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Mohr NM, Santos Leon E, Carlson JN, Driver B, Krishnadasan A, Harland KK, Ten Eyck P, Mower WR, Foley TM, Wallace K, McDonald LC, Kutty PK, Santibanez S, Talan DA. Endotracheal Intubation Strategy, Success, and Adverse Events Among Emergency Department Patients During the COVID-19 Pandemic. Ann Emerg Med 2023; 81:145-157. [PMID: 36336542 PMCID: PMC9633323 DOI: 10.1016/j.annemergmed.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/09/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022]
Abstract
STUDY OBJECTIVE To describe endotracheal intubation practices in emergency departments by staff intubating patients early in the coronavirus disease 2019 (COVID-19) pandemic. METHODS Multicenter prospective cohort study of endotracheal intubations conducted at 20 US academic emergency departments from May to December 2020, stratified by known or suspected COVID-19 status. We used multivariable regression to measure the association between intubation strategy, COVID-19 known or suspected status, first-pass success, and adverse events. RESULTS There were 3,435 unique emergency department endotracheal intubations by 586 participating physicians or advanced practice providers; 565 (18%) patients were known or suspected of having COVID-19 at the time of endotracheal intubation. Compared with patients not known or suspected of COVID-19, endotracheal intubations of patients with known or suspected COVID-19 were more often performed using video laryngoscopy (88% versus 82%, difference 6.3%; 95% confidence interval [CI], 3.0% to 9.6%) and passive nasal oxygenation (44% versus 39%, difference 5.1%; 95% CI, 0.9% to 9.3%). First-pass success was not different between those who were and were not known or suspected of COVID-19 (87% versus 86%, difference 0.6%; 95% CI, -2.4% to 3.6%). Adjusting for patient characteristics and procedure factors in those with low anticipated airway difficulty (n=2,374), adverse events (most commonly hypoxia) occurred more frequently in patients with known or suspected COVID-19 (35% versus 19%, adjusted odds ratio 2.4; 95% CI, 1.7 to 3.3). CONCLUSION Compared with patients not known or suspected of COVID-19, endotracheal intubation of those confirmed or suspected to have COVID-19 was associated with a similar first-pass intubation success rate but higher risk-adjusted adverse events.
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Affiliation(s)
- Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa College of Public Health, Iowa City, IA; Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA.
| | - Eliezer Santos Leon
- Department of Emergency Medicine, University of Iowa College of Public Health, Iowa City, IA
| | - Jestin N Carlson
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA
| | - Brian Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Anusha Krishnadasan
- Olive View-University of California Los Angeles Education and Research Institute, Los Angeles, CA
| | - Karisa K Harland
- Department of Emergency Medicine, University of Iowa College of Public Health, Iowa City, IA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Sciences, University of Iowa, Iowa City, IA
| | - William R Mower
- University of California Los Angeles, Ronald Reagan Medical Center, Los Angeles, CA
| | - Tyler M Foley
- Department of Internal Medicine, University of Virginia, Charlottesville, VA
| | - Kelli Wallace
- Department of Emergency Medicine, University of Iowa College of Public Health, Iowa City, IA
| | - L Clifford McDonald
- Division of Healthcare Quality Promotion, Division of Preparedness and Emerging Infections, Atlanta, GA
| | - Preeta K Kutty
- Division of Healthcare Quality Promotion, Division of Preparedness and Emerging Infections, Atlanta, GA
| | - Scott Santibanez
- Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Atlanta, GA
| | - David A Talan
- Department of Emergency Medicine, University of Iowa College of Public Health, Iowa City, IA; Olive View-University of California Los Angeles Education and Research Institute, Los Angeles, CA; University of California Los Angeles, Ronald Reagan Medical Center, Los Angeles, CA
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Mohr NM, Krishnadasan A, Harland KK, Ten Eyck P, Mower WR, Schrading WA, Montoy JCC, McDonald LC, Kutty PK, Hesse E, Santibanez S, Weissman DN, Slev P, Talan DA. Emergency department personnel patient care-related COVID-19 risk. PLoS One 2022; 17:e0271597. [PMID: 35867681 PMCID: PMC9307202 DOI: 10.1371/journal.pone.0271597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/04/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Emergency department (ED) health care personnel (HCP) are at risk of exposure to SARS-CoV-2. The objective of this study was to determine the attributable risk of SARS-CoV-2 infection from providing ED care, describe personal protective equipment use, and identify modifiable ED risk factors. We hypothesized that providing ED patient care increases the probability of acquiring SARS-CoV-2 infection. METHODS We conducted a multicenter prospective cohort study of 1,673 ED physicians, advanced practice providers (APPs), nurses, and nonclinical staff at 20 U.S. centers over 20 weeks (May to December 2020; before vaccine availability) to detect a four-percentage point increased SARS-CoV-2 incidence among HCP related to direct patient care. Participants provided monthly nasal and serology specimens and weekly exposure and procedure information. We used multivariable regression and recursive partitioning to identify risk factors. RESULTS Over 29,825 person-weeks, 75 participants (4.5%) acquired SARS-CoV-2 infection (31 were asymptomatic). Physicians/APPs (aOR 1.07; 95% CI 0.56-2.03) did not have higher risk of becoming infected compared to nonclinical staff, but nurses had a marginally increased risk (aOR 1.91; 95% CI 0.99-3.68). Over 99% of participants used CDC-recommended personal protective equipment (PPE), but PPE lapses occurred in 22.1% of person-weeks and 32.1% of SARS-CoV-2-infected patient intubations. The following factors were associated with infection: household SARS-CoV-2 exposure; hospital and community SARS-CoV-2 burden; community exposure; and mask non-use in public. SARS-CoV-2 intubation was not associated with infection (attributable risk fraction 13.8%; 95% CI -2.0-38.2%), and nor were PPE lapses. CONCLUSIONS Among unvaccinated U.S. ED HCP during the height of the pandemic, the risk of SARS-CoV-2 infection was similar in nonclinical staff and HCP engaged in direct patient care. Many identified risk factors were related to community exposures.
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Affiliation(s)
- Nicholas M. Mohr
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
- * E-mail:
| | - Anusha Krishnadasan
- Olive View-UCLA Education and Research Institute, Los Angeles, California, United States of America
| | - Karisa K. Harland
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
| | - William R. Mower
- Department of Emergency Medicine, Ronald Reagan-UCLA Medical Center, Los Angeles, California, United States of America
| | - Walter A. Schrading
- Department of Emergency Medicine, University of Alabama and Birmingham, Birmingham, Alabama, United States of America
| | - Juan Carlos C. Montoy
- Department of Emergency Medicine, University of California-San Francisco, San Francisco, California, United States of America
| | - L. Clifford McDonald
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Preeta K. Kutty
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elisabeth Hesse
- Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Scott Santibanez
- Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - David N. Weissman
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, United States of America
| | - Patricia Slev
- ARUP Laboratories, Salt Lake City, Utah, United States of America
| | - David A. Talan
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
- Olive View-UCLA Education and Research Institute, Los Angeles, California, United States of America
- Department of Emergency Medicine, Ronald Reagan-UCLA Medical Center, Los Angeles, California, United States of America
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Kaur H, Welch S, Bhairavabhotla R, Weidle PJ, Santibanez S, Haberling DL, Smith EM, Ferris-George W, Hayashi K, Hostler A, Ao T, Dieke A, Boyer D, King E, Teton R, Williams-Singleton N, Flying EM, Hladik W, Marshall KJ, Pourier D, Ruiz Z, Yatabe G, Abe K, Parise M, Anderson M, Evans ME, Hunt H, Balajee SA. Partnership Between a Federal Agency and 4 Tribal Nations to Improve COVID-19 Response Capacities. Public Health Rep 2022; 137:820-825. [PMID: 35658738 PMCID: PMC9357744 DOI: 10.1177/00333549221099239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Upon request from tribal nations, and as part of the Centers for Disease Control and Prevention's (CDC's) emergency response, CDC staff provided both remote and on-site assistance to tribes to plan, prepare, and respond to the COVID-19 pandemic. From April 2, 2020, through June 11, 2021, CDC deployed a total of 275 staff to assist 29 tribal nations. CDC staff typically collaborated in multiple work areas including epidemiology and surveillance (86%), contact tracing (76%), infection prevention control (72%), community mitigation (72%), health communication (66%), incident command structure (55%), emergency preparedness (38%), and worker safety (31%). We describe the activities of CDC staff in collaboration with 4 tribal nations, Northern Cheyenne, Hoopa Valley, Shoshone-Bannock, and Oglala Sioux Tribe, to combat COVID-19 and lessons learned from the engagement.
