[Show abstract][Hide abstract] ABSTRACT: The first ever case of Middle East Respiratory Syndrome Coronavirus (MERSCoV) was reported in September 2012. This report describes the approaches taken by CDC, in collaboration with the World Health Organization (WHO) and other partners, to respond to this novel virus, and outlines the agency responses prior to the first case appearing in the United States in May 2014. During this time, CDC’s response integrated multiple disciplines and was divided into three distinct phases: before, during, and after the initial activation of its Emergency Operations Center. CDC’s response to MERS-CoV required a large effort, deploying at least 353 staff members who worked in the areas of surveillance, laboratory capacity, infection control guidance, and travelers’ health. This response built on CDC’s experience with previous outbreaks of other pathogens and provided useful lessons for future emerging threats.
[Show abstract][Hide abstract] ABSTRACT: Since mid-March 2014, the frequency with which cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported has increased, with the majority of recent cases reported from Saudi Arabia and United Arab Emirates (UAE). In addition, the frequency with which travel-associated MERS cases have been reported and the number of countries that have reported them to the World Health Organization (WHO) have also increased. The first case of MERS in the United States, identified in a traveler recently returned from Saudi Arabia, was reported to CDC by the Indiana State Department of Health on May 1, 2014, and confirmed by CDC on May 2. A second imported case of MERS in the United States, identified in a traveler from Saudi Arabia having no connection with the first case, was reported to CDC by the Florida Department of Health on May 11, 2014. The purpose of this report is to alert clinicians, health officials, and others to increase awareness of the need to consider MERS-CoV infection in persons who have recently traveled from countries in or near the Arabian Peninsula. This report summarizes recent epidemiologic information, provides preliminary descriptions of the cases reported from Indiana and Florida, and updates CDC guidance about patient evaluation, home care and isolation, specimen collection, and travel as of May 13, 2014.
Full-text · Article · May 2014 · MMWR. Morbidity and mortality weekly report
[Show abstract][Hide abstract] ABSTRACT: Few medical interventions compete with vaccines for their cumulative impact on health and well-being of entire populations. Routine immunization of children in the United States now targets 16 vaccine-preventable diseases; and vaccines are now routinely given across the lifespan. Immunization efforts achieved the global eradication of smallpox, as well as the elimination of polio, measles, and rubella from the Americas. The childhood vaccine series including DTP, polio, MMR, Hib, hepatitis B, and varicella vaccines is estimated to prevent 14 million infections, avoid 33,000 premature deaths, and save $9.9 billion in direct medical costs as well as $33 billion in indirect costs for each U.S. birth cohort fully vaccinated. Newer vaccines such as pneumococcal conjugate, rotavirus, and hepatitis A vaccines have also reduced illness and hospitalizations among the target populations but also have amplified benefits beyond their direct effects through reduced transmission from those immunized to other groups. Although for most of the 20th century there was a substantial delay between a vaccine's introduction in developed countries and its broad use in poor countries, newer global public-private partnerships and advocacy are leading to accelerated uptake of new and underutilized vaccines. Since the Measles Initiative was established in 2001, more than 700 million children worldwide have received a measles vaccination and an estimated 4.3 million childhood measles deaths have been averted. The full impact of increasing routine immunization further and implementing new vaccines against pneumonia and diarrhea agents in the poorest countries could prevent more than 2 million additional childhood deaths each year. (C) 2011 Published by Elsevier Ltd. Selection and/or peer-review under responsibility of Integrated Laboratory Systems, Inc.
Preview · Article · Dec 2011 · Procedia in Vaccinology
[Show abstract][Hide abstract] ABSTRACT: During 1946–2005, vaccine-preventable diseases were the topic of approximately 20% of all epidemic-assistance investigations
by the Centers for Disease Control and Prevention. Both in the United States and abroad, current and former Epidemic Intelligence
Service officers have played a critical role in describing the epidemiology of vaccine-preventable diseases, contributing
to development of immunization policies, participating in the implementation of immunization programs, and establishing effective
means for assessing adverse events following immunization. As newer vaccines are developed and introduced, they will continue
to play similar roles and most likely will be involved increasingly in investigations of the factors that affect people's
willingness to accept vaccination for themselves or their children.
Full-text · Article · Dec 2011 · American journal of epidemiology
[Show abstract][Hide abstract] ABSTRACT: The rate of bacterial meningitis declined by 55% in the United States in the early 1990s, when the Haemophilus influenzae type b (Hib) conjugate vaccine for infants was introduced. More recent prevention measures such as the pneumococcal conjugate vaccine and universal screening of pregnant women for group B streptococcus (GBS) have further changed the epidemiology of bacterial meningitis.
We analyzed data on cases of bacterial meningitis reported among residents in eight surveillance areas of the Emerging Infections Programs Network, consisting of approximately 17.4 million persons, during 1998-2007. We defined bacterial meningitis as the presence of H. influenzae, Streptococcus pneumoniae, GBS, Listeria monocytogenes, or Neisseria meningitidis in cerebrospinal fluid or other normally sterile site in association with a clinical diagnosis of meningitis.
