Chris Van Beneden

Centers for Disease Control and Prevention, Атланта, Michigan, United States

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Publications (67)322.31 Total impact

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    ABSTRACT: Active Bacterial Core surveillance (ABCs) was established in 1995 as part of the Centers for Disease Control and Prevention Emerging Infections Program (EIP) network to assess the extent of invasive bacterial infections of public health importance. ABCs is distinctive among surveillance systems because of its large, population-based, geographically diverse catchment area; active laboratory-based identification of cases to ensure complete case capture; detailed collection of epidemiologic information paired with laboratory isolates; infrastructure that allows for more in-depth investigations; and sustained commitment of public health, academic, and clinical partners to maintain the system. ABCs has directly affected public health policies and practices through the development and evaluation of vaccines and other prevention strategies, the monitoring of antimicrobial drug resistance, and the response to public health emergencies and other emerging infections.
    Emerging Infectious Diseases 09/2015; 21(9):1520-8. DOI:10.3201/eid2109.141333 · 7.33 Impact Factor
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    ABSTRACT: Acute rheumatic fever is a nonsuppurative, immune-mediated consequence of group A streptococcal pharyngitis (strep throat). Recurrent or severe acute rheumatic fever can cause permanent cardiac valve damage and rheumatic heart disease, which increases the risk for cardiac conditions (e.g., infective endocarditis, stroke, and congestive heart failure). Antibiotics can prevent acute rheumatic fever if administered no more than 9 days after symptom onset. Long-term benzathine penicillin G (BPG) injections are effective in preventing recurrent acute rheumatic fever attacks and are recommended to be administered every 3-4 weeks for 10 years or until age 21 years to children who receive a diagnosis of acute rheumatic fever. During August 2013, in response to anecdotal reports of increasing rates of acute rheumatic fever and rheumatic heart disease, CDC collaborated with the American Samoa Department of Health and the Lyndon B. Johnson Tropical Medical Center (the only hospital in American Samoa) to quantify the number of cases of pediatric acute rheumatic fever and rheumatic heart disease in American Samoa and to assess the potential roles of missed pharyngitis diagnosis, lack of timely prophylaxis prescription, and compliance with prescribed BPG prophylaxis. Using data from medical records, acute rheumatic fever incidence was calculated as 1.1 and 1.5 cases per 1,000 children aged ≤18 years in 2011 and 2012, respectively; 49% of those with acute rheumatic fever subsequently received a diagnosis of rheumatic heart disease. Noncompliance with recommended prophylaxis with BPG after physician-diagnosed acute rheumatic fever was noted for 22 (34%) of 65 patients. Rheumatic heart disease point prevalence was 3.2 cases per 1,000 children in August 2013. Establishment of a coordinated acute rheumatic fever and rheumatic heart disease control program in American Samoa, likely would improve diagnosis, treatment, and patient compliance with BPG prophylaxis.
    MMWR. Morbidity and mortality weekly report 05/2015; 64(20):555-8.
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    Emerging infectious diseases 01/2015; 21(1):177-9. DOI:10.3201/eid2101.141148 · 7.33 Impact Factor
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    ABSTRACT: Meningitis and pneumonia are leading causes of morbidity and mortality in children globally infected with Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis, and Haemophilus influenzae causing a large proportion of disease. Vaccines are available to prevent many of the common types of these infections. S. pneumoniae was estimated to have caused 11% of deaths in children aged <5 years globally in the pre-pneumococcal conjugate vaccine (PCV) era. Since 2007, the World Health Organization (WHO) has recommended inclusion of PCV in childhood immunization programs worldwide, especially in countries with high child mortality. As of November 26, 2014, a total of 112 (58%) of all 194 WHO member states and 44 (58%) of the 76 member states ever eligible for support from Gavi, the Vaccine Alliance (Gavi), have introduced PCV. Invasive pneumococcal disease (IPD) surveillance that includes data on serotypes, along with meningitis and pneumonia syndromic surveillance, provides important data to guide decisions to introduce PCV and monitor its impact.
