.2% and 39.1%, respectively. State and local health departments, in collaboration with CDC, should continue working to improve reporting of cases and completeness of critical varicella-specific variables to better monitor impact of the varicella vaccination program.
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Affiliation(s)
- Adriana S Lopez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
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Sejvar JJ, Lopez AS, Cortese MM, Leshem E, Pastula DM, Miller L, Glaser C, Kambhampati A, Shioda K, Aliabadi N, Fischer M, Gregoricus N, Lanciotti R, Nix WA, Sakthivel SK, Schmid DS, Seward JF, Tong S, Oberste MS, Pallansch M, Feikin D. Acute Flaccid Myelitis in the United States, August-December 2014: Results of Nationwide Surveillance. Clin Infect Dis 2016; 63:737-745. [PMID: 27318332 DOI: 10.1093/cid/ciw372] [Citation(s) in RCA: 153] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/20/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND During late summer/fall 2014, pediatric cases of acute flaccid myelitis (AFM) occurred in the United States, coincident with a national outbreak of enterovirus D68 (EV-D68)-associated severe respiratory illness. METHODS Clinicians and health departments reported standardized clinical, epidemiologic, and radiologic information on AFM cases to the Centers for Disease Control and Prevention (CDC), and submitted biological samples for testing. Cases were ≤21 years old, with acute onset of limb weakness 1 August-31 December 2014 and spinal magnetic resonance imaging (MRI) showing lesions predominantly restricted to gray matter. RESULTS From August through December 2014, 120 AFM cases were reported from 34 states. Median age was 7.1 years (interquartile range, 4.8-12.1 years); 59% were male. Most experienced respiratory (81%) or febrile (64%) illness before limb weakness onset. MRI abnormalities were predominantly in the cervical spinal cord (103/118). All but 1 case was hospitalized; none died. Cerebrospinal fluid (CSF) pleocytosis (>5 white blood cells/µL) was common (81%). At CDC, 1 CSF specimen was positive for EV-D68 and Epstein-Barr virus by real-time polymerase chain reaction, although the specimen had >3000 red blood cells/µL. The most common virus detected in upper respiratory tract specimens was EV-D68 (from 20%, and 47% with specimen collected ≤7 days from respiratory illness/fever onset). Continued surveillance in 2015 identified 16 AFM cases reported from 13 states. CONCLUSIONS Epidemiologic data suggest this AFM cluster was likely associated with the large outbreak of EV-D68-associated respiratory illness, although direct laboratory evidence linking AFM with EV-D68 remains inconclusive. Continued surveillance will help define the incidence, epidemiology, and etiology of AFM.
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Affiliation(s)
- James J Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases
| | - Adriana S Lopez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Margaret M Cortese
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eyal Leshem
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel M Pastula
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins
| | - Lisa Miller
- Epidemiology Division, Colorado Department of Public Health and Environment, Denver
| | - Carol Glaser
- Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Anita Kambhampati
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute of Science and Education, Tennessee
| | - Kayoko Shioda
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute of Science and Education, Tennessee
| | - Negar Aliabadi
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marc Fischer
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins
| | - Nicole Gregoricus
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert Lanciotti
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins
| | - W Allan Nix
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Senthilkumar K Sakthivel
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - D Scott Schmid
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jane F Seward
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Suxiang Tong
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M Steven Oberste
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark Pallansch
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel Feikin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Jones JL, Akstein RB, Hlavsa MC, Lopez AS, Wilson M, Holland GN. Follow-up of the 1977 Georgia Outbreak of Toxoplasmosis. Am J Trop Med Hyg 2016; 94:1299-300. [PMID: 27044565 DOI: 10.4269/ajtmh.15-0919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/02/2016] [Indexed: 11/07/2022] Open
Abstract
In 1977, an outbreak of toxoplasmosis occurred among 37 persons associated with exposure to an indoor horse arena. Cat feces containing the organism were most likely stirred up when horses ran on the dirt floor, and were inhaled or ingested by riders and observers. After 25 or more years, we attempted to locate persons from the outbreak and offer them an eye examination. Of the 37 persons in the outbreak, 18 (49%) were located; four had died, and the remaining 14 agreed to an examination. Among the 14 persons examined, three (21%) were found to have lesions typical of toxoplasmic retinochoroiditis. If these three persons were the only ones with ocular disease among the 37 persons in the outbreak, the disease rate would still be high (8%). As a result of exposure to Toxoplasma gondii during this outbreak, a relatively high percentage of persons developed ocular disease.
