Publications by authors named "Marc Fischer"

255 Publications

Cost effectiveness and impact of a targeted age- and incidence-based West Nile virus vaccine strategy.

Clin Infect Dis 2021 Jun 12. Epub 2021 Jun 12.

Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), Fort Collins, Colorado, USA.

Background: West Nile virus (WNV) is the leading cause of arboviral disease in the United States and is associated with significant morbidity and mortality. A previous analysis found that a vaccination program targeting persons aged ≥60 years was more cost effective than universal vaccination, but costs remained high.

Methods: We used a mathematical Markov model to evaluate cost-effectiveness of an age- and incidence-based WNV vaccination program. We grouped states and large counties (≥100,000 persons aged ≥60 years) by median annual WNV incidence rates from 2004 to 2017 for persons aged ≥60 years. We defined WNV incidence thresholds, in increments of 0.5 cases per 100,000 persons ≥60 years. We calculated potential cost per WNV vaccine-prevented case and per quality adjusted life years (QALYs) saved.

Results: Vaccinating persons aged ≥60 years in states with an annual incidence of WNV neuroinvasive disease of ≥0.5 per 100,000 resulted in approximately half the cost per health outcome averted compared to vaccinating persons aged ≥60 years in all the contiguous United States. This approach could potentially prevent 37% of all neuroinvasive disease cases and 63% of WNV-related deaths nationally. Employing such a threshold at a county-level further improved cost-effectiveness ratios while preventing 19% and 30% of WNV-related neuroinvasive disease cases and deaths, respectively.

Conclusions: An age- and incidence-based WNV vaccination program could be a more cost-effective strategy than an age-based program while still having a substantial impact on lowering WNV-related morbidity and mortality.
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http://dx.doi.org/10.1093/cid/ciab540DOI Listing
June 2021

Characterizing Areas with Increased Burden of West Nile Virus Disease in California, 2009-2018.

Vector Borne Zoonotic Dis 2021 Jun 2. Epub 2021 Jun 2.

California Department of Public Health, Sacramento, California, USA.

West Nile virus (WNV) is a mosquito-borne flavivirus that can cause severe neurological disease in humans, for which there is no treatment or vaccine. From 2009 to 2018, California has reported more human disease cases than any other state in the United States. We sought to identify smaller geographic areas within the 10 California counties with the highest number of WNV cases that accounted for disproportionately large numbers of human cases from 2009 to 2018. Eleven areas, consisting of groups of high-burden ZIP codes, were identified in nine counties within southern California and California's Central Valley. Despite containing only 2% of California's area and 17% of the state's population, these high-burden ZIP codes accounted for 44% of WNV cases reported and had a mean annual incidence that was 2.4 times the annual state incidence. Focusing mosquito control and public education efforts in these areas would lower WNV disease burden.
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http://dx.doi.org/10.1089/vbz.2021.0014DOI Listing
June 2021

Interim Estimates of Vaccine Effectiveness of Pfizer-BioNTech and Moderna COVID-19 Vaccines Among Health Care Personnel - 33 U.S. Sites, January-March 2021.

MMWR Morb Mortal Wkly Rep 2021 May 21;70(20):753-758. Epub 2021 May 21.

Throughout the COVID-19 pandemic, health care personnel (HCP) have been at high risk for exposure to SARS-CoV-2, the virus that causes COVID-19, through patient interactions and community exposure (1). The Advisory Committee on Immunization Practices recommended prioritization of HCP for COVID-19 vaccination to maintain provision of critical services and reduce spread of infection in health care settings (2). Early distribution of two mRNA COVID-19 vaccines (Pfizer-BioNTech and Moderna) to HCP allowed assessment of the effectiveness of these vaccines in a real-world setting. A test-negative case-control study is underway to evaluate mRNA COVID-19 vaccine effectiveness (VE) against symptomatic illness among HCP at 33 U.S. sites across 25 U.S. states. Interim analyses indicated that the VE of a single dose (measured 14 days after the first dose through 6 days after the second dose) was 82% (95% confidence interval [CI] = 74%-87%), adjusted for age, race/ethnicity, and underlying medical conditions. The adjusted VE of 2 doses (measured ≥7 days after the second dose) was 94% (95% CI = 87%-97%). VE of partial (1-dose) and complete (2-dose) vaccination in this population is comparable to that reported from clinical trials and recent observational studies, supporting the effectiveness of mRNA COVID-19 vaccines against symptomatic disease in adults, with strong 2-dose protection.
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http://dx.doi.org/10.15585/mmwr.mm7020e2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136422PMC
May 2021

Surveillance for West Nile virus disease - United States, 2009-2018.

Am J Transplant 2021 05;21(5):1959-1974

Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA.

Problem/condition: West Nile virus (WNV) is an arthropod-borne virus (arbovirus) in the family Flaviviridae and is the leading cause of domestically acquired arboviral disease in the contiguous United States. An estimated 70%-80% of WNV infections are asymptomatic. Symptomatic persons usually develop an acute systemic febrile illness. Less than 1% of infected persons develop neuroinvasive disease, which typically presents as encephalitis, meningitis, or acute flaccid paralysis.

Reporting Period: 2009-2018.

Description Of System: WNV disease is a nationally notifiable condition with standard surveillance case definitions. State health departments report WNV cases to CDC through ArboNET, an electronic passive surveillance system. Variables collected include patient age, sex, race, ethnicity, county and state of residence, date of illness onset, clinical syndrome, hospitalization, and death.

Results: During 2009-2018, a total of 21 869 confirmed or probable cases of WNV disease, including 12 835 (59%) WNV neuroinvasive disease cases, were reported to CDC from all 50 states, the District of Columbia, and Puerto Rico. A total of 89% of all WNV patients had illness onset during July-September. Neuroinvasive disease incidence and case-fatalities increased with increasing age, with the highest incidence (1.22 cases per 100 000 population) occurring among persons aged ≥70 years. Among neuroinvasive cases, hospitalization rates were >85% in all age groups but were highest among patients aged ≥70 years (98%). The national incidence of WNV neuroinvasive disease peaked in 2012 (0.92 cases per 100 000 population). Although national incidence was relatively stable during 2013-2018 (average annual incidence: 0.44; range: 0.40-0.51), state level incidence varied from year to year. During 2009-2018, the highest average annual incidence of neuroinvasive disease occurred in North Dakota (3.16 cases per 100 000 population), South Dakota (3.06), Nebraska (1.95), and Mississippi (1.17), and the largest number of total cases occurred in California (2819), Texas (2043), Illinois (728), and Arizona (632). Six counties located within the four states with the highest case counts accounted for 23% of all neuroinvasive disease cases nationally.

