Anne Schuchat

Centers for Disease Control and Prevention, Druid Hills, GA, United States

Are you Anne Schuchat?

Claim your profile

Publications (183)2128.96 Total impact

  • Anne Schuchat, Kevin M De Cock
    The Journal of Infectious Diseases 03/2012; 205 Suppl 1:S1-3. · 5.85 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: The rate of bacterial meningitis declined by 55% in the United States in the early 1990s, when the Haemophilus influenzae type b (Hib) conjugate vaccine for infants was introduced. More recent prevention measures such as the pneumococcal conjugate vaccine and universal screening of pregnant women for group B streptococcus (GBS) have further changed the epidemiology of bacterial meningitis. We analyzed data on cases of bacterial meningitis reported among residents in eight surveillance areas of the Emerging Infections Programs Network, consisting of approximately 17.4 million persons, during 1998-2007. We defined bacterial meningitis as the presence of H. influenzae, Streptococcus pneumoniae, GBS, Listeria monocytogenes, or Neisseria meningitidis in cerebrospinal fluid or other normally sterile site in association with a clinical diagnosis of meningitis. We identified 3188 patients with bacterial meningitis; of 3155 patients for whom outcome data were available, 466 (14.8%) died. The incidence of meningitis changed by -31% (95% confidence interval [CI], -33 to -29) during the surveillance period, from 2.00 cases per 100,000 population (95% CI, 1.85 to 2.15) in 1998-1999 to 1.38 cases per 100,000 population (95% CI 1.27 to 1.50) in 2006-2007. The median age of patients increased from 30.3 years in 1998-1999 to 41.9 years in 2006-2007 (P<0.001 by the Wilcoxon rank-sum test). The case fatality rate did not change significantly: it was 15.7% in 1998-1999 and 14.3% in 2006-2007 (P=0.50). Of the 1670 cases reported during 2003-2007, S. pneumoniae was the predominant infective species (58.0%), followed by GBS (18.1%), N. meningitidis (13.9%), H. influenzae (6.7%), and L. monocytogenes (3.4%). An estimated 4100 cases and 500 deaths from bacterial meningitis occurred annually in the United States during 2003-2007. The rates of bacterial meningitis have decreased since 1998, but the disease still often results in death. With the success of pneumococcal and Hib conjugate vaccines in reducing the risk of meningitis among young children, the burden of bacterial meningitis is now borne more by older adults. (Funded by the Emerging Infections Programs, Centers for Disease Control and Prevention.).
    New England Journal of Medicine 05/2011; 364(21):2016-25. · 51.66 Impact Factor
  • Anne Schuchat
    [show abstract] [hide abstract]
    ABSTRACT: The author reflects on her personal experiences during the 2009 H1N1 influenza, acquired immune deficiency syndrome (AIDS), and severe acute respiratory syndrome (SARS) pandemics. The roles played by the Centers for Disease Control and Prevention related to pregnancy-associated influenza during the 2009 pandemic are described. Risk communication principles are summarized and resources provided.
    American journal of obstetrics and gynecology 02/2011; 204(6 Suppl 1):S4-6. · 3.28 Impact Factor
  • Source
    Anne Schuchat, Beth P Bell, Stephen C Redd
    [show abstract] [hide abstract]
    ABSTRACT: A strong evidence base provides the foundation for planning and response strategies. Investments in pandemic preparedness included support for research that aided early detection, response, and control of the 2009 influenza A (H1N1) (pH1N1) pandemic. Scientific investigations conducted during the pandemic guided understanding of the virus, disease severity, and epidemiologic risk factors. Field investigations also produced information that strengthened guidance for the use of antivirals, identification of target populations for monovalent pH1N1 vaccine, and refinement of recommendations for social distancing measures. Communication of this evolving evidence base was important to sustaining credibility of public health. Areas where substantial controversy emerged, such as the optimal approach to respiratory protection of healthcare workers, often suffered from gaps in the evidence base. Many aspects of the 2009-2010 pandemic influenza experience provide ongoing opportunities for additional study, which will strengthen plans for future pandemic response as well as control of seasonal influenza.