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Affiliation(s)
- Jeffrey L Jones
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Ophthalmology, Akstein Eye Center, Riverdale, Georgia; Jules Stein Eye Institute, University of California, Los Angeles (UCLA), Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Ricardo B Akstein
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Ophthalmology, Akstein Eye Center, Riverdale, Georgia; Jules Stein Eye Institute, University of California, Los Angeles (UCLA), Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Michele C Hlavsa
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Ophthalmology, Akstein Eye Center, Riverdale, Georgia; Jules Stein Eye Institute, University of California, Los Angeles (UCLA), Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Adriana S Lopez
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Ophthalmology, Akstein Eye Center, Riverdale, Georgia; Jules Stein Eye Institute, University of California, Los Angeles (UCLA), Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Mariana Wilson
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Ophthalmology, Akstein Eye Center, Riverdale, Georgia; Jules Stein Eye Institute, University of California, Los Angeles (UCLA), Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Gary N Holland
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Ophthalmology, Akstein Eye Center, Riverdale, Georgia; Jules Stein Eye Institute, University of California, Los Angeles (UCLA), Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California
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Perella D, Wang C, Civen R, Viner K, Kuguru K, Daskalaki I, Schmid DS, Lopez AS, Tseng HF, Newbern EC, Mascola L, Bialek SR. Varicella Vaccine Effectiveness in Preventing Community Transmission in the 2-Dose Era. Pediatrics 2016; 137:peds.2015-2802. [PMID: 26977081 PMCID: PMC4887293 DOI: 10.1542/peds.2015-2802] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We examined overall and incremental effectiveness of 2-dose varicella vaccination in preventing community transmission of varicella among children aged 4 to 18 years in 2 active surveillance sites. One-dose varicella vaccine effectiveness (VE) was examined in those aged 1 to 18 years. METHODS From May 2009 through June 2011, varicella cases identified during active surveillance in Antelope Valley, CA and Philadelphia, PA were enrolled into a matched case-control study. Matched controls within 2 years of the patient's age were selected from immunization registries. A standardized questionnaire was administered to participants' parents, and varicella vaccination history was obtained from health care provider, immunization registry, or parent records. We used conditional logistic regression to estimate varicella VE against clinically diagnosed and laboratory-confirmed varicella. RESULTS A total of 125 clinically diagnosed varicella cases and 408 matched controls were enrolled. Twenty-nine cases were laboratory confirmed. One-dose VE (1-dose versus unvaccinated) was 75.6% (95% confidence interval [CI], 38.7%-90.3%) in preventing any clinically diagnosed varicella and 78.1% (95% CI, 12.7%-94.5%) against moderate or severe, clinically diagnosed disease (≥50 lesions). Among subjects aged ≥4 years, 2-dose VE (2-dose versus unvaccinated) was 93.6% (95% CI, 75.6%-98.3%) against any varicella and 97.9% (95% CI, 83.0%-99.7%) against moderate or severe varicella. Incremental effectiveness (2-dose versus 1-dose) was 87.5% against clinically diagnosed varicella and 97.3% against laboratory-confirmed varicella. CONCLUSIONS Two-dose varicella vaccination offered better protection against varicella from community transmission among school-aged children compared with 1-dose vaccination.
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Affiliation(s)
- Dana Perella
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania;
| | - Chengbin Wang
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Rachel Civen
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kendra Viner
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Karen Kuguru
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Irini Daskalaki
- Los Angeles County Department of Public Health, Los Angeles, California
| | - D. Scott Schmid
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | | | - Hung Fu Tseng
- Southern California Permanente Medical Group, Kaiser Permanente, Pasadena, CA
| | - E. Claire Newbern
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Laurene Mascola
- Los Angeles County Department of Public Health, Los Angeles, California
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Yoshida T, Zhang G, Smith MA, Lopez AS, Bai Y, Li J. Correction: Tyrosine Phosphoproteomics Identifies Both Codrivers and Cotargeting Strategies for T790M-Related EGFR-TKI Resistance in Non-Small Cell Lung Cancer. Clin Cancer Res 2015; 21:3571. [PMID: 26240294 DOI: 10.1158/1078-0432.ccr-15-1183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lopez AS, Lichtenstein M, Schmid DS, Bialek S. Assessment of varicella surveillance and outbreak control practices - United States, 2012. MMWR Morb Mortal Wkly Rep 2014; 63:785-8. [PMID: 25211543 PMCID: PMC4584694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Case-based varicella (chickenpox) surveillance is important for monitoring the impact of the varicella vaccination program. In 2002, the Council of State and Territorial Epidemiologists (CSTE) recommended that all states move toward case-based varicella surveillance by 2005; in 2003, varicella was made nationally notifiable. To ease the transition to case-based reporting, CSTE and CDC recommended starting with sentinel site or outbreak surveillance and then moving to statewide case-based surveillance when feasible. To gauge progress in varicella surveillance, in 2012 CDC and CSTE developed a survey for assessing varicella surveillance practices, which CSTE administered to all states and the District of Columbia (DC). As of 2012, varicella was reportable in 44 (86.3%) of the 51 jurisdictions surveyed, of which 37 (84.1%) conduct statewide case-based surveillance. Of the 38 jurisdictions conducting statewide or sentinel site varicella case-based surveillance, more than 84% reported collecting information on age, sex, and race/ethnicity (all 97.4%), vaccination status (94.7%), outbreak association (86.8%), and disease severity (84.2%). Nineteen (43.2%) of the 44 jurisdictions where reporting was mandated transmitted varicella-specific data to CDC using Health Level 7 (HL7) messaging. Currently, HL7 messaging is the only mechanism available for states to send varicella-specific data to CDC. Although public health agencies have made much progress to strengthen varicella surveillance throughout the United States, strategies are needed to facilitate transmission of varicella-specific data to CDC from all jurisdictions, using HL7 messaging, and to increase the number of jurisdictions collecting the varicella-specific data necessary to monitor varicella epidemiology and the impact of the vaccination program nationally.
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Affiliation(s)
- Adriana S. Lopez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC,Corresponding author: Adriana S. Lopez, , 404-639-8369
| | | | - D. Scott Schmid
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Stephanie Bialek
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
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Leung J, Lopez AS, Tootell E, Baumrind N, Mohle-Boetani J, Leistikow B, Harriman KH, Preas CP, Cosentino G, Bialek SR, Marin M. Challenges with controlling varicella in prison settings: experience of California, 2010 to 2011. J Correct Health Care 2014; 20:292-301. [PMID: 25201912 DOI: 10.1177/1078345814541535] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article describes the epidemiology of varicella in one state prison in California during 2010 and 2011, control measures implemented, and associated costs. Eleven varicella cases were reported, of which nine were associated with two outbreaks. One outbreak consisted of three cases and the second consisted of six cases with two generations of spread. Among exposed inmates serologically tested, 98% (643/656) were varicella-zoster virus seropositive. The outbreaks resulted in > 1,000 inmates exposed, 444 staff exposures, and > $160,000 in costs. The authors documented the challenges and costs associated with controlling and managing varicella in a prison setting. A screening policy for evidence of varicella immunity for incoming inmates and staff and vaccination of susceptible persons has the potential to mitigate the impact of future outbreaks and reduce resources necessary to manage cases and outbreaks.
