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Factors Associated with Time to Appropriate Treatment in Pertussis Cases in Georgia, 2009 to 2013.

ABSTRACT: Pertussis is endemic in the United States, with periodic epidemics that continue to highlight its importance as a public health issue. The clinical presentation of pertussis can vary by age and vaccination status. However, little is known about the factors that affect time to antibiotic treatment of pertussis cases. We analyzed 5 years of data from the Georgia Department of Public Health to understand how factors such as age, symptoms, and vaccination status can alter the clinical picture of pertussis and affect time to treatment. We used multivariable linear regression to assess the impact of each variable on time to antibiotic treatment. There was little consistency across age groups for symptom and demographic predictors of time to antibiotic treatment. Overall, the multivariate linear regression showed that among patients ?18 years old, none of the variables had an impact on time to antibiotic treatment greater than -0.25 to 1.47 days. Among patients >18 years old, most variables had little impact on time to treatment, though two (paroxysmal cough in >18- to 40-year-olds and hospitalization in individuals over 40) were associated with an additional 5 days in time to treatment from cough onset. This study highlights how the difficulties in pertussis diagnosis, particularly among adults, can affect time to antibiotic treatment; adults may not begin antibiotic treatment until there is an accumulation of symptoms. Health care providers need to recognize the variety of symptoms that pertussis can present with and consider confirmatory testing early.

SUBMITTER: Goodenough D

PROVIDER: S-EPMC4862493 | biostudies-literature | 2016 May

REPOSITORIES: biostudies-literature

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Factors Associated with Time to Appropriate Treatment in Pertussis Cases in Georgia, 2009 to 2013.

Goodenough Dana D Thomas Ebony E Tuttle Jessica J Bednarczyk Robert A RA

Antimicrobial agents and chemotherapy 20160422 5

Pertussis is endemic in the United States, with periodic epidemics that continue to highlight its importance as a public health issue. The clinical presentation of pertussis can vary by age and vaccination status. However, little is known about the factors that affect time to antibiotic treatment of pertussis cases. We analyzed 5 years of data from the Georgia Department of Public Health to understand how factors such as age, symptoms, and vaccination status can alter the clinical picture of per ...[more]

PMID: 26953196

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Project description:BACKGROUND:TB/HIV coinfection is a serious public health issue in Brazil, and patients with coinfection have difficulty adhering to treatments. Directly observed treatment (DOT) has been recommended by the World Health Organization, considering the vulnerability of those affected. The purpose is to investigate the occurrence of DOT and associated factors compared to conventional treatment in Porto Alegre, Brazil. METHODS:A retrospective cohort study was carried out with all patients with coinfection from 2009 to 2013 in the city of Porto Alegre, Brazil, the state capital with the highest rate of coinfection in Brazil. The data came from national health information systems. The dependent variable was the performance of DOT. Bivariate and multivariable models were used to determine factors associated with DOT. The percentage of cure and death was verified in a period of two years, comparing patients who received and did not receive DOT. RESULTS:2,400 cases of coinfection were reported, with 1,574 males and 826 females and a mean age of 38 years ± 9.91 years. The occurrence of DOT was 16.9%. In the multivariable analysis, factors independently associated to DOT were the year (with greater chances of being received in 2012 and 2013), place of origin, non-white race (OR = 1.29, 95% CI = 1.08-1.54), cases of relapse (OR = 1.33; 95% CI = 1.03-1.73), readmission after abandonment (OR = 1.48, 95% CI = 1.20-1.83), transfer (OR = 2.04; 95% CI = 1.40-2.98), acid-fast bacilli (AFB) test with positive result in first sample (OR = 1.73, 95% CI = 1.24-2.42), alcohol abuse (OR = 1.39; 95% CI = 1.16-1.67), and mental disorders (OR = 1.83; 95% CI = 1.38-2.44.) Of the 532 cases of death, occurring in two years, 10.2% were in patients who underwent DOT and 89.8% in patients who did not undergo DOT (p<0.001). O percentual de óbitos em pessoas que receberam DOT foi de 13% e o percentual de óbitos para pessoas que receberam tratamento convencional foi de 24%. CONCLUSIONS:There was an increase in the percentage of DOT over the years in the scenario studied, and the predictors for DOT were related to social vulnerability. In relation to death within two years, a lower proportion was found in patients who underwent DOT, suggesting a protective effect of the strategy.

