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1.
MMWR Morb Mortal Wkly Rep ; 69(17): 509-514, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32352955

RESUMO

To evaluate progress toward prevention of enteric illnesses, the Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program monitors the incidence of laboratory-diagnosed infections caused by eight pathogens transmitted commonly through food at 10 U.S. sites.* This report summarizes preliminary 2019 data and describes changes in incidence compared with that during 2016-2018. The incidence of enteric infections caused by these eight pathogens reported by FoodNet sites in 2019 continued to increase or remained unchanged, indicating progress in controlling major foodborne pathogens in the United States has stalled. Campylobacter and Salmonella caused the largest proportion of illnesses; trends in incidence varied by Salmonella serotype. Widespread adoption of whole genome sequencing (WGS) of bacteria has improved the ability to identify outbreaks, emerging strains, and sources of pathogens. To maximize the potential of WGS to link illnesses to particular sources, testing of isolates by clinical and public health laboratories is needed. Reductions in Salmonella serotype Typhimurium suggest that targeted interventions (e.g., vaccinating chickens and other food animals) might decrease human infections. Reducing contamination during food production, processing, and preparation will require more widespread implementation of known prevention measures and of new strategies that target particular pathogens and serotypes.


Assuntos
Doenças Transmitidas por Alimentos/epidemiologia , Vigilância da População , Microbiologia de Alimentos , Parasitologia de Alimentos , Doenças Transmitidas por Alimentos/microbiologia , Doenças Transmitidas por Alimentos/parasitologia , Humanos , Incidência , Estados Unidos/epidemiologia
2.
MMWR Morb Mortal Wkly Rep ; 69(15): 446-450, 2020 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-32298246

RESUMO

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), has spread rapidly around the world since it was first recognized in late 2019. Most early reports of person-to-person SARS-CoV-2 transmission have been among household contacts, where the secondary attack rate has been estimated to exceed 10% (1), in health care facilities (2), and in congregate settings (3). However, widespread community transmission, as is currently being observed in the United States, requires more expansive transmission events between nonhousehold contacts. In February and March 2020, the Chicago Department of Public Health (CDPH) investigated a large, multifamily cluster of COVID-19. Patients with confirmed COVID-19 and their close contacts were interviewed to better understand nonhousehold, community transmission of SARS-CoV-2. This report describes the cluster of 16 cases of confirmed or probable COVID-19, including three deaths, likely resulting from transmission of SARS-CoV-2 at two family gatherings (a funeral and a birthday party). These data support current CDC social distancing recommendations intended to reduce SARS-CoV-2 transmission. U.S residents should follow stay-at-home orders when required by state or local authorities.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções Comunitárias Adquiridas/transmissão , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Chicago/epidemiologia , Criança , Pré-Escolar , Análise por Conglomerados , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Família , Humanos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Adulto Jovem
3.
Artigo em Inglês | MEDLINE | ID: mdl-32108879

RESUMO

BACKGROUND: Annual United States (US) estimates of influenza vaccine effectiveness (VE) in children typically measure protection against outpatient medically attended influenza illness, with limited data evaluating VE against influenza hospitalizations. We estimated VE for preventing laboratory-confirmed influenza hospitalization among US children. METHODS: We included children aged 6 months-17 years with acute respiratory illness enrolled in the New Vaccine Surveillance Network during the 2015-2016 influenza season. Documented influenza vaccination status was obtained from state immunization information systems, the electronic medical record, and/or provider records. Midturbinate nasal and throat swabs were tested for influenza using molecular assays. We estimated VE as 100% × (1 - odds ratio), comparing the odds of vaccination among subjects testing influenza positive with subjects testing negative, using multivariable logistic regression. RESULTS: Of 1653 participants, 36 of 707 (5%) of those fully vaccinated, 18 of 226 (8%) of those partially vaccinated, and 85 of 720 (12%) of unvaccinated children tested positive for influenza. Of those vaccinated, almost 90% were documented to have received inactivated vaccine. The majority (81%) of influenza cases were in children ≤ 8 years of age. Of the 139 influenza-positive cases, 42% were A(H1N1)pdm09, 42% were B viruses, and 14% were A(H3N2). Overall, adjusted VE for fully vaccinated children was 56% (95% confidence interval [CI], 34%-71%) against any influenza-associated hospitalization, 68% (95% CI, 36%-84%) for A(H1N1)pdm09, and 44% (95% CI, -1% to 69%) for B viruses. CONCLUSIONS: These findings demonstrate the importance of annual influenza vaccination in prevention of severe influenza disease and of reducing the number of children who remain unvaccinated or partially vaccinated against influenza.