    MMWR. Morbidity and mortality weekly report 12/2014; 63(49):1159-62.
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    ABSTRACT: Since early 2014, there have been more than 6,000 reported deaths from Ebola virus disease (Ebola), mostly in Guinea, Liberia, and Sierra Leone (1). On July 9, 2014, CDC activated its Emergency Operations Center for the Ebola outbreak response and formalized the consultation service it had been providing to assist state and local public health officials and health care providers evaluate persons in the United States thought to be at risk for Ebola. During July 9–November 15, CDC responded to clinical inquiries from public health officials and health care providers from 49 states and the District of Columbia regarding 650 persons thought to be at risk. Among these, 118 (18%) had initial signs or symptoms consistent with Ebola and epidemiologic risk factors placing them at risk for infection, thereby meeting the definition of persons under investigation (PUIs). Testing was not always performed for PUIs because alternative diagnoses were made or symptoms resolved. In total, 61 (9%) persons were tested for Ebola virus, and four, all of whom met PUI criteria, had laboratory-confirmed Ebola. Overall, 490 (75%) inquiries concerned persons who had neither traveled to an Ebola-affected country nor had contact with an Ebola patient. Appropriate medical evaluation and treatment for other conditions were noted in some instances to have been delayed while a person was undergoing evaluation for Ebola. Evaluating and managing persons who might have Ebola is one component of the overall approach to domestic surveillance, the goal of which is to rapidly identify and isolate Ebola patients so that they receive appropriate medical care and secondary transmission is prevented. Health care providers should remain vigilant and consult their local and state health departments and CDC when assessing ill travelers from Ebola-affected countries. Most of these persons do not have Ebola; prompt diagnostic assessments, laboratory testing, and provision of appropriate care for other conditions are essential for appropriate patient care and reflect hospital preparedness.
    MMWR. Morbidity and mortality weekly report 12/2014; 63(49):1175-1179.
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    ABSTRACT: Since early 2014, there have been more than 6,000 reported deaths from Ebola virus disease (Ebola), mostly in Guinea, Liberia, and Sierra Leone (1). On July 9, 2014, CDC activated its Emergency Operations Center for the Ebola outbreak response and formalized the consultation service it had been providing to assist state and local public health officials and health care providers evaluate persons in the United States thought to be at risk for Ebola. During July 9–November 15, CDC responded to clinical inquiries from public health officials and health care providers from 49 states and the District of Columbia regarding 650 persons thought to be at risk. Among these, 118 (18%) had initial signs or symptoms consistent with Ebola and epidemiologic risk factors placing them at risk for infection, thereby meeting the definition of persons under investigation (PUIs). Testing was not always performed for PUIs because alternative diagnoses were made or symptoms resolved. In total, 61 (9%) persons were tested for Ebola virus, and four, all of whom met PUI criteria, had laboratory-confirmed Ebola. Overall, 490 (75%) inquiries concerned persons who had neither traveled to an Ebola-affected country nor had contact with an Ebola patient. Appropriate medical evaluation and treatment for other conditions were noted in some instances to have been delayed while a person was undergoing evaluation for Ebola. Evaluating and managing persons who might have Ebola is one component of the overall approach to domestic surveillance, the goal of which is to rapidly identify and isolate Ebola patients so that they receive appropriate medical care and secondary transmission is prevented. Health care providers should remain vigilant and consult their local and state health departments and CDC when assessing ill travelers from Ebola-affected countries. Most of these persons do not have Ebola; prompt diagnostic assessments, laboratory testing, and provision of appropriate care for other conditions are essential for appropriate patient care and reflect hospital preparedness.
    MMWR. Morbidity and mortality weekly report 12/2014; 63(49):1175-1179.
