Digital Commons Network^™

The Impact Of Polio Eradication On Routine Immunization And Primary Health Care: A Mixed-Methods Study, Svea Closser, Kelly Cox, Thomas M. Parris, R Matthew Landis, Judith Justice, Ranjani Gopinath, Kenneth Maes, Hailom Banteyerga Amaha, Ismaila Zango Mohammed, Rashid Jooma

Section of Neurosurgery

Background: After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC).
Methods: Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review.
Results: Our quantitative analysis did not find compelling evidence of widespread and …

Human Papillomavirus And The Gardasil Vaccine: Medicalization And The Gendering Of Bodies And Bodily Risk, Lauren Camara

Laurier Undergraduate Journal of the Arts

No abstract provided.

Public Health In The Age Of Ebola In West Africa, Michael T. Osterholm, Kristine A. Moore, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The Ebola epidemic, with its fast-growing toll and real potential for spreading into much of Africa, including major cities, has the makings of a “Black Swan” event. Such events, using the term coined by Nassim Nicholas Taleb, are: 1) unpredictable, outside the realm of regular expectations; 2) have a major impact, and; 3) are rationalized after the fact as being explainable and predictable.

We have learned from this outbreak the potential for an infectious disease to be politically, economically, and socially destabilizing, and that what kills us may be very different from what frightens us or substantially affects our social …

Assessment Of Anthelmintic Efficacy Of Mebendazole In School Children In Six Countries Where Soil-Transmitted Helminths Are Endemic, Bruno Levecke, Antonio Montresor, Marco Albonico, Shaali M. Ame, Jerzy M. Behnke, Jeffrey M. Bethony, +15 Additional Authors

Microbiology, Immunology, and Tropical Medicine Faculty Publications

BACKGROUND:

Robust reference values for fecal egg count reduction (FECR) rates of the most widely used anthelmintic drugs in preventive chemotherapy (PC) programs for controlling soil-transmitted helminths (STHs; Ascaris lumbricoides, Trichuris trichiura, and hookworm) are still lacking. However, they are urgently needed to ensure detection of reduced efficacies that are predicted to occur due to growing drug pressure. Here, using a standardized methodology, we assessed the FECR rate of a single oral dose of mebendazole (MEB; 500 mg) against STHs in six trials in school children in different locations around the world. Our results are compared with those previously obtained …

Necrotizing Fasciitis, Holly Herron

Nursing Student Class Projects (Formerly MSN)

Necrotizing fasciitis also known as necrotizing soft tissue infections (NSTIs) is a rare life-threatening infection that involves the skin and soft tissue. A rapid and accurate diagnosis of NSTIs must be identified by healthcare providers to diminish morbidity and mortality. NSTIs are characterized by progressive necrosis of subcutaneous tissue and fascia involving large areas of tissue (Lin, Chang, Lai, Lin, & Chen, 2013). Hippocrates (500 BC) described necrotizing fasciitis as “diffuse erysipelas caused by trivial accidents [where] flesh, sinews, and bones fell away in large quantities, [leading to] death in many cases” (Lancerotto, Tocco, Salmaso, Vindigni & Bassetto, 2012). In …

Necrotizing Fasciitis: The “Flesh Eating” Disease, John Neukam

Nursing Student Class Projects (Formerly MSN)

Necrotizing fasciitis, often referred to as the “flesh-eating disease”, is a rare bacterial infection with an extremely high mortality rate with symptoms that begin subtle but can quickly ravish the human body.1 While the prevalence of this disease is relatively low, evidence of this disease can be traced back as far as the 5th century BC where it was initially described by Hippocrates.2 It wasn’t until 1952 however that Dr. Bob Wilson termed the disease “necrotizing fasciitis”.3 The rapid progression of this disease and the acute deterioration it causes in a patient is extremely intriguing. This “flesh-eating disease” can present …

Myasthenia Gravis: A Closer Look, Erin L. Ricker

Nursing Student Class Projects (Formerly MSN)