4.
Clin Infect Dis ; 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32009161

RESUMO

BACKGROUND: Acute gastroenteritis(AGE) is a common reason for children to seek medical care. However, the viral etiology of AGE illness is not well described in the post-rotavirus vaccine era, particularly in the outpatient(OP) setting. METHODS: Between 2012 and 2015, children 15 days through 17 years old presenting to Vanderbilt Children's Hospital, Nashville, TN with AGE were enrolled prospectively from the inpatient, emergency department, and OP settings and stool specimens were collected. Healthy controls(HCs) were enrolled and frequency-matched for period, age group, race, and ethnicity. Stool specimens were tested by reverse-transcription real-time quantitative polymerase chain reaction for norovirus, sapovirus, and astrovirus RNA and by Rotaclone enzyme immunoassay for rotavirus antigen, followed by PCR verification of antigen detection. RESULTS: A total of 3705 AGE cases and 1563 HC were enrolled, among whom 2885 cases(78%) and 1110 HCs(71%) provided stool specimens that were tested. All four viruses were more frequently detected in AGE cases vs. HC: norovirus, 22% vs. 8%; rotavirus, 10% vs. 1%; sapovirus, 10% vs. 5%; and astrovirus, 5% vs. 2%(p<0.001 for each virus, respectively). AGE rates in the OP setting due to norovirus were highest compared to the other three viruses. Children under five years old had higher OP AGE rates compared to older children for all viruses. CONCLUSIONS: Norovirus remains the most common virus detected in all settings, occurring nearly twice as frequently as the next most common pathogens, sapovirus and rotavirus. Combined, these four viruses were associated with almost half of all AGE visits and therefore are an important reason for children to seek medical care.

5.
Clin Infect Dis ; 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-32060546

RESUMO

BACKGROUND: Since 2006, the New Vaccine Surveillance Network has conducted active, population-based surveillance for acute gastroenteritis (AGE) hospitalizations and emergency department (ED) visits in three US counties. Trends in the epidemiology and disease burden of rotavirus hospitalizations and ED visits were examined from 2006-2016. METHODS: Children <3 years of age hospitalized or visiting the ED with AGE, were enrolled from January 2006-June 2016. Bulk stool specimens were collected and tested for rotavirus. Rotavirus-associated hospitalization and ED visit rates were calculated annually with 2006-2007 defined as pre-vaccine and 2008-2016 as post-vaccine periods. Rotavirus genotype trends were compared over time. RESULTS: Over 11 seasons, 6954 children with AGE were enrolled and submitted a stool specimen (2187 hospitalized and 4767 in the ED). Comparing pre- and post-vaccine periods, the proportion of children with rotavirus dramatically declined for hospitalization (49% vs 10%) and ED visits (49% vs 8%). In the post-vaccine era, a biennial pattern of rotavirus rates was observed, with a trend toward an older median age. G1P[8] (63%) was the predominant genotype in the pre-vaccine period with a significantly lower proportion (7%) in the post-vaccine period (p<.001). G2P[4] remained stable (8% to 14%) in both periods, while G3P[8] and G12P[8] increased in proportion from pre-to post-vaccine periods (1% to 25% and 17% to 40%) respectively. CONCLUSIONS: The epidemiology and disease burden of rotavirus has been altered by rotavirus vaccination with a biennial disease pattern, sustained low rates of rotavirus in children <3 years of age and a shift in the residual genotypes from G1P[8] to other genotypes.

6.
Sports (Basel) ; 7(11)2019 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-31752086

RESUMO

Vitamin D plays a key role in bone health, musculoskeletal function, and sport performance. Collegiate athletes competing in indoor sports may be at greater risk of vitamin D deficiency due to limited outdoor time. Therefore, the purpose was to assess 25-hydroxyvitamin D (25(OH)D) concentrations among collegiate men and women basketball (MBB, WBB) athletes. National Collegiate Athletic Association Division I men (MBB, n = 11) and women (WBB, n = 9) were tested during the off-season (T1; July) and pre-season (T2; October). Measurements included serum 25(OH)D; skin pigmentation, bone mineral density, and daily sun exposure (self-reported). Paired t-tests determined changes in 25(OH)D by sport-season and sex. Pearson correlations examined relationships between outcome variables. MBB athletes (mean ± SD; 19.6 ± 1.3 years) showed a reduction in 25(OH)D (T1: 64.53 nmol·L-1 ± 11.96) (T2: 56.11 nmol·L-1 ± 7.90) (p = 0.001). WBB (20.1 ± 1.1 years) had no change in 25(OH)D (T1: 99.07 nmol·L-1 ± 49.94. T2: 97.56 nmol·L-1 ± 36.47, p = 0.848). A positive association between 25(OH)D and skin pigmentation was observed (r = 0.47, p = 0.038). 25(OH)D was inversely correlated with lean body mass (LBM), body mass (BM), and bone mineral density (BMD), while a positive association was seen between 25(OH)D and skin pigmentation. In summary, 25(OH)D insufficiency was prevalent amongst male collegiate basketball athletes, with 25(OH)D levels being lower in the pre-season (October) than the off-season (July). Furthermore, darker skin pigmentation significantly correlated with 25(OH)D, indicating that individuals with darker skin tones may be at a greater risk of insufficiency/deficiency. More research is needed to examine the relationships between 25(OH)D and bone health in athletes.

