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Bruce MG, Bruden D, Hurlburt D, Morris J, Bressler S, Thompson G, Lecy D, Rudolph K, Bulkow L, Hennessy T, Simons BC, Weng MK, Nelson N, McMahon BJ. Protection and antibody levels 35 years after primary series with hepatitis B vaccine and response to a booster dose. Hepatology 2022; 76:1180-1189. [PMID: 35320592 PMCID: PMC9790192 DOI: 10.1002/hep.32474] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/25/2022] [Accepted: 03/16/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS The duration of protection from hepatitis B vaccination in children and adults is not known. In 1981, we used three doses of plasma-derived hepatitis B vaccine to immunize a cohort of 1578 Alaska Native adults and children from 15 Alaska communities who were ≥6 months old. APPROACH AND RESULTS We tested persons for antibody to hepatitis B surface antigen (anti-HBs) levels 35 years after receiving the primary series. Those with levels <10 mIU/ml received one booster dose of recombinant hepatitis B vaccine 2-4 weeks later and were then evaluated on the basis of anti-HBs measurements 30 days postbooster. Among the 320 recruited, 112 persons had not participated in the 22- or 30-year follow-up study (group 1), and 208 persons had participated but were not given an HBV booster dose (group 2). Among the 112 persons in group 1 who responded to the original primary series, 53 (47.3%) had an anti-HBs level ≥10 mIU/ml. Among group 1, 73.7% (28 of 38) of persons available for a booster dose responded to it with an anti-HBs level ≥10 mIU/ml at 30 days. Initial anti-HBs level after the primary series was correlated with higher anti-HBs levels at 35 years. Among 8 persons who tested positive for antibody to hepatitis B core antigen, none tested positive for HBsAg or HBV DNA. CONCLUSIONS Based on anti-HBs level ≥10 mIU/ml at 35 years and a 73.7% booster dose response, we estimate that 86% of participants had evidence of protection 35 years later. Booster doses are not needed in the general population at this time.
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Affiliation(s)
- Michael G. Bruce
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Dana Bruden
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Debby Hurlburt
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Julie Morris
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Sara Bressler
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Gail Thompson
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Danielle Lecy
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Karen Rudolph
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Lisa Bulkow
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Thomas Hennessy
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Brenna C. Simons
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Mark K. Weng
- Epidemiology and Surveillance BranchDivision of Viral HepatitisNational Center for HIV/AIDSViral HepatitisSexually Transmitted Disease, and Tuberculosis PreventionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Noele Nelson
- Epidemiology and Surveillance BranchDivision of Viral HepatitisNational Center for HIV/AIDSViral HepatitisSexually Transmitted Disease, and Tuberculosis PreventionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Brian J. McMahon
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA,Liver Disease and Hepatitis ProgramAlaska Native Tribal Health ConsortiumAnchorageAlaskaUSA
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Nolen LD, Tiffany A, DeByle C, Bruden D, Thompson G, Reasonover A, Hurlburt D, Mosites E, Simons BC, Klejka J, Castrodale L, McLaughlin J, Bruce MG. Haemophilus influenzae Serotype a (Hia) Carriage in a Small Alaska Community After a Cluster of Invasive Hia Disease, 2018. Clin Infect Dis 2021; 73:e280-e286. [PMID: 32531017 DOI: 10.1093/cid/ciaa750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/05/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Between May and July 2018, 4 Haemophilus influenzae serotype a (Hia) infections occurred in a remote Alaska community. We performed a public health response to prevent further illness and understand Hia carriage. METHODS We collected oropharyngeal samples community-wide to evaluate baseline carriage. Risk factors were evaluated by interview. We offered prophylactic rifampin to individuals in contact with invasive Hia patients (contacts) and to all children aged <10 years. Oropharyngeal samples were collected again 8 weeks after rifampin distribution. Samples were tested using real-time polymerase chain reaction and culture. RESULTS At baseline, 4 of 27 (14.8%) contacts and 7 of 364 (1.9%) noncontacts (P < .01) carried Hia. Contacts aged <10 years were more likely to carry Hia at any timepoint (11/18 [61%]) compared to contacts aged ≥10 years (3/34 [8.8%]), noncontacts aged <10 years (2/139 [1.4%]), and noncontacts ≥10 years (6/276 [2.2%]) (P < .001 for all). Hia carriers were clustered in 9 households (7% of total households). At the household level, carriage was associated with households with ≥1 contact (prevalence ratio [PR], 5.6 [95% confidence interval {CI}, 1.3-21.6]), crowding (PR, 7.7 [95% CI, 1.1-199.5]), and ≥3 tobacco users (PR, 5.0 [95% CI, 1.2-19.6]). Elevated carriage prevalence persisted in contacts compared to noncontacts 8 weeks after rifampin distribution (6/25 [24%] contacts, 2/114 [1.8%] noncontacts; P < .001). CONCLUSIONS Hia carriage prevalence was significantly higher among contacts than noncontacts. Rifampin prophylaxis did not result in a reduction of Hia carriage prevalence in this community.
