1
|
McAuley JB. COVID at the Whiteriver Indian Hospital. Clin Infect Dis 2024; 78:815-817. [PMID: 37791954 DOI: 10.1093/cid/ciad579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/12/2023] [Accepted: 10/02/2023] [Indexed: 10/05/2023] Open
Affiliation(s)
- James B McAuley
- Medical Staff Office, Whiteriver Indian Hospital, 200 W. Hospital Drive, PO Box 860, Whiteriver, Arizona 85941, USA
| |
Collapse
|
2
|
Close RM, Lutz CS, Jones TS, Stone M, Bratsch N, Thompson T, Jentoft C, McAuley JB. Characteristics and outcomes of a hospitalized cohort with reduced mortality from COVID-19, White Mountain apache tribal lands, April 1 - July 31, 2020. BMC Public Health 2024; 24:648. [PMID: 38424548 PMCID: PMC10905852 DOI: 10.1186/s12889-024-18098-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Widespread transmission of COVID-19 continues to threaten public health, particularly of rural, American Indian communities. Although COVID-19 risk factors for severe disease and clinical characteristics are well described in the general population, there has been little shared on hospitalized American Indian populations. METHODS In this observational study, we performed chart extractions on all persons hospitalized with COVID-19 from April 1 through July 31, 2020 among an exclusively American Indian population living on or near Tribal lands in eastern Arizona. We provide descriptive statistics for the cohort stratified by presentation, comparing those who self-presented or were referred by an outreach program. Exploratory analyses were performed to identify risk factors for morbidity and mortality. RESULTS During the observation period, 2262 persons were diagnosed with COVID-19 and 490 (22%) were hospitalized. Hospitalized persons had a median age of 54 years; 92% had at least one comorbidity, 72% had greater than one comorbidity, and 60% had a BMI of > 30. Most persons required supplemental oxygen (83%), but the majority (62%) only required nasal cannula and only 11% were intubated. The case fatality rates were 1.7% for the population, 7.1% among hospitalizations, and 9.3% among hospitalized patients 50 years and older. All rates that are significantly lower than those reported nationally during the same period. CONCLUSIONS We observed a cohort of American Indian patients hospitalized secondary to COVID-19 with greater number of comorbidities compared to the general population but with lower mortality rates. We posit that the primary driver of mortality reduction for this population and the hospitalized cohort was a community-based referral program that led to disproportionately lower fatality rates among the oldest persons.
Collapse
Affiliation(s)
- Ryan M Close
- Whiteriver Service Unit, Indian Health Service, 200 W. Hospital Drive, Whiteriver, AZ, 85941, USA.
- Maine Medical Center, MaineHealth, Portland, ME, USA.
| | - Chelsea S Lutz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - T Shaifer Jones
- Whiteriver Service Unit, Indian Health Service, 200 W. Hospital Drive, Whiteriver, AZ, 85941, USA
| | - Myles Stone
- United States Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Nicole Bratsch
- Whiteriver Service Unit, Indian Health Service, 200 W. Hospital Drive, Whiteriver, AZ, 85941, USA
| | - Trevor Thompson
- Whiteriver Service Unit, Indian Health Service, 200 W. Hospital Drive, Whiteriver, AZ, 85941, USA
- United States Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Christopher Jentoft
- Whiteriver Service Unit, Indian Health Service, 200 W. Hospital Drive, Whiteriver, AZ, 85941, USA
| | - James B McAuley
- Whiteriver Service Unit, Indian Health Service, 200 W. Hospital Drive, Whiteriver, AZ, 85941, USA
| |
Collapse
|
3
|
Close RM, Palmer AS, McAuley JB. Potential Benefits of Expanded Palivizumab in American Indian Children Under the Age of 2 Years. J Pediatric Infect Dis Soc 2023; 12:522-524. [PMID: 37671822 DOI: 10.1093/jpids/piad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Indexed: 09/07/2023]
Abstract
Severe respiratory syncytial virus (RSV) infections disparately impact American Indian communities. We implemented a program that expanded palivizumab to all children under 2 years of age that led to significant reductions in RSV infections and hospitalizations for both high-risk and non-high-risk recipients in a rural American Indian community in Eastern Arizona.
Collapse
Affiliation(s)
- Ryan M Close
- Whiteriver Service Unit, Indian Health Service, Whiteriver, Arizona, USA
| | - Alvin S Palmer
- Whiteriver Service Unit, Indian Health Service, Whiteriver, Arizona, USA
| | - James B McAuley
- Whiteriver Service Unit, Indian Health Service, Whiteriver, Arizona, USA
| |
Collapse
|
4
|
Close RM, Coles K, Enos LA, Nashio JT, McAuley JB. Innovative and Integrated Contact Tracing: Indian Health Service, Arizona, December 2020-January 2021. Public Health Rep 2022; 137:51S-55S. [PMID: 35189766 PMCID: PMC9679940 DOI: 10.1177/00333549221074388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 11/16/2022] Open
Abstract
SARS-CoV-2 has exposed limitations of public health mitigation measures such as traditional case investigations and contact tracing. The Whiteriver Service Unit is a rural, acute care hospital on the Fort Apache Indian Reservation in Arizona with integrated health care delivery and public health services. During the first wave of COVID-19 cases in May-June 2020, we developed an innovative case investigation contact tracing approach that relied heavily on cross-trained personnel, in-person encounters, and baseline clinical evaluations. A second COVID-19 surge during December 13, 2020-January 31, 2021, caused incidence to peak at 413 cases per 100 000 community members. During that second surge, we investigated all 769 newly identified COVID-19 cases and notified 1911 (99.4%) of 1922 reported contacts. Median time interval from nasopharyngeal specimen collection to both case investigation and contact notification was 0 days (range, 0-5 days and 0-13 days, respectively). Our primary lesson was the importance of cross-trained personnel who integrated tasks along the testing-tracing continuum (eg, in-person interviews, prompt referral for additional testing and evaluation). These successive steps fed forward to identify new cases and their respective contacts. Our innovative community-based approach was both successful and efficient; our experience suggests that when adapted based on local needs, case investigation and contact tracing remain valuable and feasible public health tools, even in rural, resource-limited settings.
