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Temate-Tiagueu Y, Winquist A, Davis M, Dietz S, Robinson B, Pevzner E, Arvelo W. Characterizing the Role of International Graduates of the Epidemic Intelligence Service in Increasing the Epidemiological Capacity and Diversity of the United States Public Health Workforce. J Public Health Manag Pract 2023; 29:E169-E175. [PMID: 36867708 PMCID: PMC10475142 DOI: 10.1097/phh.0000000000001723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
CONTEXT A trained and diverse public health workforce is needed to respond to public health threats. The Epidemic Intelligence Service (EIS) is an applied epidemiology training program. Most EIS officers are from the United States, but some are from other countries and bring unique perspectives and skills. OBJECTIVES/EVALUATION To characterize international officers who participated in the EIS program and describe their employment settings after training completion. DESIGN International officers were people who participated in EIS and who were not US citizens or permanent residents. We analyzed data from EIS's application database during 2009-2017 to describe officers' characteristics. We used data from the Centers for Disease Control and Prevention's (CDC's) workforce database for civil servants and EIS exit surveys to describe jobs taken after program completion. MAIN OUTCOME MEASURES We described the characteristics of the international officers, jobs taken immediately after program completion, and duration of employment at CDC. RESULTS Among 715 officers accepted in EIS classes of 2009-2017, 85 (12%) were international applicants, with citizenships from 40 different countries. Forty (47%) had 1 or more US postgraduate degrees, and 65 (76%) were physicians. Of 78 (92%) international officers with available employment data, 65 (83%) reported taking a job at CDC after program completion. The remaining took a public health job with an international entity (6%), academia (5%), or other jobs (5%). Among 65 international officers who remained working at CDC after graduation, the median employment duration was 5.2 years, including their 2 years in EIS. CONCLUSIONS Most international EIS graduates remain at CDC after program completion, which strengthens the diversity and capacity of CDC's epidemiological workforce. Further evaluations are needed to determine the effects of pulling away crucial talent from other countries needing experienced epidemiologists and to what extent retaining those persons can benefit public health globally.
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Affiliation(s)
- Yvette Temate-Tiagueu
- Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
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Walker J, Tran T, Lappe B, Gastanaduy P, Paul P, Kracalik IT, Fields VL, Lopez A, Schwartz A, Lewis NM, Tate JE, Kirking HL, Hall AJ, Pevzner E, Khong H, Smithee M, Lowry J, Dunn A, Kiphibane T, Tran CH. Epidemiology of SARS-CoV-2 transmission and superspreading in Salt Lake County, Utah, March-May 2020. PLoS One 2023; 18:e0275125. [PMID: 37352280 PMCID: PMC10289415 DOI: 10.1371/journal.pone.0275125] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 09/10/2022] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Understanding the drivers of SARS-CoV-2 transmission can inform the development of interventions. We evaluated transmission identified by contact tracing investigations between March-May 2020 in Salt Lake County, Utah, to quantify the impact of this intervention and identify risk factors for transmission. METHODS RT-PCR positive and untested symptomatic contacts were classified as confirmed and probable secondary case-patients, respectively. We compared the number of case-patients and close contacts generated by different groups, and used logistic regression to evaluate factors associated with transmission. RESULTS Data were collected on 184 index case-patients and up to six generations of contacts. Of 1,499 close contacts, 374 (25%) were classified as secondary case-patients. Decreased transmission odds were observed for contacts aged <18 years (OR = 0.55 [95% CI: 0.38-0.79]), versus 18-44 years, and for workplace (OR = 0.36 [95% CI: 0.23-0.55]) and social (OR = 0.44 [95% CI: 0.28-0.66]) contacts, versus household contacts. Higher transmission odds were observed for case-patient's spouses than other household contacts (OR = 2.25 [95% CI: 1.52-3.35]). Compared to index case-patients identified in the community, secondary case-patients identified through contract-tracing generated significantly fewer close contacts and secondary case-patients of their own. Transmission was heterogeneous, with 41% of index case-patients generating 81% of directly-linked secondary case-patients. CONCLUSIONS Given sufficient resources and complementary public health measures, contact tracing can contain known chains of SARS-CoV-2 transmission. Transmission is associated with age and exposure setting, and can be highly variable, with a few infections generating a disproportionately high share of onward transmission.
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Affiliation(s)
- Joseph Walker
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tiffany Tran
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Brooke Lappe
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Paul Gastanaduy
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Prabasaj Paul
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ian T. Kracalik
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Victoria L. Fields
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Adriana Lopez
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amy Schwartz
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nathaniel M. Lewis
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Utah Department of Health, Salt Lake City, Utah, United States of America
| | - Jacqueline E. Tate
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hannah L. Kirking
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Aron J. Hall
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eric Pevzner
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ha Khong
- Salt Lake County Health Department, Salt Lake City, Utah, United States of America
| | - Maureen Smithee
- Salt Lake County Health Department, Salt Lake City, Utah, United States of America
| | - Jason Lowry
- Salt Lake County Health Department, Salt Lake City, Utah, United States of America
| | - Angela Dunn
- Utah Department of Health, Salt Lake City, Utah, United States of America
| | - Tair Kiphibane
- Salt Lake County Health Department, Salt Lake City, Utah, United States of America
| | - Cuc H. Tran
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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So M, Winquist A, Fisher S, Eaton D, Carroll D, Simone P, Pevzner E, Arvelo W. Epidemic Intelligence Service Alumni in Public Health Leadership Roles. Int J Environ Res Public Health 2022; 19:ijerph19116662. [PMID: 35682243 PMCID: PMC9180484 DOI: 10.3390/ijerph19116662] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 12/04/2022]
Abstract
Since 1951, the Epidemic Intelligence Service (EIS) of the U.S. Centers for Disease Control and Prevention (CDC) has trained physicians, nurses, scientists, veterinarians, and other allied health professionals in applied epidemiology. To understand the program's effect on graduates' leadership outcomes, we examined the EIS alumni representation in five select leadership positions. These positions were staffed by 353 individuals, of which 185 (52%) were EIS alumni. Among 12 CDC directors, four (33%) were EIS alumni. EIS alumni accounted for 29 (58%) of the 50 CDC center directors, 61 (35%) of the 175 state epidemiologists, 27 (56%) of the 48 Field Epidemiology Training Program resident advisors, and 70 (90%) of the 78 Career Epidemiology Field Officers. Of the 185 EIS alumni in leadership positions, 136 (74%) were physicians, 22 (12%) were scientists, 21 (11%) were veterinarians, 6 (3%) were nurses, and 94 (51%) were assigned to a state or local health department. Among the 61 EIS alumni who served as state epidemiologists, 40 (66%) of them were assigned to a state or local health department during EIS. Our evaluation suggests that epidemiology training programs can serve as a vital resource for the public health workforce, particularly given the capacity strains brought to light by the COVID-19 pandemic.
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Affiliation(s)
- Marvin So
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA
- Correspondence:
| | - Andrea Winquist
- Epidemiology Workforce Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (A.W.); (D.E.); (D.C.); (P.S.); (E.P.); (W.A.)
| | | | - Danice Eaton
- Epidemiology Workforce Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (A.W.); (D.E.); (D.C.); (P.S.); (E.P.); (W.A.)
- Commissioned Corps, U.S. Public Health Service, Rockville, MD 20852, USA
| | - Dianna Carroll
- Epidemiology Workforce Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (A.W.); (D.E.); (D.C.); (P.S.); (E.P.); (W.A.)
- Commissioned Corps, U.S. Public Health Service, Rockville, MD 20852, USA
| | - Patricia Simone
- Epidemiology Workforce Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (A.W.); (D.E.); (D.C.); (P.S.); (E.P.); (W.A.)
| | - Eric Pevzner
- Epidemiology Workforce Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (A.W.); (D.E.); (D.C.); (P.S.); (E.P.); (W.A.)
- Commissioned Corps, U.S. Public Health Service, Rockville, MD 20852, USA
| | - Wences Arvelo
- Epidemiology Workforce Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (A.W.); (D.E.); (D.C.); (P.S.); (E.P.); (W.A.)