7.
Clin Infect Dis ; 2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31720684

RESUMO

BACKGROUND: In the United States, surveillance of norovirus gastroenteritis is largely restricted to outbreaks, limiting our knowledge of the contribution of sporadic illness to the overall impact on reported outbreaks. Understanding norovirus transmission dynamics is vital for improving preventive measures, including norovirus vaccine development. METHODS: We analyzed seasonal patterns and genotypic distribution between sporadic pediatric norovirus cases and reported norovirus outbreaks in middle Tennessee. Sporadic cases were ascertained via the New Vaccine Surveillance Network in a single county, while reported norovirus outbreaks from seven middle Tennessee counties were included in the study. We investigated the predictive value of sporadic cases on outbreaks using a two-state discrete Markov model. RESULTS: Between December 2012 and June 2016, there were 755 pediatric sporadic norovirus cases and 45 reported outbreaks. Almost half (42.2%) of outbreaks occurred in long-term care facilities. Most sporadic cases (74.9%) and reported outbreaks (86.8%) occurred between November and April. Peak sporadic norovirus activity was often contemporaneous with outbreak occurrence. Among both sporadic cases and outbreaks, GII genogroup noroviruses were most prevalent (90.1% and 83.3%) with GII.4 being the dominant genotype (39.0% and 52.8%). The predictive model suggested that the 3-day moving average of sporadic cases was positively associated with the probability of an outbreak occurring. CONCLUSIONS: Despite the demographic differences between the surveillance populations, the seasonal and genotypic associations between sporadic cases and outbreaks are suggestive of contemporaneous community transmission. Public health agencies may use this knowledge to expand surveillance and identify target populations for interventions, including future vaccines.

8.
Clin Infect Dis ; 2019 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-31626687

RESUMO

International Classification of Diseases diagnostic codes are used to estimate acute gastroenteritis (AGE) disease burden. We validated AGE-related codes in pediatric and adult populations using 2 multiregional active surveillance platforms. The sensitivity of AGE codes was similar (54% and 58%) in both populations and increased with addition of vomiting-specific codes.

9.
Artigo em Inglês | MEDLINE | ID: mdl-31550350

RESUMO

BACKGROUND: Acute gastroenteritis (AGE) in hematopoietic cell transplant (HCT) patients causes significant morbidity and mortality. Data regarding the longitudinal assessment of infectious pathogens during symptomatic AGE and asymptomatic periods, particularly in children, are limited. We investigated the prevalence of AGE-associated infectious pathogens in children undergoing allogeneic HCT. METHODS: From March 2015 through May 2016, 31 pediatric patients at 4 US children's hospitals were enrolled and had stool collected weekly from pre-HCT through 100 days post-HCT for infectious AGE pathogens by molecular testing. Demographics, clinical symptoms, antimicrobials, vaccination history, and outcomes were manually abstracted from the medical record into a standardized case report form. RESULTS: We identified a pathogen in 18% (38/206) of samples, with many detections occurring during asymptomatic periods. Clostridioides difficile was the most commonly detected pathogen in 39% (15/38) of positive specimens, although only 20% (3/15) of C. difficile-positive specimens were obtained from children with diarrhea. Detection of sapovirus, in 21% (8/38) of pathogen-positive specimens, was commonly associated with AGE, with 87.5% of specimens obtained during symptomatic periods. Norovirus was not detected, and rotavirus was detected infrequently. Prolonged shedding of infectious pathogens was rare. CONCLUSIONS: This multicenter, prospective, longitudinal study suggests that the epidemiology of AGE pathogens identified from allogeneic HCT patients may be changing. Previously reported viruses, such as rotavirus and norovirus, may be less common due to widespread vaccination and institution of infection control precautions, and emerging viruses such as sapoviruses may be increasingly recognized due to the use of molecular diagnostics.

