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Groom HC, Schmidt M, Calderwood LE, Mirza SA, Mattison C, Salas S, Donald J, Naleway AL. Attitudes toward a future norovirus vaccine among members of an integrated healthcare delivery system in Portland, Oregon, 2016-2017. Hum Vaccin Immunother 2024; 20:2317599. [PMID: 38416866 PMCID: PMC10903669 DOI: 10.1080/21645515.2024.2317599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/08/2024] [Indexed: 03/01/2024] Open
Abstract
With recent advances in U.S. clinical trials for norovirus vaccines, it is an opportune time to examine what is known about the public receptivity to this novel vaccine. From October 2016-September 2017, we surveyed Kaiser Permanente Northwest members in Portland, Oregon, to ask their level of agreement on a 5-point scale with statements about the need for and willingness to get a potential norovirus vaccine for themselves or their child and analyzed their responses according to age, occupational status, prior vaccine uptake, and history of prior norovirus diagnoses. The survey response rate was 13.5% (n = 3,894); 807 (21%) responded as legal guardians, on behalf of a child <18 y of age and 3,087 (79%) were adults aged 18+ y. The majority of respondents were in agreement about getting the norovirus vaccine, if available (60% of legal guardians, 52% of adults aged 18-64 y, and 55% of adults aged 65+ y). Prior vaccination for influenza and rotavirus (among children) was the only correlate significantly associated with more positive attitudes toward receiving norovirus vaccine. Pre-pandemic attitudes in our all-ages study population reveal generally positive attitudes toward willingness to get a norovirus vaccine, particularly among those who previously received influenza or rotavirus vaccines.
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Affiliation(s)
- Holly C. Groom
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Mark Schmidt
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Laura E. Calderwood
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Cherokee Nation Operational Solutions, Tulsa, OK, USA
| | - Sara A. Mirza
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Claire Mattison
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Cherokee Nation Operational Solutions, Tulsa, OK, USA
| | - Suzanne Salas
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Judy Donald
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Allison L. Naleway
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, OR, USA
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Miko S, Calderwood L, Dale AP, King RF, Maurer MB, Said MA, Gebhardt M, Dyer LP, Maurer W, Wikswo ME, Mirza SA. Acute Gastroenteritis Outbreak Among Colorado River Rafters and Backpackers in the Grand Canyon, 2022. Wilderness Environ Med 2024:10806032241245093. [PMID: 38613339 DOI: 10.1177/10806032241245093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
INTRODUCTION From April 1 to May 31, 2022, Grand Canyon National Park received increased acute gastroenteritis reports. Pooled portable toilet specimens identified norovirus genogroups I and II. We sought to determine outbreak transmission contributors and individual risk factors while rafting or backpacking in the park. METHODS Grand Canyon rafters and backpackers were surveyed online from June 13-July 8, 2022, and a Cox proportional hazards model was used to identify predictors associated with illness and adjusted for potential confounding factors. RESULTS Among 762 surveys, 119 cases and 505 well persons submitted complete survey data. Illness among rafters was associated with interaction with ill persons during the trip (adjusted hazard ratio [adjHR] = 3.4 [95%CI 2.3-5.0]) and lack of any hand hygiene (1.2 [0.7-1.9]) or use of only sanitizer or water (1.6 [1.04-2.6]) before snacks. Younger rafters had higher illness rates compared to those ≥60 y (1.5 [1.2-1.8] for ages 40-59 and 2.2 [1.4-3.5] for ages <40 y). CONCLUSIONS Person-to-person transmission likely accounted for the widespread outbreak. Future outbreak mitigation efforts on river trips could focus on symptom screening before the trip starts, prompt separation of ill and well passengers, strict adherence to hand hygiene with soap and water, minimizing social interactions among rafting groups, and widespread outbreak notices and education to all park users.
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Affiliation(s)
- Shanna Miko
- Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Atlanta, GA, USA
| | - Laura Calderwood
- Centers for Disease Control and Prevention, Atlanta, GA, USA
- Cherokee Nation Assurance, Atlanta, GA, USA
| | - Ariella P Dale
- Epidemic Intelligence Service, Atlanta, GA, USA
- Arizona Department of Health Services, Phoenix, AZ, USA
- Maricopa County Department of Public Health, Maricopa, AZ, USA
| | - Ronan F King
- National Park Service - Office of Public Health, Washington, DC, USA
| | - Matthew B Maurer
- Coconino County Health and Human Services, Coconino County, Flagstaff, AZ, USA
| | - Maria A Said
- National Park Service - Office of Public Health, Washington, DC, USA
| | - Marette Gebhardt
- Coconino County Health and Human Services, Coconino County, Flagstaff, AZ, USA
| | | | - Wendy Maurer
- Coconino County Health and Human Services, Coconino County, Flagstaff, AZ, USA
| | - Mary E Wikswo
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sara A Mirza
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Cates J, Mattison CP, Groom H, Donald J, Hall RP, Schmidt MA, Hall AJ, Naleway AL, Mirza SA. Health Care Utilization and Clinical Management of All-Cause and Norovirus-Associated Acute Gastroenteritis Within a US Integrated Health Care System. Open Forum Infect Dis 2024; 11:ofae151. [PMID: 38628950 PMCID: PMC11020278 DOI: 10.1093/ofid/ofae151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/14/2024] [Indexed: 04/19/2024] Open
Abstract
Background Norovirus-associated acute gastroenteritis (AGE) exacts a substantial disease burden, yet the health care utilization for and clinical management of norovirus-associated AGE are not well characterized. Methods We describe the health care encounters and therapeutics used for patients with all-cause and norovirus-associated AGE in the Kaiser Permanente Northwest health system from 1 April 2014 through 30 September 2016. Medical encounters for patients with AGE were extracted from electronic health records, and encounters within 30 days of one another were grouped into single episodes. An age-stratified random sample of patients completed surveys and provided stool samples for norovirus testing. Results In total, 40 348 individuals had 52 509 AGE episodes; 460 (14%) of 3310 participants in the substudy tested positive for norovirus. An overall 35% of all-cause AGE episodes and 29% of norovirus-associated AGE episodes had ≥2 encounters. While 80% of norovirus-associated AGE episodes had at least 1 encounter in the outpatient setting, all levels of the health care system were affected: 10%, 22%, 10%, and 2% of norovirus-associated AGE episodes had at least 1 encounter in virtual, urgent care, emergency department, and inpatient settings, respectively. Corresponding proportions of therapeutic use between norovirus-positive and norovirus-negative episodes were 13% and 10% for intravenous hydration (P = .07), 65% and 50% for oral rehydration (P < .001), 7% and 14% for empiric antibiotic therapy (P < .001), and 33% and 18% for antiemetics (P < .001). Conclusions Increased health care utilization and therapeutics are likely needed for norovirus-associated AGE episodes during peak norovirus winter seasons, and these data illustrate that effective norovirus vaccines will likely result in less health care utilization.
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Affiliation(s)
- Jordan Cates
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Claire P Mattison
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Cherokee Nation Operational Solutions, Tulsa, Oklahoma, USA
| | - Holly Groom
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Judy Donald
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Rebecca P Hall
- Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Aron J Hall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Sara A Mirza
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Ilboudo AK, Cissé A, Milucky J, Tialla D, Mirza SA, Diallo AO, Bicaba BW, Charlemagne KJ, Diagbouga PS, Owusu D, Waller JL, Talla-Nzussouo N, Charles MD, Whitney CG, Tarnagda Z. Predictors of severity and prolonged hospital stay of viral acute respiratory infections (ARI) among children under five years in Burkina Faso, 2016-2019. BMC Infect Dis 2024; 24:331. [PMID: 38509462 PMCID: PMC10953152 DOI: 10.1186/s12879-024-09219-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/13/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Viruses are the leading etiology of acute respiratory infections (ARI) in children. However, there is limited knowledge on drivers of severe acute respiratory infection (SARI) cases involving viruses. We aimed to identify factors associated with severity and prolonged hospitalization of viral SARI among children < 5 years in Burkina Faso. METHODS Data were collected from four SARI sentinel surveillance sites during October 2016 through April 2019. A SARI case was a child < 5 years with an acute respiratory infection with history of fever or measured fever ≥ 38 °C and cough with onset within the last ten days, requiring hospitalization. Very severe ARI cases required intensive care or had at least one danger sign. Oropharyngeal/nasopharyngeal specimens were collected and analyzed by multiplex real-time reverse-transcription polymerase chain reaction (rRT-PCR) using FTD-33 Kit. For this analysis, we included only SARI cases with rRT-PCR positive test results for at least one respiratory virus. We used simple and multilevel logistic regression models to assess factors associated with very severe viral ARI and viral SARI with prolonged hospitalization. RESULTS Overall, 1159 viral SARI cases were included in the analysis after excluding exclusively bacterial SARI cases (n = 273)very severe viral ARI cases were common among children living in urban areas (AdjOR = 1.3; 95% CI: 1.1-1.6), those < 3 months old (AdjOR = 1.5; 95% CI: 1.1-2.3), and those coinfected with Klebsiella pneumoniae (AdjOR = 1.9; 95% CI: 1.2-2.2). Malnutrition (AdjOR = 2.2; 95% CI: 1.1-4.2), hospitalization during the rainy season (AdjOR = 1.71; 95% CI: 1.2-2.5), and infection with human CoronavirusOC43 (AdjOR = 3; 95% CI: 1.2-8) were significantly associated with prolonged length of hospital stay (> 7 days). CONCLUSION Younger age, malnutrition, codetection of Klebsiella pneumoniae, and illness during the rainy season were associated with very severe cases and prolonged hospitalization of SARI involving viruses in children under five years. These findings emphasize the need for preventive actions targeting these factors in young children.
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Affiliation(s)
- Abdoul Kader Ilboudo
- Laboratoire National de Référence-Grippes (LNR-G), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso.
| | - Assana Cissé
- Laboratoire National de Référence-Grippes (LNR-G), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Jennifer Milucky
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dieudonné Tialla
- Laboratoire National de Référence-Grippes (LNR-G), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Sara A Mirza
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alpha Oumar Diallo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brice W Bicaba
- Direction de la Protection de la Santé de la Population, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Kondombo Jean Charlemagne
- Direction de la Protection de la Santé de la Population, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Potiandi Serge Diagbouga
- Laboratoire National de Référence-Grippes (LNR-G), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Daniel Owusu
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica L Waller
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ndahwouh Talla-Nzussouo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Noguchi Memorial Institute for Medical Research, Legon, Accra, Ghana
- Dexis Professional Services, 1331 Pennsylvania Avenue NW Suite 300, Washington, DC, 20004, USA
| | - Myrna D Charles
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cynthia G Whitney
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zekiba Tarnagda
- Laboratoire National de Référence-Grippes (LNR-G), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
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Balachandran N, Mattison CP, Calderwood LE, Burke RM, Schmidt MA, Donald J, Mirza SA. Household Transmission of Viral Acute Gastroenteritis Among Participants Within an Integrated Health Care Delivery System, 2014-2016. Open Forum Infect Dis 2023; 10:ofad619. [PMID: 38156052 PMCID: PMC10753916 DOI: 10.1093/ofid/ofad619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/06/2023] [Indexed: 12/30/2023] Open
Abstract
Background While enteric viruses are highly transmissible, household factors associated with transmission are less well documented. We identified individual- and household-level factors associated with viral acute gastroenteritis (AGE) transmission in a large health care network in the United States. Methods Patients presenting with AGE were enrolled from April 2014 to September 2016. Patients and symptomatic household members were interviewed, and stool specimens were collected and tested for viral pathogens. Within a household, primary cases were those with the earliest symptom onset and a positive viral test result; secondary cases were household contacts (HHCs) with symptom onset 1-7 days from the primary case onset. Transmission households had at least 1 secondary case. Results Our analysis included 570 primary cases with 1479 HHCs. The overall secondary attack rate was 23%. HHCs were likely to become secondary cases (n = 338) if they were <5 years old (adjusted odds ratio [aOR], 1.8; 95% CI, 1.2-2.6). Secondary transmission was likely to occur if the primary case was aged <5 years (aOR, 2.2; 95% CI, 1.4-3.6) or 5 to 17 years (aOR, 3.3; 95% CI, 1.9-5.7), was norovirus positive (aOR, 2.7; 95% CI, 1.9-3.7), had a diapered contact (aOR: 2.2, 95% CI: 1.6-3.2), or reported symptoms for >4 days (aOR, 1.5; 95% CI, 1.1-2.1). Households with ≥3 members (aOR, 2.1; 95% CI, 1.1-4.5) were more likely to experience transmission. Discussion Risk of AGE transmission within households increased if the primary case was younger, was norovirus positive, had a longer symptom duration, or had a diapered contact. Targeted prevention messaging around appropriate cleaning, disinfection, and isolation of persons with AGE should be encouraged.
