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Goel K, Naithani S, Bhatt D, Khera A, Sharapov UM, Kriss JL, Goodson JL, Laserson KF, Goel P, Kumar RM, Chauhan LS. The World Health Organization Measles Programmatic Risk Assessment Tool-Pilot Testing in India, 2014. Risk Anal 2017; 37:1063-1071. [PMID: 27088758 DOI: 10.1111/risa.12615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 02/05/2016] [Accepted: 02/10/2016] [Indexed: 06/05/2023]
Abstract
Measles is a leading cause of child mortality, and reduction of child mortality is a key Millennium Development Goal. In 2014, the World Health Organization and the U.S. Centers for Disease Control and Prevention developed a measles programmatic risk assessment tool to support country measles elimination efforts. The tool was pilot tested in the State of Uttarakhand in August 2014 to assess its utility in India. The tool assessed measles risk for the 13 districts of Uttarakhand as a function of indicator scores in four categories: population immunity, surveillance quality, program delivery performance, and threat. The highest potential overall score was 100. Scores from each category were totaled to assign an overall risk score for each district. From this risk score, districts were categorized as low, medium, high, or very high risk. Of the 13 districts in Uttarakhand in 2014, the tool classified one district (Haridwar) as very high risk and three districts (Almora, Champawat, and Pauri Garhwal) as high risk. The measles risk in these four districts was largely due to low population immunity from high MCV1-MCV2 drop-out rates, low MCV1 and MCV2 coverage, and the lack of a supplementary immunization activity (SIA) within the past three years. This tool can be used to support measles elimination in India by identifying districts that might be at risk for measles outbreaks, and to guide risk mitigation efforts, including strengthening routine immunization services and implementing SIAs.
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Affiliation(s)
- Kapil Goel
- India Epidemic Intelligence Service, India Centers for Disease Control and Prevention, Delhi, India
| | | | | | - Ajay Khera
- Ministry of Health & Family Welfare, Immunization & Child Health, Delhi, India
| | - Umid M Sharapov
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Global Immunization Division, Atlanta, GA, USA
| | - Jennifer L Kriss
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Global Immunization Division, Atlanta, GA, USA
| | - James L Goodson
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Global Immunization Division, Atlanta, GA, USA
| | - Kayla F Laserson
- India Centers for Disease Control and Prevention, Division of Global Health Protection, Delhi, India
| | - Parul Goel
- India Epidemic Intelligence Service, India Centers for Disease Control and Prevention, Delhi, India
| | - R Mohan Kumar
- India Epidemic Intelligence Service, India Centers for Disease Control and Prevention, Delhi, India
| | - L S Chauhan
- National Center for Disease Control, Delhi, India
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Sharapov UM, Wendel AM, Davis JP, Keene WE, Farrar J, Sodha S, Hyytia-Trees E, Leeper M, Gerner-Smidt P, Griffin PM, Braden C. Multistate Outbreak of Escherichia coli O157:H7 Infections Associated with Consumption of Fresh Spinach: United States, 2006. J Food Prot 2016; 79:2024-2030. [PMID: 28221950 DOI: 10.4315/0362-028x.jfp-15-556] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
During September to October, 2006, state and local health departments and the Centers for Disease Control and Prevention investigated a large, multistate outbreak of Escherichia coli O157:H7 infections. Case patients were interviewed regarding specific foods consumed and other possible exposures. E. coli O157:H7 strains isolated from human and food specimens were subtyped using pulsed-field gel electrophoresis and multiple-locus variable-number tandem repeat analyses (MLVA). Two hundred twenty-five cases (191 confirmed and 34 probable) were identified in 27 states; 116 (56%) case patients were hospitalized, 39 (19%) developed hemolytic uremic syndrome, and 5 (2%) died. Among 176 case patients from whom E. coli O157:H7 with the outbreak genotype (MLVA outbreak strain) was isolated and who provided details regarding spinach exposure, 161 (91%) reported fresh spinach consumption during the 10 days before illness began. Among 116 patients who provided spinach brand information, 106 (91%) consumed bagged brand A. E. coli O157:H7 strains were isolated from 13 bags of brand A spinach collected from patients' homes; isolates from 12 bags had the same MLVA pattern. Comprehensive epidemiologic and laboratory investigations associated this large multistate outbreak of E. coli O157:H7 infections with consumption of fresh bagged spinach. MLVA, as a supplement to pulsed-field gel electrophoresis genotyping of case patient isolates, was important to discern outbreak-related cases. This outbreak resulted in enhanced federal and industry guidance to improve the safety of leafy green vegetables and launched an independent collaborative approach to produce safety research in 2007.
