W Schaffner

Vanderbilt University, Nashville, Michigan, United States

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Publications (153)1853.41 Total impact

  • R Murphree, J R Dunn, W Schaffner, T F Jones
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    ABSTRACT: We evaluated the validity of single versus paired serologic testing for La Crosse virus (LACV) encephalitis surveillance. Compared with paired serology, a single positive IgG or IgM immunoflourescent antibody titre appears useful for LACV encephalitis surveillance with sensitivity, 75%; specificity, 98%; positive predictive value, 95%; and overall test efficiency 92%.
    Zoonoses and Public Health 08/2011; 59(3):181-3. · 2.09 Impact Factor
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    ABSTRACT: During the 2004-2005 influenza season two independent influenza surveillance systems operated simultaneously in three United States counties. The New Vaccine Surveillance Network (NVSN) prospectively enrolled children hospitalized for respiratory symptoms/fever and tested them using culture and RT-PCR. The Emerging Infections Program (EIP) and a similar clinical-laboratory surveillance system identified hospitalized children who had positive influenza tests obtained as part of their usual medical care. Using data from these systems, we applied capture-recapture analyses to estimate the burden of influenza related-hospitalizations in children aged<5 years. During the 2004-2005 influenza season the influenza-related hospitalization rate estimated by capture-recapture analysis was 8.6/10,000 children aged<5 years. When compared to this estimate, the sensitivity of the prospective surveillance system was 69% and the sensitivity of the clinical-laboratory based system was 39%. In the face of limited resources and an increasing need for influenza surveillance, capture-recapture analysis provides better estimates than either system alone.
    Epidemiology and Infection 08/2007; 135(6):951-8. · 2.87 Impact Factor
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    ABSTRACT: This is a cohort study of pediatric outpatients receiving total parenteral nutrition (TPN) and follow-up care in a Tennessee hospital between January and June 1999. The study was conducted following an increase in the incidence of candidemia. Of 13 children receiving home TPN, five had candidemia; three were due to Candida parapsilosis. Case patients were more likely to have an underlying hematologic disease (P = 0.02) as well as previous history of fungemia (P = 0.02). Two case patients had successive candidemia episodes 3 months apart; karyotypes and RAPD profiles of each patient's successive C. parapsilosis isolates were similar. Candida spp. were frequently detected in hand cultures from cohort members (four of 10) and family member caregivers (nine of 11); C parapsilosis was isolated from five caregivers. Our findings underscore the challenges of maintaining stringent infection control practices in the home health care setting and suggest the need for more intensive follow-up and coordination of home TPN therapy among pediatric patients.
    Medical Mycology 06/2005; 43(3):219-25. · 1.98 Impact Factor
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    ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
    Journal of Bronchology & Interventional Pulmonology. 03/2003; 10(2):155.
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    ABSTRACT: CONTEXT: Overuse of antibiotics has contributed to microbial resistance, compromising the treatment of bacterial infections. Very high levels (>50%) of antibiotic resistance among invasive Streptococcus pneumoniae have been documented in Knox County, Tennessee. OBJECTIVE: To determine the effectiveness of a community-wide intervention aimed at reducing inappropriate antibiotic use among children. DESIGN, SETTING, AND PARTICIPANTS: The Knox County Health Department led a multifaceted year-long campaign (May 1997 through April 1998) aimed at decreasing unnecessary antibiotic use among children. Tennessee's 3 other major urban counties (Shelby, Hamilton, and Davidson) did not conduct similar campaigns and served as controls. Evaluation included white and black children (aged <15 years) enrolled in Tennessee's Medicaid Managed Care Program in the 4 study counties, representing 36% of the study counties' children (464 200 person-years observed). INTERVENTION: Educational efforts were directed toward health
    Jama. 06/2002; 287:3103-9.
  • C G Whitney, W Schaffner, J C Butler
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    ABSTRACT: Streptococcus pneumoniae remains a major cause of disease worldwide; the emergence of antibiotic-resistant strains emphasizes the importance of disease prevention by use of vaccines. Recent studies have provided information that is useful for the evaluation of current vaccine recommendations. Recommendations target most people who are at high risk for invasive pneumococcal disease. However, higher risk has also been identified for African Americans and smokers, but these groups are not specifically targeted by current recommendations. The vaccine is effective against invasive disease in immunocompetent people, although studies in immunocompromised subjects have found few subgroups in which the vaccine appears to be effective. Questions with regard to optimal timing and indications for revaccination remain a challenge, because the duration of protection and effectiveness of revaccination remain unknown. New pneumococcal vaccines appear promising but will need to be tested against the performance of the polysaccharide vaccine. Improving delivery of the currently available pneumococcal polysaccharide vaccine to adults who will benefit should be a high priority.