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Affiliation(s)
- Neha Balachandran
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Claire P Mattison
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Laura E Calderwood
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Rachel M Burke
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Judy Donald
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Sara A Mirza
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Cates J, Cardemil CV, Mirza SA, Lopman B, Hall AJ, Holodniy M, Lucero-Obusan C. Risk of Hospitalization and Mortality Following Medically Attended Norovirus Infection-Veterans Health Administration, 2010-2018. Open Forum Infect Dis 2023; 10:ofad556. [PMID: 38023542 PMCID: PMC10667024 DOI: 10.1093/ofid/ofad556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Background While prior studies have suggested a role for norovirus gastroenteritis in contributing to severe morbidity and mortality, the importance of norovirus as a causal pathogen for hospitalization and mortality remains poorly understood. We estimated the effect of laboratory-confirmed norovirus infection on hospitalization and mortality among a national cohort of veterans who sought care within the Veterans Affairs health care system. Methods We analyzed electronic health record data from a cohort study of adults who were tested for norovirus within the Veterans Affairs system between 1 January 2010 and 31 December 2018. Adjusted risk ratios (aRRs) for hospitalization and mortality were estimated using log-binomial regression models, adjusting for age, Clostridioides difficile, underlying medical conditions, and nursing home residence. Results In total, 23 196 veterans had 25 668 stool samples tested for norovirus; 2156 samples (8.4%) tested positive. Testing positive for norovirus infection, compared with testing negative, was associated with a slight increased risk of hospitalization (aRR, 1.13 [95% confidence interval, 1.06-1.21]) and a significant increased risk of mortality within 3 days after the norovirus test (2.14 [1.10-4.14]). The mortality aRR within 1 week and 1 month were reduced to 1.40 (95% confidence interval, .84-2.34) and 0.97 (.70-1.35), respectively. Conclusions Older veterans with multiple comorbid conditions were at a slight increased risk of hospitalization and significant increased risk of mortality in the 3 days after a norovirus-positive test, compared with those testing negative. Clinicians should be aware of these risks and can use these data to inform clinical management for veterans with norovirus.
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Affiliation(s)
- Jordan Cates
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cristina V Cardemil
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara A Mirza
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ben Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Aron J Hall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark Holodniy
- Public Health National Program Office, Department of Veterans Affairs, Palo Alto, California, and Washington, DC, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California USA
| | - Cynthia Lucero-Obusan
- Public Health National Program Office, Department of Veterans Affairs, Palo Alto, California, and Washington, DC, USA
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Satter SM, Abdullah Z, Fariha F, Karim Y, Rahman MM, Balachandran N, Ghosh PK, Hossain ME, Mirza SA, Hall AJ, Gastañaduy PA, Rahman M, Vinjé J, Parashar UD. Epidemiology and Risk Factors of Norovirus Infections Among Diarrhea Patients Admitted to Tertiary Care Hospitals in Bangladesh. J Infect Dis 2023; 228:818-828. [PMID: 37503737 PMCID: PMC10547458 DOI: 10.1093/infdis/jiad274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/21/2023] [Accepted: 07/27/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Norovirus is a major cause of endemic acute gastroenteritis (AGE) worldwide. We described the epidemiology, risk factors, and genotypic distribution of noroviruses among hospitalized patients of all ages in Bangladesh. METHODS From March 2018 to October 2021, 1250 AGE case patients and controls (age, sex, season, and site matched) were enrolled at 10 hospitals. Demographic and clinical information was collected; real-time reverse-transcriptase polymerase chain reaction (RT-PCR) used to test stool specimens, and positive samples were genotyped. RESULTS Norovirus was detected in 9% of cases (111 of 1250) and 15% (182 of 1250) of controls. Eighty-two percent of norovirus-positive cases were in children <5 years old. Norovirus-positive AGE hospitalizations occurred year-round, with peaks in April and October. Risk factors for norovirus included age <5 years (adjusted odds ratio, 3.1 [95% confidence interval, 1.9-5.2]) and exposure to a patient with AGE in the 10 days before enrollment (3.8 [1.9-7.2]). GII.3[P16] and GII.4 Sydney[P16] were the predominant genotypes. CONCLUSIONS We highlight the burden of norovirus in hospital settings. Young age and recent exposure to a patient with AGE were risk factors for norovirus. A high prevalence of norovirus among controls might represent asymptomatic reinfections or prolonged shedding from a previous infection; carefully designed longitudinal studies are needed to improve our understanding of norovirus infections in Bangladesh.
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Affiliation(s)
- Syed M Satter
- International Center for Diarrheal Disease Research (ICDDR,B), Dhaka, Bangladesh
| | - Zarin Abdullah
- International Center for Diarrheal Disease Research (ICDDR,B), Dhaka, Bangladesh
| | - Farzana Fariha
- International Center for Diarrheal Disease Research (ICDDR,B), Dhaka, Bangladesh
| | - Yeasir Karim
- International Center for Diarrheal Disease Research (ICDDR,B), Dhaka, Bangladesh
| | - Md Mahfuzur Rahman
- International Center for Diarrheal Disease Research (ICDDR,B), Dhaka, Bangladesh
| | - Neha Balachandran
- Center for Disease Control and Prevention, Atlanta, Georgia, USA
- Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Probir Kumar Ghosh
- International Center for Diarrheal Disease Research (ICDDR,B), Dhaka, Bangladesh
| | | | - Sara A Mirza
- Center for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aron J Hall
- Center for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Mustafizur Rahman
- International Center for Diarrheal Disease Research (ICDDR,B), Dhaka, Bangladesh
| | - Jan Vinjé
- Center for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Umesh D Parashar
- Center for Disease Control and Prevention, Atlanta, Georgia, USA
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Lappe BL, Wikswo ME, Kambhampati AK, Mirza SA, Tate JE, Kraay ANM, Lopman BA. Predicting norovirus and rotavirus resurgence in the United States following the COVID-19 pandemic: a mathematical modelling study. BMC Infect Dis 2023; 23:254. [PMID: 37081456 PMCID: PMC10117239 DOI: 10.1186/s12879-023-08224-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 04/04/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND To reduce the burden from the COVID-19 pandemic in the United States, federal and state local governments implemented restrictions such as limitations on gatherings, restaurant dining, and travel, and recommended non-pharmaceutical interventions including physical distancing, mask-wearing, surface disinfection, and increased hand hygiene. Resulting behavioral changes impacted other infectious diseases including enteropathogens such as norovirus and rotavirus, which had fairly regular seasonal patterns prior to the COVID-19 pandemic. The study objective was to project future incidence of norovirus and rotavirus gastroenteritis as contacts resumed and other NPIs are relaxed. METHODS We fitted compartmental mathematical models to pre-pandemic U.S. surveillance data (2012-2019) for norovirus and rotavirus using maximum likelihood estimation. Then, we projected incidence for 2022-2030 under scenarios where the number of contacts a person has per day varies from70%, 80%, 90%, and full resumption (100%) of pre-pandemic levels. RESULTS We found that the population susceptibility to both viruses increased between March 2020 and November 2021. The 70-90% contact resumption scenarios led to lower incidence than observed pre-pandemic for both viruses. However, we found a greater than two-fold increase in community incidence relative to the pre-pandemic period under the 100% contact scenarios for both viruses. With rotavirus, for which population immunity is driven partially by vaccination, patterns settled into a new steady state quickly in 2022 under the 70-90% scenarios. For norovirus, for which immunity is relatively short-lasting and only acquired through infection, surged under the 100% contact scenario projection. CONCLUSIONS These results, which quantify the consequences of population susceptibility build-up, can help public health agencies prepare for potential resurgence of enteric viruses.
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Affiliation(s)
- Brooke L Lappe
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Mary E Wikswo
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anita K Kambhampati
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sara A Mirza
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacqueline E Tate
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alicia N M Kraay
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Ben A Lopman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
- Epidemiology Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Kambhampati AK, Calderwood L, Wikswo ME, Barclay L, Mattison CP, Balachandran N, Vinjé J, Hall AJ, Mirza SA. Spatiotemporal Trends in Norovirus Outbreaks in the United States, 2009-2019. Clin Infect Dis 2023; 76:667-673. [PMID: 35913377 DOI: 10.1093/cid/ciac627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/18/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Globally, noroviruses cause infections year-round but have recognized winter seasonality in the Northern Hemisphere and yearly variations in incidence. With candidate norovirus vaccines in development, understanding temporal and geographic trends in norovirus disease is important to inform potential vaccination strategies and evaluate vaccine impact. METHODS We analyzed data from the National Outbreak Reporting System (NORS) and CaliciNet on single-state norovirus outbreaks that occurred during August 2009-July 2019 in the contiguous United States. We defined norovirus season onset and offset as the weeks by which 10% and 90% of norovirus outbreaks in a surveillance year occurred, respectively, and duration as the difference in weeks between onset and offset. We compared norovirus seasons across surveillance years and geographic regions. RESULTS During August 2009-July 2019, 24 995 single-state norovirus outbreaks were reported to NORS and/or CaliciNet. Nationally, the median norovirus season duration was 24 weeks, with onset occurring between October and December and offset occurring between April and May. Across all years combined, we observed a west-to-east trend in seasonality, with the earliest onset (October) and latest offset (May) occurring in western regions and the latest onset (December) and earliest offset (April) occurring in northeastern regions. CONCLUSIONS Timing and duration of the US norovirus season varied annually but generally occurred during October-May. Norovirus wintertime seasonality was less distinct in western regions and was progressively more pronounced moving east. Further understanding the drivers of spatiotemporal dynamics of norovirus could provide insights into factors that promote virus transmission and help guide future interventions.
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Affiliation(s)
- Anita K Kambhampati
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura Calderwood
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Mary E Wikswo
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Leslie Barclay
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Claire P Mattison
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Neha Balachandran
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Jan Vinjé
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aron J Hall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara A Mirza
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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10
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Mattison CP, Calderwood LE, Marsh ZA, Wikswo ME, Balachandran N, Kambhampati AK, Gleason ME, Lawinger H, Mirza SA. Childcare and School Acute Gastroenteritis Outbreaks: 2009-2020. Pediatrics 2022; 150:e2021056002. [PMID: 36278284 PMCID: PMC10061552 DOI: 10.1542/peds.2021-056002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVES Acute gastroenteritis (AGE) outbreaks commonly occur in congregate settings, including schools and childcare facilities. These outbreaks disrupt institutions, causing absences and temporary facility closures. This study analyzed the epidemiology of school and childcare AGE outbreaks in the United States. METHODS We analyzed AGE outbreaks occurring in kindergarten to grade 12 schools and childcare facilities reported via the National Outbreak Reporting System in the United States from 2009 to 2019 and compared this information to 2020 data. Outbreak and case characteristics were compared using the Kruskal-Wallis rank sum test, χ2 goodness-of-fit test, and Fisher exact test. RESULTS From 2009 to 2019, there were 2623 school, 1972 childcare, and 38 school and childcare outbreaks. School outbreaks were larger (median, 29 cases) than childcare outbreaks (median, 10 cases). Childcare outbreaks were longer (median, 15 days) than school outbreaks (median, 9 days). Norovirus (2383 outbreaks; 110 190 illnesses) and Shigella spp. (756 outbreaks; 9123 illnesses) were the most reported etiologies. Norovirus was the leading etiology in schools; norovirus and Shigella spp. were dominant etiologies in childcare centers. Most (85.7%) outbreaks were spread via person-to-person contact. In 2020, 123 outbreaks were reported, 85% in the first quarter. CONCLUSIONS Schools and childcare centers are common AGE outbreak settings in the United States. Most outbreaks were caused by norovirus and Shigella spp. and spread via person-to-person transmission. Fewer outbreaks were reported in 2020 from the COVID-19 pandemic. Prevention and control efforts should focus on interrupting transmission, including environmental disinfection, proper handwashing, safe diapering, and exclusion of ill persons.
