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Worley RR, Moore SM, Tierney BC, Ye X, Calafat AM, Campbell S, Woudneh MB, Fisher J. Per- and polyfluoroalkyl substances in human serum and urine samples from a residentially exposed community. Environ Int 2017; 106:135-143. [PMID: 28645013 PMCID: PMC5673082 DOI: 10.1016/j.envint.2017.06.007] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/06/2017] [Accepted: 06/07/2017] [Indexed: 05/19/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are considered chemicals of emerging concern, in part due to their environmental and biological persistence and the potential for widespread human exposure. In 2007, a PFAS manufacturer near Decatur, Alabama notified the United States Environmental Protection Agency (EPA) it had discharged PFAS into a wastewater treatment plant, resulting in environmental contamination and potential exposures to the local community. OBJECTIVES To characterize PFAS exposure over time, the Agency for Toxic Substances and Disease Registry (ATSDR) collected blood and urine samples from local residents. METHODS Eight PFAS were measured in serum in 2010 (n=153). Eleven PFAS were measured in serum, and five PFAS were measured in urine (n=45) from some of the same residents in 2016. Serum concentrations were compared to nationally representative data and change in serum concentration over time was evaluated. Biological half-lives were estimated for perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), and perfluorohexane sulfonic acid (PFHxS) using a one-compartment pharmacokinetic model. RESULTS In 2010 and 2016, geometric mean PFOA and PFOS serum concentrations were elevated in participants compared to the general U.S. POPULATION In 2016, the geometric mean PFHxS serum concentration was elevated compared to the general U.S. POPULATION Geometric mean serum concentrations of PFOA, PFOS, and perfluorononanoic acid (PFNA) were significantly (p≤0.0001) lower (49%, 53%, and 58%, respectively) in 2016 compared to 2010. Half-lives for PFOA, PFOS, and PFHxS were estimated to be 3.9, 3.3, and 15.5years, respectively. Concentrations of PFOA in serum and urine were highly correlated (r=0.75) in males. CONCLUSIONS Serum concentrations of some PFAS are decreasing in this residentially exposed community, but remain elevated compared to the U.S. general population.
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Affiliation(s)
- Rachel Rogers Worley
- Division of Community Health Investigations, Agency for Toxic Substances and Disease Registry, Atlanta, GA, USA.
| | - Susan McAfee Moore
- Division of Community Health Investigations, Agency for Toxic Substances and Disease Registry, Atlanta, GA, USA
| | - Bruce C Tierney
- Division of Community Health Investigations, Agency for Toxic Substances and Disease Registry, Atlanta, GA, USA
| | - Xiaoyun Ye
- Division of Laboratory Sciences, National Center for Environmental Health, Atlanta, GA, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Atlanta, GA, USA
| | | | | | - Jeffrey Fisher
- National Center for Toxicological Research, Food and Drug Administration, Jefferson, AR, USA
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Martin SW, Tierney BC, Aranas A, Rosenstein NE, Franzke LH, Apicella L, Marano N, McNeil MM. An overview of adverse events reported by participants in CDC's anthrax vaccine and antimicrobial availability program. Pharmacoepidemiol Drug Saf 2005; 14:393-401. [PMID: 15717323 DOI: 10.1002/pds.1085] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The CDC's Anthrax Vaccine and Antibiotic Availability Program was implemented under an Investigational New Drug (IND) application to provide additional post-exposure prophylaxis for individuals potentially exposed to Bacillus anthracis in the fall of 2001. Participants were provided with two options: (1) 40 additional days of antimicrobial prophylaxis (i.e., ciprofloxacin, doxycycline, or amoxicillin); or (2) 40 additional days of antimicrobial prophylaxis plus three doses of anthrax vaccine adsorbed (AVA). METHODS Participants were monitored for adverse events (AEs). Participants were asked to complete 2-week AE diaries for 6 weeks post-enrollment, and approximately 2 months after enrollment, active surveillance was conducted through telephone interviews with 1113 (64%) participants. RESULTS A total of 1727 of approximately 10 000 previously prophylaxed persons enrolled to receive 40 additional days of antibiotics. Of these, 199 opted at enrollment to receive three doses of AVA in addition to the additional 40 days of antibiotic. Overall, 28% of participants reported at least one AE on their diaries. Results varied by surveillance mechanism, the diary data indicated differences in the proportion reporting AEs between participants receiving antibiotic only and participants receiving antibiotic and AVA. However, during the active 2-month telephone follow-up, the rates of AEs reported for both the antibiotic only and antibiotic plus AVA treatment regimens were similar. Additionally, ciprofloxacin and doxycycline had similar AE profiles, with only rigors reported significantly more often among ciprofloxacin recipients. CONCLUSIONS Overall, the rates of AEs experienced by all participants were acceptable given the seriousness of potential B. anthracis exposure.
