16 July 2015

NACDD Now Accepting Applications for the 2015-2016 Epidemiology Mentoring Program

Applications are now being accepted for the Centers for Disease Control and Prevention and National Association of Chronic Disease Directors 2015-2016 National Mentorship Program in Applied Chronic Disease Epidemiology cohort. 
The goals of the Mentorship Program are to:
·    enlarge the pool of trained chronic disease epidemiologists at public health agencies,
·    improve the practice of chronic disease epidemiology; and
·    increase the epidemiological science in chronic disease programs and policies.
NACDD will select up to nine newly-hired (less than one year) and junior-level epidemiologists from state, tribal, local and territorial health departments.  Interested applicants must select a project that will serve as the focus of their mentorship.  
NACDD is also accepting resumes or curricula vitae from senior chronic disease epidemiologists and senior-level epidemiologists with substantial experience in applied chronic disease epidemiology.  Mentors will receive a $5,000 stipend and travel support to complete a mentor site visit.  Anyone interested in serving as a mentor must be able to enter into a contractual agreement with NACDD to receive the stipend. 
The mentoring program will begin in August 2015 and continue until June 30, 2016.  Program participants will receive travel support to attend the 16th annual Council of State and Territorial Epidemiologists Conference, June 19-23, 2016, in Anchorage, Alaska.    To Apply:
Mentee: Send completed mentee application, letters of support and required documents to nmccoy@chronicdisease.org
Mentor: Send cover letter and most recent resume or curriculum vitae to nmccoy@chronicdisease.org.   Address all letters to John Robitscher, MPH, Chief Executive Officer, National Association of Chronic Disease Directors, ATTN: Epidemiology Mentoring Program, 2200 Century Parkway, Suite 250, Atlanta, GA, 30345.  
NACDD must receive all applications and resumes by midnight, local time, on Friday, August 14, 2015.
Application and supporting documents attached.  Information on the CDC-NACDD National Mentorship in Applied Chronic Disease Epidemiology can be accessed online at http://www.chronicdisease.org/members/group_content_view.asp?group=128220&id=321462. 

Access official application announcement online at http://www.chronicdisease.org/forums/Posts.aspx?topic=1127936&page=1#post_1127936. 



The CDC and NACDD National Mentorship Program in Applied Chronic Disease Epidemiology serves to enhance state and local capacity through networking and professional development opportunities.  This program is supported by a cooperative agreement from the Centers for Disease Control and Prevention's Division of Population Health.
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15 July 2015

Research Committee Selected Articles of the Week, July 13, 2015

Articles from July_06_2015

Research Committee Selected Articles for the Week of July_06_2015


  • Jiang L., Lee V.J., Lim W.Y., Chen M.I., Chen Y., Tan L., Lin R.T., Leo Y.S., Barr I., Cook A.R. Performance of case definitions for influenza surveillance
  • Hlavinkova L., Kristufkova Z., Mikas J. Risk factors for severe outcome of cases with pandemic influenza A(H1N1)pdm09
  • Barde P.V., Shukla M.K., Kori B.K., Chand G., Jain L., Varun B.M., Dutta D., Baruah K., Singh N. Emergence of dengue in tribal villages of Mandla district, Madhya Pradesh, India
  • Davila-Torres J., Chowell G., Borja-Aburto V.H., Viboud C., Grajalez-Muniz C., Miller M.A. Intense seasonal A/H1N1 influenza in Mexico, winter 2013-2014 ★
  • Boggild A.K., Esposito D.H., Kozarsky P.E., Ansdell V., Beeching N.J., Campion D., Castelli F., Caum Differential diagnosis of illness in travelers arriving from sierra Leone, Liberia, or guinea: A cross-sectional study from the Geosentinel surveillance network
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    The movement pattern of horses around race meetings in New Zealand


    In order to describe the implications of racehorse movement on the potential spread and control of infectious disease in New Zealand, the movement of horses due to regular racing activities needed to be quantified. Race meeting, trainer and starter data we re collected in 2009 from the governing bodies for the two racing codes in New Zealand; Harness Racing New Zealand and New Zealand Thoroughbred Racing. During 2009, 507 Thoroughbred and 506 Standardbred race meetings were held. A random selection of 42 Sta ndardbred and 39 Thoroughbred race meetings were taken from all race meetings held in 2009 and the distances travelled by trainers to these race meetings were determined. The trainers attending selected race meetings represented 50% (1135/2287) of all regi stered trainers in 2009. There was no seasonal pattern of when race meetings were held between racing codes (P ? 0.18) or by race type (P ? 0.83). There were significant differences in the distance travelled by trainers to race meetings, by racing code (P < 0.001). Thoroughbred trainers travelled a median of 91 km (IQR 40-203 km), while Standardbred trainers travelled a median of 45 km (IQR 24-113 km) (P < 0.001). Within each racing code, trainers travelled further to attend premier races than other types o f race meetings (P < 0.001). These data demonstrate there is higher potential for more widespread disease dissemination from premier race meetings compared with other types of race meetings. Additionally, lack of a seasonal pattern indicates that a widespr ead outbreak could occur at any time of the year. Widespread disease dissemination would increase the logistic effort required for effective infectious disease control and has the potential to increase the time required to achieve control. © CSIRO 2015.
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    Performance of case definitions for influenza surveillance