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Affiliation(s)
- Claire P. Mattison
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
- Cherokee Nation Assurance, Arlington, Virginia
| | - Laura E. Calderwood
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
- Cherokee Nation Assurance, Arlington, Virginia
| | - Zachary A. Marsh
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary E. Wikswo
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
| | - Neha Balachandran
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
- Cherokee Nation Assurance, Arlington, Virginia
| | - Anita K. Kambhampati
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
| | - Michelle E. Gleason
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hannah Lawinger
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sara A. Mirza
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
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11
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Kambhampati AK, Wikswo ME, Barclay L, Vinjé J, Mirza SA, Rei E, Sabina B, Beggs J, Riner DK, Cebelinski E, Saupe A, Bartling A, Loeck BK, Chase N, Houston J, Brandt E, Salehi E, DeBess E, Tsaknaridis L, Goodwin G, Mohamed H, Golwalkar M, Thomas L, Donnelly MK, Greene H, Davis T, Roberts L, Christensen R, Peterson M. Notes from the Field: Norovirus Outbreaks Reported Through NoroSTAT — 12 States, August 2012–July 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1222-1224. [PMID: 36136940 PMCID: PMC9531565 DOI: 10.15585/mmwr.mm7138a3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Anita K. Kambhampati
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Mary E. Wikswo
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Leslie Barclay
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Jan Vinjé
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Sara A. Mirza
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
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12
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Dale AP, Miko S, Calderwood LE, King RF, Maurer M, Dyer L, Gebhardt M, Maurer W, Crosby S, Wikswo ME, Said MA, Mirza SA. Outbreak of Acute Gastroenteritis Among Rafters and Backpackers in the Backcountry of Grand Canyon National Park, April–June 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1207-1211. [PMID: 36136954 PMCID: PMC9531568 DOI: 10.15585/mmwr.mm7138a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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13
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Balachandran N, Cates J, Kambhampati AK, Marconi VC, Whitmire A, Morales E, Brown ST, Lama D, Rodriguez-Barradas MC, Moronez RG, Domiguez GR, Beenhouwer DO, Poteshkina A, Matolek ZA, Holodniy M, Lucero-Obusan C, Agarwal M, Cardemil C, Parashar U, Mirza SA. Risk Factors for Acute Gastroenteritis Among Patients Hospitalized in 5 Veterans Affairs Medical Centers, 2016-2019. Open Forum Infect Dis 2022; 9:ofac339. [PMID: 35949407 PMCID: PMC9356693 DOI: 10.1093/ofid/ofac339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/22/2022] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND In the United States, ∼179 million acute gastroenteritis (AGE) episodes occur annually. We aimed to identify risk factors for all-cause AGE, norovirus-associated vs non-norovirus AGE, and severe vs mild/moderate AGE among hospitalized adults. METHODS We enrolled 1029 AGE cases and 624 non-AGE controls from December 1, 2016, to November 30, 2019, at 5 Veterans Affairs Medical Centers. Patient interviews and medical chart abstractions were conducted, and participant stool samples were tested using the BioFire Gastrointestinal Panel. Severe AGE was defined as a modified Vesikari score of ≥11. Multivariate logistic regression was performed to assess associations between potential risk factors and outcomes; univariate analysis was conducted for norovirus-associated AGE due to limited sample size. RESULTS Among 1029 AGE cases, 551 (54%) had severe AGE and 44 (4%) were norovirus positive. Risk factors for all-cause AGE included immunosuppressive therapy (adjusted odds ratio [aOR], 5.6; 95% CI, 2.7-11.7), HIV infection (aOR, 3.9; 95% CI, 1.8-8.5), severe renal disease (aOR, 3.1; 95% CI, 1.8-5.2), and household contact with a person with AGE (aOR, 2.9; 95% CI, 1.3-6.7). Household (OR, 4.4; 95% CI, 1.6-12.0) and non-household contact (OR, 5.0; 95% CI, 2.2-11.5) with AGE was associated with norovirus-associated AGE. Norovirus positivity (aOR, 3.4; 95% CI, 1.3-8.8) was significantly associated with severe AGE. CONCLUSIONS Patients with immunosuppressive therapy, HIV, and severe renal disease should be monitored for AGE and may benefit from targeted public health messaging regarding AGE prevention. These results may also direct future public health interventions, such as norovirus vaccines, to specific high-risk populations.
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Affiliation(s)
- Neha Balachandran
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Cherokee Nation Assurance, Arlington, Virginia, contracting agency to the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
| | - Jordan Cates
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anita K Kambhampati
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Vincent C Marconi
- Atlanta VA Medical Center, Atlanta, Georgia, USA
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, Georgia, USA
| | | | | | - Sheldon T Brown
- James J. Peters VA Medical Center, Bronx, New York, USA
- Icahn School of Medicine at Mt. Sinai, New York, New York, USA
| | - Diki Lama
- James J. Peters VA Medical Center, Bronx, New York, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Rosalba Gomez Moronez
- Infectious Diseases Section, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Gilberto Rivera Domiguez
- Infectious Diseases Section, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - David O Beenhouwer
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | | | - Mark Holodniy
- Department of Veterans Affairs, Public Health Surveillance and Research, Washington DC, USA
- VA Palo Alto Health Care System, Palo Alto California, USA
- Stanford University, Stanford, California, USA
| | - Cynthia Lucero-Obusan
- Department of Veterans Affairs, Public Health Surveillance and Research, Washington DC, USA
- VA Palo Alto Health Care System, Palo Alto California, USA
| | - Madhuri Agarwal
- Department of Veterans Affairs, Public Health Surveillance and Research, Washington DC, USA
| | - Cristina Cardemil
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Umesh Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara A Mirza
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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14
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Johnson JA, Read TD, Petit RA, Marconi VC, Meagley KL, Rodriguez-Barradas MC, Beenhouwer DO, Brown ST, Holodniy M, Lucero-Obusan CA, Schirmer P, Ingersoll JM, Kraft CS, Neill FH, Atmar RL, Kambhampati AK, Cates JE, Mirza SA, Hall A, Cardemil CV, Lopman BA. Association of Secretor Status and Recent Norovirus Infection With Gut Microbiome Diversity Metrics in a Veterans Affairs Population. Open Forum Infect Dis 2022; 9:ofac125. [PMID: 35434176 PMCID: PMC9007923 DOI: 10.1093/ofid/ofac125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/08/2022] [Indexed: 11/12/2022] Open
Abstract
Norovirus infection causing acute gastroenteritis could lead to adverse effects on the gut microbiome. We assessed the association of microbiome diversity with norovirus infection and secretor status in patients from Veterans Affairs medical centers. Alpha diversity metrics were lower among patients with acute gastroenteritis but were similar for other comparisons.
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Affiliation(s)
- Jordan A Johnson
- Department of Epidemiology, Emory University Rollins School of Public Health, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Timothy D Read
- Department of Epidemiology, Emory University Rollins School of Public Health, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Robert A Petit
- Department of Epidemiology, Emory University Rollins School of Public Health, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Vincent C Marconi
- Department of Epidemiology, Emory University Rollins School of Public Health, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Kathryn L Meagley
- Department of Epidemiology, Emory University Rollins School of Public Health, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - David O Beenhouwer
- Veterans Affairs Greater Los Angeles Health System, Los Angeles, California, USA
| | - Sheldon T Brown
- James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Mark Holodniy
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Office of Population Health, Public Health Surveillance and Research, Veterans Health Administration, Washington, DC, USA
- Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, California, USA
| | - Cynthia A Lucero-Obusan
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Office of Population Health, Public Health Surveillance and Research, Veterans Health Administration, Washington, DC, USA
| | - Patricia Schirmer
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Office of Population Health, Public Health Surveillance and Research, Veterans Health Administration, Washington, DC, USA
| | - Jessica M Ingersoll
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Colleen S Kraft
- Department of Epidemiology, Emory University Rollins School of Public Health, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Frederick H Neill
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Robert L Atmar
- Office of Population Health, Public Health Surveillance and Research, Veterans Health Administration, Washington, DC, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Anita K Kambhampati
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jordan E Cates
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara A Mirza
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aron J Hall
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cristina V Cardemil
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Benjamin A Lopman
- Department of Epidemiology, Emory University Rollins School of Public Health, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
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15
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Calderwood LE, Wikswo ME, Mattison CP, Kambhampati AK, Balachandran N, Vinjé J, Barclay L, Hall AJ, Parashar U, Mirza SA. Norovirus Outbreaks in Long-term Care Facilities in the United States, 2009-2018: A Decade of Surveillance. Clin Infect Dis 2022; 74:113-119. [PMID: 34523674 PMCID: PMC8978331 DOI: 10.1093/cid/ciab808] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 05/26/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In the United States, norovirus is the leading cause of healthcare-associated gastroenteritis outbreaks. To inform prevention efforts, we describe the epidemiology of norovirus outbreaks in long-term care facilities (LTCFs). METHODS The Centers for Disease Control and Prevention (CDC) collect epidemiologic and laboratory data on norovirus outbreaks from US health departments through the National Outbreak Reporting System (NORS) and CaliciNet. Reports from both systems were merged, and norovirus outbreaks in nursing homes, assisted living, and other LTCFs occurring in 2009-2018 were analyzed. Data from the Centers for Medicare and Medicaid Services and the National Center for Health Statistics were used to estimate state LTCF counts. RESULTS During 2009-2018, 50 states, Washington D.C., and Puerto Rico reported 13 092 norovirus outbreaks and 416 284 outbreak-associated cases in LTCFs. Participation in NORS and CaliciNet increased from 2009 to 2014 and median reporting of LTCF norovirus outbreaks stabilized at 4.1 outbreaks per 100 LTCFs (interquartile range [IQR]: 1.0-7.1) annually since 2014. Most outbreaks were spread via person-to-person transmission (90.4%), and 75% occurred during December-March. Genogroup was reported for 7292 outbreaks with 862 (11.8%) positive for GI and 6370 (87.3%) for GII. Among 4425 GII outbreaks with typing data, 3618 (81.8%) were GII.4. LTCF residents had higher attack rates than staff (median 29.0% vs 10.9%; P < .001). For every 1000 cases, there were 21.6 hospitalizations and 2.3 deaths. CONCLUSIONS LTCFs have a high burden of norovirus outbreaks. Most LTCF norovirus outbreaks occurred during winter months and were spread person-to-person. Outbreak surveillance can inform development of interventions for this vulnerable population, such as vaccines targeting GII.4 norovirus strains.
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Affiliation(s)
- Laura E. Calderwood
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;,Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Mary E. Wikswo
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Claire P. Mattison
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;,Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Anita K. Kambhampati
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Neha Balachandran
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;,Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Jan Vinjé
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Leslie Barclay
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aron J. Hall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Umesh Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara A. Mirza
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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16
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Diez Valcarce M, Kambhampati AK, Calderwood LE, Hall AJ, Mirza SA, Vinjé J. Global distribution of sporadic sapovirus infections: A systematic review and meta-analysis. PLoS One 2021; 16:e0255436. [PMID: 34411109 PMCID: PMC8376006 DOI: 10.1371/journal.pone.0255436] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/15/2021] [Indexed: 02/04/2023] Open
Abstract
Acute gastroenteritis (AGE), characterized by diarrhea and vomiting, is an important cause of global mortality, accounting for 9% of all deaths in children under five years of age. Since the reduction of rotavirus in countries that have included rotavirus vaccines in their national immunization programs, other viruses such as norovirus and sapovirus have emerged as more common causes of AGE. Due to widespread use of real-time RT-PCR testing, sapovirus has been increasingly reported as the etiologic agent in both AGE outbreaks and sporadic AGE cases. We aimed to assess the role of sapovirus as a cause of endemic AGE worldwide by conducting a systematic review of published studies that used molecular diagnostics to assess the prevalence of sapovirus among individuals with AGE symptoms. Of 106 articles included, the pooled sapovirus prevalence was 3.4%, with highest prevalence among children <5 years of age (4.4%) and among individuals in community settings (7.1%). Compared to studies that used conventional RT-PCR, RT-qPCR assays had a higher pooled prevalence (5.6%). Among individuals without AGE symptoms, the pooled sapovirus prevalence was 2.7%. These results highlight the relative contribution of sapovirus to cases of AGE, especially in community settings and among children <5 years of age.
