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Bekele A, Hrapcak S, Mohammed JA, Yimam JA, Tilahun T, Antefe T, Kumssa H, Kassa D, Mengistu S, Mirkovic K, Dziuban EJ, Belay Z, Ross C, Teferi W. Rates of confirmatory HIV testing, linkage to HIV services, and rapid initiation of antiretroviral treatment among newly diagnosed children living with HIV in Ethiopia: perspectives from caregivers and healthcare workers. BMC Pediatr 2022; 22:736. [PMID: 36572846 PMCID: PMC9791729 DOI: 10.1186/s12887-022-03784-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 11/30/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Successful linkage to HIV services and initiation of antiretroviral treatment (ART) for children living with HIV (CLHIV) is critical to improve pediatric ART coverage. We aimed to assess confirmatory testing, linkage, and rapid ART initiation among newly diagnosed CLHIV in Ethiopia from the perspectives of caregivers and healthcare workers (HCWs). METHODS We conducted standardized surveys with HCWs and caregivers of children 2-14 years who were diagnosed with HIV but not yet on ART who had been identified during a cross-sectional study in Ethiopia from May 2017-March 2018. Eight health facilities based on their HIV caseload and testing volume and 21 extension sites were included. Forty-one children, 34 care givers and 40 healthcare workers were included in this study. Three months after study enrollment, caregivers were surveyed about timing and experiences with HIV service enrollment, confirmatory testing, and ART initiation. Data collected from HCWs included perceptions of confirmatory testing in CLHIV before ART initiation. SPSS was used to conduct descriptive statistics. RESULTS The majority of the 41 CLHIV were enrolled to HIV services (n = 34, 83%) and initiated ART by three months (n = 32, 94%). Median time from diagnosis to ART initiation was 12 days (interquartile range 5-18). Five children died before the follow-up interview. Confirmatory HIV testing was conducted in 34 children and found no discordant results; the majority (n = 23, 68%) received it within one week of HIV diagnosis. Almost all HCWs (n = 39/40, 98%) and caregivers (n = 31/34, 91%) felt better/the same about test results after conducting confirmatory testing. CONCLUSION Opportunities remain to strengthen linkage for newly diagnosed CLHIV in Ethiopia through intensifying early follow-up to ensure prompt confirmatory testing and rapid ART initiation. Additional services could help caregivers with decision-making around treatment initiation for their children.
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Affiliation(s)
- Alemayehu Bekele
- grid.428935.10000 0000 9552 339XEthiopian Public Health Association, Addis Ababa, Ethiopia
| | - Susan Hrapcak
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention, Atlanta, Georgia USA
| | | | - Jemal Ayalew Yimam
- grid.428935.10000 0000 9552 339XEthiopian Public Health Association, Addis Ababa, Ethiopia
| | - Tsegaye Tilahun
- United States Agency for International Development, Addis Ababa, Ethiopia
| | - Tenagnework Antefe
- grid.463120.20000 0004 0455 2507Amhara Regional Health Bureau, Amhara, Ethiopia
| | - Hanna Kumssa
- grid.463056.2Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia
| | - Desta Kassa
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Semegnew Mengistu
- grid.428935.10000 0000 9552 339XEthiopian Public Health Association, Addis Ababa, Ethiopia
| | - Kelsey Mirkovic
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention, Atlanta, Georgia USA
| | - Eric J. Dziuban
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention, Atlanta, Georgia USA
| | - Zena Belay
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention, Atlanta, Georgia USA
| | - Christine Ross
- Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Wondimu Teferi
- Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
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Smith-Sreen J, Miller B, Kabaghe AN, Kim E, Wadonda-Kabondo N, Frawley A, Labuda S, Manuel E, Frietas H, Mwale AC, Segolodi T, Harvey P, Seitio-Kgokgwe O, Vergara AE, Gudo ES, Dziuban EJ, Shoopala N, Hines JZ, Agolory S, Kapina M, Sinyange N, Melchior M, Mirkovic K, Mahomva A, Modhi S, Salyer S, Azman AS, McLean C, Riek LP, Asiimwe F, Adler M, Mazibuko S, Okello V, Auld AF. Comparison of COVID-19 Pandemic Waves in 10 Countries in Southern Africa, 2020-2021. Emerg Infect Dis 2022; 28:S93-S104. [PMID: 36502398 DOI: 10.3201/eid2813.220228] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We used publicly available data to describe epidemiology, genomic surveillance, and public health and social measures from the first 3 COVID-19 pandemic waves in southern Africa during April 6, 2020-September 19, 2021. South Africa detected regional waves on average 7.2 weeks before other countries. Average testing volume 244 tests/million/day) increased across waves and was highest in upper-middle-income countries. Across the 3 waves, average reported regional incidence increased (17.4, 51.9, 123.3 cases/1 million population/day), as did positivity of diagnostic tests (8.8%, 12.2%, 14.5%); mortality (0.3, 1.5, 2.7 deaths/1 million populaiton/day); and case-fatality ratios (1.9%, 2.1%, 2.5%). Beta variant (B.1.351) drove the second wave and Delta (B.1.617.2) the third. Stringent implementation of safety measures declined across waves. As of September 19, 2021, completed vaccination coverage remained low (8.1% of total population). Our findings highlight opportunities for strengthening surveillance, health systems, and access to realistically available therapeutics, and scaling up risk-based vaccination.
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3
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So M, Dziuban EJ, Pedati CS, Holbrook JR, Claussen AH, O'Masta B, Maher B, Cerles AA, Mahmooth Z, MacMillan L, Kaminski JW, Rush M. Childhood Physical Health and Attention Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Modifiable Factors. Prev Sci 2022:10.1007/s11121-022-01398-w. [PMID: 35947281 PMCID: PMC10032176 DOI: 10.1007/s11121-022-01398-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 10/15/2022]
Abstract
Although neurobiologic and genetic factors figure prominently in the development of attention deficit/hyperactivity disorder (ADHD), adverse physical health experiences and conditions encountered during childhood may also play a role. Poor health is known to impact the developing brain with potential lifelong implications for behavioral issues. In attempt to better understand the relationship between childhood physical health and the onset and presence of ADHD symptoms, we summarized international peer-reviewed articles documenting relationships between a select group of childhood diseases or health events (e.g., illnesses, injuries, syndromes) and subsequent ADHD outcomes among children ages 0-17 years. Drawing on a larger two-phase systematic review, 57 longitudinal or retrospective observational studies (1978-2021) of childhood allergies, asthma, eczema, head injury, infection, or sleep problems and later ADHD diagnosis or symptomatology were identified and subjected to meta-analysis. Significant associations were documented between childhood head injuries, infections, and sleep problems with both dichotomous and continuous measures of ADHD, and between allergies with dichotomous measures of ADHD. We did not observe significant associations between asthma or eczema with ADHD outcomes. Heterogeneity detected for multiple associations, primarily among continuously measured outcomes, underscores the potential value of future subgroup analyses and individual studies. Collectively, these findings shed light on the importance of physical health in understanding childhood ADHD. Possible etiologic links between physical health factors and ADHD are discussed, as are implications for prevention efforts by providers, systems, and communities.
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Affiliation(s)
- Marvin So
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-E88, Atlanta, GA, 30341, USA.
