Arthur Reingold

University of California, Berkeley, Berkeley, California, United States

Are you Arthur Reingold?

Claim your profile

Publications (250)2493.15 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: A healthy vaginal environment is predominated by certain Lactobacillus species, which lead to the prevention of infections of the reproductive tract. This study examined the characteristics of cultivable Lactobacillus species between healthy women and women with bacterial vaginosis (BV). Between November 2011 and Sept 2013, 139 women attending a women's clinic in Mysore, India were diagnosed for BV in a cross-sectional study. BV was diagnosed using Amsel's criteria: homogeneous vaginal discharge, vaginal pH > 4.5, production of amines, and presence of 'clue' cells. Those with three or more of the characteristics were considered to have BV. Vaginal swabs were then cultured in Rogosa agar, de Man-Rogosa-Sharpe broth. Gram-positive lactobacilli generating 600- 800bp amplicon by16 sRNA were further characterized by sequencing. Cultivable vaginal samples were obtained from 132 (94.9%) women. According to Amsel criteria, 83(62.1%) women were healthy and 49(37.1%) women had BV. Eleven different Lactobacillus species were isolated from 47 women. The common lactobacilli species found in this sample included L. crispatus (39.6%), L. gasseri (45.8%), and L. jensenii (14.6%). Lactobacilli were isolated from 39 healthy and 8 women with BV. L. gasseri was cultured from 18.8% of healthy and 6.1% of women with BV. The presence of L. reuteri was significantly associated with normal vaginal microbiota (p-value = 0.026). These results further our understanding of vaginal lactobacilli colonisation and richness in this particular population. Our findings showed lactobacilli species present in healthy vagina of women in India do not differ from those reported from other countries.
    Journal of Medical Microbiology 04/2015; DOI:10.1099/jmm.0.000070 · 2.27 Impact Factor
  • Source
    The Journal of Infectious Diseases 03/2015; DOI:10.1093/infdis/jiv200 · 5.78 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In 2000, seven-valent pneumococcal conjugate vaccine (PCV7) was introduced in the USA and resulted in dramatic reductions in invasive pneumococcal disease (IPD) and moderate increases in non-PCV7 type IPD. In 2010, PCV13 replaced PCV7 in the US immunisation schedule. We aimed to assess the effect of use of PCV13 in children on IPD in children and adults in the USA. We used laboratory-based and population-based data on incidence of IPD from the Active Bacterial Core surveillance (part of the Centers for Disease Control and Prevention's Emerging Infections Program) in a time-series model to compare rates of IPD before and after the introduction of PCV13. Cases of IPD between July 1, 2004, and June 30, 2013, were classified as being caused by the PCV13 serotypes against which PCV7 has no effect (PCV13 minus PCV7). In a time-series model, we used an expected outcomes approach to compare the reported incidence of IPD to that which would have been expected if PCV13 had not replaced PCV7. Compared with incidence expected among children younger than 5 years if PCV7 alone had been continued, incidence of IPD overall declined by 64% (95% interval estimate [95% IE] 59-68) and IPD caused by PCV13 minus PCV7 serotypes declined by 93% (91-94), by July, 2012, to June, 2013. Among adults, incidence of IPD overall also declined by 12-32% and IPD caused by PCV13 minus PCV7 type IPD declined by 58-72%, depending on age. We estimated that over 30 000 cases of IPD and 3000 deaths were averted in the first 3 years after the introduction of PCV13. PCV13 reduced IPD across all age groups when used routinely in children in the USA. These findings provide reassurance that, similar to PCV7, PCVs with additional serotypes can also prevent transmission to unvaccinated populations. Centers for Disease Control and Prevention. Copyright © 2015 Elsevier Ltd. All rights reserved.
