scholarly journals 159. Genomic Epidemiology of MRSA at Intake to a Large Inner-City Jail: Evidence for Community Transmission Networks?

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S13-S14 ◽  
Author(s):  
Kyle J Popovich ◽  
Evan S Snitkin ◽  
Stefan J Green ◽  
Alla Aroutcheva ◽  
Michael Schoeny ◽  
...  
Keyword(s):  
Cook County ◽  
Hiv Care ◽  
Transmission Networks ◽  
Genomic Epidemiology ◽  
High Prevalence ◽  
Community Transmission ◽  
Clonal Spread ◽  
Small Clusters ◽  
The Impact ◽  
Mrsa Colonization

Abstract Background USA300 is endemic in the community, with congregate settings potentially facilitating spread. The impact of community MRSA transmission networks on importation of MRSA into urban jails is unknown. We examined MRSA colonization isolates entering the jail and determined whether there are community transmission networks for MRSA that precede incarceration. Methods HIV-infected and HIV-negative males incarcerated at the Cook County Jail were enrolled within 72 hours of intake. Surveillance cultures (nares, throat, and groin) were collected to determine prevalence of MRSA colonization. A survey was administered to identify predictors of colonization. Whole-genome sequencing (WGS) and phylogenetic analysis were integrated with epidemiologic data to identify community transmission networks. Results A total of 800 males were enrolled (83% AA and 9% Hispanic); 58% were HIV-infected. The prevalence of MRSA colonization at intake was 19%. In multivariate analysis, methamphetamine use (METH), unstable housing, and prior jail incarceration were significant predictors of MRSA. Among HIV patients, injection drug use and HIV care at outpatient Clinic A that emphasize comprehensive care to the LGBTQ community were significant predictors of MRSA. Of the 31 (45%) patients with care at Clinic A, 14 had MRSA colonization. We sequenced 145 isolates from unique individuals, with 102 and 13 closely related to USA300 and USA500 reference genomes, respectively. USA300 strains from intake were diverse (median pairwise SNV distance = 109), with several small clusters noted. WGS revealed the high prevalence of MRSA in Clinic A was not due to clonal spread but rather an intermingling of distinct community transmission networks (strains were highly diverse; median pairwise SNV distance = 410). We did identify a 13-member community transmission network underlying spread of USA500 (figure). Members of this network were more likely to be HIV-infected (P < 0.004), MSM (P < 0.001), and METH (P < 0.001). Conclusion A high proportion of individuals enter jail already colonized with MRSA and colonization risk factors provide clues to community reservoirs for MRSA. WGS extended epidemiologic analysis and revealed community transmission networks that could be a potential focus for an intervention. Disclosures All authors: No reported disclosures.

scholarly journals Frequent Methicillin-Resistant Staphylococcus aureus Introductions Into an Inner-city Jail: Indications of Community Transmission Networks

2019 ◽  
Vol 71 (2) ◽  
pp. 323-331 ◽  
Author(s):  
Kyle J Popovich ◽  
Evan S Snitkin ◽  
Chad Zawitz ◽  
Alla Aroutcheva ◽  
Darjai Payne ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Drug Use ◽  
Molecular Epidemiology ◽  
Skin Infection ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Transmission Networks ◽  
Methicillin Resistant ◽  
Community Transmission ◽  
Mrsa Colonization

