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Neighborhood-Level Poverty, Poverty-Associated Factors, and Severe Outcomes among Adults Hospitalized with Influenza—United States, 2012–2015

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Open Forum Infectious Diseases 2017年第SUPPL_1期4卷 S569–S569页

作者： Schicker, Rebekah Stewart Yousey-Hindes, Kimberly Rolfes, Melissa a Cummings, Charisse Nitura Anderson, Evan J Bargsten, Marisa Bennett, Nancy Eckel, Seth Lung, Krista McMahon, Melissa Miller, Lisa Monroe, Maya Risk, Ilene Schaffner, William Thomas, Ann Watt, James Zansky, Shelley M Reed, Carrie Fry, Alicia M Garg, Shikha Centers for Disease Control and Prevention Atlanta Georgia Emerging Infections Program Yale New Haven Connecticut Yale School of Public Health New Haven Connecticut Influenza Division Centers for Disease Control and Prevention Atlanta Georgia Pediatrics and Medicine Emory University School of Medicine Atlanta Georgia New Mexico Department of Health Santa Fe New Mexico University of Rochester Medical Center Rochester New York Communicable Disease Division Michigan Department of Health and Human Services Lansing Michigan Bureau of Infectious Diseases Ohio Department of Health Columbus Ohio Minnesota Department of Health St. Paul Minnesota Preventive Medicine Residency Program University of Colorado School of Public Health Aurora Colorado Maryland Department of Health and Mental Hygiene Baltimore Maryland Salt Lake County Health Department Salt Lake City Utah Vanderbilt University School of Medicine Nashville Tennessee Department of Human Services Health Services Portland Oregon Center for Infectious Diseases California Department of Public Health Sacramento California New York State Department of Health Albany New York

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Socioeconomic Status Factors Associated with Increased Incidence of Community-AssociatedClostridium difficileInfection

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Open Forum Infectious Diseases 2017年第SUPPL_1期4卷 S381–S381页

作者： Skrobarcek, Kimberly Mu, Yi Winston, Lisa G Brousseau, Geoff Lyons, Carol Farley, Monica Perlmutter, Rebecca Holzbauer, Stacy Phipps, Erin C Dumyati, Ghinwa Beldavs, Zintars G Kainer, Marion Guh, Alice Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Atlanta Georgia Medicine University of California San Francisco and Zuckerberg San Francisco General Hospital and Trauma Center San Francisco California Colorado Department of Public Health and Environment Denver Colorado Yale School of Public Health Connecticut Emerging Infections Program New Haven Connecticut Department of Medicine Emory University School of Medicine and Atlanta VA Medical Center Atlanta Georgia Maryland Department of Health and Mental Hygiene Baltimore MD Minnesota Department of Health St. Paul Minnesota University of New Mexico New Mexico Emerging Infections Program Albuquerque New Mexico New York Emerging Infections Program at the University of Rochester Medical Center Rochester New York Oregon Health Authority Portland Oregon Tennessee Department of Health Nashville Tennessee

Background Traditionally a hospital-acquired pathogen, Clostridium difficile is increasingly recognized as an important cause of diarrhea in community settings. Health disparities in C. difficile infection (CDI) have been reported, but little is known about the social determinants of health that influence community-associated (CA) CDI incidence. We sought to identify socioeconomic status (SES) factors associated with increased CA-CDI incidence. Methods Population-based CDI surveillance is conducted in 35 U.S. counties through the Centers for Disease control and prevention’s Emerging Infections program. A CA-CDI case is defined as a positive C. difficile stool specimen collected as an outpatient or within three days of hospitalization in a person aged ≥ 1 year who did not have a positive test in the prior 8 weeks or an overnight stay in a healthcare facility in the prior 12 weeks. ArcGIS software was used to geocode 2014–2015 CA-CDI case addresses to a 2010 census tract (CT). Incidence rate was calculated using 2010 Census population denominators. CT-level SES factors were obtained from the 2011–2015 American Community Survey 5-year estimates and divided into deciles. To account for CT-level clustering effects, separate generalized linear mixed models with negative binomial distribution were used to evaluate the association between each SES factor and CA-CDI incidence, adjusted by age, sex and race. Results Of 9686 CA-CDI cases, 9417 (97%) had addresses geocoded to a CT; of these, 62% were female, 82% were white, and 35% were aged ≥65 years. Annual CA-CDI incidence was 42.9 per 100,000 persons. After adjusting for age, sex and race, CT-level SES factors significantly associated with increased CA-CDI incidence included living under the poverty level (rate ratio [RR] 1.12; 95% confidence interval [CI] 1.09–1.53), crowding in homes (RR 1.11; 95% CI 1.01–1.21), low education (RR 1.11; 95% CI 1.07–1.15), low income (RR 1.15; 95% CI 1.12–1.17), having public health insuran