Interpretation: Despite the recent stability in annual national incidence of neuroinvasive disease, peaks in activity were reported in different years for different regions of the country. Variations in vectors, avian amplifying hosts, human activity, and environmental factors make it difficult to predict future WNV disease incidence and outbreak locations.

Public Health Action: WNV disease surveillance is important for detecting and monitoring seasonal epidemics and for identifying persons at increased risk for severe disease. Surveillance data can be used to inform prevention and control activities. Health care providers should consider WNV infection in the differential diagnosis of aseptic meningitis and encephalitis, obtain appropriate specimens for testing, and promptly report cases to public health authorities. Public health education programs should focus prevention messaging on older persons because they are at increased risk for severe neurologic disease and death. In the absence of a human vaccine, WNV disease prevention depends on community-level mosquito control and household and personal protective measures. Understanding the geographic distribution of cases, particularly at the county level, appears to provide the best opportunity for directing finite resources toward effective prevention and control activities. Additional work to further develop and improve predictive models that can foreshadow areas most likely to be impacted in a given year by WNV outbreaks could allow for proactive targeting of interventions and ultimately lowering of WNV disease morbidity and mortality.
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http://dx.doi.org/10.1111/ajt.16595DOI Listing
May 2021

Augmented Reality Visualization Tool For The Future of Tactical Combat Casualty Care.

J Trauma Acute Care Surg 2021 Apr 29. Epub 2021 Apr 29.

Nakamir Inc, Palo Alto, CA Nakamir Inc, Palo Alto, CA Department of Anesthesia, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, CA Nakamir Inc, Palo Alto, CA US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA.

The objective of this project was to identify and develop software for an Augmented Reality (AR) application that runs on the US Army Integrated Visual Augmentation System (IVAS) to support a medical caregiver during training and combat casualty care (TC3) scenarios. In this AR-TC3 application, human anatomy of individual soldiers obtained pre-deployment is superimposed on the view of an injured warfighter through the IVAS. This offers insight into the anatomy of the injured warfighter to advance treatment in austere environments.

In this article, we describe various software components required for an AR-TC3-tool. These include a body pose tracking system to track the patient's body pose, a virtual rendering of a human anatomy avatar, speech input to control the application and rendering techniques to visualize the virtual anatomy and treatment information on the AR display. We then implemented speech commands and visualization for four common medical scenarios including injury of a limb, a blast to the pelvis, cricothyrotomy, and a pneumothorax on the Microsoft Hololens 1.

The software is designed for a forward surgical care tool on the US Army IVAS, with the intention to provide the medical caregiver with a unique ability to quickly assess affected internal anatomy. The current software components still had some limitations with respect to speech recognition reliability during noise and body pose tracking. These will likely be improved with the improved hardware of the IVAS, which is based on a modified Hololens 2.

Level Of Evidence: Basic science paper.
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http://dx.doi.org/10.1097/TA.0000000000003263DOI Listing
April 2021

Fully Automated and Standardized Segmentation of Adipose Tissue Compartments via Deep Learning in 3D Whole-Body MRI of Epidemiologic Cohort Studies.

Radiol Artif Intell 2020 Nov 28;2(6):e200010. Epub 2020 Oct 28.

Department of Diagnostic and Interventional Radiology, Medical Image and Data Analysis, University Hospital Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany (T.K., T.H., M.F., K.N., S.G.); Department of Signal Processing and System Theory, University of Stuttgart, Stuttgart, Germany (T.K., M.F., M.S., B.Y.); School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, England (T.K.); Department of Empirical Inference, Max-Planck Institute for Intelligent Systems, Tübingen, Germany (T.H.); Department of Diagnostic and Interventional Radiology, Section of Experimental Radiology, University Hospital Tübingen, Tübingen, Germany (M.F., M.S., F.S., J.M.); Department of Internal Medicine IV, Eberhard Karls University, Tübingen, Germany (A.F.); Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Zentrum München, University of Tübingen, Tübingen, Germany (A.F., F.S., J.M.); German Center for Diabetes Research (DZD), Tübingen, Germany (A.F., H.U.H., F.S., J.M.); and Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (F.B.).

Purpose: To enable fast and reliable assessment of subcutaneous and visceral adipose tissue compartments derived from whole-body MRI.

Materials And Methods: Quantification and localization of different adipose tissue compartments derived from whole-body MR images is of high interest in research concerning metabolic conditions. For correct identification and phenotyping of individuals at increased risk for metabolic diseases, a reliable automated segmentation of adipose tissue into subcutaneous and visceral adipose tissue is required. In this work, a three-dimensional (3D) densely connected convolutional neural network (DCNet) is proposed to provide robust and objective segmentation. In this retrospective study, 1000 cases (average age, 66 years ± 13 [standard deviation]; 523 women) from the Tuebingen Family Study database and the German Center for Diabetes research database and 300 cases (average age, 53 years ± 11; 152 women) from the German National Cohort (NAKO) database were collected for model training, validation, and testing, with transfer learning between the cohorts. These datasets included variable imaging sequences, imaging contrasts, receiver coil arrangements, scanners, and imaging field strengths. The proposed DCNet was compared to a similar 3D U-Net segmentation in terms of sensitivity, specificity, precision, accuracy, and Dice overlap.

Results: Fast (range, 5-7 seconds) and reliable adipose tissue segmentation can be performed with high Dice overlap (0.94), sensitivity (96.6%), specificity (95.1%), precision (92.1%), and accuracy (98.4%) from 3D whole-body MRI datasets (field of view coverage, 450 × 450 × 2000 mm). Segmentation masks and adipose tissue profiles are automatically reported back to the referring physician.

Conclusion: Automated adipose tissue segmentation is feasible in 3D whole-body MRI datasets and is generalizable to different epidemiologic cohort studies with the proposed DCNet.© RSNA, 2020.
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http://dx.doi.org/10.1148/ryai.2020200010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082356PMC
November 2020

Deep Learning-Based Automated Abdominal Organ Segmentation in the UK Biobank and German National Cohort Magnetic Resonance Imaging Studies.

Invest Radiol 2021 Jun;56(6):401-408

From the Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK.

Purpose: The aims of this study were to train and evaluate deep learning models for automated segmentation of abdominal organs in whole-body magnetic resonance (MR) images from the UK Biobank (UKBB) and German National Cohort (GNC) MR imaging studies and to make these models available to the scientific community for analysis of these data sets.