    The Lancet Infectious Diseases 02/2015; DOI:10.1016/S1473-3099(14)71081-3 · 19.45 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The incidence of meningococcal disease is currently at historic lows in the United States; however, incidence remains highest among infants aged <1 year. With routine use of Haemophilus influenzae type b and pneumococcal vaccines in infants and children in the United States, Neisseria meningitidis remains an important cause of bacterial meningitis in young children. Data were collected from active, population- and laboratory-based surveillance for N meningitidis conducted through Active Bacterial Core surveillance during 2006 through 2012. Expanded data collection forms were completed for infant cases identified in the surveillance area during 2006 through 2010. An estimated 113 cases of culture-confirmed meningococcal disease occurred annually among infants aged <1 year in the United States from 2006 through 2012, for an overall incidence of 2.74 per 100 000 infants. Among these cases, an estimated 6 deaths occurred. Serogroup B was responsible for 64%, serogroup C for 12%, and serogroup Y for 16% of infant cases. Based on the expanded data collection forms, a high proportion of infant cases (36/58, 62%) had a smoker in the household and the socioeconomic status of the census tracts where infant meningococcal cases resided was lower compared with the other Active Bacterial Core surveillance areas and the United States as a whole. The burden of meningococcal disease remains highest in young infants and serogroup B predominates. Vaccines that provide long-term protection early in life have the potential to reduce the burden of meningococcal disease, especially if they provide protection against serogroup B meningococcal disease. Copyright © 2015 by the American Academy of Pediatrics.
    Pediatrics 01/2015; DOI:10.1542/peds.2014-2035 · 5.30 Impact Factor
  • Arthur Reingold
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Incidence of invasive pneumococcal disease (IPD) dramatically declined among children and adults after 7-valent pneumococcal conjugate vaccine (PCV7) introduction for children in 2000. In February 2010, 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7. We evaluated PCV13 impact on IPD rates among children and adults. Methods: IPD cases (isolation of pneumococcus from sterile sites) were identified through 10 Active Bacterial Core surveillance (ABCs) sites during July 2006–June 2013. Isolates were serotyped at reference laboratories. To distinguish the incremental effect of PCV13, we focused on the 5 serotypes (PCV5 types) not affected by PCV7. We used pre-PCV13 observed cases in time-series models to forecast post-PCV13 incidence in the absence of PCV13. PCV13 impact was the difference between forecasted and observed incidence. Results: ABCs identified 3,355 and 21,747 IPD cases among children and adults, respectively; 90% of isolates had serotyping results. Incidence of PCV5-type IPD declined in all age groups after PCV13 introduction with the largest decline among children <5 years (Table). Reductions in PCV5-type IPD were driven by serotypes 19A and 7F. No significant increase was seen in non-PCV13 serotypes, except among 50–64 year olds in 2012–2013 (percent change, 26; 95% interval estimate (IE): 13–44). Table. Changes in incidence of PCV5-type IPD, by age Percent Change Compared to Incidence Expected in Absence of PCV13 (95% IE) Age group (years) 2010–2011 2011–2012 2012–2013 <5 -66 (-70, -61) -88 (-89, -86) -93 (-94, -91) 5–17 -35 (-45, -21) -59 (-66, -48) -75 (-80, -67) 18–49 -33 (-38, -26) -64 (-68, -60) -72 (-75, -69) 50–64 -23 (-28, -18) -54 (-57, -50) -62 (-65, -59) 65+ -23 (-31, -13) -46 (-52, -39) -58 (-64, -52) Conclusion: Dramatic reductions in PCV5-type IPD were evident among children and adults after 3 years of PCV13 use. Continued surveillance is needed to monitor for serotype replacement.