Myasthenia gravis (MG) is a rare, chronic autoimmune disease that affects the neurotransmitter acetylcholine and the acetylcholine receptors at the neuromuscular junction (Mestecky, 2013). MG causes fluctuating skeletal muscle weakness and fatigue. According to the Myasthenia Gravis Foundation of America (MGFA) (2010), 20 per 100,000 patients are diagnosed with MG, although researchers believe several more patients are misdiagnosed or missed entirely. Several neurological disorders have similar clinical presentations to MG making it difficult for inexperienced practitioners to identify and properly diagnose patients. Patients are often misdiagnosed and delayed proper treatment for one to two years after initial presentation of symptoms …

Global Burden Of Tuberculosis, Diana Moses

Nursing Student Class Projects (Formerly MSN)

Tuberculosis (TB) is a major health concern not only in the United States, but in the entire world. TB is an airborne communicable infection which has affected human beings from immemorial times, evidenced by TB being found in the skeletal remains of ancient mummies (Gough & Kaufman, 2011). There are many patho physiological events in TB that concern the entire body, especially the respiratory and immunological systems. According to Knechel, TB prevalence is rising due to the increased number of patients infected with HIV, bacterial resistance to medications, increased international travel and immigration from countries with high prevalence of TB, …

Enterovirus: What Everyone Should Know, Debra Mccorkle

Nursing Student Class Projects (Formerly MSN)

Enterovirus is capturing the attention of everyone; but what is it, who is affected by it, and can it be treated and/or prevented? Like any virus the enterovirus has many different strains. The strain capturing everyone’s attention lately is human enterovirus 68 (HEV68). This strain was first detected in California in 1962 (Oberste et al., 2004). Most cases of HEV68 are mild and do not require medical attention, however some can become severe and may cause serious heart or brain infections according to the Center for Disease Control and Prevention (CDC) website (Updated September 8, 2014). HEV68 is a respiratory …

Ebola: Protecting Healthcare Workers, Martha Mccoy

Nursing Student Class Projects (Formerly MSN)

Ebola is a hemorrhagic disease that has been seen throughout Liberia, but because of international travel it is spreading. Gilsdorf, Morgan and Leitmeyer (2012) researched air travel and reported that, “In 2010, 5.04 billion passengers arrived and departed from 1318 airports worldwide… and travel to and from Africa almost doubled between 1995 and 2005.” (p.1471). In the last few months there have been cases of Ebola reported in Spain and the United States linked to travel. These are recent developments because as of July, 2014 the Center for Disease Control and Prevention (CDC) reported “to date there are no cases …

Ebola Pandemic, Lurajean Cravens

Nursing Student Class Projects (Formerly MSN)

Ebolavirus, or Ebola Virus Disease (EVD), is of the filovirus family causing hemorrhagic fever first discovered in the African country of Zaire in 1976 (Turner, 2014; Hampton, 2014) and has gained global concern and attention since the recent epidemic outbreak in West Africa. There are five known species of Ebola: Zaire, Sudan, Ivory Coast, Bundibugyo and Reston, based on the region of origination. The Zaire species has been identified as the strain responsible for the current outbreak in West Africa, and has spread to Liberia, Sierra Leone, Nigeria and Senegal (Centers for Disease Control and Prevention,2014; Gostin, Lucey & Phelan, …

Chagas Disease: A Dangerous Kiss, Stephen Maynard

Nursing Student Class Projects (Formerly MSN)

Parasitic infections are a common occurrence worldwide and are often more common in low income countries. While these infections are associated with poor compromised communities outside the United States these diseases effect people within the United States and are more common than realized. One specific parasitic infection infects its human host causing Chagas disease. Chagas disease is an infection that occurs from the parasite T. cruzi and was named for the Brazilian physician Carlos Chagas who discovered the disease in 1909 (CDC, 2014). According to the Centers for Disease Control (CDC, 2014), Chagas disease has been targeted as a priority …

Ebola, A Deadly Viral Disease Affecting The West African Country Of Sierra Leone, Unisa Seisay

Nursing Student Class Projects (Formerly MSN)

Presently, there has been an outbreak of Ebola Virus Disease (EVD) in the West African countries of Sierra Leone, Liberia, Nigeria, Senegal and Guinea. The outbreak was first discovered in Guinea in March 21, 2014 and has spread to the neighboring countries. This has resulted in a lot of fatalities and is now considered a global public health concern (WHO, 2014).

