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1.
Vaccine ; 37(43): 6543-6549, 2019 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-31515146

RESUMO

BACKGROUND: Guillain-Barré syndrome (GBS) is a serious acute demyelinating disease, an increased risk of which was found after the 1976 swine flu vaccinations. The U.S. Food and Drug Administration, in collaboration with the Centers for Medicare & Medicaid Services, has been conducting active surveillance for GBS after influenza vaccinations of Medicare Fee-For-Service beneficiaries since 2009. METHODS: We conducted active surveillance for GBS claims in the 2015-2016 and 2016-2017 influenza seasons using the Updating Sequential Probability Ratio Test (USPRT) to monitor for signals of GBS risk. We performed self-controlled risk interval (SCRI) analyses at the end of both seasons, including chart confirmation in the 2015-2016 season, to estimate the odds ratio of GBS risk. We used 1-42 and 8-21 days post-vaccination as primary and secondary risk windows, respectively, and 43-84 days post-vaccination as the control window. RESULTS: Over 13 million beneficiaries were vaccinated in each season. USPRT found a low magnitude signal for GBS in both seasons. SCRI analyses did not find excess GBS risk following any influenza vaccine for days 1-42 post-vaccination in either season. In the 2015-2016 season, for the 8-21 day window, our chart-confirmation showed an attributable GBS risk of 0.87 (95% CI: 0.16, 1.49) and 1.68 (95% CI: 0.69, 2.41) cases per million vaccinees after all seasonal and high dose (HD) vaccines, respectively, an elevated GBS risk for beneficiaries aged ≥75 years following all seasonal vaccines (OR: 2.25; 95% CI: 1.15, 4.39) and HD vaccine (OR: 3.67, 95% CI: 1.52, 8.85), and an elevated GBS risk for males who received seasonal vaccines (OR: 2.18; 95% CI: 1.15, 4.15) and HD vaccine (OR: 3.33; 95% CI: 1.35, 8.20). The finding of elevated GBS risk with advancing age and in males is consistent with literature; however, a distinction between HD and SD was a new finding. In the 2016-17 season, for the 8-21 day window, attributed cases showed an attributable GBS risk of 0.87 (95% CI: 0.03, 1.61) and 1.11 (95% CI: 0.00, 2.01) cases per million vaccinees after all seasonal and HD vaccines, respectively. We found no excess GBS risk for standard dose vaccines in the 8-21 day window in either season. CONCLUSIONS: Our primary analysis finding of no excess GBS risk during both seasons was reassuring. The slightly elevated GBS risk, although in the expected range, in the 8-21 day window after all seasonal and high dose vaccines, but not after standard dose vaccines is hypothesis-generating because the difference may be due to vaccine factors such as antigen amount or strains in various seasons or due to host factors.

2.
Zoonoses Public Health ; 66(5): 504-511, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31152500

RESUMO

Mass bat exposures (MBEs) occur when multiple people are exposed to a bat or a bat colony, often over an extended period. In August 2017, a public health investigation was started in response to an MBE that occurred during May-August 2017 at a national park research station in Wyoming. We identified 176 people who had slept primarily in two lodges (Lodges A and B) at the research station, and successfully contacted 165 (93.8%) of these individuals. Risk assessments (RAs) were administered to all 165 individuals to determine degree and type of exposures to bats (e.g., biting or scratching). Exposure status for research station guests was classified as "non-exposed," "low risk" or "high risk," and counselling was provided to guide post-exposure prophylaxis (PEP) recommendations. Prior to public health notification and intervention, 19 persons made the decision to pursue PEP. The healthcare-seeking behaviours of this group were taken to represent outcomes in the absence of public health intervention. (These persons received a RA, and their risk classification was retrospectively assigned.) Approximately 1-2 weeks after conducting the RAs, we conducted a follow-up survey to determine whether recommendations regarding PEP were ultimately followed. The proportion of individuals that unnecessarily pursued PEP was higher among the 19 individuals that sought health care prior to receiving the RA (p < 0.00001). Among those receiving the RA first, all persons classified as high risk followed public health guidance to seek PEP treatment. Despite this, upon re-interview, only 21/79 (26.6%) of guests could accurately recall their risk classification, with most people (55.7%) overestimating their risk. Study findings demonstrate that early public health interventions such as RAs can reduce unnecessary use of PEP and that messaging used during rabies counselling should be clear.