10.
JAMA Netw Open ; 2(9): e1912242, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31560386

RESUMO

Importance: Rotavirus vaccines have been recommended for universal US infant immunization for more than 10 years, and understanding their effectiveness is key to the continued success of the US rotavirus vaccine immunization program. Objective: To assess the association of RotaTeq (RV5) and Rotarix (RV1) with inpatient and emergency department (ED) visits for rotavirus infection. Design, Setting, and Participants: This case-control vaccine effectiveness study was performed at inpatient and ED clinical settings in 7 US pediatric medical institutions from November 1, 2009, through June 30, 2016. Children younger than 5 years seeking medical care for acute gastroenteritis were enrolled. Clinical and epidemiologic data, vaccination verification, and results of stool sample tests for laboratory-confirmed rotavirus were collected. Data were analyzed from November 1, 2009, through June 30, 2016. Main Outcomes and Measures: Rotavirus vaccine effectiveness for preventing rotavirus-associated inpatient and ED visits over time for each licensed vaccine, stratified by clinical severity and age. Results: Among the 10 813 children included (5927 boys [54.8%] and 4886 girls [45.2%]; median [range] age, 21 [8-59] months), RV5 and RV1 analyses found that compared with controls, rotavirus-positive cases were more often white (RV5, 535 [62.2%] vs 3310 [57.7%]; RV1, 163 [43.1%] vs 864 [35.1%]), privately insured (RV5, 620 [72.1%] vs 4388 [76.5%]; RV1, 305 [80.7%] vs 2140 [87.0%]), and older (median [range] age for RV5, 26 [8-59] months vs 21 [8-59] months; median [range] age for RV1, 22 [8-59] months vs 19 [8-59] months) but did not differ by sex. Among 1193 rotavirus-positive cases and 9620 rotavirus-negative controls, at least 1 dose of any rotavirus vaccine was 82% (95% CI, 77%-86%) protective against rotavirus-associated inpatient visits and 75% (95% CI, 71%-79%) protective against rotavirus-associated ED visits. No statistically significant difference during this 7-year period was observed for either rotavirus vaccine. Vaccine effectiveness against inpatient and ED visits was 81% (95% CI, 78%-84%) for RV5 (3 doses) and 78% (95% CI, 72%-82%) for RV1 (2 doses) among the study population. A mixed course of both vaccines provided 86% (95% CI, 74%-93%) protection. Rotavirus patients who were not vaccinated had severe infections 4 times more often than those who were vaccinated (74 of 426 [17.4%] vs 28 of 605 [4.6%]; P < .001), and any dose of rotavirus vaccine was 65% (95% CI, 56%-73%) effective against mild infections, 81% (95% CI, 76%-84%) against moderate infections, and 91% (95% CI, 85%-95%) against severe infections. Conclusions and Relevance: Evidence from this large postlicensure study of rotavirus vaccine performance in the United States from 2010 to 2016 suggests that RV5 and RV1 rotavirus vaccines continue to perform well, particularly in preventing inpatient visits and severe infections and among younger children.

11.
Eur J Clin Microbiol Infect Dis ; 38(12): 2371-2379, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31502119

RESUMO

Little is known about the epidemiology and severity of gastroenteritis among children treated at home. We sought to compare illness severity and etiology between children brought for emergency department (ED) care to those managed at home (i.e., community). Prospective cohort study of children enrolled between December 2014 and December 2016 in two pediatric EDs in Alberta, Canada along with children treated at home after telephone triage (i.e., community). Primary outcomes were maximal frequency of vomiting and diarrhea in the 24-h pre-enrollment period; secondary outcomes included etiologic pathogens, dehydration severity, future healthcare visits, and treatments provided. A total of 1613 patients (1317 ED, 296 community) were enrolled. Median maximal frequency of vomiting was higher in the ED cohort (5 (3, 10) vs. 5 (2, 8); P < 0.001). Proportion of children with diarrhea and its 24-h median frequency were lower in the ED cohort (61.3 vs. 82.8% and 2 (0, 6) vs. 4 (1, 7); P < 0.001, respectively). In regression analysis, the ED cohort had a higher maximum number of vomiting episodes pre-enrollment (incident rate ratio (IRR) 1.25; 95% CI 1.12, 1.40) while the community cohort had higher maximal 24-h period diarrheal episodes (IRR 1.20; 95% CI 1.01, 1.43). Norovirus was identified more frequently in the community cohort (36.8% vs. 23.6%; P < 0.001). Children treated in the ED have a greater number of vomiting episodes; those treated at home have more diarrheal episodes. Norovirus is more common among children treated symptomatically at home and thus may represent a greater burden of disease than previously thought.


