This document reports on increases in hepatitis A virus (HAV) infections in the United States from 2013-2018. HAV infections reported to the CDC increased 294% during 2016-2018 compared to 2013-2015, related to outbreaks among people who use drugs or experience homelessness. Additionally, increases occurred among men who have sex with men and from imported contaminated foods. Genotype IB was the most common strain identified during 2016-2018. Increased vaccination of at-risk groups, including people who use drugs or experience homelessness, could help control ongoing outbreaks and prevent future increases in HAV infections.
History of vaccine preventable disease in usJeffrey Stone
Estimates of the percent reductions from baseline to re- cent were made without adjustment for factors that could affect vaccine-preventable disease morbidity, mortality, or reporting.
Dr. Shweta Bansal - Modeling Emerging Disease in the US Swine HerdJohn Blue
Modeling Emerging Disease in the US Swine Herd - Dr. Shweta Bansal, PhD, Assistant Professor, Department of Biology at Georgetown University, from the 2015 NIAA Annual Conference titled 'Water and the Future of Animal Agriculture', March 23 - March 26, 2015, Indianapolis, IN, USA.
More presentations at http://www.trufflemedia.com/agmedia/conference/2015_niaa_water_future_animal_ag
Economic analysis of malaria burden in kenyaNanyingi Mark
This framework uses a cost of illness approach to evaluate the burden of malaria. The evaluation is based on private direct costs (PDC) and private indirect cost (PIC) of malaria attack per episode.
History of vaccine preventable disease in usJeffrey Stone
Estimates of the percent reductions from baseline to re- cent were made without adjustment for factors that could affect vaccine-preventable disease morbidity, mortality, or reporting.
Dr. Shweta Bansal - Modeling Emerging Disease in the US Swine HerdJohn Blue
Modeling Emerging Disease in the US Swine Herd - Dr. Shweta Bansal, PhD, Assistant Professor, Department of Biology at Georgetown University, from the 2015 NIAA Annual Conference titled 'Water and the Future of Animal Agriculture', March 23 - March 26, 2015, Indianapolis, IN, USA.
More presentations at http://www.trufflemedia.com/agmedia/conference/2015_niaa_water_future_animal_ag
Economic analysis of malaria burden in kenyaNanyingi Mark
This framework uses a cost of illness approach to evaluate the burden of malaria. The evaluation is based on private direct costs (PDC) and private indirect cost (PIC) of malaria attack per episode.
Epidermiologic pattern of viral hepatitis in afghanistanIslam Saeed
Epidemiology of Viral Hepatitis in Afghanistan. The presentation is prepared by Dr. Islam Saeed, Director for Surveillance/DEWS at Afghan National Public Health Institute (ANPHI), MoPH
Laura Bamford, MD, MSCE
Associate Professor of Medicine
Medical Director, Owen Clinic
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
Estimating HIV prevalence and risk behaviors of transgender persons in the Un...Santé des trans
Cet article, paru en 2008 dans la revue AIDS and Behavior, présente une synthèse des données disponibles dans la littérature scientifique concernant la prévalence du VIH parmi les trans aux Etats-Unis et leurs facteurs de risque comportementaux par rapport à la transmission du virus.
IFPMA Geneva Pharma Forum on 9 May 2014
Bringing Psoriasis into the Light
Presentation of Kim kjoeller, Senior Vice President
Global Development, Leo Pharma
HealthMap.org: Aggregation of Online Media Reports for Global Infectious Dise...Forum One
Clark Freifeld, co-creator of HealthMap.org, discusses the potential of his Google Map mashup of publically-available RSS feeds (and tools like it) for improving the early reporting of infections diseases around the world. More information at http://ow.ly/oYll . Contact: Suzanne Rainey / srainey@ForumOne.com .
Leandro Mena, MD, MPH
Chair and Professor of Population Health Science
Department of Population Health Science
University of Mississippi Medical Center
e632 www.thelancet.comhiv Vol 6 September 2019ViewpoiAlyciaGold776
e632 www.thelancet.com/hiv Vol 6 September 2019
Viewpoint
The disconnect between individual-level and population-level
HIV prevention benefits of antiretroviral treatment
Stefan Baral, Amrita Rao, Patrick Sullivan, Nancy Phaswana-Mafuya, Daouda Diouf, Greg Millett, Helgar Musyoki, Elvin Geng, Sharmistha Mishra
In 2019, the HIV pandemic is growing and soon over 40 million people will be living with HIV. Effective population-
based approaches to decrease HIV incidence are as relevant as ever given modest reductions observed over the past
decade. Treatment as prevention is often heralded as the path to improve HIV outcomes and to reduce HIV
incidence. Although treatment of an individual does eliminate onward transmission to serodifferent partners
(unde tectable=untransmittable or U=U), population-level observational and experimental data have not shown a similar
effect with scale-up of treatment on reducing HIV incidence. This disconnect might be the result of little attention given
to heterogeneities of HIV acquisition and transmission risks that exist in people at risk for and living with HIV, even in
the most broadly generalised epidemics. Available data suggest that HIV treatment is treatment, HIV prevention is
prevention, and specificity of HIV treatment approaches towards people at highest risk of onward transmission drives
the intersection between the two. All people living with HIV deserve HIV treatment, but both more accurately estimating
and optimising the potential HIV prevention effects of universal treatment approaches necessitates understanding who
is being supported with treatment rather than a focus on treatment targets such as 90-90-90 or 95-95-95.
