Stephen C. Redd

Obstructive and restrictive lung disease and markers of inflammation: data from the third national health and nutrition examination

Although chronic obstructive pulmonary disease (COPD) and restrictive lung diseases are important causes of morbidity and mortality in the United States (1–3), a large proportion of the morbidity and mortality is not pulmonary (4). This raises the possibility that lung disease may be an indicator of susceptibility to the development of other diseases or may be associated with systemic inflammation that leads to other diseases (5,6). Previous analyses of the relation between lung function and markers of inflammation (7,8) have not looked at restrictive lung disease separately. We applied spirometric criteria to define obstructive and restrictive lung disease in adults who had pulmonary function measurements obtained as part of the Third National Health and Nutrition Examination Survey (NHANES III). We then assessed the relation of impaired lung function to circulating levels of C-reactive protein and fibrinogen, adjusting for potential covariates that may also influence these measures.

Estimating the Burden of 2009 Pandemic Influenza A (H1N1) in the United States (April 2009–April 2010)

To calculate the burden of 2009 pandemic influenza A (pH1N1) in the United States, we extrapolated from the Centers for Disease Control and Preventions Emerging Infections Program laboratory-confirmed hospitalizations across the entire United States, and then corrected for underreporting. From 12 April 2009 to 10 April 2010, we estimate that approximately 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (195,086-402,719), and 12,469 deaths (8868-18,306) occurred in the United States due to pH1N1. Eighty-seven percent of deaths occurred in those under 65 years of age with children and working adults having risks of hospitalization and death 4 to 7 times and 8 to 12 times greater, respectively, than estimates of impact due to seasonal influenza covering the years 1976-2001. In our study, adults 65 years of age or older were found to have rates of hospitalization and death that were up to 75% and 81%, respectively, lower than seasonal influenza. These results confirm the necessity of a concerted public health response to pH1N1.

Genetic Analysis of Measles Viruses Isolated in the United States, 1995–1996

Genetic analysis was conducted on 28 wild type measles viruses isolated from outbreaks or cases in the United States during 1995-1996. These viruses were members of at least 6 distinct genetic groups. However, none of these viruses was related to the group 2 viruses that were associated with the resurgence of measles in the United States between 1989 and 1992 except for a single importation from the Philippines. The sequence data support and extend previous findings showing that transmission of group 2 viruses within the United States was interrupted after 1993. The data also suggest that all measles cases that occurred in the United States in 1995-1996 were the result of importation of virus, even in instances when the source was unknown. Molecular epidemiologic studies can provide a means to measure the success of measles control programs by helping to identify the transmission pathways of the virus.

Obstructive and restrictive lung disease and functional limitation: data from the Third National Health and Nutrition Examination.

Objective.  To determine functional limitations in adults with obstructive or restrictive lung disease or respiratory symptoms.

Nonclassic measles infections in an immune population exposed to measles during a college bus trip

This study investigated the frequency of mild or asymptomatic measles infections among 44 persons exposed to a student with measles during a 3‐day bus trip using two buses. Questionnaires and serum samples were obtained 26–37 days after the trip. All participants had detectable measles‐neutralizing antibodies, and none developed classic measles symptoms. Ten persons (23%) were IgM positive for measles, indicating recent infection. Among previously vaccinated IgM‐negative persons, those who rode on bus A with the index case‐patient had significantly higher microneutralization titers than those on bus B (P = .001), suggesting that some persons on bus A were infected but were IgM negative at the time of the study. Mild or asymptomatic measles infections are probably very common among measles‐immune persons exposed to measles cases and may be the most common manifestation of measles during outbreaks in highly immune populations. J. Med. Virol. 56:337–341, 1998.

Epidemiologic investigations of bioterrorism-related anthrax, New Jersey, 2001.

At least four Bacillus anthracis–containing envelopes destined for New York City and Washington, D.C., were processed at the Trenton Processing and Distribution Center (PDC) on September 18 and October 9, 2001. When cutaneous anthrax was confirmed in a Trenton postal worker, the PDC was closed. Four cutaneous and two inhalational anthrax cases were identified. Five patients were hospitalized; none died. Four were PDC employees; the others handled or received mail processed there. Onset dates occurred in two clusters following envelope processing at the PDC. The attack rate among the 170 employees present when the B. anthracis–containing letters were sorted on October 9 was 1.2%. Of 137 PDC environmental samples, 57 (42%) were positive. Five (10%) of 50 local post offices each yielded one positive sample. Cutaneous or inhalational anthrax developed in four postal employees at a facility where B. anthracis–containing letters were processed. Cross-contaminated mail or equipment was the likely source of infection in two other case-patients with cutaneous anthrax.