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Affiliation(s)
- Marta Diez Valcarce
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Emory University Rollins School of Public Health, Atlanta, GA, United States of America
| | - Anita K. Kambhampati
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Laura E. Calderwood
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Cherokee Nation Assurance, Arlington, VA, United States of America
| | - Aron J. Hall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Sara A. Mirza
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Jan Vinjé
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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17
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Kraay ANM, Han P, Kambhampati AK, Wikswo ME, Mirza SA, Lopman BA. Impact of Nonpharmaceutical Interventions for Severe Acute Respiratory Syndrome Coronavirus 2 on Norovirus Outbreaks: An Analysis of Outbreaks Reported By 9 US States. J Infect Dis 2021; 224:9-13. [PMID: 33606027 PMCID: PMC7928764 DOI: 10.1093/infdis/jiab093] [Citation(s) in RCA: 43] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/09/2021] [Indexed: 01/17/2023] Open
Abstract
In April 2020, the incidence of norovirus outbreaks reported to the National Outbreak Reporting System (NORS) dramatically declined. We used regression models to determine if this decline was best explained by underreporting, seasonal trends, or reduced exposure due to non-pharmaceutical interventions (NPIs) implemented for SARS-CoV-2 using data from 9 states from July 2012–July 2020. The decline in norovirus outbreaks was significant for all 9 states and underreporting or seasonality are unlikely to be the primary explanations for these findings. These patterns were similar across a variety of settings. NPIs appear to have reduced incidence of norovirus, a non-respiratory pathogen.
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Affiliation(s)
- Alicia N M Kraay
- Epidemiology Department, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Peichun Han
- Epidemiology Department, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Anita K Kambhampati
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary E Wikswo
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara A Mirza
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Benjamin A Lopman
- Epidemiology Department, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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18
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Kraay ANM, Han P, Kambhampati AK, Wikswo ME, Mirza SA, Lopman BA. Impact of Nonpharmaceutical Interventions for Severe Acute Respiratory Syndrome Coronavirus 2 on Norovirus Outbreaks: An Analysis of Outbreaks Reported By 9 US States. J Infect Dis 2021; 224:9-13. [PMID: 33606027 DOI: 10.1101/2020.11.25.20237115] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/09/2021] [Indexed: 05/26/2023] Open
Abstract
In April 2020, the incidence of norovirus outbreaks reported to the National Outbreak Reporting System dramatically declined. We used regression models to determine if this decline was best explained by underreporting, seasonal trends, or reduced exposure due to nonpharmaceutical interventions (NPIs) implemented for severe acute respiratory syndrome coronavirus 2 using data from 9 states from July 2012 to July 2020. The decline in norovirus outbreaks was significant for all 9 states, and underreporting and/or seasonality are unlikely to be the primary explanation for these findings. These patterns were similar across a variety of settings. NPIs appear to have reduced incidence of norovirus, a nonrespiratory pathogen.
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Affiliation(s)
- Alicia N M Kraay
- Epidemiology Department, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Peichun Han
- Epidemiology Department, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Anita K Kambhampati
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary E Wikswo
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara A Mirza
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Benjamin A Lopman
- Epidemiology Department, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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19
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Li Z, Jones C, Ejigu GS, George N, Geller AL, Chang GC, Adamski A, Igboh LS, Merrill RD, Ricks P, Mirza SA, Lynch M. Countries with delayed COVID-19 introduction - characteristics, drivers, gaps, and opportunities. Global Health 2021; 17:28. [PMID: 33731178 PMCID: PMC7968140 DOI: 10.1186/s12992-021-00678-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 03/02/2021] [Indexed: 01/02/2023] Open
Abstract
Background Three months after the first reported cases, COVID-19 had spread to nearly 90% of World Health Organization (WHO) member states and only 24 countries had not reported cases as of 30 March 2020. This analysis aimed to 1) assess characteristics, capability to detect and monitor COVID-19, and disease control measures in these 24 countries, 2) understand potential factors for the reported delayed COVID-19 introduction, and 3) identify gaps and opportunities for outbreak preparedness, particularly in low and middle-income countries (LMICs). We collected and analyzed publicly available information on country characteristics, COVID-19 testing, influenza surveillance, border measures, and preparedness activities in these countries. We also assessed the association between the temporal spread of COVID-19 in all countries with reported cases with globalization indicator and geographic location. Results Temporal spreading of COVID-19 was strongly associated with countries’ globalization indicator and geographic location. Most of the 24 countries with delayed COVID-19 introduction were LMICs; 88% were small island or landlocked developing countries. As of 30 March 2020, only 38% of these countries reported in-country COVID-19 testing capability, and 71% reported conducting influenza surveillance during the past year. All had implemented two or more border measures, (e.g., travel restrictions and border closures) and multiple preparedness activities (e.g., national preparedness plans and school closing). Conclusions Limited testing capacity suggests that most of the 24 delayed countries may have lacked the capability to detect and identify cases early through sentinel and case-based surveillance. Low global connectedness, geographic isolation, and border measures were common among these countries and may have contributed to the delayed introduction of COVID-19 into these countries. This paper contributes to identifying opportunities for pandemic preparedness, such as increasing disease detection, surveillance, and international collaborations. As the global situation continues to evolve, it is essential for countries to improve and prioritize their capacities to rapidly prevent, detect, and respond, not only for COVID-19, but also for future outbreaks. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-021-00678-4.
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Affiliation(s)
- Zheng Li
- Centers for Disease Control and Prevention, COVID-19 Response, 4770 Buford Highway, Atlanta, GA, 30341, USA.
| | - Cynthia Jones
- Centers for Disease Control and Prevention, COVID-19 Response, 4770 Buford Highway, Atlanta, GA, 30341, USA
| | - Girum S Ejigu
- Centers for Disease Control and Prevention, COVID-19 Response, 4770 Buford Highway, Atlanta, GA, 30341, USA
| | - Nisha George
- Centers for Disease Control and Prevention, COVID-19 Response, 4770 Buford Highway, Atlanta, GA, 30341, USA
| | - Amanda L Geller
- Centers for Disease Control and Prevention, COVID-19 Response, 4770 Buford Highway, Atlanta, GA, 30341, USA
| | - Gregory C Chang
- Centers for Disease Control and Prevention, COVID-19 Response, 4770 Buford Highway, Atlanta, GA, 30341, USA
| | - Alys Adamski
- Centers for Disease Control and Prevention, COVID-19 Response, 4770 Buford Highway, Atlanta, GA, 30341, USA
| | - Ledor S Igboh
- Centers for Disease Control and Prevention, COVID-19 Response, 4770 Buford Highway, Atlanta, GA, 30341, USA
| | - Rebecca D Merrill
- Centers for Disease Control and Prevention, COVID-19 Response, 4770 Buford Highway, Atlanta, GA, 30341, USA
| | - Philip Ricks
- Centers for Disease Control and Prevention, COVID-19 Response, 4770 Buford Highway, Atlanta, GA, 30341, USA
| | - Sara A Mirza
- Centers for Disease Control and Prevention, COVID-19 Response, 4770 Buford Highway, Atlanta, GA, 30341, USA
| | - Michael Lynch
- Centers for Disease Control and Prevention, COVID-19 Response, 4770 Buford Highway, Atlanta, GA, 30341, USA
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20
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Mirza SA, Wentworth AB, Harvey JA, Bridges AG, Camilleri MJ, El-Azhary RA, McEvoy MT, Sartori Valinotti JC, Wetter DA, Davis MDP. Serum triamcinolone levels during intensive, inpatient wet-dressing therapy. Clin Exp Dermatol 2020; 45:549-554. [PMID: 32410250 DOI: 10.1111/ced.14161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Wet dressings combined with topical corticosteroids are beneficial for patients with generalized and refractory dermatosis; however, to our knowledge, serum levels after topical corticosteroid absorption during intensive therapy have not been reported previously. AIM To examine serum levels of triamcinolone acetonide (TAC) after topical corticosteroid application during intensive wet-dressing therapy. METHODS We performed a retrospective study of adult patients admitted for inpatient wet-dressing therapy from 7 November 2015 to 24 June 2016. Data were collected on sex, age, body surface area, TAC serum levels, number of wet-dressing changes after 24 and 48 h, and type of wet dressing. RESULTS In total, 29 patients (14 men, 15 women) were assessed. Median [interquartile range (IQR)] age was 57 years (51.5-67.0 years) and involved body surface area was 1.98 m2 (1.88-2.15) m2 . Before the 24-hour blood draw, patients had received 1-3 dressing changes. Median (IQR) TAC level at 24 h was 0.33 µg/dL (0.20-0.58 µg/dL), with no significant difference noted between the number of dressing changes and TAC serum level. At 48 h, results of a serum TAC test were available for 22 patients with 2-6 dressing changes. Mean (IQR) serum level was 0.30 µg/dL (0.30-0.87 µg/dL). For each additional dressing change, there was an estimated 0.21 µg/dL increase in TAC serum level (95% CI 0.11-0.31; P < 0.001). TAC serum level was not significantly associated with sex, age, body surface area or dressing type. CONCLUSIONS Intensive, inpatient wet-dressing therapy is associated with detectable TAC serum levels. However, we suspect that topical TAC has a primarily local therapeutic effect on the skin.
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Affiliation(s)
- S A Mirza
- Departments of, Departments of, Dermatology, Mayo Clinic, Rochester, MN, USA
| | - A B Wentworth
- Departments of, Departments of, Dermatology, Mayo Clinic, Rochester, MN, USA
| | - J A Harvey
- Departments of, Departments of, Dermatology, Mayo Clinic, Rochester, MN, USA
| | - A G Bridges
- Departments of, Departments of, Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of, Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - M J Camilleri
- Departments of, Departments of, Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of, Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - R A El-Azhary
- Departments of, Departments of, Dermatology, Mayo Clinic, Rochester, MN, USA
| | - M T McEvoy
- Departments of, Departments of, Dermatology, Mayo Clinic, Rochester, MN, USA
| | | | - D A Wetter
- Departments of, Departments of, Dermatology, Mayo Clinic, Rochester, MN, USA
| | - M D P Davis
- Departments of, Departments of, Dermatology, Mayo Clinic, Rochester, MN, USA
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21
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Dama E, Nikiema A, Nichols K, Bicaba BW, Porgho S, Greco Koné R, Tarnagda Z, Cissé A, Ngendakumana I, Adjami A, Medah I, Ake F, Mirza SA. Designing and Piloting a Specimen Transport System in Burkina Faso. Health Secur 2020; 18:S98-S104. [PMID: 32004130 DOI: 10.1089/hs.2019.0068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Efficient specimen transport systems are critical for early disease detection and reporting by laboratory networks. In Burkina Faso, centralized reference laboratories receive specimens from multiple surveillance sites for testing, but transport methods vary, resulting in potential delays and risk to specimen quality. The ministry of health and partners, under the Global Health Security Agenda implementation, piloted a specimen transport system for severe acute respiratory illness (SARI) surveillance in 4 Burkina Faso districts. A baseline assessment was conducted of the current specimen transport network structure and key stakeholders. Assessment results and guidelines for processing SARI specimens informed the pilot specimen transport system design and implementation. Monitoring and evaluation performance indicators included: proportion of packages delivered, timeliness, and quality of courier services (missed or damaged packages). Our baseline assessment found that laboratorians routinely carried specimens from the health center to reference laboratories, resulting in time away from laboratory duties and potential specimen delays or loss of quality. The pilot specimen transport system design engaged Sonapost, the national postal service, to transport specimens from SARI sites to the influenza national reference laboratory. From May 2017 to December 2018, the specimen transport system transported 557 packages containing 1,158 SARI specimens; 95% (529/557) were delivered within 24 hours of pick-up and 77% (892/1,158) within 48 hours of collection. No packages were lost. This article highlights lessons learned that may be useful for other countries considering establishment of a specimen transport system to strengthen laboratory system infrastructure in global health security implementation.
