RESUMO
Acute flaccid myelitis (AFM) is a serious neurologic condition primarily affecting children; AFM can cause acute respiratory failure and permanent paralysis. AFM is a rare but known complication of various viral infections, particularly those of enteroviruses (EVs). Increases in AFM cases during 2014, 2016, and 2018 were associated with EV-D68 infection. This report examines trends in confirmed AFM cases during 2018-2022 and patients' clinical and laboratory characteristics. The number of AFM cases was low during 2019-2022 (28-47 cases per year); the number of cases remained low in 2022 despite evidence of increased EV-D68 circulation in the United States. Compared with cases during the most recent peak year (2018), fewer cases during 2019-2021 had upper limb involvement, prodromal respiratory or febrile illness, or cerebrospinal fluid pleocytosis, and more were associated with lower limb involvement. It is unclear why EV-D68 circulation in 2022 was not associated with an increase in AFM cases or when the next increase in AFM cases will occur. Nonetheless, clinicians should continue to suspect AFM in any child with acute flaccid limb weakness, especially those with a recent respiratory or febrile illness.
Assuntos
Viroses do Sistema Nervoso Central , Enterovirus Humano D , Infecções por Enterovirus , Mielite , Doenças Neuromusculares , Criança , Humanos , Estados Unidos/epidemiologia , Doenças Neuromusculares/epidemiologia , Paralisia , Mielite/epidemiologia , Viroses do Sistema Nervoso Central/epidemiologia , Infecções por Enterovirus/epidemiologiaRESUMO
BACKGROUND: The largest West African monkeypox outbreak began September 2017, in Nigeria. Four individuals traveling from Nigeria to the United Kingdom (n = 2), Israel (n = 1), and Singapore (n = 1) became the first human monkeypox cases exported from Africa, and a related nosocomial transmission event in the United Kingdom became the first confirmed human-to-human monkeypox transmission event outside of Africa. METHODS: Epidemiological and molecular data for exported and Nigerian cases were analyzed jointly to better understand the exportations in the temporal and geographic context of the outbreak. RESULTS: Isolates from all travelers and a Bayelsa case shared a most recent common ancestor and traveled to Bayelsa, Delta, or Rivers states. Genetic variation for this cluster was lower than would be expected from a random sampling of genomes from this outbreak, but data did not support direct links between travelers. CONCLUSIONS: Monophyly of exportation cases and the Bayelsa sample, along with the intermediate levels of genetic variation, suggest a small pool of related isolates is the likely source for the exported infections. This may be the result of the level of genetic variation present in monkeypox isolates circulating within the contiguous region of Bayelsa, Delta, and Rivers states, or another more restricted, yet unidentified source pool.
Assuntos
Monkeypox virus , Mpox , Surtos de Doenças , Humanos , Mpox/epidemiologia , Monkeypox virus/genética , Nigéria/epidemiologia , Reino UnidoRESUMO
BACKGROUND: Monkeypox is a poorly described emerging zoonosis endemic to Central and Western Africa. METHODS: Using surveillance data from Tshuapa Province, Democratic Republic of the Congo during 2011-2015, we evaluated differences in incidence, exposures, and clinical presentation of polymerase chain reaction-confirmed cases by sex and age. RESULTS: We report 1057 confirmed cases. The average annual incidence was 14.1 per 100 000 (95% confidence interval, 13.3-15.0). The incidence was higher in male patients (incidence rate ratio comparing males to females, 1.21; 95% confidence interval, 1.07-1.37), except among those 20-29 years old (0.70; .51-.95). Females aged 20-29 years also reported a high frequency of exposures (26.2%) to people with monkeypox-like symptoms.The highest incidence was among 10-19-year-old males, the cohort reporting the highest proportion of animal exposures (37.5%). The incidence was lower among those presumed to have received smallpox vaccination than among those presumed unvaccinated. No differences were observed by age group in lesion count or lesion severity score. CONCLUSIONS: Monkeypox incidence was twice that reported during 1980-1985, an increase possibly linked to declining immunity provided by smallpox vaccination. The high proportion of cases attributed to human exposures suggests changing exposure patterns. Cases were distributed across age and sex, suggesting frequent exposures that follow sociocultural norms.