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Fields VL, Kracalik IT, Carthel C, Lopez A, Schwartz A, Lewis NM, Bray M, Claflin C, Jorgensen K, Khong H, Richards W, Risk I, Smithee M, Clawson M, Booth LC, Scribellito T, Lowry J, Huynh J, Davis L, Birch H, Tran T, Walker J, Fry A, Hall A, Baker J, Pevzner E, Dunn AC, Tate JE, Kirking HL, Kiphibane T, Tran CH. Coronavirus Disease Contact Tracing Outcomes and Cost, Salt Lake County, Utah, USA, March-May 2020. Emerg Infect Dis 2021; 27:2999-3008. [PMID: 34698628 PMCID: PMC8632199 DOI: 10.3201/eid2712.210505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Outcomes and costs of coronavirus disease (COVID-19) contact tracing are limited. During March–May 2020, we constructed transmission chains from 184 index cases and 1,499 contacts in Salt Lake County, Utah, USA, to assess outcomes and estimate staff time and salaries. We estimated 1,102 staff hours and $29,234 spent investigating index cases and contacts. Among contacts, 374 (25%) had COVID-19; secondary case detection rate was ≈31% among first-generation contacts, ≈16% among second- and third-generation contacts, and ≈12% among fourth-, fifth-, and sixth-generation contacts. At initial interview, 51% (187/370) of contacts were COVID-19–positive; 35% (98/277) became positive during 14-day quarantine. Median time from symptom onset to investigation was 7 days for index cases and 4 days for first-generation contacts. Contact tracing reduced the number of cases between contact generations and time between symptom onset and investigation but required substantial resources. Our findings can help jurisdictions allocate resources for contact tracing.
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Salvatore PP, Dawson P, Wadhwa A, Rabold EM, Buono S, Dietrich EA, Reses HE, Vuong J, Pawloski L, Dasu T, Bhattacharyya S, Pevzner E, Hall AJ, Tate JE, Kirking HL. Epidemiological Correlates of Polymerase Chain Reaction Cycle Threshold Values in the Detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Clin Infect Dis 2021; 72:e761-e767. [PMID: 32986120 PMCID: PMC7543310 DOI: 10.1093/cid/ciaa1469] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Indexed: 01/01/2023] Open
Abstract
Background Detection of SARS-CoV-2 infection has principally been performed through the use of real-time reverse-transcription PCR (rRT-PCR) testing. Results of such tests can be reported as cycle threshold (Ct) values, which may provide semi-quantitative or indirect measurements of viral load. Previous reports have examined temporal trends in Ct values over the course of a SARS-CoV-2 infection. Methods Using testing data collected during a prospective household transmission investigation of outpatient and mild COVID-19 cases, we examined the relationship between Ct values of the viral RNA N1 target and demographic, clinical, and epidemiological characteristics collected through participant interviews and daily symptom diaries. Results We found Ct values are lowest (corresponding to higher viral RNA concentration) soon after symptom onset and are significantly correlated with time elapsed since onset (p<0.001); within 7 days after symptom onset, the median Ct value was 26.5 compared with a median Ct value of 35.0 occurring 21 days after onset. Ct values were significantly lower among participants under 18 years of age (p=0.01) and those reporting upper respiratory symptoms at the time of sample collection (p=0.001) and were higher among participants reporting no symptoms (p=0.05). Conclusions These results emphasize the importance of early testing for SARS-CoV-2 among individuals with symptoms of respiratory illness and allows cases to be identified and isolated when their viral shedding may be highest.
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Affiliation(s)
- Phillip P Salvatore
- Coronavirus Disease 2019 (COVID-19) Response Team, Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Patrick Dawson
- Coronavirus Disease 2019 (COVID-19) Response Team, Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ashutosh Wadhwa
- Coronavirus Disease 2019 (COVID-19) Response Team, Laboratory Leadership Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth M Rabold
- Coronavirus Disease 2019 (COVID-19) Response Team, Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sean Buono
- Coronavirus Disease 2019 (COVID-19) Response Team, Laboratory Leadership Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth A Dietrich
- Coronavirus Disease 2019 (COVID-19) Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hannah E Reses
- Coronavirus Disease 2019 (COVID-19) Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jeni Vuong
- Coronavirus Disease 2019 (COVID-19) Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lucia Pawloski
- Coronavirus Disease 2019 (COVID-19) Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Trivikram Dasu
- City of Milwaukee Health Department, Milwaukee, Wisconsin, USA
| | | | - Eric Pevzner
- Coronavirus Disease 2019 (COVID-19) Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aron J Hall
- Coronavirus Disease 2019 (COVID-19) Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jacqueline E Tate
- Coronavirus Disease 2019 (COVID-19) Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hannah L Kirking
- Coronavirus Disease 2019 (COVID-19) Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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6
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Leidner AJ, Barry V, Bowen VB, Silver R, Musial T, Kang GJ, Ritchey MD, Fletcher K, Barrios L, Pevzner E. Opening of Large Institutions of Higher Education and County-Level COVID-19 Incidence - United States, July 6-September 17, 2020. MMWR Morb Mortal Wkly Rep 2021; 70:14-19. [PMID: 33411699 PMCID: PMC7790156 DOI: 10.15585/mmwr.mm7001a4] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Laws RL, Chancey RJ, Rabold EM, Chu VT, Lewis NM, Fajans M, Reses HE, Duca LM, Dawson P, Conners EE, Gharpure R, Yin S, Buono S, Pomeroy M, Yousaf AR, Owusu D, Wadhwa A, Pevzner E, Battey KA, Njuguna H, Fields VL, Salvatore P, O'Hegarty M, Vuong J, Gregory CJ, Banks M, Rispens J, Dietrich E, Marcenac P, Matanock A, Pray I, Westergaard R, Dasu T, Bhattacharyya S, Christiansen A, Page L, Dunn A, Atkinson-Dunn R, Christensen K, Kiphibane T, Willardson S, Fox G, Ye D, Nabity SA, Binder A, Freeman BD, Lester S, Mills L, Thornburg N, Hall AJ, Fry AM, Tate JE, Tran CH, Kirking HL. Symptoms and Transmission of SARS-CoV-2 Among Children - Utah and Wisconsin, March-May 2020. Pediatrics 2021; 147:peds.2020-027268. [PMID: 33033178 DOI: 10.1542/peds.2020-027268] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Limited data exist on severe acute respiratory syndrome coronavirus 2 in children. We described infection rates and symptom profiles among pediatric household contacts of individuals with coronavirus disease 2019. METHODS We enrolled individuals with coronavirus disease 2019 and their household contacts, assessed daily symptoms prospectively for 14 days, and obtained specimens for severe acute respiratory syndrome coronavirus 2 real-time reverse transcription polymerase chain reaction and serology testing. Among pediatric contacts (<18 years), we described transmission, assessed the risk factors for infection, and calculated symptom positive and negative predictive values. We compared secondary infection rates and symptoms between pediatric and adult contacts using generalized estimating equations. RESULTS Among 58 households, 188 contacts were enrolled (120 adults; 68 children). Secondary infection rates for adults (30%) and children (28%) were similar. Among households with potential for transmission from children, child-to-adult transmission may have occurred in 2 of 10 (20%), and child-to-child transmission may have occurred in 1 of 6 (17%). Pediatric case patients most commonly reported headache (79%), sore throat (68%), and rhinorrhea (68%); symptoms had low positive predictive values, except measured fever (100%; 95% confidence interval [CI]: 44% to 100%). Compared with symptomatic adults, children were less likely to report cough (odds ratio [OR]: 0.15; 95% CI: 0.04 to 0.57), loss of taste (OR: 0.21; 95% CI: 0.06 to 0.74), and loss of smell (OR: 0.29; 95% CI: 0.09 to 0.96) and more likely to report sore throat (OR: 3.4; 95% CI: 1.04 to 11.18). CONCLUSIONS Children and adults had similar secondary infection rates, but children generally had less frequent and severe symptoms. In two states early in the pandemic, we observed possible transmission from children in approximately one-fifth of households with potential to observe such transmission patterns.