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Affiliation(s)
- Harpriya Kaur
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Seh Welch
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Paul J Weidle
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Scott Santibanez
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dana L Haberling
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eva M Smith
- K'ima:w Medical Center, Hoopa Valley Tribe, CA, USA
| | - Wendy Ferris-George
- Hoopa Fire Department and Office of Emergency Services, Hoopa Valley Tribe, CA, USA
| | - Konrad Hayashi
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Allie Hostler
- Hoopa Fire Department and Office of Emergency Services, Hoopa Valley Tribe, CA, USA
| | - Trong Ao
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ada Dieke
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Eric King
- Shoshone-Bannock Tribe, Fort Hall, ID, USA
| | - Randy'L Teton
- Office of Public Affairs, Shoshone-Bannock Tribes, Fort Hall, ID, USA
| | | | | | - Wolfgang Hladik
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Khiya J Marshall
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Zuleyma Ruiz
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Graydon Yatabe
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karon Abe
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Monica Parise
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark Anderson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary E Evans
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Holly Hunt
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - S Arunmozhi Balajee
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Rodriguez RM, Montoy JCC, Hoth KF, Talan DA, Harland KK, Eyck PT, Mower W, Krishnadasan A, Santibanez S, Mohr N. Symptoms of Anxiety, Burnout, and PTSD and the Mitigation Effect of Serologic Testing in Emergency Department Personnel During the COVID-19 Pandemic. Ann Emerg Med 2021; 78:35-43.e2. [PMID: 33846014 PMCID: PMC7862892 DOI: 10.1016/j.annemergmed.2021.01.028] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [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] [Received: 12/23/2020] [Revised: 01/13/2021] [Accepted: 01/29/2021] [Indexed: 12/19/2022]
Abstract
Study Objective Among a comprehensive range of frontline emergency department health care personnel, we assessed symptoms of anxiety and burnout, specific coronavirus disease 2019 (COVID-19) work-related stressors, and risk for post-traumatic stress disorder (PTSD). We also determined whether COVID-19 serologic testing of HCP decreased their self-reported anxiety. Methods In a prospective cohort study from May 13, 2020, to July 8, 2020, we used electronic surveys to capture participant self-reported symptoms before and after serologic testing for anti-SARS-CoV-2 immunoglobulin G antibodies. Participants were physicians, nurses, advanced practice providers, and nonclinical ED personnel at 20 geographically diverse United States EDs. We evaluated these domains: 1) the effects of the COVID-19 pandemic on overall stress and anxiety; 2) COVID-19-related work stressors; 3) burnout; and 4) PTSD risk (measured using the Primary Care-PTSD Screen for DSM-5, a 5-item screening instrument in which a score of ≥3 signifies high risk for PTSD). We also assessed perceptions of whether results of COVID-19 antibody testing decreased participants’ self-reported anxiety. Results Of 1,606 participants, 100% and 88% responded to the baseline and follow-up surveys, respectively. At baseline, approximately half (46%) reported symptoms of emotional exhaustion and burnout from their work, and 308 (19.2%, 95% confidence interval [CI] 17.3% to 21.1%) respondents screened positive for increased PTSD risk. Female respondents were more likely than males to screen positive (odds ratio [OR] 2.03, 95% CI 1.49 to 2.78). Common concerns included exposing their family and the health of coworkers diagnosed with COVID-19. After receiving antibody test results, 54% (95% CI 51.8 to 56.7) somewhat agreed, agreed, or strongly agreed that knowledge of their immune status had decreased their anxiety. A positive serology result indicating prior SARS-CoV-2 infection was associated with a higher likelihood of reporting decreased anxiety (2.83, 95% CI 1.37 to 5.83). Conclusion Symptoms of anxiety and burnout were prevalent across the spectrum of ED staff during the COVID-19 pandemic. One-fifth of ED personnel appeared to be at risk for PTSD. Increased provision of serologic testing may help to mitigate anxiety.
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Affiliation(s)
- Robert M Rodriguez
- Department of Emergency Medicine, University of California, San Francisco School of Medicine, San Francisco, CA.
| | - Juan Carlos C Montoy
- Department of Emergency Medicine, University of California, San Francisco School of Medicine, San Francisco, CA
| | - Karin F Hoth
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA
| | - David A Talan
- Olive View-UCLA Education and Research Institute, Los Angeles, CA; Department of Emergency Medicine, University of California-Los Angeles Ronald Reagan Medical Center, Los Angeles, CA
| | - Karisa K Harland
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Patrick Ten Eyck
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - William Mower
- Department of Emergency Medicine, University of California-Los Angeles Ronald Reagan Medical Center, Los Angeles, CA
| | | | - Scott Santibanez
- Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Atlanta, GA
| | - Nicholas Mohr
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
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Mohr NM, Harland KK, Krishnadasan A, Eyck PT, Mower WR, Willey J, Chisolm-Straker M, Lim SC, McDonald LC, Kutty PK, Hesse E, Santibanez S, Talan DA. Diagnosed and Undiagnosed COVID-19 in US Emergency Department Health Care Personnel: A Cross-sectional Analysis. Ann Emerg Med 2020; 78:27-34. [PMID: 33771413 PMCID: PMC7746085 DOI: 10.1016/j.annemergmed.2020.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 12/17/2022]
Abstract
Study objective We determine the percentage of diagnosed and undiagnosed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among a sample of US emergency department (ED) health care personnel before July 2020. Methods This was a cross-sectional analysis of ED health care personnel in 20 geographically diverse university-affiliated EDs from May 13, to July 8, 2020, including case counts of prior laboratory-confirmed coronavirus disease 2019 (COVID-19) diagnoses among all ED health care personnel, and then point-in-time serology (with confirmatory testing) and reverse transcriptase–polymerase chain reaction testing in a sample of volunteers without a previous COVID-19 diagnosis. Health care staff were categorized as clinical (physicians, advanced practice providers, and nurses) and nonclinical (clerks, social workers, and case managers). Previously undiagnosed infection was based on positive SARS-CoV-2 serology or reverse transcriptase–polymerase chain reaction result among health care personnel without prior diagnosis. Results Diagnosed COVID-19 occurred in 2.8% of health care personnel (193/6,788), and the prevalence was similar for nonclinical and clinical staff (3.8% versus 2.7%; odds ratio 1.5; 95% confidence interval 0.7 to 3.2). Among 1,606 health care personnel without previously diagnosed COVID-19, 29 (1.8%) had evidence of current or past SARS-CoV-2 infection. Most (62%; 18/29) who were seropositive did not think they had been infected, 76% (19/25) recalled COVID-19–compatible symptoms, and 89% (17/19) continued to work while symptomatic. Accounting for both diagnosed and undiagnosed infections, 4.6% (95% confidence interval 2.8% to 7.5%) of ED health care personnel were estimated to have been infected with SARS-CoV-2, with 38% of those infections undiagnosed. Conclusion In late spring and early summer 2020, the estimated prevalence of severe acute respiratory syndrome coronavirus 2 infection was 4.6%, and greater than one third of infections were undiagnosed. Undiagnosed SARS-CoV-2 infection may pose substantial risk for transmission to other staff and patients.
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Affiliation(s)
- Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
| | - Karisa K Harland
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | | | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa Carver College of Medicine, Iowa City, IA
| | - William R Mower
- Department of Emergency Medicine, University of California-Los Angeles Ronald Reagan Medical Center, Los Angeles
| | - James Willey
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | | | - Stephen C Lim
- Department of Emergency Medicine, University Medical Center, New Orleans, LA
| | - L Clifford McDonald
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Preeta K Kutty
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elisabeth Hesse
- Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Atlanta, GA
| | - Scott Santibanez
- Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Atlanta, GA
| | - David A Talan
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Olive View-UCLA Education and Research Institute, Los Angeles, CA; Department of Emergency Medicine, University of California-Los Angeles Ronald Reagan Medical Center, Los Angeles
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Walker TA, Lockhart SR, Beekmann SE, Polgreen PM, Santibanez S, Mody RK, Beer KD, Chiller TM, Jackson BR. Recognition of Azole-Resistant Aspergillosis by Physicians Specializing in Infectious Diseases, United States. Emerg Infect Dis 2018; 24. [PMID: 29261092 PMCID: PMC5749442 DOI: 10.3201/eid2401.170971] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Of 709 physicians, 348 were familiar with azole-resistant Aspergillusfumigatus; of those treating case-patients, 21% lacked access to susceptibility testing. Infections caused by pan–azole-resistant Aspergillus fumigatus strains have emerged in Europe and recently in the United States. Physicians specializing in infectious diseases reported observing pan–azole-resistant infections and low rates of susceptibility testing, suggesting the need for wider-scale testing.
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7
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Rapoport AB, Fischer LS, Santibanez S, Beekmann SE, Polgreen PM, Rowley CF. Infectious Diseases Physicians' Perspectives Regarding Injection Drug Use and Related Infections, United States, 2017. Open Forum Infect Dis 2018; 5:ofy132. [PMID: 30018999 PMCID: PMC6041812 DOI: 10.1093/ofid/ofy132] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/06/2018] [Indexed: 01/31/2023] Open
Abstract
Background In the context of the opioid epidemic, injection drug use (IDU)-related infections are an escalating health issue for infectious diseases (ID) physicians in the United States. Methods We conducted a mixed methods survey of the Infectious Diseases Society of America's Emerging Infections Network between February and April 2017 to evaluate perspectives relating to care of persons who inject drugs (PWID). Topics included the frequency of and management strategies for IDU-related infection, the availability of addiction services, and the evolving role of ID physicians in substance use disorder (SUD) management. Results More than half (53%, n = 672) of 1273 network members participated. Of these, 78% (n = 526) reported treating PWID. Infections frequently encountered included skin and soft tissue (62%, n = 324), bacteremia/fungemia (54%, n = 281), and endocarditis (50%, n = 263). In the past year, 79% (n = 416) reported that most IDU-related infections required ≥2 weeks of parenteral antibiotics; strategies frequently employed for prolonged treatment included completion of the entire course in the inpatient unit (41%, n = 218) or at another supervised facility (35%, n = 182). Only 35% (n = 184) of respondents agreed/strongly agreed that their health system offered comprehensive SUD management; 46% (n = 242) felt that ID providers should actively manage SUD. Conclusions The majority of physicians surveyed treated PWID and reported myriad obstacles to providing care. Public health and health care systems should consider ways to support ID physicians caring for PWID, including (1) guidelines for providing complex care, including safe provision of multiweek parenteral antibiotics; (2) improved access to SUD management; and (3) strategies to assist those interested in roles in SUD management.
