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Li Y, Rivers J, Mathis S, Li Z, Chochua S, Metcalf BJ, Beall B, Onukwube J, Gregory CJ, McGee L. Expansion of Invasive Group A Streptococcus M1 UK Lineage in Active Bacterial Core Surveillance, United States, 2019‒2021. Emerg Infect Dis 2023; 29:2116-2120. [PMID: 37640370 PMCID: PMC10521608 DOI: 10.3201/eid2910.230675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
From 2015-2018 to 2019‒2021, hypertoxigenic M1UK lineage among invasive group A Streptococcus increased in the United States (1.7%, 21/1,230 to 11%, 65/603; p<0.001). M1UK was observed in 9 of 10 states, concentrated in Georgia (n = 41), Tennessee (n = 13), and New York (n = 13). Genomic cluster analysis indicated recent expansions.
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Hooli S, King C, McCollum ED, Colbourn T, Lufesi N, Mwansambo C, Gregory CJ, Thamthitiwat S, Cutland C, Madhi SA, Nunes MC, Gessner BD, Hazir T, Mathew JL, Addo-Yobo E, Chisaka N, Hassan M, Hibberd PL, Jeena P, Lozano JM, MacLeod WB, Patel A, Thea DM, Nguyen NTV, Zaman SM, Ruvinsky RO, Lucero M, Kartasasmita CB, Turner C, Asghar R, Banajeh S, Iqbal I, Maulen-Radovan I, Mino-Leon G, Saha SK, Santosham M, Singhi S, Awasthi S, Bavdekar A, Chou M, Nymadawa P, Pape JW, Paranhos-Baccala G, Picot VS, Rakoto-Andrianarivelo M, Rouzier V, Russomando G, Sylla M, Vanhems P, Wang J, Basnet S, Strand TA, Neuman MI, Arroyo LM, Echavarria M, Bhatnagar S, Wadhwa N, Lodha R, Aneja S, Gentile A, Chadha M, Hirve S, O'Grady KAF, Clara AW, Rees CA, Campbell H, Nair H, Falconer J, Williams LJ, Horne M, Qazi SA, Nisar YB. In-hospital mortality risk stratification in children aged under 5 years with pneumonia with or without pulse oximetry: A secondary analysis of the Pneumonia REsearch Partnership to Assess WHO REcommendations (PREPARE) dataset. Int J Infect Dis 2023; 129:240-250. [PMID: 36805325 PMCID: PMC10017350 DOI: 10.1016/j.ijid.2023.02.005] [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] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVES We determined the pulse oximetry benefit in pediatric pneumonia mortality risk stratification and chest-indrawing pneumonia in-hospital mortality risk factors. METHODS We report the characteristics and in-hospital pneumonia-related mortality of children aged 2-59 months who were included in the Pneumonia Research Partnership to Assess WHO Recommendations dataset. We developed multivariable logistic regression models of chest-indrawing pneumonia to identify mortality risk factors. RESULTS Among 285,839 children, 164,244 (57.5%) from hospital-based studies were included. Pneumonia case fatality risk (CFR) without pulse oximetry measurement was higher than with measurement (5.8%, 95% confidence interval [CI] 5.6-5.9% vs 2.1%, 95% CI 1.9-2.4%). One in five children with chest-indrawing pneumonia was hypoxemic (19.7%, 95% CI 19.0-20.4%), and the hypoxemic CFR was 10.3% (95% CI 9.1-11.5%). Other mortality risk factors were younger age (either 2-5 months [adjusted odds ratio (aOR) 9.94, 95% CI 6.67-14.84] or 6-11 months [aOR 2.67, 95% CI 1.71-4.16]), moderate malnutrition (aOR 2.41, 95% CI 1.87-3.09), and female sex (aOR 1.82, 95% CI 1.43-2.32). CONCLUSION Children with a pulse oximetry measurement had a lower CFR. Many children hospitalized with chest-indrawing pneumonia were hypoxemic and one in 10 died. Young age and moderate malnutrition were risk factors for in-hospital chest-indrawing pneumonia-related mortality. Pulse oximetry should be integrated in pneumonia hospital care for children under 5 years.
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Affiliation(s)
- Shubhada Hooli
- Division of Pediatric Emergency Medicine, Texas Children's Hospital/Baylor College of Medicine, Houston, United States of America
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden and Institute for Global Health, University College London, London, United Kingdom
| | - Eric D McCollum
- Global Program in Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, United States of America and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Tim Colbourn
- Institute for Global Health, University College London, London, United Kingdom
| | | | | | - Christopher J Gregory
- Division of Vector-Borne Diseases, US Centers for Disease Control and Prevention, Fort Collins, United States of America
| | - Somsak Thamthitiwat
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Clare Cutland
- African Leadership in Vaccinology Expertise (Alive), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir Ahmed Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Marta C Nunes
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Tabish Hazir
- The Children's Hospital, (Retired), Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan (deceased)
| | - Joseph L Mathew
- Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Emmanuel Addo-Yobo
- Kwame Nkrumah University of Science & Technology/Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Noel Chisaka
- World Bank, Washington DC, United States of America
| | - Mumtaz Hassan
- The Children's Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan (deceased)
| | - Patricia L Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, United States of America
| | | | - Juan M Lozano
- Florida International University, Miami, United States of America
| | - William B MacLeod
- Department of Global Health, Boston University School of Public Health, Boston, United States of America
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur and Datta Meghe Institute of Medical Sciences, Sawangi, India
| | - Donald M Thea
- Department of Global Health, Boston University School of Public Health, Boston, United States of America
| | | | - Syed Ma Zaman
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Raul O Ruvinsky
- Dirección de Control de Enfermedades Inmunoprevenibles, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Marilla Lucero
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Cissy B Kartasasmita
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | | | - Rai Asghar
- Rawalpindi Medical College, Rawalpindi, Pakistan
| | | | - Imran Iqbal
- Combined Military Hospital Institute of Medical Sciences, Multan, Pakistan
| | - Irene Maulen-Radovan
- Instituto Nacional de Pediatria Division de Investigacion Insurgentes, Mexico City, Mexico
| | - Greta Mino-Leon
- Children's Hospital Dr Francisco de Ycaza Bustamante, Head of Department, Infectious diseases, Guayaquil, Ecuador
| | - Samir K Saha
- Child Health Research Foundation and Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Mathuram Santosham
- International Vaccine Access Center (IVAC), Department of International Health, Johns Hopkins University, Baltimore, United States of America
| | | | - Shally Awasthi
- King George's Medical University, Department of Pediatrics, Lucknow, India
| | | | - Monidarin Chou
- University of Health Sciences, Rodolph Mérieux Laboratory & Ministry of Environment, Phom Phen, Cambodia
| | - Pagbajabyn Nymadawa
- Mongolian Academy of Sciences, Academy of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | | | | | | | - Graciela Russomando
- Universidad Nacional de Asuncion, Departamento de Biología Molecular y Genética, Instituto de Investigaciones en Ciencias de la Salud, Asuncion, Paraguay
| | - Mariam Sylla
- Gabriel Touré Hospital, Department of Pediatrics, Bamako, Mali
| | - Philippe Vanhems
- Unité d'Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon, Lyon, France and Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, CNRS Unité Mixte de Recherche 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Jianwei Wang
- Chinese Academy of Medical Sciences & Peking Union, Medical College Institute of Pathogen Biology, MOH Key Laboratory of Systems Biology of Pathogens and Dr Christophe Mérieux Laboratory, Beijing, China
| | - Sudha Basnet
- Center for Intervention Science in Maternal and Child Health, University of Bergen, Norway and Department of Pediatrics, Tribhuvan University Institute of Medicine, Nepal
| | - Tor A Strand
- Research Department, Innlandet Hospital Trust, Lillehammer, Norway
| | - Mark I Neuman
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, United States of America
| | | | - Marcela Echavarria
- Clinical Virology Unit, Centro de Educación Médica e Investigaciones Clínicas, Mar del Plata, Argentina
| | | | - Nitya Wadhwa
- Translational Health Science and Technology Institute, Faridabad, India
| | - Rakesh Lodha
- All India Institute of Medical Sciences, New Delhi, India
| | - Satinder Aneja
- School of Medical Sciences & Research, Sharda University, Greater Noida, India
| | - Angela Gentile
- Department of Epidemiology, "R. Gutiérrez" Children's Hospital, Buenos Aires, Argentina
| | - Mandeep Chadha
- Former Scientist G, ICMR National Institute of Virology, Pune, India
| | | | - Kerry-Ann F O'Grady
- Australian Centre for Health Services Innovation, Queensland University of Technology, Kelvin Grove, Australia
| | - Alexey W Clara
- Centers for Disease Control, Central American Region, Guatemala City, Guatemala
| | - Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, United States of America
| | - Harry Campbell
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Harish Nair
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Jennifer Falconer
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Linda J Williams
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Margaret Horne
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Shamim A Qazi
- Department of Maternal, Newborn, Child, and Adolescent Health (Retired), World Health Organization, Geneva, Switzerland
| | - Yasir Bin Nisar
- Department of Maternal, Newborn, Child, and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland.
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Barnes M, Youngkin E, Zipprich J, Bilski K, Gregory CJ, Dominguez SR, Mumm E, McMahon M, Como-Sabetti K, Lynfield R, Chochua S, Onukwube J, Arvay M, Herlihy R. Notes from the Field: Increase in Pediatric Invasive Group A Streptococcus Infections - Colorado and Minnesota, October-December 2022. MMWR Morb Mortal Wkly Rep 2023; 72:265-267. [PMID: 36893049 PMCID: PMC10010751 DOI: 10.15585/mmwr.mm7210a4] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
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Martin H, Falconer J, Addo-Yobo E, Aneja S, Arroyo LM, Asghar R, Awasthi S, Banajeh S, Bari A, Basnet S, Bavdekar A, Bhandari N, Bhatnagar S, Bhutta ZA, Brooks A, Chadha M, Chisaka N, Chou M, Clara AW, Colbourn T, Cutland C, D'Acremont V, Echavarria M, Gentile A, Gessner B, Gregory CJ, Hazir T, Hibberd PL, Hirve S, Hooli S, Iqbal I, Jeena P, Kartasasmita CB, King C, Libster R, Lodha R, Lozano JM, Lucero M, Lufesi N, MacLeod WB, Madhi SA, Mathew JL, Maulen-Radovan I, McCollum ED, Mino G, Mwansambo C, Neuman MI, Nguyen NTV, Nunes MC, Nymadawa P, O'Grady KAF, Pape JW, Paranhos-Baccala G, Patel A, Picot VS, Rakoto-Andrianarivelo M, Rasmussen Z, Rouzier V, Russomando G, Ruvinsky RO, Sadruddin S, Saha SK, Santosham M, Singhi S, Soofi S, Strand TA, Sylla M, Thamthitiwat S, Thea DM, Turner C, Vanhems P, Wadhwa N, Wang J, Zaman SMA, Campbell H, Nair H, Qazi SA, Nisar YB. Assembling a global database of child pneumonia studies to inform WHO pneumonia management algorithm: Methodology and applications. J Glob Health 2022; 12:04075. [PMID: 36579417 PMCID: PMC9798037 DOI: 10.7189/jogh.12.04075] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background The existing World Health Organization (WHO) pneumonia case management guidelines rely on clinical symptoms and signs for identifying, classifying, and treating pneumonia in children up to 5 years old. We aimed to collate an individual patient-level data set from large, high-quality pre-existing studies on pneumonia in children to identify a set of signs and symptoms with greater validity in the diagnosis, prognosis, and possible treatment of childhood pneumonia for the improvement of current pneumonia case management guidelines. Methods Using data from a published systematic review and expert knowledge, we identified studies meeting our eligibility criteria and invited investigators to share individual-level patient data. We collected data on demographic information, general medical history, and current illness episode, including history, clinical presentation, chest radiograph findings when available, treatment, and outcome. Data were gathered separately from hospital-based and community-based cases. We performed a narrative synthesis to describe the final data set. Results Forty-one separate data sets were included in the Pneumonia Research Partnership to Assess WHO Recommendations (PREPARE) database, 26 of which were hospital-based and 15 were community-based. The PREPARE database includes 285 839 children with pneumonia (244 323 in the hospital and 41 516 in the community), with detailed descriptions of clinical presentation, clinical progression, and outcome. Of 9185 pneumonia-related deaths, 6836 (74%) occurred in children <1 year of age and 1317 (14%) in children aged 1-2 years. Of the 285 839 episodes, 280 998 occurred in children 0-59 months old, of which 129 584 (46%) were 2-11 months of age and 152 730 (54%) were males. Conclusions This data set could identify an improved specific, sensitive set of criteria for diagnosing clinical pneumonia and help identify sick children in need of referral to a higher level of care or a change of therapy. Field studies could be designed based on insights from PREPARE analyses to validate a potential revised pneumonia algorithm. The PREPARE methodology can also act as a model for disease database assembly.