Collapse
Affiliation(s)
- Ryan M Close
- Whiteriver Indian Hospital, Indian Health Service, Whiteriver, AZ, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kateri Coles
- Whiteriver Indian Hospital, Indian Health Service, Whiteriver, AZ, USA
| | - Laura A Enos
- Whiteriver Indian Hospital, Indian Health Service, Whiteriver, AZ, USA
| | - J T Nashio
- Division of Health Programs, White Mountain Apache Tribe, Whiteriver, AZ, USA
| | - James B McAuley
- Whiteriver Indian Hospital, Indian Health Service, Whiteriver, AZ, USA
- University of Arizona College of Medicine, Department of Medicine, Tucson, AZ, USA
| |
Collapse
|
5
|
Close RM, Sutcliffe CG, Galdun P, Reid A, Askew MR, Davidson AM, Kellywood K, Parker D, Patel J, Romancito E, Brown LB, McAuley JB, Hammitt LL. Point-of-care molecular diagnostics for the detection of group A Streptococcus in non-invasive skin and soft tissue infections: a validation study. Diagn Microbiol Infect Dis 2022; 103:115729. [DOI: 10.1016/j.diagmicrobio.2022.115729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 01/21/2023]
|
6
|
Stone MJ, Close RM, Jentoft CK, Pocock K, Lee-Gatewood G, Grow BI, Parker KH, Twarkins A, Nashio JT, McAuley JB. High-Risk Outreach for COVID-19 Mortality Reduction in an Indigenous Community. Am J Public Health 2021; 111:1939-1941. [PMID: 34648378 PMCID: PMC8630494 DOI: 10.2105/ajph.2021.306472] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 12/15/2022]
Abstract
Indigenous populations have been disproportionally affected by COVID-19, particularly those in rural and remote locations. Their unique environments and risk factors demand an equally unique public health response. Our rural Native American community experienced one of the highest prevalence outbreaks in the world, and we developed an aggressive management strategy that appears to have had a considerable effect on mortality reduction. The results have implications far beyond pandemic response, and have reframed how our community addresses several complicated health challenges. (Am J Public Health. 2021;111(11):1939-1941. https://doi.org/10.2105/AJPH.2021.306472).
Collapse
Affiliation(s)
- Myles J Stone
- Myles J. Stone and Kristen H. Parker are with the US Public Health Service Commissioned Corps, Rockville, MD. Ryan M. Close, Christopher K. Jentoft, Katherine Pocock, April Twarkins, and James B. McAuley are with the Whiteriver Indian Hospital, Whiteriver, AZ. Gwendena Lee-Gatewood and J. T. Nashio are with the White Mountain Apache Tribe, Whiteriver, AZ. Brooke I. Grow is with the Johns Hopkins Center for American Indian Health, Whiteriver, AZ
| | - Ryan M Close
- Myles J. Stone and Kristen H. Parker are with the US Public Health Service Commissioned Corps, Rockville, MD. Ryan M. Close, Christopher K. Jentoft, Katherine Pocock, April Twarkins, and James B. McAuley are with the Whiteriver Indian Hospital, Whiteriver, AZ. Gwendena Lee-Gatewood and J. T. Nashio are with the White Mountain Apache Tribe, Whiteriver, AZ. Brooke I. Grow is with the Johns Hopkins Center for American Indian Health, Whiteriver, AZ
| | - Christopher K Jentoft
- Myles J. Stone and Kristen H. Parker are with the US Public Health Service Commissioned Corps, Rockville, MD. Ryan M. Close, Christopher K. Jentoft, Katherine Pocock, April Twarkins, and James B. McAuley are with the Whiteriver Indian Hospital, Whiteriver, AZ. Gwendena Lee-Gatewood and J. T. Nashio are with the White Mountain Apache Tribe, Whiteriver, AZ. Brooke I. Grow is with the Johns Hopkins Center for American Indian Health, Whiteriver, AZ
| | - Katherine Pocock
- Myles J. Stone and Kristen H. Parker are with the US Public Health Service Commissioned Corps, Rockville, MD. Ryan M. Close, Christopher K. Jentoft, Katherine Pocock, April Twarkins, and James B. McAuley are with the Whiteriver Indian Hospital, Whiteriver, AZ. Gwendena Lee-Gatewood and J. T. Nashio are with the White Mountain Apache Tribe, Whiteriver, AZ. Brooke I. Grow is with the Johns Hopkins Center for American Indian Health, Whiteriver, AZ
| | - Gwendena Lee-Gatewood
- Myles J. Stone and Kristen H. Parker are with the US Public Health Service Commissioned Corps, Rockville, MD. Ryan M. Close, Christopher K. Jentoft, Katherine Pocock, April Twarkins, and James B. McAuley are with the Whiteriver Indian Hospital, Whiteriver, AZ. Gwendena Lee-Gatewood and J. T. Nashio are with the White Mountain Apache Tribe, Whiteriver, AZ. Brooke I. Grow is with the Johns Hopkins Center for American Indian Health, Whiteriver, AZ
| | - Brooke I Grow
- Myles J. Stone and Kristen H. Parker are with the US Public Health Service Commissioned Corps, Rockville, MD. Ryan M. Close, Christopher K. Jentoft, Katherine Pocock, April Twarkins, and James B. McAuley are with the Whiteriver Indian Hospital, Whiteriver, AZ. Gwendena Lee-Gatewood and J. T. Nashio are with the White Mountain Apache Tribe, Whiteriver, AZ. Brooke I. Grow is with the Johns Hopkins Center for American Indian Health, Whiteriver, AZ
| | - Kristen H Parker
- Myles J. Stone and Kristen H. Parker are with the US Public Health Service Commissioned Corps, Rockville, MD. Ryan M. Close, Christopher K. Jentoft, Katherine Pocock, April Twarkins, and James B. McAuley are with the Whiteriver Indian Hospital, Whiteriver, AZ. Gwendena Lee-Gatewood and J. T. Nashio are with the White Mountain Apache Tribe, Whiteriver, AZ. Brooke I. Grow is with the Johns Hopkins Center for American Indian Health, Whiteriver, AZ
| | - April Twarkins
