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Birch L, Lithander F, Turner K, Hewer SL, Harriman K, Hamilton-Shield J. P178 A feasibility assessment of delivering a glycaemic index dietary intervention for managing glucose abnormalities in people with cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00508-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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2
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Birch L, Lithander F, Turner K, Hewer SL, Harriman K, Hamilton-Shield J. P179 Glycaemic index dietary intervention in cystic fibrosis: preliminary findings from a feasibility study of dietary manipulation. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00509-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3
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Probert WS, Glenn-Finer R, Espinosa A, Yen C, Stockman L, Harriman K, Hacker JK. Molecular Epidemiology of Measles in California, United States-2019. J Infect Dis 2021; 224:1015-1023. [PMID: 33528506 DOI: 10.1093/infdis/jiab059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/26/2021] [Indexed: 11/13/2022] Open
Abstract
In 2019, the United States (US) experienced the highest number of measles importations and cases in the postelimination era. More than a quarter of imported cases entered the US through California. Measles surveillance efforts in California resulted in the identification of 26 importations, 6 outbreaks, and 72 cases in 2019. Only genotype B3 and D8 measles strains were detected. Genotype-specific differences were noted in the incidence of vaccine failures, hospitalizations, and severe complications among cases. A targeted whole genome sequencing approach provided higher-resolution discrimination between epidemiologically linked and sporadically introduced strains than conventional N450 sequencing. Our report underscores the importance of ensuring appropriate measles vaccination status, especially prior to international travel to measles-endemic regions, and highlights the value of a strong measles surveillance system in minimizing outbreaks and preserving measles elimination status in the US.
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Affiliation(s)
- William S Probert
- Viral and Rickettsial Disease Laboratory, California Department of Public Health, Richmond, California, USA
| | - Rosie Glenn-Finer
- Immunization Branch, California Department of Public Health, Richmond, California, USA
| | - Alex Espinosa
- Viral and Rickettsial Disease Laboratory, California Department of Public Health, Richmond, California, USA
| | - Cynthia Yen
- Immunization Branch, California Department of Public Health, Richmond, California, USA
| | - Lauren Stockman
- Immunization Branch, California Department of Public Health, Richmond, California, USA
| | - Kathleen Harriman
- Immunization Branch, California Department of Public Health, Richmond, California, USA
| | - Jill K Hacker
- Viral and Rickettsial Disease Laboratory, California Department of Public Health, Richmond, California, USA
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Kujawski SA, Wong KK, Collins JP, Epstein L, Killerby ME, Midgley CM, Abedi GR, Ahmed NS, Almendares O, Alvarez FN, Anderson KN, Balter S, Barry V, Bartlett K, Beer K, Ben-Aderet MA, Benowitz I, Biggs H, Binder AM, Black SR, Bonin B, Brown CM, Bruce H, Bryant-Genevier J, Budd A, Buell D, Bystritsky R, Cates J, Charles EM, Chatham-Stephens K, Chea N, Chiou H, Christiansen D, Chu V, Cody S, Cohen M, Conners E, Curns A, Dasari V, Dawson P, DeSalvo T, Diaz G, Donahue M, Donovan S, Duca LM, Erickson K, Esona MD, Evans S, Falk J, Feldstein LR, Fenstersheib M, Fischer M, Fisher R, Foo C, Fricchione MJ, Friedman O, Fry AM, Galang RR, Garcia MM, Gerber SI, Gerrard G, Ghinai I, Gounder P, Grein J, Grigg C, Gunzenhauser JD, Gutkin GI, Haddix M, Hall AJ, Han G, Harcourt J, Harriman K, Haupt T, Haynes A, Holshue M, Hoover C, Hunter JC, Jacobs MW, Jarashow C, Jhung MA, Joshi K, Kamali T, Kamili S, Kim L, Kim M, King J, Kirking HL, Kita-Yarbro A, Klos R, Kobayashi M, Kocharian A, Komatsu KK, Koppaka R, Layden JE, Li Y, Lindquist S, Lindstrom S, Link-Gelles R, Lively J, Livingston M, Lo K, Lo J, Lu X, Lynch B, Madoff L, Malapati L, Marks G, Marlow M, Mathisen GE, McClung N, McGovern O, McPherson TD, Mehta M, Meier A, Mello L, Moon SS, Morgan M, Moro RN, Murray J, Murthy R, Novosad S, Oliver SE, O'Shea J, Pacilli M, Paden CR, Pallansch MA, Patel M, Patel S, Pedraza I, Pillai SK, Pindyck T, Pray I, Queen K, Quick N, Reese H, Rha B, Rhodes H, Robinson S, Robinson P, Rolfes M, Routh J, Rubin R, Rudman SL, Sakthivel SK, Scott S, Shepherd C, Shetty V, Smith EA, Smith S, Stierman B, Stoecker W, Sunenshine R, Sy-Santos R, Tamin A, Tao Y, Terashita D, Thornburg NJ, Tong S, Traub E, Tural A, Uehara A, Uyeki TM, Vahey G, Verani JR, Villarino E, Wallace M, Wang L, Watson JT, Westercamp M, Whitaker B, Wilkerson S, Woodruff RC, Wortham JM, Wu T, Xie A, Yousaf A, Zahn M, Zhang J. Clinical and virologic characteristics of the first 12 patients with coronavirus disease 2019 (COVID-19) in the United States. Nat Med 2020; 26:861-868. [PMID: 32327757 DOI: 10.1101/2020.03.09.20032896] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/06/2020] [Indexed: 05/28/2023]
Abstract
Data on the detailed clinical progression of COVID-19 in conjunction with epidemiological and virological characteristics are limited. In this case series, we describe the first 12 US patients confirmed to have COVID-19 from 20 January to 5 February 2020, including 4 patients described previously1-3. Respiratory, stool, serum and urine specimens were submitted for SARS-CoV-2 real-time reverse-transcription polymerase chain reaction (rRT-PCR) testing, viral culture and whole genome sequencing. Median age was 53 years (range: 21-68); 8 patients were male. Common symptoms at illness onset were cough (n = 8) and fever (n = 7). Patients had mild to moderately severe illness; seven were hospitalized and demonstrated clinical or laboratory signs of worsening during the second week of illness. No patients required mechanical ventilation and all recovered. All had SARS-CoV-2 RNA detected in respiratory specimens, typically for 2-3 weeks after illness onset. Lowest real-time PCR with reverse transcription cycle threshold values in the upper respiratory tract were often detected in the first week and SARS-CoV-2 was cultured from early respiratory specimens. These data provide insight into the natural history of SARS-CoV-2. Although infectiousness is unclear, highest viral RNA levels were identified in the first week of illness. Clinicians should anticipate that some patients may worsen in the second week of illness.
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Briggs BJ, Santos Y, Ramesh A, Grabherr M, Achari A, Yu G, Miller S, Miller S, Federman S, Arevalo S, Sample H, Zorn K, Harriman K, Messenger S, Domingue S, Dominguez S, Glaser C, Wadford D, Messacar K, Messacar K, Wilson M, Chiu C, Chiu C. LB14. Cerebrospinal Fluid Profiling of the Human Host Response Reveals Species-Specific Enterovirus Biosignatures in Acute Flaccid Myelitis Cases. Open Forum Infect Dis 2019. [PMCID: PMC6810260 DOI: 10.1093/ofid/ofz415.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Since 2014 there have been global biennial outbreaks of acute flaccid myelitis (AFM), a rare but severe “polio-like” illness of as yet-unknown etiology primarily affecting children. Enteroviruses (EVs),, especially EV-D68 and EV-A71, have been implicated in association with AFM cases, but proving causality has been difficult as EVs are rarely isolated from cerebrospinal fluid. In addition, early identification of EV-associated AFM is challenging given that the diagnosis is reliant on potentially subjective clinical and radiological criteria with no specific biomarkers described to date. Methods We leveraged existing and newly generated data from a clinical CSF metagenomic assay for pathogen identification at University of California, San Francisco (UCSF) to interrogate the host response at the transcriptome level by RNA sequencing (RNA-Seq). These transcriptome RNA-Seq data were used to create statistical classification models to discriminate among viral infections that have been linked to AFM, including EV-D68, EV-A71, West Nile virus, and Powassan virus. The dynamic range of CSF cellularity (0 to >106 cells/mL), resulting in varying trancriptome coverage, as well as technical variation across samples required the development and validation of novel normalization techniques. In total, we analyzed ~50 CSF samples split into independent training and test sets. Results We were able to demonstrate a distinct signature of AFM that was able to predict the virus associated with AFM in blinded test samples with >80% accuracy. The key transcriptional features that best discriminated EV-A71 from EV-D68-associated AFM involved protein targeting, viral transcription, viral gene expression, and translation initiation pathways. Conclusion Here we demonstrate a novel approach to diagnosis of AFM that relies on host transcriptional biomarkers from cerebrospinal fluid. In the future, this method might allow earlier diagnosis of AFM to drive appropriate therapies and vaccines and predict patient outcomes, as well as guide research studies on the pathophysiology of EV-associated AFM. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Yale Santos
- University of California, San Francisco, San Francisco, California
| | - Akshaya Ramesh
- University of California, San Francisco, San Francisco, California
| | | | - Asmeeta Achari
- University of California, San Francisco, San Francisco, California
| | - Guixia Yu
- University of California, San Francisco, San Francisco, California
| | - Steve Miller
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California
| | - Steve Miller
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California
| | - Scot Federman
- University of California, San Francisco, San Francisco, California
| | - Shaun Arevalo
- University of California, San Francisco, San Francisco, California
| | - Hannah Sample
- University of California, San Francisco, San Francisco, California
| | - Kelsey Zorn
- University of California, San Francisco, San Francisco, California
| | | | - Sharon Messenger
- California Department of Public Health, San Francisco, California
| | - Samuel Domingue
- University of Colorado, School of Medicine, San Francisco, California
| | - Samuel Dominguez
- University of Colorado, School of Medicine, San Francisco, California
| | | | - Debra Wadford
- California Department of Public Health, San Francisco, California
| | | | | | - Michael Wilson
- University of California, San Francisco, San Francisco, California
| | - Charles Chiu
- University of California, San Francisco, San Francisco, California
| | - Charles Chiu
- University of California, San Francisco, San Francisco, California
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Harriman K, Collins L. P333 The development of a nutrition education and social session for families with children with cystic fibrosis: “work in progress”. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30625-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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7
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Chu V, Carpenter DM, Winter K, Harriman K, Glaser C. Increased Risk of Late-onset Streptococcus pneumoniae Meningitis in Adults With Prior Head or Spine Surgeries. Clin Infect Dis 2019; 68:2120-2122. [PMID: 30452617 DOI: 10.1093/cid/ciy974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/12/2018] [Indexed: 11/15/2022] Open
Abstract
In a case-control study within the Kaiser Permanente Northern California adult population, prior head or spine surgery was associated with increased Streptococcus pneumoniae meningitis outside of the postoperative period (no prior head or spine surgery; odds ratio, 6.0 [95% confidence interval, 1.9-18.6]). Among the cases, only 33.3% had received any prior pneumococcal vaccinations.
