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Kazazian L, Silver R, Rao CY, Park M, Ciuba C, Farron M, Henao OL. A toolkit for planning and implementing acute febrile illness (AFI) surveillance. PLOS Glob Public Health 2024; 4:e0003115. [PMID: 38635502 PMCID: PMC11025857 DOI: 10.1371/journal.pgph.0003115] [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] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/06/2024] [Indexed: 04/20/2024]
Abstract
Acute febrile illness (AFI) is a broad clinical syndrome with a wide range of potential infectious etiologies. The lack of accessible, standardized approaches to conducting AFI etiologic investigations has contributed to significant global gaps in data on the epidemiology of AFI. Based on lessons learned from years of supporting AFI sentinel surveillance worldwide, the U.S. Centers for Disease Control and Prevention developed the toolkit for planning and implementing AFI surveillance, described here. This toolkit provides a comprehensive yet flexible framework to guide researchers, public health officials, and other implementers in developing a strategy to identify and/or monitor the potential causes of AFI. The toolkit comprises a cohesive set of planning aids and supporting materials, including an implementation framework, generic protocol, several generic forms (including screening, case report, specimen collection and testing, and informed consent and assent), and a generic data dictionary. These materials incorporate key elements intended to harmonize approaches for AFI surveillance, as well as setting-specific components and considerations for adaptation based on local surveillance objectives and limitations. Appropriate adaptation and implementation of this toolkit may generate data that expand the global AFI knowledge base, strengthen countries' surveillance and laboratory capacity, and enhance outbreak detection and response efforts.
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Affiliation(s)
- Lilit Kazazian
- Global Epidemiology, Laboratory, and Surveillance Branch, Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rachel Silver
- Global Epidemiology, Laboratory, and Surveillance Branch, Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Carol Y. Rao
- Global Epidemiology, Laboratory, and Surveillance Branch, Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Michael Park
- Global Epidemiology, Laboratory, and Surveillance Branch, Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Chandler Ciuba
- Global Epidemiology, Laboratory, and Surveillance Branch, Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Madeline Farron
- Global Epidemiology, Laboratory, and Surveillance Branch, Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Olga L. Henao
- Global Epidemiology, Laboratory, and Surveillance Branch, Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Choudhary R, Watakulsin P, Promduangsi P, Chuenchom N, Khemla S, Lurchachaiwong W, Mock P, Heffelfinger JD, MacArthur JR, Bloss E, Thamthitiwat S, Rao CY. Underdiagnosis in clinical documentation of community-acquired sepsis among children admitted to hospitals in two rural provinces: Thailand, October-December 2017. BMJ Paediatr Open 2024; 8:e002293. [PMID: 38413125 PMCID: PMC10900380 DOI: 10.1136/bmjpo-2023-002293] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/19/2024] [Indexed: 02/29/2024] Open
Abstract
Paediatric sepsis prevalence data from low-income and middle-income countries are lacking. In a cross-sectional study, we assessed clinician recognition and documentation of non-neonatal community-acquired paediatric sepsis in two rural border provinces in Thailand among children admitted between October and December 2017. Of the 152 children meeting sepsis criteria (26.9 paediatric sepsis patients per 1000 admissions), 15 (9.9%) had a clinician-documented admission diagnosis of sepsis or septic shock and 18 (11.8%) had a discharge diagnosis with International Classification of Diseases-10 codes related to sepsis. Clinician underdocumentation may cause challenges in global paediatric sepsis surveillance.
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Affiliation(s)
- Rewa Choudhary
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of Global Health Protection, Centers for Disease Control and Prevention Global Health Center, Atlanta, Georgia, USA
| | - Peeriya Watakulsin
- Department of Disease Control (DDC), Royal Thai Government Ministry of Public Health, Bangkok, Thailand
| | - Pitiphon Promduangsi
- Department of Disease Control (DDC), Royal Thai Government Ministry of Public Health, Bangkok, Thailand
| | | | | | | | - Philip Mock
- Totally Joined for Achieving Collaborative Techniques (TJFACT) LLC, Atlanta, Georgia, USA
| | - James D Heffelfinger
- Division of Global Health Protection, Centers for Disease Control and Prevention Global Health Center, Atlanta, Georgia, USA
- Thailand Ministry of Public Health-US CDC Collaboration, Bangkok, Thailand
| | - John R MacArthur
- Division of Global Health Protection, Centers for Disease Control and Prevention Global Health Center, Atlanta, Georgia, USA
- Thailand Ministry of Public Health-US CDC Collaboration, Bangkok, Thailand
| | - Emily Bloss
- Division of Global Health Protection, Centers for Disease Control and Prevention Global Health Center, Atlanta, Georgia, USA
- Thailand Ministry of Public Health-US CDC Collaboration, Bangkok, Thailand
| | | | - Carol Y Rao
- Division of Global Health Protection, Centers for Disease Control and Prevention Global Health Center, Atlanta, Georgia, USA
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Atherstone CJ, Guagliardo SAJ, Hawksworth A, O'Laughlin K, Wong K, Sloan ML, Henao O, Rao CY, McElroy PD, Bennett SD. COVID-19 Epidemiology during Delta Variant Dominance Period in 45 High-Income Countries, 2020-2021. Emerg Infect Dis 2023; 29:1757-1764. [PMID: 37494699 PMCID: PMC10461680 DOI: 10.3201/eid2909.230142] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
The SARS-CoV-2 Delta variant, first identified in October 2020, quickly became the dominant variant worldwide. We used publicly available data to explore the relationship between illness and death (peak case rates, death rates, case-fatality rates) and selected predictors (percentage vaccinated, percentage of the population >65 years, population density, testing volume, index of mitigation policies) in 45 high-income countries during the Delta wave using rank-order correlation and ordinal regression. During the Delta-dominant period, most countries reported higher peak case rates (57%) and lower peak case-fatality rates (98%). Higher vaccination coverage was protective against peak case rates (odds ratio 0.95, 95% CI 0.91-0.99) and against peak death rates (odds ratio 0.96, 95% CI 0.91-0.99). Vaccination coverage was vital to preventing infection and death from COVID-19 during the Delta wave. As new variants emerge, public health authorities should encourage the uptake of COVID-19 vaccination and boosters.
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Burkel VK, Newton SM, Acosta J, Valencia D, Benavides M, Tong VT, Daza M, Sancken C, Gonzalez M, Polen K, Rodriguez H, Borbón M, Rao CY, Gilboa SM, Honein MA, Ospina ML, Johnson CY. Zika virus knowledge, attitudes and prevention behaviors among pregnant women in the ZEN cohort study, Colombia, 2017-2018. Trans R Soc Trop Med Hyg 2023; 117:496-504. [PMID: 36864562 PMCID: PMC10910550 DOI: 10.1093/trstmh/trad005] [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: 11/10/2022] [Revised: 01/20/2023] [Accepted: 02/07/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Zika virus (ZIKV) infection during pregnancy can cause severe birth defects in the fetus and is associated with neurodevelopmental abnormalities in childhood. Our objective was to describe ZIKV knowledge and attitudes among pregnant women in Colombia while ZIKV was circulating and whether they predicted the adoption of behaviors to prevent ZIKV mosquito-borne and sexual transmission. METHODS We used self-reported data from Zika en Embarazadas y Niños (ZEN), a cohort study of women in early pregnancy across three regions of Colombia during 2017-2018. We used Poisson regression to estimate associations between knowledge, attitudes and previous experience with mosquito-borne infection and preventative behaviors. RESULTS Among 1519 women, knowledge of mosquito-borne transmission was high (1480; 97.8%) and 1275 (85.5%) participants were worried about ZIKV infection during pregnancy. The most common preventive behavior was wearing long pants (1355; 89.4%). Regular mosquito repellent use was uncommon (257; 17.0%). While ZIKV knowledge and attitudes were not associated with the adoption of ZIKV prevention behaviors, previous mosquito-borne infection was associated with increased condom use (prevalence ratio 1.4, 95% CI 1.1 to 1.7). CONCLUSIONS Participants were well informed about ZIKV transmission and its health consequences. However, whether this knowledge resulted in behavior change is less certain.
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Affiliation(s)
- Veronica K. Burkel
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
- Eagle Global Services, LLC, Atlanta, GA 30341, USA
| | - Suzanne M. Newton
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | | | - Diana Valencia
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | | | - Van T. Tong
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | | | - Christina Sancken
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | | | - Kara Polen
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | | | | | - Carol Y. Rao
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Suzanne M. Gilboa
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Margaret A. Honein
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | | | - Candice Y. Johnson
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
- Department of Family Medicine and Community Health, Duke University, Durham, NC 27705, USA
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Moore JT, Wigington C, Green J, Horter L, Kone A, Lopes-Cardozo B, Byrkit R, Rao CY. Understanding Low Utilization of Employee Assistance Programs and Time Off by US Public Health Workers During the COVID-19 Pandemic. Public Health Rep 2023:333549231165287. [PMID: 37052332 PMCID: PMC10102824 DOI: 10.1177/00333549231165287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE Despite high rates of reported mental health symptoms among public health workers (PHWs) during the COVID-19 pandemic, utilization of employer-offered resources was low. Our objective was to understand what barriers and deterrents exist for PHWs accessing employer-offered resources. METHODS Four national public health organizations disseminated a national online survey of public health department employees during March-April 2021; 26 174 PHWs completed the survey. We examined 5164 write-in survey responses using thematic analysis to identify key reasons why PHWs were not accessing time off and employee assistance programs (EAPs) and to understand what resources PHWs would like to see their employers offer. RESULTS The top reasons that PHWs reported for not taking time off during the COVID-19 pandemic were financial concerns (24.4%), fear of judgment or retaliation (20.8%), and limitations in the amount of time off offered or available (11.0%). The top reasons that PHWs reported for not using EAPs during the COVID-19 pandemic were difficulty accessing EAPs (53.1%), use of external services (21.5%), and a lack of awareness about EAPs or motivation to initiate their use (11.3%). While desired employer-offered resources varied widely, PHWs most frequently listed financial incentives, paid time off, flexible scheduling, and organizational change. CONCLUSION Organizations can best help their employees by organizing the workforce in a way that allows PHWs to take time off, creating a positive and supportive organizational climate, regularly assessing the needs of PHWs, clearly communicating the availability of employer-offered benefits, and emphasizing the acceptability of using those benefits.
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Affiliation(s)
- Jazmyn T Moore
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Claire Wigington
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Jamilla Green
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Libby Horter
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Goldbelt C6, LLC, Chesapeake, VA, USA
| | - Ahoua Kone
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Barbara Lopes-Cardozo
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ramona Byrkit
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carol Y Rao
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Tiesman HM, Hendricks SA, Wiegand DM, Lopes-Cardozo B, Rao CY, Horter L, Rose CE, Byrkit R. Workplace Violence and the Mental Health of Public Health Workers During COVID-19. Am J Prev Med 2023; 64:315-325. [PMID: 36464557 PMCID: PMC9659550 DOI: 10.1016/j.amepre.2022.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION During the COVID-19 pandemic, public health workers were at an increased risk for violence and harassment due to their public health work and experienced adverse mental health conditions. This article quantifies the prevalence of job-related threats, harassment, and discrimination against public health workers and measures the association of these incidents with mental health symptoms during the COVID-19 pandemic. METHODS A nonprobability convenience sample of state, local, and tribal public health workers completed a self-administered, online survey in April 2021. The survey link was emailed to members of national public health associations and included questions on workplace violence, demographics, workplace factors, and mental health symptoms. Mental health symptoms were measured using standardized, validated tools to assess depression, anxiety, post-traumatic stress disorder, and suicidal ideation. Multivariable Poisson models calculated adjusted prevalence ratios of mental health symptoms, with workplace violence as the primary risk factor. Analyses were conducted in 2021-2022. RESULTS Experiencing any type or combination of workplace violence was significantly associated with an increased likelihood of reporting depression symptoms (prevalence ratio=1.21, 95% CI=1.15, 1.27), anxiety (prevalence ratio=1.21, 95% CI=1.15, 1.27), post-traumatic stress disorder (prevalence ratio=1.31, 95% CI=1.25, 1.37), and suicidal ideation (prevalence ratio=1.26, 95% CI=1.14, 1.38), after adjusting for confounders. A dose‒response relationship was found between the number of workplace violence events experienced by a public health worker and the likelihood of reporting mental health symptoms. CONCLUSIONS Violence targeted at the public health workforce is detrimental to workers and their communities. Ongoing training, workplace support, and increased communication after a workplace violence incident may be helpful. Efforts to strengthen public health capacities and support the public health workforce are also needed.