Methods: A total of 200 T1-weighted MR image data sets of healthy volunteers each from UKBB and GNC (400 data sets in total) were available in this study. Liver, spleen, left and right kidney, and pancreas were segmented manually on all 400 data sets, providing labeled ground truth data for training of a previously described U-Net-based deep learning framework for automated medical image segmentation (nnU-Net). The trained models were tested on all data sets using a 4-fold cross-validation scheme. Qualitative analysis of automated segmentation results was performed visually; performance metrics between automated and manual segmentation results were computed for quantitative analysis. In addition, interobserver segmentation variability between 2 human readers was assessed on a subset of the data.

Results: Automated abdominal organ segmentation was performed with high qualitative and quantitative accuracy on UKBB and GNC data. In more than 90% of data sets, no or only minor visually detectable qualitative segmentation errors occurred. Mean Dice scores of automated segmentations compared with manual reference segmentations were well higher than 0.9 for the liver, spleen, and kidneys on UKBB and GNC data and around 0.82 and 0.89 for the pancreas on UKBB and GNC data, respectively. Mean average symmetric surface distance was between 0.3 and 1.5 mm for the liver, spleen, and kidneys and between 2 and 2.2 mm for pancreas segmentation. The quantitative accuracy of automated segmentation was comparable with the agreement between 2 human readers for all organs on UKBB and GNC data.

Conclusion: Automated segmentation of abdominal organs is possible with high qualitative and quantitative accuracy on whole-body MR imaging data acquired as part of UKBB and GNC. The results obtained and deep learning models trained in this study can be used as a foundation for automated analysis of thousands of MR data sets of UKBB and GNC and thus contribute to tackling topical and original scientific questions.
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http://dx.doi.org/10.1097/RLI.0000000000000755DOI Listing
June 2021

Case Series of Laboratory-Associated Zika Virus Disease, United States, 2016-2019.

Emerg Infect Dis 2021 05;27(5):1296-1300

Zika virus diagnostic testing and laboratory research increased considerably when Zika virus began spreading through the Americas in 2015, increasing the risk for potential Zika virus exposure of laboratory workers and biomedical researchers. We report 4 cases of laboratory-associated Zika virus disease in the United States during 2016-2019. Of these, 2 were associated with needlestick injuries; for the other 2 cases, the route of transmission was undetermined. In laboratories in which work with Zika virus is performed, good laboratory biosafety practices must be implemented and practiced to reduce the risk for infection among laboratory personnel.
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http://dx.doi.org/10.3201/eid2705.203602DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084508PMC
May 2021

Epidemiologic Findings from Case Investigations and Contact Tracing for First 200 Cases of Coronavirus Disease, Santa Clara County, California, USA.

Emerg Infect Dis 2021 05;27(5):1301-1308

In January 2020, Santa Clara County, California, USA, began identifying laboratory-confirmed coronavirus disease among residents. County staff conducted case and contact investigations focused on households and collected detailed case demographic, occupation, exposure, and outcome information. We describe the first 200 test-positive cases during January 31-March 20, 2020, to inform future case and contact investigations. Probable infection sources included community transmission (104 cases), known close contact with a confirmed case-patient (66 cases), and travel (30 cases). Disease patterns across race and ethnicity, occupational, and household factors suggested multiple infection risk factors. Disproportionately high percentages of case-patients from racial and ethnic subgroups worked outside the home (Hispanic [86%] and Filipino [100%]); household transmission was more common among persons from Vietnam (53%). Even with the few initial cases, detailed case and contact investigations of household contacts capturing occupational and disaggregated race and ethnicity data helped identify at-risk groups and focused solutions for disease control.
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http://dx.doi.org/10.3201/eid2705.204876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084524PMC
May 2021

Demographic, clinical, and epidemiologic characteristics of persons under investigation for Coronavirus Disease 2019-United States, January 17-February 29, 2020.

PLoS One 2021 15;16(4):e0249901. Epub 2021 Apr 15.

CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.

Background: The Coronavirus Disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), evolved rapidly in the United States. This report describes the demographic, clinical, and epidemiologic characteristics of 544 U.S. persons under investigation (PUI) for COVID-19 with complete SARS-CoV-2 testing in the beginning stages of the pandemic from January 17 through February 29, 2020.

Methods: In this surveillance cohort, the U.S. Centers for Disease Control and Prevention (CDC) provided consultation to public health and healthcare professionals to identify PUI for SARS-CoV-2 testing by quantitative real-time reverse-transcription PCR. Demographic, clinical, and epidemiologic characteristics of PUI were reported by public health and healthcare professionals during consultation with on-call CDC clinicians and subsequent submission of a CDC PUI Report Form. Characteristics of laboratory-negative and laboratory-positive persons were summarized as proportions for the period of January 17-February 29, and characteristics of all PUI were compared before and after February 12 using prevalence ratios.

Results: A total of 36 PUI tested positive for SARS-CoV-2 and were classified as confirmed cases. Confirmed cases and PUI testing negative for SARS-CoV-2 had similar demographic, clinical, and epidemiologic characteristics. Consistent with changes in PUI evaluation criteria, 88% (13/15) of confirmed cases detected before February 12, 2020, reported travel from China. After February 12, 57% (12/21) of confirmed cases reported no known travel- or contact-related exposures.

Conclusions: These findings can inform preparedness for future pandemics, including capacity for rapid expansion of novel diagnostic tests to accommodate broad surveillance strategies to assess community transmission, including potential contributions from asymptomatic and presymptomatic infections.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249901PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8049245PMC
April 2021

Surveillance for West Nile Virus Disease - United States, 2009-2018.

MMWR Surveill Summ 2021 03 5;70(1):1-15. Epub 2021 Mar 5.

Problem/condition: West Nile virus (WNV) is an arthropodborne virus (arbovirus) in the family Flaviviridae and is the leading cause of domestically acquired arboviral disease in the contiguous United States. An estimated 70%-80% of WNV infections are asymptomatic. Symptomatic persons usually develop an acute systemic febrile illness. Less than 1% of infected persons develop neuroinvasive disease, which typically presents as encephalitis, meningitis, or acute flaccid paralysis.

Reporting Period: 2009-2018.

Description Of System: WNV disease is a nationally notifiable condition with standard surveillance case definitions. State health departments report WNV cases to CDC through ArboNET, an electronic passive surveillance system. Variables collected include patient age, sex, race, ethnicity, county and state of residence, date of illness onset, clinical syndrome, hospitalization, and death.