Assuntos
Mpox , Adolescente , Adulto , Criança , República Democrática do Congo/epidemiologia , Feminino , Humanos , Masculino , Mpox/diagnóstico , Mpox/epidemiologia , Monkeypox virus/genética , Vacina Antivariólica , Adulto JovemRESUMO
A suspected outbreak of influenza A and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at a long-term care facility in Los Angeles County was, months later, determined to not involve influenza. To prevent inadvertent transmission of infections, facilities should use highly specific influenza diagnostics and follow Centers for Disease Control and Prevention (CDC) guidelines that specifically address infection control challenges.
Assuntos
COVID-19 , Influenza Humana , Surtos de Doenças , Humanos , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Assistência de Longa Duração , SARS-CoV-2RESUMO
Outbreaks of Guillain-Barré syndrome (GBS) are uncommon. In May 2019, national surveillance in Peru detected an increase in GBS cases in excess of the expected incidence of 1.2 cases/100,000 population. Several clinical and epidemiologic findings call into question the suggested association between this GBS outbreak and Campylobacter.
Assuntos
Infecções por Campylobacter , Surtos de Doenças , Síndrome de Guillain-Barré , Adolescente , Adulto , Campylobacter , Infecções por Campylobacter/epidemiologia , Criança , Pré-Escolar , Feminino , Síndrome de Guillain-Barré/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Adulto JovemRESUMO
On November 7, 2018, the Utah Department of Health (UDOH) reported the first confirmed human rabies death in the state since 1944 (1). The case occurred in a person who had been treated over a period of 19 days at four health care facilities and an emergency medical transport service across three counties and two states. Human rabies is preventable through preexposure or postexposure vaccination but is invariably fatal upon symptom onset. Timely identification of persons who might have been exposed to rabies virus is therefore crucial to administer postexposure prophylaxis (PEP). Because of the large number of health care workers who had been involved in the patient's care, a standardized online risk assessment survey was developed by UDOH based on Advisory Committee on Immunization Practices recommendations (2). This online tool was evaluated for accuracy, acceptability, and administrative obligation by reviewing the results from the tool and conducting focus group discussions and a follow-up survey. Among 90 health care workers initially identified by the online risk assessment as being potentially exposed to infectious material, 74 were classified as exposed. All 74 health care workers received PEP following consultation with occupational health staff members, indicating a positive predictive value of the assessment tool of 82%. In a follow-up survey, 42 (76%) of the 55 respondents reported that they were satisfied with the assessment process. In focus group discussions, participants suggested that the survey could be improved by providing additional information about rabies exposures because many of them were unfamiliar with human-to-human rabies transmission. This evaluation highlighted the importance of adopting clear communication strategies, demonstrated the benefits of using an online risk assessment during a mass rabies exposure, and provided specific feedback for CDC to improve resources available for states and health care facilities after mass rabies exposures.
Assuntos
Pessoal de Saúde , Internet , Exposição Ocupacional/estatística & dados numéricos , Raiva/prevenção & controle , Medição de Risco/métodos , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Exposição Ocupacional/efeitos adversos , Satisfação do Paciente/estatística & dados numéricos , Profilaxia Pós-Exposição/estatística & dados numéricos , Raiva/epidemiologia , Raiva/transmissão , Utah/epidemiologiaRESUMO
On November 3, 2018, the Utah Department of Health (UDOH) was notified of a suspected human rabies case in a man aged 55 years. The patient's symptoms had begun 18 days earlier, and he was hospitalized for 15 days before rabies was suspected. As his symptoms worsened, he received supportive care, but he died on November 4. On November 7, a diagnosis of rabies was confirmed by CDC. This was the first documented rabies death in a Utah resident since 1944. This report summarizes the patient's clinical course and the subsequent public health investigation, which determined that the patient had handled several bats in the weeks preceding symptom onset. Public health agencies, in partnership with affected health care facilities, identified and assessed the risk to potentially exposed persons, facilitated receipt of postexposure prophylaxis (PEP), and provided education to health care providers and the community about the risk for rabies associated with bats. Human rabies is rare and almost always fatal. The findings from this investigation highlight the importance of early recognition of rabies, improved public awareness of rabies in bats, and the use of innovative tools after mass rabies exposure events to ensure rapid and recommended risk assessment and provision of PEP.