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    ABSTRACT: Background: Macrolide resistance among group A Streptococcus (GAS) is common in many countries. We analyzed prevalence of resistance to erythromycin (EryR) and other antibiotics among GAS isolates obtained from CDC’s Active Bacterial Core surveillance (ABCs) over a 14-year period. Methods: ABCs is active, laboratory- and population-based surveillance for select bacterial infections in 10 geographically diverse U.S. sites. Isolates from invasive GAS infections were collected in participating ABCs sites from 1999-2012. Susceptibility was assessed using broth microdilution and D-zone testing for inducible clindamycin resistance (CliR); emm typing was performed using DNA sequencing. Results: We tested 9175 (85%) isolates from 10,794 invasive GAS cases; 10.5% were EryR. Both EryR and CliR increased over the 14 years (test for trend: P<0.001). Marked yearly shifts in EryR prevalence occurred among several ABCs sites: CA (2001: 8.5%; 2006: 23.6%; 2010: 4.0%), MD (1999: 3.4%; 2008: 34.2%; 2012: 8.0%) and OR (2007: 4.4%; 2012: 28.3%). No penicillin or cephalosporin resistance was found. Among >85 emm types, 10 (emm 12, 49, 58, 73, 75, 76, 83, 92, 94, 114) accounted for 21% of all isolates but 65% of EryR isolates. Site-specific variability in EryR prevalence was primarily due to fluctuations of these emm types. Among 105 EryR isolates from 2012, 62 (59%) were inducibly CliR and 35 (41%) constitutively CliR; 72 of CliR (74.2%) were also tetracycline-resistant. Data from 2001-2010 indicated that a genetic element that contains both ermTR and tetM accounted for most CliR. The patient case fatality ratio did not differ by EryR (10.7% EryR vs 12.2% erythromycin susceptible; P=0.18). EryR infections were more common (P<0.05) among men than women (11.7% vs. 9.3%) and among persons age 18-34 (13.2%) and 50-64 years (13.1%) than other age groups. EryR was lowest among children age <5 years (7.5%). Conclusion: Macrolide resistance among invasive GAS infections in the U.S. gradually increased over 14 years. However, local frequency of macrolide-resistant GAS infections fluctuated markedly, depending on circulating strains. Community-specific susceptibility testing is important for clinical management. Penicillin remains a good choice for therapy of invasive GAS infections.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: With limited prevention strategies, identifying prognostic factors for invasive group A Streptococcus (iGAS) infections is important. Obesity and diabetes have been linked to increased risk of skin and soft tissue infections (SSTIs)--common manifestations of iGAS. We analyzed iGAS incidence and outcomes in obese versus normal weight persons and diabetics versus non-diabetics. Methods: We identified 2010-2012 community-onset cases of iGAS among non-pregnant adults from select counties at 10 US Active Bacterial Core surveillance sites. Cases are defined by isolation of GAS from a normally sterile site or from a wound in a patient with necrotizing fasciitis or streptococcal toxic shock syndrome in a resident of the surveillance area. Patient demographics, height, weight and clinical data were obtained from medical records. We used height and weight to calculate body mass index (BMI) or imputed BMI for missing values, categorizing patients into normal weight (BMI 18.5-<25.0), overweight (25.0-<30.0), obese grades 1-2 (30.0-<40.0) and obese grade 3 (≥40.0). Through Poisson regression, we estimated iGAS incidence by BMI category and diabetes status after controlling for sex, age, race and other underlying conditions using ABCs catchment area population estimates from the 2011 Behavioral Risk Factor Surveillance System survey for denominators. Multivariable logistic regression was used to compare risk of death by BMI category and diabetes status. Results: There were 2135 iGAS cases. Diabetes [relative risk (RR)= 3.0, 95% confidence interval (CI)= (2.3-3.9)] and grade 3 obesity among non-diabetics (RR= 2.8, 95%CI= 2.3-3.4) were associated with an increased risk of iGAS. Neither obesity nor diabetes was associated with increased risk of death. SSTIs, with the lowest case fatality ratio (1.9%) among all infection types, were more common in obese and diabetic persons compared to normal weight (p<0.001) and non-diabetic (p=0.001) persons, respectively. Conclusion: Diabetes and extreme obesity in non-diabetics were independent risk factors for iGAS. SSTIs, which tend to be less severe than other infection types, seem to be driving the increased risk. Efforts to prevent and treat obesity and diabetes may help reduce the occurrence of iGAS.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
