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Issue 27, June 11, 2017


CDC Science Clips: Volume 9, Issue 27, July 11, 2017

Science Clips is produced weekly to enhance awareness of emerging scientific knowledge for the public health community. Each article features an Altmetric Attention score to track social and mainstream media mentions!

The report consists of these components:

  1. Top Articles of the Week

    Selected weekly by a senior CDC scientist from the standard sections listed below.
    The names of CDC authors are indicated in bold text.
    • Chronic Diseases and Conditions RSS Word feed
      • BACKGROUND: Antihypertension medication (antihypertensive) adherence lowers risk of cardiovascular disease (CVD); few studies have examined this association among older adults. METHODS AND RESULTS: We assessed this association among Medicare fee-for-service beneficiaries aged 66 to 79 years who were newly diagnosed with hypertension and initiated on antihypertensives in 2008-2009 (n=155 597). We calculated proportion of days covered (PDC) during follow-up, using proportional subdistribution hazard models, to examine association between antihypertensive adherence and a composite CVD outcomes, including first incident of fatal/nonfatal acute myocardial infarction, ischemic heart disease, stroke/transient ischemic attack, and heart failure. During follow-up (median 5.8 years and 798 621 person-years), we documented 47 198 CVD events. Among beneficiaries, 60.8%, 30.3%, and 8.9% had PDC >/=80%, 40% to 79%, and <40%. Crude incidence of CVD events were 40.1 (95% CI, 40.0-40.1), 93.9 (93.8-93.9), and 98.1 (98.1-98.2) per 1000 person-years for PDC >/=80%, 40% to 79%, and <40%, respectively. Adjusted hazard ratios for CVD events were 1.0 (<40% as reference), 1.0 (0.97-1.03) for 40% to 79%, and 0.44 (0.42-0.45) for >/=80% (P<0.001). Dose-response analysis suggested a nonlinear relationship between PDC and risk for CVD events with a protective effect of >/=80%. The pattern of associations between PDC and ischemic heart disease, stroke/transient ischemic attack, and heart failure were largely consistent as for CVD events and across different groups. CONCLUSIONS: Antihypertensive adherence was associated with a significantly lower risk of CVD events among older adults. There appeared to be a threshold effect in reducing CVD events at around PDC 80%, above which the risk for CVD reduced substantially.

    • Communicable Diseases RSS Word feed
      • BACKGROUND: Although there is evidence for heightened sexually transmitted disease (STD) acquisition among women who experienced sexual violence, little is known about their patterns of STD testing, STD diagnosis, and STD treatment. METHODS: Data was drawn from cycle eight of the National Survey of Family Growth (2011-2013). Logistic regression analyses used SUDAAN to examine the link between forced sex and risky sexual behavior as well as forced sex and STD testing, diagnoses, treatment, and connection to care. RESULTS: Women who experienced forced sex were more likely to have risky sex (adjusted odds ratio [AOR], 1.56; 95% confidence interval [CI], 1.08-2.24), risky partners (AOR, 1.90; 95% CI, 1.11-3.23), and report substance abuse (AOR, 1.80; 95% CI, 1.28-2.53) than women who never experienced forced sex. Women who reported forced sex were more likely to be tested for an STD (AOR, 1.67; 95% CI, 1.34-2.09), and be diagnosed with herpes (AOR, 1.94; 95% CI, 1.13-3.32), genital warts (AOR, 2.55; 95% CI, 1.90-3.41), and chlamydia (AOR, 1.83; 95% CI, 1.03-3.25) than those who have never had forced sex. Results indicated a direct relationship between particular STD diagnoses and treatment in the past 12 months (AOR, 6.81; 95% CI, 4.50-10.31). Further analyses indicate that forced sex moderated the link between STD diagnoses and STD treatment (AOR, 0.43; 95% CI, 0.19-0.98). CONCLUSIONS: Results indicate that women who reported experiencing forced sex were more likely to be diagnosed with chlamydia, herpes, and genital warts than women who never had forced sex. There may be a need to pay particular attention to women who experienced forced sex and a history of STDs to ensure that they are retained in care.

      • CDC’S Testing Makes Us Stronger (TMUS) campaign: Was campaign exposure associated with HIV testing behavior among black gay and bisexual men?
        Habarta N, Boudewyns V, Badal H, Johnston J, Uhrig J, Green D, Ruddle P, Rosenthal J, Stryker JE.
        AIDS Educ Prev. 2017 Jun;29(3):228-240.
        This study assessed exposure among Black gay, bisexual, and other men who have sex with men (BMSM) to a communication campaign, Testing Makes Us Stronger (TMUS), and its association with HIV testing to determine campaign effectiveness. Data from an online survey (N = 3,105) were analyzed using propensity score weight-adjusted logistic regression to examine the effect of exposure on HIV testing. Among BMSM aged 18-44 (n = 702), 43.2% reported TMUS exposure. The majority of those exposed were aged 25-34 (54%), HIV-negative (65%), and had some college education (87%). TMUS exposure was associated with reported increased HIV testing behaviors at 6- and 12-month frequencies. Communication campaigns with clear implementation strategies, focused objectives, and online and event presence can be associated with longer-term outcomes such as HIV testing.

      • Federal travel restrictions to prevent disease transmission in the United States: An analysis of requested travel restrictions
        Jungerman MR, Vonnahme LA, Washburn F, Alvarado-Ramy F.
        Travel Med Infect Dis. 2017 Jun 22.
        BACKGROUND: Individuals with certain communicable diseases may pose risks to the health of the traveling public; there has been documented transmission on commercial aircraft of tuberculosis (TB), measles, and severe acute respiratory syndrome (SARS). Federal public health travel restrictions (PHTR) prevent commercial air or international travel of persons with communicable diseases that pose a public health threat. METHODS: We described demographics and clinical characteristics of all cases considered for PHTR because of suspected or confirmed communicable disease from May 22, 2007, to December 31, 2015. RESULTS: We reviewed 682 requests for PHTR; 414 (61%) actions were completed to place 396 individuals on PHTR. The majority (>99%) had suspected (n = 27) or confirmed (n = 367) infectious pulmonary TB; 58 (16%) had multidrug-resistant-TB. There were 128 (85%) interceptions that prevented the initiation or continuation of travel. PHTR were removed for 310 (78%) individuals after attaining noninfectious status and 86 (22%) remained on PHTR at the end of the analysis period. CONCLUSIONS: PHTR effectively prevent exposure during commercial air travel to persons with potentially infectious diseases. In addition, they are effective tools available to public health agencies to prevent commercial travel of individuals with certain communicable diseases and possibly reconnect them with public health authorities.

      • BACKGROUND: From 2012 to 2014, rates of congenital syphilis increased in Louisiana and Florida. We evaluated the effectiveness of early (first or second) and third trimester syphilis screening for the prevention of congenital syphilis in these high-morbidity states. METHODS: Reported syphilis cases among pregnant women in Louisiana and Florida during January 1, 2013, to December 31, 2014, were reviewed for documented screening for syphilis in the first 2 trimesters and third trimester. Pregnant women with syphilis were linked to congenital syphilis records and stratified by whether the pregnancy led to a reported congenital syphilis case. RESULTS: Seven hundred ten pregnant women with syphilis in Louisiana and Florida were linked to 155 congenital syphilis cases. Three hundred seventy (52%) pregnant women with syphilis were staged as early syphilis (n = 270) or high-titer late or unknown duration-latent syphilis (n = 100), and 109 (70% of the total) were linked to congenital syphilis cases. Screening in the first 2 trimesters identified 513 pregnant women who tested positive for syphilis, and 470 (92%) potential congenital syphilis were averted. One hundred nine pregnant women tested positive for syphilis in the third trimester, and 85 (78%) had babies without congenital syphilis. During their pregnancy, 85 (12%) women tested negative at least once, and 55 (65%) had babies with congenital syphilis. Thirty-nine women had no reported syphilis screening 30 days or longer before delivery. CONCLUSIONS: Screening for syphilis both early and in the third trimester prevented many pregnant women with syphilis from having a baby with congenital syphilis. Preventing all congenital syphilis would likely require preventing all syphilis among women.

    • Disaster Control and Emergency Services RSS Word feed
      • Hurricane Sandy (New Jersey): Mortality rates in the following month and quarter
        Kim S, Kulkarni PA, Rajan M, Thomas P, Tsai S, Tan C, Davidow A.
        Am J Public Health. 2017 Jun 22:e1-e4.
        OBJECTIVES: To describe changes in mortality after Hurricane Sandy made landfall in New Jersey on October 29, 2012. METHODS: We used electronic death records to describe changes in all-cause and cause-specific mortality overall, in persons aged 76 years or older, and by 3 Sandy impact levels for the month and quarter following Hurricane Sandy compared with the same periods in earlier years adjusted for trends. RESULTS: All-cause mortality increased 6% (95% confidence interval [CI] = 2%, 11%) for the month, 5%, 8%, and 12% by increasing Sandy impact level; and 7% (95% CI = 5%, 10%) for the quarter, 5%, 8%, and 15% by increasing Sandy impact level. In elderly persons, all-cause mortality rates increased 10% (95% CI = 5%, 15%) and 13% (95% CI = 10%, 16%) in the month and quarter, respectively. Deaths that were cardiovascular disease-related increased by 6% in both periods, noninfectious respiratory disease-related by 24% in the quarter, infection-related by 20% in the quarter, and unintentional injury-related by 23% in the month. CONCLUSIONS: Mortality increased, heterogeneous by cause, for both periods after Hurricane Sandy, particularly in communities more severely affected and in the elderly, who may benefit from supportive services. (Am J Public Health. Published online ahead of print June 22, 2017: e1-e4. doi:10.2105/AJPH.2017.303826).

    • Healthcare Associated Infections RSS Word feed
      • Candida auris for the clinical microbiology laboratory: Not your grandfather’s Candida species
        Lockhart SR, Berkow EL, Chow N, Welsh RM.
        Clin Microbiol Newsl. 2017 ;39(13):99-103.
        Candida auris is a newly emerging species that was first identified in Asia in 2009 but has rapidly spread across the world. C. auris differs from most other Candida species in that antifungal resistance is the norm rather than the exception, it is a commensal of human skin rather than the human gut, and it can be easily transmitted from person to person in a health care setting. This review discusses the emergence of C. auris, global epidemiology, identification, antifungal susceptibility testing, and precautions to be taken when it is identified from a patient specimen.

    • Injury and Violence RSS Word feed
      • Deciphering suicide and other manners of death associated with drug intoxication: A Centers for Disease Control and Prevention Consultation Meeting Summary
        Stone DM, Holland KM, Bartholow B, Logan J, LiKamWa McIntosh W, Trudeau A, Rockett IR.
        Am J Public Health. 2017 Jun 22:e1-e7.
        Manner of death (MOD) classification (i.e., natural, accident, suicide, homicide, or undetermined cause) affects mortality surveillance and public health research, policy, and practice. Determination of MOD in deaths caused by drug intoxication is challenging, with marked variability across states. The Centers for Disease Control and Prevention hosted a multidisciplinary meeting to discuss drug intoxication deaths as they relate to suicide and other MOD. The meeting objectives were to identify individual-level, system-level, and place-based factors affecting MOD classification and identify potential solutions to classification barriers. Suggested strategies included improved standardization in death scene investigation, toxicology, and autopsy practice; greater accountability; and creation of job aids for investigators. Continued collaboration and coordination of activities are needed among stakeholders to affect prevention efforts. (Am J Public Health. Published online ahead of print June 22, 2017: e1-e7. doi:10.2105/AJPH.2017.303863).

