169 results on '"Hicks LA"'
Search Results
152. U.S. outpatient antibiotic prescribing, 2010.
- Author
-
Hicks LA, Taylor TH Jr, and Hunkler RJ
- Subjects
- Humans, United States, Anti-Bacterial Agents therapeutic use, Drug Utilization statistics & numerical data, Practice Patterns, Physicians' statistics & numerical data
- Published
- 2013
- Full Text
- View/download PDF
153. A national evaluation of antibiotic expenditures by healthcare setting in the United States, 2009.
- Author
-
Suda KJ, Hicks LA, Roberts RM, Hunkler RJ, and Danziger LH
- Subjects
- Humans, United States, Anti-Bacterial Agents economics, Anti-Bacterial Agents therapeutic use, Health Care Costs statistics & numerical data
- Abstract
Objectives: Promoting appropriate antibiotic use has the potential to decrease healthcare costs by reducing unnecessary prescriptions and the incidence of resistant infections. However, little is known about where antibiotic costs are incurred in the US healthcare system. We evaluated antibiotic expenditures by healthcare setting and antibiotic class in the USA., Methods: Systemic antibiotic expenditures in 2009 were extracted from the IMS Health(©) National Sales Perspectives database. These data represent a statistically valid projection of all medication purchases in the USA from 1 January 2009 to 31 December 2009., Results: Antibiotic expenditures totalled $10.7 billion. The majority (61.5%) of expenditures were associated with the outpatient setting, especially from community pharmacies. Inpatient and long-term care settings accounted for 33.6% and 4.9% of expenditures, respectively. The class of antibiotics that accounted for the most antibiotic expenditure overall was the quinolones, followed by the penicillins., Conclusions: Over $10.7 billion was spent in 2009 on antibiotic therapy in the USA. Differences were observed in antibiotic expenditures by healthcare setting, with the majority in the outpatient setting, 87% of which was in community pharmacies.
- Published
- 2013
- Full Text
- View/download PDF
154. Direct healthcare costs of selected diseases primarily or partially transmitted by water.
- Author
-
Collier SA, Stockman LJ, Hicks LA, Garrison LE, Zhou FJ, and Beach MJ
- Subjects
- Ambulatory Care economics, Cryptosporidiosis transmission, Giardiasis transmission, Hospitalization economics, Humans, Legionnaires' Disease transmission, Medicaid economics, Medicare economics, Mycobacterium Infections, Nontuberculous transmission, United States, Water Microbiology, Cost of Illness, Cryptosporidiosis economics, Giardiasis economics, Health Care Costs statistics & numerical data, Legionnaires' Disease economics, Mycobacterium Infections, Nontuberculous economics, Otitis Externa economics
- Abstract
Despite US sanitation advancements, millions of waterborne disease cases occur annually, although the precise burden of disease is not well quantified. Estimating the direct healthcare cost of specific infections would be useful in prioritizing waterborne disease prevention activities. Hospitalization and outpatient visit costs per case and total US hospitalization costs for ten waterborne diseases were calculated using large healthcare claims and hospital discharge databases. The five primarily waterborne diseases in this analysis (giardiasis, cryptosporidiosis, Legionnaires' disease, otitis externa, and non-tuberculous mycobacterial infection) were responsible for over 40 000 hospitalizations at a cost of $970 million per year, including at least $430 million in hospitalization costs for Medicaid and Medicare patients. An additional 50 000 hospitalizations for campylobacteriosis, salmonellosis, shigellosis, haemolytic uraemic syndrome, and toxoplasmosis cost $860 million annually ($390 million in payments for Medicaid and Medicare patients), a portion of which can be assumed to be due to waterborne transmission.
- Published
- 2012
- Full Text
- View/download PDF
155. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults.
- Author
-
Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, and File TM Jr
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anti-Infective Agents administration & dosage, Bacterial Infections diagnosis, Bacterial Infections drug therapy, Child, Child, Preschool, Female, Humans, Infant, Male, Middle Aged, Young Adult, Rhinitis diagnosis, Rhinitis drug therapy, Sinusitis diagnosis, Sinusitis drug therapy
- Abstract
Evidence-based guidelines for the diagnosis and initial management of suspected acute bacterial rhinosinusitis in adults and children were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America comprising clinicians and investigators representing internal medicine, pediatrics, emergency medicine, otolaryngology, public health, epidemiology, and adult and pediatric infectious disease specialties. Recommendations for diagnosis, laboratory investigation, and empiric antimicrobial and adjunctive therapy were developed.