- Myles J. Stone and Kristen H. Parker are with the US Public Health Service Commissioned Corps, Rockville, MD. Ryan M. Close, Christopher K. Jentoft, Katherine Pocock, April Twarkins, and James B. McAuley are with the Whiteriver Indian Hospital, Whiteriver, AZ. Gwendena Lee-Gatewood and J. T. Nashio are with the White Mountain Apache Tribe, Whiteriver, AZ. Brooke I. Grow is with the Johns Hopkins Center for American Indian Health, Whiteriver, AZ
| | - J T Nashio
- Myles J. Stone and Kristen H. Parker are with the US Public Health Service Commissioned Corps, Rockville, MD. Ryan M. Close, Christopher K. Jentoft, Katherine Pocock, April Twarkins, and James B. McAuley are with the Whiteriver Indian Hospital, Whiteriver, AZ. Gwendena Lee-Gatewood and J. T. Nashio are with the White Mountain Apache Tribe, Whiteriver, AZ. Brooke I. Grow is with the Johns Hopkins Center for American Indian Health, Whiteriver, AZ
| | - James B McAuley
- Myles J. Stone and Kristen H. Parker are with the US Public Health Service Commissioned Corps, Rockville, MD. Ryan M. Close, Christopher K. Jentoft, Katherine Pocock, April Twarkins, and James B. McAuley are with the Whiteriver Indian Hospital, Whiteriver, AZ. Gwendena Lee-Gatewood and J. T. Nashio are with the White Mountain Apache Tribe, Whiteriver, AZ. Brooke I. Grow is with the Johns Hopkins Center for American Indian Health, Whiteriver, AZ
| |
Collapse
|
7
|
Close RM, Jones TS, Jentoft C, McAuley JB. Outcome Comparison of High-Risk Native American Patients Who Did or Did Not Receive Monoclonal Antibody Treatment for COVID-19. JAMA Netw Open 2021; 4:e2125866. [PMID: 34546375 PMCID: PMC8456379 DOI: 10.1001/jamanetworkopen.2021.25866] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/30/2022] Open
Abstract
This quality improvement study compares outcomes among high-risk Native American patients who did or did not receive monoclonal antibody treatment for COVID-19.
Collapse
Affiliation(s)
- Ryan M. Close
- Whiteriver Indian Hospital, Indian Health Service, Whiteriver, Arizona
| | - T. Shaifer Jones
- Whiteriver Indian Hospital, Indian Health Service, Whiteriver, Arizona
| | | | - James B. McAuley
- Whiteriver Indian Hospital, Indian Health Service, Whiteriver, Arizona
| |
Collapse
|
8
|
Abstract
Active surveillance of invasive group A Streptococcus (iGAS) disease indicates that its incidence in the US general population is low, but limited studies show rates for American Indians and Alaska Natives (AI/AN) are severalfold higher. Major disparities in rates of iGAS exist between Indigenous and non-Indigenous populations of Australia, New Zealand, and Canada, but much less is understood about iGAS among AI/AN in the United States. Although complex host-pathogen interactions influence the rates of iGAS, including strain variation and virulence, the number and type of concurrent conditions, and socioeconomic status, the relative contribution of each remains unclear. We highlight the poor correlation between the substantial effect of iGAS among Indigenous persons in industrialized countries and the current understanding of factors that influence iGAS disease in these populations. Prospective, large-scale, population-based studies of iGAS are needed that include AI/AN as a necessary first step to understanding the effects of iGAS.
Collapse
|
9
|
Solomon H, Moraes AN, Williams DB, Fotso AS, Duong YT, Ndongmo CB, Voetsch AC, Patel H, Lupoli K, McAuley JB, Mulundu G, Kasongo W, Mulenga L. Prevalence and correlates of active syphilis and HIV co-Infection among sexually active persons aged 15-59 years in Zambia: Results from the Zambia Population-based HIV Impact Assessment (ZAMPHIA) 2016. PLoS One 2020; 15:e0236501. [PMID: 32706823 PMCID: PMC7380641 DOI: 10.1371/journal.pone.0236501] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/07/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The main objectives of the study are to estimate HIV prevalence, active syphilis prevalence, and correlates of co-infection with HIV in Zambia, among recently sexually active individuals aged 15 to 59 years old. METHODS We used data from the 2016 Zambia Population-based HIV Impact Assessment (ZAMPHIA), a national household survey that included biomarker testing for HIV and syphilis. Chembio DPP® Syphilis Screen and Confirm Assay was used to distinguish between active and older syphilis infections. This is the first time Chembio DPP® has been used in a national survey. Log-binominal modelling was utilized to understand the risk of acquiring HIV/active syphilis co-infection using select socio-demographic and sexual behavior variables. Multivariable analysis compared those with co-infection and those with no infection. All reported results account for the complex survey design and are weighted. RESULTS A total of 19,114 individuals aged 15-59 years responded to the individual interview and had a valid syphilis and/or HIV test. The prevalence for those sexually active in the 12 months preceding ZAMPHIA 2016 was 3.5% and 13% for active syphilis and HIV, respectively. The prevalence of HIV/active syphilis co-infection was 1.5%. Factors associated with higher prevalence of co-infection versus no infection among females included, but were not limited to, those living in urban areas (adjusted prevalence ratio (aPR) = 3.0, 95% CI = 1.8, 4.8), those had sexual intercourse before age 15 years (aPR = 1.8, 95% CI = 1.1, 2.9), and those who had two or more sexual partners in the 12 months preceding the survey (aPR = 2.7, 95% CI = 1.6, 4.7). CONCLUSION These findings show high prevalence for both mono-infection with HIV and syphilis, as well as co-infection with HIV/active syphilis in Zambia. There is a need for better screening and partner services, particularly among those engaging in high-risk sexual behaviors (e.g., engaging in transactional sex).
