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ABSTRACT: The effects of influenza on a population are attributable to the clinical severity of illness and the number of persons infected, which can vary greatly between seasons or pandemics. To create a systematic framework for assessing the public health effects of an emerging pandemic, we reviewed data from past influenza seasons and pandemics to characterize severity and transmissibility (based on ranges of these measures in the United States) and outlined a formal assessment of the potential effects of a novel virus. The assessment was divided into 2 periods. Because early in a pandemic, measurement of severity and transmissibility is uncertain, we used a broad dichotomous scale in the initial assessment to divide the range of historic values. In the refined assessment, as more data became available, we categorized those values more precisely. By organizing and prioritizing data collection, this approach may inform an evidence-based assessment of pandemic effects and guide decision making.
Emerging Infectious Diseases 01/2013; 19(1):85-91. · 6.79 Impact Factor
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ABSTRACT: This article synthesizes and extends discussions held during an international meeting on "Surveillance for Decision Making: The Example of 2009 Pandemic Influenza A/H1N1," held at the Center for Communicable Disease Dynamics (CCDD), Harvard School of Public Health, on June 14 and 15, 2010. The meeting involved local, national, and global health authorities and academics representing 7 countries on 4 continents. We define the needs for surveillance in terms of the key decisions that must be made in response to a pandemic: how large a response to mount and which control measures to implement, for whom, and when. In doing so, we specify the quantitative evidence required to make informed decisions. We then describe the sources of surveillance and other population-based data that can presently--or in the future--form the basis for such evidence, and the interpretive tools needed to process raw surveillance data. We describe other inputs to decision making besides epidemiologic and surveillance data, and we conclude with key lessons of the 2009 pandemic for designing and planning surveillance in the future.
Biosecurity and bioterrorism: biodefense strategy, practice, and science 06/2011; 9(2):89-115. · 1.64 Impact Factor
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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. · 9.15 Impact Factor
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Sundar S Shrestha,
David L Swerdlow,
Rebekah H Borse,
Vimalanand S Prabhu,
Lyn Finelli,
Charisma Y Atkins,
Kwame Owusu-Edusei,
Beth Bell,
Paul S Mead,
Matthew Biggerstaff, [......],
Heidi Davidson,
Daniel Jernigan,
Michael A Jhung,
Laurie A Kamimoto,
Toby L Merlin,
Mackenzie Nowell, Stephen C Redd,
Carrie Reed,
Anne Schuchat,
Martin I Meltzer
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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. · 9.15 Impact Factor
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Public Health Reports 04/2010; 125 Suppl 3:3-5. · 1.27 Impact Factor
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ABSTRACT: Protecting vulnerable populations from pandemic influenza is a strategic imperative. The US national strategy for pandemic influenza preparedness and response assigns roles to governments, businesses, civic and community-based organizations, individuals, and families. Because influenza is highly contagious, inadequate preparedness or untimely response in vulnerable populations increases the risk of infection for the general population. Recent public health emergencies have reinforced the importance of preparedness and the challenges of effective response among vulnerable populations. We explore definitions and determinants of vulnerable, at-risk, and special populations and highlight approaches for ensuring that pandemic influenza preparedness includes these populations and enables them to respond appropriately. We also provide an overview of population-specific and cross-cutting articles in this theme issue on influenza preparedness for vulnerable populations.
American Journal of Public Health 10/2009; 99 Suppl 2:S243-8. · 3.93 Impact Factor
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ABSTRACT: Previous studies support a strong association between viral respiratory tract infections and asthma exacerbations. The effect of newly discovered viruses on asthma control is less well defined.
We sought to determine the contribution of respiratory viruses to asthma exacerbations in children with a panel of PCR assays for common and newly discovered respiratory viruses.
Respiratory specimens from children aged 2 to 17 years with asthma exacerbations (case patients, n = 65) and with well-controlled asthma (control subjects, n = 77), frequency matched by age and season of enrollment, were tested for rhinoviruses, enteroviruses, respiratory syncytial virus, human metapneumovirus, coronaviruses 229E and OC43, parainfluenza viruses 1 to 3, influenza viruses, adenoviruses, and human bocavirus.