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Affiliation(s)
- Jessica Leung
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adriana S Lopez
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elena Tootell
- California Correctional Health Care Services, Elk Grove, CA, USA
| | - Nikki Baumrind
- California Correctional Health Care Services, Elk Grove, CA, USA
| | | | - Bruce Leistikow
- California Correctional Health Care Services, Elk Grove, CA, USA
| | | | | | | | - Stephanie R Bialek
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mona Marin
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Lopez AS, Cardemil C, Pabst LJ, Cullen KA, Leung J, Bialek SR. Two-dose varicella vaccination coverage among children aged 7 years--six sentinel sites, United States, 2006-2012. MMWR Morb Mortal Wkly Rep 2014; 63:174-7. [PMID: 24572613 PMCID: PMC4584524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In 2007, the Advisory Committee on Immunization Practices (ACIP) recommended a routine second dose of varicella vaccine for children at age 4-6 years, in addition to the first dose given at age 12-15 months. One strategy recommended for increasing varicella vaccination coverage is a school entry requirement of proof of varicella immunity. To determine the extent of implementation of the routine 2-dose varicella vaccination program, the number of states with a 2-dose varicella vaccination elementary school entry requirement in 2012 was compared with the number in 2007, and 2-dose varicella vaccination coverage during 2006 was compared with coverage in 2012 among children aged 7 years, using data from six Immunization Information System (IIS) sentinel sites. The number of states (including the District of Columbia) with a 2-dose varicella vaccination elementary school entry requirement increased from four in 2007 to 36 in 2012. Two-dose varicella vaccination coverage levels among children aged 7 years in the six IIS sentinel sites increased from a range of 3.6%-8.9% in 2006 to a range of 79.9%-92.0% in 2012 and were approaching the levels of 2-dose measles, mumps, and rubella (MMR) coverage, which had a range of 81.9%-94.0% in 2012. These increases suggest substantial progress in implementing the routine 2-dose varicella vaccination program in the first 6 years since its recommendation by ACIP. Wider adoption of 2-dose varicella vaccination school entry requirements might help progress toward the Healthy People 2020 target of 95% of kindergarten students having received 2 doses of varicella vaccine.
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Affiliation(s)
- Adriana S. Lopez
- Division of Viral Diseases,Corresponding author: Adriana S. Lopez, , 404-639-8369
| | - Cristina Cardemil
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Laura J. Pabst
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Karen A. Cullen
- Division of Parasitic Diseases and Malaria, Center for Global Health, CDC
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Bialek SR, Perella D, Zhang J, Mascola L, Viner K, Jackson C, Lopez AS, Watson B, Civen R. Impact of a routine two-dose varicella vaccination program on varicella epidemiology. Pediatrics 2013; 132:e1134-40. [PMID: 24101763 PMCID: PMC4620660 DOI: 10.1542/peds.2013-0863] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE One-dose varicella vaccination for children was introduced in the United States in 1995. In 2006, a second dose was recommended to further decrease varicella disease and outbreaks. We describe the impact of the 2-dose vaccination program on varicella incidence, severity, and outbreaks in 2 varicella active surveillance areas. METHODS We examined varicella incidence rates and disease characteristics in Antelope Valley (AV), CA, and West Philadelphia, PA, and varicella outbreak characteristics in AV during 1995-2010. RESULTS In 2010, varicella incidence was 0.3 cases per 1000 population in AV and 0.1 cases per 1000 population in West Philadelphia: 76% and 67% declines, respectively, since 2006 and 98% declines in both sites since 1995; incidence declined in all age groups during 2006-2010. From 2006-2010, 61.7% of case patients in both surveillance areas had been vaccinated with 1 dose of varicella vaccine and 7.5% with 2 doses. Most vaccinated case patients had <50 lesions with no statistically significant differences among 1- and 2-dose cases (62.8% and 70.3%, respectively). Varicella-related hospitalizations during 2006-2010 declined >40% compared with 2002-2005 and >85% compared with 1995-1998. Twelve varicella outbreaks occurred in AV during 2007-2010, compared with 47 during 2003-2006 and 236 during 1995-1998 (P < .01). CONCLUSIONS Varicella incidence, hospitalizations, and outbreaks in 2 active surveillance areas declined substantially during the first 5 years of the 2-dose varicella vaccination program. Declines in incidence across all ages, including infants who are not eligible for varicella vaccination, and adults, in whom vaccination levels are low, provide evidence of the benefit of high levels of immunity in the population.
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Affiliation(s)
- Stephanie R. Bialek
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dana Perella
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - John Zhang
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laurene Mascola
- County of Los Angeles Department of Public Health, Los Angeles, California
| | - Kendra Viner
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Christina Jackson
- County of Los Angeles Department of Public Health, Los Angeles, California
| | - Adriana S. Lopez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Barbara Watson
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Rachel Civen
- County of Los Angeles Department of Public Health, Los Angeles, California
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Hyde TB, Andrus JK, Dietz VJ, Andrus JK, Hyde TB, Lee CE, Widdowson MA, Verani JR, Friedman C, Azziz-Baumgartner E, Lopez AS, Jumaan A, Dietz VJ. Critical issues in implementing a national integrated all-vaccine preventable disease surveillance system. Vaccine 2013; 31 Suppl 3:C94-8. [PMID: 23777699 DOI: 10.1016/j.vaccine.2013.05.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 04/29/2013] [Accepted: 05/08/2013] [Indexed: 11/18/2022]
Abstract
In 2007, the World Health Organization published the Global Framework for Immunization Monitoring and Surveillance (GFIMS) outlining measures to enhance national surveillance for vaccine preventable diseases (VPDs). The GFIMS emphasized that VPD surveillance should be integrated and placed in a 'unified framework' building upon the strengths of existing surveillance systems to prevent duplication of activities common to all surveillance systems and to minimize human resource and supply expenditures. Unfortunately, there was little experience in actually developing integrated VPD surveillance. We describe the process of developing operational guidance for ministries of health to implement such an integrated surveillance system for multiple VPDs.
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Affiliation(s)
- Terri B Hyde
- Global Immunization Division, US Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA 30333, USA.
