scholarly journals Repeated introductions and intensive community transmission fueled a mumps virus outbreak in Washington State

eLife ◽  
2021 ◽  
Vol 10 ◽  
Author(s):  
Louise H Moncla ◽  
Allison Black ◽  
Chase DeBolt ◽  
Misty Lang ◽  
Nicholas R Graff ◽  
...  
Keyword(s):  
Virus Disease ◽  
Mumps Virus ◽  
Washington State ◽  
Childhood Vaccination ◽  
Data Set ◽  
Vaccination Rates ◽  
Epidemiologic Factors ◽  
Increased Risk ◽  
Community Transmission ◽  
Virus Genomes

In 2016/2017, Washington State experienced a mumps outbreak despite high childhood vaccination rates, with cases more frequently detected among school-aged children and members of the Marshallese community. We sequenced 166 mumps virus genomes collected in Washington and other US states, and traced mumps introductions and transmission within Washington. We uncover that mumps was introduced into Washington approximately 13 times, primarily from Arkansas, sparking multiple co-circulating transmission chains. Although age and vaccination status may have impacted transmission, our data set could not quantify their precise effects. Instead, the outbreak in Washington was overwhelmingly sustained by transmission within the Marshallese community. Our findings underscore the utility of genomic data to clarify epidemiologic factors driving transmission and pinpoint contact networks as critical for mumps transmission. These results imply that contact structures and historic disparities may leave populations at increased risk for respiratory virus disease even when a vaccine is effective and widely used.

scholarly journals Repeated introductions and intensive community transmission fueled a mumps virus outbreak in Washington State

2020 ◽  
Author(s):  
Louise H. Moncla ◽  
Allison Black ◽  
Chas DeBolt ◽  
Misty Lang ◽  
Nicholas R. Graff ◽  
...  
Keyword(s):  
Genomic Data ◽  
Mumps Virus ◽  
Washington State ◽  
Vaccination Status ◽  
Childhood Vaccination ◽  
Contact Networks ◽  
Vaccination Rates ◽  
Epidemiologic Factors ◽  
School Aged Children ◽  
Community Transmission

AbstractIn 2016/2017, Washington State experienced a mumps outbreak despite high childhood vaccination rates, with cases more frequently detected among school-aged children and members of the Marshallese community. Sequencing 166 mumps genomes revealed that mumps was introduced into Washington approximately 13 times, primarily from Arkansas, sparking multiple, co-circulating transmission chains. Neither vaccination status nor age were strong determinants of transmission. Instead, the outbreak in Washington was overwhelmingly sustained by transmission within the Marshallese community. Our findings underscore the utility of genomic data to clarify epidemiologic factors driving transmission, and pinpoint contact networks as critical determinants of mumps transmission in Washington.

scholarly journals Vaccinating Children Against COVID-19 is Essential Prior to the Removal of Non-Pharmaceutical Interventions

2021 ◽  
Author(s):  
Erik Rosenstrom ◽  
Jessica A Mele ◽  
Julie Ivy ◽  
Maria Mayorga ◽  
Mehul D Patel ◽  
...  
Keyword(s):  
North Carolina ◽  
Total Population ◽  
Adult Population ◽  
Childhood Vaccination ◽  
Agent Based ◽  
Vaccination Rates ◽  
Vaccination Uptake ◽  
Community Transmission ◽  
The Impact ◽  
Child Vaccination

Objectives(s): To evaluate the joint impact of childhood vaccination rates and masking policies, in schools and workplaces, on community transmission and severe outcomes due to COVID-19. Study design: We utilized a stochastic, agent-based simulation of North Carolina, to evaluate the impact of 24 health policy decisions on overall incidence of disease, COVID-19 related hospitalization, and mortality from July 1, 2021-July 1, 2023. Results: Universal mask removal in schools in January 2022 could lead to a 38.1-47%, 27.6-36.2%, and 15.9-19.7% increase in cumulative infections for ages 5-9, 10-19, and the total population, respectively, depending on the rate of vaccination of children relative to the adult population. Additionally, without increased vaccination uptake in the adult population, a 25% increase in child vaccination uptake from 50% to 75% uptake and from 75% to 100% uptake relative to the adult population, leads to a 22% and 18% or 28% and 33% decrease in peak hospitalizations in 2022 across scenarios when masks are removed either January 1st or March 8th 2022, respectively. Increasing vaccination uptake for the entire eligible population can reduce peak hospitalizations in 2022 by an average of 89% and 92% across all masking scenarios compared to the scenarios where no children are vaccinated. Conclusion(s): High vaccination uptake among both children and adults is necessary to mitigate the increase in infections from mask removal in schools and workplaces.

