Demographic and Epidemiological Characteristics Associated With Reduced Antimicrobial Susceptibility to Neisseria gonorrhoeae in the United States, Strengthening the US Response to Resistant Gonorrhea, 2018 to 2019.

BACKGROUND: Jurisdictions participating in Strengthening the US Response to Resistant Gonorrhea (SURRG) implemented specimen collection for culture and antimicrobial susceptibility testing from a sample of persons of all genders (at multiple anatomic sites) attending sexually transmitted disease clinics and community clinics. We describe the percentage and characteristics of patients whose isolates demonstrated reduced susceptibility (RS) to azithromycin, ceftriaxone, or cefixime. METHODS: We included patients from clinics that participated in SURRG whose isolates underwent antimicrobial susceptibility testing by Etest. We defined RS as azithromycin minimum inhibitory concentrations (MICs) ≥2 µg/mL (AZM-RS), ceftriaxone MICs ≥0.125 µg/mL (CRO-RS), or cefixime MICs ≥0.25 µg/mL (CFX-RS). Patients with repeated infections appeared >1 time in the data. We calculated the frequency and percentage of patients with an isolate demonstrating RS by epidemiological characteristics. RESULTS: During the period 2018-2019, 10,013 patients from 8 jurisdictions provided 10,735 isolates. Among 10,013 patients, 11.0% (n = 1099) had ≥1 isolate with AZM-RS (range by jurisdiction, 2.5%-18.0%). Approximately 11.3% of 8771 of patients visiting sexually transmitted disease clinics and approximately 8.8% of 1242 patients visiting community clinics had an AZM-RS isolate. Nearly 6% of 1013 females had an AZM-RS isolate; among males, the percents of patients with an AZM-RS isolate were 17.7% among 4177 men who have sex only with men and 6.1% among 3581 men who have sex only with women. Few (0.4%) patients had isolates with CFX-RS (n = 40) or CRO-RS (n = 43). CONCLUSIONS: Although infections with reduced cephalosporin susceptibility were rare, AZM-RS infections were prevalent in this sample of patients in multiple jurisdictions and across gender and gender of sex partner categories.

Exploring and Comparing the Structure of Sexual Networks Affected by Neisseria gonorrhoeae Using Sexual Partner Services Investigation and Genomic Data.

BACKGROUND: Sexual networks are difficult to construct because of incomplete sexual partner data. The proximity of people within a network may be inferred from genetically similar infections. We explored genomic data combined with partner services investigation (PSI) data to extend our understanding of sexual networks affected by Neisseria gonorrhoeae (NG). METHODS: We used 2017-2019 PSI and whole-genome sequencing (WGS) data from 8 jurisdictions participating in Centers for Disease Control and Prevention's Strengthening the US Response to Resistant Gonorrhea (SURRG) project. Clusters were identified from sexual contacts and through genetically similar NG isolates. Sexual mixing patterns were characterized by describing the clusters by the individual's gender and gender of their sex partners. RESULTS: Our study included 4627 diagnoses of NG infection (81% sequenced), 2455 people received a PSI, 393 people were negative contacts of cases, and 495 were contacts with an unknown NG status. We identified 823 distinct clusters using PSI data combined with WGS data. Of cases that were not linked to any other case using PSI data, 37% were linked when using WGS data. Overall, 40% of PSI cases were allocated to a larger cluster when PSI and WGS data were combined compared with PSI data alone. Mixed clusters containing women, men who report sex with women, and men who report sex with men were common when using the WGS data either alone or in combination with the PSI data. CONCLUSIONS: Combining PSI and WGS data improves our understanding of sexual network connectivity.

Occupational hazardous drug exposure among non-oncology nurses.

Oncology units where patients with cancer receive chemotherapy are not the only settings where hazardous drugs are found. Because of increased use of antineoplastic agents for non-oncology indications, nurses' risk for occupational exposure is distributed more widely than in the past.

Sustainability of community-capacity to promote safer motherhood in northwestern Tanzania: what remains?