Assuntos
Serviço Hospitalar de Emergência , Gastroenterite/epidemiologia , Gastroenterite/terapia , Autocuidado , Doença Aguda , Alberta/epidemiologia , Infecções por Caliciviridae/epidemiologia , Canadá/epidemiologia , Pré-Escolar , Desidratação/epidemiologia , Diarreia/diagnóstico , Diarreia/epidemiologia , Diarreia/terapia , Feminino , Gastroenterite/diagnóstico , Gastroenterite/patologia , Hospitais Pediátricos , Humanos , Lactente , Masculino , Norovirus/isolamento & purificação , Estudos Prospectivos , Telefone , Triagem , Vômito/diagnóstico , Vômito/epidemiologia , Vômito/terapia
12.
MMWR Morb Mortal Wkly Rep ; 68(12): 277-280, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30921299

RESUMO

In the fall of 2014, an outbreak of enterovirus D68 (EV-D68)-associated acute respiratory illness (ARI) occurred in the United States (1,2); before 2014, EV-D68 was rarely reported to CDC (2,3). In the United States, reported EV-D68 detections typically peak during late summer and early fall (3). EV-D68 epidemiology is not fully understood because testing in clinical settings seldom has been available and detections are not notifiable to CDC. To better understand EV-D68 epidemiology, CDC recently established active, prospective EV-D68 surveillance among pediatric patients at seven U.S. medical centers through the New Vaccine Surveillance Network (NVSN) (4). This report details a preliminary characterization of EV-D68 testing and detections among emergency department (ED) and hospitalized patients with ARI at all NVSN sites during July 1-October 31, 2017, and the same period in 2018. Among patients with ARI who were tested, EV-D68 was detected in two patients (0.8%) in 2017 and 358 (13.9%) in 2018. Continued active, prospective surveillance of EV-D68-associated ARI is needed to better understand EV-D68 epidemiology in the United States.


Assuntos
Surtos de Doenças , Enterovirus Humano D/isolamento & purificação , Infecções por Enterovirus/epidemiologia , Vigilância da População/métodos , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/virologia , Adolescente , Criança , Pré-Escolar , Enterovirus Humano D/genética , Infecções por Enterovirus/virologia , Feminino , Humanos , Lactente , Masculino , Estados Unidos/epidemiologia
13.
Clin Infect Dis ; 69(2): 357-365, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-30753367

RESUMO

Globally, noroviruses are among the foremost causes of acute diarrheal disease, yet there are many unanswered questions on norovirus immunity, particularly following natural infection in young children during the first 2 years of life when the disease burden is highest. We conducted a literature review on birth cohort studies assessing norovirus infections in children from birth to early childhood. Data on infection, immunity, and risk factors are summarized from 10 community-based birth cohort studies conducted in low- and middle-income countries. Up to 90% of children experienced atleast one norovirus infection and up to 70% experienced norovirus-associated diarrhea, most often affecting children 6 months of age and older. Data from these studies help to fill critical knowledge gaps for vaccine development, yet study design and methodological differences limit comparison between studies, particularly for immunity and risk factors for disease. Considerations for conducting future birth cohort studies on norovirus are discussed.

14.
Artigo em Inglês | MEDLINE | ID: mdl-30753568

RESUMO

Background: Rotavirus is a leading cause of acute gastroenteritis (AGE) in children and is highly transmissible. In this study, we assessed the presence of AGE in household contacts (HHCs) of pediatric patients with laboratory-confirmed rotavirus. Methods: Between December 2011 and June 2016, children aged 14 days to 11 years with AGE were enrolled at 1 of 7 hospitals or emergency departments as part of the New Vaccine Surveillance Network. Parental interviews, medical and vaccination records, and stool specimens were collected at enrollment. Stool was tested for rotavirus by an enzyme immunoassay and confirmed by real-time or conventional reverse transcription-polymerase chain reaction assay or repeated enzyme immunoassay. Follow-up telephone interviews were conducted to assess AGE in HHCs the week after the enrolled child's illness. A mixed-effects multivariate model was used to calculate odds ratios. Results: Overall, 829 rotavirus-positive subjects and 8858 rotavirus-negative subjects were enrolled. Households of rotavirus-positive subjects were more likely to report AGE illness in ≥1 HHC than were rotavirus-negative households (35% vs 20%, respectively; P < .0001). A total of 466 (16%) HHCs of rotavirus-positive subjects reported AGE illness. Of the 466 ill HHCs, 107 (23%) sought healthcare; 6 (6%) of these encounters resulted in hospitalization. HHCs who were <5 years old (odds ratio, 2.2 [P = .004]) were more likely to report AGE illness than those in other age groups. In addition, 144 households reported out-of-pocket expenses (median, $20; range, $2-$640) necessary to care for an ill HHC. Conclusions: Rotavirus-associated AGE in children can lead to significant disease burden in HHCs, especially in children aged <5 years. Prevention of pediatric rotavirus illness, notably through vaccination, can prevent additional illnesses in HHCs.