    Influenza-like illness (ILI) case definitions, such as those from the European Centre for Disease Control and Prevention, World Health Organization (WHO) and United States Centers for Disease Control and Prevention, are commonly used for influenza surveill ance. We assessed how various case definitions performed during the initial wave of influenza A(H1N1 pdm09 infections in Singapore on a cohort of 727 patients with two to three blood samples and whose symptoms were reviewed fortnightly from June to October 2009. Using seroconversion (? 4-fold rise) to A/California/7/2009 (H1N1), we identified 36 presumptive influenza A(H1N1)pdm09 episodes and 664 episodes unrelated to influenza A(H1N1)pdm09. Cough, fever and headache occurred more commonly in presumptive in fluenza A(H1N1)pdm09. Although the sensitivity was low (36%), the recently revised WHO ILI case definition gave a higher positive predictive value (42%) and positive likelihood ratio (13.3) than the other case definitions. Results including only episodes w ith primary care consultations were similar. Individuals who worked or had episodes with fever, cough or sore throat were more likely to consult a physician, while episodes with Saturday onset were less likely, with some consultations skipped or postponed. Our analysis supports the use of the revised WHO ILI case definition,which includes only cough in the presence of fever defined as body temperature ?38 °C for influenza surveillance. © 2015 European Centre for Disease Prevention and Control (ECDC). All ri ghts reserved.
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    Risk factors for severe outcome of cases with pandemic influenza A(H1N1)pdm09


    OBJECTIVES: The aim of this study is to describe demographic, clinical and epidemiological characteristics of cases with laboratory-confirmed pandemic influenza virus A(H1N1)pdm09 reported in Slovakia from May 28, 2009 to December 30, 2009 and analyse the association between risk factors and severe outcome of these cases. BACKGROUND: In the spring of 2009, an outbreak of a pandemic influenza virus A(H1N1)pdm09, emerged in Mexico and spread globally. Until December 2009, 1,014 cases were notified in Slovakia . METHODS: The data were collected within national influenza surveillance system. Odds ratios (95% CI) were calculated. Associations were found to be significantly associated with the worse outcome (p < 0.05) in the univariate analysis and were adjusted fo r possible effects of age and sex by using a logistic regression model. RESULTS: Out of the total number of 1,014 cases, 131 (12.9 %) cases were hospitalized, and 43 (4.2 %) of those were admitted to intensive care units. During the reporting period, 38 de aths were reported, representing a case fatality rate of 3.75 %. The median age of severe cases (35 years, IQR = 29 y) was significantly higher than the median age of mild cases (24 years, IQR = 19 y; p < 0.001). By using a logistic regression, we found ou t that chronic obstructive pulmonary disease (COPD) (aOR = 9.2; 95%CI: 1.42-59.98), cardiovascular diseases (aOR = 14.97; 95%CI: 5.49-40.79), malignity (aOR = 7.6; 95%CI: 1.95-29.37) and gravidity (aOR = 55.21; 95% CI: 14.40-211.58) were significantly asso ciated with severe outcomes of the cases. CONCLUSION: The fact, that 35% of severely ill patients did not report any risk factor suggests the importance of vaccination as a prevention of influenza.
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    Emergence of dengue in tribal villages of Mandla district, Madhya Pradesh, India


    Background & objectives: Dengue (DEN) is a rapidly spreading arboviral disease transmitted by Aedes mosquitoes. Although it is endemic in India, dengue virus (DENV) infection has not been reported from tribal areas of Madhya Pradesh. Investigations were co nducted to establish the aetiology of sudden upsurge of cases with febrile illness in June 2013 from tribal villages of Mandla district of Madhya Pradesh, India. Methods: The rapid response team of the National Institute for Research in Tribal Health, Jaba lpur, conducted clinical investigations and field surveys to collect the samples from suspected cases. Samples were tested using molecular and serological tools. Collected mosquitoes were identified and tested for the presence of virus using semi nested re verse transcriptase-polymerase chain reaction (nRT-PCR). The sequences were analysed to identify serotype and genotype of the virus. Results: of the 648 samples collected from 18 villages of Mandla, 321 (49.53%) were found to be positive for dengue. The nR T-PCR and sequencing confirmed the aetiology as dengue virus type 2. Eighteen per cent of patients needed hospitalization and five deaths were attributed to dengue. The virus was also detected from Aedes aegypti mosquito, which was incriminated as a vector . Phylogenetic analysis revealed that the dengue virus 2 detected belonged to cosmopolitan genotype of the virus. Interpretation & conclusions: Dengue virus serotype 2 was detected as the aetiological agent in the outbreak in tribal villages of Mandla dist rict of Madhya Pradesh. Conducive man-made environment favouring mosquitogenic conditions and seeding of virus could be the probable reasons for this outbreak. Urgent attention is needed to control this new threat to tribal population, which is already ove rburdened with other vector borne diseases. © 2015, Indian Council of Medical Research. All rights reserved.
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    Intense seasonal A/H1N1 influenza in Mexico, winter 2013-2014