Assuntos
Quirópteros , Doenças Transmissíveis/transmissão , Zoonoses/epidemiologia , Animais , Controle de Doenças Transmissíveis , Habitação , Humanos , Parques Recreativos , Profilaxia Pós-Exposição , Saúde Pública , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Wyoming/epidemiologia
3.
J Allergy Clin Immunol ; 143(4): 1465-1473, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30654049

RESUMO

BACKGROUND: Anaphylaxis, a rare and potentially life-threatening hypersensitivity reaction, can occur after vaccination. OBJECTIVE: We sought to describe reports of anaphylaxis after vaccination made to the Vaccine Adverse Event Reporting System (VAERS) during 1990-2016. METHODS: We identified domestic reports of anaphylaxis within VAERS using a combination of Medical Dictionary for Regulatory Activity queries and Preferred Terms. We performed a descriptive analysis, including history of hypersensitivity (anaphylaxis, respiratory allergies, and drug allergies) and vaccines given. We reviewed all serious reports and all nonserious reports with available medical records to determine if they met the Brighton Collaboration case definition for anaphylaxis or received a physician's diagnosis. RESULTS: During the analytic period, VAERS received 467,960 total reports; 828 met the Brighton Collaboration case definition or received a physician's diagnosis of anaphylaxis: 654 (79%) were classified as serious, and 669 (81%) had medical records available. Of 478 reports in children aged less than 19 years, 65% were male; childhood vaccines were most commonly reported. Of 350 reports in persons aged 19 years or greater, 80% were female, and influenza vaccines were most frequently reported. Overall, 41% of reports described persons with no history of hypersensitivity. We identified 8 deaths, 4 among persons with no history of hypersensitivity. CONCLUSION: Anaphylaxis after vaccination is rare in the United States and can occur among persons with no history of hypersensitivity. Most persons recover fully with treatment, but serious complications, including death, can occur.

6.
World Allergy Organ J ; 11(1): 2, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29308116

RESUMO

Background: The 2010 Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines are the only Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines for cow's milk allergy (CMA). They indicate oral food challenge (OFC) as the reference test for diagnosis, and suggest the choice of specific alternative formula in different clinical conditions. Their recommendations are flexible, both in diagnosis and in treatment. Objectives & methods: Using the Scopus citation records, we evaluated the influence of the DRACMA guidelines on milk allergy literature. We also reviewed their impact on successive food allergy and CMA guidelines at national and international level. We describe some economic consequences of their application. Results: DRACMA are the most cited CMA guidelines, and the second cited guidelines on food allergy. Many subsequent guidelines took stock of DRACMA's metanalyses adapting recommendations to the local context. Some of these chose not to consider OFC as an absolute requirement for the diagnosis of CMA. Studies on their implementation show that in this case, the treatment costs may increase and there is a risk of overdiagnosis. Interestingly, we observed a reduction in the cost of alternative formulas following the publication of the DRACMA guidelines. Conclusions: DRACMA reconciled international differences in the diagnosis and management of CMA. They promoted a cultural debate, improved clinician's knowledge of CMA, improved the quality of diagnosis and care, reduced inappropriate practices, fostered the efficient use of resources, empowered patients, and influenced some public policies. The accruing evidence on diagnosis and treatment of CMA necessitates their update in the near future.

7.
J AOAC Int ; 101(1): 60-69, 2018 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29202903

RESUMO

Food allergies are increasing globally, including numbers of allergens, the sensitization rate, and the prevalence rate. To protect food-allergic individuals in the community, food allergies need to be appropriately managed. This paper describes current Australian food allergen management practices. In Australia, the prevalence of food allergies, the anaphylaxis rate, and the fatal anaphylaxis rate are among the highest in the world. Interagency and stakeholder collaboration is facilitated and enhanced as Australia moves through past, current, and ongoing food allergen challenges. As a result, Australia has been a global leader in regulating the labeling of common allergens in packaged foods and their disclosure in foods not required to bear a label. Moreover, the food industry in Australia and New Zealand has developed a unique food allergen risk management tool, the Voluntary Incidental Trace Allergen Labelling program, which is managed by the Allergen Bureau. This paper summarizes insights and information provided by the major stakeholders involved to protect food-allergic consumers from any allergic reaction. Stakeholders include government; consumer protection, regulation, and enforcement agencies; the food industry; and food allergen testing and food allergen/allergy research bodies in Australia. The ongoing goal of all stakeholders in food allergen management in Australia is to promote best practice food allergen management procedures and provide a wide choice of foods, while enabling allergic consumers to manage their food allergies and reduce the risk of an allergic reaction.