    Clinical Infectious Diseases 01/2011; 52 Suppl 1:S8-12. · 9.37 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: To calculate the burden of 2009 pandemic influenza A (pH1N1) in the United States, we extrapolated from the Centers for Disease Control and Prevention's Emerging Infections Program laboratory-confirmed hospitalizations across the entire United States, and then corrected for underreporting. From 12 April 2009 to 10 April 2010, we estimate that approximately 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (195,086-402,719), and 12,469 deaths (8868-18,306) occurred in the United States due to pH1N1. Eighty-seven percent of deaths occurred in those under 65 years of age with children and working adults having risks of hospitalization and death 4 to 7 times and 8 to 12 times greater, respectively, than estimates of impact due to seasonal influenza covering the years 1976-2001. In our study, adults 65 years of age or older were found to have rates of hospitalization and death that were up to 75% and 81%, respectively, lower than seasonal influenza. These results confirm the necessity of a concerted public health response to pH1N1.
    Clinical Infectious Diseases 01/2011; 52 Suppl 1:S75-82. · 9.37 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: The introduction of Haemophilus influenzae type b (Hib) vaccine in developing countries has suffered from a long delay. Between 2005 and 2009, a surge in Hib vaccine adoption took place, particularly among GAVI-eligible countries. Several factors contributed to the increase in Hib vaccine adoption, including support provided by the Hib Initiative, a project funded by the GAVI Alliance in 2005 to accelerate evidence-informed decisions for use of Hib vaccine. This paper reviews the strategy adopted by the Hib Initiative and the lessons learned in the process, which provide a useful model to accelerate uptake of other new vaccines.
    Vaccine 10/2010; 28(43):7123-9. · 3.77 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: We examined associations between the socioeconomic characteristics of census tracts and racial/ethnic disparities in the incidence of bacteremic community-acquired pneumonia among US adults. We analyzed data on 4870 adults aged 18 years or older with community-acquired bacteremic pneumonia identified through active, population-based surveillance in 9 states and geocoded to census tract of residence. We used data from the 2000 US Census to calculate incidence by age, race/ethnicity, and census tract characteristics and Poisson regression to estimate rate ratios (RRs) and 95% confidence intervals (CIs). During 2003 to 2004, the average annual incidence of bacteremic pneumonia was 24.2 episodes per 100 000 Black adults versus 10.1 per 100 000 White adults (RR = 2.40; 95% CI = 2.24, 2.57). Incidence among Black residents of census tracts with 20% or more of persons in poverty (most impoverished) was 4.4 times the incidence among White residents of census tracts with less than 5% of persons in poverty (least impoverished). Racial disparities in incidence were reduced but remained significant in models that controlled for age, census tract poverty level, and state. Adults living in impoverished census tracts are at increased risk of bacteremic pneumonia and should be targeted for prevention efforts.
    American Journal of Public Health 10/2010; 100(10):1904-11. · 3.93 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Human immunodeficiency virus (HIV) infection and AIDS increase the risk of invasive pneumococcal disease (IPD). We evaluated IPD among HIV-infected adults over a 10-year period in the US to identify opportunities for prevention of IPD among HIV-infected adults. IPD and HIV surveillance in seven population-based and laboratory-based Active Bacterial Core surveillance areas. IPD cases were adults 18-64 years old with pneumococcus isolated from a normally sterile site during 1998-2007. Isolates were serotyped using the Quellung reaction. HIV/AIDS status was determined by medical record review. We calculated incidence of IPD among adults with AIDS using national case-based surveillance data. Of 13 812 IPD cases among 18-64-year-olds, 3236 (23%) occurred among HIV-infected adults (with or without AIDS) and 1313 (10%) occurred among the subset of HIV-infected adults with AIDS. Compared with the period (1998-1999) before childhood 7-valent pneumococcal conjugate vaccine (PCV7) introduction in the US, the overall incidence of IPD among adults with AIDS decreased 25% from 399 to 298 cases per 100 000 by 2007 (P = 0.008). In 2006-2007, 8, 39 and 55% of IPD cases among adults with AIDS were caused by serotypes included in the 7-valent PCV, 13-valent PCV and 23-valent pneumococcal polysaccharide vaccines, respectively. Sustained declines in IPD have occurred among adults with AIDS in the US, but incidence remained high 7 years after PCV7 introduction. More aggressive efforts, including HIV-prevention measures and the use of new PCVs in children and possibly HIV-infected adults, are necessary to further reduce IPD among HIV-infected adults.