    Background and Aims: A recrudescent wave of pandemic influenza A/H1N1 affected Mexico during the winter of 2013-2014 following a mild 2012-2013 A/H3N2 influenza season. Methods: We compared the demographic and geographic characteristics of hospitalizations and inpatient deaths for severe acute respiratory infection (SARI) and laboratory-confirmed influenza during the 2013-2014 influenza season compared to previous influenza seasons, based on a large prospective surveillance system maintained by the Mexican Social Security health care system. Results: A total of 14,236 SARI hospitalizations and 1,163 inpatient deaths (8.2%) were reported between October 1, 2013 and March 31, 2014. Rates of laboratory-confirmed A/H1N1 hospitalizations and deaths were significa ntly higher among individuals aged 30-59years and lower among younger age groups for the 2013-2014 A/H1N1 season compared to the previous A/H1N1 season in 2011-2012 (?2 test, p<0 data-blogger-escaped-.001="" data-blogger-escaped-1.3-1.4="" data-blogger-escaped-2011-2012="" data-blogger-escaped-2013-2014="" data-blogger-escaped-2013-march="" data-blogger-escaped-2014="" data-blogger-escaped-2015="" data-blogger-escaped-a="" data-blogger-escaped-absence="" data-blogger-escaped-activity="" data-blogger-escaped-adults="" data-blogger-escaped-age="" data-blogger-escaped-among="" data-blogger-escaped-and="" data-blogger-escaped-antigenic="" data-blogger-escaped-at="" data-blogger-escaped-build-up="" data-blogger-escaped-but="" data-blogger-escaped-c="" data-blogger-escaped-ce="" data-blogger-escaped-change="" data-blogger-escaped-clear="" data-blogger-escaped-conclusions:="" data-blogger-escaped-deaths="" data-blogger-escaped-disease="" data-blogger-escaped-distribution="" data-blogger-escaped-documented="" data-blogger-escaped-drift="" data-blogger-escaped-during="" data-blogger-escaped-estimated="" data-blogger-escaped-for="" data-blogger-escaped-from="" data-blogger-escaped-globally="" data-blogger-escaped-gradual="" data-blogger-escaped-hospitalizations="" data-blogger-escaped-immunity="" data-blogger-escaped-imss.="" data-blogger-escaped-in2009.="" data-blogger-escaped-in="" data-blogger-escaped-increase="" data-blogger-escaped-infections="" data-blogger-escaped-influenza="" data-blogger-escaped-initial="" data-blogger-escaped-irculating="" data-blogger-escaped-line="" data-blogger-escaped-lower="" data-blogger-escaped-mexico="" data-blogger-escaped-middle-aged="" data-blogger-escaped-ntral="" data-blogger-escaped-number="" data-blogger-escaped-observed="" data-blogger-escaped-october="" data-blogger-escaped-of="" data-blogger-escaped-pandemic="" data-blogger-escaped-pandemics.="" data-blogger-escaped-past="" data-blogger-escaped-period="" data-blogger-escaped-populations="" data-blogger-escaped-post-2009="" data-blogger-escaped-preceding="" data-blogger-escaped-profile="" data-blogger-escaped-proportionate="" data-blogger-escaped-related="" data-blogger-escaped-relative="" data-blogger-escaped-reminiscent="" data-blogger-escaped-reported="" data-blogger-escaped-reproduction="" data-blogger-escaped-season.="" data-blogger-escaped-season="" data-blogger-escaped-severe="" data-blogger-escaped-shift="" data-blogger-escaped-slow="" data-blogger-escaped-substantial="" data-blogger-escaped-suggests="" data-blogger-escaped-than="" data-blogger-escaped-that="" data-blogger-escaped-the="" data-blogger-escaped-to="" data-blogger-escaped-viruses="" data-blogger-escaped-was="" data-blogger-escaped-waves="" data-blogger-escaped-we="" data-blogger-escaped-winter="" data-blogger-escaped-with="" data-blogger-escaped-younger="">
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    Differential diagnosis of illness in travelers arriving from sierra Leone, Liberia, or guinea: A cross-sectional study from the Geosentinel surveillance network


    Background: The largest-ever outbreak of Ebola virus disease (EVD), ongoing in West Africa since late 2013, has led to export of cases to Europe and North America. Clinicians encountering ill travelers arriving from countries with widespread Ebola virus tr ansmission must be aware of alternate diagnoses associated with fever and other nonspecific symptoms. Objective: To define the spectrum of illness observed in persons returning from areas of West Africa where EVD transmission has been widespread. Design: D escriptive, using GeoSentinel records. Setting: 57 travel or tropical medicine clinics in 25 countries. Patients: 805 ill returned travelers and new immigrants from Sierra Leone, Liberia, or Guinea seen between September 2009 and August 2014. Measurements: Frequencies of demographic and travelrelated characteristics and illnesses reported. Results: The most common specific diagnosis among 770 nonimmigrant travelers was malaria (n = 310 [40.3%]), with Plasmodium falciparum or severe malaria in 267 (86%) and non-P. falciparum malaria in 43 (14%). Acute diarrhea was the second most common diagnosis among nonimmigrant travelers (n= 95 [12.3%]). Such common diagnoses as upper respiratory tract infection, urinary tract infection, and influenza-like illness occurre d in only 26, 9, and 7 returning travelers, respectively. Few instances of typhoid fever (n = 8), acute HIV infection (n = 5), and dengue (n = 2) were encountered.
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    Research Committee Articles of the Week, 06 Jul, 2015

    Articles from July_06_2015

    Research Committee Selected Articles for the Week of July_06_2015

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    Major emerging vector-borne zoonotic diseases of public health importance in Canada

    In Canada, the emergence of vector-borne diseases may occur via international movement and subsequent establishment of vectors and pathogens, or via northward spread from endemic areas in the USA. Re-emergence of endemic vector-borne diseases may occur due to climate-driven changes to their geographic range and ecology. Lyme disease, West Nile virus (WNV), and other vector-borne diseases were identified as priority emerging non-enteric zoonoses in Canada in a prioritization exercise conducted by public heal th stakeholders in 2013. We review and present the state of knowledge on the public health importance of these high priority emerging vector-borne diseases in Canada. Lyme disease is emerging in Canada due to range expansion of the tick vector, which also signals concern for the emergence of human granulocytic anaplasmosis, babesiosis, and Powassan virus. WNV has been established in Canada since 2001, with epidemics of varying intensity in following years linked to climatic drivers. Eastern equine encephali tis virus, Jamestown Canyon virus, snowshoe hare virus, and Cache Valley virus are other mosquito-borne viruses endemic to Canada with the potential for human health impact. Increased surveillance for emerging pathogens and vectors and coordinated efforts among sectors and jurisdictions will aid in early detection and timely public health response. © 2015 SSCC. All rights reserved.