15.
Pediatrics ; 143(2)2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30655333

RESUMO

BACKGROUND: Rotavirus vaccines (RVVs) were included in the US immunization program in 2006 and are coadministered with the diphtheria-tetanus-acellular pertussis (DTaP) vaccine, yet their coverage lags behind DTaP. We assessed timing, initiation, and completion of the RVV series among children enrolled in active gastroenteritis surveillance at 7 US medical institutions during 2014-2016. METHODS: We compared coverage and timing of each vaccine series and analyzed characteristics associated with RVV initiation and completion. We report odds ratios (ORs) and 95% confidence intervals (CIs) from multivariable logistic regression models. RESULTS: We enrolled 10 603 children. In 2015, ≥1 dose coverage was 91% for RVV and 97% for DTaP. Seven percent of children received their first DTaP vaccine at age ≥15 weeks versus 4% for RVV (P ≤ .001). Recent birth years (2013-2016) were associated with higher odds of RVV initiation (OR = 5.72; 95% CI 4.43-7.39), whereas preterm birth (OR = 0.32; 95% CI 0.24-0.41), older age at DTaP initiation (OR 0.85; 95% CI 0.80-0.91), income between $50 000 and $100 000 (OR = 0.56; 95% CI 0.40-0.78), and higher maternal education (OR = 0.52; 95% CI 0.36-0.74) were associated with lower odds. Once RVV was initiated, recent birth years (2013-2016; OR = 1.57 [95% CI 1.32-1.88]) and higher maternal education (OR = 1.31; 95% CI 1.07-1.60) were associated with higher odds of RVV completion, whereas preterm birth (OR = 0.76; 95% CI 0.62-0.94), African American race (OR = 0.82; 95% CI 0.70-0.97) and public or no insurance (OR = 0.75; 95% CI 0.60-0.93) were associated with lower odds. Regional differences existed. CONCLUSIONS: RVV coverage remains lower than that for the DTaP vaccine. Timely DTaP administration may help improve RVV coverage.


Assuntos
Vacina contra Difteria, Tétano e Coqueluche/administração & dosagem , Esquemas de Imunização , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/administração & dosagem , Cobertura Vacinal/métodos , Fatores Etários , Pré-Escolar , Grupos de Populações Continentais , Feminino , Humanos , Lactente , Masculino , Pessoas sem Cobertura de Seguro de Saúde , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/epidemiologia , Infecções por Rotavirus/epidemiologia , Cobertura Vacinal/tendências
16.
J Virol ; 93(1)2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30333170

RESUMO

Rotavirus is the leading global cause of diarrheal mortality for unvaccinated children under 5 years of age. The outer capsid of rotavirus virions consists of VP7 and VP4 proteins, which determine viral G and P types, respectively, and are primary targets of neutralizing antibodies. Successful vaccination depends upon generating broadly protective immune responses following exposure to rotaviruses presenting a limited number of G- and P-type antigens. Vaccine introduction resulted in decreased rotavirus disease burden but also coincided with the emergence of uncommon G and P genotypes, including G12. To gain insight into the recent predominance of G12P[8] rotaviruses in the United States, we evaluated 142 complete rotavirus genome sequences and metadata from 151 clinical specimens collected in Nashville, TN, from 2011 to 2013 through the New Vaccine Surveillance Network. Circulating G12P[8] strains were found to share many segments with other locally circulating strains but to have distinct constellations. Phylogenetic analyses of G12 sequences and their geographic sources provided evidence for multiple separate introductions of G12 segments into Nashville, TN. Antigenic epitopes of VP7 proteins of G12P[8] strains circulating in Nashville, TN, differ markedly from those of vaccine strains. Fully vaccinated children were found to be infected with G12P[8] strains more frequently than with other rotavirus genotypes. Multiple introductions and significant antigenic mismatch may in part explain the recent predominance of G12P[8] strains in the United States and emphasize the need for continued monitoring of rotavirus vaccine efficacy against emerging rotavirus genotypes.IMPORTANCE Rotavirus is an important cause of childhood diarrheal disease worldwide. Two immunodominant proteins of rotavirus, VP7 and VP4, determine G and P genotypes, respectively. Recently, G12P[8] rotaviruses have become increasingly predominant. By analyzing rotavirus genome sequences from stool specimens obtained in Nashville, TN, from 2011 to 2013 and globally circulating rotaviruses, we found evidence of multiple introductions of G12 genes into the area. Based on sequence polymorphisms, VP7 proteins of these viruses are predicted to present themselves to the immune system very differently than those of vaccine strains. Many of the sick children with G12P[8] rotavirus in their diarrheal stools also were fully vaccinated. Our findings emphasize the need for continued monitoring of circulating rotaviruses and the effectiveness of the vaccines against strains with emerging G and P genotypes.