We identified 3188 patients with bacterial meningitis; of 3155 patients for whom outcome data were available, 466 (14.8%) died. The incidence of meningitis changed by -31% (95% confidence interval [CI], -33 to -29) during the surveillance period, from 2.00 cases per 100,000 population (95% CI, 1.85 to 2.15) in 1998-1999 to 1.38 cases per 100,000 population (95% CI 1.27 to 1.50) in 2006-2007. The median age of patients increased from 30.3 years in 1998-1999 to 41.9 years in 2006-2007 (P<0.001 by the Wilcoxon rank-sum test). The case fatality rate did not change significantly: it was 15.7% in 1998-1999 and 14.3% in 2006-2007 (P=0.50). Of the 1670 cases reported during 2003-2007, S. pneumoniae was the predominant infective species (58.0%), followed by GBS (18.1%), N. meningitidis (13.9%), H. influenzae (6.7%), and L. monocytogenes (3.4%). An estimated 4100 cases and 500 deaths from bacterial meningitis occurred annually in the United States during 2003-2007.
The rates of bacterial meningitis have decreased since 1998, but the disease still often results in death. With the success of pneumococcal and Hib conjugate vaccines in reducing the risk of meningitis among young children, the burden of bacterial meningitis is now borne more by older adults. (Funded by the Emerging Infections Programs, Centers for Disease Control and Prevention.).
Full-text · Article · May 2011 · New England Journal of Medicine
[Show abstract][Hide abstract] ABSTRACT: The author reflects on her personal experiences during the 2009 H1N1 influenza, acquired immune deficiency syndrome (AIDS), and severe acute respiratory syndrome (SARS) pandemics. The roles played by the Centers for Disease Control and Prevention related to pregnancy-associated influenza during the 2009 pandemic are described. Risk communication principles are summarized and resources provided.
No preview · Article · Feb 2011 · American journal of obstetrics and gynecology
[Show abstract][Hide abstract] 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.
Full-text · Article · Jan 2011 · Clinical Infectious Diseases
[Show abstract][Hide abstract] 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.
Preview · Article · Jan 2011 · Clinical Infectious Diseases
[Show abstract][Hide abstract] ABSTRACT: The introduction of Haemophilus influenzae type b (Hib) vaccine in developing countries has suffered from a long delay. Between 2005 and 2009, a surge in Hib vaccine adoption took place, particularly among GAVI-eligible countries. Several factors contributed to the increase in Hib vaccine adoption, including support provided by the Hib Initiative, a project funded by the GAVI Alliance in 2005 to accelerate evidence-informed decisions for use of Hib vaccine. This paper reviews the strategy adopted by the Hib Initiative and the lessons learned in the process, which provide a useful model to accelerate uptake of other new vaccines.
[Show abstract][Hide abstract] ABSTRACT: We examined associations between the socioeconomic characteristics of census tracts and racial/ethnic disparities in the incidence of bacteremic community-acquired pneumonia among US adults.
We analyzed data on 4870 adults aged 18 years or older with community-acquired bacteremic pneumonia identified through active, population-based surveillance in 9 states and geocoded to census tract of residence. We used data from the 2000 US Census to calculate incidence by age, race/ethnicity, and census tract characteristics and Poisson regression to estimate rate ratios (RRs) and 95% confidence intervals (CIs).
During 2003 to 2004, the average annual incidence of bacteremic pneumonia was 24.2 episodes per 100 000 Black adults versus 10.1 per 100 000 White adults (RR = 2.40; 95% CI = 2.24, 2.57). Incidence among Black residents of census tracts with 20% or more of persons in poverty (most impoverished) was 4.4 times the incidence among White residents of census tracts with less than 5% of persons in poverty (least impoverished). Racial disparities in incidence were reduced but remained significant in models that controlled for age, census tract poverty level, and state.
Adults living in impoverished census tracts are at increased risk of bacteremic pneumonia and should be targeted for prevention efforts.
Full-text · Article · Oct 2010 · American Journal of Public Health
[Show abstract][Hide abstract] ABSTRACT: Human immunodeficiency virus (HIV) infection and AIDS increase the risk of invasive pneumococcal disease (IPD). We evaluated IPD among HIV-infected adults over a 10-year period in the US to identify opportunities for prevention of IPD among HIV-infected adults.
IPD and HIV surveillance in seven population-based and laboratory-based Active Bacterial Core surveillance areas.
IPD cases were adults 18-64 years old with pneumococcus isolated from a normally sterile site during 1998-2007. Isolates were serotyped using the Quellung reaction. HIV/AIDS status was determined by medical record review. We calculated incidence of IPD among adults with AIDS using national case-based surveillance data.
Of 13 812 IPD cases among 18-64-year-olds, 3236 (23%) occurred among HIV-infected adults (with or without AIDS) and 1313 (10%) occurred among the subset of HIV-infected adults with AIDS. Compared with the period (1998-1999) before childhood 7-valent pneumococcal conjugate vaccine (PCV7) introduction in the US, the overall incidence of IPD among adults with AIDS decreased 25% from 399 to 298 cases per 100 000 by 2007 (P = 0.008). In 2006-2007, 8, 39 and 55% of IPD cases among adults with AIDS were caused by serotypes included in the 7-valent PCV, 13-valent PCV and 23-valent pneumococcal polysaccharide vaccines, respectively.
Sustained declines in IPD have occurred among adults with AIDS in the US, but incidence remained high 7 years after PCV7 introduction. More aggressive efforts, including HIV-prevention measures and the use of new PCVs in children and possibly HIV-infected adults, are necessary to further reduce IPD among HIV-infected adults.
No preview · Article · Sep 2010 · AIDS (London, England)