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    Global spatio-temporal patterns of influenza in the post-pandemic era

    We study the global spatio-temporal patterns of influenza dynamics. This is achieved by analysing and modelling weekly laboratory confirmed cases of influenza A and B from 138 countries between January 2006 and January 2015. The data were obtained from Flu Net, the surveillance network compiled by the the World Health Organization. We report a pattern of skip-and-resurgence behavior between the years 2011 and 2013 for influenza H1N1pdm, the strain responsible for the 2009 pandemic, in Europe and Eastern Asia . In particular, the expected H1N1pdm epidemic outbreak in 2011/12 failed to occur (or "skipped") in many countries across the globe, although an outbreak occurred in the following year. We also report a pattern of well-synchronized wave of H1N1pdm in earl y 2011 in the Northern Hemisphere countries, and a pattern of replacement of strain H1N1pre by H1N1pdm between the 2009 and 2012 influenza seasons. Using both a statistical and a mechanistic mathematical model, and through fitting the data of 108 countries , we discuss the mechanisms that are likely to generate these events taking into account the role of multi-strain dynamics. A basic understanding of these patterns has important public health implications and scientific significance.

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    Rodent reservoirs of future zoonotic diseases

    The increasing frequency of zoonotic disease events underscores a need to develop forecasting tools toward a more preemptive approach to outbreak investigation. We apply machine learning to data describing the traits and zoonotic pathogen diversity of the most speciose group of mammals, the rodents, which also comprise a disproportionate number of zoonotic disease reservoirs. Our models predict reservoir status in this group with over 90% accuracy, identifying species with high probabilities of harboring un discovered zoonotic pathogens based on trait profiles that may serve as rules of thumb to distinguish reservoirs from nonreservoir species. Key predictors of zoonotic reservoirs include biogeographical properties, such as range size, as well as intrinsic h ost traits associated with lifetime reproductive output. Predicted hotspots of novel rodent reservoir diversity occur in the Middle East and Central Asia and the Midwestern United States. © 2015, National Academy of Sciences. All rights reserved.

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    Distribution and diversity of the vectors of Rift Valley fever along the livestock movement routes in the northeastern and coastal regions of Kenya

    Background: Knowledge of vector ecology is important in understanding the transmission dynamics of vector borne disease. In this study, we determined the distribution and diversity of mosquitoes along the major nomadic livestock movement routes (LMR) in th e traditional pastoral ecozone of northeastern Kenya. We focused on the vectors of Rift Valley fever virus (RVFv) with the aim of understanding their ecology and how they can potentially influence the circulation of RVFv. Methods: Mosquito surveys were con ducted during the short and long rainy seasons from November 2012 to August 2014 using CO2-baited CDC light traps at seven sites selected for their proximity to stopover points that provide pasture, water and night bomas (where animals spend nig hts). We compared mosquito abundance and diversity across the sites, which were located in three ecological zones (IV, V and VI), based on the classification system of agro-ecological zones in Kenya. Results: Over 31,000 mosquitoes were trapped comprising 21 species belonging to 6 genera. Overall mosquito abundance varied significantly by ecological zones and sites. Mansonia species (Ma. uniformis and Ma. africana) were predominant (n?=?12,181, 38.3 %). This was followed by the primary RVF vectors, Ae. ochr aceus and Ae. mcintoshi comprising 17.9 and 14.98 %, respectively, of the total captures and represented across all sites and ecological zones. The Shannon diversity index ranged from 0.8 to 2.4 with significant zone, site and seasonal variations. There wa s also significant species richness of RVF vector across ecological zones. Conclusion: Our findings highlight differential occurrence of RVFv vectors across ecological zones and sampling sites, which may be important in determining areas at risk of emergen ce and circulation of RVFv. Moreover, the vector distribution map along LMR generated in this study will guide potential interventions for control of the disease, including strategic vaccination for livestock

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    Estimating risks of heat strain by age and sex: A population-level simulation model

    Individuals living in hot climates face health risks from hyperthermia due to excessive heat. Heat strain is influenced by weather exposure and by individual characteristics such as age, sex, body size, and occupation. To explore the population-level drive rs of heat strain, we developed a simulation model that scales up individual risks of heat storage (estimated using Myrup and Morgan’s man model “MANMO”) to a large population. Using Australian weather data, we identify high-risk weather conditions togethe r with individual characteristics that increase the risk of heat stress under these conditions. The model identifies elevated risks in children and the elderly, with females aged 75 and older those most likely to experience heat strain. Risk of heat strain in males does not increase as rapidly with age, but is greatest on hot days with high solar radiation. Although cloudy days are less dangerous for the wider population, older women still have an elevated risk of heat strain on hot cloudy days or when indo ors during high temperatures. Simulation models provide a valuable method for exploring population level risks of heat strain, and a tool for evaluating public health and other government policy interventions. © 2015 by the authors; licensee MDPI, Basel, S witzerland.

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    EigenEvent: An algorithm for event detection from complex data streams in syndromic surveillance

    Syndromic surveillance systems continuously monitor multiple pre-diagnostic daily streams of indicators from different regions with the aim of early detection of disease outbreaks. The main objective of these systems is to detect outbreaks hours or days be fore the clinical and laboratory confirmation. The type of data that is being generated via these systems is usually multivariate and seasonal with spatial and temporal dimensions. The algorithm What's Strange About Recent Events (WSARE) is the state-of-th e-art method for such problems. It exhaustively searches for contrast sets in the multivariate data and signals an alarm when find statistically significant rules. This bottom-up approach presents a much lower detection delay comparing the existing top-dow n approaches. However, WSARE is very sensitive to the small-scale changes and subsequently comes with a relatively high rate of false alarms. We propose a new approach called EigenEvent that is neither fully top-down nor bottom-up. In this method, we inste ad of top-down or bottom-up search, track changes in data correlation structure via eigenspace techniques. This new methodology enables us to detect both overall changes (via eigenvalue) and dimension-level changes (via eigenvectors). Experimental results on hundred sets of benchmark data reveals that EigenEvent presents a better overall performance comparing state-of-the-art, in particular in terms of the false alarm rate. © 2015 - IOS Press and the authors. All rights reserved.

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    What can we learn about the Ebola outbreak from tweets?