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Affiliation(s)
- Umid M Sharapov
- Epidemic Intelligence Service, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329.,Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329
| | - Arthur M Wendel
- Epidemic Intelligence Service, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329.,Wisconsin Division of Public Health, 1 West Wilson Street, P.O. Box 2659, Madison, Wisconsin 53703
| | - Jeffrey P Davis
- Wisconsin Division of Public Health, 1 West Wilson Street, P.O. Box 2659, Madison, Wisconsin 53703
| | - William E Keene
- Oregon Public Health Division, 800 N.E. Oregon Street, Portland, Oregon 97232
| | - Jeffrey Farrar
- California Department of Health Services, P.O. Box 997377, MS 0500, Sacramento, California 95899, USA
| | - Samir Sodha
- Epidemic Intelligence Service, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329.,Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329
| | - Eija Hyytia-Trees
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329
| | - Molly Leeper
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329
| | - Peter Gerner-Smidt
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329
| | - Patricia M Griffin
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329
| | - Chris Braden
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329
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Sharapov UM, Kentenyants K, Groeger J, Roberts H, Holmberg SD, Collier MG. Hepatitis A Infections Among Food Handlers in the United States, 1993-2011. Public Health Rep 2016; 131:26-9. [PMID: 26843666 DOI: 10.1177/003335491613100107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We reviewed news reports of hepatitis A virus (HAV)-infected food handlers in the United States from 1993 to 2011 using the LexisNexis® search engine. Using U.S. news reports, we identified 192 HAV-infected food handlers who worked while infectious; of these HAV-infected individuals, 34 (18%) transmitted HAV to restaurant patrons. News reports of HAV-infected food handlers declined from 1993 to 2011. This analysis suggests that universal childhood vaccination contributed to the decrease in reports of HAV-infected food handlers, but mandatory vaccination of this group is unlikely to be cost-effective.
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Affiliation(s)
- Umid M Sharapov
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, GA
| | - Karine Kentenyants
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, GA; Emory University, Rollins School of Public Health, Atlanta, GA
| | - Justina Groeger
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, GA; Emory University, Rollins School of Public Health, Atlanta, GA
| | - Henry Roberts
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, GA
| | - Scott D Holmberg
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, GA
| | - Melissa G Collier
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, GA
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Khanal S, Sedai TR, Choudary GR, Giri JN, Bohara R, Pant R, Gautam M, Sharapov UM, Goodson JL, Alexander J, Dabbagh A, Strebel P, Perry RT, Bah S, Abeysinghe N, Thapa A. Progress Toward Measles Elimination - Nepal, 2007-2014. MMWR Morb Mortal Wkly Rep 2016; 65:206-10. [PMID: 26937619 DOI: 10.15585/mmwr.mm6508a3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
In 2013, the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region (SEAR) established a goal to eliminate measles and to control rubella and congenital rubella syndrome (CRS) in SEAR by 2020. Current recommended measles elimination strategies in the region include 1) achieving and maintaining ≥95% coverage with 2 doses of measles-containing vaccine (MCV) in every district, delivered through the routine immunization program or through supplementary immunization activities (SIAs); 2) developing and sustaining a sensitive and timely measles case-based surveillance system that meets minimum recommended performance indicators; 3) developing and maintaining an accredited measles laboratory network; and 4) achieving timely identification, investigation, and response to measles outbreaks. In 2013, Nepal, one of the 11 SEAR member states, adopted a goal for national measles elimination by 2019. This report updates a previous report and summarizes progress toward measles elimination in Nepal during 2007-2014. During 2007-2014, estimated coverage with the first MCV dose (MCV1) increased from 81% to 88%. Approximately 3.9 and 9.7 million children were vaccinated in SIAs conducted in 2008 and 2014, respectively. Reported suspected measles incidence declined by 13% during 2007-2014, from 54 to 47 cases per 1 million population. However, in 2014, 81% of districts did not meet the measles case-based surveillance performance indicator target of ≥2 discarded non-measles cases per 100,000 population per year. To achieve and maintain measles elimination, additional measures are needed to strengthen routine immunization services to increase coverage with MCV1 and a recently introduced second dose of MCV (MCV2) to ≥95% in all districts, and to enhance sensitivity of measles case-based surveillance by adopting a more sensitive case definition, expanding case-based surveillance sites nationwide, and ensuring timely transport of specimens to the accredited national laboratory.