Enterococcus Faecalis Endocarditis: A Case Study, Torri Curtis

Nursing Student Class Projects (Formerly MSN)

Infectious endocarditis is an uncommon disease of the heart stemming from a bacterial or fungal infection on the endocardial surface of the heart or heart valve (Pierce, Calkins, & Thornton, 2012). From review of the literature, infective endocarditis is fairly uncommon and may be difficult to initially diagnose. Per Sabe, Shrestha, and Menon, occurrence of infective endocarditis (IE) is nearly 0.9-6.2 per 100,000 persons per year (2013). Several preexisting conditions such as aging, heart valve disease, implantable cardiac devices, a history of heart disease such as rheumatic fever, and invasive procedures can put a patient at higher risk for IE …

Enterovirus D68, Kimberly Meyers

Nursing Student Class Projects (Formerly MSN)

Enterovirus D68 (EVD68) “belongs to the family Picornaviridae, genus Enterovirus, and species Human enterovirus D: (Kaida et al.,2011, para.2). It is a small nonenveloped RNA virus (Xiang et al., 2012). EVD68 “shares characteristics with rhinoviruses, such as infection of the respiratory tract and acid lability” (Lauinger et al., 2012). There is no specific treatment for EVD68. Since the infection is caused by a virus, antibiotics would be ineffective. There are no antiviral medications currently available to treat EVD68 (Herold, 2014). Treatment may include antipyretics, cough medicines, bronchodilators, oxygen, and mechanical ventilation if required.

Ascaris Lumbricoides: The Unforeseen Diagnosis, Suzette Maynard

Nursing Student Class Projects (Formerly MSN)

Infections from Ascaris lumbricoides have become very prevalent in lesser developed countries. These infections are believed to migrate into the United States through the border with Mexico, and immigration from other countries, through increased world travel and international adoptions (Cardenas et al., 2010). A. lumbricoides have been found to cause cases in the United States, one being in Westerville, Ohio (J. Leonard, personal communication, September 6, 2014). As the world has become smaller, it has become imperative that as a nation we are able to prepare for infections that are popular outside the United States. The first step in preparing …

Genetics Of The Pig Tapeworm In Madagascar Reveal A History Of Human Dispersal And Colonization, Tetsuya Yanagida, Jean-François Carod, Yasuhito Sako, Minoru Nakao, Eric P. Hoberg, Akira Ito

Harold W. Manter Laboratory of Parasitology: Faculty Publications

An intricate history of human dispersal and geographic colonization has strongly affected the distribution of human pathogens. The pig tapeworm Taenia solium occurs throughout the world as the causative agent of cysticercosis, one of the most serious neglected tropical diseases. Discrete genetic lineages of T. solium in Asia and Africa/Latin America are geographically disjunct; only in Madagascar are they sympatric. Linguistic, archaeological and genetic evidence has indicated that the people in Madagascar have mixed ancestry from Island Southeast Asia and East Africa. Hence, anthropogenic introduction of the tapeworm from Southeast Asia and Africa had been postulated. This study shows that …

Intimate Partner Violence After Disclosure Of Hiv Test Results Among Pregnant Women In Harare, Zimbabwe, Simukai Shamu, Christina Zarowsky, Tamara Shefer, Marleen Temmerman, Naeemah Abrahams

Obstetrics and Gynaecology, East Africa

Background: HIV status disclosure is a central strategy in HIV prevention and treatment but in high prevalence settings women test disproportionately and most often during pregnancy. This study reports intimate partner violence (IPV) following disclosure of HIV test results by pregnant women.