    AIDS (London, England) 09/2010; 24(14):2253-62. · 4.91 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: We conducted a case-control study to evaluate risk factors for invasive pneumococcal disease (IPD) among children who were aged 3 to 59 months in the era of pneumococcal conjugate vaccine (PCV7). IPD cases were identified through routine surveillance during 2001-2004. We matched a median of 3 control subjects to each case patient by age and zip code. We calculated odds ratios for potential risk factors for vaccine-type and non-vaccine-type IPD by using multivariable conditional logistic regression. We enrolled 782 case patients (45% vaccine-type IPD) and 2512 matched control subjects. Among children who received any PCV7, children were at increased risk for vaccine-type IPD when they had underlying illnesses, were male, or had no health care coverage. Vaccination with PCV7 did not influence the risk for non-vaccine-type IPD. Presence of underlying illnesses increased the risk for non-vaccine-type IPD, particularly among children who were not exposed to household smoking. Non-vaccine-type case patients were more likely than control subjects to attend group child care, be male, live in low-income households, or have asthma; case patients were less likely than control subjects to live in households with other children. Vaccination with PCV7 has reduced the risk for vaccine-type IPD that is associated with race and group child care attendance. Because these factors are still associated with non-vaccine-type IPD risk, additional reductions in disparities should be expected with new, higher valency conjugate vaccines.
    PEDIATRICS 07/2010; 126(1):e9-17. · 4.47 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Polysaccharide-protein conjugate vaccines against Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae have proven efficacy against radiologically confirmed pneumonia. Measurement of pneumonia incidence provides a platform to estimate of the vaccine-preventable burden. Over 24 months, we conducted surveillance for radiologically confirmed severe pneumonia episodes among children <2 years of age admitted to a rural hospital in Manhiça, southern Mozambique. Study children were tested for HIV during the second year of surveillance. Severe pneumonia accounted for 15% of 5132 hospital admissions and 32% of in-hospital mortality among children <2 years of age. Also, 43% of chest radiographs were interpreted as radiologically confirmed pneumonia. HIV-infection was associated with 81% of fatal pneumonia episodes among children tested for HIV. The minimum incidence rate of radiologically confirmed pneumonia requiring hospitalization was 19 episodes/1000 child-years. Incidence rates among HIV-infected children were 9.3-19.0-fold higher than HIV-uninfected. Introduction of Hib and pneumococcal conjugate vaccines would have a substantial impact on pneumonia hospitalizations among African children if vaccine effects are similar to those observed in clinical trials.
    Vaccine 04/2010; 28(30):4851-7. · 3.77 Impact Factor
  • Source
    Public Health Reports 04/2010; 125 Suppl 3:3-5. · 1.42 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Nearly 1 million sepsis-related deaths per year occur in developing countries, primarily in the first week of life. In 2 nonrandomized studies in Africa, intravaginal washes during labor with cotton wipes soaked in chlorhexidine, a commonly available wide-spectrum antibiotic, were associated with reductions of 50% to 75% in neonatal sepsis-related morbidity and mortality. The lack of a definitive randomized, controlled trial has impeded widespread acceptance and use of chlorhexidine wipes. The results of a meta-analysis including randomized or quasi-randomized trials showed that chlorhexidine significantly reduced vertical transmission of group B streptococcus, but not early-onset neonatal infection caused by this bacterium or other neonatal pathogens. This randomized controlled trial investigated the efficacy of intravaginal chlorhexidine in reducing early-onset neonatal sepsis (the first 3 days of life) and vertical transmission of group B streptococcus. The study was conducted between 2004 and 2007 at a hospital in Soweto, South Africa. A total of 8011 pregnant women (age, 12–51 years) in active labor, were randomly assigned to intravaginal washes with either chlorhexidine wipes (interventional group) or external genitalia water wipes (control group); their 8129 newborn babies were assigned to either full-body (intervention group, n = 4072) or foot (control group, n = 4057) washes at birth, respectively. After delivery, swabs of the maternal lower vagina and neonatal skin were obtained from a maternal subset (n = 5144) to assess colonization with potentially pathogenic bacteria. The analysis was according to intention to treat. A total of 289 cases of early-onset sepsis occurred, with no difference in rates of neonatal sepsis between the chlorhexidine (34.6 per 1000 births) and control groups (36.5 per 1000 births). Similarly, the rates of colonization with group B streptococcus in neonates born to mothers in the chlorhexidine (54%, 217/401) and control groups (55%, 234/429) did not differ and there was no substantial reduction in vertical transmission. These findings demonstrate that the use of maternal and neonatal chlorhexidine wipes does not prevent the occurrence of early-onset sepsis or affect vertical transmission of one of the main sepsis-causing pathogens.