  • JAMA Pediatrics 09/2014; 168(11). DOI:10.1001/jamapediatrics.2014.1582 · 4.25 Impact Factor
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    ABSTRACT: Large, hospital-based clinical laboratories must be prepared to rapidly investigate potential infectious disease outbreaks. To challenge the ability of our molecular diagnostics laboratory to use whole genome sequencing in a potential outbreak scenario and identify impediments, we studied 84 invasive serotype emm59 group A Streptococcus (GAS) strains collected in the United States. We performed a rapid-response exercise to the mock outbreak scenario using whole genome sequencing, genome-wide transcript analysis and mouse virulence studies. Protocol changes installed in response to lessons learned were tested in a second iteration. The initial investigation was completed in 9 days. Whole genome sequencing showed that the invasive infections were caused by multiple subclones of epidemic emm59 GAS likely spread to the United States from Canada. The phylogenetic tree showed a strong temporal-spatial structure with diversity in mobile genetic element content, features useful for identifying closely related
    Journal of Clinical Microbiology 09/2014; DOI:10.1128/JCM.02164-14 · 4.23 Impact Factor
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    ABSTRACT: IMPORTANCE Liposuction is one of the most common cosmetic surgery procedures in the United States. Tumescent liposuction, in which crystalloid fluids, lidocaine, and epinephrine are infused subcutaneously before cannula-assisted aspiration of fat, can be performed without intravenous or general anesthesia, often at outpatient facilities. However, some of these facilities are not subject to state or federal regulation and may not adhere to appropriate infection control practices. OBJECTIVE To describe an outbreak of severe group A Streptococcus (GAS) infections among persons undergoing tumescent liposuction at 2 outpatient cosmetic surgery facilities not subject to state or federal regulation. DESIGN Outbreak investigation (including cohort analysis of at-risk patients), interviews using a standardized questionnaire, medical record review, facility assessment, and laboratory analysis of GAS isolates. SETTING AND PARTICIPANTS Patients undergoing liposuction at 2 outpatient facilities, one in Maryland and the other in Pennsylvania, between July 1 and September 14, 2012. MAIN OUTCOMES AND MEASURES Confirmed invasive GAS infections (isolation of GAS from a normally sterile site or wound of a patient with necrotizing fasciitis or streptococcal toxic shock syndrome), suspected GAS infections (inflamed surgical site and either purulent discharge or fever and chills in a patient with no alternative diagnosis), postsurgical symptoms and patient-reported experiences related to his or her procedure, and emm types, T-antigen types, and antimicrobial susceptibility of GAS isolates. RESULTS We identified 4 confirmed cases and 9 suspected cases, including 1 death (overall attack rate, 20% [13 of 66]). One instance of likely secondary GAS transmission to a household member occurred. All confirmed case patients had necrotizing fasciitis and had undergone surgical debridement. Procedures linked to illness were performed by a single surgical team that traveled between the 2 locations; 2 team members (1 of whom reported recent cellulitis) were colonized with a GAS strain that was indistinguishable by laboratory analysis of the isolates from the case patients. Facility assessments and patient reports indicated substandard infection control, including errors in equipment sterilization and infection prevention training. CONCLUSIONS AND RELEVANCE This outbreak of severe GAS infections was likely caused by transmission from colonized health care workers to patients during liposuction procedures. Additional oversight of outpatient cosmetic surgery facilities is needed to assure that they maintain appropriate infection control practices and other patient protections.