Introduction
In 2019, we are at a pivotal time in the global HIV response
in that many people believe that the HIV pandemic is
over given the advances in HIV treatment.1 Yet the HIV
pandemic continues to grow as defined by numbers of
people living with HIV. Specifically, given the encouraging
decreases in overall mortality among people living with
HIV, in the context of universal treat ment as prevention,
approximately 930 000 more people annually (1·7 million
new infections minus 770 000 deaths of people living with
HIV) require anti retroviral therapy (ART) and many more
would need to change ART regimens. At the current rate
of new infections, over 40 million people will be living
with HIV by 2025.2 The global optimism about the HIV
pandemic has not been matched by decreases in new
HIV infections. New infections have declined by less than
2% per year since 2005, which means that between
1·8 and 2·5 million people acquired HIV in 2017.2,3 To
date, just over 60% of the 37·9 million people living with
HIV are on ART; of those 37·9 million, just over half
(20·1 million) are estimated to have achieved viral sup
pression.2 Taken together, these data suggest that an
estimated 18 million people living with HIV require ART
or improved ART regimens giv ...
Epidermiologic pattern of viral hepatitis in afghanistanIslam Saeed
Epidemiology of Viral Hepatitis in Afghanistan. The presentation is prepared by Dr. Islam Saeed, Director for Surveillance/DEWS at Afghan National Public Health Institute (ANPHI), MoPH
Laura Bamford, MD, MSCE
Associate Professor of Medicine
Medical Director, Owen Clinic
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
Estimating HIV prevalence and risk behaviors of transgender persons in the Un...Santé des trans
Cet article, paru en 2008 dans la revue AIDS and Behavior, présente une synthèse des données disponibles dans la littérature scientifique concernant la prévalence du VIH parmi les trans aux Etats-Unis et leurs facteurs de risque comportementaux par rapport à la transmission du virus.
IFPMA Geneva Pharma Forum on 9 May 2014
Bringing Psoriasis into the Light
Presentation of Kim kjoeller, Senior Vice President
Global Development, Leo Pharma
HealthMap.org: Aggregation of Online Media Reports for Global Infectious Dise...Forum One
Clark Freifeld, co-creator of HealthMap.org, discusses the potential of his Google Map mashup of publically-available RSS feeds (and tools like it) for improving the early reporting of infections diseases around the world. More information at http://ow.ly/oYll . Contact: Suzanne Rainey / srainey@ForumOne.com .
Leandro Mena, MD, MPH
Chair and Professor of Population Health Science
Department of Population Health Science
University of Mississippi Medical Center
e632 www.thelancet.comhiv Vol 6 September 2019ViewpoiAlyciaGold776
e632 www.thelancet.com/hiv Vol 6 September 2019
Viewpoint
The disconnect between individual-level and population-level
HIV prevention benefits of antiretroviral treatment
Stefan Baral, Amrita Rao, Patrick Sullivan, Nancy Phaswana-Mafuya, Daouda Diouf, Greg Millett, Helgar Musyoki, Elvin Geng, Sharmistha Mishra
In 2019, the HIV pandemic is growing and soon over 40 million people will be living with HIV. Effective population-
based approaches to decrease HIV incidence are as relevant as ever given modest reductions observed over the past
decade. Treatment as prevention is often heralded as the path to improve HIV outcomes and to reduce HIV
incidence. Although treatment of an individual does eliminate onward transmission to serodifferent partners
(unde tectable=untransmittable or U=U), population-level observational and experimental data have not shown a similar
effect with scale-up of treatment on reducing HIV incidence. This disconnect might be the result of little attention given
to heterogeneities of HIV acquisition and transmission risks that exist in people at risk for and living with HIV, even in
the most broadly generalised epidemics. Available data suggest that HIV treatment is treatment, HIV prevention is
prevention, and specificity of HIV treatment approaches towards people at highest risk of onward transmission drives
the intersection between the two. All people living with HIV deserve HIV treatment, but both more accurately estimating
and optimising the potential HIV prevention effects of universal treatment approaches necessitates understanding who
is being supported with treatment rather than a focus on treatment targets such as 90-90-90 or 95-95-95.
Introduction
In 2019, we are at a pivotal time in the global HIV response
in that many people believe that the HIV pandemic is
over given the advances in HIV treatment.1 Yet the HIV
pandemic continues to grow as defined by numbers of
people living with HIV. Specifically, given the encouraging
decreases in overall mortality among people living with
HIV, in the context of universal treat ment as prevention,
approximately 930 000 more people annually (1·7 million
new infections minus 770 000 deaths of people living with
HIV) require anti retroviral therapy (ART) and many more
would need to change ART regimens. At the current rate
of new infections, over 40 million people will be living
with HIV by 2025.2 The global optimism about the HIV
pandemic has not been matched by decreases in new
HIV infections. New infections have declined by less than
2% per year since 2005, which means that between
1·8 and 2·5 million people acquired HIV in 2017.2,3 To
date, just over 60% of the 37·9 million people living with
HIV are on ART; of those 37·9 million, just over half
(20·1 million) are estimated to have achieved viral sup
pression.2 Taken together, these data suggest that an
estimated 18 million people living with HIV require ART
or improved ART regimens giv ...