    Obstetrical and Gynecological Survey 03/2010; 65(4):215-216. · 2.51 Impact Factor
  • Kenneth G Castro, Beth P Bell, Anne Schuchat
    The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease 02/2010; 14(2):127-9. · 2.61 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: About 500,000 sepsis-related deaths per year arise in the first 3 days of life. On the basis of results from non-randomised studies, use of vaginal chlorhexidine wipes during labour has been proposed as an intervention for the prevention of early-onset neonatal sepsis in developing countries. We therefore assessed the efficacy of chlorhexidine in early-onset neonatal sepsis and vertical transmission of group B streptococcus. In a trial in Soweto, South Africa, 8011 women (aged 12-51 years) were randomly assigned in a 1:1 ratio to chlorhexidine vaginal wipes or external genitalia water wipes during active labour, and their 8129 newborn babies were assigned to full-body (intervention group) or foot (control group) washes with chlorhexidine at birth, respectively. In a subset of mothers (n=5144), we gathered maternal lower vaginal swabs and neonatal skin swabs after delivery to assess colonisation with potentially pathogenic bacteria. Primary outcomes were neonatal sepsis in the first 3 days of life and vertical transmission of group B streptococcus. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00136370. Rates of neonatal sepsis did not differ between the groups (chlorhexidine 141 [3%] of 4072 vs control 148 [4%] of 4057; p=0.6518). Rates of colonisation with group B streptococcus in newborn babies born to mothers in the chlorhexidine (217 [54%] of 401) and control groups (234 [55%] of 429] did not differ (efficacy -0.05%, 95% CI -9.5 to 7.9). Because chlorhexidine intravaginal and neonatal wipes did not prevent neonatal sepsis or the vertical acquisition of potentially pathogenic bacteria among neonates, we need other interventions to reduce childhood mortality. US Agency for International Development, National Vaccine Program Office and Centers for Disease Control's Antimicrobial Resistance Working Group, and Bill & Melinda Gates Foundation.
    The Lancet 10/2009; 374(9705):1909-16. · 39.06 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Group B streptococcal disease is one of the most common infections in the first week after birth. In 2002, national guidelines recommended universal late antenatal screening of pregnant women for colonization with group B streptococcus to identify candidates for intrapartum chemoprophylaxis. We evaluated the implementation of the guidelines in a multistate, retrospective cohort selected from the Active Bacterial Core surveillance, a 10-state, population-based system that monitors invasive group B streptococcal disease. We abstracted data from the labor and delivery records of a stratified random sample of live births and of all cases in which the newborn had early-onset group B streptococcal disease (i.e., disease in infants <7 days of age) in 2003 and 2004. We compared our results with those from a study with a similar design that evaluated screening practices in 1998 and 1999. We abstracted records of 254 births in which the infant had group B streptococcal disease and 7437 births in which the infant did not. The rate of screening for group B streptococcus before delivery increased from 48.1% in 1998-1999 to 85.0% in 2003-2004; the percentage of infants exposed to intrapartum antibiotics increased from 26.8% to 31.7%. Chemoprophylaxis was administered in 87.0% of the women who were positive for group B streptococcus and who delivered at term, but in only 63.4% of women with unknown colonization status who delivered preterm. The overall incidence of early-onset group B streptococcal disease was 0.32 cases per 1000 live births. Preterm infants had a higher incidence of early-onset group B streptococcal disease than did term infants (0.73 vs. 0.26 cases per 1000 live births); however, 74.4% of the cases of group B streptococcal disease (189 of 254) occurred in term infants. Missed screening among mothers who delivered at term accounted for 34 of the 254 cases of group B streptococcal disease (13.4%). A total of 61.4% of the term infants with group B streptococcal disease were born to women who had tested negative for group B streptococcus before delivery. Recommendations for universal screening were rapidly adopted. Improved management of preterm deliveries and improved collection, processing, and reporting of culture results may prevent additional cases of early-onset group B streptococcal disease.