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Behrman A, Lopez AS, Chaves SS, Watson BM, Schmid DS. Varicella immunity in vaccinated healthcare workers. J Clin Virol 2013; 57:109-14. [DOI: 10.1016/j.jcv.2013.01.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 01/22/2013] [Accepted: 01/23/2013] [Indexed: 02/04/2023]
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Chaves SS, Lopez AS, Watson TL, Civen R, Watson B, Mascola L, Seward JF. Varicella in infants after implementation of the US varicella vaccination program. Pediatrics 2011; 128:1071-7. [PMID: 22123875 DOI: 10.1542/peds.2011-0017] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe varicella disease in infants since implementation of the varicella vaccination program in the United States. PATIENTS AND METHODS From 1995 to 2008, demographic, clinical, and epidemiologic data on cases of varicella in infants were collected prospectively through a community-based active surveillance project. We examined disease patterns for infants in 2 age groups: 0 to 5 and 6 to 11 months. RESULTS Infant varicella disease incidence declined 89.7% from 1995 to 2008. Infants aged 0 to 5 months had milder clinical disease than those aged 6 to 11 months: ≥50 lesions, 49% vs 58% (P = .038); fever (body temperature > 38°C), 12% vs 21% (P = .014); and varicella-related complications, 6% vs 14% (P = .009), respectively. Age was an independent predictor of the occurrence of complications. CONCLUSIONS The varicella vaccination program has resulted in substantial indirect benefits for infants, who are not eligible for vaccination. Presence of maternal varicella-zoster virus antibodies might explain attenuated disease in very young infants likely born to mothers with history of varicella. Although varicella disease incidence has declined, exposure to varicella-zoster virus continues to occur. Improving varicella vaccination coverage in all age groups will further reduce the risk of varicella exposure and protect those not eligible for varicella vaccination.
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Affiliation(s)
- Sandra S Chaves
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Abstract
OBJECTIVE To describe the effect of the mature 1-dose varicella vaccination program on varicella morbidity, we analyzed 2 national databases for varicella-related hospitalizations in the United States since implementation of the varicella vaccination program in 1995. PATIENTS AND METHODS Data from the National Hospital Discharge Survey and Nationwide Inpatient Sample were analyzed to describe trends in varicella-related hospitalizations during the 1-dose vaccination era (2000-2006) compared with those in the prevaccination era (1988-1995). Varicella-related hospitalizations were defined by using International Classification of Diseases, Ninth Revision codes. Results were extrapolated to represent national estimates. RESULTS Using National Hospital Discharge Survey data, 24,488 varicella-related hospitalizations were estimated to occur in the United States during the 1-dose vaccination era. The varicella-related hospitalization rate was 0.12 per 10,000 population during the 1-dose vaccination era versus 0.42 per 10,000 population in the prevaccination era (P < .01). During the 1-dose vaccination era, the estimated annual average number of varicella-related hospitalizations was significantly lower and decreased by ≥ 65% in all age groups compared with those in the prevaccination era (P < .001 in all age groups). The varicella-related hospitalization rate during the 1-dose vaccination era estimated from the Nationwide Inpatient Sample was 0.09 per 10,000 population. CONCLUSIONS Varicella-related hospitalization numbers and rates declined significantly during the 1-dose varicella vaccination era. Assuming declines in varicella-related hospitalizations are due, mainly, to the routine childhood varicella vaccination program, these data suggest that varicella vaccination prevented ∼ 50,000 varicella-related hospitalizations in the United States from 2000 to 2006.
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Affiliation(s)
- Adriana S. Lopez
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John Zhang
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cedric Brown
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie Bialek
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Reynolds MA, Chaves SS, Harpaz R, Lopez AS, Seward JF. The impact of the varicella vaccination program on herpes zoster epidemiology in the United States: a review. J Infect Dis 2008; 197 Suppl 2:S224-7. [PMID: 18419401 DOI: 10.1086/522162] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Speculation that a universal varicella vaccination program might lead to an increase in herpes zoster (HZ) incidence has been supported by modeling studies that assume that exposure to varicella boosts immunity and protects against reactivation of varicella-zoster virus (VZV) as HZ. Such studies predict an increase in HZ incidence until the adult population becomes predominantly composed of individuals with vaccine-induced immunity who do not harbor wild-type VZV. In the United States, a varicella vaccination program was implemented in 1995. Since then, studies monitoring HZ incidence have shown inconsistent findings: 2 studies have shown no increase in overall incidence, whereas 1 study has shown an increase. Studies from Canada and the United Kingdom have shown increasing rates of HZ incidence in the absence of a varicella vaccination program. Data suggest that heretofore unidentified risk factors for HZ also are changing over time. Further studies are needed to identify these factors, to isolate possible additional effects from a varicella vaccination program. Untangling the contribution of these different factors on HZ epidemiology will be challenging.
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Affiliation(s)
- Meredith A Reynolds
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Lopez AS, Kolasa MS, Seward JF. Status of school entry requirements for varicella vaccination and vaccination coverage 11 years after implementation of the varicella vaccination program. J Infect Dis 2008; 197 Suppl 2:S76-81. [PMID: 18419414 DOI: 10.1086/522139] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We reviewed progress toward adoption of day care and school entry requirements in each state and the District of Columbia (DC) and compared varicella vaccination coverage by state to year of implementation of day care entry requirements. By the start of the 2006-2007 school year, 46 states (92%) and DC had implemented entry requirements for varicella vaccination. Between 1997 and 2005, national varicella vaccination coverage among children 19-35 months of age increased from 25.8% to 87.9%. Implementation of day care entry requirements in 2000 or earlier was associated with higher vaccination coverage (> or =90%; P=.002). Implementation of day care and school entry requirements for varicella vaccination is an important strategy for achieving and maintaining high vaccination coverage among preschool- and school-aged children in the United States. The newly adopted vaccine policy recommendation of 2 doses of varicella vaccine for all school-aged children should be incorporated into the states' school entry requirements.
