1
|
Chisty ZA, Li DD, Haile M, Houston H, DaSilva J, Overton R, Schuh AJ, Haynie J, Clemente J, Branch AG, Arons MM, Tsang CA, Pellegrini GJ, Bugrysheva J, Ilutsik J, Mohelsky R, Comer P, Hundia SB, Oh H, Stuckey MJ, Bohannon CD, Rasheed MAU, Epperson M, Thornburg NJ, McDonald LC, Brown AC, Kutty PK. Immune response kinetics to SARS-CoV-2 infection and COVID-19 vaccination among nursing home residents-Georgia, October 2020-July 2022. PLoS One 2024; 19:e0301367. [PMID: 38625908 PMCID: PMC11020945 DOI: 10.1371/journal.pone.0301367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/07/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Understanding the immune response kinetics to SARS-CoV-2 infection and COVID-19 vaccination is important in nursing home (NH) residents, a high-risk population. METHODS An observational longitudinal evaluation of 37 consenting vaccinated NH residents with/without SARS-CoV-2 infection from October 2020 to July 2022 was conducted to characterize the immune response to spike protein due to infection and/or mRNA COVID-19 vaccine. Antibodies (IgG) to SARS-CoV-2 full-length spike, nucleocapsid, and receptor binding domain protein antigens were measured, and surrogate virus neutralization capacity was assessed using Meso Scale Discovery immunoassays. The participant's spike exposure status varied depending on the acquisition of infection or receipt of a vaccine dose. Longitudinal linear mixed effects modeling was used to describe trajectories based on the participant's last infection or vaccination; the primary series mRNA COVID-19 vaccine was considered two spike exposures. Mean antibody titer values from participants who developed an infection post receipt of mRNA COVID-19 vaccine were compared with those who did not. In a subset of participants (n = 15), memory B cell (MBC) S-specific IgG (%S IgG) responses were assessed using an ELISPOT assay. RESULTS The median age of the 37 participants at enrollment was 70.5 years; 30 (81%) had prior SARS-CoV-2 infection, and 76% received Pfizer-BioNTech and 24% Moderna homologous vaccines. After an observed augmented effect with each spike exposure, a decline in the immune response, including %S IgG MBCs, was observed over time; the percent decline decreased with increasing spike exposures. Participants who developed an infection at least two weeks post-receipt of a vaccine were observed to have lower humoral antibody levels than those who did not develop an infection post-receipt. CONCLUSIONS These findings suggest that understanding the durability of immune responses in this vulnerable NH population can help inform public health policy regarding the timing of booster vaccinations as new variants display immune escape.
Collapse
Affiliation(s)
- Zeshan A. Chisty
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Deana D. Li
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Melia Haile
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hollis Houston
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Juliana DaSilva
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rahsaan Overton
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amy J. Schuh
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jenn Haynie
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Goldbelt C6, LLC, Chesapeake, Virginia, United States of America
| | - Jacob Clemente
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alicia G. Branch
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Melissa M. Arons
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Clarisse A. Tsang
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gerald J. Pellegrini
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Julia Bugrysheva
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Justina Ilutsik
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Goldbelt C6, LLC, Chesapeake, Virginia, United States of America
| | - Romy Mohelsky
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Patricia Comer
- A.G. Rhodes Wesley Woods Heath and Rehab, Atlanta, Georgia, United States of America
| | | | - Hyungseok Oh
- Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Matthew J. Stuckey
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Caitlin D. Bohannon
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mohammed Ata Ur Rasheed
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Monica Epperson
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Natalie J. Thornburg
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - L. Clifford McDonald
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Allison C. Brown
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Preeta K. Kutty
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
2
|
Sabour S, Bantle K, Bhatnagar A, Huang JY, Biggs A, Bodnar J, Dale JL, Gleason R, Klein L, Lasure M, Lee R, Nazarian E, Schneider E, Smith L, Snippes Vagnone P, Therrien M, Tran M, Valley A, Wang C, Young EL, Lutgring JD, Brown AC. Descriptive analysis of targeted carbapenemase genes and antibiotic susceptibility profiles among carbapenem-resistant Acinetobacter baumannii tested in the Antimicrobial Resistance Laboratory Network-United States, 2017-2020. Microbiol Spectr 2024; 12:e0282823. [PMID: 38174931 PMCID: PMC10845962 DOI: 10.1128/spectrum.02828-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
Acinetobacter baumannii is a Gram-negative bacillus that can cause severe and difficult-to-treat healthcare-associated infections. A. baumannii can harbor mobile genetic elements carrying genes that produce carbapenemase enzymes, further limiting therapeutic options for infections. In the United States, the Antimicrobial Resistance Laboratory Network (AR Lab Network) conducts sentinel surveillance of carbapenem-resistant Acinetobacter baumannii (CRAB). Participating clinical laboratories sent CRAB isolates to the AR Lab Network for characterization, including antimicrobial susceptibility testing and molecular detection of class A (Klebsiella pneumoniae carbapenemase), class B (Active-on-Imipenem, New Delhi metallo-β-lactamase, and Verona integron-encoded metallo-β-lactamase), and class D (Oxacillinase, blaOXA-23-like, blaOXA-24/40-like, blaOXA-48-like, and blaOXA-58-like) carbapenemase genes. During 2017‒2020, 6,026 CRAB isolates from 45 states were tested for targeted carbapenemase genes; 1% (64 of 5,481) of CRAB tested for targeted class A and class B genes were positive, but 83% (3,351 of 4,041) of CRAB tested for targeted class D genes were positive. The number of CRAB isolates carrying a class A or B gene increased from 2 of 312 (<1%) tested in 2017 to 26 of 1,708 (2%) tested in 2020. Eighty-three percent (2,355 of 2,846) of CRAB with at least one of the targeted carbapenemase genes and 54% (271 of 500) of CRAB without were categorized as extensively drug resistant; 95% (42 of 44) of isolates carrying more than one targeted gene had difficult-to-treat susceptibility profiles. CRAB isolates carrying targeted carbapenemase genes present an emerging public health threat in the United States, and their rapid detection is crucial to improving patient safety.IMPORTANCEThe Centers for Disease Control and Prevention has classified CRAB as an urgent public health threat. In this paper, we used a collection of >6,000 contemporary clinical isolates to evaluate the phenotypic and genotypic properties of CRAB detected in the United States. We describe the frequency of specific carbapenemase genes detected, antimicrobial susceptibility profiles, and the distribution of CRAB isolates categorized as multidrug resistant, extensively drug-resistant, or difficult to treat. We further discuss the proportion of isolates showing susceptibility to Food and Drug Administration-approved agents. Of note, 84% of CRAB tested harbored at least one class A, B, or D carbapenemase genes targeted for detection and 83% of these carbapenemase gene-positive CRAB were categorized as extensively drug resistant. Fifty-four percent of CRAB isolates without any of these carbapenemase genes detected were still extensively drug-resistant, indicating that infections caused by CRAB are highly resistant and pose a significant risk to patient safety regardless of the presence of one of these carbapenemase genes.
Collapse
Affiliation(s)
- Sarah Sabour
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katie Bantle
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amelia Bhatnagar
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Y. Huang
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Angela Biggs
- Maryland Department of Health, Baltimore, Maryland, USA
| | | | | | - Rachel Gleason
- Tennessee Department of Health, Nashville, Tennessee, USA
| | - Liore Klein
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Megan Lasure
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA
| | - Rachel Lee
- Texas Department of State Health Services, Austin, Texas, USA
| | | | - Emily Schneider
- Washington State Department of Health Public Health Laboratories, Shoreline, Washington, USA
| | - Lori Smith
- Utah Public Health Laboratory, Taylorsville, Utah, USA
| | | | | | - Michael Tran
- Washington State Department of Health Public Health Laboratories, Shoreline, Washington, USA
| | - Ann Valley
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA
| | - Chun Wang
- Texas Department of State Health Services, Austin, Texas, USA
| | - Erin L. Young
- Utah Public Health Laboratory, Taylorsville, Utah, USA
| | - Joseph D. Lutgring
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison C. Brown
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
3
|
Bhatnagar AS, Machado MJ, Patterson L, Anderson K, Abelman RL, Bateman A, Biggs A, Bumpus-White P, Craft B, Howard M, LaVoie SP, Lonsway D, Sabour S, Schneider A, Snippes-Vagnone P, Tran M, Torpey D, Valley A, Elkins CA, Karlsson M, Brown AC. Antimicrobial Resistance Laboratory Network's multisite evaluation of the ThermoFisher Sensititre GN7F broth microdilution panel for antimicrobial susceptibility testing. J Clin Microbiol 2023; 61:e0079923. [PMID: 37971271 PMCID: PMC10729754 DOI: 10.1128/jcm.00799-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/25/2023] [Indexed: 11/19/2023] Open
Abstract
In 2017, the Centers for Disease Control and Prevention (CDC) established the Antimicrobial Resistance Laboratory Network to improve domestic detection of multidrug-resistant organisms. CDC and four laboratories evaluated a commercial broth microdilution panel. Antimicrobial susceptibility testing using the Sensititre GN7F (ThermoFisher Scientific, Lenexa, KS) was evaluated by testing 100 CDC and Food and Drug Administration AR Isolate Bank isolates [40 Enterobacterales (ENT), 30 Pseudomonas aeruginosa (PSA), and 30 Acinetobacter baumannii (ACB)]. We assessed multiple amounts of transfer volume (TV) between the inoculum and tubed 11-mL cation-adjusted Mueller-Hinton broth: 1 µL [tribe Proteeae (P-tribe) only] and 10, 30, and 50 µL, resulting in respective CFU per milliter of 1 × 104, 1 × 105, 3 × 105, and 5 × 105. Four TV combinations were analyzed: standard (STD) [1 µL (P-tribe) and 10 µL], enhanced standard (E-STD) [1 µL (P-tribe) and 30 µL], 30 µL, and 50 µL. Essential agreement (EA), categorical agreement, major error (ME), and very major error (VME) were analyzed by organism then TVs. For ENT, the average EA across laboratories was <90% for 7 of 15 β-lactams using STD and E-STD TVs. As TVs increased, EA increased (>90%), and VMEs decreased. For PSA, EA improved as TVs increased; however, MEs also increased. For ACB, increased TVs provided slight EA improvements; all TVs yielded multiple VMEs and MEs. For ENT and ACB, Minimum inhibitory concentrations (MICs) trended downward using a 1 or 10 µL TV; there were no obvious MIC trends by TV for PSA. The public health and clinical consequences of missing resistance warrant increased TV of 30 µL for the GN7F, particularly for P-tribe, despite being considered "off-label" use.
Collapse
Affiliation(s)
- Amelia S. Bhatnagar
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - María-José Machado
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Logan Patterson
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA
| | - Karen Anderson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Allen Bateman
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA
| | - Angela Biggs
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Porscha Bumpus-White
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Goldbelt C6, LLC, Chesapeake, Virginia, USA
| | - Bradley Craft
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | | | - Stephen P. LaVoie
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David Lonsway
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Sabour
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Michael Tran
- Washington State Department of Health, Shoreline, Washington, USA
| | - David Torpey
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Ann Valley
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA
| | - Christopher A. Elkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria Karlsson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Goldbelt C6, LLC, Chesapeake, Virginia, USA
| | - Allison C. Brown
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
4
|
Plumb ID, Brown AC, Stokes EK, Chen JC, Carleton H, Tolar B, Sundararaman P, Saupe A, Payne DC, Shah HJ, Folster JP, Friedman CR. Increased Multidrug-Resistant Salmonella enterica I Serotype 4,[5],12:i:- Infections Associated with Pork, United States, 2009-2018. Emerg Infect Dis 2023; 29. [PMID: 36692335 PMCID: PMC9881761 DOI: 10.3201/eid2902.220950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Reports of Salmonella enterica I serotype 4,[5],12:i:- infections resistant to ampicillin, streptomycin, sulphamethoxazole, and tetracycline (ASSuT) have been increasing. We analyzed data from 5 national surveillance systems to describe the epidemiology, resistance traits, and genetics of infections with this Salmonella strain in the United States. We found ASSuT-resistant Salmonella 4,[5],12:i:- increased from 1.1% of Salmonella infections during 2009-2013 to 2.6% during 2014-2018; the proportion of Salmonella 4,[5],12:i:- isolates without this resistance pattern declined from 3.1% to 2.4% during the same timeframe. Among isolates sequenced during 2015-2018, a total of 69% were in the same phylogenetic clade. Within that clade, 77% of isolates had genetic determinants of ASSuT resistance, and 16% had genetic determinants of decreased susceptibility to ciprofloxacin, ceftriaxone, or azithromycin. Among outbreaks related to the multidrug-resistant clade, 63% were associated with pork consumption or contact with swine. Preventing Salmonella 4,[5],12:i:- carriage in swine would likely avert human infections with this strain.
Collapse
|
5
|
Chisty ZA, Haile M, DaSilva J, Biology MA, Houston H, Le S, Li D, Overton R, Arons M, Schuh AJ, Tsang CA, Selenic D, Clemente J, Bugrysheva J, Branch A, Thornburg NJ, Epperson M, Rasheed MA, Bohannon CD, Stuckey MJ, McDonald LC, Brown AC, Kutty PK. 1941. Describing the immune response kinetics to mRNA COVID-19 vaccines among previously SARS-CoV-2–infected and –uninfected nursing home residents, a prospective longitudinal observational cohort evaluation—Georgia, October 2020 – September 2021. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
To describe post-COVID-19 vaccination [fully vaccinated (FV) and first booster] immune response and occurrence of reinfection ( >90 days from prior infection) in nursing home residents (NHr) with/without evidence of prior SARS-CoV-2 infection.
Methods
In a longitudinal prospective cohort of 36 NHr from 3 NHs, interviews, chart abstractions, and specimens [blood and anterior nasal swabs (ANs)] were collected at baseline and monthly visits. ANs underwent molecular and BinaxNOW™ antigen testing. Quantitative Meso Scale Discovery platform tested blood specimens for anti-spike (S) protein and anti-nucleocapsid (N) antibodies. In addition, in a subset (n=13), S-specific memory B cells (MBCs) were tested with ELISpot assays.
Results
The cohort's median age was 72 years; 46% male, 64% White Non-Hispanic, 80% had ≥3 comorbidities, and 29 (81%) had prior SARS-CoV-2 infection. Of 36, 76% received Pfizer-BioNTech and 24% Moderna homologous vaccine. The median distribution of anti-S IgG concentrations among those with prior infection increased 15‒30 days post-FV, remained stable for 90 days, and declined by 120 days. The anti-S IgG remained above the estimated vaccine effectiveness (VE) thresholds published [Pfizer-BioNTech (95% VE: 530 BAU/ml), Moderna (90% VE: 298 BAU/ml)]. Among those without previous infection, anti-S IgG declined after 60 days and stayed near the VE thresholds until a recent infection/booster. Age, sex, and comorbidities had no appreciable impact on anti-S IgG. From enrollment to November 2021, 1of 29 had reinfection. From December 2021 to January 2022, 2 of 7 had a new infection, and 4 of 29 had reinfection, as shown by anti-N IgG rise. Persistently low numbers of total and anti-S MBC were seen across the evaluation, even with post-booster anti-S MBC rise. There was an immediate rise in anti-S IgG concentrations in all participants post-booster, irrespective of recent infection.