    JAMA Internal Medicine 05/2014; 174(7). DOI:10.1001/jamainternmed.2014.1875 · 13.25 Impact Factor
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    ABSTRACT: We sequenced the genomes of 3,615 strains of serotype Emm protein 1 (M1) group A Streptococcus to unravel the nature and timing of molecular events contributing to the emergence, dissemination, and genetic diversification of an unusually virulent clone that now causes epidemic human infections worldwide. We discovered that the contemporary epidemic clone emerged in stepwise fashion from a precursor cell that first contained the phage encoding an extracellular DNase virulence factor (streptococcal DNase D2, SdaD2) and subsequently acquired the phage encoding the SpeA1 variant of the streptococcal pyrogenic exotoxin A superantigen. The SpeA2 toxin variant evolved from SpeA1 by a single-nucleotide change in the M1 progenitor strain before acquisition by horizontal gene transfer of a large chromosomal region encoding secreted toxins NAD(+)-glycohydrolase and streptolysin O. Acquisition of this 36-kb region in the early 1980s into just one cell containing the phage-encoded sdaD2 and speA2 genes was the final major molecular event preceding the emergence and rapid intercontinental spread of the contemporary epidemic clone. Thus, we resolve a decades-old controversy about the type and sequence of genomic alterations that produced this explosive epidemic. Analysis of comprehensive, population-based contemporary invasive strains from seven countries identified strong patterns of temporal population structure. Compared with a preepidemic reference strain, the contemporary clone is significantly more virulent in nonhuman primate models of pharyngitis and necrotizing fasciitis. A key finding is that the molecular evolutionary events transpiring in just one bacterial cell ultimately have produced millions of human infections worldwide.
    Proceedings of the National Academy of Sciences 04/2014; 111(17). DOI:10.1073/pnas.1403138111 · 9.81 Impact Factor
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    ABSTRACT: Background. Most reports about respiratory syncytial virus (RSV) in developing countries rely on sentinel surveillance, from which population incidence is difficult to infer. We used the proportion of RSV infections from population-based surveillance with data from a healthcare utilization survey to produce estimates of RSV incidence in Damanhour district, Egypt. Methods. We conducted population-based surveillance in 3 hospitals (2009-2012) and 3 outpatient clinics (2011-2012) in Damanhour district. Nasopharyngeal and oropharyngeal specimens from hospitalized patients with acute respiratory illness and outpatients with influenza-like illness were tested by real-time reverse transcriptase polymerase chain reaction for RSV. We also conducted a healthcare utilization survey in 2011-2012 to determine the proportion of individuals who sought care for respiratory illness. Results. Among 5342 hospitalized patients and 771 outpatients, 12% and 5% tested positive for RSV, respectively. The incidence of RSV-associated hospitalization and outpatient visits was estimated at 24 and 608 (per 100 000 person-years), respectively. Children aged <1 year experienced the highest incidence of RSV-associated hospitalizations (1745/100 000 person-years). Conclusions. This study demonstrates the utility of combining a healthcare utilization survey and population-based surveillance data to estimate disease incidence. Estimating incidence and outcomes of RSV disease is critical to establish the burden of RSV in Egypt.