Project description:Following the emergence of 2009 pandemic influenza A virus subtype H1N1 (A[H1N1]pdm09) in the United States and Mexico in April 2009, A(H1N1)pdm09 spread rapidly all over the world. There is a dearth of information about the epidemiology of A(H1N1)pdm09 in Africa, including Morocco. We describe the epidemiologic characteristics of the A(H1N1)pdm09 epidemic in Morocco during 2009-2010, including transmissibility and risk factors associated with fatal disease.We implemented influenza surveillance for patients presenting with influenza-like illness (ILI) at 136 private and public clinics for patients with severe acute respiratory illness (SARI) at 16 regional public hospitals from June 2009 through February 2010. Respiratory samples and structured questionnaires were collected from all enrolled patients, and samples were tested by real-time reverse-transcription polymerase chain reaction for influenza viruses. We estimated the risk factors associated with fatal disease as well as the basic reproduction number (R(0)) and the serial interval of the pandemic virus.From June 2009 through February 2010, we obtained 3937 specimens, of which 1452 tested positive for influenza virus. Of these, 1398 (96%) were A(H1N1)pdm09. Forty percent of specimens from ILI cases (1056 of 2646) and 27% from SARI cases (342 of 1291) were positive for A(H1N1)pdm09. Sixty-four deaths occurred among laboratory-confirmed A(H1N1)pdm09 SARI cases. Among these cases, those who had hypertension (age-adjusted odd ratio [aOR], 28.2; 95% confidence interval [CI], 2.0-398.7), had neurological disorders (aOR, 7.5; 95% CI, 1.5-36.4), or were obese (aOR, 7.1; 95% CI, 1.6-31.1), as well as women of gestational age who were pregnant (aOR, 2.5; 95% CI, 1.1-5.6), were at increased risk of death. Across the country, elevated numbers of locally acquired infections were detected 4 months after the detection of the first laboratory-confirmed case and coincided with the expected influenza season (October-January) in Morocco. We obtained an R(0) estimate of 1.44 (95% CI, 1.32-1.56) and a mean serial interval (±SD) of 2.3 ± 1.4 days (95% CI, 1.6-3.0).Widespread but delayed community transmission of A(H1N1)pdm09 occurred in Morocco in 2009, and A(H1N1)pdm09 became the dominant influenza virus subtype during the 2009-2010 influenza season. The transmissibility characteristics were similar to those observed in other countries.

Project description:BackgroundEarly diagnosis is crucial in securing optimal outcomes in the HIV care cascade. Recent HIV infection (RHI) serves as an indicator of early detection in the course of HIV infection. Surveillance of RHI is important in uncovering at-risk groups in which HIV transmission is ongoing. The study objectives are to estimate the proportion of RHI among persons newly-diagnosed in 2013-2017, and to elucidate epidemiological factors associated with RHI in Singapore.MethodsAs part of the National HIV Molecular Surveillance Programme, residual plasma samples of treatment-naïve HIV-1 positive individuals were tested using the biotinylated peptide-capture enzyme immunoassay with a cutoff of normalized optical density ≤ 0.8 for evidence of RHI. A recent infection testing algorithm was applied for the classification of RHI. We identified risk factors associated with RHI using logistic regression analyses.ResultsA total of 701 newly-diagnosed HIV-infected persons were included in the study. The median age at HIV diagnosis was 38 years (interquartile range, 28-51). The majority were men (94.2%), and sexual route was the predominant mode of HIV transmission (98.3%). Overall, 133/701 (19.0, 95% confidence interval [CI] 16.2-22.0%) were classified as RHI. The proportions of RHI in 2015 (31.1%) and 2017 (31.0%) were significantly higher than in 2014 (11.2%). A significantly higher proportion of men having sex with men (23.4, 95% CI 19.6-27.6%) had RHI compared with heterosexual men (11.1, 95% CI 7.6-15.9%). Independent factors associated with RHI were: age 15-24 years (adjusted odds ratio [aOR] 4.18, 95% CI 1.69-10.31) compared with ≥55 years; HIV diagnosis in 2015 (aOR 2.36, 95% CI 1.25-4.46) and 2017 (aOR 2.52, 95% CI 1.32-4.80) compared with 2013-2014; detection via voluntary testing (aOR 1.91, 95% CI 1.07-3.43) compared with medical care; and self-reported history of HIV test(s) prior to diagnosis (aOR 1.72, 95% CI 1.06-2.81).ConclusionAlthough there appears to be an increasing trend towards early diagnosis, persons with RHI remain a minority in Singapore. The strong associations observed between modifiable behaviors (voluntary testing and HIV testing history) and RHI highlight the importance of increasing the accessibility to HIV testing for at-risk groups.