scholarly journals Multivariate Tail Probabilities: Predicting Regional Pertussis Cases in Washington State

Entropy ◽  
2021 ◽  
Vol 23 (6) ◽  
pp. 675
Author(s):  
Xuze Zhang ◽  
Saumyadipta Pyne ◽  
Benjamin Kedem
Keyword(s):  
Disease Modeling ◽  
Empirical Distribution ◽  
Density Ratio ◽  
Washington State ◽  
Ratio Model ◽  
Multiple Sources ◽  
Tail Probabilities ◽  
Data Set ◽  
Density Ratio Model ◽  
Regional Prediction

In disease modeling, a key statistical problem is the estimation of lower and upper tail probabilities of health events from given data sets of small size and limited range. Assuming such constraints, we describe a computational framework for the systematic fusion of observations from multiple sources to compute tail probabilities that could not be obtained otherwise due to a lack of lower or upper tail data. The estimation of multivariate lower and upper tail probabilities from a given small reference data set that lacks complete information about such tail data is addressed in terms of pertussis case count data. Fusion of data from multiple sources in conjunction with the density ratio model is used to give probability estimates that are non-obtainable from the empirical distribution. Based on a density ratio model with variable tilts, we first present a univariate fit and, subsequently, improve it with a multivariate extension. In the multivariate analysis, we selected the best model in terms of the Akaike Information Criterion (AIC). Regional prediction, in Washington state, of the number of pertussis cases is approached by providing joint probabilities using fused data from several relatively small samples following the selected density ratio model. The model is validated by a graphical goodness-of-fit plot comparing the estimated reference distribution obtained from the fused data with that of the empirical distribution obtained from the reference sample only.

scholarly journals Adaptation of the Clinical Dementia Rating Scale for adults with Down syndrome

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Christina N. Lessov-Schlaggar ◽  
Olga L. del Rosario ◽  
John C. Morris ◽  
Beau M. Ances ◽  
Bradley L. Schlaggar ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Alzheimer Disease ◽  
Rating Scale ◽  
Assessment Instruments ◽  
Clinical Dementia Rating ◽  
Data Set ◽  
Cognitive Domains ◽  
Increased Risk ◽  
Caregiver Questionnaire ◽  
Raven's Progressive Matrices

Abstract Background Adults with Down syndrome (DS) are at increased risk for Alzheimer disease dementia, and there is a pressing need for the development of assessment instruments that differentiate chronic cognitive impairment, acute neuropsychiatric symptomatology, and dementia in this population of patients. Methods We adapted a widely used instrument, the Clinical Dementia Rating (CDR) Scale, which is a component of the Uniform Data Set used by all federally funded Alzheimer Disease Centers for use in adults with DS, and tested the instrument among 34 DS patients recruited from the community. The participants were assessed using two versions of the modified CDR—a caregiver questionnaire and an in-person interview involving both the caregiver and the DS adult. Assessment also included the Dementia Scale for Down Syndrome (DSDS) and the Raven’s Progressive Matrices to estimate IQ. Results Both modified questionnaire and interview instruments captured a range of cognitive impairments, a majority of which were found to be chronic when accounting for premorbid function. Two individuals in the sample were strongly suspected to have early dementia, both of whom had elevated scores on the modified CDR instruments. Among individuals rated as having no dementia based on the DSDS, about half showed subthreshold impairments on the modified CDR instruments; there was substantial agreement between caregiver questionnaire screening and in-person interview of caregivers and DS adults. Conclusions The modified questionnaire and interview instruments capture a range of impairment in DS adults, including subthreshold symptomatology, and the instruments provide complementary information relevant to the ascertainment of dementia in DS. Decline was seen across all cognitive domains and was generally positively related to age and negatively related to IQ. Most importantly, adjusting instrument scores for chronic, premorbid impairment drastically shifted the distribution toward lower (no impairment) scores.

