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Park GW, Ng TFF, Freeland AL, Marconi VC, Boom JA, Staat MA, Montmayeur AM, Browne H, Narayanan J, Payne DC, Cardemil CV, Treffiletti A, Vinjé J. CrAssphage as a Novel Tool to Detect Human Fecal Contamination on Environmental Surfaces and Hands. Emerg Infect Dis 2020; 26:1731-1739. [PMID: 32511090 PMCID: PMC7392416 DOI: 10.3201/eid2608.200346] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
CrAssphage is a recently discovered human gut–associated bacteriophage. To validate the potential use of crAssphage for detecting human fecal contamination on environmental surfaces and hands, we tested stool samples (n = 60), hand samples (n = 30), and environmental swab samples (n = 201) from 17 norovirus outbreaks for crAssphage by real-time PCR. In addition, we tested stool samples from healthy persons (n = 173), respiratory samples (n = 113), and animal fecal specimens (n = 68) and further sequenced positive samples. Overall, we detected crAssphage in 71.4% of outbreak stool samples, 48%–68.5% of stool samples from healthy persons, 56.2% of environmental swabs, and 60% of hand rinse samples, but not in human respiratory samples or animal fecal samples. CrAssphage sequences could be grouped into 2 major genetic clusters. Our data suggest that crAssphage could be used to detect human fecal contamination on environmental surfaces and hands.
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Pindyck T, Hall AJ, Tate JE, Cardemil CV, Kambhampati AK, Wikswo ME, Payne DC, Grytdal S, Boom JA, Englund JA, Klein EJ, Halasa N, Selvarangan R, Staat MA, Weinberg GA, Beenhouwer DO, Brown ST, Holodniy M, Lucero-Obusan C, Marconi VC, Rodriguez-Barradas MC, Parashar U. Validation of Acute Gastroenteritis-related International Classification of Diseases, Clinical Modification Codes in Pediatric and Adult US Populations. Clin Infect Dis 2020; 70:2423-2427. [PMID: 31626687 PMCID: PMC7390357 DOI: 10.1093/cid/ciz846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/22/2019] [Indexed: 11/14/2022] Open
Abstract
International Classification of Diseases diagnostic codes are used to estimate acute gastroenteritis (AGE) disease burden. We validated AGE-related codes in pediatric and adult populations using 2 multiregional active surveillance platforms. The sensitivity of AGE codes was similar (54% and 58%) in both populations and increased with addition of vomiting-specific codes.
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Affiliation(s)
- Talia Pindyck
- Epidemic Intelligence Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aron J Hall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jacqueline E Tate
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cristina V Cardemil
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anita K Kambhampati
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- IHRC, Inc, Atlanta, Georgia, USA
| | - Mary E Wikswo
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel C Payne
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott Grytdal
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Natasha Halasa
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Mary Allen Staat
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Geoffrey A Weinberg
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - David O Beenhouwer
- Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Sheldon T Brown
- James J. Peters VA Medical Center, Bronx, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mark Holodniy
- Public Health Surveillance and Research, Department of Veterans Affairs, Palo Alto, California, USA
| | - Cynthia Lucero-Obusan
- Public Health Surveillance and Research, Department of Veterans Affairs, Palo Alto, California, USA
| | - Vince C Marconi
- Atlanta VA Medical Center, Decatur, Georgia, USA
- Rollins School of Public Health at Emory University, Atlanta, Georgia, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Infectious Diseases Section, Baylor College of Medicine, Houston, Texas, USA
| | - Umesh Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Cardemil CV, O’Leary ST, Beaty BL, Ivey K, Lindley MC, Kempe A, Crane LA, Hurley LP, Brtnikova M, Hall AJ. Primary care physician knowledge, attitudes, and diagnostic testing practices for norovirus and acute gastroenteritis. PLoS One 2020; 15:e0227890. [PMID: 31935271 PMCID: PMC6959576 DOI: 10.1371/journal.pone.0227890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/31/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Norovirus is a leading cause of acute gastroenteritis (AGE) across the age spectrum; candidate vaccines are in clinical trials. While norovirus diagnostic testing is increasingly available, stool testing may not be performed routinely, which can hamper surveillance and burden of disease estimates. Additionally, lack of knowledge of the burden of disease may inhibit provider vaccine recommendations, which could affect coverage rates and ultimately the impact of the vaccine. Our objectives were to understand physicians' stool testing practices in outpatients with AGE, and physician knowledge of norovirus, in order to improve surveillance and prepare for vaccine introduction. METHODS Internet and mail survey on AGE, norovirus, and future norovirus vaccines conducted January to March 2018 among national networks of primary care pediatricians, family practice and general internal medicine physicians. RESULTS The response rate was 59% (820/1383). During peak AGE season, physicians estimated they ordered stool tests for a median of 15% (interquartile range: 5-33%) of their outpatients with AGE. Stool tests were reported as more often available for ova and parasites, Clostridioides difficile, and bacterial culture (>95% for all specialties) than for norovirus (6-33% across specialties); even when available, norovirus-specific tests were infrequently ordered. Most providers were unaware that norovirus is a leading cause of AGE across all age groups (Pediatricians 80%, Family Practice 86%, General Internal Medicine 89%) or that alcohol-based hand sanitizers are ineffective against norovirus (Pediatricians 51%, Family Practice 66%, General Internal Medicine 62%). Concerns cited as major barriers to implementing a future norovirus vaccine included if the vaccine is not covered by insurance (General Internal Medicine 64%, Pediatricians 67%, Family Practice 74%) and lack of adequate reimbursement for vaccination (Pediatricians 43%, General Internal Medicine 46%, Family Practice 50%). Factors that providers believed were 'not at all a barrier' or 'minor barrier' to new vaccine introduction included the belief that "my patients won't need this vaccine" (General Internal Medicine 78%, Family Practice 86%, Pediatricians 90%) and "my patients already get too many vaccines" (Family Practice 89%, General Internal Medicine 92%, Pediatricians 95%). CONCLUSIONS Primary care physicians had few concerns regarding future norovirus vaccine introduction, but have knowledge gaps on norovirus prevalence and hand hygiene for prevention. Also, physicians infrequently order stool tests for outpatients with AGE, which limits surveillance estimates that rely on physician-ordered stool diagnostics. Closing physician knowledge gaps on norovirus burden and transmission can help support norovirus vaccine introduction.
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Affiliation(s)
- Cristina V. Cardemil
- National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sean T. O’Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Brenda L. Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Katy Ivey
- National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Megan C. Lindley
- National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lori A. Crane
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
- Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Laura P. Hurley
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
- Division of General Internal Medicine, Denver Health, Denver, CO, United States
| | - Michaela Brtnikova
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Aron J. Hall
- National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, United States
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