Results: During 2009-2018, a total of 21,869 confirmed or probable cases of WNV disease, including 12,835 (59%) WNV neuroinvasive disease cases, were reported to CDC from all 50 states, the District of Columbia, and Puerto Rico. A total of 89% of all WNV patients had illness onset during July-September. Neuroinvasive disease incidence and case-fatalities increased with increasing age, with the highest incidence (1.22 cases per 100,000 population) occurring among persons aged ≥70 years. Among neuroinvasive cases, hospitalization rates were >85% in all age groups but were highest among patients aged ≥70 years (98%). The national incidence of WNV neuroinvasive disease peaked in 2012 (0.92 cases per 100,000 population). Although national incidence was relatively stable during 2013-2018 (average annual incidence: 0.44; range: 0.40-0.51), state level incidence varied from year to year. During 2009-2018, the highest average annual incidence of neuroinvasive disease occurred in North Dakota (3.16 cases per 100,000 population), South Dakota (3.06), Nebraska (1.95), and Mississippi (1.17), and the largest number of total cases occurred in California (2,819), Texas (2,043), Illinois (728), and Arizona (632). Six counties located within the four states with the highest case counts accounted for 23% of all neuroinvasive disease cases nationally.

Interpretation: Despite the recent stability in annual national incidence of neuroinvasive disease, peaks in activity were reported in different years for different regions of the country. Variations in vectors, avian amplifying hosts, human activity, and environmental factors make it difficult to predict future WNV disease incidence and outbreak locations.

Public Health Action: WNV disease surveillance is important for detecting and monitoring seasonal epidemics and for identifying persons at increased risk for severe disease. Surveillance data can be used to inform prevention and control activities. Health care providers should consider WNV infection in the differential diagnosis of aseptic meningitis and encephalitis, obtain appropriate specimens for testing, and promptly report cases to public health authorities. Public health education programs should focus prevention messaging on older persons, because they are at increased risk for severe neurologic disease and death. In the absence of a human vaccine, WNV disease prevention depends on community-level mosquito control and household and personal protective measures. Understanding the geographic distribution of cases, particularly at the county level, appears to provide the best opportunity for directing finite resources toward effective prevention and control activities. Additional work to further develop and improve predictive models that can foreshadow areas most likely to be impacted in a given year by WNV outbreaks could allow for proactive targeting of interventions and ultimately lowering of WNV disease morbidity and mortality.
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http://dx.doi.org/10.15585/mmwr.ss7001a1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7949089PMC
March 2021

Characterization and Diversity of 243 Complete Human Papillomavirus Genomes in Cervical Swabs Using Next Generation Sequencing.

Viruses 2020 12 14;12(12). Epub 2020 Dec 14.

Epidemiology and Microbial Genomics, Laboratoire National de Santé, L-3555 Dudelange, Luxembourg.

In recent years, next generation sequencing (NGS) technology has been widely used for the discovery of novel human papillomavirus (HPV) genotypes, variant characterization and genotyping. Here, we compared the analytical performance of NGS with a commercial PCR-based assay (Anyplex II HPV28) in cervical samples of 744 women. Overall, HPV positivity was 50.2% by the Anyplex and 45.5% by the NGS. With the NGS, we detected 25 genotypes covered by Anyplex and 41 additional genotypes. Agreement between the two methods for HPV positivity was 80.8% (kappa = 0.616) and 84.8% (kappa = 0.652) for 28 HPV genotypes and 14 high-risk genotypes, respectively. We recovered and characterized 243 complete HPV genomes from 153 samples spanning 40 different genotypes. According to phylogenetic analysis and pairwise distance, we identified novel lineages and sublineages of four high-risk and 16 low-risk genotypes. In total, 17 novel lineages and 14 novel sublineages were proposed, including novel lineages of HPV45, HPV52, HPV66 and a novel sublineage of HPV59. Our study provides important genomic insights on HPV types and lineages, where few complete genomes were publicly available.
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http://dx.doi.org/10.3390/v12121437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7764970PMC
December 2020

Duration of seropositivity following yellow fever vaccination in U.S. military service members.

Vaccine 2020 12 22;38(52):8286-8291. Epub 2020 Nov 22.

Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States.

Background: The United States military regularly deploys thousands of service members throughout areas of South America and Africa that are endemic for yellow fever (YF) virus. To determine if booster doses might be needed for service members who are repetitively or continually deployed to YF endemic areas, we evaluated seropositivity among US military personnel receiving a single dose of YF vaccine based on time post-vaccination.

Methods: Serum antibodies were measured using a plaque reduction neutralization test with 50% cutoff in 682 military personnel at 5-39 years post-vaccination. We determined noninferiority of immune response by comparing the proportion seropositive among those vaccinated 10-14 years previously with those vaccinated 5-9 years previously. Noninferiority was supported if the lower-bound of the 2-tailed 95% CI for p - p was ≥-0.10. Additionally, the geometric mean antibody titer (GMT) at various timepoints following vaccination were compared to the GMT at 5-9 years.

Results: The proportion of military service members with detectable neutralizing antibodies 10-14 years after a single dose of YF vaccine (95.8%, 95% CI 91.2-98.1%) was non-inferior to the proportion 5-9 years after vaccination (97.8%, 95% CI 93.7-99.3%). Additionally, GMT among vaccine recipients at 10-14 years post vaccination (99, 95% CI 82-121) was non-inferior to GMT in YF vaccine recipients at 5-9 years post vaccination (115, 95% CI 96-139). The proportion of vaccinees with neutralizing antibodies remained high, and non-inferior, among those vaccinated 15-19 years prior (98.5%, 95%CI 95.5-99.7%). Although the proportion seropositive decreased among vaccinees ≥ 20 years post vaccination, >90% remained seropositive.

Conclusions: Neutralizing antibodies were present in > 95% of vaccine recipients for at least 19 years after vaccination, suggesting that booster doses every 10 years are not essential for most U.S. military personnel.
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http://dx.doi.org/10.1016/j.vaccine.2020.11.022DOI Listing
December 2020

Interband Cascade Laser Arrays for Simultaneous and Selective Analysis of C1-C5 Hydrocarbons in Petrochemical Industry.

Appl Spectrosc 2021 Mar 6;75(3):336-342. Epub 2021 Jan 6.

Technische Physik, Physikalisches Institut and Wilhelm Conrad Röntgen Research Center for Complex Material Systems, Universität Würzburg, Würzburg, Germany.