Assuntos
Raiva/diagnóstico , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Prática de Saúde Pública , UtahRESUMO
INTRODUCTION: Each year, rabies causes approximately 59,000 deaths worldwide, including approximately two deaths in the United States. Before 1960, dogs were a common reservoir of rabies in the United States; however, increasingly, species of wildlife (e.g., bats, raccoons) are the main reservoirs. This report characterizes human rabies deaths, summarizes trends in rabies mortality, and highlights current rabies risks in the United States. METHODS: Rabies trends in the United States during 1938-2018 were analyzed using national rabies surveillance data. Data from the Healthcare Cost and Utilization Project for 2006-2014 were used to estimate the number of postexposure prophylaxis (PEP) visits per 100,000 persons during 2017-2018. The Centers for Medicare & Medicaid Services' average sales price data were used to estimate PEP costs. RESULTS: From 1960 to 2018, a total of 125 human rabies cases were reported in the United States; 36 (28%) were attributed to dog bites during international travel. Among the 89 infections acquired in the United States, 62 (70%) were attributed to bats. In 2018, approximately 55,000 persons sought PEP after contact with a potentially rabid animal. CONCLUSIONS AND COMMENTS: In the United States, wildlife rabies, especially in bats, continues to pose a risk to humans. Travelers also might be exposed to canine rabies in countries where the disease is still present; increased awareness of rabies while traveling abroad is needed. Vaccinating pets, avoiding contact with wildlife, and seeking medical care if one is bitten or scratched by an animal are the most effective ways to prevent rabies. Understanding the need for timely administration of PEP to prevent death is critical.
Assuntos
Exposição Ambiental/estatística & dados numéricos , Vigilância da População , Raiva/mortalidade , Animais , Mordeduras e Picadas , Quirópteros/virologia , Doenças do Cão/virologia , Cães , Humanos , Internacionalidade , Mortalidade/tendências , Profilaxia Pós-Exposição , Raiva/prevenção & controle , Raiva/transmissão , Raiva/veterinária , Fatores de Risco , Doença Relacionada a Viagens , Estados Unidos/epidemiologiaRESUMO
Vaccinia virus (VACV) is an orthopoxvirus used in smallpox vaccines, as a vector for novel cancer treatments, and for experimental vaccine research (1). The Advisory Committee on Immunization Practices (ACIP) recommends smallpox vaccination for laboratory workers who handle replication-competent VACV (1). For bioterrorism preparedness, the U.S. government stockpiles tecovirimat, the first Food and Drug Administration-approved antiviral for treatment of smallpox (caused by variola virus and globally eradicated in 1980*,) (2). Tecovirimat has activity against other orthopoxviruses and can be administered under a CDC investigational new drug protocol. CDC was notified about an unvaccinated laboratory worker with a needlestick exposure to VACV, who developed a lesion on her left index finger. CDC and partners performed laboratory confirmation, contacted the study sponsor to identify the VACV strain, and provided oversight for the first case of laboratory-acquired VACV treated with tecovirimat plus intravenous vaccinia immunoglobulin (VIGIV). This investigation highlights 1) the misconception among laboratory workers about the virulence of VACV strains; 2) the importance of providing laboratorians with pathogen information and postexposure procedures; and 3) that although tecovirimat can be used to treat VACV infections, its therapeutic benefit remains unclear.
Assuntos
Pessoal de Laboratório , Ferimentos Penetrantes Produzidos por Agulha/virologia , Doenças Profissionais/terapia , Traumatismos Ocupacionais/virologia , Vacínia/terapia , Adulto , California , Feminino , HumanosRESUMO
BACKGROUND: Mobile phone Short Message Service (SMS) is a tool now used by the health research community, providing the capability for instant communication between patients and health professionals. Greater understanding of how to best use SMS as a means to improve healthcare delivery and outcomes will foster innovation in research and provide an opportunity to progress as a public health community. PURPOSE: The purposes of this systematic review are 2-fold: (1) to provide insight on the most used mobile phone SMS practices and characteristics in hypertension (HTN) outcome-focused publications and (2) to critically evaluate empirical evidence associated with SMS utilization and BP outcomes. METHODS: Two independent systematic literature searches were completed. The final selected studies each then underwent data extraction and quality-rating assessment, followed by an evaluation for a meta-analysis to measure mean difference of the change in BP. RESULTS: A total of 6 studies meeting the inclusion criteria were included in the review. Feasibility assessment for a meta-analysis was found unfavorable because of the variation among studies. Short Message Service interventions focused on BP management were most effective in studies featuring 2-way communication and individual patient-tailored content, and guided by evidence-based HTN management practices. IMPLICATIONS: Short Message Service interventions for HTN management were supported through evidence provided by the studies reviewed. Short Message Service holds strong potential to bring greater innovation to HTN management and care, especially in racial/ethnic minority populations that face psychosocial and structural barriers in healthcare access and utilization.