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Affiliation(s)
- Leisha D Nolen
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Amanda Tiffany
- Section of Epidemiology, Department of Health and Social Services, State of Alaska, Anchorage, Alaska, USA.,Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carolynn DeByle
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Dana Bruden
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Gail Thompson
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Alisa Reasonover
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Debby Hurlburt
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Emily Mosites
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Brenna C Simons
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Joe Klejka
- Yukon Kuskokwim Health Corporation, Bethel, Alaska, USA
| | - Louisa Castrodale
- Section of Epidemiology, Department of Health and Social Services, State of Alaska, Anchorage, Alaska, USA
| | - Joseph McLaughlin
- Section of Epidemiology, Department of Health and Social Services, State of Alaska, Anchorage, Alaska, USA
| | - Michael G Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
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Bruce MG, Meites E, Bulkow L, Panicker G, Hurlburt D, Lecy D, Thompson G, Rudolph K, Unger ER, Hennessy T, Markowitz LE. A prospective cohort study of immunogenicity of quadrivalent human papillomavirus vaccination among Alaska Native Children, Alaska, United States. Vaccine 2020; 38:6585-6591. [PMID: 32814639 DOI: 10.1016/j.vaccine.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In the United States, HPV vaccination is routinely recommended at age 11 or 12 years; the series can be started at age 9. We conducted a cohort study to assess long-term immunogenicity of quadrivalent HPV vaccine (4vHPV) in an American Indian/Alaska Native (AI/AN) Indigenous population. METHODS During 2011-2014, we enrolled AI/AN girls and boys aged 9-14 years, who were vaccinated with a 3-dose series of 4vHPV. Serum specimens were collected at five time points: immediately prior to doses 2 and 3, and at one month, one year, and two years after series completion. Antibody testing was performed using a multiplex virus-like-particle-IgG ELISA for 4vHPV types (HPV 6/11/16/18). RESULTS Among 477 children (405 girls/72 boys) completing the 3-dose series, median age at enrollment was 11.2 years. Of the 477, 72 (15%) were tested before dose 2 and 70 (15%) before dose 3. Following series completion, 435 (91%) were tested at one month, 382 (80%) at one year, and 351 (74%) at two years. All tested participants had detectable antibody to 4vHPV types at all time points measured. Geometric mean concentrations (GMCs) for 4vHPV types at one month and two years post-series completion were 269.9 and 32.7 AU/ml for HPV6, 349.3 and 42.9 AU/ml for HPV11, 1240.2 and 168.3 IU/ml HPV16, and 493.2 and 52.2 IU/ml for HPV18. Among children tested after each dose, GMCs after doses 1 and 2 were 3.9 and 32.2 AU/ml for HPV6, 5.3 and 45.6 AU/ml for HPV11, 20.8 and 187.9 IU/ml for HPV16; and 6.6 and 49.7 IU/ml for HPV18. No serious adverse events were reported. CONCLUSION All AI/AN children developed antibodies to all 4vHPV types after vaccination. GMCs rose after each dose, then decreased to a plateau over the subsequent two years. This cohort will continue to be followed to determine duration of antibody response.
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Affiliation(s)
- Michael G Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA.
| | - Elissa Meites
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa Bulkow
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Gitika Panicker
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Debby Hurlburt
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Danielle Lecy
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Gail Thompson
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Karen Rudolph
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas Hennessy
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Lauri E Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Mosites E, Frick A, Gounder P, Castrodale L, Li Y, Rudolph K, Hurlburt D, Lecy KD, Zulz T, Adebanjo T, Onukwube J, Beall B, Van Beneden CA, Hennessy T, McLaughlin J, Bruce MG. Outbreak of Invasive Infections From Subtype emm26.3 Group A Streptococcus Among Homeless Adults-Anchorage, Alaska, 2016-2017. Clin Infect Dis 2019; 66:1068-1074. [PMID: 29069346 DOI: 10.1093/cid/cix921] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/18/2017] [Indexed: 01/08/2023] Open
Abstract
Background In 2016, we detected an outbreak of group A Streptococcus (GAS) invasive infections among the estimated 1000 persons experiencing homelessness (PEH) in Anchorage, Alaska. We characterized the outbreak and implemented a mass antibiotic intervention at homeless service facilities. Methods We identified cases through the Alaska GAS laboratory-based surveillance system. We conducted emm typing, antimicrobial susceptibility testing, and whole-genome sequencing on all invasive isolates and compared medical record data of patients infected with emm26.3 and other emm types. In February 2017, we offered PEH at 6 facilities in Anchorage a single dose of 1 g of azithromycin. We collected oropharyngeal and nonintact skin swabs on a subset of participants concurrent with the intervention and 4 weeks afterward. Results From July 2016 through April 2017, we detected 42 invasive emm26.3 cases in Anchorage, 35 of which were in PEH. The emm26.3 isolates differed on average by only 2 single-nucleotide polymorphisms. Compared to other emm types, infection with emm26.3 was associated with cellulitis (odds ratio [OR], 2.5; P = .04) and necrotizing fasciitis (OR, 4.4; P = .02). We dispensed antibiotics to 391 PEH. Colonization with emm26.3 decreased from 4% of 277 at baseline to 1% of 287 at follow-up (P = .05). Invasive GAS incidence decreased from 1.5 cases per 1000 PEH/week in the 6 weeks prior to the intervention to 0.2 cases per 1000 PEH/week in the 6 weeks after (P = .01). Conclusions In an invasive GAS outbreak in PEH in Anchorage, mass antibiotic administration was temporally associated with reduced invasive disease cases and colonization prevalence.