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
| | - Eric J Dziuban
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Caitlin S Pedati
- Virginia Beach Department of Public Health, Virginia Beach, VA, USA
| | - Joseph R Holbrook
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-E88, Atlanta, GA, 30341, USA
| | - Angelika H Claussen
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-E88, Atlanta, GA, 30341, USA
| | | | - Brion Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Jennifer W Kaminski
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-E88, Atlanta, GA, 30341, USA
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4
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Teferi W, Gutreuter S, Bekele A, Ahmed J, Ayalew J, Gross J, Kumsa H, Antefe T, Mengistu S, Mirkovic K, Dziuban EJ, Ross C, Belay Z, Tilahun T, Kassa D, Hrapcak S. Adapting strategies for effective and efficient pediatric HIV case finding in low prevalence countries: risk screening tool for testing children presenting at high-risk entry points in Ethiopia. BMC Infect Dis 2022; 22:480. [PMID: 35596158 PMCID: PMC9121612 DOI: 10.1186/s12879-022-07460-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background Implementing effective and efficient case-finding strategies is crucial to increasing pediatric antiretroviral therapy coverage. In Ethiopia, universal HIV testing is conducted for children presenting at high-risk entry points including malnutrition treatment, inpatient wards, tuberculosis (TB) clinics, index testing for children of positive adults, and referral of orphans and vulnerable children (OVC); however, low positivity rates observed at inpatient, malnutrition and OVC entry points warrant re-assessing current case-finding strategies. The aim of this study is to develop HIV risk screening tool applicable for testing children presenting at inpatient, malnutrition and OVC entry points in low-HIV prevalence settings. Methods The study was conducted from May 2017–March 2018 at 29 public health facilities in Amhara and Addis Ababa regions of Ethiopia. All children 2–14 years presenting to five high-risk entry points including malnutrition treatment, inpatient wards, tuberculosis (TB) clinics, index testing for children of positive adults, and referral of orphans and vulnerable children (OVC) were enrolled after consent. Data were collected from registers, medical records, and caregiver interviews. Screening tools were constructed using predictors of HIV positivity as screening items by applying both logistic regression and an unweighted method. Sensitivity, specificity and number needed to test (NNT) to identify one new child living with HIV (CLHIV) were estimated for each tool. Results The screening tools had similar sensitivity of 95%. However, the specificities of tools produced by logistic regression methods (61.4 and 65.6%) which are practically applicable were higher than those achieved by the unweighted method (53.6). Applying these tools could result in 58‒63% reduction in the NNT compared to universal testing approach while maintaining the overall number of CLHIV identified. Conclusion The screening tools developed using logistic regression method could significantly improve HIV testing efficiency among children presenting to malnutrition, inpatient, and OVC entry points in Ethiopia while maintaining case identification. These tools are simplified to practically implement and can potentially be validated for use at various entry points. HIV programs in low-prevalence countries can also further investigate and optimize these tools in their settings.
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Affiliation(s)
- Wondimu Teferi
- Centers for Disease Control and Prevention, US Embassy Entoto Road, P.O.B 1014, Addis Ababa, Ethiopia.
| | - Steve Gutreuter
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jelaludin Ahmed
- Centers for Disease Control and Prevention, US Embassy Entoto Road, P.O.B 1014, Addis Ababa, Ethiopia
| | - Jemal Ayalew
- Ethiopia Public Health Association, Addis Ababa, Ethiopia
| | - Jessica Gross
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hanna Kumsa
- Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia
| | | | | | - Kelsey Mirkovic
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric J Dziuban
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christine Ross
- Centers for Disease Control and Prevention, US Embassy Entoto Road, P.O.B 1014, Addis Ababa, Ethiopia
| | - Zena Belay
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tsegaye Tilahun
- United States Agency for International Development, Addis Ababa, Ethiopia
| | - Desta Kassa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Susan Hrapcak
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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5
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Jordan MR, Bikinesi L, Ashipala L, Mutenda N, Brantuo M, Hunt G, Shiningavamwe A, Mutandi G, Beukes A, Beard S, Battey K, Dziuban EJ, Raizes E, Adjei P, Tang A, Giron A, Hong SY. Pretreatment HIV drug resistance among treatment naïve infants newly diagnosed with HIV in 2016 in Namibia: results of a nationally representative study. Open Forum Infect Dis 2022; 9:ofac102. [PMID: 35434174 PMCID: PMC9007920 DOI: 10.1093/ofid/ofac102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background The World Health Organization (WHO) recommends routine surveillance of pretreatment human immunodeficiency virus (HIV) drug resistance (HIVDR) in children <18 months of age diagnosed with HIV through early infant diagnosis (EID). In 2016, 262 children <18 months of age were diagnosed with HIV in Namibia through EID. Levels of HIVDR in this population are unknown. Methods In 2016, Namibia surveyed pretreatment HIVDR among children aged <18 months following WHO guidance. Reverse transcriptase, protease, and integrase regions of HIV-1 were genotyped from remnant dried blood spot specimens from all infants diagnosed with HIV in Namibia in 2016. HIVDR was predicted using the Stanford HIVdb algorithm. Results Of 262 specimens genotyped, 198 HIV-1 protease and reverse transcriptase sequences and 118 HIV-1 integrase sequences were successfully amplified and analyzed. The prevalence of efavirenz/nevirapine (EFV/NVP), abacavir (ABC), zidovudine, lamivudine/emtricitabine (3TC/FTC), and tenofovir (TDF) resistance was 62.6%, 17.7%, 5.6%, 15.7%, and 10.1%, respectively. No integrase inhibitor resistance was detected. Conclusions The high level of EFV/NVP resistance is unsurprising; however, levels of ABC and TDF resistance are among the highest observed to date in infants in sub-Saharan Africa. The absence of resistance to dolutegravir (DTG) is reassuring but underscores the need to further study the impact of ABC and 3TC/FTC resistance on pediatric protease inhibitor– and DTG-based regimens and accelerate access to other antiretroviral drugs. Results underscore the need for antiretroviral therapy optimization and prompt management of high viral loads in infants and pregnant and breastfeeding women.
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Affiliation(s)
- Michael R Jordan
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA and Levy Center for Integrated Management of Antimicrobial Resistance, Tufts University School of Medicine, Boston, MA, USA
| | - Leonard Bikinesi
- Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Laimi Ashipala
- Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Nicholus Mutenda
- Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | | | - Gillian Hunt
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa
| | | | - Gram Mutandi
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Anita Beukes
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Suzanne Beard
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katherine Battey
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. USA
| | - Eric J Dziuban
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Elliot Raizes
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul Adjei
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA
| | - Alice Tang
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, USA
| | - Amalia Giron
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Steven Y Hong
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Windhoek, Namibia
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6
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Nyarko KM, Miller LA, Baughman AL, Katjiuanjo P, Evering-Watley M, Antara S, Angula P, Mitonga HK, Prybylski D, Dziuban EJ, Ndevaetela EE. The role of Namibia Field Epidemiology and Laboratory Training Programme in strengthening the public health workforce in Namibia, 2012-2019. BMJ Glob Health 2021; 6:e005597. [PMID: 33849899 PMCID: PMC8051409 DOI: 10.1136/bmjgh-2021-005597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 03/04/2021] [Accepted: 03/28/2021] [Indexed: 11/16/2022] Open
Abstract
Namibia faces a critical shortage of skilled public health workers to perform emergency response operations, preparedness activities and real-time surveillance. The Namibia Field Epidemiology and Laboratory Training Programme (NamFELTP) increases the number of skilled public health professionals and strengthens the public health system in Namibia. We describe the NamFELTP during its first 7 years, assess its impact on the public health workforce and provide recommendations to further strengthen the workforce. We reviewed disease outbreak investigations and response reports, field projects and epidemiological investigations conducted during 2012-2019. The data were analysed using descriptive methods such as frequencies and rates. Maps representing the geographical distribution of NamFELTP workforce were produced using QGIS software V.3.2. There were no formally trained field epidemiologists working in Namibia before the NamFELTP. In its 7 years of operation, the programme graduated 189 field epidemiologists, of which 28 have completed the Advanced FELTP. The graduates increased epidemiological capacity for surveillance and response in Namibia at the national and provincial levels, and enhanced epidemiologist-led outbreak responses on 35 occasions, including responses to outbreaks of human and zoonotic diseases. Trainees analysed data from 51 surveillance systems and completed 31 epidemiological studies. The NamFELTP improved outcomes in the Namibia's public health systems; including functional and robust public health surveillance systems that timely and effectively respond to public health emergencies. However, the current epidemiological capacity is insufficient and there is a need to continue training and mentorship to fill key leadership and strategic roles in the public health system.