    • Maternal and Child Health RSS Word feed
      • State-based perinatal quality collaboratives (SPQC) have become increasingly widespread in the United States. Whereas the first was launched in 1997, today over 40 states have SPQCs that are actively working or are in development. Despite great variability in the structure and function of SPQCs among states, many have seen their efforts lead to significant improvements in the care of mothers and newborns. Clinical topics targeted by SPQCs have included nosocomial infection in newborns, human milk use, neonatal abstinence syndrome, early term deliveries without a medical indication, maternal hemorrhage, and maternal hypertension, among others. While each SPQC uses approaches suited to its own context, several themes are common to the goals of all SPQCs, including developing obstetric and neonatal partnerships; including families as partners; striving for participation by all providers; utilizing rigorous quality improvement science; maintaining close partnerships with public health departments; and seeking population-level improvements in health outcomes.

    • Nutritional Sciences RSS Word feed
      • Plasma trans-fatty acid concentrations in fasting adults declined from NHANES 1999-2000 to 2009-2010
        Vesper HW, Caudill SP, Kuiper HC, Yang Q, Ahluwalia N, Lacher DA, Pirkle JL.
        Am J Clin Nutr. 2017 May;105(5):1063-1069.
        Background: The consumption of trans fatty acids (TFAs) is associated with an increased risk of cardiovascular disease, and reducing their consumption is a major public health objective. Food intake studies have provided estimates for TFA concentrations in the US population; however, there is a need for data on TFA blood concentrations in the population.Objective: The objective of this study was to determine plasma TFA concentrations in a nationally representative group of fasted adults in the US population in NHANES samples from 1999-2000 and 2009-2010.Design: Four major TFAs [palmitelaidic acid (C16:1n-7t), trans vaccenic acid (C18:1n-7t), elaidic acid (C18:1n-9t), and linoelaidic acid (C18:2n-6t,9t)] were measured in plasma in 1613 subjects from NHANES 1999-2000 and 2462 subjects from NHANES 2009-2010 by gas chromatography-mass spectrometry. Geometric means and distribution percentiles were calculated for each TFA and their sum by age, sex, and race/ethnicity (non-Hispanic white, non-Hispanic black, Mexican American), and covariate-adjusted geometric means were computed by using a model that included these demographic and other dietary factors, as well as survey year and any significant interaction terms.Results: These nationally representative data for the adult US population show that TFA concentrations were 54% lower in NHANES 2009-2010 than in NHANES 1999-2000. Covariate-adjusted geometric means for the sum of the 4 TFAs were 81.4 mumol/L (95% CI: 77.3, 85.6 mumol/L) and 37.8 mumol/L (95% CI: 36.4, 39.4 mumol/L) in NHANES 1999-2000 and 2009-2010, respectively. Even with the large decline in TFA concentrations, differences between demographic subgroups were comparable in the 2 surveys.Conclusion: The results indicate an overall reduction in TFA concentrations in the US population and provide a valuable baseline to evaluate the impact of the recent regulation categorizing TFAs as food additives.

    • Occupational Safety and Health RSS Word feed
      • Health-related quality of life among US workers: Variability across occupation groups
        Shockey TM, Zack M, Sussell A.
        Am J Public Health. 2017 Jun 22:e1-e8.
        OBJECTIVES: To examine the health-related quality of life among workers in 22 standard occupation groups using data from the 2013-2014 US Behavioral Risk Factor Surveillance System. METHODS: We examined the health-related quality of life measures of self-rated health, frequent physical distress, frequent mental distress, frequent activity limitation, and frequent overall unhealthy days by occupation group for 155 839 currently employed adults among 17 states. We performed multiple logistic regression analyses that accounted for the Behavioral Risk Factor Surveillance System’s complex survey design to obtain prevalence estimates adjusted for potential confounders. RESULTS: Among all occupation groups, the arts, design, entertainment, sports, and media occupation group reported the highest adjusted prevalence of frequent physical distress, frequent mental distress, frequent activity limitation, and frequent overall unhealthy days. The personal care and service occupation group had the highest adjusted prevalence for fair or poor self-rated health. CONCLUSIONS: Workers’ jobs affect their health-related quality of life. (Am J Public Health. Published online ahead of print June 22, 2017: e1-e8. doi:10.2105/AJPH.2017.303840).

    • Zoonotic and Vectorborne Diseases RSS Word feed
      • Rescue and characterization of recombinant virus from a new world Zika virus infectious clone
        Weger-Lucarelli J, Duggal NK, Brault AC, Geiss BJ, Ebel GD.
        J Vis Exp. 2017 Jun 07(124).
        Infectious cDNA clones allow for genetic manipulation of a virus, thus facilitating work on vaccines, pathogenesis, replication, transmission and viral evolution. Here we describe the construction of an infectious clone for Zika virus (ZIKV), which is currently causing an explosive outbreak in the Americas. To prevent toxicity to bacteria that is commonly observed with flavivirus-derived plasmids, we generated a two-plasmid system which separates the genome at the NS1 gene and is more stable than full-length constructs that could not be successfully recovered without mutations. After digestion and ligation to join the two fragments, full-length viral RNA can be generated by in vitro transcription with T7 RNA polymerase. Following electroporation of transcribed RNA into cells, virus was recovered that exhibited similar in vitro growth kinetics and in vivo virulence and infection phenotypes in mice and mosquitoes, respectively.

  2. CDC Authored Publications
    The names of CDC authors are indicated in bold text.
    Articles published in the past 6-8 weeks authored by CDC or ATSDR staff.
    • Chronic Diseases and Conditions RSS Word feed
      1. Ovarian cancer knowledge in women and providers following education with Inside Knowledge Campaign materials
        Puckett MC, Townsend JS, Gelb CA, Hager P, Conlon A, Stewart SL.
        J Cancer Educ. 2017 Jun 24.
        Because no effective methods for preventing or screening for ovarian cancer exist, symptom recognition is integral to its early detection. The Centers for Disease Control and Prevention’s Inside Knowledge: Get the Facts about Gynecologic Cancer campaign was developed to raise awareness and educate women and providers about risk factors, symptoms, recommended screening, and prevention strategies for the five main gynecologic cancers, including ovarian cancer. Inside Knowledge campaign materials were utilized by CDC’s National Comprehensive Cancer Control Program grantees to educate women and providers about gynecologic cancer from 2014 to 2015. Grantees recruited participants and held educational sessions using Inside Knowledge materials. Questionnaires were given before and after the sessions to assess changes in awareness, confidence, and behavioral intentions around gynecologic cancer information and analyzed in 2016. This analysis focused on an assessment of changes related to ovarian cancer information. Participants’ knowledge increased after educational sessions. Among women, there were increases in correctly identifying that the Papanicolaou (Pap) test does not screen for ovarian cancer (89.2%) and that genetic testing is available (77.9%). There was a lower increase in knowledge that HPV is not a cause of ovarian cancer (56.4%). Providers and women reported significant increases in their confidence in their ability to talk to each other about gynecologic cancer post-session. Ovarian cancer awareness, confidence, and related behaviors increased in participants exposed to Inside Knowledge materials. Using these materials to increase knowledge could lead to more empowered patients, better provider-patient communications, and improved care for gynecologic cancers, including ovarian cancer.

    • Communicable Diseases RSS Word feed
      1. Screening for syphilis and other sexually transmitted infections in pregnant women – Guam, 2014
        Cha S, Malik T, Abara WE, DeSimone MS, Schumann B, Mallada E, Klemme M, Aguon V, Santos AM, Peterman TA, Bolan G, Kamb ML.
        MMWR Morb Mortal Wkly Rep. 2017 Jun 23;66(24):644-648.
        Prenatal screening and treatment for sexually transmitted infections (STIs) can prevent adverse perinatal outcomes. In Guam, the largest of the three U.S. territories in the Pacific, primary and secondary syphilis rates among women increased 473%, from 1.1 to 6.3 per 100,000 during 2009-2013 (1). In 2013, the first congenital syphilis case after no cases since 2008 was reported (1,2). Little is known about STI screening coverage and factors associated with inadequate screening among pregnant women in Guam. This study evaluated the prevalence of screening for syphilis, human immunodeficiency virus (HIV), chlamydia, and gonorrhea, and examined correlates of inadequate screening among pregnant women in Guam. Data came from the medical records of a randomly selected sample of mothers with live births in 2014 at a large public hospital. Bivariate analyses and multivariable models using Poisson regression were conducted to determine factors associated with inadequate screening for syphilis and other STIs. Although most (93.5%) women received syphilis screening during pregnancy, 26.8% were not screened sufficiently early to prevent adverse pregnancy outcomes. Many women were not screened for HIV infection (31.1%), chlamydia (25.3%), or gonorrhea (25.7%). Prenatal care and insurance were important factors affecting STI screening during pregnancy. Prenatal care providers play an important role in preventing congenital infections. Policies and programs increasing STI and HIV services for pregnant women and improved access to and use of prenatal care are essential for promoting healthy mothers and infants.

      2. Attrition from antiretroviral treatment services among pregnant and non-pregnant patients following adoption of Option B+ in Haiti
        Domercant JW, Puttkammer N, Young P, Yuhas K, Francois K, Grand’Pierre R, Lowrance D, Adler M.
        Glob Health Action. 2017 ;10(1):1330915.
        BACKGROUND: Access to antiretroviral therapy (ART) has expanded in Haiti because of the adoption of Option B+ and the revision of treatment guidelines. Retention in care and treatment varies greatly and few studies have examined retention rates, particularly among women enrolled in Option B+. OBJECTIVE: To assess attrition among pregnant and non-pregnant patients initiating ART following adoption of Option B+ in Haiti. METHODS: Longitudinal data of adult patients initiated on ART from October 2012 through August 2014 at 73 health facilities across Haiti were analyzed using a survival analysis framework to determine levels of attrition. The Kaplan-Meier method and Cox proportional hazards regression were used to examine risk factors associated with attrition. RESULTS: Among 17,059 patients who initiated ART, 7627 (44.7%) were non-pregnant women, 5899 (34.6%) were men, and 3533 (20.7%) were Option B+ clients. Attrition from the ART program was 36.7% at 12 months (95% CI: 35.9-37.5%). Option B+ patients had the highest level of attrition at 50.4% at 12 months (95% CI: 48.6-52.3%). While early HIV disease stage at ART initiation was protective among non-pregnant women and men, it was a strong risk factor among Option B+ clients. In adjusted analyses, key protective factors were older age (p < 0.0001), living near the health facility (p = 0.04), having another known HIV-positive household member (p < 0.0001), having greater body mass index (BMI) (p < 0.0001), pre-ART counseling (p < 0.0001), and Cotrimoxazole prophylaxis during baseline (p < 0.01). Higher attrition was associated with rapidly starting ART after enrollment (p < 0.0001), anemia (p < 0.0001), and regimen tenofovir+lamivudine+nevirapine (TDF+3TC+NVP) (p < 0.001). CONCLUSIONS: ART attrition in Haiti is high among adults, especially among Option B+ patients. Identifying newly initiated patients most at risk for attrition and providing appropriate interventions could help reduce ART attrition.

      3. Urine tenofovir and emtricitabine concentrations provide biomarker for exposure to HIV preexposure prophylaxis
        Haaland RE, Martin A, Holder A, Fountain JJ, Hall L, Pescatore NA, Heeke S, Kelley CF.
        Aids. 2017 Jul 17;31(11):1647-1650.