    Background Twitter can address the challenges of the current Ebola outbreak surveillance. The aims of this study are to demonstrate the use of Twitter as a real-time method of Ebola outbreak surveillance to monitor information spread, capture early epidemi c detection, and examine content of public knowledge and attitudes. Methods We collected tweets mentioning Ebola in English during the early stage of the current Ebola outbreak from July 24-August 1, 2014. Our analysis for this observational study includes time series analysis with geologic visualization to observe information dissemination and content analysis using natural language processing to examine public knowledge and attitudes. Results A total of 42,236 tweets (16,499 unique and 25,737 retweets) me ntioning Ebola were posted and disseminated to 9,362,267,048 people, 63 times higher than the initial number. Tweets started to rise in Nigeria 3-7 days prior to the official announcement of the first probable Ebola case. The topics discussed in tweets inc lude risk factors, prevention education, disease trends, and compassion. Conclusion Because of the analysis of a unique Twitter dataset captured in the early stage of the current Ebola outbreak, our results provide insight into the intersection of social m edia and public health outbreak surveillance. Findings demonstrate the usefulness of Twitter mining to inform public health education. © 2015 Association for Professionals in Infection Control and Epidemiology, Inc.

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    Tracking the distribution and impacts of diseases with biological records and distribution modelling

    Species distribution modelling is widely used in epidemiology for mapping spatial patterns and the risk of introduction of diseases and vectors and also for predicting how exposure may alter given future environmental change, motivated by the high societal impact and the multiple environmental drivers of disease outbreaks. Although pathogens and vectors have historically been sparsely recorded, monitoring systems and media sources are generating novel, online data sources on occurrence. Moreover, increasing ecological realism is being incorporated into distribution modelling techniques, focussing on dispersal, biotic interactions and evolutionary constraints that shape species distributions alongside abiotic factors and biases in recording effort, common to pathogens and vectors and wildlife species. Considering pathogens and arthropod vector systems with high impact on plant, animal and human health, the present review describes how biological records for vectors and pathogens arise, introduces the concepts behind distribution models and illustrates the potential for ecologically realistic distribution models to yield insight into the establishment and spread of pathogens. Because distribution modellers aim to provide policy makers with evidence and maps for planning and evaluation of disease mitigation measures, we highlight factors that currently constrain direct translation of models to policy. Disease distributions will be better understood and mapped in the future given improved occurrence data access and integration and combined (correlative and mechanistic) modelling approaches that are developed iteratively in concert with stakeholders. © 2015 The Linnean Society of London.

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    Severe pediatric adenovirus 7 disease in singapore linked to recent outbreaks across asia

    During November 2012–July 2013, a marked increase of adenovirus type 7 (Ad7) infections associated with severe disease was documented among pediatric patients in Sin­gapore. Phylogenetic analysis revealed close genetic links with severe Ad7 outbreaks in Ch ina, Taiwan, and other parts of Asia. © 2015, Centers for Disease Control and Prevention (CDC). All rights reserved.

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    Cholera outbreak linked with lack of safe water supply following a tropical cyclone in Pondicherry, India, 2012

    In the aftermath of a severe cyclonic storm on 7 January 2012, a cluster of acute diarrhoea cases was reported from two localities in Pondicherry, Southern India. We investigated the outbreak to identify causes and recommend control measures. We defined a case as occurrence of diarrhoea of more than three loose stools per day with or without vomiting in a resident of affected areas during 6-18 January 2012. We used active (door-to-door survey) and stimulated passive (healthy facility-based) surveillance to identify cases. We described the outbreak by time, place, and person. We compared the case-patients with up to three controls without any apparent signs and symptoms of diarrhoea and matched for age, gender, and neighbourhood. We calculated matched odds ra tio (MOR), 95% confidence intervals (CI), and population attributable fractions (PAF). We collected rectal swabs and water samples for laboratory diagnosis and tested water samples for microbiological quality. We identified 921 cases and one death among 8, 367 residents (attack rate: 11%, case-fatality: 0.1%). The attack rate was the highest among persons of 50 years and above (14%) and females (12%). The outbreak started on 6 January and peaked on the 9th and lasted till 14 January. Cases were clustered aro und two major leakages in water supply system. Nine of the 16 stool samples yielded V. cholerae O1 Ogawa. We identified that consumption of water from the public distribution system (MOR=37, 95% CI 4.9-285, PAF: 97%), drinking unboiled water (MOR=35, 95% C I 4.5-269, PAF: 97%), and a common latrine used by two or more households (MOR=2.7, 95% CI 1.3-5.6) were independently associated with cholera. Epidemiological evidence suggested that this outbreak was due to ingestion of water contaminated by drainage fol lowing rains during cyclone. We recommended repair of the water supply lines, cleaning-up of the drains, handwashing, and drinking of boiled water. © International Centre For Diarrhoeal Disease Research, Bang

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    Spatiotemporal dynamics of Puumala hantavirus associated with its rodent host, Myodes glareolus

    Many viruses significantly impact human and animal health. Understanding the population dynamics of these viruses and their hosts can provide important insights for epidemiology and virus evolution. Puumala virus (PUUV) is a European hantavirus that may ca use regional outbreaks of hemorrhagic fever with renal syndrome in humans. Here, we analyzed the spatiotemporal dynamics of PUUV circulating in local populations of its rodent reservoir host, the bank vole (Myodes glareolus) during eight years. Phylogeneti c and population genetic analyses of all three genome segments of PUUV showed strong geographical structuring at a very local scale. There was a high temporal turnover of virus strains in the local bank vole populations, but several virus strains persisted through multiple years. Phylodynamic analyses showed no significant changes in the local effective population sizes of PUUV, although vole numbers and virus prevalence fluctuated widely. Microsatellite data demonstrated also a temporally persisting subdiv ision between local vole populations, but these groups did not correspond to the subdivision in the virus strains. We conclude that restricted transmission between vole populations and genetic drift play important roles in shaping the genetic structure and temporal dynamics of PUUV in its natural host which has several implications for zoonotic risks of the human population. © 2015 The Authors.