Collapse
Affiliation(s)
- Hiwote Solomon
- Doctor of Public Health Program, School of Public Health, Boston University, Boston, MA, United States of America
- Ministry of Health Zambia, Ndeke House, Lusaka, Zambia
- National Health Research Authority, Lusaka, Zambia
| | - Albertina Ngomah Moraes
- Ministry of Health Zambia, Ndeke House, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | - Daniel B. Williams
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Arlette Simo Fotso
- DPS University of the Witwatersrand, Johannesburg, South Africa
- ICAP at Columbia University, Mailman School of Public Health, Pretoria, South Africa
| | - Yen T. Duong
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States of America
| | - Clement B. Ndongmo
- USAID Global Health Supply Chain Program, United States Agency for International Development, Arlington, Virginia, United States of America
| | - Andrew C. Voetsch
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hetal Patel
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kathryn Lupoli
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - James B. McAuley
- Rush University Medical Center, Chicago, Illinois, United States of America
| | - Gina Mulundu
- University Teaching Hospital, Lusaka, Zambia
- School of Medicine, University of Zambia, Lusaka, Zambia
| | | | - Lloyd Mulenga
- Ministry of Health Zambia, Ndeke House, Lusaka, Zambia
- University Teaching Hospital, Lusaka, Zambia
- School of Medicine, University of Zambia, Lusaka, Zambia
| |
Collapse
|
10
|
Sutcliffe CG, Grant LR, Reid A, Douglass G, Brown LB, Kellywood K, Weatherholtz RC, Hubler R, Quintana A, Close R, McAuley JB, Santosham M, O'Brien KL, Hammitt LL. High Burden of Staphylococcus aureus Among Native American Individuals on the White Mountain Apache Tribal Lands. Open Forum Infect Dis 2020; 7:ofaa061. [PMID: 32190709 PMCID: PMC7066796 DOI: 10.1093/ofid/ofaa061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/21/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study was done to determine the burden of invasive Staphylococcus aureus on the White Mountain Apache Tribal lands. METHODS Active population and laboratory-based surveillance for invasive S aureus infections was conducted from May 2016 to April 2018. A case was defined as a Native American individual living on or around the White Mountain Apache Tribal lands with S aureus isolated from a normally sterile body site. RESULTS Fifty-three cases were identified. Most cases were adults (90.6%) and had ≥1 underlying medical condition (86.8%), the most common of which were diabetes (49.1%) and obesity (41.5%). A total of 26.4% cases were categorized as community acquired. Most infections were methicillin-resistant (75.5%). A total of 7.5% of cases required amputation, and 7.7% of cases died within 30 days of initial culture. The incidence of invasive S aureus was 156.3 per 100 000 persons. The age-adjusted incidence of invasive methicillin-resistant S aureus was 138.2 per 100 000 persons. CONCLUSIONS This community has a disproportionately high burden of invasive methicillin-resistant S aureus compared with the general US population. Interventions are urgently needed to reduce the morbidity and mortality associated with these infections.
Collapse
Affiliation(s)
- Catherine G Sutcliffe
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lindsay R Grant
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Angelina Reid
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Grace Douglass
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura B Brown
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kamellia Kellywood
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert C Weatherholtz
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robin Hubler
- Pfizer Vaccine Medical Development, Scientific and Clinical Affairs, Collegeville, Pennsylvania, USA
| | - Alvaro Quintana
- Pfizer Vaccine Medical Development, Scientific and Clinical Affairs, Collegeville, Pennsylvania, USA
| | - Ryan Close
- Whiteriver Service Unit, Indian Health Service, Whiteriver, Arizona, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James B McAuley
- Whiteriver Service Unit, Indian Health Service, Whiteriver, Arizona, USA.,Rush Medical College, Rush University, Chicago, Illinois, USA
| | - Mathuram Santosham
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine L O'Brien
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura L Hammitt
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
11
|
McAuley JB, Close R. Better Guidance on Treating Hepatitis C Virus in Pregnancy: The Time Is Now. Clin Infect Dis 2019; 69:557. [PMID: 30615128 DOI: 10.1093/cid/ciz015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 01/04/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- James B McAuley
- Rush University Medical Center, Chicago, Illinois.,Whiteriver Indian Hospital, Arizona
| | | |
Collapse
|
12
|
Gerber SI, Jones RC, Scott MV, Price JS, Dworkin MS, Filippell MB, Rearick T, Pur SL, McAuley JB, Lavin MA, Welbel SF, Garcia-Houchins S, Bova JL, Weber SG, Arnow PM, Englund JA, Gavin PJ, Fisher AG, Thomson RB, Vescio T, Chou T, Johnson DC, Fry MB, Molloy AH, Bardowski L, Noskin GA. Management of Outbreaks of Methicillin-ResistantStaphylococcus aureusInfection in the Neonatal Intensive Care Unit: A Consensus Statement. Infect Control Hosp Epidemiol 2016; 27:139-45. [PMID: 16465630 DOI: 10.1086/501216] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Accepted: 08/18/2005] [Indexed: 01/23/2023]
Abstract
Objective.In 2002, the Chicago Department of Public Health (CDPH; Chicago, Illinois) convened the Chicago-Area Neonatal MRSA Working Group (CANMWG) to discuss and compare approaches aimed at control of methicillin-resistantStaphylococcus aureus(MRSA) in neonatal intensive care units (NICUs). To better understand these issues on a regional level, the CDPH and the Evanston Department of Health and Human Services (EDHHS; Evanston, Illinois) began an investigation.Design.Survey to collect demographic, clinical, microbiologic, and epidemiologic data on individual cases and clusters of MRSA infection; an additional survey collected data on infection control practices.Setting.Level III NICUs at Chicago-area hospitals.Participants.Neonates and healthcare workers associated with the level III NICUs.Methods.From June 2001 through September 2002, the participating hospitals reported all clusters of MRSA infection in their respective level III NICUs to the CDPH and the EDHHS.Results.Thirteen clusters of MRSA infection were detected in level III NICUs, and 149 MRSA-positive infants were reported. Infection control surveys showed that hospitals took different approaches for controlling MRSA colonization and infection in NICUs.Conclusion.The CANMWG developed recommendations for the prevention and control of MRSA colonization and infection in the NICU and agreed that recommendations should expand to include future data generated by further studies. Continuing partnerships between hospital infection control personnel and public health professionals will be crucial in honing appropriate guidelines for effective approaches to the management and control of MRSA colonization and infection in NICUs.