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Affiliation(s)
- Victoria Chu
- Kaiser Permanente Oakland Medical Center, Richmond.,California Department of Public Health, Richmond
| | | | | | | | - Carol Glaser
- Kaiser Permanente Oakland Medical Center, Richmond
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8
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Harriman K, Healy CM. How Important Is the Type of Acellular Pertussis Vaccine? Clin Infect Dis 2019; 70:208-209. [DOI: 10.1093/cid/ciz205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/21/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kathleen Harriman
- Immunization Branch, California Department of Public Health, Richmond
| | - C Mary Healy
- Department of Pediatrics, Infectious Disease Section, Baylor College of Medicine, Houston, Texas
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Han G, Batra N, Vallejo A, Schechter R, Zipprich J, Harriman K. Notes from the Field: Measles Outbreak in an Era of Stricter Immunization Requirements - California, March 2018. MMWR Morb Mortal Wkly Rep 2019; 68:201-202. [PMID: 30817744 PMCID: PMC6394388 DOI: 10.15585/mmwr.mm6808a3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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10
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Chu V, Carpenter D, Winter K, Harriman K, Glaser C. 330. Head and Spine Injuries Increase Risk of Streptococcus pneumoniae Meningitis in Adults. Open Forum Infect Dis 2018. [PMCID: PMC6255618 DOI: 10.1093/ofid/ofy210.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background In the United States, Streptococcus pneumoniae is responsible for 50% of bacterial meningitis cases. However, pneumococcal vaccines were not recommended for routine childhood immunization until pneumococcal conjugate vaccine became available in 2000, and much of the adult population has not received pneumococcal conjugate or polysaccharide vaccine. Limited case reports and series suggest that a history of neurosurgery or skull fractures may be associated with an increased risk for pneumococcal meningitis. Methods A case–control study was conducted within the Kaiser Permanente Northern California (KPNC) patient population to evaluate the association of prior head injury (HI) or head or spine surgery (H/SS) with pneumococcal meningitis. Cases were pneumococcal meningitis patients ≥18 years of age diagnosed from January 1, 2008 through October 31, 2017. Controls were individually matched 2:1 by age, sex, KPNC facility and membership length. A blinded chart review was done to identify history of HI and H/SS. Analyses were performed using conditional logistic regression. Results Eighty-four patients were found to have pneumococcal meningitis and were matched with 168 controls. Fifteen of the 84 cases (17.9%) and 6 of the 168 controls (3.6%) had prior HI or H/SS. Case histories included concussion (n = 3), mastoidectomy (n = 2), nasal surgery (n = 3), neurosurgery (n = 3), and spine surgery (n = 5). One case was noted to have two surgical histories. Ten of the 15 cases with HI or H/SS (66.7%) had not received pneumococcal vaccine. Cases had 5.0 times higher odds of having a history of HI or H/SS (95% confidence interval (CI) 1.9–12.9). These odds remained significantly elevated for H/SS only (odds ratio (OR) 10.0, 95% CI 1.2 – 85.6), but not for HI (OR 3.0, 95% CI 0.5 – 18.0). As no skull fractures were detected, HI consisted of concussions only. Conclusion Prior HI or H/SS significantly increased the odds for pneumococcal meningitis. Surveillance data from the Centers of Disease Control and Prevention indicate that 60–75% of invasive pneumococcal disease in adults is due to serotypes included in the pneumococcal vaccines. Given the number of unvaccinated cases, some of these cases may have been vaccine preventable. Such patients may benefit from pneumococcal immunization to reduce the risk of pneumococcal meningitis. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | - Kathleen Winter
- Immunization Branch, California Department of Public Health, Richmond, California
| | | | - Carol Glaser
- Pediatrics, Kaiser Permanente, Oakland, California
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New S, Winter K, Boyte R, Harriman K, Gutman A, Christiansen A, Royce S. Barriers to Receipt of Prenatal Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine Among Mothers of Infants Aged <4 Months with Pertussis - California, 2016. MMWR Morb Mortal Wkly Rep 2018; 67:1068-1071. [PMID: 30260942 PMCID: PMC6188120 DOI: 10.15585/mmwr.mm6738a6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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MacIntyre CR, Kpozehouen E, Kunasekaran M, Harriman K, Conaty S, Rosewell A, Druce J, Martin N, Heywood AE, Gidding HF, Wood J, Nicholl S. Measles control in Australia - threats, opportunities and future needs. Vaccine 2018; 36:4393-4398. [PMID: 29934234 DOI: 10.1016/j.vaccine.2018.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 11/18/2022]
Abstract
Control of measles was the focus of a national workshop held in 2015 in Sydney, Australia, bringing together stakeholders in disease control and immunisation to discuss maintaining Australia's measles elimination status in the context of regional and global measles control. The global epidemiology of measles was reviewed, including outbreaks in countries that have achieved elimination, such as the Disneyland outbreak in the United States and large outbreaks in Sydney, Australia. Transmission of measles between Australia and New Zealand occurs, but has not been a focus of control measures. Risk groups, the genetic and seroepidemiology of measles as well as surveillance, modelling and waning vaccine-induced immunity were reviewed. Gaps in policy, research and practice for maintaining measles elimination status in Australia were identified and recommendations were developed. Elimination of measles globally is challenging because of the infectiousness of measles and the need for 2-dose vaccine coverage rates in excess of 95% in all countries to achieve it. Until this occurs, international travel will continue to permit measles importation from endemic countries to countries that have achieved elimination. When measles cases are imported, failure to diagnose and isolate cases places the health system at risk of measles outbreaks. Vaccine funding models can result in gaps in vaccine coverage for adults and migrants. Australia introduced a whole-of-life immunisation register in 2016 and catch-up vaccination for at-risk communities, which will improve measles control. Research on diagnosis, immunology, case management and modelling of vaccination strategies are important to ensure continued control of measles.
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Affiliation(s)
- C Raina MacIntyre
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; Kirby Institute, Biosecurity Program, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Kpozehouen
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia.
| | - Mohana Kunasekaran
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | | | - Stephen Conaty
- Public Health Unit, South Western Sydney Local Health District, Australia
| | - Alexander Rosewell
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Julian Druce
- Victorian Infectious Diseases Reference Laboratory, Australia; VIDRL, Doherty Institute, Australia
| | - Nicolee Martin
- Victorian Infectious Diseases Reference Laboratory, Australia
| | - Anita E Heywood
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Heather F Gidding
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - James Wood
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
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Folaranmi TA, Kretz CB, Kamiya H, MacNeil JR, Whaley MJ, Blain A, Antwi M, Dorsinville M, Pacilli M, Smith S, Civen R, Ngo V, Winter K, Harriman K, Wang X, Bowen VB, Patel M, Martin S, Misegades L, Meyer SA. Increased Risk for Meningococcal Disease Among Men Who Have Sex With Men in the United States, 2012-2015. Clin Infect Dis 2018; 65:756-763. [PMID: 28505234 DOI: 10.1093/cid/cix438] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/06/2017] [Indexed: 11/14/2022] Open
Abstract
Background Several clusters of serogroup C meningococcal disease among men who have sex with men (MSM) have been reported in the United States in recent years. The epidemiology and risk of meningococcal disease among MSM is not well described. Methods All meningococcal disease cases among men aged 18-64 years reported to the National Notifiable Disease Surveillance System between January 2012 and June 2015 were reviewed. Characteristics of meningococcal disease cases among MSM and men not known to be MSM (non-MSM) were described. Annualized incidence rates among MSM and non-MSM were compared through calculation of the relative risk and 95% confidence intervals. Isolates from meningococcal disease cases among MSM were characterized using standard microbiological methods and whole-genome sequencing. Results Seventy-four cases of meningococcal disease were reported among MSM and 453 among non-MSM. Annualized incidence of meningococcal disease among MSM was 0.56 cases per 100000 population, compared to 0.14 among non-MSM, for a relative risk of 4.0 (95% confidence interval [CI], 3.1-5.1). Among the 64 MSM with known status, 38 (59%) were infected with human immunodeficiency virus (HIV). HIV-infected MSM had 10.1 times (95% CI, 6.1-16.6) the risk of HIV-uninfected MSM. All isolates from cluster-associated cases were serogroup C sequence type 11. Conclusions MSM are at increased risk for meningococcal disease, although the incidence of disease remains low. HIV infection may be an important factor for this increased risk. Routine vaccination of HIV-infected persons with a quadrivalent meningococcal conjugate vaccine in accordance with Advisory Committee on Immunization Practices recommendations should be encouraged.