Assuntos
Alérgenos/análise , Contaminação de Alimentos/análise , Hipersensibilidade Alimentar/prevenção & controle , Inocuidade dos Alimentos , Austrália , Indústria Alimentícia , Humanos , Gestão de Riscos
9.
J Paediatr Child Health ; 51(10): 949-54, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26428419

RESUMO

The aim of these guidelines is to assist staff in school and childcare settings to plan and implement appropriate risk minimisation strategies, taking into consideration the needs of the allergic child, the likely effectiveness of measures and the practicality of implementation. Although these guidelines include risk minimisation strategies for allergic reactions to insect stings or bites, latex and medication, the major focus relates to food allergy. This is due to the higher relative prevalence of food allergy in childhood (compared with other allergic triggers) and the higher likelihood of accidental exposure in these settings. Care of the allergic child in the school, pre-school or childcare settings requires accurate information obtained from parents and carers, staff training in the recognition and management of acute allergic reactions, planning for unexpected reactions (including in those not previously identified as being at risk), age appropriate education of children with severe allergies and their peers, and implementation of practical strategies to reduce the risk of accidental exposure to known allergic triggers. Strategy development also needs to take into account local or regional established legislative or procedural guidelines and the possibility that the first episode of anaphylaxis may occur outside the home. Food bans are not recommended as the primary risk minimisation strategy due to difficulties in implementation and lack of proven effectiveness.


Assuntos
Anafilaxia/prevenção & controle , Creches/normas , Hipersensibilidade Alimentar/prevenção & controle , Serviços de Saúde Escolar , Instituições Acadêmicas/normas , Criança , Cuidado da Criança , Pré-Escolar , Educação em Saúde , Humanos , Refeições , Escolas Maternais/normas , Desenvolvimento de Pessoal
10.
AIDS Behav ; 19(11): 2036-43, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26078117

RESUMO

Men who have sex with men (MSM) in Baltimore are at disproportionately high risk for HIV and syphilis infection. Testing and diagnosis are important first steps in receiving treatment and reducing transmission. We analyzed cross-sectional data collected in 2004-2005, 2008, and 2011 among MSM not reporting a previous positive HIV test (n = 1268) in Baltimore, Maryland as part of the National HIV Behavioral Surveillance System to determine the proportion of men tested for HIV and/or syphilis within the previous 12 months and examine the extent to which opportunities for testing were being missed in health care settings. Within the previous 12 months, 54 % of men had received an HIV test; 31 % had received a syphilis test; and only 23 % of men had received testing for both. Among 979 men who did not receive both tests, 72 % had seen a health care provider in the past year, suggesting missed testing opportunities.


Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Sorodiagnóstico da Sífilis/estatística & dados numéricos , Sífilis/diagnóstico , Sífilis/prevenção & controle , Adulto , Baltimore/epidemiologia , Preservativos/estatística & dados numéricos , Estudos Transversais , Infecções por HIV/epidemiologia , Humanos , Masculino , Vigilância da População , Análise de Regressão , Assunção de Riscos , Sífilis/epidemiologia , Adulto Jovem
11.
Acad Med ; 89(8 Suppl): S9-10, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25072589