- Published
- 2012
- Full Text
- View/download PDF
156. Adrenocortical carcinoma masquerading as a benign adenoma on computed tomography washout study.
- Author
-
Simhan J, Canter D, Teper E, Smaldone MC, Patil N, Patchefsky A, Guttmann MC, Milestone B, Wong YN, Hicks LA, Uzzo RG, and Kutikov A
- Subjects
- Adrenal Cortex Neoplasms surgery, Adrenalectomy, Carcinoma surgery, Contrast Media pharmacokinetics, Diagnosis, Differential, Female, Humans, Incidental Findings, Magnetic Resonance Imaging, Middle Aged, Adenoma diagnosis, Adrenal Cortex Neoplasms diagnostic imaging, Carcinoma diagnostic imaging, Diagnostic Errors, Tomography, X-Ray Computed
- Abstract
An incidental adrenal mass is a common finding on cross-sectional imaging, with most of these lesions being benign adenomas. Indications for adrenalectomy turn on the likelihood that a mass is malignant or whether it exhibits metabolic activity. Modern imaging is considered highly accurate in differentiating adrenal adenomas from other adrenal pathology. We present a case of a 5-cm adrenal lesion with computed tomography washout characteristics consistent with a benign adenoma, which proved upon resection to be an adrenocortical carcinoma., (Copyright © 2012 Elsevier Inc. All rights reserved.)
- Published
- 2012
- Full Text
- View/download PDF
157. Legionellosis--United States, 2000-2009.
- Author
-
Hicks LA, Garrison LE, Nelson GE, and Hampton LM
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Female, Humans, Male, Middle Aged, United States epidemiology, Young Adult, Legionellosis epidemiology
- Published
- 2012
- Full Text
- View/download PDF
158. Outpatient antibiotic prescribing and nonsusceptible Streptococcus pneumoniae in the United States, 1996-2003.
- Author
-
Hicks LA, Chien YW, Taylor TH Jr, Haber M, and Klugman KP
- Subjects
- Anti-Bacterial Agents therapeutic use, Bacteremia drug therapy, Bacteremia epidemiology, Bacteremia microbiology, Child, Child, Preschool, Humans, Infant, Infant, Newborn, Meningitis, Pneumococcal drug therapy, Meningitis, Pneumococcal epidemiology, Meningitis, Pneumococcal microbiology, Outpatients, Pneumococcal Infections drug therapy, Selection, Genetic, Serotyping, Streptococcus pneumoniae classification, Streptococcus pneumoniae isolation & purification, United States epidemiology, Anti-Bacterial Agents administration & dosage, Drug Prescriptions statistics & numerical data, Drug Resistance, Bacterial, Pneumococcal Infections epidemiology, Pneumococcal Infections microbiology, Streptococcus pneumoniae drug effects
- Abstract
Background: Streptococcus pneumoniae infections have become increasingly complicated and costly to treat with the spread of antibiotic resistance. We evaluated the relationship between antibiotic prescribing and nonsusceptibility among invasive pneumococcal disease (IPD) isolates., Methods: Outpatient antibiotic prescription data for penicillins, cephalosporins, macrolides, and trimethoprim-sulfamethoxazole were abstracted from the IMS Health Xponent database to calculate the annual number of prescriptions per capita. We analyzed IPD data from 7 of the Centers for Disease Control and Prevention's Active Bacterial Core surveillance sites (population, 18.6 million) for which data were available for the entire time period under study (1996-2003). Logistic regression models were used to assess whether sites with high antibiotic prescribing rates had a high proportion of nonsusceptible and serotype 19A IPD., Results: Yearly prescribing rates during the period 1996-2003 for children <5 years of age decreased by 37%, from 4.23 to 2.68 prescriptions per capita per year (P < .001), and those for persons ≥5 years of age decreased by 42%, from 0.98 to 0.57 prescriptions per capita per year (P < .001); increases in azithromycin prescribing were noted for both groups. Sites with high rates of antibiotic prescribing had a higher proportion of IPD nonsusceptibility than did low-prescribing sites (P = .003 for penicillin, P < .001 for every other antibiotic class). Cephalosporin and macrolide prescribing were associated with penicillin and multidrug nonsusceptibility and serotype 19A IPD (P < .001)., Conclusions: In sites where antibiotic prescribing is high, the proportion of nonsusceptible IPD is also high, suggesting that local prescribing practices contribute to local resistance patterns. Cephalosporins and macrolides seem to be selecting for penicillin- and multidrug-resistant pneumococci, as well as serotype 19A IPD. Antibiotic use is a major factor contributing to the spread of antibiotic resistance; strategies to reduce antibiotic resistance should continue to include judicious use of antibiotics.
- Published
- 2011
- Full Text
- View/download PDF
159. Surveillance for waterborne disease outbreaks and other health events associated with recreational water --- United States, 2007--2008.
