scholarly journals Common-Source Outbreak of Hepatitis A in an Indian Himalayan Mountain Camp

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Mangalesh Sridhar ◽  
Inam Danish Khan ◽  
Rahul Jain ◽  
Rahul Pandey ◽  
Sachin Srivastava ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Clinical Features ◽  
Hepatitis A ◽  
The United States ◽  
Mountain Stream ◽  
Common Source ◽  
Standard Case ◽  
Epidemic Curve ◽  
Himalayan Mountain

Background: Hepatitis A is an emerging public health problem worldwide, with alerts issued in developed countries, although it remains under-reported, under-diagnosed, and under-investigated in the developing world. Prolonged epidemics can occur due to person-to-person transmission. The ongoing outbreak of hepatitis A reported in the United States is one of its largest-ever outbreaks of the disease. A public health emergency for hepatitis A was declared in Florida, with over 2000 cases across several regions of The United States, in the year 2019. Methods: The outbreak investigation was carried out on 30 travelers in an Indian Himalayan mountain camp. Clinical features were correlated with laboratory parameters for establishing diagnosis by standard case definition. Line listing and epidemic curve were plotted to corroborate outbreak variables. Clinicodemographic, clinical, laboratory, and outbreak variables were descriptively analyzed. Results: Most of the 30 patients with hepatitis A were young male patients within the age range of 20 - 30 years. The most common clinical features among the case-patients were anorexia and vomiting. The epidemic curve revealed a peak of 15 case-patients from June 22 to July 5, 2019. Liver function tests showed mild derangement in all the case-patients. All the patients required hospitalization, with a mean duration of hospital stay reported as 11.86 ± 2.53 days. All the patients fully recovered with no fatalities. Conclusions: Hepatitis A outbreaks can occur through the consumption of untreated mountain stream/river water due to upstream contamination with human/animal excrements. Strengthening surveillance systems, traveler education, vaccination, and intersectoral coordination for safe water supply remains a necessary public health measure.

scholarly journals Public Health Impact and Cost-Effectiveness of Hepatitis A Vaccination in the United States: A Disease Transmission Dynamic Modeling Approach

2015 ◽  
Vol 18 (4) ◽  
pp. 358-367 ◽  
Author(s):  
Praveen Dhankhar ◽  
Chizoba Nwankwo ◽  
Matthew Pillsbury ◽  
Andreas Lauschke ◽  
Michelle G. Goveia ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Cost Effectiveness ◽  
Dynamic Modeling ◽  
Disease Transmission ◽  
Hepatitis A ◽  
Health Impact ◽  
The United States ◽  
Public Health Impact ◽  
Transmission Dynamic

scholarly journals LB10. Changing Epidemiology of Hepatitis A Virus Infections–– United States, 2007–2017

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S762-S763
Author(s):  
Monique Foster ◽  
Megan Hofmeister ◽  
Shaoman Yin ◽  
Paul Weidle
Keyword(s):  
United States ◽  
Clinical Data ◽  
Hepatitis A ◽  
Hepatitis A Virus ◽  
The United States ◽  
Risk Exposure ◽  
Common Source ◽  
Outbreak Response ◽  
Exposure Data ◽  
Response Team

Abstract Background Hepatitis A virus (HAV) is primarily spread fecal-orally and causes acute illness including fever, jaundice, and diarrhea. After introduction and widespread use of the hepatitis A vaccine in the United States, infection with HAV decreased and outbreaks typically associated with a common-source were uncommon. Method CDC receives reports of hepatitis A infections from states through the National Notifiable Disease Surveillance System (NNDSS) and/or directly to the viral hepatitis outbreak response team. We analyzed NNDSS hepatitis A data for 2007–2016, and a combination of NNDSS data and cases directly reported to the CDC hepatitis A outbreak response team during 2017; excluding 2017 NNDSS data from the four states that directly reported outbreaks to the outbreak response team to eliminate the potential for double-counting cases. Result During 2007–2011, a total of 10,619 hepatitis A cases were reported; 521 (5%) were associated with outbreaks. Of the 274 outbreak-associated cases for whom clinical data were reported, 102 (37%) were hospitalized and one (0.3%) died. Of the 407 outbreak-associated cases for whom risk exposure data were reported, 210 (52%) were associated with a common source. Comparatively, during 2012–2017, a total of 11,483 hepatitis A cases were reported; 2,323 (20%) were associated with outbreaks. Of the outbreak-associated cases for whom clinical data were reported, 1,306/2,162 (60%) were hospitalized and 43/2,178 (2%) died. Of the outbreak-associated cases for whom risk exposure data were reported, 379/2,188 (17%) were associated with a common source. Conclusion In the United States, outbreaks of hepatitis A infections in the decade prior to 2017 were infrequent and typically associated with a common source. Reported cases associated with hepatitis A outbreaks are increasing, along with concurrent increases in hospitalizations and deaths among persons with outbreak-associated infections. Recent outbreaks indicate a decrease in cases associated with a common-source exposure. Decreasing the susceptible population through adherence to childhood vaccination recommendations and targeted vaccination of recommended at-risk groups can prevent future hepatitis A outbreaks of any transmission pattern. Disclosures All authors: No reported disclosures.

scholarly journals 745. Surveillance for Oseltamivir-Resistant Influenza A(H1N1)pdm09 Virus Infections During 2016–2017 and 2017–2018, United States

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S267-S268 ◽  
Author(s):  
Sarah Spencer ◽  
Ha Nguyen ◽  
Anwar Abd Elal ◽  
Jennifer Laplante ◽  
Kirsten St George ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Influenza A ◽  
Clinical Care ◽  
The United States ◽  
Virus Infections ◽  
Standard Case ◽  
Oseltamivir Resistance ◽  
Specimen Collection ◽  
Influenza A H1n1