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Affiliation(s)
- Emily Mosites
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Anna Frick
- Section of Epidemiology, Division of Public Health, Alaska Department of Health and Social Services, Anchorage, Atlanta, Georgia
| | - Prabhu Gounder
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Louisa Castrodale
- Section of Epidemiology, Division of Public Health, Alaska Department of Health and Social Services, Anchorage, Atlanta, Georgia
| | - Yuan Li
- Respiratory Disease Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karen Rudolph
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Debby Hurlburt
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Kristen D Lecy
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Tammy Zulz
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Tolu Adebanjo
- Respiratory Disease Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Onukwube
- Respiratory Disease Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bernard Beall
- Respiratory Disease Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chris A Van Beneden
- Respiratory Disease Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas Hennessy
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Joseph McLaughlin
- Section of Epidemiology, Division of Public Health, Alaska Department of Health and Social Services, Anchorage, Atlanta, Georgia
| | - Michael G Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
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Miernyk KM, Bruden D, Parkinson AJ, Hurlburt D, Klejka J, Berner J, Stoddard RA, Handali S, Wilkins PP, Kersh GJ, Fitzpatrick K, Drebot MA, Priest JW, Pappert R, Petersen JM, Teshale E, Hennessy TW, Bruce MG. Human Seroprevalence to 11 Zoonotic Pathogens in the U.S. Arctic, Alaska. Vector Borne Zoonotic Dis 2019; 19:563-575. [PMID: 30789314 PMCID: PMC10874833 DOI: 10.1089/vbz.2018.2390] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Indexed: 12/27/2022] Open
Abstract
Background: Due to their close relationship with the environment, Alaskans are at risk for zoonotic pathogen infection. One way to assess a population's disease burden is to determine the seroprevalence of pathogens of interest. The objective of this study was to determine the seroprevalence of 11 zoonotic pathogens in people living in Alaska. Methods: In a 2007 avian influenza exposure study, we recruited persons with varying wild bird exposures. Using sera from this study, we tested for antibodies to Cryptosporidium spp., Echinococcus spp., Giardia intestinalis, Toxoplasma gondii, Trichinella spp., Brucella spp., Coxiella burnetii, Francisella tularensis, California serogroup bunyaviruses, and hepatitis E virus (HEV). Results: Eight hundred eighty-seven persons had sera tested, including 454 subsistence bird hunters and family members, 160 sport bird hunters, 77 avian wildlife biologists, and 196 persons with no wild bird exposure. A subset (n = 481) of sera was tested for California serogroup bunyaviruses. We detected antibodies to 10/11 pathogens. Seropositivity to Cryptosporidium spp. (29%), California serotype bunyaviruses (27%), and G. intestinalis (19%) was the most common; 63% (301/481) of sera had antibodies to at least one pathogen. Using a multivariable logistic regression model, Cryptosporidium spp. seropositivity was higher in females (35.7% vs. 25.0%; p = 0.01) and G. intestinalis seropositivity was higher in males (21.8% vs. 15.5%; p = 0.02). Alaska Native persons were more likely than non-Native persons to be seropositive to C. burnetii (11.7% vs. 3.8%; p = 0.005) and less likely to be seropositive to HEV (0.4% vs. 4.1%; p = 0.01). Seropositivity to Cryptosporidium spp., C. burnetii, HEV, and Echinococcus granulosus was associated with increasing age (p ≤ 0.01 for all) as was seropositivity to ≥1 pathogen (p < 0.0001). Conclusion: Seropositivity to zoonotic pathogens is common among Alaskans with the highest to Cryptosporidium spp., California serogroup bunyaviruses, and G. intestinalis. This study provides a baseline for use in assessing seroprevalence changes over time.
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Affiliation(s)
- Karen M. Miernyk
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Dana Bruden
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Alan J. Parkinson
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Debby Hurlburt
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | | | - James Berner
- Alaska Native Tribal Health Consortium, Anchorage, Alaska
| | - Robyn A. Stoddard
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sukwan Handali
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patricia P. Wilkins
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gilbert J. Kersh
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kelly Fitzpatrick
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mike A. Drebot
- Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Jeffrey W. Priest
- Waterborne Diseases Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ryan Pappert
- Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Ft. Collins, Colorado
| | - Jeannine M. Petersen
- Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Ft. Collins, Colorado
| | - Eyasu Teshale
- Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas W. Hennessy
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Michael G. Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
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Nolen LD, Bruden D, Miernyk K, McMahon BJ, Sacco F, Varner W, Mezzetti T, Hurlburt D, Tiesinga J, Bruce MG. H. pylori-associated pathologic findings among Alaska native patients. Int J Circumpolar Health 2018; 77:1510715. [PMID: 30157723 PMCID: PMC6116699 DOI: 10.1080/22423982.2018.1510715] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/27/2018] [Accepted: 08/02/2018] [Indexed: 12/17/2022] Open
Abstract
Helicobacter pylori infection is common among Alaska native (AN) people, however scant gastric histopathologic data is available for this population. This study aimed to characterise gastric histopathology and H. pylori infection among AN people. We enrolled AN adults undergoing upper endoscopy. Gastric biopsy samples were evaluated for pathologic changes, the presence of H. pylori, and the presence of cag pathogenicity island-positive bacteria. Of 432 persons; two persons were diagnosed with gastric adenocarcinoma, two with MALT lymphoma, 40 (10%) with ulcers, and 51 (12%) with intestinal metaplasia. Fifty-five per cent of H. pylori-positive persons had cag pathogenicity island positive bacteria. The gastric antrum had the highest prevalence of acute and chronic moderate-severe gastritis. H. pylori-positive persons were 16 and four times more likely to have moderate-severe acute gastritis and chronic gastritis (p < 0.01), respectively. An intact cag pathogenicity island positive was correlated with moderate-severe acute antral gastritis (53% vs. 31%, p = 0.0003). H. pylori-positive persons were more likely to have moderate-severe acute and chronic gastritis compared to H. pylori-negative persons. Gastritis and intestinal metaplasia were most frequently found in the gastric antrum. Intact cag pathogenicity island positive was correlated with acute antral gastritis and intestinal metaplasia.