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Affiliation(s)
- Adriana S Lopez
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Lopez AS, Burnett-Hartman A, Nambiar R, Ritz L, Owens P, Loparev VN, Guris D, Schmid DS. Transmission of a newly characterized strain of varicella-zoster virus from a patient with herpes zoster in a long-term-care facility, West Virginia, 2004. J Infect Dis 2008; 197:646-53. [PMID: 18260757 DOI: 10.1086/527419] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We investigated a small outbreak of varicella in a long-term-care facility after a case of herpes zoster. Clinical specimens and environmental samples were collected from all case patients and from surfaces in the case patients' rooms and other common-use areas. Wild-type varicella-zoster virus (VZV) DNA was identified in all 3 varicella case patients, and high concentrations of VZV DNA were detected in environmental samples from the room of the herpes zoster case patient. Genotypic analysis showed that the identical VZV strain was present in all samples; moreover, the strain was a unique Mosaic genotype isolate that included a stable Oka vaccine marker that had hitherto never been observed in a wild-type strain of VZV. This study provides evidence for the value of including environmental sampling during the investigation of varicella outbreaks and illustrates the importance of evaluating multiple vaccine-associated markers for the discrimination of vaccine virus from wild-type VZV.
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Affiliation(s)
- Adriana S Lopez
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Civen R, Lopez AS, Zhang J, Garcia-Herrera J, Schmid DS, Chaves SS, Mascola L. Varicella Outbreak Epidemiology in an Active Surveillance Site, 1995–2005. J Infect Dis 2008; 197 Suppl 2:S114-9. [PMID: 18419383 DOI: 10.1086/522144] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Rachel Civen
- Los Angeles County Department of Public Health, Los Angeles, California 90012, USA.
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Lopez AS, Guris D, Zimmerman L, Gladden L, Moore T, Haselow DT, Loparev VN, Schmid DS, Jumaan AO, Snow SL. One dose of varicella vaccine does not prevent school outbreaks: is it time for a second dose? Pediatrics 2006; 117:e1070-7. [PMID: 16740809 DOI: 10.1542/peds.2005-2085] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The implementation of a routine childhood varicella vaccination program in the United States in 1995 has resulted in a dramatic decline in varicella morbidity and mortality. Although disease incidence has decreased, outbreaks of varicella continue to be reported, increasingly in highly vaccinated populations. In 2000, a varicella vaccination requirement was introduced for kindergarten entry in Arkansas. In October 2003, large numbers of varicella cases were reported in a school with high vaccination coverage. We investigated this outbreak to examine transmission patterns of varicella in this highly vaccinated population, to estimate the effectiveness of 1 dose of varicella vaccine, to identify risk factors for vaccine failure, and to implement outbreak control measures. METHODS A retrospective cohort study involving students attending an elementary school was conducted. A questionnaire was distributed to parents of all of the students in the school to collect varicella disease and vaccination history; parents of varicella case patients were interviewed by telephone. A case of varicella was defined as an acute, generalized, maculopapulovesicular rash without other apparent cause in a student or staff member in the school from September 1 to November 20, 2003. Varicella among vaccinated persons was defined as varicella-like rash that developed >42 days after vaccination. In vaccinated persons, the rash may be atypical, maculopapular with few or no vesicles. Cases were laboratory confirmed by polymerase chain reaction, and genotyping was performed to identify the strain associated with the outbreak. RESULTS Of the 545 students who attended the school, 88% returned the questionnaire. Overall varicella vaccination coverage was 96%. Forty-nine varicella cases were identified; 43 were vaccinated. Three of 6 specimens tested were positive by polymerase chain reaction. The median age at vaccination of vaccinated students in the school was 18 months, and the median time since vaccination was 59 months. Forty-four cases occurred in the East Wing, where 275 students in grades kindergarten through 2 were located, and vaccination coverage was 99%. In this wing, varicella attack rates among unvaccinated and vaccinated students were 100% and 18%, respectively. Vaccine effectiveness against varicella of any severity was 82% and 97% for moderate/severe varicella. Vaccinated cases were significantly milder compared with unvaccinated cases. Among the case patients in the East Wing, the median age at vaccination was 18.5 and 14 months among non-case patients. Four cases in the West Wing did not result in further transmission in that wing. The Arkansas strains were the same as the common varicella-zoster virus strain circulating in the United States (European varicella-zoster virus strain). CONCLUSIONS Although disease was mostly mild, the outbreak lasted for approximately 2 months, suggesting that varicella in vaccinated persons was contagious and that 99% varicella vaccination coverage was not sufficient to prevent the outbreak. This investigation highlights several challenges related to the prevention and control of varicella outbreaks with the 1-dose varicella vaccination program and the need for further prevention of varicella through improved vaccine-induced immunity with a routine 2-dose vaccination program. The challenges include: 1-dose varicella vaccination not providing sufficient herd immunity levels to prevent outbreaks in school settings where exposure can be intense, the effective transmission of varicella among vaccinated children, and the difficulty in the diagnosis of mild cases in vaccinated persons and early recognition of outbreaks for implementing control measures. The efficacy of 2 doses of varicella vaccine compared with 1 dose was assessed in a trial conducted among healthy children who were followed for 10 years. The efficacy for 2 doses was significantly higher than for 1 dose of varicella vaccine. This higher efficacy translated into a 3.3-fold lower risk of developing varicella >42 days after vaccination in 2- vs 1-dose recipients. Of the children receiving 2 doses, 99% achieved a glycoprotein-based enzyme-linked immunosorbent assay level of > or =5 units (considered a correlate of protection) 6 weeks after vaccination compared with 86% of children who received 1 dose. The 6-week glycoprotein-based enzyme-linked immunosorbent assay level of > or =5 units has been shown to be a good surrogate for protection from natural disease. Ten years after the implementation of the varicella vaccination program, disease incidence has declined dramatically, and vaccination coverage has increased greatly. However, varicella outbreaks continue to occur among vaccinated persons. Although varicella disease among vaccinated persons is mild, they are contagious and able to sustain transmission. As a step toward better control of varicella outbreaks and to reduce the impact on schools and public health officials, in June 2005, the Advisory Committee on Immunization Practices recommended the use of a second dose of varicella vaccine in outbreak settings. Early recognition of outbreaks is important to effectively implement a 2-dose vaccination response and to prevent more cases. Although the current recommendation of providing a second dose of varicella vaccine during an outbreak offers a tool for controlling outbreaks, a routine 2-dose recommendation would be more effective at preventing cases. Based on published data on immunogenicity and efficacy of 2 doses of varicella vaccine, routine 2-dose vaccination will provide improved protection against disease and further reduce morbidity and mortality from varicella.