    Clinical Infectious Diseases 10/2001; 33(5):662-75. · 9.37 Impact Factor
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    ABSTRACT: Macrolide antibiotics, including erythromycin, clarithromycin, and azithromycin, are the mainstays of empirical pneumonia therapy. Macrolide resistance among Streptococcus pneumoniae, the most common cause of community-acquired pneumonia, is increasing in the United States. Whether resistance is a significant problem or whether macrolides remain useful for treatment of most resistant strains is unknown. To examine the epidemiology of macrolide-resistant pneumococci in the United States. Analysis of 15 481 invasive isolates from 1995 to 1999 collected by the Centers for Disease Control and Prevention's Active Bacterial Core surveillance system in 8 states. Trends in macrolide use (1993-1999) and resistance and factors associated with resistance, including examination of 2 subtypes, the M phenotype, associated with moderate minimum inhibitory concentrations (MICs), and the MLS(B) phenotype, associated with high MICs and clindamycin resistance. From 1993 to 1999, macrolide use increased 13%; macrolide use increased 320% among children younger than 5 years. Macrolide resistance increased from 10.6% in 1995 to 20.4% in 1999. M phenotype isolates increased from 7.4% to 16.5% (P<.001), while the proportion with the MLS(B) phenotype was stable (3%-4%). The median erythromycin MIC (MIC(50)) of M phenotype isolates increased from 4 microg/mL to 8 microg/mL. In 1999, M phenotype strains were more often from children than persons 5 years or older (25.2% vs 12.6%; P<.001) and from whites than blacks (19.3% vs 11.2%; P<.001). In the setting of increasing macrolide use, pneumococcal resistance has become common. Most resistant strains have MICs in the range in which treatment failures have been reported. Further study and surveillance are critical to understanding the clinical implications of our findings.
    JAMA The Journal of the American Medical Association 10/2001; 286(15):1857-62. · 29.98 Impact Factor
  • T F Jones, W Schaffner
    Infection Control and Hospital Epidemiology 09/2001; 22(8):479-80. · 4.02 Impact Factor
  • T F Jones, W Schaffner
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    ABSTRACT: Jails are an important reservoir of tuberculosis infection in the United States. Screening for active disease in these high-risk settings is difficult. We used decision analysis to assess the cost effectiveness of routine miniature chest radiography for screening for tuberculosis on admission to jail. Infection rates, probabilities, and costs associated with detecting and treating tuberculosis were derived from published studies. We calculated an average total cost of $6.60 per inmate for routine radiograph screening on admission to jail. The cost of screening for active tuberculosis with miniature chest radiography was estimated to be $9,600 per case identified, compared with $32,100 per case with tuberculin skin testing and $54,100 per case with symptom screening. Chest radiography would also identify substantially more cases than other methods of screening. Screening for tuberculosis with miniature chest radiography is cost effective even under a wide range of assumptions regarding risk factors and prevalence of disease. Miniature chest radiography should be strongly considered as an important tool in the fight to eliminate tuberculosis from the high-risk populations that may be reached through screening in jails.
    American Journal of Respiratory and Critical Care Medicine 08/2001; 164(1):77-81. · 11.04 Impact Factor
  • K M Neuzil, M R Griffin, W Schaffner
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    ABSTRACT: Several recent developments offer opportunities to improve the diagnosis, treatment, and prevention of influenza. Rapid diagnostic tests assist in selecting patients for antiviral therapy and avoid some antibiotic use. The neuraminidase inhibitors now offer therapeutic options with potentially fewer side effects than the traditional drugs, albeit at greater cost. Inactivated influenza vaccine is now recommended annually for all persons aged 50 and older and younger adults and children (aged 6 months and older) who have underlying risk factors for the severe complications of influenza. This includes pregnant women who are in their second or third trimesters during influenza season.
    Infectious Disease Clinics of North America 04/2001; 15(1):123-41, ix. · 2.63 Impact Factor
  • J F Perz, Allen S. Craig, William Schaffner