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Affiliation(s)
- Helena Martin
- Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer Falconer
- Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Emmanuel Addo-Yobo
- Kwame Nkrumah University of Science and Technology/Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Satinder Aneja
- School of Medical Sciences and Research, Sharda University, Greater Noida, India
| | | | - Rai Asghar
- Rawalpindi Medical College, Rawalpindi, Pakistan
| | - Shally Awasthi
- King George’s Medical University, Department of Pediatrics, Lucknow, India
| | - Salem Banajeh
- Department of Paediatrics and Child Health, University of Sana’a, Sana’a, Yemen
| | - Abdul Bari
- Independent newborn and child health consultant, Islamabad, Pakistan
| | - Sudha Basnet
- Center for Intervention Science in Maternal and Child Health, University of Bergen, Norway,Department of Pediatrics, Tribhuvan University Institute of Medicine, Nepal
| | - Ashish Bavdekar
- King Edward Memorial (KEM) Hospital Pune, Department of Pediatrics, Pune, India
| | - Nita Bhandari
- Center for Health Research and Development, Society for Applied Studies, India
| | | | - Zulfiqar A Bhutta
- Institute for Global Health and Development, Aga Khan University, Pakistan
| | - Abdullah Brooks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mandeep Chadha
- Former Scientist, Indian Council of Medical Research (ICMR), National Institute of Virology, Pune, India
| | | | - Monidarin Chou
- University of Health Sciences, Rodolphe Mérieux Laboratory, Phom Phen, Cambodia,Ministry of Environment, Phom Phen, Cambodia
| | - Alexey W Clara
- Centers for Disease Control, Central American Region, Guatemala City, Guatemala
| | - Tim Colbourn
- Institute for Global Health, University College London, London, United Kingdom
| | - Clare Cutland
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Marcela Echavarria
- Clinical Virology Unit, Centro de Educación Médica e Investigaciones Clínicas, Argentina
| | - Angela Gentile
- Department of Epidemiology, “R. Gutiérrez” Children's Hospital, Buenos Aires, Argentina
| | - Brad Gessner
- Pfizer Vaccines, Collegeville, Pennsylvania, USA
| | - Christopher J. Gregory
- Division of Vector-borne Diseases, US Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Tabish Hazir
- Retired from Children Hospital, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Patricia L. Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Shubhada Hooli
- Section of Pediatric Emergency Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Imran Iqbal
- Department of Paediatrics, Combined Military Hospital Institute of Medical Sciences, Multan, Pakistan
| | | | - Cissy B Kartasasmita
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden,Institute for Global Health, University College London, London, United Kingdom
| | | | - Rakesh Lodha
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Marilla Lucero
- Research Institute for Tropical Medicine, Manila, Philippines
| | | | - William B MacLeod
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Shabir Ahmed Madhi
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Joseph L Mathew
- Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Irene Maulen-Radovan
- Instituto Nactional de Pediatria Division de Investigacion Insurgentes, Mexico City, Mexico
| | - Eric D McCollum
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA,Global Program in Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, USA
| | - Greta Mino
- Department of Infectious diseases, Guayaquil, Ecuador
| | | | - Mark I Neuman
- Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Marta C Nunes
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pagbajabyn Nymadawa
- Mongolian Academy of Sciences, Academy of Medical Sciences, Ulaanbaatar, Mongolia
| | - Kerry-Ann F O'Grady
- Australian Centre for Health Services Innovation, Queensland University of Technology, Kelvin Grove, Australia
| | | | | | - Archana Patel
- Lata Medical Research Foundation, Nagpur and Datta Meghe Institute of Medical Sciences, Sawangi, India
| | | | | | - Zeba Rasmussen
- Division of International Epidemiology and Population Studies (DIEPS), Fogarty International Center (FIC), National Institute of Health (NIH), USA
| | | | - Graciela Russomando
- Universidad Nacional de Asuncion, Departamento de Biología Molecular y Genética, Instituto de Investigaciones en Ciencias de la Salud, Asuncion, Paraguay
| | - Raul O Ruvinsky
- Dirección de Control de Enfermedades Inmunoprevenibles, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Salim Sadruddin
- Consultant/Retired World Health Organization (WHO) Staff, Geneva, Switzerland
| | - Samir K. Saha
- Child Health Research Foundation, Dhaka, Bangladesh,Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Mathuram Santosham
- International Vaccine Access Center (IVAC), Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Sajid Soofi
- Department of Pediatrics and Child Health, Aga Khan University, Pakistan
| | - Tor A Strand
- Research Department, Innlandet Hospital Trust, Lillehammer, Norway
| | - Mariam Sylla
- Gabriel Touré Hospital, Department of Pediatrics, Bamako, Mali
| | - Somsak Thamthitiwat
- Division of Global Health Protection, Thailand Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Donald M Thea
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Philippe Vanhems
- Unité d'Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon, Lyon, France,Centre International de Recherche en Infectiologie, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Nitya Wadhwa
- Translational Health Science and Technology Institute, Faridabad, India
| | - Jianwei Wang
- Chinese Academy of Medical Sciences & Peking Union, Medical College Institute of Pathogen Biology, MOH Key Laboratory of Systems Biology of Pathogens and Dr Christophe Mérieux Laboratory, Beijing, China
| | - Syed MA Zaman
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Harry Campbell
- Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Harish Nair
- Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Shamim Ahmad Qazi
- Consultant/Retired World Health Organization (WHO) Staff, Geneva, Switzerland
| | - Yasir Bin Nisar
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization (WHO), Geneva, Switzerland
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Hasso-Agopsowicz M, Crowcroft N, Biellik R, Gregory CJ, Menozzi-Arnaud M, Amorij JP, Gilbert PA, Earle K, Frivold C, Jarrahian C, Mvundura M, Mistilis JJ, Durrheim DN, Giersing B. Accelerating the Development of Measles and Rubella Microarray Patches to Eliminate Measles and Rubella: Recent Progress, Remaining Challenges. Front Public Health 2022; 10:809675. [PMID: 35309224 PMCID: PMC8924450 DOI: 10.3389/fpubh.2022.809675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/02/2022] [Indexed: 11/28/2022] Open
Abstract
Measles and rubella microarray patches (MR-MAPs) are critical in achieving measles and rubella eradication, a goal highly unlikely to meet with current vaccines presentations. With low commercial incentive to MAP developers, limited and uncertain funding, the need for investment in a novel manufacturing facility, and remaining questions about the source of antigen, product demand, and regulatory pathway, MR-MAPs are unlikely to be prequalified by WHO and ready for use before 2033. This article describes the current progress of MR-MAPs, highlights challenges and opportunities pertinent to MR-MAPs manufacturing, regulatory approval, creating demand, and timelines to licensure. It also describes activities that are being undertaken by multiple partners to incentivise investment in and accelerate the development of MR-MAPs.
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Affiliation(s)
| | - Natasha Crowcroft
- Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | | | - Christopher J Gregory
- Immunization Unit, Programme Division, United Nations Children's Fund (UNICEF), New York, NY, United States
| | | | | | | | - Kristen Earle
- Vaccine Development and Surveillance, Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Collrane Frivold
- Medical Devices and Health Technologies, PATH, Seattle, WA, United States
| | - Courtney Jarrahian
- Medical Devices and Health Technologies, PATH, Seattle, WA, United States
| | - Mercy Mvundura
- Medical Devices and Health Technologies, PATH, Seattle, WA, United States
| | - Jessica J Mistilis
- Medical Devices and Health Technologies, PATH, Seattle, WA, United States
| | - David N Durrheim
- Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Birgitte Giersing
- Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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6
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Gable P, Huang JY, Gilbert SE, Bollinger S, Lyons AK, Sabour S, Surie D, Biedron C, Haney T, Beshearse E, Gregory CJ, Seely KA, Clemmons NS, Patil N, Kothari A, Gulley T, Garner K, Anderson K, Thornburg NJ, Halpin AL, McDonald LC, Kutty PK, Brown AC. A Comparison of Less Invasive Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Diagnostic Specimens in Nursing Home Residents-Arkansas, June-August 2020. Clin Infect Dis 2021; 73:S58-S64. [PMID: 33909063 PMCID: PMC8135387 DOI: 10.1093/cid/ciab310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 12/23/2022] Open
Abstract
Background SARS-CoV-2 testing remains essential for early identification and clinical management of cases. We compared the diagnostic performance of three specimen types for characterizing SARS-CoV-2 in infected nursing home residents. Methods A convenience sample of 17 residents were enrolled within 15 days of first positive SARS-CoV-2 result by real-time reverse transcription polymerase chain reaction (RT-PCR) and prospectively followed for 42 days. Anterior nasal swabs (AN), oropharyngeal swabs (OP), and saliva specimens (SA) were collected on the day of enrollment, every 3 days for the first 21 days, then weekly for 21 days. Specimens were tested for presence of SARS-CoV-2 RNA using RT-PCR and replication-competent virus by viral culture. Results Comparing the three specimen types collected from each participant at each time point, the concordance of paired RT-PCR results ranged from 80–88%. After the first positive result, SA and OP were RT-PCR–positive for ≤48 days; AN were RT-PCR–positive for ≤33 days. AN had the highest percentage of RT-PCR–positive results (81%; 21/26) when collected ≤10 days of participants’ first positive result. Eleven specimens were positive by viral culture: nine AN collected ≤19 days following first positive result and two OP collected ≤5 days following first positive result. Conclusions AN, OP, and SA were effective methods for repeated testing in this population. More AN than OP were positive by viral culture. SA and OP remained RT-PCR–positive longer than AN, which could lead to unnecessary interventions if RT-PCR detection occurred after viral shedding has likely ceased.
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Affiliation(s)
- Paige Gable
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Y Huang
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah E Gilbert
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan Bollinger
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amanda K Lyons
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Sabour
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Diya Surie
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caitlin Biedron
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tafarra Haney
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Elizabeth Beshearse
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christopher J Gregory
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Nakia S Clemmons
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Atul Kothari
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Trent Gulley
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Kelley Garner
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Karen Anderson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie J Thornburg
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison L Halpin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - L Clifford McDonald
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Preeta K Kutty
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison C Brown
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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7
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Surie D, Huang JY, Brown AC, Gable P, Biedron C, Gilbert SE, Garner K, Bollinger S, Gulley T, Haney T, Lyons AK, Beshearse E, Gregory CJ, Sabour S, Clemmons NS, James AE, Tamin A, Reese N, Perry-Dow KA, Brown R, Harcourt JL, Campbell D, Houston H, Chakravorty R, Paulick A, Whitaker B, Murdoch J, Spicer L, Stumpf MM, Mills L, Coughlin MM, Higdem P, Rasheed MAU, Lonsway D, Bhatnagar A, Kothari A, Anderson K, Thornburg NJ, Breaker E, Adamczyk M, McAllister GA, Halpin AL, Seely KA, Patil N, McDonald LC, Kutty PK. Infectious Period of Severe Acute Respiratory Syndrome Coronavirus 2 in 17 Nursing Home Residents-Arkansas, June-August 2020. Open Forum Infect Dis 2021; 8:ofab048. [PMID: 33723510 PMCID: PMC7928697 DOI: 10.1093/ofid/ofab048] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/28/2021] [Indexed: 12/18/2022] Open
Abstract
Background To estimate the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in older adults with underlying conditions, we assessed duration of coronavirus disease 2019 (COVID-19) symptoms, reverse-transcription polymerase chain reaction (RT-PCR) positivity, and culture positivity among nursing home residents. Methods We enrolled residents within 15 days of their first positive SARS-CoV-2 test (diagnosis) at an Arkansas facility from July 7 to 15, 2020 and instead them for 42 days. Every 3 days for 21 days and then weekly, we assessed COVID-19 symptoms, collected specimens (oropharyngeal, anterior nares, and saliva), and reviewed medical charts. Blood for serology was collected on days 0, 6, 12, 21, and 42. Infectivity was defined by positive culture. Duration of culture positivity was compared with duration of COVID-19 symptoms and RT-PCR positivity. Data were summarized using measures of central tendency, frequencies, and proportions. Results We enrolled 17 of 39 (44%) eligible residents. Median participant age was 82 years (range, 58–97 years). All had ≥3 underlying conditions. Median duration of RT-PCR positivity was 22 days (interquartile range [IQR], 8–31 days) from diagnosis; median duration of symptoms was 42 days (IQR, 28–49 days). Of 9 (53%) participants with any culture-positive specimens, 1 (11%) severely immunocompromised participant remained culture-positive 19 days from diagnosis; 8 of 9 (89%) were culture-positive ≤8 days from diagnosis. Seroconversion occurred in 12 of 12 (100%) surviving participants with ≥1 blood specimen; all participants were culture-negative before seroconversion. Conclusions Duration of infectivity was considerably shorter than duration of symptoms and RT-PCR positivity. Severe immunocompromise may prolong SARS-CoV-2 infectivity. Seroconversion indicated noninfectivity in this cohort.
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Affiliation(s)
- Diya Surie
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Y Huang
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison C Brown
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paige Gable
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caitlin Biedron
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah E Gilbert
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kelley Garner
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Susan Bollinger
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Trent Gulley
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Tafarra Haney
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Amanda K Lyons
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Beshearse
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christopher J Gregory
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Sabour
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nakia S Clemmons
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison E James
- Arkansas Department of Health, Little Rock, Arkansas, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Azaibi Tamin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natashia Reese
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - K Allison Perry-Dow
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robin Brown
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Jennifer L Harcourt
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Davina Campbell
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hollis Houston
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ashley Paulick
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brett Whitaker
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jordan Murdoch
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Lori Spicer
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Megan M Stumpf
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa Mills
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa M Coughlin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pamela Higdem
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | | | - David Lonsway
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amelia Bhatnagar
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Atul Kothari
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Karen Anderson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie J Thornburg
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Erin Breaker
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michelle Adamczyk
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gillian A McAllister
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison L Halpin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - L Clifford McDonald
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Preeta K Kutty
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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8
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Laws RL, Chancey RJ, Rabold EM, Chu VT, Lewis NM, Fajans M, Reses HE, Duca LM, Dawson P, Conners EE, Gharpure R, Yin S, Buono S, Pomeroy M, Yousaf AR, Owusu D, Wadhwa A, Pevzner E, Battey KA, Njuguna H, Fields VL, Salvatore P, O'Hegarty M, Vuong J, Gregory CJ, Banks M, Rispens J, Dietrich E, Marcenac P, Matanock A, Pray I, Westergaard R, Dasu T, Bhattacharyya S, Christiansen A, Page L, Dunn A, Atkinson-Dunn R, Christensen K, Kiphibane T, Willardson S, Fox G, Ye D, Nabity SA, Binder A, Freeman BD, Lester S, Mills L, Thornburg N, Hall AJ, Fry AM, Tate JE, Tran CH, Kirking HL. Symptoms and Transmission of SARS-CoV-2 Among Children - Utah and Wisconsin, March-May 2020. Pediatrics 2021; 147:peds.2020-027268. [PMID: 33033178 DOI: 10.1542/peds.2020-027268] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [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: 09/30/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Limited data exist on severe acute respiratory syndrome coronavirus 2 in children. We described infection rates and symptom profiles among pediatric household contacts of individuals with coronavirus disease 2019. METHODS We enrolled individuals with coronavirus disease 2019 and their household contacts, assessed daily symptoms prospectively for 14 days, and obtained specimens for severe acute respiratory syndrome coronavirus 2 real-time reverse transcription polymerase chain reaction and serology testing. Among pediatric contacts (<18 years), we described transmission, assessed the risk factors for infection, and calculated symptom positive and negative predictive values. We compared secondary infection rates and symptoms between pediatric and adult contacts using generalized estimating equations. RESULTS Among 58 households, 188 contacts were enrolled (120 adults; 68 children). Secondary infection rates for adults (30%) and children (28%) were similar. Among households with potential for transmission from children, child-to-adult transmission may have occurred in 2 of 10 (20%), and child-to-child transmission may have occurred in 1 of 6 (17%). Pediatric case patients most commonly reported headache (79%), sore throat (68%), and rhinorrhea (68%); symptoms had low positive predictive values, except measured fever (100%; 95% confidence interval [CI]: 44% to 100%). Compared with symptomatic adults, children were less likely to report cough (odds ratio [OR]: 0.15; 95% CI: 0.04 to 0.57), loss of taste (OR: 0.21; 95% CI: 0.06 to 0.74), and loss of smell (OR: 0.29; 95% CI: 0.09 to 0.96) and more likely to report sore throat (OR: 3.4; 95% CI: 1.04 to 11.18). CONCLUSIONS Children and adults had similar secondary infection rates, but children generally had less frequent and severe symptoms. In two states early in the pandemic, we observed possible transmission from children in approximately one-fifth of households with potential to observe such transmission patterns.