Project description:IntroductionAnthrax is considered endemic in livestock in Georgia. In 2007, the annual vaccination became the responsibility of livestock owners, while contracting of private veterinarians was not officially required. Six years later, due to increase in human outbreaks associated with livestock handling, there is a need to find out the risk factors of livestock anthrax in Georgia.ObjectiveTo identify exposures and risk factors associated with livestock anthrax.MethodsA matched case-control study design was used to recruit the owners of individual livestock anthrax cases that occurred between June 2013 and May 2015, and owners of unaffected livestock from within ("village control") and outside the village ("area control"). We collected data about the case and control livestock animals' exposure and risk factors within the one-month prior to the disease onset of the case livestock (or matched case for the controls). We used logistic regression analysis (univariate and multivariable) to calculate the odds ratios of exposures and risk factors.ResultsDuring the study period, 36 anthrax cases met the case definition and were enrolled in the study; 67 matched village control livestock and 71 matched area control livestock were also enrolled. The findings from multivariable logistic regression analysis demonstrate that vaccination within the last two years significantly reduced the odds of anthrax in cattle (OR = 0.014; 95% Confidence interval = <0.001, 0.99). The other factors that were significantly protective against anthrax were 'animals being in covered fence area/barn' (OR = 0.065; p-value = 0.036), and 'female animal being pregnant or milking compared to heifer' (OR = 0.006; p-value = 0.037).ConclusionsThe information obtained from this study has involved and been presented to decision makers, used to build technical capacity of veterinary staff, and to foster a One Health approach to the control of zoonotic diseases which will optimize prevention and control strategies. Georgia has embedded the knowledge and specific evidence that vaccination is a highly protective measure to prevent anthrax deaths among livestock, to which primary emphasis of the anthrax control program will be given. Education of livestock keepers in Georgia is an overriding priority.

Project description:ObjectivesTo identify the risk factors for and adverse newborn outcomes associated with maternal deaths from direct and indirect causes in the UK.DesignUnmatched case-control analysis.SettingAll hospitals caring for pregnant women in the UK.PopulationComprised 383 women who died (cases) from direct or indirect causes from 2009 to 2013 (Confidential Enquiry into Maternal Deaths in the UK) and 1516 women who did not have any life-threatening complications during pregnancy and childbirth (controls) obtained from UK Obstetric Surveillance System (UKOSS).MethodsMultivariable regression analyses were undertaken to examine potential risk factors, their incremental effects, and adverse newborn outcomes associated with maternal deaths.OutcomesOdds ratios associated for risk factors for maternal death and newborn outcomes (stillbirth, admission to neonatal intensive care unit [NICU], early neonatal death) and incremental risk.ResultsSeven factors, of 13 examined, were independently associated with increased odds of maternal death: pre-existing medical comorbidities (adjusted odds ratio [aOR] 8.65; 95% CI 6.29-11.90), anaemia during pregnancy (aOR 3.58; 95% CI 1.14-11.21), previous pregnancy problems (aOR 1.85; 95% CI 1.33-2.57), inadequate use of antenatal care (aOR 46.85; 95% CI 19.61-111.94), substance misuse (aOR 12.21; 95% CI 2.33-63.98), unemployment (aOR 1.81; 95% CI 1.08-3.04) and maternal age (aOR 1.06; 95% CI 1.04-1.09). There was a four-fold increase in the odds of death per unit increase in the number of risk factors. Odds of stillbirth, admission to NICU and early neonatal death were higher among women who died.ConclusionThis study reiterates the need for optimal care for women with medical comorbidities and older age, and the importance of adequate antenatal care. It demonstrates the existence of socio-economic inequalities in maternal death in the UK.Tweetable abstractMedical comorbidities and socio-economic inequalities are important risk factors for maternal death in the UK.

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Factors Associated with Time to Appropriate Treatment in Pertussis Cases in Georgia, 2009 to 2013.

Publications

Factors Associated with Time to Appropriate Treatment in Pertussis Cases in Georgia, 2009 to 2013.

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