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    Spread of infectious microbes during emergency medical response

    Background To our knowledge, no studies to date demonstrate potential spread of microbes during actual emergency medical service (EMS) activities. Our study introduces a novel approach to identification of contributors to EMS environment contamination and development of infection control strategies, using a bacteriophage surrogate for pathogenic organisms. Methods Bacteriophage ?X174 was used to trace cross-contamination and evaluate current disinfection practices and a hydrogen peroxide (H2O2) wipe intervention within emergency response vehicles. Prior to EMS calls, 2 surfaces were seeded with ?X174. On call completion, EMS vehicle and equipment surfaces were sampled before decontamination, after decontamination per current practices, and after implementation of the intervention. Results Current decontamination practices did not significantly reduce viral loads on surfaces (P =.3113), but H2O2 wipe intervention did (P =.0065). Bacteriophage spread to 56% (27/48) of sites and was reduced to 54% (26/48) and 40% (19/48) with current decontamination practices and intervention practices, respectively. Conclusion Results suggest firefighters' hands were the main vehicles of microbial transfer. Current practices were not c onsistently applied or standardized and minimally reduced prevalence and quantity of microbial contamination on EMS surfaces. Although use of a consistent protocol of H2O2 wipes significantly reduced percent prevalence and concentrati on of viruses, training and promotion of surface disinfection should be provided. © 2015 Association for Professionals in Infection Control and Epidemiology, Inc.

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

    Abstract Objective To assess the population-level impact and cost-effectiveness of hepatitis A vaccination programs in the United States. Methods We developed an age-structured population model of hepatitis A transmission dynamics to evaluate two policies of administering a two-dose hepatitis A vaccine to children aged 12 to 18 months: 1) universal routine vaccination as recommended by the Advisory Committee on Immunization Practices in 2006 and 2) Advisory Committee on Immunization Practices's previous reg ional policy of routine vaccination of children living in states with high hepatitis A incidence. Inputs were obtained from the published literature, public sources, and clinical trial data. The model was fitted to hepatitis A seroprevalence (National Heal th and Nutrition Examination Survey II and III) and reported incidence from the National Notifiable Diseases Surveillance System (1980-1995). We used a societal perspective and projected costs (in 2013 US $), quality-adjusted life-years, incremental cost-e ffectiveness ratio, and other outcomes over the period 2006 to 2106. Results On average, universal routine hepatitis A vaccination prevented 259,776 additional infections, 167,094 outpatient visits, 4781 hospitalizations, and 228 deaths annually. Compared with the regional vaccination policy, universal routine hepatitis A vaccination was cost saving. In scenario analysis, universal vaccination prevented 94,957 infections, 46,179 outpatient visits, 1286 hospitalizations, and 15 deaths annually and had an inc remental cost-effectiveness ratio of $21,223/quality-adjusted life-year when herd protection was ignored. Conclusions Our model predicted that universal childhood hepatitis A vaccination led to significant reductions in hepatitis A mortality and morbidity. Consequently, universal vaccination was cost saving compared with a regional vaccination policy. Herd protection effects of hepatitis A vaccination programs had a significant impact on hepatitis A mortality,

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    Drinking water quality and the geospatial distribution of notified gastro-intestinal infections

    Introduction. Even brief episodes of fecal contamination of drinking water can lead directly to illness in the consumers. In water-borne outbreaks, the connection between poor microbial water quality and disease can be quickly identified. The impact of non -compliant drinking water samples due to E. coli taken for regular monitoring on the incidence of notified acute gastrointestinal infections has not yet been studied. Methods. The objective of this study was to analyse the geographical distribution of noti fied acute gastrointestinal infections (AGI) in Slovenia in 2010, with hotspot identification. The second aim of the study was to correlate the fecal contamination of water supply system on the settlement level with the distribution of notified AGI cases. Spatial analysis using geo-information technology and other methods were used. Results. Hot spots with the highest proportion of notified AGI cases were mainly identified in areas with small supply zones. The risk for getting AGI was drinking water contami nated with E. coli from supply zones with 50-1000 users: RR was 1.25 and significantly greater than one (p-value less than 0.001). Conclusion. This study showed the correlation between the frequency of notified AGI cases and noncompliant results in drinkin g water monitoring. © Slovenian Journal of Public Health 2015.

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    The utility of Google Trends data to examine interest in cancer screening

    Objectives: We examined the utility of January 2004 to April 2014 Google Trends data from information searches for cancer screenings and preparations as a complement to population screening data, which are traditionally estimated through costly population- level surveys. Setting: State-level data across the USA. Participants: Persons who searched for terms related to cancer screening using Google, and persons who participated in the Behavioral Risk Factor Surveillance System (BRFSS). Primary and secondary ou tcome measures: (1) State-level Google Trends data, providing relative search volume (RSV) data scaled to the highest search proportion per week (RSV100) for search terms over time since 2004 and across different geographical locations. (2) RSV of new scre ening tests, free/low-cost screening for breast and colorectal cancer, and new preparations for colonoscopy (Prepopik). (3) State-level breast, cervical, colorectal and prostate cancer screening rates. Results: Correlations between Google Trends and BRFSS data ranged from 0.55 for ever having had a colonoscopy to 0.14 for having a Pap smear within the past 3 years. Free/low-cost mammography and colonoscopy showed higher RSV during their respective cancer awareness months. RSV for Miralax remained stable, wh ile interest in Prepopik increased over time. RSV for lung cancer screening, virtual colonoscopy and three-dimensional mammography was low. Conclusions: Google Trends data provides enormous scientific possibilities, but are not a suitable substitute for, b ut may complement, traditional data collection and analysis about cancer screening and related interests. © BMJ Open 2015.