Collapse
Affiliation(s)
- Susan I Gerber
- Chicago Department of Public Health, Chicago, IL 60612, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Logan LK, Meltzer LA, McAuley JB, Hayden MK, Beck T, Braykov NP, Laxminarayan R, Weinstein RA. Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Infections in Children: A Two-Center Case-Case-Control Study of Risk Factors and Outcomes in Chicago, Illinois. J Pediatric Infect Dis Soc 2014; 3:312-9. [PMID: 26625451 DOI: 10.1093/jpids/piu011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 11/12/2013] [Indexed: 11/13/2022]
Abstract
BACKGROUND Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae infections are an emerging problem in children. We sought to identify risk factors and describe outcomes associated with pediatric ESBL-producing bacterial infections at 2 hospitals in Chicago, IL from 2008 to 2011. METHODS A case-case-control study of children aged 0-17 years was conducted. Cases of Escherichia coli, Klebsiella, and Proteus spp. ESBL-producing bacterial infections (n = 30) were compared to uninfected controls and in parallel, cases of non-ESBL-producing bacterial infections (n = 30) were compared to uninfected controls (n = 60). We then qualitatively compared these results. RESULTS Median age of cases was 1.06 years; 62% of isolates were from urine, and 60% were E. coli. By multivariable analysis, ESBL cases were 5.7 and 3.3 times more likely to have gastrointestinal (P = .001; 95% confidence interval [CI] 1.9-17.0) and neurologic (P = .001; 95% CI 1.1-3.7) comorbidities, respectively, than controls; non-ESBL cases were also more likely to have gastrointestinal comorbidities than controls (P = .014; odds ratio 3.6; 95% CI 1.2-10.1). Study period prevalence remained stable (1.7%). Most (60%) infections occurred in the intensive care unit; however, 30% of children presented in the outpatient setting. Seventy-seven percent of isolates were multidrug resistant (ie, resistant to ≥3 antibiotic classes). Recurrence of infection occurred in 17% of ESBL cases. Crude mortality rates (7%) did not differ between cases and controls. CONCLUSIONS The incidence of pediatric infection due to ESBL-positive Enterobacteriaceae was stable at 2 large tertiary-care medical centers over a 4-year period. Multidrug resistance in pediatric ESBL isolates is common. Risk factors for infection due to ESBL-producing bacteria include neurologic medical conditions.
Collapse
Affiliation(s)
- Latania K Logan
- Departments of Pediatrics Section of Pediatric Infectious Diseases John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | | | - James B McAuley
- Departments of Pediatrics Section of Pediatric Infectious Diseases
| | | | - Todd Beck
- Rush Institute for Healthy Aging, Rush University Medical Center, Rush Medical College, Chicago, Illinois
| | | | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics and Policy, Washington, DC Public Health Foundation of India, New Delhi, India Princeton University, New Jersey
| | - Robert A Weinstein
- Internal Medicine, Division of Infectious Diseases John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | | |
Collapse
|
14
|
Abstract
Toxoplasmosis is caused by infection with the parasite Toxoplasma gondii. It is one of the most common parasitic infections in humans and is most typically asymptomatic. However, primary infection in a pregnant woman can cause severe and disabling disease in the developing fetus. Recent developments have included increased understanding of the role of parasite genotype in determining infectivity and disease severity. Risk factors for acquisition of infection have been better defined, and the important role of foodborne transmission has been further delineated. In addition, strategies have emerged to decrease mother-to-child transmission through prompt identification of acutely infected pregnant women followed by appropriate treatment. Refined diagnostic tools, particularly the addition of immunoglobulin G avidity testing, allow for more accurate timing of maternal infection and hence better decision making during pregnancy. Congenitally infected children can be treated, beginning in utero and continuing through the first year of life, to ameliorate the severity of disease. However, despite these many advances in our understanding of congenital toxoplasmosis prevention and treatment, significant areas of study remain: we need better drugs, well defined strategies for screening of pregnant women, improved food safety, and improved diagnostic tests.
Collapse
|
15
|
Pass RF, Nachman S, Flynn PM, Muresan P, Fenton T, Cunningham CK, Borkowsky W, McAuley JB, Spector SA, Petzold E, Levy W, Siberry GK, Handelsman E, Utech LJ, Weinberg A. Immunogenicity of Licensed Influenza A (H1N1) 2009 Monovalent Vaccines in HIV-Infected Children and Youth. J Pediatric Infect Dis Soc 2013; 2:352-60. [PMID: 24363932 PMCID: PMC3869470 DOI: 10.1093/jpids/pit040] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 10/07/2012] [Accepted: 04/25/2013] [Indexed: 11/13/2022]
Abstract
BACKGROUND With the emergence of pandemic influenza A (pH1N1) in 2009, children and youth infected with human immunodeficiency virus (HIV) were vulnerable because of immunologic impairment and the greater virulence of this infection in young persons. METHODS A multicenter study of the immunogenicity of 3 licensed influenza A (H1N1) monovalent vaccines (1 live attenuated and 2 inactivated) was conducted in children and youth with perinatal HIV infection, most of whom were receiving ≥3 antiretroviral drugs, had CD4% ≥15, and plasma HIV RNA levels <400 copies/mL. Serum hemagglutinin inhibition assay (HAI) antibody levels were measured and correlated with baseline demographic and clinical variables. RESULTS One hundred forty-nine subjects were enrolled at 26 sites in the United States and Puerto Rico. Over 40% had baseline HAI titers ≥40. For subjects aged 6 months to <10 years, 79% and 68%, respectively, achieved a ≥40- and ≥4-fold rise in HAI titers after the second dose of vaccine. Three weeks after a single immunization with an inactivated vaccine, similar immunogenicity results were achieved in youth aged 10-24 years. With multivariable analysis, only Hispanic ethnicity and CD4% ≥15 were associated with achieving both HAI titer ≥40- and ≥4-fold rise in titer. CONCLUSIONS Although licensed pH1N1 vaccines produced HAI titers that were considered to be protective in the majority of HIV-infected children and youth, the proportion with titers ≥40- and ≥4-fold rise in titer was lower than expected for children without HIV infection. Vaccine immunogenicity was lower in HIV-infected children and youth with evidence of immune suppression.