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Prevention of Antimicrobial-Resistant Infections Among Children Aged <5 Years with the 13-valent Pneumococcal Conjugate Vaccine Selected U.S. Areas, 20052013 S. Tomczyk, J. Jorgensen, R. Lynfield, W. Schaffner, D. Aragon, L. Harrison, M. Nichols, S. Petit, A. Thomas, A. Reingold, MM. Farley, S. Zansky, B. Beall, L. McGee, L. Kim Background: Following introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2000, antimicrobial-resistant (AR) invasive pneumococcal disease (IPD) decreased in the U.S. In 2010, a 13-valent PCV (PCV13) replaced PCV7. We evaluated the impact of PCV13 on AR IPD and progress towards the Healthy People (HP) 2020 goal to reduce AR IPD to 6.0 cases per 100,000 among children <5 years in the U.S. Methods: IPD cases (isolation of pneumococcus from sterile sites) were identified from 10 Active Bacterial Core surveillance (ABCs) sites during 20052013 in children <5 years. Isolates were serotyped, and antimicrobial susceptibility testing was performed at reference laboratories. AR was defined as a bacterial isolate exhibiting intermediate or resistant patterns to ≥1 antimicrobial class (i.e. penicillins, macrolides, cephalosporins, and tetracyclines) according to the Clinical and Laboratory Standards Institute's minimum inhibitory concentration breakpoints. Multidrug resistance (MR) was defined as resistance to ≥3 antimicrobial classes. We calculated overall incidence rates during 20052013 of AR and MR IPD. We also stratified overall AR by PCV5-type (i.e. the 5 serotypes not protected by PCV7) and non-vaccine type IPD (i.e. not included in PCV7 or PCV13). Results: We identified 745 resistant cases pre-PCV13 (20052009) and 378 resistant cases post-PCV13 (20102013). Overall incidence of AR IPD decreased from 9.3 to 3.5 per 100,000 in 2009 and 2013, respectively (percent change, -62) (Figure 1). Similarly, PCV5-type AR and MR IPD decreased by 93% and 86% from 2009 to 2013, respectively. Non-vaccine type AR IPD increased from 2.5 to 3.1 per 100,000 (Figure). Conclusion: Substantial decreases in overall, PCV5-type, and MR IPD occurred after PCV13 introduction in children <5 years. The HP 2020 goal was met in 2011, 9 years earlier than the target year. The use of appropriate antimicrobials remains important in addition to sustained high use of PCV13. Figure.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Since the introduction of the Haemophilus influenzae serotype b vaccine, H influenzae epidemiology has shifted. In the United States, the largest burden of disease is now in adults aged ≥65 years. However, few data exist on risk factors for disease severity and outcome in this age group. A retrospective case-series review of invasive H influenzae infections in patients aged ≥65 years was conducted for hospitalized cases reported to Active Bacterial Core surveillance in 2011. There were 299 hospitalized cases included in the analysis. The majority of cases were caused by nontypeable H influenzae, and the overall case fatality ratio (CFR) was 19.5%. Three or more underlying conditions were present in 63% of cases; 94% of cases had at least 1. Patients with chronic heart conditions (congestive heart failure, coronary artery disease, and/or atrial fibrillation) (odds ratio [OR], 3.27; 95% confidence interval [CI], 1.65-6.46), patients from private residences (OR, 8.75; 95% CI, 2.13-35.95), and patients who were not resuscitate status (OR, 2.72; 95% CI, 1.31-5.66) were more likely to be admitted to the intensive care unit (ICU). Intensive care unit admission (OR, 3.75; 95% CI, 1.71-8.22) and do not resuscitate status (OR, 12.94; 95% CI, 4.84-34.55) were significantly associated with death. Within this age group, burden of disease and CFR both increased significantly as age increased. Using ICU admission as a proxy for disease severity, our findings suggest several conditions increased risk of disease severity and patients with severe disease were more likely to die. Further research is needed to determine the most effective approach to prevent H influenzae disease and mortality in older adults.