- Author
-
Hlavsa MC, Roberts VA, Anderson AR, Hill VR, Kahler AM, Orr M, Garrison LE, Hicks LA, Newton A, Hilborn ED, Wade TJ, Beach MJ, and Yoder JS
- Subjects
- Acute Disease, Adolescent, Adult, Child, Child, Preschool, Cryptosporidiosis, Cryptosporidium isolation & purification, Female, Gastrointestinal Diseases microbiology, Gastrointestinal Diseases parasitology, Gastrointestinal Diseases virology, Humans, Infant, Male, Middle Aged, Swimming, Swimming Pools, United States epidemiology, Disease Outbreaks, Gastrointestinal Diseases epidemiology, Population Surveillance, Recreation, Water Microbiology
- Abstract
Problem/condition: Since 1978, CDC, the U.S. Environmental Protection Agency, and the Council of State and Territorial Epidemiologists have collaborated on the Waterborne Disease and Outbreak Surveillance System (WBDOSS) for collecting and reporting data on waterborne disease outbreaks associated with recreational water. This surveillance system is the primary source of data concerning the scope and health effects of waterborne disease outbreaks in the United States. In addition, data are collected on other select recreational water--associated health events, including pool chemical--associated health events and single cases of Vibrio wound infection and primary amebic meningoencephalitis (PAM)., Reporting Period: Data presented summarize recreational water--associated outbreaks and other health events that occurred during January 2007--December 2008. Previously unreported data on outbreaks that have occurred since 1978 also are presented., Description of the System: The WBDOSS database includes data on outbreaks associated with recreational water, drinking water, water not intended for drinking (excluding recreational water), and water use of unknown intent. Public health agencies in the states, the District of Columbia, U.S. territories, and Freely Associated States are primarily responsible for detecting and investigating waterborne disease outbreaks and voluntarily reporting them to CDC using a standard form. Only data on outbreaks associated with recreational water are summarized in this report. Data on other recreational water--associated health events reported to CDC, the Agency for Toxic Substances and Disease Registry (ATSDR), and the U.S. Consumer Product Safety Commission (CPSC) also are summarized., Results: A total of 134 recreational water--associated outbreaks were reported by 38 states and Puerto Rico for 2007--2008. These outbreaks resulted in at least 13,966 cases. The median outbreak size was 11 cases (range: 2--5,697 cases). A total of 116 (86.6%) outbreaks were associated with treated recreational water (e.g., pools and interactive fountains) and resulted in 13,480 (96.5%) cases. Of the 134 outbreaks, 81 (60.4%) were outbreaks of acute gastrointestinal illness (AGI); 24 (17.9%) were outbreaks of dermatologic illnesses, conditions, or symptoms; and 17 (12.7%) were outbreaks of acute respiratory illness. Outbreaks of AGI resulted in 12,477 (89.3%) cases. The etiology was laboratory-confirmed for 105 (78.4%) of the 134 outbreaks. Of the 105 outbreaks with a laboratory-confirmed etiology, 68 (64.8%) were caused by parasites, 22 (21.0%) by bacteria, five (4.8%) by viruses, nine (8.6%) by chemicals or toxins, and one (1.0%) by multiple etiology types. Cryptosporidium was confirmed as the etiologic agent of 60 (44.8%) of 134 outbreaks, resulting in 12,154 (87.0%) cases; 58 (96.7%) of these outbreaks, resulting in a total of 12,137 (99.9%) cases, were associated with treated recreational water. A total of 32 pool chemical--associated health events that occurred in a public or residential setting were reported to WBDOSS by Maryland and Michigan. These events resulted in 48 cases of illness or injury; 26 (81.3%) events could be attributed at least partially to chemical handling errors (e.g., mixing incompatible chemicals). ATSDR's Hazardous Substance Emergency Events Surveillance System received 92 reports of hazardous substance events that occurred at aquatic facilities. More than half of these events (55 [59.8%]) involved injured persons; the most frequently reported primary contributing factor was human error. Estimates based on CPSC's National Electronic Injury Surveillance System (NEISS) data indicate that 4,574 (95% confidence interval [CI]: 2,703--6,446) emergency department (ED) visits attributable to pool chemical--associated injuries occurred in 2008; the most frequent diagnosis was poisoning (1,784 ED visits [95% CI: 585--2,984]). NEISS data indicate that pool chemical--associated health events occur frequently in residential settings. A total of 236 Vibrio wound infections were reported to be associated with recreational water exposure; 36 (48.6%) of the 74 hospitalized vibriosis patients and six (66.7%) of the nine vibriosis patients who died had V. vulnificus infections. Eight fatal cases of PAM occurred after exposure to warm untreated freshwater., Interpretations: The 134 recreational water--associated outbreaks reported for 2007--2008 represent a substantial increase over the 78 outbreaks reported for 2005--2006 and the largest number of outbreaks ever reported to WBDOSS for a 2-year period. Outbreaks, especially the largest ones, were most frequently associated with treated recreational water and characterized by AGI. Cryptosporidium remains the leading etiologic agent. Pool chemical--associated health events occur frequently but are preventable. Data on other select recreational water--associated health events further elucidate the epidemiology of U.S. waterborne disease by highlighting less frequently implicated types of recreational water (e.g., oceans) and detected types of recreational water--associated illness (i.e., not AGI)., Public Health Actions: CDC uses waterborne disease outbreak surveillance data to 1) identify the types of etiologic agents, recreational water venues, and settings associated with waterborne disease outbreaks; 2) evaluate the adequacy of regulations and public awareness activities to promote healthy and safe swimming; and 3) establish public health priorities to improve prevention efforts, guidelines, and regulations at the local, state, and federal levels.
