1
|
Affiliation(s)
- Ken Gershman
- Colorado Department of Public Health and Environment, Denver, CO
| | - Krista Timm
- Denver Office of the Medical Examiner, Denver, CO
| | | | | | | | - Roy Gerona
- University of California, San Francisco, San Francisco, CA
| | | |
Collapse
|
2
|
Garg S, Jain S, Dawood FS, Jhung M, Pérez A, D'Mello T, Reingold A, Gershman K, Meek J, Arnold KE, Farley MM, Ryan P, Lynfield R, Morin C, Baumbach J, Hancock EB, Zansky S, Bennett N, Thomas A, Schaffner W, Finelli L. Pneumonia among adults hospitalized with laboratory-confirmed seasonal influenza virus infection-United States, 2005-2008. BMC Infect Dis 2015; 15:369. [PMID: 26307108 PMCID: PMC4550040 DOI: 10.1186/s12879-015-1004-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 06/29/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Influenza and pneumonia combined are the leading causes of death due to infectious diseases in the United States. We describe factors associated with pneumonia among adults hospitalized with influenza. METHODS Through the Emerging Infections Program, we identified adults ≥ 18 years, who were hospitalized with laboratory-confirmed influenza during October 2005 through April 2008, and had a chest radiograph (CXR) performed. Pneumonia was defined as the presence of a CXR infiltrate and either an ICD-9-CM code or discharge summary diagnosis of pneumonia. RESULTS Among 4,765 adults hospitalized with influenza, 1392 (29 %) had pneumonia. In multivariable analysis, factors associated with pneumonia included: age ≥ 75 years, adjusted odds ratio (AOR) 1.27 (95 % confidence interval 1.10-1.46), white race AOR 1.24 (1.03-1.49), nursing home residence AOR 1.37 (1.14-1.66), chronic lung disease AOR 1.37 (1.18-1.59), immunosuppression AOR 1.45 (1.19-1.78), and asthma AOR 0.76 (0.62-0.92). Patients with pneumonia were significantly more likely to require intensive care unit (ICU) admission (27 % vs. 10 %), mechanical ventilation (18 % vs. 5 %), and to die (9 % vs. 2 %). CONCLUSIONS Pneumonia was present in nearly one-third of adults hospitalized with influenza and was associated with ICU admission and death. Among patients hospitalized with influenza, older patients and those with certain underlying conditions are more likely to have pneumonia. Pneumonia is common among adults hospitalized with influenza and should be evaluated and treated promptly.
Collapse
Affiliation(s)
- Shikha Garg
- Epidemiology and Prevention Branch, Influenza Division, CDC, 1600 Clifton Road, Atlanta, GA, USA.
- Epidemic Intelligence Service, CDC, 1600 Clifton Road, Atlanta, GA, 30329, USA.
| | - Seema Jain
- Epidemiology and Prevention Branch, Influenza Division, CDC, 1600 Clifton Road, Atlanta, GA, USA.
| | - Fatimah S Dawood
- Epidemiology and Prevention Branch, Influenza Division, CDC, 1600 Clifton Road, Atlanta, GA, USA.
| | - Michael Jhung
- Epidemiology and Prevention Branch, Influenza Division, CDC, 1600 Clifton Road, Atlanta, GA, USA.
| | - Alejandro Pérez
- Epidemiology and Prevention Branch, Influenza Division, CDC, 1600 Clifton Road, Atlanta, GA, USA.
| | - Tiffany D'Mello
- Epidemiology and Prevention Branch, Influenza Division, CDC, 1600 Clifton Road, Atlanta, GA, USA.
- Atlanta Research and Education Foundation, 4 Executive Park East NE, Suite 355, Atlanta, GA 30329, USA.
| | - Arthur Reingold
- California Emerging Infections Program, 360 22nd Street, Suite 750, Oakland, California, 94612, USA.
| | - Ken Gershman
- Colorado Department of Public Health and Environment, 4300 Cherry Creek S Dr, Denver, Colorado, 80246, USA.
| | - James Meek
- Connecticut Emerging Infections Program, Yale University, 1 Church Street, New Haven, Connecticut, 06510, USA.
| | - Kathryn E Arnold
- Georgia Division of Public Health and Georgia Emerging Infections Program, 2 Peachtree Street NW, Atlanta, Georgia, 30303, USA.
| | - Monica M Farley
- Emory University School of Medicine and Atlanta VAMC, 1648 Pierce Dr NE, Atlanta, Georgia, 30322, USA.
| | - Patricia Ryan
- Maryland Department of Health and Mental Hygiene, 201 West Preston Street, 3rd Floor, Baltimore, MD, 21201, USA.
| | - Ruth Lynfield
- Minnesota Department of Health, P.O. Box 64975, St. Paul, Minnesota, 55164, USA.
| | - Craig Morin
- Minnesota Department of Health, P.O. Box 64975, St. Paul, Minnesota, 55164, USA.
| | - Joan Baumbach
- New Mexico Department of Health, 1190 St. Francis Drive, N1353, P.O. Box 26110, Santa Fe, NM, 87502-6110, USA.
| | - Emily B Hancock
- New Mexico Department of Health, 1190 St. Francis Drive, N1353, P.O. Box 26110, Santa Fe, NM, 87502-6110, USA.
| | - Shelley Zansky
- Emerging Infections Program, New York State Department of Health, ESP, Corning Tower, Rm 651, Albany, New York, 12237, USA.
| | - Nancy Bennett
- Department of Medicine, University of Rochester School of Medicine and Dentistry, New York, 14620, USA.
- Monroe County, Department of Public Health, 451 E Henrietta Rd #2, Rochester, New York, 14620, USA.
| | - Ann Thomas
- Oregon Public Health Division, 800 NE Oregon St., Suite 772, Portland, OR, 97232, USA.
| | - William Schaffner
- Vanderbilt University School of Medicine, Village at Vanderbilt - Suite 2600, 1500 21st Avenue South, Nashville, TN, 37212, USA.
| | - Lyn Finelli
- Epidemiology and Prevention Branch, Influenza Division, CDC, 1600 Clifton Road, Atlanta, GA, USA.
| |
Collapse
|
3
|
Wiringa AE, Shutt KA, Marsh JW, Cohn AC, Messonnier NE, Zansky SM, Petit S, Farley MM, Gershman K, Lynfield R, Reingold A, Schaffner W, Thompson J, Brown ST, Lee BY, Harrison LH. Geotemporal analysis of Neisseria meningitidis clones in the United States: 2000-2005. PLoS One 2013; 8:e82048. [PMID: 24349182 PMCID: PMC3861328 DOI: 10.1371/journal.pone.0082048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 02/02/2013] [Accepted: 10/29/2013] [Indexed: 11/30/2022] Open
Abstract
Background The detection of meningococcal outbreaks relies on serogrouping and epidemiologic definitions. Advances in molecular epidemiology have improved the ability to distinguish unique Neisseria meningitidis strains, enabling the classification of isolates into clones. Around 98% of meningococcal cases in the United States are believed to be sporadic. Methods Meningococcal isolates from 9 Active Bacterial Core surveillance sites throughout the United States from 2000 through 2005 were classified according to serogroup, multilocus sequence typing, and outer membrane protein (porA, porB, and fetA) genotyping. Clones were defined as isolates that were indistinguishable according to this characterization. Case data were aggregated to the census tract level and all non-singleton clones were assessed for non-random spatial and temporal clustering using retrospective space-time analyses with a discrete Poisson probability model. Results Among 1,062 geocoded cases with available isolates, 438 unique clones were identified, 78 of which had ≥2 isolates. 702 cases were attributable to non-singleton clones, accounting for 66.0% of all geocoded cases. 32 statistically significant clusters comprised of 107 cases (10.1% of all geocoded cases) were identified. Clusters had the following attributes: included 2 to 11 cases; 1 day to 33 months duration; radius of 0 to 61.7 km; and attack rate of 0.7 to 57.8 cases per 100,000 population. Serogroups represented among the clusters were: B (n = 12 clusters, 45 cases), C (n = 11 clusters, 27 cases), and Y (n = 9 clusters, 35 cases); 20 clusters (62.5%) were caused by serogroups represented in meningococcal vaccines that are commercially available in the United States. Conclusions Around 10% of meningococcal disease cases in the U.S. could be assigned to a geotemporal cluster. Molecular characterization of isolates, combined with geotemporal analysis, is a useful tool for understanding the spread of virulent meningococcal clones and patterns of transmission in populations.
Collapse
Affiliation(s)
- Ann E. Wiringa
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States of America
| | - Kathleen A. Shutt
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh Graduate School of Public Health and School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Jane W. Marsh
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh Graduate School of Public Health and School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Amanda C. Cohn
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nancy E. Messonnier
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shelley M. Zansky
- New York State Department of Health, Albany, New York, United States of America
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, Connecticut, United States of America
| | - Monica M. Farley
- Emory University and VA Medical Center, Atlanta, Georgia, United States of America
| | - Ken Gershman
- Colorado Department of Public Health and Environment, Denver, Colorado, United States of America
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Minnesota, United States of America
| | - Arthur Reingold
- University of California, Berkeley, Berkeley, California, United States of America
| | - William Schaffner
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Jamie Thompson
- Oregon Public Health Division, Portland, Oregon, United States of America
| | - Shawn T. Brown
- Pittsburgh Supercomputing Center, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
| | - Bruce Y. Lee
- Public Health Computational and Operations Research (PHICOR), University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania, United States of America
| | - Lee H. Harrison
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh Graduate School of Public Health and School of Medicine, Pittsburgh, Pennsylvania, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| |
Collapse
|
4
|
Kamimoto L, Euler GL, Lu PJ, Reingold A, Hadler J, Gershman K, Farley M, Terebuh P, Ryan P, Lynfield R, Albanese B, Thomas A, Craig AS, Schaffner W, Finelli L, Bresee J, Singleton JA. Seasonal influenza morbidity estimates obtained from telephone surveys, 2007. Am J Public Health 2013; 103:755-63. [PMID: 23237164 PMCID: PMC3673269 DOI: 10.2105/ajph.2012.300799] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2012] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed telephone surveys as a novel surveillance method, comparing data obtained by telephone with existing national influenza surveillance systems, and evaluated the utility of telephone surveys. METHODS We used the 2007 Behavioral Risk Factor Surveillance System (BRFSS) and the 2007 National Immunization Survey-Adult (NIS-Adult) to estimate the incidence of influenza-like illness (ILI), medically attended ILI, provider-diagnosed influenza, influenza testing, and treatment of influenza with antiviral medications during the 2006-2007 influenza season. RESULTS With the January-May BRFSS, among persons aged 18 years and older, the cumulative incidence of seasonal ILI and provider-diagnosed influenza was 37.9 and 5.7 adults per 100 persons, respectively. Monthly medically attended ILI and provider-diagnosed influenza among adults were temporally associated with influenza activity, as documented by national surveillance. With the NIS-Adult survey data, estimated provider-diagnosed influenza, influenza testing, and antiviral treatment were 2.8%, 1.4%, and 0.6%, respectively. CONCLUSIONS Our telephone interview-based estimates of influenza morbidity were consistent with those from national influenza surveillance systems. Telephone surveys may provide an alternative method by which population-based influenza morbidity information can be gathered.