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Affiliation(s)
- Rebecca L Laws
- COVID-19 Response Team, .,Contributed equally as co-first authors
| | | | | | - Victoria T Chu
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | - Nathaniel M Lewis
- COVID-19 Response Team.,Epidemic Intelligence Service, and.,Utah Department of Health, Salt Lake City, Utah
| | | | | | - Lindsey M Duca
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | - Patrick Dawson
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | | | | | | | - Sean Buono
- COVID-19 Response Team.,Laboratory Leadership Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary Pomeroy
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | - Anna R Yousaf
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | - Daniel Owusu
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | - Ashutosh Wadhwa
- COVID-19 Response Team.,Laboratory Leadership Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | | | | | | | | | - Jared Rispens
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | | | | | | | - Ian Pray
- COVID-19 Response Team.,Epidemic Intelligence Service, and.,Wisconsin Department of Health Services, Madison, Wisconsin
| | | | - Trivikram Dasu
- City of Milwaukee Health Department, Milwaukee, Wisconsin
| | | | | | - Lindsey Page
- City of Milwaukee Health Department, Milwaukee, Wisconsin
| | - Angela Dunn
- Utah Department of Health, Salt Lake City, Utah
| | | | | | - Tair Kiphibane
- Salt Lake County Health Department, Salt Lake City, Utah; and
| | | | | | | | | | | | - Brandi D Freeman
- COVID-19 Response Team.,Laboratory Leadership Service, Centers for Disease Control and Prevention, Atlanta, Georgia
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Roscoe C, Lockhart C, de Klerk M, Baughman A, Agolory S, Gawanab M, Menzies H, Jonas A, Salomo N, Taffa N, Lowrance D, Robsky K, Tollefson D, Pevzner E, Hamunime N, Mavhunga F, Mungunda H. Evaluation of the uptake of tuberculosis preventative therapy for people living with HIV in Namibia: a multiple methods analysis. BMC Public Health 2020; 20:1838. [PMID: 33261569 PMCID: PMC7708912 DOI: 10.1186/s12889-020-09902-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background In 2016, Namibia had ~ 230,000 people living with HIV (PLHIV) and 9154 new tuberculosis (TB) cases, including 3410 (38%) co-infected cases. TB preventative therapy (TPT), consisting of intensive case finding and isoniazid preventative therapy, is critical to reducing TB disease and mortality. Methods Between November 2014 and February 2015, data was abstracted from charts of PLHIV enrolled in HIV treatment. Fifty-five facilities were purposively selected based on patient volume, type and location. Charts were randomly sampled. The primary outcome was to estimate baseline TPT in PLHIV, using nationally weighted proportions. Qualitative surveys were conducted and summarized to evaluate TPT practices and quantify challenges encountered by health care workers (HCW). Results Among 861 PLHIV sampled, 96% were eligible for TPT services, of which 87.1% were screened for TB at least once. For PLHIV eligible for preventative therapy (646/810; 82.6%), 45.4% (294/646) initiated therapy and 45.7% (139/294) of those completed therapy. The proportion of eligible PLHIV completing TB screening, initiating preventative therapy and then completing preventative therapy was 20.7%. Qualitative surveys with 271 HCW identified barriers to TPT implementation including: lack of training (61.3% reported receiving training on TPT); misunderstandings about timing of TPT initiation (46.7% correctly reported TPT should be started with antiretroviral therapy); and variable screening practices and responsibilities (66.1% of HCWs screened for TB at every encounter). Though barriers were evident, 72.2% HCWs surveyed described their clinical performance as very good, often placing responsibility of difficulties on patients and downplaying challenges like staff shortages and medication stock outs. Conclusions In this study, only 1 in 5 eligible PLHIV completed the TPT cascade in Namibia. Lack of training, irregularities with TB screening and timing of TPT, unclear prescribing and recording responsibilities, and a clinical misperception may have contributed to suboptimal programmatic implementation. Addressing these challenges will be critical with continued TPT scale-up.
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Affiliation(s)
- Clay Roscoe
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia.
| | - Chris Lockhart
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Michael de Klerk
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Andrew Baughman
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Simon Agolory
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Michael Gawanab
- Ministry of Health and Social Services of Namibia, Directorate of Special Programs, Oshakati, Namibia
| | - Heather Menzies
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Anna Jonas
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Natanael Salomo
- Ministry of Health and Social Services of Namibia, Directorate of Special Programs, Oshakati, Namibia
| | - Negussie Taffa
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - David Lowrance
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | | | | | - Eric Pevzner
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ndapewa Hamunime
- Ministry of Health and Social Services of Namibia, Directorate of Special Programs, Oshakati, Namibia
| | - Farai Mavhunga
- Ministry of Health and Social Services of Namibia, Directorate of Special Programs, Oshakati, Namibia
| | - Helena Mungunda
- Ministry of Health and Social Services of Namibia, Directorate of Special Programs, Oshakati, Namibia
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Van Dyke ME, Rogers TM, Pevzner E, Satterwhite CL, Shah HB, Beckman WJ, Ahmed F, Hunt DC, Rule J. Trends in County-Level COVID-19 Incidence in Counties With and Without a Mask Mandate - Kansas, June 1-August 23, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1777-1781. [PMID: 33237889 PMCID: PMC7727605 DOI: 10.15585/mmwr.mm6947e2] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Wearing masks is a CDC-recommended* approach to reduce the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), by reducing the spread of respiratory droplets into the air when a person coughs, sneezes, or talks and by reducing the inhalation of these droplets by the wearer. On July 2, 2020, the governor of Kansas issued an executive order† (state mandate), effective July 3, requiring masks or other face coverings in public spaces. CDC and the Kansas Department of Health and Environment analyzed trends in county-level COVID-19 incidence before (June 1-July 2) and after (July 3-August 23) the governor's executive order among counties that ultimately had a mask mandate in place and those that did not. As of August 11, 24 of Kansas's 105 counties did not opt out of the state mandate§ or adopted their own mask mandate shortly before or after the state mandate was issued; 81 counties opted out of the state mandate, as permitted by state law, and did not adopt their own mask mandate. After the governor's executive order, COVID-19 incidence (calculated as the 7-day rolling average number of new daily cases per 100,000 population) decreased (mean decrease of 0.08 cases per 100,000 per day; net decrease of 6%) among counties with a mask mandate (mandated counties) but continued to increase (mean increase of 0.11 cases per 100,000 per day; net increase of 100%) among counties without a mask mandate (nonmandated counties). The decrease in cases among mandated counties and the continued increase in cases in nonmandated counties adds to the evidence supporting the importance of wearing masks and implementing policies requiring their use to mitigate the spread of SARS-CoV-2 (1-6). Community-level mitigation strategies emphasizing wearing masks, maintaining physical distance, staying at home when ill, and enhancing hygiene practices can help reduce transmission of SARS-CoV-2.
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10
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Kanu FA, Smith EE, Offutt-Powell T, Hong R, Dinh TH, Pevzner E. Declines in SARS-CoV-2 Transmission, Hospitalizations, and Mortality After Implementation of Mitigation Measures- Delaware, March-June 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1691-1694. [PMID: 33180757 PMCID: PMC7660664 DOI: 10.15585/mmwr.mm6945e1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Mitigation measures, including stay-at-home orders and public mask wearing, together with routine public health interventions such as case investigation with contact tracing and immediate self-quarantine after exposure, are recommended to prevent and control the transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1-3). On March 11, the first COVID-19 case in Delaware was reported to the Delaware Division of Public Health (DPH). The state responded to ongoing community transmission with investigation of all identified cases (commencing March 11), issuance of statewide stay-at-home orders (March 24-June 1), a statewide public mask mandate (from April 28), and contact tracing (starting May 12). The relationship among implementation of mitigation strategies, case investigations, and contact tracing and COVID-19 incidence and associated hospitalization and mortality was examined during March-June 2020. Incidence declined by 82%, hospitalization by 88%, and mortality by 100% from late April to June 2020, as the mask mandate and contact tracing were added to case investigations and the stay-at-home order. Among 9,762 laboratory-confirmed COVID-19 cases reported during March 11-June 25, 2020, two thirds (6,527; 67%) of patients were interviewed, and 5,823 (60%) reported completing isolation. Among 2,834 contacts reported, 882 (31%) were interviewed and among these contacts, 721 (82%) reported completing quarantine. Implementation of mitigation measures, including mandated mask use coupled with public health interventions, was followed by reductions in COVID-19 incidence and associated hospitalizations and mortality. The combination of state-mandated community mitigation efforts and routine public health interventions can reduce the occurrence of new COVID-19 cases, hospitalizations, and deaths.