    The Journal of Infectious Diseases 11/2013; 208(suppl 3):S189-S196. DOI:10.1093/infdis/jit457 · 5.78 Impact Factor
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    ABSTRACT: Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB), is spread from person to person by the airborne route. It can be transmitted extensively in congregate settings, making investigating exposures and treating infected contacts challenging. In December 2011, a student at a Colorado high school with 1,381 students and school personnel received a diagnosis of pulmonary TB disease. One of five household contacts had TB disease, and the other four had latent M. tuberculosis infection (LTBI). Screening of 1,249 school contacts (90%) found one person with pulmonary TB disease, who was fully treated, and 162 with LTBI, of whom 159 started an LTBI treatment regimen for preventing progression to TB disease and 153 completed a regimen. Only the index patient required inpatient care for TB, and TB caused no deaths. Use of short-course treatment regi-mens, either 12-dose weekly isoniazid and rifapentine directly observed at school or 4 months of self-supervised rifampin daily, facilitated treatment completion. State and county incident command structures led by county TB control authorities guided a response team from multiple jurisdictions. News media reports brought public scrutiny, but meetings with the community addressed the concerns and enhanced public participation. Two contacts of the index patient outside of the school had TB disease diagnosed after the school investigation. As of July 2013, no additional TB disease associated with in-school exposure had been found. An emergency plan for focusing widespread resources, an integral public communications strategy, and new, efficient interventions should be considered in other large TB contact investigations. TB disease is confirmed by detection of M. tuberculosis by culture or nucleic acid amplification, or it can be diagnosed clinically from symptoms and chest radiography findings that are consistent with TB and resolve with treatment (1). In most instances, a clinical diagnosis includes positive results from an immunologic test for M. tuberculosis infection, either the tuberculin skin test (TST) or an interferon gamma release assay (IGRA) blood test (1,2). LTBI is diagnosed by positive TST or IGRA results, absence of TB disease symptoms, and a normal chest radiograph or a stable abnormal chest radiograph with tests of sputum negative for M. tuberculosis (1–3). Index Patient In late December 2011, a student at a high school with 1,381 students and school personnel in Longmont, Colorado, was admitted to a hospital after 2 months of cough, fever, and night sweats. The student was U.S.-born, and the only TB risk (3) was living abroad at age 8–10 years in a country with a TB disease incidence 10 times greater than that for the United States. The chest radiograph showed a pulmonary cavity, and sputum-smear microscopy revealed acid-fast bacilli. Both findings are markers for potential contagiousness. The M. tuberculosis from sputum culture was susceptible to isoniazid, rifampin, ethambutol, and pyrazinamide, and treatment with the standard four-drug regi-men was completed in September 2012.
    MMWR. Morbidity and mortality weekly report 11/2013; 62(39):810-812.
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    ABSTRACT: Background. Group A Streptococcus (GAS) is an important bacterial cause of life-threatening illness among the elderly. Public health officials investigated a protracted GAS outbreak in skilled nursing facility in Georgia housing patients requiring 24-hour nursing or rehabilitation, to prevent additional cases. Methods. We defined a case as illness in a SNFA resident with onset after January 2009 with GAS isolated from a usually sterile (invasive) or non-sterile site (noninvasive). Cases were "recurrent" if >1 month elapsed between episodes. We evaluated infection control practices, performed a GAS carriage study, emm-typed available GAS isolates, and conducted a case-control study of risk factors for infection. Results. Three investigations, spanning 36 months, identified 19 residents with a total of 24 GAS infections; 15 invasive (3 recurrent) and 9 noninvasive (2 recurrent) episodes. All invasive cases required hospitalization; 4 died. Seven residents were GAS carriers. All invasive cases and resident carrier isolates were type emm 11.0. We observed hand hygiene lapses, inadequate infection documentation and more frequent wound care staff turnover on Wing A versus B. Risk factors associated with infection in multivariable analysis included living on Wing A (OR 3.4, 95% CI 0.9-16.4) and having an indwelling line (OR 5.6, 95% CI 1.2- 36.4). Cases ceased following facility-wide chemoprophylaxis in July 2012. Conclusion. Staff turnover, compromised skin integrity in residents, a sub-optimal infection control program, and lack of awareness of infections likely contributed to continued GAS transmission. In large, prolonged GAS outbreaks in SNFs, facility-wide chemoprophylaxis may be necessary to prevent sustained person-to-person transmission.