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Affiliation(s)
- Alison B Rapoport
- Cambridge Health Alliance, Cambridge, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Leah S Fischer
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Scott Santibanez
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan E Beekmann
- University of Iowa Carver College of Medicine, Iowa City, Iowa.,Emerging Infections Network, Iowa City, Iowa
| | - Philip M Polgreen
- University of Iowa Carver College of Medicine, Iowa City, Iowa.,Emerging Infections Network, Iowa City, Iowa
| | - Christopher F Rowley
- Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Harvard School of Public Health, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Santibanez S, Fischer LS, Krishnadasan A, Sederdahl B, Merlin T, Moran GJ, Talan DA. EMERGEncy ID NET: Review of a 20-Year Multisite Emergency Department Emerging Infections Research Network. Open Forum Infect Dis 2017; 4:ofx218. [PMID: 29670931 DOI: 10.1093/ofid/ofx218] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/28/2017] [Indexed: 11/12/2022] Open
Abstract
As providers of frontline clinical care for patients with acute and potentially life-threatening infections, emergency departments (EDs) have the priorities of saving lives and providing care quickly and efficiently. Although these facilities see a diversity of patients 24 hours per day and can collect prospective data in real time, their ability to conduct timely research on infectious syndromes is not well recognized. EMERGEncy ID NET is a national network that demonstrates that EDs can also collect data and conduct research in real time. This network collaborates with the Centers for Disease Control and Prevention (CDC) and other partners to study and address a wide range of infectious diseases and clinical syndromes. In this paper, we review selected highlights of EMERGEncy ID NET's history from 1995 to 2017. We focus on the establishment of this multisite research network and the network's collaborative research on a wide range of ED clinical topics.
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Affiliation(s)
- Scott Santibanez
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.,Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Leah S Fischer
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anusha Krishnadasan
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Los Angeles, California
| | | | - Toby Merlin
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gregory J Moran
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Los Angeles, California
| | - David A Talan
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Los Angeles, California
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Merlin TL, Chancey S, Zheng Y, Bowzard B, Fischer L, Parker T, Pillai S, Talan D, Moran G, Krishnadasan A, Santibanez S. How Do Advanced Molecular Tests Compare to Routine Clinical Laboratory Evaluation of CSF in Meningoencephalitis? A Study in 10 Urban Emergency Departments Across the USA. Open Forum Infect Dis 2017. [PMCID: PMC5631971 DOI: 10.1093/ofid/ofx162.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The EMERGEncy ID Net Study Group is investigating whether advanced molecular tests (AMT) increase the detection of causative agents in the CSF of patients presenting with meningoencephalitis (ME). We report findings from a pilot study using AMT on 18 CSF samples from 10 US Urban Emergency Departments. The purpose of the pilot was to compare the performance of these four AMT to established clinical laboratory methods. Methods We investigated four AMT: (1) BioFire FilmArray ME Panel targeting 14 causative agents; (2) an in-house target-directed next generation sequencing assay targeting 25 agents; (3) a microarray capable of detecting >2,500 agents; and (4) deep metagenomic next generation sequencing. For targeted sequencing, loci from 12 DNA-based and 13 RNA-based pathogens were amplified from the extracts by multiplex PCR. All sequencing was performed on an Illumina MiSeq using 500 cycle v2 Reagent Kits. Reads from the targeted sequencing were aligned to the 25 specific reference target sequences using Bowtie2 while metagenomics reads were processed with the taxonomic sequence classifying software Kraken. For microarray analysis, Lawrence Livermore Microbial Detection Array v2 arrays were hybridized with Cy3-labeled DNA or cDNA. Scanned images of arrays were analyzed by CLiMax 3.1. Results Eight CSF samples had results positive for well-established causes of ME from prior testing (Table). The pilot study demonstrated none of the four AMT detected all causative agents in the eight CSF samples known to have well-established causes of ME. BioFire and targeted sequencing performed best, both detecting 6/8, metagenomics deep sequencing detected 3/8, and microarray detected 1/8. Conclusion Despite the sophistication of AMT, they cannot detect pathogens they do not target, that are present in small numbers, or that have been eliminated from the CSF by the immune response. Despite the theoretical potential for microarray and metagenomic sequencing to detect thousands of different agents, the agents probably must be present at high levels for detection. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Toby L Merlin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Scott Chancey
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yueli Zheng
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brad Bowzard
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leah Fischer
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Todd Parker
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Satish Pillai
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David Talan
- Emergency Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Gregory Moran
- Emergency Medicine/Infectious Diseases, Olive View-UCLA Medical Center, Sylmar, California
| | | | - Scott Santibanez
- Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Atlanta, Georgia
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10
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Santibanez S, Hübschen JM, Ben Mamou MC, Muscat M, Brown KE, Myers R, Donoso Mantke O, Zeichhardt H, Brockmann D, Shulga SV, Muller CP, O'Connor PM, Mulders MN, Mankertz A. Molecular surveillance of measles and rubella in the WHO European Region: new challenges in the elimination phase. Clin Microbiol Infect 2017; 23:516-523. [PMID: 28712666 DOI: 10.1016/j.cmi.2017.06.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/14/2017] [Accepted: 06/15/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND The WHO European Region (EUR) has adopted the goal of eliminating measles and rubella but individual countries perform differently in achieving this goal. Measles virus spread across the EUR by mobile groups has recently led to large outbreaks in the insufficiently vaccinated resident population. As an instrument for monitoring the elimination process and verifying the interruption of endemic virus transmission, molecular surveillance has to provide valid and representative data. Irrespective of the country's specific situation, it is required to ensure the functionality of the laboratory surveillance that is supported by the WHO Global Measles and Rubella Laboratory Network. AIMS To investigate whether the molecular surveillance in the EUR is adequate for the challenges in the elimination phase, we addressed the quality assurance of molecular data, the continuity and intensity of molecular monitoring, and the analysis of transmission chains. SOURCES Published articles, the molecular External Quality Assessment Programme of the WHO, the Centralized Information System for Infectious Diseases of the WHO EUR and the WHO Measles and Rubella Nucleotide Surveillance databases served as information sources. CONTENT Molecular proficiency testing conducted by the WHO in 2016 has shown that the expertise for measles and rubella virus genotyping exists in all parts of the EUR. The analysis of surveillance data reported nationally to the WHO in 2013-2016 has revealed some countries with outbreaks but not sufficiently representative molecular data. Long-lasting supranational MV transmission chains were identified. IMPLICATIONS A more systematic molecular monitoring and recording of the transmission pattern for the whole EUR could help to create a meaningful picture of the elimination process.
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Affiliation(s)
- S Santibanez
- WHO European Regional Reference Laboratory for Measles and Rubella, Robert Koch-Institut, Berlin, Germany.
| | - J M Hübschen
- WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette and Laboratoire National de Santé, Dudelange, Luxembourg
| | - M C Ben Mamou
- Vaccine-preventable Diseases and Immunization, WHO Regional Office for Europe, Copenhagen, Denmark
| | - M Muscat
- Vaccine-preventable Diseases and Immunization, WHO Regional Office for Europe, Copenhagen, Denmark
| | - K E Brown
- WHO Global Specialized Laboratory for Measles and Rubella, Virus Reference Department, Public Health England, London, UK
| | - R Myers
- WHO Global Specialized Laboratory for Measles and Rubella, Virus Reference Department, Public Health England, London, UK
| | - O Donoso Mantke
- INSTAND e.V. - Gesellschaft zur Förderung der Qualitätssicherung in medizinischen Laboratorien e.V., Düsseldorf, Germany
| | - H Zeichhardt
- INSTAND e.V. - Gesellschaft zur Förderung der Qualitätssicherung in medizinischen Laboratorien e.V., Düsseldorf, Germany; Institut für Virologie, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Germany; Institut für Qualitätssicherung in der Virusdiagnostik - IQVD, Berlin, Germany
| | - D Brockmann
- Epidemiological Modelling of Infectious Diseases, Robert Koch-Institut, Berlin, Germany; Institute for Theoretical Biology, Department of Biology, Humboldt University of Berlin, Berlin, Germany
| | - S V Shulga
- WHO European Regional Reference Laboratory for Measles and Rubella, Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia
| | - C P Muller
- WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette and Laboratoire National de Santé, Dudelange, Luxembourg
| | - P M O'Connor
- Vaccine-preventable Diseases and Immunization, WHO Regional Office for Europe, Copenhagen, Denmark
| | - M N Mulders
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - A Mankertz
- WHO European Regional Reference Laboratory for Measles and Rubella, Robert Koch-Institut, Berlin, Germany
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11
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Fischer LS, Santibanez S, Jones G, Anderson B, Merlin T. How Is CDC Funded to Respond to Public Health Emergencies? Federal Appropriations and Budget Execution Process for Non-Financial Experts. Health Secur 2017; 15:307-311. [PMID: 28574728 DOI: 10.1089/hs.2017.0009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The federal budgeting process affects a wide range of people who work in public health, including those who work for government at local, state, and federal levels; those who work with government; those who operate government-funded programs; and those who receive program services. However, many people who are affected by the federal budget are not aware of or do not understand how it is appropriated or executed. This commentary is intended to give non-financial experts an overview of the federal budget process to address public health emergencies. Using CDC as an example, we provide: (1) a brief overview of the annual budget formulation and appropriation process; (2) a description of execution and implementation of the federal budget; and (3) an overview of emergency supplemental appropriations, using as examples the 2009 H1N1 influenza pandemic, the 2014-15 Ebola outbreak, and the 2016 Zika epidemic. Public health emergencies require rapid coordinated responses among Congress, government agencies, partners, and sometimes foreign, state, and local governments. It is important to have an understanding of the appropriation process, including supplemental appropriations that might come into play during public health emergencies, as well as the constraints under which Congress and federal agencies operate throughout the federal budget formulation process and execution.