        [No abstract]

      4. Trends in diagnoses among hospitalizations of HIV-infected children and adolescents in the US: 2003-2012
        Hurst SA, Ewing AC, Ellington SR, Kourtis AP.
        Pediatr Infect Dis J. 2017 Jun 20.
        OBJECTIVE: Using data from 2003-2012, we updated a previous analysis of trends in hospitalizations of HIV-infected children and adolescents in the US. METHODS: We used data from the Kids Inpatient Database of the Healthcare Cost and Utilization Project to derive nationally representative estimates of the number of hospitalizations and the rates per 1000 hospitalizations of select discharge diagnoses and procedures in 2003, 2006, 2009, and 2012 among HIV-infected and HIV-uninfected children and adolescents </=18 years, excluding hospitalizations for conditions related to pregnancy/delivery and neonatal diagnoses. We also examined trends in the prevalence of select discharge diagnoses and procedures using multivariable logistic regression models. RESULTS: During 2003-2012 the number of hospitalizations for HIV-infected children declined 58% vs 17% for uninfected, but the odds of having discharge codes for most of the diagnoses and procedures studied, including death during hospitalization, remained higher among HIV-infected compared to uninfected children. Among HIV-infected children, the prevalence of discharge diagnoses for pneumonia, pneumococcal disease, and varicella/herpes zoster infections, and odds of death during hospitalization decreased over time, while bacterial infections/sepsis and MRSA increased. Among HIV-uninfected children there was no increase in diagnoses of bacterial infection/sepsis, but otherwise trends were similar. CONCLUSION: The number of hospitalizations for HIV-infected children declined from 2003 to 2012. The decreased prevalence of several discharge diagnoses and lower risk of death during hospitalization likely reflect improvements in HIV therapies and increased uptake of other preventive strategies. However, the increasing prevalence of discharge diagnoses for bacterial infections/sepsis warrants further attention and monitoring.

      5. Increased coccidioidomycosis among inmates at a California prison: Initial investigation in 2005 to 2006
        Lee LA, Yuan J, Vugia D, Wheeler C, Chapnick R, Mohle-Boetani J.
        J Correct Health Care. 2017 Jan 01:1078345817716451.
        Since 2005, coccidioidomycosis has increased among inmates at a California prison. Our initial investigation found an incidence of 3,323 cases/100,000 persons. Black race, age >/=41 years, and residence on Yard C were significantly associated with coccidioidomycosis ( p < .05). Inmates at this prison have continued to be at risk for coccidioidomycosis.

      6. HIV drug resistance in infants increases with changing PMTCT regimens
        Poppe LK, Chunda-Liyoka C, Kwon EH, Gondwe C, West JT, Kankasa C, Ndongmo CB, Wood C.
        Aids. 2017 Jun 23.
        OBJECTIVES: The objectives of this study were to determine HIV drug resistance prevalence in Zambian infants upon diagnosis, and to determine how changing prevention of mother-to-child transmission (PMTCT) regimens affect drug resistance. DESIGN: Dried blood spot (DBS) samples from infants in the Lusaka District of Zambia, obtained during routine diagnostic screening, were collected during four different years representing three different PMTCT treatment regimens. METHODS: DNA extracted from DBS samples was used to sequence a 1493 bp region of the RT gene. Sequences were analyzed via the Stanford HIV Drug Resistance (HIVDR) Database (http://hivdb.standford.edu) to screen for resistance mutations. RESULTS: HIVDR in infants increased from 21.5% in 2007/2009 to 40.2% in 2014. Non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance increased steadily over the sampling period, while nucleoside reverse transcriptase inhibitor (NRTI) resistance and dual class resistance both increased more than threefold in 2014. Analysis of drug resistance scores in each group revealed increasing strength of resistance over time. In 2014, children with reported PMTCT exposure, defined as infant prophylaxis and/or maternal treatment, showed a higher prevalence and strength of resistance compared to those with no reported exposure. CONCLUSIONS: HIVDR is on the rise in Zambia and presents a serious problem for successful lifelong treatment of HIV infected children. PMTCT affects both the prevalence and strength of resistance and further research is needed to determine how to mitigate its role leading to resistance.

      7. Missed opportunities for chlamydia screening in Title X family planning clinics
        Salomon SG, Torrone E, Nakatsukasa-Ono W, Fine DN.
        Sex Transm Dis. 2017 ;16.
        BACKGROUND: Annual chlamydia (CT) screening is recommended for women younger than 25 years, yet less than half of young women seeking health care are screened annually. We analyzed Title X family planning service data from the Northwest United States to assess factors associated with missed opportunities for CT screening. Our primary hypothesis was screening coverage is higher during annual preventive health visits compared to other visit types. Study objectives were: (1) identify gaps in screening coverage by patient demographics, visit characteristics, and clinic measures; and (2) examine the association between visit type and CT screening by controlling for other covariates and stratifying by state. METHODS: Calendar year 2011 Title X visit records (n = 180,856) were aggregated to the patient level (n = 112,926) to assess CT screening coverage by all characteristics. Screening variation was explored by bivariate and multivariate Poisson regression. Adjusted models for each state estimated association between comprehensive examination and screening controlling for confounders. RESULTS: Clinic and visit characteristics were associated with CT screening. Coverage ranged from 45% in Washington to 80% in Alaska. Only 34% of patients visited for a routine comprehensive examination. Visit type was associated with screening; 75% of patients who had a comprehensive examination were screened versus 34% of those without a comprehensive examination (unadjusted PR, 2.18; 95% confidence interval, 2.16-2.21). The association between comprehensive examination and CT screening varied significantly by state (interaction term, P < 0.001). CONCLUSIONS: Missed screening opportunities are common among women who access brief appointments for specific needs but do not seek routine preventive care, particularly in some states. Structural interventions may help address these systematically missed opportunities.

      8. Assessment of vulnerability to coccidioidomycosis in Arizona and California
        Shriber J, Conlon KC, Benedict K, McCotter OZ, Bell JE.
        Int J Environ Res Public Health. 2017 Jun 23;14(7).
        Coccidioidomycosis is a fungal infection endemic to the southwestern United States, particularly Arizona and California. Its incidence has increased, potentially due in part to the effects of changing climatic variables on fungal growth and spore dissemination. This study aims to quantify the county-level vulnerability to coccidioidomycosis in Arizona and California and to assess the relationships between population vulnerability and climate variability. The variables representing exposure, sensitivity, and adaptive capacity were combined to calculate county level vulnerability indices. Three methods were used: (1) principal components analysis; (2) quartile weighting; and (3) percentile weighting. Two sets of indices, “unsupervised” and “supervised”, were created. Each index was correlated with coccidioidomycosis incidence data from 2000-2014. The supervised percentile index had the highest correlation; it was then correlated with variability measures for temperature, precipitation, and drought. The supervised percentile index was significantly correlated (p < 0.05) with coccidioidomycosis incidence in both states. Moderate, positive significant associations (p < 0.05) were found between index scores and climate variability when both states were concurrently analyzed and when California was analyzed separately. This research adds to the body of knowledge that could be used to target interventions to vulnerable counties and provides support for the hypothesis that population vulnerability to coccidioidomycosis is associated with climate variability.

      9. Dust exposure and coccidioidomycosis prevention among solar power farm construction workers in California
        Sondermeyer Cooksey GL, Wilken JA, McNary J, Gilliss D, Shusterman D, Materna BL, Vugia DJ.
        Am J Public Health. 2017 Jun 22:e1-e8.
        OBJECTIVES: To investigate if work activities, dust exposure, and protection measures were associated with a 2011 to 2014 coccidioidomycosis outbreak among workers constructing 2 solar farms in California. METHODS: In 2013, we mailed self-administered questionnaires to employees who were onsite at the solar farms where the outbreak occurred to identify cases of clinical coccidioidomycosis and compare with asymptomatic workers by using multivariate logistic regression. RESULTS: When we compared 89 workers with clinical coccidioidomycosis to 325 asymptomatic workers, frequently being in a dust cloud or storm (odds ratio [OR] = 5.93; 95% confidence interval [CI] = 3.18, 11.06) significantly increased the odds of clinical coccidioidomycosis, whereas frequently wetting soil before soil-disturbing activity (OR = 0.42; 95% CI = 0.24, 0.75) was protective. When we controlled for being in a dust cloud or storm, frequent soil disturbance significantly increased the odds of clinical coccidioidomycosis only among those who reported wearing a respirator infrequently (OR = 2.31; 95% CI = 1.27, 4.21). CONCLUSIONS: Utilization of personal and employer-driven safety practices and increased coccidioidomycosis awareness among construction workers should be considered during the planning of any construction work in coccidioidomycosis-endemic regions to prevent occupational infections and outbreaks. (Am J Public Health. Published online ahead of print June 22, 2017: e1-e8. doi:10.2105/AJPH.2017.303820).

      10. Clinical management of Ebola virus disease patients in low-resource settings
        Sprecher A, Van Herp M, Rollin PE.
        Curr Top Microbiol Immunol. 2017 Jun 24.
        The low-resource environment deprives healthcare providers caring for patients with Ebola virus disease (EVD) of many of the means employed for the critically ill that are available in better resourced settings, such as advanced therapeutic interventions and abundant staff. In addition to these limitations may be added those imposed by the remote tropical locations, where EVD outbreaks occur. In this setting, a safe environment is created where healthcare workers may care for their patients over the evolving course of their acute illness into their convalescent period. Clinical management of EVD combines supportive and symptomatic care while also addressing the patient’s emotional and mental health needs. A variety of specific therapies directly targeting the virus has become available, but none of these has, as of yet, conclusively demonstrated an impact. Healthcare workers caring for EVD patients must be constantly aware that they are part of a larger epidemic control operation, and their actions have consequences that go beyond their patients to their families and the community affected by the outbreak.

      11. Identifying persons living with human immunodeficiency virus (HIV) who are unaware of their infection, linking them to HIV medical care, and reducing health disparities are important national goals (1). Of the 8,841 teens and young adults aged 13-24 years (collectively referred to as youths in this report) who received a diagnosis of HIV in 2014, 70% were young men who have sex with men (MSM) (2). In the same year, an estimated 52% of young MSM living with HIV were unaware of their infection compared with 15% among all persons living with HIV (3). An average of 22% of high school students who have had sexual intercourse and 33% of young adults (persons aged 18-24 years) reported ever receiving an HIV test (4). CDC recommends screening all persons aged 13-64 years, with annual rescreening for persons at high risk for HIV infection (5). Analysis of CDC-funded program data for youths submitted by 61 health departments in 2015 revealed that young MSM, who accounted for 83% of new diagnoses among all youths in non-health care facilities, received 28% of HIV tests.* The 2020 national goal is to link at least 85% of HIV-positive persons to HIV medical care within 30 days of diagnosis. In this analysis, 66% of youths who received positive test results for HIV infection were linked to care within 90 days of diagnosis. Increasing the number of youths at risk for HIV infection who are tested for HIV on a regular basis and ensuring that youths who receive positive test results for HIV are rapidly linked to and retained in appropriate medical care, including early initiation of antiretroviral therapy, are essential steps for reducing HIV infection in this vulnerable population.

      12. Elimination of mother-to-child transmission of HIV and syphilis (EMTCT): Process, progress, and program integration
        Taylor M, Newman L, Ishikawa N, Laverty M, Hayashi C, Ghidinelli M, Pendse R, Khotenashvili L, Essajee S.
        PLoS Med. 2017 Jun;14(6):e1002329.
        Melanie Taylor and colleagues discuss progress towards eliminating vertical transmission of HIV and syphilis.