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Affiliation(s)
- Hope M Tiesman
- Analysis and Field Evaluations Branch, Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, West Virginia.
| | - Scott A Hendricks
- Analysis and Field Evaluations Branch, Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, West Virginia
| | - Douglas M Wiegand
- Hazard Evaluations & Technical Assistance Branch, Division of Field Studies & Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Barbara Lopes-Cardozo
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carol Y Rao
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Libby Horter
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia; Goldbelt C6, Chesapeake, Virginia
| | - Charles E Rose
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ramona Byrkit
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
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Koné A, Horter L, Thomas I, Byrkit R, Lopes-Cardozo B, Rao CY, Rose C. Symptoms of Mental Health Conditions and Suicidal Ideation Among State, Tribal, Local, and Territorial Public Health Workers — United States, March 14–25, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:925-930. [PMID: 35862276 PMCID: PMC9310631 DOI: 10.15585/mmwr.mm7129a4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kone A, Horter L, Rose C, Rao CY, Orquiola D, Thomas I, Byrkit R, Bryant-Genevier J, Lopes-Cardozo B. The impact of traumatic experiences, coping mechanisms, and workplace benefits on the mental health of U.S. public health workers during the COVID-19 pandemic. Ann Epidemiol 2022; 74:66-74. [PMID: 35850418 PMCID: PMC9287576 DOI: 10.1016/j.annepidem.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 12/01/2022]
Abstract
Purpose To evaluate the association between risk factors, mitigating factors, and adverse mental health outcomes among United States public health workers. Methods Cross-sectional online survey data were collected March to April 2021. The survey was distributed to public health workers who worked in a state, tribal, local, or territorial public health department since March 2020. Results In total, 26,174 United States state and local public health workers completed the survey. Feeling isolated was a risk factor for anxiety (PR, 1.84; 95% CI, 1.74–1.95), depression (PR, 1.84; 95% CI, 1.75–1.94), post-traumatic stress disorder (PR, 1.50; 95% CI, 1.43–1.57), and suicidal ideation (PR, 3.23; 95% CI, 2.82–3.69). The ability to take time off was linked to fewer reported symptoms of anxiety (PR, 0.87; 95% CI, 0.83–0.90), depression (PR, 0.86; 95% CI, 0.83–0.89), post-traumatic stress disorder (PR, 0.84; 95% CI, 0.81–0.88), and suicidal ideation (PR, 0.84; 95% CI, 0.77–0.92). Conclusions Since COVID-19 was declared a pandemic, respondents who felt isolated and alone were at an increased risk for adverse mental health outcomes. Findings from this study call for public health organizations to provide their workforce with services and resources to mitigate adverse mental health outcomes.
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Affiliation(s)
- Ahoua Kone
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Libby Horter
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Charles Rose
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carol Y Rao
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Diana Orquiola
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Isabel Thomas
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ramona Byrkit
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Barbara Lopes-Cardozo
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
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Rozo N, Valencia D, Newton SM, Avila G, Gonzalez MA, Sancken CL, Burkel VK, Ellington SR, Gilboa SM, Rao CY, Azziz‐Baumgartner E, Ospina ML, Prieto FE, Tong VT. Severity of illness by pregnancy status among laboratory-confirmed SARS-CoV-2 infections occurring in reproductive-aged women in Colombia. Paediatr Perinat Epidemiol 2022; 36:456-465. [PMID: 34467554 PMCID: PMC8662193 DOI: 10.1111/ppe.12808] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/28/2021] [Accepted: 07/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple studies have described increased risk of severe coronavirus disease (COVID-19) among pregnant women compared to nonpregnant women. The risk in middle-income countries where the distributions of age groups and preexisting conditions may differ is less known. OBJECTIVES To determine whether pregnant women with SARS-CoV-2 infection are at increased risk for severe COVID-19 compared to nonpregnant women in Colombia. METHODS We analysed national surveillance data from Colombia, of women aged 15-44 years with laboratory-confirmed infection with SARS-CoV-2 by molecular or antigen testing, from 6 March 2020 to 12 December 2020. An enhanced follow-up of pregnant women with COVID-19 was established to monitor pregnancy and birth outcomes. RESULTS Of 371,363 women aged 15-44 years with laboratory-confirmed SARS-CoV-2 infection, 1.5% (n = 5614) were reported as pregnant; among those, 2610 (46.5%) were considered a complete pregnancy for reporting purposes at the time of analysis. Hospitalisation (23.9%) and death (1.3%) occurred more frequently among pregnant symptomatic women compared to nonpregnant symptomatic women (2.9% and 0.3%, respectively). Compared to nonpregnant symptomatic women, pregnant symptomatic women were at increased risk of hospitalisation (adjusted risk ratio [RR] 2.19, 95% confidence interval [CI] 2.07, 2.32) and death (RR 1.82, 95% CI 1.60, 2.07), after adjusting for age, type of health insurance and presence of certain underlying medical conditions. Among complete pregnancies, 55 (2.1%) were pregnancy losses, 72 (2.8%) resulted in term low birthweight infants and 375 (14.4%) were preterm deliveries. CONCLUSIONS Although pregnant women were infrequently reported with laboratory-confirmed SARS-CoV-2 infection, pregnant symptomatic women with COVID-19 were at increased risk for hospitalisation and death compared to nonpregnant symptomatic women. Almost all infections we reported on were third-trimester infections; ongoing follow-up is needed to determine pregnancy outcomes among women infected earlier in pregnancy. Healthcare providers should counsel pregnant women about preventive measures to protect from SARS-CoV-2 infection and when to seek care.
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Affiliation(s)
| | - Diana Valencia
- CDC COVID‐19 ResponseCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Suzanne M. Newton
- CDC COVID‐19 ResponseCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | | | - Christina L. Sancken
- CDC COVID‐19 ResponseCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Veronica K. Burkel
- CDC COVID‐19 ResponseCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Sascha R. Ellington
- CDC COVID‐19 ResponseCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Suzanne M. Gilboa
- CDC COVID‐19 ResponseCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Carol Y. Rao
- CDC COVID‐19 ResponseCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | | | | | - Van T. Tong
- CDC COVID‐19 ResponseCenters for Disease Control and PreventionAtlantaGeorgiaUSA
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Tang S, Horter L, Bosh K, Kassem AM, Kahn EB, Ricaldi JN, Pao LZ, Kang GJ, Singleton CM, Liu T, Thomas I, Rao CY. Change in unemployment by social vulnerability among United States counties with rapid increases in COVID-19 incidence—July 1–October 31, 2020. PLoS One 2022; 17:e0265888. [PMID: 35442951 PMCID: PMC9020703 DOI: 10.1371/journal.pone.0265888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/09/2022] [Indexed: 11/29/2022] Open
Abstract
Objective During the COVID-19 pandemic, the unemployment rate in the United States peaked at 14.8% in April 2020. We examined patterns in unemployment following this peak in counties with rapid increases in COVID-19 incidence. Method We used CDC aggregate county data to identify counties with rapid increases in COVID-19 incidence (rapid riser counties) during July 1–October 31, 2020. We used a linear regression model with fixed effect to calculate the change of unemployment rate difference in these counties, stratified by the county’s social vulnerability (an indicator compiled by CDC) in the two months before the rapid riser index month compared to the index month plus one month after the index month. Results Among the 585 (19% of U.S. counties) rapid riser counties identified, the unemployment rate gap between the most and least socially vulnerable counties widened by 0.40 percentage point (p<0.01) after experiencing a rapid rise in COVID-19 incidence. Driving the gap were counties with lower socioeconomic status, with a higher percentage of people in racial and ethnic minority groups, and with limited English proficiency. Conclusion The widened unemployment gap after COVID-19 incidence rapid rise between the most and least socially vulnerable counties suggests that it may take longer for socially and economically disadvantaged communities to recover. Loss of income and benefits due to unemployment could hinder behaviors that prevent spread of COVID-19 (e.g., seeking healthcare) and could impede response efforts including testing and vaccination. Addressing the social needs within these vulnerable communities could help support public health response measures.
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Affiliation(s)
- Shichao Tang
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Libby Horter
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Karin Bosh
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ahmed M. Kassem
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Emily B. Kahn
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jessica N. Ricaldi
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Leah Zilversmit Pao
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gloria J. Kang
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christa-Marie Singleton
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tiebin Liu
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Isabel Thomas
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Carol Y. Rao
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Bryant-Genevier J, Rao CY, Lopes-Cardozo B, Kone A, Rose C, Thomas I, Orquiola D, Lynfield R, Shah D, Freeman L, Becker S, Williams A, Gould DW, Tiesman H, Lloyd G, Hill L, Byrkit R. Symptoms of Depression, Anxiety, Post-Traumatic Stress Disorder, and Suicidal Ideation Among State, Tribal, Local, and Territorial Public Health Workers During the COVID-19 Pandemic - United States, March-April 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1680-1685. [PMID: 34855723 PMCID: PMC8641565 DOI: 10.15585/mmwr.mm7048a6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Wang X, Rainey JJ, Goryoka GW, Liang Z, Wu S, Wen L, Duan R, Qin S, Huang H, Kharod G, Rao CY, Salyer SJ, Behravesh CB, Jing H. Using a One Health approach to prioritize zoonotic diseases in China, 2019. PLoS One 2021; 16:e0259706. [PMID: 34797849 PMCID: PMC8604330 DOI: 10.1371/journal.pone.0259706] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 10/26/2021] [Indexed: 12/24/2022] Open
Abstract
Background China is vulnerable to zoonotic disease transmission due to a large agricultural work force, sizable domestic livestock population, and a highly biodiverse ecology. To better address this threat, representatives from the human, animal, and environmental health sectors in China held a One Health Zoonotic Disease Prioritization (OHZDP) workshop in May 2019 to develop a list of priority zoonotic diseases for multisectoral, One Health collaboration. Methods Representatives used the OHZDP Process, developed by the US Centers for Disease Control and Prevention (US CDC), to prioritize zoonotic diseases for China. Representatives defined the criteria used for prioritization and determined questions and weights for each individual criterion. A review of English and Chinese literature was conducted prior to the workshop to collect disease specific information on prevalence, morbidity, mortality, and Disability-Adjusted Life Years (DALYs) from China and the Western Pacific Region for zoonotic diseases considered for prioritization. Results Thirty zoonotic diseases were evaluated for prioritization. Criteria selected included: 1) disease hazard/severity (case fatality rate) in humans, 2) epidemic scale and intensity (in humans and animals) in China, 3) economic impact, 4) prevention and control, and 5) social impact. Disease specific information was obtained from 792 articles (637 in English and 155 in Chinese) and subject matter experts for the prioritization process. Following discussion of the OHZDP Tool output among disease experts, five priority zoonotic diseases were identified for China: avian influenza, echinococcosis, rabies, plague, and brucellosis. Conclusion Representatives agreed on a list of five priority zoonotic diseases that can serve as a foundation to strengthen One Health collaboration for disease prevention and control in China; this list was developed prior to the emergence of SARS-CoV-2 and the COVID-19 pandemic. Next steps focused on establishing a multisectoral, One Health coordination mechanism, improving multisectoral linkages in laboratory testing and surveillance platforms, creating multisectoral preparedness and response plans, and increasing workforce capacity.