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12
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Hübschen JM, Bork SM, Brown KE, Mankertz A, Santibanez S, Ben Mamou M, Mulders MN, Muller CP. Challenges of measles and rubella laboratory diagnostic in the era of elimination. Clin Microbiol Infect 2017; 23:511-515. [PMID: 28412379 DOI: 10.1016/j.cmi.2017.04.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 11/26/2022]
Abstract
The Member States of the WHO European Region adopted the goal of measles and rubella elimination more than 10 years ago, but so far only 21 of 53 countries have reached this target. Laboratory investigation of suspected cases is essential to support disease elimination efforts. Therefore, WHO maintains a network of accredited laboratories providing high-quality testing. Laboratory investigation heavily relies on specific IgM serology and increasingly on virus detection by reverse transcription (RT)-PCR, but other methods such as IgG avidity testing and genetic characterization of virus strains have gained in importance. In elimination settings, often few samples from suspected cases are available for testing, but testing proficiency must be maintained. The predictive value of an IgM-positive result decreases and other rash-fever disease aetiologies become more important. In addition, cases with a rash after measles/rubella vaccination or with mild disease after waning of vaccine-induced antibodies are seen more often. Thus, it is necessary to perform comprehensive and potentially time-consuming and costly investigations of every suspected case using quality-controlled laboratory methods. At the same time rapid feedback to public health officers is required for timely interventions. The introduction of new laboratory methods for comprehensive case investigations requires training of staff under the supervision of WHO-accredited reference laboratories and the definition of appropriate test algorithms. Clinical, laboratory, and epidemiological data are essential for final case classification and investigation of chains of transmission in the endgame of measles and rubella elimination.
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Affiliation(s)
- J M Hübschen
- WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette and Laboratoire National de Santé, Dudelange, Luxembourg
| | - S M Bork
- WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette and Laboratoire National de Santé, Dudelange, Luxembourg
| | - K E Brown
- WHO Global Specialized Laboratory for Measles and Rubella, Virus Reference Department, Public Health England, London, UK
| | - A Mankertz
- WHO European Regional Reference Laboratory for Measles and Rubella, Robert Koch Institute, Berlin, Germany
| | - S Santibanez
- WHO European Regional Reference Laboratory for Measles and Rubella, Robert Koch Institute, Berlin, Germany
| | - M Ben Mamou
- Vaccine-Preventable Diseases and Immunization, WHO Regional Office for Europe, Copenhagen, Denmark
| | - M N Mulders
- Expanded Programme on Immunization, Department of Immunization, Vaccines, and Biologicals, WHO, Geneva, Switzerland
| | - C P Muller
- WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette and Laboratoire National de Santé, Dudelange, Luxembourg.
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13
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Fischer LS, Santibanez S, Hatchett RJ, Jernigan DB, Meyers LA, Thorpe PG, Meltzer MI. CDC Grand Rounds: Modeling and Public Health Decision-Making. MMWR Morb Mortal Wkly Rep 2016; 65:1374-1377. [PMID: 27932782 DOI: 10.15585/mmwr.mm6548a4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Mathematical models incorporate various data sources and advanced computational techniques to portray real-world disease transmission and translate the basic science of infectious diseases into decision-support tools for public health. Unlike standard epidemiologic methods that rely on complete data, modeling is needed when there are gaps in data. By combining diverse data sources, models can fill gaps when critical decisions must be made using incomplete or limited information. They can be used to assess the effect and feasibility of different scenarios and provide insight into the emergence, spread, and control of disease. During the past decade, models have been used to predict the likelihood and magnitude of infectious disease outbreaks, inform emergency response activities in real time (1), and develop plans and preparedness strategies for future events, the latter of which proved invaluable during outbreaks such as severe acute respiratory syndrome and pandemic influenza (2-6). Ideally, modeling is a multistep process that involves communication between modelers and decision-makers, allowing them to gain a mutual understanding of the problem to be addressed, the type of estimates that can be reliably generated, and the limitations of the data. As models become more detailed and relevant to real-time threats, the importance of modeling in public health decision-making continues to grow.
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14
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Meltzer MI, Santibanez S, Fischer LS, Merlin TL, Adhikari BB, Atkins CY, Campbell C, Fung ICH, Gambhir M, Gift T, Greening B, Gu W, Jacobson EU, Kahn EB, Carias C, Nerlander L, Rainisch G, Shankar M, Wong K, Washington ML. Modeling in Real Time During the Ebola Response. MMWR Suppl 2016; 65:85-9. [PMID: 27387097 DOI: 10.15585/mmwr.su6503a12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
To aid decision-making during CDC's response to the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa, CDC activated a Modeling Task Force to generate estimates on various topics related to the response in West Africa and the risk for importation of cases into the United States. Analysis of eight Ebola response modeling projects conducted during August 2014-July 2015 provided insight into the types of questions addressed by modeling, the impact of the estimates generated, and the difficulties encountered during the modeling. This time frame was selected to cover the three phases of the West African epidemic curve. Questions posed to the Modeling Task Force changed as the epidemic progressed. Initially, the task force was asked to estimate the number of cases that might occur if no interventions were implemented compared with cases that might occur if interventions were implemented; however, at the peak of the epidemic, the focus shifted to estimating resource needs for Ebola treatment units. Then, as the epidemic decelerated, requests for modeling changed to generating estimates of the potential number of sexually transmitted Ebola cases. Modeling to provide information for decision-making during the CDC Ebola response involved limited data, a short turnaround time, and difficulty communicating the modeling process, including assumptions and interpretation of results. Despite these challenges, modeling yielded estimates and projections that public health officials used to make key decisions regarding response strategy and resources required. The impact of modeling during the Ebola response demonstrates the usefulness of modeling in future responses, particularly in the early stages and when data are scarce. Future modeling can be enhanced by planning ahead for data needs and data sharing, and by open communication among modelers, scientists, and others to ensure that modeling and its limitations are more clearly understood. The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).
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Affiliation(s)
- Martin I Meltzer
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, CDC
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15
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Polgreen PM, Santibanez S, Koonin LM, Rupp ME, Beekmann SE, Del Rio C. Infectious Disease Physician Assessment of Hospital Preparedness for Ebola Virus Disease. Open Forum Infect Dis 2015; 2:ofv087. [PMID: 26180836 PMCID: PMC4499670 DOI: 10.1093/ofid/ofv087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/09/2015] [Indexed: 11/13/2022] Open
Abstract
Background. The first case of Ebola diagnosed in the United States and subsequent cases among 2 healthcare workers caring for that patient highlighted the importance of hospital preparedness in caring for Ebola patients. Methods. From October 21, 2014 to November 11, 2014, infectious disease physicians who are part of the Emerging Infections Network (EIN) were surveyed about current Ebola preparedness at their institutions. Results. Of 1566 EIN physician members, 869 (55.5%) responded to this survey. Almost all institutions represented in this survey showed a substantial degree of preparation for the management of patients with suspected and confirmed Ebola virus disease. Despite concerns regarding shortages of personal protective equipment, approximately two thirds of all respondents reported that their facilities had sufficient and ready availability of hoods, full body coveralls, and fluid-resistant or impermeable aprons. The majority of respondents indicated preference for transfer of Ebola patients to specialized treatment centers rather than caring for them locally. In general, we found that larger hospitals and teaching hospitals reported higher levels of preparedness. Conclusions. Prior to the Centers for Disease Control and Prevention's plan for a tiered approach that identified specific roles for frontline, assessment, and designated treatment facilities, our query of infectious disease physicians suggested that healthcare facilities across the United States were making preparations for screening, diagnosis, and treatment of Ebola patients. Nevertheless, respondents from some hospitals indicated that they were relatively unprepared.