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Affiliation(s)
- Kofi Mensah Nyarko
- Namibia Ministry of Health and Social Services, Windhoek, Khomas, Namibia
- School of Public Health, University of Namibia, Windhoek, Namibia
| | - Leigh Ann Miller
- US Centers for Disease Control and Prevention, Windhoek, Namibia
| | | | - Puumue Katjiuanjo
- Namibia Ministry of Health and Social Services, Windhoek, Khomas, Namibia
| | | | - Simon Antara
- Namibia Ministry of Health and Social Services, Windhoek, Khomas, Namibia
| | - Penehafo Angula
- School of Public Health, University of Namibia, Windhoek, Namibia
| | - Honore K Mitonga
- School of Public Health, University of Namibia, Windhoek, Namibia
| | | | - Eric J Dziuban
- US Centers for Disease Control and Prevention, Windhoek, Namibia
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7
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Hans L, Hong SY, Ashipala LSN, Bikinesi L, Hamunime N, Kamangu JWN, Hatutale EJ, Dziuban EJ. Maintaining ART services during COVID-19 border closures: lessons learned in Namibia. Lancet HIV 2021; 8:e7. [PMID: 33387479 DOI: 10.1016/s2352-3018(20)30334-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Linea Hans
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA
| | - Steven Y Hong
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA.
| | | | | | | | | | - Eliphas J Hatutale
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA
| | - Eric J Dziuban
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA
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8
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Hong SY, Ashipala LS, Bikinesi L, Hamunime N, Kamangu JW, Boylan A, Sithole E, Pietersen IC, Mutandi G, McLean C, Dziuban EJ. Rapid Adaptation of HIV Treatment Programs in Response to COVID-19 - Namibia, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1549-1551. [PMID: 33090979 PMCID: PMC7583497 DOI: 10.15585/mmwr.mm6942a6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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9
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Jonnalagadda S, Yuengling K, Abrams E, Stupp P, Voetsch A, Patel M, Minisi Z, Eliya M, Hamunime N, Rwebembera A, Kirungi W, Mulenga L, Mushavi A, Ryan C, Ts'oeu M, Kim E, Dziuban EJ, Hageman K, Galbraith J, Mweebo K, Mwila A, Gonese E, Patel H, Modi S, Saito S. Survival and HIV-Free Survival Among Children Aged ≤3 Years - Eight Sub-Saharan African Countries, 2015-2017. MMWR Morb Mortal Wkly Rep 2020; 69:582-586. [PMID: 32407305 PMCID: PMC7238953 DOI: 10.15585/mmwr.mm6919a3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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10
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Bustamante ND, Matyenyika SR, Miller LA, Goers M, Katjiuanjo P, Ndiitodino K, Ndevaetela EE, Kaura U, Nyarko KM, Kahuika-Crentsil L, Haufiku B, Handzel T, Teshale EH, Dziuban EJ, Nangombe BT, Hofmeister MG. Notes from the Field: Nationwide Hepatitis E Outbreak Concentrated in Informal Settlements - Namibia, 2017-2020. MMWR Morb Mortal Wkly Rep 2020; 69:355-357. [PMID: 32214080 PMCID: PMC7725516 DOI: 10.15585/mmwr.mm6912a6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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11
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Dziuban EJ, Franks JL, So M, Peacock G, Blaney DD. Elizabethkingia in Children: A Comprehensive Review of Symptomatic Cases Reported From 1944 to 2017. Clin Infect Dis 2019; 67:144-149. [PMID: 29211821 DOI: 10.1093/cid/cix1052] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/28/2017] [Indexed: 11/15/2022] Open
Abstract
Elizabethkingia species often exhibit extensive antibiotic resistance and result in high morbidity and mortality, yet no systematic reviews exist that thoroughly characterize and quantify concerns for infected infants and children. We performed a review of literature and identified an initial 902 articles; 96 articles reporting 283 pediatric cases met our inclusion criteria and were subsequently reviewed. Case reports spanned 28 countries and ranged from 1944 to 2017. Neonatal meningitis remains the most common presentation of this organism in children, along with a range of other clinical manifestations. The majority of reported cases occurred as isolated cases, rather than within outbreaks. Mortality was high but has decreased in recent years, although neurologic sequelae among survivors remains concerning. Child outcomes can be improved through effective prevention measures and early identification and treatment of infected patients.
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Affiliation(s)
- Eric J Dziuban
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia
| | - Jessica L Franks
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia
| | - Marvin So
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia
- Office of the Director, Program Performance and Evaluation Office, Atlanta, Georgia
| | - Georgina Peacock
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia
| | - David D Blaney
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Leeb RT, Franks JL, Dziuban EJ, Ruben W, Bartenfeld M, Hinton CF, Chatham-Stephens K, Peacock G. Building Children's Preparedness Capacity at the Centers for Disease Control and Prevention One Event at a Time, 2009-2018. Am J Public Health 2019; 109:S260-S262. [PMID: 31505143 DOI: 10.2105/ajph.2019.305066] [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: 11/04/2022]
Affiliation(s)
- Rebecca T Leeb
- Rebecca T. Leeb, Cynthia F. Hinton, Kevin Chatham-Stephens, and Georgina Peacock are with the Division of Human Development and Disability in the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jessica L. Franks is with McKing Consulting Corporation, Atlanta. Eric J. Dziuban is with the Division of Global HIV and TB in the Center for Global Health, CDC, Windhoek, Namibia. Wendy Ruben is with the Office of the Director in the National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta. Michael Bartenfeld is with the Office of the Director in the Center for Global Health, CDC, Atlanta
| | - Jessica L Franks
- Rebecca T. Leeb, Cynthia F. Hinton, Kevin Chatham-Stephens, and Georgina Peacock are with the Division of Human Development and Disability in the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jessica L. Franks is with McKing Consulting Corporation, Atlanta. Eric J. Dziuban is with the Division of Global HIV and TB in the Center for Global Health, CDC, Windhoek, Namibia. Wendy Ruben is with the Office of the Director in the National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta. Michael Bartenfeld is with the Office of the Director in the Center for Global Health, CDC, Atlanta
| | - Eric J Dziuban
- Rebecca T. Leeb, Cynthia F. Hinton, Kevin Chatham-Stephens, and Georgina Peacock are with the Division of Human Development and Disability in the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jessica L. Franks is with McKing Consulting Corporation, Atlanta. Eric J. Dziuban is with the Division of Global HIV and TB in the Center for Global Health, CDC, Windhoek, Namibia. Wendy Ruben is with the Office of the Director in the National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta. Michael Bartenfeld is with the Office of the Director in the Center for Global Health, CDC, Atlanta
| | - Wendy Ruben
- Rebecca T. Leeb, Cynthia F. Hinton, Kevin Chatham-Stephens, and Georgina Peacock are with the Division of Human Development and Disability in the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jessica L. Franks is with McKing Consulting Corporation, Atlanta. Eric J. Dziuban is with the Division of Global HIV and TB in the Center for Global Health, CDC, Windhoek, Namibia. Wendy Ruben is with the Office of the Director in the National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta. Michael Bartenfeld is with the Office of the Director in the Center for Global Health, CDC, Atlanta
| | - Michael Bartenfeld
- Rebecca T. Leeb, Cynthia F. Hinton, Kevin Chatham-Stephens, and Georgina Peacock are with the Division of Human Development and Disability in the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jessica L. Franks is with McKing Consulting Corporation, Atlanta. Eric J. Dziuban is with the Division of Global HIV and TB in the Center for Global Health, CDC, Windhoek, Namibia. Wendy Ruben is with the Office of the Director in the National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta. Michael Bartenfeld is with the Office of the Director in the Center for Global Health, CDC, Atlanta
| | - Cynthia F Hinton
- Rebecca T. Leeb, Cynthia F. Hinton, Kevin Chatham-Stephens, and Georgina Peacock are with the Division of Human Development and Disability in the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jessica L. Franks is with McKing Consulting Corporation, Atlanta. Eric J. Dziuban is with the Division of Global HIV and TB in the Center for Global Health, CDC, Windhoek, Namibia. Wendy Ruben is with the Office of the Director in the National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta. Michael Bartenfeld is with the Office of the Director in the Center for Global Health, CDC, Atlanta
| | - Kevin Chatham-Stephens
- Rebecca T. Leeb, Cynthia F. Hinton, Kevin Chatham-Stephens, and Georgina Peacock are with the Division of Human Development and Disability in the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jessica L. Franks is with McKing Consulting Corporation, Atlanta. Eric J. Dziuban is with the Division of Global HIV and TB in the Center for Global Health, CDC, Windhoek, Namibia. Wendy Ruben is with the Office of the Director in the National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta. Michael Bartenfeld is with the Office of the Director in the Center for Global Health, CDC, Atlanta
| | - Georgina Peacock
- Rebecca T. Leeb, Cynthia F. Hinton, Kevin Chatham-Stephens, and Georgina Peacock are with the Division of Human Development and Disability in the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jessica L. Franks is with McKing Consulting Corporation, Atlanta. Eric J. Dziuban is with the Division of Global HIV and TB in the Center for Global Health, CDC, Windhoek, Namibia. Wendy Ruben is with the Office of the Director in the National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta. Michael Bartenfeld is with the Office of the Director in the Center for Global Health, CDC, Atlanta
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Griese SE, Kisselburgh HM, Bartenfeld MT, Thomas E, Rao AK, Sobel J, Dziuban EJ. Pediatric Botulism and Use of Equine Botulinum Antitoxin in Children: A Systematic Review. Clin Infect Dis 2019; 66:S17-S29. [PMID: 29293924 DOI: 10.1093/cid/cix812] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Botulism manifests with cranial nerve palsies and flaccid paralysis in children and adults. Botulism must be rapidly identified and treated; however, clinical presentation and treatment outcomes of noninfant botulism in children are not well described. Methods We searched 12 databases for peer-reviewed and non-peer-reviewed reports with primary data on botulism in children (persons <18 years of age) or botulinum antitoxin administration to children. Reports underwent title and abstract screening and full text review. For each case, patient demographic, clinical, and outcome data were abstracted. Results Of 7065 reports identified, 184 met inclusion criteria and described 360 pediatric botulism cases (79% confirmed, 21% probable) that occurred during 1929-2015 in 34 countries. Fifty-three percent were male; age ranged from 4 months to 17 years (median, 10 years). The most commonly reported signs and symptoms were dysphagia (53%), dysarthria (39%), and generalized weakness (37%). Inpatient length of stay ranged from 1 to 425 days (median, 24 days); 14% of cases required intensive care unit admission; 25% reported mechanical ventilation. Eighty-three (23%) children died. Median interval from illness onset to death was 1 day (range, 0-260 days). Among patients who received antitoxin (n = 193), 23 (12%) reported an adverse event, including rash, fever, serum sickness, and anaphylaxis. Relative risk of death among patients treated with antitoxin compared with patients not treated with antitoxin was 0.24 (95% confidence interval, .14-.40; P < .0001). Conclusions Dysphagia and dysarthria were the most commonly reported cranial nerve symptoms in children with botulism; generalized weakness was described more than paralysis. Children who received antitoxin had better survival; serious adverse events were rare. Most deaths occurred early in the clinical course; therefore, botulism in children should be identified and treated rapidly.