Collapse
Affiliation(s)
- Robert F. Pass
- University of Alabama at Birmingham,Corresponding Author: Robert F. Pass, MD, UAB Department of Pediatrics, Children's of Alabama, 1600 7th Ave S, Ste 108, Birmingham, AL 35233. E-mail:
| | | | | | - Petronella Muresan
- Statistical and Data Analysis Center, Harvard School of Public Health, Boston, Massachusetts
| | - Terence Fenton
- Statistical and Data Analysis Center, Harvard School of Public Health, Boston, Massachusetts
| | | | | | | | - Stephen A. Spector
- University of California San Diego, La Jolla,Rady Children's Hospital, San Diego, California
| | | | - Wende Levy
- Social and Scientific Systems, Silver Spring
| | - George K. Siberry
- Pediatric Adolescent and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
| | - Ed Handelsman
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - L. Jill Utech
- St Jude's Children's Research Hospital, Memphis, Tennessee
| | | | | |
Collapse
|
16
|
Abstract
Macrolide resistance (MR) in group A Streptococcus (GAS) has been well documented in several countries and has become clinically significant since the large increases in macrolide usage during the 1970s. Macrolides are recommended as an alternative therapy for GAS pharyngitis, the most common cause of bacterial pharyngitis. Macrolide resistance has been associated with certain emm types, a sequence-based typing system of the hypervariable region of the GAS M-protein gene. Clinical failure of macrolide treatment of GAS infections can be associated with complications including acute rheumatic fever and rheumatic heart disease, the leading cause of acquired heart disease in children worldwide. Here we report 2 pediatric cases of MR and/or treatment failure in the treatment of GAS pharyngitis with the subsequent development of acute rheumatic fever. We also review the literature on worldwide MR rates, molecular classifications, and emm types, primarily associated with GAS pharyngeal isolates between the years of 2000 and 2010. The use of macrolides in the management of GAS pharyngitis should be limited to patients with significant penicillin allergy.
Collapse
Affiliation(s)
- Latania K Logan
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Rush University Medical Center, Rush Medical College, Chicago, IL 60612, USA.
| | | | | |
Collapse
|
17
|
Logan LK, Jacobs NM, McAuley JB, Weinstein RA, Anderson EJ. A multicenter retrospective study of childhood brucellosis in Chicago, Illinois from 1986 to 2008. Int J Infect Dis 2011; 15:e812-7. [DOI: 10.1016/j.ijid.2011.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 08/08/2011] [Indexed: 10/17/2022] Open
|
18
|
Smith AA, Humphrey J, McAuley JB, Tharp MD. Common variable immunodeficiency presenting as chronic urticaria. J Am Acad Dermatol 2008; 59:S40-1. [DOI: 10.1016/j.jaad.2007.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Revised: 09/04/2007] [Accepted: 09/12/2007] [Indexed: 10/21/2022]
|
19
|
Jones JL, Kruszon-Moran D, Wilson M, McQuillan G, Navin T, McAuley JB. Toxoplasma gondii infection in the United States: seroprevalence and risk factors. Am J Epidemiol 2001; 154:357-65. [PMID: 11495859 DOI: 10.1093/aje/154.4.357] [Citation(s) in RCA: 395] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Infection with Toxoplasma gondii can cause severe illness when the organism is contracted congenitally or when it is reactivated in immune-suppressed persons. To determine the prevalence of T. gondii infection in a representative sample of the US population, the authors tested sera from participants in the Third National Health and Nutrition Examination Survey (1988-1994) for immunoglobulin G antibodies to T. gondii. Of 27,145 persons aged > or =12 years, 17,658 (65%) had sera tested. The overall age-adjusted seroprevalence was 22.5% (95% confidence interval (CI): 21.1, 23.9); among women aged 15-44 years, seroprevalence was 15.0% (95% CI: 13.2, 17.0). Age-adjusted seroprevalence was higher in the Northeast (29.2%) than in the South (22.8%), Midwest (20.5%), or West (17.5%) (p < 0.05). In multivariate analysis, risk for T. gondii infection increased with age and was higher among persons who were foreign-born, persons with a lower educational level, those who lived in crowded conditions, and those who worked in soil-related occupations, although in subset analyses risk categories varied by race/ethnicity. Nearly one quarter of adults and adolescents in the United States have been infected with T. gondii. Most women of childbearing age in the United States are susceptible to acute infection and should be educated about ways to minimize exposure to T. gondii.
Collapse
Affiliation(s)
- J L Jones
- Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA.
| | | | | | | | | | | |
Collapse
|
20
|
Pratuangtham S, Bornstein SM, Boyer KM, McAuley JB, Deutsch TA, Gotoff SP. Treatment of acyclovir-resistant herpes simplex virus keratitis in a patient with Wiskott-Aldrich syndrome. Clin Infect Dis 1997; 25:1257-8. [PMID: 9402402 DOI: 10.1086/516968] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- S Pratuangtham
- Department of Pediatrics, Rush Medical College, Chicago, Illinois, USA
| | | | | | | | | | | |
Collapse
|
21
|
Abstract
Despite downward trends in the overall rate of tuberculosis in the United States for 1993 to 1994, the rate among children (0 to 14 years) has increased. To evaluate the trend in pediatric tuberculosis in Chicago and better direct public health efforts to control tuberculosis, we analyzed summary data for 1974 to 1981 and detailed data for 1982 to 1994 from surveillance case reports. These data were compared to the 1980 and 1990 census data for the 77 community areas in Chicago. Of the 18,700 cases of tuberculosis reported in Chicago for the study period, 702 (3.8%) occurred in children. Children accounted for a significantly increasing proportion of reported cases, 204/7093 (2.9%) in 1974 to 1981 versus 498/11,607 (4.3%) in 1982 to 1994, a trend which began in 1982. The number of cases among immigrants remained low throughout the study. Sites of infection were as follows: 73% pulmonary parenchymal disease, 9% hilar adenopathy, 9% extrathoracic lymph adenopathy, 3% meningitis, 3% miliary, and 3% other. From 1982 to 1994, 13 communities had a total of 224 cases (45%); average rates were > 10/100,000 in the population under 15 years old, and 7 of these communities had 127 cases (25%); average rates were > 15/100,000. Of the 77 community areas, 16 (21%) had no pediatric tuberculosis. Comparison of case rates with socioeconomic and health indicators showed the highest rates in communities with multiple indicators of poverty, including overcrowded housing units, low median income, and high infant mortality rates. Pediatric tuberculosis in Chicago remains a significant public health problem. Efforts to address this problem should provide resources to the community areas with the highest incidence rates.