RESUMO

The Medical Education Partnership Initiative (MEPI), which aims to strengthen and transform education in medicine and the health sciences in Africa, has placed special emphasis on including research as part of new curricula. The great progress achieved against HIV/AIDS globally has been based in part on major research conducted by African investigators working in African institutions at African field sites in collaboration with international partners. This experience demonstrates the key role of academic institutions in generating knowledge while training the next generation of health professionals. Research is a key driver of innovation in the health sciences, and it can spur global collaborations, build substantial financial support, empower scientific leadership, and promote economic development. Through MEPI, young investigators are becoming engaged in research training early in their careers with projects that develop research skills to help them better understand how to evaluate and integrate new evidence into policy and practice, advance the science of health within their countries, and strengthen the academic institutions in which they work. Research training is an essential component of MEPI and should endure long after the program ends. It may help build a critical mass of researchers as well as a cadre of health professionals, teachers, and leaders who will be better equipped to embrace the continually changing panorama of advances in the health sciences.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Pesquisa Biomédica/educação , Educação Médica/organização & administração , Educação em Enfermagem/organização & administração , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Cooperação Internacional , Faculdades de Medicina/organização & administração , Escolas de Enfermagem/organização & administração , Centros Médicos Acadêmicos/economia , África ao Sul do Saara/epidemiologia , Currículo , Assistência à Saúde/organização & administração , Difusão de Inovações , Humanos , Enfermeiras e Enfermeiros/provisão & distribução , Médicos/provisão & distribução , Estados Unidos
12.
JAMA Intern Med ; 174(7): 1136-42, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24861675

RESUMO

IMPORTANCE: Liposuction is one of the most common cosmetic surgery procedures in the United States. Tumescent liposuction, in which crystalloid fluids, lidocaine, and epinephrine are infused subcutaneously before cannula-assisted aspiration of fat, can be performed without intravenous or general anesthesia, often at outpatient facilities. However, some of these facilities are not subject to state or federal regulation and may not adhere to appropriate infection control practices. OBJECTIVE: To describe an outbreak of severe group A Streptococcus (GAS) infections among persons undergoing tumescent liposuction at 2 outpatient cosmetic surgery facilities not subject to state or federal regulation. DESIGN: Outbreak investigation (including cohort analysis of at-risk patients), interviews using a standardized questionnaire, medical record review, facility assessment, and laboratory analysis of GAS isolates. SETTING AND PARTICIPANTS: Patients undergoing liposuction at 2 outpatient facilities, one in Maryland and the other in Pennsylvania, between July 1 and September 14, 2012. MAIN OUTCOMES AND MEASURES: Confirmed invasive GAS infections (isolation of GAS from a normally sterile site or wound of a patient with necrotizing fasciitis or streptococcal toxic shock syndrome), suspected GAS infections (inflamed surgical site and either purulent discharge or fever and chills in a patient with no alternative diagnosis), postsurgical symptoms and patient-reported experiences related to his or her procedure, and emm types, T-antigen types, and antimicrobial susceptibility of GAS isolates. RESULTS: We identified 4 confirmed cases and 9 suspected cases, including 1 death (overall attack rate, 20% [13 of 66]). One instance of likely secondary GAS transmission to a household member occurred. All confirmed case patients had necrotizing fasciitis and had undergone surgical debridement. Procedures linked to illness were performed by a single surgical team that traveled between the 2 locations; 2 team members (1 of whom reported recent cellulitis) were colonized with a GAS strain that was indistinguishable by laboratory analysis of the isolates from the case patients. Facility assessments and patient reports indicated substandard infection control, including errors in equipment sterilization and infection prevention training. CONCLUSIONS AND RELEVANCE: This outbreak of severe GAS infections was likely caused by transmission from colonized health care workers to patients during liposuction procedures. Additional oversight of outpatient cosmetic surgery facilities is needed to assure that they maintain appropriate infection control practices and other patient protections.


Assuntos
Lipectomia/efeitos adversos , Infecções Estreptocócicas/etiologia , Streptococcus pyogenes/patogenicidade , Adulto , Feminino , Humanos , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Pennsylvania/epidemiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes/isolamento & purificação , Centros Cirúrgicos/legislação & jurisprudência , Centros Cirúrgicos/normas , Adulto Jovem
14.
Mil Med ; 178(12): e1375-8, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24306023