OBJECTIVE: To examine the remains of the Community-Based Reproductive Health Project (CBRHP) implemented by CARE-Tanzania to address high maternal mortality in two rural districts. METHODS: In early 2007, data were collected from 29 villages and used to assess sustainability of emergency transport systems, retention of village health workers (VHWs), and their potential impact on maternal health. Surveillance data from the Ministry of Health were reviewed to assess changes in prenatal and service use indicators. RESULTS: From 2001 through 2006, the CBRHP-trained VHWs have continued to provide education and referrals to women in their communities including prenatal and emergency obstetric care; six villages with emergency transport systems have continued for more than 5 years providing free or low-cost transport to health facilities. Selected maternal and infant health indicators, such as early prenatal care, identification of pregnancy-related danger signs, and data on maternal and infant outcomes, improved in the two targeted districts over time. CONCLUSIONS: The two components of CBRHP, work of VHWs and community-financing for emergency transport systems in six villages, have continued. Both of these promote maternal health and linkages with the health delivery systems. Surveillance data show changes in maternal health indicators that were targeted by the district-wide CBRHP interventions. Programs such as CBRHP, with focus on capacity-building and empowerment, can assist in mobilizing the formal and informal systems in communities, components of which may be sustained over time.

Multiple Sclerosis disease distribution and potential impact of environmental air pollutants in Georgia.

Multiple Sclerosis (MS) is one of the most common diseases of the central nervous system. Although the disease has been associated with some genetic and environmental factors, it has neither clear causes nor clear temporality with respect to exposure. The purpose of this study was to explore potential relationships between MS and outdoor air pollutants in GA. This study used cross-sectional data from the member's list of the Multiple Sclerosis Society's GA chapter (MSS-GA), the US Census, and a database of county-level Toxic Release Inventory data (emissions across identified, reporting sources to outdoor air, as a surrogate indicator of potential exposure to a criteria pollutant subject to regulation or to chemical toxicants). The final study population was 9,072,576 people, including 6247 self-reported MS cases from MSS-GA. Cases were stratified by gender and transformed into county-level, self-reported prevalence rates using 2005 US Census estimates. County-level prevalence was displayed using a Geographic Information System. Linear regression was conducted to investigate potential relationships between self-reported MS prevalence rates, census data, and environmental outdoor air pollutant indicators. MS prevalence tended to be clustered within the largest metropolitan statistical area (MSA) in Georgia, around Atlanta (Fulton County). The best predictive models for the MS prevalence in GA included both per capita income and PM-10 for females, but only per capita income only for males. The clustering of prevalence of MS in the largest MSA of Georgia, after controlling for population distribution, suggested that urban attributes may be associated with MS. The results of this study further suggested a potential role of PM-10 in the etiology of MS in females, perhaps due to the influence of PM-10 on systemic immune response and inflammation. Based on this initial exploratory study, we recommend more basic and clinical exposure research to understand environmental influences on MS. In particular, outdoor air pollutants like particles, and attached chemicals and metals, which have other known adverse cardiopulmonary health outcomes and are subject to federal and state regulations, could be examined using routinely collected outdoor air monitoring station data and/or modeling.

The evidence base for public health informing policy at the Centers for Disease Control and Prevention.

BACKGROUND: As part of a major re-examination of its organization, in 2004, the Centers for Disease Control and Prevention (CDC) assessed the evidence base for the effectiveness of population-based public health intervention programs. METHODS: For the leading causes of disease, injury, and disability, evidence was systematically reviewed for modifiable risk factors and their attributable fractions, and for public health interventions and their preventable fractions. RESULTS: For 31 conditions, 194 modifiable risk factors were identified, and attributable fractions were found for 65 (33.5%). For 137 (70.6%) of the risk factors, 702 population-based interventions were found. Preventable fractions were found for 31 (4.4%) of the interventions. CONCLUSIONS: Despite considerable information about both modifiable risk factors and interventions designed to reduce the risks of the major causes of disease, injury, and disability, the evidence base that describes the effectiveness of these interventions is limited. The CDC is committed to support research that will set priorities for program development and identify effective public health interventions.

Evaluating the American Academy of Pediatrics diagnostic standard for Streptococcus pyogenes pharyngitis: backup culture versus repeat rapid antigen testing.