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Use of Death Certificate Data in Healthcare-Associated Infection Surveillance

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Open Forum Infectious Diseases 2016年第SUPPL_1期3卷

作者： Lyman, Meghan Laplace, Lisa Buhr, Nicolai Concannon, Cathleen Ellingson, Katherine Johnston, Helen Kainer, Marion Martin, Brittany Maloney, Meghan Perry, Lewis Warnke, Linn Thompson, Nicola D. Epidemic Intelligence Service Center for Disease Control and Prevention Atlanta GA National Center for Emerging and Zoonotic Infectious Diseases Division for Healthcare Quality Promotion Center for Disease Control and Prevention Atlanta GA Centers for Disease Control and Prevention Atlanta GA Office of Infectious Disease Epidemiology and Outbreak Response Maryland Department of Health and Mental Hygiene Baltimore MD Center for Community Health University of Rochester Medical Center Rochester NY Positive Deviance MRSA Prevention Partnership Atlanta GA Colorado Department of Public Health and Environment Denver CO Tennessee Department of Health Nashville TN California Emerging Infections Program Oakland CA Connecticut Department of Public Health Hartford CT Georgia Emerging Infections Program Atlanta GA Minnesota Department of Health St. Paul MN Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Atlanta GA

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Software for administering the National Cancer Institute’s patient-reported outcomes version of the common terminology criteria for adverse events: Usability study

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JMIR Human Factors 2018年第3期5卷 e10070页

作者： Schoen, Martin W. Basch, Ethan Hudson, Lori L. Chung, Arlene E. Mendoza, Tito R. Mitchell, Sandra A. St. Germain, Diane Baumgartner, Paul Sit, Laura Rogak, Lauren J. Shouery, Marwan Shalley, Eve Reeve, Bryce B. Fawzy, Maria R. Bhavsar, Nrupen A. Cleeland, Charles Schrag, Deborah Dueck, Amylou C. Abernethy, Amy P. Division of Hematology and Medical Oncology Department of Internal Medicine Saint Louis University School of Medicine Saint Louis MO United States Division of Hematology/Oncology Department of Medicine University of North Carolina School of Medicine 170 Manning Drive Chapel Hill NC United States Department of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center New York NY United States Lineberger Comprehensive Cancer Center University of North Carolina Chapel Hill NC United States Department of Health Policy and Management Gillings School of Public Health University of North Carolina Chapel Hill NC United States Duke Clinical Research Institute Duke University Durham NC United States Division of General Medicine and Clinical Epidemiology Department of Medicine University of North Carolina School of Medicine Chapel Hill NC United States Division of General Pediatrics and Adolescent Medicine Department of Pediatrics Program on Health and Clinical Informatics University of North Carolina School of Medicine Chapel Hill NC United States Department of Symptom Research University of Texas MD Anderson Cancer Center Houston TX United States Division of Cancer Control and Population Sciences National Cancer Institute Rockville MD United States Division of Cancer Prevention National Cancer Institute Rockville MD United States SemanticBits Herndon VA United States Center for Biomedical Informatics and Information Technology National Cancer Institute Rockville MD United States Duke Cancer Institute Durham NC United States FHI 360 Durham NC United States Division of General Internal Medicine Duke University School of Medicine Durham NC United States Division of Population Sciences Dana-Farber Cancer Institute Boston MA United States Alliance Statistics and Data Center Mayo Clinic Scottsdale AZ United States Flatiron Health New York NY United States