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Affiliation(s)
- Stacey W Martin
- Anthrax Vaccine Safety Team, Epidemiology and Surveillance Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Tierney BC, Martin SW, Franzke LH, Marano N, Reissman DB, Louchart RD, Goff JA, Rosenstein NE, Sever JL, McNeil MM. Serious adverse events among participants in the Centers for Disease Control and Prevention's Anthrax Vaccine and Antimicrobial Availability Program for persons at risk for bioterrorism-related inhalational anthrax. Clin Infect Dis 2003; 37:905-11. [PMID: 13130401 DOI: 10.1086/377738] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2003] [Accepted: 05/31/2003] [Indexed: 11/03/2022] Open
Abstract
On 20 December 2001, the Centers for Disease Control and Prevention (CDC) initiated the Anthrax Vaccine and Antibiotic Availability Program (hereafter, the "Program") under an investigational new drug application with the US Food and Drug Administration. This Program provided options for additional preventive treatment for persons at risk for inhalation anthrax as a result of recent bioterrorism attacks who had concluded or were concluding a 60-day course of antimicrobial prophylaxis. Participants were offered an additional 40 days of antibiotic therapy (with ciprofloxacin, doxycycline, or amoxicillin) or antibiotic therapy plus 3 doses of anthrax vaccine. By 11 February 2002, a total of 5420 persons had received standardized education about the Program and 1727 persons (32%) had enrolled. Twelve participants have been identified as having serious adverse events (SAEs). One SAE, which occurred in a participant with ciprofloxacin-induced allergic interstitial nephritis, was considered to be probably associated with treatment received in the Program. No SAEs were associated with anthrax vaccine. CDC will continue to monitor Program participants during the next 2 years.
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Affiliation(s)
- Bruce C Tierney
- Epidemiology Program Office, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Sejvar JJ, Haddad MB, Tierney BC, Campbell GL, Marfin AA, Van Gerpen JA, Fleischauer A, Leis AA, Stokic DS, Petersen LR. Neurologic manifestations and outcome of West Nile virus infection. JAMA 2003; 290:511-5. [PMID: 12876094 DOI: 10.1001/jama.290.4.511] [Citation(s) in RCA: 373] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT The neurologic manifestations, laboratory findings, and outcome of patients with West Nile virus (WNV) infection have not been prospectively characterized. OBJECTIVE To describe prospectively the clinical and laboratory features and long-term outcome of patients with neurologic manifestations of WNV infection. DESIGN, SETTING, AND PARTICIPANTS From August 1 to September 2, 2002, a community-based, prospective case series was conducted in St Tammany Parish, La. Standardized clinical data were collected on patients with suspected WNV infection. Confirmed WNV-seropositive patients were reassessed at 8 months. MAIN OUTCOME MEASURES Clinical, neurologic, and laboratory features at initial presentation, and long-term neurologic outcome. RESULTS Sixteen (37%) of 39 suspected cases had antibodies against WNV; 5 had meningitis, 8 had encephalitis, and 3 had poliomyelitis-like acute flaccid paralysis. Movement disorders, including tremor (15 [94%]), myoclonus (5 [31%]), and parkinsonism (11 [69%]), were common among WNV-seropositive patients. One patient died. At 8-month follow-up, fatigue, headache, and myalgias were persistent symptoms; gait and movement disorders persisted in 6 patients. Patients with WNV meningitis or encephalitis had favorable outcomes, although patients with acute flaccid paralysis did not recover limb strength. CONCLUSIONS Movement disorders, including tremor, myoclonus, and parkinsonism, may be present during acute illness with WNV infection. Some patients with WNV infection and meningitis or encephalitis ultimately may have good long-term outcome, although an irreversible poliomyelitis-like syndrome may result.
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Affiliation(s)
- James J Sejvar
- Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA.