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Affiliation(s)
- Leisha Diane Nolen
- Arctic Investigations Program, DPEI/NCEZID, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Dana Bruden
- Arctic Investigations Program, DPEI/NCEZID, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Karen Miernyk
- Arctic Investigations Program, DPEI/NCEZID, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Brian J. McMahon
- Arctic Investigations Program, DPEI/NCEZID, Centers for Disease Control and Prevention, Anchorage, AK, USA
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Frank Sacco
- Department of Surgery, The Alaska Native Medical Center, Anchorage, AK, USA
| | - Wayne Varner
- Department of Pathology and Clinical Laboratory, The Alaska Native Medical Center, Anchorage, AK, USA
| | - Tom Mezzetti
- Department of Pathology and Clinical Laboratory, The Alaska Native Medical Center, Anchorage, AK, USA
| | - Debby Hurlburt
- Arctic Investigations Program, DPEI/NCEZID, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - James Tiesinga
- Department of Pathology and Clinical Laboratory, The Alaska Native Medical Center, Anchorage, AK, USA
| | - Michael G. Bruce
- Arctic Investigations Program, DPEI/NCEZID, Centers for Disease Control and Prevention, Anchorage, AK, USA
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Gounder PP, Bruden D, Rudolph K, Zulz T, Hurlburt D, Thompson G, Bruce MG, Hennessy TW. Re-emergence of pneumococcal colonization by vaccine serotype 19F in persons aged ≥5 years after 13-valent pneumococcal conjugate vaccine introduction-Alaska, 2008-2013. Vaccine 2017; 36:691-697. [PMID: 29279284 DOI: 10.1016/j.vaccine.2017.12.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/07/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The pneumococcal conjugate vaccine (PCV) was introduced in 2001. Widespread PCV use nearly eradicated pneumococcal colonization by vaccine serotypes. Since 2008, however, colonization by PCV-serotype 19F has increased in Alaska residents. We describe the epidemiology of re-emerging serotype 19F colonization. METHODS We conducted annual cross-sectional colonization surveys from 2008 to 2013. We recruited children aged <5 years at 2 urban clinics and participants of all ages from Region-A (2 villages), Region-B (4 villages), and Region-C (2 villages). We interviewed participants and reviewed their medical records to obtain demographic information and determine PCV status. We obtained nasopharyngeal swab specimens from participants to identify pneumococci and to determine the pneumococcal serotype, antimicrobial resistance, and multilocus sequence type. We used the Cochran-Armitage test to assess for significant trends in colonization across time periods. RESULTS Among participants aged <5 years, pneumococcal serotype 19F colonization remained unchanged from 2008-2009 (0.7%) to 2012-2013 (0.5%; P-value [P] = .54). Serotype 19F colonization increased from 2008-2009 to 2012-2013 among participants aged 5-11 years (0.3% to 3.2%; P < .01), participants 12-17 years (0.0% to 2.0%; P < .01), and participants aged ≥18 years (0.1% to 0.5%; P < .01). During 2012-2013, 85 (93%) of 91 pneumococcal serotype 19F isolates were identified among participants from Region B; the majority of serotype 19F isolates belonged to an antimicrobial nonsusceptibility pattern corresponding to a novel multilocus sequence type 9074. CONCLUSIONS PCV continues to protect against serotype 19F colonization in vaccinated children aged <5 years. The direct PCV impact on serotype 19F colonization in persons aged 5-11 years and indirect impact in persons aged ≥12 years is waning, possibly because of a newly introduced genotype in Region-B.
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Affiliation(s)
- Prabhu P Gounder
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infections, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Dana Bruden
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infections, Centers for Disease Control and Prevention, Anchorage, AK, USA.
| | - Karen Rudolph
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infections, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Tammy Zulz
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infections, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Debby Hurlburt
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infections, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Gail Thompson
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infections, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Michael G Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infections, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Thomas W Hennessy
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infections, Centers for Disease Control and Prevention, Anchorage, AK, USA
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Bruce MG, Bruden D, Hurlburt D, Zanis C, Thompson G, Rea L, Toomey M, Townshend-Bulson L, Rudolph K, Bulkow L, Spradling PR, Baum R, Hennessy T, McMahon BJ. Antibody Levels and Protection After Hepatitis B Vaccine: Results of a 30-Year Follow-up Study and Response to a Booster Dose. J Infect Dis 2016. [PMID: 26802139 DOI: 10.1093/infdis/jiv74832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The duration of protection in children and adults resulting from hepatitis B vaccination is unknown. In 1981, we immunized a cohort of 1578 Alaska Native adults and children from 15 Alaska communities aged ≥6 months using 3 doses of plasma-derived hepatitis B vaccine. METHODS Persons were tested for antibody to hepatitis B surface antigen (anti-HBs) levels 30 years after receiving the primary series. Those with levels <10 mIU/mL received 1 booster dose of recombinant hepatitis B vaccine 2-4 weeks later and were then evaluated on the basis of anti-HBs measurements 30 days after the booster. RESULTS Among 243 persons (56%) who responded to the original primary series but received no subsequent doses during the 30-year period, 125 (51%) had an anti-HBs level ≥10 mIU/mL. Among participants with anti-HBs levels <10 mIU/mL who were available for follow-up, 75 of 85 (88%) responded to a booster dose with an anti-HBs level ≥10 mIU/mL at 30 days. Initial anti-HBs level after the primary series was correlated with higher anti-HBs levels at 30 years. CONCLUSIONS Based on anti-HBs level ≥10 mIU/mL at 30 years and an 88% booster dose response, we estimate that ≥90% of participants had evidence of protection 30 years later. Booster doses are not needed.
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Affiliation(s)
- Michael G Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Dana Bruden
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Debby Hurlburt
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Carolyn Zanis
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Gail Thompson
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Lisa Rea
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Michele Toomey
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Lisa Townshend-Bulson
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage
| | - Karen Rudolph
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Lisa Bulkow
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Philip R Spradling
- Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard Baum
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Thomas Hennessy
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Brian J McMahon
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage
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Bruce MG, Bruden D, Hurlburt D, Zanis C, Thompson G, Rea L, Toomey M, Townshend-Bulson L, Rudolph K, Bulkow L, Spradling PR, Baum R, Hennessy T, McMahon BJ. Antibody Levels and Protection After Hepatitis B Vaccine: Results of a 30-Year Follow-up Study and Response to a Booster Dose. J Infect Dis 2016; 214:16-22. [PMID: 26802139 DOI: 10.1093/infdis/jiv748] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/27/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The duration of protection in children and adults resulting from hepatitis B vaccination is unknown. In 1981, we immunized a cohort of 1578 Alaska Native adults and children from 15 Alaska communities aged ≥6 months using 3 doses of plasma-derived hepatitis B vaccine. METHODS Persons were tested for antibody to hepatitis B surface antigen (anti-HBs) levels 30 years after receiving the primary series. Those with levels <10 mIU/mL received 1 booster dose of recombinant hepatitis B vaccine 2-4 weeks later and were then evaluated on the basis of anti-HBs measurements 30 days after the booster. RESULTS Among 243 persons (56%) who responded to the original primary series but received no subsequent doses during the 30-year period, 125 (51%) had an anti-HBs level ≥10 mIU/mL. Among participants with anti-HBs levels <10 mIU/mL who were available for follow-up, 75 of 85 (88%) responded to a booster dose with an anti-HBs level ≥10 mIU/mL at 30 days. Initial anti-HBs level after the primary series was correlated with higher anti-HBs levels at 30 years. CONCLUSIONS Based on anti-HBs level ≥10 mIU/mL at 30 years and an 88% booster dose response, we estimate that ≥90% of participants had evidence of protection 30 years later. Booster doses are not needed.