- Published
- 2011
160. Influenza-like illness in a community surrounding a school-based outbreak of 2009 pandemic influenza A (H1N1) virus-Chicago, Illinois, 2009.
- Author
-
Janusz KB, Cortes JE, Serdarevic F, Jones RC, Jones JD, Ritger KA, Morita JY, Gerber SI, Gallagher L, Biggerstaff BJ, Hicks LA, Swerdlow DL, Fischer M, and Staples JE
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Chicago epidemiology, Child, Child, Preschool, Family Characteristics, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Prevalence, Young Adult, Disease Outbreaks, Family Health, Influenza A Virus, H1N1 Subtype isolation & purification, Influenza, Human epidemiology, Influenza, Human virology, Population Surveillance methods, Schools
- Abstract
In April 2009, following the first school closure due to 2009 pandemic influenza A (H1N1) (pH1N1) in Chicago, Illinois, area hospitals were inundated with patients presenting with influenza-like illness (ILI). The extent of disease spread into the surrounding community was unclear. We performed a household survey to estimate the ILI attack rate among community residents and compared reported ILI with confirmed pH1N1 cases and ILI surveillance data (ie, hospital ILI visits, influenza testing, and school absenteeism). The estimated ILI attack rate was 4.6% (95% confidence interval, 2.8%-7.4%), with cases distributed throughout the 5-week study period. In contrast, 36 (84%) of 43 confirmed pH1N1 cases were identified the week of the school closure. Trends in surveillance data peaked during the same week and rapidly decreased to near baseline. Public awareness and health care practices impact standard ILI surveillance data. Community-based surveys are a valuable tool to help assess the burden of ILI in a community.
- Published
- 2011
- Full Text
- View/download PDF
161. Increase in pneumococcus macrolide resistance, USA.
- Author
-
Hicks LA, Monnet DL, and Roberts RM
- Subjects
- Humans, Pneumococcal Infections drug therapy, United States epidemiology, Anti-Bacterial Agents therapeutic use, Drug Resistance, Bacterial, Macrolides therapeutic use, Pneumococcal Infections epidemiology, Pneumococcal Infections microbiology, Streptococcus pneumoniae drug effects
- Published
- 2010
- Full Text
- View/download PDF
162. Comparison of laboratory diagnostic procedures for detection of Mycoplasma pneumoniae in community outbreaks.
- Author
-
Thurman KA, Walter ND, Schwartz SB, Mitchell SL, Dillon MT, Baughman AL, Deutscher M, Fulton JP, Tongren JE, Hicks LA, and Winchell JM
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Antibodies, Bacterial blood, Child, Child, Preschool, Community-Acquired Infections microbiology, Humans, Infant, Infant, Newborn, Middle Aged, Pharynx microbiology, Pneumonia, Mycoplasma microbiology, Polymerase Chain Reaction methods, Sensitivity and Specificity, Serum immunology, Young Adult, Clinical Laboratory Techniques methods, Community-Acquired Infections diagnosis, Community-Acquired Infections epidemiology, Disease Outbreaks, Mycoplasma pneumoniae isolation & purification, Pneumonia, Mycoplasma diagnosis, Pneumonia, Mycoplasma epidemiology
- Abstract
Background: Mycoplasma pneumoniae continues to be a significant cause of community-acquired pneumonia (CAP). A more definitive methodology for reliable detection of M. pneumoniae is needed to identify outbreaks and to prevent potentially fatal extrapulmonary complications., Methods: We analyzed 2 outbreaks of CAP due to M. pneumoniae. Nasopharyngeal and/or oropharyngeal swab specimens and serum samples were obtained from persons with clinically defined cases, household contacts, and asymptomatic individuals. Real-time polymerase chain reaction (PCR) for M. pneumoniae was performed on all swab specimens, and the diagnostic utility was compared with that of 2 commercially available serologic test kits., Results: For cases, 21% yielded positive results with real-time PCR, whereas 81% and 54% yielded positive results with the immunoglobulin M and immunoglobulin G/immunoglobulin M serologic tests, respectively. For noncases, 1.8% yielded positive results with real-time PCR, whereas 63% and 79% yielded serologically positive results with the immunoglobulin M and immunoglobulin G/immunoglobulin M kits, respectively. The sensitivity of real-time PCR decreased as the duration between symptom onset and sample collection increased, with a peak sensitivity of 48% at 0-21 days. A specificity of 43% for the immunoglobulin M antibody detection assay was observed for persons aged 10-18 years, but the sensitivity increased to 82% for persons aged 19 years., Discussion: Thorough data analysis indicated that no single available test was reliable for the identification of an outbreak of CAP due to M. pneumoniae. A combination of testing methodologies proved to be the most reliable approach for identification of outbreaks of CAP due to M. pneumoniae, especially in the absence of other suspected respiratory pathogens.