Conclusion
These findings from a NH convenience cohort suggest that prior SARS-CoV-2 infection has a pronounced immunomodulatory enhancing effect on the magnitude and duration of FV immune response. The decline of anti-S antibodies post-FV and rise after booster supported the booster recommendation in this cohort. The low MBC counts indicate immunosenescence in this high-risk population.
Disclosures
Hollis Houston, BA, Fidelity: Stocks/Bonds.
Collapse
Affiliation(s)
- Zeshan A Chisty
- Centers for Disease Control and Prevention , Cumming , Georgia
| | - Melia Haile
- Centers for Disease Control and Prevention , Norcross , Georgia
| | | | | | - Hollis Houston
- Centers for Disease Control and Prevention , Norcross , Georgia
| | - Shoshona Le
- Centers for Disease Control and Prevention , Norcross , Georgia
| | - Deana Li
- 1) Association of Schools & Programs of Public Health, 2) Centers for Disease Control and Prevention , Atlanta , Georgia
| | - Rahsaan Overton
- Centers for Disease Control and Prevention , Norcross , Georgia
| | | | - Amy J Schuh
- Centers for Disease Control and Prevention , Norcross , Georgia
| | | | | | - Jacob Clemente
- Centers for Disease Control and Prevention , Norcross , Georgia
| | | | - Alicia Branch
- Center for Disease Control and Prevention , Atlanta , Georgia
| | | | - Monica Epperson
- Centers for Disease Control and Prevention , Norcross , Georgia
| | | | | | - Matthew J Stuckey
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention , Atlanta , Georgia
| | - L C McDonald
- Centers for Disease Control and Prevention , Norcross , Georgia
| | - Allison C Brown
- Centers for Disease Control and Prevention , Norcross , Georgia
| | - Preeta K Kutty
- Centers for Disease Control and Prevention , Cumming , Georgia
| |
Collapse
|
6
|
Moritz ED, McKay SL, Tobolowsky FA, LaVoie SP, Waltenburg MA, Lecy KD, Thornburg NJ, Harcourt JL, Tamin A, Folster JM, Negley J, Brown AC, McDonald LC, Kutty PK. Repeated antigen testing among severe acute respiratory coronavirus virus 2 (SARS-CoV-2)-positive nursing home residents. Infect Control Hosp Epidemiol 2022; 43:1918-1921. [PMID: 34412728 PMCID: PMC8712959 DOI: 10.1017/ice.2021.370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/06/2021] [Accepted: 07/18/2021] [Indexed: 01/14/2023]
Abstract
Repeated antigen testing of 12 severe acute respiratory coronavirus virus 2 (SARS-CoV-2)-positive nursing home residents using Abbott BinaxNOW identified 9 of 9 (100%) culture-positive specimens up to 6 days after initial positive test. Antigen positivity lasted 2-24 days. Antigen positivity might last beyond the infectious period, but it was reliable in residents with evidence of early infection.
Collapse
Affiliation(s)
- Erin D. Moritz
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susannah L. McKay
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Farrell A. Tobolowsky
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen P. LaVoie
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Kristin D. Lecy
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Natalie J. Thornburg
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer L. Harcourt
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Azaibi Tamin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer M. Folster
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeanne Negley
- Acute Disease Epidemiology, Georgia Department of Public Health, Atlanta, Georgia
| | - Allison C. Brown
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - L. Clifford McDonald
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Preeta K. Kutty
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | |
Collapse
|
7
|
Tobolowsky FA, Waltenburg MA, Moritz ED, Haile M, DaSilva JC, Schuh AJ, Thornburg NJ, Westbrook A, McKay SL, LaVoie SP, Folster JM, Harcourt JL, Tamin A, Stumpf MM, Mills L, Freeman B, Lester S, Beshearse E, Lecy KD, Brown LG, Fajardo G, Negley J, McDonald LC, Kutty PK, Brown AC. Longitudinal serologic and viral testing post-SARS-CoV-2 infection and post-receipt of mRNA COVID-19 vaccine in a nursing home cohort-Georgia, October 2020‒April 2021. PLoS One 2022; 17:e0275718. [PMID: 36301805 PMCID: PMC9612440 DOI: 10.1371/journal.pone.0275718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022] Open
Abstract
There are limited data describing SARS-CoV-2-specific immune responses and their durability following infection and vaccination in nursing home residents. We conducted a prospective longitudinal evaluation of 11 consenting SARS-CoV-2-positive nursing home residents to evaluate the quantitative titers and durability of binding antibodies detected after SARS-CoV-2 infection and subsequent COVID-19 vaccination. The evaluation included nine visits over 150 days from October 25, 2020, through April 1, 2021. Visits included questionnaire administration, blood collection for serology, and paired anterior nasal specimen collection for testing by BinaxNOW™ COVID-19 Ag Card (BinaxNOW), reverse transcription polymerase chain reaction (RT-PCR), and viral culture. We evaluated quantitative titers of binding SARS-CoV-2 antibodies post-infection and post-vaccination (beginning after the first dose of the primary series). The median age among participants was 74 years; one participant was immunocompromised. Of 10 participants with post-infection serology results, 9 (90%) had detectable Pan-Ig, IgG, and IgA antibodies, and 8 (80%) had detectable IgM antibodies. At first antibody detection post-infection, two-thirds (6/9, 67%) of participants were RT-PCR-positive, but none were culture- positive. Ten participants received vaccination; all had detectable Pan-Ig, IgG, and IgA antibodies through their final observation ≤90 days post-first dose. Post-vaccination geometric means of IgG titers were 10-200-fold higher than post-infection. Nursing home residents in this cohort mounted robust immune responses to SARS-CoV-2 post-infection and post-vaccination. The augmented antibody responses post-vaccination are potential indicators of enhanced protection that vaccination may confer on previously infected nursing home residents.
Collapse
Affiliation(s)
- Farrell A. Tobolowsky
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Erin D. Moritz
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Melia Haile
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Juliana C. DaSilva
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amy J. Schuh
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Natalie J. Thornburg
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Adrianna Westbrook
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Susannah L. McKay
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stephen P. LaVoie
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennifer M. Folster
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennifer L. Harcourt
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Azaibi Tamin
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Megan M. Stumpf
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lisa Mills
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Brandi Freeman
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sandra Lester
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elizabeth Beshearse
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kristin D. Lecy
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Laura G. Brown
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Geroncio Fajardo
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeanne Negley
- Georgia Department of Public Health, Atlanta, Georgia, United States of America
| | - L. Clifford McDonald
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Preeta K. Kutty
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Allison C. Brown
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | |
Collapse
|
8
|
Costantini VP, Nguyen K, Lyski Z, Novosad S, Bardossy AC, Lyons AK, Gable P, Kutty PK, Lutgring JD, Brunton A, Thornburg NJ, Brown AC, McDonald LC, Messer W, Vinjé J. Development and Validation of an Enzyme Immunoassay for Detection and Quantification of SARS-CoV-2 Salivary IgA and IgG. J Immunol 2022; 208:1500-1508. [PMID: 35228262 PMCID: PMC8916996 DOI: 10.4049/jimmunol.2100934] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/04/2022] [Indexed: 12/14/2022]
Abstract
Oral fluids offer a noninvasive sampling method for the detection of Abs. Quantification of IgA and IgG Abs in saliva allows studies of the mucosal and systemic immune response after natural infection or vaccination. We developed and validated an enzyme immunoassay (EIA) to detect and quantify salivary IgA and IgG Abs against the prefusion-stabilized form of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein expressed in suspension-adapted HEK-293 cells. Normalization against total Ab isotype was performed to account for specimen differences, such as collection time and sample volume. Saliva samples collected from 187 SARS-CoV-2 confirmed cases enrolled in 2 cohorts and 373 prepandemic saliva samples were tested. The sensitivity of both EIAs was high (IgA, 95.5%; IgG, 89.7%) without compromising specificity (IgA, 99%; IgG, 97%). No cross-reactivity with endemic coronaviruses was observed. The limit of detection for SARS-CoV-2 salivary IgA and IgG assays were 1.98 ng/ml and 0.30 ng/ml, respectively. Salivary IgA and IgG Abs were detected earlier in patients with mild COVID-19 symptoms than in severe cases. However, severe cases showed higher salivary Ab titers than those with a mild infection. Salivary IgA titers quickly decreased after 6 wk in mild cases but remained detectable until at least week 10 in severe cases. Salivary IgG titers remained high for all patients, regardless of disease severity. In conclusion, EIAs for both IgA and IgG had high specificity and sensitivity for the confirmation of current or recent SARS-CoV-2 infections and evaluation of the IgA and IgG immune response.
Collapse
Affiliation(s)
- Veronica P Costantini
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA;
| | - Kenny Nguyen
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Zoe Lyski
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR
| | - Shannon Novosad
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ana C Bardossy
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Amanda K Lyons
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Paige Gable
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Preeta K Kutty
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Joseph D Lutgring
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Amanda Brunton
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR
| | - Natalie J Thornburg
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Allison C Brown
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - L Clifford McDonald
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - William Messer
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR.,School of Public Health, Oregon Health & Science University, Portland, OR; and.,Division of Infectious Diseases, Department of Medicine, Oregon Health & Science University, Portland, OR
| | - Jan Vinjé
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
9
|
Moody CT, Brown AE, Massaro NP, Patel AS, Agarwalla PA, Simpson AM, Brown AC, Zheng H, Pierce JG, Brudno Y. Restoring Carboxylates on Highly Modified Alginates Improves Gelation, Tissue Retention and Systemic Capture. Acta Biomater 2022; 138:208-217. [PMID: 34728426 PMCID: PMC8738153 DOI: 10.1016/j.actbio.2021.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/05/2021] [Accepted: 10/26/2021] [Indexed: 01/17/2023]
Abstract
Alginate hydrogels are gaining traction for use in drug delivery, regenerative medicine, and as tissue engineered scaffolds due to their physiological gelation conditions, high tissue biocompatibility, and wide chemical versatility. Traditionally, alginate is decorated at the carboxyl group to carry drug payloads, peptides, or proteins. While low degrees of substitution do not cause noticeable mechanical changes, high degrees of substitution can cause significant losses to alginate properties including complete loss of calcium cross-linking. While most modifications used to decorate alginate deplete the carboxyl groups, we propose that alginate modifications that replenish the carboxyl groups could overcome the loss in gel integrity and mechanics. In this report, we demonstrate that restoring carboxyl groups during functionalization maintains calcium cross-links as well as hydrogel shear-thinning and self-healing properties. In addition, we demonstrate that alginate hydrogels modified to a high degree with azide modifications that restore the carboxyl groups have improved tissue retention at intramuscular injection sites and capture blood-circulating cyclooctynes better than alginate hydrogels modified with azide modifications that deplete the carboxyl groups. Taken together, alginate modifications that restore carboxyl groups could significantly improve alginate hydrogel mechanics for clinical applications. STATEMENT OF SIGNIFICANCE: Chemical modification of hydrogels provides a powerful tool to regulate cellular adhesion, immune response, and biocompatibility with local tissues. Alginate, due to its biocompatibility and easy chemical modification, is being explored for tissue engineering and drug delivery. Unfortunately, modifying alginate to a high degree of substitution consumes carboxyl group, which are necessary for ionic gelation, leading to poor hydrogel crosslinking. We introduce alginate modifications that restore the alginate's carboxyl groups. We demonstrate that modifications that reintroduce carboxyl groups restore gelation and improve gel mechanics and tissue retention. In addition to contributing to a basic science understanding of hydrogel properties, we anticipate our approach will be useful to create tissue engineered scaffolds and drug delivery platforms.
Collapse
Affiliation(s)
- C T Moody
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University at Raleigh, NC United States of America; Comparative Medicine Institute, North Carolina State University, Raleigh, NC United States of America
| | - A E Brown
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University at Raleigh, NC United States of America
| | - N P Massaro
- Department of Chemistry, North Carolina State University, Raleigh, NC United States of America; Comparative Medicine Institute, North Carolina State University, Raleigh, NC United States of America
| | - A S Patel
- Department of Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, NC United States of America
| | - P A Agarwalla
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University at Raleigh, NC United States of America; Comparative Medicine Institute, North Carolina State University, Raleigh, NC United States of America
| | - A M Simpson
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University at Raleigh, NC United States of America
| | - A C Brown
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University at Raleigh, NC United States of America; Comparative Medicine Institute, North Carolina State University, Raleigh, NC United States of America
| | - H Zheng
- Department of Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, NC United States of America
| | - J G Pierce
- Department of Chemistry, North Carolina State University, Raleigh, NC United States of America; Comparative Medicine Institute, North Carolina State University, Raleigh, NC United States of America
| | - Y Brudno
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University at Raleigh, NC United States of America; Department of Chemistry, North Carolina State University, Raleigh, NC United States of America; Comparative Medicine Institute, North Carolina State University, Raleigh, NC United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC United States.
| |
Collapse
|
10
|
Kracalik I, Ham DC, McAllister G, Smith AR, Vowles M, Kauber K, Zambrano M, Rodriguez G, Garner K, Chorbi K, Cassidy PM, McBee S, Stoney RJ, Moser K, Villarino ME, Zazueta OE, Bhatnagar A, Sula E, Stanton RA, Brown AC, Halpin AL, Epstein L, Walters MS. Extensively Drug-Resistant Carbapenemase-Producing Pseudomonas aeruginosa and Medical Tourism from the United States to Mexico, 2018-2019. Emerg Infect Dis 2022; 28:51-61. [PMID: 34932447 PMCID: PMC8714193 DOI: 10.3201/eid2801.211880] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Carbapenem-resistant Pseudomonas aeruginosa (CRPA) producing the Verona integron‒encoded metallo-β-lactamase (VIM) are highly antimicrobial drug-resistant pathogens that are uncommon in the United States. We investigated the source of VIM-CRPA among US medical tourists who underwent bariatric surgery in Tijuana, Mexico. Cases were defined as isolation of VIM-CRPA or CRPA from a patient who had an elective invasive medical procedure in Mexico during January 2018‒December 2019 and within 45 days before specimen collection. Whole-genome sequencing of isolates was performed. Thirty-eight case-patients were identified in 18 states; 31 were operated on by surgeon 1, most frequently at facility A (27/31 patients). Whole-genome sequencing identified isolates linked to surgeon 1 were closely related and distinct from isolates linked to other surgeons in Tijuana. Facility A closed in March 2019. US patients and providers should acknowledge the risk for colonization or infection after medical tourism with highly drug-resistant pathogens uncommon in the United States.