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Affiliation(s)
- Rebecca L Laws
- COVID-19 Response Team, .,Contributed equally as co-first authors
| | | | | | - Victoria T Chu
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | - Nathaniel M Lewis
- COVID-19 Response Team.,Epidemic Intelligence Service, and.,Utah Department of Health, Salt Lake City, Utah
| | | | | | - Lindsey M Duca
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | - Patrick Dawson
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | | | | | | | - Sean Buono
- COVID-19 Response Team.,Laboratory Leadership Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary Pomeroy
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | - Anna R Yousaf
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | - Daniel Owusu
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | - Ashutosh Wadhwa
- COVID-19 Response Team.,Laboratory Leadership Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | | | | | | | | | - Jared Rispens
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | | | | | | | - Ian Pray
- COVID-19 Response Team.,Epidemic Intelligence Service, and.,Wisconsin Department of Health Services, Madison, Wisconsin
| | | | - Trivikram Dasu
- City of Milwaukee Health Department, Milwaukee, Wisconsin
| | | | | | - Lindsey Page
- City of Milwaukee Health Department, Milwaukee, Wisconsin
| | - Angela Dunn
- Utah Department of Health, Salt Lake City, Utah
| | | | | | - Tair Kiphibane
- Salt Lake County Health Department, Salt Lake City, Utah; and
| | | | | | | | | | | | - Brandi D Freeman
- COVID-19 Response Team.,Laboratory Leadership Service, Centers for Disease Control and Prevention, Atlanta, Georgia
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9
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Lewis NM, Duca LM, Marcenac P, Dietrich EA, Gregory CJ, Fields VL, Banks MM, Rispens JR, Hall A, Harcourt JL, Tamin A, Willardson S, Kiphibane T, Christensen K, Dunn AC, Tate JE, Nabity S, Matanock AM, Kirking HL. Characteristics and Timing of Initial Virus Shedding in Severe Acute Respiratory Syndrome Coronavirus 2, Utah, USA. Emerg Infect Dis 2020; 27:352-359. [PMID: 33275874 PMCID: PMC7853554 DOI: 10.3201/eid2702.203517] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Virus shedding in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can occur before onset of symptoms; less is known about symptom progression or infectiousness associated with initiation of viral shedding. We investigated household transmission in 5 households with daily specimen collection for 5 consecutive days starting a median of 4 days after symptom onset in index patients. Seven contacts across 2 households implementing no precautionary measures were infected. Of these 7, 2 tested positive for SARS-CoV-2 by reverse transcription PCR on day 3 of 5. Both had mild, nonspecific symptoms for 1–3 days preceding the first positive test. SARS-CoV-2 was cultured from the fourth-day specimen in 1 patient and from the fourth- and fifth-day specimens in the other. We also describe infection control measures taken in the households that had no transmission. Persons exposed to SARS-CoV-2 should self-isolate, including from household contacts, wear a mask, practice hand hygiene, and seek testing promptly.
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10
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Milucky J, Pondo T, Gregory CJ, Iuliano D, Chaves SS, McCracken J, Mansour A, Zhang Y, Aleem MA, Wolff B, Whitaker B, Whistler T, Onyango C, Lopez MR, Liu N, Rahman MZ, Shang N, Winchell J, Chittaganpitch M, Fields B, Maldonado H, Xie Z, Lindstrom S, Sturm-Ramirez K, Montgomery J, Wu KH, Van Beneden CA. The epidemiology and estimated etiology of pathogens detected from the upper respiratory tract of adults with severe acute respiratory infections in multiple countries, 2014-2015. PLoS One 2020; 15:e0240309. [PMID: 33075098 PMCID: PMC7571682 DOI: 10.1371/journal.pone.0240309] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/24/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction Etiology studies of severe acute respiratory infections (SARI) in adults are limited. We studied potential etiologies of SARI among adults in six countries using multi-pathogen diagnostics. Methods We enrolled both adults with SARI (acute respiratory illness onset with fever and cough requiring hospitalization) and asymptomatic adults (adults hospitalized with non-infectious illnesses, non-household members accompanying SARI patients, adults enrolled from outpatient departments, and community members) in each country. Demographics, clinical data, and nasopharyngeal and oropharyngeal specimens were collected from both SARI patients and asymptomatic adults. Specimens were tested for presence of 29 pathogens utilizing the Taqman® Array Card platform. We applied a non-parametric Bayesian regression extension of a partially latent class model approach to estimate proportions of SARI caused by specific pathogens. Results We enrolled 2,388 SARI patients and 1,135 asymptomatic adults from October 2013 through October 2015. We detected ≥1 pathogen in 76% of SARI patients and 67% of asymptomatic adults. Haemophilus influenzae and Streptococcus pneumoniae were most commonly detected (≥23% of SARI patients and asymptomatic adults). Through modeling, etiology was attributed to a pathogen in most SARI patients (range among countries: 57.3–93.2%); pathogens commonly attributed to SARI etiology included influenza A (14.4–54.4%), influenza B (1.9–19.1%), rhino/enterovirus (1.8–42.6%), and RSV (3.6–14.6%). Conclusions Use of multi-pathogen diagnostics and modeling enabled attribution of etiology in most adult SARI patients, despite frequent detection of multiple pathogens in the upper respiratory tract. Seasonal flu vaccination and development of RSV vaccine would likely reduce the burden of SARI in these populations.
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Affiliation(s)
- Jennifer Milucky
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
- * E-mail:
| | - Tracy Pondo
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Christopher J. Gregory
- Division of Global Health Protection, Centers for Disease Control and Prevention, Thailand Ministry of Public Health, Thailand
| | - Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Sandra S. Chaves
- Influenza Division, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, CDC Kenya Office, Kenya
| | - John McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Adel Mansour
- Division of Global Health Protection, Centers for Disease Control and Prevention, Egypt
| | - Yuzhi Zhang
- Division of Global Health Protection, Centers for Disease Control and Prevention, China
| | | | - Bernard Wolff
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Brett Whitaker
- Division of Viral Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Toni Whistler
- Division of Global Health Protection, Centers for Disease Control and Prevention, Thailand Ministry of Public Health, Thailand
| | - Clayton Onyango
- Kenya Medical Research Institute/Centers for Disease Control and Prevention Public Health Collaboration, Kisumu, Kenya
| | - Maria Renee Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Na Liu
- China Centers for Disease Control and Prevention, National Institute for Viral Disease, Beijing, China
| | | | - Nong Shang
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Jonas Winchell
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | | | - Barry Fields
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kenya
| | - Herberth Maldonado
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Zhiping Xie
- China Centers for Disease Control and Prevention, National Institute for Viral Disease, Beijing, China
| | - Stephen Lindstrom
- Division of Viral Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Katherine Sturm-Ramirez
- Influenza Division, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, CDC Bangladesh Office, Bangladesh
| | - Joel Montgomery
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kai-Hui Wu
- Influenza Division, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, CDC Bangladesh Office, Bangladesh
| | - Chris A. Van Beneden
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
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11
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Gilboa SM, Gregory CJ, Honein MA. Better surveillance to protect mothers and infants from Zika. Lancet Infect Dis 2020; 19:1047-1048. [PMID: 31559951 DOI: 10.1016/s1473-3099(19)30473-6] [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] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Suzanne M Gilboa
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| | - Christopher J Gregory
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Margaret A Honein
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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12
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Lee CT, Hagan JE, Jantsansengee B, Tumurbaatar OE, Altanchimeg S, Yadamsuren B, Demberelsuren S, Tserendorj C, Munkhtogoo O, Badarch D, Gunregjav N, Baatarkhuu B, Ochir C, Berman L, Anderson R, Patel MK, Gregory CJ, Goodson JL. Increase in Infant Measles Deaths During a Nationwide Measles Outbreak-Mongolia, 2015-2016. J Infect Dis 2020; 220:1771-1779. [PMID: 30923799 DOI: 10.1093/infdis/jiz140] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/23/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Surveillance data from a large measles outbreak in Mongolia suggested increased case fatality ratio (CFR) in the second of 2 waves. To confirm the increase in CFR and identify risk factors for measles death, we enhanced mortality ascertainment and conducted a case-control study among infants hospitalized for measles. METHODS We linked national vital records with surveillance data of clinically or laboratory-confirmed infant (aged <12 months) measles cases with rash onset during March-September 2015 (wave 1) and October 2015-June 2016 (wave 2). We abstracted medical charts of 95 fatal cases and 273 nonfatal cases hospitalized for measles, matched by age and sex. We calculated adjusted matched odds ratios (amORs) and 95% confidence intervals (CIs) for risk factors. RESULTS Infant measles deaths increased from 3 among 2224 cases (CFR: 0.13%) in wave 1 to 113 among 4884 cases (CFR: 2.31%) in wave 2 (P < .001). Inpatient admission, 7-21 days before measles rash onset, for pneumonia or influenza (amOR: 4.5; CI, 2.6-8.0), but not other diagnoses, was significantly associated with death. DISCUSSION Measles infection among children hospitalized with respiratory infections likely increased deaths due to measles during wave 2. Preventing measles virus nosocomial transmission likely decreases measles mortality.
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Affiliation(s)
- Christopher T Lee
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jose E Hagan
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Samdan Altanchimeg
- Mongolia National Center for Communicable Disease, Ulaanbaatar, Mongolia
| | | | | | | | | | - Darmaa Badarch
- Mongolia National Center for Communicable Disease, Ulaanbaatar, Mongolia
| | - Nyamaa Gunregjav
- Mongolia National Center for Communicable Disease, Ulaanbaatar, Mongolia
| | | | - Chimedsuren Ochir
- School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - LaShondra Berman
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Raydel Anderson
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Minal K Patel
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA
| | - Christopher J Gregory
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA
| | - James L Goodson
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA
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13
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Ma C, Hao L, Rodewald L, An Q, Wannemuehler KA, Su Q, An Z, Quick L, Liu Y, Yan R, Liu X, Zhang Y, Yu W, Zhang X, Wang H, Cairns L, Luo H, Gregory CJ. Risk factors for measles virus infection and susceptibility in persons aged 15 years and older in China: A multi-site case-control study, 2012–2013. Vaccine 2020; 38:3210-3217. [PMID: 32173094 PMCID: PMC10375840 DOI: 10.1016/j.vaccine.2020.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/28/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Endemic measles persists in China, despite >95% reported coverage of two measles-containing vaccine doses and nationwide campaign that vaccinated >100 million children in 2010. An increasing proportion of infections now occur among adults and there is concern that persistent susceptibility in adults is an obstacle to measles elimination in China. We performed a case-control study in six Chinese provinces between January 2012 to June 2013 to identify risk factors for measles virus infection and susceptibility among adults. METHODS Persons ≥15 years old with laboratory-confirmed measles were age and neighborhood matched with three controls. Controls had blood specimens collected to determine their measles IgG serostatus. We interviewed case-patients and controls about potential risk factors for measles virus infection and susceptibility. Unadjusted and adjusted matched odds ratios and 95% confidence intervals (CIs) were calculated via conditional logistic regression. We calculated attributable fractions for infection for risk factors that could be interpreted as causal. RESULTS 899 cases and 2498 controls were enrolled. Among controls, 165 (6.6%) were seronegative for measles IgG indicating persistent susceptibility to infection. In multivariable analysis, hospital visit and travel outside the prefecture in the prior 1-3 weeks were significant risk factors for measles virus infection. Occupation and reluctance to accept measles vaccination were significant risk factors for measles susceptibility. The calculated attributable fraction of measles cases from hospital visitation was 28.6% (95% CI: 20.6-38.8%). CONCLUSIONS Exposure to a healthcare facility was the largest risk factor for measles virus infection in adults in China. Improved adherence to hospital infection control practices could reduce risk of ongoing measles virus transmission and increase the likelihood of achieving and sustaining measles elimination in China. The use of control groups stratified by serological status identified distinct risk factors for measles virus infection and susceptibility among adults.