- Published
- 2009
- Full Text
- View/download PDF
163. Community outbreak of Mycoplasma pneumoniae infection: school-based cluster of neurologic disease associated with household transmission of respiratory illness.
- Author
-
Walter ND, Grant GB, Bandy U, Alexander NE, Winchell JM, Jordan HT, Sejvar JJ, Hicks LA, Gifford DR, Alexander NT, Thurman KA, Schwartz SB, Dennehy PH, Khetsuriani N, Fields BS, Dillon MT, Erdman DD, Whitney CG, and Moore MR
- Subjects
- Adolescent, Adult, Aged, Child, Child, Preschool, Community-Acquired Infections epidemiology, Community-Acquired Infections microbiology, Encephalitis epidemiology, Encephalitis microbiology, Family Characteristics, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Mycoplasma Infections microbiology, Mycoplasma pneumoniae, Prospective Studies, Retrospective Studies, Skin Diseases, Bacterial microbiology, Skin Diseases, Bacterial transmission, Community-Acquired Infections transmission, Disease Outbreaks, Mycoplasma Infections transmission, Schools
- Abstract
Background: We investigated an outbreak of severe neurologic disease and pneumonia that occurred among students at 4 schools in Rhode Island., Methods: We identified cases of encephalitis, encephalomyelitis, and pneumonia that occurred among schoolchildren from 1 September 2006 through 9 February 2007, and we performed serologic tests, polymerase chain reaction (PCR) analysis, and culture for the detection of multiple pathogens in oropharyngeal and nasopharyngeal specimens. Students with positive results of M. pneumoniae IgM serologic testing and no alternative diagnosis were considered to be infected with M. pneumoniae. At school A, we used questionnaires to identify students and their household contacts who made visits to physicians for pneumonia and cough. We compared observed and expected rates of pneumonia., Results: Rates of pneumonia among elementary students (122 cases/1000 student-years) were > 5-fold higher than expected. Three students had encephalitis or encephalomyelitis, and 76 had pneumonia. Of these 2 groups of students, 2 (66%) and 57 students (75%), respectively, had M. pneumoniae infection. M. pneumoniae was detected by PCR in 10 students with pneumonia; 5 of these specimens were cultured, and M. pneumoniae was isolated in 4. Of 202 households of students attending school A, 20 (10%) accounted for 61% of visits to physicians for pneumonia or cough. Of 19 household contacts of students with pneumonia, 8 (42%) developed pneumonia and 6 (32%) reported visits for cough., Conclusions: M. pneumoniae caused a community-wide outbreak of cough illness and pneumonia and was associated with the development of life-threatening neurologic disease. Although M. pneumoniae was detected in schools, its transmission in households amplified the outbreak. Interrupting household transmission should be a priority during future outbreaks.
- Published
- 2008
- Full Text
- View/download PDF
164. Surveillance for waterborne disease and outbreaks associated with drinking water and water not intended for drinking--United States, 2005-2006.