      13. Pathways and progress to enhanced global sexually transmitted infection surveillance
        Taylor MM, Korenromp E, Wi T.
        PLoS Med. 2017 Jun;14(6):e1002328.
        Melanie Taylor and colleagues discuss global initiatives for surveillance of sexually transmitted diseases.

      14. Syphilis testing practices in the Americas
        Trinh TT, Kamb ML, Luu M, Ham DC, Perez F.
        Trop Med Int Health. 2017 Jun 27.
        OBJECTIVE: To present the findings of the Pan American Health Organization’s 2014 survey on syphilis testing policies and practices in the Americas. METHODS: Representatives of national/regional reference and large, lower-level laboratories from 35 member-states were invited to participate. A semi-structured, electronically administered questionnaire collected data on syphilis tests, algorithms, equipment/commodities, challenges faced, and basic quality assurance (QA) strategies employed (i.e., daily controls, standard operating procedures, technician training, participating in external QA programs, on-site evaluations). RESULTS: The 69 participating laboratories from 30 (86%) member-states included 41 (59%) national/regio-nal reference and 28 (41%) lower-level laboratories. Common syphilis tests conducted were the rapid plasma reagin (RPR) (62% of surveyed laboratories), Venereal Disease Research Laboratory (VDRL) (54%), Fluorescent Treponemal Antibody Absorption (FTA-Abs) (41%) and Treponemal pallidum Hemagglutination Assay (TP-HA) (32%). Only three facilities reported using direct detection methods, and 28 (41% overall, 32% of lower-level facilities) used rapid tests. Most laboratories (62%) used only traditional testing algorithms (non-treponemal screening and treponemal confirmatory testing); however, 12% used only a reverse sequence algorithm (treponemal test first), and 14% employed both algorithms. Another 9 (12%) laboratories conducted only one type of serologic test. Although most reference (97%) and lower-level (89%) laboratories used at least one QA strategy, only 16% reported using all five basic strategies. Commonly reported challenges were stock-outs of essential reagents or commodities (46%), limited staff training (73%), and insufficient equipment (39%). CONCLUSIONS: Many reference and clinical laboratories in the Americas face challenges in conducting appropriate syphilis testing and in ensuring quality of testing. This article is protected by copyright. All rights reserved.

    • Environmental Health RSS Word feed
      1. Patterns, variability, and predictors of urinary triclosan concentrations during pregnancy and childhood
        Stacy SL, Eliot M, Etzel T, Papandonatos G, Calafat AM, Chen A, Hauser R, Lanphear BP, Sathyanarayana S, Ye X, Yolton K, Braun JM.
        Environ Sci Technol. 2017 Jun 06;51(11):6404-6413.
        Exposure to triclosan, an antimicrobial used in many consumer products, is ubiquitous in the United States, yet only limited data are available on the predictors and variability of exposure, particularly in children. We examined the patterns, variability, and predictors of urinary triclosan concentrations in 389 mother-child pairs enrolled in the Health Outcomes and Measures of the Environment Study from 2003 to 2006. We quantified triclosan in 3 urine samples collected from women between 16 weeks of pregnancy and birth and 6 urine samples collected from children between the ages of 1-8 years. For maternal and child samples, we calculated intraclass correlation coefficients (ICCs) to assess triclosan reproducibility and identified sociodemographic predictors of triclosan. Among 8 year old children, we examined associations between triclosan and personal-care product use. We detected triclosan in >70% of urine samples. Median maternal triclosan varied across pregnancy from 17 to 11 ng/mL, while in children, median concentrations increased from 3.6 to 17 ng/mL over the first 4 years of life, declining slightly at later ages. Triclosan reproducibility was fair to good during pregnancy and for child samples taken weeks apart (ICCs = 0.4-0.6) but poor for annual child samples (ICCs = 0.2-0.4). Triclosan was 66% (95% CI: 29-113) higher in 8 year olds using hand soap compared to nonusers and increased monotonically with hand-washing frequency. Toothpaste use in children was also positively associated with triclosan. Our results suggest that urinary triclosan concentrations have modest stability over weeks to months; children are exposed to triclosan through the use of some personal-care products.

      2. Rural and urban differences in air quality, 2008-2012, and community drinking water quality, 2010-2015 – United States
        Strosnider H, Kennedy C, Monti M, Yip F.
        MMWR Surveill Summ. 2017 Jun 23;66(13):1-10.
        PROBLEM/CONDITION: The places in which persons live, work, and play can contribute to the development of adverse health outcomes. Understanding the differences in risk factors in various environments can help to explain differences in the occurrence of these outcomes and can be used to develop public health programs, interventions, and policies. Efforts to characterize urban and rural differences have largely focused on social and demographic characteristics. A paucity of national standardized environmental data has hindered efforts to characterize differences in the physical aspects of urban and rural areas, such as air and water quality. REPORTING PERIOD: 2008-2012 for air quality and 2010-2015 for water quality. DESCRIPTION OF SYSTEM: Since 2002, CDC’s National Environmental Public Health Tracking Program has collaborated with federal, state, and local partners to gather standardized environmental data by creating national data standards, collecting available data, and disseminating data to be used in developing public health actions. The National Environmental Public Health Tracking Network (i.e., the tracking network) collects data provided by national, state, and local partners and includes 21 health outcomes, exposures, and environmental hazards. To assess environmental factors that affect health, CDC analyzed three air-quality measures from the tracking network for all counties in the contiguous United States during 2008-2012 and one water-quality measure for 26 states during 2010-2015. The three air-quality measures include 1) total number of days with fine particulate matter (PM2.5) levels greater than the U.S. Environmental Protection Agency’s (EPA’s) National Ambient Air Quality Standards (NAAQS) for 24-hour average PM2.5 (PM2.5 days); 2) mean annual average ambient concentrations of PM2.5 in micrograms per cubic meter (mean PM2.5); and 3) total number of days with maximum 8-hour average ozone concentrations greater than the NAAQS (ozone days). The water-quality measure compared the annual mean concentration for a community water system (CWS) to the maximum contaminant level (MCL) defined by EPA for 10 contaminants: arsenic, atrazine, di(2-ethylhexyl) phthalate (DEHP), haloacetic acids (HAA5), nitrate, perchloroethene (PCE), radium, trichloroethene (TCE), total trihalomethanes (TTHM), and uranium. Findings are presented by urban-rural classification scheme: four metropolitan (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan) and two nonmetropolitan (micropolitan and noncore) categories. Regression modeling was used to determine whether differences in the measures by urban-rural categories were statistically significant. RESULTS: Patterns for all three air-quality measures suggest that air quality improves as areas become more rural (or less urban). The mean total number of ozone days decreased from 47.54 days in large central metropolitan counties to 3.81 days in noncore counties, whereas the mean total number of PM2.5 days decreased from 11.21 in large central metropolitan counties to 0.95 in noncore counties. The mean average annual PM2.5 concentration decreased from 11.15 mug/m3 in large central metropolitan counties to 8.87 mug/m3 in noncore counties. Patterns for the water-quality measure suggest that water quality improves as areas become more urban (or less rural). Overall, 7% of CWSs reported at least one annual mean concentration greater than the MCL for all 10 contaminants combined. The percentage increased from 5.4% in large central metropolitan counties to 10% in noncore counties, a difference that was significant, adjusting for U.S. region, CWS size, water source, and potential spatial correlation. Similar results were found for two disinfection by-products, HAA5 and TTHM. Arsenic was the only other contaminant with a significant result. Medium metropolitan counties had 3.1% of CWSs reporting at least one annual mean greater than the MCL, compared with 2.4% in large central counties. INTERPRETATION: Noncore (rural) counties experienced fewer unhealthy air-quality days than large central metropolitan counties, likely because of fewer air pollution sources in the noncore counties. All categories of counties had a mean annual average PM2.5 concentration lower than the EPA standard. Among all CWSs analyzed, the number reporting one or more annual mean contaminant concentrations greater the MCL was small. The water-quality measure suggests that water quality worsens as counties become more rural, in regards to all contaminants combined and for the two disinfection by-products individually. Although significant differences were found for the water-quality measure, the odds ratios were very small, making it difficult to determine whether these differences have a meaningful effect on public health. These differences might be a result of variations in water treatment practices in rural versus urban counties. PUBLIC HEALTH ACTION: Understanding the differences between rural and urban areas in air and water quality can help public health departments to identify, monitor, and prioritize potential environmental public health concerns and opportunities for action. These findings suggest a continued need to develop more geographically targeted, evidence-based interventions to prevent morbidity and mortality associated with poor air and water quality.

      3. Per- and polyfluoroalkyl substances in human serum and urine samples from a residentially exposed community
        Worley RR, Moore SM, Tierney BC, Ye X, Calafat AM, Campbell S, Woudneh MB, Fisher J.
        Environ Int. 2017 Jun 20;106:135-143.
        BACKGROUND: Per- and polyfluoroalkyl substances (PFAS) are considered chemicals of emerging concern, in part due to their environmental and biological persistence and the potential for widespread human exposure. In 2007, a PFAS manufacturer near Decatur, Alabama notified the United States Environmental Protection Agency (EPA) it had discharged PFAS into a wastewater treatment plant, resulting in environmental contamination and potential exposures to the local community. OBJECTIVES: To characterize PFAS exposure over time, the Agency for Toxic Substances and Disease Registry (ATSDR) collected blood and urine samples from local residents. METHODS: Eight PFAS were measured in serum in 2010 (n=153). Eleven PFAS were measured in serum, and five PFAS were measured in urine (n=45) from some of the same residents in 2016. Serum concentrations were compared to nationally representative data and change in serum concentration over time was evaluated. Biological half-lives were estimated for perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), and perfluorohexane sulfonic acid (PFHxS) using a one-compartment pharmacokinetic model. RESULTS: In 2010 and 2016, geometric mean PFOA and PFOS serum concentrations were elevated in participants compared to the general U.S. POPULATION: In 2016, the geometric mean PFHxS serum concentration was elevated compared to the general U.S. POPULATION: Geometric mean serum concentrations of PFOA, PFOS, and perfluorononanoic acid (PFNA) were significantly (p</=0.0001) lower (49%, 53%, and 58%, respectively) in 2016 compared to 2010. Half-lives for PFOA, PFOS, and PFHxS were estimated to be 3.9, 3.3, and 15.5years, respectively. Concentrations of PFOA in serum and urine were highly correlated (r=0.75) in males. CONCLUSIONS: Serum concentrations of some PFAS are decreasing in this residentially exposed community, but remain elevated compared to the U.S. general population.

    • Epidemiology and Surveillance RSS Word feed
      1. Using paradata from a prior survey that is linked to a new survey can help a survey organization develop more effective sampling strategies. One example of this type of linkage or subsampling is between the National Health Interview Survey (NHIS) and the Medical Expenditure Panel Survey (MEPS). MEPS is a nationally representative sample of the U.S. civilian, noninstitutionalized population based on a complex multi-stage sample design. Each year a new sample is drawn as a subsample of households from the prior year?s NHIS. The main objective of this article is to examine how paradata from a prior survey can be used in developing a sampling scheme in a subsequent survey. A framework for optimal allocation of the sample in substrata formed for this purpose is presented and evaluated for the relative effectiveness of alternative substratification schemes. The framework is applied, using real MEPS data, to illustrate how utilizing paradata from the linked survey offers the possibility of making improvements to the sampling scheme for the subsequent survey. The improvements aim to reduce the data collection costs while maintaining or increasing effective responding sample sizes and response rates for a harder to reach population.