The detection and measurement of hydrocarbons are of high interest for a variety of applications, for example within the oil and gas industry from extraction throughout the complete refining process, as well as for environmental monitoring and for portable safety devices. This paper presents a highly sensitive, selective, and robust tunable laser analyzer that has the capability to analyze several components in a gas sample stream. More specifically, a multi-gas system for simultaneous detection of C1 to iC5 hydrocarbons, using a room temperature distributed feedback interband cascade laser array, emitting in the 3.3 µm band has been realized. It combines all the advantages of the tunable laser spectroscopy method for a fast, sensitive, and selective in-line multicomponent tunable laser analyzer. Capable of continuous and milliseconds fast monitoring of C1-iC5 hydrocarbon compositions in a process stream, the analyzer requires no consumables (e.g., purging, carrier gas) and no in-field calibration, enabling a low cost of ownership for the analyzer. The system was built based on an industrial GasEye series platform and deployed for the first time in field at Preem refinery in Lysekil, Sweden, in autumn 2018. Results of the measurement campaign and comparison with gas chromatography instrumentation are presented.
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http://dx.doi.org/10.1177/0003702820978230DOI Listing
March 2021

Methane Emissions from Abandoned Oil and Gas Wells in California.

Environ Sci Technol 2020 11 30;54(22):14617-14626. Epub 2020 Oct 30.

Department of Earth System Science, Stanford University, Stanford 94305, California, United States.

California hosts ∼124,000 abandoned and plugged (AP) oil and gas wells, ∼38,000 idle wells, and ∼63,000 active wells, whose methane (CH) emissions remain largely unquantified at levels below ∼2 kg CH h. We sampled 121 wells using two methods: a rapid mobile plume integration method (detection ∼0.5 g CH h) and a more sensitive static flux chamber (detection ∼1 × 10 g CH h). We measured small but detectable methane emissions from 34 of 97 AP wells (mean emission: 0.286 g CH h). In contrast, we found emissions from 11 of 17 idle wells-which are not currently producing (mean: 35.4 g CH h)-4 of 6 active wells (mean: 189.7 g CH h), and one unplugged well-an open casing with no infrastructure present (10.9 g CH h). Our results support previous findings that emissions from plugged wells are low but are more substantial from idle wells. In addition, our smaller sample of active wells suggests that their reported emissions are consistent with previous studies and deserve further attention. Due to limited access, we could not measure wells in most major active oil and gas fields in California; therefore, we recommend additional data collection from all types of wells but especially active and idle wells.
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http://dx.doi.org/10.1021/acs.est.0c05279DOI Listing
November 2020

Lack of Serologic Evidence of Infection Among Health Care Personnel and Other Contacts of First 2 Confirmed Patients With COVID-19 in Illinois, 2020.

Public Health Rep 2021 Jan/Feb;136(1):88-96. Epub 2020 Oct 27.

1242 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Objectives: Widespread global transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing coronavirus disease 2019 (COVID-19), continues. Many questions remain about asymptomatic or atypical infections and transmission dynamics. We used comprehensive contact tracing of the first 2 confirmed patients in Illinois with COVID-19 and serologic SARS-CoV-2 antibody testing to determine whether contacts had evidence of undetected COVID-19.

Methods: Contacts were eligible for serologic follow-up if previously tested for COVID-19 during an initial investigation or had greater-risk exposures. Contacts completed a standardized questionnaire during the initial investigation. We classified exposure risk as high, medium, or low based on interactions with 2 index patients and use of personal protective equipment (PPE). Serologic testing used a SARS-CoV-2 spike enzyme-linked immunosorbent assay on serum specimens collected from participants approximately 6 weeks after initial exposure to either index patient. The 2 index patients provided serum specimens throughout their illness. We collected data on demographic, exposure, and epidemiologic characteristics.

Results: Of 347 contacts, 110 were eligible for serologic follow-up; 59 (17% of all contacts) enrolled. Of these, 53 (90%) were health care personnel and 6 (10%) were community contacts. Seventeen (29%) reported high-risk exposures, 15 (25%) medium-risk, and 27 (46%) low-risk. No participant had evidence of SARS-CoV-2 antibodies. The 2 index patients had antibodies detected at dilutions >1:6400 within 4 weeks after symptom onset.

Conclusions: In serologic follow-up of the first 2 known patients in Illinois with COVID-19, we found no secondary transmission among tested contacts. Lack of seroconversion among these contacts adds to our understanding of conditions (ie, use of PPE) under which SARS-CoV-2 infections might not result in transmission and demonstrates that SARS-CoV-2 antibody testing is a useful tool to verify epidemiologic findings.
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http://dx.doi.org/10.1177/0033354920966064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7856379PMC
December 2020

Immune response at 12-23 months following a single dose of Vero cell culture-derived Japanese encephalitis (JE) vaccine in adults previously vaccinated with mouse brain-derived JE vaccine.

Vaccine 2020 10 6;38(44):6899-6903. Epub 2020 Sep 6.

Division of Vector-Borne Diseases, United States Centers for Disease Control and Prevention, 3156 Rampart Rd, Fort Collins, CO, USA. Electronic address:

Background: Japanese encephalitis (JE) virus is an important cause of neurological disease in Asia. JE vaccine is recommended for travelers with higher JE risk itineraries. Inactivated Vero cell culture-derived JE vaccine (JE-VC) is the only JE vaccine currently available in the United States. An inactivated mouse brain-derived JE vaccine (JE-MB) previously was available but production was discontinued. One JE-VC dose administered to adults previously vaccinated with ≥3 doses of JE-MB provides good short-term protection for at least one month, but data on longer-term protection are limited. We evaluated non-inferiority of the JE virus neutralizing antibody response at 12-23 months in JE-MB-vaccinated adults administered one JE-VC dose compared with JE vaccine-naïve adults administered a JE-VC two-dose primary series.

Methods: We obtained archived sera from U.S. military personnel and performed a 50% plaque reduction neutralization test for anti-JE virus neutralizing antibodies. We compared the geometric mean titer (GMT) and seroprotection rate at 12-23 months after one JE-VC dose in previously JE-MB-vaccinated personnel and after the second JE-VC dose in previously JE vaccine-naïve personnel. Non-inferiority was concluded if the lower bound of the two-sided 95% confidence interval (CI) of the GMT ratio in previously vaccinated to vaccine-naïve personnel was >1/1.5.

Results: The GMT in previously JE-MB-vaccinated persons was 75 (95% CI 63-90) and in previously JE vaccine-naïve persons was 12 (95% CI 11-14), and seroprotection rates were 94% (235/250) and 54% (135/250), respectively. The ratio of GMTs was 6.3 (95% CI: 5.0-7.7), satisfying the criterion for non-inferiority.