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Affiliation(s)
- Temitope A Folaranmi
- National Center for Immunization and Respiratory Diseases.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Hajime Kamiya
- National Center for Immunization and Respiratory Diseases.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Amy Blain
- National Center for Immunization and Respiratory Diseases
| | - Mike Antwi
- New York City Department of Health and Mental Hygiene
| | | | | | | | | | - Van Ngo
- Los Angeles Department of Public Health
| | | | | | - Xin Wang
- National Center for Immunization and Respiratory Diseases
| | - Virginia B Bowen
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Manisha Patel
- National Center for Immunization and Respiratory Diseases
| | - Stacey Martin
- National Center for Immunization and Respiratory Diseases
| | - Lara Misegades
- National Center for Immunization and Respiratory Diseases
| | - Sarah A Meyer
- National Center for Immunization and Respiratory Diseases
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Wendorf KA, Winter K, Zipprich J, Schechter R, Hacker JK, Preas C, Cherry JD, Glaser C, Harriman K. Subacute Sclerosing Panencephalitis: The Devastating Measles Complication That Might Be More Common Than Previously Estimated. Clin Infect Dis 2018; 65:226-232. [PMID: 28387784 DOI: 10.1093/cid/cix302] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 04/05/2017] [Indexed: 11/13/2022] Open
Abstract
Background Subacute sclerosing panencephalitis (SSPE) is a fatal complication of measles. We reviewed California cases from 1998-2015 to understand risk factors for SPPE and estimate incidence. Methods SSPE cases had clinically compatible symptoms and measles antibody detection in cerebrospinal fluid (CSF) or medical record documentation of SSPE. Cases were identified though a state death certificate search, Centers for Disease Control and Prevention reports, or investigations for undiagnosed neurologic disease. Measles detection in CSF was performed by serology at the California Department of Public Health or at clinical laboratories. Results Seventeen SSPE cases were identified. Males outnumbered females 2.4:1. Twelve (71%) cases had a history of measles-like illness; all 12 had illness prior to 15 months of age. Eight (67%) children were exposed to measles in California. SSPE was diagnosed at a median age of 12 years (3-35 years), with a latency period of 9.5 years (2.5-34 years). Among measles cases reported to CDPH during 1988-1991, the incidence of SSPE was 1:1367 for children <5 years, and 1:609 for children <12 months at time of measles disease. Conclusions SSPE cases in California occurred at a high rate among unvaccinated children, particularly those infected during infancy. Protection of unvaccinated infants requires avoidance of travel to endemic areas, or early vaccination prior to travel at age 6-11 months. Clinicians should be aware of SSPE in patients with compatible symptoms, even in older patients with no specific history of measles infection. SSPE demonstrates the high human cost of "natural" measles immunity.
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Affiliation(s)
| | | | | | | | - Jill K Hacker
- Viral and Rickettsial Disease Laboratory, California Department of Public Health, Richmond
| | - Chris Preas
- Viral and Rickettsial Disease Laboratory, California Department of Public Health, Richmond
| | - James D Cherry
- David Geffen School of Medicine, University of California,Los Angeles
| | - Carol Glaser
- Kaiser Permanente, Infectious Diseases, Oakland, California
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15
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Platt L, Thun M, Harriman K, Winter K. A Population-Based Study of Recurrent Symptomatic Bordetella pertussis Infections in Children in California, 2010–2015. Clin Infect Dis 2017; 65:2099-2104. [DOI: 10.1093/cid/cix691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 08/14/2017] [Indexed: 11/12/2022] Open
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Chu V, Carpenter D, Postlethwaite D, Harriman K, Glaser C. Meningitis in the Kaiser Permanente Northern California (KPNC) Pediatric Population 2012 through 2016 and Its Association with Prior Traumatic Brain Injury (TBI). Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The incidence of meningitis, particularly bacterial meningitis, is decreasing due to widespread vaccine use with etiologies still due to relatively common organisms. However, risk factors for the development of meningitis are largely unknown. We describe the epidemiology of meningitis among the pediatric population of KPNC and assess the association between prior TBI and meningitis.
Methods
We conducted a retrospective descriptive study among KPNC pediatric patients (1 month-18 years) between July 2012 - June 2016 with an ICD-9 meningitis diagnosis. Charts were reviewed to a.) verify and classify the meningitis diagnosis and b.) ascertain prior TBI history. Cases were classified as confirmed, probable, or possible based on clinical course, CSF culture, PCR, and CSF profile. The proportion of meningitis cases with a history of TBI was compared with the published rate of TBI in the general pediatric population.
Results
Of 266 cases reviewed, 146 cases were verified as meningitis with 19 confirmed/probable bacterial [(S. pneumoniae (7), E. coli (3), S. Agalactiae (3), N. meningitidis (2), S. Aureus (1), and not otherwise specified (3)] and 50 confirmed/probable viral [(enterovirus (44), HSV2 (4), HSV1 (1), and WNV (1)] etiologies. An additional 77 possible cases included primarily viral etiologies (65) and a minority of possible bacterial (6) or infection-related inflammatory (6) etiologies. 120 were excluded. The overall meningitis and confirmed bacterial meningitis estimated incidence rate was 17.9 per 100,000 and 2.7 per 100,000, respectively. Twenty meningitis cases (13.7%) had a history of TBI (all of which were concussions) compared with the concussion rate in the general pediatric population reported by AL Zhang et al of 0.7% (P < 0.001).
Conclusion
Our results are consistent with recent studies showing a decline in bacterial meningitis. Enteroviral meningitis remains the leading cause of identified etiologies. However, in a sizable proportion of cases there was no specific pathogen identified. An increased risk of developing meningitis may be associated with TBIs.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
| | | | | | | | - Carol Glaser
- Pediatrics, Kaiser Permanente, Oakland, California
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Platt L, Thun M, Harriman K, Winter K. A population-based Study of Recurrent Symptomatic Bordetella pertussis Infections in Children in California, 2010–2015. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx162.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Natural infection with Bordetella pertussis is thought to result in 4–20 years of immunity against subsequent symptomatic pertussis infection. However, these estimates are based on studies in unvaccinated or whole-cell vaccinated children. We conducted a population-based study of pertussis infection and reinfection during a 5-year period in California in an exclusively acellular-pertussis vaccinated cohort.
Methods
California surveillance data were reviewed to identify all children with two reported incidents of pertussis with symptom onset from January 1, 2010 through December 31, 2015. Case investigation reports were reviewed and children with at least two episodes of symptomatic pertussis infection that met the case definition were included.
Results
Of 26,259 pertussis cases reported in children <18 years, 27 children met the inclusion criteria. Recurrent cases occurred among children of all ages, and the median age for the first and second pertussis episodes were 3.5 years (range, 1.3 months-14 years) and 6.5 years (range, 5.2 months–16.3 years) respectively. The median duration of time between initial infection and reinfection was 1.3 years (range, 2.9 months–4.4 years). Twenty-one children (78%) had received ≥3 doses of DTaP vaccine at the time of their first pertussis infection, 1 (4%) had received 1 dose, and 5 (19%) were unvaccinated.
Conclusion
Recurrent cases of pertussis infection are very rare. Contrary to previous reports that natural infection with B. pertussis results in 4–20 years of sterilizing immunity, we demonstrate that symptomatic reinfection with pertussis can occur as soon as 89 days following the first infection. More research is needed to understand the immune response to B. pertussis infection in children vaccinated with acellular-pertussis vaccines.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Lauren Platt
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Melissa Thun
- County of San Diego Health and Human Services Agency, San Diego, California
| | - Kathleen Harriman
- Immunization Branch, California Department of Public Health, Richmond, California
| | - Kathleen Winter
- Immunization Branch, California Department of Public Health, Richmond, California
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18
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Burgis JC, Kong D, Salibay C, Zipprich J, Harriman K, So S. Perinatal transmission in infants of mothers with chronic hepatitis B in California. World J Gastroenterol 2017; 23:4942-4949. [PMID: 28785148 PMCID: PMC5526764 DOI: 10.3748/wjg.v23.i27.4942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/11/2017] [Accepted: 06/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate maternal hepatitis B virus (HBV) DNA as risk for perinatal HBV infection among infants of HBV-infected women in California.
METHODS Retrospective analysis among infants born to hepatitis B surface antigen (HBsAg)-positive mothers who received post vaccination serologic testing (PVST) between 2005 and 2011 in California. Demographic information was collected from the California Department of Public Health Perinatal Hepatitis B Program databaseand matched to birth certificate records. HBV DNA level and hepatitis B e antigen (HBeAg) status were obtained from three large commercial laboratories in California and provider records if available and matched to mother infant pairs. Univariate analysis compared infected and uninfected infants. Multivariate analysis was restricted to infected infants and controls with complete maternal HBV DNA results using a predefined high HBV DNA level of > 2 × 107 IU/mL, a 5:1 ratio of cases to controls and a two-sided confidence level of 95%.
RESULTS A total of 17687 infants were born to HBsAg positive mothers in California between Jan 1 2005 and Dec 31, 2011. Among 11473 infants with PVST, only 125 (1.1%) were found to be HBV infected. Among these infected infants, lapses in Advisory Committee on Immunization Practices recommended post exposure prophylaxis (PEP) occurred in only 9 infants. However, PEP errors were not significantly different between infected and uninfected infants. Among the 347 uninfected and infected infants who had maternal HBeAg and HBV DNA level, case-control analysis found HBeAg positivity (70.4% vs 28.9%, OR = 46.76, 95%CI: 6.05-361.32, P < 0.001) and a maternal HBV DNA level ≥ 2 × 107 IU/mL (92.6% vs 18.5%, OR = 54.5, 95%CI: 12.22-247.55, P < 0.001) were associated with perinatal HBV infection. In multivariate logistic regression, maternal HBV DNA level ≥ 2 × 107 IU/mL was the only significant independent predictor of perinatal HBV infection.
CONCLUSION In California, transmission is low and most infected infants receive appropriate PEP and vaccination. Maternal HBV DNA ≥ 2 × 107 IU/mL is associated with high risk of perinatal infection.