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Affiliation(s)
- Stephanie E Griese
- Office of Science and Public Health Practice, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hannah M Kisselburgh
- Division of Foodborne, Waterborne, and Environmental Diseases (DFWED), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael T Bartenfeld
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erin Thomas
- Office of Science and Public Health Practice, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Agam K Rao
- Division of Foodborne, Waterborne, and Environmental Diseases (DFWED), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeremy Sobel
- Division of Foodborne, Waterborne, and Environmental Diseases (DFWED), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric J Dziuban
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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14
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Lasry A, Medley A, Behel S, Mujawar MI, Cain M, Diekman ST, Rurangirwa J, Valverde E, Nelson R, Agolory S, Alebachew A, Auld AF, Balachandra S, Bunga S, Chidarikire T, Dao VQ, Dee J, Doumatey LN, Dzinotyiweyi E, Dziuban EJ, Ekra KA, Fuller WB, Herman-Roloff A, Honwana NB, Khanyile N, Kim EJ, Kitenge SF, Lacson RS, Loeto P, Malamba SS, Mbayiha AH, Mekonnen A, Meselu MG, Miller LA, Mogomotsi GP, Mugambi MK, Mulenga L, Mwangi JW, Mwangi J, Nicoué AA, Nyangulu MK, Pietersen IC, Ramphalla P, Temesgen C, Vergara AE, Wei S. Scaling Up Testing for Human Immunodeficiency Virus Infection Among Contacts of Index Patients - 20 Countries, 2016-2018. MMWR Morb Mortal Wkly Rep 2019; 68:474-477. [PMID: 31145718 PMCID: PMC6542477 DOI: 10.15585/mmwr.mm6821a2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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15
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So M, Dziuban EJ, Franks JL, Cobham-Owens K, Schonfeld DJ, Gardner AH, Krug SE, Peacock G, Chung S. Extending the Reach of Pediatric Emergency Preparedness: A Virtual Tabletop Exercise Targeting Children's Needs. Public Health Rep 2019; 134:344-353. [PMID: 31095469 DOI: 10.1177/0033354919849880] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Virtual tabletop exercises (VTTXs) simulate disaster scenarios to help participants improve their emergency-planning capacity. The objectives of our study were to (1) evaluate the effectiveness of a VTTX in improving preparedness capabilities specific to children's needs among pediatricians and public health practitioners, (2) document follow-up actions, and (3) identify exercise strengths and weaknesses. METHODS In February 2017, we conducted and evaluated a VTTX facilitated via videoconferencing among 26 pediatricians and public health practitioners from 4 states. Using a mixed-methods design, we assessed participants' knowledge and confidence to fulfill targeted federal preparedness capabilities immediately before and after the exercise. We also evaluated the degree to which participants made progress on actions through surveys 1 month (n = 14) and 6 months (n = 14) after the exercise. RESULTS Participants reported a greater ability to identify their state's pediatric emergency preparedness strengths and weaknesses after the exercise (16 of 18) compared with before the exercise (10 of 18). We also observed increases in (1) knowledge of and confidence in performing most pediatric emergency preparedness capabilities and (2) most dimensions of interprofessional collaboration. From 1 month to 6 months after the exercise, participants (n = 14) self-reported making progress in increasing awareness for potential preparedness partners and in conducting similar pediatric exercises (from 4-7 for both). CONCLUSIONS Participants viewed the VTTX positively and indicated increased pediatric emergency preparedness knowledge and confidence. Addressing barriers to improving local pediatric emergency preparedness-particularly long term-is an important target for future tabletop exercises.
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Affiliation(s)
- Marvin So
- 1 Division of Human Development and Disability, Centers for Disease Control and Prevention, Atlanta, GA, USA.,2 Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Research Participation Programs, Oak Ridge, TN, USA.,3 University of Minnesota Medical School, Minneapolis, MN, USA
| | - Eric J Dziuban
- 1 Division of Human Development and Disability, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica L Franks
- 1 Division of Human Development and Disability, Centers for Disease Control and Prevention, Atlanta, GA, USA.,2 Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Research Participation Programs, Oak Ridge, TN, USA
| | | | - David J Schonfeld
- 5 Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA.,6 Department of Pediatrics, University of Southern California, and Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Aaron H Gardner
- 7 Division of Pediatric Critical Care Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, ID, USA
| | - Steven E Krug
- 8 Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,9 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Georgina Peacock
- 1 Division of Human Development and Disability, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarita Chung
- 10 Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
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16
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Nash R, Riley C, Paramsothy P, Gilbertson K, Raspa M, Wheeler A, Dziuban EJ, Peacock G. A Description of the Educational Setting Among Individuals With Fragile X Syndrome. Am J Intellect Dev Disabil 2019; 124:57-76. [PMID: 30715925 PMCID: PMC6442477 DOI: 10.1352/1944-7558-124.1.57] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Children with fragile X syndrome (FXS) display wide-ranging intellectual and behavioral abilities that affect daily life. We describe the educational setting of students with FXS and assess the relationships between school setting, co-occurring conditions, and functional ability using a national survey sample ( n = 982). The majority of students with FXS in this sample have formal individualized education plans, spend part of the day outside regular classrooms, and receive modifications when in a regular classroom. Males with FXS and certain co-occurring conditions (autism, aggression, and self-injurious behavior) are more likely to spend the entire day outside regular classrooms, compared to males without these co-occurring conditions. Students who spend more time in regular classrooms are more likely to perform functional tasks without help.
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Affiliation(s)
- Rebecca Nash
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Catharine Riley
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Pangaja Paramsothy
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Kendra Gilbertson
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Melissa Raspa
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Anne Wheeler
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Eric J Dziuban
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Georgina Peacock
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
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17
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Medley AM, Hrapcak S, Golin RA, Dziuban EJ, Watts H, Siberry GK, Rivadeneira ED, Behel S. Strategies for Identifying and Linking HIV-Infected Infants, Children, and Adolescents to HIV Treatment Services in Resource Limited Settings. J Acquir Immune Defic Syndr 2018; 78 Suppl 2:S98-S106. [PMID: 29994831 PMCID: PMC10961643 DOI: 10.1097/qai.0000000000001732] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Many children living with HIV in resource-limited settings remain undiagnosed and at risk for HIV-related mortality and morbidity. This article describes 5 key strategies for strengthening HIV case finding and linkage to treatment for infants, children, and adolescents. These strategies result from lessons learned during the Accelerating Children's HIV/AIDS Treatment Initiative, a public-private partnership between the President's Emergency Plan for AIDS Relief (PEPFAR) and the Children's Investment Fund Foundation (CIFF). The 5 strategies include (1) implementing a targeted mix of HIV case finding approaches (eg, provider-initiated testing and counseling within health facilities, optimization of early infant diagnosis, index family testing, and integration of HIV testing within key population and orphan and vulnerable children programs); (2) addressing the unique needs of adolescents; (3) collecting and using data for program improvement; (4) fostering a supportive political and community environment; and (5) investing in health system-strengthening activities. Continued advocacy and global investments are required to eliminate AIDS-related deaths among children and adolescents.
