Arthur Reingold

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

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Publications (242)2411.47 Total impact

  • Arthur Reingold
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    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
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    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
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    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;
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    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; · 3.57 Impact Factor
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    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; · 9.37 Impact Factor
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    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; · 3.57 Impact Factor
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    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; · 2.44 Impact Factor
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    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; · 3.01 Impact Factor
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    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
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    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
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    ABSTRACT: Background. Data on the range and severity of influenza-associated complications among children are limited. We describe the frequency and severity of complications in hospitalized children aged <18 years with seasonal influenza (2003-2009) and influenza A(H1N1)pdm09 (2009-2010). Methods. Population-based surveillance for laboratory-confirmed influenza hospitalizations was conducted among 5.3 million children in 10 states. Complications were identified by ICD-9 codes in medical records. Results. During 2003-2010, 7,293 children hospitalized with influenza were identified, of whom 6,769 (93%) had complete ICD-9 code data. Among the 6,769 children, the median length of hospitalization was 3 days (interquartile range 2-4), 975 (14%) required intensive care, 359 (5%) had respiratory failure, and 40 (1%) died. The most common complications were pneumonia (28%), asthma exacerbations (793/3616 children >2 years, 22%), and dehydration (21%). Lung abscess/empyema, tracheitis, encephalopathy, bacteremia/sepsis, acute renal failure, and myocarditis were rare (<2%) but associated with median hospitalization >6 days and 48-70% of children required intensive care. Positive bacterial cultures were identified in 2% of children (107/6769); Staphylococcus aureus and Streptococcus pneumoniae were most commonly identified. Conclusion. Complications add substantially to the burden of hospitalized children with influenza through intensive care requirements and prolonged hospitalization, highlighting the importance of primary prevention with influenza vaccination.
    The Journal of Infectious Diseases 08/2013; · 5.85 Impact Factor
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    ABSTRACT: During 2009-2010, we examined 217 cases hospitalized with laboratory-confirmed pandemic influenza in nine FluSurv-NET sites and 413 age- and community-matched controls and found a single dose of monovalent non-adjuvanted influenza A(H1N1)pdm09 vaccine was 50% (95% CI=13%-71%) effective in preventing hospitalization associated with A(H1N1)pdm09 virus infection.
    Clinical Infectious Diseases 08/2013; · 9.37 Impact Factor
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    ABSTRACT: BACKGROUND: Acute encephalitis syndrome (AES) is a constellation of symptoms that includes fever and altered mental status. Most cases are attributed to viral encephalitis (VE), occurring either in outbreaks or sporadically. We conducted hospital-based surveillance for sporadic adult-AES in rural Central India in order to describe its incidence, spatial and temporal distribution, clinical profile, etiology and predictors of mortality. METHODS: All consecutive hospital admissions during the study period were screened to identify adult-AES cases and were followed until 30-days of hospitalization. We estimated incidence by administrative sub-division of residence and described the temporal distribution of cases. We performed viral diagnostic studies on cerebrospinal fluid (CSF) samples to determine the etiology of AES. The diagnostic tests included RT-PCR (for enteroviruses, HSV 1 and 2), conventional PCR (for flaviviruses), CSF IgM capture ELISA (for Japanese encephalitis virus, dengue, West Nile virus, Varicella zoster virus, measles, and mumps). We compared demographic and clinical variables across etiologic subtypes and estimated predictors of 30-day mortality. RESULTS: A total of 183 AES cases were identified between January and October 2007, representing 2.38% of all admissions. The incidence of adult AES in the administrative subdivisions closest to the hospital was 16 per 100,000. Of the 183 cases, a non-viral etiology was confirmed in 31 (16.9%) and the remaining 152 were considered as VE suspects. Of the VE suspects, we could confirm a viral etiology in 31 cases: 17 (11.2%) enterovirus; 8 (5.2%) flavivirus; 3 (1.9%) Varicella zoster; 1 (0.6%) herpesvirus; and 2 (1.3%) mixed etiology); the etiology remained unknown in remaining 121 (79.6%) cases. 53 (36%) of the AES patients died; the case fatality proportion was similar in patients with a confirmed and unknown viral etiology (45.1 and 33.6% respectively). A requirement for assisted ventilation significantly increased mortality (HR 2.14 (95% CI 1.0-4.77)), while a high Glasgow coma score (HR 0.76 (95% CI 0.69-0.83)), and longer duration of hospitalization (HR 0.88 (95% CI 0.83-0.94)) were protective. CONCLUSION: This study is the first description of the etiology of adult-AES in India, and provides a framework for future surveillance programs in India.
    Clinical neurology and neurosurgery 05/2013; · 1.30 Impact Factor
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    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 01/2013; 8(12):e82048. · 3.53 Impact Factor
