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New Haven, CT, United States

Vandermeer M.L.,00 NE Oregon St. | Thomas A.R.,00 NE Oregon St. | Kamimoto L.,Centers for Disease Control and Prevention | Reingold A.,California Emerging Infections Program | And 5 more authors.
Journal of Infectious Diseases | Year: 2012

Background. Statins may have anti-inflammatory and immunomodulatory effects that could reduce the risk of mortality from influenza virus infections. Methods. The Centers for Disease Control and Prevention's Emerging Infections Program conducts active surveillance for persons hospitalized with laboratory-confirmed influenza in 59 counties in 10 states. We analyzed data for hospitalized adults during the 2007-2008 influenza season to evaluate the association between receiving statins and influenza-related death. Results. We identified 3043 patients hospitalized with laboratory-confirmed influenza, of whom 1013 (33.3%) received statins and 151 (5.0%) died within 30 days of their influenza test. Patients who received statins were more likely to be older, male, and white; to suffer from cardiovascular, metabolic, renal, and chronic lung disease; and to have been vaccinated against influenza that season. In a multivariable logistic regression model, administration of statins prior to or during hospitalization was associated with a protective odds of death (adjusted odds ratio, 0.59 [95% confidence interval,. 38-.92]) when adjusting for age; race; cardiovascular, lung, and renal disease; influenza vaccination; and antiviral administration. Conclusions. Statin use may be associated with reduced mortality in patients hospitalized with influenza. © 2011 The Author.

Harrison L.H.,Maryland Emerging Infections Program | Farley M.M.,Emory University | Reingold A.L.,University of California at Berkeley | Hadler J.,Connecticut Emerging Infections Program | And 3 more authors.
AIDS | Year: 2010

Objective: Human immunodeficiency virus (HIV) infection and AIDS increase the risk of invasive pneumococcal disease (IPD). We evaluated IPD among HIV-infected adults over a 10-year period in the US to identify opportunities for prevention of IPD among HIV-infected adults. Design: IPD and HIV surveillance in seven population-based and laboratory-based Active Bacterial Core surveillance areas. Methods: IPD cases were adults 18-64 years old with pneumococcus isolated from a normally sterile site during 1998-2007. Isolates were serotyped using the Quellung reaction. HIV/AIDS status was determined by medical record review. We calculated incidence of IPD among adults with AIDS using national case-based surveillance data. Results: Of 13 812 IPD cases among 18-64-year-olds, 3236 (23%) occurred among HIV-infected adults (with or without AIDS) and 1313 (10%) occurred among the subset of HIV-infected adults with AIDS. Compared with the period (1998-1999) before childhood 7-valent pneumococcal conjugate vaccine (PCV7) introduction in the US, the overall incidence of IPD among adults with AIDS decreased 25% from 399 to 298 cases per 100 000 by 2007 (P = 0.008). In 2006-2007, 8, 39 and 55% of IPD cases among adults with AIDS were caused by serotypes included in the 7-valent PCV, 13-valent PCV and 23-valent pneumococcal polysaccharide vaccines, respectively. Conclusion: Sustained declines in IPD have occurred among adults with AIDS in the US, but incidence remained high 7 years after PCV7 introduction. More aggressive efforts, including HIV-prevention measures and the use of new PCVs in children and possibly HIV-infected adults, are necessary to further reduce IPD among HIV-infected adults. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Hale C.R.,Centers for Disease Control and Prevention | Lathrop S.,University of New Mexico | Tobin-D'Angelo M.,Georgia community health | Clogher P.,Connecticut Emerging Infections Program
Clinical Infectious Diseases | Year: 2012

Background.Contact with animals and their environment is an important, and often preventable, route of transmission for enteric pathogens. This study estimated the annual burden of illness attributable to animal contact for 7 groups of pathogens: Campylobacter species, Cryptosporidium species, Shiga toxin-producing Escherichia coli (STEC) O157, STEC non-O157, Listeria monocytogenes, nontyphoidal Salmonella species, and Yersinia enterocolitica.Methods.By using data from the US Foodborne Diseases Active Surveillance Network and other sources, we estimated the proportion of illnesses attributable to animal contact for each pathogen and applied those proportions to the estimated annual number of illnesses, hospitalizations, and deaths among US residents. We established credible intervals (CrIs) for each estimate.Results.We estimated that 14% of all illnesses caused by these 7 groups of pathogens were attributable to animal contact. This estimate translates to 445 213 (90% CrI, 234 197-774 839) illnesses annually for the 7 groups combined. Campylobacter species caused an estimated 187 481 illnesses annually (90% CrI, 66 259-372 359), followed by nontyphoidal Salmonella species (127 155; 90% CrI, 66 502-219 886) and Cryptosporidium species (113 344; 90% CrI, 22 570-299 243). Of an estimated 4933 hospitalizations (90% CrI, 2704-7914), the majority were attributable to nontyphoidal Salmonella (48%), Campylobacter (38%), and Cryptosporidium (8%) species. Nontyphoidal Salmonella (62%), Campylobacter (22%), and Cryptosporidium (9%) were also responsible for the majority of the estimated 76 deaths (90% CrI, 5-211).Conclusions.Animal contact is an important transmission route for multiple major enteric pathogens. Continued efforts are needed to prevent pathogen transmission from animals to humans, including increasing awareness and encouraging hand hygiene. © 2012 The Author.

Kattan J.A.,Centers for Disease Control and Prevention | Hadler J.L.,Connecticut Emerging Infections Program
Journal of Infectious Diseases | Year: 2011

In 2006, the Advisory Committee on Immunization Practices recommended that children routinely receive 2 varicella vaccine doses in place of the 1 dose previously recommended. This recommendation's initial impact on varicella epidemiology in Connecticut was assessed. Reported incidence and case-specific data were compared for 2005 and 2008. Varicella incidence decreased from 48.7 cases/100,000 persons in 2005 to 24.5 in 2008. Age-specific incidence decreased significantly (P< .05) among children aged 1-14 years. Reported varicella incidence has declined in Connecticut after implementation of routine 2-dose varicella vaccination for children. Continued surveillance is needed to determine the recommendation's full impact.

Kattan J.A.,Centers for Disease Control and Prevention | Kudish K.S.,Immunization Program | Cadwell B.L.,Laboratory Services | Soto K.,Infectious Diseases Section | Hadler J.L.,Connecticut Emerging Infections Program
American Journal of Public Health | Year: 2014

Objectives: We examined socioeconomic status (SES) disparities and the influence of state Immunization Action Plan-funded vaccination coordinators located in low-SES areas of Connecticut on childhood vaccination up-to-date (UTD) status at age 24 months. Methods: We examined predictors of underimmunization among the 2006 birth cohort (n= 34 568) in the state's Immunization Information System, including individual demographic and SES data, census tract SES data, and residence in an area with a vaccination coordinator. We conducted multilevel logistic regression analyses. Results: Overall, 81% of children were UTD. Differences by race/ethnicity and census tract SES were typically under 5%. Not being UTD at age 7 months was the strongest predictor of underimmunization at age 24 months. Among children who were not UTD at age 7 months, only Medicaid enrollment (adjusted odds ratio [AOR] = 0.6; 95% confidence interval [CI] = 0.5, 0.7) and residence in an area with a vaccination coordinator (AOR = 0.7; 95% CI = 0.6, 0.9) significantly decreased the odds of subsequent underimmunization. Conclusions: SES disparities associated with underimmunization at age 24 months were limited. Efforts focused on vaccinating infants born in low SES circumstances can minimize disparities.

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