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Hassan KE, Mansour A, Shaheen H, Amine M, Riddle MS, Young SYN, Sebeny P, Levin S. The impact of household hygiene on the risk of bacterial diarrhea among Egyptian children in rural areas, 2004–2007. J Infect Dev Ctries 2014; 8:1541-51. [DOI: 10.3855/jidc.4539] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 06/06/2014] [Accepted: 09/02/2014] [Indexed: 10/31/2022] Open
Abstract
Introduction: The present study, conducted between January 2004 and April 2007, explored the impact of household hygiene on the risk of bacterial diarrhea, using data from a prospective birth cohort of 348 infants in five villages in the Nile Delta in Egypt. Methodology: Neonates were enrolled at birth and followed up until 24 months of age. Children were visited twice a week to survey them for acute diarrhea. A detailed observational household hygiene survey was completed in-house every six months. Adjusted relative risk (aRR) of developing bacterial diarrhea was calculated for exposure to different hygiene variables and examined for specific bacterial pathogens. Results: Exclusive breastfeeding reduced the risk of bacterial diarrhea by 70%, while bacterial diarrhea cases were 2.6 times higher in the warm season. Risk of Campylobacter diarrhea increased with the absence of barriers to keep birds and animals out of the eating area, the presence of garbage containers and a bathing facility within the compound, and the presence of feces on the floor of the bathing facility. Use of municipal water for drinking and cooking was associated with a lower risk of Campylobacter diarrhea. Risk of enterotoxigenic Escherichia coli diarrhea increased with uncovered garbage containers and the presence of liquid materials in the garbage containers, but decreased with the use of tap water in the washing facility. Conclusion: The results highlight some potential targets for interventions, such as expanding municipal water supply to all houses and comprehensive mass-media awareness programs to change hygiene-promoting behaviors and practices.
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Farrell M, Sebeny P, Klena JD, DeMattos C, Pimentel G, Turner M, Joseph A, Espiritu J, Zumwalt J, Dueger E. Influenza risk management: lessons learned from an A(H1N1) pdm09 outbreak investigation in an operational military setting. PLoS One 2013; 8:e68639. [PMID: 23874699 PMCID: PMC3707881 DOI: 10.1371/journal.pone.0068639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 05/30/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND At the onset of an influenza pandemic, when the severity of a novel strain is still undetermined and there is a threat of introduction into a new environment, e.g., via the deployment of military troops, sensitive screening criteria and conservative isolation practices are generally recommended. OBJECTIVES In response to elevated rates of influenza-like illness among U.S. military base camps in Kuwait, U.S. Naval Medical Research Unit No. 3 partnered with local U.S. Army medical units to conduct an A(H1N1) pdm09 outbreak investigation. PATIENTS/METHODS Initial clinical data and nasal specimens were collected via the existent passive surveillance system and active surveillance was conducted using a modified version of the World Health Organization/U.S. Centers for Disease Control and Prevention influenza-like illness case definition [fever (T > 100.5˚F/38˚C) in addition to cough and/or sore throat in the previous 72 hours] as the screening criteria. Samples were tested via real-time reverse-transcription PCR and sequenced for comparison to global A(H1N1) pdm09 viruses from the same time period. RESULTS The screening criteria used in Kuwait proved insensitive, capturing only 16% of A(H1N1) pdm09-positive individuals. While still not ideal, using cough as the sole screening criteria would have increased sensitivity to 73%. CONCLUSIONS The results of and lessons learned from this outbreak investigation suggest that pandemic influenza risk management should be a dynamic process (as information becomes available regarding true attack rates and associated mortality, screening and isolation criteria should be re-evaluated and revised as appropriate), and that military operational environments present unique challenges to influenza surveillance.