Abstract Background Jails may facilitate spread of methicillin-resistant Staphylococcus aureus (MRSA) in urban areas. We examined MRSA colonization upon entrance to a large urban jail to determine if there are MRSA transmission networks preceding incarceration. Methods Males incarcerated in Cook County Jail (Chicago) were enrolled, with enrichment for people living with human immunodeficiency virus (PLHIV), within 72 hours of intake. Surveillance cultures assessed prevalence of MRSA colonization. Whole-genome sequencing (WGS) identified preincarceration transmission networks. We examined methicillin-resistant Staphylococcus aureus (MRSA) isolates to determine if there are transmission networks that precede incarceration. A large proportion of individuals enter jail colonized with MRSA. Molecular epidemiology and colonization risk factors provide clues to community reservoirs for MRSA. Results There were 718 individuals (800 incarcerations) enrolled; 58% were PLHIV. The prevalence of MRSA colonization at intake was 19%. In multivariate analysis, methamphetamine use, unstable housing, current/recent skin infection, and recent injection drug use were predictors of MRSA. Among PLHIV, recent injection drug use, current skin infection, and HIV care at outpatient clinic A that emphasizes comprehensive care to the lesbian, gay, bisexual, transgender community were predictors of MRSA. Fourteen (45%) of 31 detainees with care at clinic A had colonization. WGS revealed that this prevalence was not due to clonal spread in clinic but rather to an intermingling of distinct community transmission networks. In contrast, genomic analysis supported spread of USA500 strains within a network. Members of this USA500 network were more likely to be PLHIV (P < .01), men who have sex with men (P < .001), and methamphetamine users (P < .001). Conclusions A large proportion of individuals enter jail colonized with MRSA. Molecular epidemiology and colonization risk factors provide clues to identify colonized detainees entering jail and potential community reservoirs of MRSA.

scholarly journals Phylogenetic analysis of SARS-CoV-2 in Boston highlights the impact of superspreading events

Science ◽  
2020 ◽  
pp. eabe3261 ◽  
Author(s):  
Jacob E. Lemieux ◽  
Katherine J. Siddle ◽  
Bennett M. Shaw ◽  
Christine Loreth ◽  
Stephen F. Schaffner ◽  
...  
Keyword(s):  
International Business ◽  
Skilled Nursing Facility ◽  
Transmission Dynamics ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Genomic Epidemiology ◽  
Community Transmission ◽  
Rapid Transmission ◽  
The Impact ◽  
Significant Mortality

Analysis of 772 complete SARS-CoV-2 genomes from early in the Boston area epidemic revealed numerous introductions of the virus, a small number of which led to most cases. The data revealed two superspreading events. One, in a skilled nursing facility, led to rapid transmission and significant mortality in this vulnerable population but little broader spread, while other introductions into the facility had little effect. The second, at an international business conference, produced sustained community transmission and was exported, resulting in extensive regional, national, and international spread. The two events also differed significantly in the genetic variation they generated, suggesting varying transmission dynamics in superspreading events. Our results show how genomic epidemiology can help understand the link between individual clusters and wider community spread.

scholarly journals Quantifying the Impact of Extranasal Testing of Body Sites for Methicillin-ResistantStaphylococcus aureusColonization at the Time of Hospital or Intensive Care Unit Admission

2013 ◽  
Vol 34 (2) ◽  
pp. 161-170 ◽  
Author(s):  
James A. McKinnell ◽  
Susan S. Huang ◽  
Samantha J. Eells ◽  
Eric Cui ◽  
Loren G. Miller
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Prevention ◽  
Weighted Average ◽  
Icu Admission ◽  
High Prevalence ◽  
Healthcare Associated ◽  
Low Prevalence ◽  
The Impact ◽  
Mrsa Colonization

Objective.Methicillin-resistantStaphylococcus aureus(MRSA) is a common cause of healthcare-associated infections. Recent legislative mandates require nares screening for MRSA at hospital and intensive care unit (ICU) admission in many states. However, MRSA colonization at extranasal sites is increasingly recognized. We conducted a systematic review of the literature to identify the yield of extranasal testing for MRSA.Design.We searched MEDLINE from January 1966 through January 2012 for articles comparing nasal and extranasal screening for MRSA colonization. Studies were categorized by population tested, specifically those admitted to ICUs and those admitted to hospitals with a high prevalence (6% or greater) or low prevalence (less than 6%) of MRSA carriers. Data were extracted using a standardized instrument.Results.We reviewed 4,381 abstracts and 735 articles. Twenty-three articles met the criteria for analysis (n= 39,479 patients). Extranasal MRSA screening increased the yield by approximately one-third over nares alone. The yield was similar at ICU admission (weighted average, 33%; range, 9%–69%) and hospital admission in high-prevalence (weighted average, 37%; range, 9%–86%) and low-prevalence (weighted average, 50%; range, 0%–150%) populations. For comparisons between individual extranasal sites, testing the oropharynx increased MRSA detection by 21% over nares alone; rectum, by 20%; wounds, by 17%; and axilla, by 7%.Conclusions.Extranasal MRSA screening at hospital or ICU admission in adults will increase MRSA detection by one-third compared with nares screening alone. Findings were consistent among subpopulations examined. Extranasal testing may be a valuable strategy for outbreak control or in settings of persistent disease, particularly when combined with decolonization or enhanced infection prevention protocols.