    New England Journal of Medicine 06/2009; 360(25):2626-36. · 51.66 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Pneumonia is a leading cause of hospitalization and death among children in Africa. We describe the clinical presentation of severe pneumonia among hospitalized children in a malaria endemic area with a high prevalence of HIV infection. As part of a 2-year prospective study of radiologically confirmed pneumonia, chest radiographs, malaria parasite counts and bacterial blood cultures were systematically performed for children 0-23 months admitted with severe pneumonia. Radiographs were interpreted according to WHO guidelines. HIV tests were performed during a 12-month period. Severe pneumonia accounted for 16% of 4838 hospital admissions among children 0-23 months; 43% of episodes had endpoint consolidation, 15% were associated with bacteremia and 11% were fatal. Fever, cough >3 days, crepitations, hypoxemia and absence of malaria parasitemia were associated with radiologically confirmed pneumonia. Nineteen per cent of children with severe pneumonia and 27% with radiologically confirmed pneumonia had clinical malaria. HIV-prevalence was 26% among children hospitalized with severe pneumonia and HIV-testing results. HIV infection, anaemia, malnutrition, hypoxemia and bacteremia were associated with fatal episodes of severe pneumonia. Treatment of admitted children with severe pneumonia is complicated in settings with prevalent HIV and malaria. Children with severe pneumonia and clinical malaria require antibiotic and antimalarial treatment. In addition to vertical programs, integrated approaches may greatly contribute to reduction of pneumonia-related mortality.
    Journal of Tropical Pediatrics 04/2009; 55(6):379-87. · 1.01 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Pneumococcal polysaccharide vaccine (PPV-23) has been recommended for HIV-infected adults. We investigated factors that could influence PPV-23 effectiveness against all-cause pneumonia in a longitudinal cohort of 23,255 HIV-infected adults receiving care during 1998--2003. Patients who received PPV-23 had a lower rate of pneumonia (IRR = 0.8; 95% CI: 0.8-0.9) than patients who had never been vaccinated, independent of recent CD4 count, HIV viral load, antiretroviral therapy, and history of pneumonia. However, PPV-23 provided no benefit when patients were vaccinated at HIV viral load > 100,000 copies/ml, irrespective of CD4 count at vaccination. Receipt of PPV-23 was associated with lower incidence of all-cause pneumonia.
    Vaccine 10/2008; 26(46):5830-4. · 3.49 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Successful incorporation of a new vaccine into a nation's vaccination program requires addressing a number of issues, including: 1) establishing national recommendations; 2) assuring education of and acceptance by the public and medical community; 3) establishing and maintaining an appropriate infrastructure for vaccine delivery; 4) financing the vaccine and the program, in addition to political will. This article reviews the early experience with implementation of human papillomavirus (HPV) vaccination programs. It focuses on the United States of America and Canada and provides a brief report on Australia, where introduction is underway.
    Vaccine 09/2008; 26 Suppl 10:K68-75. · 3.49 Impact Factor
  • Anne Schuchat, Beth P Bell
    [show abstract] [hide abstract]
    ABSTRACT: Although vaccines are studied intensively before licensure, insight into important aspects of vaccine performance and the effectiveness of immunization programs and policies can only be detected after vaccines enter widespread use. Now that 17 diseases are targeted for prevention through routine immunizations in the USA, reassessment of the nation's vaccine-preventable disease-monitoring efforts is appropriate. Postlicensure disease monitoring has permitted recognition of indirect protection, vaccine effectiveness of various schedules, duration of protection, health disparities, importation patterns and microbial adaptation. The investments in vaccine research, development and regulatory procedures prelicensure, as well as resources devoted to purchase, distribution and delivery of vaccines after introduction, necessitate strategic efforts to monitor the impact of large-scale use of vaccines on disease over time.