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Affiliation(s)
- Emilie Dama
- Emilie Dama, PhD, is Senior Laboratory Advisor; Rebecca Greco Koné, MPH, is Country Director, Burkina Faso; and Irene Ngendakumana, MD, is Technical Advisor, Eagle Global Services, a CDC contractor; all with the Division of Global Health Protection, Country Office Burkina Faso, Center for Global Health, US Centers for Disease Control and Prevention, Ouagadougou, Burkina Faso. Abdoulaye Nikièma, PharmD, MSc, is Senior Laboratory Specialist and Global Health Security Program Manager for Burkina, African Society for Laboratory Medicine, Ouagadougou, Burkina Faso. Kameko Nichols is a Transport and Logistics Consultant, The Nichols Group LLC, Washington, DC. Brice Wilfried Bicaba, MD, MSc, is an Epidemiologist and Director; Souleymane Porgho, MSc, is an Epidemiologist and Data Manager; and Isaïe Medah, MD, is Director; all at Direction de la Protection de la Santé de la Population, Ministère de la Santé, Ouagadougou, Burkina Faso. Zékiba Tarnagda, DVM, PhD, is Head of Influenza, and Assana Cissé, MSc, is a Bacteriologist and Virologist, Influenza; both at the National Reference Laboratory, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso. Aimé Adjami, PhD, is a Biologist and Executive Director, and Flavien Ake, PhD, is Director; both at DAVYCAS International, Ouagadougou, Burkina Faso. Sara A. Mirza, PhD, is an Epidemiologist, US Centers for Disease Control and Prevention, Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Atlanta, GA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Abdoulaye Nikiema
- Emilie Dama, PhD, is Senior Laboratory Advisor; Rebecca Greco Koné, MPH, is Country Director, Burkina Faso; and Irene Ngendakumana, MD, is Technical Advisor, Eagle Global Services, a CDC contractor; all with the Division of Global Health Protection, Country Office Burkina Faso, Center for Global Health, US Centers for Disease Control and Prevention, Ouagadougou, Burkina Faso. Abdoulaye Nikièma, PharmD, MSc, is Senior Laboratory Specialist and Global Health Security Program Manager for Burkina, African Society for Laboratory Medicine, Ouagadougou, Burkina Faso. Kameko Nichols is a Transport and Logistics Consultant, The Nichols Group LLC, Washington, DC. Brice Wilfried Bicaba, MD, MSc, is an Epidemiologist and Director; Souleymane Porgho, MSc, is an Epidemiologist and Data Manager; and Isaïe Medah, MD, is Director; all at Direction de la Protection de la Santé de la Population, Ministère de la Santé, Ouagadougou, Burkina Faso. Zékiba Tarnagda, DVM, PhD, is Head of Influenza, and Assana Cissé, MSc, is a Bacteriologist and Virologist, Influenza; both at the National Reference Laboratory, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso. Aimé Adjami, PhD, is a Biologist and Executive Director, and Flavien Ake, PhD, is Director; both at DAVYCAS International, Ouagadougou, Burkina Faso. Sara A. Mirza, PhD, is an Epidemiologist, US Centers for Disease Control and Prevention, Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Atlanta, GA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Kameko Nichols
- Emilie Dama, PhD, is Senior Laboratory Advisor; Rebecca Greco Koné, MPH, is Country Director, Burkina Faso; and Irene Ngendakumana, MD, is Technical Advisor, Eagle Global Services, a CDC contractor; all with the Division of Global Health Protection, Country Office Burkina Faso, Center for Global Health, US Centers for Disease Control and Prevention, Ouagadougou, Burkina Faso. Abdoulaye Nikièma, PharmD, MSc, is Senior Laboratory Specialist and Global Health Security Program Manager for Burkina, African Society for Laboratory Medicine, Ouagadougou, Burkina Faso. Kameko Nichols is a Transport and Logistics Consultant, The Nichols Group LLC, Washington, DC. Brice Wilfried Bicaba, MD, MSc, is an Epidemiologist and Director; Souleymane Porgho, MSc, is an Epidemiologist and Data Manager; and Isaïe Medah, MD, is Director; all at Direction de la Protection de la Santé de la Population, Ministère de la Santé, Ouagadougou, Burkina Faso. Zékiba Tarnagda, DVM, PhD, is Head of Influenza, and Assana Cissé, MSc, is a Bacteriologist and Virologist, Influenza; both at the National Reference Laboratory, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso. Aimé Adjami, PhD, is a Biologist and Executive Director, and Flavien Ake, PhD, is Director; both at DAVYCAS International, Ouagadougou, Burkina Faso. Sara A. Mirza, PhD, is an Epidemiologist, US Centers for Disease Control and Prevention, Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Atlanta, GA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Brice Wilfried Bicaba
- Emilie Dama, PhD, is Senior Laboratory Advisor; Rebecca Greco Koné, MPH, is Country Director, Burkina Faso; and Irene Ngendakumana, MD, is Technical Advisor, Eagle Global Services, a CDC contractor; all with the Division of Global Health Protection, Country Office Burkina Faso, Center for Global Health, US Centers for Disease Control and Prevention, Ouagadougou, Burkina Faso. Abdoulaye Nikièma, PharmD, MSc, is Senior Laboratory Specialist and Global Health Security Program Manager for Burkina, African Society for Laboratory Medicine, Ouagadougou, Burkina Faso. Kameko Nichols is a Transport and Logistics Consultant, The Nichols Group LLC, Washington, DC. Brice Wilfried Bicaba, MD, MSc, is an Epidemiologist and Director; Souleymane Porgho, MSc, is an Epidemiologist and Data Manager; and Isaïe Medah, MD, is Director; all at Direction de la Protection de la Santé de la Population, Ministère de la Santé, Ouagadougou, Burkina Faso. Zékiba Tarnagda, DVM, PhD, is Head of Influenza, and Assana Cissé, MSc, is a Bacteriologist and Virologist, Influenza; both at the National Reference Laboratory, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso. Aimé Adjami, PhD, is a Biologist and Executive Director, and Flavien Ake, PhD, is Director; both at DAVYCAS International, Ouagadougou, Burkina Faso. Sara A. Mirza, PhD, is an Epidemiologist, US Centers for Disease Control and Prevention, Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Atlanta, GA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Souleymane Porgho
- Emilie Dama, PhD, is Senior Laboratory Advisor; Rebecca Greco Koné, MPH, is Country Director, Burkina Faso; and Irene Ngendakumana, MD, is Technical Advisor, Eagle Global Services, a CDC contractor; all with the Division of Global Health Protection, Country Office Burkina Faso, Center for Global Health, US Centers for Disease Control and Prevention, Ouagadougou, Burkina Faso. Abdoulaye Nikièma, PharmD, MSc, is Senior Laboratory Specialist and Global Health Security Program Manager for Burkina, African Society for Laboratory Medicine, Ouagadougou, Burkina Faso. Kameko Nichols is a Transport and Logistics Consultant, The Nichols Group LLC, Washington, DC. Brice Wilfried Bicaba, MD, MSc, is an Epidemiologist and Director; Souleymane Porgho, MSc, is an Epidemiologist and Data Manager; and Isaïe Medah, MD, is Director; all at Direction de la Protection de la Santé de la Population, Ministère de la Santé, Ouagadougou, Burkina Faso. Zékiba Tarnagda, DVM, PhD, is Head of Influenza, and Assana Cissé, MSc, is a Bacteriologist and Virologist, Influenza; both at the National Reference Laboratory, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso. Aimé Adjami, PhD, is a Biologist and Executive Director, and Flavien Ake, PhD, is Director; both at DAVYCAS International, Ouagadougou, Burkina Faso. Sara A. Mirza, PhD, is an Epidemiologist, US Centers for Disease Control and Prevention, Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Atlanta, GA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Rebecca Greco Koné
- Emilie Dama, PhD, is Senior Laboratory Advisor; Rebecca Greco Koné, MPH, is Country Director, Burkina Faso; and Irene Ngendakumana, MD, is Technical Advisor, Eagle Global Services, a CDC contractor; all with the Division of Global Health Protection, Country Office Burkina Faso, Center for Global Health, US Centers for Disease Control and Prevention, Ouagadougou, Burkina Faso. Abdoulaye Nikièma, PharmD, MSc, is Senior Laboratory Specialist and Global Health Security Program Manager for Burkina, African Society for Laboratory Medicine, Ouagadougou, Burkina Faso. Kameko Nichols is a Transport and Logistics Consultant, The Nichols Group LLC, Washington, DC. Brice Wilfried Bicaba, MD, MSc, is an Epidemiologist and Director; Souleymane Porgho, MSc, is an Epidemiologist and Data Manager; and Isaïe Medah, MD, is Director; all at Direction de la Protection de la Santé de la Population, Ministère de la Santé, Ouagadougou, Burkina Faso. Zékiba Tarnagda, DVM, PhD, is Head of Influenza, and Assana Cissé, MSc, is a Bacteriologist and Virologist, Influenza; both at the National Reference Laboratory, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso. Aimé Adjami, PhD, is a Biologist and Executive Director, and Flavien Ake, PhD, is Director; both at DAVYCAS International, Ouagadougou, Burkina Faso. Sara A. Mirza, PhD, is an Epidemiologist, US Centers for Disease Control and Prevention, Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Atlanta, GA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Zekiba Tarnagda
- Emilie Dama, PhD, is Senior Laboratory Advisor; Rebecca Greco Koné, MPH, is Country Director, Burkina Faso; and Irene Ngendakumana, MD, is Technical Advisor, Eagle Global Services, a CDC contractor; all with the Division of Global Health Protection, Country Office Burkina Faso, Center for Global Health, US Centers for Disease Control and Prevention, Ouagadougou, Burkina Faso. Abdoulaye Nikièma, PharmD, MSc, is Senior Laboratory Specialist and Global Health Security Program Manager for Burkina, African Society for Laboratory Medicine, Ouagadougou, Burkina Faso. Kameko Nichols is a Transport and Logistics Consultant, The Nichols Group LLC, Washington, DC. Brice Wilfried Bicaba, MD, MSc, is an Epidemiologist and Director; Souleymane Porgho, MSc, is an Epidemiologist and Data Manager; and Isaïe Medah, MD, is Director; all at Direction de la Protection de la Santé de la Population, Ministère de la Santé, Ouagadougou, Burkina Faso. Zékiba Tarnagda, DVM, PhD, is Head of Influenza, and Assana Cissé, MSc, is a Bacteriologist and Virologist, Influenza; both at the National Reference Laboratory, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso. Aimé Adjami, PhD, is a Biologist and Executive Director, and Flavien Ake, PhD, is Director; both at DAVYCAS International, Ouagadougou, Burkina Faso. Sara A. Mirza, PhD, is an Epidemiologist, US Centers for Disease Control and Prevention, Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Atlanta, GA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Assana Cissé
- Emilie Dama, PhD, is Senior Laboratory Advisor; Rebecca Greco Koné, MPH, is Country Director, Burkina Faso; and Irene Ngendakumana, MD, is Technical Advisor, Eagle Global Services, a CDC contractor; all with the Division of Global Health Protection, Country Office Burkina Faso, Center for Global Health, US Centers for Disease Control and Prevention, Ouagadougou, Burkina Faso. Abdoulaye Nikièma, PharmD, MSc, is Senior Laboratory Specialist and Global Health Security Program Manager for Burkina, African Society for Laboratory Medicine, Ouagadougou, Burkina Faso. Kameko Nichols is a Transport and Logistics Consultant, The Nichols Group LLC, Washington, DC. Brice Wilfried Bicaba, MD, MSc, is an Epidemiologist and Director; Souleymane Porgho, MSc, is an Epidemiologist and Data Manager; and Isaïe Medah, MD, is Director; all at Direction de la Protection de la Santé de la Population, Ministère de la Santé, Ouagadougou, Burkina Faso. Zékiba Tarnagda, DVM, PhD, is Head of Influenza, and Assana Cissé, MSc, is a Bacteriologist and Virologist, Influenza; both at the National Reference Laboratory, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso. Aimé Adjami, PhD, is a Biologist and Executive Director, and Flavien Ake, PhD, is Director; both at DAVYCAS International, Ouagadougou, Burkina Faso. Sara A. Mirza, PhD, is an Epidemiologist, US Centers for Disease Control and Prevention, Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Atlanta, GA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Irene Ngendakumana
- Emilie Dama, PhD, is Senior Laboratory Advisor; Rebecca Greco Koné, MPH, is Country Director, Burkina Faso; and Irene Ngendakumana, MD, is Technical Advisor, Eagle Global Services, a CDC contractor; all with the Division of Global Health Protection, Country Office Burkina Faso, Center for Global Health, US Centers for Disease Control and Prevention, Ouagadougou, Burkina Faso. Abdoulaye Nikièma, PharmD, MSc, is Senior Laboratory Specialist and Global Health Security Program Manager for Burkina, African Society for Laboratory Medicine, Ouagadougou, Burkina Faso. Kameko Nichols is a Transport and Logistics Consultant, The Nichols Group LLC, Washington, DC. Brice Wilfried Bicaba, MD, MSc, is an Epidemiologist and Director; Souleymane Porgho, MSc, is an Epidemiologist and Data Manager; and Isaïe Medah, MD, is Director; all at Direction de la Protection de la Santé de la Population, Ministère de la Santé, Ouagadougou, Burkina Faso. Zékiba Tarnagda, DVM, PhD, is Head of Influenza, and Assana Cissé, MSc, is a Bacteriologist and Virologist, Influenza; both at the National Reference Laboratory, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso. Aimé Adjami, PhD, is a Biologist and Executive Director, and Flavien Ake, PhD, is Director; both at DAVYCAS International, Ouagadougou, Burkina Faso. Sara A. Mirza, PhD, is an Epidemiologist, US Centers for Disease Control and Prevention, Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Atlanta, GA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Aimé Adjami