Collapse
Affiliation(s)
- Laurie Kamimoto
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Fleming-Dutra KE, Taylor T, Link-Gelles R, Garg S, Jhung MA, Finelli L, Jain S, Shay D, Chaves SS, Baumbach J, Hancock EB, Beall B, Bennett N, Zansky S, Petit S, Yousey-Hindes K, Farley MM, Gershman K, Harrison LH, Ryan P, Lexau C, Lynfield R, Reingold A, Schaffner W, Thomas A, Moore MR. Effect of the 2009 Influenza A(H1N1) Pandemic on Invasive Pneumococcal Pneumonia. J Infect Dis 2013; 207:1135-43. [DOI: 10.1093/infdis/jit008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
6
|
Cox CM, D'Mello T, Perez A, Reingold A, Gershman K, Yousey-Hindes K, Arnold KE, Farley MM, Ryan P, Lynfield R, Morin C, Baumbach J, Hancock EB, Zansky S, Bennett NM, Thomas A, Schaffner W, Finelli L. Increase in Rates of Hospitalization Due to Laboratory-Confirmed Influenza Among Children and Adults During the 2009-10 Influenza Pandemic. J Infect Dis 2012; 206:1350-8. [DOI: 10.1093/infdis/jis517] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
7
|
Livorsi DJ, Macneil JR, Cohn AC, Bareta J, Zansky S, Petit S, Gershman K, Harrison LH, Lynfield R, Reingold A, Schaffner W, Thomas A, Farley MM. Invasive Haemophilus influenzae in the United States, 1999-2008: epidemiology and outcomes. J Infect 2012; 65:496-504. [PMID: 22902945 DOI: 10.1016/j.jinf.2012.08.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 08/06/2012] [Accepted: 08/07/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Introduction of the Haemophilus influenzae type b (Hib) conjugate vaccine has resulted in a dramatic reduction of Hib disease in the U.S. and an increase in the relative importance of infections caused by nontypeable strains. The current project describes the characteristics and clinical outcomes of pediatric and adult patients with invasive H. influenzae (HI) and, through multivariable analysis, identifies risk factors for in-hospital mortality. METHODS HI cases were identified during 1999-2008 through active surveillance as part of active bacterial core surveillance (ABCs). Multivariable analysis was performed with logistic regression to identify factors predictive of in-hospital death. RESULTS 4839 cases of HI were identified from 1999-2008. Children accounted for 17.1% of cases and adults 82.9%. Underlying conditions were present in 20.7% of children and 74.8% of adults. In-hospital mortality was highest in cases ≥65 years (21.9%) and <3 months (16.2%). The risk of in-hospital death in children <1 year was higher among those who were prematurely-born (<28 weeks, OR 7.1, 95% CI 3.2-15.6; 28-36 weeks OR 2.1, 95% CI 0.9-4.8) and, among children aged 1-17 years, higher in those with healthcare-associated onset and dialysis (OR 5.66, 95% CI 1.84-17.39; OR 18.11, 95% CI 2.77-118.65). In adults, age ≥40 was associated with death in nontypeable, but not encapsulated, infections. Infections with nontypeable strains increased the risk of death in cases ≥65 years (OR 1.81, 95% CI 1.31-2.52). Healthcare-associated HI, bacteremia without identifiable focus, bacteremic pneumonia, associated cirrhosis, cerebrovascular accident, dialysis, heart failure, and non-hematologic malignancy also increased the risk of death in adults. CONCLUSION Prematurity in infants, advanced age and certain chronic diseases in adults were associated with an increased risk of in-hospital death. Nontypeable HI was associated with higher mortality in the elderly.
Collapse
Affiliation(s)
- Daniel J Livorsi
- Department of Medicine, Emory University School of Medicine, The Atlanta VA Medical Center, 1670 Clairmont Road, Mail Code 151-ID, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Vandermeer ML, Thomas AR, Kamimoto L, Reingold A, Gershman K, Meek J, Farley MM, Ryan P, Lynfield R, Baumbach J, Schaffner W, Bennett N, Zansky S. Association between use of statins and mortality among patients hospitalized with laboratory-confirmed influenza virus infections: a multistate study. J Infect Dis 2011; 205:13-9. [PMID: 22170954 DOI: 10.1093/infdis/jir695] [Citation(s) in RCA: 172] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Statins may have anti-inflammatory and immunomodulatory effects that could reduce the risk of mortality from influenza virus infections. METHODS The Centers for Disease Control and Prevention's Emerging Infections Program conducts active surveillance for persons hospitalized with laboratory-confirmed influenza in 59 counties in 10 states. We analyzed data for hospitalized adults during the 2007-2008 influenza season to evaluate the association between receiving statins and influenza-related death. RESULTS We identified 3043 patients hospitalized with laboratory-confirmed influenza, of whom 1013 (33.3%) received statins and 151 (5.0%) died within 30 days of their influenza test. Patients who received statins were more likely to be older, male, and white; to suffer from cardiovascular, metabolic, renal, and chronic lung disease; and to have been vaccinated against influenza that season. In a multivariable logistic regression model, administration of statins prior to or during hospitalization was associated with a protective odds of death (adjusted odds ratio, 0.59 [95% confidence interval, .38-.92]) when adjusting for age; race; cardiovascular, lung, and renal disease; influenza vaccination; and antiviral administration. CONCLUSIONS Statin use may be associated with reduced mortality in patients hospitalized with influenza.
Collapse
|
9
|
Hampton LM, Farley MM, Schaffner W, Thomas A, Reingold A, Harrison LH, Lynfield R, Bennett NM, Petit S, Gershman K, Baumbach J, Beall B, Jorgensen J, Glennen A, Zell ER, Moore M. Prevention of Antibiotic-Nonsusceptible Streptococcus pneumoniae With Conjugate Vaccines. J Infect Dis 2011; 205:401-11. [DOI: 10.1093/infdis/jir755] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
10
|
MacNeil JR, Cohn AC, Farley M, Mair R, Baumbach J, Bennett N, Gershman K, Harrison LH, Lynfield R, Petit S, Reingold A, Schaffner W, Thomas A, Coronado F, Zell ER, Mayer LW, Clark TA, Messonnier NE. Current Epidemiology and Trends in Invasive Haemophilus influenzae Disease--United States, 1989-2008. Clin Infect Dis 2011; 53:1230-6. [DOI: 10.1093/cid/cir735] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
11
|
Doshi S, Kamimoto L, Finelli L, Perez A, Reingold A, Gershman K, Yousey-Hindes K, Arnold K, Ryan P, Lynfield R, Morin C, Baumbach J, Hancock EB, Bennett NM, Zansky S, Thomas A, Schaffner W, Fry AM. Description of antiviral treatment among adults hospitalized with influenza before and during the 2009 pandemic: United States, 2005-2009. J Infect Dis 2011; 204:1848-56. [PMID: 22013219 DOI: 10.1093/infdis/jir648] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The 2009 influenza pandemic led to guidelines emphasizing antiviral treatment for all persons hospitalized with influenza, including pregnant women. We compared antiviral use among adults hospitalized with influenza before and during the pandemic. METHODS The Emerging Infections Program conducts active population-based surveillance for persons hospitalized with community-acquired, laboratory-confirmed influenza in 10 states. We analyzed data collected via medical record review of patients aged ≥18 years admitted during prepandemic (1 October 2005 through 14 April 2009) and pandemic (15 April 2009 through 31 December 2009) time frames. RESULTS Of 5943 adults hospitalized with influenza in prepandemic seasons, 3235 (54%) received antiviral treatment, compared with 4055 (82%) of 4966 during the pandemic. Forty-one (22%) of 187 pregnant women received antiviral treatment in prepandemic seasons, compared with 369 (86%) of 430 during the pandemic. Pregnancy was a negative predictor of antiviral treatment before the pandemic (adjusted odds ratio [aOR], 0.24; 95% confidence interval [CI], .16-.35) but was independently associated with treatment during the pandemic (aOR, 1.97; 95% CI, 1.32-2.96). Antiviral treatment among adults hospitalized >2 days after illness onset increased from 43% before the pandemic to 79% during the pandemic (P < .001). CONCLUSIONS Antiviral treatment of hospitalized adults increased during the pandemic, especially among pregnant women. This suggests that many clinicians followed published guidance to treat hospitalized adults with antiviral agents. However, compliance with antiviral recommendations could be improved.