    Expert Review of Vaccines 06/2008; 7(4):437-56. · 4.22 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: The impact of heptavalent pneumococcal conjugate vaccine (PCV7) on transmission of antimicrobial-resistant Streptococcus pneumoniae is an important concern for countries considering PCV7 introduction. Every winter from 2000 to 2004, as PCV7 was routinely introduced, we obtained nasopharyngeal swabs for pneumococcal culture, serotyping, and susceptibility testing from 150 children aged 3-59 months at each of 3 Anchorage, Alaska clinics. We assessed risk factors for pneumococcal carriage, including vaccination status and antimicrobial use. Between 2000 and 2004, 2250 nasopharyngeal swabs from 2061 infants and children were collected. The proportion of children receiving > or = 1 PCV7 vaccination increased from 0 to 89%, whereas overall pneumococcal carriage remained stable (38% versus 41%, respectively). Among S. pneumoniae carriers, we observed declines in carriage of PCV7 serotypes (from 54% to 10%, P < 0.01) and trimethoprim-sulfamethoxazole nonsusceptible strains (44% to 16%, P < 0.01), but not in PCN-nonsusceptible strains (36% versus 37%). Among PCN-nonsusceptible types, the proportion of serotype 19A strains increased from 10% to 32% (P = 0.0002). Recent beta-lactam use was stable throughout the period (29% overall), whereas trimethoprim-sulfamethoxazole use declined from 6% to 2% (P = 0.02). PCV7 vaccination in the first 5 years did not affect overall pneumococcal carriage, but was associated with a shift in serotype distribution from PCV7 types to non-PCV7 types. With persistent pressure of some antimicrobials, reductions in carriage of antimicrobial nonsusceptible PCV7 types may be offset by increases in carriage of nonsusceptible non-PCV7 types.
    The Pediatric Infectious Disease Journal 05/2008; 27(4):335-40. · 3.57 Impact Factor

Publication Stats

11k Citations
2,128.96 Total Impact Points

Top co-authors View all

Institutions

  • 1991–2012
    • Centers for Disease Control and Prevention
      • • National Center for Immunization and Respiratory Diseases
      • • Division of Bacterial Diseases
      • • Epidemiology and Analysis Program Office
      • • National Center for Emerging and Zoonotic Infectious Diseases
      Druid Hills, GA, United States
  • 2009
    • University of the Witwatersrand
      Johannesburg, Gauteng, South Africa
  • 2007
    • St George's, University of London
      Londinium, England, United Kingdom
    • Johns Hopkins Bloomberg School of Public Health
      • Center for American Indian Health
      Baltimore, MD, United States
  • 1999–2006
    • National Institute of Allergy and Infectious Diseases
      Maryland, United States
    • Jackson Memorial Hospital
      Miami, Florida, United States
  • 2005
    • Yale-New Haven Hospital
      New Haven, Connecticut, United States
  • 2004
    • University of Colorado
      • Department of Obstetrics and Gynecology
      Denver, CO, United States
    • Beijing Centers for Disease Control and Prevention
      Peping, Beijing, China
  • 2003
    • Khon Kaen University
      • Department of Obstetrics and Gynaecology
      Khon Kaen, Changwat Khon Kaen, Thailand
    • University of Washington Seattle
      • Department of Epidemiology
      Seattle, WA, United States
  • 2000
    • Johns Hopkins University
      • Department of International Health
      Baltimore, MD, United States
  • 1993–2000
    • Emory University
      • • Department of Pediatrics
      • • School of Medicine
      Atlanta, Georgia, United States
  • 1998
    • University of California, Berkeley
      Berkeley, California, United States
    • University of Pittsburgh
      • Department of Epidemiology
      Pittsburgh, PA, United States