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1.
Crit Care Med ; 52(3): 441-451, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-37947484

RESUMO

OBJECTIVE: Sepsis is a leading cause of mortality. Predicting outcomes is challenging and few biomarkers perform well. Defects in the renin-angiotensin system (RAS) can predict clinical outcomes in sepsis and may outperform traditional biomarkers. We postulated that RAS dysfunction (elevated active renin, angiotensin 1-7 [Ang-(1-7)], and angiotensin-converting enzyme 2 (ACE2) activity with depressed Ang-II and ACE activity) would be associated with mortality in a cohort of septic patients. DESIGN: Post hoc analysis of patients enrolled in the Vitamin C, Thiamine, and Steroids in Sepsis (VICTAS) randomized controlled trial. SETTING: Forty-three hospitals across the United States. PATIENTS: Biorepository samples of 103 patients. INTERVENTIONS: We analyzed day 0 (within 24 hr of respiratory failure, septic shock, or both) and day 3 samples ( n = 103 and 95, respectively) for assessment of the RAS. The association of RAS values with 30-day mortality was determined using Cox proportional hazards regression with multivariable adjustments for age, sex, VICTAS treatment arm, systolic blood pressure, Sequential Organ Failure Assessment Score, and vasopressor use. MEASUREMENTS AND MAIN RESULTS: High baseline active renin values were associated with higher 30-day mortality when dichotomized to the median of 188.7 pg/mL (hazard ratio [HR] = 2.84 [95% CI, 1.10-7.33], p = 0.031) or stratified into quartiles (Q1 = ref, HR Q2 = 2.01 [0.37-11.04], HR Q3 = 3.22 [0.64-16.28], HR Q4 = 5.58 [1.18-26.32], p for linear trend = 0.023). A 1- sd (593.6 pg/mL) increase in renin from day 0 to day 3 was associated with increased mortality (HR = 3.75 [95% CI, 1.94-7.22], p < 0.001), and patients whose renin decreased had improved survival compared with those whose renin increased (HR 0.22 [95% CI, 0.08-0.60], p = 0.003). Ang-(1-7), ACE2 activity, Ang-II and ACE activity did not show this association. Mortality was attenuated in patients with renin over the median on day 0 who received the VICTAS intervention, but not on day 3 ( p interaction 0.020 and 0.137, respectively). There were no additional consistent patterns of mortality on the RAS from the VICTAS intervention. CONCLUSIONS: Baseline serum active renin levels were strongly associated with mortality in critically ill patients with sepsis. Furthermore, a greater relative activation in circulating renin from day 0 to day 3 was associated with a higher risk of death.


Assuntos
Renina , Sepse , Humanos , Ácido Ascórbico/uso terapêutico , Tiamina/uso terapêutico , Enzima de Conversão de Angiotensina 2 , Estado Terminal , Sistema Renina-Angiotensina/fisiologia , Vitaminas/uso terapêutico , Biomarcadores , Esteroides/uso terapêutico , Sepse/tratamento farmacológico
2.
MMWR Morb Mortal Wkly Rep ; 70(32): 1084-1087, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34383734

RESUMO

On May 5, 2021, the Colorado Department of Public Health and Environment (CDPHE) identified the first five COVID-19 cases caused by the SARS-CoV-2 B.1.617.2 (Delta) variant in Mesa County in western Colorado (population 154,933, <3% of the state population). All five initial cases were associated with school settings. Through early June, Mesa County experienced a marked increase in the proportion of Delta variant cases identified through sequencing: the 7-day proportion of sequenced specimens identified as B.1.617.2 in Mesa County more than doubled, from 43% for the week ending May 1 to 88% for the week ending June 5. As of June 6, more than one half (51%) of sequenced B.1.617.2 specimens in Colorado were from Mesa County. CDPHE assessed data from surveillance, vaccination, laboratory, and hospital sources to describe the preliminary epidemiology of the Delta variant and calculate crude vaccine effectiveness (VE). Vaccination coverage in early May in Mesa County was lower (36% of eligible residents fully vaccinated) than that in the rest of the state (44%). Compared with that in all other Colorado counties, incidence, intensive care unit (ICU) admissions, and COVID-19 case fatality ratios were significantly higher in Mesa County during the analysis period, April 27-June 6, 2021. In addition, during the same time period, the proportion of COVID-19 cases in persons who were fully vaccinated (vaccine breakthrough cases) was significantly higher in Mesa County compared with that in all other Colorado counties. Estimated crude VE against reported symptomatic infection for a 2-week period ending June 5 was 78% (95% confidence interval [CI] = 71%-84%) for Mesa County and 89% (95% CI = 88%-91%) for other Colorado counties. Vaccination is a critical strategy for preventing infection, serious illness, and death from COVID-19. Enhanced mitigation strategies, including masking in indoor settings irrespective of vaccination status, should be considered in areas with substantial or high case rates.