    • Health Disparities RSS Word feed
      1. BACKGROUND: Racial disparities in the burden of sexually transmitted diseases (STDs) have been documented and described for decades. Similarly, methodological issues and limitations in the use of disparity measures to quantify disparities in health have also been well documented. The purpose of this study was to use historic STD surveillance data to illustrate four of the most well-known methodological issues associated with the use of disparity measures. METHODS: We manually searched STD surveillance reports to find examples of racial/ethnic distributions of reported STDs that illustrate key methodological issues in the use of disparity measures. The disparity measures we calculated included the black-white rate ratio, the Index of Disparity (weighted and unweighted by subgroup population), and the Gini coefficient. RESULTS: The 4 examples we developed included illustrations of potential differences in relative and absolute disparity measures, potential differences in weighted and nonweighted disparity measures, the importance of the reference point when calculating disparities, and differences in disparity measures in the assessment of trends in disparities over time. For example, the gonorrhea rate increased for all minority groups (relative to whites) from 1992 to 1993, yet the Index of Disparity suggested that racial/ethnic disparities had decreased. CONCLUSIONS: Although imperfect, disparity measures can be useful to quantify racial/ethnic disparities in STDs, to assess trends in these disparities, and to inform interventions to reduce these disparities. Our study uses reported STD rates to illustrate potential methodological issues with these disparity measures and highlights key considerations when selecting disparity measures for quantifying disparities in STDs.

      2. Racial and ethnic disparities among state Medicaid programs for breast cancer screening
        Tangka FK, Subramanian S, Mobley LR, Hoover S, Wang J, Hall IJ, Singh SD.
        Prev Med. 2017 Jun 21.
        Breast cancer screening by mammography has been shown to reduce breast cancer morbidity and mortality. The use of mammography screening though varies by race, ethnicity, and, sociodemographic characteristics. Medicaid is an important source of insurance in the US for low-income beneficiaries, who are disproportionately members of racial or ethnic minorities, and who are less likely to be screened than women with higher socioeconomic statuses. We used 2006-2008 data from Medicaid claims and enrollment files to assess racial or ethnic and geographic disparities in the use of breast cancer screening among Medicaid-insured women at the state level. There were disparities in the use of mammography among racial or ethnic groups relative to white women, and the use of mammography varied across the 44 states studied. African American and American Indian women were significantly less likely than white women to use mammography in 30% and 39% of the 44 states analyzed, respectively, whereas Hispanic and Asian American women were the minority groups most likely to receive screening compared with white women. There are racial or ethnic disparities in breast cancer screening at the state level, which indicates that analyses conducted by only using national data not stratified by insurance coverage are insufficient to identify vulnerable populations for interventions to increase the use of mammography, as recommended.

    • Health Economics RSS Word feed
      1. Costs of a community-based glaucoma detection programme: analysis of the Philadelphia Glaucoma Detection and Treatment Project
        Pizzi LT, Waisbourd M, Hark L, Sembhi H, Lee P, Crews JE, Saaddine JB, Steele D, Katz LJ.
        Br J Ophthalmol. 2017 Jun 27.
        BACKGROUND: Glaucoma is the foremost cause of irreversible blindness, and more than 50% of cases remain undiagnosed. Our objective was to report the costs of a glaucoma detection programme operationalised through Philadelphia community centres. METHODS: The analysis was performed using a healthcare system perspective in 2013 US dollars. Costs of examination and educational workshops were captured. Measures were total programme costs, cost/case of glaucoma detected and cost/case of any ocular disease detected (including glaucoma). Diagnoses are reported at the individual level (therefore representing a diagnosis made in one or both eyes). Staff time was captured during site visits to 15 of 43 sites and included time to deliver examinations and workshops, supervision, training and travel. Staff time was converted to costs by applying wage and fringe benefit costs from the US Bureau of Labor Statistics. Non-staff costs (equipment and mileage) were collected using study logs. Participants with previously diagnosed glaucoma were excluded. RESULTS: 1649 participants were examined. Mean total per-participant examination time was 56 min (SD 4). Mean total examination cost/participant was $139. The cost/case of glaucoma newly identified (open-angle glaucoma, angle-closure glaucoma, glaucoma suspect, or primary angle closure) was $420 and cost/case for any ocular disease identified was $273. CONCLUSION: Glaucoma examinations delivered through this programme provided significant health benefit to hard-to-reach communities. On a per-person basis, examinations were fairly low cost, though opportunities exist to improve efficiency. Findings serve as an important benchmark for planning future community-based glaucoma examination programmes.

    • Immunity and Immunization RSS Word feed
      1. Seasonal influenza vaccine effectiveness against laboratory-confirmed influenza hospitalizations – Latin America, 2013
        El Omeiri N, Azziz-Baumgartner E, Thompson MG, Clara W, Cerpa M, Palekar R, Mirza S, Ropero-Alvarez AM.
        Vaccine. 2017 Jun 22.
        BACKGROUND: Despite widespread utilization of influenza vaccines, effectiveness (VE) has not been routinely measured in Latin America. METHODS: We used a case test-negative control design to estimate trivalent inactivated influenza VE against laboratory-confirmed influenza among hospitalized children aged 6months-5years and adults aged >/=60years which are age-groups targeted for vaccination. We sought persons with severe acute respiratory infections (SARI), hospitalized at 71 sentinel hospitals in Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Honduras, Panama, and Paraguay during January-December 2013. Cases had an influenza virus infection confirmed by real-time reverse transcription PCR (rRT-PCR); controls had a negative rRT-PCR result for influenza viruses. We used a two-stage random effects model to estimate pooled VE per target age-group, adjusting for the month of illness onset, age and preexisting medical conditions. RESULTS: We identified 2620 SARI patients across sites: 246 influenza cases and 720 influenza-negative controls aged </=5years and 448 cases and 1206 controls aged >/=60years. The most commonly identified subtype among participants (48%) was the influenza A(H1N1)pdm09 virus followed by influenza A(H3N2) (34%) and influenza B (18%) viruses. Among children, the adjusted VE of full vaccination (one dose for previously vaccinated or two if vaccine naive) against any influenza virus SARI was 47% (95% confidence interval [CI]: 14-71%); VE was 58% (95% CI: 16-79%) against influenza A(H1N1)pdm09, and 65% (95% CI: -9; 89%) against influenza A(H3N2) viruses associated SARI. Crude VE of full vaccination against influenza B viruses associated SARI among children was 3% (95% CI: -150; 63). Among adults aged >/=60years, adjusted VE against any influenza SARI was 48% (95% CI: 34-60%); VE was 54% (95% CI: 37-69%) against influenza A(H1N1)pdm09, 43% (95% CI: 18-61%) against influenza A(H3N2) and 34% (95% CI: -4; 58%) against B viruses associated SARI. CONCLUSION: Influenza vaccine provided moderate protection against severe influenza illness among fully vaccinated young children and older adults, supporting current vaccination strategies.

      2. Modelling efforts needed to advance herpes simplex virus (HSV) vaccine development: Key findings from the World Health Organization Consultation on HSV Vaccine Impact Modelling
        Gottlieb SL, Giersing B, Boily MC, Chesson H, Looker KJ, Schiffer J, Spicknall I, Hutubessy R, Broutet N.
        Vaccine. 2017 Jun 21.
        Development of a vaccine against herpes simplex virus (HSV) is an important goal for global sexual and reproductive health. In order to more precisely define the health and economic burden of HSV infection and the theoretical impact and cost-effectiveness of an HSV vaccine, in 2015 the World Health Organization convened an expert consultation meeting on HSV vaccine impact modelling. The experts reviewed existing model-based estimates and dynamic models of HSV infection to outline critical future modelling needs to inform development of a comprehensive business case and preferred product characteristics for an HSV vaccine. This article summarizes key findings and discussions from the meeting on modelling needs related to HSV burden, costs, and vaccine impact, essential data needs to carry out those models, and important model components and parameters.

      3. Reduction in diarrhea- and rotavirus-related healthcare visits among children <5 years of age following national rotavirus vaccine introduction in Zimbabwe
        Mujuru HA, Yen C, Nathoo KJ, Gonah NA, Ticklay I, Mukaratirwa A, Berejena C, Tapfumanei O, Chindedza K, Rupfutse M, Weldegebriel G, Mwenda JM, Burnett E, Tate JE, Parashar UD, Manangazira P.
        Pediatr Infect Dis J. 2017 Jun 20.
        BACKGROUND: In Zimbabwe, rotavirus accounted for 41-56% of acute diarrhea hospitalizations prior to rotavirus vaccine introduction in 2014. We evaluated rotavirus vaccination impact on acute diarrhea and rotavirus-related healthcare visits in children. METHODS: We examined monthly and annual acute diarrhea and rotavirus test-positive hospitalizations and A&E visits among children <60 months at three active surveillance hospitals during 2012-2016; we compared pre-vaccine introduction (2012-2013) with post-vaccine introduction (2015 and 2016) data for two of the hospitals. We examined monthly acute diarrhea hospitalizations by year and age group for 2013-2016 from surveillance hospital registers and monthly acute diarrhea outpatient visits reported to the Ministry of Health and Child Care during 2012-2016. RESULTS: Active surveillance data showed winter seasonal peaks in diarrhea and rotavirus-related visits among children <60 months during 2012-2014 that were substantially blunted in 2015 and 2016 following vaccine introduction; the percentage of rotavirus test-positive visits followed a similar seasonal pattern and decrease. Hospital register data showed similar pre-introduction seasonal variation and post-introduction declines in diarrhea hospitalizations among children 0-11 and 12-23 months. Monthly variation in outpatient diarrhea-related visits mirrored active surveillance data patterns. At two surveillance hospitals, the percentage of rotavirus-positive visits declined by 40% and 43% among children 0-11 months and by 21% and 33% among children 12-23 months in 2015 and 2016, respectively. CONCLUSION: Initial reductions in diarrheal illness among children <60 months, particularly among those 0-11 months, following vaccine introduction are encouraging. These early results provide evidence to support continued rotavirus vaccination and rotavirus surveillance in Zimbabwe.

      4. VP4- and VP7-specific antibodies mediate heterotypic immunity to rotavirus in humans
        Nair N, Feng N, Blum LK, Sanyal M, Ding S, Jiang B, Sen A, Morton JM, He XS, Robinson WH, Greenberg HB.
        Sci Transl Med. 2017 Jun 21;9(395).
        Human rotaviruses (RVs) are the leading cause of severe diarrhea in young children worldwide. The molecular mechanisms underlying the rapid induction of heterotypic protective immunity to RV, which provides the basis for the efficacy of licensed monovalent RV vaccines, have remained unknown for more than 30 years. We used RV-specific single cell-sorted intestinal B cells from human adults, barcode-based deep sequencing of antibody repertoires, monoclonal antibody expression, and serologic and functional characterization to demonstrate that infection-induced heterotypic immunoglobulins (Igs) primarily directed to VP5*, the stalk region of the RV attachment protein, VP4, are able to mediate heterotypic protective immunity. Heterotypic protective Igs against VP7, the capsid glycoprotein, and VP8*, the cell-binding region of VP4, are also generated after infection; however, our data suggest that homotypic anti-VP7 and non-neutralizing VP8* responses occur more commonly in people. These results indicate that humans can circumvent the extensive serotypic diversity of circulating RV strains by generating frequent heterotypic neutralizing antibody responses to VP7, VP8*, and most often, to VP5* after natural infection. These findings further suggest that recombinant VP5* may represent a useful target for the development of an improved, third-generation, broadly effective RV vaccine and warrants more direct examination.