scholarly journals Altitude and risk of sudden unexpected infant death in the United States

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Richard Johnston ◽  
Xiaohan Yan ◽  
Tatiana M. Anderson ◽  
Edwin A. Mitchell
Keyword(s):  
United States ◽  
Logistic Regression ◽  
Infant Death ◽  
The United States ◽  
Sudden Infant ◽  
Data Set ◽  
Live Births ◽  
Sudden Unexpected Infant Death ◽  
Increased Risk ◽  
Unexpected Infant Death

AbstractThe effect of altitude on the risk of sudden infant death syndrome (SIDS) has been reported previously, but with conflicting findings. We aimed to examine whether the risk of sudden unexpected infant death (SUID) varies with altitude in the United States. Data from the Centers for Disease Control and Prevention (CDC)’s Cohort Linked Birth/Infant Death Data Set for births between 2005 and 2010 were examined. County of birth was used to estimate altitude. Logistic regression and Generalized Additive Model (GAM) were used, adjusting for year, mother’s race, Hispanic origin, marital status, age, education and smoking, father’s age and race, number of prenatal visits, plurality, live birth order, and infant’s sex, birthweight and gestation. There were 25,305,778 live births over the 6-year study period. The total number of deaths from SUID in this period were 23,673 (rate = 0.94/1000 live births). In the logistic regression model there was a small, but statistically significant, increased risk of SUID associated with birth at > 8000 feet compared with < 6000 feet (aOR = 1.93; 95% CI 1.00–3.71). The GAM showed a similar increased risk over 8000 feet, but this was not statistically significant. Only 9245 (0.037%) of mothers gave birth at > 8000 feet during the study period and 10 deaths (0.042%) were attributed to SUID. The number of SUID deaths at this altitude in the United States is very small (10 deaths in 6 years).

scholarly journals RESTING HEART RATE MODERATES THE RELATIONSHIP BETWEEN NEUROPSYCHIATRIC SYMPTOMS, MCI, AND ALZHEIMER’S DISEASE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S641-S641
Author(s):  
Shanna L Burke
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Heart Rate ◽  
Relative Risk ◽  
Neuropsychiatric Symptoms ◽  
Cognitive Status ◽  
Resting Heart Rate ◽  
Data Set ◽  
Increased Risk ◽  
The Relationship

Abstract Little is known about how resting heart rate moderates the relationship between neuropsychiatric symptoms and cognitive status. This study examined the relative risk of NPS on increasingly severe cognitive statuses and examined the extent to which resting heart rate moderates this relationship. A secondary analysis of the National Alzheimer’s Coordinating Center Uniform Data Set was undertaken, using observations from participants with normal cognition at baseline (13,470). The relative risk of diagnosis with a more severe cognitive status at a future visit was examined using log-binomial regression for each neuropsychiatric symptom. The moderating effect of resting heart rate among those who are later diagnosed with mild cognitive impairment (MCI) or Alzheimer’s disease (AD) was assessed. Delusions, hallucinations, agitation, depression, anxiety, elation, apathy, disinhibition, irritability, motor disturbance, nighttime behaviors, and appetite disturbance were all significantly associated (p&lt;.001) with an increased risk of AD, and a reduced risk of MCI. Resting heart rate increased the risk of AD but reduced the relative risk of MCI. Depression significantly interacted with resting heart rate to increase the relative risk of MCI (RR: 1.07 (95% CI: 1.00-1.01), p&lt;.001), but not AD. Neuropsychiatric symptoms increase the relative risk of AD but not MCI, which may mean that the deleterious effect of NPS is delayed until later and more severe stages of the disease course. Resting heart rate increases the relative risk of MCI among those with depression. Practitioners considering early intervention in neuropsychiatric symptomology may consider the downstream benefits of treatment considering the long-term effects of NPS.