Non-invasive Diagnostic Tools: Cardiometabolic Risk Assessment and Predictionasclepiuspdfs
Cardiometabolic risks (CMRs) have rapidly increased to epidemic proportions worldwide in the past three decades. Cardiovascular disease (CVD) remains the number one killer. No country has reduced, reversed, or prevented the increase in the incidence or prevalence of chronic metabolic diseases. Framingham Heart Study group described the modifiable risk factors that promote the development of CVD. They also developed risk calculators, for the prediction of acute vascular events such as heart attacks and stroke. The risk predictor algorithms were fine-tuned, as and when additional risk factors were discovered. However, at the time of this writing, there is no such calculator for assessment, stratification, and management of CMRs. On the other hand, numbers of non-invasive diagnostic devices have been developed for continuous monitoring of blood pressure and glucose profiles. We have described in our earlier articles, non-invasive diagnostic platform developed by LD-Technologies,
Author: Dr Christa Maria Joel
Module: Principles of Infection and Disease Control
Supervisor: Dr William Mackay Gordie and Ms Fiona Hernandez
University of the West of Scotland
Global Medical Cures™ | HIV TESTING IN USA
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
One global health issue that impacts the international health commun.docxmccormicknadine86
One global health issue that impacts the international health community is HIV. HIV stands for Human Immunodeficiency Virus. HIV attacks the CD4 cells (T cells) which are cells that help the body to fight off infections. Overtime, the HIV can destroy many of the T cells that the body will not be able to fight off infection leaving it more propense to opportunistic infections. The opportunistic infection leaves the body very weak and signal that the person has AIDS which is the last stage of HIV. There is no cure for HIV, but with adequate medical care, the virus can be controlled. The antiretroviral therapy is the medicine to treat HIV and it can make the viral load undetectable so the person with HIV can live longer. Commonly, people get or transmit HIV through sex and needle or syringe use. The person infected with HIV can transmit it to other person through body fluids such as blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk. HIV can be prevented through abstinence, limiting number of sexual partners , avoiding sharing needles and using condoms. HIV and AIDS are still a problem for United States and other countries around the world. In 2018, “37,832” people were diagnosed with HIV in USA and gay, bisexual and men who have sex with other men accounted for 69% of all new HIV diagnosis. At end of 2016, an estimated “1.1 million” people in USA had HIV with the blacks/African American being the most affected population. In 2018, African Americans accounted for “42%” or all new HIV diagnosis and most cases of HIV occur in metropolitan areas with “500,00” or more people. HIV diagnosis can also vary by age. Young gay and bisexual men ages 13 to 24 accounted for “83%” of all new cases in 2018. Worldwide, there were about “1.7 million” of new cases of HIV in 2018. An estimated “770,000” people died from AIDS related illness in 2018 (CDC, 2019).
Global health plays a role in global security and the security of USA population. The Institute of Medicine 2003, emphasized that USA should improve the capacity to respond to infectious disease threats and to promote an infectious disease surveillance system. The rapid identification and control of the infectious disease can promote health, prevent the spread of the disease and protect the USA population. Many U.S government agencies such as Millennium Development goals provide funding and human resources to global health. In addition, the International health Regulation was implemented with the purpose of preventing international spread of diseases by encouraging countries to work together to share information about known disease (Office of Disease Prevention and Health Promotion, 2020). The U.S. Department of Health and Human services in collaboration with CDC launched an initiative to reduce new HIV infections in the U.S by 90% by 2030. To reduce HIV infection involves prevention, diagnosis, treatment and outbreak response. The intervention is the use of PrEP (a .
Cancer Biomarkers Research, HPV and Cancer, HPV VaccineJames Lyons-Weiler
An overview of advances in cancer biomarker research strategies, the pathogenesis of HPV virus and a focus on the HPV vaccine with an analysis of evidence of type replacement.
The world stands to lose close to 10% of total economic value by mid-century if climate change stays on the currently-anticipated trajectory, and the Paris Agreement and 2050 net-zero emissions targets are not met.
Many emerging markets have most to gain if the world is able to rein in temperature gains. For example, action today to get back to the Paris temperature rise scenario would mean economies in southeast Asia could prevent around a quarter of the gross domestic product (GDP) loss by mid-century that they may otherwise suffer. Our analysis in this report is unique in explicitly simulating for the many uncertainties around the impacts of climate change. It shows that those economies most vulnerable to the potential physical risks of climate change stand to benefit most from keeping temperature rises in check. This includes some of the world's most dynamic emerging economies, the engines of global growth in the years to come. The message from the analysis is clear: no action on climate change is not an option.
Promise and peril: How artificial intelligence is transforming health careΔρ. Γιώργος K. Κασάπης
AI has enormous potential to improve the quality of health care, enable early diagnosis of diseases, and reduce costs. But if implemented incautiously, AI can exacerbate health disparities, endanger patient privacy, and perpetuate bias. STAT, with support from the Commonwealth Fund, explored these possibilities and pitfalls during the past year and a half, illuminating best practices while identifying concerns and regulatory gaps. This report includes many of the articles we published and summarizes our findings, as well as recommendations we heard from caregivers, health care executives, academic experts, patient advocates, and others.
This report covers the judicial use of the death penalty for the period January to December 2020.
As in previous years, information is collected from a variety of sources, including: official figures; judgements; information from individuals sentenced to death and their families and representatives; media reports; and, for a limited number of countries, other civil society organizations.
Amnesty International reports only on executions, death sentences and other aspects of the use of the death penalty, such as commutations and exonerations, where there is reasonable confirmation. In many countries governments do not publish information on their use of the death penalty. In China and Viet Nam, data on the use of the death penalty is classified as a state secret. During 2020 little or no information was available on some countries – in particular Laos and North Korea (Democratic People’s Republic of Korea) – due to restrictive state practice.
Aviva’s first How We Live report was published in September 2020 when the world was firmly in the grip of a global pandemic. In the UK the vaccination programme is well underway and the mood of the nation is hopeful. This latest How We Live report looks at the long-term effects of the Coronavirus outbreak and considers its impact on our future behaviours.
We interviewed 4,000 adults across the UK to gather their views on a wide range of lifestyle decisions including property priorities, home-working, green living, career paths, vehicle choices and holiday plans. We also asked whether people had experienced any positive outcomes from the Covid pandemic. This report considers the practical and emotional skills which have been fostered as a result. Since the beginning of 2020, the UK has seen immense change. As we look forward to a sense of “normality” it remains to be seen which aspects of life will return to their previous states, and where we can expect changes to become permanent fixtures.
The life insurance industry provides protection against the financial consequences of the premature death of a family breadwinner, disability, or outliving one’s retirement assets. But how are life insurance products actually designed and priced?