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Affiliation(s)
- Philip M Polgreen
- Emerging Infections Network , University of Iowa Carver College of Medicine , Iowa City, Iowa
| | - Scott Santibanez
- Centers for Disease Control and Prevention , Atlanta, Georgia ; Rollins School of Public Health of Emory University and Emory University School of Medicine , Atlanta, Georgia
| | - Lisa M Koonin
- Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Mark E Rupp
- Department of Internal Medicine , University of Nebraska Medical Center , Omaha, Nebraska
| | - Susan E Beekmann
- Emerging Infections Network , University of Iowa Carver College of Medicine , Iowa City, Iowa
| | - Carlos Del Rio
- Rollins School of Public Health of Emory University and Emory University School of Medicine , Atlanta, Georgia
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16
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Santibanez S, Hübschen JM, Muller CP, Freymuth F, Mosquera MM, Mamou MB, Mulders MN, Brown KE, Myers R, Mankertz A. Long-term transmission of measles virus in Central and continental Western Europe. Virus Genes 2015; 50:2-11. [DOI: 10.1007/s11262-015-1173-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 01/16/2015] [Indexed: 12/18/2022]
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17
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Meltzer MI, Atkins CY, Santibanez S, Knust B, Petersen BW, Ervin ED, Nichol ST, Damon IK, Washington ML. Estimating the future number of cases in the Ebola epidemic--Liberia and Sierra Leone, 2014-2015. MMWR Suppl 2014; 63:1-14. [PMID: 25254986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
The first cases of the current West African epidemic of Ebola virus disease (hereafter referred to as Ebola) were reported on March 22, 2014, with a report of 49 cases in Guinea. By August 31, 2014, a total of 3,685 probable, confirmed, and suspected cases in West Africa had been reported. To aid in planning for additional disease-control efforts, CDC constructed a modeling tool called EbolaResponse to provide estimates of the potential number of future cases. If trends continue without scale-up of effective interventions, by September 30, 2014, Sierra Leone and Liberia will have a total of approximately 8,000 Ebola cases. A potential underreporting correction factor of 2.5 also was calculated. Using this correction factor, the model estimates that approximately 21,000 total cases will have occurred in Liberia and Sierra Leone by September 30, 2014. Reported cases in Liberia are doubling every 15-20 days, and those in Sierra Leone are doubling every 30-40 days. The EbolaResponse modeling tool also was used to estimate how control and prevention interventions can slow and eventually stop the epidemic. In a hypothetical scenario, the epidemic begins to decrease and eventually end if approximately 70% of persons with Ebola are in medical care facilities or Ebola treatment units (ETUs) or, when these settings are at capacity, in a non-ETU setting such that there is a reduced risk for disease transmission (including safe burial when needed). In another hypothetical scenario, every 30-day delay in increasing the percentage of patients in ETUs to 70% was associated with an approximate tripling in the number of daily cases that occur at the peak of the epidemic (however, the epidemic still eventually ends). Officials have developed a plan to rapidly increase ETU capacities and also are developing innovative methods that can be quickly scaled up to isolate patients in non-ETU settings in a way that can help disrupt Ebola transmission in communities. The U.S. government and international organizations recently announced commitments to support these measures. As these measures are rapidly implemented and sustained, the higher projections presented in this report become very unlikely.
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18
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Santibanez S, Prosenc K, Lohr D, Pfaff G, Jordan Markocic O, Mankertz A. Measles virus spread initiated at international mass gatherings in Europe, 2011. Euro Surveill 2014; 19. [DOI: 10.2807/1560-7917.es2014.19.35.20891] [Citation(s) in RCA: 22] [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: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- S Santibanez
- National Reference Centre Measles, Mumps, Rubella and Regional Reference Laboratory WHO EURO, Division of Measles, Mumps, Rubella, and viruses affecting immunocompromised patients, Robert Koch Institute, Berlin, Germany
| | - K Prosenc
- Laboratory for Virology, National Institute of Public Health of Slovenia, Ljubljana, Slovenia
| | - D Lohr
- Baden-Wuerttemberg State Health Office, District of Stuttgart Government, Stuttgart, Germany
| | - G Pfaff
- Baden-Wuerttemberg State Health Office, District of Stuttgart Government, Stuttgart, Germany
| | | | - A Mankertz
- National Reference Centre Measles, Mumps, Rubella and Regional Reference Laboratory WHO EURO, Division of Measles, Mumps, Rubella, and viruses affecting immunocompromised patients, Robert Koch Institute, Berlin, Germany
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19
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Pillai SK, Beekmann SE, Santibanez S, Polgreen PM. The Infectious Diseases Society of America emerging infections network: bridging the gap between clinical infectious diseases and public health. Clin Infect Dis 2014; 58:991-6. [PMID: 24403542 DOI: 10.1093/cid/cit932] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In 1995, the Centers for Disease Control and Prevention granted a Cooperative Agreement Program award to the Infectious Diseases Society of America to develop a provider-based emerging infections sentinel network, the Emerging Infections Network (EIN). Over the past 17 years, the EIN has evolved into a flexible, nationwide network with membership representing a broad cross-section of infectious disease physicians. The EIN has an active electronic mail conference (listserv) that facilitates communication among infectious disease providers and the public health community, and also sends members periodic queries (short surveys on infectious disease topics) that have addressed numerous topics relevant to both clinical infectious diseases and public health practice. The article reviews how the various functions of EIN contribute to clinical care and public health, identifies opportunities to further link clinical medicine and public health, and describes future directions for the EIN.
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Affiliation(s)
- Satish K Pillai
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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20
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Necula G, Lazar M, Stanescu A, Pistol A, Santibanez S, Mankertz A, Lupulescu E. Transmission and molecular characterisation of wild measles virus in Romania, 2008 to 2012. ACTA ACUST UNITED AC 2013; 18:20658. [PMID: 24342518 DOI: 10.2807/1560-7917.es2013.18.50.20658] [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] [Indexed: 11/20/2022]
Abstract
Molecular characterisation of measles virus is a powerful tool for tracing transmission. Genotyping may prove the absence of endemic circulation of measles virus, i.e. transmission for more than 12 months, which is one of the criteria for verifying elimination of the disease. We have genetically characterised measles viruses detected in Romania from 2008 to 2012, focusing on the recent outbreaks from 2010 to 2012 that affected mainly groups with limited access to healthcare and schools. The findings emphasise the importance of genotyping during the different phases of an outbreak. A total of 8,170 cases were notified, and 5,093 (62%) of the 7,559 possible cases were serologically confirmed. RT-PCR was performed for 104 samples: from the 101 positive samples obtained from sporadic measles cases or clusters from different counties, 73 were genotyped. Sporadic measles cases associated with D4 and D5 viruses were observed from2008 to 2009. Genotype D4-Manchester was predominant in 2011 and 2012. In addition, the related variant D4-Maramures and MVs/Limoges.FRA/17.10[D4] and a few D4-Hamburg strains were detected. The detection of several distinct MV-D4 genotypes suggests multiple virus importations to Romania. The outbreak associated with D4 genotype is the second largest outbreak in Romania in less than 10 years.
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Affiliation(s)
- G Necula
- National Reference Laboratory for Measles and Rubella and National Influenza Center, Cantacuzino Institute, Bucharest, Romania
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21
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Brown KE, Mulders MN, Freymuth F, Santibanez S, Mosquera MM, Cordey S, Beirnes J, Shulga S, Myers R, Featherstone D. Appearance of a novel measles G3 strain in multiple European countries within a two month period, 2010. Euro Surveill 2011. [DOI: 10.2807/ese.16.17.19852-en] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
During late 2010, a previously unrecognised strain of measles genotype G3 virus was identified in five different European countries by the World Health Organization Measles and Rubella Laboratory Network. Apart from one, none had a travel history to south-east Asia, the usual source of G3 viruses, although epidemiological links could be established between some of the cases. This case series illustrates the value of genotyping and sequencing in tracking measles infections, and identifying otherwise unrecognised chains of transmission.
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Affiliation(s)
- K E Brown
- Virus Reference Department, World Health Organization Global Specialised Laboratory for Measles and Rubella, Health Protection Agency - Colindale, London, United Kingdom
| | - M N Mulders
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - F Freymuth
- Centre National de Référence de la Rougeole et des Paramyxoviridae Respiratoires (National Reference Centre for measles and respiratory Paramyxoviridae), Laboratoire de virologie humaine et moléculaire (Laboratory of human and molecular virology), Centre Hospitalier Universitaire de Caen, France
| | - S Santibanez
- National Reference Centre Measles, Mumps, Rubella, Regional Reference Laboratory WHO EURO, Robert Koch Institute, Berlin, Germany
| | - M M Mosquera
- Centro Nacional de Microbiología (National Microbiology Centre), Instituto de Salud Carlos III, Madrid, Spain
| | - S Cordey
- Swiss National Reference Centre for Emerging Viral Diseases, Division of Infectious Diseases, University of Geneva Hospitals, Geneva, Switzerland
| | - J Beirnes
- Viral Exanthemata National Microbiology Laboratory, Winnipeg, Canada
| | - S Shulga
- World Health Organization Regional Reference Laboratory, European Region, Moscow, Russian Federation
| | - R Myers
- Virus Reference Department, World Health Organization Global Specialised Laboratory for Measles and Rubella, Health Protection Agency - Colindale, London, United Kingdom
| | - D Featherstone
- Expanded Programme on Immunization, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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Brown KE, Mulders MN, Freymuth F, Santibanez S, Mosquera MM, Cordey S, Beirnes J, Shulga S, Myers R, Featherstone D. Appearance of a novel measles G3 strain in multiple European countries within a two month period, 2010. Euro Surveill 2011; 16:19852. [PMID: 21543045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
During late 2010, a previously unrecognised strain of measles genotype G3 virus was identified in five different European countries by the World Health Organization Measles and Rubella Laboratory Network.Apart from one, none had a travel history to south-east Asia, the usual source of G3 viruses, although epidemiological links could be established between some of the cases. This case series illustrates the value of genotyping and sequencing in tracking measles infections, and identifying otherwise unrecognised chains of transmission.
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Affiliation(s)
- K E Brown
- Virus Reference Department, World Health Organization Global Specialised Laboratory for Measles and Rubella, Health Protection Agency - Colindale, London, United Kingdom.