- Author
-
Yoder J, Roberts V, Craun GF, Hill V, Hicks LA, Alexander NT, Radke V, Calderon RL, Hlavsa MC, Beach MJ, and Roy SL
- Subjects
- Disease Outbreaks, Gastroenteritis etiology, Humans, Legionnaires' Disease etiology, United States epidemiology, Water Pollution, Water Purification, Gastroenteritis epidemiology, Legionnaires' Disease epidemiology, Population Surveillance, Water parasitology, Water Microbiology standards, Water Supply standards, Water Supply statistics & numerical data
- Abstract
Problem/condition: Since 1971, CDC, the U.S. Environmental Protection Agency (EPA), and the Council of State and Territorial Epidemiologists have maintained a collaborative Waterborne Disease and Outbreak Surveillance System (WBDOSS) for collecting and reporting data related to occurrences and causes of waterborne-disease outbreaks (WBDOs) and cases of waterborne disease. This surveillance system is the primary source of data concerning the scope and effects of waterborne disease in the United States., Reporting Period: Data presented summarize 28 WBDOs that occurred during January 2005--December 2006 and four previously unreported WBDOs that occurred during 1979--2002., Description of System: The surveillance system includes data on WBDOs associated with recreational water, drinking water, water not intended for drinking (WNID) (excluding recreational water), and water use of unknown intent. Public health departments in the states, territories, localities, and Freely Associated States (FAS) (i.e., the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau, formerly parts of the U.S.-administered Trust Territory of the Pacific Islands) are primarily responsible for detecting and investigating WBDOs and voluntarily reporting them to CDC by a standard form. Only cases and outbreaks associated with drinking water, WNID (excluding recreational water), and water of unknown intent (WUI) are summarized in this report. Cases and outbreaks associated with recreational water are reported in a separate Surveillance Summary., Results: Fourteen states reported 28 WBDOs that occurred during 2005--2006: a total of 20 were associated with drinking water, six were associated with WNID, and two were associated with WUI. The 20 drinking water-associated WBDOs caused illness among an estimated 612 persons and were linked to four deaths. Etiologic agents were identified in 18 (90.0%) of the drinking water-associated WBDOs. Among the 18 WBDOs with identified pathogens, 12 (66.7%) were associated with bacteria, three (16.7%) with viruses, two (11.1%) with parasites, and one (5.6%) mixed WBDO with both bacteria and viruses. In both WBDOs where the etiology was not determined, norovirus was the suspected etiology. Of the 20 drinking water WBDOs, 10 (50) were outbreaks of acute respiratory illness (ARI), nine (45%) were outbreaks of acute gastrointestinal illness (AGI), and one (5.0%) was an outbreak of hepatitis. All WBDOs of ARI were caused by Legionella, and this is the first reporting period in which the proportion of ARI WBDOs has surpassed that of AGI WBDOs since the reporting of Legionella WBDOs was initiated in 2001. A total of 23 deficiencies were cited in the 20 WBDOs associated with drinking water: 12 (52.2%) deficiencies fell under the classification NWU/POU (deficiencies occurred at points not under the jurisdiction of a water utility or at the point-of-use), 10 (43.5%) deficiencies fell under the classification SWTDs (contamination at or in the source water, treatment facility, or distribution system), and for one (4.3%) deficiency, classification was unknown. Among the 12 NWU/POU deficiencies, 10 (83.3%) involved Legionella spp. in the drinking water system. The most frequently cited SWTD deficiencies were associated with a treatment deficiency (n = four [40.0%]) and untreated ground water (n = four [40.0%]). Three of the four WBDOs with treatment deficiencies used ground water sources., Interpretation: Approximately half (52.2%) of the drinking water deficiencies occurred outside the jurisdiction of a water utility. The majority of these WBDOs were associated with Legionella spp, which suggests that increased attention should be targeted towards reducing illness risks associated with Legionella spp. Nearly all of WBDOs associated with SWTD deficiencies occurred in systems using ground water. EPA's new Ground Water Rule might prevent similar outbreaks in the future in public water systems., Public Health Actions: CDC and EPA use surveillance data to identify the types of water systems, deficiencies, and etiologic agents associated with WBDOs and to evaluate the adequacy of current technologies and practices for providing safe drinking water. Surveillance data also are used to establish research priorities, which can lead to improved water-quality regulation development. The majority of drinking water deficiencies are now associated with contamination at points outside the jurisdiction of public water systems (e.g., regrowth of Legionella spp. in hot water systems) and water contamination that might not be regulated by EPA (e.g., contamination of tap water at the POU). Improved education of consumers and plumbers might help address these risk factors.
- Published
- 2008
165. Incidence of pneumococcal disease due to non-pneumococcal conjugate vaccine (PCV7) serotypes in the United States during the era of widespread PCV7 vaccination, 1998-2004.