Collapse
Affiliation(s)
- Saumil Doshi
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Dawood FS, Kamimoto L, D'Mello TA, Reingold A, Gershman K, Meek J, Arnold KE, Farley M, Ryan P, Lynfield R, Morin C, Baumbach J, Zansky S, Bennett N, Thomas A, Schaffner W, Kirschke D, Finelli L. Children with asthma hospitalized with seasonal or pandemic influenza, 2003-2009. Pediatrics 2011; 128:e27-32. [PMID: 21646257 DOI: 10.1542/peds.2010-3343] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [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] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the characteristics and clinical courses of asthmatic children hospitalized with seasonal or 2009 pandemic H1N1 influenza and compare complications by influenza type. METHODS During the 2003-2009 influenza seasons and the 2009 pandemic, we conducted surveillance of 5.3 million children aged 17 years or younger for hospitalization with laboratory-confirmed influenza and identified those with asthma (defined as those aged 2-17 years with a history of asthma in their medical record or a discharge code for acute asthma exacerbation or status asthmaticus). We collected data from medical records on medical history and clinical course; data on asthma severity and control were not routinely collected. RESULTS During the 2003-2009 influenza seasons, 701 (32%) of 2165 children hospitalized with influenza had asthma; during the 2009 pandemic, 733 (44%) of 1660 children had asthma. The median age of the asthmatic children was 7 years, and 73% had no additional medical conditions. Compared with asthmatic children with seasonal influenza, a higher proportion with 2009 pandemic H1N1 influenza required intensive care (16% vs 22%; P=.01) and were diagnosed with pneumonia (40% vs 46%; P=.04), whereas equal proportions had respiratory failure (5% vs 5%; P=.8) and died (1% vs 1%; P=.4). More asthmatic children with influenza A (seasonal or pandemic) had diagnoses of asthma exacerbations compared with those with influenza B (51% vs 29%; P<.01). CONCLUSIONS The majority of asthmatic children hospitalized with influenza have no additional medical conditions. Complications such as pneumonia and need for intensive care occur in a substantial proportion, highlighting the importance of influenza prevention through vaccination among asthmatic children.
Collapse
Affiliation(s)
- Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS A-32, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Boehmer TK, Patnaik JL, Burnite SJ, Ghosh TS, Gershman K, Vogt RL. Use of hospital discharge data to evaluate notifiable disease reporting to Colorado's Electronic Disease Reporting System. Public Health Rep 2011; 126:100-6. [PMID: 21337935 DOI: 10.1177/003335491112600114] [Citation(s) in RCA: 29] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Notifiable disease surveillance systems are critical for communicable disease control, and accurate and timely reporting of hospitalized patients who represent the most severe cases is important. A local health department in metropolitan Denver used inpatient hospital discharge (IHD) data to evaluate the sensitivity, timeliness, and data quality of reporting eight notifiable diseases to the Colorado Electronic Disease Reporting System (CEDRS). METHODS Using IHD data, we detected hospitalized patients admitted from 2003 through 2005 with a discharge diagnosis associated with one of eight notifiable diseases. Initially, we compared all cases identified through IHD diagnoses fields with cases reported to CEDRS. Second, we chose four diseases and conducted medical record review to confirm the IHD diagnoses before comparison with CEDRS cases. RESULTS Relying on IHD diagnoses only, shigellosis, salmonellosis, and Neisseria meningitidis invasive disease had high sensitivity (> or = 90%) and timeliness (> or = 75%); legionellosis, pertussis, and West Nile virus infection were intermediate; and hepatitis A and Haemophilus influenzae (H. influenzae) invasive disease had low sensitivity (> or = 25%) and timeliness (< or = 33%). Medical record review improved the sensitivity to > or = 90% and timeliness to > or = 80% for H. influenza invasive disease, legionellosis, and pertussis; however, hepatitis A retained suboptimal sensitivity (67%) and timeliness (25%). CONCLUSIONS Hospital discharge data are useful for evaluating notifiable disease surveillance systems. Limitations encountered by using discharge diagnoses alone can be overcome by conducting medical record review. Public health agencies should conduct periodic surveillance system evaluations among hospitalized patients and reinforce notifiable disease reporting among the people responsible for this activity.
Collapse
Affiliation(s)
- Tegan K Boehmer
- Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, MS F-58, Atlanta, GA 30341, USA.
| | | | | | | | | | | |
Collapse
|
14
|
Dawood FS, Fiore A, Kamimoto L, Bramley A, Reingold A, Gershman K, Meek J, Hadler J, Arnold KE, Ryan P, Lynfield R, Morin C, Mueller M, Baumbach J, Zansky S, Bennett NM, Thomas A, Schaffner W, Kirschke D, Finelli L. Burden of seasonal influenza hospitalization in children, United States, 2003 to 2008. J Pediatr 2010; 157:808-14. [PMID: 20580018 DOI: 10.1016/j.jpeds.2010.05.012] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [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: 12/09/2009] [Revised: 03/22/2010] [Accepted: 05/05/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To estimate the rates of hospitalization with seasonal influenza in children aged <18 years from a large, diverse surveillance area during 2003 to 2008. STUDY DESIGN Through the Emerging Infections Program Network, population-based surveillance for laboratory-confirmed influenza was conducted in 10 states, including 5.3 million children. Hospitalized children were identified retrospectively; clinicians made influenza testing decisions. Data collected from the hospital record included demographics, medical history, and clinical course. Incidence rates were calculated with census data. RESULTS The highest hospitalization rates occurred in children aged <6 months (seasonal range, 9-30/10 000 children), and the lowest rates occurred in children aged 5 to 17 years (0.3-0.8/10 000). Overall, 4015 children were hospitalized, 58% of whom were identified with rapid diagnostic tests alone. Forty percent of the children who were hospitalized had underlying medical conditions; asthma (18%), prematurity (15% of children aged <2 years), and developmental delay (7%) were the most common. Severe outcomes included intensive care unit admission (12%), respiratory failure (5%), bacterial coinfection (2%), and death (0.5%). CONCLUSIONS Influenza-associated hospitalization rates varied by season and age and likely underestimate true rates because many hospitalized children are not tested for influenza. The proportion of children with severe outcomes was substantial across seasons. Quantifying incidence of influenza hospitalization and severe outcomes is critical to defining disease burden.
Collapse
Affiliation(s)
- Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Burton DC, Flannery B, Bennett NM, Farley MM, Gershman K, Harrison LH, Lynfield R, Petit S, Reingold AL, Schaffner W, Thomas A, Plikaytis BD, Rose CE, Whitney CG, Schuchat A. Socioeconomic and racial/ethnic disparities in the incidence of bacteremic pneumonia among US adults. Am J Public Health 2010; 100:1904-11. [PMID: 20724687 PMCID: PMC2936986 DOI: 10.2105/ajph.2009.181313] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2010] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined associations between the socioeconomic characteristics of census tracts and racial/ethnic disparities in the incidence of bacteremic community-acquired pneumonia among US adults. METHODS We analyzed data on 4870 adults aged 18 years or older with community-acquired bacteremic pneumonia identified through active, population-based surveillance in 9 states and geocoded to census tract of residence. We used data from the 2000 US Census to calculate incidence by age, race/ethnicity, and census tract characteristics and Poisson regression to estimate rate ratios (RRs) and 95% confidence intervals (CIs). RESULTS During 2003 to 2004, the average annual incidence of bacteremic pneumonia was 24.2 episodes per 100 000 Black adults versus 10.1 per 100 000 White adults (RR = 2.40; 95% CI = 2.24, 2.57). Incidence among Black residents of census tracts with 20% or more of persons in poverty (most impoverished) was 4.4 times the incidence among White residents of census tracts with less than 5% of persons in poverty (least impoverished). Racial disparities in incidence were reduced but remained significant in models that controlled for age, census tract poverty level, and state. CONCLUSIONS Adults living in impoverished census tracts are at increased risk of bacteremic pneumonia and should be targeted for prevention efforts.
Collapse
Affiliation(s)
- Deron C Burton
- Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Dao C, Kamimoto L, Nowell M, Reingold A, Gershman K, Meek J, Arnold K, Farley M, Ryan P, Lynfield R, Morin C, Baumbach J, Hancock E, Zansky S, Bennett N, Thomas A, Vandermeer M, Kirschke D, Schaffner W, Finelli L. Adult Hospitalizations for Laboratory‐Positive Influenza during the 2005–2006 through 2007–2008 Seasons in the United States. J Infect Dis 2010; 202:881-8. [DOI: 10.1086/655904] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
17
|
Kallen AJ, Mu Y, Bulens S, Reingold A, Petit S, Gershman K, Ray SM, Harrison LH, Lynfield R, Dumyati G, Townes JM, Schaffner W, Patel PR, Fridkin SK. Health care-associated invasive MRSA infections, 2005-2008. JAMA 2010; 304:641-8. [PMID: 20699455 DOI: 10.1001/jama.2010.1115] [Citation(s) in RCA: 326] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen of public health importance; MRSA prevention programs that may affect MRSA transmission and infection are increasingly common in health care settings. Whether there have been changes in MRSA infection incidence as these programs become established is unknown; however, recent data have shown that rates of MRSA bloodstream infections (BSIs) in intensive care units are decreasing. OBJECTIVE To describe changes in rates of invasive health care-associated MRSA infections from 2005 through 2008 among residents of 9 US metropolitan areas. DESIGN, SETTING, AND PARTICIPANTS Active, population-based surveillance for invasive MRSA in 9 metropolitan areas covering a population of approximately 15 million persons. All reports of laboratory-identified episodes of invasive (from a normally sterile body site) MRSA infections from 2005 through 2008 were evaluated and classified based on the setting of the positive culture and the presence or absence of health care exposures. Health care-associated infections (ie, hospital-onset and health care-associated community-onset), which made up 82% of the total infections, were included in this analysis. MAIN OUTCOME MEASURES Change in incidence of invasive health care-associated MRSA infections and health care-associated MRSA BSIs using population of the catchment area as the denominator. RESULTS From 2005 through 2008, there were 21,503 episodes of invasive MRSA infection; 17,508 were health care associated. Of these, 15,458 were MRSA BSIs. The incidence rate of hospital-onset invasive MRSA infections was 1.02 per 10,000 population in 2005 and decreased 9.4% per year (95% confidence interval [CI], 14.7% to 3.8%; P = .005), and the incidence of health care-associated community-onset infections was 2.20 per 10,000 population in 2005 and decreased 5.7% per year (95% CI, 9.7% to 1.6%; P = .01). The decrease was most prominent for the subset of infections with BSIs (hospital-onset: -11.2%; 95% CI -15.9% to -6.3%; health care-associated community-onset: -6.6%; 95% CI -9.5% to -3.7%). CONCLUSION Over the 4-year period from 2005 through 2008 in 9 diverse metropolitan areas, rates of invasive health care-associated MRSA infections decreased among patients with health care-associated infections that began in the community and also decreased among those with hospital-onset invasive disease.
