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1.
PLoS Comput Biol ; 18(10): e1010489, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-36206315

RESUMEN

Like other congregate living settings, military basic training has been subject to outbreaks of COVID-19. We sought to identify improved strategies for preventing outbreaks in this setting using an agent-based model of a hypothetical cohort of trainees on a U.S. Army post. Our analysis revealed unique aspects of basic training that require customized approaches to outbreak prevention, which draws attention to the possibility that customized approaches may be necessary in other settings, too. In particular, we showed that introductions by trainers and support staff may be a major vulnerability, given that those individuals remain at risk of community exposure throughout the training period. We also found that increased testing of trainees upon arrival could actually increase the risk of outbreaks, given the potential for false-positive test results to lead to susceptible individuals becoming infected in group isolation and seeding outbreaks in training units upon release. Until an effective transmission-blocking vaccine is adopted at high coverage by individuals involved with basic training, need will persist for non-pharmaceutical interventions to prevent outbreaks in military basic training. Ongoing uncertainties about virus variants and breakthrough infections necessitate continued vigilance in this setting, even as vaccination coverage increases.


Asunto(s)
COVID-19 , Personal Militar , Humanos , COVID-19/epidemiología , COVID-19/prevención & control , Brotes de Enfermedades/prevención & control , Estudios de Cohortes
2.
J Infect Dis ; 226(10): 1743-1752, 2022 11 11.
Artículo en Inglés | MEDLINE | ID: mdl-35543272

RESUMEN

BACKGROUND: Laboratory screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a key mitigation measure to avoid the spread of infection among recruits starting basic combat training in a congregate setting. Because viral nucleic acid can be detected persistently after recovery, we evaluated other laboratory markers to distinguish recruits who could proceed with training from those who were infected. METHODS: Recruits isolated for coronavirus disease 2019 (COVID-19) were serially tested for SARS-CoV-2 subgenomic ribonucleic acid (sgRNA), and viral load (VL) by reverse-transcriptase polymerase chain reaction (RT-PCR), and for anti- SARS-CoV-2. Cluster and quadratic discriminant analyses of results were performed. RESULTS: Among 229 recruits isolated for COVID-19, those with a RT-PCR cycle threshold >30.49 (sensitivity 95%, specificity 96%) or having sgRNA log10 RNA copies/mL <3.09 (sensitivity and specificity 96%) at entry into isolation were likely SARS-CoV-2 uninfected. Viral load >4.58 log10 RNA copies/mL or anti-SARS-CoV-2 signal-to-cutoff ratio <1.38 (VL: sensitivity and specificity 93%; anti-SARS-CoV-2: sensitivity 83%, specificity 79%) had comparatively lower sensitivity and specificity when used alone for discrimination of infected from uninfected. CONCLUSIONS: Orthogonal laboratory assays used in combination with RT-PCR may have utility in determining SARS-CoV-2 infection status for decisions regarding isolation.


Asunto(s)
COVID-19 , Humanos , COVID-19/diagnóstico , SARS-CoV-2 , Prueba de COVID-19 , Sensibilidad y Especificidad , ARN , ARN Viral/genética , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa
3.
J Community Health ; 43(3): 441-447, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29168085

RESUMEN

Human papillomavirus infection (HPV) is the most common sexually transmitted infection among United States Military Servicemembers, and present in the majority of cervical cancers. Many of these infections are preventable, but HPV immunization is not mandatory during military service. The objective of this study was to examine the prevalence of vaccine-preventable cervical disease among women enrolled in the San Antonio Military Health System. This is a retrospective cross-sectional study of Pap smear results and HPV genotyping data among Military Servicewomen and beneficiaries. Simple descriptive statistics and logistic regression were used to assess the association between demographics, cervical pathology and high-risk HPV (hrHPV) infection. Pap smears were obtained by 16.9% of women and cervical pathology was present in 28.8% of samples. Compared to the 25-34 year group, 35-44 year-olds were more likely to have an abnormal Pap smear (OR 1.25, CI 1.05-1.50). Of the samples tested, 10.5% were positive for hrHPV. Adjusted multivariable analysis revealed that hrHPV infection was more likely among the 23-34 year group when compared to 35-44 (OR 0.50, CI 0.38-0.67), 45-54 (0.40. CI 0.28-0.59) and 55-65 year groups (0.46, CI 0.30-0.71). Active Duty Servicewomen were more likely to test positive for hrHPV when compared to Active Duty Family Members (OR 0.59, CI 0.45-0.79) and Retiree Family Members (OR 0.59, CI 0.41-0.83). Younger women and Active Duty Servicewomen are significantly more likely to have cervical infection with hrHPV. Future studies should assess the cost-effectiveness of mandatory HPV immunization for military members.