Background: The US National Cancer Institute (NCI) developed software to gather symptomatic adverse events directly from patients participating in clinical trials. The software administers surveys to patients using items from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) through Web-based or automated telephone interfaces and facilitates the management of survey administration and the resultant data by professionals (clinicians and research associates). Objective: The purpose of this study was to iteratively evaluate and improve the usability of the PRO-CTCAE software. Methods: Heuristic evaluation of the software functionality was followed by semiscripted, think-aloud protocols in two consecutive rounds of usability testing among patients with cancer, clinicians, and research associates at 3 cancer centers. We conducted testing with patients both in clinics and at home (remotely) for both Web-based and telephone interfaces. Furthermore, we refined the software between rounds and retested. Results: Heuristic evaluation identified deviations from the best practices across 10 standardized categories, which informed initial software improvement. Subsequently, we conducted user-based testing among 169 patients and 47 professionals. Software modifications between rounds addressed identified issues, including difficulty using radio buttons, absence of survey progress indicators, and login problems (for patients) as well as scheduling of patient surveys (for professionals). The initial System Usability Scale (SUS) score for the patient Web-based interface was 86 and 82 (P=.22) before and after modifications, respectively, whereas the task completion score was 4.47, which improved to 4.58 (P=.39) after modifications. Following modifications for professional users, the SUS scores improved from 71 to 75 (P=.47), and the mean task performance improved significantly (4.40 vs 4.02;P=.001). Conclusions: Software modificati

关键词： Adverse events Cancer clinical trials Patient-reported outcomes PRO-CTCAE Symptoms Usability

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Xenotransplantation: Is the Future Upon Us?

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Infection control & Hospital Epidemiology 2015年第5期19卷 305-307页

作者： Michele L. Pearson William R. Jarvis Thomas M. Folks Louisa E. Chapman Hospital Infections Program National Center for Infectious Diseases Atlanta Georgia Division of AIDS STD TB Laboratory Research National Center for Infectious Diseases Centers for Disease Control and Prevention Atlanta Georgia

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Paralytic shellfish poisonings resulting from an algal bloom in Nicaragua

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BMC Research Notes 2015年第1期8卷 1-6页

作者： Callejas, Luis Darce, Ana Cristian Melendez Amador, Juan Jose Conklin, Laura Gaffga, Nicholas Schurz Rogers, Helen DeGrasse, Stacey Hall, Sherwood Earley, Marie Mei, Joanne Rubin, Carol Aldighieri, Sylvain Backer, Lorraine C. Azziz-Baumgartner, Eduardo Field Epidemiology Training Program Managua Nicaragua Nicaragua Ministry of Health Managua Nicaragua U.S. Centers for Disease Control and Prevention MS A32 1600 Clifton Rd NE Atlanta 30333 GA United States U.S. Food and Drug Administration College Park MD United States Pan American Health Organization Managua Nicaragua

Background: During an October 2005 algal bloom (i.e., a rapid increase or accumulation in the population of algae) off the coast of Nicaragua, 45 people developed symptoms of paralytic shellfish poisoning (PSP) and one person died. PSP in humans is caused by ingestion of saxitoxin, which is a neurotoxin often associated with shellfish contaminated by algal blooms. To explore the relationship between the algal bloom and human illnesses, we performed a case-control study of residents living in a coastal island. We administered a standardized clinical questionnaire, sampled locally harvested seafood and algae, and obtained urine samples for saxitoxin testing from symptomatic and asymptomatic persons. PSP case-patients were defined as island residents who developed at least one neurological symptom during the November 4-16 intoxication period. Seafood and algal samples were analyzed for saxitoxins using the receptor-binding assay and high-performance liquid chromatography. Two urine samples were analyzed for saxitoxins using a newly developed immunoassay. Findings: Three shellfish and two algal samples tested positive for saxitoxins. Ten (9%) of 107 participants developed neurological symptoms during the specified time period and five required hospitalization. While 6 (67%) of 9 possible case-patients and 21 (21%) of 98 controls had eaten fish (p=0.008), all case-patients and 17 (17%) of controls had eaten clams (P<0.0001). The saxitoxin concentration in the urine of a hospitalized case-patient was 21 ng saxitoxin/g creatinine compared to 0.16 ng saxitoxin/g creatinine in the single control patient's urine. Conclusions: These findings suggest that a bloom of saxitoxin-producing algae resulted in saxitoxin accumulation in local clams and was responsible for the PSP intoxication. © 2015 Callejas et al.;licensee BioMed Central.