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Affiliation(s)
- Xin Wang
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jeanette J. Rainey
- Division of Global Health Protection, United States Centers for Disease Control and Prevention, Beijing, China
| | - Grace W. Goryoka
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Zuoru Liang
- Center for Global Public Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shuyu Wu
- Division of Global Health Protection, United States Centers for Disease Control and Prevention, Beijing, China
| | - Liming Wen
- Yinchuan Animal Center for Disease Control and Prevention, Yinchuan, Ningxia, China
| | - Ran Duan
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shuai Qin
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haodi Huang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Grishma Kharod
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Carol Y. Rao
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Stephanie J. Salyer
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Casey Barton Behravesh
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Huaiqi Jing
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail:
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Rao CY, Robinson T, Huster K, Laws RL, Keating R, Tobolowsky FA, McMichael TM, Gonzales E, Mosites E. Occupational exposures and mitigation strategies among homeless shelter workers at risk of COVID-19. PLoS One 2021; 16:e0253108. [PMID: 34723986 PMCID: PMC8559982 DOI: 10.1371/journal.pone.0253108] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 07/08/2021] [Accepted: 09/29/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To describe the work environment and COVID-19 mitigation measures for homeless shelter workers and assess occupational risk factors for COVID-19. Methods Between June 9-August 10, 2020, we conducted a self-administered survey among homeless shelter workers in Washington, Massachusetts, Utah, Maryland, and Georgia. We calculated frequencies for work environment, personal protective equipment use, and SARS-CoV-2 testing history. We used generalized linear models to produce unadjusted prevalence ratios (PR) to assess risk factors for SARS-CoV-2 infection. Results Of the 106 respondents, 43.4% reported frequent close contact with clients; 75% were worried about work-related SARS-CoV-2 infections; 15% reported testing positive. Close contact with clients was associated with testing positive for SARS-CoV-2 (PR 3.97, 95%CI 1.06, 14.93). Conclusions Homeless shelter workers may be at risk of being exposed to individuals with COVID-19 during the course of their work. Frequent close contact with clients was associated with SARS-CoV-2 infection. Protecting these critical essential workers by implementing mitigation measures and prioritizing for COVID-19 vaccination is imperative during the pandemic.
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Affiliation(s)
- Carol Y. Rao
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Tashina Robinson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Karin Huster
- Public Health-Seattle & King County, Seattle, Washington, United States of America
| | - Rebecca L. Laws
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ryan Keating
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Farrell A. Tobolowsky
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Temet M. McMichael
- Public Health-Seattle & King County, Seattle, Washington, United States of America
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elysia Gonzales
- Public Health-Seattle & King County, Seattle, Washington, United States of America
| | - Emily Mosites
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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14
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Bryant-Genevier J, Rao CY, Lopes-Cardozo B, Kone A, Rose C, Thomas I, Orquiola D, Lynfield R, Shah D, Freeman L, Becker S, Williams A, Gould DW, Tiesman H, Lloyd G, Hill L, Byrkit R. Symptoms of Depression, Anxiety, Post-Traumatic Stress Disorder, and Suicidal Ideation Among State, Tribal, Local, and Territorial Public Health Workers During the COVID-19 Pandemic - United States, March-April 2021. MMWR Morb Mortal Wkly Rep 2021; 70:947-952. [PMID: 34197362 PMCID: PMC8248597 DOI: 10.15585/mmwr.mm7026e1] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [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
Increases in mental health conditions have been documented among the general population and health care workers since the start of the COVID-19 pandemic (1-3). Public health workers might be at similar risk for negative mental health consequences because of the prolonged demand for responding to the pandemic and for implementing an unprecedented vaccination campaign. The extent of mental health conditions among public health workers during the COVID-19 pandemic, however, is uncertain. A 2014 survey estimated that there were nearly 250,000 state and local public health workers in the United States (4). To evaluate mental health conditions among these workers, a nonprobability-based online survey was conducted during March 29-April 16, 2021, to assess symptoms of depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal ideation among public health workers in state, tribal, local, and territorial public health departments. Among 26,174 respondents, 53.0% reported symptoms of at least one mental health condition in the preceding 2 weeks, including depression (32.0%), anxiety (30.3%), PTSD (36.8%), or suicidal ideation (8.4%). The highest prevalence of symptoms of a mental health condition was among respondents aged ≤29 years (range = 13.6%-47.4%) and transgender or nonbinary persons (i.e., those who identified as neither male nor female) of all ages (range = 30.4%-65.5%). Public health workers who reported being unable to take time off from work were more likely to report adverse mental health symptoms. Severity of symptoms increased with increasing weekly work hours and percentage of work time dedicated to COVID-19 response activities. Implementing prevention and control practices that eliminate, reduce, and manage factors that cause or contribute to public health workers' poor mental health might improve mental health outcomes during emergencies.
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Dasgupta S, Kassem AM, Sunshine G, Liu T, Rose C, Kang GJ, Silver R, Maddox BLP, Watson C, Howard-Williams M, Gakh M, McCord R, Weber R, Fletcher K, Musial T, Tynan MA, Hulkower R, Moreland A, Pepin D, Landsman L, Brown A, Gilchrist S, Clodfelter C, Williams M, Cramer R, Limeres A, Popoola A, Dugmeoglu S, Shelburne J, Jeong G, Rao CY. Differences in rapid increases in county-level COVID-19 incidence by implementation of statewide closures and mask mandates - United States, June 1-September 30, 2020. Ann Epidemiol 2021; 57:46-53. [PMID: 33596446 PMCID: PMC7882220 DOI: 10.1016/j.annepidem.2021.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 01/25/2021] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVE Community mitigation strategies could help reduce COVID-19 incidence, but there are few studies that explore associations nationally and by urbanicity. In a national county-level analysis, we examined the probability of being identified as a county with rapidly increasing COVID-19 incidence (rapid riser identification) during the summer of 2020 by implementation of mitigation policies prior to the summer, overall and by urbanicity. METHODS We analyzed county-level data on rapid riser identification during June 1-September 30, 2020 and statewide closures and statewide mask mandates starting March 19 (obtained from state government websites). Poisson regression models with robust standard error estimation were used to examine differences in the probability of rapid riser identification by implementation of mitigation policies (P-value< .05); associations were adjusted for county population size. RESULTS Counties in states that closed for 0-59 days were more likely to become a rapid riser county than those that closed for >59 days, particularly in nonmetropolitan areas. The probability of becoming a rapid riser county was 43% lower among counties that had statewide mask mandates at reopening (adjusted prevalence ratio = 0.57; 95% confidence intervals = 0.51-0.63); when stratified by urbanicity, associations were more pronounced in nonmetropolitan areas. CONCLUSIONS These results underscore the potential value of community mitigation strategies in limiting the COVID-19 spread, especially in nonmetropolitan areas.
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Affiliation(s)
- Sharoda Dasgupta
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ahmed M Kassem
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Gregory Sunshine
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA; Public Health Law Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tiebin Liu
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Charles Rose
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Gloria J Kang
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Rachel Silver
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Christina Watson
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mara Howard-Williams
- Public Health Law Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Maxim Gakh
- University of Nevada, Las Vegas, Las Vegas, NV
| | - Russell McCord
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA; Public Health Law Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Regen Weber
- Public Health Law Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kelly Fletcher
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Trieste Musial
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michael A Tynan
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Rachel Hulkower
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA; Public Health Law Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Amanda Moreland
- Public Health Law Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Dawn Pepin
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lisa Landsman
- Public Health Law Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Amanda Brown
- Public Health Law Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Siobhan Gilchrist
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Catherine Clodfelter
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michael Williams
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ryan Cramer
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Alexa Limeres
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Adebola Popoola
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sebnem Dugmeoglu
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Julia Shelburne
- Public Health Law Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Gi Jeong
- Public Health Law Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Carol Y Rao
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA.
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Pacheco O, Beltrán M, Nelson CA, Valencia D, Tolosa N, Farr SL, Padilla AV, Tong VT, Cuevas EL, Espinosa-Bode A, Pardo L, Rico A, Reefhuis J, González M, Mercado M, Chaparro P, Martínez Duran M, Rao CY, Muñoz MM, Powers AM, Cuéllar C, Helfand R, Huguett C, Jamieson DJ, Honein MA, Ospina Martínez ML. Zika Virus Disease in Colombia - Preliminary Report. N Engl J Med 2020; 383:e44. [PMID: 27305043 DOI: 10.1056/nejmoa1604037] [Citation(s) in RCA: 189] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Colombia began official surveillance for Zika virus disease (ZVD) in August 2015. In October 2015, an outbreak of ZVD was declared after laboratory-confirmed disease was identified in nine patients. METHODS Using the national population-based surveillance system, we assessed patients with clinical symptoms of ZVD from August 9, 2015, to April 2, 2016. Laboratory test results and pregnancy outcomes were evaluated for a subgroup of pregnant women. Concurrently, we investigated reports of microcephaly for evidence of congenital ZVD. RESULTS By April 2, 2016, there were 65,726 cases of ZVD reported in Colombia, of which 2485 (4%) were confirmed by means of reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay. The overall reported incidence of ZVD among female patients was twice that in male patients. A total of 11,944 pregnant women with ZVD were reported in Colombia, with 1484 (12%) of these cases confirmed on RT-PCR assay. In a subgroup of 1850 pregnant women, more than 90% of women who were reportedly infected during the third trimester had given birth, and no infants with apparent abnormalities, including microcephaly, have been identified. A majority of the women who contracted ZVD in the first or second trimester were still pregnant at the time of this report. Among the cases of microcephaly investigated from January 2016 through April 2016, four patients had laboratory evidence of congenital ZVD; all were born to asymptomatic mothers who were not included in the ZVD surveillance system. CONCLUSIONS Preliminary surveillance data in Colombia suggest that maternal infection with the Zika virus during the third trimester of pregnancy is not linked to structural abnormalities in the fetus. However, the monitoring of the effect of ZVD on pregnant women in Colombia is ongoing. (Funded by Colombian Instituto Nacional de Salud and the Centers for Disease Control and Prevention.).
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Affiliation(s)
- Oscar Pacheco
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Mauricio Beltrán
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Christina A Nelson
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Diana Valencia
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Natalia Tolosa
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Sherry L Farr
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Ana V Padilla
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Van T Tong
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Esther L Cuevas
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Andrés Espinosa-Bode
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Lissethe Pardo
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Angélica Rico
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Jennita Reefhuis
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Maritza González
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Marcela Mercado
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Pablo Chaparro
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Mancel Martínez Duran
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Carol Y Rao
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - María M Muñoz
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Ann M Powers
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Claudia Cuéllar
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Rita Helfand
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Claudia Huguett
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Denise J Jamieson
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Margaret A Honein
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
| | - Martha L Ospina Martínez
- From Instituto Nacional de Salud (O.P., M.B., N.T., A.V.P., E.L.C., L.P., A.R., M.G., M.M., P.C., M.M.D., C.H., M.L.O.M.) and Ministerio de Salud y Protección Social (M.M.M., C.C.) - both in Bogota, Colombia; and the Centers for Disease Control and Prevention, Atlanta (C.A.N., D.V., S.L.F., V.T.T., A.E.-B., J.R., C.Y.R., A.M.P., R.H., D.J.J., M.A.H.)