RESUMO

Severe adverse events, including eczema vaccinatum (EV), can result after smallpox vaccination. Persons at risk for EV include those with underlying dermatologic conditions, such as atopic dermatitis. We investigated a case of vaccinia infection, possibly acquired during sexual contact with a recently vaccinated military service member, in a female Maryland resident with atopic dermatitis. The U.S. Department of Defense's Vaccine Healthcare Centers Network (VHCN) and the Centers for Disease Control and Prevention (CDC) worked in conjunction with the patient's physician and the Maryland Department of Health and Mental Hygiene (DHMH) to confirm the diagnosis, ensure treatment, and prevent further transmission. Specimens collected from the patient were tested at the DHMH laboratories and were positive by real-time polymerase chain reaction for nonvariola orthopoxvirus. Testing at the CDC verified the presence of vaccinia-specific DNA signatures. Continuing spread of the patient's lesions led to the administration of vaccinia immune globulin and strict infection control measures to prevent tertiary transmission to vulnerable family members, also with atopic dermatitis. VHCN contacted the service member to reinforce vaccination site care and hygiene. This case underscores the importance of prevaccination education for those receiving the smallpox vaccine to protect contacts at risk for developing severe adverse reactions.


Assuntos
Dermatite Atópica/complicações , Militares , Doenças Virais Sexualmente Transmissíveis/virologia , Varíola/prevenção & controle , Vacinação/efeitos adversos , Vaccinia/transmissão , Feminino , Humanos , Imunoglobulinas/uso terapêutico , Vaccinia/complicações , Vaccinia/tratamento farmacológico , Vírus Vaccinia/isolamento & purificação , Adulto Jovem
15.
JAMA ; 310(4): 398-407, 2013 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-23917290

RESUMO

IMPORTANCE: The rabies virus causes a fatal encephalitis and can be transmitted through tissue or organ transplantation. In February 2013, a kidney recipient with no reported exposures to potentially rabid animals died from rabies 18 months after transplantation. OBJECTIVES: To investigate whether organ transplantation was the source of rabies virus exposure in the kidney recipient, and to evaluate for and prevent rabies in other transplant recipients from the same donor. DESIGN: Organ donor and all transplant recipient medical records were reviewed. Laboratory tests to detect rabies virus-specific binding antibodies, rabies virus neutralizing antibodies, and rabies virus antigens were conducted on available specimens, including serum, cerebrospinal fluid, and tissues from the donor and the recipients. Viral ribonucleic acid was extracted from tissues and amplified for nucleoprotein gene sequencing for phylogenetic comparisons. MAIN OUTCOMES AND MEASURES: Determination of whether the donor died from undiagnosed rabies and whether other organ recipients developed rabies. RESULTS: In retrospect, the donor's clinical presentation (which began with vomiting and upper extremity paresthesias and progressed to fever, seizures, dysphagia, autonomic dysfunction, and brain death) was consistent with rabies. Rabies virus antigen was detected in archived autopsy brain tissue collected from the donor. The rabies viruses infecting the donor and the deceased kidney recipient were consistent with the raccoon rabies virus variant and were more than 99.9% identical across the entire N gene (1349/1350 nucleotides), thus confirming organ transplantation as the route of transmission. The 3 other organ recipients remained asymptomatic, with rabies virus neutralizing antibodies detected in their serum after completion of postexposure prophylaxis (range, 0.3-40.8 IU/mL). CONCLUSIONS AND RELEVANCE: Unlike the 2 previous clusters of rabies virus transmission through solid organ transplantation, there was a long incubation period in the recipient who developed rabies, and survival of 3 other recipients without pretransplant rabies vaccination. Rabies should be considered in patients with acute progressive encephalitis of unexplained etiology, especially for potential organ donors. A standard evaluation of potential donors who meet screening criteria for infectious encephalitis should be considered, and risks and benefits for recipients of organs from these donors should be evaluated.


Assuntos
Período de Incubação de Doenças Infecciosas , Transplante de Rim/efeitos adversos , Vírus da Raiva/genética , Raiva/transmissão , Doadores de Tecidos , Animais , Humanos , Masculino , Reação em Cadeia da Polimerase , Raiva/diagnóstico , Raiva/fisiopatologia , Raiva/prevenção & controle , Vacinas Antirrábicas/uso terapêutico , Vírus da Raiva/isolamento & purificação , Guaxinins/virologia , Estudos Retrospectivos
16.
J Paediatr Child Health ; 49(5): 342-5, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23647764