    09/2014; 1(2):ofu044. DOI:10.1093/ofid/ofu044
  • [Show abstract] [Hide abstract]
    ABSTRACT: Lactobacillus plays an integral part in the health of the vaginal microbiota. We compared vaginal Lactobacillus species in women with and without bacterial vaginosis (BV) from India and the US. Between July 2009 and November 2010, a cross-sectional study was conducted among 40 women attending a women's health clinic in Mysore, India, and STD clinic in San Francisco, USA. Women were diagnosed for BV by Amsel's criteria and Nugent Score. Lactobacillus 16SrDNA was sequenced to speciate the cultured isolates. Ten Indian and 10 American women without BV were compared to an equal number of women with BV. Lactobacilli were isolated from all healthy women but only 10% of Indian, and 50% of US women with BV. 16SrDNA from 164 Lactobacillus colonies were sequenced from healthy women (126 colonies) and women with BV (38 colonies). Seven cultivable Lactobacillus species were isolated from 11 Indian women, and 9 species from 15 US women. The majority of Lactobacillus colonies in Indian women were L. crispatus (25%), L. jensenii (25%), and L. reuteri (16.7%). Among US women, L. crispatus (32.0%), L. jensenii (20.0%), and L. coleohominis (12.0%) predominated. L. jensenii and L. crispatus dominated the vaginal flora of healthy Indian and US women. Indian women appeared to have a higher percentage of obligative heterofermentative species suggesting the need for a larger degree of metabolic flexibility and a more challenging vaginal environment.
    Journal of Medical Microbiology 05/2014; DOI:10.1099/jmm.0.073080-0 · 2.27 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Young children are at increased risk of severe outcomes from influenza illness, including hospitalization. We conducted a case-control study to identify risk factors for influenza-associated hospitalizations among children in U.S. Emerging Infections Program sites. Cases were children 6-59 months of age hospitalized for laboratory-confirmed influenza infections during 2005-08. Age- and zip-code-matched controls were enrolled. Data on child, caregiver, and household characteristics were collected from parents and medical records. Conditional logistic regression was used to identify independent risk factors for hospitalization. We enrolled 290 (64%) of 454 eligible cases and 1,089 (49%) of 2,204 eligible controls. Risk for influenza hospitalization increased with maternal age <26 years (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1-2.9); household income below the poverty threshold (OR 2.2, CI 1.4-3.6); smoking by >50% of household members (OR 2.9, CI 1.4-6.6); lack of household influenza vaccination (OR 1.8, CI 1.2-2.5); and presence of chronic illnesses, including hematologic/oncologic (OR 11.8, CI 4.5-31.0), pulmonary (OR 2.9, CI 1.9-4.4), and neurologic (OR 3.8, CI 1.6-9.2) conditions. Full influenza immunization decreased the risk among children aged 6-23 months (OR 0.5, CI 0.3-0.9) but not among those 24-59 months of age (OR 1.5, CI 0.8-3.0; p-value for difference = 0.01). Chronic illnesses, young maternal age, poverty, household smoking, and lack of household influenza vaccination increased the risk of influenza hospitalization. These characteristics may help providers to identify young children who are at greatest risk for severe outcomes from influenza illness.
    The Pediatric Infectious Disease Journal 03/2014; 33(6). DOI:10.1097/INF.0000000000000283 · 3.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background. Before introduction of 7-valent pneumococcal conjugate vaccine (PCV7), invasive pneumococcal disease (IPD) rates among blacks were twice rates in whites. We measured the effects of trends in PCV7-type and non-PCV7-type IPD rates on racial disparities in overall IPD and estimated the proportion of IPD caused by serotypes included in 13-valent pneumococcal conjugate vaccine (PCV13). Methods. We analyzed data from the Active Bacterial Core Surveillance (ABCs) System, which performs active, laboratory- and population-based surveillance for IPD for 29.2 million people in the United States during 1998-2009. For patients with unknown race, we multiply imputed race to calculate age-, race-, and serotype-specific IPD incidence rates. Results. During 1998-2009, 47,449 IPD cases were identified; race was unknown for 5,419 (11%). After multiple imputation, 31,981 (67%) patients were considered white and 13,750 (29%) black. PCV7-type IPD rates in all ages in both races decreased to <1 case per 100,000 while there were no decreases in overall IPD rates after 2002. By 2009, PCV13 serotypes caused 71% of cases among whites <5 years old compared with 58% among blacks (p<0.01). PCV13 serotypes caused 50% of IPD cases in whites ≥5 years old compared with 43% among blacks (p<0.01). Conclusions. Despite near elimination of PCV7-type IPD in both races, overall disparities in IPD rates persisted because non-PCV7-type IPD rates are higher among blacks. While PCV13 introduction may reduce racial disparities in IPD, higher valency conjugate vaccines and strategies to directly address underlying causes are needed to eliminate IPD disparities.