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Tobolowsky FA, Gonzales E, Self JL, Rao CY, Keating R, Marx GE, McMichael TM, Lukoff MD, Duchin JS, Huster K, Rauch J, McLendon H, Hanson M, Nichols D, Pogosjans S, Fagalde M, Lenahan J, Maier E, Whitney H, Sugg N, Chu H, Rogers J, Mosites E, Kay M. COVID-19 Outbreak Among Three Affiliated Homeless Service Sites - King County, Washington, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:523-526. [PMID: 32352954 PMCID: PMC7206987 DOI: 10.15585/mmwr.mm6917e2] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Guo C, Li Y, Huai Y, Rao CY, Lai S, Mu D, Yin W, Yu H, Nie S. Exposure history, post-exposure prophylaxis use, and clinical characteristics of human rabies cases in China, 2006-2012. Sci Rep 2018; 8:17188. [PMID: 30464190 PMCID: PMC6249250 DOI: 10.1038/s41598-018-35158-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/31/2018] [Indexed: 11/23/2022] Open
Abstract
Rabies is still a public health threat in China. Evaluating the exposure history, clinical characteristics, and post-exposure prophylaxis (PEP) of the cases could help in identifying approaches to reducing the number of these preventable deaths. We analysed data collected from 10,971 case-investigations conducted in China from 2006 to 2012. Most cases (n = 7,947; 92.0%) were caused by animal bites; 5,800 (55.8%) and 2,974 (28.6%) exposures were from domestic and free-roaming dogs, respectively. Only 278 (4.8%) of these domestic dogs had previously received rabies vaccination. Among all cases, 5,927 (59.7%) cases had category III wounds, 1,187 (11.7%) cases initiated the rabies PEP vaccination and 234 (3.9%) cases with category III wounds received rabies immunoglobulin. In our adjusted logistic regression model, male cases (adjusted odds ratio [aOR] = 1.25, 95% confidence interval [CI]: 1.09-1.44) and farmers (aOR = 1.39, 95% CI: 1.10-1.77) and person older than 55 years (aOR = 1.48, 95% CI: 1.01-2.17) were less likely than females and persons in other occupations or younger than 15 years to initiate PEP vaccination. The median incubation period was 66 days (interquartile range (IQR): 33-167 days). To reduce the number of human deaths due to rabies, rabies prevention campaigns targeting males and farmers and older people should be conducted. Increasing routine rabies vaccination among domestic dogs will be essential in the long term.
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Affiliation(s)
- Chun Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yu Li
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Yang Huai
- International Emerging Infections Program, Division of Global Health Protection, Centers for Disease Control and Prevention, Beijing, China
| | - Carol Y Rao
- International Emerging Infections Program, Division of Global Health Protection, Centers for Disease Control and Prevention, Beijing, China
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shengjie Lai
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
- WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Di Mu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenwu Yin
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hongjie Yu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
| | - Shaofa Nie
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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19
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Rao CY, Goryoka GW, Henao OL, Clarke KR, Salyer SJ, Montgomery JM. Global Disease Detection-Achievements in Applied Public Health Research, Capacity Building, and Public Health Diplomacy, 2001-2016. Emerg Infect Dis 2018; 23. [PMID: 29155662 PMCID: PMC5711302 DOI: 10.3201/eid2313.170859] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 11/19/2022] Open
Abstract
The Centers for Disease Control and Prevention has established 10 Global Disease Detection (GDD) Program regional centers around the world that serve as centers of excellence for public health research on emerging and reemerging infectious diseases. The core activities of the GDD Program focus on applied public health research, surveillance, laboratory, public health informatics, and technical capacity building. During 2015-2016, program staff conducted 205 discrete projects on a range of topics, including acute respiratory illnesses, health systems strengthening, infectious diseases at the human-animal interface, and emerging infectious diseases. Projects incorporated multiple core activities, with technical capacity building being most prevalent. Collaborating with host countries to implement such projects promotes public health diplomacy. The GDD Program continues to work with countries to strengthen core capacities so that emerging diseases can be detected and stopped faster and closer to the source, thereby enhancing global health security.
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20
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Li C, Li Y, Huai Y, Liu S, Meng X, Duan J, Klena JD, Rainey JJ, Wu A, Rao CY. Incidence and Outbreak of Healthcare-Onset Healthcare-Associated Clostridioides difficile Infections Among Intensive Care Patients in a Large Teaching Hospital in China. Front Microbiol 2018; 9:566. [PMID: 29636739 PMCID: PMC5880889 DOI: 10.3389/fmicb.2018.00566] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 01/10/2018] [Accepted: 03/12/2018] [Indexed: 12/18/2022] Open
Abstract
Background:Clostridioides difficile infection (CDI) is an important cause of morbidity and mortality among hospitalized patients. In China, however, hospital staff do not routinely test for CDI, leading to under-diagnosis and poor patient outcomes. Locally generated CDI data can help assess the magnitude of the problem and strengthen approaches for CDI prevention and control. Methods: We prospectively monitored hospital-onset hospital-associated (HOHA) CDI in four intensive care units (ICUs) from June 2013 to September 2014 in a large teaching hospital in China. We collected clinical information from all ICU patients with ≥ 3 episodes of diarrhea occurring within a 24-h period at least 48 h following admission (suspect case definition). Stool specimens were collected from all suspect cases of CDI and cultured for C. difficile. Polymerase chain reaction (PCR) was used to detect toxin genes from positive isolates; multi-locus sequence typing (MLST) was used for typing and identifying novel strains. We estimated the incidence rate as the number of HOHA CDI cases per 10,000 patient days; 95% confidence intervals were generated to assess rate differences between the four ICUs. Results: A total of 593 hospital-onset diarrhea patients met the suspect case definition during the study period. Of these, 47 patients (8%) were positive for C. difficile and toxin genes. The HOHA-CDI incidence rate was 14.1 cases per 10,000 patient days (95% CI: 10.5–18.6). Six patients with HOHA CDI died. ST54 (n = 14, 20%) was the most common type of HOHA-CDI strain circulating in the hospital during the study period and was linked to a temporal cluster (outbreak) involving two (NICU and GICU) of the four ICUs. Conclusion: HOHA-CDI occurs among ICU patients at this teaching hospital, supporting the importance of routine testing for CDI. Information on strain distribution can help detect CDI outbreaks. Detection of ST54 strain in a temporal cluster suggests possible gaps in infection control practices that should be investigated and addressed as needed.
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Affiliation(s)
- Chunhui Li
- Infection Control Center, Xiangya Hospital Central South University, Changsha, China
| | - Yuan Li
- International Emerging Infections Program, Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Beijing, China
| | - Yang Huai
- International Emerging Infections Program, Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Beijing, China
| | - Sidi Liu
- Infection Control Center, Xiangya Hospital Central South University, Changsha, China
| | - Xiujuan Meng
- Infection Control Center, Xiangya Hospital Central South University, Changsha, China
| | - Juping Duan
- Infection Control Center, Xiangya Hospital Central South University, Changsha, China
| | - John D Klena
- International Emerging Infections Program, Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Beijing, China.,Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jeanette J Rainey
- International Emerging Infections Program, Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Beijing, China.,Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Anhua Wu
- Infection Control Center, Xiangya Hospital Central South University, Changsha, China
| | - Carol Y Rao
- International Emerging Infections Program, Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Beijing, China.,Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
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21
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Cheng S, Tollefson D, He G, Li Y, Guo H, Chai S, Gao F, Gao F, Han G, Ren L, Ren Y, Li J, Wang L, Varma JK, Hu D, Fan H, Zhao F, Bloss E, Wang Y, Rao CY. Evaluating a framework for tuberculosis screening among healthcare workers in clinical settings, Inner Mongolia, China. J Occup Med Toxicol 2018; 13:11. [PMID: 29560021 PMCID: PMC5859509 DOI: 10.1186/s12995-018-0192-y] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 02/26/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Health care workers are at high risk for tuberculosis (TB). China, a high burden TB country, has no policy on medical surveillance for TB among healthcare workers. In this paper, we evaluate whether China's national TB diagnostic guidelines could be used as a framework to screen healthcare workers for pulmonary TB disease in a clinical setting in China. METHODS Between April-August 2010, healthcare workers from 28 facilities in Inner Mongolia Autonomous Region, China were eligible for TB screening, comprised of symptom check, chest X-ray and tuberculin skin testing. Healthcare workers were categorized as having presumptive, confirmed, or clinically-diagnosed pulmonary TB, using Chinese national guidelines. RESULTS All healthcare workers (N=4347) were eligible for TB screening, of which 4285 (99%) participated in at least one TB screening test. Of the healthcare workers screened, 2% had cough for ≥ 14 days, 3% had a chest X-ray consistent with TB, and 10% had a tuberculin skin test induration ≥ 20 mm. Of these, 124 healthcare workers were identified with presumptive TB (i.e., cough for ≥ 14 days in the past 4 weeks or x-ray consistent with TB). Twelve healthcare workers met the case definition for clinically-diagnosed pulmonary TB, but none were diagnosed with TB during the study period. CONCLUSION A substantial proportion of healthcare workers in Inner Mongolia had signs, symptoms, or test results suggestive of TB disease that could have been identified using national TB diagnostic guidelines as a screening framework. However, achieving medical surveillance in China will require a framework that increases the ease, accuracy, and acceptance of TB screening in the medical community. Routine screening with improved diagnostics should be considered to detect tuberculosis disease among healthcare workers and reduce transmission in health care settings in China.
