Validation and implementation of the PowerPlex 16 BIO System STR multiplex for forensic casework.

The PowerPlex 16 BIO multiplex short tandem repeat (STR) system contains the 13 CODIS loci (FGA, TPOX, D8S1179, vWA, D18S51, D21S11, TH01, D3S1358, CSF1PO, D16S539, D7S820, D13S317, and DS5S818), plus two pentanucleotide repeat loci (Penta D and Penta E) and the sex-identifying locus. Amelogenin. The PowerPlex 16 BIO System is optimized for use with the Hitachi FMBIO gel imaging systems. A consortium of seven independent laboratories collaborated to perform the studies defined by the FBI standards for performing a developmental validation, including the evaluation of sample concordance, percent stutter determination, nonprobative casework, precision, sensitivity, mixture determination, effect of substrates, the impact of environmental insults, and species specificity. All samples tested for concordance were consistent except for one sample from the Virginia Division of Forensic Science database that displayed discordance at D13S317, a locus whose primer sequence was altered. Stutter values were comparable to those of other STR multiplex systems, the precision was comparable to other multiplexes analyzed by gel electrophoresis, the DNA profiles were unchanged by the substrate upon which the blood samples were placed, and the nonprobative casework samples re-typed for the PowerPlex 16 BIO System were consistent with previous typing results. When greater than 0.125 ng of DNA was placed into the PowerPlex 16 BIO System amplification reaction, a full profile was generated by all laboratories. The mixture study results were comparable to those reported for other multiplex systems, the environmental study demonstrated a loss of larger molecular weight loci when samples were incubated at elevated temperatures for a prolonged period of time, and the only notable cross species hybridization was observed with primate DNA samples. This extensive validation work performed demonstrates that the PowerPlex 16 BIO System provides STR data of a quality comparable with other PowerPlex STR multiplex kits as well as other widely used STR multiplexes and is thus suitable for evidentiary casework analysis as well as database sample profiling.

Costs of a hepatitis A outbreak affecting homosexual men: Franklin County, Ohio, 1999.

BACKGROUND: Hepatitis A is one of the most commonly reported, vaccine-preventable diseases in the United States. Many cases occur in association with community-wide outbreaks, but societal costs to the community are seldom documented. METHODS: Hepatitis A case-patients available for a follow-up interview as part of an outbreak investigation were asked about hospitalization, healthcare costs, missed work, and lost wages associated with their illness, as well as healthcare insurance coverage and sick-leave reimbursement. Average costs were calculated by case-patient age, gender, and hospitalization status for lost wages, and by age and hospitalization status for medical costs, and then assigned to case-patients not re-interviewed to provide an estimate of overall costs. Health departments provided outbreak-associated costs. RESULTS: Between the weeks of November 2, 1998, and May 17, 1999, a total of 136 cases of hepatitis A were reported. Of the 89 (65.4%) case-patients available for interview, 74 (83%) were male; of those, 47 (64%) identified themselves as men who have sex with men (MSM). The average cost of the outbreak per case-patient was $2894 US dollars, of which 51% was associated with lost wages, 40% with medical costs, and 9% with health department costs. Case-patients incurred 44% of total outbreak costs; employers, 29%; healthcare insurers, 18%; and health departments, 9%. CONCLUSIONS: In this community-wide hepatitis A outbreak, case-patients incurred the largest portion of costs, followed by employers, healthcare insurers, and health departments.

Outbreak of hepatitis A among men who have sex with men: implications for hepatitis A vaccination strategies.

Between November 1998 and May 1999, 136 cases of hepatitis A were reported in Columbus, Ohio. Eighty-nine (65%) case patients were reinterviewed. Of 74 male case patients, 47 (66%) were men who have sex with men (MSM). These 47 MSM were compared with 88 MSM control subjects, to identify risk factors for infection and potential opportunities for vaccination. During the exposure period, 6 (13%) case patients reported contact with a person who had hepatitis A, compared with 2 (2%) control subjects (odds ratio, 6.15; 95% confidence interval, 1.04-48.02); neither number of sex partners nor any sex practice was associated with illness. Most case patients and control subjects (68% and 77%, respectively) saw a health care provider at least annually, and 93% of control subjects reported a willingness to receive hepatitis A vaccine. MSM are accessible and amenable to vaccination; increased efforts are needed to provide vaccination, regardless of reported sex practices.