Collapse
Affiliation(s)
| | | | - Gillian McAllister
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Amanda R. Smith
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Maureen Vowles
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Kelly Kauber
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Melba Zambrano
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Gretchen Rodriguez
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Kelley Garner
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Kaitlyn Chorbi
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - P. Maureen Cassidy
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Shannon McBee
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Rhett J. Stoney
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Kathleen Moser
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Margarita E. Villarino
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Oscar E. Zazueta
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Amelia Bhatnagar
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Erisa Sula
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Richard A. Stanton
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Allison C. Brown
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Alison L. Halpin
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Lauren Epstein
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Maroya Spalding Walters
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - for the Verona Integron-Encoded Metallo-β-Lactamase–Producing Carbapenem-Resistant Pseudomonas aeruginosa Medical Tourism Investigation Team2
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| |
Collapse
|
11
|
Sabour S, Huang JY, Bhatnagar A, Gilbert SE, Karlsson M, Lonsway D, Lutgring JD, Rasheed JK, Halpin AL, Stanton RA, Gumbis S, Elkins CA, Brown AC. Detection and Characterization of Targeted Carbapenem-Resistant Health Care-Associated Threats: Findings from the Antibiotic Resistance Laboratory Network, 2017 to 2019. Antimicrob Agents Chemother 2021; 65:e0110521. [PMID: 34570648 PMCID: PMC8597727 DOI: 10.1128/aac.01105-21] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/20/2021] [Indexed: 11/20/2022] Open
Abstract
Carbapenemase gene-positive (CP) Gram-negative bacilli are of significant clinical and public health concern. Their rapid detection and containment are critical to preventing their spread and additional infections they can cause. To this end, CDC developed the Antibiotic Resistance Laboratory Network (AR Lab Network), in which public health laboratories across all 50 states, several cities, and Puerto Rico characterize clinical isolates of carbapenem-resistant Enterobacterales (CRE), Pseudomonas aeruginosa (CRPA), and Acinetobacter baumannii (CRAB) and conduct colonization screens to detect the presence of mobile carbapenemase genes. In its first 3 years, the AR Lab Network tested 76,887 isolates and 31,001 rectal swab colonization screens. Targeted carbapenemase genes (blaKPC, blaNDM, blaOXA-48-like, blaVIM, or blaIMP) were detected by PCR in 35% of CRE, 2% of CRPA, and <1% of CRAB isolates and 8% of colonization screens tested, respectively. blaKPC and blaVIM were the most common genes in CP-CRE and CP-CRPA isolates, respectively, but regional differences in the frequency of carbapenemase genes detected were apparent. In CRE and CRPA isolates tested for carbapenemase production and the presence of the targeted genes, 97% had concordant results; 3% of CRE and 2% of CRPA isolates were carbapenemase production positive but PCR negative for those genes. Isolates harboring blaNDM showed the highest frequency of resistance across the carbapenems tested, and those harboring blaIMP and blaOXA-48-like genes showed the lowest frequency of carbapenem resistance. The AR Lab Network provides a national snapshot of rare and emerging carbapenemase genes, delivering data to inform public health actions to limit the spread of these antibiotic resistance threats.
Collapse
Affiliation(s)
- Sarah Sabour
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Y. Huang
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amelia Bhatnagar
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah E. Gilbert
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria Karlsson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David Lonsway
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joseph D. Lutgring
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J. Kamile Rasheed
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison Laufer Halpin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard A. Stanton
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephanie Gumbis
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christopher A. Elkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison C. Brown
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
12
|
Wilson WW, Bardossy AC, Gable P, Herzig C, Beshearse E, Gualandi N, Sabour S, Brown N, Brown AC, Kutty P, Tobin-D'Angelo M, Lea JP, Apata IW, Novosad S. Absence of SARS-CoV-2 infections among patients with end-stage renal disease following facility-wide testing in four outpatient hemodialysis facilities. Am J Infect Control 2021; 49:1318-1321. [PMID: 34375701 PMCID: PMC8349431 DOI: 10.1016/j.ajic.2021.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022]
Abstract
Facility-wide testing performed at 4 outpatient hemodialysis facilities in the absence of an outbreak or escalating community incidence did not identify new SARS-CoV-2 infections and illustrated key logistical considerations essential to successful implementation of SARS-CoV-2 screening. Facilities could consider prioritizing facility-wide SARS-CoV-2 testing during suspicion of an outbreak in the facility or escalating community spread without robust infection control strategies in place. Being prepared to address operational considerations will enhance implementation of facility-wide testing in the outpatient dialysis setting.
Collapse
Affiliation(s)
- W Wyatt Wilson
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Ana C Bardossy
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Paige Gable
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Carolyn Herzig
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth Beshearse
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Nicole Gualandi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sarah Sabour
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Nicole Brown
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Allison C Brown
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Preeta Kutty
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Janice P Lea
- Division of Renal Medicine, Department of Medicine, Emory School of Medicine, Atlanta, GA
| | - Ibironke W Apata
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA; Division of Renal Medicine, Department of Medicine, Emory School of Medicine, Atlanta, GA
| | - Shannon Novosad
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
13
|
Bardossy AC, Korhonen L, Schatzman S, Gable P, Herzig C, Brown NE, Beshearse E, Varela K, Sabour S, Lyons AK, Overton R, Hudson M, Hernandez-Romieu AC, Alvarez J, Roman K, Weng M, Soda E, Patel PR, Grate C, Dalrymple LS, Wingard RL, Thornburg NJ, Halpin ASL, Folster JM, Tobin-D’Angelo M, Lea J, Apata I, McDonald LC, Brown AC, Kutty PK, Novosad S. Clinical Course of SARS-CoV-2 Infection in Adults with ESKD Receiving Outpatient Hemodialysis. Kidney360 2021; 2:1917-1927. [PMID: 35419540 PMCID: PMC8986054 DOI: 10.34067/kid.0004372021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/14/2021] [Indexed: 02/07/2023]
Abstract
Background Patients with ESKD on maintenance dialysis receive dialysis in common spaces with other patients and have a higher risk of severe SARS-CoV-2 infections. They may have persistently or intermittently positive SARS-CoV-2 RT-PCR tests after infection. We describe the clinical course of SARS-CoV-2 infection and the serologic response in a convenience sample of patients with ESKD to understand the duration of infectivity. Methods From August to November 2020, we enrolled patients on maintenance dialysis with SARS-CoV-2 infections from outpatient dialysis facilities in Atlanta, Georgia. We followed participants for approximately 42 days. We assessed COVID-19 symptoms and collected specimens. Oropharyngeal (OP), anterior nasal (AN), and saliva (SA) specimens were tested for the presence of SARS-CoV-2 RNA, using RT-PCR, and sent for viral culture. Serology, including neutralizing antibodies, was measured in blood specimens. Results Fifteen participants, with a median age of 58 (range, 37‒77) years, were enrolled. Median duration of RT-PCR positivity from diagnosis was 18 days (interquartile range [IQR], 8‒24 days). Ten participants had at least one, for a total of 41, positive RT-PCR specimens ≥10 days after symptoms onset. Of these 41 specimens, 21 underwent viral culture; one (5%) was positive 14 days after symptom onset. Thirteen participants developed SARS-CoV-2-specific antibodies, 11 of which included neutralizing antibodies. RT-PCRs remained positive after seroconversion in eight participants and after detection of neutralizing antibodies in four participants; however, all of these samples were culture negative. Conclusions Patients with ESKD on maintenance dialysis remained persistently and intermittently SARS-CoV-2-RT-PCR positive. However, of the 15 participants, only one had infectious virus, on day 14 after symptom onset. Most participants mounted an antibody response, including neutralizing antibodies. Participants continued having RT-PCR-positive results in the presence of SARS-CoV-2-specific antibodies, but without replication-competent virus detected.
Collapse
Affiliation(s)
- Ana Cecilia Bardossy
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauren Korhonen
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sabrina Schatzman
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paige Gable
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carolyn Herzig
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole E. Brown
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth Beshearse
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kate Varela
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah Sabour
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amanda K. Lyons
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rahsaan Overton
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew Hudson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alfonso C. Hernandez-Romieu
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jorge Alvarez
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kaylin Roman
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark Weng
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth Soda
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Priti R. Patel
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Natalie J. Thornburg
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jennifer M. Folster
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Melissa Tobin-D’Angelo
- Acute Disease Epidemiology Section, Georgia Department of Public Health, Atlanta, Georgia
| | - Janice Lea
- Division of Renal Medicine, Department of Medicine, Emory School of Medicine, Atlanta, Georgia
| | - Ibironke Apata
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia,Division of Renal Medicine, Department of Medicine, Emory School of Medicine, Atlanta, Georgia
| | - L. Clifford McDonald
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison C. Brown
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Preeta K. Kutty
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shannon Novosad
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
14
|
Shugart A, Mahon G, Huang JY, Karlsson M, Valley A, Lasure M, Gross A, Pattee B, Vaeth E, Brooks R, Maruca T, Dominguez CE, Torpey D, Francis D, Bhattarai R, Kainer MA, Chan A, Dubendris H, Greene SR, Blosser SJ, Shannon DJ, Jones K, Brennan B, Hun S, D'Angeli M, Murphy CN, Tierney M, Reese N, Bhatnagar A, Kallen A, Brown AC, Spalding Walters M. Carbapenemase production among less-common Enterobacterales genera: 10 US sites, 2018. JAC Antimicrob Resist 2021; 3:dlab137. [PMID: 34514407 PMCID: PMC8417453 DOI: 10.1093/jacamr/dlab137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/30/2021] [Indexed: 12/15/2022] Open
Abstract
Background Historically, United States’ carbapenem-resistant Enterobacterales (CRE) surveillance and mechanism testing focused on three genera: Escherichia, Klebsiella, and Enterobacter (EsKE); however, other genera can harbour mobile carbapenemases associated with CRE spread. Objectives From January through May 2018, we conducted a 10 state evaluation to assess the contribution of less common genera (LCG) to carbapenemase-producing (CP) CRE. Methods State public health laboratories (SPHLs) requested participating clinical laboratories submit all Enterobacterales from all specimen sources during the surveillance period that were resistant to any carbapenem (Morganellaceae required resistance to doripenem, ertapenem, or meropenem) or were CP based on phenotypic or genotypic testing at the clinical laboratory. SPHLs performed species identification, phenotypic carbapenemase production testing, and molecular testing for carbapenemases to identify CP-CRE. Isolates were categorized as CP if they demonstrated phenotypic carbapenemase production and ≥1 carbapenemase gene (blaKPC, blaNDM, blaVIM, blaIMP, or blaOXA-48-like) was detected. Results SPHLs tested 868 CRE isolates, 127 (14.6%) were from eight LCG. Overall, 195 (26.3%) EsKE isolates were CP-CRE, compared with 24 (18.9%) LCG isolates. LCG accounted for 24 (11.0%) of 219 CP-CRE identified. Citrobacter spp. was the most common CP-LCG; the proportion of Citrobacter that were CP (11/42, 26.2%) was similar to the proportion of EsKE that were CP (195/741, 26.3%). Five of 24 (20.8%) CP-LCG had a carbapenemase gene other than blaKPC. Conclusions Participating sites would have missed approximately 1 in 10 CP-CRE if isolate submission had been limited to EsKE genera. Expanding mechanism testing to additional genera could improve detection and prevention efforts.
Collapse
Affiliation(s)
- Alicia Shugart
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Garrett Mahon
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Jennifer Y Huang
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Maria Karlsson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Ann Valley
- Wisconsin State Laboratory of Hygiene, Madison, WI, USA
| | - Megan Lasure
- Wisconsin State Laboratory of Hygiene, Madison, WI, USA
| | | | | | | | - Richard Brooks
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA.,Maryland Department of Health, Baltimore, MD, USA
| | - Tyler Maruca
- Maryland Department of Health, Baltimore, MD, USA
| | | | - David Torpey
- Maryland Department of Health, Baltimore, MD, USA
| | - Drew Francis
- Arizona Department of Health Services, Phoenix, AZ, USA
| | | | | | - Allison Chan
- Tennessee Department of Health, Nashville, TN, USA
| | - Heather Dubendris
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Shermalyn R Greene
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Sara J Blosser
- Indiana State Department of Health, Indianapolis, IN, USA
| | - D J Shannon
- Indiana State Department of Health, Indianapolis, IN, USA
| | - Kelly Jones
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Brenda Brennan
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Sopheay Hun
- Washington State Department of Health, Tumwater, WA, USA
| | | | - Caitlin N Murphy
- University of Nebraska Medical Center, Department of Pathology and Microbiology, Omaha, NE, USA
| | - Maureen Tierney
- Nebraska Department of Health and Human Services, Lincoln, NE, USA
| | - Natashia Reese
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Amelia Bhatnagar
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA.,Goldbelt C6 Inc, Juneau, AK, USA
| | - Alex Kallen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Allison C Brown
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Maroya Spalding Walters
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| |
Collapse
|
15
|
Costantini VP, Nguyen K, Lyski Z, Novosad S, Bardossy AC, Lyons AK, Gable P, Kutty PK, Lutgring JD, Brunton A, Thornburg N, Brown AC, McDonald LC, Messer W, Vinjé J. Development and validation of an enzyme immunoassay for detection and quantification of SARS-CoV-2 salivary IgA and IgG. medRxiv 2021:2021.09.03.21263078. [PMID: 34518840 PMCID: PMC8437314 DOI: 10.1101/2021.09.03.21263078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Oral fluids offer a non-invasive sampling method for the detection of antibodies. Quantification of IgA and IgG antibodies in saliva allows studies of the mucosal and systemic immune response after natural infection or vaccination. We developed and validated an enzyme immunoassay (EIA) to detect and quantify salivary IgA and IgG antibodies against the prefusion-stabilized form of the SARS-CoV-2 spike protein. Normalization against total antibody isotype was performed to account for specimen differences, such as collection time and sample volume. Saliva samples collected from 187 SARS-CoV-2 confirmed cases enrolled in 2 cohorts and 373 pre-pandemic saliva samples were tested. The sensitivity of both EIAs was high (IgA: 95.5%; IgG: 89.7%) without compromising specificity (IgA: 99%; IgG: 97%). No cross reactivity with seasonal coronaviruses was observed. The limit of detection for SARS-CoV-2 salivary IgA and IgG assays were 1.98 ng/mL and 0.30 ng/mL, respectively. Salivary IgA and IgG antibodies were detected earlier in patients with mild COVID-19 symptoms than in severe cases. However, severe cases showed higher salivary antibody titers than those with a mild infection. Salivary IgA titers quickly decreased after 6 weeks in mild cases but remained detectable until at least week 10 in severe cases. Salivary IgG titers remained high for all patients, regardless of disease severity. In conclusion, EIAs for both IgA and IgG had high specificity and sensitivity for the confirmation of current or recent SARS-CoV-2 infections and evaluation of the IgA and IgG immune response.