Assuntos
Antígenos Virais/genética , Proteínas do Capsídeo/genética , Infecções por Rotavirus/virologia , Vacinas contra Rotavirus/imunologia , Rotavirus/classificação , Antígenos Virais/imunologia , Proteínas do Capsídeo/imunologia , Pré-Escolar , Técnicas de Genotipagem , Humanos , Lactente , Filogenia , Vigilância da População , Rotavirus/genética , Rotavirus/imunologia , Infecções por Rotavirus/prevenção & controle , Análise de Sequência de RNA , Estados Unidos
17.
J Pediatric Infect Dis Soc ; 8(5): 414-421, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-30184153

RESUMO

BACKGROUND: The rotavirus disease burden has declined substantially since rotavirus vaccine was introduced in the United States in 2006. The aim of this study was to determine the viral etiology of acute gastroenteritis (AGE) in US children aged <2 years. METHODS: The New Vaccine Surveillance Network (NVSN) of geographically diverse US sites conducts active pediatric population-based surveillance in hospitals and emergency departments. Stool samples were collected from children aged <2 years with symptoms of AGE (n = 330) and age-matched healthy controls (HCs) (n = 272) between January and December 2012. Samples were tested by real-time reverse-transcriptase polymerase chain reaction assays {adenovirus (type 40 and 41), norovirus, parechovirus A, enterovirus, sapovirus, and astrovirus} and an enzyme immunoassay (rotavirus). All samples that tested positive were genotyped. RESULTS: Detection rates of pathogens in children with AGE versus those of HCs were, respectively, 23.0% versus 6.6% for norovirus (P < .01), 23.0% versus 16.0% for adenovirus (P = .08), 11.0% versus 16.0% for parechovirus A (P = .09), 11.0% versus 9.0% for enterovirus (P = .34), 7.0% versus 3.0% for sapovirus (P = .07), 3.0% versus 0.3% for astrovirus (P = .01), and 3.0% versus 0.4% for rotavirus (P = .01). A high prevalence of adenovirus was detected at 1 surveillance site (49.0% for children with AGE and 43.0% for HCs). Norovirus GII.4 New Orleans was the most frequently detected (33.0%) norovirus genotype. Codetection of >1 virus was more common in children with AGE (16.0%) than in HCs (10.0%) (P = .03). CONCLUSIONS: Norovirus, astrovirus, sapovirus, and rotavirus were detected significantly more in children with AGE than in HCs, and norovirus was the leading AGE-causing pathogen in US children aged <2 years during the year 2012.

18.
Open Forum Infect Dis ; 5(5): ofy095, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-30294616

RESUMO

Background: An outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in Jordan in 2015 involved a variant virus that acquired distinctive deletions in the accessory open reading frames. We conducted a molecular and seroepidemiologic investigation to describe the deletion variant's transmission patterns and epidemiology. Methods: We reviewed epidemiologic and medical chart data and analyzed viral genome sequences from respiratory specimens of MERS-CoV cases. In early 2016, sera and standardized interviews were obtained from MERS-CoV cases and their contacts. Sera were evaluated by nucleocapsid and spike protein enzyme immunoassays and microneutralization. Results: Among 16 cases, 11 (69%) had health care exposure and 5 (31%) were relatives of a known case; 13 (81%) were symptomatic, and 7 (44%) died. Genome sequencing of MERS-CoV from 13 cases revealed 3 transmissible deletions associated with clinical illness during the outbreak. Deletion variant sequences were epidemiologically clustered and linked to a common transmission chain. Interviews and sera were collected from 2 surviving cases, 23 household contacts, and 278 health care contacts; 1 (50%) case, 2 (9%) household contacts, and 3 (1%) health care contacts tested seropositive. Conclusions: The MERS-CoV deletion variants retained human-to-human transmissibility and caused clinical illness in infected persons despite accumulated mutations. Serology suggested limited transmission beyond that detected during the initial outbreak investigation.