Assuntos
COVID-19/epidemiologia , COVID-19/virologia , SARS-CoV-2/isolamento & purificação , Adolescente , Adulto , Idoso , COVID-19/prevenção & controle , Vacinas contra COVID-19/administração & dosagem , Criança , Pré-Escolar , Colorado/epidemiologia , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Adulto Jovem
3.
BMC Public Health ; 18(1): 1011, 2018 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-30107830

RESUMO

BACKGROUND: Yellow fever (YF) is a viral hemorrhagic fever, endemic in the tropical forests of Africa and Central and South America. The disease is transmitted by mosquitoes infected with the yellow fever virus (YFV). Ethiopia was affected by the largest YF outbreak since the vaccination era during 1960-1962. The recent YF outbreak occurred in 2013 in Southern part of the country. The current survey of was carried out to determine the YF seroprevalence so as to make recommendations from YF prevention and control in Ethiopia. METHODOLOGY: A multistage cluster design was utilized. Consequently, the country was divided into 5 ecological zones and two sampling towns were picked per zone randomly. A total of 1643 serum samples were collected from human participants. The serum samples were tested for IgG antibody against YFV using ELISA. Any serum sample testing positive by ELISA was confirmed by plaque reduction neutralization test (PRNT). In addition, differential testing was performed for other flaviviruses, namely dengue, Zika and West Nile viruses. RESULT: Of the total samples tested, 10 (0.61%) were confirmed to be IgG positive against YFV and confirmed with PRNT. Nine (0.5%) samples were antibody positive for dengue virus, 15(0.9%) forWest Nile virus and 7 (0.4%) for Zika virus by PRNT. Three out of the five ecological zones namely zones 1, 3 and 5 showed low levels (< 2%) of IgG positivity against YFV. A total of 41(2.5%) cases were confirmed to be positive for one of flaviviruses tested. CONCLUSION: Based on the seroprevalence data, the level of YFV activity and the risk of a YF epidemic in Ethiopia are low. However additional factors that could impact the likelihood of such an epidemic occurring should be considered before making final recommendations for YF prevention and control in Ethiopia. Based on the results of the serosurvey and other YF epidemic risk factors considered, a preventive mass vaccination campaign is not recommended, however the introduction of YF vaccine in routine EPI is proposed nationwide, along with strong laboratory based YF surveillance.


Assuntos
Anticorpos Antivirais/sangue , Vírus da Dengue/imunologia , Vírus do Nilo Ocidental/imunologia , Febre Amarela/epidemiologia , Vírus da Febre Amarela/imunologia , Zika virus/imunologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Epidemias/prevenção & controle , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Neutralização , Saúde Pública , Estudos Soroepidemiológicos , Febre Amarela/prevenção & controle , Vacina contra Febre Amarela , Adulto Jovem
4.
J Infect Dis ; 216(suppl_10): S875-S883, 2017 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-29267909

RESUMO

For >60 years, Zika virus (ZIKV) has been recognized as an arthropod-borne virus with Aedes species mosquitoes as the primary vector. However in the past 10 years, multiple alternative routes of ZIKV transmission have been identified. We review the available data on vector and non-vector-borne modes of transmission and interventions undertaken, to date, to reduce the risk of human infection through these routes. Although much has been learned during the outbreak in the Americas on the underlying mechanisms and pathogenesis of non-vector-borne ZIKV infections, significant gaps remain in our understanding of the relative incidence of, and risk from, these modes compared to mosquito transmission. Additional research is urgently needed on the risk, pathogenesis, and effectiveness of measures to mitigate non-vector-borne ZIKV transmission.