      5. Progress toward containment of poliovirus type 2 – worldwide, 2017
        Previsani N, Singh H, St Pierre J, Boualam L, Fournier-Caruana J, Sutter RW, Zaffran M.
        MMWR Morb Mortal Wkly Rep. 2017 Jun 23;66(24):649-652.
        The Global Polio Eradication Initiative (GPEI) continues to make progress toward the eradication target. Only one of the three serotypes, wild poliovirus (WPV) type 1 (WPV1), is still circulating, and the numbers of cases and countries with endemic transmission are at record lows. With the certification of wild poliovirus type 2 (WPV2) eradication in 2015 and the global replacement of trivalent oral poliovirus vaccine (tOPV) containing Sabin poliovirus types 1, 2, and 3 with bivalent OPV containing only Sabin poliovirus types 1 and 3 during April-May 2016, poliovirus type 2 (PV2) is now an eradicated pathogen. However, in eight countries (Cameroon, Chad, Democratic Republic of Congo, Mozambique, Niger, Nigeria, Pakistan, and Syria), monovalent type 2 OPV (mOPV2) was authorized for large-scale outbreak control after tOPV withdrawal (1). Poliovirus containment, an evolving area of work that affects every country, aims to ensure that all PV2 specimens are safely contained to minimize the risk for reintroducing the virus into communities. This report summarizes the current status of poliovirus containment and progress since the last report (2), and outlines remaining challenges. Within 30 countries, 86 facilities have been designated by the relevant national authorities (usually the Ministry of Health) to become poliovirus-essential facilities for the continued storage or handling of PV2 materials; each country is responsible for ensuring that these facilities meet all biorisk management requirements.

      6. Louisiana physicians are increasing HPV vaccination rates
        Williams DL, Wheeler CS, Lawrence M, Hall SS, Hagensee M.
        J La State Med Soc. 2017 May-Jun;169(3):63-67.
        Human papilloma virus (HPV) is a common virus that can cause genital warts and certain cancers. The HPV vaccine is effective in preventing many HPV-associated diseases, however, vaccination rates suggest many remain unprotected. This study examined successful strategies used by physicians to improve HPV vaccination rates. Providers with above average vaccination rates were identified. A representative from each provider participated in an interview to identify strategies used to boost HPV vaccination. Key strategies in ensuring vaccine completion were reminders, education, standing orders, and scheduling future vaccine appointments at time of first dose. Other successful strategies included coupling the HPV vaccine with adolescent vaccines, administering during well-visits, and recommending the vaccine as protection against cancer and genital warts. Findings suggest successful and widely used methods among high performing providers in Louisiana, the majority of which should be easily reproducible with minimal resources to improve HPV vaccination rates.

      7. Intussusception-related hospitalizations among infants before and after private market licensure of rotavirus vaccines in Taiwan, 2001-2013
        Yen C, Shih SM, Tate JE, Wu FT, Huang YC, Parashar UD, Hsiung CA.
        Pediatr Infect Dis J. 2017 Jun 17.
        INTRODUCTION: Rotavirus is a leading cause of acute gastroenteritis among Taiwanese children. Two globally licensed rotavirus vaccines recommended for inclusion in routine immunization programs that have been available for private market use in Taiwan since 2006 have been associated with a low risk of intussusception in post-marketing studies conducted in several countries. Our objective was to examine trends and characteristics of intussusception hospitalizations in Taiwan among children aged <12 months before and after rotavirus vaccine licensure to provide updated baseline and early post-licensure data. METHODS: We extracted data on intussusception-related hospitalizations among children aged <12 months during 2001-2013 from the National Health Insurance Research Database. We examined patient demographics, clinical outcome, and hospitalization trends, focusing on recommended ages for rotavirus vaccination (6-14 weeks, 15-24 weeks, and 25-34 weeks). We compared mean hospitalization rates for pre-vaccine licensure years 2001-2005 with those for post-vaccine licensure years 2007-2013 using Poisson regression analysis. RESULTS: During 2001-2013, 1998 intussusceptions hospitalizations were recorded. The mean age of hospitalization was 33 weeks. Almost all children recovered; 3 deaths occurred. The overall intussusception hospitalization rate was 75.1 per 100,000; seasonality was not evident. Hospitalization rates were greatest in children aged >/=25 weeks and occurred more frequently in boys. Pre-vaccine and post-vaccine licensure trends in annual hospitalization rates did not significantly differ. However, mean hospitalization rates were lower during the post-vaccine licensure period for children aged <12 months (RR: 0.84, 95% CI: 0.76-0.92) with the greatest decline among children aged 25-34 weeks (RR: 0.66, 95% CI: 0.55-0.78). CONCLUSIONS: Infant intussusception in Taiwan occurs at a rate within the range of other Asian countries, is rare among children aged <3 months, has a male predominance, and does not have a clear seasonality pattern. We did not observe a post-licensure increase in intussusception hospitalization rates in children aged 6-14 weeks.

    • Laboratory Sciences RSS Word feed
      1. Rapid filter-based detection and culture of Burkholderia pseudomallei from small volumes of urine
        Michel PA, Lascols C, Gee JE, Weigel LM, Sue D.
        J Clin Microbiol. 2017 Jun 21.
        Clinical outcomes of melioidosis patients improve when the infecting agent, Burkholderia pseudomallei, is rapidly detected and identified by laboratory testing. Detection of B. pseudomallei DNA or recovery of the pathogen by culture from urine can support a diagnosis of melioidosis and guide patient care. Two new methods designated as Filter-Capture DNA Isolation (FCDI) and Filter Cellular Recovery (FCR) were developed to increase the sensitivity of detection and recovery of viable B. pseudomallei cells from small volumes (0.45 ml) of urine. DNA from eight strains of B. pseudomallei that were spiked into synthetic urine at low concentrations (1 x 102 CFU/ml) was detected in FCDI cell lysates using real-time PCR with greater consistency when compared with preparations from the QIAamp DNA Blood Mini kit. The FCR method showed greater B. pseudomallei detection sensitivity than conventional urine culture methods and resulted in typical colony growth at 24 h from as few as 1 x 102 CFU/ml. In addition, the FCR method does not rely on precipitation of a urine pellet by centrifugation and requires a smaller volume of urine. The FCDI and FCR methods described here could improve time to results and decrease the number of negative B. pseudomallei reports that are currently observed from urine culture as a consequence of samples containing low or variable bacterial cell concentrations.

      2. Development of an improved standard reference material for vitamin D metabolites in human serum
        Phinney KW, Tai SS, Bedner M, Camara JE, Chia RR, Sander LC, Sharpless KE, Wise SA, Yen JH, Schleicher RL, Chaudhary-Webb M, Maw KL, Rahmani Y, Betz JM, Merkel J, Sempos CT, Coates PM, Durazo-Arvizu RA, Sarafin K, Brooks SP.
        Anal Chem. 2017 May 02;89(9):4907-4913.
        The National Institute of Standards and Technology (NIST) has developed Standard Reference Material (SRM) 972a Vitamin D Metabolites in Frozen Human Serum as a replacement for SRM 972, which is no longer available. SRM 972a was developed in collaboration with the National Institutes of Health’s Office of Dietary Supplements. In contrast to the previous reference material, three of the four levels of SRM 972a are composed of unmodified human serum. This SRM has certified and reference values for the following 25-hydroxyvitamin D [25(OH)D] species: 25(OH)D2, 25(OH)D3, and 3-epi-25(OH)D3. The value assignment and certification process included three isotope-dilution mass spectrometry approaches, with measurements performed at NIST and at the Centers for Disease Control and Prevention (CDC). The value assignment methods employed have been modified from those utilized for the previous SRM, and all three approaches now incorporate chromatographic resolution of the stereoisomers, 25(OH)D3 and 3-epi-25(OH)D3.

    • Maternal and Child Health RSS Word feed
      1. A qualitative study of cultural congruency of Legacy for Children for Spanish-speaking mothers
        Beasley LO, Silovsky JF, Espeleta HC, Robinson LR, Hartwig SA, Morris A, Esparza I.
        Child Youth Serv Rev. 2017 ;79:299-308.
        In recognition of the need to reach more families, the Legacy for Children (Legacy) program was translated and culturally adapted for Spanish-speaking Hispanic mothers and their infants. This study examined the cultural adaptations and logistical supports needed for successful implementation with Spanish-speaking mothers. The research team used purposive techniques to sample Hispanic bi-lingual providers (N = 14) and supervisors (N = 5) of local home-based parenting programs (Healthy Families, Parents as Teachers, and SafeCare). The goal of the study was to determine from providers and supervisors the social validity (satisfaction, relevancy, importance, and acceptability of the intervention) and cultural congruency of the adapted Legacy curriculum. Researchers conducted a qualitative analysis of the transcriptions using a template approach within NVivo 10 software to identify broad themes within focus group data. Overall, results indicated many positive aspects of the Legacy program including content, approach, pace, topics, structure, social engagement, and straightforward curriculum language. Emergent themes from the focus groups included best practices in identifying, recruiting, and approaching Hispanic mothers, as well as key engagement strategies. Recommended revisions of the adapted Legacy curriculum focused on enhancing visual and auditory supplements, making minor improvements to lower the reading level, and reducing barriers to attendance. Implications for cultural adaptation of parenting programs are discussed.

      2. Maternal perceptions of parenting following an evidence-based parenting program: A qualitative study of Legacy for Children
        Hartwig SA, Robinson LR, Comeau DL, Claussen AH, Perou R.
        Infant Ment Health J. 2017 Jun 28.
        This article presents the findings of a qualitative study of maternal perceptions of parenting following participation in Legacy for ChildrenTM (Legacy), an evidence-based parenting program for low-income mothers of young children and infants. To further examine previous findings and better understand participant experiences, we analyzed semistructured focus-group discussions with predominantly Hispanic and Black, non-Hispanic Legacy mothers at two sites (n = 166) using thematic analysis and grounded theory techniques. The qualitative study presented here investigated how mothers view their parenting following participation in Legacy, allowing participants to describe their experience with the program in their own words, thus capturing an “insider” perspective. Mothers at both sites communicated knowledge and use of positive parenting practices targeted by the goals of Legacy; some site-specific differences emerged related to these parenting practices. These findings align with the interpretation of quantitative results from the randomized controlled trials and further demonstrate the significance of the Legacy program in promoting positive parenting for mothers living in poverty. This study emphasizes the importance of understanding real-world context regarding program efficacy and the benefit of using qualitative research to understand participant experiences.

      3. Associations between timing of corticosteroid treatment initiation and clinical outcomes in Duchenne muscular dystrophy
        Kim S, Zhu Y, Romitti PA, Fox DJ, Sheehan DW, Valdez R, Matthews D, Barber BJ.
        Neuromuscul Disord. 2017 Jun 05.
        The long-term efficacy of corticosteroid treatment and timing of treatment initiation among Duchenne muscular dystrophy (DMD) patients is not well-understood. We used data from a longitudinal, population-based DMD surveillance program to examine associations between timing of treatment initiation (early childhood [before or at age 5 years], late childhood [after age 5 years], and naive [not treated]) and five clinical outcomes (age at loss of ambulation; ages at onset of cardiomyopathy, scoliosis, and first fracture; and pulmonary function). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using survival analysis. DMD patients who initiated corticosteroid treatment in early childhood had a higher risk of earlier onset cardiomyopathy compared to cases who initiated treatment in late childhood (HR = 2.0, 95% CI = [1.2, 3.4]) or treatment naive patients (HR = 1.9, 95% CI = [1.1, 3.2]), and higher risk of suffering a fracture (HR = 2.3, 95% CI = [1.4, 3.7] and HR = 2.6, 95% CI = [1.6, 4.2], respectively). Patients with early childhood treatment had slightly decreased respiratory function compared with those with late childhood treatment. Ages at loss of ambulation or scoliosis diagnosis did not differ statistically among treatment groups. We caution that the results from our study are subject to several limitations, as they were based on data abstracted from medical records. Further investigations using improved reporting of disease onset and outcomes are warranted to obtain a more definitive assessment of the association between the timing of corticosteroid treatment and disease severity.