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MESH Headings
- Adult
- California/epidemiology
- Case-Control Studies
- DNA, Viral/isolation & purification
- Female
- Hepatitis B Surface Antigens/isolation & purification
- Hepatitis B e Antigens/isolation & purification
- Hepatitis B virus/genetics
- Hepatitis B virus/immunology
- Hepatitis B virus/isolation & purification
- Hepatitis B, Chronic/epidemiology
- Hepatitis B, Chronic/prevention & control
- Hepatitis B, Chronic/transmission
- Hepatitis B, Chronic/virology
- Humans
- Incidence
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Male
- Mothers
- Post-Exposure Prophylaxis/methods
- Pregnancy
- Pregnancy Complications, Infectious/blood
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/prevention & control
- Pregnancy Complications, Infectious/virology
- Retrospective Studies
- Risk Factors
- Vaccination/methods
- Young Adult
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19
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Winter K, Harriman K. Reply to Abu Raya and Giles. Clin Infect Dis 2017; 64:822. [PMID: 28362953 DOI: 10.1093/cid/cix028] [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: 11/13/2022] Open
Affiliation(s)
- Kathleen Winter
- Immunization Branch, California Department of Public Health, Richmond, CA, USA.,College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Kathleen Harriman
- Immunization Branch, California Department of Public Health, Richmond, CA, USA
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20
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Enanoria WTA, Liu F, Zipprich J, Harriman K, Ackley S, Blumberg S, Worden L, Porco TC. The Effect of Contact Investigations and Public Health Interventions in the Control and Prevention of Measles Transmission: A Simulation Study. PLoS One 2016; 11:e0167160. [PMID: 27941976 PMCID: PMC5152814 DOI: 10.1371/journal.pone.0167160] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 07/01/2016] [Accepted: 11/09/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Measles cases continue to occur despite its elimination status in the United States. To control transmission, public health officials confirm the measles diagnosis, identify close contacts of infectious cases, deliver public health interventions (i.e., post-exposure prophylaxis) among those who are eligible, and follow-up with the close contacts to determine overall health outcomes. A stochastic network simulation of measles contact tracing was conducted using existing agent-based modeling software and a synthetic population with high levels of immunity in order to estimate the impact of different interventions in controlling measles transmission. METHODS AND FINDINGS The synthetic population was created to simulate California`s population in terms of population demographics, household, workplace, school, and neighborhood characteristics using California Department of Finance 2010 census data. Parameters for the model were obtained from a review of the literature, California measles case surveillance data, and expert opinion. Eight different scenarios defined by the use of three different public health interventions were evaluated: (a) post-exposure measles, mumps, and rubella (MMR) vaccine, (b) post-exposure immune globulin (IG), and (c) voluntary isolation and home quarantine in the presence or absence of public health response delays. Voluntary isolation and home quarantine coupled with one or two other interventions had the greatest reduction in the number of secondary cases infected by the index case and the probability of escape situations (i.e., the outbreak continues after 90 days). CONCLUSIONS Interrupting contact patterns via voluntary isolation and home quarantine are particularly important in reducing the number of secondary cases infected by the index case and the probability of uncontrolled outbreaks.
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Affiliation(s)
- Wayne T. A. Enanoria
- Department of Epidemiology & Biostatistics, University of California at San Francisco, San Francisco, California, United States of America
| | - Fengchen Liu
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California at San Francisco, San Francisco, California, United States of America
| | - Jennifer Zipprich
- Immunization Branch, Division of Communicable Disease Control, California Department of Public Health, Richmond, California, United States of America
| | - Kathleen Harriman
- Immunization Branch, Division of Communicable Disease Control, California Department of Public Health, Richmond, California, United States of America
| | - Sarah Ackley
- Department of Epidemiology & Biostatistics, University of California at San Francisco, San Francisco, California, United States of America
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California at San Francisco, San Francisco, California, United States of America
| | - Seth Blumberg
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California at San Francisco, San Francisco, California, United States of America
| | - Lee Worden
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California at San Francisco, San Francisco, California, United States of America
| | - Travis C. Porco
- Department of Epidemiology & Biostatistics, University of California at San Francisco, San Francisco, California, United States of America
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California at San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California at San Francisco, San Francisco, California, United States of America
- * E-mail:
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21
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Datta S, Moore A, Zipprich J, Winter K, Harriman K. Laboratory Gram Stain Misidentifications of Neisseria meningitidis and Impact on Public Health Response to Meningococcal Disease. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1129] [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: 11/12/2022] Open
Affiliation(s)
- Shrimati Datta
- Immunization Branch, California Department of Public Health, Richmond, CA
| | - Anthony Moore
- Immunization Branch, California Department of Public Health, Richmond, CA
| | - Jennifer Zipprich
- Immunization Branch, California Department of Public Health, Richmond, CA
| | - Kathleen Winter
- Immunization Branch, California Department of Public Health, Richmond, CA
| | - Kathleen Harriman
- Immunization Branch, California Department of Public Health, Richmond, CA
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22
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Wendorf K, Winter K, Harriman K, Zipprich J, Schechter R, Hacker J, Preas C, Cherry JD, Glaser C. Subacute Sclerosing Panencephalitis: The Devastating Measles Complication Is More Common Than We Think. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw194.81] [Citation(s) in RCA: 2] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kristen Wendorf
- Immunization Branch, California Department of Public Health, Richmond, California
| | - Kathleen Winter
- Immunization Branch, California Department of Public Health, Richmond, California
| | - Kathleen Harriman
- Immunization Branch, California Department of Public Health, Richmond, California
| | - Jennifer Zipprich
- Immunization Branch, California Department of Public Health, Richmond, California
| | - Robert Schechter
- Immunization Branch, California Department of Public Health, Richmond, California
| | - Jill Hacker
- Viral and Rickettsial Disease Laboratory, California Department of Public Health, Richmond, California
| | - Chris Preas
- Viral and Rickettsial Disease Laboratory, California Department of Public Health, Richmond, California
| | - James D. Cherry
- Pediatric Infectious Diseases, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
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23
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Winter K, Cherry JD, Harriman K. Effectiveness of Prenatal Tetanus, Diphtheria, and Acellular Pertussis Vaccination on Pertussis Severity in Infants. Clin Infect Dis 2016; 64:9-14. [PMID: 27624956 DOI: 10.1093/cid/ciw633] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 09/01/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND All US women are recommended to receive a tetanus, diphtheria, and acellular pertussis (Tdap) vaccine at 27-36 weeks gestation during each pregnancy to reduce the risk of pertussis to their infants. The impact of this strategy on severity of disease among infected infants has not been evaluated. METHODS We use a retrospective cohort study design evaluating whether pertussis-infected infants born in 2011-2015 whose mothers received Tdap vaccine during pregnancy had less severe pertussis, resulting in a lower risk of hospitalization or intensive care unit admission compared with infants born to unvaccinated mothers. RESULTS Infected infants of vaccinated mothers were significantly less likely to be hospitalized and had significantly shorter hospital stays compared with infants born to unvaccinated mothers, after adjustment for chronological and gestational age and receipt of diphtheria and tetanus toxoids and acellular pertussis vaccine. Unadjusted and adjusted vaccine effectiveness for preventing hospitalization among infants with pertussis was 72% (95% confidence interval [CI], 49%-85%) and 58% (95% CI 15%-80%), respectively. No infants born to vaccinated mothers required intubation or died of pertussis. CONCLUSIONS Infants with pertussis whose mothers received Tdap during pregnancy had a significantly lower risk of hospitalization and intensive care unit admission and shorter hospital stays. Prenatal Tdap vaccination is a critical strategy for reducing the morbidity and mortality from pertussis.
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Affiliation(s)
- Kathleen Winter
- California Department of Public Health, Immunization Branch, Richmond.,Department of Epidemiology, University of Kentucky, Lexington
| | - James D Cherry
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kathleen Harriman
- California Department of Public Health, Immunization Branch, Richmond
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24
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Winter K, Nickell S, Powell M, Harriman K. Effectiveness of Prenatal Versus Postpartum Tetanus, Diphtheria, and Acellular Pertussis Vaccination in Preventing Infant Pertussis. Clin Infect Dis 2016; 64:3-8. [PMID: 27624955 DOI: 10.1093/cid/ciw634] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 09/01/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Most severe and fatal cases of pertussis occur in infants <8 weeks of age, before initiation of the primary pertussis vaccine series. Women are recommended to receive tetanus, diphtheria, and acellular pertussis (Tdap) vaccine at the start of the third trimester of each pregnancy to optimize transplacental transfer of antibodies to the fetus. This recommendation was made by the Advisory Committee for Immunization Practices based on immunogenicity data, and no studies in the United States have yet evaluated the effectiveness of this strategy in reducing pertussis incidence in infants. METHODS We evaluated a cohort of mothers with documented Tdap vaccination histories in the California Immunization Registry to determine whether infants whose mothers received Tdap vaccine at 27-36 weeks gestation had a lower risk of pertussis at <8 weeks of age than infants born to women who received Tdap vaccine within 14 days post partum. RESULTS Tdap vaccination received at 27-36 weeks gestation was found to be 85% (95% confidence interval, 33%-98%) more effective than postpartum Tdap vaccination at preventing pertussis in infants <8 weeks of age . Vaccination at 27-36 weeks gestation was more effective at preventing pertussis in infant than vaccination during the second trimester. CONCLUSIONS Tdap vaccination at 27-36 weeks gestation was 85% more effective than postpartum vaccination at preventing pertussis in infants <8 weeks of age. Efforts should be made by prenatal care providers to provide Tdap vaccine to pregnant women during routine prenatal visits at the earliest opportunity between 27 and 36 weeks gestation.