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Affiliation(s)
- Adriana S Lopez
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Lopez AS, Lett SM, Yih WK, Northrup J, Jumaan AO, Seward JF. Increasing evidence of immunity to varicella among children in Massachusetts, 1999-2003. Am J Prev Med 2006; 30:232-6. [PMID: 16476639 DOI: 10.1016/j.amepre.2005.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Revised: 09/26/2005] [Accepted: 10/26/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND Experiences with vaccine-preventable diseases have demonstrated the success of school-entry requirements in increasing vaccination coverage and decreasing disease incidence. This study examines the effect of early implementation of daycare and school-entry requirements for varicella vaccination on recorded varicella immunity of preschool and school-aged children in Massachusetts. METHODS Immunization surveys were conducted in licensed child care centers and schools with kindergarten and/or 7th grades. Evidence of immunity to varicella was defined as having physician verified records of varicella vaccination or disease history from the 1999-2000 through 2003-2004 school years. RESULTS During the 5-year study period, physician-certified reliable history of varicella disease decreased in each grade level while vaccination coverage increased. The increase in the number of children in each grade level receiving varicella vaccine led to an increase in the overall percentage of children with evidence of immunity to varicella: 85% to 97% for children aged 2 years or more in child care, 93% to 98% for children in kindergarten, and 88% to 92% for children in 7th grade. CONCLUSIONS The implementation of daycare and school-entry requirements for varicella vaccination within 4 years of the start of the varicella vaccination program in Massachusetts was associated with high levels of vaccination coverage in the cohorts of children targeted by the requirements. Although evidence of immunity from varicella disease decreased during the study period, the increase in varicella vaccination coverage compensated for the decline in disease history, resulting in a higher proportion of young children with evidence of immunity to varicella.
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Affiliation(s)
- Adriana S Lopez
- National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Roy SL, Lopez AS, Schantz PM. Trichinellosis surveillance--United States, 1997-2001. MMWR Surveill Summ 2003; 52:1-8. [PMID: 14532870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
PROBLEM/CONDITION Trichinellosis is a parasitic disease caused by tissue-dwelling roundworms of the species Trichinella spiralis. The organism is acquired by eating Trichinella-infected meat products. The disease has variable clinical manifestations, ranging from asymptomatic to fatal. In the United States, trichinellosis has caused hundreds of preventable cases of illness and occasional deaths. The national trichinellosis surveillance system has documented a steady decline in the reported incidence of this disease, as well as a change in its epidemiology. REPORTING PERIOD COVERED This report summarizes surveillance data for trichinellosis in the United States for 1997-2001. DESCRIPTION OF SYSTEM Trichinellosis became a nationally reportable disease in 1966, but statistics have been kept on the disease since 1947. The national trichinellosis surveillance system is a passive system that relies on existing resources at the local, state, and federal levels. Cases are diagnosed based on clinical history with laboratory confirmation. Cases are reported weekly to CDC through the National Electronic Telecommunications System for Surveillance (NETSS). Detailed data regarding signs and symptoms, diagnostic tests, and food consumption are gathered by using a supplementary standardized surveillance form and are reported to CDC by fax or mail. This information is compared with NETSS data several times a year by CDC staff. Discrepancies are reviewed with the state health departments. The purpose of the surveillance system is to determine the incidence of trichinellosis, to maintain awareness of the disease, to monitor epidemiologic changes, to identify outbreaks, to guide prevention efforts, and to measure the effectiveness of those efforts. RESULTS Although trichinellosis was associated historically with eating Trichinella-infected pork from domesticated sources, wild game meat was the most common source of infection during 1997-2001. During this 5-year period, 72 cases were reported to CDC. Of these, 31 (43%) cases were associated with eating wild game: 29 with bear meat, one with cougar meat, and one with wild boar meat. In comparison, only 12 (17%) cases were associated with eating commercial pork products, including four cases traced to a foreign source. Nine (13%) cases were associated with eating noncommercial pork from home-raised or direct-from-farm swine where U.S. commercial pork production industry standards and Regulations do not apply. INTERPRETATIONS The majority of the decline in reported trichinellosis cases is a result of improved observance of standards and regulations in the U.S. commercial pork industry, which has altered animal husbandry practices resulting in reduced Trichinella prevalence among swine. PUBLIC HEALTH ACTIONS Because of the change in epidemiology of trichinellosis and the continued occurrence of cases among consumers of wild game meat and noncommercial pork, more targeted public education is needed to further reduce the incidence of this disease.