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23
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Otto W, Mankertz A, Santibanez S, Saygili H, Wenzel J, Jilg W, Wieland W, Borgmann S. Ongoing outbreak of mumps affecting adolescents and young adults in Bavaria, Germany, August to October 2010. Euro Surveill 2010; 15:19748. [PMID: 21172171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- W Otto
- Department of Urology, St. Josef Hospital, University of Regensburg, Regensburg, Germany
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24
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Otto W, Mankertz A, Santibanez S, Saygili H, Wenzel J, Jilg W, Wieland WF, Borgmann S. Ongoing outbreak of mumps affecting adolescents and young adults in Bavaria, Germany, August to October 2010. Euro Surveill 2010. [DOI: 10.2807/ese.15.50.19748-en] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Since the introduction of a two-dose MMR vaccination regime the incidence of mumps virus infections has substantially declined. However, mumps outbreaks have recently been reported from several countries. Here we report an ongoing mumps outbreak in Germany. Between 1 July and 31 October, 115 infections have been laboratory-confirmed. Reported complications include one case of meningitis and 21 cases of orchitis, suggesting a high rate of complications. We suggest a vaccination campaign for young adults in northern Bavaria to limit severe mumps infections.
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Affiliation(s)
- W Otto
- Department of Urology, St. Josef Hospital, University of Regensburg, Regensburg, Germany
| | - A Mankertz
- National Reference Centre Measles, Mumps, Rubella, Robert Koch Institute, Berlin, Germany
| | - S Santibanez
- National Reference Centre Measles, Mumps, Rubella, Robert Koch Institute, Berlin, Germany
| | - H Saygili
- Synlab Medical Care Service, Medical Care Centre Weiden, Weiden, Germany
| | - J Wenzel
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - W Jilg
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - W F Wieland
- Department of Urology, St. Josef Hospital, University of Regensburg, Regensburg, Germany
| | - S Borgmann
- Synlab Medical Care Service, Medical Care Centre Weiden, Weiden, Germany
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Pfaff G, Lohr D, Santibanez S, Mankertz A, van Treeck U, Schönberger K, Hautmann W. Spotlight on measles 2010: Measles outbreak among travellers returning from a mass gathering, Germany, September to October 2010. Euro Surveill 2010. [DOI: 10.2807/ese.15.50.19750-en] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- G Pfaff
- Baden-Wuerttemberg State Health Office, District of Stuttgart Government, Stuttgart, Germany
| | - D Lohr
- Baden-Wuerttemberg State Health Office, District of Stuttgart Government, Stuttgart, Germany
| | - S Santibanez
- National Reference Centre for Measles, Mumps and Rubella (NRC MMR), Robert Koch Institute (RKI), Berlin, Germany
| | - A Mankertz
- National Reference Centre for Measles, Mumps and Rubella (NRC MMR), Robert Koch Institute (RKI), Berlin, Germany
| | - U van Treeck
- NRW Institute of Health and Work, Düsseldorf, Germany
| | - K Schönberger
- Bavarian Health and Food Safety Agency, Oberschleißheim, Germany
| | - W Hautmann
- Bavarian Health and Food Safety Agency, Oberschleißheim, Germany
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26
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Pfaff G, Lohr D, Santibanez S, Mankertz A, van Treeck U, Schonberger K, Hautmann W. Spotlight on measles 2010: Measles outbreak among travellers returning from a mass gathering, Germany, September to October 2010. Euro Surveill 2010; 15:19750. [PMID: 21172175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- G Pfaff
- Baden-Wuerttemberg State Health Office, District of Stuttgart Government, Stuttgart, Germany.
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27
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Rogalska J, Santibanez S, Mankertz A, Makowka A, Szenborn L, Stefanoff P. Spotlight on measles 2010: An epidemiological overview of measles outbreaks in Poland in relation to the measles elimination goal. ACTA ACUST UNITED AC 2010; 15. [PMID: 20460084 DOI: 10.2807/ese.15.17.19549-en] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The objective of this study was to describe transmission chains of measles observed in Poland during 2008-2009. A decade ago, the incidence of measles in Poland declined and approached one case per million inhabitants one of the World Health Organization's criteria for measles elimination. Following a period of very few reported measles cases (2003 to 2005), an increase in incidence was observed in 2006. Since then, the incidence has constantly exceeded one case per million inhabitants. Of 214 measles cases reported in 2008 and 2009 in Poland, 164 (77%) were linked to 19 distinct outbreaks, with 79% of cases belonging to the Roma ethnic group. Outbreaks in the non-Roma Polish population had different dynamics compared to those in the Roma population. On average, measles outbreaks in Roma communities involved 10 individuals, seven of whom were unvaccinated, while outbreaks in the non-Roma Polish population involved five individuals, half of whom were incompletely vaccinated. The majority of outbreaks in Roma communities were related to importation of virus from the United Kingdom. In six outbreaks, the epidemiologic investigation was confirmed by identification of genotype D4 closely related to measles viruses detected in the United Kingdom and Germany. Our data indicate that Poland is approaching measles elimination, but measles virus circulation is still sustained in a vulnerable population. More efforts are needed to integrate the Roma ethnic group into the Polish healthcare system and innovative measures to reach vulnerable groups should be explored.
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Affiliation(s)
- J Rogalska
- Department of Epidemiology, National Institute of Public Health - National Institute of Hygiene (NIZP-PZH), Warsaw, Poland.
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28
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Whiters DL, Santibanez S, Dennison D, Clark HW. A case study in collaborating with Atlanta-based African-American churches: a promising means for reaching inner-city substance users with rapid HIV testing. J Evid Based Soc Work 2010; 7:103-114. [PMID: 20178028 DOI: 10.1080/15433710903175981] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This case study examined programmatic data from a federally funded faith-based rapid HIV testing initiative. In 2004, Recovery Consultants of Atlanta, Inc. (RCA, Inc.) began providing rapid HIV testing in collaboration with six Atlanta-based African-American churches. Of the 1,947 persons tested from January 2004 to July 2005, 1,872 (96.1%) were African-American, 1,247 (64%) were male, and 1,612 (82.8%) were between the age of 26 and 56. A total of 85 HIV-infected individuals were identified and 72 were identified as previously undiagnosed cases (positivity rate of 3.7%). This case study highlights and promotes rapid HIV testing offered in partnership with African American churches as a strategy for raising HIV awareness among inner-city substance users.
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Affiliation(s)
- David L Whiters
- Recovery Consultants of Atlanta, Atlanta, Georgia 30316, USA
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29
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Manangan L, Elmore K, Lewis B, Pratt R, Armstrong L, Davison J, Santibanez S, Heetderks A, Robison V, Lee V, Navin T. Disparities in tuberculosis between Asian/Pacific Islanders and non-Hispanic Whites, United States, 1993-2006. Int J Tuberc Lung Dis 2009; 13:1077-1085. [PMID: 19723395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
SETTING The United States (US) National Tuberculosis Surveillance System (NTSS), including 50 states, District of Columbia, and New York City. OBJECTIVE To examine disparities in characteristics and rates of Asian/Pacific Islander (API) and non-Hispanic White tuberculosis (TB) patients. DESIGN Descriptive analysis and logistic regression of selected 1993-2006 NTSS data. US Census Bureau Zip Code Tabulation Areas and geographic information system were used to compare API and non-Hispanic White TB patients by population density. RESULT Of 253,299 TB cases, 19.8% were APIs and 23.2% were Whites; 94.2% APIs and 11.9% Whites were foreign-born. Factors that were most often associated with APIs were being female, age 15-24 years, extra-pulmonary TB, and drug resistance. APIs were less likely than Whites to be human immunodeficiency virus (HIV) positive, homeless, substance abusers, or on directly observed therapy. From 1993 to 2006, the API TB case rate declined by 42.9% vs. 66.6% in Whites (P < 0.01). Being foreign-born was the strongest risk factor for TB, regardless of population densities, but APIs were more likely to have TB than foreign-born Whites at lower population densities. CONCLUSION Disparities in TB exist among US APIs and non-Hispanic Whites. TB program officials should allocate programs appropriately for foreign-born APIs in lower population density areas.
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Affiliation(s)
- L Manangan
- Division of Tuberculosis Elimination, National Center for HIV, Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
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30
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Morgan J, Roper MH, Sperling L, Schieber RA, Heffelfinger JD, Casey CG, Miller JW, Santibanez S, Herwaldt B, Hightower P, Moro PL, Hibbs BF, Levine NH, Chapman LE, Iskander J, Lane JM, Wharton M, Mootrey GT, Swerdlow DL. Myocarditis, pericarditis, and dilated cardiomyopathy after smallpox vaccination among civilians in the United States, January-October 2003. Clin Infect Dis 2008; 46 Suppl 3:S242-50. [PMID: 18284365 DOI: 10.1086/524747] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Myocarditis was reported after smallpox vaccination in Europe and Australia, but no association had been reported with the US vaccine. We conducted surveillance to describe and determine the frequency of myocarditis and/or pericarditis (myo/pericarditis) among civilians vaccinated during the US smallpox vaccination program between January and October 2003. We developed surveillance case definitions for myocarditis, pericarditis, and dilated cardiomyopathy after smallpox vaccination. We identified 21 myo/pericarditis cases among 37,901 vaccinees (5.5 per 10,000); 18 (86%) were revacinees, 14 (67%) were women, and the median age was 48 years (range, 25-70 years). The median time from vaccination to onset of symptoms was 11 days (range, 2-42 days). Myo/pericarditis severity was mild, with no fatalities, although 9 patients (43%) were hospitalized. Three additional vaccinees were found to have dilated cardiomyopathy, recognized within 3 months after vaccination. We describe an association between smallpox vaccination, using the US vaccinia strain, and myo/pericarditis among civilians.