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Affiliation(s)
- Kathleen Winter
- California Department of Public Health, Immunization Branch, Richmond.,Department of Epidemiology, University of Kentucky, Lexington
| | - Steve Nickell
- California Department of Public Health, Immunization Branch, Richmond
| | - Michael Powell
- California Department of Public Health, Immunization Branch, Richmond
| | - Kathleen Harriman
- California Department of Public Health, Immunization Branch, Richmond
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25
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Nanduri S, Foo C, Ngo V, Jarashow C, Civen R, Schwartz B, Holguin J, Shearer E, Zahn M, Harriman K, Winter K, Kretz C, Chang HY, Meyer S, MacNeil J. Outbreak of Serogroup C Meningococcal Disease Primarily Affecting Men Who Have Sex with Men - Southern California, 2016. MMWR Morb Mortal Wkly Rep 2016; 65:939-40. [PMID: 27606798 DOI: 10.15585/mmwr.mm6535e1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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
During March 4-August 11, 2016, 25 outbreak-associated cases of meningococcal disease, including two deaths (8% case-fatality ratio), were reported in Southern California. Twenty-four of the cases were caused by serogroup C Neisseria meningitidis (NmC) and one by N. meningitidis with an undetermined serogroup (Figure). On June 24, 2016, in response to this increase in NmC cases, primarily among men who have sex with men (MSM) in Los Angeles County, the city of Long Beach, and Orange County, the California Department of Public Health (CDPH) issued a press release and health advisory, declaring an outbreak of NmC in Southern California (1).
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26
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Biswas HH, Han GS, Wendorf K, Winter K, Zipprich J, Perti T, Martinez L, Arellano A, Kyle JL, Zhang P, Harriman K. Notes from the Field: Outbreak of Serogroup B Meningococcal Disease at a University - California, 2016. MMWR Morb Mortal Wkly Rep 2016; 65:520-1. [PMID: 27227576 DOI: 10.15585/mmwr.mm6520a3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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
On January 31, 2016, the Santa Clara County Public Health Department (SCCPHD) was notified of a suspected case of meningococcal disease in a university undergraduate student. By February 2, two additional suspected cases had been reported in undergraduate students living on the same campus. The index patient (patient A) required intensive care, whereas patients B and C had milder illness; there were no deaths. All three patients were part of overlapping social networks and had attended the same events during the week before the onset of patient A's symptoms, but whether they had direct contact with one another could not be verified. Serogroup B Neisseria meningitidis was identified in cerebrospinal fluid and blood from patient A and in blood from patient B. Serogroup B has been responsible for all U.S. college outbreaks of meningococcal disease since 2011 (1). Laboratory results for patient C were inconclusive.
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27
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Van Haren K, Ayscue P, Waubant E, Clayton A, Sheriff H, Yagi S, Glenn-Finer R, Padilla T, Strober JB, Aldrovandi G, Wadford DA, Chiu CY, Xia D, Harriman K, Watt JP, Glaser CA. Acute Flaccid Myelitis of Unknown Etiology in California, 2012-2015. JAMA 2015; 314:2663-71. [PMID: 26720027 DOI: 10.1001/jama.2015.17275] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE There has been limited surveillance for acute flaccid paralysis in North America since the regional eradication of poliovirus. In 2012, the California Department of Public Health received several reports of acute flaccid paralysis cases of unknown etiology. OBJECTIVE To quantify disease incidence and identify potential etiologies of acute flaccid paralysis cases with evidence of spinal motor neuron injury. DESIGN, SETTING, AND PARTICIPANTS Case series of acute flaccid paralysis in patients with radiological or neurophysiological findings suggestive of spinal motor neuron involvement reported to the California Department of Public Health with symptom onset between June 2012 and July 2015. Patients meeting diagnostic criteria for other acute flaccid paralysis etiologies were excluded. Cerebrospinal fluid, serum samples, nasopharyngeal swab specimens, and stool specimens were submitted to the state laboratory for infectious agent testing. MAIN OUTCOMES AND MEASURES Case incidence and infectious agent association. RESULTS Fifty-nine cases were identified. Median age was 9 years (interquartile range [IQR], 4-14 years; 50 of the cases were younger than 21 years). Symptoms that preceded or were concurrent included respiratory or gastrointestinal illness (n = 54), fever (n = 47), and limb myalgia (n = 41). Fifty-six patients had T2 hyperintensity of spinal gray matter on magnetic resonance imaging and 43 patients had cerebrospinal fluid pleocytosis. During the course of the initial hospitalization, 42 patients received intravenous steroids; 43, intravenous immunoglobulin; and 13, plasma exchange; or a combination of these treatments. Among 45 patients with follow-up data, 38 had persistent weakness at a median follow-up of 9 months (IQR, 3-12 months). Two patients, both immunocompromised adults, died within 60 days of symptom onset. Enteroviruses were the most frequently detected pathogen in either nasopharynx swab specimens, stool specimens, serum samples (15 of 45 patients tested). No pathogens were isolated from the cerebrospinal fluid. The incidence of reported cases was significantly higher during a national enterovirus D68 outbreak occurring from August 2014 through January 2015 (0.16 cases per 100,000 person-years) compared with other monitoring periods (0.028 cases per 100,000 person-years; P <.001). CONCLUSIONS AND RELEVANCE In this series of patients identified in California from June 2012 through July 2015, clinical manifestations indicated a rare but distinct syndrome of acute flaccid paralysis with evidence of spinal motor neuron involvement. The etiology remains undetermined, most patients were children and young adults, and motor weakness was prolonged.
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Affiliation(s)
- Keith Van Haren
- Department of Neurology, Stanford University School of Medicine, Stanford, California2Division of Child Neurology, Lucile Packard Children's Hospital, Stanford, California
| | - Patrick Ayscue
- US Centers for Disease Control and Prevention, Atlanta, Georgia4Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond5Now with Metabiota, San Francisco, California
| | - Emmanuelle Waubant
- Department of Neurology, University of California, San Francisco7Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco
| | - Anna Clayton
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Heather Sheriff
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Shigeo Yagi
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Rose Glenn-Finer
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Tasha Padilla
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Jonathan B Strober
- Department of Neurology, University of California, San Francisco7Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco
| | - Grace Aldrovandi
- Children's Hospital Los Angeles and University of Southern California, Los Angeles
| | - Debra A Wadford
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Charles Y Chiu
- Departments of Laboratory Medicine and Medicine, Division of Infectious Diseases, University of California, San Francisco10University of California, San Francisco, Viral Diagnostics and Discovery Center, San Francisco
| | - Dongxiang Xia
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Kathleen Harriman
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - James P Watt
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Carol A Glaser
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond7Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco11Now with Department of Pediatrics, K
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28
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Ayscue P, Kamali A, Rutledge J, Zipprich J, Morrisson M, Harriman K, Bird K. Measles Exposure in a Neonatal Intensive Care Unit and Labor and Delivery Ward—California, January 2015. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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29
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Winter K, Harriman K. Impact of Maternal Tdap Vaccination During Pregnancy on Infant Pertussis Severity. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Gallivan M, Murray E, Harriman K. Association of Streptococcus pneumoniae Meningitis After Head Injury or Brain Surgery—California, 2013–2014. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Kamiya H, MacNeil J, Blain A, Patel M, Martin S, Weiss D, Ngai S, Ezeoke I, Mascola L, Civen R, Ngo V, Black S, Kemble S, Chugh R, Murphy E, Petit C, Harriman K, Winter K, Beron A, Clegg W, Conover C, Misegades L. Meningococcal disease among men who have sex with men - United States, January 2012-June 2015. MMWR Morb Mortal Wkly Rep 2015; 64:1256-7. [PMID: 26562570 DOI: 10.15585/mmwr.mm6444a6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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
Since 2012, three clusters of serogroup C meningococcal disease among men who have sex with men (MSM) have been reported in the United States. During 2012, 13 cases of meningococcal disease among MSM were reported by the New York City Department of Health and Mental Hygiene (1); over a 5-month period during 2012–2013, the Los Angeles County Department of Public Health reported four cases among MSM; and during May–June 2015, the Chicago Department of Public Health reported seven cases of meningococcal disease among MSM in the greater Chicago area. MSM have not previously been considered at increased risk for meningococcal disease. Determining outbreak thresholds* for special populations of unknown size (such as MSM) can be difficult. The New York City health department declared an outbreak based on an estimated increased risk for meningococcal infection in 2012 among MSM and human immunodeficiency virus (HIV)–infected MSM compared with city residents who were not MSM or for whom MSM status was unknown (1). The Chicago Department of Public Health also declared an outbreak based on an increase in case counts and thresholds calculated using population estimates of MSM and HIV-infected MSM. Local public health response included increasing awareness among MSM, conducting contact tracing and providing chemoprophylaxis to close contacts, and offering vaccination to the population at risk (1–3). To better understand the epidemiology and burden of meningococcal disease in MSM populations in the United States and to inform recommendations, CDC analyzed data from a retrospective review of reported cases from January 2012 through June 2015.
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Pollett S, Wood N, Boscardin WJ, Bengtsson H, Schwarcz S, Harriman K, Winter K, Rutherford G. Validating the Use of Google Trends to Enhance Pertussis Surveillance in California. PLoS Curr 2015; 7:ecurrents.outbreaks.7119696b3e7523faa4543faac87c56c2. [PMID: 26543674 PMCID: PMC4626035 DOI: 10.1371/currents.outbreaks.7119696b3e7523faa4543faac87c56c2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND METHODS Pertussis has recently re-emerged in the United States. Timely surveillance is vital to estimate the burden of this disease accurately and to guide public health response. However, the surveillance of pertussis is limited by delays in reporting, consolidation and dissemination of data to relevant stakeholders. We fit and assessed a real-time predictive Google model for pertussis in California using weekly incidence data from 2009-2014. RESULTS AND DISCUSSION The linear model was moderately accurate (r = 0.88). Our findings cautiously offer a complementary, real-time signal to enhance pertussis surveillance in California and help to further define the limitations and potential of Google-based epidemic prediction in the rapidly evolving field of digital disease detection.
