Ellen A Spotts Whitney

Emory University, Atlanta, Georgia, United States

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Publications (26)96.38 Total impact

  • Ellen A Whitney, Ruth L Berkelman
    11/2014; 35(11):1441-2.
  • Alyssa Parr, Ellen A Whitney, Ruth L Berkelman
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    ABSTRACT: Reported cases of legionellosis more than tripled between 2001 and 2012 in the United States. The disease results primarily from exposure to aerosolized water contaminated with Legionella.
    Journal of public health management and practice: JPHMP 09/2014; · 1.47 Impact Factor
  • Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 06/2014;
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    ABSTRACT: To identify factors associated with vaccine receipt among correctional facilities during the A(H1N1)pdm09 influenza pandemic, this study surveyed one third of U.S. correctional facilities. Analysis of the association of average daily population (ADP) on A(H1N1)pdm09 influenza vaccine receipt found that an ADP increase of 100 inmates resulted in a 32% increased likelihood of receiving influenza vaccine among smaller jails. Zero percent of large jails, 14% of federal prisons, 11% of nonfederal prisons, and 57% of small jails reported never receiving pandemic influenza vaccine. A qualitative assessment identified barriers to vaccine delivery, lessons learned from pandemic response, and recommendations for public health partners. Building stronger relationships between public health entities and correctional facilities to collaborate in influenza pandemic preparedness efforts may help protect correctional and community populations.
    Journal of correctional health care : the official journal of the National Commission on Correctional Health Care. 06/2014; 20(3):228-239.
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    ABSTRACT: Little is known about the prevalence of zoonotic infections among laboratory animal care technicians (LAT). Q fever, a disease caused by Coxiella burnetii, is a known occupational hazard for persons caring for livestock. We sought to determine the seroprevalence of C. burnetii antibodies among LAT and to identify risk factors associated with C. burnetii seropositivity. A survey was administered and serum samples collected from a convenience sample of 97 LAT. Samples were screened by using a Q fever IgG ELISA. Immunofluorescent antibody assays for phase I and phase II IgG were used to confirm the status of samples that were positive or equivocal by ELISA; positive samples were titered to endpoint. Antibodies against C. burnetii were detected in 6 (6%) of the 97 respondents. In our sample of LAT, seropositivity to C. burnetii was therefore twice as high in LAT as compared with the general population. Age, sex, and working with sheep regularly were not associated with seropositivity. Risk factors associated with seropositivity included breeding cattle within respondent's research facility, any current job contact with waste from beef cattle or goats, and exposure to animal waste during previous jobs or outside of current job duties. Only 15% of responding LAT reported being aware that sheep, goats, and cattle can transmit Q fever. Research facilities that use cattle or goats should evaluate their waste-management practices and educational programs in light of these findings. Additional efforts are needed to increase awareness among LAT regarding Q fever and heightened risk of exposure to infectious materials. Physicians should consider the risk of infection with C. burnetii when treating LAT with potential occupational exposures.
    Journal of the American Association for Laboratory Animal Science: JAALAS 01/2013; 52(6):725-31. · 1.15 Impact Factor
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    ABSTRACT: To understand immunization programs' experience managing the 2007 to 2009 Haemophilus influenzae type B (Hib) vaccine shortage and identify ways in which the US immunization system can be improved to assist in responses to future shortages of routine vaccines and large-scale public health emergencies. An Internet-based survey was conducted from July 2009 to October 2009 among the 64 city, state, and territorial immunization program managers (IPMs). Fifty-eight percent (37 of the 64) of IPMs responded. Forty percent of responding IPMs indicated not having enough Hib vaccine within their Vaccines for Children program to fulfill the temporary 3-dose recommendation issued in December 2007 in response to the Hib vaccine shortage. While 73% of IPMs indicated success in monitoring provider inventory and 68% indicated success in monitoring doses administered during the shortage, fewer than half indicated success in monitoring providers' compliance with shortage-specific recommendations regarding Hib vaccine. Forty-six percent of IPMs used their immunization information system (IIS) to monitor provider compliance with recommendations regarding Hib vaccine use, and of these, nearly 60% reported success in monitoring provider compliance with recommendations compared with 35% of IPMs who did not use their IIS in this way. Forty-two percent of IPMs felt that the Centers for Disease Control and Prevention (CDC) was successful in determining stockpiled vaccine allocations to their program, and 56% felt that the CDC was successful in communicating its rationale for their immunization program's Hib allocation during the shortage. Experiences from the 2007 to 2009 Hib vaccine shortage offer insights on how the US immunization system and system-wide response to vaccine shortages can be improved. Results from this survey suggest that improving vaccine transfer between jurisdictions and using IIS to track provider compliance with shortage recommendations are 2 ways that can help the US immunization system respond to future vaccine shortages and large-scale public health emergencies like influenza pandemics.