Collapse
Affiliation(s)
- Veronica P Costantini
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Kenny Nguyen
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, 37830
| | - Zoe Lyski
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Shannon Novosad
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Ana C Bardossy
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Amanda K Lyons
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Paige Gable
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Preeta K Kutty
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Joseph D Lutgring
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Amanda Brunton
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Natalie Thornburg
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Allison C Brown
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - L Clifford McDonald
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - William Messer
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR, 97239, USA
- School of Public Health, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jan Vinjé
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| |
Collapse
|
16
|
Ham DC, Mahon G, Bhaurla SK, Horwich-Scholefield S, Klein L, Dotson N, Rasheed JK, McAllister G, Stanton RA, Karlsson M, Lonsway D, Huang JY, Brown AC, Walters MS. Gram-Negative Bacteria Harboring Multiple Carbapenemase Genes, United States, 2012-2019. Emerg Infect Dis 2021; 27:2475-2479. [PMID: 34424168 PMCID: PMC8386808 DOI: 10.3201/eid2709.210456] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Reports of organisms harboring multiple carbapenemase genes have increased since 2010. During October 2012–April 2019, the Centers for Disease Control and Prevention documented 151 of these isolates from 100 patients in the United States. Possible risk factors included recent history of international travel, international inpatient healthcare, and solid organ or bone marrow transplantation.
Collapse
|
17
|
Gable P, Huang JY, Gilbert SE, Bollinger S, Lyons AK, Sabour S, Surie D, Biedron C, Haney T, Beshearse E, Gregory CJ, Seely KA, Clemmons NS, Patil N, Kothari A, Gulley T, Garner K, Anderson K, Thornburg NJ, Halpin AL, McDonald LC, Kutty PK, Brown AC. A Comparison of Less Invasive Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Diagnostic Specimens in Nursing Home Residents-Arkansas, June-August 2020. Clin Infect Dis 2021; 73:S58-S64. [PMID: 33909063 PMCID: PMC8135387 DOI: 10.1093/cid/ciab310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background SARS-CoV-2 testing remains essential for early identification and clinical management of cases. We compared the diagnostic performance of three specimen types for characterizing SARS-CoV-2 in infected nursing home residents. Methods A convenience sample of 17 residents were enrolled within 15 days of first positive SARS-CoV-2 result by real-time reverse transcription polymerase chain reaction (RT-PCR) and prospectively followed for 42 days. Anterior nasal swabs (AN), oropharyngeal swabs (OP), and saliva specimens (SA) were collected on the day of enrollment, every 3 days for the first 21 days, then weekly for 21 days. Specimens were tested for presence of SARS-CoV-2 RNA using RT-PCR and replication-competent virus by viral culture. Results Comparing the three specimen types collected from each participant at each time point, the concordance of paired RT-PCR results ranged from 80–88%. After the first positive result, SA and OP were RT-PCR–positive for ≤48 days; AN were RT-PCR–positive for ≤33 days. AN had the highest percentage of RT-PCR–positive results (81%; 21/26) when collected ≤10 days of participants’ first positive result. Eleven specimens were positive by viral culture: nine AN collected ≤19 days following first positive result and two OP collected ≤5 days following first positive result. Conclusions AN, OP, and SA were effective methods for repeated testing in this population. More AN than OP were positive by viral culture. SA and OP remained RT-PCR–positive longer than AN, which could lead to unnecessary interventions if RT-PCR detection occurred after viral shedding has likely ceased.
Collapse
Affiliation(s)
- Paige Gable
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Y Huang
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah E Gilbert
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan Bollinger
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amanda K Lyons
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Sabour
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Diya Surie
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caitlin Biedron
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tafarra Haney
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Elizabeth Beshearse
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christopher J Gregory
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Nakia S Clemmons
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Atul Kothari
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Trent Gulley
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Kelley Garner
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Karen Anderson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie J Thornburg
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison L Halpin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - L Clifford McDonald
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Preeta K Kutty
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison C Brown
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | |
Collapse
|
18
|
McKay SL, Tobolowsky FA, Moritz ED, Hatfield KM, Bhatnagar A, LaVoie SP, Jackson DA, Lecy KD, Bryant-Genevier J, Campbell D, Freeman B, Gilbert SE, Folster JM, Medrzycki M, Shewmaker PL, Bankamp B, Radford KW, Anderson R, Bowen MD, Negley J, Reddy SC, Jernigan JA, Brown AC, McDonald LC, Kutty PK. Performance Evaluation of Serial SARS-CoV-2 Rapid Antigen Testing During a Nursing Home Outbreak. Ann Intern Med 2021; 174:945-951. [PMID: 33900791 PMCID: PMC8108910 DOI: 10.7326/m21-0422] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To address high COVID-19 burden in U.S. nursing homes, rapid SARS-CoV-2 antigen tests have been widely distributed in those facilities. However, performance data are lacking, especially in asymptomatic people. OBJECTIVE To evaluate the performance of SARS-CoV-2 antigen testing when used for facility-wide testing during a nursing home outbreak. DESIGN A prospective evaluation involving 3 facility-wide rounds of testing where paired respiratory specimens were collected to evaluate the performance of the BinaxNOW antigen test compared with virus culture and real-time reverse transcription polymerase chain reaction (RT-PCR). Early and late infection were defined using changes in RT-PCR cycle threshold values and prior test results. SETTING A nursing home with an ongoing SARS-CoV-2 outbreak. PARTICIPANTS 532 paired specimens collected from 234 available residents and staff. MEASUREMENTS Percentage of positive agreement (PPA) and percentage of negative agreement (PNA) for BinaxNOW compared with RT-PCR and virus culture. RESULTS BinaxNOW PPA with virus culture, used for detection of replication-competent virus, was 95%. However, the overall PPA of antigen testing with RT-PCR was 69%, and PNA was 98%. When only the first positive test result was analyzed for each participant, PPA of antigen testing with RT-PCR was 82% among 45 symptomatic people and 52% among 343 asymptomatic people. Compared with RT-PCR and virus culture, the BinaxNOW test performed well in early infection (86% and 95%, respectively) and poorly in late infection (51% and no recovered virus, respectively). LIMITATION Accurate symptom ascertainment was challenging in nursing home residents; test performance may not be representative of testing done by nonlaboratory staff. CONCLUSION Despite lower positive agreement compared with RT-PCR, antigen test positivity had higher agreement with shedding of replication-competent virus. These results suggest that antigen testing could be a useful tool to rapidly identify contagious people at risk for transmitting SARS-CoV-2 during nascent outbreaks and help reduce COVID-19 burden in nursing homes. PRIMARY FUNDING SOURCE None.
Collapse
Affiliation(s)
- Susannah L McKay
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Farrell A Tobolowsky
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Erin D Moritz
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Kelly M Hatfield
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Amelia Bhatnagar
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Stephen P LaVoie
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - David A Jackson
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - K Danielle Lecy
- Centers for Disease Control and Prevention, Anchorage, Alaska (K.D.L.)
| | - Jonathan Bryant-Genevier
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Davina Campbell
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Brandi Freeman
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Sarah E Gilbert
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Jennifer M Folster
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Magdalena Medrzycki
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Patricia L Shewmaker
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Bettina Bankamp
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Kay W Radford
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Raydel Anderson
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Michael D Bowen
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Jeanne Negley
- Georgia Department of Public Health, Atlanta, Georgia (J.N.)
| | - Sujan C Reddy
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - John A Jernigan
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Allison C Brown
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - L Clifford McDonald
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Preeta K Kutty
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | | |
Collapse
|
19
|
Maxwell AS, Armstrong GSJ, Ciappina MF, Pisanty E, Kang Y, Brown AC, Lewenstein M, Figueira de Morisson Faria C. Manipulating twisted electrons in strong-field ionization. Faraday Discuss 2021; 228:394-412. [PMID: 33591304 DOI: 10.1039/d0fd00105h] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We investigate the discrete orbital angular momentum (OAM) of photoelectrons freed in strong-field ionization. We use these 'twisted' electrons to provide an alternative interpretation on existing experimental work of vortex interferences caused by strong field ionization mediated by two counter-rotating circularly polarized pulses separated by a delay. Using the strong field approximation, we derive an interference condition for the vortices. In computations for a neon target we find very good agreement of the vortex condition with photoelectron momentum distributions computed with the strong field approximation, as well as with the time-dependent methods Qprop and R-Matrix. For each of these approaches we examine the OAM of the photoelectrons, finding a small number of vortex states localized in separate energy regions. We demonstrate that the vortices arise from the interference of pairs of twisted electron states. The OAM of each twisted electron state can be directly related to the number of arms of the spiral in that region. We gain further understanding by recreating the vortices with pairs of twisted electrons and use this to determine a semiclassical relation for the OAM. A discussion is included on measuring the OAM in strong field ionization directly or by employing specific laser pulse schemes as well as utilizing the OAM in time-resolved imaging of photo-induced dynamics.
Collapse
Affiliation(s)
- A S Maxwell
- Department of Physics & Astronomy, University College London, Gower Street, London WC1E 6BT, UK. and ICFO-Institut de Ciencies Fotoniques, The Barcelona Institute of Science and Technology, 08860 Castelldefels, Barcelona, Spain
| | - G S J Armstrong
- Centre for Theoretical Atomic, Molecular and Optical Physics, School of Mathematics and Physics, Queen's University Belfast, University Road, Belfast BT7 1NN, Northern Ireland, UK
| | - M F Ciappina
- ICFO-Institut de Ciencies Fotoniques, The Barcelona Institute of Science and Technology, 08860 Castelldefels, Barcelona, Spain and Physics Program, Guangdong Technion - Israel Institute of Technology, Shantou, Guangdong 515063, China and Technion - Israel Institute of Technology, Haifa, 32000, Israel
| | - E Pisanty
- ICFO-Institut de Ciencies Fotoniques, The Barcelona Institute of Science and Technology, 08860 Castelldefels, Barcelona, Spain
| | - Y Kang
- Department of Physics & Astronomy, University College London, Gower Street, London WC1E 6BT, UK.
| | - A C Brown
- Centre for Theoretical Atomic, Molecular and Optical Physics, School of Mathematics and Physics, Queen's University Belfast, University Road, Belfast BT7 1NN, Northern Ireland, UK
| | - M Lewenstein
- ICFO-Institut de Ciencies Fotoniques, The Barcelona Institute of Science and Technology, 08860 Castelldefels, Barcelona, Spain and ICREA, Pg. Lluís Companys 23, 08010, Spain
| | | |
Collapse
|
20
|
Surie D, Huang JY, Brown AC, Gable P, Biedron C, Gilbert SE, Garner K, Bollinger S, Gulley T, Haney T, Lyons AK, Beshearse E, Gregory CJ, Sabour S, Clemmons NS, James AE, Tamin A, Reese N, Perry-Dow KA, Brown R, Harcourt JL, Campbell D, Houston H, Chakravorty R, Paulick A, Whitaker B, Murdoch J, Spicer L, Stumpf MM, Mills L, Coughlin MM, Higdem P, Rasheed MAU, Lonsway D, Bhatnagar A, Kothari A, Anderson K, Thornburg NJ, Breaker E, Adamczyk M, McAllister GA, Halpin AL, Seely KA, Patil N, McDonald LC, Kutty PK. Infectious Period of Severe Acute Respiratory Syndrome Coronavirus 2 in 17 Nursing Home Residents-Arkansas, June-August 2020. Open Forum Infect Dis 2021; 8:ofab048. [PMID: 33723510 PMCID: PMC7928697 DOI: 10.1093/ofid/ofab048] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/28/2021] [Indexed: 12/18/2022] Open
Abstract
Background To estimate the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in older adults with underlying conditions, we assessed duration of coronavirus disease 2019 (COVID-19) symptoms, reverse-transcription polymerase chain reaction (RT-PCR) positivity, and culture positivity among nursing home residents. Methods We enrolled residents within 15 days of their first positive SARS-CoV-2 test (diagnosis) at an Arkansas facility from July 7 to 15, 2020 and instead them for 42 days. Every 3 days for 21 days and then weekly, we assessed COVID-19 symptoms, collected specimens (oropharyngeal, anterior nares, and saliva), and reviewed medical charts. Blood for serology was collected on days 0, 6, 12, 21, and 42. Infectivity was defined by positive culture. Duration of culture positivity was compared with duration of COVID-19 symptoms and RT-PCR positivity. Data were summarized using measures of central tendency, frequencies, and proportions. Results We enrolled 17 of 39 (44%) eligible residents. Median participant age was 82 years (range, 58–97 years). All had ≥3 underlying conditions. Median duration of RT-PCR positivity was 22 days (interquartile range [IQR], 8–31 days) from diagnosis; median duration of symptoms was 42 days (IQR, 28–49 days). Of 9 (53%) participants with any culture-positive specimens, 1 (11%) severely immunocompromised participant remained culture-positive 19 days from diagnosis; 8 of 9 (89%) were culture-positive ≤8 days from diagnosis. Seroconversion occurred in 12 of 12 (100%) surviving participants with ≥1 blood specimen; all participants were culture-negative before seroconversion. Conclusions Duration of infectivity was considerably shorter than duration of symptoms and RT-PCR positivity. Severe immunocompromise may prolong SARS-CoV-2 infectivity. Seroconversion indicated noninfectivity in this cohort.