    Clinical Infectious Diseases 02/2014; DOI:10.1093/cid/ciu108 · 9.42 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Little information is available describing the epidemiology and clinical characteristics of those <12 months hospitalized with influenza, particularly at a population level. We used population-based, laboratory-confirmed influenza hospitalization surveillance data from 2003-2012 seasons to describe the impact of influenza by age category (<3, 3 to <6 and 6 to <12 months). Logistic regression was used to explore risk factors for intensive care unit (ICU) admission. Adjusted age specific influenza-associated hospitalization rates were calculated and applied to the number of U.S. infants to estimate national numbers of hospitalizations. Influenza was associated with an annual average of 6,514 infant hospitalizations (range 1,842- 12,502). Hospitalization rates among infants <3 months were substantially higher than the rate in older infants. Most hospitalizations occurred in otherwise healthy infants (75%) among whom up to 10% were admitted to the ICU and up to 4% had respiratory failure. These proportions were 2-3 times higher in infants with high risk conditions. Infants <6 months were 40% more likely to be admitted to the ICU than older infants. Lung disease (adjusted odds ratio [aOR] 1.80; 95% confidence interval [CI] 1.22, 2.67), cardiovascular disease (aOR 4.16; 95% CI 2.65, 6.53), and neuromuscular disorder (aOR 2.99; 95% CI 1.87, 4.78) were risk factors for ICU admission among all infants. The impact of influenza on infants, particularly those very young or with high risk conditions, underscore the importance of influenza vaccination, especially among pregnant women and those in contact with young infants not eligible for vaccination.
    The Pediatric Infectious Disease Journal 02/2014; 33(9). DOI:10.1097/INF.0000000000000321 · 3.14 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Children are highly susceptible to tuberculosis; thus, there is need for safe and effective preventive interventions. Our objective was to evaluate the efficacy of isoniazid in prevention of tuberculosis morbidity and mortality in children aged 15 years or younger by performing a meta-analysis of randomized controlled trials. To our knowledge, this is the first meta-analysis evaluating efficacy of isoniazid prophylaxis in prevention of tuberculosis in children. A systematic search of the literature was done to identify randomized controlled trials evaluating isoniazid prophylaxis efficacy among children. Each study was evaluated for relevance and validity for inclusion in the analysis. Subgroup analyses were conducted based on study quality, HIV status, tuberculosis endemicity, type of prophylaxis and age of participants. Eight studies comprising 10,320 participants were included in this analysis. Upon combining data from all eight studies, isoniazid prophylaxis was found to be efficacious in preventing development of tuberculosis, with a pooled RR of 0.65 (95% CI 0.47, 0.89) p = 0.004 , with confidence intervals adjusted for heterogeneity. Among the sub-group analyses conducted, only age of the participants yielded dramatic differences in the summary estimate of efficacy, suggesting that age might be an effect modifier of the efficacy of isoniazid among children, with no effect realised in children initiating isoniazid at four months of age or earlier and an effect being present in older children. Excluding studies in which isoniazid was initiated at four months of age or earlier yielded an even stronger effect (RR = 0.41 (95% CI 0.31, 0.55) p <0.001). Data on the effect of isoniazid on all-cause mortality, excluding studies in which isoniazid was initiated in infants, yielded an imprecise estimate of mortality benefit (RR = 0.58 (95% CI 0.31, 1.09) p = 0.092). Isoniazid prophylaxis reduces the risk of developing tuberculosis by 59% among children aged 15 years or younger excluding children initiated during early infancy for primary prophylaxis (RR = 0.41, 95% CI 0.31, 0.55 p < 0.001) . However, further studies are needed to assess effects on mortality and to determine prophylaxis effectiveness in very young children and among HIV-infected children.