Assuntos
Aedes/virologia , Surtos de Doenças , Mosquitos Vetores/virologia , Infecção por Zika virus/transmissão , Zika virus/fisiologia , América , Animais , Humanos , Incidência , Risco , Zika virus/patogenicidade , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/virologia
5.
MMWR Morb Mortal Wkly Rep ; 64(10): 279-81, 2015 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-25789744

RESUMO

In September 2014, a previously healthy Oregon woman in her 60s went to a hospital emergency department with malaise, dyspnea, vomiting, and diarrhea of 3-5 days' duration. She reported no recent travel, ill contacts, or dietary changes. Six days earlier, she had received a single dose of yellow fever vaccine and typhoid vaccine before planned travel to South America.


Assuntos
Síndrome de Resposta Inflamatória Sistêmica/etiologia , Vacina contra Febre Amarela/efeitos adversos , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Oregon
6.
MMWR Morb Mortal Wkly Rep ; 63(12): 270-1, 2014 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-24670929

RESUMO

Heartland virus is a newly identified phlebovirus that was first isolated from two northwestern Missouri farmers hospitalized with fever, leukopenia, and thrombocytopenia in 2009. Based on the patients' clinical findings and their reported exposures, the virus was suspected to be transmitted by ticks. After this discovery, CDC worked with state and local partners to define the ecology and modes of transmission of Heartland virus, develop diagnostic assays, and identify additional cases to describe the epidemiology and clinical disease. From this work, it was learned that Heartland virus is found in the Lone Star tick (Amblyomma americanum). Six additional cases of Heartland virus disease were identified during 2012-2013; four of those patients were hospitalized, including one with comorbidities who died.


Assuntos
Infecções por Bunyaviridae/diagnóstico , Infecções por Bunyaviridae/transmissão , Ixodidae/virologia , Phlebovirus/isolamento & purificação , Idoso , Idoso de 80 Anos ou mais , Animais , Infecções por Bunyaviridae/terapia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
8.
Pan Afr Med J ; 38: 402, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34381546

RESUMO

INTRODUCTION: accurate and timely laboratory diagnosis of yellow fever (YF) is critical to the Eliminate Yellow Fever Epidemics (EYE) strategy. Gavi, the Vaccine Alliance recognized the need to support and build capacity in the national and regional laboratories in the Global YF Laboratory Network (GYFLN) as part of this strategy. METHODS: to better understand current capacity, gaps and needs of the GYFLN laboratories in Africa, assessments were carried out in national and regional reference laboratories in the 25 African countries at high risk for YF outbreaks that were eligible for new financial support from Gavi. RESULTS: the assessments found that the GYFLN in Africa has high capacity but 21% of specimens were not tested due to lack of testing kits or reagents and approximately 50% of presumptive YF cases were not confirmed at the regional reference laboratory due to problems with shipping. CONCLUSION: the laboratory assessments helped to document the baseline capacities of these laboratories prior to Gavi funding to support strengthening YF laboratories.


Assuntos
Surtos de Doenças , Laboratórios/estatística & dados numéricos , Febre Amarela/diagnóstico , África/epidemiologia , Fortalecimento Institucional , Epidemias , Humanos , Febre Amarela/epidemiologia
9.
J Med Virol ; 81(2): 305-8, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19107960

RESUMO

Eastern equine encephalitis (EEE) is rare, but the most severe of the mosquito-borne encephalitides in the United States with a high case fatality rate of 30%. Here, we present a patient with EEE. EEE virus causes sporadic human disease in the Eastern parts of the United States, but the case we describe was a Scottish tourist who acquired the disease from mosquito bites while in holiday in the United States. This is a first report of an imported case to Europe.


