Human papillomavirus vaccine uptake and barriers: association with perceived risk, actual risk and race/ethnicity among female students at a New York State university, 2010.

Understanding human papillomavirus (HPV) vaccine uptake patterns is critical to improve vaccination levels. Approximately half (56%) of female undergraduate students surveyed at a large public university reported HPV vaccine series initiation, with 79% of initiators completing the three dose series. Predictors of series initiation included having a conversation with a health-care provider about the vaccine, reporting a history of sexual intercourse and receipt of the meningitis vaccine. Compared to whites, black/African-American women were 33% less likely to have initiated HPV vaccination. Common reasons for not receiving the HPV vaccine included concerns about vaccine safety and doctors' not recommending vaccination.

An investigation of potential neurosurgical transmission of Creutzfeldt-Jakob disease: challenges and lessons learned.

In 2001, New York State health officials were notified about 2 patients with Creutzfeldt-Jakob disease who had undergone neurosurgical procedures at the same hospital within 43 days of each other. One patient had Creutzfeldt-Jakob disease at the time of surgery; the other patient developed Creutzfeldt-Jakob disease 6.5 years later. This investigation highlights the difficulties in assessing possible transmission of Creutzfeldt-Jakob disease.

Characteristics of human calicivirus enteritis in intestinal transplant recipients.

OBJECTIVES: The human caliciviruses, which include Norwalk-like viruses (or Noroviruses) and Sapporo viruses, commonly cause epidemic and endemic viral gastroenteritis of short duration in healthy individuals. However, the impact of human calicivirus in immunosuppressed populations has not been established. The authors report five pediatric patients who developed human calicivirus enteritis after intestinal transplantation. METHODS: Infection was documented with repetitive reverse transcription polymerase chain reaction testing with nucleotide sequencing of tissue and lumen fluid specimens. RESULTS: A single strain, type Miami Beach, affected all patients in the hospital with an apparent index case. A potential mode of transmission was not defined. Severe osmotic or secretory diarrhea necessitated intravenous fluid therapy for 40 days or more in three of the five infants. Concurrent or recent subclinical allograft infection with adenovirus in two patients was associated with more severe symptoms. Virus excretion exceeded 80 days in two patients. Differentiation of human calicivirus enteritis from allograft rejection was difficult, as both disorders were associated with increased enterocyte apoptosis and inflammation. Intensification of immunosuppressive therapy because of suspected rejection appeared to prolong symptoms. CONCLUSION: These findings demonstrate that human calicivirus can be a significant pathogen in intestinal transplant recipients and potentially in other immunocompromised patients.

Calicivirus infection in pediatric small intestine transplant recipients: pathological considerations.

Human calicivirus (HuCV), a common cause of mild gastroenteritis in the general population, produces a prolonged diarrheal illness in pediatric recipients of small intestinal transplant (IT). By use of reverse-transcription polymerase chain reaction to detect the viral RNA polymerase gene in stool and tissue from gastrointestinal biopsies, 5 pediatric IT recipients with high-volume diarrhea were diagnosed with HuCV enteritis. Histopathologic findings of biopsies obtained at different gastrointestinal sites were studied retrospectively to identify characteristic features of HuCV enteritis and to distinguish these changes from rejection. Controls were 8 pediatric IT recipients with high-volume diarrhea but negative HuCV reverse-transcription polymerase chain reaction assays during the same time period. All HuCV biopsies showed increased mononuclear infiltrates in the lamina propria and villous blunting. Reactive disarray of surface epithelial cells and increased apoptosis in the surface epithelium and superficial lamina propria were characteristic features (in 4/5 patients). Increased glandular apoptosis was also present in 3/5 patients. Findings were more pronounced in jejunal allograft than ileal allograft, and were present in both graft and native bowel. In comparison with the control group, the architectural changes, surface epithelial reactive changes, and superficial apoptosis were characteristic of HuCV enteritis, while the presence of glandular apoptosis was a feature shared with cases of mild acute cellular rejection HuCV may cause severe allograft dysfunction after pediatric IT. Calicivirus infection has clinical and histological features that overlap with allograft rejection. Knowledge of the characteristic histologic features of HuCV enteritis aids in differential diagnosis.

Molecular epidemiology of outbreaks of viral gastroenteritis in New York State, 1998-1999.

This investigation evaluated the role of Norwalk-like virus (NLV) and other viruses (rotavirus, enteric adenovirus, and enterovirus) in 11 outbreaks of acute nonbacterial gastroenteritis that occurred in multiple settings in a span of 18 months in New York State. To determine the etiology of illness, patients' stool specimens were analyzed with a combination of reverse-transcription polymerase chain reaction (RT-PCR) and nucleotide sequencing, cell culture, and ELISA diagnostic techniques. NLV was detected from all of these outbreaks, with an overall detection rate of 64% (51 of 79) for all specimens tested. Repeated attempts to isolate other viral pathogens were unsuccessful. Phylogenetic analysis of a subset of 27 specimens from these outbreaks showed the presence of both genogroup I and genogroup II NLVs. A spectrum of different nucleotide sequences were detected, demonstrating interoutbreak sequence variation and unrelated infections. NLV is a significant causative agent of diarrhea outbreaks in New York State.