Infection with respiratory viruses was associated with asthma exacerbations (63.1% in case patients vs 23.4% in control subjects; odds ratio, 5.6; 95% CI, 2.7- 11.6). Rhinovirus was by far the most prevalent virus (60% among case patients vs 18.2% among control subjects) and the only virus significantly associated with exacerbations (odds ratio, 6.8; 95% CI, 3.2-14.5). However, in children without clinically manifested viral respiratory tract illness, the prevalence of rhinovirus infection was similar in case patients (29.2%) versus control subjects (23.4%, P > .05). Other viruses detected included human metapneumovirus (4.6% in patients with acute asthma vs 2.6% in control subjects), enteroviruses (4.6% vs 0%), coronavirus 229E (0% vs 1.3%), and respiratory syncytial virus (1.5% vs 0%).
Symptomatic rhinovirus infections are an important contributor to asthma exacerbations in children.
These results support the need for therapies effective against rhinovirus as a means to decrease asthma exacerbations.
Journal of Allergy and Clinical Immunology 02/2007; 119(2):314-21. · 11.00 Impact Factor
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ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the United States. In 2000, an estimated 10.5 million people had COPD, of which more than 7.2 million were from the under-age 65 employed population. The prevalence of COPD in the workforce population was substantial with 46.5% of current employment among adults having the disease. However, the cost burden in the employed population is unknown. We examined COPD prevalence and costs in a large employment-based population. Using claims data from 1999 to 2003, we estimated the cost associated with COPD-related hospitalizations, emergency department visits, outpatient services, and prescription drug use. Per patient use of hospital care for COPD decreased during 1999 through 2003, including a decrease in the number of hospital admissions (from 0.10 in 1999 to 0.04 in 2003) and in the length of stay in hospitals (from 0.53 in 1999 to 0.17 in 2003). The number of outpatient visits, however, increased from 3.45 in 1999 to 3.80 in 2003. COPD-related per patient total medical costs decreased from $1460 in 1999 to $1138 in 2003 largely because of a decrease in the cost of hospitalizations for COPD. In contrast, mean per patient expenditures for outpatient services increased over the same period from $243 in 1999 to $295 in 2003. The cost of COPD to employers is high, but the cost could be reduced by programs aimed at preventing new cases of COPD, reducing hospitalizations, and providing more outpatient services to COPD patients.
COPD Journal of Chronic Obstructive Pulmonary Disease 01/2007; 3(4):203-9. · 1.79 Impact Factor
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ABSTRACT: Several themes emerged from the information provided in this supplement. 1. Implementation of the protocol was feasible, although retention of participants was challenging and customization at each site was essential. 2. Master's degree level social workers were well suited to partnering with health care professionals to address the many issues involved in caring for children with asthma and their families. 3. Collaboration between team members and community partners was critical to successful implementation. 4. Sustainability beyond external funding is attainable if local funding is sought and outcome measures that are considered important to the community are measured and reported.
Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 08/2006; 97(1 Suppl 1):S4-5. · 2.83 Impact Factor
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ABSTRACT: In 2000, the Centers for Disease Control and Prevention funded a 4-year project to implement the Inner-City Asthma Intervention (ICAI)-an asthma treatment and management project based on the protocol developed for the National Cooperative Inner-City Asthma Study (NCICAS) funded by the National Institutes of Health, National Institute of Allergy and Infectious Disease.
To describe the ICAI's major components and implementation issues.
Information contained in this article is based on project activity and management reports, site client tracking and data collection reports, site visit and other program oversight activity, and general subject matter knowledge. The site client tracking data collection process varied among sites during the intervention. Common definitions and processes were developed and implemented as needed.
Three of the 24 original sites discontinued participation. The remaining sites enrolled 4,174 children into the intervention. Although the project ended earlier than originally scheduled, 1,035 children completed the entire intervention. Of the 3,139 children who did not complete the entire protocol, 1,355 children and their families completed the core activities or the core activities plus one or more follow-up activities.
The ICAI project demonstrated that although there were a number of implementation issues to overcome, it is possible to implement effectively a proven National Institutes of Health protocol in the community setting.
Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 08/2006; 97(1 Suppl 1):S6-10. · 2.83 Impact Factor
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ABSTRACT: To evaluate the impact of a multifaceted environmental and educational intervention on the indoor environment and health in 5-12-year-old children with asthma living in urban environments.
Changes in indoor allergen levels and asthma severity measurements were compared between children who were randomized to intervention and delayed intervention groups in a 14-month prospective field trial. Intervention group households received dust mite covers, a professional house cleaning, and had roach bait and trays placed in their houses.
Of 981 eligible children, 410 (42%) were enrolled; 161 (40%) completed baseline activities and were randomized: 84 to intervention and 77 to delayed intervention groups. At the study's end, dust mite levels were 163% higher than at baseline for the delayed intervention group. Overall asthma severity scores did not change. However, the median functional severity score (FSS) component of the severity score improved more in the intervention group (33% vs. 20%) than in the delayed intervention group. At the study's end, the median FSSs for the intervention group improved 25% compared with the delayed intervention group, (p<0.01). Differences between groups for medication use, emergency department (ED) visits or hospitalization were not significant.
Despite low retention, the intervention resulted in decreased dust mite allergen levels and increased FSSs among the intervention group. The interventions probably contributed to the improvements, especially among the more severely affected children. This study highlights the complexities of designing and assessing the outcomes from a multifaceted asthma intervention.
Journal of the National Medical Association 03/2006; 98(2):249-60. · 1.16 Impact Factor
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ABSTRACT: We assessed the sex differences in asthma prevalence and asthma-control characteristics within eight states.
We analyzed data from the 2001 Behavioral Risk Factor Surveillance System survey.
Lifetime and current asthma prevalence were higher for females in each of the eight states compared to males. Adult onset of asthma was reported more often by females with current asthma, and childhood onset was reported more often by males. Sex differences were identified for the eight asthma-control characteristics.
Females in eight states presented higher asthma risk and poorer asthma profiles than males. State surveillance data can be used to identify disparities and to develop appropriate public health interventions.
Journal of Asthma 12/2005; 42(9):777-82. · 1.52 Impact Factor
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ABSTRACT: COPD is one of the leading causes of mortality and morbidity in the United States, yet little is known about the prevalence of comorbid conditions and mortality in hospitalized patients with COPD.
From the National Hospital Discharge Survey, 1979 to 2001, we evaluated whether or not COPD in adults > or = 25 years old is associated with increased prevalence and in-hospital mortality of several comorbidities.
During 1979 to 2001, there were an estimated total of 47,404,700 hospital discharges (8.5% of all hospitalizations in adults > 25 years old) of patients with COPD; 37,540,374 discharges (79.2%) were made with COPD as a secondary diagnosis, and 9,864,278 discharges (20.8%) were made with COPD as the primary diagnosis. The prevalence and in-hospital mortality for pneumonia, congestive heart failure, ischemic heart disease, thoracic malignancies, and respiratory failure were larger in hospital discharges with any mention of COPD.
In a nationally representative sample of hospitalizations, any mention of COPD in the discharge diagnosis is associated with higher hospitalization prevalence and in-hospital mortality from other comorbidities. These results highlight the fact that the burden of disease associated with COPD is likely underestimated.
Chest 10/2005; 128(4):2005-11. · 5.25 Impact Factor
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ABSTRACT: Community based interventions are an important part of public health management of many diseases, including asthma. However, there are few scientifically proven and readily available community interventions for asthma. In an effort to increase the number of available interventions, we have identified ongoing asthma intervention research, identified potentially effective asthma interventions based on completed research, and prepared several of the effective interventions for widespread implementation through a process called "translation." We provide an example of one of these effective interventions now available for widespread implementation, "Creating a medical home for asthma." This intervention grew out of need for an intervention in New York City Department of Health (NYCDOH) clinics. The intervention includes training all clinic staff in a comprehensive, preventive approach to asthma care. All of the materials needed to implement the intervention are available to all through the NYCDOH web site (www.nyc.gov/ html/doh/html/cmha/index.html). This example points to the importance of making the tools needed to implement effective interventions available across the country and the role of public/private partnerships to assure the availability of science-based interventions for asthma control.