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Affiliation(s)
- Amy M. Medley
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
| | - Susan Hrapcak
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
| | - Rachel A. Golin
- United States Agency for International Development (USAID), Office of HIV/AIDS, Washington, DC
| | - Eric J. Dziuban
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
| | - Heather Watts
- U.S. State Department, Office of the Global AIDS Coordinator, Washington, DC
| | - George K. Siberry
- U.S. State Department, Office of the Global AIDS Coordinator, Washington, DC
| | - Emilia D. Rivadeneira
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
| | - Stephanie Behel
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
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18
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Mann TZ, Haddad LB, Williams TR, Hills SL, Read JS, Dee DL, Dziuban EJ, Pérez-Padilla J, Jamieson DJ, Honein MA, Shapiro-Mendoza CK. Breast milk transmission of flaviviruses in the context of Zika virus: A systematic review. Paediatr Perinat Epidemiol 2018; 32:358-368. [PMID: 29882971 PMCID: PMC6103797 DOI: 10.1111/ppe.12478] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Since the Zika virus epidemic in the Americas began in 2015, Zika virus transmission has occurred throughout the Americas. However, limited information exists regarding possible risks of transmission of Zika virus and other flaviviruses through breast feeding and human milk. We conducted a systematic review of the evidence regarding flaviviruses detection in and transmission through milk, specifically regarding Zika virus, Japanese encephalitis virus, tick-borne encephalitis virus, Powassan virus, West Nile virus, dengue virus, and yellow fever virus. METHODS Medline, Embase, Global Health, CINAHL, Cochrane Library, Scopus, Popline, Virtual Health Library, and WorldCat were searched through June 2017. Two authors independently screened potential studies for inclusion and extracted data. Human and nonhuman (animal) studies describing: 1) confirmed or suspected cases of mother-to-child transmission through milk; or 2) the presence of flavivirus genomic material in milk. RESULTS Seventeen studies were included, four animal models and thirteen observational studies. Dengue virus, West Nile virus, and Zika virus viral ribonucleic acid was detected in human milk, including infectious Zika virus and dengue virus viral particles. Human breast-feeding transmission was confirmed for only yellow fever virus. There was evidence of milk-related transmission of dengue virus, Powassan virus, and West Nile virus in animal studies. CONCLUSIONS Because the health advantages of breast feeding are considered greater than the potential risk of transmission, the World Health Organization recommends that mothers with possible or confirmed Zika virus infection or exposure continue to breast feed. This review did not identify any data that might alter this recommendation.
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Affiliation(s)
- Taylor Z. Mann
- Division of Congenital and Developmental Disorders, Centers for
Disease Control and Prevention,Oak Ridge Institute for Science and Education (ORISE) Research
Participation Program
| | - Lisa B. Haddad
- Division of Reproductive Health, Centers for Disease Control and
Prevention,Emory University, Department of Gynecology & Obstetrics,
Atlanta, GA
| | - Tonya R. Williams
- Division of Human Development and Disability, Centers for Disease
Control and Prevention
| | - Susan L. Hills
- Division of Vector-Borne Diseases, Centers for Disease Control and
Prevention
| | - Jennifer S. Read
- Division of Vector-Borne Diseases, Centers for Disease Control and
Prevention
| | - Deborah L. Dee
- Division of Reproductive Health, Centers for Disease Control and
Prevention,United States Public Health Service, Commissioned Corps, Rockville,
MD
| | - Eric J. Dziuban
- Division of Human Development and Disability, Centers for Disease
Control and Prevention,United States Public Health Service, Commissioned Corps, Rockville,
MD
| | | | - Denise J. Jamieson
- Division of Reproductive Health, Centers for Disease Control and
Prevention,Emory University, Department of Gynecology & Obstetrics,
Atlanta, GA
| | - Margaret A. Honein
- Division of Congenital and Developmental Disorders, Centers for
Disease Control and Prevention
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19
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Affiliation(s)
- David Greenky
- Division of General Pediatrics/Hospital Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Barbara Knust
- National Center for Emerging and Zoonotic Infectious Diseases, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric J. Dziuban
- National Center on Birth Defects and Developmental Disabilities, Division of Human Development and Disability, Centers for Disease Control and Prevention, Atlanta, Georgia
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20
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Dziuban EJ, Peacock G, Frogel M. A Child's Health Is the Public's Health: Progress and Gaps in Addressing Pediatric Needs in Public Health Emergencies. Am J Public Health 2017; 107:S134-S137. [PMID: 28892439 DOI: 10.2105/ajph.2017.303950] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Children are the most prevalent vulnerable population in US society and have unique needs during the response to and recovery from public health emergencies. The physiological, behavioral, developmental, social, and mental health differences of children require specific attention in preparedness efforts. Despite often being more severely affected in disasters, children's needs are historically underrepresented in preparedness. Since 2001, much progress has been made in addressing this disparity through better pediatric incorporation in preparedness planning from national to local levels. Innovative approaches, policies, and collaborations contribute to these advances. However, many gaps remain in the appropriate and proportional inclusion of children in planning for public health emergencies. Successful models of pediatric planning can be developed, evaluated, and widely disseminated to ensure that further progress can be achieved.
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Affiliation(s)
- Eric J Dziuban
- Eric J. Dziuban and Georgina Peacock are with the Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA. Michael Frogel is with the National Pediatric Disaster Coalition, and is also with Maimonides Infant and Children's Hospital, Brooklyn, NY
| | - Georgina Peacock
- Eric J. Dziuban and Georgina Peacock are with the Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA. Michael Frogel is with the National Pediatric Disaster Coalition, and is also with Maimonides Infant and Children's Hospital, Brooklyn, NY
| | - Michael Frogel
- Eric J. Dziuban and Georgina Peacock are with the Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA. Michael Frogel is with the National Pediatric Disaster Coalition, and is also with Maimonides Infant and Children's Hospital, Brooklyn, NY
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Abstract
Antiretroviral treatment coverage for children living with HIV is low, and new efforts are underway to expand eligibility so that all children and adolescents qualify for the treatment regardless of immune suppression or clinical stage. Although recent trials provide direct evidence of the benefit of this approach in adults, no such studies have been performed in children. This report examines the available body of evidence regarding universal HIV treatment for children and adolescents and assesses the benefits and challenges both at individual patient health, as well as at programmatic level. Universal treatment eligibility for children with HIV has great potential for improved growth and neurodevelopment and fewer morbidities for children, and treatment coverage would be expected to increase through guideline simplification. However, concerns regarding toxicities, drug resistance and costs require careful planning. Successful implementation will depend on effective strategies for case-finding, treatment adherence support and program monitoring that will contribute to the growing evidence base for this pivotal pediatric HIV policy shift.
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22
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Goodman AB, Dziuban EJ, Powell K, Bitsko RH, Langley G, Lindsey N, Franks JL, Russell K, Dasgupta S, Barfield WD, Odom E, Kahn E, Martin S, Fischer M, Staples JE. Characteristics of Children Aged <18 Years with Zika Virus Disease Acquired Postnatally - U.S. States, January 2015-July 2016. MMWR Morb Mortal Wkly Rep 2016; 65:1082-1085. [PMID: 27711041 DOI: 10.15585/mmwr.mm6539e2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Zika virus is an emerging mosquito-borne flavivirus that typically causes an asymptomatic infection or mild illness, although infection during pregnancy is a cause of microcephaly and other serious brain abnormalities. Guillain-Barré syndrome and other neurologic complications can occur in adults after Zika virus infection. However, there are few published reports describing postnatally acquired Zika virus disease among children. During January 2015-July 2016, a total of 158 cases of confirmed or probable postnatally acquired Zika virus disease among children aged <18 years were reported to CDC from U.S. states. The median age was 14 years (range = 1 month-17 years), and 88 (56%) were female. Two (1%) patients were hospitalized; none developed Guillain-Barré syndrome, and none died. All reported cases were travel-associated. Overall, 129 (82%) children had rash, 87 (55%) had fever, 45 (29%) had conjunctivitis, and 44 (28%) had arthralgia. Health care providers should consider a diagnosis of Zika virus disease in children who have an epidemiologic risk factor and clinically compatible illness, and should report cases to their state or local health department.
