Chris Van Beneden

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

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Publications (79)422.45 Total impact

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    ABSTRACT: Group A Streptococcus (GAS) is the most common bacterial cause of pharyngitis, implicated in 20%-30% of pediatric and 5%-15% of adult health care visits for sore throat (1). Along with the sudden onset of throat pain, GAS pharyngitis symptoms include fever, headache, and bilateral tender cervical lymphadenopathy (1,2). Accurate diagnosis and management of GAS pharyngitis is critical for limiting antibiotic overuse and preventing rheumatic fever (2), but distinguishing between GAS and viral pharyngitis clinically is challenging (1). Guidelines for diagnosis and management of GAS pharyngitis have been published by the Infectious Diseases Society of America (IDSA)* (1). IDSA recommends that patients with sore throat be tested for GAS to distinguish between GAS and viral pharyngitis; however, IDSA emphasizes the use of selective testing based on clinical symptoms and signs to avoid identifying GAS carriers rather than acute GAS infections (1). Therefore, testing for GAS usually is not recommended for the following: patients with sore throat and accompanying symptoms (e.g., cough, rhinorrhea) that strongly suggest a viral etiology; children aged <3 years, because acute rheumatic fever is extremely rare in this age group; and asymptomatic household contacts of patients with GAS pharyngitis (1). IDSA recommends penicillin or amoxicillin as the treatment of choice based on effectiveness and narrow spectrum of activity. To date, penicillin-resistant GAS has never been documented (1).
    No preview · Article · Dec 2015 · MMWR. Morbidity and mortality weekly report
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    ABSTRACT: Background: Invasive group A Streptococcus (iGAS) infections cause significant morbidity and mortality worldwide. We analyzed whether obesity and diabetes were associated with iGAS infections and worse outcomes among an adult US population. Methods: We determined the incidence of iGAS infections using 2010-2012 cases in adults aged ≥18 years from Active Bacterial Core surveillance (ABCs), a population-based surveillance system, as the numerator. For the denominator, we used ABCs catchment area population estimates from the 2011-2012 Behavioral Risk Factor Surveillance System (BRFSS) survey. The relative risk (RR) of iGAS was determined by obesity and diabetes status after adjusting for age group, gender, race and other underlying conditions through binomial logistic regression. Multivariable logistic regression was used to determine whether obesity or diabetes was associated with increased odds of death due to iGAS compared to normal weight and non-diabetic patients, respectively. Results: Between 2010 and 2012, 2927 iGAS cases were identified. Diabetes was associated with an increased risk of iGAS in all racial groups (adjusted (a)RR ranged from 2.71-5.08). Grade 3 obesity (body mass index [BMI] ≥40) was associated with an increased risk of iGAS for whites (aRR=3.47; 95% confidence interval [CI] =3.00-4.01). Grades 1-2 (BMI= 30.0-<40.0) and grade 3 obesity were associated with an increased odds of death (OR=1.55, [95% CI=1.05, 2.29] and OR=1.62 [95% CI=1.01, 2.61], respectively) when compared to normal weight patients. Conclusions: . These results may help target vaccines against GAS that are currently under development. Efforts to develop enhanced treatment regimens for iGAS may improve prognoses for obese patients.
    No preview · Article · Dec 2015 · Clinical Infectious Diseases
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    ABSTRACT: Background: Streptococcus pneumoniae is a leading cause of pneumonia, meningitis and sepsis in developing countries, particularly among children and HIV-infected persons. Pneumococcal oropharyngeal (OP) or nasopharyngeal (NP) colonization is a precursor to development of invasive disease. New conjugate vaccines hold promise for reducing colonization and disease. Methods: Prior to introduction of 10-valent pneumococcal conjugate vaccine (PCV10), we conducted a cross-sectional survey among HIV-infected parents of children <5 years old in rural Kenya. Other parents living with an HIV-infected adult were also enrolled. After broth enrichment, NP and OP swabs were cultured for pneumococcus. Serotypes were identified by Quellung. Antimicrobial susceptibility was performed using broth microdilution. Results: We enrolled 973 parents; 549 (56.4 %) were HIV-infected, 153 (15.7 %) were HIV-uninfected and 271 (27.9 %) had unknown HIV status. Among HIV-infected parents, the median age was 32 years (range 15-74) and 374/549 (68 %) were mothers. Pneumococci were isolated from 237/549 (43.2 %) HIV-infected parents and 41/153 (26.8 %) HIV-non-infected parents (p = 0.0003). Colonization with PCV10 serotypes was not significantly more frequent in HIV-infected (12.9 %) than HIV-uninfected parents (11.8 %; p = 0.70). Among HIV-infected parents, cooking site separate from sleeping area and CD4 count >250 were protective (OR = 0.6; 95 % CI 0.4, 0.9 and OR = 0.5; 95 % CI 0.2, 0.9, respectively); other associations were not identified. Among 309 isolates tested from all parents, 255 (80.4 %) were penicillin non-susceptible (MIC ≥0.12 μg/ml). Conclusions: Prevalence of pneumococcal colonization is high among HIV-infected parents in rural Kenya. If young children are the pneumococcal reservoir for this population, PCV10 introduction may reduce vaccine-type colonization and disease among HIV-infected parents through indirect protection.
    Full-text · Article · Dec 2015 · BMC Infectious Diseases
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    ABSTRACT: Background: Scabies, a highly pruritic and contagious mite infestation of the skin, is endemic among tropical regions and causes a substantial proportion of skin disease among lower-income countries. Delayed treatment can lead to bacterial superinfection, and treatment of close contacts is necessary to prevent reinfestation. We describe scabies incidence and superinfection among children in American Samoa (AS) to support scabies control recommendations. Methodology/principal findings: We reviewed 2011-2012 pharmacy records from the only AS pharmacy to identify children aged ≤14 years with filled prescriptions for permethrin, the only scabicide available in AS. Medical records of identified children were reviewed for physician-diagnosed scabies during January 1, 2011-December 31, 2012. We calculated scabies incidence, bacterial superinfection prevalence, and reinfestation prevalence during 14-365 days after first diagnosis. We used log binomial regression to calculate incidence ratios for scabies by age, sex, and county. Medical record review identified 1,139 children with scabies (incidence 29.3/1,000 children aged ≤14 years); 604 (53%) had a bacterial superinfection. Of 613 children who received a scabies diagnosis during 2011, 94 (15.3%) had one or more reinfestation. Scabies incidence varied significantly among the nine counties (range 14.8-48.9/1,000 children). Children aged <1 year had the highest incidence (99.9/1,000 children). Children aged 0-4 years were 4.9 times more likely and those aged 5-9 years were 2.2 times more likely to have received a scabies diagnosis than children aged 10-14 years. Conclusions/significance: Scabies and its sequelae cause substantial morbidity among AS children. Bacterial superinfection prevalence and frequent reinfestations highlight the importance of diagnosing scabies and early treatment of patients and close contacts. Investigating why certain AS counties have a lower scabies incidence might help guide recommendations for improving scabies control among counties with a higher incidence. We recommend interventions targeting infants and young children who have frequent close family contact.
    Preview · Article · Oct 2015 · PLoS ONE
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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.
    Full-text · Article · Sep 2015 · Emerging Infectious Diseases
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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.
    No preview · Article · May 2015 · MMWR. Morbidity and mortality weekly report
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    Full-text · Article · Jan 2015 · Emerging infectious diseases
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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.
    Full-text · Article · Dec 2014 · MMWR. Morbidity and mortality weekly report
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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.
    Full-text · Article · Dec 2014 · MMWR. Morbidity and mortality weekly report
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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.
    Full-text · Article · Dec 2014 · MMWR. Morbidity and mortality weekly report
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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.
    No preview · Conference Paper · Oct 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.
    No preview · Conference Paper · Oct 2014