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Te HS, Drobeniuc J, Kamili S, Dong C, Hart J, Sharapov UM. Hepatitis E virus infection in a liver transplant recipient in the United States: a case report. Transplant Proc 2013; 45:810-3. [PMID: 23498824 DOI: 10.1016/j.transproceed.2012.08.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 08/28/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic infection with hepatitis E virus (HEV) has recently been recognized in immunocompromised or immunosuppressed individuals. CASE REPORT We report a case of concurrent HEV and human herpes virus-6 (HHV-6) infection, documented by serum HEV RNA and HHV-6 DNA, in an orthotopic liver transplant (OLT) recipient in the United States, where HEV genotype 3 infection, although prevalent, is considered to be self-limited and almost always asymptomatic. The coinfection was accompanied by elevated serum aminotransaminases, liver biopsies demonstrating chronic hepatitis, and the presence of HEV RNA in the tissue. After lowering of immunosuppressive therapy and 2 courses of valganciclovir, sequential clearance of the viruses and normalization of the serum aminotransaminases were observed. CONCLUSIONS HEV infection can lead to chronic hepatitis in OLT recipients, and evaluation of this virus should be considered in immunosuppressed individuals with unexplained liver test abnormalities.
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Affiliation(s)
- H S Te
- Center for Liver Diseases, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA.
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Drobeniuc J, Greene-Montfort T, Le NT, Mixson-Hayden TR, Ganova-Raeva L, Dong C, Novak RT, Sharapov UM, Tohme RA, Teshale E, Kamili S, Teo CG. Laboratory-based surveillance for hepatitis E virus infection, United States, 2005-2012. Emerg Infect Dis 2013; 19:218-22; quiz 353. [PMID: 23347695 PMCID: PMC3563276 DOI: 10.3201/eid1902.120961] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Clinicians should consider this virus in the differential diagnosis of hepatitis, regardless of patient travel history.
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Affiliation(s)
- Jan Drobeniuc
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Raczniak GA, Bulkow LR, Bruce MG, Zanis CL, Baum RL, Snowball MM, Byrd KK, Sharapov UM, Hennessy TW, McMahon BJ. Long-term immunogenicity of hepatitis A virus vaccine in Alaska 17 years after initial childhood series. J Infect Dis 2012. [PMID: 23204169 DOI: 10.1093/infdis/jis710] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Centers for Disease Control and Prevention recommends hepatitis A virus (HAV) vaccination for all children at age 1 year and for high-risk adults. The vaccine is highly effective; however, protection duration is unknown. We report HAV antibody concentrations 17 years after childhood immunization, demonstrating that protective antibody levels remain and have stabilized over the past 7 years.
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Affiliation(s)
- Gregory A Raczniak
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Sharapov UM, Bulkow LR, Negus SE, Spradling PR, Homan C, Drobeniuc J, Bruce M, Kamili S, Hu DJ, McMahon BJ. Persistence of hepatitis A vaccine induced seropositivity in infants and young children by maternal antibody status: 10-year follow-up. Hepatology 2012; 56:516-22. [PMID: 22371069 DOI: 10.1002/hep.25687] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 02/17/2012] [Indexed: 12/13/2022]
Abstract
UNLABELLED Persistence of seropositivity conferred by hepatitis A vaccine administered to children <2 years of age is unknown and passively transferred maternal antibodies to hepatitis A virus (maternal anti-HAV) may lower the infant's immune response to the vaccine. One hundred ninety-seven infants and young children were randomized into three groups to receive a two-dose hepatitis A vaccine: group 1 at 6 and 12 months, group 2 at 12 and 18 months, and group 3 at 15 and 21 months of age. Within each group, infants were randomized by maternal anti-HAV status. Anti-HAV levels were measured at 1 and 6 months and at 3, 5, 7, and 10 years after the second dose of hepatitis A vaccination. Children in all groups had evidence of seroprotection (>10 mIU/mL) at 1 month after the second dose. At 10 years, all children retained seroprotective anti-HAV levels except for only 7% and 11% of children in group 1 born to anti-HAV-negative and anti-HAV-positive mothers, respectively, and 4% of group 3 children born to anti-HAV-negative mothers. At 10 years, children born to anti-HAV-negative mothers in group 3 had the highest geometric mean concentration (GMC) (97 mIU/mL; 95% confidence interval, 71-133 mIU/mL) and children born to anti-HAV-positive mothers in group 1 had the lowest GMC (29 mIU/mL; 95% confidence interval, 20-40 mIU/mL). Anti-HAV levels through 10 years of age correlated with initial peak anti-HAV levels (tested at 1 month after the second dose). CONCLUSION The seropositivity induced by hepatitis A vaccine given to children <2 years of age persists for at least 10 years regardless of presence of maternal anti-HAV.