    BMC Infectious Diseases 02/2014; 14(1):91. DOI:10.1186/1471-2334-14-91 · 2.56 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The detection of meningococcal outbreaks relies on serogrouping and epidemiologic definitions. Advances in molecular epidemiology have improved the ability to distinguish unique Neisseria meningitidis strains, enabling the classification of isolates into clones. Around 98% of meningococcal cases in the United States are believed to be sporadic. Meningococcal isolates from 9 Active Bacterial Core surveillance sites throughout the United States from 2000 through 2005 were classified according to serogroup, multilocus sequence typing, and outer membrane protein (porA, porB, and fetA) genotyping. Clones were defined as isolates that were indistinguishable according to this characterization. Case data were aggregated to the census tract level and all non-singleton clones were assessed for non-random spatial and temporal clustering using retrospective space-time analyses with a discrete Poisson probability model. Among 1,062 geocoded cases with available isolates, 438 unique clones were identified, 78 of which had ≥2 isolates. 702 cases were attributable to non-singleton clones, accounting for 66.0% of all geocoded cases. 32 statistically significant clusters comprised of 107 cases (10.1% of all geocoded cases) were identified. Clusters had the following attributes: included 2 to 11 cases; 1 day to 33 months duration; radius of 0 to 61.7 km; and attack rate of 0.7 to 57.8 cases per 100,000 population. Serogroups represented among the clusters were: B (n = 12 clusters, 45 cases), C (n = 11 clusters, 27 cases), and Y (n = 9 clusters, 35 cases); 20 clusters (62.5%) were caused by serogroups represented in meningococcal vaccines that are commercially available in the United States. Around 10% of meningococcal disease cases in the U.S. could be assigned to a geotemporal cluster. Molecular characterization of isolates, combined with geotemporal analysis, is a useful tool for understanding the spread of virulent meningococcal clones and patterns of transmission in populations.
    PLoS ONE 12/2013; 8(12):e82048. DOI:10.1371/journal.pone.0082048 · 3.53 Impact Factor
  • Source
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We examined heavy alcohol use as a risk factor for severe influenza (intensive care admission or death) among hospitalized adults. In <65- and ≥65-year-olds, heavy alcohol use increased disease severity [relative risk (RR) 1.34; 95 % confidence interval (CI): 1.04-1.74, and RR 2.47; 95 % CI: 1.69-3.60, respectively]. Influenza vaccination and early, empiric antiviral treatment should be emphasized in this population.
    Infection 11/2013; 42(1). DOI:10.1007/s15010-013-0534-8 · 2.86 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Seasonal influenza is responsible for more than 200,000 hospitalizations each year in the United States. Although hospital-onset (HO) influenza contributes to morbidity and mortality among these patients, little is known about its overall epidemiology. We describe patients with HO influenza in the United States during the 2010-2011 influenza season and compare them with community-onset (CO) cases to better understand factors associated with illness. We identified laboratory-confirmed, influenza-related hospitalizations using the Influenza Hospitalization Surveillance Network (FluSurv-NET), a network that conducts population-based surveillance in 16 states. CO cases had laboratory confirmation ≤ 3 days after hospital admission; HO cases had laboratory confirmation > 3 days after admission. We identified 172 (2.8%) HO cases among a total of 6,171 influenza-positive hospitalizations. HO and CO cases did not differ by age (P = .22), sex (P = .29), or race (P = .25). Chronic medical conditions were more common in HO cases (89%) compared with CO cases (78%) (P < .01), and a greater proportion of HO cases (42%) than CO cases (17%) were admitted to the intensive care unit (P < .01). The median length of stay after influenza diagnosis of HO cases (7.5 days) was greater than that of CO cases (3 days) (P < .01). HO cases had greater length of stay and were more likely to be admitted to the intensive care unit or die compared with CO cases. HO influenza may play a role in the clinical outcome of hospitalized patients, particularly among those with chronic medical conditions.