    Clinical Infectious Diseases 09/2013; 57(11). DOI:10.1093/cid/cit558 · 9.42 Impact Factor
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    ABSTRACT: To describe epidemiology of bacterial meningitis in the World Health Organization Eastern Mediterranean Region countries and assist in introduction of new bacterial vaccines. A laboratory-based sentinel surveillance was established in 2004, and up to 10 countries joined the network until 2010. Personnel at participating hospitals and national public health laboratories received training in surveillance and laboratory methods and used standard clinical and laboratory-confirmed case definitions. Over 22 000 suspected cases of meningitis were reported among children ≤5 years old and >6600 among children >5 years old. In children ≤5 years old, 921 of 13 125 probable cases (7.0%) were culture-confirmed. The most commonly isolated pathogens were S pneumoniae (27% of confirmed cases), N meningitidis (22%), and H influenzae (10%). Among culture-confirmed case-patients with known outcome, case-fatality rate was 7.0% and 12.2% among children ≤5 years old and those >5 years old, respectively. Declining numbers of Haemophilus influenzae type b meningitis cases within 2 years post-Haemophilus influenzae type b conjugate vaccine introduction were observed in Pakistan. Bacterial meningitis continues to cause significant morbidity and mortality in the Eastern Mediterranean Region. Surveillance networks for bacterial meningitis ensure that all sites are using standardized methodologies. Surveillance data are useful to monitor impact of various interventions including vaccines, but maintaining data quality requires consistent reporting and regular technical support.
    The Journal of pediatrics 07/2013; 163(1 Suppl):S25-31. DOI:10.1016/j.jpeds.2013.03.027 · 3.74 Impact Factor
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    ABSTRACT: BACKGROUND: In November 2011, the Georgia Department of Public Health (GDPH) partnered with the Centers for Disease Control and Prevention (CDC) and the local health department to investigate an outbreak of 11 cases of invasive group A Streptococcus (GAS) between June 2009 and October 2011 in a 240-bed skilled nursing facility (SNF). This included additional case finding, an infection control review, case-control study, and GAS carriage study. Residents and staff with positive cultures received antibiotic treatment. However, 4 new invasive GAS cases were detected by GDPH from March 24-May 19, 2012. METHODS: Additional case finding was performed through review of microbiology laboratory results at two referral hospitals. To detect persistent carriage among SNF residents, we cultured any non-surgical wounds and the oropharynx of residents who were recent cases or who had positive cultures during the November carriage study. Aggressive efforts were made to treat all staff and residents with either an intramuscular injection of penicillin + 4 days of oral rifampin, or a 10-day course of oral cephalexin to eradicate possible carriage. Throat cultures were performed on those who declined or had contraindications to antibiotics. Until culture results were negative, untreated residents were placed on contact precautions and untreated staff members were furloughed. Follow-up throat and wound cultures were performed on residents who: 1) had a positive wound culture prior to antibiotic treatment; 2) did not receive antibiotics during the facility-wide treatment period, or 3) were newly admitted to the facility during the treatment period. Emm sequence typing was performed on GAS isolates obtained from invasive cases and from throat and wound screening cultures. RESULTS: Case finding identified 2 non-invasive cases in addition to the 4 invasive cases. Four residents had GAS-positive wound cultures during pre-treatment testing. All GAS isolates tested were emm type 11, matching cases from the previous investigation. During treatment, 80% of employees and 75% of residents received penicillin/rifampin, 18% of employees and 23% of residents received cephalexin, and only 2% of each received throat swabs instead of antibiotics. Those who did not receive antibiotics had negative cultures. All follow-up cultures at 5 weeks were negative. No further cases of invasive GAS have occurred among facility residents since May 2012. CONCLUSIONS: Facility-wide prophylactic antibiotic treatment was an aggressive but necessary measure to stop this prolonged and persistent outbreak of invasive GAS. High treatment rates were achieved through partnership with clinical and administrative leadership of the SNF.