    Journal of public health management and practice: JPHMP 05/2012; 18(3):E9-E16. · 1.47 Impact Factor
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    ABSTRACT: In June and July 2010, we conducted a national internet-based survey of 64 city, state, and territorial immunization program managers (IPMs) to assess their experiences in managing the 2009-10 H1N1 influenza vaccination campaign. Fifty-four (84%) of the managers or individuals responsible for an immunization program responded to the survey. To manage the campaign, 76% indicated their health department activated an incident command system (ICS) and 49% used an emergency operations center (EOC). Forty percent indicated they shared the leadership of the campaign with their state-level emergency preparedness program. The managers' perceptions of the helpfulness of the emergency preparedness staff was higher when they had collaborated with the emergency preparedness program on actual or simulated mass vaccination events within the previous 2 years. Fifty-seven percent found their pandemic influenza plan helpful, and those programs that mandated that vaccine providers enter data into their jurisdiction's immunization information system (IIS) were more likely than those who did not mandate data entry to rate their IIS as valuable for facilitating registration of nontraditional providers (42% vs. 25%, p<0.05) and tracking recalled influenza vaccine (50% vs. 38%, p<0.05). Results suggest that ICS and EOC structures, pandemic influenza plans, collaborations with emergency preparedness partners during nonemergencies, and expanded use of IIS can enhance immunization programs' ability to successfully manage a large-scale vaccination campaign. Maintaining the close working relationships developed between state-level immunization and emergency preparedness programs during the H1N1 influenza vaccination campaign will be especially important as states prepare for budget cuts in the coming years.
    Biosecurity and bioterrorism: biodefense strategy, practice, and science 02/2012; 10(1):142-50. · 1.64 Impact Factor
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    ABSTRACT: Since 2001, many state and local health departments have implemented automated systems to monitor healthcare use and to promptly identify and track epidemics and other public health threats. In 2007-08, we conducted case studies of selected events with actual or potential public health impacts to determine whether and how health departments and hospitals used these new systems. We interviewed public health and hospital representatives and applied qualitative analysis methods to identify response themes. So-called "syndromic" surveillance methods were most useful in situations with widespread health effects, such as respiratory illness associated with seasonal influenza or exposures to smoke from wildfires. In other instances, such as a tornado or hazardous material exposures, these systems were useful for detecting or monitoring health impacts that affected relatively few people, or they were used to affirm the absence of outbreaks following natural disasters or the detection of a potential pathogen in air samples. Typically, these data supplemented information from traditional sources to provide a timelier or fuller mosaic of community health status, and use was shaped by long-standing contacts between health department and hospital staffs. State or local epidemiologists generally preferred syndromic systems they had developed over the CDC BioSense system, citing lesser familiarity with BioSense and less engagement in its development. Instances when BioSense data were most useful to state officials occurred when analyses and reports were provided by CDC staff. Understanding the uses of surveillance information during such events can inform further investments in surveillance capacity in public health emergency preparedness programs.
    Biosecurity and bioterrorism: biodefense strategy, practice, and science 07/2009; 7(2):165-77. · 1.64 Impact Factor
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    ABSTRACT: To determine the seroprevalence of antibodies against Leptospira serovars among veterinarians and identify risk factors for seropositivity in veterinary care settings. Seroepidemiologic survey. Veterinarians attending the 2006 AVMA Annual Convention. Blood samples were collected from 511 veterinarians, and serum was harvested for a microcapsule agglutination test (MAT) to detect antibodies against 6 serovars of Leptospira. Aggregate data analysis was performed to determine the ratio of the odds of a given exposure (eg, types of animals treated or biosafety practices) in seropositive individuals to the odds in seronegative individuals. Evidence of previous leptospiral infection was detected in 2.5% of veterinarians. Most veterinarians reported multiple potential exposures to Leptospira spp and other pathogens in the previous 12 months, including unintentional needlestick injuries (379/511 [74.2%]), animal bites (345/511 [67.5%]), and animal scratches (451/511 [88.3%]). Treatment of a dog with an influenza-like illness within the past year was associated with seropositivity for antibodies against Leptospira spp. Veterinarians are at risk for leptospirosis and should take measures to decrease potential exposure to infectious agents in general. Diagnostic tests for leptospirosis should be considered when veterinarians have febrile illnesses of unknown origin.