Comparing the Impact of Religious Discourse on HIV/AIDS in Islam and Christianity in Africa

2012 ◽  
Vol 8 ◽  
Author(s):  
Sloane Speakman
Keyword(s):  
Social Factors ◽  
Negative Relationship ◽  
Hiv Prevalence ◽  
Religious Discourse ◽  
Prevalence Rates ◽  
The Social ◽  
High Prevalence ◽  
Islam And Christianity ◽  
Sub Saharan ◽  
The Impact

In examining the strikingly high prevalence rates of HIV in many parts of Africa, reaching as high as 5% in some areas, how does the discourse promoted by the predominant religions across the continent, Islam and Christianity, affect the outlook of their followers on the epidemic? This question becomes even more intriguing after discovering the dramatic difference in rate of HIV prevalence between Muslims and Christians in Africa, confirmed by studies that have found a negative relationship to exist between HIV prevalence and being Muslim in Africa, even in Sub-Saharan African nations. Why does this gap in prevalence rates exist? Does Islam advocate participating in less risky behavior more so than Christianity? By comparing the social construction, epidemiological understanding and public responses among Muslim populations in Africa with Christian ones, it becomes apparent that many similarities exist between the two regarding discourse and that, rather than religious discourse itself, other social factors, such as circumcision practices, contribute more to the disparity in HIV prevalence than originally thought.

Double, triple or quadruple hits? Exploring the impact of cybercrime on victims in the Netherlands

2021 ◽  
pp. 026975802110106
Author(s):  
Raoul Notté ◽  
E.R. Leukfeldt ◽  
Marijke Malsch
Keyword(s):  
Public Opinion ◽  
Literature Review ◽  
The Netherlands ◽  
Public Discourse ◽  
Moral Judgments ◽  
Victim Blaming ◽  
High Prevalence ◽  
Different Types ◽  
The Impact ◽  
Insight Into

This article explores the impact of online crime victimisation. A literature review and 41 interviews – 19 with victims and 22 with experts – were carried out to gain insight into this. The interviews show that most impacts of online offences correspond to the impacts of traditional offline offences. There are also differences with offline crime victimisation. Several forms of impact seem to be specific to victims of online crime: the substantial scale and visibility of victimhood, victimisation that does not stop in time, the interwovenness of online and offline, and victim blaming. Victims suffer from double, triple or even quadruple hits; it is the accumulation of different types of impact, enforced by the limitlessness in time and space, which makes online crime victimisation so extremely invasive. Furthermore, the characteristics of online crime victimisation greatly complicate the fight against and prevention of online crime. Finally, the high prevalence of cybercrime victimisation combined with the severe impact of these crimes seems contradictory with public opinion – and associated moral judgments – on victims. Further research into the dominant public discourse on victimisation and how this affects the functioning of the police and victim support would be valuable.

scholarly journals The RATIONS (Reducing Activation of Tuberculosis by Improvement of Nutritional Status) study: a cluster randomised trial of nutritional support (food rations) to reduce TB incidence in household contacts of patients with microbiologically confirmed pulmonary tuberculosis in communities with a high prevalence of undernutrition, Jharkhand, India

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e047210
Author(s):  
Anurag Bhargava ◽  
Madhavi Bhargava ◽  
Banurekha Velayutham ◽  
Kannan Thiruvengadam ◽  
Basilea Watson ◽  
...  
Keyword(s):  
Risk Factor ◽  
Nutritional Status ◽  
G Proteins ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Household Contacts ◽  
Cluster Randomised ◽  
High Prevalence ◽  
Secondary Outcomes ◽  
The Impact