Collapse
Affiliation(s)
- Alexander J Kallen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Cohn AC, MacNeil JR, Harrison LH, Hatcher C, Theodore J, Schmidt M, Pondo T, Arnold KE, Baumbach J, Bennett N, Craig AS, Farley M, Gershman K, Petit S, Lynfield R, Reingold A, Schaffner W, Shutt KA, Zell ER, Mayer LW, Clark T, Stephens D, Messonnier NE. Changes in Neisseria meningitidis disease epidemiology in the United States, 1998-2007: implications for prevention of meningococcal disease. Clin Infect Dis 2010; 50:184-91. [PMID: 20001736 DOI: 10.1086/649209] [Citation(s) in RCA: 289] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In January 2005, a quadrivalent (serogroups A, C , Y, and W-135) meningococcal conjugate vaccine was licensed for use in adolescents. This report describes the epidemiologic features of meningococcal disease in the United States from January 1998 through December 2007, before and during implementation of adolescent quadrivalent meningococcal conjugate vaccination. METHODS Data were collected from active surveillance for invasive Neisseria meningitidis conducted through the Active Bacterial Core surveillance (ABCs) sites during 1998-2007. Isolates from cases were serogrouped at the ABCs site and confirmed at the Centers for Disease Control and Prevention. Estimates of the incidence and number of cases in the 50 states were calculated, standardizing for race and age group. RESULTS In the period 1998-2007, a total of 2262 cases of meningococcal disease were reported from ABCs sites; 11.3% of these cases were fatal. The estimated United States average annual incidence of meningococcal disease was 0.53 cases per 100,000 population (95% confidence interval, 0.51-0.55), and an estimated 1525 (95% confidence interval, 1470-1598) cases occurred annually. The annual incidence decreased 64.1%, from 0.92 cases per 100,000 population in 1998 to 0.33 cases per 100,000 population in 2007. Infants aged <1 year have the highest incidence of meningococcal disease (5.38 cases per 100,000 population). After introduction of the quadrivalent meningococcal conjugate vaccine, no significant decrease in serogroup C or Y meningococcal disease was seen among those aged 11-19 years in 2006-2007, compared with 2004-2005. CONCLUSIONS Before the introduction of the quadrivalent meningococcal conjugate vaccine, the incidence of meningococcal disease in the United States decreased to a historic low. However, meningococcal disease still causes a substantial burden of disease among all age groups. Future vaccination strategies may include targeting infants and preventing serogroup B meningococcal disease.
Collapse
Affiliation(s)
- Amanda C Cohn
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta Georgia 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
Case-based surveillance provides more information than any other influenza surveillance component. Colorado became the first state to make laboratory-confirmed influenza-associated hospitalizations a case-based reportable condition in 2004. We summarized surveillance for influenza hospitalizations in Colorado during the first 4 recorded influenza seasons (2004–2008). We highlight the similarities and differences among influenza seasons; no 2 seasons were entirely the same. The 2005–06 influenza season had 2 distinct waves of activity (types A and B), the 2006–07 season was substantially later and milder, and 2007–08 had substantially greater influenza B activity. The case-based surveillance for influenza hospitalizations provides information regarding the time course of seasonal influenza activity, reported case numbers and population-based rates by age group and influenza virus type, and a measure of relative severity. Influenza hospitalization surveillance provides more information about seasonal influenza activity than any other surveillance measure (e.g., surveillance for influenza-like illness) currently in widespread use among states. More states should consider implementing case-based surveillance for influenza hospitalizations.
Collapse
|
20
|
Lucero CA, Hageman J, Zell ER, Bulens S, Nadle J, Petit S, Gershman K, Ray S, Harrison LH, Lynfield R, Dumyati G, Townes JM, Schaffner W, Fridkin SK. Evaluating the potential public health impact of a Staphylococcus aureus vaccine through use of population-based surveillance for invasive methicillin-resistant S. aureus disease in the United States. Vaccine 2009; 27:5061-8. [DOI: 10.1016/j.vaccine.2009.06.055] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 06/02/2009] [Accepted: 06/12/2009] [Indexed: 10/20/2022]
|
21
|
Skoff TH, Farley MM, Petit S, Craig AS, Schaffner W, Gershman K, Harrison LH, Lynfield R, Mohle-Boetani J, Zansky S, Albanese BA, Stefonek K, Zell ER, Jackson D, Thompson T, Schrag SJ. Increasing burden of invasive group B streptococcal disease in nonpregnant adults, 1990-2007. Clin Infect Dis 2009; 49:85-92. [PMID: 19480572 DOI: 10.1086/599369] [Citation(s) in RCA: 321] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Group B Streptococcus (GBS), traditionally considered to be a neonatal pathogen, is an important cause of morbidity and mortality among older adults and among those with underlying medical conditions. We used population-based surveillance to examine trends in adult GBS disease during the period 1990-2007 and to describe the epidemiology of adult GBS disease to guide prevention efforts. METHODS Active Bacterial Core surveillance was conducted in selected counties in 10 US states. A case was defined as isolation of GBS from a normally sterile site in a nonpregnant resident of a surveillance area who was 18 years of age. Rates were calculated using US Census data. Demographic and clinical information was abstracted from medical records. Serotyping and susceptibility testing were performed on isolates collected from a subset of case patients. RESULTS A total of 19,512 GBS cases were identified in nonpregnant adults during 1990-2007 (median patient age, 63 years); the incidence of adult GBS disease doubled from 3.6 cases per 100,000 persons during 1990 to 7.3 cases per 100,000 persons during 2007 (P < .001). The mean difference in incidence between black and white persons was 4.6 cases per 100,000 persons (range, 3.1 cases per 100,000 persons during 1991 to 5.8 cases per 100,000 persons during 1999). Common clinical syndromes in 2007 included bacteremia without focus (39.3%), skin and/or soft-tissue infection (25.6%), and pneumonia (12.6%). Most (88.0%) GBS cases in adults had 1 underlying condition; diabetes was present in 44.4% of cases. Serotypes V, Ia, II, and III accounted for 80.8% of infections during 1998-1999 and 78.5% of infections during 2005-2006. CONCLUSIONS Invasive GBS disease in nonpregnant adults represents a substantial and increasing burden, particularly among older persons, black persons, and adults with diabetes. Prevention strategies are needed.
Collapse
Affiliation(s)
- Tami H Skoff
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Van Dyke MK, Phares CR, Lynfield R, Thomas AR, Arnold KE, Craig AS, Mohle-Boetani J, Gershman K, Schaffner W, Petit S, Zansky SM, Morin CA, Spina NL, Wymore K, Harrison LH, Shutt KA, Bareta J, Bulens SN, Zell ER, Schuchat A, Schrag SJ. Evaluation of universal antenatal screening for group B streptococcus. N Engl J Med 2009; 360:2626-36. [PMID: 19535801 DOI: 10.1056/nejmoa0806820] [Citation(s) in RCA: 295] [Impact Index Per Article: 19.7] [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: 11/19/2022]
Abstract
BACKGROUND Group B streptococcal disease is one of the most common infections in the first week after birth. In 2002, national guidelines recommended universal late antenatal screening of pregnant women for colonization with group B streptococcus to identify candidates for intrapartum chemoprophylaxis. METHODS We evaluated the implementation of the guidelines in a multistate, retrospective cohort selected from the Active Bacterial Core surveillance, a 10-state, population-based system that monitors invasive group B streptococcal disease. We abstracted data from the labor and delivery records of a stratified random sample of live births and of all cases in which the newborn had early-onset group B streptococcal disease (i.e., disease in infants <7 days of age) in 2003 and 2004. We compared our results with those from a study with a similar design that evaluated screening practices in 1998 and 1999. RESULTS We abstracted records of 254 births in which the infant had group B streptococcal disease and 7437 births in which the infant did not. The rate of screening for group B streptococcus before delivery increased from 48.1% in 1998-1999 to 85.0% in 2003-2004; the percentage of infants exposed to intrapartum antibiotics increased from 26.8% to 31.7%. Chemoprophylaxis was administered in 87.0% of the women who were positive for group B streptococcus and who delivered at term, but in only 63.4% of women with unknown colonization status who delivered preterm. The overall incidence of early-onset group B streptococcal disease was 0.32 cases per 1000 live births. Preterm infants had a higher incidence of early-onset group B streptococcal disease than did term infants (0.73 vs. 0.26 cases per 1000 live births); however, 74.4% of the cases of group B streptococcal disease (189 of 254) occurred in term infants. Missed screening among mothers who delivered at term accounted for 34 of the 254 cases of group B streptococcal disease (13.4%). A total of 61.4% of the term infants with group B streptococcal disease were born to women who had tested negative for group B streptococcus before delivery. CONCLUSIONS Recommendations for universal screening were rapidly adopted. Improved management of preterm deliveries and improved collection, processing, and reporting of culture results may prevent additional cases of early-onset group B streptococcal disease.
Collapse
Affiliation(s)
- Melissa K Van Dyke
- Epidemic Intelligence Service Program, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Boehmer TK, Bamberg WM, Ghosh TS, Cronquist A, Fornof ME, Cichon MK, Gershman K, Vogt RL. Health care-associated outbreak of Salmonella Tennessee in a neonatal intensive care unit. Am J Infect Control 2009; 37:49-55. [PMID: 18834739 DOI: 10.1016/j.ajic.2007.12.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Revised: 12/18/2007] [Accepted: 12/27/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND In December 2006, we investigated an outbreak of Salmonella serotype Tennessee in a neonatal intensive care unit (NICU) that coincided with a nationwide Salmonella Tennessee outbreak associated with contaminated peanut butter. METHODS Salmonellosis was defined as isolation of Salmonella Tennessee from any clinical specimen or more than 1 episode of bloody stool within a 24-hour period. We conducted a cohort study among 13 NICU infants, reviewed medical records, cultured stool from infants and staff, collected environmental samples, and examined infection control practices. RESULTS Ten of the 13 infants had salmonellosis (77%). No medical or dietary risk factors were identified. The proportion of days in which the NICU census exceeded its 11-bed design capacity was higher in December compared with the previous 11 months (41.9% vs 0.3%; P < .001). Hand sinks did not meet operational standards. Salmonella Tennessee was isolated from 9 of the 13 infants, 2 of 40 staff members, and 6 of 42 environmental samples; all isolates matched the pulsed-field gel electrophoresis pattern of the nationwide Salmonella Tennessee outbreak. CONCLUSIONS Although the source of Salmonella Tennessee was not identified, the high census and limited access to sinks likely facilitated transmission to the NICU infants. Infection control interventions, including halting new NICU admissions, interrupted further transmission.