    Journal of the American Veterinary Medical Association 05/2009; 234(7):938-44. · 1.72 Impact Factor
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    ABSTRACT: As pandemic influenza becomes an increasing threat, partnerships between public health and correctional facilities are necessary to prepare criminal justice systems adequately. In September 2007, the Planning for Pandemic Influenza in Prison Settings Conference took place in Georgia. This article describes the collaboration and ongoing goals established between administrative leaders and medical staff in Georgia prison facilities and public health officials. Sessions covered topics such as nonpharmaceutical interventions, health care surge capacity, and prison-community interfaces. Interactive activities and tabletop scenarios were used to promote dynamic learning, and pretests and posttests were administered to evaluate the short-term impact of conference participation. The conference has been followed by subsequent meetings and an ongoing process to guide prisons' preparation for pandemic influenza.
    Journal of Correctional Health Care 05/2009; 15(2):118-28; quiz 159.
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    ABSTRACT: Little is known about the occurrence of Q fever among veterinarians in the United States. In this study, we sought to estimate the prevalence of Coxiella burnetii antibodies among veterinarians and to identify risk factors for exposure. We tested serum samples from 508 veterinarians who attended the 143rd American Veterinary Medical Association Annual Convention in 2006. Samples were screened using a Q fever IgG enzyme-linked immunosorbent assay (ELISA). Samples with positive or equivocal results of ELISA were confirmed using phase I and phase II IgG immunofluorescence antibody assays, and end point IgG titers were determined for samples with positive results. Antibodies against C. burnetii were detected in 113 (22.2%) of 508 veterinarians. Risk factors associated with seropositivity included age 46 years, routine contact with ponds, and treatment of cattle, swine, or wildlife. Veterinarians have a high level of exposure to C. burnetii, the causative organism of Q fever, especially those veterinarians who treat livestock. In this study, risk of C. burnetii seropositivity was also independently associated with contact with ponds. The role of exposure to standing bodies of water in infection is not usually considered and should be investigated in future studies. Additionally, the evidence of past infection with C. burnetii in >20% of veterinarians also highlights the need for use of appropriate personal protective equipment when treating animals that are potentially infected with C. burnetii. Physicians should consider the risk of infection with C. burnetii when treating ill veterinarians and others with potential occupational exposures.
    Clinical Infectious Diseases 03/2009; 48(5):550-7. · 9.37 Impact Factor
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    ABSTRACT: Concern over the adequacy of biosafety training and incident-reporting practices within biological laboratories in the United States has risen in recent years due to the increase in research on infectious diseases and the concomitant rise in the number of biocontainment laboratories. Reports of laboratory-acquired infections and delays in reporting such incidents have also contributed to the concern. Consequently, biosafety training and incident-reporting practices are being given considerable attention by both the executive branch and Congress. We conducted a 51-question survey of biosafety professionals in June 2008 to capture information on methods used to train new laboratory workers within biosafety level 2 (BSL-2) laboratories, animal biosafety level 2 (ABSL-2) laboratories, biosafety level 3 (BSL-3) laboratories, and animal biosafety level 3 (ABSL-3) laboratories. The survey results suggest nearly all senior scientists, faculty, staff, and students working in these biocontainment laboratories are required to have biosafety training, and three-quarters of respondents indicated a biosafety or environmental health and safety professional provides explicit instructions on reporting incidents to each new lab worker. Only half of the respondents with BSL-2/ABSL-2 laboratories at their institution and 59% of respondents from institutions with BSL-3/ABSL-3 laboratories indicated custodial or maintenance workers are required to receive biosafety training at the BSL-2/ABSL-2 and BSL-3/ABSL-3 levels, respectively. Opportunities for targeted improvement such as providing training to non-traditional laboratory workers (e.g., custodians, maintenance workers) and posting laboratory incident-reporting protocols on institutional environmental health and safety websites may exist. Variations in biosafety training requirements, incident-reporting practices, and attitudes towards laboratory safety revealed through this survey of biosafety professionals also support the development of core competencies in biosafety practice that could lead to more uniform practices and robust safety cultures.