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Affiliation(s)
- Sharon L Roy
- Division of Parasitic Diseases, National Center for Infectious Diseases, USA
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Lopez AS, Bendik JM, Alliance JY, Roberts JM, da Silva AJ, Moura INS, Arrowood MJ, Eberhard ML, Herwaldt BL. Epidemiology of Cyclospora cayetanensis and other intestinal parasites in a community in Haiti. J Clin Microbiol 2003; 41:2047-54. [PMID: 12734247 PMCID: PMC154728 DOI: 10.1128/jcm.41.5.2047-2054.2003] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We conducted an exploratory investigation in a community in Haiti to determine the prevalence of Cyclospora cayetanensis infection and to identify potential risk factors for C. cayetanensis infection. In 2001, two cross-sectional stool surveys and a nested case-control study were conducted. In 2002, a follow-up cross-sectional stool survey was conducted among children < or =10 years of age. Stool specimens from study participants and water samples from their wells were examined for Cyclospora and other intestinal parasites. In stools, the prevalence of infection with Cyclospora in persons of all ages decreased from 12% (20 of 167 persons) in February 2001 to 1.1% (4 of 352 persons) in April 2001, a 90.8% decrease. For children < or =10 years of age, the prevalence rates were 22.5% (16 of 71 children) in February 2001, 3.0% (4 of 135 children) in April 2001, and 2.5% (2 of 81 children) in January 2002. Use of the water from the artesian well in the northern region of the community versus the one in the south was the only risk factor associated with Cyclospora infection in multivariate analyses (odds ratio, 18.5; 95% confidence interval, 2.4 to 143.1). The water sample from one of the nine wells or water sources tested (one sample per source) in January 2001, shortly before the investigation began, was positive for Cyclospora by UV fluorescence microscopy and PCR. None of the water samples from the 46 wells or water sources tested during the investigation (one sample per source per testing period, including the artesian wells) were positive for Cyclospora. Further studies are needed to assess the role of water as a possible risk factor for Cyclospora infection in Haiti and other developing countries.
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Ho AY, Lopez AS, Eberhart MG, Levenson R, Finkel BS, da Silva AJ, Roberts JM, Orlandi PA, Johnson CC, Herwaldt BL. Outbreak of cyclosporiasis associated with imported raspberries, Philadelphia, Pennsylvania, 2000. Emerg Infect Dis 2002; 8:783-8. [PMID: 12141962 PMCID: PMC2732521 DOI: 10.3201/eid0808.020012] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
An outbreak of cyclosporiasis occurred in attendees of a wedding reception held in Philadelphia, Pennsylvania, on June 10, 2000. In a retrospective cohort study, 54 (68.4%) of the 79 interviewed guests and members of the wedding party met the case definition. The wedding cake, which had a cream filling that included raspberries, was the food item most strongly associated with illness (multivariate relative risk, 5.9; 95% confidence interval, 3.6 to 10.5). Leftover cake was positive for Cyclospora DNA by polymerase chain reaction analyses. Sequencing of the amplified fragments confirmed that the organism was Cyclospora cayetanensis. The year 2000 was the fifth year since 1995 that outbreaks of cyclosporiasis definitely or probably associated with Guatemalan raspberries have occurred in the spring in North America. Additionally, this is the second documented U.S. outbreak, and the first associated with raspberries, for which Cyclospora has been detected in the epidemiologically implicated food item.
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Affiliation(s)
- Alice Y Ho
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania 19146, USA.
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Slom TJ, Cortese MM, Gerber SI, Jones RC, Holtz TH, Lopez AS, Zambrano CH, Sufit RL, Sakolvaree Y, Chaicumpa W, Herwaldt BL, Johnson S. An outbreak of eosinophilic meningitis caused by Angiostrongylus cantonensis in travelers returning from the Caribbean. N Engl J Med 2002; 346:668-75. [PMID: 11870244 DOI: 10.1056/nejmoa012462] [Citation(s) in RCA: 173] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Outbreaks of eosinophilic meningitis caused by the roundworm Angiostrongylus cantonensis are rarely reported, even in regions of endemic infection such as Southeast Asia and the Pacific Basin. We report an outbreak of A. cantonensis meningitis among travelers returning from the Caribbean. METHODS We conducted a retrospective cohort study among 23 young adults who had traveled to Jamaica. We used a clinical definition of eosinophilic meningitis that included headache that began within 35 days after the trip plus at least one of the following: neck pain, nuchal rigidity, altered cutaneous sensations, photophobia, or visual disturbances. RESULTS Twelve travelers met the case definition for eosinophilic meningitis. The symptoms began a median of 11 days (range, 6 to 31) after their return to the United States. Eosinophilia was eventually documented in all nine patients who were hospitalized, although on initial evaluation, it was present in the peripheral blood of only four of the nine (44 percent) and in the cerebrospinal fluid of five (56 percent). Repeated lumbar punctures and corticosteroid therapy led to improvement in symptoms in two of three patients with severe headache, and intracranial pressure decreased during corticosteroid therapy in all three. Consumption of one meal (P=0.001) and of a Caesar salad at that meal (P=0.007) were strongly associated with eosinophilic meningitis. Antibodies against an A. cantonensis--specific 31-kD antigen were detected in convalescent-phase serum samples from 11 patients. CONCLUSIONS Among travelers at risk, the presence of headache, elevated intracranial pressure, and pleocytosis, with or without eosinophilia, particularly in association with paresthesias or hyperesthesias, should alert clinicians to the possibility of A. cantonensis infection.
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Affiliation(s)
- Trevor J Slom
- Department of Infectious Diseases, Northwestern University Medical School, Chicago, USA
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Lopez AS, Dodson DR, Arrowood MJ, Orlandi PA, da Silva AJ, Bier JW, Hanauer SD, Kuster RL, Oltman S, Baldwin MS, Won KY, Nace EM, Eberhard ML, Herwaldt BL. Outbreak of cyclosporiasis associated with basil in Missouri in 1999. Clin Infect Dis 2001; 32:1010-7. [PMID: 11264028 DOI: 10.1086/319597] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2000] [Revised: 08/08/2000] [Indexed: 11/03/2022] Open
Abstract
During the summer of 1999, an outbreak of cyclosporiasis occurred among attendees of 2 events held on 24 July in different counties in Missouri. We conducted retrospective cohort studies of the 2 clusters of cases, which comprised 62 case patients. The chicken pasta salad served at one event (relative risk [RR], 4.25; 95% confidence interval [CI], 1.80-10.01) and the tomato basil salad served at the other event (RR, 2.95; 95% CI, 1.72-5.07) were most strongly associated with illness. The most likely vehicle of infection was fresh basil, which was included in both salads and could have been grown either in Mexico or the United States. Leftover chicken pasta salad was found to be positive for Cyclospora DNA by means of polymerase chain reaction analysis, and 1 sporulated Cyclospora oocyst was found by use of microscopy. This is the second documented outbreak of cyclosporiasis in the United States linked to fresh basil and the first US outbreak for which Cyclospora has been detected in an epidemiologically implicated food item.