Influence of tranexamic acid use on venous thromboembolism risk in patients undergoing surgery for spine tumors

2021 ◽  
pp. 1-11
Author(s):  
Zach Pennington ◽  
Jeff Ehresman ◽  
Andrew Schilling ◽  
James Feghali ◽  
Andrew M. Hersh ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Tranexamic Acid ◽  
Vertebral Column ◽  
Comprehensive Cancer Center ◽  
Primary Study ◽  
High Dose ◽  
Data Set ◽  
Web Based ◽  
Spine Tumors ◽  
Increased Risk

OBJECTIVE Patients with spine tumors are at increased risk for both hemorrhage and venous thromboembolism (VTE). Tranexamic acid (TXA) has been advanced as a potential intervention to reduce intraoperative blood loss in this surgical population, but many fear it is associated with increased VTE risk due to the hypercoagulability noted in malignancy. In this study, the authors aimed to 1) develop a clinical calculator for postoperative VTE risk in the population with spine tumors, and 2) investigate the association of intraoperative TXA use and postoperative VTE. METHODS A retrospective data set from a comprehensive cancer center was reviewed for adult patients treated for vertebral column tumors. Data were collected on surgery performed, patient demographics and medical comorbidities, VTE prophylaxis measures, and TXA use. TXA use was classified as high-dose (≥ 20 mg/kg) or low-dose (< 20 mg/kg). The primary study outcome was VTE occurrence prior to discharge. Secondary outcomes were deep venous thrombosis (DVT) or pulmonary embolism (PE). Multivariable logistic regression was used to identify independent risk factors for VTE and the resultant model was deployed as a web-based calculator. RESULTS Three hundred fifty patients were included. The mean patient age was 57 years, 53% of patients were male, and 67% of surgeries were performed for spinal metastases. TXA use was not associated with increased VTE (14.3% vs 10.1%, p = 0.37). After multivariable analysis, VTE was independently predicted by lower serum albumin (odds ratio [OR] 0.42 per g/dl, 95% confidence interval [CI] 0.23–0.79, p = 0.007), larger mean corpuscular volume (OR 0.91 per fl, 95% CI 0.84–0.99, p = 0.035), and history of prior VTE (OR 2.60, 95% CI 1.53–4.40, p < 0.001). Longer surgery duration approached significance and was included in the final model. Although TXA was not independently associated with the primary outcome of VTE, high-dose TXA use was associated with increased odds of both DVT and PE. The VTE model showed a fair fit of the data with an area under the curve of 0.77. CONCLUSIONS In the present cohort of patients treated for vertebral column tumors, TXA was not associated with increased VTE risk, although high-dose TXA (≥ 20 mg/kg) was associated with increased odds of DVT or PE. Additionally, the web-based clinical calculator of VTE risk presented here may prove useful in counseling patients preoperatively about their individualized VTE risk.

scholarly journals Epidemiology and Outcomes of Nontyphoidal Salmonella Bacteremias from England, 2004 to 2015

2018 ◽  
Vol 57 (1) ◽  
Author(s):  
Shannon Katiyo ◽  
Berit Muller-Pebody ◽  
Mehdi Minaji ◽  
David Powell ◽  
Alan P. Johnson ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
High Morbidity ◽  
First Line ◽  
Data Set ◽  
Content Type ◽  
Increased Risk ◽  
Resistance Patterns ◽  
Prolonged Hospital ◽  
Antibiotic Resistance Patterns ◽  
Emergence Of Resistance