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14
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Paz-Bailey G, Gregory CJ. Balancing sensitivity and specificity of Zika virus case definitions. Lancet Infect Dis 2020; 20:270-272. [PMID: 31870904 PMCID: PMC8673467 DOI: 10.1016/s1473-3099(19)30686-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Gabriela Paz-Bailey
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, San Juan 00920, Puerto Rico.
| | - Christopher J Gregory
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
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15
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Honein MA, Woodworth KR, Gregory CJ. Neurodevelopmental Abnormalities Associated With In Utero Zika Virus Infection in Infants and Children-The Unfolding Story. JAMA Pediatr 2020; 174:237-238. [PMID: 31904764 PMCID: PMC7523619 DOI: 10.1001/jamapediatrics.2019.5257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Margaret A. Honein
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kate R. Woodworth
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher J. Gregory
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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16
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Sawatwong P, Sapchookul P, Whistler T, Gregory CJ, Sangwichian O, Makprasert S, Jorakate P, Srisaengchai P, Thamthitiwat S, Promkong C, Nanvatthanachod P, Vanaporn M, Rhodes J. High Burden of Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Bacteremia in Older Adults: A Seven-Year Study in Two Rural Thai Provinces. Am J Trop Med Hyg 2020; 100:943-951. [PMID: 30793684 PMCID: PMC6447101 DOI: 10.4269/ajtmh.18-0394] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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] [Indexed: 11/07/2022] Open
Abstract
Bloodstream infection surveillance conducted from 2008 to 2014 in all 20 hospitals in Sa Kaeo and Nakhon Phanom provinces, Thailand, allowed us to look at disease burden, antibiotic susceptibilities, and recurrent infections caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae. Of 97,832 blood specimens, 3,338 were positive for E. coli and 1,086 for K. pneumoniae. The proportion of E. coli isolates producing ESBL significantly increased from 19% to 22% in 2008-2010 to approximately 30% from 2011 to 2014 (P-value for trend = 0.02), whereas ESBL production among K. pneumoniae cases was 27.4% with no significant trend over time. Incidence of community-onset ESBL-producing E. coli increased from 5.4 per 100,000 population in 2008 to 12.8 in 2014, with the highest rates among persons aged ≥ 70 years at 79 cases per 100,000 persons in 2014. From 2008 to 2014, community-onset ESBL-producing K. pneumoniae incidence was 2.7 per 100,000, with a rate of 12.9 among those aged ≥ 70 years. Although most (93.6% of E. coli and 87.6% of K. pneumoniae) infections were community-onset, hospital-onset infections were twice as likely to be ESBL. Population-based surveillance, as described, is vital to accurately monitor emergence and trends in antimicrobial resistance, and in guiding the development of rational antimicrobial therapy recommendations.
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Affiliation(s)
- Pongpun Sawatwong
- Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand.,Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Patranuch Sapchookul
- Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Toni Whistler
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia.,Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Christopher J Gregory
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia.,Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Ornuma Sangwichian
- Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Sirirat Makprasert
- Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Possawat Jorakate
- Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Prasong Srisaengchai
- Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Somsak Thamthitiwat
- Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | | | | | - Muthita Vanaporn
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Julia Rhodes
- Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
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17
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Sharp TM, Fischer M, Muñoz-Jordán JL, Paz-Bailey G, Staples JE, Gregory CJ, Waterman SH. Dengue and Zika Virus Diagnostic Testing for Patients with a Clinically Compatible Illness and Risk for Infection with Both Viruses. MMWR Recomm Rep 2019; 68:1-10. [PMID: 31194720 PMCID: PMC6581290 DOI: 10.15585/mmwr.rr6801a1] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Dengue and Zika viruses are closely related mosquitoborne flaviviruses with similar transmission cycles, distribution throughout the tropics and subtropics, and disease manifestations including fever, rash, myalgia, and arthralgia. For patients with suspected dengue or Zika virus disease, nucleic acid amplification tests (NAATs) are the preferred method of diagnosis. Immunoglobulin M (IgM) antibody testing can identify additional infections and remains an important tool for the diagnosis of these diseases, but interpreting the results is complicated by cross-reactivity, and determining the specific timing of infection can be difficult. These limitations are a particular challenge for pregnant women in determining whether Zika virus infection occurred during or before the pregnancy. This report summarizes existing and new guidance on dengue and Zika virus diagnostic testing for patients with a clinically compatible illness who live in or recently traveled to an area where there is risk for infection with both viruses. CDC recommendations for screening of asymptomatic pregnant women with possible Zika virus exposure are unchanged. For symptomatic nonpregnant persons, dengue and Zika virus NAATs should be performed on serum collected ≤7 days after symptom onset. Dengue and Zika virus IgM antibody testing should be performed on NAAT-negative serum specimens or serum collected >7 days after onset of symptoms. For symptomatic pregnant women, serum and urine specimens should be collected as soon as possible within 12 weeks of symptom onset for concurrent dengue and Zika virus NAATs and IgM antibody testing. Positive IgM antibody test results with negative NAAT results should be confirmed by neutralizing antibody tests when clinically or epidemiologically indicated, including for all pregnant women. Data on the epidemiology of viruses known to be circulating at the location of exposure and clinical findings should be considered when deciding which tests to perform and for interpreting results. Patients with clinically suspected dengue should receive appropriate management to monitor and treat shock and hemorrhage. Women with laboratory evidence of possible Zika virus infection during pregnancy and their infants should be evaluated and managed for possible adverse outcomes. Dengue and Zika virus disease are nationally notifiable conditions, and cases should be reported to public health authorities.
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Affiliation(s)
- Tyler M Sharp
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Marc Fischer
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jorge L Muñoz-Jordán
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Gabriela Paz-Bailey
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - J Erin Staples
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Christopher J Gregory
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Stephen H Waterman
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
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18
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Lu Y, Joseph L, Bélisle P, Sawatwong P, Jatapai A, Whistler T, Thamthitiwat S, Paveenkittiporn W, Khemla S, Van Beneden CA, Baggett HC, Gregory CJ. Pneumococcal pneumonia prevalence among adults with severe acute respiratory illness in Thailand - comparison of Bayesian latent class modeling and conventional analysis. BMC Infect Dis 2019; 19:423. [PMID: 31092207 PMCID: PMC6521483 DOI: 10.1186/s12879-019-4067-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 05/07/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Determining the etiology of pneumonia is essential to guide public health interventions. Diagnostic test results, including from polymerase chain reaction (PCR) assays of upper respiratory tract specimens, have been used to estimate prevalence of pneumococcal pneumonia. However limitations in test sensitivity and specificity and the specimen types available make establishing a definitive diagnosis challenging. Prevalence estimates for pneumococcal pneumonia could be biased in the absence of a true gold standard reference test for detecting Streptococcus pneumoniae. METHODS We conducted a case control study to identify etiologies of community acquired pneumonia (CAP) from April 2014 through August 2015 in Thailand. We estimated the prevalence of pneumococcal pneumonia among adults hospitalized for CAP using Bayesian latent class models (BLCMs) incorporating results of real-time polymerase chain reaction (qPCR) testing of upper respiratory tract specimens and a urine antigen test (UAT) from cases and controls. We compared the prevalence estimate to conventional analyses using only UAT as a reference test. RESULTS The estimated prevalence of pneumococcal pneumonia was 8% (95% CI: 5-11%) by conventional analyses. By BLCM, we estimated the prevalence to be 10% (95% CrI: 7-16%) using binary qPCR and UAT results, and 11% (95% CrI: 7-17%) using binary UAT results and qPCR cycle threshold (Ct) values. CONCLUSIONS BLCM suggests a > 25% higher prevalence of pneumococcal pneumonia than estimated by a conventional approach assuming UAT as a gold standard reference test. Higher quantities of pneumococcal DNA in the upper respiratory tract were associated with pneumococcal pneumonia in adults but the addition of a second specific pneumococcal test was required to accurately estimate disease status and prevalence. By incorporating the inherent uncertainty of diagnostic tests, BLCM can obtain more reliable estimates of disease status and improve understanding of underlying etiology.
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Affiliation(s)
- Ying Lu
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
| | - Lawrence Joseph
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Patrick Bélisle
- Centre Hospitalier de l'Universite de Montreal,Montreal, Montreal, Canada
| | - Pongpun Sawatwong
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Anchalee Jatapai
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.,Office of Public Health, Regional Development Mission for Asia, US Agency for International Development, Bangkok, Thailand
| | - Toni Whistler
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Somsak Thamthitiwat
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Wantana Paveenkittiporn
- Department of Medical Sciences, Ministry of Public Health, National Institute of Health, Nonthaburi, Thailand
| | - Supphacoke Khemla
- Nakhon Phanom Provincial Hospital, Ministry of Public Health, Nakhon Phanom, Thailand
| | - Chris A Van Beneden
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Disease, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Henry C Baggett
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christopher J Gregory
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.,Present affiliation: Division of Vector-Borne Diseases, US Centers for Disease Control and Prevention, Fort Collins, CO, USA
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19
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Rhodes J, Jorakate P, Makprasert S, Sangwichian O, Kaewpan A, Akarachotpong T, Srisaengchai P, Thamthitiwat S, Khemla S, Yuenprakhon S, Paveenkittiporn W, Kerdsin A, Whistler T, Baggett HC, Gregory CJ. Population-based bloodstream infection surveillance in rural Thailand, 2007-2014. BMC Public Health 2019; 19:521. [PMID: 32326935 PMCID: PMC6696817 DOI: 10.1186/s12889-019-6775-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Bloodstream infection (BSI) surveillance is essential to characterize the public health threat of bacteremia. We summarize BSI epidemiology in rural Thailand over an eight year period. Methods Population-based surveillance captured clinically indicated blood cultures and associated antimicrobial susceptibility results performed in all 20 hospitals in Nakhon Phanom (NP) and Sa Kaeo (SK) provinces. BSIs were classified as community-onset (CO) when positive cultures were obtained ≤2 days after hospital admission and hospital-onset (HO) thereafter. Hospitalization denominator data were available for incidence estimates for 2009–2014. Results From 2007 to 2014 a total of 11,166 BSIs were identified from 134,441 blood cultures. Annual CO BSI incidence ranged between 89.2 and 123.5 cases per 100,000 persons in SK and NP until 2011. Afterwards, CO incidence remained stable in SK and increased in NP, reaching 155.7 in 2013. Increases in CO BSI incidence over time were limited to persons aged ≥50 years. Ten pathogens, in rank order, accounted for > 65% of CO BSIs in both provinces, all age-groups, and all years: Escherichia coli, Klebsiella pneumoniae, Burkholderia pseudomallei, Staphylococcus aureus, Salmonella non-typhi spp., Streptococcus pneumoniae, Acinetobacter spp., Streptococcus agalactiae, Streptococcus pyogenes, Pseudomonas aeruginosa. HO BSI incidence increased in NP from 0.58 cases per 1000 hospitalizations in 2009 to 0.91 in 2014, but were higher (ranging from 1.9 to 2.3) in SK throughout the study period. Extended-spectrum beta-lactamase production among E. coli isolates and multi-drug resistance among Acinetobacter spp. isolates was common (> 25% of isolates), especially among HO cases (> 50% of isolates), and became more common over time, while methicillin-resistance among S. aureus isolates (10%) showed no clear trend. Carbapenem-resistant Enterobacteriaceae were documented in 2011–2014. Conclusions Population-based surveillance documented CO BSI incidence estimates higher than previously reported from Thailand and the region, with temporal increases seen in older populations. The most commonly observed pathogens including resistance profiles were similar to leading pathogens and resistance profiles worldwide, thus; prevention strategies with demonstrated success elsewhere may prove effective in Thailand. Electronic supplementary material The online version of this article (10.1186/s12889-019-6775-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Rhodes
- Global Disease Detection Center, Thailand Ministry of Public Health (MOPH) - United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand.
| | - Possawat Jorakate
- Global Disease Detection Center, Thailand Ministry of Public Health (MOPH) - United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
| | - Sirirat Makprasert
- Global Disease Detection Center, Thailand Ministry of Public Health (MOPH) - United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
| | - Ornuma Sangwichian
- Global Disease Detection Center, Thailand Ministry of Public Health (MOPH) - United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
| | - Anek Kaewpan
- Global Disease Detection Center, Thailand Ministry of Public Health (MOPH) - United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
| | - Thantapat Akarachotpong
- Global Disease Detection Center, Thailand Ministry of Public Health (MOPH) - United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
| | - Prasong Srisaengchai
- Global Disease Detection Center, Thailand Ministry of Public Health (MOPH) - United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
| | - Somsak Thamthitiwat
- Global Disease Detection Center, Thailand Ministry of Public Health (MOPH) - United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
| | | | | | - Wantana Paveenkittiporn
- Department of Medical Sciences, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Anusak Kerdsin
- Department of Medical Sciences, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand.,Faculty of Public Health, Kasetsart University Chalermphrakiat, Sakon Nakhon Province, Thailand
| | - Toni Whistler
- Global Disease Detection Center, Thailand Ministry of Public Health (MOPH) - United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand.,Division of Global Health Protection, Center for Global Health, CDC, Atlanta, GA, USA
| | - Henry C Baggett
- Global Disease Detection Center, Thailand Ministry of Public Health (MOPH) - United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand.,Division of Global Health Protection, Center for Global Health, CDC, Atlanta, GA, USA
| | - Christopher J Gregory
- Global Disease Detection Center, Thailand Ministry of Public Health (MOPH) - United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand.,Division of Global Health Protection, Center for Global Health, CDC, Atlanta, GA, USA
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20
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Bunthi C, Baggett HC, Gregory CJ, Thamthitiwat S, Yingyong T, Paveenkittiporn W, Kerdsin A, Chittaganpitch M, Ruangchira-Urai R, Akarasewi P, Ungchusak K. Enhanced surveillance for severe pneumonia, Thailand 2010-2015. BMC Public Health 2019; 19:472. [PMID: 32326941 PMCID: PMC6696659 DOI: 10.1186/s12889-019-6774-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background The etiology of severe pneumonia is frequently not identified by routine disease surveillance in Thailand. Since 2010, the Thailand Ministry of Public Health (MOPH) and US CDC have conducted surveillance to detect known and new etiologies of severe pneumonia. Methods Surveillance for severe community-acquired pneumonia was initiated in December 2010 among 30 hospitals in 17 provinces covering all regions of Thailand. Interlinked clinical, laboratory, pathological and epidemiological components of the network were created with specialized guidelines for each to aid case investigation and notification. Severe pneumonia was defined as chest-radiograph confirmed pneumonia of unknown etiology in a patient hospitalized ≤48 h and requiring intubation with ventilator support or who died within 48 h after hospitalization; patients with underlying chronic pulmonary or neurological disease were excluded. Respiratory and pathological specimens were tested by reverse transcription polymerase chain reaction for nine viruses, including Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and 14 bacteria. Cases were reported via a secure web-based system. Results Of specimens from 972 cases available for testing during December 2010 through December 2015, 589 (60.6%) had a potential etiology identified; 399 (67.8%) were from children aged < 5 years. At least one viral agent was detected in 394 (40.5%) cases, with the most common of single vial pathogen detected being respiratory syncytial virus (RSV) (110/589, 18.7%) especially in children under 5 years. Bacterial pathogens were detected in 341 cases of which 67 cases had apparent mixed infections. The system added MERS-CoV testing in September 2012 as part of Thailand’s outbreak preparedness; no cases were identified from the 767 samples tested. Conclusions Enhanced surveillance improved the understanding of the etiology of severe pneumonia cases and improved the MOPH’s preparedness and response capacity for emerging respiratory pathogens in Thailand thereby enhanced global health security. Guidelines for investigation of severe pneumonia from this project were incorporated into surveillance and research activities within Thailand and shared for adaption by other countries.