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Affiliation(s)
- Shiming Cheng
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Deanna Tollefson
- U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS-93, Atlanta, GA 30329 USA
| | - Guangxue He
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Yuan Li
- U.S. Centers for Disease Control and Prevention (CDC), Beijing, China
| | - Hui Guo
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Shua Chai
- U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS-93, Atlanta, GA 30329 USA
- U.S. Centers for Disease Control and Prevention (CDC), Beijing, China
| | - Fangfang Gao
- Inner Mongolia Center for Tuberculosis Control and Prevention, Middle Hugao Rd, New District, Hohhot, Inner Mongolia 010080 People’s Republic of China
| | - Fei Gao
- Inner Mongolia Center for Tuberculosis Control and Prevention, Middle Hugao Rd, New District, Hohhot, Inner Mongolia 010080 People’s Republic of China
| | - Guoxin Han
- Inner Mongolia Center for Tuberculosis Control and Prevention, Middle Hugao Rd, New District, Hohhot, Inner Mongolia 010080 People’s Republic of China
| | - Liping Ren
- Inner Mongolia Center for Tuberculosis Control and Prevention, Middle Hugao Rd, New District, Hohhot, Inner Mongolia 010080 People’s Republic of China
| | - Yulin Ren
- Inner Mongolia Center for Tuberculosis Control and Prevention, Middle Hugao Rd, New District, Hohhot, Inner Mongolia 010080 People’s Republic of China
| | - Jianbo Li
- Ulanqab General Hospital, No.157, Jiefang Road, Jining District, Ulanqab, Inner Mongolia 012000 People’s Republic of China
| | - Lixia Wang
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Jay K. Varma
- U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS-93, Atlanta, GA 30329 USA
- U.S. Centers for Disease Control and Prevention (CDC), Beijing, China
| | - Dongmei Hu
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Haiying Fan
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Fei Zhao
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Emily Bloss
- U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS-93, Atlanta, GA 30329 USA
| | - Yu Wang
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Carol Y. Rao
- U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS-93, Atlanta, GA 30329 USA
- U.S. Centers for Disease Control and Prevention (CDC), Beijing, China
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Tolosa N, Tinker SC, Pacheco O, Valencia D, Botero DS, Tong VT, Mercado M, Gilboa SM, Gonzalez M, Nelson CA, Pardo L, Rao CY, Rico A, Moore M, Parra E, Honein MA, Ospina Martínez ML. Zika Virus Disease in Children in Colombia, August 2015 to May 2016. Paediatr Perinat Epidemiol 2017; 31:537-545. [PMID: 28806479 DOI: 10.1111/ppe.12391] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Children are considered a potentially vulnerable population for Zika virus infection. However, data on paediatric Zika virus infection are sparse. METHODS We analysed data from Colombia's national surveillance system during the 2015-2016 Zika virus outbreak on patients meeting the clinical case definition of Zika virus disease (ZVD) among children aged 1 month to 18 years to estimate incidence by demographic characteristics and characterize the occurrence of selected complications. RESULTS Between August 14, 2015, and May 28, 2016, there were 18 576 reported cases of postnatal ZVD among children aged 1 month to 18 years. Laboratory testing was prioritized for high-risk patients (infants, pregnant women, adults aged ≥65 years, and persons with serious co-morbidities); among 1655 that were tested by real-time reverse transcriptase polymerase chain reaction, 1207 (72.9%) were positive. The cumulative incidence of reported ZVD was 114.4 per 100 000. The incidence differed by sex, depending on age group; the largest difference was observed for 15-18 year olds, with females having a higher incidence than males (cumulative incidence ratio 2.5, 95% confidence interval 2.3, 2.7). At the time of report to the surveillance system, 631 patients (3.4%) were hospitalised and 96 (0.5%) had a report of an accompanying neurological diagnosis, including Guillain-Barré syndrome in 40 patients. CONCLUSIONS Only a small proportion of reported paediatric ZVD cases in Colombia were hospitalized or had reported neurological conditions following ZVD. However, the potential for some serious outcomes demonstrates the importance of preventing Zika virus infection in children.
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Affiliation(s)
| | | | | | | | | | - Van T Tong
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | | | | - Carol Y Rao
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Edgar Parra
- Instituto Nacional de Salud, Bogota, Colombia
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Abstract
The potential for exposure to mycotoxins in indoor environments is of increasing concern. In order to evaluate the potential for mycotoxin production by toxigenic fungi growing on water-damaged building materials, two aflatoxin producing strains of Aspergillus flavus (American Type Culture Collection 16875 and 15547) were inoculated onto culture media, plain wallboard, and vinyl wallpapered wallboard (cellulose-based and wheat-based wallpaper paste) and incubated at high relative humidity and room temperature for up to 16 weeks. Each sample was extracted with 60% methanol and aflatoxins in the crude extract were collected by immunoaffinity chromatography and quantified by fluorometry. Analysis by high performance liquid chromatography was performed for confirmation. Varying degrees of fungal growth were evident on all tested substrate types. Up to 4800 ppb of aflatoxin was detected when strain ATCC 16875 was grown on potato dextrose agar. However, when inoculation was standardized to minimize initial aflatoxin concentration in the inoculum, aflatoxin production was not detected on any wallboard sample under any of the incubation conditions provided. The presence of a toxigenic fungal strain on an indoor substrate does not necessarily indicate that the fungus is producing mycotoxins and our data provide evidence that wet wallboard is unlikely to provide appropriate conditions for aflatoxin production.
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Affiliation(s)
- Carol Y. Rao
- Harvard School of Public Health, Boston,
Massachusetts
| | - Richard C. Fink
- Massachusetts Institute of Technology,
Cambridge, Massachusetts
| | - Linda B. Wolfe
- Massachusetts Institute of Technology,
Cambridge, Massachusetts
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Oduyebo T, Igbinosa I, Petersen EE, Polen KND, Pillai SK, Ailes EC, Villanueva JM, Newsome K, Fischer M, Gupta PM, Powers AM, Lampe M, Hills S, Arnold KE, Rose LE, Shapiro-Mendoza CK, Beard CB, Muñoz JL, Rao CY, Meaney-Delman D, Jamieson DJ, Honein MA. Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure - United States, July 2016. MMWR Morb Mortal Wkly Rep 2016; 65:739-44. [PMID: 27467820 DOI: 10.15585/mmwr.mm6529e1] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
CDC has updated its interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure, to include the emerging data indicating that Zika virus RNA can be detected for prolonged periods in some pregnant women. To increase the proportion of pregnant women with Zika virus infection who receive a definitive diagnosis, CDC recommends expanding real-time reverse transcription-polymerase chain reaction (rRT-PCR) testing. Possible exposures to Zika virus include travel to or residence in an area with active Zika virus transmission, or sex* with a partner who has traveled to or resides in an area with active Zika virus transmission without using condoms or other barrier methods to prevent infection.(†) Testing recommendations for pregnant women with possible Zika virus exposure who report clinical illness consistent with Zika virus disease(§) (symptomatic pregnant women) are the same, regardless of their level of exposure (i.e., women with ongoing risk for possible exposure, including residence in or frequent travel to an area with active Zika virus transmission, as well as women living in areas without Zika virus transmission who travel to an area with active Zika virus transmission, or have unprotected sex with a partner who traveled to or resides in an area with active Zika virus transmission). Symptomatic pregnant women who are evaluated <2 weeks after symptom onset should receive serum and urine Zika virus rRT-PCR testing. Symptomatic pregnant women who are evaluated 2-12 weeks after symptom onset should first receive a Zika virus immunoglobulin (IgM) antibody test; if the IgM antibody test result is positive or equivocal, serum and urine rRT-PCR testing should be performed. Testing recommendations for pregnant women with possible Zika virus exposure who do not report clinical illness consistent with Zika virus disease (asymptomatic pregnant women) differ based on the circumstances of possible exposure. For asymptomatic pregnant women who live in areas without active Zika virus transmission and who are evaluated <2 weeks after last possible exposure, rRT-PCR testing should be performed. If the rRT-PCR result is negative, a Zika virus IgM antibody test should be performed 2-12 weeks after the exposure. Asymptomatic pregnant women who do not live in an area with active Zika virus transmission, who are first evaluated 2-12 weeks after their last possible exposure should first receive a Zika virus IgM antibody test; if the IgM antibody test result is positive or equivocal, serum and urine rRT-PCR should be performed. Asymptomatic pregnant women with ongoing risk for exposure to Zika virus should receive Zika virus IgM antibody testing as part of routine obstetric care during the first and second trimesters; immediate rRT-PCR testing should be performed when IgM antibody test results are positive or equivocal. This guidance also provides updated recommendations for the clinical management of pregnant women with confirmed or possible Zika virus infection. These recommendations will be updated when additional data become available.
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Levy B, Rao CY, Miller L, Kennedy N, Adams M, Davis R, Hastings L, Kabano A, Bennett SD, Sesay M. Ebola infection control in Sierra Leonean health clinics: A large cross-agency cooperative project. Am J Infect Control 2015; 43:752-5. [PMID: 25891979 DOI: 10.1016/j.ajic.2015.03.011] [Citation(s) in RCA: 16] [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: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 11/17/2022]
Abstract
The Ebola virus disease outbreak occurring in West Africa has resulted in at least 199 cases of Ebola in Sierra Leonean health care workers, many as a result of transmission occurring in health facilities. The Ministry of Health and Sanitation of Sierra Leone recognized that improvements in infection prevention and control (IPC) were necessary at all levels of health care delivery. To this end, the U.S. Centers for Disease Control and Prevention, United Nations Children's Fund, and multiple nongovernmental organizations implemented a national IPC training program in 1,200 peripheral health units (PHUs) in Sierra Leone. A tiered training of trainers program was used. Trainers conducted multiday trainings at PHUs and coordinated the delivery of personal protective equipment (gloves, gowns, masks, boots) and infection control supplies (chlorine, buckets, disposable rags, etc) to all PHU staff. Under the ongoing project, 4,264 health workers have already been trained, and 98% of PHUs have received their first shipment of supplies.
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Affiliation(s)
- Benjamin Levy
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Carol Y Rao
- Division of Global Health Protection, Centers for Disease Control and Prevention, Beijing, People's Republic of China
| | | | | | - Monica Adams
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | - Sarah D Bennett
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Momodu Sesay
- Ministry of Health and Sanitation, Freetown, Sierra Leone
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He G, Li Y, Zhao F, Wang L, Cheng S, Guo H, Klena JD, Fan H, Gao F, Gao F, Han G, Ren L, Song Y, Xiong Y, Geng M, Hou Y, He G, Li J, Guo S, Yang J, Yan D, Wang Y, Gao H, An J, Duan X, Wu C, Duan F, Hu D, Lu K, Zhao Y, Rao CY, Wang Y. The Prevalence and Incidence of Latent Tuberculosis Infection and Its Associated Factors among Village Doctors in China. PLoS One 2015; 10:e0124097. [PMID: 25996960 PMCID: PMC4440671 DOI: 10.1371/journal.pone.0124097] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 02/25/2015] [Indexed: 11/19/2022] Open
Abstract
Background China is a high tuberculosis (TB) burden country. More than half of acute TB cases first seek medical care in village doctors’ clinics or community health centers. Despite being responsible for patient referral and management, village doctors are not systematically evaluated for TB infection or disease. We assessed prevalence and incidence of latent TB infection (LTBI) among village doctors in China. Methods and Findings A longitudinal study was conducted in Inner Mongolia Autonomous Region. We administered a questionnaire on demographics and risk factors for TB exposure and disease; Tuberculin skin testing (TST) and QuantiFERON-TB Gold in-tube assay (QFT-GIT) was conducted at baseline and repeated 12 months later. We used a logistic regression model to calculate adjusted odds ratios (ORs) for risk factors for TST and QFT-GIT prevalence and incidence. At the time of follow up, 19.5% of the 880 participating village doctors had a positive TST and 46.0% had a positive QFT-GIT result. Factors associated with TST prevalence included having a BCG scar (OR = 1.45, 95%CI 1.03–2.04) and smoking (OR = 1.69, 95%CI 1.17–2.44). Risk factors associated with QFT-GIT prevalence included being male (OR = 2.17, 95%CI 1.63–2.89), below college education (OR=1.42, 95%CI 1.01–1.97), and working for ≥25 years as a village doctor (OR = 1.64, 95%CI 1.12–2.39). The annual incidence of LTBI was 11.4% by TST and 19.1% by QFT-GIT. QFT-GIT conversion was associated with spending 15 minutes or more per patient on average (OR = 2.62, 95%CI 1.39–4.97) and having BCG scar (OR = 0.53, 95%CI 0.28–1.00). Conclusions Prevalence and incidence of LTBI among Chinese village doctors is high. TB infection control measures should be strengthened among village doctors and at village healthcare settings.