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Affiliation(s)
- Michael G Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Dana Bruden
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Debby Hurlburt
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Carolyn Zanis
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Gail Thompson
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Lisa Rea
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Michele Toomey
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Lisa Townshend-Bulson
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage
| | - Karen Rudolph
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Lisa Bulkow
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Philip R Spradling
- Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard Baum
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Thomas Hennessy
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Brian J McMahon
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage
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Bulkow LR, Bruce MG, Raczniak G, Hennessy T, Hurlburt D, Bruden D, Klejka J, Thompson G, Case S. The Challenge of Using Data about Household-level Characteristics Obtained from Multiple Informants: Experience in Rural Alaska. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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11
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Bruce MG, Zulz T, Debyle C, Singleton R, Hurlburt D, Bruden D, Rudolph K, Hennessy T, Klejka J, Wenger J. Invasive Disease Caused by Haemophilus Influenzae Serotype a, an Emerging Pathogen in Alaska. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bruce MG, Singleton R, Bulkow L, Rudolph K, Zulz T, Gounder P, Hurlburt D, Bruden D, Hennessy T. Impact of the 13-valent pneumococcal conjugate vaccine (pcv13) on invasive pneumococcal disease and carriage in Alaska. Vaccine 2015; 33:4813-9. [PMID: 26247901 DOI: 10.1016/j.vaccine.2015.07.080] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/21/2015] [Accepted: 07/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Alaska Native (AN) children have experienced high rates of invasive pneumococcal disease (IPD). In March 2010, PCV13 was introduced statewide in Alaska. We evaluated the impact of PCV13 on IPD in children and adults, 45 months after introduction. METHODS Pneumococcal sterile site isolates, reported through state-wide surveillance, were serotyped using standard methods. We defined a pre-PCV13 time period 2005-2008 and post-PCV13 time period April 2010-December 2013; excluding Jan 2009-March 2010 because PCV13 was introduced pre-licensure in one high-risk region in 2009. RESULTS Among Alaska children <5 years, PCV13 serotypes comprised 65% of IPD in the pre-PCV13 period and 26% in the PCV13 period. Among all Alaska children <5 years, IPD rates decreased from 60.9 (pre) to 25.4 (post) per 100,000/year (P<0.001); PCV13 serotype IPD decreased from 37.7 to 6.4 (P<0.001). Among AN children <5 years, IPD rates decreased from 149.2 to 60.8 (P<0.001); PCV13 serotype IPD decreased from 87.0 to 17.4 (P<0.001); non-PCV13 serotype IPD did not change significantly. Among persons 5-17 and ≥45 years, the post-vaccine IPD rate was similar to the baseline period, but declined in persons 18-44 years (39%, P<0.001); this decline was similar in AN and non-AN persons (38%, P=0.016, 43%, P=0.014, respectively). CONCLUSIONS Forty-five months after PCV13 introduction, overall IPD and PCV13-serotype IPD rates had decreased 58% and 83%, respectively, in Alaska children <5 years of age when compared with 2005-2008. We observed evidence of indirect effect among adults with a 39% reduction in IPD among persons 18-44 years.
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Affiliation(s)
- Michael G Bruce
- Arctic Investigations Program, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA.
| | | | - Lisa Bulkow
- Arctic Investigations Program, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Karen Rudolph
- Arctic Investigations Program, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Tammy Zulz
- Arctic Investigations Program, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Prabhu Gounder
- Arctic Investigations Program, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Debby Hurlburt
- Arctic Investigations Program, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Dana Bruden
- Arctic Investigations Program, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Thomas Hennessy
- Arctic Investigations Program, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
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Reed C, Bruden D, Byrd KK, Veguilla V, Bruce M, Hurlburt D, Wang D, Holiday C, Hancock K, Ortiz JR, Klejka J, Katz JM, Uyeki TM. Characterizing wild bird contact and seropositivity to highly pathogenic avian influenza A (H5N1) virus in Alaskan residents. Influenza Other Respir Viruses 2014; 8:516-23. [PMID: 24828535 PMCID: PMC4181814 DOI: 10.1111/irv.12253] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Highly pathogenic avian influenza A (HPAI) H5N1 viruses have infected poultry and wild birds on three continents with more than 600 reported human cases (59% mortality) since 2003. Wild aquatic birds are the natural reservoir for avian influenza A viruses, and migratory birds have been documented with HPAI H5N1 virus infection. Since 2005, clade 2.2 HPAI H5N1 viruses have spread from Asia to many countries. OBJECTIVES We conducted a cross-sectional seroepidemiological survey in Anchorage and western Alaska to identify possible behaviors associated with migratory bird exposure and measure seropositivity to HPAI H5N1. METHODS We enrolled rural subsistence bird hunters and their families, urban sport hunters, wildlife biologists, and a comparison group without bird contact. We interviewed participants regarding their exposures to wild birds and collected blood to perform serologic testing for antibodies against a clade 2.2 HPAI H5N1 virus strain. RESULTS Hunters and wildlife biologists reported exposures to wild migratory birds that may confer risk of infection with avian influenza A viruses, although none of the 916 participants had evidence of seropositivity to HPAI H5N1. CONCLUSIONS We characterized wild bird contact among Alaskans and behaviors that may influence risk of infection with avian influenza A viruses. Such knowledge can inform surveillance and risk communication surrounding HPAI H5N1 and other influenza viruses in a population with exposure to wild birds at a crossroads of intercontinental migratory flyways.