Collapse
Affiliation(s)
- Diya Surie
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Y Huang
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison C Brown
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paige Gable
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caitlin Biedron
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah E Gilbert
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kelley Garner
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Susan Bollinger
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Trent Gulley
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Tafarra Haney
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Amanda K Lyons
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Beshearse
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christopher J Gregory
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Sabour
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nakia S Clemmons
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison E James
- Arkansas Department of Health, Little Rock, Arkansas, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Azaibi Tamin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natashia Reese
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - K Allison Perry-Dow
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robin Brown
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Jennifer L Harcourt
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Davina Campbell
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hollis Houston
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ashley Paulick
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brett Whitaker
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jordan Murdoch
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Lori Spicer
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Megan M Stumpf
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa Mills
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa M Coughlin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pamela Higdem
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | | | - David Lonsway
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amelia Bhatnagar
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Atul Kothari
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Karen Anderson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie J Thornburg
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Erin Breaker
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michelle Adamczyk
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gillian A McAllister
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison L Halpin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - L Clifford McDonald
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Preeta K Kutty
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
21
|
Plumb ID, Brown AC, Stokes EK, Chen J, Tolar B, Sundararaman P, Folster J, Carleton H, Friedman CR. 714. Increase in Multidrug-resistant Salmonella Serotype I 4,[5],12:i:- Infections Linked to Pork—United States, 2009–2018. Open Forum Infect Dis 2020. [PMCID: PMC7778232 DOI: 10.1093/ofid/ofaa439.906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Salmonella enterica I 4,[5],12:i:- is the 5th most common serotype causing clinical Salmonella infections in the United States. A strain with resistance to ampicillin, streptomycin, sulfamethoxazole, and tetracycline (ASSuT) has been linked to swine production in Europe and the United States. We reviewed U.S. surveillance data to describe clinical infections with antibiotic-resistant I 4,[5],12:i:-. Methods We reviewed data from CDC’s National Antimicrobial Resistance Monitoring System (NARMS) from 2009–2018 to describe trends. We analyzed whole-genome sequence data in PulseNet, the molecular surveillance network for foodborne illness in the United States, from 2015–2018 to distinguish between strains of I 4,[5],12:i:- using core-genome multilocus sequence typing, and identified antibiotic resistance determinants (ARDs). We reviewed data from the Foodborne Disease Outbreak Surveillance System to identify foods associated with outbreaks during 2009–2018. Results From 2009–2013 to 2014–2018, I 4,[5],12:i:- increased as a proportion of nontyphoidal Salmonella isolates in NARMS from 4.3% to 5.0% (P=0.006), while I 4,[5],12:i:- resistant to ASSuT increased from 1.1% to 2.6% (P< 0.001). Of the 3,056 sequenced I 4,[5],12:i:- isolates in PulseNet, 2,105 (69%) were in a clade within 0–108 alleles of each other (ASSuT clade). Within this clade, 77% of isolates had ARDs conferring resistance to ASSuT, compared with 3% outside the clade. Isolates in the clade were also more likely than those outside the clade to have ARDs conferring decreased susceptibility to ciprofloxacin (13.1% vs. 5.2%, P< 0.001) and resistance to ceftriaxone (5.4% vs. 2.3%, P< 0.001). Among I 4,[5],12:i:- outbreaks with a single food source, those related to the ASSuT clade were more often linked to pork (10/15 [67%] vs. 1/5 [20%], P=0.07). Conclusion The increase in I 4,[5],12:i:- infections during 2009–2018 was likely driven by a clade of which most members had resistance to ASSuT, and many had decreased susceptibility to antibiotics used for empiric treatment. The association of this strain with outbreaks linked to pork suggests that measures to decrease carriage of Salmonella and selection for this strain in swine could prevent clinical infections with multidrug resistant Salmonella I 4,[5],12:i-. Disclosures All Authors: No reported disclosures
Collapse
Affiliation(s)
- Ian D Plumb
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, Atlanta, Georgia
| | | | - Erin K Stokes
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica Chen
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Beth Tolar
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Preethi Sundararaman
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, Atlanta, Georgia
| | - Jason Folster
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, Atlanta, Georgia
| | | | | |
Collapse
|
22
|
Chester D, Theetharappan P, Ngobili T, Daniele M, Brown AC. Ultrasonic Microplotting of Microgel Bioinks. ACS Appl Mater Interfaces 2020; 12:47309-47319. [PMID: 33026794 DOI: 10.1021/acsami.0c15056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Material scaffolds that mimic the structure, function, and bioactivity of native biological tissues are in constant development. Recently, material scaffolds composed of microgel particles have shown promise for applications ranging from bone regeneration to spheroid cell growth. Previous studies with poly N-isopropylacrylamide microgel scaffolds utilized a layer-by-layer (LBL) technique where individual, uniform microgel layers are built on top of each other resulting in a multilayer scaffold. However, this technique is limited in its applications due to the inability to control microscale deposition or patterning of multiple particle types within a microgel layer. In this study, an ultrasonic microplotting technique is used to address the limitations of LBL fabrication to create patterned microgel films. Printing parameters, such as bioink formulation, surface contact angle, and print head diameter, are optimized to identify the ideal parameters needed to successfully print microgel films. It was found that bioinks composed of 2 mg/mL of microgels and 20% polyethylene glycol by volume (v/v), on bovine serum albumin-coated glass, with a print head diameter of 50 μm resulted in the highest quality prints. Patterned films were created with a maximum resolution of 50 μm with the potential for finer resolutions to be achieved with alternative bioink compositions and printing parameters. Overall, ultrasonic microplotting can be used to create more complex microgel films than is possible with LBL techniques and offers the possibility of greater printing resolution in 3D with further technology development.
Collapse
Affiliation(s)
- D Chester
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina 27695, United States
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - P Theetharappan
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina 27695, United States
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - T Ngobili
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina 27695, United States
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - M Daniele
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina 27695, United States
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina 27695, United States
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - A C Brown
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina 27695, United States
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina 27695, United States
| |
Collapse
|
23
|
Ham D, Mahon G, Bhaurla S, Horwich-Scholefield S, Klein L, Dotson N, Rasheed J, Huang J, Brown AC, Kallen A, Walters MS. 604. Gram-Negative Bacilli Carrying Multiple Carbapenemases: the United States, 2012–2018. Open Forum Infect Dis 2019. [PMCID: PMC6810981 DOI: 10.1093/ofid/ofz360.673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Gram-negative bacilli carrying multiple carbapenemase genes (multi-CP-GNB) present an emerging public health threat; to date, most isolates reported in the literature have been from outside the United States. We reviewed multi-CP-GNB reported to CDC. Methods Reports of multi-CP-GNB isolates carrying genes encoding >1 targeted carbapenemases (i.e., KPC, NDM, OXA-48-type, VIM, or IMP) were received from healthcare facilities, health departments, and public health laboratories, and included isolates tested through the AR Laboratory Network (ARLN) beginning in 2017 as well as isolates sent to CDC for reference testing. Epidemiologic data were gathered by health departments during public health investigations. Results From October 2012 to November 2018, 111 multi-CP-GNB isolates from 71 patients in 20 states were identified. Two patients had three different multi-CP-GNB and one patient had two different multi-CP-GNB. The majority of cases (76%) were reported in 2017 or later, after ARLN testing began. Among patients with multi-CP-GNB, the most common organism-mechanisms combination was Klebsiella pneumoniae carrying NDM and OXA-48-type enzymes (table). Urine (44%) and rectal (20%) were the most frequent specimen sources for isolates. The median age of patients was 63 years (range 2–89 years); most had specimens collected at acute care hospitals (87%) or post-acute care facilities (9%). Of 50 patients with information available, 37 traveled internationally in the 12 months prior to culture collection. Among these, 88% were hospitalized for ≥1 night while outside the United States with 10 countries reported, of which India was most common (n = 18). All 5 patients with Pseudomonas aeruginosa co-carrying carbapenemases reported recent hospitalization outside the United States. Conclusion The multi-CP-GNB reported to CDC include diverse organisms and carbapenemase combinations and often harbored carbapenemases from different β-lactamase classes, which may severely limit treatment options. Healthcare exposures outside the United States were common; providers should ask about this exposure at healthcare admission and, when present, institute interventions to stop transmission in order to slow further US emergence. ![]()
Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
- David Ham
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Sandeep Bhaurla
- Los Angeles County Department of Public Health, Los Angeles, California
| | | | - Liore Klein
- Maryland Department of Health, Baltimore, Maryland
| | | | | | | | | | | | - Maroya S Walters
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
24
|
Brown AC, Malik S, Huang J, Bhatnagar A, Balbuena R, Reese N, Lonsway D, Karlsson M. 484. Metallo-β-Lactamase-Positive Carbapenem-Resistant Enterobacteriaceae and Pseudomonas aeruginosa in the Antibiotic Resistance Laboratory Network, 2017–2018. Open Forum Infect Dis 2019. [PMCID: PMC6811257 DOI: 10.1093/ofid/ofz360.557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Infections with metallo-β-lactamase (MBL)-producing organisms are emerging in the United States. Treatment options for these infections are limited. We describe MBL genes among carbapenemase positive carbapenem-resistant Enterobacteriaceae (CP-CRE) and Pseudomonas aeruginosa (CP-CRPA) isolates tested during the first two years of the Antibiotic Resistance Laboratory Network (AR Lab Network). Methods State and local public health laboratories tested CRE and CRPA isolates for organism identification, antimicrobial susceptibility, and PCR-based detection of blaKPC, blaNDM, blaOXA-48-like, blaVIM, and blaIMP carbapenemase genes. All testing results were sent to CDC at least monthly. Results Since January 2017, the AR Lab Network tested 21,733 CRE and 14,141 CRPA. CP-CRE were detected in 37% of CRE; 2% of CRPA were CP-CRPA. Among CP-CRE, 9% (686/8016) were MBL-producers (NDM, VIM, or IMP). Among MBL-producers, a blaNDM gene was detected most often (81%; 551/686). blaNDM were most common among Klebsiella spp. (47%; 261/551), blaIMP were most common among Providencia spp. (53%; 40/75), blaVIM was most common among Enterobacter spp. (19%; 25/62). Twelve percent (96) of MBL CP-CRE contained more than one carbapenemase gene. Among CP-CRPA, 73% (218/300) were MBL producers and blaVIM was the most common gene (62%; 186). Three (1%) MBL CP-CRPA contained more than one carbapenemase. Conclusion Increased testing of CRE and CRPA isolates through the AR Lab Network has facilitated early and rapid detection of hard-to-treat infections caused by MBL-producing organisms across the United States. The widespread distribution of MBL genes highlights the continued need for containment strategies that help prevent transmission between patients and among healthcare facilities. To support therapeutic decisions for severe infections caused by MBL-producing organisms, the AR Lab Network is now offering rapid susceptibility testing against aztreonam/avibactam, using digital dispenser technology. This testing program aims to close the gap between the availability of new drugs or drug combinations and the availability of commercial AST methods, thereby improving patient safety and antimicrobial stewardship. ![]()
Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Maria Karlsson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
25
|
Stanton RA, McAllister GA, Bhatnagar A, Karlsson M, Brown AC, Rasheed J, Elkins C, Halpin AL. 603. Identification of a Carbapenemase-Producing, Extensively Drug-Resistant Klebsiella pneumoniae Isolate Carrying a blaNDM-1-Bearing, Hypervirulent Plasmid, United States 2017. Open Forum Infect Dis 2019. [PMCID: PMC6810911 DOI: 10.1093/ofid/ofz360.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The recent discovery of carbapenemase-producing hypervirulent Klebsiella pneumoniae (CP-HvKP) has signaled the convergence of multidrug resistance and pathogenicity, with the potential for increased mortality. While previous studies of CP-HvKP isolates revealed that most carried carbapenemase genes and hypervirulence elements on separate plasmids, a 2018 report from China confirmed that both could be harbored on a single, hybrid carbapenemase-hypervirulent plasmid. As part of a project sequencing isolates carrying multiple carbapenemase genes identified through CDC’s Antibiotic Resistance Laboratory Network (AR Lab Network), we discovered a blaNDM-1-bearing hypervirulent plasmid found in a KPC- and NDM-positive K. pneumoniae from the United States. Methods Antimicrobial susceptibility testing (AST) was performed by reference broth microdilution against 23 agents. Whole-genome sequencing (WGS) was performed on Illumina MiSeq and PacBio RS II platforms. Results AST results indicated the isolate was extensively drug-resistant, as it was non-susceptible to at least one agent in all but two drug classes; it was susceptible to only tigecycline and tetracycline. Analysis of WGS data showed the isolate was ST11, the same sequence type that caused a fatal outbreak of CP-HvKP in China in 2016. The genome included two plasmids. The smaller one (129kbp) carried seven antibiotic resistance (AR) genes, including the carbapenemase gene blaKPC-2. The larger plasmid (354kbp) harbored 11 AR genes, including the metallo-β-lactamase gene blaNDM-1, as well as virulence factors iucABCD/iutA, peg-344, rmpA, and rmpA2, which comprise four of the five genes previously identified as predictors of hypervirulence in K. pneumoniae. Conclusion This is the first report of a hybrid carbapenemase-hypervirulent plasmid in the United States. The presence of both blaNDM-1 and hypervirulence elements on the same plasmid suggests that the CP-Hv pathotype could spread rapidly through horizontal transfer. This discovery demonstrates the critical role of genomic characterization of emerging resistance and virulence phenotypes by the AR Lab Network as part of US containment efforts. Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
| | | | | | - Maria Karlsson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Alison L Halpin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
26
|
Kim S, Brown AC, Murphy J, Oremo J, Owuor M, Ouda R, Person B, Quick R. Evaluation of the impact of antimicrobial hand towels on hand contamination with Escherichia coli among mothers in Kisumu County, Kenya, 2011-2012. Water Res 2019; 157:564-571. [PMID: 30995574 PMCID: PMC6545572 DOI: 10.1016/j.watres.2019.03.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 03/19/2019] [Accepted: 03/27/2019] [Indexed: 06/09/2023]
Abstract
Poor hand hygiene contributes to diarrhea in developing countries. Handwashing with soap reduces diarrhea risk, but drying hands on contaminated towels can compromise the benefits of handwashing. In response to the challenge of keeping hands clean, an antimicrobial hand towel was developed and shown to be promising in the laboratory, but has not been adequately tested in the field. We evaluated the effectiveness of an antimicrobial towel in two randomized, double-blinded crossover trials among mothers with children<5 years old in 125 households in western Kenya. In trial 1, we randomly assigned mothers to use either the treated towel or an identical untreated (placebo) towel and made surprise home visits at random times once a week for three weeks. At each visit, we tested hands for Escherichia coli using sterile hand rinses, then switched towel types in the two groups and repeated three weekly rounds of E. coli testing. In crossover trial 2, we compared E. coli contamination of maternal hands immediately following three different handwashing/drying procedures: soap and water + treated towel, water only + treated towel, and soap and water + air dry. There was no statistically significant difference in the level of E. coli contamination on maternal hands by type of towel used during trial 1 (odds ratio for treated vs untreated towel: 1.14, 95% confidence interval 0.83-1.56). In trial 2, there were no significant differences in E. coli contamination of maternal hands by handwashing/drying procedure. In these trials, use of antimicrobial hand towels did not prevent E. coli contamination of mothers' hands in Kenyan households during random testing and offered no advantages over standard handwashing and drying practices. Handwashing with soap and clean water and drying with clean towels are recommended.
Collapse
Affiliation(s)
- Sunkyung Kim
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Allison C Brown
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Murphy
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Bobbie Person
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert Quick
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
27
|
Brown AC, Chen JC, Watkins LKF, Campbell D, Folster JP, Tate H, Wasilenko J, Van Tubbergen C, Friedman CR. CTX-M-65 Extended-Spectrum β-Lactamase-Producing Salmonella enterica Serotype Infantis, United States 1. Emerg Infect Dis 2019; 24:2284-2291. [PMID: 30457533 PMCID: PMC6256390 DOI: 10.3201/eid2412.180500] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Extended-spectrum β-lactamases (ESBLs) confer resistance to clinically important third-generation cephalosporins, which are often used to treat invasive salmonellosis. In the United States, ESBLs are rarely found in Salmonella. However, in 2014, the US Food and Drug Administration found blaCTX-M-65 ESBL-producing Salmonella enterica serotype Infantis in retail chicken meat. The isolate had a rare pulsed-field gel electrophoresis pattern. To clarify the sources and potential effects on human health, we examined isolates with this pattern obtained from human surveillance and associated metadata. Using broth microdilution for antimicrobial susceptibility testing and whole-genome sequencing, we characterized the isolates. Of 34 isolates, 29 carried the blaCTX-M-65 gene with <9 additional resistance genes on 1 plasmid. Of 19 patients with travel information available, 12 (63%) reported recent travel to South America. Genetically, isolates from travelers, nontravelers, and retail chicken meat were similar. Expanded surveillance is needed to determine domestic sources and potentially prevent spread of this ESBL-containing plasmid.