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    ABSTRACT: Objectives. We assessed telephone surveys as a novel surveillance method, comparing data obtained by telephone with existing national influenza surveillance systems, and evaluated the utility of telephone surveys. Methods. We used the 2007 Behavioral Risk Factor Surveillance System (BRFSS) and the 2007 National Immunization Survey-Adult (NIS-Adult) to estimate the incidence of influenza-like illness (ILI), medically attended ILI, provider-diagnosed influenza, influenza testing, and treatment of influenza with antiviral medications during the 2006-2007 influenza season. Results. With the January-May BRFSS, among persons aged 18 years and older, the cumulative incidence of seasonal ILI and provider-diagnosed influenza was 37.9 and 5.7 adults per 100 persons, respectively. Monthly medically attended ILI and provider-diagnosed influenza among adults were temporally associated with influenza activity, as documented by national surveillance. With the NIS-Adult survey data, estimated provider-diagnosed influenza, influenza testing, and antiviral treatment were 2.8%, 1.4%, and 0.6%, respectively. Conclusions. Our telephone interview-based estimates of influenza morbidity were consistent with those from national influenza surveillance systems. Telephone surveys may provide an alternative method by which population-based influenza morbidity information can be gathered. (Am J Public Health. Published online ahead of print December 13, 2012: e1-e9. doi:10.2105/AJPH.2012.300799).
    American Journal of Public Health 12/2012; · 3.93 Impact Factor
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    ABSTRACT: BACKGROUND: The efficiency of hepatitis C virus (HCV) transmission by sexual activity remains controversial. We conducted a cross-sectional study of HCV-positive persons and their partners to estimate the risk for HCV infection among monogamous heterosexual couples. METHODS: 500 anti-HCV-positive, HIV-negative index persons and their long-term heterosexual partners were studied. Couples were interviewed separately for lifetime risk factors for HCV infection, within-couple sexual practices and sharing of personal grooming items. Blood samples were tested for anti-HCV, HCV RNA, and HCV genotype and serotype. Sequencing and phylogenetic analysis determined the relatedness of virus isolates among genotype-concordant couples. RESULTS: HCV-positive index persons were mostly Non-Hispanic Whites, with median age 49 years (range 26-79) and median 15 years (range 2-52) of sexual activity with their partners. Overall, HCV prevalence among partners was 4% (n=20), and 9 couples had concordant genotype/serotype. Viral isolates in 3 couples (0.6%) were highly related, consistent with transmission of virus within the couple. Based upon 8377 person-years of follow-up, the maximum incidence rate of HCV transmission by sex was 0.07% per year (95% CI: 0.01, 0.13) or ∼1 per 190,000 sexual contacts. No specific sexual practices were related to HCV-positivity among couples. CONCLUSIONS: The results of this study provide quantifiable risk information for counseling long-term monogamous heterosexual couples in which one partner has chronic HCV infection. In addition to the extremely low estimated risk for HCV infection in sexual partners, the lack of association with specific sexual practices provides unambiguous and reassuring counseling messages. (HEPATOLOGY 2012.).
    Hepatology 11/2012; · 12.00 Impact Factor
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    ABSTRACT: Background. Certain chronic diseases increase risk for invasive pneumococcal disease (IPD) and are indications for receipt of 23-valent pneumococcal polysaccharide vaccine (PPV23). Since the pediatric introduction of 7-valent pneumococcal conjugate vaccine (PCV7) in 2000, incidence of IPD among adults has declined. The relative magnitude of these indirect effects among persons with and without PPV23 indications is unknown.Methods. We evaluated IPD incidence among adults with and without PPV23 indications using population- and laboratory-based data collected during 1998-2009 and estimates of the denominator populations with PPV23 indications from the National Health Interview Survey. We compared rates before and after PCV7 use by age, race, PPV23 indication and serotype.Results. The proportion of adult IPD cases with PPV23 indications increased from 51% before to 61% after PCV7 introduction (p<0.0001). PCV7-serotype IPD declined among all race, age and PPV23 indication strata, ranging from 82-97%. Overall IPD rates declined in most strata, by up to 65%. However, incidence remained highest among adults with PPV23 indications compared to those without (34.9 vs. 8.8 cases per 100,000 population, respectively). Apart from age ≥65 years, diabetes is now the most common indication for PPV23 (20% of all cases vs. 10% of cases in 1998-99).Conclusions. Although IPD rates have declined among adults, adults with underlying conditions remain at increased risk of IPD and comprise a larger proportion of adult IPD cases in 2009 compared to 2000. A continued increase in the prevalence of diabetes among U.S. adults could lead to increased burden of pneumococcal disease.
    Clinical Infectious Diseases 11/2012; · 9.37 Impact Factor
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    ABSTRACT: Background: Pediatric use of 7-valent pneumococcal conjugate vaccine (PCV7) dramatically reduced the incidence of invasive pneumococcal disease (IPD) among children (direct effects) and adults (indirect effects). U.S. introduction of 13-valent pneumococcal conjugate vaccine (PCV13) began in March 2010. We evaluated the impact of routine PCV13 use on rates of IPD among children and adults. Methods: IPD cases (isolation of pneumococcus from sterile sites) were identified through 10 Active Bacterial Core surveillance (ABCs) sites. Isolates were serotyped at reference laboratories. To distinguish effects of PCV13 from residual effects of PCV7, we focused on the 6 serotypes (PCV6) included in PCV13 that are not included in PCV7. We compared quarterly rates (cases per 100,000) of IPD in 2011 with baseline rates from 2006-08 (excluding 2009, year of influenza pandemic). To account for multiple comparisons, we considered P<0.0025 as significant. Results: During 2006-2008 and 2011, 12,181 and 3,523 cases of IPD were identified, respectively; 88% of isolates had serotype results. Among children <5 years old, a statistically significant reduction (65%) in the rate of PCV6-type IPD was evident by the first quarter of 2011. By the second quarter of 2011, reductions were evident among adults ≥65 years old. By the fourth quarter of 2011, rates of PCV6-type IPD had declined by nearly 90% among children <5 years old and by 45-64% among all adult age groups (Table). Reductions were driven primarily by declines in serotypes 19A and 7F. Table. Change in rates, expressed as cases per 100,000, of PCV6-type IPD by age and quarter, 2011 vs. baseline (2006-2008). Jan-Mar Apr-Jun Jul-Sep Oct-Dec Age, yrs Baseline 2011 % Change Baseline 2011 % Change Baseline 2011 % Change Baseline 2011 % Change <5 16.5 5.7 -65* 12.8 2.9 -77* 6.4 1.7 -73* 15.8 1.9 -88* 5-17 2.1 1.5 -29 1.7 0.8 -53 0.7 0.2 -71 1.9 0.9 -53 18-49 5.2 3.7 -29 3.1 2.0 -35 1.5 1.0 -33 3.9 1.4 -64* 50-64 10.8 11.9 10 7.4 5.9 -20 3.5 2.4 -31 9.7 5.3 -45* >65 19.4 13.7 -29 11.9 6.7 -44* 3.9 3.4 -13 18.4 7.1 -61* *P<0.0025 Conclusion: PCV13 introduction was followed by rapid and dramatic reductions in the incidence of IPD caused by the 6 new serotypes included in the vaccine. Indirect effects of PCV13 use in children are evident in all adult age groups.
    IDWeek 2012 Meeting of the Infectious Diseases Society of America; 10/2012