Conclusions: One JE-VC dose in previously JE-MB-vaccinated military personnel provides good protection for at least 1-2 years. The benefits of administration of a single JE-VC dose in previously JE-MB-vaccinated adults include a shorter time to completion of re-vaccination before travel, a decrease in the risk of adverse events, and reduced costs.
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http://dx.doi.org/10.1016/j.vaccine.2020.08.061DOI Listing
October 2020

Enhanced contact investigations for nine early travel-related cases of SARS-CoV-2 in the United States.

PLoS One 2020 2;15(9):e0238342. Epub 2020 Sep 2.

The COVID-19 Close Contact Investigation Team, United States of America.

Coronavirus disease 2019 (COVID-19), the respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China and has since become pandemic. In response to the first cases identified in the United States, close contacts of confirmed COVID-19 cases were investigated to enable early identification and isolation of additional cases and to learn more about risk factors for transmission. Close contacts of nine early travel-related cases in the United States were identified and monitored daily for development of symptoms (active monitoring). Selected close contacts (including those with exposures categorized as higher risk) were targeted for collection of additional exposure information and respiratory samples. Respiratory samples were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction at the Centers for Disease Control and Prevention. Four hundred four close contacts were actively monitored in the jurisdictions that managed the travel-related cases. Three hundred thirty-eight of the 404 close contacts provided at least basic exposure information, of whom 159 close contacts had ≥1 set of respiratory samples collected and tested. Across all actively monitored close contacts, two additional symptomatic COVID-19 cases (i.e., secondary cases) were identified; both secondary cases were in spouses of travel-associated case patients. When considering only household members, all of whom had ≥1 respiratory sample tested for SARS-CoV-2, the secondary attack rate (i.e., the number of secondary cases as a proportion of total close contacts) was 13% (95% CI: 4-38%). The results from these contact tracing investigations suggest that household members, especially significant others, of COVID-19 cases are at highest risk of becoming infected. The importance of personal protective equipment for healthcare workers is also underlined. Isolation of persons with COVID-19, in combination with quarantine of exposed close contacts and practice of everyday preventive behaviors, is important to mitigate spread of COVID-19.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238342PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467265PMC
September 2020

Evaluation for Arboviral Infection Among Children Hospitalized in Colorado With Aseptic Meningitis and Encephalitis.

Pediatr Infect Dis J 2020 11;39(11):e382-e384

From the Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado and.

Among 39 children hospitalized in Colorado with aseptic meningitis or encephalitis, 16 (41%) had an etiology identified, including 2 (5%) with West Nile virus infection. Despite extensive testing, no other arboviral infections were identified. Arboviral infection should be considered in children with neuroinvasive disease during arboviral season with testing directed toward viruses endemic to the region and type of exposure.
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http://dx.doi.org/10.1097/INF.0000000000002856DOI Listing
November 2020

Hospital-based surveillance for Japanese encephalitis in Bangladesh, 2007-2016: Implications for introduction of immunization.

Int J Infect Dis 2020 Oct 25;99:69-74. Epub 2020 Jul 25.

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Background: Japanese encephalitis (JE) virus is recognized as a major cause of encephalitis in Bangladesh. The World Health Organization (WHO) recommends human immunization as the most effective means to control JE. Several WHO-prequalified vaccines are available to prevent JE but no vaccination program has been implemented in Bangladesh.

Methods: We conducted hospital-based surveillance for acute meningitis-encephalitis syndrome (AMES) to describe JE epidemiology and help inform policy decisions about possible immunization strategies for Bangladesh.

Results: During 2007-2016, a total of 6543 AMES patients were identified at four tertiary hospitals. Of the 6525 patients tested, 548 (8%) were classified as JE cases. These 548 patients resided in 36 (56%) out of 64 districts of Bangladesh, with the highest proportion of JE cases among AMES patients (12% and 7%) presenting at two hospitals in the northwestern part of the country. The median age of JE cases was 30 years, and 193 (35%) were aged ≤15 years. The majority of JE cases (80%) were identified from July through November.

Conclusions: Surveillance results suggest that JE continues to be an important cause of meningo-encephalitis in Bangladesh. Immunization strategies including JE vaccine introduction into the routine childhood immunization program or mass vaccination in certain age groups or geographic areas need to be examined, taking into consideration the cost-effectiveness ratio of the approach and potential for decreasing disease burden.
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http://dx.doi.org/10.1016/j.ijid.2020.07.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566160PMC
October 2020

A case of possible Fournier's gangrene associated with proning in COVID-19 ARDS.

Can J Anaesth 2020 11 27;67(11):1697-1698. Epub 2020 Jul 27.

Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada.

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http://dx.doi.org/10.1007/s12630-020-01772-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384719PMC
November 2020

The FLUXNET2015 dataset and the ONEFlux processing pipeline for eddy covariance data.

Sci Data 2020 07 9;7(1):225. Epub 2020 Jul 9.

Department of Sustainable Agro-ecosystems and Bioresources, Research and Innovation Centre, Fondazione Edmund Mach, San Michele All'adige, 38010, Italy.

The FLUXNET2015 dataset provides ecosystem-scale data on CO, water, and energy exchange between the biosphere and the atmosphere, and other meteorological and biological measurements, from 212 sites around the globe (over 1500 site-years, up to and including year 2014). These sites, independently managed and operated, voluntarily contributed their data to create global datasets. Data were quality controlled and processed using uniform methods, to improve consistency and intercomparability across sites. The dataset is already being used in a number of applications, including ecophysiology studies, remote sensing studies, and development of ecosystem and Earth system models. FLUXNET2015 includes derived-data products, such as gap-filled time series, ecosystem respiration and photosynthetic uptake estimates, estimation of uncertainties, and metadata about the measurements, presented for the first time in this paper. In addition, 206 of these sites are for the first time distributed under a Creative Commons (CC-BY 4.0) license. This paper details this enhanced dataset and the processing methods, now made available as open-source codes, making the dataset more accessible, transparent, and reproducible.
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http://dx.doi.org/10.1038/s41597-020-0534-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347557PMC
July 2020

Assessment of Regional Methane Emission Inventories through Airborne Quantification in the San Francisco Bay Area.

Environ Sci Technol 2020 08 20;54(15):9254-9264. Epub 2020 Jul 20.

Bay Area Air Quality Management District, San Francisco, California 94105, United States.