Collapse
|
24
|
Bamberg WM, Pape WJ, Beebe JL, Nevin-Woods C, Ray W, Maguire H, Nucci J, Massung RF, Gershman K. Outbreak of Q fever associated with a horse-boarding ranch, Colorado, 2005. Vector Borne Zoonotic Dis 2008; 7:394-402. [PMID: 17896873 DOI: 10.1089/vbz.2007.0104] [Citation(s) in RCA: 26] [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: 11/12/2022] Open
Abstract
Coxiella burnetii is a bacterium located worldwide that can cause Q fever when inhaled. We describe an outbreak of Q fever associated with a horse-boarding ranch that had acquired two herds of goats. We conducted case finding and cohort studies among persons who boarded horses on the ranch and ranchers and among residents in the surrounding community, and conducted sampling of the goats and environment, to determine risk factors for infection and guide public health interventions. Sixty-six ranchers and persons who boarded horses on the ranch were interviewed; 62 (94%) were not professional ranchers. Twenty persons (53%) of 38 persons tested had evidence of infection with C. burnetii. Contact with goats was associated with seropositivity, including having helped birth goats (relative risk [RR] 2.4, 95% confidence interval [CI] 1.6-3.6), having had contact with newborn goats (RR 2.3, CI 1.2-4.3), having vaccinated goats (RR 2.1, CI 1.3-3.5), having had contact with stillbirths or newborns that died (RR 2.1, CI 1.2-3.7), and having fed goats (RR 2.1, CI 1.0-4.3). Among 138 tested persons living within 1 mile of the ranch, 11 (8%) demonstrated evidence of C. burnetii infection; eight seropositive persons (73%) had no direct contact with the ranch. Testing of the soil and goats with an IS1111 polymerase chain reaction (PCR) assay confirmed the presence of C. burnetii among the herd and in the environment. This outbreak of Q fever was caused by exposure to infected goats, but exposure to the environment likely played a secondary role. Laypersons should not participate in the birthing process of goats; professionals who come into contact with birthing goats should be educated on reducing their infection risk. This is the first time an IS1111 PCR assay has been used in an outbreak investigation in the United States.
Collapse
Affiliation(s)
- Wendy M Bamberg
- Epidemic Intelligence Service, Colorado Department of Public Health and Environment, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Herrera GA, Iwane MK, Cortese M, Brown C, Gershman K, Shupe A, Averhoff F, Chaves SS, Gargiullo P, Bridges CB. Corrigendum to “Influenza vaccine effectiveness among 50–64-year-old persons during a season of poor antigenic match between vaccine and circulating influenza virus strains: Colorado, United States, 2003–2004” [Vaccine 25 (1) (2006) 154–160]. Vaccine 2008. [DOI: 10.1016/j.vaccine.2006.05.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
26
|
Phares CR, Lynfield R, Farley MM, Mohle-Boetani J, Harrison LH, Petit S, Craig AS, Schaffner W, Zansky SM, Gershman K, Stefonek KR, Albanese BA, Zell ER, Schuchat A, Schrag SJ. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA 2008; 299:2056-65. [PMID: 18460666 DOI: 10.1001/jama.299.17.2056] [Citation(s) in RCA: 619] [Impact Index Per Article: 38.7] [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: 11/14/2022]
Abstract
CONTEXT Group B streptococcus is a leading infectious cause of morbidity in newborns and causes substantial disease in elderly individuals. Guidelines for prevention of perinatal disease through intrapartum chemoprophylaxis were revised in 2002. Candidate vaccines are under development. OBJECTIVE To describe disease trends among populations that might benefit from vaccination and among newborns during a period of evolving prevention strategies. DESIGN AND SETTING Analysis of active, population-based surveillance in 10 states participating in the Active Bacterial Core surveillance/Emerging Infections Program Network. MAIN OUTCOME MEASURES Age- and race-specific incidence of invasive group B streptococcal disease. RESULTS There were 14,573 cases of invasive group B streptococcal disease during 1999-2005, including 1348 deaths. The incidence of invasive group B streptococcal disease among infants from birth through 6 days decreased from 0.47 per 1000 live births in 1999-2001 to 0.34 per 1000 live births in 2003-2005 (P < .001), a relative reduction of 27% (95% confidence interval [CI], 16%-37%). Incidence remained stable among infants aged 7 through 89 days (mean, 0.34 per 1000 live births) and pregnant women (mean, 0.12 per 1000 live births). Among persons aged 15 through 64 years, disease incidence increased from 3.4 per 100,000 population in 1999 to 5.0 per 100,000 in 2005 (chi2(1) for trend, 57; P < .001), a relative increase of 48% (95% CI, 32%-65%). Among adults 65 years or older, incidence increased from 21.5 per 100,000 to 26.0 per 100,000 (chi2(1) for trend, 15; P < .001), a relative increase of 20% (95% CI, 8%-35%). All 4882 isolates tested were susceptible to penicillin, ampicillin, and vancomycin, but 32% and 15% were resistant to erythromycin and clindamycin, respectively. Serotypes Ia, Ib, II, III, and V accounted for 96% of neonatal cases and 88% of adult cases. CONCLUSIONS Among infants from birth through 6 days, the incidence of group B streptococcal disease was lower in 2003-2005 relative to 1999-2001. This reduction coincided with the release of revised disease prevention guidelines in 2002. However, the disease burden in adults is substantial and increased significantly during the study period.
Collapse
Affiliation(s)
- Christina R Phares
- Epidemic Intelligence Service Program, Office of Workforce and Career Development, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Thigpen MC, Richards CL, Lynfield R, Barrett NL, Harrison LH, Arnold KE, Reingold A, Bennett NM, Craig AS, Gershman K, Cieslak PR, Lewis P, Greene CM, Beall B, Van Beneden CA. Invasive group A streptococcal infection in older adults in long-term care facilities and the community, United States, 1998-2003. Emerg Infect Dis 2008; 13:1852-9. [PMID: 18258035 PMCID: PMC2876747 DOI: 10.3201/eid1312.070303] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [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: 11/29/2022] Open
Abstract
Invasive infection develops almost 6 times as frequently in the elderly in long-term care facilities. Limited information exists on the incidence and characteristics of invasive group A streptococcal (GAS) infections among residents of long-term care facilities (LTCFs). We reviewed cases of invasive GAS infections occurring among persons >65 years of age identified through active, population-based surveillance from 1998 through 2003. We identified 1,762 invasive GAS cases among persons >65 years, including 1,662 with known residence type (LTCF or community). Incidence of invasive GAS infection among LTCF residents compared to community-based elderly was 41.0 versus 6.9 cases per 100,000 population. LTCF case-patients were 1.5 times as likely to die from the infection as community-based case-patients (33% vs. 21%, p<0.01) but were less often hospitalized (90% vs. 95%, p<0.01). In multivariate logistic regression modeling, LTCF residence remained an independent predictor of death. Additional prevention strategies against GAS infection in this high-risk population are urgently needed.
Collapse
|
28
|
Klevens RM, Morrison MA, Nadle J, Petit S, Gershman K, Ray S, Harrison LH, Lynfield R, Dumyati G, Townes JM, Craig AS, Zell ER, Fosheim GE, McDougal LK, Carey RB, Fridkin SK. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007; 298:1763-71. [PMID: 17940231 DOI: 10.1001/jama.298.15.1763] [Citation(s) in RCA: 2422] [Impact Index Per Article: 142.5] [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: 12/11/2022]
Abstract
CONTEXT As the epidemiology of infections with methicillin-resistant Staphylococcus aureus (MRSA) changes, accurate information on the scope and magnitude of MRSA infections in the US population is needed. OBJECTIVES To describe the incidence and distribution of invasive MRSA disease in 9 US communities and to estimate the burden of invasive MRSA infections in the United States in 2005. DESIGN AND SETTING Active, population-based surveillance for invasive MRSA in 9 sites participating in the Active Bacterial Core surveillance (ABCs)/Emerging Infections Program Network from July 2004 through December 2005. Reports of MRSA were investigated and classified as either health care-associated (either hospital-onset or community-onset) or community-associated (patients without established health care risk factors for MRSA). MAIN OUTCOME MEASURES Incidence rates and estimated number of invasive MRSA infections and in-hospital deaths among patients with MRSA in the United States in 2005; interval estimates of incidence excluding 1 site that appeared to be an outlier with the highest incidence; molecular characterization of infecting strains. RESULTS There were 8987 observed cases of invasive MRSA reported during the surveillance period. Most MRSA infections were health care-associated: 5250 (58.4%) were community-onset infections, 2389 (26.6%) were hospital-onset infections; 1234 (13.7%) were community-associated infections, and 114 (1.3%) could not be classified. In 2005, the standardized incidence rate of invasive MRSA was 31.8 per 100,000 (interval estimate, 24.4-35.2). Incidence rates were highest among persons 65 years and older (127.7 per 100,000; interval estimate, 92.6-156.9), blacks (66.5 per 100,000; interval estimate, 43.5-63.1), and males (37.5 per 100,000; interval estimate, 26.8-39.5). There were 1598 in-hospital deaths among patients with MRSA infection during the surveillance period. In 2005, the standardized mortality rate was 6.3 per 100,000 (interval estimate, 3.3-7.5). Molecular testing identified strains historically associated with community-associated disease outbreaks recovered from cultures in both hospital-onset and community-onset health care-associated infections in all surveillance areas. CONCLUSIONS Invasive MRSA infection affects certain populations disproportionately. It is a major public health problem primarily related to health care but no longer confined to intensive care units, acute care hospitals, or any health care institution.