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11
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Pray IW, Gibbons-Burgener SN, Rosenberg AZ, Cole D, Borenstein S, Bateman A, Pevzner E, Westergaard RP. COVID-19 Outbreak at an Overnight Summer School Retreat - Wisconsin, July-August 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1600-1604. [PMID: 33119558 PMCID: PMC7640998 DOI: 10.15585/mmwr.mm6943a4] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
During July 2-August 11, 2020, an outbreak of coronavirus disease 2019 (COVID-19) occurred at a boys' overnight summer school retreat in Wisconsin. The retreat included 152 high school-aged boys, counselors, and staff members from 21 states and territories and two foreign countries. All attendees were required to provide documentation of either a positive serologic test result* within the past 3 months or a negative reverse transcription-polymerase chain reaction (RT-PCR) tests result for SARS-CoV-2 (the virus that causes COVID-19) ≤7 days before travel, to self-quarantine within their households for 7 days before travel, and to wear masks during travel. On July 15, the Wisconsin Department of Health Services (WDHS) began an investigation after being notified that two students at the retreat had received positive SARS-CoV-2 RT-PCR test results. WDHS offered RT-PCR testing to attendees on July 28 and serologic testing on August 5 and 6. Seventy-eight (51%) attendees received positive RT-PCR results (confirmed cases), and 38 (25%) met clinical criteria for COVID-19 without a positive RT-PCR result (probable cases). By the end of the retreat, 118 (78%) persons had received a positive serologic test result. Among 24 attendees with a documented positive serologic test result before the retreat, all received negative RT-PCR results. After RT-PCR testing on July 28, WDHS recommended that remaining susceptible persons (asymptomatic and with negative RT-PCR test results) quarantine from other students and staff members at the retreat. Recommended end dates for isolation or quarantine were based on established guidance (1,2) and determined in coordination with CDC. All attendees were cleared for interstate and commercial air travel to return home on August 11. This outbreak investigation documented rapid spread of SARS-CoV-2, likely from a single student, among adolescents and young adults in a congregate setting. Mitigation plans that include prearrival quarantine and testing, cohorting, symptom monitoring, early identification and isolation of cases, mask use, enhanced hygiene and disinfection practices, and maximal outdoor programming are necessary to prevent COVID-19 outbreaks in these settings (3,4).
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12
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Dasgupta S, Bowen VB, Leidner A, Fletcher K, Musial T, Rose C, Cha A, Kang G, Dirlikov E, Pevzner E, Rose D, Ritchey MD, Villanueva J, Philip C, Liburd L, Oster AM. Association Between Social Vulnerability and a County's Risk for Becoming a COVID-19 Hotspot - United States, June 1-July 25, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1535-1541. [PMID: 33090977 PMCID: PMC7583500 DOI: 10.15585/mmwr.mm6942a3] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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13
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Lewis NM, Chu VT, Ye D, Conners EE, Gharpure R, Laws RL, Reses HE, Freeman BD, Fajans M, Rabold EM, Dawson P, Buono S, Yin S, Owusu D, Wadhwa A, Pomeroy M, Yousaf A, Pevzner E, Njuguna H, Battey KA, Tran CH, Fields VL, Salvatore P, O'Hegarty M, Vuong J, Chancey R, Gregory C, Banks M, Rispens JR, Dietrich E, Marcenac P, Matanock AM, Duca L, Binder A, Fox G, Lester S, Mills L, Gerber SI, Watson J, Schumacher A, Pawloski L, Thornburg NJ, Hall AJ, Kiphibane T, Willardson S, Christensen K, Page L, Bhattacharyya S, Dasu T, Christiansen A, Pray IW, Westergaard RP, Dunn AC, Tate JE, Nabity SA, Kirking HL. Household Transmission of SARS-CoV-2 in the United States. Clin Infect Dis 2020; 73:1805-1813. [PMID: 33185244 PMCID: PMC7454394 DOI: 10.1093/cid/ciaa1166] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Indexed: 01/08/2023] Open
Abstract
Background Although many viral respiratory illnesses are transmitted within households, the evidence base for SARS-CoV-2 is nascent. We sought to characterize SARS-CoV-2 transmission within US households and estimate the household secondary infection rate (SIR) to inform strategies to reduce transmission. Methods We recruited laboratory-confirmed COVID-19 patients and their household contacts in Utah and Wisconsin during March 22–April 25, 2020. We interviewed patients and all household contacts to obtain demographics and medical histories. At the initial household visit, 14 days later, and when a household contact became newly symptomatic, we collected respiratory swabs from patients and household contacts for testing by SARS-CoV-2 rRT-PCR and sera for SARS-CoV-2 antibodies testing by enzyme-linked immunosorbent assay (ELISA). We estimated SIR and odds ratios (OR) to assess risk factors for secondary infection, defined by a positive rRT-PCR or ELISA test. Results Thirty-two (55%) of 58 households had evidence of secondary infection among household contacts. The SIR was 29% (n = 55/188; 95% confidence interval [CI]: 23–36%) overall, 42% among children (<18 years) of the COVID-19 patient and 33% among spouses/partners. Household contacts to COVID-19 patients with immunocompromised conditions had increased odds of infection (OR: 15.9, 95% CI: 2.4–106.9). Household contacts who themselves had diabetes mellitus had increased odds of infection (OR: 7.1, 95% CI: 1.2–42.5). Conclusions We found substantial evidence of secondary infections among household contacts. People with COVID-19, particularly those with immunocompromising conditions or those with household contacts with diabetes, should take care to promptly self-isolate to prevent household transmission.
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Affiliation(s)
- Nathaniel M Lewis
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA.,Utah Department of Health, Salt Lake City, Utah, USA
| | - Victoria T Chu
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Dongni Ye
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | - Erin E Conners
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Radhika Gharpure
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | | | | | - Brandi D Freeman
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Laboratory Leadership Service, CDC, Atlanta, Georgia, USA
| | - Mark Fajans
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | - Elizabeth M Rabold
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Patrick Dawson
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Sean Buono
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Laboratory Leadership Service, CDC, Atlanta, Georgia, USA
| | - Sherry Yin
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | - Daniel Owusu
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Ashutosh Wadhwa
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Laboratory Leadership Service, CDC, Atlanta, Georgia, USA
| | - Mary Pomeroy
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Anna Yousaf
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Eric Pevzner
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | | | | | - Cuc H Tran
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | - Victoria L Fields
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Phillip Salvatore
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | | | - Jeni Vuong
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | | | | | | | - Jared R Rispens
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | | | - Perrine Marcenac
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | | | - Lindsey Duca
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | | | - Garrett Fox
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | | | - Lisa Mills
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | | | - John Watson
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | | | | | | | - Aron J Hall
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | - Tair Kiphibane
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | | | | | - Lindsey Page
- City of Milwaukee Health Department, Milwaukee, Wisconsin, USA
| | | | - Trivikram Dasu
- City of Milwaukee Health Department, Milwaukee, Wisconsin, USA
| | | | - Ian W Pray
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA.,Wisconsin Department of Health Services, Madison, Wisconsin, USA
| | | | - Angela C Dunn
- Utah Department of Health, Salt Lake City, Utah, USA
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14
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Yousaf AR, Duca LM, Chu V, Reses HE, Fajans M, Rabold EM, Laws RL, Gharpure R, Matanock A, Wadhwa A, Pomeroy M, Njuguna H, Fox G, Binder AM, Christiansen A, Freeman B, Gregory C, Tran CH, Owusu D, Ye D, Dietrich E, Pevzner E, Conners EE, Pray I, Rispens J, Vuong J, Christensen K, Banks M, O'Hegarty M, Mills L, Lester S, Thornburg NJ, Lewis N, Dawson P, Marcenac P, Salvatore P, Chancey RJ, Fields V, Buono S, Yin S, Gerber S, Kiphibane T, Dasu T, Bhattacharyya S, Westergaard R, Dunn A, Hall AJ, Fry AM, Tate JE, Kirking HL, Nabity S. A prospective cohort study in non-hospitalized household contacts with SARS-CoV-2 infection: symptom profiles and symptom change over time. Clin Infect Dis 2020; 73:e1841-e1849. [PMID: 32719874 PMCID: PMC7454397 DOI: 10.1093/cid/ciaa1072] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Improved understanding of SARS-CoV-2 spectrum of disease is essential for clinical and public health interventions. There are limited data on mild or asymptomatic infections, but recognition of these individuals is key as they contribute to viral transmission. We describe the symptom profiles from individuals with mild or asymptomatic SARS-CoV-2 infection. METHODS From March 22 to April 22, 2020 in Wisconsin and Utah, we enrolled and prospectively observed 198 household contacts exposed to SARS-CoV-2. We collected and tested nasopharyngeal (NP) specimens by RT-PCR two or more times during a 14-day period. Contacts completed daily symptom diaries. We characterized symptom profiles on the date of first positive RT-PCR test and described progression of symptoms over time. RESULTS We identified 47 contacts, median age 24 (3-75) years, with detectable SARS-CoV-2 by RT-PCR. The most commonly reported symptoms on the day of first positive RT-PCR test were upper respiratory (n=32, 68%) and neurologic (n=30, 64%); fever was not commonly reported (n=9, 19%). Eight (17%) individuals were asymptomatic at the date of first positive RT-PCR collection; two (4%) had preceding symptoms that resolved and six (13%) subsequently developed symptoms. Children less frequently reported lower respiratory symptoms (age <18: 21%, age 18-49: 60%, age 50+ years: 69%; p=0.03). CONCLUSIONS Household contacts with lab-confirmed SARS-CoV-2 infection reported mild symptoms. When assessed at a single time-point, several contacts appeared to have asymptomatic infection; however, over time all developed symptoms. These findings are important to inform infection control, contact tracing, and community mitigation strategies.