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Keating EM, Lukolyo H, Rees CA, Dziuban EJ, Ferris MG, Schutze GE, Marton SA. Beyond the learning curve: length of global health electives. Int J Med Educ 2016; 7:295-6. [PMID: 27614032 PMCID: PMC5018357 DOI: 10.5116/ijme.57c1.4e07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 08/27/2016] [Indexed: 05/08/2023]
Affiliation(s)
| | - Heather Lukolyo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Chris A. Rees
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Eric J. Dziuban
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Margaret G. Ferris
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Gordon E. Schutze
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Kruk ME, Riley PL, Palma AM, Adhikari S, Ahoua L, Arnaldo C, Belo DF, Brusamento S, Cumba LIG, Dziuban EJ, El-Sadr WM, Gutema Y, Habtamu Z, Heller T, Kidanu A, Langa J, Mahagaja E, McCarthy CF, Melaku Z, Shodell D, Tsiouris F, Young PR, Rabkin M. How Can the Health System Retain Women in HIV Treatment for a Lifetime? A Discrete Choice Experiment in Ethiopia and Mozambique. PLoS One 2016; 11:e0160764. [PMID: 27551785 PMCID: PMC4994936 DOI: 10.1371/journal.pone.0160764] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 01/29/2016] [Accepted: 07/25/2016] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Option B+, an approach that involves provision of antiretroviral therapy (ART) to all HIV-infected pregnant women for life, is the preferred strategy for prevention of mother to child transmission of HIV. Lifelong retention in care is essential to its success. We conducted a discrete choice experiment in Ethiopia and Mozambique to identify health system characteristics preferred by HIV-infected women to promote continuity of care. METHODS Women living with HIV and receiving care at hospitals in Oromia Region, Ethiopia and Zambézia Province, Mozambique were shown nine choice cards and asked to select one of two hypothetical health facilities, each with six varying characteristics related to the delivery of HIV services for long term treatment. Mixed logit models were used to estimate the influence of six health service attributes on choice of clinics. RESULTS 2,033 women participated in the study (response rate 97.8% in Ethiopia and 94.7% in Mozambique). Among the various attributes of structure and content of lifelong ART services, the most important attributes identified in both countries were respectful provider attitude and ability to obtain non-HIV health services during HIV-related visits. Availability of counseling support services was also a driver of choice. Facility type, i.e., hospital versus health center, was substantially less important. CONCLUSIONS Efforts to enhance retention in HIV care and treatment for pregnant women should focus on promoting respectful care by providers and integrating access to non-HIV health services in the same visit, as well as continuing to strengthen counseling.
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Affiliation(s)
- Margaret E. Kruk
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Patricia L. Riley
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anton M. Palma
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Sweta Adhikari
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Laurence Ahoua
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Carlos Arnaldo
- Center for Population and Health Research, Maputo, Mozambique
| | | | - Serena Brusamento
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | | | - Eric J. Dziuban
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Wafaa M. El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Yoseph Gutema
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Zelalem Habtamu
- Oromio Regional Health Bureau, Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Thomas Heller
- Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | - Judite Langa
- Centers for Disease Control and Prevention, Maputo, Mozambique
| | | | - Carey F. McCarthy
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Zenebe Melaku
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Daniel Shodell
- Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Fatima Tsiouris
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Paul R. Young
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Miriam Rabkin
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America
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Staples JE, Dziuban EJ, Fischer M, Cragan JD, Rasmussen SA, Cannon MJ, Frey MT, Renquist CM, Lanciotti RS, Muñoz JL, Powers AM, Honein MA, Moore CA. Interim Guidelines for the Evaluation and Testing of Infants with Possible Congenital Zika Virus Infection - United States, 2016. MMWR Morb Mortal Wkly Rep 2016; 65:63-7. [PMID: 26820387 DOI: 10.15585/mmwr.mm6503e3] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
CDC has developed interim guidelines for health care providers in the United States who are caring for infants born to mothers who traveled to or resided in an area with Zika virus transmission during pregnancy. These guidelines include recommendations for the testing and management of these infants. Guidance is subject to change as more information becomes available; the latest information, including answers to commonly asked questions, can be found online (http://www.cdc.gov/zika). Pediatric health care providers should work closely with obstetric providers to identify infants whose mothers were potentially infected with Zika virus during pregnancy (based on travel to or residence in an area with Zika virus transmission [http://wwwnc.cdc.gov/travel/notices]), and review fetal ultrasounds and maternal testing for Zika virus infection (see Interim Guidelines for Pregnant Women During a Zika Virus Outbreak*) (1). Zika virus testing is recommended for 1) infants with microcephaly or intracranial calcifications born to women who traveled to or resided in an area with Zika virus transmission while pregnant; or 2) infants born to mothers with positive or inconclusive test results for Zika virus infection. For infants with laboratory evidence of a possible congenital Zika virus infection, additional clinical evaluation and follow-up is recommended. Health care providers should contact their state or territorial health department to facilitate testing. As an arboviral disease, Zika virus disease is a nationally notifiable condition.
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Staples JE, Dziuban EJ, Fischer M, Cragan JD, Rasmussen SA, Cannon MJ, Frey MT, Renquist CM, Lanciotti RS, Muñoz JL, Powers AM, Honein MA, Moore CA. Interim Guidelines for the Evaluation and Testing of Infants with Possible Congenital Zika Virus Infection — United States, 2016. MMWR Morb Mortal Wkly Rep 2016. [DOI: 10.15585/mmwr.mm6503e3er] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Dziuban EJ, Raizes E, Koumans EH. A farewell to didanosine: harm reduction and cost savings by eliminating use of didanosine. Int J STD AIDS 2015; 26:903-6. [PMID: 25281538 PMCID: PMC4677683 DOI: 10.1177/0956462414554433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 08/21/2014] [Accepted: 09/08/2014] [Indexed: 11/17/2022]
Abstract
Didanosine (ddI) is a nucleoside reverse transcriptase inhibitor associated with adverse events and public health concerns which have diminished its place in HIV clinical practice, particularly in resource-rich settings. While international guidelines do not contain ddI-containing regimens in preferred first- or second-line antiretroviral therapy (ART), there is no guidance for management of patients currently on ddI. In 2012 at least 20 countries purchased a total of $1-2 million of ddI. Drug purchase data in that year show 3.2-10.3 times higher costs for ddI compared to lamivudine (3TC). Given issues of multiple toxicities, monitoring, drug interactions, inconvenience, and virologic efficacy, as well as cost and formulary concerns, national (including resource-limited setting) ART programmes should consider complete phase-out of ddI.
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Affiliation(s)
- Eric J Dziuban
- Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, GA, USA
| | - Elliot Raizes
- Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, GA, USA
| | - Emilia H Koumans
- Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, GA, USA
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Amzel A, Toska E, Lovich R, Widyono M, Patel T, Foti C, Dziuban EJ, Phelps BR, Sugandhi N, Mark D, Altschuler J. Promoting a combination approach to paediatric HIV psychosocial support. AIDS 2013; 27 Suppl 2:S147-57. [PMID: 24361624 PMCID: PMC4672375 DOI: 10.1097/qad.0000000000000098] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ninety percent of the 3.4 million HIV-infected children live in sub-Saharan Africa. Their psychosocial well being is fundamental to establishing and maintaining successful treatment outcomes and overall quality of life. With the increased roll-out of antiretroviral treatment, HIV infection is shifting from a life-threatening to a chronic disease. However, even for paediatric patients enrolled in care and treatment, HIV can still be devastating due to the interaction of complex factors, particularly in the context of other household illness and overextended healthcare systems in sub-Saharan Africa.This article explores the negative effect of several interrelated HIV-specific factors on the psychosocial well being of HIV-infected children: disclosure, stigma and discrimination, and bereavement. However, drawing on clinical studies of resilience, it stresses the need to move beyond a focus on the individual as a full response to the needs of a sick child requires support for the individual child, caregiver-child dyads, extended families, communities, and institutions. This means providing early and progressive age appropriate interventions aimed at increasing the self-reliance and self-acceptance in children and their caregivers and promoting timely health-seeking behaviours. Critical barriers that cause poorer biomedical and psychosocial outcomes among children and caregiver must also be addressed as should the causes and consequences of stigma and associated gender and social norms.This article reviews interventions at different levels of the ecological model: individual-centred programs, family-centred interventions, programs that support or train healthcare providers, community interventions for HIV-infected children, and initiatives that improve the capacity of schools to provide more supportive environments for HIV-infected children. Although experience is increasing in approaches that address the psychosocial needs of vulnerable and HIV-infected children, there is still limited evidence demonstrating which interventions have positive effects on the well being of HIV-infected children. Interventions that improve the psychosocial well being of children living with HIV must be replicable in resource-limited settings, avoiding dependence on specialized staff for implementation.This paper advocates for combination approaches that strengthen the capacity of service providers, expand the availability of age appropriate and family-centred support and equip schools to be more protective and supportive of children living with HIV. The coordination of care with other community-based interventions is also needed to foster more supportive and less stigmatizing environments. To ensure effective, feasible, and scalable interventions, improving the evidence base to document improved outcomes and longer term impact as well as implementation of operational studies to document delivery approaches are needed.