- Author
-
Hicks LA, Harrison LH, Flannery B, Hadler JL, Schaffner W, Craig AS, Jackson D, Thomas A, Beall B, Lynfield R, Reingold A, Farley MM, and Whitney CG
- Subjects
- Age Distribution, Aged, Anti-Bacterial Agents pharmacology, Child, Preschool, Drug Resistance, Multiple, Bacterial, Humans, Incidence, Population Surveillance, Serotyping, Streptococcus pneumoniae immunology, Time Factors, United States epidemiology, Pneumococcal Infections epidemiology, Pneumococcal Infections microbiology, Pneumococcal Vaccines immunology, Streptococcus pneumoniae classification
- Abstract
Background: Widespread use of pneumococcal conjugate vaccine (PCV7) resulted in decreases in invasive disease among children and elderly persons. The benefits may be offset by increases in disease due to serotypes not included in the vaccine (hereafter, "nonvaccine serotypes"). We evaluated the effect of PCV7 on incidence of disease due to nonvaccine serotypes., Methods: Cases of invasive disease were identified in 8 geographic areas through the Centers for Disease Control and Prevention's Active Bacterial Core surveillance. Serotyping and susceptibility testing of isolates were performed. We calculated the incidence of disease for children aged <5 years and adults aged > or =65 years. We compared rates of serotype-specific disease before and after PCV7 was licensed for use., Results: The annual incidence of disease due to nonvaccine serotypes increased from an average of 16.3 cases/100,000 population during prevaccine years (1998-1999) to 19.9 cases/100,000 population in 2004 for children aged <5 years (P=.01) and from 27.0 cases/100,000 population during prevaccine years to 29.8 cases/100,000 population in 2004 for adults aged > or =65 years (P=.05). Significant increases in the incidences of disease due to serotypes 3, 15, 19A, 22F, and 33F were observed among children during this period (P<.05 for each serotype); serotype 19A has become the predominant cause of invasive disease in children. The incidence of disease due to these serotypes also increased among elderly persons., Conclusions: The incidence of pneumococcal disease caused by nonvaccine serotypes is increasing. Ongoing surveillance is needed to monitor the magnitude of disease caused by nonvaccine serotypes, to ensure that future vaccines target the appropriate serotypes.
- Published
- 2007
- Full Text
- View/download PDF
166. Increased rainfall is associated with increased risk for legionellosis.
- Author
-
Hicks LA, Rose CE Jr, Fields BS, Drees ML, Engel JP, Jenkins PR, Rouse BS, Blythe D, Khalifah AP, Feikin DR, and Whitney CG
- Subjects
- Adult, Aged, Aged, 80 and over, Humans, Middle Aged, Risk Factors, Temperature, Legionellosis etiology, Rain, Water Microbiology
- Abstract
Legionnaires' disease (LD) is caused by Legionella species, most of which live in water. The Mid-Atlantic region experienced a sharp rise in LD in 2003 coinciding with a period of record-breaking rainfall. To investigate a possible relationship, we analysed the association between monthly legionellosis incidence and monthly rainfall totals from January 1990 to December 2003 in five Mid-Atlantic states. Using negative binomial model a 1-cm increase in rainfall was associated with a 2.6% (RR 1.026, 95% CI 1.012-1.040) increase in legionellosis incidence. The average monthly rainfall from May to September 1990-2002 was 10.4 cm compared to 15.7 cm from May to September 2003. This change in rainfall corresponds to an increased risk for legionellosis of approximately 14.6% (RR 1.146, 95% CI 1.067-1.231). Legionellosis incidence increased during periods of increased rainfall; identification of mechanisms that increase exposure and transmission of Legionella during rainfall might lead to opportunities for prevention.
- Published
- 2007
- Full Text
- View/download PDF
167. A large, travel-associated outbreak of legionellosis among hotel guests: utility of the urine antigen assay in confirming Pontiac fever.
- Author
-
Burnsed LJ, Hicks LA, Smithee LM, Fields BS, Bradley KK, Pascoe N, Richards SM, Mallonee S, Littrell L, Benson RF, and Moore MR
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Antibodies, Bacterial blood, Child, Child, Preschool, Cohort Studies, Female, Humans, Infant, Legionnaires' Disease immunology, Legionnaires' Disease urine, Male, Middle Aged, Oklahoma epidemiology, Retrospective Studies, Surveys and Questionnaires, Antigens, Bacterial urine, Disease Outbreaks, Legionnaires' Disease diagnosis, Legionnaires' Disease epidemiology, Travel
- Abstract
Background: During March 2004, a large outbreak of legionnaires disease and Pontiac fever occurred among hotel guests in Oklahoma. An investigation was conducted to identify the source and evaluate the utility of the Legionella urine antigen assay and serologic testing for the identification of Pontiac fever., Methods: A retrospective cohort investigation of hotel guests and employees and an environmental evaluation were performed. Participants were interviewed, and clinical specimens were collected from consenting individuals., Results: Six cases of legionnaires disease and 101 cases of Pontiac fever were identified. Exposure to the indoor pool and hot tub area was associated with legionellosis (relative risk, 4.4; 95% confidence interval, 2.8-6.9). Specimens from the pool and hot tub tested positive for Legionella pneumophila serogroup 1 by polymerase chain reaction. For Pontiac fever, the sensitivity and positive predictive value were 35.7% and 100%, respectively, for the urine antigen assay, and 46.4% and 90%, respectively, for serologic testing. The specificity and negative predictive value were 100% and 47.8%, respectively, for the urine antigen assay, and 89.3% and 45.5%, respectively, for serologic testing., Conclusions: Urine antigen testing, with or without serologic testing, can be used to confirm outbreak-associated cases of Pontiac fever caused by L. pneumophila serogroup 1.