Collapse
Affiliation(s)
- R Monina Klevens
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
O'Loughlin RE, Roberson A, Cieslak PR, Lynfield R, Gershman K, Craig A, Albanese BA, Farley MM, Barrett NL, Spina NL, Beall B, Harrison LH, Reingold A, Van Beneden C. The epidemiology of invasive group A streptococcal infection and potential vaccine implications: United States, 2000-2004. Clin Infect Dis 2007; 45:853-62. [PMID: 17806049 DOI: 10.1086/521264] [Citation(s) in RCA: 347] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 05/23/2007] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Invasive group A Streptococcus (GAS) infection causes significant morbidity and mortality in the United States. We report the current epidemiologic characteristics of invasive GAS infections and estimate the potential impact of a multivalent GAS vaccine. METHODS From January 2000 through December 2004, we collected data from Centers for Disease Control and Prevention's Active Bacterial Core surveillance (ABCs), a population-based system operating at 10 US sites (2004 population, 29.7 million). We defined a case of invasive GAS disease as isolation of GAS from a normally sterile site or from a wound specimen obtained from a patient with necrotizing fasciitis or streptococcal toxic shock syndrome in a surveillance area resident. All available isolates were emm typed. We used US census data to calculate rates and to make age- and race-adjusted national projections. RESULTS We identified 5400 cases of invasive GAS infection (3.5 cases per 100,000 persons), with 735 deaths (case-fatality rate, 13.7%). Case-fatality rates for streptococcal toxic shock syndrome and necrotizing fasciitis were 36% and 24%, respectively. Incidences were highest among elderly persons (9.4 cases per 100,000 persons), infants (5.3 cases per 100,000 persons), and black persons (4.7 cases per 100,000 persons) and were stable over time. We estimate that 8950-11,500 cases of invasive GAS infection occur in the United States annually, resulting in 1050-1850 deaths. The emm types in a proposed 26-valent vaccine accounted for 79% of all cases and deaths. Independent factors associated with death include increasing age; having streptococcal toxic shock syndrome, meningitis, necrotizing fasciitis, pneumonia, or bacteremia; and having emm types 1, 3, or 12. CONCLUSIONS GAS remains an important cause of severe disease in the United States. The introduction of a vaccine could significantly reduce morbidity and mortality due to these infections.
Collapse
Affiliation(s)
- Rosalyn E O'Loughlin
- Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Klevens RM, Morrison MA, Fridkin SK, Reingold A, Petit S, Gershman K, Ray S, Harrison LH, Lynfield R, Dumyati G, Townes JM, Craig AS, Fosheim G, McDougal LK, Tenover FC. Community-associated methicillin-resistant Staphylococcus aureus and healthcare risk factors. Emerg Infect Dis 2007; 12:1991-3. [PMID: 17326962 PMCID: PMC3291355 DOI: 10.3201/eid1212.060505] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To determine frequency of methicillin-resistant Staphylococcus aureus infections caused by strains typically associated with community-acquired infections (USA300) among persons with healthcare-related risk factors (HRFs), we evaluated surveillance data. Of patients with HRFs, 18%–28% had a "community-associated" strain, primarily USA300; of patients without HRFs, 26% had a "healthcare-associated" strain, typically USA100.
Collapse
Affiliation(s)
- R Monina Klevens
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Herrera GA, Iwane MK, Cortese M, Brown C, Gershman K, Shupe A, Averhoff F, Chaves SS, Gargiullo P, Bridges CB. Influenza vaccine effectiveness among 50–64-year-old persons during a season of poor antigenic match between vaccine and circulating influenza virus strains: Colorado, United States, 2003–2004. Vaccine 2007; 25:154-60. [PMID: 17064823 DOI: 10.1016/j.vaccine.2006.05.129] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Revised: 05/23/2006] [Accepted: 05/31/2006] [Indexed: 11/17/2022]
Abstract
During the 2003-2004 influenza season, we conducted a case-control study of influenza vaccine effectiveness (VE) among Colorado residents aged 50-64 years. Cases (n=330) were identified from laboratory-confirmed influenza reports to the Colorado Department of Public Health and Environment (CDPHE). Controls (n=1055) were recruited by random-digit dial telephone survey. VE was 60% (43-72%) and 48% (21-66%) among those without and with high-risk medical conditions, respectively. VE was 90% (68-97%) and 36% (0-63%) against influenza-related hospitalization for persons without and with high-risk conditions, respectively.
Collapse
Affiliation(s)
- Guillermo A Herrera
- Centers for Disease Control and Prevention (CDC), National Immunization Program (NIP), Epidemiology and Surveillance Division (ESD), Centers for Disease Control and Prevention, Atlanta, GA 30333, United States.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Kyaw MH, Greene CM, Schaffner W, Ray SM, Shapiro M, Barrett NL, Gershman K, Craig AS, Roberson A, Zell ER, Schuchat A, Bennett NM, Whitney CG. Adults with invasive pneumococcal disease: missed opportunities for vaccination. Am J Prev Med 2006; 31:286-92. [PMID: 16979452 DOI: 10.1016/j.amepre.2006.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 05/08/2006] [Accepted: 06/02/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The pneumococcal polysaccharide vaccine (PPV) can prevent invasive pneumococcal disease (IPD) in the elderly and those with certain underlying illnesses. However, vaccine uptake remains suboptimal. Identification of missed opportunities for vaccination could guide new strategies for improving uptake. Missed opportunities for vaccination were defined as one or more visits to a hospital, emergency room (ER), or main provider in the 2 years before infection among unvaccinated, adult IPD case-patients with a vaccine indication. METHODS Adults aged 18 years or older with IPD were identified in six Active Bacterial Core surveillance/Emerging Infections Program Network sites during a 1-year period in 2001 to 2003. Using chart review, patient/proxy interview, a main provider questionnaire, and vaccine questionnaires from additional providers, data were collected on demographics, vaccine indications, vaccine status, and recent healthcare encounters. RESULTS A total of 1878 cases were enrolled, and 83% had a vaccine indication. Of the 1177 cases with a vaccine indication and sufficient information on recent healthcare encounters, 617 (52%) were unvaccinated. Of these, 566 (92%) had one or more opportunities for vaccination, 54% were hospitalized, 58% had ER visits, and 76% visited their main provider in the 2 years before illness. The number of visits to main providers (median = 6) was higher than hospitalizations (median = 1), and ER visits (median = 1). CONCLUSIONS One or more missed opportunities for vaccination were documented in nearly all unvaccinated IPD case-patients with a vaccine indication. Most visited their main provider multiple times. Implementation of systematic PPV programs in outpatient settings will likely increase pneumococcal vaccine uptake among high-risk adults.
Collapse
Affiliation(s)
- Moe H Kyaw
- Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Greene CM, Kyaw MH, Ray SM, Schaffner W, Lynfield R, Barrett NL, Long C, Gershman K, Pilishvili T, Roberson A, Zell ER, Whitney CG, Bennett NM. Preventability of invasive pneumococcal disease and assessment of current polysaccharide vaccine recommendations for adults: United States, 2001-2003. Clin Infect Dis 2006; 43:141-50. [PMID: 16779739 DOI: 10.1086/505117] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Accepted: 03/24/2006] [Indexed: 11/03/2022] Open
Abstract
UNLABELLED BACKGROUND. To prevent Streptococcus pneumoniae infection among persons at highest risk for invasive pneumococcal disease (IPD), the pneumococcal polysaccharide vaccine (PPV) is currently recommended for persons >or=65 years old and persons 2-64 years old with certain underlying conditions. Policymakers have considered expanding recommendations for PPV to include persons who are 50-64 years old and additional populations at risk for IPD. Our objectives were to determine the proportion of IPD cases that might have been prevented if all persons with vaccine indications had been vaccinated and to evaluate new indications. METHODS From 2001 to 2003, we performed a case series study of IPD in adults at 6 sites of the Active Bacterial Core surveillance-Emerging Infections Program Network. A case of IPD was defined as isolation of pneumococcus from a normally sterile site from a resident of 1 of the surveillance areas. RESULTS Among 1878 case patients, 1558 (83%) had at least 1 current vaccine indication; of these, 968 case patients (62%) were unvaccinated. Adherence to existing vaccine recommendations would have prevented 21% of all cases. The proportions of all cases potentially prevented by each new indication were as follows: lowering the universal age of recommended vaccination to 50 years, 5.0%-7.0%; adding new risk-based indications to include current smoking, 1.5%-2.5%; former smoking, 0.4%-0.7%; black race, 1.0%-1.4%; and asthma, 0.3%-0.4%. CONCLUSIONS Increasing vaccine coverage rates among persons with a current indication may prevent more cases than expanding existing indications. Of the potential new indications studied, the strategy that may prevent most cases is lowering the recommended age for universal vaccination to 50 years.
Collapse
Affiliation(s)
- Carolyn M Greene
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Schrag SJ, Shay DK, Gershman K, Thomas A, Craig AS, Schaffner W, Harrison LH, Vugia D, Clogher P, Lynfield R, Farley M, Zansky S, Uyeki T. Multistate surveillance for laboratory-confirmed, influenza-associated hospitalizations in children: 2003-2004. Pediatr Infect Dis J 2006; 25:395-400. [PMID: 16645501 DOI: 10.1097/01.inf.0000214988.81379.71] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [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: 11/25/2022]
Abstract
BACKGROUND Increasing use of rapid influenza diagnostics facilitates laboratory confirmation of influenza infections. We describe laboratory-confirmed, influenza-associated hospitalizations in a population representing almost 6% of children in the United States. METHODS We conducted population-based surveillance for influenza-associated hospitalizations between October 1, 2003, and March 31, 2004, in 54 counties in 9 states (4.2 million children) participating in the Emerging Infections Program Network. Clinical characteristics, predictors of intensive care unit admission and geographic and age-specific incidence were evaluated. RESULTS Surveillance identified 1,308 case-patients; 80% were <5 years and 27% were <6 months of age. Half of the patients and 4 of 5 pediatric deaths did not have a medical indication for influenza vaccination and were outside the 6- to 23-month age group. Twenty-eight percent of case-patients had radiographic evidence of a pulmonary infiltrate, 11% were admitted to intensive care and 3% received mechanical ventilation. The median length of hospital stay was 2 days. Community-acquired invasive bacterial coinfections (1% of patients) were associated with intensive care admission (adjusted odds ratio, 16.9; 95% confidence interval, 5.0-56.8). Thirty-five percent of patients >or=6 months old had received at least one influenza vaccine dose that season. The overall incidence of influenza-associated hospitalizations was 36 per 100,000 children (range per state, 10 per 100,000 to 86 per 100,000). CONCLUSIONS Influenza was an important cause of hospitalizations in children during 2003-2004. Hospitalizations were particularly common among children <6 months of age, a group for whom influenza vaccine is not licensed. Continued surveillance for laboratory-confirmed influenza could inform prevention strategies.