Publication Stats

12k Citations
2,411.47 Total Impact Points

Institutions

  • 1988–2014
    • University of California, Berkeley
      • • Division of Epidemiology
      • • School of Public Health
      Berkeley, California, United States
  • 2013
    • AIIMS Bhopal All India Institute of Medical Sciences
      Bhopal, Madhya Pradesh, India
  • 2012
    • University of Berkley
      Berkley, Michigan, United States
    • Institut National de Santé Publique du Québec (INSPQ)
      Québec, Quebec, Canada
  • 2011
    • Florida International University
      • Robert Stempel College of Public Health and Social Work
      Miami, Florida, United States
    • Santa Casa Medicine School, São Paulo
      • Departamento de Medicina Social
      São Paulo, Estado de Sao Paulo, Brazil
  • 2010–2011
    • Public Health research Institute, India
      Davis, California, United States
    • University of Newcastle
      Newcastle, New South Wales, Australia
  • 1989–2011
    • University of California, San Francisco
      • • Division of Hospital Medicine
      • • Division of General Internal Medicine
      • • Department of Family and Community Medicine
      San Francisco, CA, United States
  • 1982–2010
    • Centers for Disease Control and Prevention
      • • Division of Bacterial Diseases
      • • Division of HIV/AIDS Prevention, Intervention and Support
      Druid Hills, GA, United States
  • 2009
    • San Francisco Department of Public Health
      San Francisco, California, United States
    • McGill University
      • Department of Epidemiology, Biostatistics and Occupational Health
      Montréal, Quebec, Canada
  • 2007
    • McGill University Health Centre
      Montréal, Quebec, Canada
    • Asha Hospitals
      Bhaganagar, Andhra Pradesh, India
  • 2002–2006
    • National Institute of Allergy and Infectious Diseases
      Maryland, United States
  • 1991–2006
    • Kaiser Permanente
      Oakland, California, United States
  • 2005
    • Yale-New Haven Hospital
      New Haven, Connecticut, United States
    • Minnesota Department of Health
      Saint Paul, Minnesota, United States
    • Mahatma Gandhi Institute of Medical Sciences
      • Department of Medicine
      Wardha, State of Maharashtra, India
    • Ministry of Health, Uganda
      Kampala, Central Region, Uganda
  • 2000
    • Centro Nacional De Investigaciones En Salud Materno Infantil (Cenismi)
      Santo Domingo Pueblo, New Mexico, United States
  • 1984
    • U.S. Department of Health and Human Services
      Washington, Washington, D.C., United States