- Published
- 2007
- Full Text
- View/download PDF
168. Provider knowledge, attitudes, and practices regarding obstetric and postsurgical gynecologic infections due to group A Streptococcus and other infectious agents.
- Author
-
Van Beneden CA, Hicks LA, Riley LE, and Schulkin J
- Subjects
- Attitude of Health Personnel, Data Collection, Female, Humans, Male, Physicians, Pregnancy, Puerperal Infection microbiology, Surgical Wound Infection microbiology, United States, Clinical Competence, Gynecology, Obstetrics, Puerperal Infection diagnosis, Streptococcal Infections diagnosis, Streptococcus pyogenes pathogenicity, Surgical Wound Infection diagnosis
- Abstract
Background: Knowledge, attitudes, and practices of obstetricians and gynecologists regarding the Centers for Disease Control and Prevention (CDC) recommendations for prevention of healthcare-associated group A streptococcal (GAS) infections as well as general management of pregnancy-related and postpartum infections are unknown., Methods: Questionnaires were sent to 1300 members of the American College of Obstetricians and Gynecologists., Results: Overall, 53% of providers responded. Postpartum and postsurgical infections occurred in 3% and 7% of patients, respectively. Only 14% of clinicians routinely obtain diagnostic specimens for postpartum infections; providers collecting specimens determined the microbial etiology in 28%. Microbiologic diagnoses were confirmed in 20% of postsurgical cases. Approximately 13% and 15% of postpartum and postsurgical infections for which diagnoses were confirmed were attributed to GAS, respectively. Over 70% of clinicians were unaware of CDC recommendations., Conclusions: Postpartum and postsurgical infections are common. Providing empiric treatment without attaining diagnostic cultures represents a missed opportunity for potential prevention of diseases such as severe GAS infections.
- Published
- 2007
- Full Text
- View/download PDF
169. Two outbreaks of severe respiratory disease in nursing homes associated with rhinovirus.
- Author
-
Hicks LA, Shepard CW, Britz PH, Erdman DD, Fischer M, Flannery BL, Peck AJ, Lu X, Thacker WL, Benson RF, Tondella ML, Moll ME, Whitney CG, Anderson LJ, and Feikin DR
- Subjects
- Acute Disease, Adult, Aged, Aged, 80 and over, Antibodies, Viral immunology, DNA, Viral genetics, Female, Humans, Male, Middle Aged, Pennsylvania epidemiology, Picornaviridae Infections virology, Respiratory Tract Infections virology, Disease Outbreaks, Nursing Homes, Picornaviridae Infections epidemiology, Respiratory Tract Infections epidemiology, Rhinovirus genetics, Rhinovirus immunology
- Abstract
Objectives: To characterize illness and identify the etiology for two nursing home outbreaks of respiratory illness., Design: Multisite outbreak investigations; cohort., Setting: Two nursing homes in Pennsylvania., Participants: Facility A residents (n = 170), Facility B residents (n = 124), and employees (n = 91)., Measurements: Medical records for Facility A and B residents were reviewed, and employees from Facility B self-administered a questionnaire to identify risk factors for illness. Serological, oropharyngeal, and nasopharyngeal specimens were collected for both outbreaks, and testing for respiratory pathogens was performed., Results: In Facility A, 40 (24%) of 170 residents were identified with respiratory illness; 13 (33%) case-patients had radiographically confirmed pneumonia, 15 (38%) were taken to a hospital, and two (5%) died. Of 10 specimens collected from symptomatic Facility A case-patients, four (40%) tested positive using reverse transcription polymerase chain reaction for rhinovirus. In Facility B, 77 (62%) of 124 residents had respiratory illness, and 40 (52%) had radiographically confirmed pneumonia; 12 (16%) case-patients were hospitalized, and five (6%) died. Of 19 respiratory specimens collected from symptomatic Facility B case-patients, six (32%) were positive for rhinovirus; one was from an employee. Five (50%) of 10 rhinovirus-positive cases in both outbreaks had clinical and radiographic evidence of pneumonia., Conclusion: These investigations suggest that rhinoviruses may be an underrecognized cause of respiratory outbreaks in nursing homes, capable of causing pneumonia and perhaps death.
- Published
- 2006
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.