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Sejvar JJ, Leis AA, Stokic DS, Van Gerpen JA, Marfin AA, Webb R, Haddad MB, Tierney BC, Slavinski SA, Polk JL, Dostrow V, Winkelmann M, Petersen LR. Acute flaccid paralysis and West Nile virus infection. Emerg Infect Dis 2003; 9:788-93. [PMID: 12890318 PMCID: PMC3023428 DOI: 10.3201/eid0907.030129] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Acute weakness associated with West Nile virus (WNV) infection has previously been attributed to a peripheral demyelinating process (Guillain-Barré syndrome); however, the exact etiology of this acute flaccid paralysis has not been systematically assessed. To thoroughly describe the clinical, laboratory, and electrodiagnostic features of this paralysis syndrome, we evaluated acute flaccid paralysis that developed in seven patients in the setting of acute WNV infection, consecutively identified in four hospitals in St. Tammany Parish and New Orleans, Louisiana, and Jackson, Mississippi. All patients had acute onset of asymmetric weakness and areflexia but no sensory abnormalities. Clinical and electrodiagnostic data suggested the involvement of spinal anterior horn cells, resulting in a poliomyelitis-like syndrome. In areas in which transmission is occurring, WNV infection should be considered in patients with acute flaccid paralysis. Recognition that such weakness may be of spinal origin may prevent inappropriate treatment and diagnostic testing.
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Affiliation(s)
- James J Sejvar
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Dewan PK, Fry AM, Laserson K, Tierney BC, Quinn CP, Hayslett JA, Broyles LN, Shane A, Winthrop KL, Walks I, Siegel L, Hales T, Semenova VA, Romero-Steiner S, Elie C, Khabbaz R, Khan AS, Hajjeh RA, Schuchat A. Inhalational anthrax outbreak among postal workers, Washington, D.C., 2001. Emerg Infect Dis 2002; 8:1066-72. [PMID: 12396917 PMCID: PMC2730301 DOI: 10.3201/eid0810.020330] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In October 2001, four cases of inhalational anthrax occurred in workers in a Washington, D.C., mail facility that processed envelopes containing Bacillus anthracis spores. We reviewed the envelopes' paths and obtained exposure histories and nasal swab cultures from postal workers. Environmental sampling was performed. A sample of employees was assessed for antibody concentrations to B. anthracis protective antigen. Case-patients worked on nonoverlapping shifts throughout the facility, suggesting multiple aerosolization events. Environmental sampling showed diffuse contamination of the facility. Potential workplace exposures were similar for the case-patients and the sample of workers. All nasal swab cultures and serum antibody tests were negative. Available tools could not identify subgroups of employees at higher risk for exposure or disease. Prophylaxis was necessary for all employees. To protect postal workers against bioterrorism, measures to reduce the risk of occupational exposure are necessary.
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Affiliation(s)
- Puneet K. Dewan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alicia M. Fry
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kayla Laserson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bruce C. Tierney
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Conrad P. Quinn
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Laura N. Broyles
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andi Shane
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ivan Walks
- Washington, D.C. Department of Health, Washington, D.C., USA
| | - Larry Siegel
- Washington, D.C. Department of Health, Washington, D.C., USA
| | - Thomas Hales
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Vera A. Semenova
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Cheryl Elie
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rima Khabbaz
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ali S. Khan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rana A. Hajjeh
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anne Schuchat
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - members of the Washington
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Washington, D.C. Department of Health, Washington, D.C., USA
| | - D.C.
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Washington, D.C. Department of Health, Washington, D.C., USA
| | - Anthrax Response Team1
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Washington, D.C. Department of Health, Washington, D.C., USA
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Traeger MS, Wiersma ST, Rosenstein NE, Malecki JM, Shepard CW, Raghunathan PL, Pillai SP, Popovic T, Quinn CP, Meyer RF, Zaki SR, Kumar S, Bruce SM, Sejvar JJ, Dull PM, Tierney BC, Jones JD, Perkins BA. First case of bioterrorism-related inhalational anthrax in the United States, Palm Beach County, Florida, 2001. Emerg Infect Dis 2002; 8:1029-34. [PMID: 12396910 PMCID: PMC2730309 DOI: 10.3201/eid0810.020354] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
On October 4, 2001, we confirmed the first bioterrorism-related anthrax case identified in the United States in a resident of Palm Beach County, Florida. Epidemiologic investigation indicated that exposure occurred at the workplace through intentionally contaminated mail. One additional case of inhalational anthrax was identified from the index patient's workplace. Among 1,076 nasal cultures performed to assess exposure, Bacillus anthracis was isolated from a co-worker later confirmed as being infected, as well as from an asymptomatic mail-handler in the same workplace. Environmental cultures for B. anthracis showed contamination at the workplace and six county postal facilities. Environmental and nasal swab cultures were useful epidemiologic tools that helped direct the investigation towards the infection source and transmission vehicle. We identified 1,114 persons at risk and offered antimicrobial prophylaxis.
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Affiliation(s)
- Marc S Traeger
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
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