Collapse
Affiliation(s)
- Stephanie J Schrag
- National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Ferguson DD, Gershman K, LeBailly A, Petersen LR. Characteristics of the rash associated with West Nile virus fever. Clin Infect Dis 2005; 41:1204-7. [PMID: 16163642 DOI: 10.1086/444506] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Accepted: 06/19/2005] [Indexed: 11/03/2022] Open
Abstract
We characterized rash in 15 patients with West Nile virus (WNV) fever. Generalized, maculopapular rash typically occurred on days 5-12 of illness. Dysesthesia was reported by 27% of patients, and pruritus by 33% of patients. Because the rash was nonspecific and serologic test results were often negative for WNV at presentation, convalescent-phase testing was frequently required to diagnose WNV fever.
Collapse
Affiliation(s)
- Dayna D Ferguson
- Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | |
Collapse
|
36
|
Ferguson DD, Scheftel J, Cronquist A, Smith K, Woo-Ming A, Anderson E, Knutsen J, De AK, Gershman K. Temporally distinct Escherichia coli 0157 outbreaks associated with alfalfa sprouts linked to a common seed source--Colorado and Minnesota, 2003. Epidemiol Infect 2005; 133:439-47. [PMID: 15962550 PMCID: PMC2870267 DOI: 10.1017/s0950268804003589] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [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: 12/21/2022] Open
Abstract
Escherichia coli O157 outbreaks were identified in Minnesota in February 2003 involving seven persons and in Colorado in July 2003 involving 13 persons. Case isolates from the two states had matching pulsed-field gel electrophoresis (PFGE) patterns. Independent case-control studies linked infections in each outbreak with eating alfalfa sprouts that were traced to the same seed distributor. The Colorado sprouter reportedly complied with the Food and Drug Administration (FDA) sprout guidance, whereas the Minnesota sprouter did not. These investigations revealed that increased compliance with existing FDA guidance is needed and that additional research is needed to improve the alfalfa seed decontamination process. This reaffirms the FDA recommendation that raw alfalfa sprouts should be considered potentially contaminated and avoided by persons at high-risk such as the elderly, young children, and immunocompromised persons. PFGE played an essential role in linking these two temporally and geographically distinct E. coli O157 outbreaks.
Collapse
Affiliation(s)
- D D Ferguson
- Epidemic Intelligence Service, Colorado Department of Public Health and Environment, Denver, CO 80246, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Ferguson DD, Gershman K, Jensen B, Arduino MJ, Yakrus MA, Cooksey RC, Srinivasan A. Mycobacterium goodii infections associated with surgical implants at Colorado hospital. Emerg Infect Dis 2004; 10:1868-71. [PMID: 15504281 PMCID: PMC3323279 DOI: 10.3201/eid1010.040402] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [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] [Indexed: 11/19/2022] Open
Abstract
From February to October 2003, Mycobacterium goodii wound infections were identified among three patients who received surgical implants at a Colorado hospital. This report summarizes the investigation of the first reported nosocomial outbreak of M. goodii. Increased awareness is needed about the potential for nontuberculous mycobacteria to cause postoperative wound infections.
Collapse
Affiliation(s)
- Dayna Devon Ferguson
- Communicable Disease Epidemiology, Colorado Department of Public Health and Environment, Denver, Colorado 80246, USA.
| | | | | | | | | | | | | |
Collapse
|
38
|
Hannah EL, Bailey AM, Hajjeh R, Gershman K, Lindsley M, Hoffman RE. Public health response to 2 clinical cases of blastomycosis in colorado residents. Clin Infect Dis 2001; 32:E151-3. [PMID: 11340548 DOI: 10.1086/320516] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2000] [Revised: 10/12/2000] [Indexed: 11/04/2022] Open
Abstract
We summarize the public health response after the identification of 2 cases of pneumonia caused by Blastomyces dermatitidis infection in Colorado residents. The response to these cases emphasizes the need for physicians to add fungal infection to the list of differential diagnoses for patients who have refractory pneumonia, even those who live in areas of nonendemicity.
Collapse
Affiliation(s)
- E L Hannah
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | | | | | | | | | | |
Collapse
|
39
|
Torkko KC, Gershman K, Crane LA, Hamman R, Barón A. Testing for Chlamydia and sexual history taking in adolescent females: results from a statewide survey of Colorado primary care providers. Pediatrics 2000; 106:E32. [PMID: 10969116 DOI: 10.1542/peds.106.3.e32] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [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: 11/24/2022] Open
Abstract
OBJECTIVES Little is known about the practice patterns of primary care providers as they relate to assessing risk of and screening for chlamydial infections, an important cause of preventable reproductive morbidity in young women in the United States. The present cross-sectional study was undertaken to assess levels of chlamydia testing, sexual history taking, and prevention practices by Colorado primary care physicians, nurse practitioners, and physician assistants who provide gynecologic care to adolescent females (13-19 years old). METHODS Between July 1998 and October 1998, an anonymous, self-administered questionnaire was mailed to a 25% random sample (n = 1265) of Colorado physicians (family practitioners, internal medicine specialists, obstetrician-gynecologists, and pediatricians), nurse practitioners, and physician assistants. Practitioners were identified through professional organization membership, state-licensing bodies, and listings in the yellow pages. RESULTS After estimating the eligibility rate among non-respondents, the adjusted response rate was 71.5%. Only 53.8% of providers reported regularly testing sexually active female adolescents for chlamydia; 71.8% of providers regularly took a sexual history. Female providers reported significantly higher levels of regularly taking a sexual history (87. 2% vs 60.6% of males), feeling comfortable discussing sex (94.4% vs 77.8%), discussing sexually transmitted disease (STD) prevention (81. 5% vs 71.3%), and testing for chlamydia (64.4% vs 38.6%). Among provider types, obstetrician-gynecologists, nurse practitioners, and pediatricians were most likely to report regularly taking a sexual history (90.1%, 88.6%, and 76.0%, respectively). Internal medicine specialists were the least likely to report taking a sexual history (43.9%). Pediatricians and nurse practitioners were the most likely to report testing sexually active adolescent females for chlamydia (74.1% and 70.1%, respectively), whereas physician assistants and internal medicine specialists were the least likely (46.0% and 38.5%, respectively). In multivariate analysis, variables independently associated with regularly taking a sexual history included female provider gender (odds ratio [OR]: 5.5; 95% confidence interval [CI]: 2.9-10.9), obstetrics/gynecology specialty (OR: 4.0; 95% CI: 1.7-10. 3; referent group: family practitioners), and provider comfort level in discussing sex (OR: 4.9; 95% CI: 2.3-11.1). Variables independently associated with regularly testing adolescent females for chlamydia included female provider gender (OR: 2.8; 95% CI: 1. 6-4.8), regularly discussing STD prevention (OR: 2.1; 95% CI: 1.1-4. 1), and regularly discussing limiting the number of patients' sex partners (OR: 2.4; 95% CI: 1.4-4.1). CONCLUSIONS Only a little over one half of providers (54%) reported regularly performing chlamydia tests on adolescent females who are sexually active by history. Because this falls well short of the recommendations of the Centers for Disease Control and Prevention to test all sexually active female adolescents, efforts are needed to improve STD clinical practices of Colorado physician and nonphysician providers of primary care for adolescent females. Particular efforts are needed to close the provider gender gap.
Collapse
Affiliation(s)
- K C Torkko
- Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, CO 80220, USA.
| | | | | | | | | |
Collapse
|
40
|
Bunnell RE, Dahlberg L, Rolfs R, Ransom R, Gershman K, Farshy C, Newhall WJ, Schmid S, Stone K, St Louis M. High prevalence and incidence of sexually transmitted diseases in urban adolescent females despite moderate risk behaviors. J Infect Dis 1999; 180:1624-31. [PMID: 10515825 DOI: 10.1086/315080] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.6] [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: 11/04/2022] Open
Abstract
To better understand the prevalence, incidence, and risk factors for sexually transmitted diseases (STDs) among female adolescents, a prospective 6-month cohort study was conducted at four teen clinics in a southeastern city. At enrollment, 260 (40%) of 650 sexually active females ages 14-19 years had an STD: chlamydia, 27%; herpes simplex virus type 2 (HSV-2), 14%; gonorrhea, 6%; trichomoniasis, 3%; and hepatitis B, 2%. At follow-up, 112 (23%) of 501 participants had an incident infection: chlamydia, 18%; HSV-2, 4%; gonorrhea, 4%; and trichomoniasis, 3%. At either enrollment or follow-up, 53% had >/=1 STD; of those with 1 lifetime partner, 30% had an STD. Having a new partner (odds ratio [OR], 2.2; 95% confidence interval [CI], 1. 1-4.2) or friends who sell cocaine (OR, 1.6; CI, 1.0-2.6) was independently associated with incident infection. STD incidence and prevalence were extremely high in this population, even in teenagers with only 1 lifetime partner. Individual risk behaviors appeared less important for STD risk than population factors.