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Affiliation(s)
- A S Lopez
- Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Herwaldt BL, de Arroyave KR, Wahlquist SP, de Merida AM, Lopez AS, Juranek DD. Multiyear prospective study of intestinal parasitism in a cohort of Peace Corps volunteers in Guatemala. J Clin Microbiol 2001; 39:34-42. [PMID: 11136744 PMCID: PMC87675 DOI: 10.1128/jcm.39.1.34-42.2001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2000] [Accepted: 10/04/2000] [Indexed: 12/12/2022] Open
Abstract
We conducted a prospective, longitudinal study in a cohort of 36 Peace Corps volunteers (PCVs) in Guatemala to study the incidence and natural history of intestinal parasitic infections during the PCVs' >2-year overseas stay. PCVs collected stool specimens at least monthly and when ill with gastrointestinal symptoms. Of the 1,168 specimens tested, 453 (38.8%) were positive for at least one parasite and 48 (4.1%) were positive for a pathogenic parasite. A median interval of 187 days (range, 14 to 752 days) elapsed before the first documented parasitic infection, and the median intervals from arrival until subsequent infections (e.g., second or third) were >300 days. The PCVs had 116 episodes of infection with 11 parasites, including up to 4 episodes per PCV with specific nonpathogens and Blastocystis hominis. The incidence, in episodes per 100 person-years, was highest for B. hominis (65), followed by Entamoeba coli (31), Cryptosporidium parvum (17), and Entamoeba hartmanni (17). The PCVs' B. hominis episodes lasted 6,809 person-days (28.7% of the 23,689 person-days in the study), the E. coli episodes lasted 2,055 person-days (8.7%), and each of the other types of episodes lasted <2% of the person-days in the study. Gastrointestinal symptoms were somewhat more common and more persistent, but not significantly so, in association with pathogen episodes than with B. hominis and nonpathogen episodes. Although infections with pathogenic parasites could account for only a minority of the PCVs' diarrheal episodes, the continued acquisition of parasitic infections throughout the PCVs' >2-year stay in Guatemala suggests that PCVs repeatedly had fecal exposures and thus were at risk for infections with both parasitic and nonparasitic pathogens throughout their overseas service.
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Affiliation(s)
- B L Herwaldt
- Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA
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Golub JE, Haselow DT, Hageman JC, Lopez AS, Oldach DW, Grattan LM, Perl TM. Pfiesteria in Maryland: preliminary epidemiologic findings. Md Med J 1998; 47:137-43. [PMID: 9601201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In the fall of 1996, fish kills in Maryland rivers were attributed to the dinoflagellate, Pfiesteria piscicida. After a group of researchers established a potential link between exposure to Pfiesteria and an illness causing memory problems, state health authorities closed a portion of the Pocomoke River. To determine the extent of illness, the range of symptoms, potential risk factors for disease, and to provide information to concerned citizens, a toll-free hotline was created. All symptomatic persons who called the toll-free number were administered a standardized questionnaire. Persons who had been exposed to Pfiesteria or Pfiesteria-laden waters were more likely to have respiratory, neurologic, dermatologic, and gastrointestinal problems than those persons without exposure. Among the persons calling the hotline, many had extensive neuropsychologic testing. Of the neuropsychologic test battery, low scores on the Rey Auditory Verbal Learning Test (RAVLT), a standardized measure of learning and memory, best characterized illness related to Pfiesteria exposure. Patients with low RAVLT scores were more likely to have neurologic symptoms and skin lesions than control subjects. Low RAVLT scores were associated with fishing (OR, 9.00, 95% CI, 106, 409.87), catching fish with lesions (OR, 6.17, 95% CI 1.27, 32.10), and handling fish with lesions (OR, 5.34, 95% CI, 1.05, 29.92), but not with consumption of seafood. While preliminary, these results do suggest that some risk factors for Pfiesteria-related illness may be easy to modify and used to prevent unnecessary human exposure.
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Affiliation(s)
- J E Golub
- Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, USA
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Sarti E, Schantz PM, Plancarte A, Wilson M, Gutierrez IO, Lopez AS, Roberts J, Flisser A. Prevalence and risk factors for Taenia solium taeniasis and cysticercosis in humans and pigs in a village in Morelos, Mexico. Am J Trop Med Hyg 1992; 46:677-85. [PMID: 1621892 DOI: 10.4269/ajtmh.1992.46.677] [Citation(s) in RCA: 130] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In a Mexican village in which Taenia solium infection was known to be endemic, we selected a cluster sample of 368 households (21% of the total) for demographic, environmental, and diagnostic surveys, and medical histories for taeniasis and cysticercosis. Coproparasitologic studies of 1,531 participants revealed infection by Taenia sp. in four (0.3%) individuals; however, 5.8% of the respondents reported a history of having passed tapeworm proglottids in feces. Of 1,552 human serum specimens, 10.8% tested positive in the cysticercosis immunoblot assay. Seropositivity increased with age and reached a maximum in subjects ages 46-55 years. Risk factors associated with seropositivity included a history of passing tapeworm proglottids, frequent consumption of pork, and poor personal and household hygiene (P less than 0.05). A history of seizures was also significantly associated with seropositivity (P less than 0.05); approximately one-third of persons with such histories were seropositive. Of 571 pigs examined by tongue inspection, 23 (4.0%) had cysticerci; infection rates increased with the age of pigs, and were higher in pigs that habitually ran loose or were fed human feces (P less than 0.05). Goodness of fit analysis confirmed that seropositive persons (but not infected pigs) were significantly clustered within households, particularly, in households in which a member reported a history of having passed tapeworm proglottids. The results of this study have identified community behavioral and environmental practices that must be modified to prevent continued transmission of cysticercosis and taeniasis.
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Affiliation(s)
- E Sarti
- Division of Parasitic Diseases, Centers For Disease Control, Atlanta, Georgia
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