    American journal of infection control 10/2013; 42(1). DOI:10.1016/j.ajic.2013.06.018 · 2.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Persons with immunocompromising conditions (IC) have a higher risk of invasive pneumococcal disease (IPD). Routine use of 7–valent pneumococcal conjugate vaccine (PCV) among children aged <5 years reduced IPD incidence in vaccinated children, and in unvaccinated older individuals with the exception of those with IC. CDC’s ACIP recently recommended 13–valent PCV (PCV-13) for persons aged >6 years with IC, including HIV, sickle cell disease (SCD), and hematologic malignancies (HM). We evaluated the potential benefits of PCV13 use in these populations. Methods: IPD cases, defined as isolation from a sterile site, were identified using active, population-based surveillance during 2007–09 (pre-PCV13 introduction). National estimates of IPD cases were obtained by extrapolating age– and race–adjusted surveillance cases to US population using Census data. The corresponding denominators were estimated using neonatal screening data for SCD, National Program of Cancer Registries for HM, and CDC’s HIV surveillance report (for children) and National Health Interview Survey (for adults). We compared IPD rates (cases/100,000 population) among persons with HM, HIV and SCD (African-American children only) with rates among persons without these conditions using rate ratios (RR) and 95% confidence intervals. Results: During 2007–09, 10,882 IPD cases were identified among individuals > 6 years; 1,454 (13%) had IC (511 HM, 28 SCD, and 928 HIV/AIDS). PCV13–type IPD rates (per 100,000) were higher among children aged 6–18 years with HM (1,282 versus 1.6; RR: 822[687–983]), SCD (56 versus 2.1; RR: 27[9–73]), and HIV/AIDS (122 versus 1.6; RR: 122[94–161]) compared to those without. In 2009, PCV13–type IPD rates were higher in adults 18–64 years (67 vs. 4.1; RR: 16[6.0–44]) and >64 years (89 vs. 11; RR: 8[4.3–15]) with HIV, and in adults 18–64 years (68 vs. 4.1; RR: 17[6.1–45]) and >64 years (128 vs. 11; RR: 12[6.3–22]) with HM compared to healthy adults. Conclusion: Rates of PCV13-type IPD in individuals > 6 years with IC were high pre-PCV13 introduction, especially among children under 18 years, suggesting that the new PCV13 recommendations may have a substantial impact in this population.
    IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: A significant indirect effect was shown in adults after seven-valent pneumococcal conjugate vaccine (PCV7) was introduced in children aged 2–59 months. In 2010, 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7 in the immunization schedule. We examined rates of invasive pneumococcal pneumonia (IPP) before and after PCV13 introduction to evaluate the indirect impact of PCV13 on adults. Methods: IPP cases (adults ≥ 18 years with bacteremic pneumonia and pneumococcus isolated from a normally sterile site) were identified from the Emerging Infections Program Network’s Active Bacterial Core surveillance (ABCs), an active, laboratory and population-based surveillance system of 29 million persons. Isolates were serotyped at reference laboratories. We focused on the 6 serotypes (PCV6) included in PCV13 that are not in PCV7. Cases with missing serotype results were distributed according to those with known serotypes. We compared annual rates (cases per 100,000) of PCV6-type IPP during July 2011–June 2012 (after PCV13 introduction) to July 2009–June 2010 (baseline). Results: During July 2009–June 2010 and July 2011–June 2012, 2,447 and 1,863 IPP cases were identified, respectively; 91% of cases had serotyping results. Crude rates in adults were 11.1/100,000 during the baseline period and 8.3/100,000 after PCV13 introduction. For both periods, rates increased with age. After PCV13 introduction, PCV6-type IPP declined significantly from baseline rates among all adult age groups, with the largest decline occurring among those aged 18–49 years (Table). Serotypes 7F and 19A caused 78% of PCV6-type IPP during the baseline period, but experienced reductions of 60% and 45% after PCV13 introduction, respectively; serotype 6C IPP declined by 31%. Table. PCV6-type IPP rates (cases per 100,000 persons in ABCs) before and after PCV13 introduction, by age Age (years) Baseline (July 2009–June 2010) After PCV13 introduction (July 2011–June 2012) Percent change (%) 18–49 2.8 1.3 -53* 50–64 7.2 3.9 -46* 65–79 9.5 5.3 -45* ≥ 80 15.5 9.9 -36* * Significant result (p-value < 0.002) due to multiple comparisons Conclusion: Significant declines in IPP among adults occurred within 2 years of PCV13 introduction, demonstrating a rapid indirect effect.
    IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
  • Richard Ssekitoleko, Moses R Kamya, Arthur L Reingold
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine the role of primary antifungal prophylaxis in the prevention of cryptococcal meningitis and all-cause mortality in advanced HIV infection. This was a systematic review and meta-analysis of randomized trials and observational studies. Google Scholar™, PubMed and Embase databases were searched for relevant studies. Quality was assessed using different criteria, depending on study type. Publication bias was assessed and subgroup and sensitivity analyses were performed. When the results of the meta-analysis were homogeneous, the fixed-effects model was used; when the results of the meta-analysis were heterogenous, the random effects model was used. Primary prophylaxis prevented cryptococcal meningitis but did not confer protection against overall mortality, although there was evidence of a reduction in cryptococcal-specific mortality in resource-limited settings. Primary antifungal prophylaxis should be recommended in patients with advanced HIV infection in resource-limited settings with a high incidence of cryptococcal meningitis.
    Future Virology 09/2013; 8(9). DOI:10.2217/fvl.13.71 · 1.00 Impact Factor

Publication Stats

15k Citations
2,493.15 Total Impact Points


  • 1988–2015
    • University of California, Berkeley
      • • School of Public Health
      • • Division of Epidemiology
      Berkeley, California, United States
  • 2014
    • Battelle Memorial Institute
      Columbus, Ohio, United States
  • 2011
    • Santa Casa Medicine School, São Paulo
      • Departamento de Medicina Social
      São Paulo, Estado de Sao Paulo, Brazil
  • 1982–2011
    • Centers for Disease Control and Prevention
      • • Influenza Division
      • • National Center for Emerging and Zoonotic Infectious Diseases
      • • Division of Bacterial Diseases
      Atlanta, Michigan, United States
  • 2010
    • University of Newcastle
      Newcastle, New South Wales, Australia
  • 2007
    • Asha Hospitals
      Bhaganagar, Andhra Pradesh, India
    • McGill University Health Centre
      Montréal, Quebec, Canada
  • 2006
    • Kaiser Permanente
      Oakland, California, United States
  • 2002–2006
    • National Institute of Allergy and Infectious Diseases
      Maryland, United States
    • Johns Hopkins University
      • Department of International Health
      Baltimore, Maryland, United States
  • 1998–2006
    • University of California, San Francisco
      San Francisco, California, United States
  • 2005
    • Emory University
      Atlanta, Georgia, United States
    • Yale-New Haven Hospital
      New Haven, Connecticut, United States
    • Mahatma Gandhi Institute of Medical Sciences
      • Department of Medicine
      Wardha, State of Maharashtra, India
  • 2004
    • University of Pittsburgh
      Pittsburgh, Pennsylvania, United States
  • 1996
    • Oakland University
      Рочестер, Michigan, United States
  • 1985
    • Zoo Atlanta
      Atlanta, Georgia, United States
  • 1984
    • U.S. Department of Health and Human Services
      Washington, Washington, D.C., United States