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Affiliation(s)
- Charatdao Bunthi
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Tivanond Road, Nonthaburi, 11000, Thailand.
| | - Henry C Baggett
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Tivanond Road, Nonthaburi, 11000, Thailand.,Division of Global Health Protection, Centers for Disease Control and Prevention, Clifton Road, Atlanta, GA, 30329, USA
| | - Christopher J Gregory
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Tivanond Road, Nonthaburi, 11000, Thailand.,Division of Global Health Protection, Centers for Disease Control and Prevention, Clifton Road, Atlanta, GA, 30329, USA
| | - Somsak Thamthitiwat
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Tivanond Road, Nonthaburi, 11000, Thailand
| | - Thitipong Yingyong
- Department of Disease Control, Bureau of Epidemiology, Ministry of Public Health, Tivanond Road, Nonthaburi, 11000, Thailand
| | - Wantana Paveenkittiporn
- National Institute of Health, Ministry of Public Health, Tivanond Road, Nonthaburi, 11000, Thailand
| | - Anusak Kerdsin
- Faculty of Public Health, Kasetsart University Chalermphrakiat Sakon Nakhon Province Campus, Sakon Nakhon, 47000, Thailand
| | - Malinee Chittaganpitch
- National Institute of Health, Ministry of Public Health, Tivanond Road, Nonthaburi, 11000, Thailand
| | | | - Pasakorn Akarasewi
- Department of Disease Control, Bureau of Epidemiology, Ministry of Public Health, Tivanond Road, Nonthaburi, 11000, Thailand
| | - Kumnuan Ungchusak
- Department of Disease Control, Bureau of Epidemiology, Ministry of Public Health, Tivanond Road, Nonthaburi, 11000, Thailand
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21
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Gregory CJ, Oduyebo T, Brault AC, Brooks JT, Chung KW, Hills S, Kuehnert MJ, Mead P, Meaney-Delman D, Rabe I, Staples E, Petersen LR. Modes of Transmission of Zika Virus. J Infect Dis 2019; 216:S875-S883. [PMID: 29267909 DOI: 10.1093/infdis/jix396] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [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: 12/28/2022] Open
Abstract
For >60 years, Zika virus (ZIKV) has been recognized as an arthropod-borne virus with Aedes species mosquitoes as the primary vector. However in the past 10 years, multiple alternative routes of ZIKV transmission have been identified. We review the available data on vector and non-vector-borne modes of transmission and interventions undertaken, to date, to reduce the risk of human infection through these routes. Although much has been learned during the outbreak in the Americas on the underlying mechanisms and pathogenesis of non-vector-borne ZIKV infections, significant gaps remain in our understanding of the relative incidence of, and risk from, these modes compared to mosquito transmission. Additional research is urgently needed on the risk, pathogenesis, and effectiveness of measures to mitigate non-vector-borne ZIKV transmission.
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Affiliation(s)
- Christopher J Gregory
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Titilope Oduyebo
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aaron C Brault
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - John T Brooks
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Koo-Whang Chung
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan Hills
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Matthew J Kuehnert
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul Mead
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Dana Meaney-Delman
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ingrid Rabe
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Erin Staples
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Lyle R Petersen
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
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22
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Whistler T, Sapchookul P, McCormick DW, Sangwichian O, Jorakate P, Makprasert S, Jatapai A, Naorat S, Surin U, Koosakunwat S, Supcharassaeng S, Piralam B, Mikoleit M, Baggett HC, Rhodes J, Gregory CJ. Epidemiology and antimicrobial resistance of invasive non-typhoidal Salmonellosis in rural Thailand from 2006-2014. PLoS Negl Trop Dis 2018; 12:e0006718. [PMID: 30080897 PMCID: PMC6095622 DOI: 10.1371/journal.pntd.0006718] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/16/2018] [Accepted: 07/25/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Invasive salmonellosis is a common cause of bloodstream infection in Southeast Asia. Limited epidemiologic and antimicrobial resistance data are available from the region. METHODS Blood cultures performed in all 20 hospitals in the northeastern province of Nakhon Phanom (NP) and eastern province of Sa Kaeo (SK), Thailand were captured in a bloodstream infection surveillance system. Cultures were performed as clinically indicated in hospitalized patients; patients with multiple positive cultures had only the first included. Bottles were incubated using the BacT/Alert system (bioMérieux, Thailand) and isolates were identified using standard microbiological techniques; all Salmonella isolates were classified to at least the serogroup level. Antimicrobial resistance was assessed using disk diffusion. RESULTS Salmonella was the fifth most common pathogen identified in 147,535 cultures with 525 cases (211 in Nakhon Phanom (NP) and 314 in Sa Kaeo (SK)). The overall adjusted iNTS incidence rate in NP was 4.0 cases/100,000 person-years (95% CI 3.5-4.5) and in SK 6.4 cases/100,000 person-years (95% CI 5.7-7.1; p = 0.001). The most common serogroups were C (39.4%), D (35.0%) and B (9.9%). Serogroup D predominated in NP (103/211) with 59.2% of this serogroup being Salmonella serovar Enteritidis. Serogroup C predominated in SK (166/314) with 84.3% of this serogroup being Salmonella serovar Choleraesuis. Antibiotic resistance was 68.2% (343/503) for ampicillin, 1.2% (6/482) for ciprofloxacin (or 58.1% (280/482) if both intermediate and resistant phenotypes are considered), 17.0% (87/512) for trimethoprim-sulfamethoxazole, and 12.2% (59/484) for third-generation cephalosporins (cefotaxime or ceftazidime). Multidrug resistance was seen in 99/516 isolates (19.2%). CONCLUSIONS The NTS isolates causing bloodstream infections in rural Thailand are commonly resistant to ampicillin, cefotaxime, and TMP-SMX. Observed differences between NP and SK indicate that serogroup distribution and antibiotic resistance may substantially differ throughout Thailand and the region.
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Affiliation(s)
- Toni Whistler
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Patranuch Sapchookul
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - David W. McCormick
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ornuma Sangwichian
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Possawat Jorakate
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Sirirat Makprasert
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Anchalee Jatapai
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Sathapana Naorat
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Uraiwan Surin
- Nakhon Phanom General Hospital, Nakhon Phanom Provincial Health Office, Nakhon Phanom, Thailand
| | - Surathinee Koosakunwat
- Nakhon Phanom General Hospital, Nakhon Phanom Provincial Health Office, Nakhon Phanom, Thailand
| | - Surachai Supcharassaeng
- Sa Kaeo Crown Prince Hospital, Sa Kaeo Provincial Health Office, Ministry of Public Health, Thailand
| | - Barameht Piralam
- Nakhon Phanom General Hospital, Nakhon Phanom Provincial Health Office, Nakhon Phanom, Thailand
| | - Mathew Mikoleit
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Henry C. Baggett
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Julia Rhodes
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christopher J. Gregory
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Jatapai A, Gregory CJ, Thamthitiwat S, Tanwisaid K, Bhengsri S, Baggett HC, Sangwichian O, Jorakate P, MacArthur JR. Hospitalized Bacteremic Melioidosis in Rural Thailand: 2009-2013. Am J Trop Med Hyg 2018; 98:1585-1591. [PMID: 29611505 PMCID: PMC6086176 DOI: 10.4269/ajtmh.17-0402] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 01/28/2018] [Indexed: 01/08/2023] Open
Abstract
Melioidosis incidence and mortality have reportedly been increasing in endemic areas of Thailand, but little population-based data on culture-confirmed Burkholderia pseudomallei infections exist. We provide updated estimates of melioidosis bacteremia incidence and in-hospital mortality rate using integration of two population-based surveillance databases in Nakhon Phanom, Thailand, since automated blood culture became available in 2005. From 2009 to 2013, 564 hospitalized bacteremic melioidosis patients were identified. The annual incidence of bacteremic melioidosis ranged from 14 to 17 per 100,000 persons, and average population mortality rate was 2 per 100,000 persons per year. In-hospital mortality rate declined nonsignificantly from 15% (15/102) to 13% (15/118). Of 313 (56%) bacteremic melioidosis patients who met criteria for acute lower respiratory infection and were included in the hospital-based pneumonia surveillance system, 65% (202/313) had a chest radiograph performed within 48 hours of admission; 46% (92/202) showed radiographic evidence of pneumonia. Annual incidence of bacteremic melioidosis with pneumonia was 2.4 per 100,000 persons (95% confidence intervals; 1.9-2.9). In-hospital death was more likely among bacteremic melioidosis patients with pneumonia (34%; 20/59) compared with non-pneumonia patients (18%; 59/321) (P-value = 0.007). The overall mortality could have been as high as 46% (257/564) if patients with poor clinical condition at the time of discharge had died. The continued high incidence of bacteremic melioidosis, pneumonia, and deaths in an endemic area highlights the need for early diagnosis and treatment and additional interventions for the prevention and control for melioidosis.
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Affiliation(s)
- Anchalee Jatapai
- Global Disease Detection Regional Center, Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Christopher J. Gregory
- Global Disease Detection Regional Center, Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Somsak Thamthitiwat
- Global Disease Detection Regional Center, Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | - Saithip Bhengsri
- Global Disease Detection Regional Center, Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Henry C. Baggett
- Global Disease Detection Regional Center, Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ornuma Sangwichian
- Global Disease Detection Regional Center, Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Possawat Jorakate
- Global Disease Detection Regional Center, Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - John R. MacArthur
- Global Disease Detection Regional Center, Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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24
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Jaganath D, Jorakate P, Makprasert S, Sangwichian O, Akarachotpong T, Thamthitiwat S, Khemla S, DeFries T, Baggett HC, Whistler T, Gregory CJ, Rhodes J. Staphylococcus aureus Bacteremia Incidence and Methicillin Resistance in Rural Thailand, 2006-2014. Am J Trop Med Hyg 2018; 99:155-163. [PMID: 29761760 DOI: 10.4269/ajtmh.17-0631] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Staphylococcus aureus is a common cause of bloodstream infection and methicillin-resistant S. aureus (MRSA) is a growing threat worldwide. We evaluated the incidence rate of S. aureus bacteremia (SAB) and MRSA from population-based surveillance in all hospitals from two Thai provinces. Infections were classified as community-onset (CO) when blood cultures were obtained ≤ 2 days after hospital admission and as hospital-onset (HO) thereafter. The incidence rate of HO-SAB could only be calculated for 2009-2014 when hospitalization denominator data were available. Among 147,524 blood cultures, 919 SAB cases were identified. Community-onset S. aureus bacteremia incidence rate doubled from 4.4 (95% confidence interval [CI]: 3.3-5.8) in 2006 to 9.3 per 100,000 persons per year (95% CI: 7.6-11.2) in 2014. The highest CO-SAB incidence rate was among adults aged 50 years and older. Children less than 5 years old had the next highest incidence rate, with most cases occurring among neonates. During 2009-2014, there were 89 HO-SAB cases at a rate of 0.13 per 1,000 hospitalizations per year (95% CI: 0.10-0.16). Overall, MRSA prevalence among SAB cases was 10% (90/911) and constituted 7% (55/736) of CO-SAB and 20% (22/111) of HO-SAB without a clear temporal trend in incidence rate. In conclusion, CO-SAB incidence rate has increased, whereas MRSA incidence rate remained stable. The increasing CO-SAB incidence rate, especially the burden on older adults and neonates, underscores the importance of strong SAB surveillance to identify and respond to changes in bacteremia trends and antimicrobial resistance.
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Affiliation(s)
- Devan Jaganath
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California San Francisco, San Francisco, California.,Global Disease Detection Center, Thailand Ministry of Public Health (MOPH)-United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
| | - Possawat Jorakate
- Global Disease Detection Center, Thailand Ministry of Public Health (MOPH)-United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
| | - Sirirat Makprasert
- Global Disease Detection Center, Thailand Ministry of Public Health (MOPH)-United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
| | - Ornuma Sangwichian
- Global Disease Detection Center, Thailand Ministry of Public Health (MOPH)-United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
| | - Thantapat Akarachotpong
- Global Disease Detection Center, Thailand Ministry of Public Health (MOPH)-United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
| | - Somsak Thamthitiwat
- Global Disease Detection Center, Thailand Ministry of Public Health (MOPH)-United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
| | | | - Triveni DeFries
- Global Disease Detection Center, Thailand Ministry of Public Health (MOPH)-United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
| | - Henry C Baggett
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.,Global Disease Detection Center, Thailand Ministry of Public Health (MOPH)-United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
| | - Toni Whistler
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.,Global Disease Detection Center, Thailand Ministry of Public Health (MOPH)-United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
| | - Christopher J Gregory
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.,Global Disease Detection Center, Thailand Ministry of Public Health (MOPH)-United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
| | - Julia Rhodes
- Global Disease Detection Center, Thailand Ministry of Public Health (MOPH)-United States Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
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25
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Rosenberg R, Lindsey NP, Fischer M, Gregory CJ, Hinckley AF, Mead PS, Paz-Bailey G, Waterman SH, Drexler NA, Kersh GJ, Hooks H, Partridge SK, Visser SN, Beard CB, Petersen LR. Vital Signs: Trends in Reported Vectorborne Disease Cases - United States and Territories, 2004-2016. MMWR Morb Mortal Wkly Rep 2018; 67:496-501. [PMID: 29723166 PMCID: PMC5933869 DOI: 10.15585/mmwr.mm6717e1] [Citation(s) in RCA: 478] [Impact Index Per Article: 79.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction Vectorborne diseases are major causes of death and illness worldwide. In the United States, the most common vectorborne pathogens are transmitted by ticks or mosquitoes, including those causing Lyme disease; Rocky Mountain spotted fever; and West Nile, dengue, and Zika virus diseases. This report examines trends in occurrence of nationally reportable vectorborne diseases during 2004–2016. Methods Data reported to the National Notifiable Diseases Surveillance System for 16 notifiable vectorborne diseases during 2004–2016 were analyzed; findings were tabulated by disease, vector type, location, and year. Results A total 642,602 cases were reported. The number of annual reports of tickborne bacterial and protozoan diseases more than doubled during this period, from >22,000 in 2004 to >48,000 in 2016. Lyme disease accounted for 82% of all tickborne disease reports during 2004–2016. The occurrence of mosquitoborne diseases was marked by virus epidemics. Transmission in Puerto Rico, the U.S. Virgin Islands, and American Samoa accounted for most reports of dengue, chikungunya, and Zika virus diseases; West Nile virus was endemic, and periodically epidemic, in the continental United States. Conclusions and Implications for Public Health Practice Vectorborne diseases are a large and growing public health problem in the United States, characterized by geographic specificity and frequent pathogen emergence and introduction. Differences in distribution and transmission dynamics of tickborne and mosquitoborne diseases are often rooted in biologic differences of the vectors. To effectively reduce transmission and respond to outbreaks will require major national improvement of surveillance, diagnostics, reporting, and vector control, as well as new tools, including vaccines.