Assuntos
Hipertensão/terapia , Envio de Mensagens de Texto , HumanosRESUMO
Little is known about the effects of burdensome symptoms dur- ing chemotherapy treatment in African-American women. This study explored the symptom burden occurring during chemotherapy treatment and how these symptoms impacted functional well-being and quality of life (QOL). A sample of 30 African-American women with breast cancer (BC) completed a battery of questionnaires that were used to collect the data at baseline, midpoint, and at the completion of chemotherapy. There were significant differences in the severity of symptoms for worse pain, pain inteiference with activities of daily living (ADLs), present fatigue and history offatigue, present nausea and history of nausea and insomnia as well as lower intensity of QOL measures over the course of chemotherapy treatment. All symptoms had greater intensity at midpoint and completion than at baseline. Worst pain had a significant negative effect on functional well-being. Both pain and depression each had significant negative effects on QOL.
Assuntos
Antineoplásicos/uso terapêutico , Negro ou Afro-Americano , Neoplasias da Mama/tratamento farmacológico , Qualidade de Vida , Adulto , Idoso , Neoplasias da Mama/etnologia , Neoplasias da Mama/fisiopatologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
More than a fifth of people living with HIV in the US President's Emergency Plan for AIDS Relief-supported programmes are older individuals, defined as aged 50 years and older, yet optimal person-centred models of care for older adults with HIV in sub-Saharan Africa, including screening and treatment for geriatric syndromes and common comorbidities associated with ageing, remain undefined. This Position Paper explores the disproportionate burden of comorbidities and geriatric syndromes faced by older adults with HIV, with a special focus on women. We seek to motivate global interest in improving quality of life for older people with HIV by presenting available research and identifying research gaps for common geriatric syndromes, including frailty and cognitive decline, and multimorbidity among older people with HIV in sub-Saharan Africa. We share two successful models of holistic care for older people with HIV that are ongoing in Zimbabwe and Kenya. Lastly, we provide policy, research, and implementation considerations to best serve this growing population.
Assuntos
Infecções por HIV , Assistência Centrada no Paciente , Qualidade de Vida , Humanos , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Idoso , África Subsaariana/epidemiologia , Feminino , Pessoa de Meia-Idade , Masculino , Fragilidade/epidemiologia , ComorbidadeRESUMO
Post-exposure prophylaxis (PEP) for rabies is widely administered and highly effective. Nevertheless, sporadic breakthrough infections (ie, rabies in people who have started PEP) have been reported. We conducted a systematic review of articles published between Jan 1, 1980 and June 1, 2022 to characterise breakthrough infections. After reviewing 3380 articles from across all continents, we identified 52 articles, which included a total of 122 breakthrough infections. We classified breakthrough infections on the basis of adherence to core practices (ie, wound cleaning and vaccine administration). Of 86 breakthrough infections with data, median time from exposure to symptom onset was 20 days (IQR 16-24). Most (89 [77%] of 115) participants received PEP within 2 days of an exposure. Severe wounds (defined as those involving multiple wound sites or bites to the head, face, or neck) were common (80 [69%] of 116 [with data]). Deviations from core practices were reported in 68 (56%) of 122 cases. Other possible causes for breakthrough infections included errors in the administration of rabies immunoglobulin, delays in seeking health care, and comorbidities or immunosuppression. Cold-chain integrity assessments and potency testing of PEP biologics were only rarely assessed (8 [7%] of 122 cases), neither of which were found to be a cause of breakthrough infections. Timely and appropriate administration of PEP is crucial to prevent rabies, and although people with high-risk exposures or immunosuppression can develop rabies despite adherence to core practices, this occurrence remains exceedingly rare.