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Affiliation(s)
- Anna R Yousaf
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC
| | - Lindsey M Duca
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC
| | - Victoria Chu
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC
| | | | | | | | | | | | | | - Ash Wadhwa
- COVID-19 Response Team, CDC.,Laboratory Leadership Service, CDC
| | - Mary Pomeroy
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC
| | | | | | | | | | - Brandi Freeman
- COVID-19 Response Team, CDC.,Laboratory Leadership Service, CDC
| | | | | | - Daniel Owusu
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC
| | | | | | | | | | - Ian Pray
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC.,Wisconsin Department of Health
| | - Jared Rispens
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC
| | | | | | | | | | | | | | | | - Nathaniel Lewis
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC.,Utah Department of Health
| | - Patrick Dawson
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC
| | | | | | | | - Victoria Fields
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC
| | - Sean Buono
- COVID-19 Response Team, CDC.,Laboratory Leadership Service, CDC
| | | | | | | | - Trivikram Dasu
- Davis County (UT) Health Department.,City of Milwaukee (WI) Health Department
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15
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Pathmanathan I, Ahmedov S, Pevzner E, Anyalechi G, Modi S, Kirking H, Cavanaugh JS. TB preventive therapy for people living with HIV: key considerations for scale-up in resource-limited settings. Int J Tuberc Lung Dis 2019; 22:596-605. [PMID: 29862942 DOI: 10.5588/ijtld.17.0758] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Tuberculosis (TB) is the leading cause of death for persons living with the human immunodeficiency virus (PLHIV). TB preventive therapy (TPT) works synergistically with, and independently of, antiretroviral therapy to reduce TB morbidity, mortality and incidence among PLHIV. However, although TPT is a crucial and cost-effective component of HIV care for adults and children and has been recommended as an international standard of care for over a decade, it remains highly underutilized. If we are to end the global TB epidemic, we must address the significant reservoir of tuberculous infection, especially in those, such as PLHIV, who are most likely to progress to TB disease. To do so, we must confront the pervasive perception that barriers to TPT scale-up are insurmountable in resource-limited settings. Here we review available evidence to address several commonly stated obstacles to TPT scale-up, including the need for the tuberculin skin test, limited diagnostic capacity to reliably exclude TB disease, concerns about creating drug resistance, suboptimal patient adherence to therapy, inability to monitor for and prevent adverse events, a 'one size fits all' option for TPT regimen and duration, and uncertainty about TPT use in children, adolescents, and pregnant women. We also discuss TPT delivery in the era of differentiated care for PLHIV, how best to tackle advanced planning for drug procurement and supply chain management, and how to create an enabling environment for TPT scale-up success.
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Affiliation(s)
- I Pathmanathan
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - S Ahmedov
- Bureau for Global Health, United States Agency for International Development, Washington, DC
| | - E Pevzner
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - G Anyalechi
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - S Modi
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - H Kirking
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - J S Cavanaugh
- Office of the Global AIDS Coordinator, Washington, DC, USA
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16
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Pathmanathan I, Pevzner E, Cavanaugh J, Nelson L. Addressing tuberculosis in differentiated care provision for people living with HIV. Bull World Health Organ 2019; 95:3. [PMID: 28053356 PMCID: PMC5180337 DOI: 10.2471/blt.16.187021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Ishani Pathmanathan
- Division of Global HIV and TB, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Mailbox E-04, GA, 30329, United States of America (USA)
| | - Eric Pevzner
- Division of Global HIV and TB, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Mailbox E-04, GA, 30329, United States of America (USA)
| | - Joseph Cavanaugh
- Division of Global HIV and TB, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Mailbox E-04, GA, 30329, United States of America (USA)
| | - Lisa Nelson
- Office of the Global AIDS Coordinator, Washington, USA
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17
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Click ES, Murithi W, Ouma GS, McCarthy K, Willby M, Musau S, Alexander H, Pevzner E, Posey J, Cain KP. Detection of Apparent Cell-free M. tuberculosis DNA from Plasma. Sci Rep 2018; 8:645. [PMID: 29330384 PMCID: PMC5766485 DOI: 10.1038/s41598-017-17683-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/29/2017] [Indexed: 11/26/2022] Open
Abstract
New diagnostics are needed to improve clinicians’ ability to detect tuberculosis (TB) disease in key populations such as children and persons living with HIV and to rapidly detect drug resistance. Circulating cell-free DNA (ccfDNA) in plasma is a diagnostic target in new obstetric and oncologic applications, but its utility for diagnosing TB is not known. Here we show that Mycobacterium tuberculosis complex DNA can be detected in plasma of persons with sputum smear-positive TB, even in the absence of mycobacteremia. Among 40 participants with bacteriologically-confirmed smear-positive TB disease who had plasma tested by quantitative PCR (qPCR), 18/40 (45%) had a positive result on at least one triplicate reaction. Our results suggest that plasma DNA may be a useful target for improving clinicians’ ability to diagnose TB. We anticipate these findings to be the starting point for optimized methods of TB ccfDNA testing and sequence-based diagnostic applications such as molecular detection of drug resistance.
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Affiliation(s)
- E S Click
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - W Murithi
- Kenya Medical Research Institute, Kisumu, Kenya
| | - G S Ouma
- Kenya Medical Research Institute, Kisumu, Kenya
| | - K McCarthy
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M Willby
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - S Musau
- Kenya Medical Research Institute, Kisumu, Kenya
| | - H Alexander
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - E Pevzner
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J Posey
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - K P Cain
- Centers for Disease Control and Prevention, Kisumu, Kenya
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18
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Danyuttapolchai J, Kittimunkong S, Nateniyom S, Painujit S, Klinbuayaem V, Maipanich N, Maokamnerd Y, Pevzner E, Whitehead S, Kanphukiew A, Monkongdee P, Martin M. Implementing an isoniazid preventive therapy program for people living with HIV in Thailand. PLoS One 2017; 12:e0184986. [PMID: 28949995 PMCID: PMC5614535 DOI: 10.1371/journal.pone.0184986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 04/20/2017] [Accepted: 09/04/2017] [Indexed: 11/18/2022] Open
Abstract
Treatment of people living with HIV (PLHIV) with latent tuberculosis (TB) infection using isoniazid preventive therapy (IPT) can reduce the risk of TB disease, however, the scale-up of IPT among PLHIV in Thailand and worldwide has been slow. To hasten the implementation of IPT in Thailand, we developed IPT implementation training curricula and tools for health care providers and implemented IPT services in seven large government hospitals. Of the 659 PLHIV enrolled, 272 (41.3%) reported symptoms of TB and 39 (14.3% of those with TB symptoms) were diagnosed with TB. A total of 346 (52.4%) participants were eligible for IPT; 318 (91.9%) of these participants opted to have a tuberculin skin test (TST) and 52 (16.3% of those who had a TST) had a positive TST result. Among the 52 participants with a positive TST, 46 (88.5%) initiated and 39 (75.0%) completed 9 months of IPT: physicians instructed three participants to stop IPT, two participants were lost to follow-up, one chose to stop therapy, and one developed TB. IPT can be implemented among PLHIV in Thailand and could reduce the burden of TB in the country.