19.
Am J Trop Med Hyg ; 99(2): 413-416, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29869599

RESUMO

We instituted active surveillance among febrile patients presenting to the largest Houston-area pediatric emergency department to identify acute infections of dengue virus (DENV), West Nile virus (WNV), and chikungunya virus (CHIKV). In 2014, 1,063 children were enrolled, and 1,015 (95%) had blood and/or cerebrospinal fluid specimens available for DENV, WNV, and CHIKV testing. Almost half (49%) reported recent mosquito bites, and 6% (N = 60) reported either recent international travel or contact with an international traveler. None were positive for acute WNV; three had false-positive CHIKV results; and two had evidence of DENV. One DENV-positive case was an acute infection associated with international travel, whereas the other was identified as a potential secondary acute infection, also likely travel-associated. Neither of the DENV-positive cases were clinically recognized, highlighting the need for education and awareness. Health-care professionals should consider the possibility of arboviral disease among children who have traveled to or from endemic areas.


Assuntos
Anticorpos Antivirais/sangue , Infecções por Arbovirus/epidemiologia , Monitoramento Epidemiológico , Febre/epidemiologia , Febre/virologia , Doença Aguda/epidemiologia , Adolescente , Infecções por Arbovirus/sangue , Infecções por Arbovirus/líquido cefalorraquidiano , Mordeduras e Picadas/epidemiologia , Febre de Chikungunya/sangue , Febre de Chikungunya/líquido cefalorraquidiano , Febre de Chikungunya/epidemiologia , Criança , Pré-Escolar , Coinfecção/epidemiologia , Coinfecção/virologia , Doenças Transmissíveis Importadas/epidemiologia , Doenças Transmissíveis Importadas/virologia , Dengue/sangue , Dengue/líquido cefalorraquidiano , Dengue/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Texas/epidemiologia , Viagem , Febre do Nilo Ocidental/sangue , Febre do Nilo Ocidental/líquido cefalorraquidiano , Febre do Nilo Ocidental/epidemiologia , Adulto Jovem
20.
J Pediatric Infect Dis Soc ; 7(3): e86-e91, 2018 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-29788403

RESUMO

Background: Epidemiologic studies that evaluate the relationship between previous antibiotic use and acute gastroenteritis (AGE) in the pediatric population are currently lacking. Methods: We analyzed inpatient and outpatient children with AGE and healthy controls from Vanderbilt University Medical Center between December 1, 2014, and November 30, 2015. The following 4 outcome groups were defined: overall AGE, norovirus-associated AGE, rotavirus-associated AGE, and nonnorovirus/nonrotavirus AGE. Multiple logistic regression was performed to evaluate the association between previous antibiotic use and the 4 AGE outcomes and with AGE severity. Results: Reported antibiotic use rates in the 3 months before illness onset were similar across the 4 AGE outcomes (overall AGE, 21%; norovirus-associated AGE, 23%; rotavirus-associated AGE, 28%; and nonnorovirus/nonrotavirus AGE, 22%) but were higher than that reported for healthy controls (9%). Compared with healthy controls, patients with AGE overall were 4.6 (95% confidence interval [CI], 1.8-11.4) times more likely to have reported antibiotic use in the 3 weeks before illness onset and 2.6 (95% CI, 1.7-4.1) times more likely to have reported antibiotic use within 3 months before illness onset. Similar results were found for the other specific AGE outcomes. For the overall AGE group, the odds of antibiotic use in the 3 months before illness onset was 3.5 (95% CI, 1.8-7.1) times higher for inpatients than for outpatients. Conclusions: Previous antibiotic use among children was associated with increased odds of AGE, irrespective of etiology, and this association was stronger with more recent antibiotic use. Previous antibiotic use was associated also with more severe AGE.


Assuntos
Antibacterianos/efeitos adversos , Infecções por Caliciviridae/epidemiologia , Gastroenterite/epidemiologia , Infecções por Rotavirus/epidemiologia , Doença Aguda , Adolescente , Criança , Pré-Escolar , Feminino , Gastroenterite/virologia , Microbioma Gastrointestinal/efeitos dos fármacos , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Vigilância da População , Fatores de Risco , Índice de Gravidade de Doença , Tennessee/epidemiologia , Fatores de Tempo
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