Product committees comprising agents, underwriters, actuaries, and senior management sit and discuss what new products should be offered. The agents have vast experience visiting with policyholders to determine their needs. Underwriters set the guidelines on which policyholders will be accepted and/or rated. Smart actuaries (while most would find this redundant, some would call it an oxymoron) assess the potential risks in these products and set a potential price. Senior management listens to agents, underwriters, and actuaries and helps finalize the product design, the guidelines for accepting risks, and the price. The programmers will also have to be contacted to determine the cost of administering the products. Many iterations of these discussions may take place before a product is ready for sale. The entire process could take up to a year.
Some of these products are quite complex, taking into account long-term interest rates and probabilities of death/survival, disability, and lapse. With this lengthy and rigorous process, one would imagine that few mistakes are made. However, this is not the case. What follows are a few examples of major product mistakes which cost the life insurance industry a lot of time, money, and bad publicity.
The COVID-19 pandemic and subsequent lockdowns forced many insurers to accelerate the transition to digital business models. In many countries, this transition has been remarkably successful, however, the crisis also highlighted the critical role played by national regulatory frameworks in both hindering and facilitating the shift to digitalisation in the insurance industry. COVID-19 lockdowns highlighted the critical role of national regulatory frameworks in both hindering and facilitating the shift to digitalisation in the insurance industry. Digitalisation is not a goal in itself, but provides insurers and their customers with benefits that are particularly useful in situations where in-person interactions cannot take place, played out in its fullest form during the COVID-19-induced lockdowns. Digitalisation drives an increase in speed and efficiency, irrespective of where the customer is located, and promises improved customer service and satisfaction.
The Internet of Things (IoT) has been developing over the last 20 years and is often referred to as Industry 4.0 or the “fourth industrial revolution.” It is an umbrella term for all the digital assets and entities connected to the internet. Many of these are intangibles, such as data, human capital via artificial intelligence (AI), intellectual property (IP), and cyber; as such, they need to be made tangible to address value on a balance sheet. Others are connected entities, such as sensor devices, collecting and receiving information in an intelligent fashion across networks.
The rapid rise of online political campaigning has made most political financing regulations obsolete, putting transparency and accountability at risk. Seven in 10 countries worldwide do not have any specific limits on online spending on election campaigns, with six out of 10 not having any restrictions on online political advertising at all.
Highlights
• On average, concerns over Innovation was ranked highest, followed by Implications of Covid-19 • Respondents indicated innovation is important, but are mostly in process
• Respondents were mostly confident in implementing their innovation plans.
• Nearly half of respondents indicated their focus was on the customer experience • Most respondents expect some negative impact from Covid-19, with decreased profit indicated most, followed by decreased sales effectiveness, which are likely related
• The most common change in response to the Covid-19 impact were workplace and staffing changes, followed by technology investments
• Of the respondents, 92% indicated cyber security was important or very important.
• Continuous effort was ranked highest, and Mitigating internal threats, Identifying external threats, and Prioritizing identifying cyber risks were ranked next.
• While 95% of respondents indicated emerging threats were important or very important, 28% Indicated they were very good at responding to them
• For resiliency and sustainability, corporate ESG and R&S for internal operations were ranked as the highest priorities
iis the institutes innovation covid-19
What North America’s top finance executives are thinking - and doingΔρ. Γιώργος K. Κασάπης
Each quarter (since 2Q10), CFO Signals has tracked the thinking and actions of CFOs representing many of North America’s largest and most influential companies. All respondents are CFOs from the US, Canada, and Mexico, and the vast majority are from companies with more than $1 billion in annual revenue. The 1Q 2021 survey was open from February 8-19, 2021. A total of 128 CFOs participated, 69% from public companies and 31% from privately held companies.
Democratic watchdog organization Freedom House has released its annual ranking of the world's most free and most suppressed nations.
The report is a key barometer for global democracy and this year's edition found that global freedom has declined for the 15th straight year. 2020 was a turbulent year with the pandemic, violent conflict and economic and physical insecurity leading to democracy's defenders sustaining heavy losses against authoritarian foes which has resulted in a shift in the internatioal baance in favor of tyranny.
A total of 195 countries and 15 territories were analyzed on their levels of access to political rights and civil liberties with the number experiencing a deterioration in their freedom scores exceeding the number that saw improvement by the widest margin since 2006. In 2020, nearly 75 percent of the world's population lived under a government that saw its democracy score decline in the past year.
Women, Business and the Law 2021 is the seventh in a series of annual studies measuring the laws and regulations that affect women’s economic opportunity in 190 economies. Amidst a global pandemic that threatens progress toward gender equality, the report identifies barriers to women’s economic participation and encourages reform of discriminatory laws. This year, the study also includes important findings on government responses to the COVID-19 crisis and pilot research related to childcare and women’s access to justice.
Strong competition undoubtedly contributes to a country’s productivity and economic growth. The primary objective of a competition policy is to enhance consumer welfare by promoting competition and controlling practices that could restrict it. More competitive markets stimulate innovation and generally lead to lower prices for consumers, increased product variety and quality, more entry and enhanced investment. Overall, greater competition is expected to deliver higher levels of welfare and economic growth.
Long-erm Care and Health Care Insurance in OECD and Other CountriesΔρ. Γιώργος K. Κασάπης
This report carries out a stocktaking of what systems have in OECD and non-OECD countries for longterm care and health care, as well as the types of insurance products that are made available in these countries. It is part of a broader project that examines the complementarity of the social security network with the private insurance market, which examines how insurance could support the public sector longterm care and health care systems, as well as considering the financing of long-term care and health care.