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Affiliation(s)
- Guangxue He
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuan Li
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention Atlanta, Georgia, United States of America
| | - Fei Zhao
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lixia Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shiming Cheng
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Guo
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - John D. Klena
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention Atlanta, Georgia, United States of America
| | - Haiying Fan
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fangfang Gao
- Inner Mongolia Center for Tuberculosis Control and Prevention, Hohhot, China
| | - Fei Gao
- Inner Mongolia Center for Tuberculosis Control and Prevention, Hohhot, China
| | - Guoxin Han
- Inner Mongolia Center for Tuberculosis Control and Prevention, Hohhot, China
| | - Liping Ren
- Inner Mongolia Center for Tuberculosis Control and Prevention, Hohhot, China
| | - Yudan Song
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yongchao Xiong
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mengjie Geng
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yueyun Hou
- The Tongzhou Maternal & Child Health Hospital, Beijing, China
| | - Guoming He
- Ulanqab Center for Tuberculosis Control and Prevention, Jining, China
| | - Jianbo Li
- Ulanqab Center for Tuberculosis Control and Prevention, Jining, China
| | - Shufang Guo
- Ulanqab Center for Tuberculosis Control and Prevention, Jining, China
| | - Jun Yang
- Ulanqab Center for Tuberculosis Control and Prevention, Jining, China
| | - Daiqin Yan
- the Bayannur for Tuberculosis Control and Prevention, Bayannur, China
| | - Yali Wang
- the Bayannur for Tuberculosis Control and Prevention, Bayannur, China
| | - Haiyan Gao
- the Bayannur for Tuberculosis Control and Prevention, Bayannur, China
| | - Jing An
- Linhe District Center for Disease Control and Prevention, Bayannur, China
| | - Xiaoyan Duan
- Linhe District Center for Disease Control and Prevention, Bayannur, China
| | - Chunru Wu
- Hanggin Rear Banner Center for Disease Control and Prevention, Bayannur, China
| | - Fengming Duan
- Hanggin Rear Banner Center for Disease Control and Prevention, Bayannur, China
| | - Dongmei Hu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Kai Lu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yanlin Zhao
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Carol Y. Rao
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention Atlanta, Georgia, United States of America
- * E-mail: (YW); (CYR)
| | - Yu Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (YW); (CYR)
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Rao CY, Pachucki C, Cali S, Santhiraj M, Krankoski KLK, Noble-Wang JA, Leehey D, Popli S, Brandt ME, Lindsley MD, Fridkin SK, Arduino MJ. Contaminated Product Water as the Source ofPhialemonium curvatumBloodstream Infection among Patients Undergoing Hemodialysis. Infect Control Hosp Epidemiol 2015; 30:840-7. [DOI: 10.1086/605324] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.We investigated a cluster of cases of bloodstream infection (BSI) due to the moldPhialemoniumat a hemodialysis center in Illinois and conducted a cohort study to identify risk factors.Design.Environmental assessment and cohort study.Setting.A hemodialysis center in a tertiary care hospital.Methods.A case patient was defined as a person who underwent dialysis at the center and had a blood sample that tested positive forPhialemonium curvatumon culture. We reviewed microbiology and medical records and tested water, surface, and dialysate samples by culture. Molds isolated from environmental and clinical specimens were identified by their morphological features and confirmed by sequencing DNA.Results.We identified 2 case patients with BSI due toP. curvatum. Both became febrile and hypotensive while undergoing dialysis on the same machine at the same treatment station, although on different days. Dialysis machines were equipped with waste handling option ports that are used to discard dialyzer priming fluid. We isolatedP. curvatumfrom the product water (ie, water used for dialysis purposes) at 2 of 19 treatment stations, one of which was the implicated station.Conclusion.The source ofP. curvatumwas likely the water distribution system. To our knowledge, this is the first report of patients acquiring a mold BSI from contaminated product water. The route of exposure in these cases of BSI due toP. curvatummay be related to the malfunction and improper maintenance of the waste handling option ports. Waste handling option ports have been previously implicated as the source of bacterial BSI due to the backflow of waste fluid into a patient's blood line. No additional cases of infection were noted after remediation of the water distribution system and after discontinuing use of waste handling option ports at the facility.
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Pathmanathan I, O’Connor KA, Adams ML, Rao CY, Kilmarx PH, Park BJ, Mermin J, Kargbo B, Wurie AH, Clarke KR. Rapid assessment of Ebola infection prevention and control needs--six districts, Sierra Leone, October 2014. MMWR Morb Mortal Wkly Rep 2014; 63:1172-4. [PMID: 25503922 PMCID: PMC4584542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
As of October 31, 2014, the Sierra Leone Ministry of Health and Sanitation had reported 3,854 laboratory-confirmed cases of Ebola virus disease (Ebola) since the outbreak began in May 2014; 199 (5.2%) of these cases were among health care workers. Ebola infection prevention and control (IPC) measures are essential to interrupt Ebola virus transmission and protect the health workforce, a population that is disproportionately affected by Ebola because of its increased risk of exposure yet is essential to patient care required for outbreak control and maintenance of the country's health system at large. To rapidly identify existing IPC resources and high priority outbreak response needs, an assessment by CDC Ebola Response Team members was conducted in six of the 14 districts in Sierra Leone, consisting of health facility observations and structured interviews with key informants in facilities and government district health management offices. Health system gaps were identified in all six districts, including shortages or absence of trained health care staff, personal protective equipment (PPE), safe patient transport, and standardized IPC protocols. Based on rapid assessment findings and key stakeholder input, priority IPC actions were recommended. Progress has since been made in developing standard operating procedures, increasing laboratory and Ebola treatment capacity and training the health workforce. However, further system strengthening is needed. In particular, a successful Ebola outbreak response in Sierra Leone will require an increase in coordinated and comprehensive district-level IPC support to prevent ongoing Ebola virus transmission in household, patient transport, and health facility settings.
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Affiliation(s)
- Ishani Pathmanathan
- Epidemic Intelligence Service, CDC,CDC Sierra Leone Ebola Response Team,Corresponding author: Ishani Pathmanathan, e-mail , 404-718-8387
| | | | - Monica L. Adams
- Epidemic Intelligence Service, CDC,CDC Sierra Leone Ebola Response Team
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Chao HJ, Chan CC, Rao CY, Lee CT, Chuang YC, Chiu YH, Hsu HH, Wu YH. The effects of transported Asian dust on the composition and concentration of ambient fungi in Taiwan. Int J Biometeorol 2012; 56:211-219. [PMID: 21328007 DOI: 10.1007/s00484-011-0413-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 01/25/2011] [Accepted: 01/25/2011] [Indexed: 05/30/2023]
Abstract
This study was conducted to evaluate the effects of transported Asian dust and other environmental parameters on the levels and compositions of ambient fungi in the atmosphere of northern Taiwan. We monitored Asian dust events in Taipei County, Taiwan from January 2003 to June 2004. We used duplicate Burkard portable air samplers to collect ambient fungi before, during, and after dust events. Six transported Asian dust events were monitored during the study period. Elevated concentrations of Aspergillus (A. niger, specifically), Coelomycetes, Rhinocladiella, Sporothrix and Verticillium were noted (p < 0.05) during Asian dust periods. Botryosporium and Trichothecium were only recovered during dust event days. Multiple regression analysis showed that fungal levels were positively associated with temperature, wind speed, rainfall, non-methane hydrocarbons and particulates with aerodynamic diameters ≤10 μm (PM(10)), and negatively correlated with relative humidity and ozone. Our results demonstrated that Asian dust events affected ambient fungal concentrations and compositions in northern Taiwan. Ambient fungi also had complex dynamics with air pollutants and meteorological factors. Future studies should explore the health impacts of ambient fungi during Asian dust events, adjusting for the synergistic/antagonistic effects of weather and air pollutants.
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Affiliation(s)
- H Jasmine Chao
- School of Public Health, Taipei Medical University, 5F Health Science Building, No. 250 Wu-Hsing St, Taipei, Taiwan, 110.
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Shieh WJ, Paddock CD, Lederman E, Rao CY, Gould LH, Mohamed M, Mosha F, Mghamba J, Bloland P, Njenga MK, Mutonga D, Samuel AA, Guarner J, Breiman RF, Zaki SR. Pathologic studies on suspect animal and human cases of Rift Valley fever from an outbreak in Eastern Africa, 2006-2007. Am J Trop Med Hyg 2010; 83:38-42. [PMID: 20682904 DOI: 10.4269/ajtmh.2010.09-0463] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Rift Valley fever (RVF) is an important viral zoonotic disease in Africa with periodic outbreaks associated with severe disease, death, and economic hardship. During the 2006-2007 outbreaks in Eastern Africa, postmortem and necropsy tissue samples from 14 animals and 20 humans clinically suspected of RVF were studied with histopathologic evaluation and immunohistochemical (IHC) assays. Six animal and 11 human samples had IHC evidence of Rift Valley fever virus (RVFV) antigens. We found that extensive hepatocellular necrosis without prominent inflammatory cell infiltrates is the most distinctive histopathologic change in liver tissues infected with RVFV. Pathologic studies on postmortem tissue samples can help establish the diagnosis of RVF, differentiating from endemic diseases with clinical manifestations similar to RVF, such as malaria, leptospirosis, or yellow fever.
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Affiliation(s)
- Wun-Ju Shieh
- Infectious Disease Pathology Branch, Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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31
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Alexander BD, Schell WA, Siston AM, Rao CY, Bower WA, Balajee SA, Howell DN, Moore ZS, Noble-Wang J, Rhyne JA, Fleischauer AT, Maillard JM, Kuehnert M, Vikraman D, Collins BH, Marroquin CE, Park BJ. Fatal Apophysomyces elegans infection transmitted by deceased donor renal allografts. Am J Transplant 2010; 10:2161-7. [PMID: 20883549 DOI: 10.1111/j.1600-6143.2010.03216.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Two patients developed renal mucormycosis following transplantation of kidneys from the same donor, a near-drowning victim in a motor vehicle crash. Genotypically, indistinguishable strains of Apophysomyces elegans were recovered from both recipients. We investigated the source of the infection including review of medical records, environmental sampling at possible locations of contamination and query for additional cases at other centers. Histopathology of the explanted kidneys revealed extensive vascular invasion by aseptate, fungal hyphae with relative sparing of the renal capsules suggesting a vascular route of contamination. Disseminated infection in the donor could not be definitively established. A. elegans was not recovered from the same lots of reagents used for organ recovery or environmental samples and no other organ transplant-related cases were identified. This investigation suggests either isolated contamination of the organs during recovery or undiagnosed disseminated donor infection following a near-drowning event. Although no changes to current organ recovery or transplant procedures are recommended, public health officials and transplant physicians should consider the possibility of mucormycosis transmitted via organs in the future, particularly for near-drowning events. Attention to aseptic technique during organ recovery and processing is re-emphasized.
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Affiliation(s)
- B D Alexander
- Department of Medicine, Duke University Medical Center, Durham, NC, USA.
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Anyangu AS, Gould LH, Sharif SK, Nguku PM, Omolo JO, Mutonga D, Rao CY, Lederman ER, Schnabel D, Paweska JT, Katz M, Hightower A, Njenga MK, Feikin DR, Breiman RF. Risk factors for severe Rift Valley fever infection in Kenya, 2007. Am J Trop Med Hyg 2010; 83:14-21. [PMID: 20682901 PMCID: PMC2913492 DOI: 10.4269/ajtmh.2010.09-0293] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [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] [Indexed: 11/07/2022] Open
Abstract
A large Rift Valley fever (RVF) outbreak occurred in Kenya from December 2006 to March 2007. We conducted a study to define risk factors associated with infection and severe disease. A total of 861 individuals from 424 households were enrolled. Two hundred and two participants (23%) had serologic evidence of acute RVF infection. Of these, 52 (26%) had severe RVF disease characterized by hemorrhagic manifestations or death. Independent risk factors for acute RVF infection were consuming or handling products from sick animals (odds ratio [OR] = 2.53, 95% confidence interval [CI] = 1.78-3.61, population attributable risk percentage [PAR%] = 19%) and being a herds person (OR 1.77, 95% CI = 1.20-2.63, PAR% = 11%). Touching an aborted animal fetus was associated with severe RVF disease (OR = 3.83, 95% CI = 1.68-9.07, PAR% = 14%). Consuming or handling products from sick animals was associated with death (OR = 3.67, 95% CI = 1.07-12.64, PAR% = 47%). Exposures related to animal contact were associated with acute RVF infection, whereas exposures to mosquitoes were not independent risk factors.