Collapse
|
28
|
Kracalik I, Ham C, Smith AR, Vowles M, Kauber K, Zambrano M, Rodriguez G, Garner K, Chorbi K, Cassidy PM, McBee S, Stoney R, Brown AC, Moser K, Villarino ME, Walters MS. Notes from the Field: Verona Integron-Encoded Metallo-β-Lactamase-Producing Carbapenem-Resistant Pseudomonas aeruginosa Infections in U.S. Residents Associated with Invasive Medical Procedures in Mexico, 2015-2018. MMWR Morb Mortal Wkly Rep 2019; 68:463-464. [PMID: 31120867 PMCID: PMC6532950 DOI: 10.15585/mmwr.mm6820a4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
29
|
Nellenbach K, Guzzetta NA, Brown AC. Analysis of the structural and mechanical effects of procoagulant agents on neonatal fibrin networks following cardiopulmonary bypass. J Thromb Haemost 2018; 16:2159-2167. [PMID: 30182421 DOI: 10.1111/jth.14280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Indexed: 12/18/2022]
Abstract
Essentials The standard of care (SOC) for treating neonatal bleeding is transfusion of adult blood products. We compared neonatal clots formed with cryoprecipitate (SOC) to two procoagulant therapies. The current SOC resulted in clots with increased stiffness and decreased fibrinolytic properties. Procoagulant therapies may be a viable alternative to SOC treatment for neonatal bleeding. SUMMARY: Background Bleeding is a serious complication of neonates undergoing cardiopulmonary bypass (CPB) and associated with substantial morbidity and mortality. Bleeding is addressed through the transfusion of adult blood products, including platelets and cryoprecipitate. However, significant differences exist between neonatal and adult clotting components, specifically fibrinogen. Our recent ex vivo studies have shown that neonatal fibrinogen does not fully integrate with adult fibrinogen, leading to decreased susceptibility to fibrinolysis. These differences may contribute to ineffective clot formation and/or an increased risk of thrombosis. A need exists to identify more effective and safer methods to promote clotting in neonates. Objectives Procoagulant agents, such as prothrombin complex concentrates (PCCs) and recombinant activated factor VII (rFVIIa), are being used off-label to treat excessive bleeding in neonates after CPB. Because these agents stimulate endogenous fibrin formation, we hypothesize that their addition to post-CPB neonatal plasma will better recapitulate native clot properties than cryoprecipitate. Methods We analyze the structural, mechanical and degradation properties of fibrin matrices formed by neonatal plasma collected after CPB in the presence of an activated four-factor (F) PCC (FEIBA), rFVIIa, or cryoprecipitate using confocal microscopy, atomic force microscopy and a fluidics-based degradation assay. Results The ex vivo addition of FEIBA and rFVIIa to post-CPB neonatal plasma resulted in enhanced clot networks with differences in fibrin alignment, mechanics and degradation properties. Conclusions Our results suggest that these procoagulant agents could be used as an alternative to the transfusion of adult fibrinogen for the treatment of bleeding after CPB in neonates.
Collapse
Affiliation(s)
- K Nellenbach
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Raleigh, NC, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA
| | - N A Guzzetta
- Department of Anesthesiology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - A C Brown
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Raleigh, NC, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA
| |
Collapse
|
30
|
Harvey RR, Friedman CR, Crim SM, Judd M, Barrett KA, Tolar B, Folster JP, Griffin PM, Brown AC. Epidemiology of Salmonella enterica Serotype Dublin Infections among Humans, United States, 1968-2013. Emerg Infect Dis 2018; 23. [PMID: 28820133 PMCID: PMC5572876 DOI: 10.3201/eid2309.170136] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Infection incidence and antimicrobial drug resistance are increasing. Salmonella enterica serotype Dublin is a cattle-adapted bacterium that typically causes bloodstream infections in humans. To summarize demographic, clinical, and antimicrobial drug resistance characteristics of human infections with this organism in the United States, we analyzed data for 1968–2013 from 5 US surveillance systems. During this period, the incidence rate for infection with Salmonella Dublin increased more than that for infection with other Salmonella. Data from 1 system (FoodNet) showed that a higher percentage of persons with Salmonella Dublin infection were hospitalized and died during 2005−2013 (78% hospitalized, 4.2% died) than during 1996–2004 (68% hospitalized, 2.7% died). Susceptibility data showed that a higher percentage of isolates were resistant to >7 classes of antimicrobial drugs during 2005–2013 (50.8%) than during 1996–2004 (2.4%).
Collapse
|
31
|
Woodworth KR, Walters MS, Weiner LM, Edwards J, Brown AC, Huang JY, Malik S, Slayton RB, Paul P, Capers C, Kainer MA, Wilde N, Shugart A, Mahon G, Kallen AJ, Patel J, McDonald LC, Srinivasan A, Craig M, Cardo DM. Vital Signs: Containment of Novel Multidrug-Resistant Organisms and Resistance Mechanisms - United States, 2006-2017. MMWR Morb Mortal Wkly Rep 2018; 67:396-401. [PMID: 29621209 PMCID: PMC5889247 DOI: 10.15585/mmwr.mm6713e1] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Approaches to controlling emerging antibiotic resistance in health care settings have evolved over time. When resistance to broad-spectrum antimicrobials mediated by extended-spectrum β-lactamases (ESBLs) arose in the 1980s, targeted interventions to slow spread were not widely promoted. However, when Enterobacteriaceae with carbapenemases that confer resistance to carbapenem antibiotics emerged, directed control efforts were recommended. These distinct approaches could have resulted in differences in spread of these two pathogens. CDC evaluated these possible changes along with initial findings of an enhanced antibiotic resistance detection and control strategy that builds on interventions developed to control carbapenem resistance. METHODS Infection data from the National Healthcare Safety Network from 2006-2015 were analyzed to calculate changes in the annual proportion of selected pathogens that were nonsusceptible to extended-spectrum cephalosporins (ESBL phenotype) or resistant to carbapenems (carbapenem-resistant Enterobacteriaceae [CRE]). Testing results for CRE and carbapenem-resistant Pseudomonas aeruginosa (CRPA) are also reported. RESULTS The percentage of ESBL phenotype Enterobacteriaceae decreased by 2% per year (risk ratio [RR] = 0.98, p<0.001); by comparison, the CRE percentage decreased by 15% per year (RR = 0.85, p<0.01). From January to September 2017, carbapenemase testing was performed for 4,442 CRE and 1,334 CRPA isolates; 32% and 1.9%, respectively, were carbapenemase producers. In response, 1,489 screening tests were performed to identify asymptomatic carriers; 171 (11%) were positive. CONCLUSIONS The proportion of Enterobacteriaceae infections that were CRE remained lower and decreased more over time than the proportion that were ESBL phenotype. This difference might be explained by the more directed control efforts implemented to slow transmission of CRE than those applied for ESBL-producing strains. Increased detection and aggressive early response to emerging antibiotic resistance threats have the potential to slow further spread.
Collapse
|
32
|
Brown AC, van der Hart HW. Extreme-Ultraviolet-Initated High-Order Harmonic Generation: Driving Inner-Valence Electrons Using Below-Threshold-Energy Extreme-Ultraviolet Light. Phys Rev Lett 2016; 117:093201. [PMID: 27610852 DOI: 10.1103/physrevlett.117.093201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Indexed: 06/06/2023]
Abstract
We propose a novel scheme for resolving the contribution of inner- and outer-valence electrons in extreme-ultraviolet (XUV)-initiated high-harmonic generation in neon. By probing the atom with a low-energy (below the 2s ionization threshold) ultrashort XUV pulse, the 2p electron is steered away from the core, while the 2s electron is enabled to describe recollision trajectories. By selectively suppressing the 2p recollision trajectories, we can resolve the contribution of the 2s electron to the high-harmonic spectrum. We apply the classical trajectory model to account for the contribution of the 2s electron, which allows for an intuitive understanding of the process.
Collapse
Affiliation(s)
- A C Brown
- Centre for Theoretical Atomic, Molecular and Optical Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast BT7 1NN, United Kingdom
| | - H W van der Hart
- Centre for Theoretical Atomic, Molecular and Optical Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast BT7 1NN, United Kingdom
| |
Collapse
|
33
|
Hlavsa MC, Gerth TR, Collier SA, Dunbar EL, Rao G, Epperson G, Bramlett B, Ludwig DF, Gomez D, Stansbury MM, Miller F, Warren J, Nichol J, Bowman H, Huynh BA, Loewe KM, Vincent B, Tarrier AL, Shay T, Wright R, Brown AC, Kunz JM, Fullerton KE, Cope JR, Beach MJ. Immediate Closures and Violations Identified During Routine Inspections of Public Aquatic Facilities - Network for Aquatic Facility Inspection Surveillance, Five States, 2013. MMWR Surveill Summ 2016; 65:1-26. [PMID: 27199095 DOI: 10.15585/mmwr.ss6505a1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PROBLEM/CONDITION Aquatic facility-associated illness and injury in the United States include disease outbreaks of infectious or chemical etiology, drowning, and pool chemical-associated health events (e.g., respiratory distress or burns). These conditions affect persons of all ages, particularly young children, and can lead to disability or even death. A total of 650 aquatic facility-associated outbreaks have been reported to CDC for 1978-2012. During 1999-2010, drownings resulted in approximately 4,000 deaths each year in the United States. Drowning is the leading cause of injury deaths in children aged 1-4 years, and approximately half of fatal drownings in this age group occur in swimming pools. During 2003-2012, pool chemical-associated health events resulted in an estimated 3,000-5,000 visits to U.S. emergency departments each year, and approximately half of the patients were aged <18 years. In August 2014, CDC released the Model Aquatic Health Code (MAHC), national guidance that can be adopted voluntarily by state and local jurisdictions to minimize the risk for illness and injury at public aquatic facilities. REPORTING PERIOD COVERED 2013. DESCRIPTION OF SYSTEM The Network for Aquatic Facility Inspection Surveillance (NAFIS) was established by CDC in 2013. NAFIS receives aquatic facility inspection data collected by environmental health practitioners when assessing the operation and maintenance of public aquatic facilities. This report presents inspection data that were reported by 16 public health agencies in five states (Arizona, California, Florida, New York, and Texas) and focuses on 15 MAHC elements deemed critical to minimizing the risk for illness and injury associated with aquatic facilities (e.g., disinfection to prevent transmission of infectious pathogens, safety equipment to rescue distressed bathers, and pool chemical safety). Although these data (the first and most recent that are available) are not nationally representative, 15.7% of the estimated 309,000 U.S. public aquatic venues are located in the 16 reporting jurisdictions. RESULTS During 2013, environmental health practitioners in the 16 reporting NAFIS jurisdictions conducted 84,187 routine inspections of 48,632 public aquatic venues. Of the 84,187 routine inspection records for individual aquatic venues, 78.5% (66,098) included data on immediate closure; 12.3% (8,118) of routine inspections resulted in immediate closure because of at least one identified violation that represented a serious threat to public health. Disinfectant concentration violations were identified during 11.9% (7,662/64,580) of routine inspections, representing risk for aquatic facility-associated outbreaks of infectious etiology. Safety equipment violations were identified during 12.7% (7,845/61,648) of routine inspections, representing risk for drowning. Pool chemical safety violations were identified during 4.6% (471/10,264) of routine inspections, representing risk for pool chemical-associated health events. INTERPRETATION Routine inspections frequently resulted in immediate closure and identified violations of inspection items corresponding to 15 MAHC elements critical to protecting public health, highlighting the need to improve operation and maintenance of U.S. public aquatic facilities. These findings also underscore the public health function that code enforcement, conducted by environmental health practitioners, has in preventing illness and injury at public aquatic facilities. PUBLIC HEALTH ACTION Findings from the routine analyses of aquatic facility inspection data can inform program planning, implementation, and evaluation. At the state and local level, these inspection data can be used to identify aquatic facilities and venues in need of more frequent inspections and to select topics to cover in training for aquatic facility operators. At the national level, these data can be used to evaluate whether the adoption of MAHC elements minimizes the risk for aquatic facility-associated illness and injury. These findings also can be used to prioritize revisions or updates to the MAHC. To optimize the collection and analysis of aquatic facility inspection data and thus application of findings, environmental health practitioners and epidemiologists need to collaborate extensively to identify public aquatic facility code elements deemed critical to protecting public health and determine the best way to assess and document compliance during inspections.
Collapse
Affiliation(s)
- Michele C Hlavsa
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infections Diseases, CDC
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Brown AC, Powell JG, Kegley EB, Gadberry MS, Reynolds JL, Hughes HD, Carroll JA, Burdick Sanchez NC, Thaxton YV, Backes EA, Richeson JT. Effect of castration timing and oral meloxicam administration on growth performance, inflammation, behavior, and carcass quality of beef calves. J Anim Sci 2016; 93:2460-70. [PMID: 26020341 DOI: 10.2527/jas.2014-8695] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Beef bull calves (n = 62) were assigned randomly, within sire breed, to 1 of 4 treatments at birth. Treatments were 1) surgical castration near birth, 2) surgical castration near birth with oral administration of meloxicam (1 mg/kg BW), 3) surgical castration at weaning (WNG), or 4) surgical castration at weaning with oral administration of meloxicam (1 mg/kg BW; WMX). A subset of calves (n = 7/treatment group) were selected randomly near birth for blood collection, behavioral analyses, and rectal temperature (RT) records for a 7-d postcastration period on d 0 (birth), 1, 3, and 7, and on d 214 (weaning), 214 + 6 h, 215, 217, 221, and 228. Calf standing and lying activity were monitored from the same subsets by recording x- and y-axis positions of an accelerometer attached to the right metatarsus for 7 d postcastration. Calf BW was recorded throughout the entire production cycle, and carcass data were collected at slaughter. For statistical analyses, bulls left intact at birth were considered a positive control (BUL) for observations that occurred before their treatment application at weaning; likewise, bulls castrated at birth were considered a negative control (STR) during postweaning observations. No difference (P > 0.88) occurred in ADG between treatments throughout the preweaning period (d 0 to 214); however, 56-d postweaning ADG was greatest ( P= 0.02) in STR, intermediate in WMX, and least in WNG. At weaning, haptoglobin (Hp) was greater (P ≤ 0.005) for WNG and WMX compared to STR on d 214+6 h, 215, and 217, and Hp was greater (P = 0.05) in WNG compared to WMX on d 217. Neutrophils increased (P < 0.001) and red blood cells decreased (P ≤ 0.03) for WNG and WMX on d 214+6 h and 217, respectively. Postweaning behavior observations indicated that STR calves spent the least proportion of time standing (P = 0.002) when compared to WNG and WMX. Furthermore, WMX calves exhibited a greater proportion of time spent standing (P = 0.03) compared to WNG. Grazing and finishing phase ADG and carcass measurements did not differ (P ≥ 0.24) across treatments. In this study, surgical castration at weaning, but not near birth, altered the acute phase response, behavior, and growth performance. Oral meloxicam reduced serum Hp and improved ADG briefly when administered to calves castrated at weaning. Oral administration of meloxicam may be efficacious for mitigating some of the stress and inflammation associated with castration of weaning-age bull calves.