    • Occupational Safety and Health RSS Word feed
      1. Transfer of bacteriophage MS2 and fluorescein from N95 filtering facepiece respirators to hands: Measuring fomite potential
        Brady TM, Strauch AL, Almaguer CM, Niezgoda G, Shaffer RE, Yorio PL, Fisher EM.
        J Occup Environ Hyg. 2017 Jun 26:0.
        Contact transmission of pathogens from personal protective equipment is a concern within the healthcare industry. During public health emergency outbreaks, resources become constrained and the reuse of personal protective equipment, such as N95 filtering facepiece respirators, may be needed. This study was designed to characterize the transfer of bacteriophage MS2 and fluorescein between filtering facepiece respirators and the wearer’s hands during three simulated use scenarios. Filtering facepiece respirators were contaminated with MS2 and fluorescein in droplets or droplet nuclei. Thirteen test subjects performed filtering facepiece respirator use scenarios including improper doffing, proper doffing and reuse, and improper doffing and reuse. Fluorescein and MS2 contamination transfer were quantified. The average MS2 transfer from filtering facepiece respirators to the subjects’ hands ranged from 7.6-15.4% and 2.2-2.7% for droplet and droplet nuclei derived contamination, respectively. Handling filtering facepiece respirators contaminated with droplets resulted in higher levels of MS2 transfer compared to droplet nuclei for all use scenarios (p = 0.007). MS2 transfer from droplet contaminated filtering facepiece respirators during improper doffing and reuse was greater than transfer during improper doffing (p = 0.008) and proper doffing and reuse (p = 0.042). Droplet contamination resulted in higher levels of fluorescein transfer compared to droplet nuclei contaminated filtering facepiece respirators for all use scenarios (p = 0.009). Fluorescein transfer was greater for improper doffing and reuse (p = 0.007) from droplet contaminated masks compared to droplet nuclei contaminated filtering facepiece respirators and for improper doffing and reuse when compared improper doffing (p = 0.017) and proper doffing and reuse (p = 0.018) for droplet contaminated filtering facepiece respirators. For droplet nuclei contaminated filtering facepiece respirators, the difference in MS2 and fluorescein transfer did not reach statistical significance when comparing any of the use scenarios. The findings suggest that the results of fluorescein and MS2 transfer were consistent and highly correlated across the conditions of study. The data supports CDC recommendations for using proper doffing techniques and discarding filtering facepiece respirators that are directly contaminated with secretions from a cough or sneeze.

      2. Air, hand wipe, and surface wipe sampling for bisphenol A (BPA) among workers in industries that manufacture and use BPA in the United States
        Hines CJ, Jackson MV, Christianson AL, Clark JC, Arnold JE, Pretty JR, Deddens JA.
        J Occup Environ Hyg. 2017 Jun 26.
        For decades, bisphenol A (BPA) has been used in making polycarbonate, epoxy, and phenolic resins and certain investment casting waxes, yet published exposure data are lacking for U.S. manufacturing workers. In 2013-2014, BPA air and hand exposures were quantified for 78 workers at six U.S. companies making BPA or BPA-based products. Exposure measures included an inhalable-fraction personal air sample on each of two consecutive work days (n = 146), pre- and end-shift hand wipe samples on the second day (n = 74 each), and surface wipe samples (n = 88). Potential determinants of BPA air and end-shift hand exposures (after natural log transformation) were assessed in univariate and multiple regression mixed models. The geometric mean (GM) BPA air concentration was 4.0 microg/m3 (maximum 920 microg/m3). The end-shift GM BPA hand level (26 microg/sample) was 10-times higher than the pre-shift level (2.6 microg/sample). BPA air and hand exposures differed significantly by industry and job. BPA air concentrations and end-shift hand levels were highest in the BPA-filled wax manufacturing/reclaim industry (GMAir = 48 microg/m3, GMHand-End = 130 microg/sample) and in the job of working with molten BPA-filled wax (GMAir = 43 microg/m3, GMHand-End = 180 microg/sample), and lowest in the phenolic resins industry (GMAir = 0.85 microg/m3, GMHand-End = 0.43 microg/sample) and in the job of flaking phenolic resins (GMAIR = 0.62 microg/m3, GMHand-End = 0.38 microg/sample). Determinants of increased BPA air concentration were industry, handling BPA containers, spilling BPA, and spending >/=50% of the shift in production areas; increasing age was associated with lower air concentrations. BPA hand exposure determinants were influenced by high values for two workers; for all other workers, tasks involving contact with BPA-containing materials and spending >/=50% of the shift in production areas were associated with increased BPA hand levels. Surface wipe BPA levels were significantly lower in eating/office areas (GM = 9.3 microg/100 cm2) than in production areas (GM = 140 microg/100 cm2). In conclusion, worker BPA exposure was associated with tasks and conditions affecting both inhalation and dermal exposure. The potential for BPA-related health effects among these workers is unknown.

      3. Performance evaluation of mobile downflow booths for reducing airborne particles in the workplace
        Lo LM, Hocker B, Steltz AE, Kremer J, Feng HA.
        J Occup Environ Hyg. 2017 Jun 23:0.
        Compared to other common control measures, the downflow booth is a costly engineering control used to contain airborne dust or particles. The downflow booth provides unidirectional filtered airflow from the ceiling, entraining released particles away from the workers’ breathing zone, and delivers contained airflow to a lower level exhaust for removing particulates by filtering media. In this study, we designed and built a mobile downflow booth that is capable of quick assembly and easy size change to provide greater flexibility and particle control for various manufacturing processes or tasks. An experimental study was conducted to thoroughly evaluate the control performance of downflow booths used for removing airborne particles generated by the transfer of powdered lactose between two containers. Statistical analysis compared particle reduction ratios obtained from various test conditions including booth size (short, regular, or extended), supply air velocity (0.41 and 0.51 m/s or 80 and 100 feet per minute, fpm), powder transfer location (near or far from the booth exhaust), and inclusion or exclusion of curtains at the booth entrance. Our study results show that only short-depth downflow booths failed to protect the worker performing powder transfer far from the booth exhausts. Statistical analysis shows that better control performance can be obtained with supply air velocity of 0.51 m/s (100 fpm) than with 0.41 m/s (80 fpm) and that use of curtains for downflow booths did not improve their control performance.

      4. A review of high performance liquid chromatographic-mass spectrometric urinary methods for anticancer drug exposure of health care workers
        Mathias PI, Connor TH, B’Hymer C.
        J Chromatogr B Analyt Technol Biomed Life Sci. 2017 Jun 19;1060:316-324.
        This review describes published high performance liquid chromatography/mass spectrometry (HPLC-MS) methods for the determination of anticancer drugs in human urine as non-invasive tool for monitoring of health care worker exposure to antineoplastic and cytotoxic drugs. HPLC-MS is a sensitive and specific method for analysis of anticancer drugs and their metabolites in biological fluids. In this review, a tabular summary and overview of published HPLC-MS methods are presented, as well as future trends and limitations in this area of research.

      5. Evaluation of postural sway and impact forces during ingress and egress of scissor lifts at elevations
        Pan CS, Chiou SS, Kau T, Wimer BM, Ning X, Keane P.
        Appl Ergon. 2017 ;65:152-162.
        Workers are at risk when entering (ingress) or exiting (egress) elevated scissor lifts. In this study, we recorded ground impact forces and postural sway from 22 construction workers while they performed ingress and egress between a scissor lift and an adjacent work surface with varying conditions: lift opening designs, horizontal and vertical gaps, and sloped work surfaces. We observed higher peak ground shear forces when using a bar-and-chain opening, with larger horizontal gap, with the lift surface more than 0.2 m below the work surface, and presence of a sloped (26) work surface. Similar trends were observed for postural sway, except that the influence of vertical distance was not significant. To reduce slip/trip/fall risk and postural sway of workers while ingress or egress of an elevated scissor lift, we suggest scissor lifts be equipped with a gate-type opening instead of a bar-and-chain design. We also suggest the lift surface be placed no more than 0.2 m lower than the work surface and the horizontal gap between lift and work surfaces be as small as possible. Selecting a non-sloped surface to ingress or egress a scissor lift is also preferred to reduce risk.

    • Parasitic Diseases RSS Word feed
      1. Molecular diagnosis of Plasmodium ovale by photo-induced electron transfer fluorogenic primers: PET-PCR
        Akerele D, Ljolje D, Talundzic E, Udhayakumar V, Lucchi NW.
        PLoS One. 2017 ;12(6):e0179178.
        Accurate diagnosis of malaria infections continues to be challenging and elusive, especially in the detection of submicroscopic infections. Developing new malaria diagnostic tools that are sensitive enough to detect low-level infections, user friendly, cost effective and capable of performing large scale diagnosis, remains critical. We have designed novel self-quenching photo-induced electron transfer (PET) fluorogenic primers for the detection of P. ovale by real-time PCR. In our study, a total of 173 clinical samples, consisting of different malaria species, were utilized to test this novel PET-PCR primer. The sensitivity and specificity were calculated using nested-PCR as the reference test. The novel primer set demonstrated a sensitivity of 97.5% and a specificity of 99.2% (95% CI 85.2-99.8% and 95.2-99.9% respectively). Furthermore, the limit of detection for P. ovale was found to be 1 parasite/mul. The PET-PCR assay is a new molecular diagnostic tool with comparable performance to other commonly used PCR methods. It is relatively easy to perform, and amiable to large scale malaria surveillance studies and malaria control and elimination programs. Further field validation of this novel primer will be helpful to ascertain the utility for large scale malaria screening programs.

      2. Prevalence, clinical manifestations and genotyping of Cryptosporidium spp. in patients with gastrointestinal illnesses in western Iran
        Kiani H, Haghighi A, Seyyedtabaei SJ, Azargashsb E, Zebardast N, Taghipour N, Rostami A, Xiao L.
        Iran J Parasitol. 2017 ;12(2):169-176.
        Background: Cryptosporidium species are recognized as important gastrointestinal pathogens. This study was conducted to identify the prevalence, clinical manifestations and genotyping of Cryptosporidium spp. in patients with gastrointestinal illnesses (GIs) in western Iran. Methods: Overall, 1301 fecal samples were collected from patients with GIs referred to the 12 clinical laboratories in Nahavand County, west of Iran. Modified Ziehl-Neelsen staining method was used to identify the oocysts. DNA was extracted from positive samples and Cryptosporidium spp. were characterized by Nested PCR and sequence analysis of the 60-kDa glycoprotein (gp60) gene. Data analysis was performed using SPSS ver. 16. Results: Prevalence of cryptosporidiosis was 1.3% (17/1301). Cryptosporidium infection was significantly associated with vomiting and nausea (P=0.001, OR=0.013; CI 95%=0.004- 0.044), abdominal pain (P=0.018, OR=0.073; CI 95%=0.008- 0.633) and diarrhea (P=0.001, OR=0.092; CI 95%=0.023- 0.362). Of the 17 isolates typed, 11 belonged to the C. parvum IId subtype family (subtypes IIdA26G1 and IIdA20G1) and six belonged to the C. parvum IIa subtype family (subtypes IIaA15G2R1 and IIaA16G3R1). There was no significant difference between subtype families IIa and IId in occurrence of clinical symptoms (P= 0.75). Conclusion: Improved hygiene and avoidance of contact with animals and contaminated soil should be advocated to reduce the occurrence of Cryptosporidium infections, especially in children.