    Applied biosafety : journal of the American Biological Safety Association. 01/2009; 14(3):135-143.
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    ABSTRACT: Similar to other mycobacterial diseases, susceptibility to Buruli ulcer (Mycobacterium ulcerans infection) may be determined by host genetic factors. We investigated the role of SLC11A1 (NRAMP1) in Buruli ulcer because of its associations with both tuberculosis and leprosy. We enrolled 182 Buruli ulcer patients (102 with positive laboratory confirmation) and 191 healthy neighbourhood-matched controls in Ghana, and studied three polymorphisms in the SLC11A1 gene: 3' UTR TGTG ins/del, D543N G/A, and INT4 G/C. Finger prick blood samples from study subjects were dried on filter papers (FTA) and processed. D543N was significantly associated with Buruli ulcer: the odds ratio (adjusted for gender, age, and region of the participant) of the GA genotype versus the GG genotype was 2.89 (95% confidence intervals (CI): 1.41-5.91). We conclude that a genetic polymorphism in the SLC11A1 gene plays a role in susceptibility to develop Buruli ulcer, with an estimated 13% population attributable risk.
    Genes and Immunity 05/2006; 7(3):185-9. · 3.68 Impact Factor
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    James W Buehler, Ellen A Whitney, Ruth L Berkelman
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    ABSTRACT: Governments may be overwhelmed by a large-scale public health emergency, such as a massive bioterrorist attack or natural disaster, requiring collaboration with businesses and other community partners to respond effectively. In Georgia, public health officials and members of the Business Executives for National Security have successfully collaborated to develop and test procedures for dispensing medications from the Strategic National Stockpile. Lessons learned from this collaboration should be useful to other public health and business leaders interested in developing similar partnerships. The authors conducted a case study based on interviews with 26 government, business, and academic participants in this collaboration. The partnership is based on shared objectives to protect public health and assure community cohesion in the wake of a large-scale disaster, on the recognition that acting alone neither public health agencies nor businesses are likely to manage such a response successfully, and on the realization that business and community continuity are intertwined. The partnership has required participants to acknowledge and address multiple challenges, including differences in business and government cultures and operational constraints, such as concerns about the confidentiality of shared information, liability, and the limits of volunteerism. The partnership has been facilitated by a business model based on defining shared objectives, identifying mutual needs and vulnerabilities, developing carefully-defined projects, and evaluating proposed project methods through exercise testing. Through collaborative engagement in progressively more complex projects, increasing trust and understanding have enabled the partners to make significant progress in addressing these challenges. As a result of this partnership, essential relationships have been established, substantial private resources and capabilities have been engaged in government preparedness programs, and a model for collaborative, emergency mass dispensing of pharmaceuticals has been developed, tested, and slated for expansion. The lessons learned from this collaboration in Georgia should be considered by other government and business leaders seeking to develop similar partnerships.
    BMC Public Health 02/2006; 6:285. · 2.08 Impact Factor
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    ABSTRACT: In Georgia, most individuals reported with West Nile virus (WNV) disease have been diagnosed with West Nile neuroinvasive disease (WNND). Relatively few cases of West Nile Fever (WNF) are reported, and the burden of illness due to WNV is likely underestimated. From July through October 2003, WNV serologic testing was performed on enrolled patients>or=18 years of age with fever admitted to a large, urban hospital in Atlanta, Georgia through the emergency department (ED). Patients' history, clinical, and laboratory data were recorded. Residual blood drawn in the ED was tested to determine the presence of WNV IgG and IgM antibodies. Of 254 patients tested for WNV, four (1.6%) patients were positive for WNV IgM and IgG antibodies, and had a clinical illness compatible with WNV. None of the four positive patients were clinically suspected of having WNV infection; discharge diagnoses included pneumonia, migraine, stroke, and gout. These four patients accounted for 80% of all WNV diagnosed in this hospital, 44% of all cases in Fulton County, and 7% of all cases reported in Georgia in 2003. The occurrence of WNV disease may be substantially greater than currently reflected in disease statistics in Georgia and many other states. When indicators of WNV activity are present and patients are likely to have had intensive mosquito exposure, WNV should be considered in the differential diagnosis of seriously ill, febrile patients.