Asunto(s)
Personal Militar/estadística & datos numéricos , Infecciones por Papillomavirus/diagnóstico , Enfermedades de Transmisión Sexual/diagnóstico , Frotis Vaginal/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Prueba de Papanicolaou , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/epidemiología , Prevalencia , Estudios Retrospectivos , Enfermedades de Transmisión Sexual/virología , Estados Unidos , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/virología
4.
Med J (Ft Sam Houst Tex) ; (Per 22-07/08/09): 70-76, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35951235

RESUMEN

The coronavirus (COVID-19) pandemic has changed the world; and the US military changed with it. Although this virus presents with a wide spectrum of disease progression (no symptoms to acute respiratory distress syndrome leading to death), its impact extends beyond health outcomes. At the time of this study, numerous research and development projects were underway to develop a COVID-19 vaccine or other treatment modalities; however, there were no Federal Drug Administration (FDA) approved vaccines or medical therapeutics that definitively provided a cure. Instead, public health officials relied on non-pharmaceutical interventions (NPI) as a main strategy to contain and mitigate the disease. The US military in partnership with host nation countries, such as the Kingdom of Saudi Arabia, exemplified unity of effort through a coordinated response: mass testing, prompt contact tracing, quarantine, and isolation. One main non-pharmaceutical intervention (NPI) strategy includes social distancing which has been shown to significantly impact pandemic influenza transmission translating to COVID-19 mitigation measures. In the military, strict adherence to quarantine, restriction of movement, and isolation orders can be a challenge since appropriate facilities and resources are limited in deployed and training environments. Further, asymptomatic carriage and transmission of COVID-19 disease (mean incubation time 6.2 days and range of 2-14 days) can complicate quarantine and testing methodologies. Moreover, deployment of the NPI mitigation strategies such as quarantine and isolation in an effective and timely manner is essential to prevent further spread. In essence, quarantine is the prevention, and isolation is the cure. This paper aims to describe how a deployed US Army Role I can effectively utilize NPI and containment strategies during a global pandemic in an austere environment.


Asunto(s)
COVID-19 , Cuarentena , COVID-19/epidemiología , COVID-19/prevención & control , Vacunas contra la COVID-19 , Humanos , Pandemias/prevención & control , SARS-CoV-2
5.
Med J (Ft Sam Houst Tex) ; (PB 8-21-01/02/03): 118-121, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33666923

RESUMEN

Since December 2019, the novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) became an emerging infectious disease pathogen that led to a global pandemic with over 43 million cases reported worldwide and more than 1.1 million global deaths (as of 26 Oct 2020, from https://coronavirus.jhu.edu/map.html). Commonly known as coronavirus disease 2019 (COVID-19), this pathogen presents with a broad spectrum of disease progression and manifestations (no symptoms to acute respiratory distress syndrome leading to severe complications and death).1,2 Multiple publications have reported risk of disease and co-morbidities to include select underlying medical conditions and risks: older age (≥65 years), hypertension (HTN), cardiovascular disease, smoking, chronic respiratory disease, cancer, diabetes (DM), obesity (BMI ≥ 30 kg/m2), and male sex.2,3,4,5,6,7,8 In one study, researchers found severe obesity (BMI ≥ 35 kg/m2) associated with intensive care unit (ICU) admission alone.8 Nonetheless, risk factors for severity of the disease are determined by the pathogen, host, and environment.9.


Asunto(s)
Ambulancias Aéreas , COVID-19/diagnóstico , COVID-19/terapia , Control de Infecciones , Personal Militar , Transferencia de Pacientes , Adulto , Estudios de Cohortes , Humanos , Masculino , Persona de Mediana Edad
6.
Open Forum Infect Dis ; 8(9): ofab407, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34514020

RESUMEN

BACKGROUND: Significant variability exists in the application of infection control policy throughout the US Army initial entry training environment. To generate actionable information for the prevention of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/coronavirus disease 2019 (COVID-19) transmission among new recruits, active enhanced surveillance was conducted for evidence of and exposure to SARS-CoV-2/COVID-19. METHODS: We serially tested recruits with a reverse transcriptase polymerase chain reaction (RT-PCR) COVID-19 and/or total antibody to SARS-CoV-2 tests at days 0, 14, and week 10 upon arrival for basic combat training at a location in the Southern United States. RESULTS: Among 1403 recruits who were enrolled over a 6-week period from August 25 through October 11, 2020, 84 recruits tested positive by RT-PCR, with more than half (55%, 46/84) testing positive at arrival and almost two-thirds (63%, 53/84) also testing seropositive at arrival. Similarly, among an overall 146 recruits who tested seropositive for SARS-CoV-2 during the period of observation, a majority (86%) tested seropositive at arrival; no hospitalizations were observed among seropositive recruits, and antibody response increased at week 10. CONCLUSIONS: These findings that suggest serological testing may complement current test-based measures and provide another tool to incorporate in COVID-19 mitigation measures among trainees in the US Army.