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    ABSTRACT: A preseasonal outbreak of influenza-like illness was reported in a tourist group that had returned from Ireland to the United States on October 1 and 2, 1999. The authors investigated to determine the timing, extent, and nature of the outbreak. A cohort study was conducted among the entire group. Cases were defined as illness occurring among tour members who experienced cough or sore throat with onset from September 29 through October 5. Nasopharyngeal and throat cultures were examined for respiratory viruses. Eighteen (60%) of the 30 tourists were ill; the majority (66%) of cases had onset of illness within 1 day of departure from Ireland. Human parainfluenza virus type 1 was isolated from six cultures, and influenza B from three. The attack rate was 100% among the eight persons 65 years of age or older versus 45% among the 22 persons younger than 65 years (P = 0.01). International travellers, particularly older persons and members of organized tour groups, may experience increased risks for respiratory viral infection. The recognition and containment of imported infectious diseases depend on prompt reporting and epidemiologic investigation.
    International Journal of Infectious Diseases 02/2001; 5(4):189-91. · 2.36 Impact Factor
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    ABSTRACT: In 1998 and 1999, we performed a serosurvey and active surveillance for La Crosse encephalitis at a children's hospital in eastern Tennessee. Fifteen cases of La Crosse encephalitis were confirmed. Only 5 (0.5%) of 1000 serum samples being tested at the state laboratory for other diseases had evidence of antibodies to La Crosse virus. These findings suggest that La Crosse virus is newly endemic to eastern Tennessee.
    Clinical Infectious Diseases 12/2000; 31(5):1284-7. · 9.37 Impact Factor
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    ABSTRACT: Mass psychogenic illness may be difficult to differentiate from illness caused by bioterrorism, rapidly spreading infection, or toxic substances. We investigated symptoms attributed to exposure to toxic gas at a high school in Tennessee. In November 1998, a teacher noticed a 'gasoline-like' smell in her classroom, and soon thereafter she had a headache, nausea, shortness of breath, and dizziness. The school was evacuated, and 80 students and 19 staff members went to the emergency room at the local hospital; 38 persons were hospitalized overnight. Five days later, after the school had reopened, another 71 persons went to the emergency room. An extensive investigation was performed by several government agencies. We were unable to find a medical or environmental explanation for the reported illnesses. The persons who reported symptoms on the first day came from 36 classrooms scattered throughout the school. The most frequent symptoms (in this group and the group of people who reported symptoms five days later) were headache, dizziness, nausea, and drowsiness. Blood and urine specimens showed no evidence of carbon monoxide, volatile organic compounds, pesticides, polychlorinated biphenyls, paraquat, or mercury. There was no evidence of toxic compounds in the environment. A questionnaire administered a month later showed that the reported symptoms were significantly associated with female sex, seeing another ill person, knowing that a classmate was ill, and reporting an unusual odor at the school. The illness attributed to toxic exposure had features of mass psychogenic illness - notably, widespread subjective symptoms thought to be associated with environmental exposure to a toxic substance in the absence of objective evidence of an environmental cause. Alleviation of the anxiety surrounding an episode of mass psychogenic illness requires prompt recognition and a detailed investigation.
    New England Journal of Medicine 02/2000; 342(2):96-100. · 54.42 Impact Factor
  • Pediatrics 12/1999; 104(5 Pt 2):1223-5. · 5.12 Impact Factor
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    ABSTRACT: Three cases of meningitis due to multidrug-resistant serotype 14 Streptococcus pneumoniae occurred at a day care center (DCC) over 5 days. Cultures of nasopharyngeal samples were done at the index DCC, 2 comparison DCCs, and a pediatrics practice. Isolates were serotyped and subtyped by pulsed-field gel electrophoresis (PFGE) with SmaI. Pneumococcal carriage rates ranged from 44%-65% at the 3 DCCs and 29% in the pediatrics practice. Carriage of multidrug-resistant serotype 14 S. pneumoniae was noted in 13%-19% of children at the 3 DCCs. An outbreak strain was identified by PFGE at the index DCC and 1 other DCC; a closely related strain was found in the third DCC. Carriage of the outbreak strain was associated with being age 0-24 months, antibiotic use, upper respiratory tract infections, and otitis media. DCC contacts of the ill children were offered chemoprophylaxis with rifampin and clindamycin, which produced a profound but transient decrease in carriage. No additional cases occurred.
    Clinical Infectious Diseases 12/1999; 29(5):1257-64. · 9.37 Impact Factor