    2013 Council of State and Territorial Epidemiologists Annual Conference; 06/2013
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    ABSTRACT: Background Chlamydia pneumoniae illness is poorly characterized, particularly as a sole causative pathogen. We investigated a C. pneumoniae outbreak at a federal correctional facility.Methods We identified inmates with acute respiratory illness (ARI) from 1 November 2009 to 24 February 2010 through clinic self-referral and active case finding. We tested oropharyngeal and/or nasopharyngeal swabs for C. pneumoniae by real-time polymerase chain reaction (qPCR) and serum samples by microimmunofluorescence. Cases were inmates with ARI and radiologically confirmed pneumonia, positive qPCR, or serological evidence of recent infection. Swabs from 7 acutely ill inmates were tested for 18 respiratory pathogens using qPCR TaqMan Array Cards (TACs). Follow-up swabs from case patients were collected for up to 8 weeks.ResultsAmong 33 self-referred and 226 randomly selected inmates, 52 (20.1%) met the case definition; pneumonia was confirmed in 4 by radiology only, in 9 by qPCR only, in 17 by serology only, and in 22 by both qPCR and serology. The prison attack rate was 10.4% (95% confidence interval, 7.0%-13.8%). White inmates and residents of housing unit Y were at highest risk. TAC testing detected C. pneumoniae in 4 (57%) inmates; no other causative pathogens were identified. Among 40 inmates followed prospectively, C. pneumoniae was detected for up to 8 weeks. Thirteen (52%) of 25 inmates treated with azithromycin continued to be qPCR positive >2 weeks after treatment.Conclusions Chlamydia pneumoniae was the causative pathogen of this outbreak. Higher risk among certain groups suggests that social interaction contributed to transmission. Persistence of C. pneumoniae in the oropharynx creates challenges for outbreak control measures. © 2013 Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2013. This work is written by (a) US Government employee(s) and is in the public domain in the US.
    Clinical Infectious Diseases 05/2013; 57(5). DOI:10.1093/cid/cit357 · 9.42 Impact Factor
  • Chris A. Van Beneden · Melissa Arvay · Somsak Thamthitiwat · Ruth Lynfield
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    ABSTRACT: Active, population-based surveillance is a powerful tool for monitoring infectious diseases and evaluating disease prevention strategies. When carefully implemented and maintained, this type of surveillance can provide accurate data on disease incidence that are generalizable to larger populations, capture changes in disease epidemiology, and reliably measure the impact of public health and provider-initiated disease interventions. Because this model is resource intensive, the disease chosen for surveillance should provide important, actionable information. In this chapter, we discuss the methods and key components of establishing and evaluating active, population-based surveillance. We also describe the advantages and challenges, using examples taken from active, population-based surveillance systems in the both the USA and Thailand.
    Infectious Disease Surveillance, 03/2013: pages 93-108; , ISBN: 9780470654675
  • Ruth Lynfield · Nkuchia M. M'ikanatha · Chris A. Van Beneden · Henriette de Valk
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    ABSTRACT: Political instability, natural disasters, medical advances, globalization of food supply, and global travel will continue to be accompanied by public health challenges. Infectious disease surveillance will remain an important tool to detect infections and to monitor the impact of interventions. International collaboration in surveillance is critical because infections do not respect state boundaries. Advances such as culture-independent laboratory diagnosis will bring new challenges to traditional infectious disease surveillance systems. Innovations in information systems will enable progress in the collection of data, data analysis, and dissemination of data, but it is important to weigh the costs, understand the limitations, and ensure the appropriate protections of data when using new systems. It remains essential to regularly assess surveillance systems, and include evaluation and feedback from partners and stakeholders to ensure that systems are relevant and that data are being used optimally.
    Infectious Disease Surveillance, 03/2013: pages 668-670; , ISBN: 9780470654675

Publication Stats

945 Citations
322.31 Total Impact Points

Institutions

  • 2002–2014
    • Centers for Disease Control and Prevention
      • • National Center for Immunization and Respiratory Diseases
      • • Division of Bacterial Diseases
      Атланта, Michigan, United States
  • 2008
    • Beth Israel Medical Center
      New York, New York, United States
  • 2005
    • National Institute of Allergy and Infectious Diseases
      Maryland, United States