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Affiliation(s)
- Margaret Farrell
- Global Disease Detection and Response Program, United States of America. Naval Medical Research Unit No, Cairo, Egypt
| | - Peter Sebeny
- Clinical Trials and Military Studies Department, United States Naval Medical Research Unit No. 3, Cairo, Egypt
| | - John D. Klena
- Clinical Trials and Military Studies Department, United States Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Cecilia DeMattos
- Naval Health Research Center, San Diego, California, United States of America
- Viral and Zoonotic Disease Research Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Guillermo Pimentel
- Viral and Zoonotic Disease Research Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Mark Turner
- Naval Hospital Bremerton, Bremerton, Washington, United States of America
| | - Antony Joseph
- Navy Environmental and Preventative Medicine Unit, Naval Medical Center San Diego, San Diego, California, United States of America
| | - Jennifer Espiritu
- Epidemic Intelligence Service Program, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John Zumwalt
- Navy Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida, United States of America
| | - Erica Dueger
- Global Disease Detection and Response Program, United States of America. Naval Medical Research Unit No, Cairo, Egypt
- Global Disease Detection Branch, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Nada RA, Armstrong A, Shaheen HI, Nakhla I, Sanders JW, Riddle MS, Young S, Sebeny P. Phenotypic and genotypic characterization of enterotoxigenic Escherichia coli isolated from U.S. military personnel participating in Operation Bright Star, Egypt, from 2005 to 2009. Diagn Microbiol Infect Dis 2013; 76:272-7. [PMID: 23639795 DOI: 10.1016/j.diagmicrobio.2013.03.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 03/06/2013] [Accepted: 03/22/2013] [Indexed: 11/16/2022]
Abstract
Enterotoxigenic Escherichia coli (ETEC) is a major health problem for travelers to the Middle East. During the autumn months of 2005, 2007, and 2009, U.S. military personnel participated in Operation Bright Star (OBS) exercises in Egypt. Out of 181 military personnel enrolled in a diarrheal surveillance study, E. coli-like colonies were isolated from 170 patients. Isolates were tested for the detection of ETEC enterotoxins and colonization factors (CFs) using phenotypic and genotypic methods. Additionally, we studied the secular trends of ETEC isolates obtained from OBS studies since 1999. ETEC was isolated from 51.2% and 60.0% of the patients based on enzyme-linked immunosorbent assay and polymerase chain reaction (PCR), respectively. Heat stable (ST) was the dominant enterotoxin detected followed by heat labile (LT) and LTST. Additionally, we detected a CF in 59.7% and 67.6% of the ETEC-positive isolates using dot blot and PCR assays, respectively. The predominant CF isolated was CS6 followed by CS3.
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Affiliation(s)
- Rania A Nada
- U.S. Naval Medical Research Unit No. 3, Cairo, Egypt.
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McKenzie R, Porter CK, Cantrell JA, Denearing B, O'Dowd A, Grahek SL, Sincock SA, Woods C, Sebeny P, Sack DA, Tribble DR, Bourgeois AL, Savarino SJ. Volunteer challenge with enterotoxigenic Escherichia coli that express intestinal colonization factor fimbriae CS17 and CS19. J Infect Dis 2011; 204:60-4. [PMID: 21628659 DOI: 10.1093/infdis/jir220] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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
Human challenges with enterotoxigenic Escherichia coli (ETEC) have broadened our understanding of this important enteropathogen. We report findings from the first challenge studies using ETEC-expressing colonization factor fimbria CS17 and CS19. LSN03-016011/A (LT, CS17) elicited a dose-dependent effect, with the upper dose (6 × 10(9) organisms) causing diarrhea in 88% of recipients. WS0115A (LTSTp, CS19) also showed a dose response, with a 44% diarrhea rate at 9 × 10(9) organisms. Both strains elicited homologous antifimbrial and anti-LT antibody seroconversion. These studies establish the relative pathogenicity of ETEC expressing newer class 5 fimbriae and suggest suitability of the LT|CS17-ETEC challenge model for interventional trials.