    • Program Evaluation RSS Word feed
      1. Impact of a participatory analysis of a campus sustainability social network: A case study of Emory University
        Chuvileva IM, Reef L, Wilt GE, Shriber J, Aleman M, Smith B.
        Sustainability (United States). 2017 ;10(3):193-203.
        Social network analysis makes visible the invisible connections and flows that underlie complex social relationships. Applied organizational researchers have used social network analysis to assess and improve organizational and leadership effectiveness by helping organizations design interventions to overcome siloing, enhance collaboration and productivity, and implement strategic innovations. Some analysts of sustainability in higher education have explicitly called for a similar use of social network analysis to enhance sustainability progress on campuses. Addressing this call and literature gap, this article details the purpose, process, and results of the Mapping Emory’s Sustainability Social Network project at Emory University (Atlanta, Georgia). The project had three major components: 1.) researching and creating visual maps of the university’s sustainability collaboration networks, 2.) engaging key stakeholders and the wider campus sustainability community in participatory analysis of the results, and 3.) evaluating the effectiveness of this information for community members in deepening their own sustainability thinking and practice. The project demonstrates the power of social network analysis as a critical tool to engage and mobilize staff, faculty, and students in sustainability on campus by supporting evidence-based, strategic decision making among community leaders.

    • Public Health Law RSS Word feed
      1. Personally identifiable information in state laws: Use, release, and collaboration at health departments
        Begley EB, Ware JM, Hexem SA, Rapposelli K, Thompson K, Penn MS, Aquino GA.
        Am J Public Health. 2017 Jun 22:e1-e5.
        Despite benefits to sharing data among public health programs, confidentiality laws are often presumed to obstruct collaboration or data sharing. We present an overview of the use and release of confidential, personally identifiable information as consistent with public health interests and identify opportunities to align data-sharing procedures with use and release provisions in state laws to improve program outcomes. In August 2013, Centers for Disease Control and Prevention staff and legal researchers from the National Nurse-Led Care Consortium conducted a review of state laws regulating state and local health departments in 50 states and the District of Columbia. Nearly all states and the District of Columbia employ provisions for the general use and release of personally identifiable information without patient consent; disease-specific use or release provisions vary by state. Absence of law regarding use and release provisions was noted. Health departments should assess existing state laws to determine whether the use or release of personally identifiable information is permitted. Absence of direction should not prevent data sharing but prompt an analysis of existing provisions in confidentiality laws. (Am J Public Health. Published online ahead of print June 22, 2017: e1-e5. doi:10.2105/AJPH.2017.303862).

    • Substance Use and Abuse RSS Word feed
      1. A retrospective review of unintentional opioid overdose risk and mitigating factors among acutely injured trauma patients
        Baird J, Faul M, Green TC, Howland J, Adams CA, George A, Mello MJ.
        Drug Alcohol Depend. 2017 Jun 13;178:130-135.
        BACKGROUND: Opioid medication to treat acutely injured patients is usual care in trauma settings. A higher prevalence of alcohol and other substance misuse in this population compared to the general population increases the vulnerability of such patients to both misuse of their prescribed opioids, and also unintentional opioid overdose. The primary purpose of this study was to assess the prevalence of substance use and unintentional opioid overdose risk among acutely injured trauma patients, and to examine the frequency and predictors of high opioid dose at discharge. METHODS: A retrospective electronic medical record (EMR) review of three-months of data from two Level 1 trauma centers. We assessed the prevalence of substance misuse, unintentional opioid overdose risk, and presence of documentation of clinical strategies to mitigate these risks, such as co-prescription of the opioid agonist naloxone. RESULTS: In total, 352 patient EMRs were examined. Over 40% of the patients reviewed had at least one indication of substance misuse (42.5% [95%CI: 37.3, 47.7]); at least 1 unintentional opioid overdose risk factor was identified in 240 EMR reviewed (68.2% [95%CI: 63.3, 73.1]). Dose of opioid medication was not significantly different for patients with substance misuse versus those without. There was no co-prescription of naloxone for any of the discharged patients. CONCLUSIONS: Our results indicate that despite the high rates of substance misuse, the potential for misuse, dependence and unintentional overdose risk from prescribed opioid medications are prevalent among acutely injured trauma patients. Prescribing after acute trauma care should address these risk factors.

      2. A qualitative analysis of smokers’ perceptions about lung cancer screening
        Gressard L, DeGroff AS, Richards TB, Melillo S, Kish-Doto J, Heminger CL, Rohan EA, Allen KG.
        BMC Public Health. 2017 Jun 21;17(1):589.
        BACKGROUND: In 2013, the US Preventive Services Task Force (USPSTF) began recommending lung cancer screening for high risk smokers aged 55-80 years using low-dose computed tomography (CT) scan. In light of these updated recommendations, there is a need to understand smokers’ knowledge of and experiences with lung cancer screening in order to inform the design of patient education and tobacco cessation programs. The purpose of this study is to describe results of a qualitative study examining smokers’ perceptions around lung cancer screening tests. METHODS: In 2009, prior to the release of the updated USPSTF recommendations, we conducted 12 120-min, gender-specific focus groups with 105 current smokers in Charlotte, North Carolina and Cincinnati, Ohio. Focus group facilitators asked participants about their experience with three lung cancer screening tests, including CT scan, chest x-ray, and sputum cytology. Focus group transcripts were transcribed and qualitatively analyzed using constant comparative methods. RESULTS: Participants were 41-67 years-old, with a mean smoking history of 38.9 pack-years. Overall, 34.3% would meet the USPSTF’s current eligibility criteria for screening. Most participants were unaware of all three lung cancer screening tests. The few participants who had been screened recalled limited information about the test. Nevertheless, many participants expressed a strong desire to pursue lung cancer screening. Using the social ecological model for health promotion, we identified potential barriers to lung cancer screening at the 1) health care system level (cost of procedure, confusion around results), 2) cultural level (fatalistic beliefs, distrust of medical system), and 3) individual level (lack of knowledge, denial of risk, concerns about the procedure). Although this study was conducted prior to the updated USPSTF recommendations, these findings provide a baseline for future studies examining smokers’ perceptions of lung cancer screening. CONCLUSION: We recommend clear and patient-friendly educational tools to improve patient understanding of screening risks and benefits and the use of best practices to help smokers quit. Further qualitative studies are needed to assess changes in smokers’ perceptions as lung cancer screening with CT scan becomes more widely used in community practice.

      3. Cross-sectional association between ZIP code-level gentrification and homelessness among a large community-based sample of people who inject drugs in 19 US cities
        Linton SL, Cooper HL, Kelley ME, Karnes CC, Ross Z, Wolfe ME, Friedman SR, Jarlais DD, Semaan S, Tempalski B, Sionean C, DiNenno E, Wejnert C, Paz-Bailey G.
        BMJ Open. 2017 Jun 20;7(6):e013823.
        BACKGROUND: Housing instability has been associated with poor health outcomes among people who inject drugs (PWID). This study investigates the associations of local-level housing and economic conditions with homelessness among a large sample of PWID, which is an underexplored topic to date. METHODS: PWID in this cross-sectional study were recruited from 19 large cities in the USA as part of National HIV Behavioral Surveillance. PWID provided self-reported information on demographics, behaviours and life events. Homelessness was defined as residing on the street, in a shelter, in a single room occupancy hotel, or in a car or temporarily residing with friends or relatives any time in the past year. Data on county-level rental housing unaffordability and demand for assisted housing units, and ZIP code-level gentrification (eg, index of percent increases in non-Hispanic white residents, household income, gross rent from 1990 to 2009) and economic deprivation were collected from the US Census Bureau and Department of Housing and Urban Development. Multilevel models evaluated the associations of local economic and housing characteristics with homelessness. RESULTS: Sixty percent (5394/8992) of the participants reported homelessness in the past year. The multivariable model demonstrated that PWID living in ZIP codes with higher levels of gentrification had higher odds of homelessness in the past year (gentrification: adjusted OR=1.11, 95% CI=1.04 to 1.17). CONCLUSIONS: Additional research is needed to determine the mechanisms through which gentrification increases homelessness among PWID to develop appropriate community-level interventions.

    • Zoonotic and Vectorborne Diseases RSS Word feed
      1. Evaluation of placental and fetal tissue specimens for Zika virus infection – 50 states and District of Columbia, January-December, 2016
        Reagan-Steiner S, Simeone R, Simon E, Bhatnagar J, Oduyebo T, Free R, Denison AM, Rabeneck DB, Ellington S, Petersen E, Gary J, Hale G, Keating MK, Martines RB, Muehlenbachs A, Ritter J, Lee E, Davidson A, Conners E, Scotland S, Sandhu K, Bingham A, Kassens E, Smith L, St George K, Ahmad N, Tanner M, Beavers S, Miers B, VanMaldeghem K, Khan S, Rabe I, Gould C, Meaney-Delman D, Honein MA, Shieh WJ, Jamieson DJ, Fischer M, Zaki SR.
        MMWR Morb Mortal Wkly Rep. 2017 Jun 23;66(24):636-643.
        Zika virus infection during pregnancy can cause congenital microcephaly and brain abnormalities (1), and detection of Zika virus RNA in clinical and tissue specimens can provide definitive laboratory evidence of recent Zika virus infection. Whereas duration of viremia is typically short, prolonged detection of Zika virus RNA in placental, fetal, and neonatal brain tissue has been reported and can provide key diagnostic information by confirming recent Zika virus infection (2). In accordance with recent guidance (3,4), CDC provides Zika virus testing of placental and fetal tissues in clinical situations where this information could add diagnostic value. This report describes the evaluation of formalin-fixed paraffin-embedded (FFPE) tissue specimens tested for Zika virus infection in 2016 and the contribution of this testing to the public health response. Among 546 live births with possible maternal Zika virus exposure, for which placental tissues were submitted by the 50 states and District of Columbia (DC), 60 (11%) were positive by Zika virus reverse transcription-polymerase chain reaction (RT-PCR). Among 81 pregnancy losses for which placental and/or fetal tissues were submitted, 18 (22%) were positive by Zika virus RT-PCR. Zika virus RT-PCR was positive on placental tissues from 38/363 (10%) live births with maternal serologic evidence of recent unspecified flavivirus infection and from 9/86 (10%) with negative maternal Zika virus immunoglobulin M (IgM) where possible maternal exposure occurred >12 weeks before serum collection. These results demonstrate that Zika virus RT-PCR testing of tissue specimens can provide a confirmed diagnosis of recent maternal Zika virus infection.

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DISCLAIMER: Articles listed in the CDC Science Clips are selected by the Stephen B. Thacker CDC Library to provide current awareness of the public health literature. An article's inclusion does not necessarily represent the views of the Centers for Disease Control and Prevention nor does it imply endorsement of the article's methods or findings. CDC and DHHS assume no responsibility for the factual accuracy of the items presented. The selection, omission, or content of items does not imply any endorsement or other position taken by CDC or DHHS. Opinion, findings and conclusions expressed by the original authors of items included in the Clips, or persons quoted therein, are strictly their own and are in no way meant to represent the opinion or views of CDC or DHHS. References to publications, news sources, and non-CDC Websites are provided solely for informational purposes and do not imply endorsement by CDC or DHHS.

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