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Affiliation(s)
- Junya Danyuttapolchai
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi province, Thailand
- * E-mail:
| | - Somyot Kittimunkong
- Bureau of Vector-Borne Diseases, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi province, Thailand
| | - Sriprapa Nateniyom
- Bureau of Tuberculosis, Department of Disease Control, Thailand Ministry of Public Health, Bangkok, Thailand
| | - Sutthapa Painujit
- Nakhon Si Thammarat Hospital, Nakhon Si Thammarat Province, Thailand
| | | | | | | | - Eric Pevzner
- U. S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sara Whitehead
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi province, Thailand
| | - Apiratee Kanphukiew
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi province, Thailand
| | - Patama Monkongdee
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi province, Thailand
| | - Michael Martin
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi province, Thailand
- U. S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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19
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Baker BJ, Peterson B, Mohanlall J, Singh S, Hicks C, Jacobs R, Ramos R, Allen B, Pevzner E. Scale-up of collaborative TB/HIV activities in Guyana. Rev Panam Salud Publica 2017. [PMID: 28444006 PMCID: PMC6660869 DOI: 10.26633/rpsp.2017.6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess scale-up of recommended tuberculosis (TB)/HIV activities in Guyana and to identify specific strategies for further expansion. METHODS Medical records and clinic registers were reviewed at nine TB clinics and 10 HIV clinics. At TB clinics, data were collected on HIV testing and antiretroviral therapy (ART) for patients with TB/HIV; at HIV clinics, data were collected on intensified case finding (ICF), tuberculin skin test (TST) results, and provision of isoniazid preventive therapy (IPT). RESULTS At TB clinics, among 461 patients newly diagnosed with TB, 419 (90.9%) had a known HIV status and 121 (28.9%) were HIV-infected. Among the 63 patients with TB/HIV, 33 (52.4%) received ART. Among the 45 patients with TB/HIV for whom dates of HIV diagnosis were available, 38 (84.4%) individuals knew their HIV status prior to TB diagnosis. At HIV clinics, among 127 patients eligible to receive a TST, 87 (68.5%) received a TST, 66 (75.9%) had a TST result, seven (10.6%) had a newly positive result, two had a previously positive result, and six of nine patients with positive results (66.7%) received IPT. ICF could not be assessed because of incomplete or discrepant documentation. CONCLUSIONS An in-depth evaluation of TB/HIV activities successfully identified areas of success and remaining challenges. At TB clinics, HIV testing rates are high; further scale-up of ART for persons with TB/HIV is needed. At HIV clinics, use of TST to focus IPT is a feasible and efficient strategy; improving rates of annual TST screening will allow for further expansion of IPT.
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Affiliation(s)
- Brian J Baker
- U.S. Centers for Disease Control and PreventionU.S. Centers for Disease Control and PreventionAtlantaGeorgiaUnited States of AmericaU.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.,Send correspondence to: Brian J. Baker,
| | - Brandy Peterson
- U.S. Centers for Disease Control and PreventionU.S. Centers for Disease Control and PreventionAtlantaGeorgiaUnited States of AmericaU.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
| | - Jeetendra Mohanlall
- Ministry of Health, National TB ProgrammeMinistry of Health, National TB ProgrammeGeorgetownGuyanaMinistry of Health, National TB Programme, Georgetown, Guyana.
| | - Shanti Singh
- Ministry of Health, National AIDS Programme SecretariatMinistry of Health, National AIDS Programme SecretariatGeorgetownGuyanaMinistry of Health, National AIDS Programme Secretariat, Georgetown, Guyana.
| | - Collene Hicks
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and PreventionDivision of Global HIV/AIDS, U.S. Centers for Disease Control and PreventionGeorgetownGuyanaDivision of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Georgetown, Guyana.
| | - Ruth Jacobs
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and PreventionDivision of Global HIV/AIDS, U.S. Centers for Disease Control and PreventionGeorgetownGuyanaDivision of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Georgetown, Guyana.
| | - Ruth Ramos
- Ministry of Health, National Care and Treatment CentreMinistry of Health, National Care and Treatment CentreGeorgetownGuyanaMinistry of Health, National Care and Treatment Centre, Georgetown, Guyana.
| | - Barbara Allen
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and PreventionDivision of Global HIV/AIDS, U.S. Centers for Disease Control and PreventionGeorgetownGuyanaDivision of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Georgetown, Guyana.
| | - Eric Pevzner
- U.S. Centers for Disease Control and PreventionU.S. Centers for Disease Control and PreventionAtlantaGeorgiaUnited States of AmericaU.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
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Turinawe K, Vandebriel G, Lowrance DW, Uwinkindi F, Mutwa P, Boer KR, Mutembayire G, Tugizimana D, Nsanzimana S, Pevzner E, Howard AA, Gasana M. Operating Characteristics of a Tuberculosis Screening Tool for People Living with HIV in Out-Patient HIV Care and Treatment Services, Rwanda. PLoS One 2016; 11:e0163462. [PMID: 27685783 PMCID: PMC5042481 DOI: 10.1371/journal.pone.0163462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 09/08/2016] [Indexed: 12/02/2022] Open
Abstract
Background The World Health Organization (WHO) 2010 guidelines for intensified tuberculosis (TB) case finding (ICF) among people living with HIV (PLHIV) includes a recommendation that PLHIV receive routine TB screening. Since 2005, the Rwandan Ministry of Health has been using a five-question screening tool. Our study objective was to assess the operating characteristics of the tool designed to identify PLHIV with presumptive TB as measured against a composite reference standard, including bacteriologically confirmed TB. Methods In a cross-sectional study, the TB screening tool was routinely administered at enrolment in outpatient HIV care and treatment services at seven public health facilities. From March to September 2011, study enrollees were examined for TB disease irrespective of TB screening outcome. The examination consisted of a chest radiograph (CXR), three sputum smears (SS), sputum culture (SC) and polymerase chain reaction line-probe assay (Hain test). PLHIV were classified as having “laboratory-confirmed TB” with positive results on SS for acid-fast bacilli, SC on Lowenstein-Jensen medium, or a Hain test. Results Overall, 1,767 patients were enrolled and screened of which; 1,017 (57.6%) were female, median age was 33 (IQR, 27–41), and median CD4+ cell count was 385 (IQR, 229–563) cells/mm3. Of the patients screened, 138 (7.8%) were diagnosed with TB of which; 125 (90.5%) were laboratory-confirmed pulmonary TB. Of 404 (22.9%) patients who screened positive and 1,363 (77.1%) who screened negative, 79 (19.5%) and 59 (4.3%), respectively, were diagnosed with TB. For laboratory-confirmed TB, the tool had a sensitivity of 54.4% (95% CI 45.3–63.3), specificity of 79.5% (95% CI 77.5–81.5), PPV of 16.8% and NPV of 95.8%. Conclusion TB prevalence among PLHIV newly enrolling into HIV care and treatment was 65 times greater than the overall population prevalence. However, the performance of the tool was poorer than the predicted performance of the WHO recommended TB screening questions.