Assuntos
Vírus da Encefalite Equina do Leste/fisiologia , Encefalomielite Equina do Leste/diagnóstico , Encefalomielite Equina do Leste/virologia , Adulto , Aedes , Animais , Encéfalo/patologia , Encéfalo/virologia , Vírus da Encefalite Equina do Leste/genética , Vírus da Encefalite Equina do Leste/imunologia , Vírus da Encefalite Equina do Leste/isolamento & purificação , Encefalomielite Equina do Leste/tratamento farmacológico , Humanos , Imageamento por Ressonância Magnética , Masculino , Viagem , Resultado do Tratamento , Reino Unido , Estados Unidos
10.
Vector Borne Zoonotic Dis ; 7(4): 529-40, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-18047395

RESUMO

Plague and tularemia are serious zoonotic diseases endemic to North America. We evaluated spatial patterns in their transmission in view of changing climates. First, we tested whether observed shifts since the 1960s are consistent with expected patterns of shift given known climate changes over that period. Then, we used general circulation model results summarizing global patterns of changing climates into the future to forecast likely shifts in patterns of transmission over the next 50 years. The results indicate that these diseases are indeed shifting in accord with patterns of climatic shift, but that overall geographic shifts will likely be subtle, with some northward movement of southern limits and possibly northward movement of northern limits as well.


Assuntos
Efeito Estufa , Peste/epidemiologia , Tularemia/epidemiologia , Animais , Clima , Previsões , Humanos , Modelos Estatísticos , Modelos Teóricos , Peste/transmissão , Chuva , Fatores de Risco , Temperatura , Fatores de Tempo , Tularemia/transmissão , Estados Unidos/epidemiologia
11.
Vector Borne Zoonotic Dis ; 11(5): 597-9, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-20849276

RESUMO

We surveyed state public health and commercial diagnostic reference laboratories regarding current testing practices for West Nile virus (WNV). The majority of WNV testing is now performed in commercial diagnostic reference laboratories using commercially available Food and Drug Administration-cleared kits labeled for the presumptive diagnosis of WNV. However, only 25% of surveyed state public health or commercial diagnostic reference laboratories currently have the capacity to perform the recommended confirmatory testing. These findings indicate the need for both manufacturers and laboratories to monitor the performance of these WNV test kits. Further, clinicians should be aware of the limitations of these kits and the need for additional testing to confirm a diagnosis of WNV disease.


Assuntos
Anticorpos Antivirais/análise , Ensaio de Imunoadsorção Enzimática/normas , Febre do Nilo Ocidental/diagnóstico , Vírus do Nilo Ocidental/imunologia , Centers for Disease Control and Prevention, U.S. , Inquéritos Epidemiológicos , Humanos , Imunoglobulina M/análise , Laboratórios/normas , Saúde Pública , Kit de Reagentes para Diagnóstico/normas , Sensibilidade e Especificidade , Estados Unidos , United States Food and Drug Administration
12.
Vaccine ; 27(43): 5974-81, 2009 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-19679215

RESUMO

Five suspected cases of yellow fever vaccine-associated viscerotropic disease (YEL-AVD) clustered in space and time following a vaccination campaign in Ica, Peru in 2007. All five people received the same lot of 17DD live attenuated yellow fever vaccine before their illness; four of the five died of confirmed YEL-AVD. The surviving case was classified as probable YEL-AVD. Intensive investigation yielded no abnormalities of the implicated vaccine lot and no common risk factors. This is the first described space-time cluster of yellow fever viscerotropic disease involving more than two cases. Mass yellow fever vaccination should be avoided in areas that present extremely low risk of yellow fever.


Assuntos
Vacinação/efeitos adversos , Vacina contra Febre Amarela/efeitos adversos , Febre Amarela/prevenção & controle , Adulto , Idoso , Evolução Fatal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Fatores de Risco , Vacinas Atenuadas/efeitos adversos , Adulto Jovem
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