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Affiliation(s)
- Umid M Sharapov
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Williams RE, Sena AC, Moorman AC, Moore ZS, Sharapov UM, Drobenuic J, Hu DJ, Wood HW, Xing J, Spradling PR. Hepatitis B vaccination of susceptible elderly residents of long term care facilities during a hepatitis B outbreak. Vaccine 2012; 30:3147-50. [PMID: 22421557 DOI: 10.1016/j.vaccine.2012.02.078] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 02/20/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
Abstract
Protection of older persons, particularly those with diabetes, against hepatitis B virus (HBV) infection is of growing concern because of increased reports of outbreaks among long-term care facility residents receiving assisted blood glucose monitoring. We evaluated hepatitis B vaccine immunogenicity among residents immunized in response to two such outbreaks in skilled nursing facilities during June 2009-July 2010. One hundred forty-eight (71%) of 209 residents were found to be susceptible to HBV infection. Of 105 patients who began a vaccination series with Twinrix(®) (0-, 1-, 6-month dosing), 86 (82%) completed the series and postvaccination testing. Of these, most were elderly (median age 79.5 years; range 45-101), female (56%), and African-American (51%). Twenty-nine (34%) vaccinated residents had post-vaccination hepatitis B surface antibody levels ≥10 mIU/ml. There were no significant differences in vaccine response by age, gender, race, diabetes status, body mass index, or current smoking status. Our findings indicate that a low proportion of skilled nursing facility residents achieved a seroprotective response after hepatitis B vaccination.
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Affiliation(s)
- Roxanne E Williams
- Division of Viral Hepatitis, Centers for Disease Control, Prevention, Atlanta, GA, United States
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Pelletier AR, Mehta PJ, Burgess DR, Bondeson LM, Carson PJ, Rea VE, Sharapov UM, Hu DJ. An outbreak of hepatitis A among primary and secondary contacts of an international adoptee. Public Health Rep 2010; 125:642-6. [PMID: 20873279 DOI: 10.1177/003335491012500505] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Advisory Committee on Immunization Practices recommends that susceptible people traveling to developing countries receive hepatitis A vaccine or immune globulin prior to departure. Until 2009, the recommendations did not address non-traveling family members or other close contacts of international adoptees. We report an outbreak of hepatitis A in 2008 that occurred in Maine. Eight members of an extended family developed hepatitis A following the arrival of an asymptomatic infant from Ethiopia who was brought to the United States by an adoption agency. Two children in the family attended an elementary school where five additional cases of hepatitis A were subsequently identified. Only three (1%) of 208 students at the school had previously been immunized against hepatitis A. This outbreak highlights the need to immunize household members and other close contacts of families adopting children from countries where hepatitis A is endemic, as well as all children at one year of age.
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Sharapov UM, Hu DJ. Viral hepatitis A, B, and C: grown-up issues. Adolesc Med State Art Rev 2010; 21:265-ix. [PMID: 21047029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Viral hepatitis is a major global health problem associated with significant morbidity and mortality. Although there are five major and distinct human hepatitis viruses characterized to date--referred to as hepatitis A, B, C, D, and E, respectively--only hepatitis A, B, and C are epidemiologically and clinically relevant for adolescents in North America. The clinical presentation of acute infection with each of these viruses is similar; thus, diagnosis depends on the use of specific serologic markers and viral nucleic acids. This review provides data on the epidemiology, clinical symptoms, diagnosis, treatment, and prevention of each of these three viral infections, along with points that are important or unique to adolescent patients.
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Affiliation(s)
- Umid M Sharapov
- Division of Viral Hepatitis, National Center for HIV/AIDS, VH, STD, and TB Prevention, Centers for Disease Control and Prevention, MS G-37, 1600 Clifton Road, Atlanta, Georgia 30333, USA.
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