关键词： Algal bloom Anadara tuberculosa Nicaragua Paralytic shellfish poisoning Pyrodinium bahamense Saxitoxin

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An Outbreak of Invasive Group AStreptococcal Infections in Injection Drug Users

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Open Forum Infectious Diseases 2017年第SUPPL_1期4卷 S241-S241页

作者： Gittzus, Jennifer White, Joshua Caine, Lynda Hansen, Katrina Daly, Elizabeth Chan, Benjamin Bowen, Hannah Metcalf, Erin Pierce, Lindsay Kusch, Rachel Benton, Christopher Gao, Fenxiang Talbot, Elizabeth Noble, James Infectious Disease Concord Hospital Concord NH Infectious Disease - Concord Disease Concord New Hampshire Infection Prevention Concord Hospital Concord New Hampshire Healthcare-Associated Infections Program Bureau of Infectious Disease Control/NH Department of Health and Human Services Concord New Hampshire New Hampshire Department of Health and Human Services Concord New Hampshire Infectious Disease and International Health Dartmouth Hitchcock Medical Center Lebanon New Hampshire NH Division of Public Health Services Concord New Hampshire Infectious Diseases Concord Hospital Concord New Hampshire

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Treatment ofClostridium difficileInfection in 10 US Geographical Locations, 2013–2014

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Open Forum Infectious Diseases 2016年第SUPPL_1期3卷

作者： Novosad, Shannon Winston, Lisa G. Johnston, Helen Badolato, Elizabeth Lyons, Carol Farley, Monica Revis, Andrew Wilson, Lucy Perlmutter, Rebecca Holzbauer, Stacy M. Whitten, Tory Phipps, Erin C. Dumyati, Ghinwa Beldaversus, Zintars G. Ocampo, Valerie L.S. Kainer, Marion Davis, Corinne M. Barnes, Jamie Gerding, Dale Guh, Alice Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Atlanta Georgia University of California San Francisco School of Medicine Department of Medicine San Francisco California Colorado Department of Public Health and Environment Denver Colorado Yale School of Public Health Connecticut Emerging Infections Program New Haven Connecticut Department of Medicine Emory University School of Medicine and Atlanta Veterans Affairs Medical Center Atlanta Georgia Georgia Emerging Infections Program Research and Education Foundation Decatur Georgia Maryland Department of Health and Mental Hygiene Baltimore Maryland Centers for Disease Control and Prevention St. Paul Minnesota Infectious Disease Epidemiology Prevention and Control Division Minnesota Department of Health St. Paul Minnesota New Mexico Emerging Infections Program Albuquerque New Mexico University of Rochester Medical Center Rochester New York Oregon Health Authority Portland Oregon Tennessee Department of Health Nashville Tennessee Centers for Disease Control and Prevention Atlanta Georgia Hines Veterans Affairs Hospital Hines Illinois

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Causes of In-hospital and Post discharge Mortality Among Patients Hospitalized with Laboratory-Confirmed Influenza, Influenza Hospitalization Surveillance Network, 2014–2015

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Open Forum Infectious Diseases 2017年第SUPPL_1期4卷 S24-S24页

作者： McGowan, Craig Arriola, Carmen Cummings, Charisse Nitura Kirley, Pam D Miller, Lisa Meek, James I Anderson, Evan J Monroe, Maya Bohm, Susan McMahon, Melissa Bargsten, Marisa Zansky, Shelley Bennett, Nancy Lung, Krista Thomas, Ann Schaffner, William Price, Andrea Chaves, Sandra Dos Santos Reed, Carrie Garg, Shikha Influenza Division Centers for Disease Control and Prevention Atlanta Georgia California Emerging Infections Program Oakland California Colorado Department of Public Health and Environment Denver Colorado Connecticut Emerging Infections Program Yale School of Public Health New Haven Connecticut Pediatrics and Medicine Emory University School of Medicine Atlanta Georgia Maryland Department of Health and Mental Hygiene Baltimore MD Michigan Department of Health and Human Services Lansing Michigan Minnesota Department of Health St. Paul Minnesota New Mexico Department of Health Santa Fe New Mexico Emerging Infections Program New York State Department of Health Albany New York University of Rochester Medical Center Rochester New York Bureau of Infectious Diseases Ohio Department of Health Columbus Ohio Oregon Public Health Division Portland Oregon Vanderbilt University School of Medicine Nashville Tennessee Salt Lake County Health Department Salt Lake City Utah