IntroductionIndia has the largest burden of cases and deaths related to tuberculosis (TB). Undernutrition is the leading risk factor accounting for TB incidence, while severe undernutrition is a common risk factor for mortality in patients with TB in India. The impact of nutritional supplementation on TB incidence is unknown, while few underpowered studies have assessed its impact on TB mortality. We designed an open-label, field-based cluster randomised trial to assess the impact of nutritional supplementation (with food rations) on TB incidence in a group at higher risk of TB infection and disease, viz household contacts (HHC) of patients with microbiologically confirmed pulmonary TB (PTB) in Jharkhand, a state with a high prevalence of undernutrition.Methods and analysisWe shall enrol 2800 adult patients with PTB of the national TB programme, across 28 treatment units in 4 districts, and their approximately 11 200 eligible contacts. The sample size has 80% power to detect the primary outcome of 50% reduction in incidence of active TB in HHC over 2 years of follow-up. Patients and HHC in both the arms will undergo nutritional assessment and counselling. Patients will receive monthly food rations (supplying 1200 kcal and 52 g proteins/day) and multivitamins along with antitubercular treatment. The HHC in the intervention arm will receive food rations (supplying 750 kcal and 23 g proteins/day) and multivitamins while HHC in control arm will be on usual diet. The secondary outcomes in HHC will include effects on nutritional status, non-TB infections. Secondary outcomes in patients are effects on TB mortality, adherence, adverse effects, nutritional and performance status. Substudies will examine micronutrient status and effects on dietary intake, body composition, muscle strength and immune function.Ethics and disseminationThe institutional ethics committee of ICMR-NIRT, Chennai, approved the study (289/NIRT-IEC/2018). The results will be disseminated in publications and presentations.Trial registration numberClinical Trial Registry of India: CTRI/2019/08/020490.

Computational Analysis of Olfactory Airspace in Patients With Unilateral Cleft Lip Nasal Deformity

2020 ◽  
pp. 105566562098275
Author(s):  
Reanna Shah ◽  
Jeffrey R. Marcus ◽  
Dennis O. Frank-Ito
Keyword(s):  
Cleft Lip ◽  
Computational Analysis ◽  
Normal Subjects ◽  
Nasal Deformity ◽  
Normal Anatomy ◽  
3 Dimensional ◽  
Computed Tomography Images ◽  
High Prevalence ◽  
Dimensional Reconstruction ◽  
The Impact

Objectives: To evaluate the magnitude of olfactory recess opacity in patients with unilateral cleft lip nasal deformity (uCLND). Design: Subject-specific 3-dimensional reconstruction of the nasal airway anatomy was created from computed tomography images in 11 (4 males and 7 females) subjects with uCLND and 7 (3 males, and 4 females) normal subjects. The volume and surface area of each subject’s unilateral and bilateral olfactory airspace was quantified to assess the impact of opacification. Qualitatively speaking, patients with 75% to 100% olfactory recess opacification were classified as extreme, 50% to 75% as severe, 25% to 50% as moderate, and 0% to 25% as mild. Results: Of the 11 subjects with uCLND, 5 (45%) were classified as having extreme olfactory recess opacification, 3 (27%) subjects had severe opacification, and 3 (27%) subjects had moderate opacification. Mean (±SD) bilateral olfactory recess volume was significantly greater in normal subjects than in subjects with uCLND (0.9668 cm3 ± 0.4061 cm3 vs 0.3426 cm3 ± 0.1316 cm3; P < .001). Furthermore, unilateral olfactory airspace volumes for the cleft and non-cleft sides in subjects with uCLND were considerably less than unilateral olfactory volume in subjects with normal anatomy (uCLND cleft side = 0.1623 cm3 ± 0.0933 cm3; uCLND non-cleft side = 0.1803 cm3 ± 0.0938 cm3; normal = 0.4834 cm3 ± 0.2328 cm3; P < .001). Conclusions: Our findings indicate a high prevalence of olfactory recess opacification among subjects with uCLND when compared to subjects with normal anatomy. The majority of subjects with uCLND had extreme olfactory recess opacity, which will likely influence their sense of smell.

scholarly journals Impact of On-Farm Interventions against CTX-Resistant Escherichia coli on the Contamination of Carcasses before and during an Experimental Slaughter