Assuntos
Vacina Antirrábica , Raiva , Humanos , Raiva/prevenção & controle , Raiva/epidemiologia , Infecções Irruptivas , Vacina Antirrábica/uso terapêutico , Fatores Imunológicos , Imunoglobulinas , Profilaxia Pós-ExposiçãoAssuntos
Envelhecimento Cognitivo , Metáfora , Envelhecimento , Doença de Alzheimer , Humanos , NarraçãoRESUMO
BACKGROUND: An evaluation of postexposure prophylaxis (PEP) surveillance has not been conducted in over 10 years in the United States. An accurate assessment would be important to understand current rabies trends and inform public health preparedness and response to human rabies. METHODOLOGY/PRINCIPLE FINDINGS: To understand PEP surveillance, we sent a survey to public health leads for rabies in 50 U.S. states, Puerto Rico, Washington DC, Philadelphia, and New York City. Of leads from 54 jurisdictions, 39 (72%) responded to the survey; 12 reported having PEP-specific surveillance, five had animal bite surveillance that included data about PEP, four had animal bite surveillance without data about PEP, and 18 (46%) had neither. Although 12 jurisdictions provided data about PEP use, poor data quality and lack of national representativeness prevented use of this data to derive a national-level PEP estimate. We used national-level and state specific data from the Healthcare Cost & Utilization Project (HCUP) to estimate the number of people who received PEP based on emergency department (ED) visits. The estimated annual average of initial ED visits for PEP administration during 2012-2017 in the United States was 46,814 (SE: 1,697), costing upwards of 165 million USD. State-level ED data for initial visits for administration of PEP for rabies exposure using HCUP data was compared to state-level surveillance data from Maryland, Vermont, and Georgia between 2012-2017. In all states, state-level surveillance data was consistently lower than estimates of initial ED visits, suggesting even states with robust PEP surveillance may not adequately capture individuals who receive PEP. CONCLUSIONS: Our findings suggest that making PEP a nationally reportable condition may not be feasible. Other methods of tracking administration of PEP such as syndromic surveillance or identification of sentinel states should be considered to obtain an accurate assessment.
Assuntos
Profilaxia Pós-Exposição/estatística & dados numéricos , Raiva/prevenção & controle , Raiva/veterinária , Animais , Anticorpos Antivirais/administração & dosagem , Humanos , Raiva/epidemiologia , Raiva/virologia , Vacina Antirrábica/administração & dosagem , Vírus da Raiva/imunologia , Vírus da Raiva/fisiologia , Vigilância de Evento Sentinela , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) in South Africa remain close to 50%. Lack of access to timely, decentralized care is a contributing factor. We evaluated MDR-TB treatment outcomes from a clinical cohort with task-sharing between a clinical nurse practitioner (CNP) and a medical officer (MO). METHODS: We completed a retrospective evaluation of outcomes from a prospective, programmatically-based MDR-TB cohort who were enrolled and received care between 2012 and 2015 at a peri-urban hospital in KwaZulu-Natal, South Africa. Treatment was provided by either by a CNP or MO. FINDINGS: The cohort included 197 participants with a median age of 33 years, 51% female, and 74% co-infected with HIV. The CNP initiated 123 participants on treatment. Overall MDR-TB treatment success rate in this cohort was 57.9%, significantly higher than the South African national average of 45% in 2012 (p<0·0001) and similar to the provincal average of 60% (p = NS). There were no significant differences by provider type: treatment success was 61% for patients initiated by the CNP and 52.7% for those initiated by the MO. INTERPRETATION: Clinics that adopted a task sharing approach for MDR-TB demonstrated greater treatment success rates than the national average. Task-sharing between the CNP and MO did not adversely impact treatment outcome with similar success rates noted. Task-sharing is a feasible option for South Africa to support decentralization without compromising patient outcomes. Models that allow sharing of responsibility for MDR-TB may optimize the use of human resources and improve access to care.
Assuntos
Profissionais de Enfermagem , Assistência ao Paciente/métodos , Médicos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Segurança , África do Sul , Resultado do TratamentoRESUMO
BACKGROUND: Easy access to health-related information on the Internet has the potential to empower patients in making health-related decisions. However, little is known regarding the association between Internet use and decision-making preference in older adults. The aim of the study is to evaluate the association between Internet use and decision-making preference in older adults. METHOD: The study analyzed cross-sectional data from 1,945 participants of the National Health and Aging Trends Study. RESULTS: Older adults who used the Internet had greater odds of active decision-making preference (OR 1.75, 95%CI 1.22-2.52, p=0.002) compared to older adults who did not use the Internet. Similarly, older adults, who searched the Internet for health-related information, had higher odds of active decision-making preference (OR 2.16, 95%CI 1.14-4.09, p=0.019) compared to their counterparts. CONCLUSION: Internet use was found to be associated with active decision-making preference in older adults. Similarly, health-related Internet use was positively associated with decision-making involvement in older adults.