ABSTRACT Nontyphoidal Salmonella (NTS) bacteremia causes hospitalization and high morbidity and mortality. We linked Gastrointestinal Bacteria Reference Unit (GBRU) data to the Hospital Episode Statistics (HES) data set to study the trends and outcomes of NTS bacteremias in England between 2004 and 2015. All confirmed NTS isolates from blood from England submitted to GBRU between 1 January 2004 and 31 December 2015 were deterministically linked to HES records. Adjusted odds ratios (AOR), proportions, and confidence intervals (CI) were calculated to describe differences in age, sex, antibiotic resistance patterns, and serotypes over time. Males, neonates, and adults above 65 years were more likely to have NTS bacteremia (AOR, 1.54 [95% CI, 1.46 to 1.67]; 2.57 [95% CI, 1.43 to 4.60]; and 3.56 [95% CI, 3.25 to 3.90], respectively). Proportions of bacteremia increased from 1.41% in 2004 to 2.67% in 2015. Thirty-four percent of all blood isolates were resistant to a first-line antibiotic, and 1,397 (56%) blood isolates were linked to an HES record. Of the patients with NTS bacteremia, 969 (69%) had a cardiovascular condition and 155 (12%) patients died, out of which 120 (77%) patients were age 65 years and above. NTS bacteremia mainly affects older people with comorbidities placing them at increased risk of prolonged hospital stay and death. Resistance of invasive NTS to first-line antimicrobial agents appeared to be stable in England, but the emergence of resistance to last-resort antibiotics, such as colistin, requires careful monitoring.

scholarly journals Utility of intraoperative electromyography in placing C7 pedicle screws

2020 ◽  
Vol 32 (6) ◽  
pp. 891-899 ◽  
Author(s):  
Jonathan J. Rasouli ◽  
Brooke T. Kennamer ◽  
Frank M. Moore ◽  
Alfred Steinberger ◽  
Kevin C. Yao ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Pedicle Screw ◽  
Thoracolumbar Spine ◽  
Pedicle Screws ◽  
Neurological Injury ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Data Set ◽  
Subaxial Cervical Spine ◽  
Increased Risk

OBJECTIVEThe C7 vertebral body is morphometrically unique; it represents the transition from the subaxial cervical spine to the upper thoracic spine. It has larger pedicles but relatively small lateral masses compared to other levels of the subaxial cervical spine. Although the biomechanical properties of C7 pedicle screws are superior to those of lateral mass screws, they are rarely placed due to increased risk of neurological injury. Although pedicle screw stimulation has been shown to be safe and effective in determining satisfactory screw placement in the thoracolumbar spine, there are few studies determining its utility in the cervical spine. Thus, the purpose of this study was to determine the feasibility, clinical reliability, and threshold characteristics of intraoperative evoked electromyographic (EMG) stimulation in determining satisfactory pedicle screw placement at C7.METHODSThe authors retrospectively reviewed a prospectively collected data set. All adult patients who underwent posterior cervical decompression and fusion with placement of C7 pedicle screws at the authors’ institution between January 2015 and March 2019 were identified. Demographic, clinical, neurophysiological, operative, and radiographic data were gathered. All patients underwent postoperative CT scanning, and the position of C7 pedicle screws was compared to intraoperative neurophysiological data.RESULTSFifty-one consecutive C7 pedicle screws were stimulated and recorded intraoperatively in 25 consecutive patients. Based on EMG findings, 1 patient underwent intraoperative repositioning of a C7 pedicle screw, and 1 underwent removal of a C7 pedicle screw. CT scans demonstrated ideal placement of the C7 pedicle screw in 40 of 43 instances in which EMG stimulation thresholds were > 15 mA. In the remaining 3 cases the trajectories were suboptimal but safe. When the screw stimulation thresholds were between 11 and 15 mA, 5 of 6 screws were suboptimal but safe, and in 1 instance was potentially dangerous. In instances in which the screw stimulated at thresholds ≤ 10 mA, all trajectories were potentially dangerous with neural compression.CONCLUSIONSIdeal C7 pedicle screw position strongly correlated with EMG stimulation thresholds > 15 mA. In instances, in which the screw stimulates at values between 11 and 15 mA, screw trajectory exploration is recommended. Screws with thresholds ≤ 10 mA should always be explored, and possibly repositioned or removed. In conjunction with other techniques, EMG threshold testing is a useful and safe modality in determining appropriate C7 pedicle screw placement.

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