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Affiliation(s)
- Juliette Morgan
- Centers for Disease Control and Prevention and 2Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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31
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Richard JL, Masserey-Spicher V, Santibanez S, Mankertz A. Measles outbreak in Switzerland--an update relevant for the European football championship (EURO 2008). Euro Surveill 2008; 13:8043. [PMID: 18445414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- J l Richard
- Division of Communicable Diseases, Swiss Federal Office of Public Health, Bern, Switzerland.
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32
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Pfaff G, Mezger B, Santibanez S, Hoffmann U, Maassen S, Wagner U, Siedler A. Measles in south-west Germany imported from Switzerland - a preliminary outbreak description. Euro Surveill 2008. [DOI: 10.2807/ese.13.08.08044-en] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- G Pfaff
- Baden-Wuerttemberg State Health Office, District of Stuttgart Government, Stuttgart, Germany
| | - B Mezger
- Baden-Wuerttemberg State Health Office, District of Stuttgart Government, Stuttgart, Germany
| | - S Santibanez
- National Reference Laboratory for Measles, Mumps and Rubella, Robert Koch Institute, Berlin, Germany
| | | | - S Maassen
- Public Health Office, Freiburg im Breisgau, Germany
| | - U Wagner
- Public Health Office, Karlsruhe, Germany
| | - A Siedler
- Robert Koch institut, Department for Infectious Disease Epidemiology, Berlin, Germany
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33
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Richard JL, Masserey-Spicher V, Santibanez S, Mankertz A. Measles outbreak in Switzerland - an update relevant for the European football championship (EURO 2008). Euro Surveill 2008. [DOI: 10.2807/ese.13.08.08043-en] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Since November 2006, Switzerland has been experiencing the largest measles outbreak registered in the country since the introduction of mandatory notification for this disease in 1999. The first eight months of this outbreak have already been described in this journal [1]. From November 2006 to 13 February 2008, 1,405 measles cases were reported by physicians or laboratories in Switzerland (1,106 of them in 2007). Of these, 976 cases (69%) occurred in the cantons of Lucerne (29% of the total), Basel-Land (16%), Zurich (11%) Bern (7%), and Aargau (7%). The incidence for the whole country and all ages, calculated for this 15-month period, was 19 cases per 100,000 inhabitants (15 cases per 100,000 for the year 2007). For children under the age of 16 years living in the canton of Lucerne, it was 500 per 100,000.
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Affiliation(s)
- J L Richard
- Division of Communicable Diseases, Swiss Federal Office of Public Health, Bern, Switzerland
| | - V Masserey-Spicher
- Division of Communicable Diseases, Swiss Federal Office of Public Health, Bern, Switzerland
| | - S Santibanez
- Division of Viral Infections, Robert-Koch Institute, Berlin, Germany
| | - A Mankertz
- Division of Viral Infections, Robert-Koch Institute, Berlin, Germany
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34
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Pfaff G, Mezger B, Santibanez S, Hoffmann U, Maassen S, Wagner U, Siedler A. Measles in south-west Germany imported from Switzerland--a preliminary outbreak description. Euro Surveill 2008; 13:8044. [PMID: 18445413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- G Pfaff
- Baden-Wuerttemberg State Health Office, District of Stuttgart Government, Stuttgart, Germany.
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35
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Makowka A, Gut W, Litwinska B, Santibanez S, Mankertz A. Genotyping of measles and rubella virus strains circulating in Poland in 2007. ACTA ACUST UNITED AC 2007; 12:E071025.2. [PMID: 17997912 DOI: 10.2807/esw.12.43.03295-en] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The elimination of measles and rubella and the prevention of congenital rubella in the European Region are objectives the World Health Organization has set to achieve by the year 2010.
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Affiliation(s)
- A Makowka
- Department of Virology, National Institute of Hygiene, Warsaw, Poland.
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36
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Abstract
Between January and June 2007, a total of 90 cases of measles were notified in Passau and Rottal-Inn, two districts of Lower Bavaria in south-east Germany sharing a border with Austria.
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Affiliation(s)
- H Bernard
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany.
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37
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Wilkinson JD, Zhao W, Santibanez S, Arnsten J, Knowlton A, Gómez CA, Metsch LR. Providers' HIV prevention discussions with HIV-seropositive injection drug users. AIDS Behav 2006; 10:699-705. [PMID: 16639542 DOI: 10.1007/s10461-006-9088-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Public health agencies have recommended incorporating HIV prevention counseling into the medical care of persons living with HIV/AIDS. Injection drug users (IDUs) especially need HIV risk-reduction counseling because of their high risk for HIV transmission through both sexual and injection behaviors. The objective of this study was to assess the prevalence of, and patient factors associated with, the delivery of HIV prevention messages to HIV-seropositive IDUs in primary care settings. A majority of participants reported having an HIV prevention discussion with their provider during their most recent primary care visit. Factors significantly associated with report of such discussion were being Hispanic or non-Hispanic Black; high school education or less; and better perception of engagement with provider. Medical providers should provide prevention messages to all HIV-seropositive IDUs, regardless of demographic factors. Effective HIV prevention interventions in primary care settings, including interventions to improve patient-provider communication, are needed for HIV-seropositive IDUs.
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Affiliation(s)
- James D Wilkinson
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, 1801 NW 9th Avenue, Suite 200, FL 33136, USA.
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38
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Mizuno Y, Wilkinson JD, Santibanez S, Dawson Rose C, Knowlton A, Handley K, Gourevitch MN. Correlates of health care utilization among HIV-seropositive injection drug users. AIDS Care 2006; 18:417-25. [PMID: 16777632 DOI: 10.1080/09540120500162247] [Citation(s) in RCA: 15] [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: 10/24/2022]
Abstract
This study sought to identify correlates of poor health care utilization among HIV-positive injection drug users (IDUs) using Andersen's behavioural health model. We used baseline data from INSPIRE, a study of HIV-positive IDUs (n=1161) to identify predisposing, enabling, and need factors related to poor utilization (defined as fewer than two outpatient visits in the past six months, or identification of emergency room (ER) as the usual place for care). Using bivariate and multivariate models, we found a number of enabling factors that could facilitate the use of health care services such as having health insurance, having seen a case manager, and better engagement with health care providers. These enabling factors could be modified through interventions targeting HIV-positive IDUs. In addition, health insurance and case management appear to be important factors to address because they contributed in making other factors (e.g. lower education, lack of stable housing) non-significant barriers to outpatient care utilization. In the future, these findings may be used to inform the development of interventions that maximize use of scarce HIV resources and improve health care utilization among HIV-positive IDUs.
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Affiliation(s)
- Y Mizuno
- Centers for Disease Control and Prevention, Atlanta, GA. USA.
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39
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Abstract
Measles re-emerged in some counties in Germany in 2005, despite increasing vaccination coverage rates in children at school entry in recent years, which had led to decreasing incidence (with the lowest incidence ever recorded, 0.2 cases per 100 000 inhabitants in 2004).
Regional outbreaks have been detected by the mandatory reporting system in the states of Hesse and Bavaria. Although both outbreaks led to similar incidences in the affected areas (14 and 12 cases respectively per 100 000 inhabitants) they differed in age distribution, transmission patterns and measles virus genotype.
In Hesse, 223 cases were submitted, from which 160 belonged to 41 clusters mainly defined by family or household contacts. Attack rate was highest in children aged between 1-4 years (102 cases per 100 000). Results of measles virus diagnosis showed genotype D4 and identical nucleotide sequences for all analysed cases from Hesse.
In Bavaria, 279 cases were submitted, most of which had occurred in schools and preschool facilities. Age-specific attack rate was highest in children aged between 5-9 years (129 per 100 000). Laboratory diagnosed viruses were identified as genotype D6 and were identical at the nucleotide level.
In both outbreaks the vast majority of cases (95% in Hesse and 98% in Bavaria) were in unvaccinated children, but vaccination coverage differed in the affected areas and was slightly lower in Bavaria than in Hesse. Local accumulation of unvaccinated children and their concentration in schools and kindergarten preceded the outbreak in Bavaria.
Despite high average vaccination coverage levels, local variations may lead to regionally limited outbreaks.