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Affiliation(s)
- Anouk Amzel
- US Agency for International Development, Global Health/Office of HIV/AIDS, Washington, DC USA
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK and
- Paediatric AIDS Treatment for Africa (PATA), Cape Town, SA
| | - Ronnie Lovich
- Elizabeth Glaser Paediatric AIDS Foundation, Washington, DC USA
| | - Monique Widyono
- US Agency for International Development, Global Health/Office of HIV/AIDS, Washington, DC USA
| | - Tejal Patel
- US Agency for International Development, Global Health/Office of HIV/AIDS, Washington, DC USA
| | - Carrie Foti
- Education Development Center, Inc., Waltham, MA USA
| | - Eric J. Dziuban
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - B. Ryan Phelps
- US Agency for International Development, Global Health/Office of HIV/AIDS, Washington, DC USA
| | | | - Daniella Mark
- Department of Psychology, University of Cape Town, Cape Town, SA
- Paediatric AIDS Treatment for Africa (PATA), Cape Town, SA
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Dziuban EJ. The expanding role of the African nurse and midwife in paediatric HIV. Afr J Midwifery Womens Health 2013; 7:98-99. [PMID: 26692907 PMCID: PMC4676411 DOI: 10.12968/ajmw.2013.7.2.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Eric J Dziuban
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV/AIDS, Atlanta, Georgia, USA
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30
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Dziuban EJ, Marton SA, Hughey AB, Mbingo TL, Draper HR, Schutze GE. Seroprevalence of hepatitis B in a cohort of HIV-infected children and adults in Swaziland. Int J STD AIDS 2013; 24:561-5. [DOI: 10.1177/0956462413476274] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Summary Hepatitis B virus (HBV) is an important co-morbidity in the HIV epidemic. A retrospective chart review was performed of HIV-infected patients with no previous antiretroviral history enrolled in a Swaziland clinic from January 2009 to May 2011. The seroprevalence of HBV surface antigen (HBsAg) was calculated and the data were analyzed using Mann-Whitney U and Fisher's exact tests. A total of 1282 patients were included in analysis. Five hundred were children aged <15 years. Overall HBsAg seroprevalence was 3.7% (1.4% of children and 5.1% of adults). Prevalence in under-5s was low (0.4%). Among adult women and men, prevalence was 4.2% and 9.8%, respectively ( P = 0.022). Median alanine aminotransferase level was 19 U/L in the HBsAg-negative adults and 25 U/L in the HBsAg-positive adults ( P = 0.005). Given the number of patients found to be HBsAg-positive, especially among adults, it is important for antiretroviral programmes to consider universal screening and strategically utilize medications that have been found effective in treating both HBV and HIV.
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Affiliation(s)
- E J Dziuban
- Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Houston, TX, USA
- Baylor College of Medicine Department of Pediatrics, Houston, TX, USA
- Baylor College of Medicine Bristol Myers Squibb Children's Clinical Center of Excellence-Swaziland, Mbabane, Swaziland
| | - S A Marton
- Baylor College of Medicine Department of Pediatrics, Houston, TX, USA
| | - A B Hughey
- Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Houston, TX, USA
| | - T L Mbingo
- Baylor College of Medicine Children's Foundation, Mbabane, Swaziland
| | - H R Draper
- Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Houston, TX, USA
- Baylor College of Medicine Department of Pediatrics, Houston, TX, USA
| | - G E Schutze
- Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Houston, TX, USA
- Baylor College of Medicine Department of Pediatrics, Houston, TX, USA
- Baylor College of Medicine Bristol Myers Squibb Children's Clinical Center of Excellence-Swaziland, Mbabane, Swaziland
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Dziuban EJ, Saab-Abazeed L, Chaudhry SR, Streetman DS, Nasr SZ. Identifying barriers to treatment adherence and related attitudinal patterns in adolescents with cystic fibrosis. Pediatr Pulmonol 2010; 45:450-8. [PMID: 20425852 DOI: 10.1002/ppul.21195] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The treatment of cystic fibrosis (CF) is directed toward correction of organ dysfunction and relief of symptoms resulting from the disease. Lack of adherence to daily treatment regimens may have substantial short-term and long-term effects on patients with CF. In this study, we attempted to identify barriers to treatment adherence which could be predicted by objective measures and explore ways to improve adherence in adolescents with CF. METHODS A questionnaire was given to patients 12.0-20.9 years of age, designed with focus on specific barriers to adhering to treatment plan and related attitudinal patterns. Observational and analytical results were collected. RESULTS We obtained questionnaires and objective health data for 60 respondents. The most commonly identified barriers to adherence were forgetting or losing medications (32/60) and being too busy (23/60). Attitudinal patterns that played a significant role for nonadherence included unintentional forgetting (40/60), feeling that following CF treatments resulted in less freedom in their lives (30/60), and believing it is acceptable to miss a treatment every few days (18/60) or to miss treatments when busy (18/60). DISCUSSION There were a few statistically significant differences of adherence patterns between demographic subgroups in our study. Males were more likely to agree that it is acceptable to miss doses if they are made up with extra doses later (24% vs. 3%, P = 0.04). Patients who perceived themselves to be less healthy agreed more to statements of limited freedom, nonsympathetic medical providers, and difficulty adhering during times of decreased symptoms. This highlights an unexpected risk: as CF progresses and patients perceive themselves to be less healthy, they may become less likely to be adherent during the periods they are feeling the best, while at the same time becoming less likely to perceive empathy from their physicians. CONCLUSIONS Survey results describe a variety of beliefs and attitudinal patterns which contribute to nonadherence in CF treatment, especially relating to time management. While patients largely understood the importance of treatments to their health, predictors of risky behaviors could lead to targeted interventions by CF centers to address these challenges and improve adherence.
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Affiliation(s)
- Eric J Dziuban
- Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
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Dziuban EJ, Castle VP, Haftel HM. Microscopic polyangiitis in an adolescent presenting as severe anemia and syncope. Rheumatol Int 2009; 31:1507-10. [PMID: 20013269 DOI: 10.1007/s00296-009-1270-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 11/29/2009] [Indexed: 11/29/2022]
Abstract
Microscopic polyangiitis (MPA) is an autoimmune systemic vasculitis of small vessels. The condition has been best characterized in older adults and little is known of the natural history of this disease in children and adolescents. In this report, a case of an adolescent presenting with symptomatic anemia and syncopal episodes is described. An extensive evaluation ultimately led to the diagnosis of MPA. The unique findings in this case and review of the literature are presented, outlining the variable clinical presentations and challenge of diagnosing this condition in pediatric patients.
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Affiliation(s)
- Eric J Dziuban
- Department of Pediatrics and Communicable Diseases, C.S. Mott's Children's Hospital, University of Michigan, Ann Arbor, MI 48109, USA.
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Dziuban EJ, Teitelbaum DH, Bakhtyar A, Kandlikar J, McLean S, Yarram S, Russell MW, Ohye RG, Sanchez R. Mesenteric pseudoaneurysm and cerebral stroke as sequelae of infective endocarditis in an adolescent. J Pediatr Surg 2008; 43:1923-7. [PMID: 18926234 DOI: 10.1016/j.jpedsurg.2008.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 04/15/2008] [Revised: 07/03/2008] [Accepted: 07/04/2008] [Indexed: 01/16/2023]
Abstract
Infective endocarditis is uncommon in children, and there is a paucity of literature concerning cases that involve unique or resistant organisms. Complications associated with infective endocarditis are distinctly rare and poorly characterized, especially unusual sequelae such as pseudoaneurysm of the abdominal mesentery. Our case involves an adolescent who presented with several weeks of fever and eventual cardiac murmur and was found to have vancomycin-resistant Enterococcus growing as a vegetation on a previously undiagnosed bicuspid aortic valve. He had a cerebral stroke presenting as Broca's aphasia before cardiac surgery, as well as a superior mesenteric artery pseudoaneurysm several days postoperatively. The case highlights some of the serious surgical complications that can occur in young persons with infective endocarditis, as well as many of the problems involved in managing a patient with highly resistant pathogens and a surgically challenging location of the aneurysm.