Methods: In this cross sectional study we interviewed 1951 postnatal women who tested positive and negative for HIV about IPV experiences following HIV test disclosure, using an adapted WHO questionnaire. Multivariate regression models assessed factors associated with IPV after disclosure and controlled for factors such as previous IPV and other known behavioural factors associated with IPV.

Results: Over …

Prevalence Of Hepatitis B Virus Infection Among Barbers And Their Knowledge, Attitude And Practices In The District Of Sukkur, Sindh ., Imran Naeem Abbasi, Zafar Fatmi, Muhammad Masood Kadir, Nalini Sathiakumar

Community Health Sciences

Abstract

OBJECTIVES:

Several occupations in developing countries lag behind in ensuring the safety of their workers in occupational settings. Lack of implementation of safety guidelines at workplaces can expose workers to health risks. In Pakistan, barbers are one of the un-regulated occupational groups. Low literacy, increased frequency of direct skin contact and blade/razors use can expose barbers to body fluids including blood of the customers. We conducted this study in order to determine hepatitis B virus (HBV) prevalence among barbers and their knowledge, attitude and practices in a peri-urban district of Sindh.

MATERIAL AND METHODS:

Three hundred eighty-five barbers from …

Virus Sharing, Genetic Sequencing, And Global Health Security, Lawrence O. Gostin, Alexandra Phelan, Michael A. Stoto, John D. Kraemer, K. Srinath Reddy

Georgetown Law Faculty Publications and Other Works

The WHO’s Pandemic Influenza Preparedness (PIP) Framework was a milestone global agreement designed to promote the international sharing of biological samples to develop vaccines, while that ensuring poorer countries would have access to those vaccines. Since the PIP Framework was negotiated, scientists have developed the capacity to use genetic sequencing data (GSD) to develop synthetic viruses rapidly for product development of life-saving technologies in a time-sensitive global emergency—threatening to unravel the Framework. Access to GSD may also have major implications for biosecurity, biosafety, and intellectual property (IP).

By rendering the physical transfer of viruses antiquated, GSD may also undermine the …

Enhanced Expression Of Codon Optimized Mycobacterium Avium Subsp. Paratuberculosis Antigens In Lactobacillus Salivarius, Christopher D. Johnston, John P. Bannatine, Rodney Govender, Lorraine Endersen, Daniel Pletzer, Helge Weingart, Aidan Coffey, Jim O'Mahony, Roy D. Sleator

Department of Biological Sciences Publications

It is well documented that open reading frames containing high GC content show poor expression in A+T rich hosts. Specifically, G+C-rich codon usage is a limiting factor in heterologous expression of Mycobacterium avium subsp. paratuberculosis (MAP) proteins using Lactobacillus salivarius. However, re-engineering opening reading frames through synonymous substitutions can offset codon bias and greatly enhance MAP protein production in this host. In this report, we demonstrate that codon-usage manipulation of MAP2121c can enhance the heterologous expression of the major membrane protein (MMP), analogous to the form in which it is produced natively by MAP bacilli. When heterologously over-expressed, antigenic determinants …

Enhancing Immunomodulation On Innate Immunity By Shape Transition Among Rna Triangle, Square And Pentagon Nanovehicles, Emil F. Khisamutdinov, Hui Li, Daniel L. Jasinski, Jiao Chen, Jian Fu, Peixuan Guo

Center for Research on Environmental Disease Faculty Publications

Modulation of immune response is important in cancer immunotherapy, vaccine adjuvant development and inflammatory or immune disease therapy. Here we report the development of new immunomodulators via control of shape transition among RNA triangle, square and pentagon. Changing one RNA strand in polygons automatically induced the stretching of the interior angle from 60° to 90° or 108°, resulting in self-assembly of elegant RNA triangles, squares and pentagons. When immunological adjuvants were incorporated, their immunomodulation effect for cytokine TNF-α and IL-6 induction was greatly enhanced in vitro and in animals up to 100-fold, while RNA polygon controls induced unnoticeable effect. The …