    Vector Borne and Zoonotic Diseases 02/2006; 6(1):42-9. · 2.28 Impact Factor
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    ABSTRACT: Morbidity due to Buruli ulcer disease (BUD), a cutaneous infection caused by Mycobacterium ulcerans, has been increasingly recognized in rural West Africa. The source and mode of transmission remain unknown. To identify BUD risk factors, we conducted a case-control study in 3 BUD-endemic districts in Ghana. We enrolled case patients with clinically diagnosed BUD and obtained skin biopsy specimens. M. ulcerans infection was confirmed by at least 1 of the following diagnostic methods: histopathologic analysis, culture, polymerase chain reaction, and Ziehl-Neelsen staining of a lesion smear. We compared characteristics of case patients with confirmed BUD with those of age- and community-matched control subjects using conditional logistic regression analysis. Among 121 case patients with confirmed BUD, leg lesions (49%) or arm lesions (36%) were common. Male case patients were significantly more likely than female case patients to have lesions on the trunk (25% vs. 6%; P = .009). Multivariable modeling among 116 matched case-control pairs identified wading in a river as a risk factor for BUD (odds ratio [OR], 2.69; 95% confidence interval [CI], 1.27-5.68; P = .0096). Wearing a shirt while farming (OR, 0.27; 95% CI, 0.11-0.70; P = .0071), sharing indoor living space with livestock (OR, 0.36; 95% CI, 0.15-0.86; P = .022), and bathing with toilet soap (OR, 0.41; 95% CI, 0.19-0.90; P = .026) appeared to be protective. BUD was not significantly associated with penetrating injuries (P = .14), insect bites near water bodies (P = .84), bacille Calmette-Guerin vaccination (P = .33), or human immunodeficiency virus infection (P = .99). BUD is an environmentally acquired infection strongly associated with exposure to river areas. Exposed skin may facilitate transmission. Until transmission is better defined, control strategies in BUD-endemic areas could include covering exposed skin.
    Clinical Infectious Diseases 06/2005; 40(10):1445-53. · 9.37 Impact Factor
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    ABSTRACT: Background: The incidence of West Nile Virus (WNV) fever as a cause of hospitalization is unknown. From 2001-2003, the Georgia Division of Public Health (GDPH) limited testing for WNV to patients suspected to have West Nile Neuroinvasive Disease (WNND). Methods: Between 7/1-10/31/03, informed consent for WNV testing was obtained from patients ≥18 yrs with history of or documented fever (≥100ºF) admitted from the emergency department (ED) to Grady Memorial Hospital (GMH), Atlanta, GA. Patients’ history and clinical presentation were recorded; lab results and discharge diagnosis were abstracted. Using blood drawn in the ED, an antibody-capture ELISA was used to determine the presence of WNV IgG and IgM antibodies. Results: Four patients tested positive for WNV IgG/IgM and had a clinical illness compatible with WNV; none were clinically suspected of having WNV by the physicians who provided their care. They were admitted for a mean of 4 days and were discharged with diagnoses of community acquired pneumonia, migraine, stroke, and gout. These 4 cases (1.6%) were identified from 254 patients tested, accounting for 80% of all WNV cases detected at GMH and 44% in that county. None of the 4 cases met GDPH WNND testing criteria. Conclusions: More WNV testing is needed in seriously ill febrile patients. In many states, public health agencies restrict WNV testing due to resource limitations likely underestimating the burden of disease. As feasible, states should consider expanding WNV testing criteria to include seriously ill, febrile patients with no other identified source of infection when risk of WNV transmission is high. For 2004, GDPH is expanding their testing criteria for WNV.