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Affiliation(s)
- Eric J Dziuban
- Department of Pediatrics and Communicable Diseases, CS Mott's Children's Hospital, University of Michigan, Ann Arbor, MI 48109, USA
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Liang JL, Dziuban EJ, Craun GF, Hill V, Moore MR, Gelting RJ, Calderon RL, Beach MJ, Roy SL. Surveillance for waterborne disease and outbreaks associated with drinking water and water not intended for drinking--United States, 2003-2004. MMWR Surveill Summ 2006; 55:31-65. [PMID: 17183231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PROBLEM/CONDITION Since 1971, CDC, the U.S. Environmental Protection Agency (EPA), and the Council of State and Territorial Epidemiologists have maintained a collaborative Waterborne Disease and Outbreaks Surveillance System for collecting and reporting data related to occurrences and causes of waterborne disease and outbreaks (WBDOs). This surveillance system is the primary source of data concerning the scope and effects of WBDOs in the United States. REPORTING PERIOD Data presented summarize 36 WBDOs that occurred during January 2003-December 2004 and nine previously unreported WBDOs that occurred during 1982-2002. DESCRIPTION OF SYSTEM The surveillance system includes data on WBDOs associated with drinking water, water not intended for drinking (excluding recreational water), and water of unknown intent. Public health departments in the states, territories, localities, and Freely Associated States (i.e., the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau, formerly parts of the U.S.-administered Trust Territory of the Pacific Islands) are primarily responsible for detecting and investigating WBDOs and voluntarily reporting them to CDC by using a standard form. RESULTS During 2003-2004, a total of 36 WBDOs were reported by 19 states; 30 were associated with drinking water, three were associated with water not intended for drinking, and three were associated with water of unknown intent. The 30 drinking water-associated WBDOs caused illness among an estimated 2,760 persons and were linked to four deaths. Etiologic agents were identified in 25 (83.3%) of these WBDOs: 17 (68.0%) involved pathogens (i.e., 13 bacterial, one parasitic, one viral, one mixed bacterial/parasitic, and one mixed bacterial/parasitic/viral), and eight (32.0%) involved chemical/toxin poisonings. Gastroenteritis represented 67.7% of the illness related to drinking water-associated WBDOs; acute respiratory illness represented 25.8%, and dermatitis represented 6.5%. The classification of deficiencies contributing to WBDOs has been revised to reflect the categories of concerns associated with contamination at or in the source water, treatment facility, or distribution system (SWTD) that are under the jurisdiction of water utilities, versus those at points not under the jurisdiction of a water utility or at the point of water use (NWU/POU), which includes commercially bottled water. A total of 33 deficiencies were cited in the 30 WBDOs associated with drinking water: 17 (51.5%) NWU/POU, 14 (42.4%) SWTD, and two (6.1%) unknown. The most frequently cited NWU/POU deficiencies involved Legionella spp. in the drinking water system (n = eight [47.1%]). The most frequently cited SWTD deficiencies were associated with distribution system contamination (n = six [42.9%]). Contaminated ground water was a contributing factor in seven times as many WBDOs (n = seven) as contaminated surface water (n = one). INTERPRETATION Approximately half (51.5%) of the drinking water deficiencies occurred outside the jurisdiction of a water utility in situations not currently regulated by EPA. The majority of the WBDOs in which deficiencies were not regulated by EPA were associated with Legionella spp. or chemicals/toxins. Problems in the distribution system were the most commonly identified deficiencies under the jurisdiction of a water utility, underscoring the importance of preventing contamination after water treatment. The substantial proportion of WBDOs involving contaminated ground water provides support for the Ground Water Rule (finalized in October 2006), which specifies when corrective action is required for public ground water systems. PUBLIC HEALTH ACTIONS CDC and EPA use surveillance data to identify the types of water systems, deficiencies, and etiologic agents associated with WBDOs and to evaluate the adequacy of current technologies and practices for providing safe drinking water. Surveillance data also are used to establish research priorities, which can lead to improved water-quality regulation development. The growing proportion of drinking water deficiencies that are not addressed by current EPA rules emphasizes the need to address risk factors for water contamination in the distribution system and at points not under the jurisdiction of water utilities.
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Affiliation(s)
- Jennifer L Liang
- Division of Parasitic Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases (proposed), CDC, Atlanta, GA 30341, USA.
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Dziuban EJ, Liang JL, Craun GF, Hill V, Yu PA, Painter J, Moore MR, Calderon RL, Roy SL, Beach MJ. Surveillance for waterborne disease and outbreaks associated with recreational water--United States, 2003-2004. MMWR Surveill Summ 2006; 55:1-30. [PMID: 17183230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PROBLEM/CONDITION Since 1971, CDC, the U.S. Environmental Protection Agency, and the Council of State and Territorial Epidemiologists have collaboratively maintained the Waterborne Disease and Outbreak Surveillance System for collecting and reporting waterborne disease and outbreak (WBDO)-related data. In 1978, WBDOs associated with recreational water (natural and treated water) were added. This system is the primary source of data regarding the scope and effects of WBDOs in the United States. REPORTING PERIOD Data presented summarize WBDOs associated with recreational water that occurred during January 2003-December 2004 and one previously unreported outbreak from 2002. DESCRIPTION OF THE SYSTEM Public health departments in the states, territories, localities, and the Freely Associated States (i.e., the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau, formerly parts of the U.S.-administered Trust Territory of the Pacific Islands) have primary responsibility for detecting, investigating, and voluntarily reporting WBDOs to CDC. Although the surveillance system includes data for WBDOs associated with drinking water, recreational water, and water not intended for drinking, only cases and outbreaks associated with recreational water are summarized in this report. RESULTS During 2003-2004, a total 62 WBDOs associated with recreational water were reported by 26 states and Guam. Illness occurred in 2,698 persons, resulting in 58 hospitalizations and one death. The median outbreak size was 14 persons (range: 1-617 persons). Of the 62 WBDOs, 30 (48.4%) were outbreaks of gastroenteritis that resulted from infectious agents, chemicals, or toxins; 13 (21.0%) were outbreaks of dermatitis; and seven (11.3%) were outbreaks of acute respiratory illness (ARI). The remaining 12 WBDOs resulted in primary amebic meningoencephalitis (n = one), meningitis (n = one), leptospirosis (n = one), otitis externa (n = one), and mixed illnesses (n = eight). WBDOs associated with gastroenteritis resulted in 1,945 (72.1%) of 2,698 illnesses. Forty-three (69.4%) WBDOs occurred at treated water venues, resulting in 2,446 (90.7%) cases of illness. The etiologic agent was confirmed in 44 (71.0%) of the 62 WBDOs, suspected in 15 (24.2%), and unidentified in three (4.8%). Twenty (32.3%) WBDOs had a bacterial etiology; 15 (24.2%), parasitic; six (9.7%), viral; and three (4.8%), chemical or toxin. Among the 30 gastroenteritis outbreaks, Cryptosporidium was confirmed as the causal agent in 11 (36.7%), and all except one of these outbreaks occurred in treated water venues where Cryptosporidium caused 55.6% (10/18) of the gastroenteritis outbreaks. In this report, 142 Vibrio illnesses (reported to the Cholera and Other Vibrio Illness Surveillance System) that were associated with recreational water exposure were analyzed separately. The most commonly reported species were Vibrio vulnificus, V. alginolyticus, and V. parahaemolyticus. V. vulnificus illnesses associated with recreational water exposure had the highest Vibrio illness hospitalization (87.2%) and mortality (12.8%) rates. INTERPRETATION The number of WBDOs summarized in this report and the trends in recreational water-associated disease and outbreaks are consistent with previous years. Outbreaks, especially the largest ones, are most likely to be associated with summer months, treated water venues, and gastrointestinal illness. Approximately 60% of illnesses reported for 2003-2004 were associated with the seven largest outbreaks (>100 cases). Deficiencies leading to WBDOs included problems with water quality, venue design, usage, and maintenance. PUBLIC HEALTH ACTIONS CDC uses WBDO surveillance data to 1) identify the etiologic agents, types of aquatic venues, water-treatment systems, and deficiencies associated with outbreaks; 2) evaluate the adequacy of efforts (i.e., regulations and public awareness activities) to provide safe recreational water; and 3) establish public health prevention priorities that might lead to improved regulations and prevention measures at the local, state, and federal levels.
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Affiliation(s)
- Eric J Dziuban
- Division of Parasitic Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases (proposed), CDC, Atlanta, GA 30341, USA
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