Delayed Switch Of Antiretroviral Therapy After Virologic Failure Associated With Elevated Mortality Among Hiv-Infected Adults In Africa, Maya L. Petersen, Linh Tran, Elvin H. Geng, Steven J. Reynolds, Andrew Kambugu, Robin Wood, David Bangsberg, Constantin T. Yiannoutsos, Steven G. Deeks, Jeffrey N. Martin

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective—Routine monitoring of plasma HIV RNA among HIV-infected patients on antiretroviral therapy (ART) is unavailable in many resource-limited settings. Alternative monitoring approaches correlate poorly with virologic failure and can substantially delay switch to second-line therapy. We evaluated the impact of delayed switch on mortality among patients with virologic failure in Africa.

Design—A cohort.

Methods—We examined patients with confirmed virologic failure on first-line non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens from four cohorts with serial HIV RNA monitoring in Uganda and South Africa. Marginal structural models aimed to estimate the effect of delayed switch on mortality in a hypothetical trial in which …

Persistent Hiv-Related Stigma In Rural Uganda During A Period Of Increasing Hiv Incidence Despite Treatment Expansion, Brian T. Chan, Sheri D. Weiser, Yap Boum Ii, Mark J. Siedner, Rain Mocello, Jessica E. Haberer, Peter Hunt, Jeffrey N. Martin, Kenneth H. Mayer, David Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective—Program implementers have argued that the increasing availability of anti-retroviral therapy (ART) will reduce the stigma of HIV. We analyzed data from Uganda to assess how HIV-related stigma has changed during a period of ART expansion.

Design—Serial cross-sectional surveys.

Methods—We analyzed data from the Uganda AIDS Rural Treatment Outcomes (UARTO) study during 2007-2012 to estimate trends in internalized stigma among people living with HIV (PLHIV) at the time of treatment initiation. We analyzed data from the Uganda Demographic and Health Surveys (DHS) from 2006 and 2011 to estimate trends in stigmatizing attitudes and anticipated stigma in the general population. We …

High Medication Adherence During Periconception Periods Among Hiv-1–Uninfected Women Participating In A Clinical Trial Of Antiretroviral Pre-Exposure Prophylaxis, Lynn T. Matthews, Renee Heffron, Nelly R. Mugo, Craig R. Cohen, Craig W. Hendrix, Connie Celum, David Bangsberg, Jared M. Baten

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction: Pre-exposure prophylaxis (PrEP) may be an important safer conception strategy for HIV-1–uninfected women with HIV-1–infected partners. Understanding medication adherence in this population may inform whether PrEP is a feasible safer conception strategy.

Methods: We evaluated predictors of pregnancy and adherence to study medication among HIV-1–uninfected women enrolled in a randomized placebo-controlled trial of PrEP among African HIV-1– serodiscordant couples. Participants were counseled on HIV-1 risk reduction, contraception, and adherence and tested for pregnancy at monthly study visits. Pill counts of dispensed drug were performed and, at a subset of visits, plasma was collected to measure active drug concentration.

Results: …

Disrupted Human–Pathogen Co-Evolution: A Model For Disease, Nuri Kodaman, Rafal S. Sobota, Robertino Mera, Barbara G. Schneider, Scott M. Williams

Dartmouth Scholarship

A major goal in infectious disease research is to identify the human and pathogenic genetic variants that explain differences in microbial pathogenesis. However, neither pathogenic strain nor human genetic variation in isolation has proven adequate to explain the heterogeneity of disease pathology. We suggest that disrupted co-evolution between a pathogen and its human host can explain variation in disease outcomes, and that genome-by-genome interactions should therefore be incorporated into genetic models of disease caused by infectious agents. Genetic epidemiological studies that fail to take both the pathogen and host into account can lead to false and misleading conclusions about disease …