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Affiliation(s)
- Simon Pollett
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, Australia; Department of Epidemiology & Biostatistics, University of California at San Francisco, California, USA
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, NSW, Australia
| | - W John Boscardin
- Department of Epidemiology & Biostatistics, University of California at San Francisco, California, USA; Department of Medicine, University of California at San Francisco, California, USA
| | - Henrik Bengtsson
- Department of Epidemiology & Biostatistics, University of California at San Francisco, California, USA
| | - Sandra Schwarcz
- Department of Epidemiology & Biostatistics, University of California at San Francisco, California, USA
| | | | - Kathleen Winter
- California Department of Public Health, Richmond, California, USA
| | - George Rutherford
- Department of Epidemiology & Biostatistics, University of California at San Francisco, California, USA
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Winter K, Zipprich J, Harriman K, Murray EL, Gornbein J, Hammer SJ, Yeganeh N, Adachi K, Cherry JD. Risk Factors Associated With Infant Deaths From Pertussis: A Case-Control Study. Clin Infect Dis 2015; 61:1099-106. [DOI: 10.1093/cid/civ472] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/07/2015] [Indexed: 11/13/2022] Open
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Liu F, Enanoria WTA, Zipprich J, Blumberg S, Harriman K, Ackley SF, Wheaton WD, Allpress JL, Porco TC. The role of vaccination coverage, individual behaviors, and the public health response in the control of measles epidemics: an agent-based simulation for California. BMC Public Health 2015; 15:447. [PMID: 25928152 PMCID: PMC4438575 DOI: 10.1186/s12889-015-1766-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [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: 11/14/2014] [Accepted: 04/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measles cases continue to occur among susceptible individuals despite the elimination of endemic measles transmission in the United States. Clustering of disease susceptibility can threaten herd immunity and impact the likelihood of disease outbreaks in a highly vaccinated population. Previous studies have examined the role of contact tracing to control infectious diseases among clustered populations, but have not explicitly modeled the public health response using an agent-based model. METHODS We developed an agent-based simulation model of measles transmission using the Framework for Reconstructing Epidemiological Dynamics (FRED) and the Synthetic Population Database maintained by RTI International. The simulation of measles transmission was based on interactions among individuals in different places: households, schools, daycares, workplaces, and neighborhoods. The model simulated different levels of immunity clustering, vaccination coverage, and contact investigations with delays caused by individuals' behaviors and/or the delay in a health department's response. We examined the effects of these characteristics on the probability of uncontrolled measles outbreaks and the outbreak size in 365 days after the introduction of one index case into a synthetic population. RESULTS We found that large measles outbreaks can be prevented with contact investigations and moderate contact rates by having (1) a very high vaccination coverage (≥ 95%) with a moderate to low level of immunity clustering (≤ 0.5) for individuals aged less than or equal to 18 years, or (2) a moderate vaccination coverage (85% or 90%) with no immunity clustering for individuals (≤ 18 years of age), a short intervention delay, and a high probability that a contact can be traced. Without contact investigations, measles outbreaks may be prevented by the highest vaccination coverage with no immunity clustering for individuals (≤ 18 years of age) with moderate contact rates; but for the highest contact rates, even the highest coverage with no immunity clustering for individuals (≤ 18 years of age) cannot completely prevent measles outbreaks. CONCLUSIONS The simulation results demonstrated the importance of vaccination coverage, clustering of immunity, and contact investigations in preventing uncontrolled measles outbreaks.
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Affiliation(s)
- Fengchen Liu
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.
| | - Wayne T A Enanoria
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
| | - Jennifer Zipprich
- California Department of Public Health, Immunization Branch, Richmond, CA, USA.
| | - Seth Blumberg
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.
| | - Kathleen Harriman
- California Department of Public Health, Immunization Branch, Richmond, CA, USA.
| | - Sarah F Ackley
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.
| | - William D Wheaton
- RTI Research Triangle Institute International, San Francisco, CA, USA.
| | | | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA. .,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA. .,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.
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Yen C, Murray E, Zipprich J, Winter K, Harriman K. Missed opportunities for tetanus postexposure prophylaxis--California, January 2008-March 2014. MMWR Morb Mortal Wkly Rep 2015; 64:243-6. [PMID: 25763876 PMCID: PMC5779607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Tetanus is an acute and sometimes fatal disease characterized by sudden muscle contractions. The number of tetanus cases reported annually in the United States has declined significantly since the 1930s and 1940s as a result of the introduction of tetanus vaccines. However, sporadic cases continue to occur in persons who are not up-to-date with tetanus toxoid-containing vaccinations (TT) and do not receive appropriate postexposure prophylaxis (PEP). To assess the extent of these cases, the California Department of Public Health reviewed all tetanus cases reported during January 2008-March 2014. A total of 21 tetanus patients were reported; five (24%) died. An average of three cases were reported each year during 2008-2013; the average annual incidence among patients aged ≥65 years (0.23 cases per 1 million population) was twice that among patients aged 21-64 years (0.10 cases per 1 million population). Of 16 patients with an acute injury before illness and diagnosis, nine (56%) sought medical care, and two (22%) of the nine received appropriate PEP. Although tetanus is rare, it is a life-threatening disease that is preventable. Health care providers should ensure that their patients are up-to-date with TT vaccination and provide appropriate postexposure prophylaxis for patients with wounds.
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Affiliation(s)
- Cynthia Yen
- California Department of Public Health,Corresponding author: Cynthia Yen, , 510-620-3987
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Zipprich J, Winter K, Hacker J, Xia D, Watt J, Harriman K. Measles outbreak--California, December 2014-February 2015. MMWR Morb Mortal Wkly Rep 2015; 64:153-4. [PMID: 25695321 PMCID: PMC4584705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
On January 5, 2015, the California Department of Public Health (CDPH) was notified about a suspected measles case. The patient was a hospitalized, unvaccinated child, aged 11 years with rash onset on December 28. The only notable travel history during the exposure period was a visit to one of two adjacent Disney theme parks located in Orange County, California. On the same day, CDPH received reports of four additional suspected measles cases in California residents and two in Utah residents, all of whom reported visiting one or both Disney theme parks during December 17-20. By January 7,seven California measles cases had been confirmed, and CDPH issued a press release and an Epidemic Information Exchange (Epi-X) notification to other states regarding this outbreak. Measles transmission is ongoing.
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Affiliation(s)
- Jennifer Zipprich
- California Department of Public Health,Corresponding author: Jennifer Zipprich, , 510-620-3848
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Weber SG, Huang SS, Oriola S, Huskins WC, Noskin GA, Harriman K, Olmsted RN, Bonten M, Lundstrom T, Climo MW, Roghmann MC, Murphy CL, Karchmer TB. Legislative Mandates for Use of Active Surveillance Cultures to Screen for Methicillin-ResistantStaphylococcus aureusand Vancomycin-Resistant Enterococci: Position Statement From the Joint SHEA and APIC Task Force. Infect Control Hosp Epidemiol 2015; 28:249-60. [PMID: 17326014 DOI: 10.1086/512261] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [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: 12/11/2006] [Accepted: 01/05/2007] [Indexed: 01/14/2023]
Abstract
Legislation aimed at controlling antimicrobial-resistant pathogens through the use of active surveillance cultures to screen hospitalized patients has been introduced in at least 2 US states. In response to the proposed legislation, the Society for Healthcare Epidemiology of America (SHEA) and the Association of Professionals in Infection Control and Epidemiology (APIC) have developed this joint position statement. Both organizations are dedicated to combating healthcare-associated infections with a wide array of methods, including the use of active surveillance cultures in appropriate circumstances. This position statement reviews the proposed legislation and the rationale for use of active surveillance cultures, examines the scientific evidence supporting the use of this strategy, and discusses a number of unresolved issues surrounding legislation mandating use of active surveillance cultures. The following 5 consensus points are offered. (1) Although reducing the burden of antimicrobial-resistant pathogens, including methicillin-resistantStaphylococcus aureus(MRSA) and vancomycin-resistant enterococci (VRE), is of preeminent importance, APIC and SHEA do not support legislation to mandate use of active surveillance cultures to screen for MRSA, VRE, or other antimicrobial-resistant pathogens. (2) SHEA and APIC support the continued development, validation, and application of efficacious and cost-effective strategies for the prevention of infections caused by MRSA, VRE, and other antimicrobial-resistant and antimicrobial-susceptible pathogens. (3) APIC and SHEA welcome efforts by healthcare consumers, together with private, local, state, and federal policy makers, to focus attention on and formulate solutions for the growing problem of antimicrobial resistance and healthcare-associated infections. (4) SHEA and APIC support ongoing additional research to determine and optimize the appropriateness, utility, feasibility, and cost-effectiveness of using active surveillance cultures to screen both lower-risk and high-risk populations. (5) APIC and SHEA support stronger collaboration between state and local public health authorities and institutional infection prevention and control experts.
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Affiliation(s)
- Stephen G Weber
- Section of Infectious Diseases, University of Chicago, Chicago, IL 60637, USA.
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Winter K, Glaser C, Watt J, Harriman K. Pertussis epidemic--California, 2014. MMWR Morb Mortal Wkly Rep 2014; 63:1129-32. [PMID: 25474033 PMCID: PMC4584602] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
On June 13, 2014, the California Department of Public Health (CDPH) declared that a pertussis epidemic was occurring in the state when reported incidence was more than five times greater than baseline levels. The incidence of pertussis in the United States is cyclical, with peaks every 3-5 years, as the number of susceptible persons in the population increases. The last pertussis epidemic in California occurred in 2010, when approximately 9,000 cases were reported, including 808 hospitalizations and 10 infant deaths, for a statewide incidence of 24.6 cases per 100,000 population. During January 1-November 26, 2014, a total of 9,935 cases of pertussis with onset in 2014 were reported to CDPH, for a statewide incidence of 26.0 cases per 100,000. CDPH is working closely with local health departments to prioritize public health activities, with the primary goal of preventing severe cases of pertussis, which typically occurs in infants. All prenatal care providers are being encouraged to provide tetanus, diphtheria, and acellular pertussis vaccine (Tdap) to pregnant women during each pregnancy, ideally at 27-36 weeks' gestation, as is recommended by the Advisory Committee on Immunization Practices (ACIP), or refer patients to an alternative provider, such as a pharmacy or local public health department, to receive Tdap.