Antibiotics ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 228
Author(s):  
Michaela Projahn ◽  
Jana Sachsenroeder ◽  
Guido Correia-Carreira ◽  
Evelyne Becker ◽  
Annett Martin ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Broiler Chickens ◽  
Stocking Density ◽  
Resistant Bacteria ◽  
Control Group ◽  
Cross Contamination ◽  
High Prevalence ◽  
On Farm ◽  
The Impact ◽  
Slow Growing

Cefotaxime (CTX)-resistant Enterobacteriaceae are still an ongoing challenge in human and veterinary health. High prevalence of these resistant bacteria is detected in broiler chickens and the prevention of their dissemination along the production pyramid is of major concern. The impact of certain on-farm interventions on the external bacterial contamination of broiler chickens, as well as their influence on single processing steps and (cross-) contamination, have not yet been evaluated. Therefore, we investigated breast skin swab samples of broiler chickens before and during slaughter at an experimental slaughter facility. Broiler chickens were previously challenged with CTX-resistant Escherichia coli strains in a seeder-bird model and subjected to none (control group (CG)) or four different on-farm interventions: drinking water supplementation based on organic acids (DW), slow growing breed Rowan × Ranger (RR), reduced stocking density (25 kg/sqm) and competitive exclusion with Enterobacteriales strain IHIT36098(CE). Chickens of RR, 25 kg/sqm, and CE showed significant reductions of the external contamination compared to CG. The evaluation of a visual scoring system indicated that wet and dirty broiler chickens are more likely a vehicle for the dissemination of CTX-resistant and total Enterobacteriaceae into the slaughterhouses and contribute to higher rates of (cross-) contamination during processing.

scholarly journals The effects of non-pharmaceutical interventions on SARS-CoV-2 transmission in different socioeconomic populations in Kuwait: a modeling study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fatima Khadadah ◽  
Abdullah A. Al-Shammari ◽  
Ahmad Alhashemi ◽  
Dari Alhuwail ◽  
Bader Al-Saif ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Reproduction Number ◽  
Transmission Model ◽  
Socioeconomic Groups ◽  
Before And After ◽  
Cross Transmission ◽  
Community Transmission ◽  
The Impact ◽  
Pharmaceutical Interventions ◽  
The Basic Reproduction Number

Abstract Background Aggressive non-pharmaceutical interventions (NPIs) may reduce transmission of SARS-CoV-2. The extent to which these interventions are successful in stopping the spread have not been characterized in countries with distinct socioeconomic groups. We compared the effects of a partial lockdown on disease transmission among Kuwaitis (P1) and non-Kuwaitis (P2) living in Kuwait. Methods We fit a modified metapopulation SEIR transmission model to reported cases stratified by two groups to estimate the impact of a partial lockdown on the effective reproduction number ($$ {\mathcal{R}}_e $$ R e ). We estimated the basic reproduction number ($$ {\mathcal{R}}_0 $$ R 0 ) for the transmission in each group and simulated the potential trajectories of an outbreak from the first recorded case of community transmission until 12 days after the partial lockdown. We estimated $$ {\mathcal{R}}_e $$ R e values of both groups before and after the partial curfew, simulated the effect of these values on the epidemic curves and explored a range of cross-transmission scenarios. Results We estimate $$ {\mathcal{R}}_e $$ R e at 1·08 (95% CI: 1·00–1·26) for P1 and 2·36 (2·03–2·71) for P2. On March 22nd, $$ {\mathcal{R}}_e $$ R e for P1 and P2 are estimated at 1·19 (1·04–1·34) and 1·75 (1·26–2·11) respectively. After the partial curfew had taken effect, $$ {\mathcal{R}}_e $$ R e for P1 dropped modestly to 1·05 (0·82–1·26) but almost doubled for P2 to 2·89 (2·30–3·70). Our simulated epidemic trajectories show that the partial curfew measure greatly reduced and delayed the height of the peak in P1, yet significantly elevated and hastened the peak in P2. Modest cross-transmission between P1 and P2 greatly elevated the height of the peak in P1 and brought it forward in time closer to the peak of P2. Conclusion Our results indicate and quantify how the same lockdown intervention can accentuate disease transmission in some subpopulations while potentially controlling it in others. Any such control may further become compromised in the presence of cross-transmission between subpopulations. Future interventions and policies need to be sensitive to socioeconomic and health disparities.

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