Infection With Mers-Cov Causes Lethal Pneumonia In The Common Marmoset, Darryl Falzarano, Emmie De Wit, Friederike Feldmann, Angela L. Rasmussen, Atsushi Okumura, Xinxia Peng, Matthew J. Thomas, Neeltje Van Doremalen, Elaine Haddock, Lee Nagy, Rachel Lacasse, Tingting Liu, Jiang Zhu, Jason S. Mclellan, Dana P. Scott, Michael G. Katze, Heinz Feldmann, Vincent J. Munster

Dartmouth Scholarship

The availability of a robust disease model is essential for the development of countermeasures for Middle East respiratory syndrome coronavirus (MERS-CoV). While a rhesus macaque model of MERS-CoV has been established, the lack of uniform, severe disease in this model complicates the analysis of countermeasure studies. Modeling of the interaction between the MERS-CoV spike glycoprotein and its receptor dipeptidyl peptidase 4 predicted comparable interaction energies in common marmosets and humans. The suitability of the marmoset as a MERS-CoV model was tested by inoculation via combined intratracheal, intranasal, oral and ocular routes. Most of the marmosets developed a progressive severe pneumonia …

The Mucosal Expression Pattern Of Interferon-Ε In Rhesus Macaques, Andrew Demers, Guobin Kang, Fangrui Ma, Wuxun Lu, Zhe Yuan, Yue Li, Mark Lewis, Edmundo N. Kraiselburd, Luis Montaner, Qingsheng Li

Qingsheng Li Publications

Type I IFNs play an important role in innate and adaptive immunity against viral infections. A novel type I IFN, namely IFN-ε, which can protect against vaginal transmission of HSV2 and Chlamydia muridarum bacterial infection, has been described in mice and humans. Nevertheless, the principle cell type and the expression pattern of IFN-ε in tissues remain uncertain. In addition, the expression of IFN-ε in Indian rhesus macaques (Macaca mulatta) has not been reported. Here, we analyzed IFN-ε expression in multiple mucosal sites of uninfected or SIV-infected Indian rhesus macaques using IHCS. We report for the first time the …

Empiric Deworming And Cd4 Count Recovery In Hiv-Infected Ugandans Initiating Antiretroviral Therapy, Alexander J. Lankowski, Alexander C. Tsai, Michael Kanyesigye, Mwebesa B. Bwana, Jessica E. Haberer, Megan Wenger, Jeffrey N. Martin, David Bangsberg, Peter W. Hunt, Mark J. Siedner

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: There is conflicting evidence on the immunologic benefit of treating helminth co-infections (‘‘deworming’’) in HIV-infected individuals. Several studies have documented reduced viral load and increased CD4 count in antiretroviral therapy (ART) naive individuals after deworming. However, there are a lack of data on the effect of deworming therapy on CD4 count recovery among HIV-infected persons taking ART.

Methodology/Principal Findings: To estimate the association between empiric deworming therapy and CD4 count after ART initiation, we performed a retrospective observational study among HIV-infected adults on ART at a publicly operated HIV clinic in southwestern Uganda. Subjects were assigned as having received …

South Africans With Recent Pregnancy Rarely Know Partner’S Hiv Serostatus: Implications For Serodiscordant Couples Interventions, Lynn T. Matthews, Lizzie Moore, Tamaryn L. Crankshaw, Cecilia Milford, Fortunate N. Mosery, Ross Greener, Christina Psaros, Steven A, Safren, David Bangsberg, Jennifer A. Smit

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Implementation of safer conception strategies requires knowledge of partner HIV-serostatus. We recruited women and men in a high HIV-prevalence setting for a study to assess periconception risk behavior among individuals reporting HIV-serodiscordant partnerships. We report screening data from that study with the objective of estimating the proportion of individuals who are aware that they are in an HIV-serodiscordant relationship at the time of conception.

Methods: We screened women and men attending antenatal and antiretroviral clinics in Durban, South Africa for enrollment in a study of periconception risk behavior among individuals with serodiscordant partners. Screening questionnaires assessed for study eligibility …