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Affiliation(s)
- A Siedler
- Robert Koch-Institut, Berlin, Germany
| | - A Tischer
- National Reference Centre for Measles, Mumps and Rubella, Department of Viral Infections, Robert Koch-Institut, Berlin, Germany
| | - A Mankertz
- National Reference Centre for Measles, Mumps and Rubella, Department of Viral Infections, Robert Koch-Institut, Berlin, Germany
| | - S Santibanez
- National Reference Centre for Measles, Mumps and Rubella, Department of Viral Infections, Robert Koch-Institut, Berlin, Germany
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40
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Siedler A, Tischer A, Mankertz A, Santibanez S. Two outbreaks of measles in Germany 2005. Euro Surveill 2006; 11:131-4. [PMID: 16645244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
Measles re-emerged in some counties in Germany in 2005, despite increasing vaccination coverage rates in children at school entry in recent years, which had led to decreasing incidence (with the lowest incidence ever recorded, 0.2 cases per 100,000 inhabitants in 2004). Regional outbreaks have been detected by the mandatory reporting system in the states of Hesse and Bavaria. Although both outbreaks led to similar incidences in the affected areas (14 and 12 cases respectively per 100,000 inhabitants) they differed in age distribution, transmission patterns and measles virus genotype. In Hesse, 223 cases were submitted, from which 160 belonged to 41 clusters mainly defined by ,000). Results of measles virus diagnosis showed genotype D4 and identical nucleotide sequences for all analysed cases from Hesse. In Bavaria, 279 cases were submitted, most of which had occurred in schools and preschool facilities. Age-specific attack rate was highest in children aged between 5-9 years (129 per 100,000). Laboratory diagnosed viruses were identified as genotype D6 and were identical at the nucleotide level. In both outbreaks the vast majority of cases (95% in Hesse and 98% in Bavaria) were in unvaccinated children, but vaccination coverage differed in the affected areas and was slightly lower in Bavaria than in Hesse. Local accumulation of unvaccinated children and their concentration in schools and kindergarten preceded the outbreak in Bavaria. Despite high average vaccination coverage levels, local variations may lead to regionally limited outbreaks.
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Affiliation(s)
- A Siedler
- Respiratory Diseases and Immunization group, Department for Infectious Disease Epidemiology, Robert Koch-Institut, Berlin, Germany
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41
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Greenberg AE, Tappero J, Choopanya K, van Griensven F, Martin M, Vanichseni S, Santibanez S, Molotilov V, Hader S, Broyles LN. CDC international HIV prevention research activities among injection drug users in Thailand and Russia. J Urban Health 2005; 82:iv24-33. [PMID: 16107437 DOI: 10.1093/jurban/jti105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
The Centers for Disease Control and Prevention (CDC) has participated in collaborative HIV prevention research activities in injection drug users (IDUs) with the Bangkok Metropolitan Administration (BMA) in Bangkok, Thailand, from 1995 to the present and with the Orel AIDS Center in Orel Oblast, Russia, from 2001 to 2003. Studies in Bangkok have included an HIV prevention trial preparatory cohort from 1995 to 1998, a seroconverter cohort from 1998 to the present, a phase III trial of the AIDSVAX B/E gp120 HIV vaccine from 1999 to 2003, and a phase II/III HIV prophylaxis trial with tenofovir scheduled to begin in 2005. Activities in Orel included a review of HIV surveillance data in 2001, focus group discussions and a case-control study with HIV-infected and -uninfected IDUs in 2001, a cross-sectional study with the female sex partners of male IDUs in 2002, and a community outreach intervention in 2002-2003. In Bangkok, 1,209 IDUs were enrolled in the preparatory cohort which revealed an HIV incidence of 5.8% per 100 person-years; 133 HIV-infected IDUs have been followed in the seroconverter cohort with >85% follow-up and HIV and tuberculosis care provided; 2,546 IDUs were enrolled in the HIV vaccine efficacy trial which was successfully completed with a follow-up rate of >95%, although the vaccine was not shown to be effective at reducing HIV incidence; and 1,600 IDUs will be enrolled in the daily tenofovir HIV prophylaxis trial in 2005. In Orel, initial focus group discussions and epidemiologic studies revealed low HIV knowledge and high rates of unsafe injecting and sexual practices among IDUs and their female sex partners; and educational campaigns and the community outreach intervention were developed and implemented. A steady decline in new HIV infections in IDUs was then observed in Orel in 2002-2003. CDC has participated in the conduct of successful collaborative HIV prevention research activities in Thailand and Russia over the past decade. The establishment of long-term relationships with in-country public health and community partners has been instrumental in the success of these efforts.
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Affiliation(s)
- Alan E Greenberg
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Vellozzi C, Averhoff F, Lane JM, Wen X, Moore AC, Santibanez S, Kroger A, Hasbrouck LM, Kennedy A, Casey CG. Superinfection Following Smallpox Vaccination (Vaccinia), United States: Surveillance January 2003 through January 2004. Clin Infect Dis 2004; 39:1660-6. [PMID: 15578368 DOI: 10.1086/425617] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Accepted: 07/29/2004] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Superinfection is an adverse event following smallpox vaccination. The clinical presentation is similar to that of a large normal vaccine reaction or "robust take," and the frequency is unknown. METHODS We retrospectively reviewed all reported severe local reactions consistent with superinfection among United States civilian smallpox vaccinees from January 2003 through January 2004. We applied a standard case definition and estimated the frequency of superinfection following smallpox vaccination. RESULTS We identified 48 reported cases for further review among 39,350 [corrected] smallpox vaccinees. Two (4%) of the 48 reported cases met the case definition for superinfection; neither of the patients had a pathogenic organism isolated from their infection site. Both were treated with antibiotics and resolved their infection. Of the 46 cases determined not to be superinfection, 41 (89%) were temporally consistent with a large normal vaccine reaction. Thirty (75%) of 40 reported case patients for whom data were available received antibiotic therapy. CONCLUSIONS Superinfection following smallpox vaccination is rare. Most of the reported superinfection cases were probably large normal smallpox vaccine reactions. Educating providers about the normal response to smallpox vaccine may decrease the overdiagnosis of superinfection and the unnecessary use of antimicrobials.
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Affiliation(s)
- Claudia Vellozzi
- National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Purcell DW, Metsch LR, Latka M, Santibanez S, Gómez CA, Eldred L, Latkin CA. Interventions for Seropositive Injectors—Research and Evaluation. J Acquir Immune Defic Syndr 2004; 37 Suppl 2:S110-8. [PMID: 15385907 DOI: 10.1097/01.qai.0000140609.44016.c4] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Behavioral interventions to address the complex medical and HIV risk reduction needs of HIV-seropositive (HIV-positive) injection drug users (IDUs) are urgently needed. We describe the development of Interventions for Seropositive Injectors-Research and Evaluation (INSPIRE), a randomized controlled trial of an integrated intervention for HIV-positive IDUs, and the characteristics of the baseline sample. METHODS HIV-positive IDUs were recruited from community settings in 4 US cities. After completing a baseline assessment, participants who attended the first session were randomly assigned to (1) a 10-session peer mentoring intervention designed to improve utilization of HIV care, to improve adherence to HIV medications, and to reduce sexual and injection risk or (2) an 8-session videotape control. Periodic follow-up for 12 months is ongoing. RESULTS A total of 1161 HIV-positive IDUs completed the baseline assessment, and 966 (83%) were randomized. Retention rates are greater than 80% for all follow-up periods. Approximately 79% of baseline participants reported a recent medical visit, 49% were taking highly active antiretroviral therapy, and 19% had an undetectable viral load. Use of injection and noninjection substances was prevalent, and sexual and injection risks were each reported by more than 25% of participants. CONCLUSION There is a need for an integrated intervention for HIV-positive IDUs, and these data show the acceptability of such an approach.
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Affiliation(s)
- David W Purcell
- Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Santibanez S, Heider A, Gerike E, Agafonov A, Schreier E. Genotyping of measles virus isolates from central Europe and Russia. J Med Virol 1999; 58:313-20. [PMID: 10447429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Sequence analysis of 285 nucleotides located on the variable part of the N gene was undertaken on measles virus (MV) samples collected from acutely infected patients in Germany, the Czech Republic, Denmark, Poland, and Russia. Two distinct genotypes (C2 and D6) have circulated in Germany between 1993 and 1996. Isolates of genotype C2 were related to strains reported in Germany before 1993. This genotype was also found in the Czech Republic in 1992 and in Denmark in 1997. The occurrence of genotype D6 in Germany is described below for the first time. In 1998, this genotype was identified in Poland. Genotypes C2 and D6 were also reported in Spain and in the United Kingdom between 1992 and 1996. Therefore, it is concluded that these genotypes are widely distributed over Europe. The analysis of the isolates from Russia revealed that genotype A was present in 1988 in the European part of the country and in 1996 in Siberia. An isolate identified in 1997 in Siberia belonged to genotype D6, which had never been found previously in Russia. We also analysed MV obtained from a case of subacute sclerosing panencephalitis (SSPE) in 1995 in Turkey. A comparison of this sequence with published sequences implied that this SSPE case was associated with a new genetic lineage of MV.
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Heider A, Santibanez S, Tischer A, Gerike E, Tikhonova N, Ignatyev G, Mrazova M, Enders G, Schreier E. Comparative investigation of the long non-coding M-F genome region of wild-type and vaccine measles viruses. Arch Virol 1998; 142:2521-8. [PMID: 9672611 DOI: 10.1007/s007050050259] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The sequence of the 300 nucleotides region of the measles virus genome was determined that includes a part of the 3'-untranslated region of the matrix (M) gene, the intergenic region and a part of the 5'-untranslated region of the fusion (F) gene [M-F region] for vaccine strain Leningrad-16 and 14 wild-type isolates. The data obtained demonstrate the variability of this long non-coding M-F region. No mutations in this region of the genome were found which seem to be specific for vaccine strains of measles virus (MV).
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Affiliation(s)
- A Heider
- Research Institute of Viral Preparations, Russian Academy of Medical Sciences, Moscow, Russia
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Abstract
Experts met in Copenhagen on 19 and 20 November 1996 to discuss the elimination of measles in Europe. European countries were assigned to four different categories on the basis of a recent survey conducted by the World Health Organization's Regional Offic
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