RESUMO

Appropriate management and prevention of anaphylaxis in the school, pre-school and childcare settings requires advanced planning and communication. The Australasian Society of Clinical Immunology and Allergy has developed Guidelines for Prevention of Anaphylaxis in Schools, Pre-schools and Childcare to assist school, pre-school and childcare staff in appropriate implementation of risk-minimisation strategies. Risk-minimisation strategies recommended take into consideration the needs of the allergic child; effectiveness of measures; stresses on parents and staff, the allergic child and their peers; and the implications of the recommended risk-minimisation strategies. These Guidelines address risk-minimisation strategies for food, insect and medication allergies; however, the majority of strategies relate to food allergy due to the higher risk of exposure in these settings. Training in recognition of allergic symptoms (including anaphylaxis), appropriate response and treatment, as well as how to prevent exposure to known allergens are essential for effective anaphylaxis management in the school, pre-school and childcare settings.


Assuntos
Anafilaxia/prevenção & controle , Creches/normas , Hipersensibilidade/terapia , Instituições Acadêmicas/normas , Australásia , Criança , Pré-Escolar , Educação em Saúde , Humanos , Refeições , Escolas Maternais/normas , Desenvolvimento de Pessoal
17.
PLoS One ; 8(4): e60273, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23565216

RESUMO

BACKGROUND: Pneumococcal pneumonia causes significant morbidity and mortality among adults. Given limitations of diagnostic tests for non-bacteremic pneumococcal pneumonia, most studies report the incidence of bacteremic or invasive pneumococcal disease (IPD), and thus, grossly underestimate the pneumococcal pneumonia burden. We aimed to develop a conceptual and quantitative strategy to estimate the non-bacteremic disease burden among adults with community-acquired pneumonia (CAP) using systematic study methods and the availability of a urine antigen assay. METHODS AND FINDINGS: We performed a systematic literature review of studies providing information on the relative yield of various diagnostic assays (BinaxNOW® S. pneumoniae urine antigen test (UAT) with blood and/or sputum culture) in diagnosing pneumococcal pneumonia. We estimated the proportion of pneumococcal pneumonia that is bacteremic, the proportion of CAP attributable to pneumococcus, and the additional contribution of the Binax UAT beyond conventional diagnostic techniques, using random effects meta-analytic methods and bootstrapping. We included 35 studies in the analysis, predominantly from developed countries. The estimated proportion of pneumococcal pneumonia that is bacteremic was 24.8% (95% CI: 21.3%, 28.9%). The estimated proportion of CAP attributable to pneumococcus was 27.3% (95% CI: 23.9%, 31.1%). The Binax UAT diagnosed an additional 11.4% (95% CI: 9.6, 13.6%) of CAP beyond conventional techniques. We were limited by the fact that not all patients underwent all diagnostic tests and by the sensitivity and specificity of the diagnostic tests themselves. We address these resulting biases and provide a range of plausible values in order to estimate the burden of pneumococcal pneumonia among adults. CONCLUSIONS: Estimating the adult burden of pneumococcal disease from bacteremic pneumococcal pneumonia data alone significantly underestimates the true burden of disease in adults. For every case of bacteremic pneumococcal pneumonia, we estimate that there are at least 3 additional cases of non-bacteremic pneumococcal pneumonia.


Assuntos
Pneumonia Pneumocócica/diagnóstico , Streptococcus pneumoniae , Adulto , Bacteriemia/diagnóstico , Infecções Comunitárias Adquiridas , Humanos , Pneumonia Pneumocócica/epidemiologia , Sensibilidade e Especificidade , Streptococcus pneumoniae/imunologia , Streptococcus pneumoniae/isolamento & purificação
18.
J Allergy Clin Immunol Pract ; 1(2): 186-94, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24565458