This study derives methane emission rates from 92 airborne observations collected over 23 facilities including 5 refineries, 10 landfills, 4 wastewater treatment plants (POTWs), 2 composting operations, and 2 dairies in the San Francisco Bay Area. Emission rates are measured using an airborne mass-balance technique from a low-flying aircraft. Annual measurement-based sectorwide methane emissions are 19,000 ± 2300 Mg for refineries, 136,700 ± 25,900 Mg for landfills, 11,900 ± 1,500 Mg for POTWs, and 11,100 ± 3,400 Mg for composting. The average of measured emissions for each refinery ranges from 4 to 23 times larger than the corresponding emissions reported to regulatory agencies, while measurement-derived landfill and POTW estimates are approximately twice the current inventory estimates. Significant methane emissions at composting facilities indicate that a California mandate to divert organics from landfills to composting may not be an effective measure for mitigating methane emissions unless best management practices are instituted at composting facilities. Complementary evidence from airborne remote sensing imagery indicates atmospheric venting from refinery hydrogen plants, landfill working surfaces, composting stockpiles, etc., to be among the specific source types responsible for the observed discrepancies. This work highlights the value of multiple measurement approaches to accurately estimate facility-scale methane emissions and perform source attribution at subfacility scales to guide and verify effective mitigation policy and action.
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http://dx.doi.org/10.1021/acs.est.0c01212DOI Listing
August 2020

Clinical Characteristics, Histopathology, and Tissue Immunolocalization of Chikungunya Virus Antigen in Fatal Cases.

Clin Infect Dis 2021 Jul;73(2):e345-e354

Centers for Disease Control and Prevention, Infectious Diseases Pathology Branch, Atlanta, Georgia, USA.

Background: Death in patients with chikungunya is rare and has been associated with encephalitis, hemorrhage, and septic shock. We describe clinical, histologic, and immunohistochemical findings in individuals who died following chikungunya virus (CHIKV) infection.

Methods: We identified individuals who died in Puerto Rico during 2014 following an acute illness and had CHIKV RNA detected by reverse transcriptase-polymerase chain reaction in a pre- or postmortem blood or tissue specimen. We performed histopathology and immunohistochemistry (IHC) for CHIKV antigen on tissue specimens and collected medical data via record review and family interviews.

Results: Thirty CHIKV-infected fatal cases were identified (0.8/100 000 population). The median age was 61 years (range: 6 days-86 years), and 19 (63%) were male. Death occurred a median of 4 days (range: 1-29) after illness onset. Nearly all (93%) had at least 1 comorbidity, most frequently hypertension, diabetes, or obesity. Nine had severe comorbidities (eg, chronic heart or kidney disease, sickle cell anemia) or coinfection (eg, leptospirosis). Among 24 fatal cases with tissue specimens, 11 (46%) were positive by IHC. CHIKV antigen was most frequently detected in mesenchymal tissues and mononuclear cells including tissue macrophages, blood mononuclear cells, splenic follicular dendritic cells, and Kupffer cells. Common histopathologic findings were intra-alveolar hemorrhage and edema in the lung, chronic or acute tenosynovitis, and increased immunoblasts in the spleen. CHIKV infection likely caused fatal septic shock in 2 patients.

Conclusions: Evaluation of tissue specimens provided insights into the pathogenesis of CHIKV, which may rarely result in septic shock and other severe manifestations.
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http://dx.doi.org/10.1093/cid/ciaa837DOI Listing
July 2021

Investigation of Heartland Virus Disease Throughout the United States, 2013-2017.

Open Forum Infect Dis 2020 May 11;7(5):ofaa125. Epub 2020 Apr 11.

Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA.

Background: Heartland virus (HRTV) was first described as a human pathogen in 2012. From 2013 to 2017, the Centers for Disease Control and Prevention (CDC) implemented a national protocol to evaluate patients for HRTV disease, better define its geographic distribution, epidemiology, and clinical characteristics, and develop diagnostic assays for this novel virus.

Methods: Individuals aged ≥12 years whose clinicians contacted state health departments or the CDC about testing for HRTV infections were screened for recent onset of fever with leukopenia and thrombocytopenia. A questionnaire was administered to collect data on demographics, risk factors, and signs and symptoms; blood samples were tested for the presence of HRTV RNA and neutralizing antibodies.

Results: Of 85 individuals enrolled and tested, 16 (19%) had evidence of acute HRTV infection, 1 (1%) had past infection, and 68 (80%) had no infection. Patients with acute HRTV disease were residents of 7 states, 12 (75%) were male, and the median age (range) was 71 (43-80) years. Illness onset occurred from April to September. The majority reported fatigue, anorexia, nausea, headache, confusion, arthralgia, or myalgia. Fourteen (88%) cases were hospitalized; 2 (13%) died. Fourteen (88%) participants reported finding a tick on themselves in the 2 weeks before illness onset. HRTV-infected individuals were significantly older (.001) and more likely to report an attached tick (.03) than uninfected individuals.

Conclusions: Health care providers should consider HRTV disease testing in patients with an acute febrile illness with either leukopenia or thrombocytopenia not explained by another condition or who were suspected to have a tickborne disease but did not improve following appropriate treatment.
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http://dx.doi.org/10.1093/ofid/ofaa125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246346PMC
May 2020

COVID-19 Among Workers in Meat and Poultry Processing Facilities - 19 States, April 2020.

MMWR Morb Mortal Wkly Rep 2020 May 8;69(18). Epub 2020 May 8.

Congregate work and residential locations are at increased risk for infectious disease transmission including respiratory illness outbreaks. SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is primarily spread person to person through respiratory droplets. Nationwide, the meat and poultry processing industry, an essential component of the U.S. food infrastructure, employs approximately 500,000 persons, many of whom work in proximity to other workers (1). Because of reports of initial cases of COVID-19, in some meat processing facilities, states were asked to provide aggregated data concerning the number of meat and poultry processing facilities affected by COVID-19 and the number of workers with COVID-19 in these facilities, including COVID-19-related deaths. Qualitative data gathered by CDC during on-site and remote assessments were analyzed and summarized. During April 9-27, aggregate data on COVID-19 cases among 115 meat or poultry processing facilities in 19 states were reported to CDC. Among these facilities, COVID-19 was diagnosed in 4,913 (approximately 3%) workers, and 20 COVID-19-related deaths were reported. Facility barriers to effective prevention and control of COVID-19 included difficulty distancing workers at least 6 feet (2 meters) from one another (2) and in implementing COVID-19-specific disinfection guidelines.* Among workers, socioeconomic challenges might contribute to working while feeling ill, particularly if there are management practices such as bonuses that incentivize attendance. Methods to decrease transmission within the facility include worker symptom screening programs, policies to discourage working while experiencing symptoms compatible with COVID-19, and social distancing by workers. Source control measures (e.g., the use of cloth face covers) as well as increased disinfection of high-touch surfaces are also important means of preventing SARS-CoV-2 exposure. Mitigation efforts to reduce transmission in the community should also be considered. Many of these measures might also reduce asymptomatic and presymptomatic transmission (3). Implementation of these public health strategies will help protect workers from COVID-19 in this industry and assist in preserving the critical meat and poultry production infrastructure (4).
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http://dx.doi.org/10.15585/mmwr.mm6918e3DOI Listing
May 2020

Fully Automated Segmentation and Shape Analysis of the Thoracic Aorta in Non-contrast-enhanced Magnetic Resonance Images of the German National Cohort Study.