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Affiliation(s)
- Kenneth Turinawe
- ICAP at Columbia University, Mailman School of Public Health, Kigali, Rwanda
| | - Greet Vandebriel
- ICAP at Columbia University, Mailman School of Public Health, Kigali, Rwanda
- * E-mail:
| | - David W. Lowrance
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Francois Uwinkindi
- Ministry of Health, Rwanda Biomedical Center/Institute of HIV Disease Prevention and Care, Kigali, Rwanda
| | - Philippe Mutwa
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Kimberly R. Boer
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Grace Mutembayire
- Ministry of Health, Rwanda Biomedical Center/Institute of HIV Disease Prevention and Care, Kigali, Rwanda
| | - David Tugizimana
- Ministry of Health, Rwanda Biomedical Center/Institute of HIV Disease Prevention and Care, Kigali, Rwanda
| | - Sabin Nsanzimana
- Ministry of Health, Rwanda Biomedical Center/Institute of HIV Disease Prevention and Care, Kigali, Rwanda
| | - Eric Pevzner
- Global TB Branch, Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Andrea A. Howard
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, United States of America
| | - Michel Gasana
- Ministry of Health, Rwanda Biomedical Center/Institute of HIV Disease Prevention and Care, Kigali, Rwanda
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Jackson-Morris A, Fujiwara PI, Pevzner E. Clearing the smoke around the TB-HIV syndemic: smoking as a critical issue for TB and HIV treatment and care. Int J Tuberc Lung Dis 2016; 19:1003-6. [PMID: 26260816 DOI: 10.5588/ijtld.14.0813] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The collision of the tuberculosis (TB) and human immunodeficiency virus (HIV) epidemics has been described as a 'syndemic' due to the synergistic impact on the burden of both diseases. This paper explains the urgent need for practitioners and policy makers to address a third epidemic that exacerbates TB, HIV and TB-HIV. Tobacco use is the leading cause of preventable death worldwide. Smoking is more prevalent among persons diagnosed with TB or HIV. Smoking is associated with tuberculous infection, TB disease and poorer anti-tuberculosis treatment outcomes. It is also associated with an increased risk of smoking-related diseases among people living with HIV, and smoking may also inhibit the effectiveness of life-saving ART. In this paper, we propose integrating into TB and HIV programmes evidence-based strategies from the 'MPOWER' package recommended by the World Health Organization's Framework Convention on Tobacco Control. Specific actions that can be readily incorporated into current practice are recommended to improve TB and HIV outcomes and care, and reduce the unnecessary burden of death and disease due to smoking.
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Affiliation(s)
- A Jackson-Morris
- Department of Tobacco Control, International Union Against Tuberculosis and Lung Disease (The Union), Edinburgh, Scotland, UK
| | | | - E Pevzner
- International Research and Programs Branch, Division of Tuberculosis Elimination, National Center for HIV, Hepatitis, STD, and TB Prevention, United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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22
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Clark CD, Langkjaer S, Chinikamwala S, Joseph H, Semaan S, Clement J, Marshall R, Pevzner E, Truman BI, Kroeger K. Providers' Perspectives on Program Collaboration and Service Integration for Persons Who Use Drugs. J Behav Health Serv Res 2016; 44:158-167. [PMID: 26943642 DOI: 10.1007/s11414-016-9506-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Claire D Clark
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Staci Langkjaer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sara Chinikamwala
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Heather Joseph
- Division of HIV/AIDs Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Salaam Semaan
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jillian Clement
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rebekah Marshall
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Eric Pevzner
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benedict I Truman
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karen Kroeger
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-44, Atlanta, GA, 30333, USA.
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23
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Chapman KN, Pevzner E, Mangan JM, Breese P, Lamunu D, Shrestha-Kuwahara R, Nakibali JG, Goldberg SV. Evaluation of the Informed Consent Process of a Multicenter Tuberculosis Treatment Trial. AJOB Empir Bioeth 2015; 6:31-43. [PMID: 28317002 PMCID: PMC5351885 DOI: 10.1080/23294515.2015.1015184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 05/02/2023]
Abstract
BACKGROUND Ethical principles obligate researchers to maximize study participants' comprehension during the informed consent process for clinical trials. A pilot evaluation of the consent process was conducted during an international clinical trial of treatment for pulmonary tuberculosis to assess the feasibility of conducting an evaluation in a larger population and to guide these future efforts. METHODS Study staff administered an informed consent assessment tool (ICAT) to a convenience sample of trial participants, measuring comprehension of consent components as derived from the Common Rule and FDA Title 21 Part 50, and satisfaction with the process. Participating site staff completed a consent process questionnaire about consent practices at their respective sites and provided improvement recommendations. ICAT scores and corresponding practices were compared where both were completed. RESULTS ICATs (n = 54) were submitted from one site in Spain (n = 10), one in Uganda (n = 30), and five in the United States (n = 14). Participants were primarily male (76%), born in Africa (n = 31, 57%), and had a median age of 27 years (interquartile range [IQR]: 24-42). Median ICAT scores were 80% (IQR: 67-93) for comprehension and 89% (IQR: 78-100) for satisfaction. Ugandan participants scored higher than participants from other sites on comprehension (87% vs. 64%) and satisfaction (100% vs. 78%). Staff from 14 sites completed consent process questionnaires. Median ICAT scores for comprehension and satisfaction were higher at sites that utilized visual aids. Practice recommendations included shorter forms, simpler documents, and supplementary materials. CONCLUSIONS Participants achieved high levels (≥80%) of comprehension and satisfaction with their current consent processes. Higher ICAT scores at one site suggest an additional evaluation may identify approaches to improve comprehension and satisfaction in future trials. Through this pilot evaluation, complexities and challenges were identified in obtaining consent in a large, international multicenter trial and provided insights for a more robust assessment of the consent process in future trials.
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Affiliation(s)
- Kimberley N Chapman
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention and CDC Foundation
| | - Eric Pevzner
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention
| | - Joan M Mangan
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention
| | - Peter Breese
- Denver Public Health and University of Colorado Health Sciences Center
| | - Dorcas Lamunu
- Uganda-Case Western Reserve University Research Collaboration
| | | | - Joseph G Nakibali
- Uganda-Case Western Reserve University Research Collaboration and Community Research Advisory Group, Tuberculosis Trials Consortium
| | - Stefan V Goldberg
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention and Tuberculosis Trials Consortium (TBTC)
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24
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Lo TQ, Oeltmann JE, Odhiambo FO, Beynon C, Pevzner E, Cain KP, Laserson KF, Phillips-Howard PA. Alcohol use, drunkenness and tobacco smoking in rural western Kenya. Trop Med Int Health 2013; 18:506-15. [PMID: 23489316 DOI: 10.1111/tmi.12066] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe the prevalence of smoking and alcohol use and abuse in an impoverished rural region of western Kenya. METHODS Picked from a population-based longitudinal database of demographic and health census data, 72 292 adults (≥18 years) were asked to self-report their recent (within the past 30 days) and lifetime use of tobacco and alcohol and frequency of recent 'drunkenness'. RESULTS Overall prevalence of ever smoking was 11.2% (11.0-11.5) and of ever drinking, 20.7% (20.4-21.0). The prevalence of current smoking was 6.3% (6.1-6.5); 5.7% (5.5-5.9) smoked daily. 7.3% (7.1-7.5) reported drinking alcohol within the past 30 days. Of these, 60.3% (58.9-61.6) reported being drunk on half or more of all drinking occasions. The percentage of current smokers rose with the number of drinking days in a month (P < 0.0001). Tobacco and alcohol use increased with decreasing socio-economic status and amongst women in the oldest age group (P < 0.0001). CONCLUSIONS Tobacco and alcohol use are prevalent in this rural region of Kenya. Abuse of alcohol is common and likely influenced by the availability of cheap, home-manufactured alcohol. Appropriate evidence-based policies to reduce alcohol and tobacco use should be widely implemented and complemented by public health efforts to increase awareness of their harmful effects.
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Affiliation(s)
- T Q Lo
- Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, Atlanta, GA 30333, USA.
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25
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Auld SC, Pevzner E. Reaching beyond our Xpert potential: reflections on the 43rd Union World Conference [Correspondence]. Int J Tuberc Lung Dis 2013; 17:423-4. [DOI: 10.5588/ijtld.13.0023] [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: 11/10/2022] Open
Affiliation(s)
- Sara C. Auld
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric Pevzner
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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26
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Adam D, Pevzner E, Gepstein R. Comparison of percutaneous nucleoplasty and open discectomy in patients with lumbar disc protrusions. Chirurgia (Bucur) 2013; 108:94-98. [PMID: 23464777] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2013] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Coblation nucleoplasty is a minimally invasive method, at middle way between conservative and open surgical treatment of patients with degenerative disc disease and lumbar disc protrusion. Authors compare the outcome of patients treated through the two methods. MATERIAL AND RESULTS Two groups of 80 patients each were treated through open discectomy and nucleoplasty. Patients with radicular symptoms caused by disc protrusions, having antero-posterior diameter of herniated disc less 6 mm, resistant to conservative treatment, were operated using nucleoplasty. When antero-posterior diameter of the disc herniation was > 6 mm, classical discectomy method was applied. Classical surgeries (discectomies) were performed by the senior author (D.A.), while the nucleoplasty procedures all three authors equally participated. In the first group improvement of radicular pain was immediate. At 1 year after the procedure only one third of the patients returned to work. In the group treated through nucleoplasty improvement of pain was slow but gradual. After 1 postoperative year the VAS score of patients treated through the two methods were very close. At 3 days post nucleoplasty all patients returned to work. In this group there were not intraoperative or post-operative complications. One patient was afterwards operated through open discectomy. CONCLUSION Coblation nucleoplasty is a safe and efficient method to treat patients with lumbar disc protrusion.