This tenth edition of Global Insurance Market Trends provides an overview of market trends to better understand the overall performance and health of the insurance market. This monitoring report is compiled using data from the OECD Global Insurance Statistics (GIS) exercise. The OECD has collected and analysed data on insurance in OECD countries, such as the number of insurance companies and employees, insurance premiums and investments by insurance companies, dating back to the 1980s. Over time, the framework of this exercise has expanded and now includes key items of the balance sheet and income statement of direct insurers and reinsurers.
Does AI threaten and undermine human value in the workplace more than any other technology? There have been significant advances in AI, but will their impact really be different this time?
This literature review takes stock of what is known about the impact of artificial intelligence on the labour market, including the impact on employment and wages, how AI will transform jobs and skill needs, and the impact on the work environment. The purpose is to identify gaps in the evidence base and inform future research on AI and the labour market.
The OECD has estimated that 14% of jobs are at high risk of automation.
•Despite this, employment grew in nearly all OECD countries over the period 2012-2019.
•At the country level, a higher risk of automation was associated with higher employment growth over the period. This might be because automation promotes employment growth by increasing productivity, although other factors are also at play.
•At the occupational level, however, employment growth was much lower in occupations at high risk of automation (6%) than in occupations at low risk (18%).
•Low-educated workers were more concentrated in high-risk occupations in 2012 and have become even more concentrated in these occupations since then.
•The low growth in jobs in high risk occupations has not led to a drop in the employment rate of low-educated workers. This is largely because the number of workers with a low education has fallen in line with the demand for these workers.
•Going forward, however, the risk of automation is increasingly falling on low-educated workers and the COVID-19 crisis is likely to accelerate automation, as companies reduce reliance on human labour and contact between workers, or re-shore some production.
Prescription drug prices in U.S. more than 2.5 times higher than in other cou...Δρ. Γιώργος K. Κασάπης
Prescription drugs cost an average of 2.56 times more in the United States than they do in 32 other countries, according to a new report from RAND Corporation.
That disparity is even greater for brand name drugs, with U.S. prices averaging 3.44 times those in comparison nations. The study also found that prices for unbranded generic drugs — which account for 84% of drugs sold in the United States by volume but only 12% of U.S. spending — are slightly lower in the United States than in most other countries.
‘A circular nightmare’: Short-staffed nursing homes spark Covid-19 outbreaks,...Δρ. Γιώργος K. Κασάπης
Nursing homes have suffered grievously in the coronavirus pandemic. Chronically understaffed, that’s getting worse, a new US Pirg Education Fund analysis says. The shortage of direct-care workers rose from 20% of U.S. nursing homes in May to 23% in December. Too few workers raises stress among staff, the authors argue, making them and the residents they care for more vulnerable to Covid-19 infections, reducing staff further in “a circular nightmare.”
Keeping the lights on, the water running, and the landlord at bay could turn out to be good ways to control Covid-19 infection, a new NBER (National Bureau of Economic Research) analysis suggests, based on the idea that social distancing is easier for people who can stay home. When utility shutoffs and evictions were halted, Covid-19 cases in certain counties across the country fell by 8% from March through November 2020, the report says. The study can't prove cause and effect, but the authors venture that if such measures had been implemented nationwide, eviction moratoria would have resulted in a 14% decrease in Covid-19 cases and up to a 40% decrease in deaths. Utility shutoff moratoria would have cut infections by 9% and deaths by 15%, the study estimates.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. Morbidity and Mortality Weekly Report
Weekly / Vol. 68 / No. 18 May 10, 2019
INSIDE
416 Disparities in Incidence of Human
Immunodeficiency Virus Infection Among Black and
White Women — United States, 2010–2016
419 Racial Disparities in Mortality Associated with
Systemic Lupus Erythematosus — Fulton and
DeKalb Counties, Georgia, 2002–2016
423 Vital Signs: Pregnancy-Related Deaths, United States,
2011–2015, and Strategies for Prevention, 13 States,
2013–2017
430 QuickStats
Continuing Education examination available at
https://www.cdc.gov/mmwr/cme/conted_info.html#weekly.
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
Hepatitis Awareness Month and
Testing Day — May 2019
May is designated as Hepatitis Awareness Month,
and May 19 is Hepatitis Testing Day. Hepatitis B and
hepatitis C, the most common types of viral hepatitis in
the United States, can cause chronic infections, and many
persons remain unaware of their infection until serious
complications occur. In 2016, an estimated 862,000
and 2.4 million persons were living with hepatitis B and
hepatitis C, respectively, despite availability of a vaccine
and effective treatment for hepatitis B and a cure for
hepatitis C (1,2).
Although hepatitis A is preventable through vaccina-
tion, multiple states have had outbreaks since 2016, with
unprecedented large numbers of cases and person-to-
person spread (primarily among persons who use drugs or
experience homelessness). A report in this issue of MMWR
summarizes this resurgence of hepatitis A among unvac-
cinated adults at risk (3).
New cases of hepatitis C are also increasing; during
2010–2016, they increased 3.5-fold, mostly among young
adults (4). Recent increases in viral hepatitis infections,
many attributed to surges in injection-drug use (4), high-
light the importance of acknowledging and combatting the
infectious disease consequences of the nation’s opioid crisis.
References
1. Patel EU, Thio CL, Boon D, Thomas DL, Tobian AAR. Prevalence
of hepatitis B and hepatitis D virus infections in the United States,
2011–2016. Clin Infect Dis 2019.https://doi.org/10.1093/cid/ciz001
2. Hofmeister MG, Rosenthal EM, Barker LK, et al. Estimating
prevalence of hepatitis C virus infection in the United States,
2013–2016. Hepatology 2019;69:1020–31. https://doi.
org/10.1002/hep.30297
3. Foster M, Hofmeister MG, Kupronis BA, et al. Increase in hepatitis A
virus infections—United States, 2013–2018. MMWR Morb Mortal
Wkly Rep 2019;68:413–5.