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    A mathematical model for understanding the spread of nipah fever epidemic in Bangladesh

    In this paper, a mathematical model for the nipah virus (NiV) infections, commonly known as 'nipah fever' in Bangladesh is proposed. The host-pathogen interaction of NiV infection in terms of nonlinear ordinary differential equations (ODEs) is studied. The aim is to investigate the disease propagation and control strategy of NiV infections. The behavior of the dynamics of NiV infections as well as the optimal control strategy has been studied in vein of optimal control theory and the results are presented w ith an illustration by the numerical simulations. © 2015 IEEE.

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    Emergence in Taiwan of novel norovirus GII.4 variants causing acute gastroenteritis and intestinal haemorrhage in children

    Norovirus is the leading cause of viral gastroenteritis globally. Norovirus genotype GII.4 is responsible for the majority of outbreaks, but new variants are continuously emerging. The objective of the study was to delineate the clinical manifestations and complications associated with these new norovirus GII.4 variants in children. We investigated norovirus infections from the community outbreak in October 2011–September 2012 and an earlier outbreak in 2006–2007, in northern Taiwan. Norovirus genotypes and their variants were validated using molecular methods. A norovirus outbreak started in mid-2011 and continued through 2012 in northern Taiwan. Hospitalized children infected by norovirus in 2012 showed a significantly higher incidence of intestinal haemor rhage, as indicated by grossly bloody faeces (P50.012) and occult blood in faeces (P=0.001), and also presented with more high fever>39 °C (P<0.001), fever.38.5 °C (P<0.001) and fever of any temperature.38 °C (P<0.001), compared with children hospitalized in 2006–2007. Analysis of 20 near-full-length genome sequences indicated an emergence of GII.4 2012 variants in 2011–2012. Circulating noroviruses can be divided into two clusters: GII.4 2012a, which is identical to the newly reported strain GII.4 Sydney 2 012, and GII.4 2012b, which is close to GII.4 2006b, the earlier predominant strain. The emerging new variants of norovirus GII.4 caused a distinct clinical syndrome of acute gastroenteritis with severe fever and a high rate of intestinal haemorrhage in ch ildren. The genetic diversity associated with changing clinical manifestations poses major obstacles to norovirus control. © 2015 The Authors.

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    The impacts of mosquito density and meteorological factors on dengue fever epidemics in Guangzhou, China, 2006-2014: A time-series analysis

    Objective To explore the associations between the monthly number of dengue fever(DF) cases and possible risk factors in Guangzhou, a subtropical city of China.1 Methods The monthly number of DF cases, Breteau Index (BI), and meteorological measures during 2006-2014 recorded in Guangzhou, China, were assessed. A negative binomial regression model was used to evaluate the relationships between BI, meteorological factors, and the monthly number of DF cases. Results A total of 39,697 DF cases were detected in G uangzhou during the study period. DF incidence presented an obvious seasonal pattern, with most cases occurring from June to November. The current month's BI, average temperature (Tave), previous month's minimum temperature (Tmin), an d Tave were positively associated with DF incidence. A threshold of 18.25 °C was found in the relationship between the current month's Tmin and DF incidence. Conclusion Mosquito density, Tave, and Tmin play a cri tical role in DF transmission in Guangzhou. These findings could be useful in the development of a DF early warning system and assist in effective control and prevention strategies in the DF epidemic. © 2015 The Editorial Board of Biomedical and Environmen tal Sciences.

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    Geographical and temporal correlations in the incidence of lyme disease, RMSF, ehrlichiosis, and coccidioidomycosis with search data

    [No abstract available]

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    Armies of pestilence: CNS infections as potential weapons of mass destruction

    Infectious agents have been investigated, developed, and used by both governments and terrorist groups as weapons of mass destruction. CNS infections, though traditionally considered less often than respiratory diseases in this scenario, may be very import ant. Viruses responsible for encephalitides can be highly infectious in aerosol form. CNS involvement in anthrax is ominous but should change treatment. Brucellosis, plague, Q fever, and other bacteria can uncommonly manifest with meningoencephalitis and o ther findings. Emerging diseases may also pose threats. We review infectious agents of particular concern for purposes of biowarfare with respect to CNS manifestations and imaging features.

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    Numerical identification of epidemic thresholds for susceptible-infectedrecovered model on finite-size networks

    Epidemic threshold has always been a very hot topic for studying epidemic dynamics on complex networks. The previous studies have provided different theoretical predictions of the epidemic threshold for the susceptible-infected-recovered (SIR) model, but t he numerical verification of these theoretical predictions is still lacking. Considering that the large fluctuation of the outbreak size occurs near the epidemic threshold, we propose a novel numerical identification method of SIR epidemic threshold by ana lyzing the peak of the epidemic variability. Extensive experiments on synthetic and real-world networks demonstrate that the variability measure can successfully give the numerical threshold for the SIR model. The heterogeneous mean-field prediction agrees very well with the numerical threshold, except the case that the networks are disassortative, in which the quenched mean-field prediction is relatively close to the numerical threshold. Moreover, the numerical method presented is also suitable for the sus ceptible-infected-susceptible model. This work helps to verify the theoretical analysis of epidemic threshold and would promote further studies on the phase transition of epidemic dynamics. © 2015 AIP Publishing LLC.

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    A proposed approach to systematically identify and monitor the corporate political activity of the food industry with respect to public health using publicly available informatio

    Unhealthy diets represent one of the major risk factors for non-communicable diseases. There is currently a risk that the political influence of the food industry results in public health policies that do not adequately balance public and commercial intere sts. This paper aims to develop a framework for categorizing the corporate political activity of the food industry with respect to public health and proposes an approach to systematically identify and monitor it. The proposed framework includes six strateg ies used by the food industry to influence public health policies and outcomes: information and messaging; financial incentive; constituency building; legal; policy substitution; opposition fragmentation and destabilization. The corporate political activit y of the food industry could be identified and monitored through publicly available data sourced from the industry itself, governments, the media and other sources. Steps for country-level monitoring include identification of key food industry actors and r elated sources of information, followed by systematic data collection and analysis of relevant documents, using the proposed framework as a basis for classification of results. The proposed monitoring approach should be pilot tested in different countries as part of efforts to increase the transparency and accountability of the food industry. This approach has the potential to help redress any imbalance of interests and thereby contribute to the prevention and control of non-communicable diseases. © 2015 Wo rld Obesity.