Background Influenza results in an estimated 12,000–56,000 deaths annually in the USA. While in-hospital deaths are well characterized, less is known about deaths that occur after discharge among those hospitalized with influenza. Methods We identified patients hospitalized with laboratory-confirmed influenza who died during hospitalization or within 30 days after discharge during the 2014–2015 influenza season for 11 Influenza Hospitalization Surveillance Network sites. We matched cases to the National Center for Health Statistics Electronic Death Registration System and abstracted cause and location of death from death certificates. We compared clinical characteristics between those who died during hospitalization and those who died after hospital discharge using χ 2 tests. Results Among 795 patients with laboratory-confirmed influenza who died, 370 (47%) died during hospitalization, and 425 (53%) died within 30 days after discharge. Eighteen (2%) were 0–17 years and 652 (82%) were ≥65 years. Common causes of death listed in any position on the death certificate included influenza (35%), other respiratory causes (50%), cardiovascular disease (37%), and sepsis (15%). Among those who died after discharge, 207 (49%) died within 7 days, 86 (20%) within 8–14 days, and 132 (31%) within 15–30 days post discharge. Patients who died after discharge were more likely to be ≥65 years (88 vs. 74%) or admitted from a nursing home (48 vs. 36%), but were less likely to be admitted to an intensive care unit (30 vs. 68%) or receive a pneumonia diagnosis (46 vs. 62%) than patients who died during hospitalization (all P < 0.001). There were no significant differences in sex, race, underlying conditions, vaccination rates, or time from symptom onset to hospitalization. Patients who died in hospital were more likely to have influenza listed as a cause of death (55 vs. 21%, P < 0.01). Conclusion Over half of deaths among patients hospitalized with laboratory-confirmed influenza occurred

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Nosocomial Transmission of Salmonella Gastroenteritis to Laundry Workers in a Nursing Home

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Infection control & Hospital Epidemiology 2015年第1期15卷 22-26页

作者： Steven M. Standaert Robert H. Hutcheson William Schaffner Epidemic Intelligence Service Division of Field Epidemiology Epidemiology Program Office Centers for Disease Control and Prevention Atlanta Georgia Tennessee Department of Health Nashville Tennessee Department of Preventive Medicine Vanderbilt University School of Medicine Nashville Tennessee

Background:Outbreaks of salmonella gastroenteritis in nursing homes are common. Person-to-person transmission to nursing home personnel occurs occasionally, but infection of laundry staff as a result of handling soiled linen rarely has been ***:To examine the nosocomial transmission of infection to laundry staff during an outbreak of salmonellosis in a nursing ***:A 250-bed nursing home in a rural Tennessee ***:Residents and staff of the nursing home were interviewed and cultures of stool samples examined for enteric ***:Stool cultures from 32 residents and 8 employees were positive for Salmonella hadar. Infection among the residents was food-borne, but infection among employees likely represented secondary transmission, as none of the employees ate food prepared in the kitchen and their onset of symptoms occurred seven to 10 days after that of ill residents. Three laundry personnel who had no contact with residents were infected. Most of the ill residents (81%) were incontinent, which led to an increase in both the degree of fecal soiling and the amount of soiled linen received by the laundry during the outbreak. Laundry personnel regularly ate in the laundry room, did not wear protective clothing, and did not wear gloves consistently while handling soiled laundry,Conclusions:This investigation implicates linen soiled with feces as the source of nosocomial S hadar infection in laundry workers and underscores the importance of using appropriate precautions when handling linen.

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