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Affiliation(s)
- Carrie Reed
- Epidemic Intelligence Service, Centers for Disease Control and PreventionAtlanta, GA, USA
- Influenza Division, Centers for Disease Control and PreventionAtlanta, GA, USA
| | - Dana Bruden
- Arctic Investigations Program, Centers for Disease Control and PreventionAnchorage, AK, USA
| | - Kathy K Byrd
- Epidemic Intelligence Service, Centers for Disease Control and PreventionAtlanta, GA, USA
- Arctic Investigations Program, Centers for Disease Control and PreventionAnchorage, AK, USA
| | - Vic Veguilla
- Influenza Division, Centers for Disease Control and PreventionAtlanta, GA, USA
| | - Michael Bruce
- Arctic Investigations Program, Centers for Disease Control and PreventionAnchorage, AK, USA
| | - Debby Hurlburt
- Arctic Investigations Program, Centers for Disease Control and PreventionAnchorage, AK, USA
| | - David Wang
- Influenza Division, Centers for Disease Control and PreventionAtlanta, GA, USA
| | - Crystal Holiday
- Influenza Division, Centers for Disease Control and PreventionAtlanta, GA, USA
| | - Kathy Hancock
- Influenza Division, Centers for Disease Control and PreventionAtlanta, GA, USA
| | - Justin R Ortiz
- Epidemic Intelligence Service, Centers for Disease Control and PreventionAtlanta, GA, USA
- Departments of Medicine and Global Health, University of WashingtonSeattle, WA, USA
| | - Joe Klejka
- Yukon Kuskokwim Health CorporationBethel, AK, USA
| | - Jacqueline M Katz
- Influenza Division, Centers for Disease Control and PreventionAtlanta, GA, USA
| | - Timothy M Uyeki
- Influenza Division, Centers for Disease Control and PreventionAtlanta, GA, USA
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Reisman J, Rudolph K, Bruden D, Hurlburt D, Bruce MG, Hennessy T. Risk Factors for Pneumococcal Colonization of the Nasopharynx in Alaska Native Adults and Children. J Pediatric Infect Dis Soc 2014; 3:104-11. [PMID: 26625363 PMCID: PMC6924510 DOI: 10.1093/jpids/pit069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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] [Received: 04/30/2013] [Accepted: 08/22/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND Alaska Native children have high invasive pneumococcal disease (IPD) rates, and lack of in-home running water has been shown to have a significant association with infection. Pneumococcal conjugate vaccines reduced IPD; however, this population saw substantial replacement disease and colonization with nonvaccine serotypes. We evaluated risk factors for nasopharyngeal pneumococcal colonization in Alaska Native adults and children. METHODS We conducted annual surveys from 2008 through 2011 of residents of all ages in 8 rural Alaskan villages. Interviews were conducted, medical charts were reviewed, and nasopharyngeal swabs were cultured for Streptococcus pneumoniae. Multivariate logistic regression models were developed for 3 age groups (under 10 years, 10-17 years, and 18 years and older) to determine risk factors for colonization. RESULTS We obtained 12 535 nasopharyngeal swabs from 4980 participants. Our population lived in severely crowded conditions, and 48% of households lacked in-home running water. In children <10 years, colonization was associated with lack of in-home running water, household crowding, and more children in the home. Pneumococcal vaccination status was not associated with colonization. In older children and adults, increased number of persons in the household was associated with pneumococcal colonization. CONCLUSIONS Higher colonization prevalence may partially explain increased IPD rates seen in those lacking in-home water services. Improving availability of sanitation services and reducing household crowding may reduce the burden of IPD in this population.
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Affiliation(s)
- Jonathan Reisman
- Department of Internal Medicine-Pediatrics, Harvard-Massachusetts General Hospital, Boston
| | - Karen Rudolph
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Dana Bruden
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Debby Hurlburt
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Michael G. Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Thomas Hennessy
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
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Bruce MG, Zulz T, DeByle C, Singleton R, Hurlburt D, Bruden D, Rudolph K, Hennessy T, Klejka J, Wenger JD. Haemophilus influenzae serotype a invasive disease, Alaska, USA, 1983-2011. Emerg Infect Dis 2013; 19:932-7. [PMID: 23735653 PMCID: PMC3713835 DOI: 10.3201/eid1906.121805] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [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] [Indexed: 12/01/2022] Open
Abstract
Before introduction of Haemophilus influenzae type b (Hib) vaccines, rates of Hib disease in Alaska’s indigenous people were among the highest in the world. Vaccination reduced rates dramatically; however, invasive H. influenzae type a (Hia) disease has emerged. Cases of invasive disease were identified through Alaska statewide surveillance during1983–2011. Of 866 isolates analyzed for serotype, 32 (4%) were Hia. No Hia disease was identified before 2002; 32 cases occurred during 2002–2011 (p<0.001). Median age of case-patients was 0.7 years; 3 infants died. Incidence of Hia infection (2002–2011) among children <5 years was 5.4/100,000; 27 cases occurred in Alaska Native children (18/100,000) versus 2 cases in non-Native children (0.5/100,000) (risk ratio = 36, p<0.001). From 12/2009 to 12/2011, 15 cases of Hia disease occurred in southwestern Alaska (in children <5 years, rate = 204/100,000). Since introduction of the Hib conjugate vaccine, Hia infection has become a major invasive bacterial disease in Alaska Native children.
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Affiliation(s)
- Michael G Bruce
- Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska 99507, USA.
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Rudolph K, Bruce MG, Bulkow L, Zulz T, Reasonover A, Harker-Jones M, Hurlburt D, Hennessy TW. Molecular epidemiology of serotype 19A Streptococcus pneumoniae among invasive isolates from Alaska, 1986-2010. Int J Circumpolar Health 2013; 72:20854. [PMID: 23984273 PMCID: PMC3753058 DOI: 10.3402/ijch.v72i0.20854] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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] [Indexed: 11/18/2022] Open
Abstract
Background After the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in Alaska, the incidence of invasive pneumococcal disease (IPD) due to non-vaccine serotypes, particularly serotype 19A, increased. The aim of this study was to describe the molecular epidemiology of IPD due to serotype 19A in Alaska. Methods IPD data were collected from 1986 to 2010 through population-based laboratory surveillance. Isolates were serotyped by the Quellung reaction and MICs determined by broth microdilution. Genotypes were assessed by multilocus sequence typing. Results Among 3,294 cases of laboratory-confirmed IPD, 2,926 (89%) isolates were available for serotyping, of which 233 (8%) were serotype 19A. Across all ages, the proportion of IPD caused by serotype 19A increased from 3.5% (63/1823) pre-PCV7 (1986–2000) to 15.4% (170/1103) post-PCV7 (2001–2010) (p<0.001); among children <5 years of age, the proportion increased from 5.0% (39/776) to 33.0% (76/230) (p<0.001). The annual incidence rate of IPD due to serotype 19A (all ages) increased from 0.73 cases pre-PCV7 to 2.56 cases/100,000 persons post-PCV7 (p<0.001); rates among children <5 years of age increased from 4.84 cases to 14.1 cases/100,000 persons (p<0.001). Among all IPD isolates with reduced susceptibility to penicillin, 17.8% (32/180) were serotype 19A pre-PCV7 and 64% (121/189) were serotype 19A post-PCV7 (p<0.001). Eighteen different sequence types (STs) were identified; ST199 or single locus variants of ST199 (n=150) and ST172 (n=59) accounted for the majority of isolates. Multidrug-resistant isolates were clustered in ST199 and ST320. Conclusion While PCV13 should significantly reduce the burden of disease due to 19A, these data highlight the need to continue surveillance for IPD to monitor the effects of vaccination on the expansion and emergence of non-PCV strains.