Abstract Background Three neuraminidase inhibitors (NAIs) are approved and recommended for treatment of influenza in the United States; however, antiviral resistance can emerge during or after treatment, and sporadic resistant viruses unrelated to NAI exposure may occur, especially in influenza A(H1N1)pdm09 viruses. Limited transmission of oseltamivir-resistant A(H1N1)pdm09 viruses between persons has also occurred. Oseltamivir resistance is most commonly caused by an H275Y substitution in the neuraminidase (NA). We describe findings from surveillance for oseltamivir-resistant A(H1N1)pdm09 viruses. Methods The CDC requested state public health laboratories to submit up to eight viruses (two of each subtype/lineage) every 2 weeks for virus sequencing and NA inhibition assay testing; up to five additional A(H1N1)pdm09 clinical specimens were requested for H275Y pyrosequencing. NA sequencing and functional phenotypic NA inhibition assays were performed on drug-resistant virus isolates. A standard case form was collected on persons infected with oseltamivir-resistant viruses. Results From October 1, 16 to April 18, 18, 1,368 A(H1N1)pdm09 viruses were tested (median 89 specimens, range 20–328, tested/month during the influenza season). Overall, 12 (~0.9%) oseltamivir-resistant A(H1N1)pdm09 viruses were detected from nine states; all contained H275Y in the NA. All viruses were also resistant to peramivir, but none to zanamivir. The 12 patients had a median age of 34 years (range, 2 months–69 years). Eight (67%) had an immunosuppressive condition. Six (50%) reported no exposure to NAIs before specimen collection, two were taking oseltamivir (for 1 and 20 days) at the time of specimen collection, and antiviral receipt was unknown for 4. Three (23%) patients were hospitalized; there were no deaths. Conclusion During the 2016–2017 and 2017–2018 influenza seasons, influenza A(H1N1)pdm09 viruses resistant to both oseltamivir and peramivir were infrequently detected; all retained susceptibility to zanamivir. Among those with available information, half had no exposure to oseltamivir. Viruses harboring H275Y continue to circulate at low levels in the community. Ongoing surveillance for trends in oseltamivir- and peramivir-resistant A(H1N1)pdm09 is critical to inform clinical care and public health policies. Disclosures All authors: No reported disclosures.

Can increases in Twitter posts predict increases in cumulative incidence of COVID-19 in the United States? Evidence that social media can inform epidemic surveillance. (Preprint)

2020 ◽  
Author(s):  
Ruoyan Sun ◽  
Henna Budhwani
Keyword(s):  
Public Health ◽  
United States ◽  
Cumulative Incidence ◽  
Hot Spots ◽  
Adult Population ◽  
State Level ◽  
The United States ◽  
Education Attainment ◽  
Public Health Systems ◽  
Per Capita

BACKGROUND Though public health systems are responding rapidly to the COVID-19 pandemic, outcomes from publicly available, crowd-sourced big data may assist in helping to identify hot spots, prioritize equipment allocation and staffing, while also informing health policy related to “shelter in place” and social distancing recommendations. OBJECTIVE To assess if the rising state-level prevalence of COVID-19 related posts on Twitter (tweets) is predictive of state-level cumulative COVID-19 incidence after controlling for socio-economic characteristics. METHODS We identified extracted COVID-19 related tweets from January 21st to March 7th (2020) across all 50 states (N = 7,427,057). Tweets were combined with state-level characteristics and confirmed COVID-19 cases to determine the association between public commentary and cumulative incidence. RESULTS The cumulative incidence of COVID-19 cases varied significantly across states. Ratio of tweet increase (p=0.03), number of physicians per 1,000 population (p=0.01), education attainment (p=0.006), income per capita (p = 0.002), and percentage of adult population (p=0.003) were positively associated with cumulative incidence. Ratio of tweet increase was significantly associated with the logarithmic of cumulative incidence (p=0.06) with a coefficient of 0.26. CONCLUSIONS An increase in the prevalence of state-level tweets was predictive of an increase in COVID-19 diagnoses, providing evidence that Twitter can be a valuable surveillance tool for public health.

Review of form 483s and warning letters to pharmaceutical manufacturers issued by USFDA

2021 ◽  
pp. 174113432110235
Author(s):  
Chandan Saini ◽  
Ashish Miglani ◽  
Pankaj Musyuni ◽  
Geeta Aggarwal
Keyword(s):  
Public Health ◽  
United States ◽  
Regulatory Authority ◽  
The United States ◽  
Federal Law ◽  
Pharmaceutical Manufacturers ◽  
The World ◽  
Considerable Impact ◽  
A Company ◽  
Responsible Person

Regular inspections are carried out to ensure system conformity by the Food and Drugs Regulatory Authority (FDA) of the United States one of the most stringent regulatory authorities in the world. The inspectors send Form 483 to the management after the inspection, detailing the inappropriate conditions. Because the FDA guidelines are difficult to comply with, a company can contravene the regulations. If any significant infringements can affect the protection, quality, effectiveness, or public health of the drug is identified, the FDA issues advice to the company. Warning Letters (WL) shall be an official notification of non-compliance with federal law within a period to be issued by manufacturer, clinician, distributor, or responsible person in the company. The delivery of a letter has a considerable impact on the company's reputation and position in the market. Inadequate WL reactions could lead to a refusal, import denial, memorandum or even conviction and order. A brief study was conducted in this document of Form 483 and WL for four years (2017–2020) on an understanding the regulatory provisions.

Sign in / Sign up

Export Citation Format

Share Document