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Affiliation(s)
- Ronald Rosenberg
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado
| | - Nicole P Lindsey
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado
| | - Marc Fischer
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado
| | - Christopher J Gregory
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado
| | - Alison F Hinckley
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado
| | - Paul S Mead
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado
| | - Gabriela Paz-Bailey
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado
| | - Stephen H Waterman
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado
| | - Naomi A Drexler
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado
| | - Gilbert J Kersh
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado
| | - Holley Hooks
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado
| | - Susanna K Partridge
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado
| | - Susanna N Visser
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado
| | - Charles B Beard
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado
| | - Lyle R Petersen
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado
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26
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Greiner AL, Bhengsri S, Million M, Edouard S, Thamthitiwat S, Clarke K, Kersh GJ, Gregory CJ, Raoult D, Parola P. Acute Q Fever Case Detection among Acute Febrile Illness Patients, Thailand, 2002-2005. Am J Trop Med Hyg 2018; 98:252-257. [PMID: 29141767 PMCID: PMC5928714 DOI: 10.4269/ajtmh.17-0413] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/29/2017] [Indexed: 12/21/2022] Open
Abstract
Acute Q fever cases were identified from a hospital-based acute febrile illness study conducted in six community hospitals in rural north and northeast Thailand from 2002 to 2005. Of 1,784 participants that underwent Coxiella burnetii testing, nine (0.5%) participants were identified in this case-series as acute Q fever cases. Eight case-patients were located in one province. Four case-patients were hospitalized. Median age was 13 years (range: 7-69); five were male. The proportion of children with acute Q fever infection was similar to adults (P = 0.17). This previously unrecognized at-risk group, school-age children, indicates that future studies and prevention interventions should target this population. The heterogeneity of disease burden across Thailand and milder clinical presentations found in this case-series should be considered in future studies. As diagnosis based on serology is limited during the acute phase of the disease, other diagnostic options, such as polymerase chain reaction, should be explored to improve acute case detection.
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Affiliation(s)
- Ashley L. Greiner
- Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Saithip Bhengsri
- Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Matthieu Million
- Aix Marseille Université, AP-HM, URMITE, IHU-Méditerranée Infection, Marseille, France
| | - Sophie Edouard
- Aix Marseille Université, AP-HM, URMITE, IHU-Méditerranée Infection, Marseille, France
| | - Somsak Thamthitiwat
- Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Kevin Clarke
- Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gilbert J. Kersh
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher J. Gregory
- Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Didier Raoult
- Aix Marseille Université, AP-HM, URMITE, IHU-Méditerranée Infection, Marseille, France
| | - Philippe Parola
- Aix Marseille Université, AP-HM, URMITE, IHU-Méditerranée Infection, Marseille, France
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27
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Oduyebo T, Polen KD, Walke HT, Reagan-Steiner S, Lathrop E, Rabe IB, Kuhnert-Tallman WL, Martin SW, Walker AT, Gregory CJ, Ades EW, Carroll DS, Rivera M, Perez-Padilla J, Gould C, Nemhauser JB, Ben Beard C, Harcourt JL, Viens L, Johansson M, Ellington SR, Petersen E, Smith LA, Reichard J, Munoz-Jordan J, Beach MJ, Rose DA, Barzilay E, Noonan-Smith M, Jamieson DJ, Zaki SR, Petersen LR, Honein MA, Meaney-Delman D. Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure - United States (Including U.S. Territories), July 2017. MMWR Morb Mortal Wkly Rep 2017; 66:781-793. [PMID: 28749921 PMCID: PMC5657812 DOI: 10.15585/mmwr.mm6629e1] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
CDC has updated the interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure in response to 1) declining prevalence of Zika virus disease in the World Health Organization's Region of the Americas (Americas) and 2) emerging evidence indicating prolonged detection of Zika virus immunoglobulin M (IgM) antibodies. Zika virus cases were first reported in the Americas during 2015-2016; however, the incidence of Zika virus disease has since declined. As the prevalence of Zika virus disease declines, the likelihood of false-positive test results increases. In addition, emerging epidemiologic and laboratory data indicate that, as is the case with other flaviviruses, Zika virus IgM antibodies can persist beyond 12 weeks after infection. Therefore, IgM test results cannot always reliably distinguish between an infection that occurred during the current pregnancy and one that occurred before the current pregnancy, particularly for women with possible Zika virus exposure before the current pregnancy. These limitations should be considered when counseling pregnant women about the risks and benefits of testing for Zika virus infection during pregnancy. This updated guidance emphasizes a shared decision-making model for testing and screening pregnant women, one in which patients and providers work together to make decisions about testing and care plans based on patient preferences and values, clinical judgment, and a balanced assessment of risks and expected outcomes.
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28
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Holmes SE, Hinz R, Drake RJ, Gregory CJ, Conen S, Matthews JC, Anton-Rodriguez JM, Gerhard A, Talbot PS. In vivo imaging of brain microglial activity in antipsychotic-free and medicated schizophrenia: a [ 11C](R)-PK11195 positron emission tomography study. Mol Psychiatry 2016; 21:1672-1679. [PMID: 27698434 DOI: 10.1038/mp.2016.180] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [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] [Received: 04/12/2016] [Revised: 08/24/2016] [Accepted: 08/26/2016] [Indexed: 12/11/2022]
Abstract
Positron emission tomography (PET) imaging of the 18 kDa translocator protein (TSPO) has been used to investigate whether microglial activation, an indication of neuroinflammation, is evident in the brain of adults with schizophrenia. Interpretation of these studies is confounded by potential modulatory effects of antipsychotic medication on microglial activity. In the first such study in antipsychotic-free schizophrenia, we have used [11C](R)-PK11195 PET to compare TSPO availability in a predominantly antipsychotic-naive group of moderate-to-severely symptomatic unmedicated patients (n=8), similarly symptomatic medicated patients with schizophrenia taking risperidone or paliperidone by regular intramuscular injection (n=8), and healthy comparison subjects (n=16). We found no evidence for increased TSPO availability in antipsychotic-free patients compared with healthy controls (mean difference 4%, P=0.981). However, TSPO availability was significantly elevated in medicated patients (mean increase 88%, P=0.032) across prefrontal (dorsolateral, ventrolateral, orbital), anterior cingulate and parietal cortical regions. In the patients, TSPO availability was also strongly correlated with negative symptoms measured using the Positive and Negative Syndrome Scale across all the brain regions investigated (r=0.651-0.741). We conclude that the pathophysiology of schizophrenia is not associated with microglial activation in the 2-6 year period following diagnosis. The elevation in the medicated patients may be a direct effect of the antipsychotic, although this study cannot exclude treatment resistance and/or longer illness duration as potential explanations. It also remains to be determined whether it is present only in a subset of patients, represents a pro- or anti-inflammatory state, its association with primary negative symptoms, and whether there are significant differences between antipsychotics.
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Affiliation(s)
- S E Holmes
- Wolfson Molecular Imaging Centre, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - R Hinz
- Wolfson Molecular Imaging Centre, Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - R J Drake
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - C J Gregory
- Wolfson Molecular Imaging Centre, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - S Conen
- Wolfson Molecular Imaging Centre, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - J C Matthews
- Wolfson Molecular Imaging Centre, Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - J M Anton-Rodriguez
- Wolfson Molecular Imaging Centre, Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - A Gerhard
- Wolfson Molecular Imaging Centre, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - P S Talbot
- Wolfson Molecular Imaging Centre, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Paveenkittiporn W, Kerdsin A, Chokngam S, Bunthi C, Sangkitporn S, Gregory CJ. Emergence of plasmid-mediated colistin resistance and New Delhi metallo-β-lactamase genes in extensively drug-resistant Escherichia coli isolated from a patient in Thailand. Diagn Microbiol Infect Dis 2016; 87:157-159. [PMID: 27894674 DOI: 10.1016/j.diagmicrobio.2016.11.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 09/23/2016] [Revised: 11/03/2016] [Accepted: 11/10/2016] [Indexed: 11/29/2022]
Abstract
We reported a case of Escherichia coli with colistin resistance and an extensively drug-resistant phenotype. Molecular analysis revealed that the isolate carried mcr-1 and multiple β-lactamase genes includingblaNDM1, blaCTX-M-15, blaTEM1, and blaCMY-2. This is the first report of a clinical mcr-1 isolate in Thailand highlighting the urgent need for a comprehensive antimicrobial resistance containment strategy to prevent further spread.
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Affiliation(s)
- Wantana Paveenkittiporn
- Department of Medical Sciences, Ministry of Public Health, National Institute of Health, Bangkok, 10400, Thailand
| | - Anusak Kerdsin
- Faculty of Public Health, Kasetsart University Chalermphrakiat Sakon Nakhon Province Campus, Sakon Nakhon, 47000, Thailand.
| | | | - Charatdao Bunthi
- International Emerging Infections Program, Global Disease Detection Center, Nonthaburi, Thailand
| | - Somchai Sangkitporn
- Department of Medical Sciences, Ministry of Public Health, National Institute of Health, Bangkok, 10400, Thailand
| | - Christopher J Gregory
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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30
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Han GS, Gregory CJ, Biggerstaff BJ, Horiuchi K, Perez-Guerra C, Soto-Gomez E, Matos D, Margolis HS, Tomashek KM. Effect of a Dengue Clinical Case Management Course on Physician Practices in Puerto Rico. Clin Infect Dis 2016; 63:1297-1303. [PMID: 27506689 DOI: 10.1093/cid/ciw511] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 07/21/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Prior to 2010, the clinical management of dengue in Puerto Rico was inconsistent with World Health Organization guidelines. A 4-hour classroom-style course on dengue clinical management was developed in 2009 and mandated for Puerto Rico medical licensure in 2010. Fifty physicians were trained as "master trainers" and gave this course to 7638 physicians. This study evaluated the effect of the course on the clinical management of hospitalized dengue patients. METHODS Pre- and post-course test responses were compared. Changes in physician practices were assessed by reviewing medical records of 430 adult and 1075 pediatric dengue patients at the 12 hospitals in Puerto Rico that reported the most cases during 2008-2009 (pre-intervention) and 2011 (post-intervention). Mixed-effects logistic regression was used to compare key indicators of dengue management. RESULTS Physician test scores increased from 48% to 72% correct. Chart reviews showed that the percentage of adult patients who did not receive corticosteroids increased from 30% to 68% (odds ratio [OR], 5.9; 95% confidence interval [CI], 3.7-9.5) and from 91% to 96% in pediatric patients (OR, 2.7; 95% CI, 1.5-4.9). Usage of isotonic intravenous saline during the critical period increased from 57% to 90% in adult patients (OR, 6.2; 95% CI, 1.9-20.4) and from 25% to 44% in pediatric patients (OR, 3.4; 95% CI, 2.2-5.3). CONCLUSIONS Management of dengue inpatients significantly improved following implementation of a classroom-style course taught by master trainers. An online version of the course was launched in 2014 to expand its reach and sustainability.
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Affiliation(s)
- George S Han
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Brad J Biggerstaff
- Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Kalanthe Horiuchi
- Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Carmen Perez-Guerra
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Eunice Soto-Gomez
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Desiree Matos
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Harold S Margolis
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Kay M Tomashek
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
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Kittikraisak W, Chittaganpitch M, Gregory CJ, Laosiritaworn Y, Thantithaveewat T, Dawood FS, Lindblade KA. Assessment of potential public health impact of a quadrivalent inactivated influenza vaccine in Thailand. Influenza Other Respir Viruses 2016; 10:211-9. [PMID: 26588892 PMCID: PMC4814859 DOI: 10.1111/irv.12361] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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] [Accepted: 11/10/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Each year, an influenza B strain representing only one influenza B lineage is included in the trivalent inactivated influenza vaccine (IIV3); a mismatch between the selected lineage and circulating viruses can result in suboptimal vaccine effectiveness. We modeled the added potential public health impact of a quadrivalent inactivated influenza vaccine (IIV4) that includes strains from both influenza B lineages compared to IIV3 on influenza-associated morbidity and mortality in Thailand. METHODS Using data on the incidence of influenza-associated hospitalizations and deaths, vaccine effectiveness, and vaccine coverage from the 2007-2012 influenza seasons in Thailand, we estimated rates of influenza-associated outcomes that might be averted using IIV4 instead of IIV3. We then applied these rates to national population estimates to calculate averted illnesses, hospitalizations, and deaths for each season. We assumed that the influenza B lineage included in IIV3 would provide a relative vaccine effectiveness of 75% against the other B lineage. RESULTS Compared to use of IIV3, use of IIV4 might have led to an additional reduction ranging from 0·4 to 14·3 influenza-associated illnesses per 100 000 population/year, <0·1 to 0·5 hospitalizations per 100 000/year, and <0·1 to 0·4 deaths per 1000/year. Based on extrapolation to national population estimates, replacement of IIV3 with IIV4 might have averted an additional 267-9784 influenza-associated illnesses, 9-320 hospitalizations, and 0-3 deaths. CONCLUSION Compared to use of IIV3, IIV4 has the potential to further reduce the burden of influenza-associated morbidity and mortality in Thailand.