- Emilie Dama, PhD, is Senior Laboratory Advisor; Rebecca Greco Koné, MPH, is Country Director, Burkina Faso; and Irene Ngendakumana, MD, is Technical Advisor, Eagle Global Services, a CDC contractor; all with the Division of Global Health Protection, Country Office Burkina Faso, Center for Global Health, US Centers for Disease Control and Prevention, Ouagadougou, Burkina Faso. Abdoulaye Nikièma, PharmD, MSc, is Senior Laboratory Specialist and Global Health Security Program Manager for Burkina, African Society for Laboratory Medicine, Ouagadougou, Burkina Faso. Kameko Nichols is a Transport and Logistics Consultant, The Nichols Group LLC, Washington, DC. Brice Wilfried Bicaba, MD, MSc, is an Epidemiologist and Director; Souleymane Porgho, MSc, is an Epidemiologist and Data Manager; and Isaïe Medah, MD, is Director; all at Direction de la Protection de la Santé de la Population, Ministère de la Santé, Ouagadougou, Burkina Faso. Zékiba Tarnagda, DVM, PhD, is Head of Influenza, and Assana Cissé, MSc, is a Bacteriologist and Virologist, Influenza; both at the National Reference Laboratory, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso. Aimé Adjami, PhD, is a Biologist and Executive Director, and Flavien Ake, PhD, is Director; both at DAVYCAS International, Ouagadougou, Burkina Faso. Sara A. Mirza, PhD, is an Epidemiologist, US Centers for Disease Control and Prevention, Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Atlanta, GA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Isaïe Medah
- Emilie Dama, PhD, is Senior Laboratory Advisor; Rebecca Greco Koné, MPH, is Country Director, Burkina Faso; and Irene Ngendakumana, MD, is Technical Advisor, Eagle Global Services, a CDC contractor; all with the Division of Global Health Protection, Country Office Burkina Faso, Center for Global Health, US Centers for Disease Control and Prevention, Ouagadougou, Burkina Faso. Abdoulaye Nikièma, PharmD, MSc, is Senior Laboratory Specialist and Global Health Security Program Manager for Burkina, African Society for Laboratory Medicine, Ouagadougou, Burkina Faso. Kameko Nichols is a Transport and Logistics Consultant, The Nichols Group LLC, Washington, DC. Brice Wilfried Bicaba, MD, MSc, is an Epidemiologist and Director; Souleymane Porgho, MSc, is an Epidemiologist and Data Manager; and Isaïe Medah, MD, is Director; all at Direction de la Protection de la Santé de la Population, Ministère de la Santé, Ouagadougou, Burkina Faso. Zékiba Tarnagda, DVM, PhD, is Head of Influenza, and Assana Cissé, MSc, is a Bacteriologist and Virologist, Influenza; both at the National Reference Laboratory, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso. Aimé Adjami, PhD, is a Biologist and Executive Director, and Flavien Ake, PhD, is Director; both at DAVYCAS International, Ouagadougou, Burkina Faso. Sara A. Mirza, PhD, is an Epidemiologist, US Centers for Disease Control and Prevention, Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Atlanta, GA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Flavien Ake
- Emilie Dama, PhD, is Senior Laboratory Advisor; Rebecca Greco Koné, MPH, is Country Director, Burkina Faso; and Irene Ngendakumana, MD, is Technical Advisor, Eagle Global Services, a CDC contractor; all with the Division of Global Health Protection, Country Office Burkina Faso, Center for Global Health, US Centers for Disease Control and Prevention, Ouagadougou, Burkina Faso. Abdoulaye Nikièma, PharmD, MSc, is Senior Laboratory Specialist and Global Health Security Program Manager for Burkina, African Society for Laboratory Medicine, Ouagadougou, Burkina Faso. Kameko Nichols is a Transport and Logistics Consultant, The Nichols Group LLC, Washington, DC. Brice Wilfried Bicaba, MD, MSc, is an Epidemiologist and Director; Souleymane Porgho, MSc, is an Epidemiologist and Data Manager; and Isaïe Medah, MD, is Director; all at Direction de la Protection de la Santé de la Population, Ministère de la Santé, Ouagadougou, Burkina Faso. Zékiba Tarnagda, DVM, PhD, is Head of Influenza, and Assana Cissé, MSc, is a Bacteriologist and Virologist, Influenza; both at the National Reference Laboratory, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso. Aimé Adjami, PhD, is a Biologist and Executive Director, and Flavien Ake, PhD, is Director; both at DAVYCAS International, Ouagadougou, Burkina Faso. Sara A. Mirza, PhD, is an Epidemiologist, US Centers for Disease Control and Prevention, Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Atlanta, GA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Sara A Mirza
- Emilie Dama, PhD, is Senior Laboratory Advisor; Rebecca Greco Koné, MPH, is Country Director, Burkina Faso; and Irene Ngendakumana, MD, is Technical Advisor, Eagle Global Services, a CDC contractor; all with the Division of Global Health Protection, Country Office Burkina Faso, Center for Global Health, US Centers for Disease Control and Prevention, Ouagadougou, Burkina Faso. Abdoulaye Nikièma, PharmD, MSc, is Senior Laboratory Specialist and Global Health Security Program Manager for Burkina, African Society for Laboratory Medicine, Ouagadougou, Burkina Faso. Kameko Nichols is a Transport and Logistics Consultant, The Nichols Group LLC, Washington, DC. Brice Wilfried Bicaba, MD, MSc, is an Epidemiologist and Director; Souleymane Porgho, MSc, is an Epidemiologist and Data Manager; and Isaïe Medah, MD, is Director; all at Direction de la Protection de la Santé de la Population, Ministère de la Santé, Ouagadougou, Burkina Faso. Zékiba Tarnagda, DVM, PhD, is Head of Influenza, and Assana Cissé, MSc, is a Bacteriologist and Virologist, Influenza; both at the National Reference Laboratory, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso. Aimé Adjami, PhD, is a Biologist and Executive Director, and Flavien Ake, PhD, is Director; both at DAVYCAS International, Ouagadougou, Burkina Faso. Sara A. Mirza, PhD, is an Epidemiologist, US Centers for Disease Control and Prevention, Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Atlanta, GA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
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Rolfes MA, Vonglokham P, Khanthamaly V, Chitry B, Pholsena V, Chitranondh V, Mirza SA, Moen A, Bresee JS, Xeuatvongsa A, Olsen SJ. Measurement of birth outcomes in analyses of the impact of maternal influenza vaccination. Influenza Other Respir Viruses 2019; 13:547-555. [PMID: 31424627 PMCID: PMC6800304 DOI: 10.1111/irv.12673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 11/29/2022] Open
Abstract
Background The estimated association of maternal influenza vaccination and birth outcomes may be sensitive to methods used to define preterm birth or small‐for‐gestational age (SGA). Methods In a cohort of pregnant women in Lao People's Democratic Republic, we estimated gestational age from: (a) date of last menstrual period (LMP), (b) any prenatal ultrasound, (c) first trimester ultrasound, (d) Ballard Score at delivery, and (e) an algorithm combining LMP and ultrasound. Infants were classified as SGA at birth using a Canadian, global, and equation‐based growth reference. We estimated the association of maternal influenza vaccination and birth outcomes, by influenza activity, using multivariable log‐binomial regression and Cox proportional hazards regression with vaccination as a time‐varying exposure. Results The frequency of preterm birth in the cohort varied by method to estimate gestational age, from 5% using Ballard Score to 15% using any ultrasound. Using LMP, any ultrasound, or the algorithm, we found statistically significant reductions in preterm birth among vaccinated women during periods of high influenza activity and statistically significant increases in SGA, using a Canadian growth reference. We did not find statistically significant associations with SGA when using global or equation‐based growth references. Conclusions The association of maternal influenza vaccination and birth outcomes was most affected by the choice of a growth reference used to define SGA at birth. The association with pre‐term birth was present and consistent across multiple statistical approaches. Future studies of birth outcomes, specifically SGA, should carefully consider the potential for bias introduced by measurement choice.
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Affiliation(s)
- Melissa A Rolfes
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Viengphone Khanthamaly
- Influenza Program, U.S. CDC-Lao PDR, American Embassy, Vientiane, Lao People's Democratic Republic
| | - Bounlap Chitry
- Mother and Child Hospital, Vientiane, Lao People's Democratic Republic
| | | | - Visith Chitranondh
- Luang Prabang Provincial Hospital, Luang Prabang, Lao People's Democratic Republic
| | - Sara A Mirza
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ann Moen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph S Bresee
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Sonja J Olsen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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Olsen SJ, Mirza SA, Vonglokham P, Khanthamaly V, Chitry B, Pholsena V, Chitranonh V, Omer SB, Moen A, Bresee JS, Corwin A, Xeuatvongsa A. The Effect of Influenza Vaccination on Birth Outcomes in a Cohort of Pregnant Women in Lao PDR, 2014-2015. Clin Infect Dis 2016; 63:487-94. [PMID: 27143672 DOI: 10.1093/cid/ciw290] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/26/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Some studies suggest that maternal influenza vaccination can improve birth outcomes. However, there are limited data from tropical settings, particularly Southeast Asia. We conducted an observational study in Laos to assess the effect of influenza vaccination in pregnant women on birth outcomes. METHODS We consented and enrolled a cohort of pregnant woman who delivered babies at 3 hospitals during April 2014-February 2015. We collected demographic and clinical information on mother and child. Influenza vaccination status was ascertained by vaccine card. Primary outcomes were the proportion of live births born small for gestational age (SGA) or preterm and mean birth weight. Multivariate models controlled for differences between vaccinated and unvaccinated women and influenza virus circulation. RESULTS We enrolled 5103 women (2172 [43%] were vaccinated). Among the 4854 who had a live birth, vaccinated women were statistically significantly less likely than unvaccinated women to have an infant born preterm during the period of high influenza virus circulation (risk ratio [RR] = 0.56, 95% confidence interval [CI], .45-.70), and the effect remained after adjusting for covariates (adjusted RR, 0.69; 95% CI, .55-.87). There was no effect of vaccine on mean birth weight. Vaccinated mothers had a statistically significant elevated risk of having an infant born SGA (adjusted RR, 1.25; 95% CI, 1.11–1.41). CONCLUSIONS In this observational study, we found indirect evidence of influenza vaccine safety during pregnancy, and women who received vaccine had a reduced risk of delivering a preterm infant during times of high influenza virus circulation. Vaccination may prevent 1 in 5 preterm births that occur during periods of high influenza circulation.
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Affiliation(s)
- Sonja J Olsen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sara A Mirza
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | - Saad B Omer
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ann Moen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph S Bresee
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrew Corwin
- Influenza Program, U.S. CDC-Lao People's Democratic Republic, American Embassy The QED Group, American Embassy, Vientiane, Lao People's Democratic Republic
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Phengxay M, Mirza SA, Reyburn R, Xeuatvongsa A, Winter C, Lewis H, Olsen SJ, Tsuyuoka R, Khanthamaly V, Palomeque FS, Bresee JS, Moen AC, Corwin AL. Introducing seasonal influenza vaccine in low-income countries: an adverse events following immunization survey in the Lao People's Democratic Republic. Influenza Other Respir Viruses 2015; 9:94-8. [PMID: 25598475 PMCID: PMC4353322 DOI: 10.1111/irv.12299] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2014] [Indexed: 11/29/2022] Open
Abstract
Objective In 2012, Lao PDR introduced seasonal influenza vaccine in pregnant women, persons aged ≥50 years, persons with chronic diseases, and healthcare personnel. We assessed adverse events following immunization (AEFI). Methods We used a multistage randomized cluster sample design to interview vaccine recipients. Findings Between April and May 2012, 355 902 were vaccinated. Of 2089 persons interviewed, 261 (12·5%) reported one or more AEFI. The most commonly reported AEFIs were local reactions. No hospitalizations or deaths were reported; 16% sought medical care. Acceptance and awareness of vaccination were high. Conclusions Following the introduction of seasonal influenza vaccine in Lao PDR, self-reported adverse events were mild.