Collapse
|
35
|
Gold MJ, Hiebert PR, Park HY, Stefanowicz D, Le A, Starkey MR, Deane A, Brown AC, Liu G, Horvat JC, Ibrahim ZA, Sukkar MB, Hansbro PM, Carlsten C, VanEeden S, Sin DD, McNagny KM, Knight DA, Hirota JA. Mucosal production of uric acid by airway epithelial cells contributes to particulate matter-induced allergic sensitization. Mucosal Immunol 2016; 9:809-20. [PMID: 26509876 DOI: 10.1038/mi.2015.104] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 09/03/2015] [Indexed: 02/07/2023]
Abstract
Exposure to particulate matter (PM), a major component of air pollution, contributes to increased morbidity and mortality worldwide. PM induces innate immune responses and contributes to allergic sensitization, although the mechanisms governing this process remain unclear. Lung mucosal uric acid has also been linked to allergic sensitization. The links among PM exposure, uric acid, and allergic sensitization remain unexplored. We therefore investigated the mechanisms behind PM-induced allergic sensitization in the context of lung mucosal uric acid. PM10 and house dust mite exposure selectively induced lung mucosal uric acid production and secretion in vivo, which did not occur with other challenges (lipopolysaccharide, virus, bacteria, or inflammatory/fibrotic stimuli). PM10-induced uric acid mediates allergic sensitization and augments antigen-specific T-cell proliferation, which is inhibited by uricase. We then demonstrate that human airway epithelial cells secrete uric acid basally and after stimulation through a previously unidentified mucosal secretion system. Our work discovers a previously unknown mechanism of air pollution-induced, uric acid-mediated, allergic sensitization that may be important in the pathogenesis of asthma.
Collapse
Affiliation(s)
- M J Gold
- Biomedical Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - P R Hiebert
- James Hogg Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - H Y Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - D Stefanowicz
- James Hogg Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Le
- James Hogg Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - M R Starkey
- Priority Research Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, Callaghan, Australia
| | - A Deane
- Priority Research Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, Callaghan, Australia
| | - A C Brown
- Priority Research Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, Callaghan, Australia
| | - G Liu
- Priority Research Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, Callaghan, Australia
| | - J C Horvat
- Priority Research Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, Callaghan, Australia
| | - Z A Ibrahim
- Discipline of Pharmacy, Graduate School of Health, The University of Technology Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - M B Sukkar
- Discipline of Pharmacy, Graduate School of Health, The University of Technology Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - P M Hansbro
- Priority Research Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, Callaghan, Australia
| | - C Carlsten
- James Hogg Research Centre, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Research Institute, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - S VanEeden
- James Hogg Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - D D Sin
- James Hogg Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - K M McNagny
- Biomedical Research Centre, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - D A Knight
- Priority Research Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, Callaghan, Australia.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia.,Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - J A Hirota
- James Hogg Research Centre, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Research Institute, Vancouver General Hospital, Vancouver, British Columbia, Canada
| |
Collapse
|
36
|
Cope JR, Collier SA, Schein OD, Brown AC, Verani JR, Gallen R, Beach MJ, Yoder JS. Acanthamoeba Keratitis among Rigid Gas Permeable Contact Lens Wearers in the United States, 2005 through 2011. Ophthalmology 2016; 123:1435-41. [PMID: 27117780 DOI: 10.1016/j.ophtha.2016.03.039] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/12/2016] [Accepted: 03/22/2016] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To describe the clinical presentation and outcomes of Acanthamoeba keratitis (AK) in rigid gas permeable (RGP) contact lens wearers and to identify modifiable risk factors. DESIGN Case-control investigation. PARTICIPANTS Patients were RGP contact lens-wearing United States residents with a diagnosis of AK from 2005 through 2011. Controls were RGP contact lens wearers with no history of AK who were at least 12 years of age. METHODS Patients were identified during 2 multistate AK outbreak investigations. Controls from the first investigation in 2007 were identified using a reverse address directory. In the second investigation, controls were recruited from participating ophthalmology and optometry practices. Patients and controls were interviewed by phone using a standardized questionnaire. Odds ratios (ORs) and Fisher exact P values were calculated to assess risk factors associated with infection. MAIN OUTCOME MEASURES Acanthamoeba keratitis, a rare eye disease primarily affecting contact lens wearers, is caused by free-living amebae, Acanthamoeba species. RESULTS We identified 37 patients in the 2 investigations, 10 (27%) from the 2007 investigation and 27 (73%) from 2011. There were 17 healthy controls, 9 (53%) from 2007 and 8 (47%) from 2011. Among patients, 9 (24%) wore RGP lenses for orthokeratology or therapeutic indication; no controls wore RGP lenses for these indications. Significant risk factors for AK were wearing lenses for orthokeratology (OR, undefined; P = 0.02), sleeping while wearing lenses (OR, 8.00; P = 0.04), storing lenses in tap water (OR, 16.00; P = 0.001), and topping off contact lens solution in the case (OR, 4.80; P = 0.01). After stratifying by use of RGP lenses for orthokeratology, storing lenses in tap water and topping off remained significant exposures. CONCLUSIONS Nearly one quarter of patients were orthokeratology wearers. Using tap water to store RGP lenses and topping off solution in the lens case were modifiable risk behaviors identified in RGP wearers who wore lenses for both orthokeratology and nonorthokeratology indications. Rigid gas permeable wearers should avoid exposing their lenses to tap water and should empty their cases and use fresh lens solution each time they take out their lenses.
Collapse
Affiliation(s)
- Jennifer R Cope
- Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Sarah A Collier
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Oliver D Schein
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Allison C Brown
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Rachel Gallen
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael J Beach
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | |
Collapse
|
37
|
Slayton RB, Murphy JL, Morris J, Faith SH, Oremo J, Odhiambo A, Ayers T, Feinman SJ, Brown AC, Quick RE. A Cluster Randomized Controlled Evaluation of the Health Impact of a Novel Antimicrobial Hand Towel on the Health of Children Under 2 Years Old in Rural Communities in Nyanza Province, Kenya. Am J Trop Med Hyg 2015; 94:437-44. [PMID: 26643530 DOI: 10.4269/ajtmh.14-0566] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 08/17/2015] [Indexed: 01/09/2023] Open
Abstract
To assess the health impact of reusable, antimicrobial hand towels, we conducted a cluster randomized, yearlong field trial. At baseline, we surveyed mothers, and gave four towels plus hygiene education to intervention households and education alone to controls. At biweekly home visits, we asked about infections in children < 2 years old and tested post-handwashing hand rinse samples of 20% of mothers for Escherichia coli. At study's conclusion, we tested 50% of towels for E. coli. Baseline characteristics between 188 intervention and 181 control households were similar. Intervention and control children had similar rates of diarrhea (1.47 versus 1.48, P = 0.99), respiratory infections (1.38 versus 1.48, P = 0.92), skin infections (1.76 versus 1.79, P = 0.81), and subjective fever (2.62 versus 3.40, P = 0.04) per 100 person-visits. Post-handwashing hand contamination was similar; 67% of towels exhibited E. coli contamination. Antimicrobial hand towels became contaminated over time, did not improve hand hygiene, or prevent diarrhea, respiratory infections, or skin infections.
Collapse
Affiliation(s)
- Rachel B Slayton
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Safe Water and AIDS Project, Kisumu, Kenya
| | - Jennifer L Murphy
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Safe Water and AIDS Project, Kisumu, Kenya
| | - Jamae Morris
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Safe Water and AIDS Project, Kisumu, Kenya
| | - Sitnah Hamidah Faith
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Safe Water and AIDS Project, Kisumu, Kenya
| | - Jared Oremo
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Safe Water and AIDS Project, Kisumu, Kenya
| | - Aloyce Odhiambo
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Safe Water and AIDS Project, Kisumu, Kenya
| | - Tracy Ayers
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Safe Water and AIDS Project, Kisumu, Kenya
| | - Shawna J Feinman
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Safe Water and AIDS Project, Kisumu, Kenya
| | - Allison C Brown
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Safe Water and AIDS Project, Kisumu, Kenya
| | - Robert E Quick
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Safe Water and AIDS Project, Kisumu, Kenya
| |
Collapse
|
38
|
Brown AC, Koufos E, Balashova NV, Boesze-Battaglia K, Lally ET. Inhibition of LtxA toxicity by blocking cholesterol binding with peptides. Mol Oral Microbiol 2015; 31:94-105. [PMID: 26352738 DOI: 10.1111/omi.12133] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2015] [Indexed: 12/30/2022]
Abstract
The leukotoxin (LtxA) produced by Aggregatibacter actinomycetemcomitans kills host immune cells, allowing the bacterium to establish an ecological niche in the upper aerodigestive tract of its human host. The interaction of LtxA with human immune cells is both complex and multifaceted, involving membrane lipids as well as cell-surface proteins. In the initial encounter with the host cell, LtxA associates with lymphocyte function-associated antigen-1, a cell surface adhesion glycoprotein. However, we have also demonstrated that the toxin associates strongly with the plasma membrane lipids, specifically cholesterol. This association with cholesterol is regulated by a cholesterol recognition amino acid consensus (CRAC) motif, with a sequence of (334) LEEYSKR(340), in the N-terminal region of the toxin. Here, we have demonstrated that removal of cholesterol from the plasma membrane or mutation of the LtxA CRAC motif inhibits the activity of the toxin in THP-1 cells. To inhibit LtxA activity, we designed a short peptide corresponding to the CRAC(336) motif of LtxA (CRAC(336WT)). This peptide binds to cholesterol and thereby inhibits the toxicity of LtxA in THP-1 cells. Previously, we showed that this peptide inhibits LtxA toxicity against Jn.9 (Jurkat) cells, indicating that peptides derived from the cholesterol-binding site of LtxA may have a potential clinical applicability in controlling infections of repeats-in-toxin-producing organisms.
Collapse
Affiliation(s)
- A C Brown
- Department of Chemical and Biomolecular Engineering, Lehigh University, Bethlehem, PA, USA
| | - E Koufos
- Department of Chemical and Biomolecular Engineering, Lehigh University, Bethlehem, PA, USA
| | - N V Balashova
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - K Boesze-Battaglia
- Department of Biochemistry, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - E T Lally
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
39
|
Walters MJ, Brown AC, Edrington TC, Baranwal S, Du Y, Lally ET, Boesze-Battaglia K. Membrane association and destabilization by Aggregatibacter actinomycetemcomitans leukotoxin requires changes in secondary structures. Mol Oral Microbiol 2013; 28:342-53. [PMID: 23678967 DOI: 10.1111/omi.12028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2013] [Indexed: 01/13/2023]
Abstract
Aggregatibacter actinomycetemcomitans is a common inhabitant of the upper aerodigestive tract of humans and non-human primates and is associated with disseminated infections, including lung and brain abscesses, pediatric infective endocarditis, and localized aggressive periodontitis. Aggregatibacter actinomycetemcomitans secretes a repeats-in-toxin protein, leukotoxin, which exclusively kills lymphocyte function-associated antigen-1-bearing cells. The toxin's pathological mechanism is not fully understood; however, experimental evidence indicates that it involves the association with and subsequent destabilization of the target cell's plasma membrane. We have long hypothesized that leukotoxin secondary structure is strongly correlated with membrane association and destabilization. In this study, we tested this hypothesis by analysing lipid-induced changes in leukotoxin conformation. Upon incubation of leukotoxin with lipids that favor leukotoxin-membrane association, we observed an increase in leukotoxin α-helical content that was not observed with lipids that favor membrane destabilization. The change in leukotoxin conformation after incubation with these lipids suggests that membrane binding and membrane destabilization have distinct secondary structural requirements, suggesting that they are independent events. These studies provide insight into the mechanism of cell damage that leads to disease progression by A. actinomycetemcomitans.
Collapse
Affiliation(s)
- M J Walters
- Department of Pathology, University of Pennsylvania School of Dental Medicine, Philadelphia, PA 19104, USA
| | | | | | | | | | | | | |
Collapse
|
40
|
Clotfelter ED, Lapidus SJH, Brown AC. The effects of temperature and dissolved oxygen on antioxidant defences and oxidative damage in the fathead minnow Pimephales promelas. J Fish Biol 2013; 82:1086-1092. [PMID: 23464565 DOI: 10.1111/jfb.12050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 12/15/2012] [Indexed: 06/01/2023]
Abstract
Fathead minnows Pimephales promelas maintained at 25° C for 6 h had significantly higher superoxide dismutase (SOD) activity than fish maintained at 7 or 32° C, but hypoxic conditions (3 mg l(-1) O2 ) over the same time period did not affect SOD activity. Fish in better body condition (length-adjusted mass) had higher SOD activity. In a separate experiment, P. promelas maintained at three water temperatures (7, 23 and 32° C) for 31 days did not differ in liver acrolein, a biomarker of oxidative stress.
Collapse
Affiliation(s)
- E D Clotfelter
- Department of Biology, Amherst College, Amherst, MA 01002, USA.
| | | | | |
Collapse
|
41
|
Brown AC, Hutchinson S, Lysaght MA, van der Hart HW. Interference between competing pathways in atomic harmonic generation. Phys Rev Lett 2012; 108:063006. [PMID: 22401067 DOI: 10.1103/physrevlett.108.063006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Indexed: 05/31/2023]
Abstract
We investigate the influence of the autoionizing 3s3p(6)nℓ resonances on the fifth harmonic generated by 200-240 nm laser fields interacting with Ar. To determine the influence of a multielectron response we develop the capability within time-dependent R-matrix theory to determine the harmonic spectra generated. The fifth harmonic is affected by interference between the response of a 3s electron and the response of a 3p electron, as demonstrated by the asymmetric profiles in the harmonic yields as functions of wavelength.