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Affiliation(s)
- Wanitchaya Kittikraisak
- Influenza ProgramThailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention CollaborationNonthaburiThailand
| | | | - Christopher J. Gregory
- International Emerging Infections ProgramThailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention CollaborationNonthaburiThailand
- Division of Global Health ProtectionU.S. Centers for Disease Control and PreventionAtlantaGAUSA
| | | | | | - Fatimah S. Dawood
- Influenza DivisionU.S. Centers for Disease Control and PreventionAtlantaGAUSA
| | - Kim A. Lindblade
- Influenza ProgramThailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention CollaborationNonthaburiThailand
- Influenza DivisionU.S. Centers for Disease Control and PreventionAtlantaGAUSA
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Ma C, Gregory CJ, Hao L, Wannemuehler KA, Su Q, An Z, Quick L, Rodewald L, Ma F, Yan R, Song L, Zhang Y, Kong Y, Zhang X, Wang H, Li L, Cairns L, Wang N, Luo H. Risk factors for measles infection in 0-7 month old children in China after the 2010 nationwide measles campaign: A multi-site case-control study, 2012-2013. Vaccine 2016; 34:6553-6560. [PMID: 27013438 PMCID: PMC6524948 DOI: 10.1016/j.vaccine.2016.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/30/2016] [Accepted: 02/01/2016] [Indexed: 11/25/2022]
Abstract
Introduction: Endemic measles persists in China, despite >95% reported coverage of two measles-containing vaccine doses and nationwide campaign that vaccinated more than 100 million children in 2010. We performed a case–control study in six Chinese provinces during January 2012 through June 2013 to identify risk factors for measles infection among children aged 0–7 months. Methods: Children with laboratory-confirmed measles were neighborhood matched with three controls. We interviewed parents of case and control infants on potential risk factors for measles. Adjusted matched odds ratios (mOR) and 95% confidence intervals (CIs) were calculated by multivariable conditional logistic modeling. We calculated attributable fractions for risk factors that could be interpreted as causal. Results: Eight hundred thirty cases and 2303 controls were enrolled. In multivariable analysis, male sex (mOR 1.6 [1.3, 2.0]), age 5–7 months (mOR 3.9 [3.0, 5.1]), migration between counties (mOR 2.3 [1.6, 3.4]), outpatient hospital visits (mOR 9.4 [6.6, 13.3]) and inpatient hospitalization (mOR 107.1 [48.8, 235.1]) were significant risk factors. The calculated attributable fractions for hospital visits was 43.1% (95% CI: 40.1, 47.5%) adjusted for age, sex and migration. Conclusions: Hospital visitation was the largest risk factor for measles infection in infants. Improved hospital infection control practices would accelerate measles elimination in China.
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Affiliation(s)
- Chao Ma
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Christopher J Gregory
- Global Immunization Division, Centers for Disease Control and Prevention, United States
| | - Lixin Hao
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | | | - Qiru Su
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhijie An
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Linda Quick
- Global Immunization Division, Centers for Disease Control and Prevention, United States
| | - Lance Rodewald
- Expanded Program on Immunization, World Health Organization Office in China, Beijing, China
| | - Fubao Ma
- Jiangsu Provincial Center for Disease Control and Prevention, Jiangsu Province, China
| | - Rui Yan
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Lizhi Song
- Shandong Provincial Center for Disease Control and Prevention, Shangdong Province, China
| | - Yanyang Zhang
- Henan Provincial Center for Disease Control and Prevention, Henan Province, China
| | - Yi Kong
- Yunnan Provincial Center for Disease Control and Prevention, Yunnan Province, China
| | - Xiaoshu Zhang
- Gansu Provincial Center for Disease Control and Prevention, Gansu Province, China
| | - Huaqing Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Li
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lisa Cairns
- Global Immunization Division, Centers for Disease Control and Prevention, United States
| | - Ning Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huiming Luo
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.
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Hao L, Ma C, Wannemuehler KA, Su Q, An Z, Cairns L, Quick L, Rodewald L, Liu Y, He H, Xu Q, Ma Y, Yu W, Zhang N, Li L, Wang N, Luo H, Wang H, Gregory CJ. Risk factors for measles in children aged 8 months-14 years in China after nationwide measles campaign: A multi-site case-control study, 2012-2013. Vaccine 2016; 34:6545-6552. [PMID: 26876440 PMCID: PMC6293465 DOI: 10.1016/j.vaccine.2016.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/30/2016] [Accepted: 02/01/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Endemic measles persists in China, despite >95% reported coverage of two measles-containing vaccine doses and nationwide campaign that vaccinated more than 100 million children in 2010. In 2011, almost half of the 9943 measles cases in China occurred in children eligible for measles vaccination. We conducted a case-control study during 2012-2013 to identify risk factors for measles infection in children aged 8 months-14 years. METHODS Children with laboratory-confirmed measles were age- and neighborhood-matched with three controls. We interviewed parents of case and control infants on potential risk factors for measles. We calculated adjusted matched odds ratios and 95% confidence intervals of risk factors. We calculated attributable fractions for risk factors that could be interpreted as causal and vaccine efficacy (VE) for the measles containing vaccine (MCV) used in the Chinese immunization program. RESULTS In all, 969 case-patients and 2845 controls were enrolled. In multivariable analysis, lack of measles vaccination both overall (mOR 22.7 [16.6, 31.1] and when stratified by region (east region, mOR 74.2 [27.3, 202]; central/western regions mOR 17.4 [12.5, 24.3]), hospital exposure (mOR 63.0, 95% CI [32.8, 121]), and migration among counties (overall mOR 3.0 [2.3, 3.9]) were significant risk factors. The calculated VE was 91.9-96.1% for a single dose of MCV and 96.6-99.5% for 2 doses. CONCLUSIONS Lack of vaccination was the leading risk factor for measles infection, especially in children born since the 2010 supplementary immunization activity. Reducing missed vaccination opportunities, improving immunization access for migrant children, and strengthening school/kindergarten vaccine checks are needed to strengthen the routine immunization program and maintain progress toward measles elimination in China.
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Affiliation(s)
- Lixin Hao
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Chao Ma
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Kathleen A Wannemuehler
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Qiru Su
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Zhijie An
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Lisa Cairns
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Linda Quick
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Lance Rodewald
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Yuanbao Liu
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Hanqing He
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Qing Xu
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Yating Ma
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Wen Yu
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Ningjing Zhang
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Li Li
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Ning Wang
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Huiming Luo
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Huaqing Wang
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China.
| | - Christopher J Gregory
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
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Piralam B, Tomczyk SM, Rhodes JC, Thamthitiwat S, Gregory CJ, Olsen SJ, Praphasiri P, Sawatwong P, Naorat S, Chantra S, Areerat P, Hurst CP, Moore MR, Muangchana C, Baggett HC. Incidence of Pneumococcal Pneumonia Among Adults in Rural Thailand, 2006-2011: Implications for Pneumococcal Vaccine Considerations. Am J Trop Med Hyg 2015; 93:1140-1147. [PMID: 26503277 PMCID: PMC4674225 DOI: 10.4269/ajtmh.15-0429] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/20/2015] [Indexed: 11/07/2022] Open
Abstract
The incidence of pneumococcal pneumonia among adults is a key driver for the cost-effectiveness of pneumococcal conjugate vaccine used among children. We sought to obtain more accurate incidence estimates among adults by including results of pneumococcal urine antigen testing (UAT) from population-based pneumonia surveillance in two Thai provinces. Active surveillance from 2006 to 2011 identified acute lower respiratory infection (ALRI)-related hospital admissions. Adult cases of pneumococcal pneumonia were defined as hospitalized ALRI patients aged ≥ 18 years with isolation of Streptococcus pneumoniae from blood or with positive UAT. Among 39,525 adult ALRI patients, we identified 481 pneumococcal pneumonia cases (105 by blood culture, 376 by UAT only). Estimated incidence of pneumococcal pneumonia hospitalizations was 30.5 cases per 100,000 persons per year (2.2 and 28.3 cases per 100,000 persons per year by blood culture and UAT, respectively). Incidence varied between 22.7 in 2007 and 43.5 in 2010, and increased with age to over 150 per 100,000 persons per year among persons aged ≥ 70 years. Viral coinfections including influenza A/B, respiratory syncytial virus (RSV), and adenovirus occurred in 11% (44/409) of pneumococcal pneumonia cases tested. Use of UAT to identify cases of pneumococcal pneumonia among adults in rural Thailand substantially increases estimates of pneumococcal pneumonia burden, thereby informing cost-effectiveness analyses and vaccine policy decisions.
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Affiliation(s)
- Barameht Piralam
- *Address correspondence to Barameht Piralam, Nakhon Phanom Provincial Health Office, 356 Abhibanbancha Road, Muang, Nakhon Phanom 48000, Thailand. E-mail:
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Gregory CJ, Llata E, Stine N, Gould C, Santiago LM, Vazquez GJ, Robledo IE, Srinivasan A, Goering RV, Tomashek KM. Outbreak of Carbapenem-Resistant Klebsiella pneumoniae in Puerto Rico Associated with a Novel Carbapenemase Variant. Infect Control Hosp Epidemiol 2015; 31:476-84. [DOI: 10.1086/651670] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background.Carbapenem-resistantKlebsiella pneumoniae(CRKP) is resistant to almost all antimicrobial agents, and CRKP infections are associated with substantial morbidity and mortality.Objective.To describe an outbreak of CRKP in Puerto Rico, determine risk factors for CRKP acquisition, and detail the successful measures taken to control the outbreak.Design.Two case-control studies.Setting.A 328-bed tertiary care teaching hospital.Patients.Twenty-six CRKP case patients identified during the outbreak period of February through September 2008, 26 randomly selected uninfected control patients, and 26 randomly selected control patients with carbapenem-susceptibleK. pneumoniae(CSKP) hospitalized during the same period.Methods.We performed active case finding, including retrospective review of the hospital's microbiology database and prospective perirectal surveillance culture sampling in high-risk units. Case patients were compared with each control group while controlling for time at risk. We sequenced theblaKPCgene with polymerase chain reaction for 7 outbreak isolates and subtyped these isolates with pulsed-field gel electrophoresis.Results.In matched, multivariable analysis, the presence of wounds (hazard ratio, 19.0 [95% confidence interval {CI}, 2.5-142.0]) was associated with CRKP compared with noK. pneumoniae.Transfer between units (adjusted odds ratio [OR], 7.5 [95% CI, 1.8-31.1]), surgery (adjusted OR, 4.0 [95% CI, 1.0-15.7]), and wounds (adjusted OR, 4.9 [95% CI, 1.1-21.8]) were independent risk factors for CRKP compared to CSKP. A novelK. pneumoniaecarbapenemase variant (KPC-8) was present in 5 isolates. Implementation of active surveillance for CRKP colonization and cohorting of CRKP patients rapidly controlled the outbreak.Conclusions.Enhanced surveillance for CRKP colonization and intensified infection control measures that include limiting the physical distribution of patients can reduce CRKP transmission during an outbreak.
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Lorenzi OD, Gregory CJ, Santiago LM, Acosta H, Galarza IE, Hunsperger E, Muñoz J, Bui DM, Oberste MS, Peñaranda S, García-Gubern C, Tomashek KM. Acute febrile illness surveillance in a tertiary hospital emergency department: comparison of influenza and dengue virus infections. Am J Trop Med Hyg 2013; 88:472-80. [PMID: 23382160 DOI: 10.4269/ajtmh.12-0373] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In 2009, an increased proportion of suspected dengue cases reported to the surveillance system in Puerto Rico were laboratory negative. As a result, enhanced acute febrile illness (AFI) surveillance was initiated in a tertiary care hospital. Patients with fever of unknown origin for 2-7 days duration were tested for Leptospira, enteroviruses, influenza, and dengue virus. Among the 284 enrolled patients, 31 dengue, 136 influenza, and 3 enterovirus cases were confirmed. Nearly half (48%) of the confirmed dengue cases met clinical criteria for influenza. Dengue patients were more likely than influenza patients to have hemorrhage (81% versus 26%), rash (39% versus 9%), and a positive tourniquet test (52% versus 18%). Mean platelet and white blood cell count were lower among dengue patients. Clinical diagnosis can be particularly difficult when outbreaks of other AFI occur during dengue season. A complete blood count and tourniquet test may be useful to differentiate dengue from other AFIs.
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Affiliation(s)
- Olga D Lorenzi
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico.
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Gregory CJ, Ndiaye S, Patel M, Hakizamana E, Wannemuehler K, Ndinga E, Chu S, Talani P, Kretsinger K. Investigation of elevated case-fatality rate in poliomyelitis outbreak in Pointe Noire, Republic of Congo, 2010. Clin Infect Dis 2012; 55:1299-306. [PMID: 22911644 DOI: 10.1093/cid/cis715] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Multiple cases of paralysis, often resulting in death, occurred among young adults during a wild poliovirus (WPV) type 1 outbreak in Pointe Noire, Republic of Congo, in 2010. We conducted an investigation to identify factors associated with fatal outcomes among persons with poliomyelitis in Pointe Noire. METHODS Polio cases were defined as acute flaccid paralysis (AFP) cases reported from 7 October to 7 December 2010 with either a stool specimen positive for WPV or clinically classified as polio-compatible. Data were obtained from medical records, hospital databases, AFP case investigation forms and, when possible, via interviews with persons with polio or surrogates using a standard questionnaire. RESULTS A total of 369 polio cases occurred in Pointe Noire between 7 October and 7 December 2010. Median age was 22 years for nonsurvivors and 18 years for survivors (P = .01). Small home size, as defined by ≤2 rooms, use of a well for drinking water during a water shortage, and age ≥15 years were risk factors for death in multivariate analysis. CONCLUSIONS Consideration should be given during polio risk assessment planning and outbreak response to water/sanitation status and potential susceptibility to polio in older children and adults. Serosurveys to estimate immunity gaps in older age groups in countries at high risk of polio importation might be useful to guide preparedness and response planning.