J Thorac Imaging 2020 Nov;35(6):389-398

Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen.

Purpose: The purpose of this study was to develop and validate a deep learning-based framework for automated segmentation and vessel shape analysis on non-contrast-enhanced magnetic resonance (MR) data of the thoracic aorta within the German National Cohort (GNC) MR study.

Materials And Methods: One hundred data sets acquired in the GNC MR study were included (56 men, average age 53 y [22 to 72 y]). All participants had undergone non-contrast-enhanced MR imaging of the thoracic vessels. Automated vessel segmentation of the thoracic aorta was performed using a Convolutional Neural Network in a supervised setting with manually annotated data sets as the ground truth. Seventy data sets were used for training; 30 data sets were used for quantitative and qualitative evaluation. Automated shape analysis based on centerline extraction from segmentation masks was performed to derive a diameter profile of the vessel. For comparison, 2 radiologists measured vessel diameters manually.

Results: Overall, automated aortic segmentation was successful, providing good qualitative analyses with only minor irregularities in 29 of 30 data sets. One data set with severe MR artifacts led to inadequate automated segmentation results. The mean Dice score of automated vessel segmentation was 0.85. Automated aortic diameter measurements were similar to manual measurements (average difference -0.9 mm, limits of agreement: -5.4 to 3.9 mm), with minor deviations in the order of the interreader agreement between the 2 radiologists (average difference -0.5 mm, limits of agreement: -5.8 to 4.8 mm).

Conclusion: Automated segmentation and shape analysis of the thoracic aorta is feasible with high accuracy on non-contrast-enhanced MR imaging using the proposed deep learning approach.
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http://dx.doi.org/10.1097/RTI.0000000000000522DOI Listing
November 2020

Assessment of Immunoglobulin M Enzyme-Linked Immunosorbent Assay Ratios to Identify West Nile Virus and St. Louis Encephalitis Virus Infections During Concurrent Outbreaks of West Nile Virus and St. Louis Encephalitis Virus Diseases, Arizona 2015.

Vector Borne Zoonotic Dis 2020 08 21;20(8):619-623. Epub 2020 Apr 21.

Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA.

West Nile virus (WNV) and St. Louis encephalitis virus (SLEV) are closely related mosquito-borne flaviviruses that cause clinical disease ranging from febrile illness to encephalitis. The standard for serological diagnosis is immunoglobulin M (IgM) testing followed by confirmatory plaque reduction neutralization test (PRNT) to differentiate the infecting virus. However, the PRNT is time-consuming and requires manipulation of live virus. During concurrent WNV and SLEV outbreaks in Arizona in 2015, we assessed use of a diagnostic algorithm to simplify testing. It incorporated WNV and SLEV ratios based on positive-to-negative (P/N) values derived from the IgM antibody-capture enzyme-linked immunosorbent assay. We compared each sample's ratio-based result with the confirmed WNV or SLEV sample result indicated by PRNT or PCR testing. We analyzed data from 70 patients with 77 serum and cerebrospinal fluid samples, including 53 patients with confirmed WNV infection and 17 patients with confirmed SLEV infection. Both WNV and SLEV ratios had specificity ≥95%, indicating a high likelihood that each ratio was correctly identifying the infecting virus. The SLEV ratio sensitivity of 30% was much lower than the WNV ratio sensitivity of 91%, likely because of higher cross-reactivity of SLEV antibodies and generation of lower P/N values. The standard for serological diagnosis of WNV and SLEV infections remains IgM testing followed by PRNT. However, these results suggest the ratios could potentially be used as part of a diagnostic algorithm in outbreaks to substantially reduce the need for PRNTs.
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http://dx.doi.org/10.1089/vbz.2019.2571DOI Listing
August 2020

Rapid Sentinel Surveillance for COVID-19 - Santa Clara County, California, March 2020.

MMWR Morb Mortal Wkly Rep 2020 Apr 10;69(14):419-421. Epub 2020 Apr 10.

On February 27, 2020, the Santa Clara County Public Health Department (SCCPHD) identified its first case of coronavirus disease 2019 (COVID-19) associated with probable community transmission (i.e., infection among persons without a known exposure by travel or close contact with a patient with confirmed COVID-19). At the time the investigation began, testing guidance recommended focusing on persons with clinical findings of lower respiratory illness and travel to an affected area or an epidemiologic link to a laboratory-confirmed COVID-19 case, or on persons hospitalized for severe respiratory disease and no alternative diagnosis (1). To rapidly understand the extent of COVID-19 in the community, SCCPHD, the California Department of Public Health (CDPH), and CDC began sentinel surveillance in Santa Clara County. During March 5-14, 2020, four urgent care centers in Santa Clara County participated as sentinel sites. For this investigation, county residents evaluated for respiratory symptoms (e.g., fever, cough, or shortness of breath) who had no known risk for COVID-19 were identified at participating urgent care centers. A convenience sample of specimens that tested negative for influenza virus was tested for SARS-CoV-2 RNA. Among 226 patients who met the inclusion criteria, 23% had positive test results for influenza. Among patients who had negative test results for influenza, 79 specimens were tested for SARS-CoV-2, and 11% had evidence of infection. This sentinel surveillance system helped confirm community transmission of SARS-CoV-2 in Santa Clara County. As a result of these data and an increasing number of cases with no known source of transmission, the county initiated a series of community mitigation strategies. Detection of community transmission is critical for informing response activities, including testing criteria, quarantine guidance, investigation protocols, and community mitigation measures (2). Sentinel surveillance in outpatient settings and emergency departments, implemented together with hospital-based surveillance, mortality surveillance, and serologic surveys, can provide a robust approach to monitor the epidemiology of COVID-19.
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http://dx.doi.org/10.15585/mmwr.mm6914e3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7147906PMC
April 2020
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