Collapse
Affiliation(s)
- A C Brown
- Centre for Theoretical Atomic, Molecular and Optical Physics, Queen's University Belfast, Belfast, United Kingdom
| | | | | | | |
Collapse
|
42
|
Fong KP, Tang HY, Brown AC, Kieba IR, Speicher DW, Boesze-Battaglia K, Lally ET. Aggregatibacter actinomycetemcomitans leukotoxin is post-translationally modified by addition of either saturated or hydroxylated fatty acyl chains. Mol Oral Microbiol 2011; 26:262-76. [PMID: 21729247 DOI: 10.1111/j.2041-1014.2011.00617.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aggregatibacter actinomycetemcomitans, a common inhabitant of the human upper aerodigestive tract, produces a repeat in toxin (RTX), leukotoxin (LtxA). The LtxA is transcribed as a 114-kDa inactive protoxin with activation being achieved by attachment of short chain fatty acyl groups to internal lysine residues. Methyl esters of LtxA that were isolated from A. actinomycetemcomitans strains JP2 and HK1651 and subjected to gas chromatography/mass spectrometry contained palmitoyl (C16:0, 27-29%) and palmitolyl (C16:1 cis Δ9, 43-44%) fatty acyl groups with smaller quantities of myristic (C14:0, 14%) and stearic (C18:0, 12-14%) fatty acids. Liquid chromatography/mass spectrometry of tryptic peptides from acylated and unacylated recombinant LtxA confirmed that Lys(562) and Lys(687) are the sites of acyl group attachment. During analysis of recombinant LtxA peptides, we observed peptide spectra that were not observed as part of the RTX acylation schemes of either Escherichia coliα-hemolysin or Bordetella pertussis cyclolysin. Mass calculations of these spectra suggested that LtxA was also modified by the addition of monohydroxylated forms of C14 and C16 acyl groups. Multiple reaction monitoring mass spectrometry identified hydroxymyristic and hydroxypalmitic acids in wild-type LtxA methyl esters. Single or tandem replacement of Lys(562) and Lys(687) with Arg blocks acylation, resulting in a >75% decrease in cytotoxicity when compared with wild-type toxin, suggesting that these post-translational modifications are playing a critical role in LtxA-mediated target cell cytotoxicity.
Collapse
Affiliation(s)
- K P Fong
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | | | | | | | | | | |
Collapse
|
43
|
Ostrov DA, Barnes CL, Smith LE, Binns S, Brusko TM, Brown AC, Quint PS, Litherland SA, Roopenian DC, Iczkowski KA. Characterization of HKE2: an ancient antigen encoded in the major histocompatibility complex. ACTA ACUST UNITED AC 2007; 69:181-8. [PMID: 17257322 DOI: 10.1111/j.1399-0039.2006.00730.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Genes at the centromeric end of the human leukocyte antigen region influence adaptive autoimmune diseases and cancer. In this study, we characterized protein expression of HKE2, a gene located in the centromeric portion of the class II region of the major histocompatibility complex encoding subunit 6 of prefoldin. Immunohistochemical analysis using an anti-HKE2 antibody indicated that HKE2 protein expression is dramatically upregulated as a consequence of activation. In a tissue microarray and in several tumors, HKE2 was overexpressed in certain cancers compared with normal counterparts. The localization of the HKE2 gene to the class II region, its cytoplasmic expression and putative protein-binding domain suggest that HKE2 may function in adaptive immunity and cancer.
Collapse
Affiliation(s)
- D A Ostrov
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Brown AC, Harrison LM, Kapulkin W, Jones BF, Sinha A, Savage A, Villalon N, Cappello M. Molecular cloning and characterization of a C-type lectin from Ancylostoma ceylanicum: evidence for a role in hookworm reproductive physiology. Mol Biochem Parasitol 2006; 151:141-7. [PMID: 17129620 PMCID: PMC1831819 DOI: 10.1016/j.molbiopara.2006.10.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Revised: 10/25/2006] [Accepted: 10/26/2006] [Indexed: 11/24/2022]
Abstract
Lectins comprise a family of related proteins that mediate essential cell functions through binding to carbohydrates. Within this protein family, C-type lectins are defined by the requirement of calcium for optimal biologic activity. Using reverse transcription PCR, a cDNA corresponding to a putative C-type lectin has been amplified from the hookworm parasite Ancylostoma ceylanicum. The 550 nucleotide open reading frame of the A. ceylanicum C-type Lectin-1 (AceCTL-1) cDNA corresponds to a 167 amino acid mature protein (18,706 Da) preceded by a 17 amino acid secretory signal sequence. The recombinant protein (rAceCTL-1) was expressed in Drosophila S2 cells and purified using a combination of affinity chromatography and reverse phase HPLC. Using in vitro carbohydrate binding studies, it was determined that rAceCTL-1 binds N-acetyl-d-glucosamine, a common component of eukaryotic egg cell membranes. Using a polyclonal IgG raised against the recombinant protein, the native AceCTL-1 was identified in sperm and soluble protein extracts of adult male A. ceylanicum by immunoblot. Probing of adult hookworm sections with the polyclonal IgG demonstrated localization to the testes in males, as well as the spermatheca and developing embryos in females, consistent with its role as a sperm protein. Together, these data strongly suggest that AceCTL-1 is a male gender-specific C-type lectin with a function in hookworm reproductive physiology.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Michael Cappello
- Corresponding author: Mail: Yale Child Health Research Center, 464 Congress Avenue, New Haven, CT 06520, , Tel: 203-737-432, Fax: 203-737-5972
| |
Collapse
|
45
|
Brown AC, Lerner CP, Graber JH, Shaffer DJ, Roopenian DC. Pooling and PCR as a method to combat low frequency gene targeting in mouse embryonic stem cells. Cytotechnology 2006; 51:81-8. [PMID: 19002898 DOI: 10.1007/s10616-006-9021-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 08/22/2006] [Accepted: 08/23/2006] [Indexed: 10/24/2022] Open
Abstract
The introduction of germ line modifications by gene targeting in mouse embryonic stem (ES) cells has proven a fundamental technology to relate genes to mammalian biology. Critical aspects required for successful gene targeting have traditionally been experimental enhancements that increase the frequency or detection of homologous recombination within ES cells; however, the utilization of such methods may still result in the failed isolation of a positively targeted ES cell clone. In this study, we discuss the current enhancement methods and describe an ES cell pooling strategy that maximizes the ability to detect properly targeted ES cells regardless of an inherent low targeting efficiency. The sensitivity required to detect correctly targeted events out of a pool of ES cell clones is provided by polymerase chain reaction (PCR), and only those pools containing positives need to be expanded and screened to find individually targeted clones. This method made it possible to identify targeted clones from a screen of approximately 2,300 ES cell colonies by performing only 123 PCR reactions. This technically streamlined approach bypasses the need to troubleshoot and re-engineer an existing targeting construct that is functionally suitable despite its low targeting frequency.
Collapse
Affiliation(s)
- A C Brown
- The Jackson Laboratory, 600 Main Street, Bar Harbor, ME, 04609, USA,
| | | | | | | | | |
Collapse
|
46
|
Hart GT, Shaffer DJ, Akilesh S, Brown AC, Moran L, Roopenian DC, Baker PJ. Quantitative gene expression profiling implicates genes for susceptibility and resistance to alveolar bone loss. Infect Immun 2004; 72:4471-9. [PMID: 15271905 PMCID: PMC470695 DOI: 10.1128/iai.72.8.4471-4479.2004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2003] [Revised: 03/06/2004] [Accepted: 04/12/2004] [Indexed: 01/22/2023] Open
Abstract
Periodontal disease is one of the most prevalent chronic inflammatory diseases. There is a genetic component to susceptibility and resistance to this disease. Using a mouse model, we investigated the progression of alveolar bone loss by gene expression profiling of susceptible and resistant mouse strains (BALB/cByJ and A/J, respectively). We employed a novel and sensitive quantitative real-time PCR method to compare basal RNA transcription of a 48-gene set in the gingiva and the spleen and the subsequent changes in gene expression due to Porphyromonas gingivalis oral infection. Basal expression of interleukin-1 beta (Il1b) and tumor necrosis factor alpha (Tnf) mRNA was higher in the gingiva of the susceptible BALB/cByJ mice than in the gingiva of resistant A/J mice. Gingival Il1b gene expression increased further and Stat6 gene expression was turned on after P. gingivalis infection in BALB/cByJ mice but not in A/J mice. The basal expression of interleukin-15 (Il15) in the gingiva and the basal expression of p-selectin (Selp) in the spleen were higher in the resistant A/J mice than in the susceptible BALB/cByJ mice. In the resistant A/J mice the expression of no genes detectably changed in the gingiva after infection. These results suggest a molecular phenotype in which discrete sets of differentially expressed genes are associated with genetically determined susceptibility (Il1b, Tnf, and Stat6) or resistance (Il15 and Selp) to alveolar bone loss, providing insight into the genetic etiology of this complex disease.
Collapse
Affiliation(s)
- G T Hart
- Bates College, Lewiston, ME 04240, USA
| | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
BACKGROUND Sentinel lymph node (SLN) dissection in the management of high-risk melanoma and other cancers, such as breast cancer, has recently increased in use. The procedure identifies an SLN by intradermal or intraparenchymal injection of an isosulfan blue dye, a radiocolloid, or both around the primary malignancy. METHODS At the time of selective SLN mapping, 3 to 5 mL of isosulfan blue was injected either intradermally or intraparenchymally around the primary malignancy. From October 1997 to May 2000, 267 patients underwent intraoperative lymphatic mapping with the use of both isosulfan 1% blue dye and radiocolloid injection. Five cases with adverse reactions to isosulfan blue were reviewed. RESULTS We report 2 cases of anaphylaxis and 3 cases of "blue hives" after injection with isosulfan blue of 267 patients who had intraoperative lymphatic mapping by the procedure described above. The 2 patients with anaphylaxis experienced cardiovascular collapse, erythema, perioral edema, urticaria, and uvular edema. The blue hives in 3 patients resolved and transformed to blue patches during the course of the procedures. CONCLUSIONS The incidence of allergic reactions in our series was 2.0%. As physicians expand the role of SLN mapping, they should consider the use of histamine blockers as prophylaxis and have emergency treatment readily available to treat the life- threatening complication of anaphylactic reaction.
Collapse
Affiliation(s)
- V M Cimmino
- Department of Surgery, University of Michigan Medical School and University Hospital, Ann Arbor, MI 48109-0932, USA
| | | | | | | | | | | | | |
Collapse
|
48
|
Derrickson JP, Fisher AG, Anderson JE, Brown AC. An assessment of various household food security measures in Hawaiì has implications for national food security research and monitoring. J Nutr 2001; 131:749-57. [PMID: 11238755 DOI: 10.1093/jn/131.3.749] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Core Food Security Module (CFSM), the national food security monitoring tool, requires three affirmative responses to categorize households as food insecure. If this tool is unreliable or inaccurate, vulnerable segments of our population may be adversely affected. The objectives of the present study were to assess the credibility of applying the CFSM categorical measure to a population sample from Hawaiì and to assess the concurrent validity of the CFSM, the new face-valid measure and measures adapted from the Radimer/Cornell (RC) measure and Community Childhood Hunger Identification Project. The sample included 1469 respondents gathered through a statewide telephone sample and 144 food pantry recipients. Responses to the 18 CFSM questions were used to create all four measures. The credibility of the CFSM categorical measure was also assessed via comparisons with individual items and with the 1995 national modal CFSM response pattern. Categorical measures were compared across food security prevalence estimates and indices of income and vegetable intake and with the CFSM scale measure. Differences in the modal response pattern between samples affected CFSM categorization. Only 36% of households followed the Hawaiì modal response pattern, and categorization was not consistent with the content of key items. Although 85% of the households were classified as food secure by the CFSM, only 78% were classified as food secure with each of the other food security measures. Concurrent validity of all measures was confirmed. A reassessment of the national CFSM categorical measure appears warranted.
Collapse
|
49
|
Shintani TT, Beckham S, Brown AC, O'Connor HK. The Hawaii Diet: ad libitum high carbohydrate, low fat multi-cultural diet for the reduction of chronic disease risk factors: obesity, hypertension, hypercholesterolemia, and hyperglycemia. Hawaii Med J 2001; 60:69-73. [PMID: 11320614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the health effects of a high carbohydrate, low fat multi-cultural traditional diet, The Hawaii Diet, fed ad libitum to an adult population. METHODS Twenty-two adults recruited from various cultural backgrounds in Hawaii were fed, without calorie or portion size restriction, the Hawaii Diet for 21 days. The Hawaii Diet, based on familiar traditional foods from different cultures, is high in complex carbohydrate (77% of calories), low in fat (12% of calories), and moderate in protein (11% of calories). Participants were encouraged to eat to satiety. RESULTS There was a significant weight loss on The Hawaii Diet averaging 10.8 lbs (23.8 kg) (P < .0001). Blood pressure was decreased from an average of 136.0/82.7 mm Hg to 125.5/78.9 mm Hg yielding a significant decrease of 10.4 mm Hg for systolic (P < .01). Beginning diastolic levels were normal so decreases in these values were not significant. Average lipid values also decreased with total serum cholesterol being significantly reduced from 205.3 to 156.9 mg/dl (P < .0001); LDL from 125.9 to 94.9 mg/dl (P < .001); and HDL from 38.3 to 31.3 mg/dl (P < .0005). Triglycerides (238.7 to 152.2 mg/dl) and the Chol:HDL ratio (5.8 to 5.2) improved at marginally significant levels (P < .08). There was also a significant reduction in blood glucose levels from 112.2 to 91.5 mg/dL (P < .01). CONCLUSION The Hawaii Diet consisting of high carbohydrate, low fat ethnic meals appears to have a beneficial influence on weight loss and in decreasing systolic blood pressure, total cholesterol, LDL, and blood glucose values. Marginal improvement occurred for triglyceride levels. There was also a significant drop in HDL levels, however, the Chol:HDL was ratio did not increase. Further studies of longer duration with a control group should be conducted to test the effectiveness of The Hawaii Diet in maintaining these health benefits over a longer period of time.
Collapse
Affiliation(s)
- T T Shintani
- Preventive Health Department, Waianae Coast Comprehensive Health Center, 86-260 Farrington Hwy, Waianae, HI 96792, USA
| | | | | | | |
Collapse
|
50
|
Abstract
The purpose of this review was to search the scientific literature for dietary compounds that alleviate or exacerbate symptoms of lupus erythematosus (LE) in both animal and human models. A detailed literature review was undertaken to find articles showing a relationship between LE and nutrition by using MEDLINE/INDEX MEDICUS (1950-March 2000) for English-language articles, followed by cross-referencing. Aggravating substances appear to include excess calories, excess protein, high fat (especially saturated and omega-6 polyunsaturated fatty acids), zinc, iron, and L-canavanine found in alfalfa tablets. Possible beneficial dietary compounds include vitamin E, vitamin A (beta-carotene), selenium, fish oils (omega-3 polyunsaturated fatty acids), evening primrose oil, flaxseed, a plant herb (Tripterygium wilfordii), dehydroepiandrosterone, and calcium plus vitamin D (if taking corticosteroids). Some people with systemic LE placed on food allergy elimination diets reported improvement in their LE symptoms; however, this may be related to a decrease of other substances in the diet. Also, although no direct evidence was reported on the beneficial effects of either bromelain or a vegetarian diet (possibly allowing fish), it is suggested that they might be beneficial. Limitations to this research are that the findings are based on relatively few studies, many of which were without control groups or extrapolated from animal models. No large-scale studies have been performed with LE patients to substantiate the benefit, if any, of these individual dietary interventions, and if they were conducted, the remission and exacerbation pattern of LE may interfere with elucidating their effectiveness. Also, dietary changes should not be attempted without a physician's approval/monitoring.
Collapse
Affiliation(s)
- A C Brown
- Department of Human Nutrition, Food, & Animal Sciences, University of Hawaii at Manoa, Honolulu, HI 96822, USA
| |
Collapse
|