    Infectious Diseases Society of America 2004 Annual Meeting; 10/2004
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    ABSTRACT: Background: HIV infected patients may be at increased risk for severe West Nile Virus (WNV) infection. Previously, only one WNV/HIV co-infection has been reported. We describe the spectrum of illness and ED presentation of WNV/HIV co-infected patients. Methods: Cases were identified in 2003 through active surveillance of febrile patients admitted to the hospital through the ED of an urban county hospital and in 2002 through retrospective chart review of patients diagnosed with WNV infection. Results: In 2002-2003, 9 WNV infected patients were identified (WNV IgM ELISA + in serum and/or CSF). 5 of the 9 were HIV-infected. The mean age of the co-infected group was 41 years (range 33-50); 5 were male; 5 had headache; 3 were homeless; the mean CD4=251 cells/µL (range 100-477); 3 were diagnosed with encephalitis/meningitis; and 2 were not clinically suspected of WNV infection. Pt 1 was a homeless 50 y/o, CD4=104, with headache and fever then altered mental status. He died at day 18; autopsy revealed marked encephalitis in pons and midbrain. Pt 2 was 48 y/o, CD4=161, with headache, cough, and mild encephalopathy; he was discharged at day 6 without sequelae. Pt 3 was a homeless 38 y/o, CD4=477, with subjective fever, chest pain, cough, and chronic headache. He was discharged on day 5; WNV was unsuspected. Pt 4 was a homeless 37 y/o, CD4=413, with subjective fever, cough, headache, vomiting, and diarrhea. CXR showed right lower lobe infiltrate. He was discharged on day 3 diagnosed with bacterial pneumonia; WNV was unsuspected. Pt 5 was 33 y/o, CD4=100, with headache, fever, and stiff neck. Head CT showed right hilar cistern hypodensity. Conclusion: In a small sample of WNV/HIV co-infected patients we have observed the full spectrum of WNV associated illness. Among our 5 co-infected patients, 3 had meningitis/encephalitis and one died. All 3 of these more serious cases had low CD4 counts, while the other 2 patients had CD4 counts greater than 400 and had milder presentations. This suggests that risk of serious illness may be dependent on the level of immunosuppression. The 2 milder cases were not clinically suspected as having WNV infection, and were identified only by active surveillance of febrile ED patients.
    Infectious Diseases Society of America 2004 Annual Meeting; 10/2004
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    ABSTRACT: Little is known about potential long-term health effects of bioterrorism-related Bacillus anthracis infection. To describe the relationship between anthrax infection and persistent somatic symptoms among adults surviving bioterrorism-related anthrax disease approximately 1 year after illness onset in 2001. Cross-sectional study of 15 of 16 adult survivors from September through December 2002 using a clinical interview, a medical review-of-system questionnaire, 2 standardized self-administered questionnaires, and a review of available medical records. Health complaints summarized by the body system affected and by symptom categories; psychological distress measured by the Revised 90-Item Symptom Checklist; and health-related quality-of-life indices by the Medical Outcomes Study 36-Item Short-Form Health Survey (version 2). The anthrax survivors reported symptoms affecting multiple body systems, significantly greater overall psychological distress (P<.001), and significantly reduced health-related quality-of-life indices compared with US referent populations. Eight survivors (53%) had not returned to work since their infection. Comparing disease manifestations, inhalational survivors reported significantly lower overall physical health than cutaneous survivors (mean scores, 30 vs 41; P =.02). Available medical records could not explain the persisting health complaints. The anthrax survivors continued to report significant health problems and poor life adjustment 1 year after onset of bioterrorism-related anthrax disease.
    JAMA The Journal of the American Medical Association 05/2004; 291(16):1994-8. · 29.98 Impact Factor
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    ABSTRACT: Buruli ulcer disease (BUD) is an emerging disease caused by Mycobacterium ulcerans. In the present study we have characterized the serological reactivities of sera from volunteer case patients with laboratory-confirmed BUD and controls living in three different regions of Ghana where the disease is endemic to determine if serology may be useful for disease confirmation. Our results showed highly reactive immunoglobulin G (IgG) responses among patients with laboratory-confirmed disease, healthy control family members of the case patients, and sera from patients with tuberculosis from areas where BUD is not endemic. These responses were represented by reactivities to multiple protein bands found in the M. ulcerans culture filtrate (CF). In contrast, patient IgM antibody responses to the M. ulcerans CF (MUCF) proteins were more distinct than those of healthy family members living in the same village. A total of 84.8% (56 of 66) of the BUD patients exhibited strong IgM antibody responses against MUCF proteins (30, 43 and 70 to 80 kDa), whereas only 4.5% (3 of 66) of the family controls exhibited such responses. The sensitivity of the total IgM response for the patients was 84.8% (95% confidence interval [CI], 74.3 to 91.6%), and the specificity determined with sera from family controls was 95.5% (95% CI, 87.5 to 98.4%). These studies suggest that the IgM responses of patients with BUD will be helpful in the identification and production of the M. ulcerans recombinant antigens required for the development of a sensitive and specific serological assay for the confirmation of active BUD.
    Clinical and Diagnostic Laboratory Immunology 04/2004; 11(2):387-91. · 2.51 Impact Factor