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Cox-Ganser JM, Rao CY, Park JH, Schumpert JC, Kreiss K. Asthma and respiratory symptoms in hospital workers related to dampness and biological contaminants. Indoor Air 2009; 19:280-290. [PMID: 19500175 DOI: 10.1111/j.1600-0668.2009.00586.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
UNLABELLED The National Institute for Occupational Safety and Health investigated respiratory symptoms and asthma in relation to damp indoor environments in employees of two hospitals. A cluster of six work-related asthma cases from one hospital department, whose symptoms arose during a time of significant water incursions, led us to conduct a survey of respiratory health in 1171/1834 employees working in the sentinel cases hospital and a nearby hospital without known indoor environmental concerns. We carried out observational assessment of dampness, air, chair, and floor dust sampling for biological contaminants, and investigation of exposure-response associations for about 500 participants. Many participants with post-hire onset asthma reported diagnosis dates in a period of water incursions and renovations. Post-hire asthma and work-related lower respiratory symptoms were positively associated with the dampness score. Work-related lower respiratory symptoms showed monotonically increasing odds ratios with ergosterol, a marker of fungal biomass. Other fungal and bacterial indices, particle counts, cat allergen and latex allergen were associated with respiratory symptoms. Our data imply new-onset of asthma in relation to water damage, and indicate that work-related respiratory symptoms in hospital workers may be associated with diverse biological contaminants. PRACTICAL IMPLICATIONS In healthcare facilities with indoor dampness and microbial contamination, possible associations between such conditions and respiratory health effects should be considered. Good building maintenance and housekeeping procedures should lead to improvements in employee respiratory health.
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Affiliation(s)
- J M Cox-Ganser
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA.
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Riggs MA, Rao CY, Brown CM, Van Sickle D, Cummings KJ, Dunn KH, Deddens JA, Ferdinands J, Callahan D, Moolenaar RL, Pinkerton LE. Resident cleanup activities, characteristics of flood-damaged homes and airborne microbial concentrations in New Orleans, Louisiana, October 2005. Environ Res 2008; 106:401-409. [PMID: 18199434 DOI: 10.1016/j.envres.2007.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Revised: 09/19/2007] [Accepted: 11/20/2007] [Indexed: 05/25/2023]
Abstract
BACKGROUND Flooding in the greater New Orleans (GNO) area after the hurricanes caused extensive mold growth in homes resulting in public health concerns. OBJECTIVES We conducted an environmental assessment of homes to determine the extent and type of microbial growth. METHODS We randomly selected 112 homes, stratified by water damage, and then visually assessed mold growth. Air samples from a subset of 20 homes were analyzed for culturable fungi, fungal spores, and markers of mold ((1-->3, 1-->6)-beta-D-glucans) and bacteria (endotoxin). RESULTS Visible mold growth occurred in 49 (44%) homes; 18 (16%) homes had >50% mold coverage. Flood levels were >6 ft at 20 (19%), 3-6 ft at 20 (19%), and <3 ft at 28 (26%) homes out of 107; no flooding at 39 (36%) homes. The residents spent an average of 18 h (range: 1-84) doing heavy cleaning and of those, 22 (38%) reported using an N-95 or other respirator. Visible mold growth was significantly associated with flood height 3 ft and the predominant fungi indoors were Aspergillus and Penicillium species, which were in higher concentrations in homes with a flood level 3 ft. Geometric mean (GM) levels of endotoxin were as high as 40.2 EU/m(3), while GM glucan levels were as high as 3.5 microg/m(3) even when flooding was 3 ft. CONCLUSIONS Based on our observations of visible mold, we estimated that elevated mold growth was present in 194,000 (44%) homes in the GNO area and 70,000 (16%) homes had heavy mold growth. Concentrations of endotoxin and glucans exceeded those previously associated with health effects. With such high levels of microbial growth following flooding, potentially harmful inhalation exposures can be present for persons entering or cleaning affected homes. Persons exposed to water-damaged homes should follow the CDC recommendations developed following the 2005 hurricanes for appropriate respiratory precautions.
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Affiliation(s)
- Margaret A Riggs
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Park JH, Cox-Ganser JM, Kreiss K, White SK, Rao CY. Hydrophilic fungi and ergosterol associated with respiratory illness in a water-damaged building. Environ Health Perspect 2008; 116:45-50. [PMID: 18197298 PMCID: PMC2199298 DOI: 10.1289/ehp.10355] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Accepted: 10/08/2007] [Indexed: 05/08/2023]
Abstract
BACKGROUND Damp building-related respiratory illnesses are an important public health issue. OBJECTIVE We compared three respiratory case groups defined by questionnaire responses [200 respiratory cases, 123 of the respiratory cases who met the epidemiologic asthma definition, and 49 of the epidemiologic asthma cases who had current physician-diagnosed asthma with post-occupancy onset] to a comparison group of 152 asymptomatic employees in an office building with a history of water damage. METHODS We analyzed dust samples collected from floors and chairs of 323 cases and comparisons for culturable fungi, ergosterol, endotoxin, and cat and dog allergens. We examined associations of total fungi, hydrophilic fungi (requiring water activity > or = 0.9), and ergosterol with the health outcomes using logistic regression models. RESULTS In models adjusted for demographics, respiratory illnesses showed significant linear exposure-response relationships to total culturable fungi [interquartile range odds ratios (IQR-OR) = 1.37-1.72], hydrophilic fungi (IQR-OR = 1.45-2.19), and ergosterol (IQR-OR = 1.54-1.60) in floor and chair dusts. Of three outcomes analyzed, current asthma with postoccupancy physician diagnosis was most strongly associated with exposure to hydrophilic fungi in models adjusted for ergosterol, endotoxin, and demographics (IQR-OR = 2.09 for floor and 1.79 for chair dusts). Ergosterol levels in floor dust were significantly associated with epidemiologic asthma independent of culturable fungi (IQR-OR = 1.54-1.55). CONCLUSIONS Our findings extend the 2004 conclusions of the Institute of Medicine [Human health effects associated with damp indoor environments. In: Damp Indoor Spaces and Health. Washington DC:National Academies Press, 183-269] by showing that mold levels in dust were associated with new-onset asthma in this damp indoor environment. Hydrophilic fungi and ergosterol as measures of fungal biomass may have promise as markers of risk of building-related respiratory diseases in damp indoor environments.
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Affiliation(s)
- Ju-Hyeong Park
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA.
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Rao CY, Kurukularatne C, Garcia-Diaz JB, Kemmerly SA, Reed D, Fridkin SK, Morgan J. Implications of detecting the mold Syncephalastrum in clinical specimens of New Orleans residents after Hurricanes Katrina and Rita. J Occup Environ Med 2007; 49:411-6. [PMID: 17426524 DOI: 10.1097/jom.0b013e31803b94f9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 11/26/2022]
Abstract
After the extensive flooding in New Orleans following Hurricanes Katrina and Rita, thousands of homes in the flooded areas had significant growth of mold. The potential health effects from exposures to these extraordinary environments are unknown. In February 2006, we investigated a cluster of patients with clinical specimens yielding Syncephalastrum, a zygomycete that rarely causes infection. We identified the cases of eight patients from September 12, 2005, to January 12, 2006, with specimens from sputum, bronchoalveolar lavage, endotracheal aspirate, ear swab, and nasal swab. All patients appeared to be transiently colonized without evidence of infection, even among immunosuppressed patients. Only one patient reported significant exposure to mold (working on mold remediation without wearing a respirator) on the day of his incident culture.
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Affiliation(s)
- Carol Y Rao
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Rao CY, Riggs MA, Chew GL, Muilenberg ML, Thorne PS, Van Sickle D, Dunn KH, Brown C. Characterization of airborne molds, endotoxins, and glucans in homes in New Orleans after Hurricanes Katrina and Rita. Appl Environ Microbiol 2007; 73:1630-4. [PMID: 17209066 PMCID: PMC1828784 DOI: 10.1128/aem.01973-06] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [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: 11/20/2022] Open
Abstract
In August and September 2005, Hurricanes Katrina and Rita caused breeches in the New Orleans, LA, levee system, resulting in catastrophic flooding. The city remained flooded for several weeks, leading to extraordinary mold growth in homes. To characterize the potential risks of mold exposures, we measured airborne molds and markers of molds and bacteria in New Orleans area homes. In October 2005, we collected air samples from 5 mildly water-damaged houses, 15 moderately to heavily water-damaged houses, and 11 outdoor locations. The air filters were analyzed for culturable fungi, spores, (1-->3,1-->6)-beta-D-glucans, and endotoxins. Culturable fungi were significantly higher in the moderately/heavily water-damaged houses (geometric mean=67,000 CFU/m3) than in the mildly water-damaged houses (geometric mean=3,700 CFU/m3) (P=0.02). The predominant molds found were Aspergillus niger, Penicillium spp., Trichoderma, and Paecilomyces. The indoor and outdoor geometric means for endotoxins were 22.3 endotoxin units (EU)/m3 and 10.5 EU/m3, respectively, and for (1-->3,1-->6)-beta-D-glucans were 1.7 microg/m3 and 0.9 microg/m3, respectively. In the moderately/heavily water-damaged houses, the geometric means were 31.3 EU/m3 for endotoxins and 1.8 microg/m3 for (1-->3,1-->6)-beta-D-glucans. Molds, endotoxins, and fungal glucans were detected in the environment after Hurricanes Katrina and Rita in New Orleans at concentrations that have been associated with health effects. The species and concentrations were different from those previously reported for non-water-damaged buildings in the southeastern United States.
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Affiliation(s)
- Carol Y Rao
- Epidemic Intelligence Service, Mycotic Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS-C09, Atlanta, GA 30333, USA.
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Chang DC, Grant GB, O'Donnell K, Wannemuehler KA, Noble-Wang J, Rao CY, Jacobson LM, Crowell CS, Sneed RS, Lewis FMT, Schaffzin JK, Kainer MA, Genese CA, Alfonso EC, Jones DB, Srinivasan A, Fridkin SK, Park BJ. Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution. JAMA 2006; 296:953-63. [PMID: 16926355 DOI: 10.1001/jama.296.8.953] [Citation(s) in RCA: 445] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Fusarium keratitis is a serious corneal infection, most commonly associated with corneal injury. Beginning in March 2006, the Centers for Disease Control and Prevention received multiple reports of Fusarium keratitis among contact lens wearers. OBJECTIVE To define the specific activities, contact lens hygiene practices, or products associated with this outbreak. DESIGN, SETTING, AND PARTICIPANTS Epidemiological investigation of Fusarium keratitis occurring in the United States. A confirmed case was defined as keratitis with illness onset after June 1, 2005, with no history of recent ocular trauma and a corneal culture growing Fusarium species. Data were obtained by patient and ophthalmologist interviews for case patients and neighborhood-matched controls by trained personnel. Available Fusarium isolates from patients' clinical and environmental specimens were genotyped by multilocus sequence typing. Environmental sampling for Fusarium was conducted at a contact lens solution manufacturing plant. MAIN OUTCOME MEASURES Keratitis infection with Fusarium species. RESULTS As of June 30, 2006, we identified 164 confirmed case patients in 33 states and 1 US territory. Median age was 41 years (range, 12-83 years). Corneal transplantation was required or planned in 55 (34%). One hundred fifty-four (94%) of the confirmed case patients wore soft contact lenses. Forty-five case patients and 78 controls were included in the case-control study. Case patients were significantly more likely than controls to report using a specific contact lens solution, ReNu with MoistureLoc (69% vs 15%; odds ratio, 13.3; 95% confidence interval, 3.1-119.5). The prevalence of reported use of ReNu MultiPlus solution was similar between case patients and controls (18% vs 20%; odds ratio, 0.7; 95% confidence interval, 0.2-2.8). Fusarium was not recovered from the factory, warehouse, solution filtrate, or unopened solution bottles; production of implicated lots was not clustered in time. Among 39 isolates tested, at least 10 different Fusarium species were identified, comprising 19 unique multilocus genotypes. CONCLUSIONS The findings from this investigation indicate that this outbreak of Fusarium keratitis was associated with use of ReNu with MoistureLoc contact lens solution. Contact lens users should not use ReNu with MoistureLoc.