Collapse
Affiliation(s)
- C Reinhard
- Department of Pediatrics, Cook County Hospital, Chicago, Illinois, USA
| | | | | |
Collapse
|
22
|
Smith KL, Wilson M, Hightower AW, Kelley PW, Struewing JP, Juranek DD, McAuley JB. Prevalence of Toxoplasma gondii antibodies in US military recruits in 1989: comparison with data published in 1965. Clin Infect Dis 1996; 23:1182-3. [PMID: 8922828 DOI: 10.1093/clinids/23.5.1182] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- K L Smith
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
Fasciola hepatica is a common and important parasite of sheep, cattle, and other ruminants. In May 1991, 30 persons with possible acute fascioliasis were identified by health care providers at a district hospital in the Bolivian Altiplano, and two deaths were associated with this illness. A cross-sectional survey of a random sample of 30 (20%) of the 148 households in the community and a case-control study were performed to determine the extent of the outbreak and the vehicle of transmission. Ninety-one members from 23 of the 30 selected families participated in the cross-sectional survey. Twenty-one of the 91 members met the case definition for acute fascioliasis (illness since 16 February 1991 that was characterized by fever and abdominal pain plus serum IgG antibodies to F. hepatica), and 38 (49%) of 78 members had serum IgG antibodies to F. hepatica. If this rate is extrapolated to the entire community, an estimated 116 individuals (23% of 504) would have acute fascioliasis and 247 individuals (49% of 504) would have evidence of current or previous infection. Case-control analysis indicated that the only factor associated with illness was eating kjosco (an aquatic plant) while tending animals in the fields; 27 (52%) of the 52 case-patients vs. 9 (14%) of the 66 controls ate kjosco (OR = 6.84; 95% CI = 2.60, 18.44). The cause of the two deaths attributed to fascioliasis could not be firmly established. Fascioliasis is a significant human health problem and is highly endemic in the Aymara Indian community in the Bolivian Altiplano. Efforts to prevent fascioliasis should include educating people to avoid eating uncooked aquatic plants such as kjosco.
Collapse
Affiliation(s)
- J Bjorland
- Danchurchaid and Instituto Nacional de Laboratorios de Salud, La Paz, Bolivia
| | | | | | | | | |
Collapse
|
24
|
Cunningham CK, Kazacos KR, McMillan JA, Lucas JA, McAuley JB, Wozniak EJ, Weiner LB. Diagnosis and management of Baylisascaris procyonis infection in an infant with nonfatal meningoencephalitis. Clin Infect Dis 1994; 18:868-72. [PMID: 8086545 DOI: 10.1093/clinids/18.6.868] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Baylisacaris procyonis, the common raccoon ascarid, is known to cause life-threatening visceral, neural, and ocular larva migrans in mammals and birds. Two human fatalities have been previously described; however, little is known about the spectrum of human disease caused by B. procyonis. In this report, the case of a 13-month-old child who had nonfatal meningoencephalitis secondary to B. procyonis infection is presented. The suspected diagnosis was confirmed with use of newly developed enzyme immunoassay and immunoblot techniques. The diagnosis, management, and prevention of B. procyonis infection in humans is discussed. Clinical, serological, and epidemiological evaluations established B. procyonis as the etiologic agent. The child survived his infection but continued to have severe neurological sequelae. The potential for human contact and infection with B. procyonis is great. There is no effective therapy; therefore, prevention is paramount.
Collapse
Affiliation(s)
- C K Cunningham
- Department of Pediatrics, SUNY Health Science Center at Syracuse 13210
| | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
Trichinella spiralis infection has been reported sporadically in several areas in Central and South America. However, several countries, including Bolivia, have not reported trichinellosis in animals or humans. A small survey of pigs slaughtered in an abattoir in Bolivia was undertaken during September 1991, to determine the presence of Trichinella spiralis. In a group of 100 pigs slaughtered consecutively on a single day and tested using the pooled digestion method, two of eight pools (25%) were positive. Twenty-one of 188 pigs (11.2%) from ten communities slaughtered consecutively on a second day tested positive for the presence of antibodies to Trichinella spiralis using an enzyme-linked immunosorbent assay. It was concluded that trichinellosis is present in pigs in Bolivia and the rate of infection may be quite high.
Collapse
|
26
|
McAuley JB, Herwaldt BL, Stokes SL, Becher JA, Roberts JM, Michelson MK, Juranek DD. Diloxanide furoate for treating asymptomatic Entamoeba histolytica cyst passers: 14 years' experience in the United States. Clin Infect Dis 1992; 15:464-8. [PMID: 1520794 DOI: 10.1093/clind/15.3.464] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.6] [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: 12/27/2022] Open
Abstract
Diloxanide furoate is used for treating asymptomatic or mildly symptomatic persons who are passing cysts of Entamoeba histolytica. The Centers for Disease Control (Atlanta) released this drug for 4,371 treatment courses from 1977 through 1990. Of the 2,815 report forms (64%) returned, 656 adverse effects were reported for 390 treatment courses (14%); they included flatulence (260), diarrhea or cramping (100), nausea (93), headache (17), disorientation or dizziness (9), and diplopia (4). During 1984-1990 uniform collection of data allowed more detailed analysis of toxicity and efficacy; fewer adverse effects were reported for persons aged 20 months to 10 years than for persons aged greater than 10 years (6 of 206 [3%] vs. 89 of 763 [12%], relative risk = 0.27, 95% confidence interval = 0.12 less than relative risk less than 0.61). Parasitological cures were achieved during 497 (86%) of the 575 treatment courses (52%) administered to asymptomatic persons who were passing cysts, who had received a full 10-day treatment course, and for whom results of a follow-up stool examination (greater than or equal to 14 days post-treatment) were available. Diloxanide furoate is safe and effective for treating asymptomatic persons who are passing E. histolytica cysts and may be particularly well tolerated in children.