OBJECTIVE: The American Academy of Pediatrics recommends that all negative rapid diagnostic tests for Streptococcus pyogenes pharyngitis be backed up by culture, which creates a dilemma for clinicians who must make treatment decisions without complete diagnostic information at the time of visit. The use of a follow-up serial rapid antigen test instead of a follow-up culture would provide a more timely result. METHODS: Two swabs were collected from children who were suspected of having S pyogenes pharyngitis. Each swab was used for a culture and an OSOM Ultra Strep A Test rapid antigen test. The gold standard of comparison was defined as the identification of S pyogenes on either of the 2 culture plates. Three diagnostic strategies were evaluated: a single rapid antigen test, a rapid antigen test with follow-up rapid antigen test (rapid-rapid), and a rapid antigen test with follow-up culture (rapid-culture). RESULTS: A total of 210 (23.7%) of 887 throat cultures with matched data were identified with S pyogenes. A single rapid antigen test had a sensitivity of 87.6% (95% confidence interval [CI]: 83.2%-92.1%), the sensitivity of the rapid-rapid follow-up was 91.4% (95% CI: 87.6%-95.2%), and the sensitivity of the rapid-culture follow-up was 95.7% (95% CI: 93.0%-98.5%), which was significantly higher than the others. As shown in Fig 1, when these test strategies were evaluated on a subgroup with clinical symptoms commonly associated with S pyogenes pharyngitis, the sensitivities all increased and were no longer significantly different. None of the strategies reliably exceeded a 95% sensitivity threshold. CONCLUSIONS: The American Academy of Pediatrics strategy for S pyogenes detection in children with pharyngitis, requiring a backup culture for those with negative antigen tests, was not exceeded by any other test strategy; however, a rapid-rapid diagnostic strategy may approximate it with the use of judicious clinical selection of patients.

Comparison of two rapid Streptococcus pyogenes diagnostic tests with a rigorous culture standard.

BACKGROUND: Comparisons of rapid antigen tests for the diagnosis of pharyngitis are often made between published studies but may not be reliable given differences in study design, sampling and reference standard definitions. Tests are rarely compared against each other in a single study. METHODS: The sensitivity and specificity of two rapid diagnostic tests were compared against a multiplate culture standard defined as the identification of on any of four culture plates. Paired swabs were tested for antigen using Genzyme's OSOM Ultra Strep A Test and compared with Biostar's Strep A OIA Max Test. RESULTS: Ninety-four (31.1%) of 302 matched samples were identified with The sensitivity of Genzyme's OSOM Ultra Strep A Test against the multiplate culture standard was 92.6%, significantly higher ( P= 0.001) than that (75.5%) of Biostar's Strep A OIA Max Test. Specificities were 92.8 and 97.1%, respectively. Data analysis of culture results and statistical modeling showed that cultures of two or more samples are necessary for a sensitivity of 95% or greater for a comparison standard compared with true disease status. CONCLUSIONS: When comparing the performance of rapid antigen tests for pharyngitis, a rigorous culture standard should be used consisting of at least two separate samples (swabs and/or pledgets), ultimately plated on selective agar. Genzyme's OSOM Ultra Strep A Test was significantly more sensitive than Biostar's Strep A OIA Max Test in comparison with a multiplate culture standard and a same swab, single plate culture standard.

Impact of rapid polymerase chain reaction results on management of pediatric patients with enteroviral meningitis.

BACKGROUND: Enterovirus (EV) infections can be rapidly detected by PCR. However, several studies suggest that results must be available early in the management of the patient to impact significantly on patient care. We evaluated this hypothesis directly during an outbreak of EV aseptic meningitis. METHODS: From June through November, 1998, EV PCR was performed 5 days a week on cerebrospinal fluid specimens from pediatric patients evaluated for meningitis. We compared antibiotic use, length of stay and hospital charges in a group of patients with EV meningitis whose positive EV PCR results were available within 24 h of specimen collection, to a group of similar patients whose results were available >24 h after collection. RESULTS: Cerebrospinal fluid specimens were submitted for EV PCR from 113 patients with suspected EV meningitis, and 50 of 113 (44%) were positive. Of these 50 EV-PCR-positive patients, 17 of 50 (34%) had EV PCR results available in < or = 24 h and 33 of 50 (66%) had results available in >24 h. Patients with EV-positive results reported < or = 24 h after specimen collection had 20 h less of antibiotic use (P = 0.006) and $2,798 less in hospital charges (P = 0.001) than patients with positive results available in >24 h. Hospitalized patients who received positive results rapidly did not have significantly less antibiotic therapy or shorter length of stay, but hospital charges were reduced by $2,331 (P = 0.009). CONCLUSION: Rapid reporting of PCR results can have a significant impact on several outcome measures for patients with EV meningitis.