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Affiliation(s)
- Douglas C Chang
- Mycotic Diseases Branch, Career Development Division, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Ga, USA.
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Cummings KJ, Van Sickle D, Rao CY, Riggs MA, Brown CM, Moolenaar RL. Knowledge, attitudes, and practices related to mold exposure among residents and remediation workers in posthurricane New Orleans. Arch Environ Occup Health 2006; 61:101-8. [PMID: 17672351 DOI: 10.3200/aeoh.61.3.101-108] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
To assess knowledge, attitudes, and practices related to mold exposure in postflood New Orleans, the authors surveyed 159 residents and 76 remediation workers, using logistic regression to explore associations. Nearly all answered "yes" to the questionnaire item, "Do you think mold can make people sick?" and most knew respirators were recommended for cleaning mold. Residents (87%) and workers (47%) said they believed that television or radio were the best ways to communicate information about mold. Workers (24%) also suggested employers provided the best means for communication of this information. Few participants reliably used all recommended protective equipment. Residents cited respirator discomfort and unavailability as reasons for noncompliance; workers cited discomfort and inadequate training, with 50% reporting respirator fit testing. Spanish-speaking workers relied on employers for information. Self-employed workers used protective equipment infrequently. The authors recommend that information on postflood mold exposure be disseminated through media and employers, that protective equipment be made readily available for residents, and that workers receive better training and fit testing. In addition, they suggest that targeted approaches may benefit Spanish-speaking workers and the self-employed.
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Affiliation(s)
- Kristin J Cummings
- Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
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Cox-Ganser JM, White SK, Jones R, Hilsbos K, Storey E, Enright PL, Rao CY, Kreiss K. Respiratory morbidity in office workers in a water-damaged building. Environ Health Perspect 2005; 113:485-90. [PMID: 15811840 PMCID: PMC1278490 DOI: 10.1289/ehp.7559] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2004] [Accepted: 01/19/2005] [Indexed: 05/18/2023]
Abstract
We conducted a study on building-related respiratory disease and associated social impact in an office building with water incursions in the northeastern United States. An initial questionnaire had 67% participation (888/1,327). Compared with the U.S. adult population, prevalence ratios were 2.2-2.5 for wheezing, lifetime asthma, and current asthma, 3.3 for adult-onset asthma, and 3.4 for symptoms improving away from work (p < 0.05). Two-thirds (66/103) of the adult-onset asthma arose after occupancy, with an incidence rate of 1.9/1,000 person-years before building occupancy and 14.5/1,000 person-years after building occupancy. We conducted a second survey on 140 respiratory cases, 63 subjects with fewer symptoms, and 44 comparison subjects. Health-related quality of life decreased with increasing severity of respiratory symptoms and in those with work-related symptoms. Symptom status was not associated with job satisfaction or how often jobs required hard work. Respiratory health problems accounted for one-third of sick leave, and respiratory cases with work-related symptoms had more respiratory sick days than those without work-related symptoms (9.4 vs. 2.4 days/year; p < 0.01). Abnormal lung function and/or breathing medication use was found in 67% of respiratory cases, in 38% of participants with fewer symptoms, and in 11% of the comparison group (p < 0.01), with similar results in never-smokers. Postoccupancy-onset asthma was associated with less atopy than preoccupancy-onset asthma. Occupancy of the water-damaged building was associated with onset and exacerbation of respiratory conditions, confirmed by objective medical tests. The morbidity and lost work time burdened both employees and employers.
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Affiliation(s)
- Jean M Cox-Ganser
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, West Virginia 26505, USA.
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Rao CY, Cox-Ganser JM, Chew GL, Doekes G, White S. Use of surrogate markers of biological agents in air and settled dust samples to evaluate a water-damaged hospital. Indoor Air 2005; 15 Suppl 9:89-97. [PMID: 15910534 DOI: 10.1111/j.1600-0668.2005.00348.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
UNLABELLED An environmental survey was conducted in two hospital buildings in Montana, one of which had historical water incursion on the top floors and higher prevalence of reported respiratory symptoms that improved when the occupants were away from work. We measured culturable fungi and bacteria, fungal spores, endotoxin, and sub-micron particles in air; and culturable fungi and bacteria, endotoxin, markers of fungi (extra-cellular polysaccharides specific for Penicillium/Aspergillus, ergosterol, and beta(1-->3) glucans) and cat allergen in chair and floor dusts. For the analytes measured in air, the correlation coefficients ranged from 0.43 to 0.78 (P < 0.05). In chair dust, beta(1-->3) glucan concentrations correlated with culturable fungi and ergosterol concentrations. We found that sub-micron particles and markers of microbiological agents, but not culturable microbiological agents, were significantly positively associated with the building that had both historical water damage and higher prevalence of reported respiratory symptoms. Chair dust measurements tended to be higher in the non-complaint building. These results suggest that air and floor dust measurements of marker compounds may be better indicators of current health risk in a water-damaged environment than chair dust measurements or measurements of culturable fungi or bacteria in air or settled dust. PRACTICAL IMPLICATIONS Detection and quantification of nonculture-based microbiological markers and/or agents of disease may be useful methods to assess microbial contamination and to more accurately evaluate microbial exposures in the indoor environment for exposure-response studies.
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Affiliation(s)
- C Y Rao
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA.
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Abstract
The fungus Stachybotrys chartarum has been implicated in cases of nonspecific indoor air quality complaints in adults and in cases of pulmonary hemorrhaging in infants. The effects that have been described have been attributed to mycotoxins. Previous dose-effect studies focused on exposure to a single mycotoxin in a solvent, a strategy which is unlikely to accurately characterize the effects of inhaled spores. In this study we examined the role of mycotoxins in the pulmonary effects caused by S. chartarum spores and the dose dependency of these effects. S. chartarum spores were extracted in methanol to reduce the mycotoxin content of the spores. Then either untreated (toxin-containing) or methanol-extracted S. chartarum spores were intratracheally instilled into male 10-week-old Charles River-Dawley rats. After 24 h, the lungs were lavaged, and the bronchoalveolar lavage fluid was analyzed to determine differences in lactic dehydrogenase, albumin, hemoglobin, myeloperoxidase, and leukocyte differential counts. Weight change was also monitored. Our data show that methanol extraction dramatically reduced the toxicity of S. chartarum spores. No statistically significant effects were observed in the bronchoalveolar lavage fluids of the animals that were treated with methanol-extracted spores at any dose. Conversely, dose-dependent effects of the toxin-containing spores were observed when we examined the lactic dehydrogenase, albumin, and hemoglobin concentrations, the polymorphonuclear leukocyte counts, and weight loss. Our findings show that a single, intense exposure to toxin-containing S. chartarum spores results in pulmonary inflammation and injury in a dose-dependent manner. Importantly, the effects are related to methanol-soluble toxins in the spores.
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Affiliation(s)
- C Y Rao
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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Abstract
Stachybotrys chartarum is a fungal species that can produce mycotoxins, specifically trichothecenes. Exposures in the indoor environment have reportedly induced neurogenic symptoms in adults and hemosiderosis in infants. However, little evidence has linked measured exposures to any fungal agent with any health outcome. We present here a study that focuses on quantitatively assessing the health risks from fungal toxin exposure. Male, 10 week old Charles River-Dawley rats were intratracheally instilled with approximately 9.6 million Stachybotrys chartarum spores in a saline suspension. The lungs were lavaged 0 h (i.e., immediately post-instillation), 6, 24 or 72 h after instillation. Biochemical indicators (albumin, myeloperoxidase, lactic dehydrogenase, hemoglobin) and leukocyte differentials in the bronchoalveolar lavage fluid and weight change were measured. We have demonstrated that a single, acute pulmonary exposure to a large quantity of Stachybotrys chartarum spores by intratracheal instillation causes severe injury detectable by bronchoalveolar lavage. The primary effect appears to be cytotoxicity and inflammation with hemorrhage. There is a measurable effect as early as 6 h after instillation, which may be attributable to mycotoxins in the fungal spores. The time course of responses supports early release of some toxins, with the most severe effects occurring between 6 and 24 h following exposure. By 72 h, recovery has begun, although macrophage concentrations remained elevated.
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Affiliation(s)
- C Y Rao
- Department of Environmental Health, Harvard School of Public Health, Boston, MA 02115, USA.
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Abstract
Existing quantitative standards/guidelines for fungi in indoor air issued by governmental agencies are based primarily on baseline data (rather than health effects data), and are either absolute (numerical) or relative (indoor/outdoor comparisons) or a combination of the two. The Russian Federation is the only governmental agency that has binding quantitative regulations for bioaerosols. Recommended guidelines have been proposed or sponsored by North American and European governmental agencies and private professional organizations. A considerable number of frequently cited guidelines have been proposed by individuals based either on baseline data or on personal experience. Quantitative standards/guidelines range from less than 100 CFU/m3 to greater than 1000 CFU/m3 (total fungi) as the upper limit for non-contaminated indoor environments. Major issues with existing quantitative standards and guidelines are the lack of connection to human dose/response data, reliance on short term grab samples analyzed only by culture, and the absence of standardized protocols for data collection, analysis, and interpretation. Urgent research needs include the study of human responses to specific fungal agents, development and widespread use of standard protocols using currently available sampling methodologies, and the development of long term, time-discriminating personal samplers that are inexpensive, easy to use, and amenable to straightforward, relevant analysis.
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Affiliation(s)
- C Y Rao
- Harvard School of Public Health, Department of Environmental Health, Boston, Massachusetts, USA
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Bitran JD, Desser RK, DeMeester T, Shapiro CM, Billings A, Rubenstein L, Evans R, Colman M, Rao CY, Griem M, Golomb HM. Combined modality therapy for stage IIIMO non-oat cell bronchogenic carcinoma. Cancer Treat Rep 1978; 62:327-32. [PMID: 348305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Thirty-nine patients with stage IIIMO non-cell bronchogenic carcinoma (NOBC) were treated with combined modality therapy: radiation therapy and chemotherapy with cyclophosphamide, adriamycin, methotrexate, and procarbazine. The median survival for all patients treated was 9.6 months compared to 6.4 months for historical controls (P = 0.015). Patients who responded to the treatment program had a significantly longer survival (median, 15.2 months) compared to nonresponders and historical controls (P less than 0.005). It is concluded that combined modality therapy is moderately effective therapy in stage IIIMO NOBC.
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