4. CDC. Viral hepatitis surveillance—United States, 2016. Atlanta,
GA: US Department of Health and Human Services, CDC; 2016.
https://www.cdc.gov/hepatitis/statistics/2016surveillance/index.htm
Increase in Hepatitis A Virus
Infections — United States,
2013–2018
Monique A. Foster, MD1; Megan G. Hofmeister, MD1;
Benjamin A. Kupronis, MPH1; Yulin Lin, MD1; Guo-Liang Xia, MD1;
Shaoman Yin, PhD1; Eyasu Teshale, MD1
Hepatitis A virus (HAV) is primarily transmitted fecal-orally
after close contact with an infected person (1); it is the most
common cause of viral hepatitis worldwide, typically causing
acute and self-limited symptoms, although rarely liver failure
and death can occur (1). Rates of hepatitis A had declined
by approximately 95% during 1996–2011; however, during
2016–2018, CDC received approximately 15,000 reports of
HAV infections from U.S. states and territories, indicating
a recent increase in transmission (2,3). Since 2017, the vast
majority of these reports were related to multiple outbreaks
of infections among persons reporting drug use or homeless-
ness (4). In addition, increases of HAV infections have also
occurred among men who have sex with men (MSM) and,
to a much lesser degree, in association with consumption of
imported HAV-contaminated food (5,6). Overall, reports of
hepatitis A cases increased 294% during 2016–2018 compared
2. Morbidity and Mortality Weekly Report
414 MMWR / May 10, 2019 / Vol. 68 / No. 18 US Department of Health and Human Services/Centers for Disease Control and Prevention
The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC),
U.S. Department of Health and Human Services, Atlanta, GA 30329-4027.
Suggested citation: [Author names; first three, then et al., if more than six.] [Report title]. MMWR Morb Mortal Wkly Rep 2019;68:[inclusive page numbers].
Centers for Disease Control and Prevention
Robert R. Redfield, MD, Director
Anne Schuchat, MD, Principal Deputy Director
Chesley L. Richards, MD, MPH, Deputy Director for Public Health Science and Surveillance
Rebecca Bunnell, PhD, MEd, Director, Office of Science
Barbara Ellis, PhD, MS, Acting Director, Office of Science Quality, Office of Science
Michael F. Iademarco, MD, MPH, Director, Center for Surveillance, Epidemiology, and Laboratory Services
MMWR Editorial and Production Staff (Weekly)
Charlotte K. Kent, PhD, MPH, Editor in Chief
Jacqueline Gindler, MD, Editor
Mary Dott, MD, MPH, Online Editor
Terisa F. Rutledge, Managing Editor
Douglas W. Weatherwax, Lead Technical Writer-Editor
Glenn Damon, Soumya Dunworth, PhD, Teresa M. Hood, MS,
Technical Writer-Editors
Martha F. Boyd, Lead Visual Information Specialist
Maureen A. Leahy, Julia C. Martinroe,
Stephen R. Spriggs, Tong Yang,
Visual Information Specialists
Quang M. Doan, MBA, Phyllis H. King,
Terraye M. Starr, Moua Yang,
Information Technology Specialists
MMWR Editorial Board
Timothy F. Jones, MD, Chairman
Matthew L. Boulton, MD, MPH
Virginia A. Caine, MD
Katherine Lyon Daniel, PhD
Jonathan E. Fielding, MD, MPH, MBA
David W. Fleming, MD
William E. Halperin, MD, DrPH, MPH
Robin Ikeda, MD, MPH
Phyllis Meadows, PhD, MSN, RN
Jewel Mullen, MD, MPH, MPA
Jeff Niederdeppe, PhD
Patricia Quinlisk, MD, MPH
Stephen C. Redd, MD
Patrick L. Remington, MD, MPH
Carlos Roig, MS, MA
William Schaffner, MD
Morgan Bobb Swanson, BS
with 2013–2015. During 2016–2018, CDC tested 4,282
specimens, of which 3,877 (91%) had detectable HAV RNA;
565 (15%), 3,255 (84%), and 57 (<1%) of these specimens
were genotype IA, IB, or IIIA, respectively. Adherence to the
Advisory Committee on Immunization Practices (ACIP)
recommendations to vaccinate populations at risk can help
control the current increases and prevent future outbreaks of
hepatitis A in the United States (7).
Hepatitis A infections among persons who meet the Council
of State andTerritorial Epidemiologists (CSTE) hepatitis A case
definition (https://wwwn.cdc.gov/nndss/conditions/hepatitis-
a-acute/) are notified to CDC through the National Notifiable
Diseases Surveillance System (NNDSS). Cases reported to
CDC through NNDSS during 2013–2018 were used to
calculate percent change (2013–2015 versus 2016–2018) by
state and mapped using RStudio software (version 1.2.1335;
RStudio, Inc.). Serum specimens from CSTE confirmed cases
submitted to the CDC laboratory were tested for HAV RNA by
polymerase chain reaction, and isolated virus was amplified to
characterize a 315–base-pair fragment of the VP1/P2B region,
which defines the genotype of the virus.
Overall, reports of hepatitis A cases increased 294% during
2016–2018 compared with 2013–2015 (Figure). Eighteen
states had lower case counts during 2016–2018 compared
with 2013–2015. Nine states and Washington, DC had an
increase of approximately 500%. During 2013–2018, 4,508
HAV anti-immunoglobulin M–positive specimens under-
went additional testing at CDC. During 2013–2015, 226
specimens underwent additional testing, of which 197 (87%)
had detectable HAV RNA; of the RNA-positive specimens, 76
(39%), 121 (61%), and 0 (0%) tested positive for a genotype
IA, IB, or IIIA viral strain, respectively. In comparison, 4,282
specimens were tested by CDC during 2016–2018, of which
3,877 (91%) had detectable HAV RNA; 565 (15%), 3,255
(84%), and 57 (<1%) of these specimens were genotype IA,
IB, or IIIA, respectively.