RESUMO

BACKGROUND: Three studies have analyzed in-flight peanut/tree nut reactions, although the studies were conducted exclusively among Americans. OBJECTIVE: We studied the international in-flight experience and determined the efficacy of certain risk-mitigation strategies. METHODS: A 47-question on-line survey was distributed through the websites and social media outlets of the member organizations of the Food Allergy & Anaphylaxis Alliance. Both persons reporting an in-flight reaction and nonreactors were surveyed to assess details of air travel preparation and any reported reaction. Data were analyzed to determine the association among flying behaviors, reported reactions, and nationality. RESULTS: We found that 349 reactions were reported among 3273 respondents from 11 countries; 13.3% received epinephrine as treatment. Flight crews were notified about 50.1% of reactions. Sixty-nine percent of all respondents reported making a preflight accommodation request, although just 55% of reactors did so compared with 71.6% of nonreactors (P < .001). Adjusted odds of epinephrine use were increased with reported gastrointestinal or cardiovascular symptoms or with notifying the crew. Passengers who requested any accommodation, requested a peanut/tree nut-free meal, wiped their tray table, avoided airline pillows or blankets, requested a buffer zone, requested other passengers not consume peanut/tree nut-containing products, or reported not consuming airline-provided food had significantly lower adjusted odds of reporting a reaction. CONCLUSIONS: In-flight peanut and tree nut reactions occur internationally. Epinephrine was sparsely used to treat reactions. We identified 8 risk-mitigating behaviors associated with lower odds of a reported reaction. Future study is necessary to further validate the effectiveness of these passenger-initiated risk-mitigating behaviors.


Assuntos
Viagem Aérea , Hipersensibilidade a Noz/prevenção & controle , Hipersensibilidade a Amendoim/prevenção & controle , Adolescente , Adulto , Criança , Pré-Escolar , Epinefrina/uso terapêutico , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade
19.
Vaccine ; 29(33): 5355-62, 2011 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-21664217

RESUMO

Alaska Native and some American Indian (AI/AN) populations suffer disproportionately high rates of invasive pneumococcal disease (IPD) in both the pediatric and adult populations compared to the general U.S. population. Two pneumococcal vaccines are currently available in the U.S.: a 23-valent pneumococcal polysaccharide vaccine (PPSV23), available since 1983 and recommended for the elderly and those over 2 years of age with underlying medical conditions, and a 13-valent pneumococcal conjugate vaccine (PCV13), used in the routine infant immunization schedule since 2010. The U.S. Advisory Committee on Immunization Practice (ACIP) previously recommended use of PPSV23 for persons living in special environments or social settings, including AN and certain AI persons 2-64 years of age, on the basis of higher disease rates. The recommendation for routine PPSV23 use among AI/AN persons <65 years of age, regardless of underlying conditions, was removed in 2008, although the option for use among those 50-64 years of age living in areas with high pneumococcal disease rates was maintained. The rationale for the revised recommendations lay in the recognition that much of the excess disease burden occurs among those with an existing medical indication for PPSV23. Other considerations for the change were the potential risks of giving multiple PPSV23 doses and the considerable heterogeneity in pneumococcal disease risk among American Indian populations requiring a more tailored approach to local recommendations based on local epidemiology.


Assuntos
Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/imunologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Índios Norte-Americanos , Lactente , Recém-Nascido , Inuítes , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
20.
Clin Infect Dis ; 47(9): 1202-8, 2008 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-18808354

RESUMO

Noroviruses, recognized as the leading global cause of viral gastroenteritis and a major contributor to food-borne illness, present a growing challenge in health care and long-term care facilities. The virus spreads easily and by multiple routes. A visitor to a ward might initiate an outbreak by person-to-person contact, vomiting staff members or patients can disseminate the virus by airborne means, and contaminated surfaces, such as doorknobs and computer keyboards, can sustain an epidemic. In addition, although self-limited in healthy hosts, the virus can cause increased morbidity in more-vulnerable people. The GII.4 strain of the virus now dominates in multiple recent worldwide epidemics as well as in health care and long-term care facilities. Much like the influenza virus, norovirus appears to evolve by antigenic drift and evading the immune system, causing waves of global epidemics. Previous attempts at controlling outbreaks, both in the community and in closed facilities, provide guidance about the vigilance and action required by the health care community to diminish the clinical impact of norovirus infection.


Assuntos
Infecções por Caliciviridae/epidemiologia , Gastroenterite/epidemiologia , Instalações de Saúde , Norovirus , Infecções por Caliciviridae/prevenção & controle , Infecções por Caliciviridae/transmissão , Surtos de Doenças/prevenção & controle , Gastroenterite/prevenção & controle , Humanos , Assistência de Longa Duração
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