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Affiliation(s)
- Karen Rudolph
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Anchorage, Alaska 99508, USA.
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Rudolph K, Bruce M, Bruden D, Zulz T, Wenger J, Reasonover A, Harker-Jones M, Hurlburt D, Hennessy T. Epidemiology of pneumococcal serotype 6A and 6C among invasive and carriage isolates from Alaska, 1986-2009. Diagn Microbiol Infect Dis 2012; 75:271-6. [PMID: 23276772 DOI: 10.1016/j.diagmicrobio.2012.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 10/19/2012] [Accepted: 11/21/2012] [Indexed: 11/19/2022]
Abstract
We investigated serotype 6A/6C invasive pneumococcal disease (IPD) incidence, genetic diversity, and carriage before and after 7-valent pneumococcal conjugate vaccine (PCV7) introduction in Alaska. IPD cases (1986-2009) were identified through population-based laboratory surveillance. Isolates were initially serotyped by conventional methods, and 6C isolates were differentiated from 6A by polymerase chain reaction. Among invasive and carriage isolates initially typed as 6A, 35% and 50% were identified as 6C, respectively. IPD rates caused by serotype 6A or 6C among children <5 years did not change from the pre- to post-PCV7 period (P = 0.71 and P = 0.09, respectively). Multilocus sequence typing of IPD isolates revealed 28 sequence types. The proportion of serotype 6A carriage isolates decreased from 7.4% pre-PCV7 to 1.8% (P < 0.001) during 2008-2009; the proportion of serotype 6C carriage isolates increased from 3.0% to 8.4% (P = 0.004) among children <5 years. Continued surveillance is warranted to monitor changes in serotype distribution and prevalence.
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Affiliation(s)
- Karen Rudolph
- Arctic Investigations Program, Centers for Disease Control and Prevention, Anchorage, AK 99508, USA
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18
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Bruden DL, Bruce MG, Miernyk KM, Morris J, Hurlburt D, Hennessy TW, Peters H, Sacco F, Parkinson AJ, McMahon BJ. Diagnostic accuracy of tests for Helicobacter pylori in an Alaska Native population. World J Gastroenterol 2011; 17:4682-8. [PMID: 22180710 PMCID: PMC3233674 DOI: 10.3748/wjg.v17.i42.4682] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 12/01/2010] [Accepted: 12/08/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the accuracy of two non-invasive tests in a population of Alaska Native persons. High rates of Helicobacter pylori (H. pylori) infection, H. pylori treatment failure, and gastric cancer in this population necessitate documentation of infection status at multiple time points over a patient’s life.
METHODS: In 280 patients undergoing endoscopy, H. pylori was diagnosed by culture, histology, rapid urease test, 13C urea breath test (UBT), and immunoglobulin G antibodies to H. pylori in serum. The performances of 13C-UBT and antibody test were compared to a gold standard defined by a positive H. pylori test by culture or, in case of a negative culture result, by positive histology and a positive rapid urease test.
RESULTS: The sensitivity and specificity of the 13C-UBT were 93% and 88%, respectively, relative to the gold standard. The antibody test had an equivalent sensitivity of 93% with a reduced specificity of 68%. The false positive results for the antibody test were associated with previous treatment for an H. pylori infection [relative risk (RR) = 2.8]. High levels of antibodies to H. pylori were associated with chronic gastritis and male gender, while high scores in the 13C-UBT test were associated with older age and with the H. pylori bacteria load on histological examination (RR = 4.4).
CONCLUSION: The 13C-UBT outperformed the antibody test for H. pylori and could be used when a non-invasive test is clinically necessary to document treatment outcome or when monitoring for reinfection.
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Wenger JD, Castrodale LJ, Bruden DL, Keck JW, Zulz T, Bruce MG, Fearey DA, McLaughlin J, Hurlburt D, Hummel KB, Kitka S, Bentley S, Thomas TK, Singleton R, Redd JT, Layne L, Cheek JE, Hennessy TW. 2009 Pandemic influenza A H1N1 in Alaska: temporal and geographic characteristics of spread and increased risk of hospitalization among Alaska Native and Asian/Pacific Islander people. Clin Infect Dis 2011; 52 Suppl 1:S189-97. [PMID: 21342894 DOI: 10.1093/cid/ciq037] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Alaska Native people have suffered disproportionately from previous influenza pandemics. We evaluated 3 separate syndromic data sources to determine temporal and geographic patterns of spread of 2009 pandemic influenza A H1N1 (pH1N1) in Alaska, and reviewed records from persons hospitalized with pH1N1 disease in 3 areas in Alaska to characterize clinical and epidemiologic features of disease in Alaskans. A wave of pH1N1 disease swept through Alaska beginning in most areas in August or early September. In rural regions, where Alaska Native people comprise a substantial proportion of the population, disease occurred earlier than in other regions. Alaska Native people and Asian/Pacific Islanders (A/PI) were 2-4 times more likely to be hospitalized than whites. Alaska Native people and other minorities remain at high risk for early and substantial morbidity from pandemic influenza episodes. These findings should be integrated into plans for distribution and use of vaccine and antiviral agents.
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Affiliation(s)
- Jay D Wenger
- Arctic Investigations Program, Centers for Disease Control and Prevention, Anchorage, Alaska 99508, USA.