  • No preview · Article · Sep 2014 · JAMA Pediatrics
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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
    Full-text · Article · Sep 2014 · Journal of Clinical Microbiology
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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.
    No preview · Article · May 2014 · JAMA Internal Medicine
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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.
    Full-text · Article · Apr 2014 · Proceedings of the National Academy of Sciences
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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.
    Preview · Article · Nov 2013 · The Journal of Infectious Diseases
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    Robert F. Breiman · Chris A. Van Beneden · Eileen C. Farnon

    Preview · Article · Nov 2013 · The Journal of Infectious Diseases
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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.
    Full-text · Article · Nov 2013 · MMWR. Morbidity and mortality weekly report
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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 a 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 skilled nursing facility resident with onset after January 2009 with GAS isolated from a usually sterile (invasive) or nonsterile 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 patients 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 wing B. Risk factors associated with infection in multivariable analysis included living on wing A (odds ratio [OR], 3.4; 95% confidence interval [CI], .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. Conclusions: Staff turnover, compromised skin integrity in residents, a suboptimal infection control program, and lack of awareness of infections likely contributed to continued GAS transmission. In widespread, prolonged GAS outbreaks in skilled nursing facilities, facility-wide chemoprophylaxis may be necessary to prevent sustained person-to-person transmission.
    Preview · Article · Sep 2013 · Clinical Infectious Diseases

Publication Stats

1k Citations
422.45 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
    • University of Toronto
      Toronto, Ontario, Canada
  • 2008
    • Beth Israel Medical Center
      New York, New York, United States
  • 2005-2006
    • National Institute of Allergy and Infectious Diseases
      베서스다, Maryland, United States
  • 2003
    • Naval Health Research Center
      San Diego, California, United States