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Affiliation(s)
- Christopher J Gregory
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
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Radke EG, Gregory CJ, Kintziger KW, Sauber-Schatz EK, Hunsperger EA, Gallagher GR, Barber JM, Biggerstaff BJ, Stanek DR, Tomashek KM, Blackmore CGM. Dengue outbreak in Key West, Florida, USA, 2009. Emerg Infect Dis 2012; 18:135-7. [PMID: 22257471 PMCID: PMC3310087 DOI: 10.3201/eid1801.110130] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [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] [Indexed: 11/19/2022] Open
Abstract
After 3 dengue cases were acquired in Key West, Florida, we conducted a serosurvey to determine the scope of the outbreak. Thirteen residents showed recent infection (infection rate 5%; 90% CI 2%-8%), demonstrating the reemergence of dengue in Florida. Increased awareness of dengue among health care providers is needed.
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Tomashek KM, Gregory CJ, Rivera Sánchez A, Bartek MA, Garcia Rivera EJ, Hunsperger E, Muñoz-Jordán JL, Sun W. Dengue deaths in Puerto Rico: lessons learned from the 2007 epidemic. PLoS Negl Trop Dis 2012; 6:e1614. [PMID: 22530072 PMCID: PMC3328431 DOI: 10.1371/journal.pntd.0001614] [Citation(s) in RCA: 48] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 02/23/2012] [Indexed: 11/24/2022] Open
Abstract
Background The incidence and severity of dengue in Latin America has increased substantially in recent decades and data from Puerto Rico suggests an increase in severe cases. Successful clinical management of severe dengue requires early recognition and supportive care. Methods Fatal cases were identified among suspected dengue cases reported to two disease surveillance systems and from death certificates. To be included, fatal cases had to have specimen submitted for dengue diagnostic testing including nucleic acid amplification for dengue virus (DENV) in serum or tissue, immunohistochemical testing of tissue, and immunoassay detection of anti-DENV IgM from serum. Medical records from laboratory-positive dengue fatal case-patients were reviewed to identify possible determinants for death. Results Among 10,576 reported dengue cases, 40 suspect fatal cases were identified, of which 11 were laboratory-positive, 14 were laboratory-negative, and 15 laboratory-indeterminate. The median age of laboratory-positive case-patients was 26 years (range 5 months to 78 years), including five children aged <15 years; 7 sought medical care at least once prior to hospital admission, 9 were admitted to hospital and 2 died upon arrival. The nine hospitalized case-patients stayed a mean of 15 hours (range: 3–48 hours) in the emergency department (ED) before inpatient admission. Five of the nine case-patients received intravenous methylprednisolone and four received non-isotonic saline while in shock. Eight case-patients died in the hospital; five had their terminal event on the inpatient ward and six died during a weekend. Dengue was listed on the death certificate in only 5 instances. Conclusions During a dengue epidemic in an endemic area, none of the 11 laboratory-positive case-patients who died were managed according to current WHO Guidelines. Management issues identified in this case-series included failure to recognize warning signs for severe dengue and shock, prolonged ED stays, and infrequent patient monitoring. Dengue is a major public health problem in the tropics and subtropics; an estimated 50 million cases occur annually and 40 percent of the world's population lives in areas with dengue virus (DENV) transmission. Dengue has a wide range of clinical presentations from an undifferentiated acute febrile illness, classic dengue fever, to severe dengue (i.e., dengue hemorrhagic fever or dengue shock syndrome). About 5% of patients develop severe dengue, which is more common with second or subsequent infections. No vaccines are available to prevent dengue, and there are no specific antiviral treatments for patients with dengue. However, early recognition of shock and intensive supportive therapy can reduce risk of death from ∼10% to less than 1% among severe dengue cases. Reviewing dengue deaths is one means to identify issues in clinical management. These findings can be used to develop healthcare provider education to minimize dengue morbidity and mortality.
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Affiliation(s)
- Kay M Tomashek
- Dengue Branch, Division of Vector-Borne Diseases (DVBD), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico.
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Gregory CJ, Lorenzi OD, Colón L, García AS, Santiago LM, Rivera RC, Bermúdez LJC, Báez FO, Aponte DV, Tomashek KM, Gutierrez J, Alvarado L. Utility of the tourniquet test and the white blood cell count to differentiate dengue among acute febrile illnesses in the emergency room. PLoS Negl Trop Dis 2011; 5:e1400. [PMID: 22163057 PMCID: PMC3232191 DOI: 10.1371/journal.pntd.0001400] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 10/03/2011] [Indexed: 11/19/2022] Open
Abstract
Dengue often presents with non-specific clinical signs, and given the current paucity of accurate, rapid diagnostic laboratory tests, identifying easily obtainable bedside markers of dengue remains a priority. Previous studies in febrile Asian children have suggested that the combination of a positive tourniquet test (TT) and leucopenia can distinguish dengue from other febrile illnesses, but little data exists on the usefulness of these tests in adults or in the Americas. We evaluated the diagnostic accuracy of the TT and leucopenia (white blood cell count <5000/mm3) in identifying dengue as part of an acute febrile illness (AFI) surveillance study conducted in the Emergency Department of Saint Luke's Hospital in Ponce, Puerto Rico. From September to December 2009, 284 patients presenting to the ED with fever for 2–7 days and no identified source were enrolled. Participants were tested for influenza, dengue, leptospirosis and enteroviruses. Thirty-three (12%) patients were confirmed as having dengue; 2 had dengue co-infection with influenza and leptospirosis, respectively. An infectious etiology was determined for 141 others (136 influenza, 3 enterovirus, 2 urinary tract infections), and 110 patients had no infectious etiology identified. Fifty-two percent of laboratory-positive dengue cases had a positive TT versus 18% of patients without dengue (P<0.001), 87% of dengue cases compared to 28% of non-dengue cases had leucopenia (P<0.001). The presence of either a positive TT or leucopenia correctly identified 94% of dengue patients. The specificity and positive predictive values of these tests was significantly higher in the subset of patients without pandemic influenza A H1N1, suggesting improved discriminatory performance of these tests in the absence of concurrent dengue and influenza outbreaks. However, even during simultaneous AFI outbreaks, the absence of leucopenia combined with a negative tourniquet test may be useful to rule out dengue. In the Americas, the incidence and severity of dengue cases has increased dramatically in the past 30 years. Early diagnosis and initiation of appropriate therapy can substantially reduce dengue morbidity and mortality. However the absence of a point-of-care diagnostic test and the non-specific clinical signs and symptoms in early disease make differentiating dengue from other acute febrile illnesses challenging. Identifying dengue during an outbreak of another disease is especially difficult. The combination of a simple bedside test, the tourniquet test (TT), and a readily available laboratory test, the white blood cell count, has been reported to be a useful triage tool for identifying children with dengue in Asia, but little information exists on the performance of these tests in the Americas or among adults. We evaluated the utility of these tests in the setting of a concurrent influenza epidemic in Puerto Rico in 2009. A positive TT or leucopenia (white blood cell count <5000) was present in 94% of patients with laboratory proven dengue. Patients without either of these findings rarely had dengue. Our study indicates that a combination of two rapid, widely available tests can assist clinicians in distinguishing dengue from other illnesses with similar signs and symptoms.
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Affiliation(s)
- Christopher J Gregory
- Dengue Branch, Division of Vector-Borne Diseases, Centers For Disease Control and Prevention, San Juan, Puerto Rico.
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Gregory CJ, Nicholls PJ. Effect of lipopolysaccharide (LPS) and (1→3)-β-D glucan either alone or in combination on rat peritoneal mast cells: A preliminary study. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1998.tb02275.x] [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: 11/30/2022]
Affiliation(s)
- C J Gregory
- Welsh School of Pharmacy, Cardiff University, Cathays Park Cardiff CF1 3XF
| | - P J Nicholls
- Welsh School of Pharmacy, Cardiff University, Cathays Park Cardiff CF1 3XF
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Lopez Rodriguez E, Tomashek KM, Gregory CJ, Munoz J, Hunsperger E, Lorenzi OD, Irizarry JG, Garcia-Gubern C. Co-infection with dengue virus and pandemic (H1N1) 2009 virus. Emerg Infect Dis 2010; 16:882-4. [PMID: 20409395 PMCID: PMC2954016 DOI: 10.3201/eid1605.091920] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Gregory CJ, Santiago LM, Argüello DF, Hunsperger E, Tomashek KM. Clinical and laboratory features that differentiate dengue from other febrile illnesses in an endemic area--Puerto Rico, 2007-2008. Am J Trop Med Hyg 2010; 82:922-9. [PMID: 20439977 DOI: 10.4269/ajtmh.2010.09-0552] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Dengue infection can be challenging to diagnose early in the course of infection before severe manifestations develop, but early diagnosis can improve patient outcomes and promote timely public health interventions. We developed age-based predictive models generated from 2 years of data from an enhanced dengue surveillance system in Puerto Rico. These models were internally validated and were able to differentiate dengue infection from other acute febrile illnesses with moderate accuracy. The accuracy of the models was greater than either the current World Health Organization case definition for dengue fever or a proposed modification to this definition, while requiring the collection of fewer data. In young children, thrombocytopenia and the absence of cough were associated with dengue infection; for adults, rash, leucopenia, and the absence of sore throat were associated with dengue infection; in all age groups, retro-orbital pain was associated with dengue infection.
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Affiliation(s)
- Christopher J Gregory
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Fleskes JP, Gregory CJ. Distribution and Dynamics of Waterbird Habitat During Spring in Southern Oregon—Northeastern California. WEST N AM NATURALIST 2010. [DOI: 10.3398/064.070.0104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wylie GD, Casazza ML, Halstead BJ, Gregory CJ. Sex, season, and time of day interact to affect body temperatures of the Giant Gartersnake. J Therm Biol 2009. [DOI: 10.1016/j.jtherbio.2009.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gregory CJ, Nasrollahzadeh F, Dharmar M, Parsapour K, Marcin JP. Comparison of critically ill and injured children transferred from referring hospitals versus in-house admissions. Pediatrics 2008; 121:e906-11. [PMID: 18381519 DOI: 10.1542/peds.2007-2089] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this work was to compare the outcomes, severity of illness, and resource use of patients transferred to PICUs from outside hospitals to patients admitted from within the same hospital. METHODS We conducted a secondary analysis of patients from the 20 US PICUs in the most recent Pediatric Intensive Care Unit Evaluations Software Recalibration Database on a total of 13,017 emergent PICU admissions between January 2001 and January 2006. Dependent variables were PICU resource use and risk-adjusted mortality. The main independent variable was the PICU admission source: patients transferred from referring emergency departments and inpatient wards versus in-house admissions from the same hospitals' emergency departments and inpatient ward. RESULTS Patients admitted from referring emergency departments had higher use of vasoactive infusions (7.31% vs 5.23%) and mechanical ventilation (33.45% vs 23.6%) than same-hospital emergency department admissions. Compared with in-house ward admissions, patients transferred from referring inpatient wards had higher mechanical ventilation rates (45.05% vs 28.56%) and PICU lengths of stay (8.0 vs 6.7 days). CONCLUSIONS On average, children admitted to a cohort of US PICUs from referring hospitals were more ill and required more intensive care resources than patients admitted to the same PICUs from within the institution. Hospital-level differences in PICU efficiency and severity of illness were highly variable. These data highlight the need for standardized PICU admission criteria to maximize hospital efficiency and suggest opportunities for earlier intervention and consultation by hospitals with PICU-level services to improve quality of care for critically ill children.
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Burr ML, Matthews IP, Arthur RA, Watson HL, Gregory CJ, Dunstan FDJ, Palmer SR. Effects on patients with asthma of eradicating visible indoor mould: a randomised controlled trial. Thorax 2007; 62:767-72. [PMID: 17389753 PMCID: PMC2117320 DOI: 10.1136/thx.2006.070847] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND It is not clear whether associations between respiratory symptoms and indoor mould are causal. A randomised controlled trial was conducted to see whether asthma improves when indoor mould is removed. METHODS Houses of patients with asthma were randomly allocated into two groups. In one group, indoor mould was removed, fungicide was applied and a fan was installed in the loft. In the control group, intervention was delayed for 12 months. Questionnaires were administered and peak expiratory flow rate was measured at baseline, 6 months and 12 months. RESULTS Eighty-one houses were allocated to the intervention group and 83 to the control group; 95 participants in 68 intervention houses and 87 in 63 control houses supplied follow-up information. Peak expiratory flow rate variability declined in both groups, with no significant differences between them. At 6 months, significantly more of the intervention group showed a net improvement in wheeze affecting activities (difference between groups 25%, 95% CI 3% to 47%; p = 0.028), perceived improvement of breathing (52%, 95% CI 30% to 74%; p<0.0001) and perceived reduction in medication (59%, 95% CI 35% to 81%; p<0.0001). By 12 months the intervention group showed significantly greater reductions than the controls in preventer and reliever use, and more improvement in rhinitis (24%, 95% CI 9% to 39%; p = 0.001) and rhinoconjunctivitis (20%, 95% CI 5% to 36%; p = 0.009). CONCLUSIONS Although there was no objective evidence of benefit, symptoms of asthma and rhinitis improved and medication use declined following removal of indoor mould. It is unlikely that this was entirely a placebo effect.
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Affiliation(s)
- M L Burr
- Department of Epidemiology, Statistics and Public Health, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
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Gregory CJ. Elfrida K. Berzins: world record holder, olympic athlete, concert soloist, author, and pioneer physical educator. Can J Hist Sport Phys Educ 2001; 10:1-14. [PMID: 11616772 DOI: 10.1123/cjhspe.10.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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