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Bruce M, Deeks S, Cottle T, Palacios C, Case C, Hemsley C, Lovgren M, Sobol I, Corriveau A, Larke B, Hennessy T, Debyle C, Harker-Jones M, Hurlburt D, Peters H, Parkinson A. O253 Epidemiology of Haemophilus in fluenzae serotype A from 2000–2005, an emerging pathogen in Northern Canada and Alaska. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70161-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Singleton RJ, Butler JC, Bulkow LR, Hurlburt D, O'Brien KL, Doan W, Parkinson AJ, Hennessy TW. Invasive pneumococcal disease epidemiology and effectiveness of 23-valent pneumococcal polysaccharide vaccine in Alaska Native adults. Vaccine 2007; 25:2288-95. [PMID: 17254673 DOI: 10.1016/j.vaccine.2006.11.065] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Revised: 11/18/2006] [Accepted: 11/30/2006] [Indexed: 10/23/2022]
Abstract
Alaska Native persons have age-adjusted invasive pneumococcal disease (IPD) rates two- to three-fold greater than non-Native Alaskans. To characterize IPD epidemiology and 23-valent polysaccharide pneumococcal vaccine (PPV-23) effectiveness in Alaska Native adults we reviewed IPD cases from Alaska-wide, laboratory-based surveillance. Sterile site isolates were serotyped. Vaccine effectiveness (VE) was estimated using the indirect cohort method. 394 cases (44.5 cases/100,000/year) occurred in 374 Alaska Native adults (36.0% aged > or =55 years). Underlying conditions included heavy alcohol use (65.7%), smoking (60.8%) and COPD (25.0%). Overall VE was 75% (95% confidence interval [CI]: 27%, 91%) but declined with increasing age; for persons > or =55 years (VE=<0; 95% CI: <0, 78%; p=0.713). Alaska Native adults experience high rates of IPD. The majority of IPD cases occurred in persons with underlying conditions and behaviors associated with increased risk of IPD in other populations. PPV-23 vaccine effectiveness was confirmed in younger Alaska Native adults but not among adults > or =55 years.
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Affiliation(s)
- Rosalyn J Singleton
- Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK 99508, USA.
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Hennessy TW, Petersen KM, Bruden D, Parkinson AJ, Hurlburt D, Getty M, Schwartz B, Butler JC. Changes in antibiotic-prescribing practices and carriage of penicillin-resistant Streptococcus pneumoniae: A controlled intervention trial in rural Alaska. Clin Infect Dis 2002; 34:1543-50. [PMID: 12032887 DOI: 10.1086/340534] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2001] [Revised: 01/17/2002] [Indexed: 11/03/2022] Open
Abstract
From 1998 to 2000, 13 rural Alaskan villages (population, 3326) were surveyed annually by nasopharyngeal cultures for Streptococcus pneumoniae carriage. Data regarding antibiotic use for the entire population was abstracted from clinic records. In 1999, education of medical providers and the community about appropriate antibiotic use began in 4 villages; this program was expanded to include all villages in 2000. Antibiotic courses per person decreased by 31% in the initial intervention villages and by 35% in the remaining villages after education (P<.01 for each). Samples were obtained for culture from a mean of 31% of the population each year; 31% carried pneumococcus. No sustained decrease in carriage of penicillin-nonsusceptible strains was observed. When linear regression was used, serotype accounted for 81% of the variance in pneumococcal minimum inhibitory concentrations after the intervention, compared with 7% for antibiotic use. This suggests that reducing the carriage of serotypes associated with antibiotic resistance by use of pneumococcal conjugate vaccines may have a greater short-term impact than does decreasing antibiotic use.
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Affiliation(s)
- Thomas W Hennessy
- Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, 99508, USA.
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Hennessy TW, Bruden D, Petersen KM, Parkinson AJ, Hurlburt D, Getty M, Butler JC, Schwartz B. Effect of high-dose amoxicillin on the prevalence of penicillin-resistant Streptococcus pneumoniae in rural Alaska. JAMA 2002; 287:2078-9. [PMID: 11966381 DOI: 10.1001/jama.287.16.2078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Karron RA, Singleton RJ, Bulkow L, Parkinson A, Kruse D, DeSmet I, Indorf C, Petersen KM, Leombruno D, Hurlburt D, Santosham M, Harrison LH. Severe respiratory syncytial virus disease in Alaska native children. RSV Alaska Study Group. J Infect Dis 1999; 180:41-9. [PMID: 10353859 DOI: 10.1086/314841] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.3] [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: 11/03/2022] Open
Abstract
Hospitalization rates for respiratory syncytial virus (RSV) infection range from 1 to 20/1000 infants. To determine the rate and severity of RSV infections requiring hospitalization for infants in the Yukon-Kuskokwim (YK) Delta of Alaska, a 3-year prospective surveillance study was conducted. The annual rate of RSV hospitalization for YK Delta infants <1 year of age was 53-249/1000. RSV infection was the most frequent cause of infant hospitalization. RSV disease severity did not differ among non-high-risk infants in the YK Delta and at Johns Hopkins Hospital (JHH). On average, 1/125 infants born in the YK Delta required mechanical ventilation for RSV infection. During the peak season, approximately $1034/child <3 years of age was spent on RSV hospitalization in the YK Delta. In YK Delta infants </=6 months old, RSV microneutralizing antibody titers <1200 were associated with severe disease (odds ratio=6.2, P=.03). In the YK Delta and at JHH, newborns may be at greater risk for severe RSV illness than previously thought.
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Affiliation(s)
- R A Karron
- Center for Immunization Research, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205, USA.
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Abstract
Deep friction massage (DFM) is a therapeutic modality for tendinitis, muscle strains, ligamentous sprains, and capsulitis of the trapezio-first-metacarpal joint. Depending on the stage and site of the lesion, treatment sessions may be as brief as 5 minutes or as long as 20 minutes. Many therapists find DFM to be very effective but state that treatment is very fatiguing to administer. Therapists with hypermobile fingers find it particularly difficult to perform. In order to overcome these two problems, a number of splints have been designed to treat various lesions. This article describes how to fabricate one of these splints. This splint is useful for commonly seen lesions such as supraspinatus tendinitis and a sprained acromioclavicular ligament.
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