Anderson, United States
Anderson, United States

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Cohen C.,South African National Institute for Communicable Diseases | Wu H.M.,Epidemic Intelligence Service Program | Wu H.M.,Centers for Disease Control and Prevention | Martin S.,Centers for Disease Control and Prevention | And 8 more authors.
AIDS | Year: 2010

OBJECTIVES: We aimed to compare the incidence of meningococcal disease amongst HIV-infected and uninfected individuals and to evaluate whether HIV is a risk factor for mortality and bacteremia amongst patients with meningococcal disease. DESIGN: Cohort surveillance study. METHODS: We conducted laboratory-based surveillance for meningococcal disease in Gauteng Province, South Africa. HIV status and outcome data were obtained at sentinel sites. Incidence in HIV-infected and uninfected persons was calculated assuming a similar age-specific HIV prevalence in tested and untested individuals. Risk factors for death and bacteremia (as compared with meningitis) were evaluated using multivariable logistic regression. RESULTS: From 2003 to 2007, 1336 meningococcal cases were reported. Of 504 patients at sentinel sites with known outcome, 308 (61%) had HIV serostatus data. HIV prevalence amongst cases of meningococcal disease was higher than the population HIV prevalence in all age groups. The incidence of meningococcal disease in HIV-infected individuals was elevated in all age groups with an age-adjusted relative risk of 11.3 [95% confidence interval (CI) 8.9-14.3, P < 0.001]. The case-fatality ratio (CFR) was 20% (27/138) amongst HIV-infected and 11% (18/170) amongst HIV-uninfected individuals [odds ratio (OR) 2.1, 95% CI 1.1-3.9]. On multivariable analysis, CFR was greater amongst patients with bacteremia (35%, 29/82) compared with meningitis (7%, 16/226) (OR 7.8, 95% CI 3.4-17.7). HIV infection was associated with increased odds of bacteremia (OR 2.7, 95% CI 1.5-5.0). CONCLUSION: HIV-infected individuals may be at increased risk of meningococcal disease. The increased CFR in HIV-infected patients may be explained by their increased odds of bacteremia compared to meningitis. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Forrester J.D.,Epidemic Intelligence Service Program | Forrester J.D.,Centers for Disease Control and Prevention | Brett M.,Epidemic Intelligence Service Program | Brett M.,Centers for Disease Control and Prevention | And 3 more authors.
Ticks and Tick-borne Diseases | Year: 2015

Lyme disease is the most common vector-borne disease in the U.S. Surveillance data from four states with a low-incidence of Lyme disease was evaluated. Most cases occurred after travel to high-incidence Lyme disease areas. Cases without travel-related exposure in low-incidence states differed epidemiologically; misdiagnosis may be common in these areas. © 2015 Published by Elsevier GmbH.


Gibney K.B.,Epidemic Intelligence Service Program | Edupuganti S.,Epidemic Intelligence Service Program | Panella A.J.,Epidemic Intelligence Service Program | Kosoy O.I.,Epidemic Intelligence Service Program | And 5 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2012

The duration of anti-yellow fever (YF) virus immunoglobulin M (IgM) antibodies following YF vaccination is unknown, making it difficult to interpret positive IgM antibody results in previously vaccinated travelers. We evaluated the frequency and predictors of YF IgM antibody positivity 3-4 years following YF vaccination. Twenty-nine (73%) of 40 participants had YF IgM antibodies 3-4 years postvaccination. No demographic or exposure variables were predictive of YF IgM positivity. However, persons who were YF IgM positive at 3-4 years postvaccination had earlier onset viremia and higher neutralizing antibody geometric mean titers at 1 month and 3-4 years postvaccination compared with persons who were YF IgM negative. Detection of YF IgM antibodies several years postvaccination might reflect remote YF vaccination rather than recent YF vaccination or YF virus infection. Copyright © 2012 by The American Society of Tropical Medicine and Hygiene.

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