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Affiliation(s)
- Manilay Phengxay
- Lao PDR Country Office Western Pacific Regional Office WHO, Vientiane, Lao People's Democratic Republic
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Abstract
OBJECTIVE Exposure to secondhand smoke (SHS) from burning tobacco products causes disease and premature death among non-smoking adults and children. The objective of this study was to determine the nature, extent and demographic correlates of SHS exposure among adults in low- and middle-income countries with a high burden of tobacco use. METHODS Data were obtained from the Global Adult Tobacco Survey (GATS), a nationally representative household survey of individuals 15 years of age or older. Interviews were conducted during 2008-2010 in Bangladesh, Brazil, China, Egypt, India, Mexico, the Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam. Descriptive statistics were used to determine the prevalence and correlates of SHS exposure in homes, workplaces, government buildings, restaurants, public transportation and healthcare facilities. RESULTS Exposure to SHS in the home ranged from 17.3% (Mexico) to 73.1% (Vietnam). Among those who work in an indoor area outside the home, SHS exposure in the workplace ranged from 16.5% (Uruguay) to 63.3% (China). Exposure to SHS ranged from 6.9% (Uruguay) to 72.7% (Egypt) in government buildings, 4.4% (Uruguay) to 88.5% (China) in restaurants, 5.4% (Uruguay) to 79.6% (Egypt) on public transportation, and 3.8% (Uruguay) to 49.2% (Egypt) in healthcare facilities. CONCLUSIONS A large proportion of adults living in low- and middle-income countries are exposed to SHS in their homes, workplaces, and other public places. Countries can enact and enforce legislation requiring 100% smoke-free public places and workplaces, and can also conduct educational initiatives to reduce SHS exposure in homes.
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Affiliation(s)
- Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, USA.
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Giovino GA, Mirza SA, Samet JM, Gupta PC, Jarvis MJ, Bhala N, Peto R, Zatonski W, Hsia J, Morton J, Palipudi KM, Asma S. Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys. Lancet 2012; 380:668-79. [PMID: 22901888 DOI: 10.1016/s0140-6736(12)61085-x] [Citation(s) in RCA: 485] [Impact Index Per Article: 40.4] [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: 11/23/2022]
Abstract
BACKGROUND Despite the high global burden of diseases caused by tobacco, valid and comparable prevalence data for patterns of adult tobacco use and factors influencing use are absent for many low-income and middle-income countries. We assess these patterns through analysis of data from the Global Adult Tobacco Survey (GATS). METHODS Between Oct 1, 2008, and March 15, 2010, GATS used nationally representative household surveys with comparable methods to obtain relevant information from individuals aged 15 years or older in 14 low-income and middle-income countries (Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay, and Vietnam). We compared weighted point estimates and 95% CIs of tobacco use between these 14 countries and with data from the 2008 UK General Lifestyle Survey and the 2006-07 US Tobacco Use Supplement to the Current Population Survey. All these surveys had cross-sectional study designs. FINDINGS In countries participating in GATS, 48·6% (95% CI 47·6-49·6) of men and 11·3% (10·7-12·0) of women were tobacco users. 40·7% of men (ranging from 21·6% in Brazil to 60·2% in Russia) and 5·0% of women (0·5% in Egypt to 24·4% in Poland) in GATS countries smoked a tobacco product. Manufactured cigarettes were favoured by most smokers (82%) overall, but smokeless tobacco and bidis were commonly used in India and Bangladesh. For individuals who had ever smoked daily, women aged 55-64 years at the time of the survey began smoking at an older age than did equivalently aged men in most GATS countries. However, those individuals who had ever smoked daily and were aged 25-34-years when surveyed started to do so at much the same age in both sexes. Quit ratios were very low (<20% overall) in China, India, Russia, Egypt, and Bangladesh. INTERPRETATION The first wave of GATS showed high rates of smoking in men, early initiation of smoking in women, and low quit ratios, reinforcing the view that efforts to prevent initiation and promote cessation of tobacco use are needed to reduce associated morbidity and mortality. FUNDING Bloomberg Philanthropies' Initiative to Reduce Tobacco Use, Bill and Melinda Gates Foundation, Brazilian and Indian Governments.
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Affiliation(s)
- Gary A Giovino
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY 14214-8028, USA. ggiovino@buff alo.edu
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Caraballo RS, Yee SL, Gfroerer J, Mirza SA. Adult tobacco use among racial and ethnic groups living in the United States, 2002-2005. Prev Chronic Dis 2008; 5:A78. [PMID: 18558028 PMCID: PMC2483561] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION U.S. data on adult tobacco use and the relationship between such use and tobacco-related health disparities are primarily limited to broad racial or ethnic populations. To monitor progress in tobacco control among adults living in the United States, we present information on tobacco use for both aggregated and disaggregated racial and ethnic subgroups. METHODS We used data from the nationally representative sample of adults aged 18 years or older who participated in the National Survey on Drug Use and Health conducted 4 times during 2002-2005. We calculated 2 outcome measures: 1) use of any tobacco product (cigarettes, chewing or snuff tobacco, cigars, or pipes) during the 30 days before each survey and 2) cigarette smoking during the 30 days before each survey. RESULTS The prevalence of tobacco use among adults aged 18 years or older varied widely across racial or ethnic groups or subgroups. Overall, about 3 of 10 adults living in the United States were tobacco users during the 30 days before being surveyed. The population groups or subgroups with a tobacco-use prevalence of 30% or higher were African Americans, American Indians or Alaska Natives, Native Hawaiians or other Pacific Islanders, Puerto Ricans, and whites. CONCLUSION These results indicate that the prevalence of adult tobacco use is still high among several U.S. population groups or subgroups. Our results also support the need to design and evaluate interventions to prevent or control tobacco use that would reach distinct U.S. adult population groups or subgroups.
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Affiliation(s)
- Ralph S Caraballo
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
| | - Sue Lin Yee
- Coordinating Center for Terrorism Preparedness and Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joe Gfroerer
- Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Rockville, Maryland
| | - Sara A Mirza
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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McCarthy KM, Morgan J, Wannemuehler KA, Mirza SA, Gould SM, Mhlongo N, Moeng P, Maloba BR, Crewe-Brown HH, Brandt ME, Hajjeh RA. Population-based surveillance for cryptococcosis in an antiretroviral-naive South African province with a high HIV seroprevalence. AIDS 2006; 20:2199-206. [PMID: 17086060 DOI: 10.1097/qad.0b013e3280106d6a] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To measure the burden of disease and describe the epidemiology of cryptococcosis in Gauteng Province, South Africa. DESIGN AND METHODS The study was an active, prospective, laboratory-based, population-based surveillance. An incident case of cryptococcosis was defined as the first isolation by culture of any Cryptococcus species from any clinical specimen, a positive India ink cryptococcal latex agglutination test or a positive histopathology specimen from a Gauteng resident. Cases were identified prospectively at all laboratories in Gauteng. Case report forms were completed using medical record review and patient interview where possible. RESULTS Between 1 March 2002 and 29 February 2004, 2753 incident cases were identified. The overall incidence rate was 15.6/100 000. Among HIV-infected persons, the rate was 95/100 000, and among persons living with AIDS 14/1000. Males and children under 15 years accounted for 49 and 0.9% of cases, respectively. The median age was 34 years (range, 1 month-74 years). Almost all cases (97%) presented with meningitis. Antifungal therapy was given to 2460 (89%) cases of which 72% received fluconazole only. In-hospital mortality was 27% (749 cases). Recurrences occurred in 263 (9.5%) incident cases. Factors associated with death included altered mental status, coma or wasting; factors associated with survival included employment in the mining industry, visual changes or headache on presentation. CONCLUSIONS This study demonstrates the high disease burden due to cryptococcosis in an antiretroviral-naive South African population and emphasizes the need to improve early recognition, diagnosis and treatment of the condition.
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Affiliation(s)
- Kerrigan M McCarthy
- Mycology Reference Unit, National Institute for Communicable Diseases, National Health Laboratory Service, Division of Virology and Communicable Diseases Surveillance, University of the Witwatersrand, Johannesburg 2000, South Africa.
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Shetty SS, Harrison LH, Hajjeh RA, Taylor T, Mirza SA, Schmidt AB, Sanza LT, Shutt KA, Fridkin SK. Determining risk factors for candidemia among newborn infants from population-based surveillance: Baltimore, Maryland, 1998-2000. Pediatr Infect Dis J 2005; 24:601-4. [PMID: 15999000 DOI: 10.1097/01.inf.0000168751.11375.d6] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [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: 11/26/2022]
Abstract
BACKGROUND Our objective was to determine risks factors for late onset candidemia, independent of birth weight, in newborn infants. METHODS We performed a matched case-control study. Cases were identified through active, population-based surveillance for candidemia, conducted in Baltimore City and County during 1998-2000, and were defined as the incident isolation of any Candida species from the bloodstream of an infant 3 months old or younger. Four controls, matched by age, hospital, birth weight category, hospital stay and admission date, were selected for each case. Potential risk factors included clinical, demographic and maternal prenatal data. RESULTS Of the 35 cases, 19 (54%) infections were with Candida albicans, 9 (26%) were with Candida parapsilosis and 5 (14%) were with Candida glabrata. Cases had a median birth weight of 680 g (range, 430-3200 g); median gestational ages of cases and controls were 25 and 27 weeks, respectively. Compared with controls, cases had significant higher mortality (20% versus 4%; P = 0.004). No maternal factors were associated with increased risk of disease; cases were as likely as controls to be of black race. Multivariable conditional logistic regression analysis revealed that gestational age younger than 26 weeks [adjusted odds ratio, 6.5; 95% confidence interval (95% CI), 1.3-32], vaginal delivery (adjusted odds ratio, 4.3; 95% CI 1.3-14.2) and abdominal surgery (adjusted odds ratio, 10.9; 95% CI 1.9-62) were independently associated with increased risk of candidemia. CONCLUSIONS Independent of birth weight, infants born at <26 weeks or those who have had abdominal surgery are at a significantly increased risk of candidemia. This study helps define a subgroup of preterm infants at high risk of developing bloodstream infections with Candida species.
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MESH Headings
- Baltimore
- Candida/classification
- Candida/isolation & purification
- Candidiasis/epidemiology
- Candidiasis/microbiology
- Candidiasis/mortality
- Case-Control Studies
- Fungemia/epidemiology
- Fungemia/microbiology
- Fungemia/mortality
- Gestational Age
- Humans
- Infant
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/microbiology
- Infant, Premature, Diseases/mortality
- Intensive Care Units, Neonatal
- Population Surveillance
- Retrospective Studies
- Risk Factors
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Affiliation(s)
- Sharmila S Shetty
- Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Chamany S, Mirza SA, Fleming JW, Howell JF, Lenhart SW, Mortimer VD, Phelan MA, Lindsley MD, Iqbal NJ, Wheat LJ, Brandt ME, Warnock DW, Hajjeh RA. A large histoplasmosis outbreak among high school students in Indiana, 2001. Pediatr Infect Dis J 2004; 23:909-14. [PMID: 15602189 DOI: 10.1097/01.inf.0000141738.60845.da] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [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: 11/27/2022]
Abstract
BACKGROUND A histoplasmosis outbreak occurred in an Indiana high school in November-December 2001. METHODS To describe the risk factors for this outbreak, we conducted a cohort study of all available students and staff (N = 682) and an environmental investigation. RESULTS Of the 523 (77%) persons who displayed serologic evidence of recent Histoplasma capsulatum infection, 355 (68%) developed symptoms consistent with acute pulmonary histoplasmosis. Rototilling of soil in a school courtyard known to be a bird roosting site had been performed during school hours on November 12, 2001, 14 days before both the peak of the onset of illness and a rise in student absenteeism. Being a student (odds ratio, 3.3; 95% confidence interval, 2.2-5.0) and being a student in a classroom near the courtyard during the rototilling (odds ratio, 3.1; 95% confidence interval, 1.8-5.2) were independently associated with infection and symptomatic illness. H. capsulatum was isolated from environmental samples, including soil from the courtyard and dust collected from a filter of a heating, ventilating and air-conditioning system. CONCLUSIONS Soil-disrupting activities within a school courtyard caused the largest outbreak to date of histoplasmosis among adolescents. Improved efforts are needed to educate the community in endemic areas about histoplasmosis to prevent the occurrence of such outbreaks in the future. In addition, increased awareness among health care providers of this disease would facilitate appropriate diagnosis and treatment.