International Journal of Hygiene and Environmental Health 02/2005; 208(1-2):21-5. · 3.81 Impact Factor
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ABSTRACT: We investigated the cardiorespiratory health effects of smoke exposure from the 1997 Southeast Asian Forest Fires among persons who were hospitalized in the region of Kuching, Malaysia. We selected admissions to seven hospitals in the Kuching region from a database of all hospital admissions in the state of Sarawak during January 1, 1995 and December 31, 1998. For several cardiorespiratory disease classifications we used Holt-Winters time-series analyses to determine whether the total number of monthly hospitalizations during the forest fire period (August 1 to October 31, 1997), or post-fire period (November 1, 1997 to December 31, 1997) exceeded forecasted estimates established from a historical baseline period of January 1, 1995 to July 31, 1997. We also identified age-specific cohorts of persons whose members were admitted for specific cardiorespiratory problems during January 1 to July 31 of each year (1995--1997). We compared Kaplan-Meier survival curves of time to first readmission for the 1997 cohorts (exposed to the forest fire smoke) with the survival curves for the 1995 and 1996 cohorts (not exposed, pre-fire cohorts). The time-series analyses indicated that statistically significant fire-related increases were observed in respiratory hospitalizations, specifically those for chronic obstructive pulmonary disease (COPD) and asthma. The survival analyses indicated that persons over age 65 years with previous hospital admissions for any cause (chi2(1df) = 5.98, p = 0.015), any cardiorespiratory disease (chi2(1df) = 5.3, p = 0.02), any respiratory disease (chi2(1df) = 7.8, p = 0.005), or COPD (chi2(1df) = 3.9, p = 0.047), were significantly more likely to be rehospitalized during the follow-up period in 1997 than during the follow-up periods in the pre-fire years of 1995 or 1996. The survival functions of the exposed cohorts resumed similar trajectories to unexposed cohorts during the post-fire period of November 1, 1997 to December 31, 1998. Communities exposed to forest fire smoke during the Southeast Asian forest fires of 1997 experienced short-term increases in cardiorespiratory hospitalizations. When an air quality emergency is anticipated, persons over age 65 with histories of respiratory hospitalizations should be preidentified from existing hospitalization records and given priority access to interventions.
International Journal of Hygiene and Environmental Health 02/2005; 208(1-2):75-85. · 3.81 Impact Factor
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ABSTRACT: In the United States, among Hispanics, Mexican Americans have the lowest rate of asthma. However, this population includes Mexican Americans born in the United States and in Mexico, and risk factors that might impact the prevalence of asthma differ between these groups. To determine the prevalence of and risk factors for asthma among U.S.- and Mexican-born Mexican Americans, we analyzed data from two U.S. surveys that included 4,574 persons who self-reported their ethnicity as Mexican American from the Third National Health and Nutrition Examination Survey (NHANES III) 1998-1994 and 12,980 persons who self-reported their ethnicity as Mexican American from National Health Interview Survey (NHIS) 1997-2001. U.S.-born Mexican Americans were more likely than Mexican-born Mexican Americans to report ever having asthma in both the NHANES III (7% [SE 0.5] vs. 3% [SE 0.3], p < 0.001) and NHIS surveys (8.1% [0.4] vs. 2.5% [0.2], p < 0.001). In a multivariate regression model controlling for multiple demographic variables and health care, the risk for asthma was higher among U.S.-born Mexicans in NHANES III (odds ratio 2.1, 95% confidence interval 1.4-3.3) and NHIS (odds ratio 2.7, 95% confidence interval 1.6-5.5). In conclusion, the prevalence of asthma was higher in U.S.-born than in Mexican-born Mexican Americans. This finding highlights the importance of environmental exposures in developing asthma in a migratory population.