Collapse
Affiliation(s)
- J B McAuley
- Division of Parasitic Diseases, Centers for Disease Control, Atlanta, Georgia 30333
| | | | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Abstract
The number of cases of trichinosis reported to Centers for Disease Control has declined steadily, with an average of only 44 cases per year from 1984 through 1988. This decline was almost entirely due to a reduction in cases acquired from ingestion of fresh commercial pork. However, from July 21 through September 3, 1990, 90 (72%) of 125 Southeast Asian refugees from six states and Canada developed trichinosis after attending or eating pork sausage taken from a wedding held in Des Moines, Iowa, on July 14, 1990. Eating uncooked sausage prepared at home from commercially obtained pork was associated with the development of this illness (odds ratio = 34.0, p less than 0.001). Analysis by amount of pork consumed was significant (Mann-Whitney U rank sum test, p less than 0.001). This outbreak of trichinosis in Iowa is the fourth reported within the last 15 years among the 900,000 Southeast Asian refugees resident in the United States and one of the largest reported outbreaks in US history. The continued presence of Trichinella spiralis in commercial pork emphasizes the need for further education and control measures for persons whose dietary habits place them at risk for developing trichinosis.
Collapse
Affiliation(s)
- J B McAuley
- Parasitic Diseases Branch, Centers for Disease Control, Atlanta, GA 30333
| | | | | | | | | | | |
Collapse
|
29
|
|
30
|
Wilson M, McAuley JB. Laboratory diagnosis of toxoplasmosis. Clin Lab Med 1991; 11:923-39. [PMID: 1802529] [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: 12/28/2022]
Abstract
Toxoplasmosis is usually diagnosed in the clinical laboratory by detecting antibodies to Toxoplasma gondii, and only rarely by isolating the parasites. A number of serologic tests are used; each has its own advantages and disadvantages. The methods of diagnosis and their interpretations differ for each clinical category of infection.
Collapse
Affiliation(s)
- M Wilson
- Division of Parasitic Diseases, Centers for Disease Control, Atlanta, Georgia
| | | |
Collapse
|
31
|
|
32
|
McAuley JB, Michelson MK, Schantz PM. Trichinosis surveillance, United States, 1987-1990. MMWR CDC Surveill Summ 1991; 40:35-42. [PMID: 1770927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Since the Public Health Service began recording statistics on trichinosis in 1947, the number of cases reported by state health departments each year has declined. In the late 1940s, health departments reported an average of 400 cases and 10-15 deaths each year; from 1982 through 1986, the number declined to an average of 57 cases per year and a total of three deaths for the period. From 1987 through 1990, 206 cases of trichinosis from 22 states, including 14 multiple-case outbreaks, were reported to CDC. In 1990, two large outbreaks associated with commercial pork accounted for 106 cases. In the 192 instances in which a suspect food item was identified, pork was implicated in 144 (75%) cases, walrus meat in 34 (18%), and bear meat in 14 (7%). Sausage, the most frequently implicated pork product, was associated with 128 of the 139 cases for which a form of ingested pork was specified. Before 1990, the proportion of cases of trichinosis attributable to consumption of commercial pork had declined steadily. This decline was probably due to a combination of factors, including laws prohibiting the feeding of garbage to hogs, the increased use of home freezers, and the practice of thoroughly cooking pork. Although the incidence of trichinosis has decreased substantially since national reporting was initiated in 1947, a dramatic increase in 1990, resulting from two large outbreaks, emphasizes the need for further education and control measures.
Collapse
|
33
|
Abstract
To define the incidence of trichinosis associated with foreign travel and characterize the epidemiologic and clinical features of cases acquired abroad, all case report forms submitted to the Centers for Disease Control through state health departments and the National Morbidity Reporting System from 1975 to 1989 were reviewed. Twenty-six cases of travel-associated trichinosis were identified during that period. Most reported cases (73%) occurred between 1982 and 1987. Affected patients were more likely to have traveled to Mexico and Asian countries (65%). Reported high-risk behaviors included consumption of undercooked pork products, use of unsanitary cooking practices, and importation of potentially contaminated meat products into the United States. Trichinosis should be considered in the differential diagnosis of eosinophilia in travelers returning from abroad. Pretravel counseling that includes information concerning the risk of eating improperly prepared meat products may help future travelers minimize the risk of acquiring this illness.
Collapse
Affiliation(s)
- J B McAuley
- Parasitic Diseases Branch, Centers for Disease Control, Atlanta, Georgia 30333
| | | | | |
Collapse
|
34
|
Shulman ST, McAuley JB, Pachman LM, Miller ML, Ruschhaupt DG. Risk of coronary abnormalities due to Kawasaki disease in urban area with small Asian population. Am J Dis Child 1987; 141:420-5. [PMID: 3565328 DOI: 10.1001/archpedi.1987.04460040078020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The epidemiology of Kawasaki disease in the six-county Chicago metropolitan area (total population, greater than 7,100,000 inhabitants) was characterized by identifying cases, with onset occurring from 1979 to 1983, inclusively, that had been studied by echocardiography. A retrospective survey of the records from pediatric echocardiographic laboratories and pediatric cardiologists at teaching hospitals, as well as a random sample survey of nonteaching hospitals with pediatric beds in the metropolitan area, was carried out. A total of 190 cases were identified, yielding an annual mean minimum incidence of 5.95 per 100,000 children less than 5 years old. Cases occurred endemically with superimposed spring clusters in 1980 and 1983. As seen in other studies, the male-female ratio was 1.58:1, and the peak incidence occurred in children between 1 and 2 years old, with 85% of cases occurring in children under 5 years of age. The racial distribution of cases was as follows: whites, including Hispanics, 62%; blacks, 32%; Asians, 5%; and half-white/half-Asian, 1%. Asians were slightly overrepresented in that they made up only 1.7% of the study area population. The annual minimum incidence for Asian Americans was 24.4 per 100,000 children less than 5 years old; this rate was significantly greater than those for the other racial groups. Although few cases were observed in Japanese-American children, the calculated annual minimum incidence in this small group was approximately 44 per 100,000 children less than 5 years old. The highest incidence was observed in several suburban Chicago zip code areas, where annual rates as high as 84.7 per 100,000 children less than 5 years old were documented. Coronary artery abnormalities were diagnosed by echocardiography in 30 (16%) of 190 cases; the male-female ratio of patients with such abnormalities was 2.75:1. Whites and children under 1 year of age demonstrated the highest incidence of coronary artery abnormalities. White children under 1 year of age appeared to be at particularly high risk for development of coronary abnormalities, with 11 (41%) of 27 white infants manifesting such findings by echocardiography. These infants may represent a subgroup of patients who would benefit particularly from therapy with intravenous gamma globulin for prevention of coronary abnormalities and who require particularly close follow-up care.
Collapse
|