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Affiliation(s)
- D Adam
- "Carol Davila" Medicine and Pharmacy, Bucharest, Romania
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27
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Click ES, Feleke B, Pevzner E, Fantu R, Gadisa T, Assefa D, Melaku Z, Cain K, Menzies H. Evaluation of integrated registers for tuberculosis and HIV surveillance in children, Ethiopia, 2007-2009. Int J Tuberc Lung Dis 2012; 16:625-7. [PMID: 22417732 DOI: 10.5588/ijtld.11.0655] [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] [Indexed: 11/10/2022] Open
Abstract
In 2008, Ethiopia implemented tuberculosis (TB) treatment registers that included columns for recording human immunodeficiency virus (HIV) test results (integrated registers) to replace the previous system of separate TB and HIV registers (pre-integration registers). We compared the proportion of children with documented HIV rapid test results at eight hospitals before and after adopting the integrated registers. HIV status was more consistently documented in the integrated registers; however, HIV status for infants aged <18 months could not be assessed, as the registers did not capture results from polymerase chain reaction-based testing. Recording procedures should be revised to document age-appropriate HIV diagnostic results and ensure referral for appropriate care.
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Affiliation(s)
- E S Click
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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28
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Aburto NJ, Pevzner E, Lopez-Ridaura R, Rojas R, Lopez-Gatell H, Lazcano E, Hernandez-Avila M, Harrington TA. Knowledge and adoption of community mitigation efforts in Mexico during the 2009 H1N1 pandemic. Am J Prev Med 2010; 39:395-402. [PMID: 20965376 DOI: 10.1016/j.amepre.2010.07.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Revised: 05/24/2010] [Accepted: 07/02/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND The public's ability and willingness to adopt community mitigation efforts during a pandemic are debated in the literature. PURPOSE Awareness and adoption of community mitigation efforts in Mexico during the 2009 pandemic influenza A (H1N1) (pH1N1) outbreak were measured to evaluate if the population received, understood, and acted on public health messages. METHODS A cross-sectional representative household survey in Mexico City; San Luis Potosi (high case ratio); and Queretaro (low case ratio) was conducted in May and June 2009. Accounting for the complex survey design, percentages and 95% CI for answers to all questions were generated and compared based on living inside or outside Mexico City, high versus low prevalence of infection in the community, and perceived severity and knowledge of the virus. RESULTS Greater than 90% of respondents received community mitigation messages and adopted one or more community mitigation efforts. There were few differences among cities. Respondents reported high cost of masks, soaps, and gels as barriers to community mitigation-effort adoption. Nearly one fifth of respondents, disproportionally from the lower socioeconomic tertile, found some messages confusing. Half of all households reported a negative economic impact resulting from the outbreak. CONCLUSIONS Mexico's community mitigation campaign reached the majority of the population in three surveyed cities. Confusion regarding messages and economic barriers to community mitigation-effort adoption were sometimes reported.
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Ohkado A, Pevzner E, Sugiyama T, Murakami K, Yamada N, Cavanaugh S, Ishikawa N, Harries AD. Evaluation of an international training course to build programmatic capacity for tuberculosis control. Int J Tuberc Lung Dis 2010; 14:371-373. [PMID: 20132631] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
We evaluated the international training course of the Research Institute of Tuberculosis, Kiyose, Japan, by e-mailing structured questionnaires to participants who attended the course from 2001 to 2007. Of 62 responding participants, 34 developed action plan projects (APPs) and 28 developed operations research projects (ORPs). Among respondents drafting APPs, 27 (79%) started implementing projects, and 24 (88%) completed over half of their planned activities. Among respondents drafting ORPs, 11 (39%) started projects but no scientific papers were published. The main reasons for the failure to implement ORPs were due to lack of time, funds, and disapproval by supervisors. A sequential training model may better address barriers to teaching and assisting ORPs.
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Affiliation(s)
- A Ohkado
- Department of Epidemiology and Clinical Research, Japan Anti-Tuberculosis Association, Kiyose, Japan.
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Prushansky T, Dvir Z, Pevzner E, Gordon CR. Electro-oculographic measures in patients with chronic whiplash and healthy subjects: a comparative study. J Neurol Neurosurg Psychiatry 2004; 75:1642-4. [PMID: 15489407 PMCID: PMC1738789 DOI: 10.1136/jnnp.2003.031278] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite their high incidence, costs, and long lasting disability, whiplash associated disorders (WAD) lack an identifiable objective pathology that explains their acute or chronic symptoms. OBJECTIVE In view of previous suggestions of a possible effect of neck torsion on several electro-oculography (EOG) parameters, the main objective of this study was to examine their applicability in differentiating patients from uninvolved subjects. METHODS Smooth pursuit and saccadic eye movements were assessed in 26 patients with chronic WAD and 23 healthy subjects. All tests were executed in three neck positions: neutral and rotations to left and right. RESULTS Neck torsion did not influence eye movement performance of either the WAD or healthy groups. However, compared with the healthy group, patients with WAD had significantly lower smooth pursuit velocity gain (SPVG) (p = 0.01) and prolonged saccadic latency (p = 0.001), irrespective of neck position. CONCLUSIONS Despite scattered differences that reached significance, the electro-oculographic measures used in this study do not seem to offer a clinically relevant method for differentiating between patients with WAD and normal subjects.
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Affiliation(s)
- T Prushansky
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Israel 69978
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31
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Steinberg MB, Delnevo CD, Foulds J, Pevzner E. Characteristics of smoking and cessation behaviors among high school students in New Jersey. J Adolesc Health 2004; 35:231-3. [PMID: 15313505 DOI: 10.1016/j.jadohealth.2003.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2003] [Indexed: 11/27/2022]
Abstract
Treatment for adolescent smokers requires understanding of use patterns, attitudes, and practices relating to cessation. Results of the 1999 New Jersey Youth Tobacco Survey show that frequent smokers have higher daily consumption, more difficulty abstaining, high interest in quitting, and lower self-efficacy. These findings may help in developing effective treatment strategies.
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Affiliation(s)
- Michael B Steinberg
- School of Public Health, University of Medicine and Dentistry of New Jersey (UMDNJ), 317 George Street, New Brunswick, NJ 08901, USA.
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Pevzner E, Ehrenberg B. Principal component analysis of the absorption and resonance Raman spectra of the metallochromic indicator antipyrylazo III. Spectrochim Acta A Mol Biomol Spectrosc 2000; 56:637-651. [PMID: 10794441 DOI: 10.1016/s1386-1425(99)00164-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Metallochromic indicators, whose spectral properties are changed in the presence of metal cations, are used mainly in biological studies to monitor Ca2+ and Mg2+ ions. Antipyrylazo III is such indicator, employed for mid-range Ca2+ concentrations (10-1000 microM). The stoichiometry of the interactions of antipyrylazo III with Ca2+, Mg2+, Ba2+, Sr2+ and Zn2+ ions and the relevant binding constants were studied by principal component analysis (PCA) of the absorption spectral changes. The resonance Raman spectra of the above systems were measured as well, and the resolved Raman spectra of the various species were calculated and assigned. The vibrational spectra are more featured, more characteristic of the binding ions and exhibit stronger relative spectral changes upon binding the cations. The basis sets of Raman spectra could thus be used as an analytical tool for these divalent metallic cations.
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Affiliation(s)
- E Pevzner
- Department of Physics, Bar Ilan University, Ramat Gan, Israel
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