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Affiliation(s)
| | - Carol Glaser
- Immunization Branch, California Department of Public Health
| | - James Watt
- Division of Communicable Disease Control, California Department of Public Health
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Ayscue P, Van Haren K, Sheriff H, Waubant E, Waldron P, Yagi S, Yen C, Clayton A, Padilla T, Pan C, Reichel J, Harriman K, Watt J, Sejvar J, Nix WA, Feikin D, Glaser C. Acute flaccid paralysis with anterior myelitis - California, June 2012-June 2014. MMWR Morb Mortal Wkly Rep 2014; 63:903-6. [PMID: 25299608 PMCID: PMC4584614] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In August 2012, the California Department of Public Health (CDPH) was contacted by a San Francisco Bay area clinician who requested poliovirus testing for an unvaccinated man aged 29 years with acute flaccid paralysis (AFP) associated with anterior myelitis (i.e., evidence of inflammation of the spinal cord involving the grey matter including anterior horn cell bodies) and no history of international travel during the month before symptom onset. Within 2 weeks, CDPH had received reports of two additional cases of AFP with anterior myelitis of unknown etiology. Testing at CDPH's Viral and Rickettsial Disease Laboratory for stool, nasopharyngeal swab, and cerebrospinal fluid (CSF) did not detect the presence of an enterovirus (EV), the genus of the family Picornaviridae that includes poliovirus. Additional laboratory testing for infectious diseases conducted at the CDPH Viral and Rickettsial Disease Laboratory did not identify a causative agent to explain the observed clinical syndrome reported among the patients. To identify other cases of AFP with anterior myelitis and elucidate possible common etiologies, CDPH posted alerts in official communications for California local health departments during December 2012, July 2013, and February 2014. Reports of cases of neurologic illness received by CDPH were investigated throughout this period, and clinicians were encouraged to submit clinical samples for testing. A total of 23 cases of AFP with anterior myelitis of unknown etiology were identified. Epidemiologic and laboratory investigation did not identify poliovirus infection as a possible cause for the observed cases. No common etiology was identified to explain the reported cases, although EV-D68 was identified in upper respiratory tract specimens of two patients. EV infection, including poliovirus infection, should be considered in the differential diagnosis in cases of AFP with anterior myelitis and testing performed per CDC guidelines.
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Affiliation(s)
- Patrick Ayscue
- Epidemic Intelligence Service, CDC
- California Department of Public Health
| | - Keith Van Haren
- Stanford University, Stanford, California
- Lucile Packard Children’s Hospital, Palo Alto, California
| | | | - Emmanuelle Waubant
- University of California San Francisco Multiple Sclerosis Center, San Francisco, California
| | | | | | | | | | | | - Chao Pan
- California Department of Public Health
| | | | | | | | - James Sejvar
- National Center for Zoonotic, Vectorborne, and Enteric Diseases, CDC
| | | | - Daniel Feikin
- National Center for Immunization and Respiratory Diseases, CDC
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Affiliation(s)
- Kathleen Harriman
- California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA 94804, USA.
| | - Kathleen Winter
- California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA 94804, USA.
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Ayscue P, Murray E, Uyeki T, Zipprich J, Harriman K, Salibay C, Kang M, Luu A, Glenn-Finer R, Watt J, Glaser C, Louie J. Influenza-associated intensive-care unit admissions and deaths - California, September 29, 2013-January 18, 2014. MMWR Morb Mortal Wkly Rep 2014; 63:143-7. [PMID: 24553197 PMCID: PMC4584758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The California Department of Public Health (CDPH) conducts surveillance on severe influenza illness among California residents aged <65 years. Severe cases are defined as those resulting in admission to an intensive care unit (ICU) or death; reporting of ICU cases is voluntary, and reporting of fatal cases is mandatory. This report describes the epidemiologic, laboratory, and clinical characteristics of ICU and fatal influenza cases with symptom onset on or after September 29, 2013, and reported by January 18, 2014 of the 2013-14 influenza season. At the time of this report, local health jurisdictions (LHJs) in California had reported 94 deaths and 311 ICU admissions of patients with a positive influenza test result. The 405 reports of severe cases (i.e., fatal and ICU cases combined) were more than in any season since the 2009 pandemic caused by the influenza A (H1N1)pdm09 (pH1N1) virus. The pH1N1 virus is the predominant circulating influenza virus this season. Of 405 ICU and fatal influenza cases, 266 (66%) occurred among patients aged 41-64 years; 39 (10%) severe influenza illnesses occurred among children aged <18 years. Only six (21%) of 28 patients with fatal illness whose vaccination status was known had received 2013-14 seasonal influenza vaccine ≥2 weeks before symptom onset. Of 80 patients who died for whom sufficient information was available, 74 (93%) had underlying medical conditions known to increase the risk for severe influenza, as defined by the Advisory Committee on Immunization Practices (ACIP). Of 47 hospitalized patients with fatal illness and known symptom onset and antiviral therapy dates, only eight (17%) received neuraminidase inhibitors within 48 hours of symptom onset. This report supports previous recommendations that vaccination is important to prevent influenza virus infections that can result in ICU admission or death, particularly in high-risk populations, and that empiric antiviral treatment should be promptly initiated when influenza virus infection is suspected in hospitalized patients, despite negative results from rapid diagnostic tests.
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Affiliation(s)
- Patrick Ayscue
- EIS officer, CDC,California Department of Public Health, Richmond, CA,Corresponding author: Patrick Ayscue, , 510-620-5847
| | - Erin Murray
- California Department of Public Health, Richmond, CA
| | - Timothy Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | | | | | | | - Monica Kang
- California Department of Public Health, Richmond, CA
| | - Annie Luu
- California Department of Public Health, Richmond, CA
| | | | - James Watt
- California Department of Public Health, Richmond, CA
| | - Carol Glaser
- California Department of Public Health, Richmond, CA
| | - Janice Louie
- California Department of Public Health, Richmond, CA
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Atwell JE, Van Otterloo J, Zipprich J, Winter K, Harriman K, Salmon DA, Halsey NA, Omer SB. Nonmedical vaccine exemptions and pertussis in California, 2010. Pediatrics 2013; 132:624-30. [PMID: 24082000 DOI: 10.1542/peds.2013-0878] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [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: 11/24/2022] Open
Abstract
BACKGROUND In 2010, 9120 cases of pertussis were reported in California, more than any year since 1947. Although this resurgence has been widely attributed to waning immunity of the acellular vaccine, the role of vaccine refusal has not been explored in the published literature. Many factors likely contributed to the outbreak, including the cyclical nature of pertussis, improved diagnosis, and waning immunity; however, it is important to understand if clustering of unvaccinated individuals also played a role. METHODS We analyzed nonmedical exemptions (NMEs) for children entering kindergarten from 2005 through 2010 and pertussis cases with onset in 2010 in California to determine if NMEs increased in that period, if children obtaining NMEs clustered spatially, if pertussis cases clustered spatially and temporally, and if there was statistically significant overlap between clusters of NMEs and cases. RESULTS Kulldorff's scan statistics identified 39 statistically significant clusters of high NME rates and 2 statistically significant clusters of pertussis cases in this time period. Census tracts within an exemptions cluster were 2.5 times more likely to be in a pertussis cluster (odds ratio = 2.47, 95% confidence interval: 2.22-2.75). More cases occurred within as compared with outside exemptions clusters (incident rate ratios = 1.20, 95% confidence interval: 1.10-1.30). The association remained significant after adjustment for demographic factors. NMEs clustered spatially and were associated with clusters of pertussis cases. CONCLUSIONS Our data suggest clustering of NMEs may have been 1 of several factors in the 2010 California pertussis resurgence.
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Murray EL, Nieves D, Bradley JS, Gargas J, Mason WH, Lehman D, Harriman K, Cherry JD. Characteristics of Severe Bordetella pertussis Infection Among Infants ≤90 Days of Age Admitted to Pediatric Intensive Care Units - Southern California, September 2009-June 2011. J Pediatric Infect Dis Soc 2013; 2:1-6. [PMID: 26619437 DOI: 10.1093/jpids/pis105] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [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: 02/17/2012] [Accepted: 10/04/2012] [Indexed: 11/14/2022]
Abstract
BACKGROUND Bordetella pertussis infection can cause severe illness and death among young infants. METHODS We collected demographic and clinical information from the medical records of infants who were ≤90 days of age and hospitalized for pertussis in 5 Southern California pediatric intensive care units (PICUs) from September 1, 2009 to June 30, 2011. Infants who died or were diagnosed with pulmonary hypertension were considered to have more severe pertussis. RESULTS Thirty-one infants were admitted to a participating PICU. Eight infants had more severe infections, 6 infants had pulmonary hypertension, and 4 infants died. The 8 infants with more severe infections had white blood cell counts that exceeded 30 000, heart rates that exceeded 170, and respiratory rates that exceeded 70 more rapidly after cough onset than the 23 infants with less severe illness. CONCLUSIONS Identifying higher-risk infants earlier might allow for more rapid implementation of interventions.