Collapse
Affiliation(s)
- R E Bunnell
- Division of STD Prevention, Centers for Disease Control, Atlanta, GA 30315, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Gershman K, Nielsen C. Prevention and screening in the nursing home. Prim Care 1995; 22:731-53. [PMID: 8668740] [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: 02/01/2023]
Abstract
The primary care physicians must use screening procedures for the elderly that focus on function, with special attention paid to falls, incontinence, malnutrition, and sexuality. Nursing home staff and patients' families can be particularly helpful to the physician.
Collapse
Affiliation(s)
- K Gershman
- Department of Community Medicine, Dartmouth Medical School, Augusta, Maine 04330, USA
| | | |
Collapse
|
42
|
Ellerbeck EF, Lewis JA, Nalin D, Gershman K, Miller WJ, Armstrong ME, Davide JP, Rhoad AE, McGuire B, Calandra G. Safety profile and immunogenicity of an inactivated vaccine derived from an attenuated strain of hepatitis A. Vaccine 1992; 10:668-72. [PMID: 1523877 DOI: 10.1016/0264-410x(92)90087-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [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]
Abstract
To determine the safety and immunogenicity of an inactivated hepatitis A vaccine, 56 healthy adult volunteers were randomly assigned to receive an intramuscular injection of 6.3, 12.5 or 25 ng of inactivated hepatitis A vaccine or placebo at 0, 2 or 4, and 24 weeks. Adverse reactions occurred with similar frequency in vaccine and placebo recipients and consisted primarily of pain or tenderness at the injection site. By 4 weeks after a single 6.3, 12.5 or 25 ng injection, seven, nine and ten out of ten vaccinees, respectively, had antibody detectable by a HAV AB assay modified to increase its sensitivity tenfold. All vaccinees had antibodies detectable by this assay within 2 weeks of their second inoculation. Geometric mean antibody levels increased with higher doses of vaccine (p = 0.05). Neutralizing antibody was detected within 4 weeks of a single inoculation in all vaccinees. Neutralizing antibody was detected after the third inoculation at dilutions of greater than or equal to 1:2048 in all 12.5 and 25 ng vaccinees. All 19 vaccinees tested at 24 months still had HAV antibodies detectable by a modified HAV AB assay. This inactivated hepatitis A vaccine appears to be well tolerated and immunogenic at doses of 6.3-25 ng. The choice of dose and vaccination schedule may depend on the rapidity with which seroconversion is desired.
Collapse
Affiliation(s)
- E F Ellerbeck
- Center for Immunization Research, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Miskovsky E, Gershman K, Clements ML, Cupps T, Calandra G, Hesley T, Ioli V, Ellis R, Kniskern P, Miller W. Comparative safety and immunogenicity of yeast recombinant hepatitis B vaccines containing S and pre-S2 + S antigens. Vaccine 1991; 9:346-50. [PMID: 1872019 DOI: 10.1016/0264-410x(91)90062-b] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
One hundred and four healthy, hepatitis B virus (HBV) seronegative males were enrolled in a single blind, randomized pilot study to compare antibody and clinical responses to a yeast recombinant pre-S2 + S vaccine and a yeast recombinant S antigen vaccine (Recombivax HBR). Participants received either a 12, 24 or 48 micrograms dose of pre-S2 + S vaccine (with a 1:5 ratio by weight of pre-S2 and S antigens) or a 10 micrograms dose of Recombivax HBR by intramuscular injection at 0, 1 and 6 months; their serological and biochemical responses were measured at 0, 1, 2, 3, 6 and 7 months, while their clinical responses were monitored for 5 days after each injection. The proportion of vaccines with minor local or systemic complaints (mainly sore arm, malaise, myalgia, fatigue) and the proportion developing antibody to surface antigen (anti-HBs) were similar for all vaccine groups. Transient elevations in alanine aminotransferase occurred infrequently. By 7 months almost all vaccinees developed anti-HBs, but titres were generally higher among recipients of pre-S2 + S vaccine. Antibody to pre-S2 antigen developed in 70-75% by 2 months and in 91-96% by 7 months. These data imply that the recombinant yeast pre-S2 + S vaccine is as well tolerated and as immunogenic as Recombivax HBR. Further studies are being conducted to assess antibody responses in larger numbers of healthy adults as well as in special populations with sub-optimal responses to currently licensed hepatitis B vaccines.
Collapse
Affiliation(s)
- E Miskovsky
- Division of Immunology and Rheumatology, Georgetown University Hospital, Washington, DC
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Midthun K, Ellerbeck E, Gershman K, Calandra G, Krah D, McCaughtry M, Nalin D, Provost P. Safety and immunogenicity of a live attenuated hepatitis A virus vaccine in seronegative volunteers. J Infect Dis 1991; 163:735-9. [PMID: 1849160 DOI: 10.1093/infdis/163.4.735] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.4] [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: 12/29/2022] Open
Abstract
Seronegative adults were enrolled in a dose-escalating study of a live attenuated hepatitis A virus (HAV) vaccine that was prepared from the F' variant of HAV strain CR326F. They were injected subcutaneously with 10(4.1), 10(5.2), 10(6.1), or 10(7.3) TCID 50 of HAV vaccine (n = 40) or with placebo (n = 12) and were followed for 6 months. None of the vaccine recipients developed significant systemic reactions or aminotransferase elevations. HAV was not isolated in cell culture from any postvaccination serum or stool specimen tested. Antibody to HAV was detected by modifications of HAV antibody assays (HAVAB or HAVAB-M) in 20%, 40%, 60%, and 100% of the recipients of each vaccine dose, in ascending order. Neutralizing antibody was present in all 10(7.3) TCID50 recipients tested at 3 and 6 months after vaccination. This live attenuated HAV vaccine was well tolerated and highly immunogenic at a dose of 10(7.3) TCID50.
Collapse
Affiliation(s)
- K Midthun
- Center for Immunization Research, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Meyer DL, Gershman K, Broberg L, Craigie FC, Antonucci J. Conducting family meetings in nursing homes: resident, nurse, and family perceptions. Fam Med 1991; 23:36-9. [PMID: 2001779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
One facet of the teaching nursing home activities of the Maine-Dartmouth Family Practice Residency Program involves requiring residents to schedule a yearly family meeting in collaboration with nursing staff for each of the three to six nursing home patients for whom they are primarily responsible. During a one-year period, meetings were held for 45 of 63 nursing home patients (71%). All participants used a simple instrument to evaluate the experience. A general outline of the content and process of successful meetings is described. Results indicate that families, patients, nurses, and physicians found the meetings useful for sharing medical information and providing emotional support. Meetings typically reinforced or made only minor refinements in the ongoing plan of care. The implementation methods of the project are briefly described so that others might consider making yearly family meetings in nursing homes a part of their training programs.
Collapse
Affiliation(s)
- D L Meyer
- Maine-Dartmouth Family Practice Residency, Augusta 04330-5796
| | | | | | | | | |
Collapse
|
46
|
Dowell SF, Halsey NA, Boulos R, Brutus JR, Holt E, Quinn TC, Blattner W, McArthur J, Gershman K, Ruff A. HTLV-I and HIV-1-associated neurologic abnormalities; syphilis as a confounding factor. AIDS 1989; 3:763-4. [PMID: 2515883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
47
|
Tennen H, Affleck G, Gershman K. Self-blame among parents of infants with perinatal complications: the role of self-protective motives. J Pers Soc Psychol 1986. [PMID: 3712220 DOI: 10.1037//0022-3514.50.4.690] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
According to the literature on defensive attribution, behavioral self-blame can bolster a sense of personal efficacy and is more likely to occur when victims perceive their misfortune as severe. In this study, mothers of infants with severe perinatal complications rated the severity of their child's condition, were asked about its causes, and completed a measure of emotional adaptation. As predicted according to the defensive attribution hypothesis, behavioral self-blame was associated with greater perceived severity and preventability of recurrence. The pattern of correlations suggests that greater perceived severity may produce greater self-blame, which in turn may play an indirect role in adaptation through its association with the belief that a recurrence could be prevented. Results of a post hoc path analysis were consistent with this hypothesis. These findings are discussed in terms of the adaptive features of behavioral self-blame, its relation to perceived control, methodological issues in the study of coping with victimization, and implications for helping professionals.
Collapse
|
48
|
Tennen H, Affleck G, Gershman K. Self-blame among parents of infants with perinatal complications: The role of self-protective motives. J Pers Soc Psychol 1986; 50:690-6. [PMID: 3712220 DOI: 10.1037/0022-3514.50.4.690] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
According to the literature on defensive attribution, behavioral self-blame can bolster a sense of personal efficacy and is more likely to occur when victims perceive their misfortune as severe. In this study, mothers of infants with severe perinatal complications rated the severity of their child's condition, were asked about its causes, and completed a measure of emotional adaptation. As predicted according to the defensive attribution hypothesis, behavioral self-blame was associated with greater perceived severity and preventability of recurrence. The pattern of correlations suggests that greater perceived severity may produce greater self-blame, which in turn may play an indirect role in adaptation through its association with the belief that a recurrence could be prevented. Results of a post hoc path analysis were consistent with this hypothesis. These findings are discussed in terms of the adaptive features of behavioral self-blame, its relation to perceived control, methodological issues in the study of coping with victimization, and implications for helping professionals.
Collapse
|
49
|
Affleck G, Tennen H, Gershman K. Cognitive adaptations to high-risk infants: the search for mastery, meaning, and protection from future harm. Am J Ment Defic 1985; 89:653-6. [PMID: 3159262] [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: 01/04/2023]
Abstract
Cognitive adaptations suggesting orientations to primary or secondary control over stress were explored in a sample of 42 mothers who were interviewed shortly after discharge of their infant from a newborn intensive care unit. Mothers reported how much the infant's current recovery and future developmental status was or is dependent on personal actions and the degree to which they thought they could prevent perinatal complications in future deliveries (primary control). Also, they were asked whether there were gains or advantages from the crises of newborn intensive care and whether they had answered the question: "Why me?" (secondary control). Standard measures of mood state and stress reactions to aversive events were also administered. Results showed that each of the control cognitions was related to one or more measures of adaptational outcome. Findings were discussed in the context of theory and research on cognitive adaptations to threatening occurrences.
Collapse
|