7.
MSMR ; 24(5): 12-17, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28570089

RESUMEN

Hepatitis C virus (HCV) infection remains an important concern for the Military Health System (MHS). This report updates numbers and incidence rates of HCV infection of U.S. military service members and MHS beneficiaries, incorporating a surveillance period before and after 2012 screening policy changes for military members. From 2008 to 2016, there were 342 and 1,491 incident cases of acute and chronic hepatitis C, respectively, among active component members of the U.S. Armed Forces; crude overall incidence rates during the period were 2.8 (acute) and 12.2 (chronic) cases per 100,000 person-years. Annual incidence rates of chronic hepatitis C decreased over the surveillance period; however, rates of acute hepatitis C remained steady. There were 141 acute and 587 chronic incident cases among reserve/guard service members, with annual counts of both acute and chronic cases decreasing over the surveillance period. In addition, there were 2,541 acute and 21,418 chronic cases among non-service member beneficiaries, with annual counts of acute and chronic cases also decreasing steadily over the surveillance period. Given recent pharmaceutical advances in treatment, screening and linkage to care are critical to improving health outcomes for those with HCV infection.


Asunto(s)
Hepatitis C Crónica/epidemiología , Hepatitis C/epidemiología , Personal Militar/estadística & datos numéricos , Vigilancia de la Población , Enfermedad Aguda , Adolescente , Adulto , Distribución por Edad , Etnicidad/estadística & datos numéricos , Femenino , Hepatitis C/etnología , Hepatitis C Crónica/etnología , Humanos , Incidencia , Masculino , Familia Militar/estadística & datos numéricos , Grupos Raciales/estadística & datos numéricos , Distribución por Sexo , Estados Unidos/epidemiología , Adulto Joven
8.
Front Public Health ; 4: 207, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27774446

RESUMEN

This paper reviews several common challenges encountered in statistical analyses of epidemiological data for epidemiologists. We focus on the application of linear regression, multivariate logistic regression, and log-linear modeling to epidemiological data. Specific topics include: (a) deletion of outliers, (b) heteroscedasticity in linear regression, (c) limitations of principal component analysis in dimension reduction, (d) hazard ratio vs. odds ratio in a rate comparison analysis, (e) log-linear models with multiple response data, and (f) ordinal logistic vs. multinomial logistic models. As a general rule, a thorough examination of a model's assumptions against both current data and prior research should precede its use in estimating effects.

15.
Ann Allergy Asthma Immunol ; 102(1): 57-61, 2009 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-19205287

RESUMEN

BACKGROUND: Recommendations regarding the administration of imported fire ant whole body extract (IFA WBE) combined with aeroallergens or environmental allergens in a single immunotherapy injection are lacking. OBJECTIVE: To evaluate the degradative effect of IFA WBE on cat, ragweed, Dermatophagoides pteronyssinus, and timothy grass allergens. METHODS: Imported fire ant whole body extract was combined with extracts of cat, ragweed, D pteronyssinus, and timothy grass. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) was performed on each sample after storage for 0, 1, 3, and 6 months at 4 degrees C. In addition, cat and ragweed combinations were evaluated by radial immunodiffusion (RID); D pteronyssinus by enzyme-linked immunosorbent assay (ELISA) inhibition; and timothy grass by ELISA inhibition and Western blot. RESULTS: Imported fire ant whole body extract combined with timothy grass demonstrated degradation of timothy grass allergens by SDS-PAGE, ELISA inhibition, and Western blot results. Cat and ragweed allergens were stable after mixing with IFA WBE, based on SDS-PAGE and RID analyses. Stability of D pteronyssinus allergens with IFA WBE was evident from SDS-PAGE and ELISA inhibition data. CONCLUSIONS: Imported fire ant whole body extract combined with timothy grass resulted in significant and rapid timothy protein degradation. Imported fire ant whole body extract mixed with cat, ragweed, or D pteronyssinus revealed aeroallergen stability, yielding the possibility of combining these extracts in a single immunotherapy injection. Compatibilities of IFA WBE with other common aeroallergens remain undetermined and thus are not recommended for single-injection immunotherapy formulations.


Asunto(s)
Alérgenos/química , Ambrosia/química , Hormigas/química , Dermatophagoides pteronyssinus/química , Phleum/química , Extractos de Tejidos/química , Alérgenos/inmunología , Ambrosia/inmunología , Animales , Hormigas/inmunología , Gatos , Dermatophagoides pteronyssinus/inmunología , Desensibilización Inmunológica , Incompatibilidad de Medicamentos , Humanos , Phleum/inmunología , Conejos , Extractos de Tejidos/inmunología
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