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    Surveillance of adverse events following vaccination in the French armed forces, 2011-2012

    Objectives: French military personnel are subject to a compulsory vaccination schedule. The aim of this study was to present the results of surveillance of vaccine adverse events (VAEs) reported from 2011 to 2012 in the French armed forces. Study design: V AEs were surveyed among all French armed forces from 2011 to 2012 by the epidemiological departments of the military health service. For each case, a notification form providing patient and clinical information was provided. Methods: Case definitions were derived from the French drug safety guidelines. Three types of VAE were considered: non-serious, serious and unexpected. Incidence rates were calculated by relating VAEs to the number of vaccine doses delivered. Results: In total, 161 VAE cases were report ed. The overall VAE reporting rate was 24.6 VAEs per 100,000 doses, and the serious VAE rate was 1.3 per 100,000 doses (nine cases). The serious VAEs included two cases of Guillain-Barré syndrome, one case of optic neuritis, one case of a meningeal-like sy ndrome, one case of rheumatoid purpura, one case of acute asthma and three cases of fainting. The highest rates of VAE were observed with the Bacille Calmette-Guérin vaccine (BCG) (482.3 per 100,000 doses), inactivated diphtheria-tetanus-poliovirus with ac ellular pertussis vaccine (dTap-IPV) (106.1 per 100,000 doses) and meningococcal quadrivalent glycoconjugate vaccine (MenACWY-CRM) (39.3 per 100,000 doses). Conclusions: The global rates of VAE observed in 2011 and 2012 confirm the increase that has been o bserved since 2009 in the French armed forces, which could reflect improved practitioner awareness about VAEs and the use of certain vaccines added to the vaccination schedule recently (dTap-IPV in 2008 and MenACWY-CRM in 2010). VAEs appear to be relativel y rare, particularly serious VAEs, which indicates acceptable tolerance of vaccines. © 2015 The Royal Society for Public Health.

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    Lack of transmission among close contacts of patient with case of middle east respiratory syndrome imported into the United States, 2014

    In May 2014, a traveler from the Kingdom of Saudi Arabia was the first person identified with Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the United States. To evaluate transmission risk, we determined the type, duration, and frequ ency of patient contact among health care personnel (HCP), household, and community contacts by using standard questionnaires and, for HCP, global positioning system (GPS) tracer tag logs. Respiratory and serum samples from all contacts were tested for MER S-CoV. Of 61 identified contacts, 56 were interviewed. HCP exposures occurred most frequently in the emergency department (69%) and among nurses (47%); some HCP had contact with respiratory secretions. Household and community contacts had brief contact (e. g., hugging). All laboratory test results were negative for MERS-CoV. This contact investigation found no secondary cases, despite case-patient contact by 61 persons, and provides useful information about MERS-CoV transmission risk. Compared with GPS trace r tag recordings, self-reported contact may not be as accurate © 2015, Centers for Disease Control and Prevention (CDC). All rights reserved.

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    Prognostics and health management: A review on data driven approaches

    Prognostics and health management (PHM) is a framework that offers comprehensive yet individualized solutions for managing system health. In recent years, PHM has emerged as an essential approach for achieving competitive advantages in the global market by improving reliability, maintainability, safety, and affordability. Concepts and components in PHM have been developed separately in many areas such as mechanical engineering, electrical engineering, and statistical science, under varied names. In this pap er, we provide a concise review of mainstream methods in major aspects of the PHM framework, including the updated research from both statistical science and engineering, with a focus on data-driven approaches. Real world examples have been provided to ill ustrate the implementation of PHM in practice. © 2015 Kwok L. Tsui et al.

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    Interim influenza vaccine effectiveness: A good proxy for final estimates in Spain in the seasons 2010-2014

    Introduction: The agreement between interim and final influenza vaccine effectiveness (VE) estimates would support the use of interim assessments as a proxy for final VE results to guide health authorities in influenza prevention. We aimed to compare inter im/final VE estimates in Spain. Methods: We used a test-negative case-control study (cycEVA) for 2010/11-2013/14 seasons. Sensitivity analyses were carried out by type/subtype of influenza virus and by target groups for vaccination. Results: In general, in terim estimates were higher compared to end-season estimates. Interim and final VE differences were higher for the target groups compared to all population. Subtype-specific interim/final VE estimates showed greater concordance (3-13%) than for any virus ( 7-24%). Conclusion: In Spain, interim influenza VE estimates over 2010-2014 were a good proxy of the final protection of the vaccine. Interim and final estimates showed greater concordance for all population and if performed subtype-specific. © 2015 Elsevi er Ltd.

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    06 July 2015

    Register for the CSTE BRFSS Small Area Estimation Webinar!

    CSTE will be hosting a BRFSS small areas estimation webinar on Thursday, July 16th at 1pm ET. This training will be focused on the concept of small area estimation, its uses and limitations, and will illustrate how survey data are used to produce estimates for areas that do not have a sufficient sample size for direct estimation. Please refer to the attached one pager for a full summary of the webinar.

    Please use the link below to register for this webinar. To maximize the number of attendees, we encourage those of you in one office to have one person register and share the viewing space with other colleagues.

    Topic: CSTE BRFSS Small Area Estimation Webinar
    Host: Nidal Kram
    Date: Thursday, July 16, 2015
    Time: 1:00 pm, Eastern Daylight Time (New York, GMT-04:00)
    Session number: Not Available
    Registration password: This session does not require a registration password.

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    To register for this session
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    Go to https://cste.webex.com/cste/k2/j.php?MTID=t89168b19a3a9cd11fcfebb18a24d649a and register.

    Once the host approves your registration, you will receive a confirmation email with instructions for joining the session.

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