American Journal of Respiratory and Critical Care Medicine 02/2005; 171(2):103-8. · 11.08 Impact Factor
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ABSTRACT: Childhood asthma may be affected by dietary changes and increased body mass related to a sedentary lifestyle, although the mechanisms are poorly understood. To test this hypothesis, we used data from the National Health and Nutrition Survey (NHANES III) from 1988-1994, including 7,904 children. We analyzed cross-sectional information on body mass index (BMI = weight/height2), physical activity (hr/day viewing television), dietary intake (24-hr recall), and vitamin C intake (60 mg/day). The probability of self-reported asthma or wheezing relating to risk factors was calculated by logistic regression. After controlling for dietary intake, physical activity, and sociodemographic variables, asthma risk was three times higher for children aged 6-16 years in the highest percentiles of BMI (>95th percentile) when compared to children in percentiles 25-49 (OR = 3.44; 95% CI, 1.49-7.96). No increase was observed in children aged 2-5 years. Low vitamin C intake was marginally related to self-reported current wheezing in children aged 6-16 years. Our results show that increased BMI may influence asthma prevalence in children, but further investigation is needed.
Pediatric Pulmonology 07/2004; 38(1):31-42. · 2.53 Impact Factor
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ABSTRACT: As part of a strategy to eliminate measles, 7 indicators were adopted in the United States in 1996 to ensure the quality of measles surveillance. This report summarizes the US experience with these indicators during 1996-1998. The indicators are compiled from data reported to the Centers for Disease Control and Prevention (CDC) during routine surveillance supplemented with information collected directly from states. Measles case investigations are generally thorough, and sufficient information is collected to control and monitor disease. A high proportion of measles cases are imported from other countries, suggesting that investigations are complete. For some states, the lag from disease onset to reporting is long, and the number of health department investigations of measleslike illnesses is low. Most of these investigations include laboratory testing of clinical specimens. Collection of measles virus specimens from cases for genetic analysis needs improvement. The CDC and health departments need to continue efforts directed at health care professionals to ensure the recognition, proper diagnostic workup, and reporting of measles.
The Journal of Infectious Diseases 06/2004; 189 Suppl 1:S196-203. · 6.41 Impact Factor
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ABSTRACT: To determine seroconversion rates with measles-mumps-rubella vaccine administered to children at 9, 12, or 15 months of age, we undertook a prospective randomized trial. Among children vaccinated at 15 months of age, 98% seroconverted to measles, compared with 95% of those vaccinated at 12 months of age and 87% of those vaccinated at 9 months of age. In each age group, children of mothers born in or before 1963 had lower rates of seroconversion against measles, with the lowest rate in children vaccinated at 9 months. The seroconversion rate of rubella paralleled that of measles, with the lowest seroconversion rates in children vaccinated at 9 months of age whose mothers were born in or before 1963. The response to mumps varied little by age of the child or birth year of the child's mother. These results support the recommended age for first vaccination with measles-mumps-rubella at 12-15 months.
The Journal of Infectious Diseases 06/2004; 189 Suppl 1:S116-22. · 6.41 Impact Factor
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ABSTRACT: Antioxidants may protect the lungs of people with asthma against oxidative stress. Among participants aged > or = 20 years from the Third National Health and Nutrition Examination Survey (1988-1994), we examined serum antioxidant concentrations of 771 persons with current asthma, 352 persons with former asthma, and 15,418 persons without asthma. After adjustment for age, participants with current asthma had similar mean concentrations of vitamin A, retinyl esters, vitamin C, vitamin E, vitamin E/cholesterol ratio, vitamin E/triglyceride ratio, alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein/zeaxanthin, lycopene, and selenium as participants without asthma. We repeated these analyses among participants who did not use vitamin or mineral supplements. After age adjustment, participants with current asthma had lower vitamin C and beta-cryptoxanthin concentrations and a lower mean vitamin E/triglyceride ratio than participants without asthma. In multiple linear regression models that included age, sex, race or ethnicity, education, smoking status, nonhigh-density lipoprotein cholesterol concentration, high-density lipoprotein cholesterol concentration, body mass index, physical activity, and alcohol use, asthma status was not significantly associated with any of the antioxidant concentrations. However, lower vitamin C concentrations were observed among people with current or former asthma than among people who never had asthma (p = 0.014). In the United States, people with asthma do not have manifest antioxidant deficiencies.
Journal of Asthma 05/2004; 41(2):179-87. · 1.52 Impact Factor