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    ABSTRACT: Outbreaks of tuberculosis are uncommonly recognized in jails. In 1996, an increase in active tuberculosis cases was noted among inmates of a large urban jail. To determine the source and extent of a tuberculosis outbreak in an urban jail and to recommend control measures. Retrospective cohort study. Urban jail. Inmates and guards with tuberculosis. Outbreak evaluation and control. Medical records of inmates and guards with tuberculosis were reviewed, and inmates were interviewed. DNA fingerprinting was performed on Mycobacterium tuberculosis isolates. From 1 January 1995 through 31 December 1997, active tuberculosis was diagnosed in 38 inmates and 5 guards from the jail. Nineteen (79%) of the 24 culture-positive inmates had isolates with DNA fingerprints matching those of other inmates. Isolates from both culture-positive guards matched the predominant inmate strain; only 6 (14%) of 43 isolates from infected persons in the community had this pattern. The median length of incarceration of all inmates in the jail was 1 day; the median length of continuous incarceration before diagnosis of tuberculosis in inmates was 138 days. Inmates with tuberculosis had been incarcerated a median of 15 times. Forty-three percent of persons in this city with tuberculosis diagnosed from January 1995 through July 1997 had been incarcerated in the jail at some time before diagnosis. Traditional and molecular epidemiologic investigations suggest that tuberculosis was transmitted among inmates and guards in an urban jail. Aggressive measures to screen for active tuberculosis upon incarceration are important for preventing spread of disease in jails and to the surrounding community.
    Annals of internal medicine 11/1999; 131(8):557-63. · 13.98 Impact Factor
  • The American Journal of Medicine 05/1999; 106(4):480-2. · 5.30 Impact Factor
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    ABSTRACT: Soon after a patient from Tennessee died of Rocky Mountain spotted fever (RMSF), several family members developed symptoms suggestive of the disease and were treated presumptively for RMSF. Fifty-four persons visiting the index patient's home were interviewed; serum samples were collected from 35. Three additional cases of RMSF were confirmed, all of which occurred in first-degree relatives. Time spent at the family home and going into the surrounding woods were significantly associated with developing antibodies to Rickettsia rickettsii. Ticks were collected and examined for rickettsiae by polymerase chain reaction analysis. Because hyperendemic foci and family clusters of RMSF can occur, when a case is suspected clinicians should be vigilant for signs and symptoms consistent with R. rickettsii infection in other persons who may have been similarly exposed.
    Clinical Infectious Diseases 05/1999; 28(4):853-9. · 9.37 Impact Factor
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    ABSTRACT: La Crosse virus is a mosquito-borne arbovirus that causes encephalitis in children. Only nine cases were reported in Tennessee during the 33-year period from 1964-1996. We investigated a cluster of La Crosse encephalitis cases in eastern Tennessee in 1997. Medical records of all suspected cases of La Crosse virus infection at a pediatric referral hospital were reviewed, and surveillance was enhanced in the region. Previous unreported cases were identified by surveying 20 hospitals in the surrounding 16 counties. Mosquito eggs were collected from five sites. Ten cases of La Crosse encephalitis were serologically confirmed. None of the patients had been discharged from hospitals in the region with diagnosed La Crosse encephalitis in the preceding 5 years. Aedes triseriatus and Aedes albopictus were collected at the case sites; none of the mosquitos had detectable La Crosse virus. This cluster may represent an extension of a recently identified endemic focus of La Crosse virus infection in West Virginia.
    Clinical Infectious Diseases 02/1999; 28(1):93-7. · 9.37 Impact Factor
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    ABSTRACT: Hepatitis A outbreaks in communities are often difficult to control. From July 1994 through June 1995, 676 cases of hepatitis A were reported in Shelby County, Tennessee. With the licensure of a hepatitis A vaccine in February 1995, a new tool for outbreak control became available. During August-October 1995, a mass vaccination campaign was conducted. A total of 34,054 children received the first dose of hepatitis A vaccine. From December 1995 through December 1996, the number of hepatitis A cases reported inside the intervention area declined by 64%; outside the intervention area, the number of cases declined by 40%. The precise contribution of the vaccine campaign to the decline in the number of outbreak cases is difficult to quantify because community outbreaks often wane over time. The vaccine campaign may have hastened the decline of the number of outbreak cases. Future interventions should consider an earlier campaign with greater vaccine coverage.
    Clinical Infectious Diseases 10/1998; 27(3):531-5. · 9.37 Impact Factor

Publication Stats

4k Citations
1,853.41 Total Impact Points

Institutions

  • 1981–2011
    • Vanderbilt University
      • • Department of Preventive Medicine
      • • Division of Infectious Diseases
      • • Department of Medicine
      Nashville, Michigan, United States
  • 2001
    • University of Washington Seattle
      • Division of Allergy and Infectious Diseases
      Seattle, WA, United States
    • Department of Environment & Conservation, Tennessee
      Nashville, Tennessee, United States
  • 1989–2001
    • Centers for Disease Control and Prevention
      • • Epidemiology and Analysis Program Office
      • • National Center for Emerging and Zoonotic Infectious Diseases
      • • Division of Bacterial Diseases
      Druid Hills, GA, United States
  • 1983
    • University of Charleston
      Charleston, West Virginia, United States
  • 1967
    • National Institute of Allergy and Infectious Diseases
      Maryland, United States