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Affiliation(s)
| | | | | | | | | | | | | | - James D Cherry
- Mattel Children's Hospital, University of California, Los Angeles, California
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Misegades LK, Winter K, Harriman K, Talarico J, Messonnier NE, Clark TA, Martin SW. Association of childhood pertussis with receipt of 5 doses of pertussis vaccine by time since last vaccine dose, California, 2010. JAMA 2012. [PMID: 23188029 DOI: 10.1001/jama.2012.14939] [Citation(s) in RCA: 190] [Impact Index Per Article: 15.8] [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: 11/14/2022]
Abstract
CONTEXT In 2010, California experienced its largest pertussis epidemic in more than 60 years; a substantial burden of disease was noted in the 7- to 10-year-old age group despite high diphtheria, tetanus, and acellular pertussis vaccine (DTaP) coverage, indicating the possibility of waning protection. OBJECTIVE To evaluate the association between pertussis and receipt of 5 DTaP doses by time since fifth DTaP dose. DESIGN, SETTING, AND PARTICIPANTS Case-control evaluation conducted in 15 California counties. Cases (n = 682) were all suspected, probable, and confirmed pertussis cases among children aged 4 to 10 years reported from January through December 14, 2010; controls (n = 2016) were children in the same age group who received care from the clinicians reporting the cases. Three controls were selected per case. Vaccination histories were obtained from medical records and immunization registries. MAIN OUTCOME MEASURES Primary outcomes were (1) odds ratios (ORs) for the association between pertussis and receipt of the 5-dose DTaP series and (2) ORs for the association between pertussis and time since completion (<12, 12-23, 24-35, 36-47, 48-59, or ≥60 months) of the 5-dose DTaP series. Logistic regression was used to calculate ORs, accounting for clustering by county and clinician, and vaccine effectiveness (VE) was estimated as (1 - OR) × 100%. RESULTS Among cases and controls, 53 (7.8%) and 19 (0.9%) had not received any pertussis-containing vaccines, respectively. Compared with controls, children with pertussis had a lower odds of having received all 5 doses of DTaP (OR, 0.11; 95% CI, 0.06-0.21 [estimated VE, 88.7%; 95% CI, 79.4%-93.8%]). When children were categorized by time since completion of the DTaP series, using an unvaccinated reference group, children with pertussis compared with controls were less likely to have received their fifth dose within the prior 12 months (19 [2.8%] vs 354 [17.6%], respectively; OR, 0.02; 95% CI, 0.01-0.04 [estimated VE, 98.1%; 95% CI, 96.1%-99.1%]). This association was evident with longer time since vaccination, with ORs increasing with time since the fifth dose. At 60 months or longer (n = 231 cases [33.9%] and n = 288 controls [14.3%]), the OR was 0.29 (95% CI, 0.15-0.54 [estimated VE, 71.2%; 95% CI, 45.8%-84.8%]). Accordingly, the estimated VE declined each year after receipt of the fifth dose of DTaP. CONCLUSION Among children in 15 California counties, children with pertussis, compared with controls, had lower odds of having received the 5-dose DTaP series; as time since last DTaP dose increased, the odds increased, which is consistent with a progressive decrease in estimated vaccine effectiveness each year after the final dose of pertussis vaccine.
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Affiliation(s)
- Lara K Misegades
- Epidemic Intelligence Service and Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS-C25, Atlanta, GA 30329, USA.
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Glaser CA, Winter K, DuBray K, Harriman K, Uyeki TM, Sejvar J, Gilliam S, Louie JK. A population-based study of neurologic manifestations of severe influenza A(H1N1)pdm09 in California. Clin Infect Dis 2012; 55:514-20. [PMID: 22573853 DOI: 10.1093/cid/cis454] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Reported influenza-associated neurologic complications are generally limited to case series or case reports. We conducted a population-based study of neurologic manifestations associated with severe and fatal influenza A(H1N1)pdm09 (2009 H1N1) cases. METHODS Medical records of patients with fatal or severe (hospitalized in intensive care unit) laboratory-confirmed 2009 H1N1 reported to the California Department of Public Health from 15 April 2009 through 31 December 2009 were reviewed to identify those with primary neurological manifestations. Cases with secondary neurologic manifestations (eg, hypoxia) were excluded. Primary influenza-associated neurologic complications (INCs) were classified into 4 groups: encephalopathy/encephalitis, seizures, meningitis, and other. Severe 2009 H1N1-associated neurologic incidence was calculated by using estimates of 2009 H1N1 illnesses in California. RESULTS Of 2069 reported severe or fatal 2009 H1N1 cases, 419 (20%) had neurologic manifestations. Of these, 77 (18%) met our definition of INCs: encephalopathy/encephalitis (n = 29), seizures (n = 44), meningitis (n = 3), and other (Guillain-Barré Syndrome) (n = 1). The median age was 9 years (range, 4 months-92 years); the highest rate of disease was among pediatric Asian/Pacific Islanders (12.79 per 1,000,000) compared with pediatric white, non-Hispanics (3.09 per 1,000,000), Hispanics (4.58 per 1,000,000), and blacks (6.57 per 1,000,000). The median length of stay (LOS) was 4 days (range, 1-142), and there were 4 fatalities. The estimated incidence of INCs was 1.2 per 100,000 symptomatic 2009 H1N1 illnesses. CONCLUSIONS Influenza-associated neurologic complications were observed in 4% of patients with fatal or severe 2009 H1N1. They were observed most often in pediatric patients, and Asian/Pacific Islanders appear to be overrepresented compared with the California population. Most patients with INCs had a relatively short LOS, and there were few fatalities.
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Affiliation(s)
- Carol A Glaser
- Communicable Disease and Emergency Response Branch, Division of Communicable Disease Control, Department of Public Health, Richmond, CA 94804, USA.
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Jaeger JL, Patel M, Dharan N, Hancock K, Meites E, Mattson C, Gladden M, Sugerman D, Doshi S, Blau D, Harriman K, Whaley M, Sun H, Ginsberg M, Kao AS, Kriner P, Lindstrom S, Jain S, Katz J, Finelli L, Olsen SJ, Kallen AJ. Transmission of 2009 pandemic influenza A (H1N1) virus among healthcare personnel-Southern California, 2009. Infect Control Hosp Epidemiol 2011; 32:1149-57. [PMID: 22080652 DOI: 10.1086/662709] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE In April 2009, 2009 pandemic influenza A (H1N1) (hereafter, pH1N1) virus was identified in California, which caused widespread illness throughout the United States. We evaluated pH1N1 transmission among exposed healthcare personnel (HCP) and assessed the use and effectiveness of personal protective equipment (PPE) early in the outbreak. DESIGN Cohort study. SETTING Two hospitals and 1 outpatient clinic in Southern California during March 28-April 24, 2009. PARTICIPANTS Sixty-three HCP exposed to 6 of the first 8 cases of laboratory-confirmed pH1N1 in the United States. METHODS Baseline and follow-up questionnaires were used to collect demographic, epidemiologic, and clinical data. Paired serum samples were obtained to test for pH1N1-specific antibodies by microneutralization and hemagglutination-inhibition assays. Serology results were compared with HCP work setting, role, and self-reported PPE use. RESULTS Possible healthcare-associated pH1N1 transmission was identified in 9 (14%) of 63 exposed HCP; 6 (67%) of 9 seropositive HCP had asymptomatic infection. The highest attack rates occurred among outpatient HCP (6/19 [32%]) and among allied health staff (eg, technicians; 8/33 [24%]). Use of mask or N95 respirator was associated with remaining seronegative (P = .047). Adherence to PPE recommendations for preventing transmission of influenza virus and other respiratory pathogens was inadequate, particularly in outpatient settings. CONCLUSIONS pH1N1 transmission likely occurred in healthcare settings early in the pandemic associated with inadequate PPE use. Organizational support for a comprehensive approach to infectious hazards, including infection prevention training for inpatient- and outpatient-based HCP, is essential to improve HCP and patient safety.
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Affiliation(s)
- Jenifer L Jaeger
- Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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GuardiaLaBar L, Owen A, Lee T, Harriman K, Petru A. Healthcare Worker Pertussis Cases in a Pediatric Hospital. Am J Infect Control 2011. [DOI: 10.1016/j.ajic.2011.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wise ME, De Perio M, Halpin J, Jhung M, Magill S, Black SR, Gerber SI, Harriman K, Rosenberg J, Borlaug G, Finelli L, Olsen SJ, Swerdlow DL, Kallen AJ. Transmission of pandemic (H1N1) 2009 influenza to healthcare personnel in the United States. Clin Infect Dis 2011; 52 Suppl 1:S198-204. [PMID: 21342895 DOI: 10.1093/cid/ciq038] [Citation(s) in RCA: 38] [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: 11/12/2022] Open
Abstract
After identification of pandemic 2009 influenza (pH1N1) in the United States, the Centers for Disease Control and Prevention (CDC) worked with state and local health officials to characterize infections among healthcare personnel (HCP). Detailed information, including likely routes of exposure, was reported for 70 HCP from 22 states. Thirty-five cases (50%) were classified as being infected in healthcare settings, 18 cases (26%) were considered to have been infected in community settings, and no definitive source was identified for 17 cases (24%). Of the 23 HCP infected by ill patients, only 20% reported using an N95 respirator or surgical mask during all encounters and more than half worked in outpatient clinics. In addition to community transmission, likely patient-to-HCP and HCP-to-HCP transmission were identified in healthcare settings, highlighting the need for comprehensive infection control strategies including administration of influenza vaccine, appropriate management of ill HCP, and adherence to infection control precautions.
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Affiliation(s)
- Matthew E Wise
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Louie JK, Acosta M, Samuel MC, Schechter R, Vugia DJ, Harriman K, Matyas BT. A Novel Risk Factor for a Novel Virus: Obesity and 2009 Pandemic Influenza A (H1N1). Clin Infect Dis 2011; 52:301-12. [DOI: 10.1093/cid/ciq152] [Citation(s) in RCA: 319] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Jean C, Louie JK, Glaser CA, Harriman K, Hacker JK, Aranki F, Bancroft E, Farley S, Ginsberg M, Hernandez LB, Sallenave CS, Radner AB. Invasive group A streptococcal infection concurrent with 2009 H1N1 influenza. Clin Infect Dis 2010; 50:e59-62. [PMID: 20377405 DOI: 10.1086/652291] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe 10 patients with 2009 H1N1 influenza and concurrent invasive group A streptococcal infection with marked associated morbidity and mortality. Seven patients required intensive care, 8 required mechanical ventilation, and 7 died. Five of the patients, including 4 of the fatalities, were previously healthy.
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Affiliation(s)
- Cynthia Jean
- California Department of Public Health, Richmond, CA, USA.
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