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Affiliation(s)
- Robin McKenzie
- Department of Medicine, Johns Hopkins University, Johns Hopkins Bayview Medical Center, MD, USA
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Porter CK, Riddle MS, Tribble DR, Louis Bougeois A, McKenzie R, Isidean SD, Sebeny P, Savarino SJ. A systematic review of experimental infections with enterotoxigenic Escherichia coli (ETEC). Vaccine 2011; 29:5869-85. [PMID: 21616116 DOI: 10.1016/j.vaccine.2011.05.021] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 05/04/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
Abstract
Volunteer challenge with enterotoxigenic Escherichia coli (ETEC) has been used for four decades to elucidate the pathogenesis and immune responses and assess efficacy of various interventions. We performed a systematic review of these studies and a meta-analysis of individual patient-level data (IPD) from a subset of studies using standard methodology. We identified 27 studies of 11 ETEC strains administered to 443 naive subjects at doses from 1×10(6) to 1×10(10) colony forming units (cfu). Diarrhea attack rates varied by strain, dose and enterotoxin. Similar rates were seen at doses of 5×10(8) to 1×10(10)cfu with the three most commonly used strains B7A, E24377A, H10407. In IPD analysis, the highest diarrhea attack rates were seen with strains B7A, H10407 and E24377A. The H10407 induced significantly higher stool output than the other strains. Additionally, the rate of output was different across strains. The risk of diarrhea, abdominal cramps, nausea and headaches differed significantly by ETEC strain. An increased risk of nausea, abdominal cramps and headaches was seen for females. Baseline anti-LT IgG titers appeared to be associated with a decrease risk of diarrhea outcomes, a trend not seen with anti-LT IgA or seen consistently with anti-colonization factor antibodies. Neither early antibiotic treatment nor diarrhea duration significantly affected the frequency or magnitude of serologic responses. These studies have served as an invaluable tool in understanding disease course, pathogenicity, innate immune responses and an early assessment of product efficacy. When designing and planning experimental ETEC infection studies in this age of increased ethical scrutiny and growing appreciation of post-infectious sequelae, better understanding of available data is essential.
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Affiliation(s)
- Chad K Porter
- Naval Medical Research Center, Enteric Diseases Department, Silver Spring, MD, United States.
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Money NN, Maves RC, Sebeny P, Kasper MR, Riddle MS, Wu M, Lee JE, Schnabel D, Bowden R, Oaks EV, Ocaña V, Acosta L, Gotuzzo E, Lanata C, Ochoa T, Aguayo N, Bernal M, Meza R, Canal E, Gregory M, Cepeda D, Listiyaningsih E, Putnam SD, Young S, Mansour A, Nakhla I, Moustafa M, Hassan K, Klena J, Bruton J, Shaheen H, Farid S, Fouad S, El-Mohamady H, Styles T, Shiau LCDRD, Espinosa B, McMullen K, Reed E, Neil D, Searles D, Nevin R, Von Thun A, Sessions C. Enteric disease surveillance under the AFHSC-GEIS: current efforts, landscape analysis and vision forward. BMC Public Health 2011; 11 Suppl 2:S7. [PMID: 21388567 PMCID: PMC3092417 DOI: 10.1186/1471-2458-11-s2-s7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The mission of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) is to support global public health and to counter infectious disease threats to the United States Armed Forces, including newly identified agents or those increasing in incidence. Enteric diseases are a growing threat to U.S. forces, which must be ready to deploy to austere environments where the risk of exposure to enteropathogens may be significant and where routine prevention efforts may be impractical. In this report, the authors review the recent activities of AFHSC-GEIS partner laboratories in regards to enteric disease surveillance, prevention and response. Each partner identified recent accomplishments, including support for regional networks. AFHSC/GEIS partners also completed a Strengths, Weaknesses, Opportunities and Threats (SWOT) survey as part of a landscape analysis of global enteric surveillance efforts. The current strengths of this network include excellent laboratory infrastructure, equipment and personnel that provide the opportunity for high-quality epidemiological studies and test platforms for point-of-care diagnostics. Weaknesses include inconsistent guidance and a splintered reporting system that hampers the comparison of data across regions or longitudinally. The newly chartered Enterics Surveillance Steering Committee (ESSC) is intended to provide clear mission guidance, a structured project review process, and central data management and analysis in support of rationally directed enteric disease surveillance efforts.
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Affiliation(s)
- Nisha N Money
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
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