Discussion
The number of hepatitis A infections reported to CDC
increased during 2016–2018, along with the number of
specimens from infected persons submitted to CDC for
additional testing. In the past, outbreaks of hepatitis A virus
infections occurred every 10–15 years and were associated
with asymptomatic children (8). With the widespread adop-
tion of universal childhood vaccination recommendations
(https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5507a1.
htm), asymptomatic children are no longer the main drivers
of hepatitis A outbreaks (3,9). Although the overall incidence
rate of HAV infections has decreased within all age groups, a
large population of susceptible, unvaccinated adults who were
not infected by being exposed to the virus during childhood
remain vulnerable to infection by contaminated foods (typi-
cally imported from countries with endemic HAV transmis-
sion) and recently, on a much larger scale, through behaviors
that increase risk for infection in certain vulnerable popula-
tions, such as drug use (3).
3. Morbidity and Mortality Weekly Report
MMWR / May 10, 2019 / Vol. 68 / No. 18 415US Department of Health and Human Services/Centers for Disease Control and Prevention
FIGURE. Percent change in reported hepatitis A infections, by
state — National Notifiable Diseases Surveillance System, United
States, 2013–2015 and 2016–2018*
>500
>100–500
>0–100
−100–0
DC
Abbreviation: DC = District of Columbia.
* 2017 and 2018 case counts are provisional.
Increasingly, molecular epidemiology is employed by public
health laboratories to better characterize hepatitis A transmis-
sion patterns. When combined with reliable epidemiologic
data, these laboratory data can be used to identify transmission
networks and confirm the source of exposure during common-
source outbreaks, facilitating prompt and effective public
health response. Historically, genotype IA has been the most
common genotype circulating in North and South America.
During 2013–2018, HAV genotype IB predominated in the
United States. Increasing numbers of genotype IIIA were seen,
a genotype that is considered rare in the United States.
Decreasing new infections from hepatitis A virus can be
achieved and sustained by maintaining a high level of popu-
lation immunity through vaccination. There is no universal
vaccination recommendation for adults in the United States;
however, ACIP does recommend vaccination for adults who
plan travel to HAV-endemic countries, MSM, persons who
use drugs, persons with chronic liver disease, and recently,
persons experiencing homelessness (7). Continued efforts to
increase hepatitis A vaccination coverage among the ACIP-
recommended risk groups is vital to halting the current hepa-
titis A outbreaks and reducing overall hepatitis A incidence in
the United States.
Acknowledgments
Members of the Division of Viral Hepatitis Laboratory, Division
of Viral Hepatitis HAV Incident Management Team, Food and
Drug Administration CORE Signals Teams; state and local health
departments; medical and mental health partners; corrections
partners; syringe service providers.
Summary
What is already known about this topic?
Hepatitis A is a vaccine-preventable viral infection of the liver
that is primarily transmitted through consumption of micro-
scopic amounts of feces.
What is added by this report?
During 2016–2018, reports of hepatitis A infections in the
United States increased by 294% compared with 2013–2015,
related to outbreaks associated with contaminated food items,
among men who have sex with men, and primarily, among
persons who report drug use or homelessness.
What are the implications for public health practice?
Increasing vaccination among groups at risk for hepatitis A infection
might halt ongoing outbreaks and prevent future outbreaks.
1Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD,
and TB Prevention, CDC.
Corresponding author: Monique A. Foster, ydg9@cdc.gov, 404-718-8561.
All authors have completed and submitted the ICMJE form for
disclosure of potential conflicts of interest. No potential conflicts of
interest were disclosed.
References
1. Franco E, Meleleo C, Serino L, Sorbara D, Zaratti L. Hepatitis A:
epidemiology and prevention in developing countries. World J Hepatol
2012;4:68–73. https://doi.org/10.4254/wjh.v4.i3.68
2. CDC. Viral hepatitis surveillance, United States 2016. Atlanta, GA: US
Department of Health and Human Services, CDC; 2017. https://www.cdc.
gov/hepatitis/statistics/2016surveillance/pdfs/2016HepSurveillanceRpt.pdf
3. CDC. National notifiable infectious diseases: weekly tables, 2018. Atlanta,
GA: US Department of Health and Human Services, CDC; 2018. https://
wonder.cdc.gov/nndss/static/2018/52/2018-52-table2H-H.pdf
4. Foster M, Ramachandran S, Myatt K, et al. Hepatitis A virus outbreaks
associated with drug use and homelessness—California, Kentucky,
Michigan, and Utah, 2017. MMWR Morb Mortal Wkly Rep
2018;67:1208–10. https://doi.org/10.15585/mmwr.mm6743a3
5. Viray MA, Hofmeister MG, Johnston DI, et al. Public health investigation
and response to a hepatitis A outbreak from imported scallops consumed
raw—Hawaii, 2016. Epidemiol Infect 2018;147:1–8.
6. Latash J, Dorsinville M, Del Rosso P, et al. Notes from the field: increase
in reported hepatitis A infections among men who have sex with men—
New York City, January–August 2017. MMWR Morb Mortal Wkly Rep
2017;66:999–1000. https://doi.org/10.15585/mmwr.mm6637a7
7. Doshani M, Weng M, Moore KL, Romero JR, Nelson NP.
Recommendations of the Advisory Committee on Immunization Practices
for use of hepatitis A vaccine for persons experiencing homelessness.