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Affiliation(s)
- Shadi Chamany
- Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS C09, Atlanta, GA 30333, USA
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Hajjeh RA, Sofair AN, Harrison LH, Lyon GM, Arthington-Skaggs BA, Mirza SA, Phelan M, Morgan J, Lee-Yang W, Ciblak MA, Benjamin LE, Sanza LT, Huie S, Yeo SF, Brandt ME, Warnock DW. Incidence of bloodstream infections due to Candida species and in vitro susceptibilities of isolates collected from 1998 to 2000 in a population-based active surveillance program. J Clin Microbiol 2004; 42:1519-27. [PMID: 15070998 PMCID: PMC387610 DOI: 10.1128/jcm.42.4.1519-1527.2004] [Citation(s) in RCA: 457] [Impact Index Per Article: 22.9] [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: 10/27/2003] [Revised: 12/15/2003] [Accepted: 01/07/2004] [Indexed: 11/20/2022] Open
Abstract
To determine the incidence of Candida bloodstream infections (BSI) and antifungal drug resistance, population-based active laboratory surveillance was conducted from October 1998 through September 2000 in two areas of the United States (Baltimore, Md., and the state of Connecticut; combined population, 4.7 million). A total of 1,143 cases were detected, for an average adjusted annual incidence of 10 per 100,000 population or 1.5 per 10,000 hospital days. In 28% of patients, Candida BSI developed prior to or on the day of admission; only 36% of patients were in an intensive care unit at the time of diagnosis. No fewer than 78% of patients had a central catheter in place at the time of diagnosis, and 50% had undergone surgery within the previous 3 months. Candida albicans comprised 45% of the isolates, followed by C. glabrata (24%), C. parapsilosis (13%), and C. tropicalis (12%). Only 1.2% of C. albicans isolates were resistant to fluconazole (MIC, > or = 64 microg/ml), compared to 7% of C. glabrata isolates and 6% of C. tropicalis isolates. Only 0.9% of C. albicans isolates were resistant to itraconazole (MIC, > or = 1 micro g/ml), compared to 19.5% of C. glabrata isolates and 6% of C. tropicalis isolates. Only 4.3% of C. albicans isolates were resistant to flucytosine (MIC, > or = 32 microg/ml), compared to < 1% of C. parapsilosis and C. tropicalis isolates and no C. glabrata isolates. As determined by E-test, the MICs of amphotericin B were > or = 0.38 microg/ml for 10% of Candida isolates, > or =1 microg/ml for 1.7% of isolates, and > or = 2 microg/ml for 0.4% of isolates. Our findings highlight changes in the epidemiology of Candida BSI in the 1990s and provide a basis upon which to conduct further studies of selected high-risk subpopulations.
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Affiliation(s)
- Rana A Hajjeh
- Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Morgan J, Cano MV, Feikin DR, Phelan M, Monroy OV, Morales PK, Carpenter J, Weltman A, Spitzer PG, Liu HH, Mirza SA, Bronstein DE, Morgan DJ, Kirkman LA, Brandt ME, Iqbal N, Lindsley MD, Warnock DW, Hajjeh RA. A large outbreak of histoplasmosis among American travelers associated with a hotel in Acapulco, Mexico, spring 2001. Am J Trop Med Hyg 2003; 69:663-9. [PMID: 14740886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
During spring 2001, college students from Pennsylvania reported an acute febrile respiratory illness after returning from spring break vacation in Acapulco, Mexico. Acute pulmonary histoplasmosis was presumptively diagnosed and the cluster of illness was reported to the Centers of Disease Control and Prevention. A large investigation then ensued, which included finding student-travelers for interviews and requesting sera for histoplasmosis testing. We defined a clinical case by fever and at least one of the following: cough, shortness of breath, chest pain, or headache, in an Acapulco traveler during March-May 2001. A laboratory-confirmed case had positive serology. An initial study determined that the likely site of histoplasmosis exposure was Hotel H; we therefore performed a large cohort study among travelers who stayed at Hotel H. Of 757 contacted, 262 (36%) met the clinical case definition. Of 273 serum specimens tested, 148 (54%) were positive. Frequent use of Hotel H's stairwells, where construction was ongoing, was associated with increased risk of illness (relative risk = 10.5, 95% confidence interval = 3.7-30.5; P < 0.001). This is the first histoplasmosis outbreak associated with a hotel undergoing construction. Hotels in endemic areas should consider construction precaution measures to prevent histoplasmosis among their guests.
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Affiliation(s)
- Juliette Morgan
- Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Mirza SA, Phelan M, Rimland D, Graviss E, Hamill R, Brandt ME, Gardner T, Sattah M, de Leon GP, Baughman W, Hajjeh RA. The changing epidemiology of cryptococcosis: an update from population-based active surveillance in 2 large metropolitan areas, 1992-2000. Clin Infect Dis 2003; 36:789-94. [PMID: 12627365 DOI: 10.1086/368091] [Citation(s) in RCA: 283] [Impact Index Per Article: 13.5] [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: 10/07/2002] [Accepted: 11/15/2002] [Indexed: 11/04/2022] Open
Abstract
To examine trends in the incidence and epidemiology of cryptococcosis, active, population-based surveillance was conducted during 1992-2000 in 2 areas of the United States (the Atlanta, Georgia, and Houston, Texas, metropolitan areas; combined population, 7.4 million). A total of 1491 incident cases were detected, of which 1322 (89%) occurred in HIV-infected persons. The annual incidence of cryptococcosis per 1000 persons with AIDS decreased significantly during the study period, from 66 in 1992 to 7 in 2000 in the Atlanta area, and from 24 in 1993 to 2 in 1994 in the Houston area. Poisson regression analysis revealed that African American persons with AIDS were more likely than white persons with AIDS to develop disease. Less than one-third of all HIV-infected persons with cryptococcosis were receiving antiretroviral therapy before diagnosis. Our findings suggest that HIV-infected persons who continue to develop cryptococcosis in the era of highly active antiretroviral therapy (HAART) in the United States are those with limited access to health care. More efforts are needed to expand the availability of HAART and routine HIV care services to these persons.
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Affiliation(s)
- Sara A Mirza
- Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Abstract
PURPOSE To assess the incidence of surgically induced miosis during phacoemulsification in diabetic patients. METHODS A total of 76 patients with diabetes mellitus were compared to 76 age- and race-matched controls. A combination of cyclopentolate 1%, phenylephrine 2.5% and diclofenac sodium 0.1% was applied topically 60, 45 and 30 min before surgery. Adrenaline mixed with buffered saline solution was used for irrigation during surgery. The procedure included phacoemulsification and implantation into the bag of a foldable acrylic implant. Measurements of the horizontal pupillary diameter were taken at three stages: before corneal incision, after phacoemulsification, and at the end of surgery. The duration of phacoemulsification was also recorded. RESULTS Surgically induced miosis or dilation of the pupil was defined as constriction or dilation noted at any interval during surgery. The pairs of diabetic-control were grouped into three groups: those in which constriction was noted, those in which dilation was noted, and those in which there was no change in pupil size during the procedure. Surgically induced miosis was noted more often in the diabetics (McNemar's test, chi(2), P=0.016). The mean pupil size at the beginning of surgery was 7.38 (+/-0.95) mm in the diabetics as compared to 7.65 (+/-0.89) mm in the control group. No statistically significant difference was noted between the two groups (paired t-test, P=0.07). The mean (+/-SD) duration of phacoemulsification in the diabetic group was 2.31 (+/-1) min as compared to 2.05 (+/-0.82) min in the control group. No statistically significant difference was found between the two groups (paired t-test, P=0.08). CONCLUSION Surgically induced miosis occurred more often in the diabetics. Therefore, it is advisable that phacoemulsification in this group of patients is undertaken by an experienced surgeon.
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Affiliation(s)
- S A Mirza
- Birmingham and Midland Eye Centre, City Hospital, UK
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Affiliation(s)
- B N Matthews
- Birmingham and Midland Eye Centre, City Hospital, B18 7QH, Birmingham, UK
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Calles-Escandon J, Mirza SA, Sobel BE, Schneider DJ. Induction of hyperinsulinemia combined with hyperglycemia and hypertriglyceridemia increases plasminogen activator inhibitor 1 in blood in normal human subjects. Diabetes 1998; 47:290-3. [PMID: 9519730 DOI: 10.2337/diab.47.2.290] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.6] [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: 02/06/2023]
Abstract
Hypofibrinolysis caused by increased plasminogen activator inhibitor 1 (PAI-1) has been implicated in the vasculopathy of type 2 diabetes, typified by increased insulin, glucose, and triglycerides. However, short-term infusions of insulin have not increased PAI-1 in normal subjects. We hypothesized that induction of increased insulin accompanied by increased glucose and triglycerides would increase PAI-1. Accordingly, 30% glucose and 10% Intralipid were infused for 6 h in ten normal lean individuals (54 +/- 3 years) resulting in increased insulin (42 +/- 5 microU/dl), glucose (200 +/- 24 mg/dl), and triglycerides (425 +/- 45 mg/dl), simulating changes in type 2 diabetes. In contrast to results with infusion of saline alone (n = 16) and euglycemic-hyperinsulinemic clamps (n = 10, serum insulin = 89 +/- 7 microU/dl), PAI-1 in blood increased significantly 6 h after the onset of infusion (15 +/- 5 ng/ml, P < 0.05 vs. baseline = 7.4 +/- 1.1, saline 6 h = 3.4 +/- 1.1, and insulin alone 6 h = 3.7 +/- 0.8) and remained elevated for an additional 6 h (combined infusion = 13.8 +/- 3.8 ng/ml, saline = 6.7 +/- 2 ng/ml, insulin alone = 7.8 +/- 1.7 ng/ml, P = 0.06). Our data suggest that combined hyperinsulinemia, hypertriglyceridemia, and hyperglycemia are likely to contribute to hypofibrinolysis of type 2 diabetes by increasing the blood levels of PAI-1. Moreover, these results underscore the potential importance of modifying insulin resistance as well as achieving glycemic and lipidemic control in individuals with type 2 diabetes.
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Affiliation(s)
- J Calles-Escandon
- Department of Medicine, The University of Vermont College of Medicine, Burlington 05405, USA.
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Rousseau J, Sikorska HM, Gervais A, Bisson G, Margaron P, Lamoureux G, Mirza SA, van Lier JE. Evaluation of a 99mTc-antimyosin kit for myocardial infarct imaging. J Nucl Biol Med (1991) 1994; 38:43-53. [PMID: 7632767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The Fab fragment of a mouse monoclonal antibody AM(3-48) that recognizes alpha and beta-heavy chains of human atrial and ventricular myosin and beta-heavy chain of human slow skeletal muscle myosin [CardioVisionTM] was labeled with 99mTc using stannous reductant in a simple, instant kit method. The infarcted heart uptake in dogs of 99mTc-AM(3-48)Fab' was compared with that of established radiopharmaceuticals routinely used for cardiac imaging in humans. The dog infarct was induced by bringing a catheter from the femoral artery to the coronary artery where an artificial blood clot was generated. The 99mTc-AM(3-48)Fab' preparation was selectively taken up by infarcted myocardium, resulting in diagnostic quality images of the infarcted area as early as 6 hour post-injection, rendering CardioVisionTM particularly useful for SPECT imaging. Good agreement was found between the images obtained with 99mTc-Pyrophosphate and those obtained with 99mTc-AM(3-48)Fab', while the infarcted area was clearly delineated as a cold spot with 99mTc-MIBI or 201 Tl-thallous chloride. The biodistribution of 99mTc-AM(3-48)Fab' was also studied in healthy and isoproterenol-infarcted rats, from which dosimetry values in man were extrapolated. The data indicate that the kidneys will receive the highest radiation dose and that they will be the main contributors to the total radiation burden, which was estimated at 0.005 rad/mCi.
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Affiliation(s)
- J Rousseau
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine, Université de Sherbrooke, Québec, Canada
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