MMWR Morb Mortal Wkly Rep 2019;68:153–6. https://doi.
org/10.15585/mmwr.mm6806a6
8. MurphyTV, Denniston MM, Hill HA, et al. Progress toward eliminating
hepatitis A disease in the United States. MMWR Suppl 2016;65:29–41.
https://doi.org/10.15585/mmwr.su6501a6
9. Klevens RM, Denniston MM, Jiles-Chapman RB, Murphy TV.
Decreasing immunity to hepatitis A virus infection among US adults:
findings from the National Health and Nutrition Examination Survey
(NHANES), 1999–2012. Vaccine 2015;33:6192–8. https://doi.
org/10.1016/j.vaccine.2015.10.009
![Morbidity and Mortality Weekly Report
414 MMWR / May 10, 2019 / Vol. 68 / No. 18 US Department of Health and Human Services/Centers for Disease Control and Prevention
The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC),
U.S. Department of Health and Human Services, Atlanta, GA 30329-4027.
Suggested citation: [Author names; first three, then et al., if more than six.] [Report title]. MMWR Morb Mortal Wkly Rep 2019;68:[inclusive page numbers].
Centers for Disease Control and Prevention
Robert R. Redfield, MD, Director
Anne Schuchat, MD, Principal Deputy Director
Chesley L. Richards, MD, MPH, Deputy Director for Public Health Science and Surveillance
Rebecca Bunnell, PhD, MEd, Director, Office of Science
Barbara Ellis, PhD, MS, Acting Director, Office of Science Quality, Office of Science
Michael F. Iademarco, MD, MPH, Director, Center for Surveillance, Epidemiology, and Laboratory Services
MMWR Editorial and Production Staff (Weekly)
Charlotte K. Kent, PhD, MPH, Editor in Chief
Jacqueline Gindler, MD, Editor
Mary Dott, MD, MPH, Online Editor
Terisa F. Rutledge, Managing Editor
Douglas W. Weatherwax, Lead Technical Writer-Editor
Glenn Damon, Soumya Dunworth, PhD, Teresa M. Hood, MS,
Technical Writer-Editors
Martha F. Boyd, Lead Visual Information Specialist
Maureen A. Leahy, Julia C. Martinroe,
Stephen R. Spriggs, Tong Yang,
Visual Information Specialists
Quang M. Doan, MBA, Phyllis H. King,
Terraye M. Starr, Moua Yang,
Information Technology Specialists
MMWR Editorial Board
Timothy F. Jones, MD, Chairman
Matthew L. Boulton, MD, MPH
Virginia A. Caine, MD
Katherine Lyon Daniel, PhD
Jonathan E. Fielding, MD, MPH, MBA
David W. Fleming, MD
William E. Halperin, MD, DrPH, MPH
Robin Ikeda, MD, MPH
Phyllis Meadows, PhD, MSN, RN
Jewel Mullen, MD, MPH, MPA
Jeff Niederdeppe, PhD
Patricia Quinlisk, MD, MPH
Stephen C. Redd, MD
Patrick L. Remington, MD, MPH
Carlos Roig, MS, MA
William Schaffner, MD
Morgan Bobb Swanson, BS
with 2013–2015. During 2016–2018, CDC tested 4,282
specimens, of which 3,877 (91%) had detectable HAV RNA;
565 (15%), 3,255 (84%), and 57 (<1%) of these specimens
were genotype IA, IB, or IIIA, respectively. Adherence to the
Advisory Committee on Immunization Practices (ACIP)
recommendations to vaccinate populations at risk can help
control the current increases and prevent future outbreaks of
hepatitis A in the United States (7).
Hepatitis A infections among persons who meet the Council
of State andTerritorial Epidemiologists (CSTE) hepatitis A case
definition (https://wwwn.cdc.gov/nndss/conditions/hepatitis-
a-acute/) are notified to CDC through the National Notifiable
Diseases Surveillance System (NNDSS). Cases reported to
CDC through NNDSS during 2013–2018 were used to
calculate percent change (2013–2015 versus 2016–2018) by
state and mapped using RStudio software (version 1.2.1335;
RStudio, Inc.). Serum specimens from CSTE confirmed cases
submitted to the CDC laboratory were tested for HAV RNA by
polymerase chain reaction, and isolated virus was amplified to
characterize a 315–base-pair fragment of the VP1/P2B region,
which defines the genotype of the virus.
Overall, reports of hepatitis A cases increased 294% during
2016–2018 compared with 2013–2015 (Figure). Eighteen
states had lower case counts during 2016–2018 compared
with 2013–2015. Nine states and Washington, DC had an
increase of approximately 500%. During 2013–2018, 4,508
HAV anti-immunoglobulin M–positive specimens under-
went additional testing at CDC. During 2013–2015, 226
specimens underwent additional testing, of which 197 (87%)
had detectable HAV RNA; of the RNA-positive specimens, 76
(39%), 121 (61%), and 0 (0%) tested positive for a genotype
IA, IB, or IIIA viral strain, respectively. In comparison, 4,282
specimens were tested by CDC during 2016–2018, of which
3,877 (91%) had detectable HAV RNA; 565 (15%), 3,255
(84%), and 57 (<1%) of these specimens were genotype IA,
IB, or IIIA, respectively.
Discussion
The number of hepatitis A infections reported to CDC
increased during 2016–2018, along with the number of
specimens from infected persons submitted to CDC for
additional testing. In the past, outbreaks of hepatitis A virus
infections occurred every 10–15 years and were associated
with asymptomatic children (8). With the widespread adop-
tion of universal childhood vaccination recommendations
(https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5507a1.
htm), asymptomatic children are no longer the main drivers
of hepatitis A outbreaks (3,9). Although the overall incidence
rate of HAV infections has decreased within all age groups, a
large population of susceptible, unvaccinated adults who were
not infected by being exposed to the virus during childhood
remain vulnerable to infection by contaminated foods (typi-
cally imported from countries with endemic HAV transmis-
sion) and recently, on a much larger scale, through behaviors
that increase risk for infection in certain vulnerable popula-
tions, such as drug use (3).](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)