Increased Susceptibility to Measles in Infants in the United States

Background. Women born in the United States after measles vaccine licensure in 1963 transfer less measles antibody to their infants than do older women. This may result in increased susceptibility to measles among infants. Objective. To determine the effect of maternal year of birth on the risk for measles in infants. Methods. We enrolled 128 unvaccinated infants ≤15 months of age who had documented exposure to measles from 1990 through 1992 in a retrospective cohort study. We interviewed their mothers by telephone to obtain demographic data, medical and vaccination history, and details of measles exposure and outcome. We used logistic regression analysis to estimate the effect of maternal year of birth. Results. Infants whose mothers were born after 1963 had a measles attack rate of 33%, compared with 12% for infants of older mothers. In logistic regression analysis, the adjusted odds ratio for maternal year of birth (born after 1963) was 7.5 (95% confidence interval 1.8, 30.6). Other significant risk factors were older infant age, mothers who developed measles after delivery, and exposure within 2 days of the rash onset of the exposing case. Conclusions. Infants whose mothers were born after 1963 are more susceptible to measles than are infants of older mothers. An increasing proportion of infants born in the United States may be susceptible to measles. Infants at high risk of exposure to measles should be vaccinated at 12 months of age. Vaccination programs that reduce transmission of the measles virus in the general population reduce the risk of infant exposure to measles.

Transmission of measles virus in healthcare settings during a communitywide outbreak.

OBJECTIVE To describe the epidemiology of measles in medical settings and to evaluate the implementation and effectiveness of the 1989 Advisory Committee on Immunization Practices (ACIP) guidelines for measles immunization in healthcare workers (HCWs). DESIGN Confirmed cases of measles reported in Clark County, Washington, from March 14 to June 2, 1996, were analyzed for characteristics of cases occurring in medical settings. A questionnaire was used to assess employee immunization (95% response rate). SETTING AND PARTICIPANTS Reported measles cases and HCWs at community hospitals, primary-care medical facilities, a health-maintenance organization, and a multispecialty group practice. RESULTS Of 31 cases of measles, 8 (26%) occurred in HCWs, and 5 (16%) occurred in patients or visitors to medical facilities. Cases of measles occurred in HCWs who were not required to have proof of measles immunity as defined by the 1989 ACIP guidelines. The relative risk of measles in HCWs compared to Clark County adults was 18.6 (95% confidence interval, 7.4-45.8; P<.001). A survey of medical facilities revealed that 47% had an employee measles immunization policy; only 21% met ACIP recommendations and enforced their policies. CONCLUSIONS HCWs were at higher risk of measles than the adult population. Transmission of measles in medical settings was related to both deficiencies in, and lack of implementation of, the ACIP guidelines.

Changing Epidemiology of Congenital Rubella Syndrome in the United States

To describe clinical presentation and epidemiology of US infants with congenital rubella syndrome (CRS) and to identify missed opportunities for maternal vaccination, data from CRS cases reported to the National Congenital Rubella Syndrome Registry (NCRSR) from 1985 through 1996 were analyzed. Missed opportunities for maternal vaccination were defined as missed postpartum, premarital, and occupational opportunities, that is, times when rubella vaccination is recommended but was not given. From 1985 through 1996, 122 CRS cases were reported to the NCRSR. The most frequent CRS-related defect was congenital heart disease. Of the reported infants with CRS, 44% were Hispanic. Of 121 known missed opportunities for rubella vaccination among 94 mothers of infants with indigenous CRS, 98 (81%) were missed postpartum opportunities. CRS continues to occur in the United States. Hispanic infants have an increased risk of CRS. Missed opportunities for postpartum rubella vaccination were identified for 52% of indigenous CRS cases.

Determinants of Quality of Life Among People with Asthma: Findings from the Behavioral Risk Factor Surveillance System

Asthma is a major contributor to impaired quality of life in the U.S. population. Little is known about population‐based determinants of quality of life among people with asthma, however. Using data from the 2000 Behavioral Risk Factor Surveillance System, we examined the associations between selected sociodemographic, behavioral, and other determinants and quality of life among 12,111 participants with current asthma. In multiple logistical regression models, three variables—employment status, smoking status, and physical activity—were significantly associated with all measures of impaired quality of life (poor or fair health, ≥ 14 physically unhealthy days, ≥ 14 mentally unhealthy days, ≥ 14 activity limitation days, or ≥ 14 physically or mentally unhealthy days). Education was significantly and inversely related to impaired quality of life for all measures except activity limitation days. Men were less likely than women to report having ≥ 14 physically unhealthy days, ≥ 14 mentally unhealthy days, or ≥ 14 physically or mentally unhealthy days. Compared with whites, Hispanics were more likely to report being in poor or fair health, and African Americans were less likely to report having ≥ 14 physically unhealthy days or ≥ 14 physically or mentally unhealthy days. In addition, participants with lower incomes were more likely to report impaired quality of life for three measures (general health status, ≥ 14 physically unhealthy days, and activity limitation days). The heaviest participants were more likely to be in poor or fair health or to report having more ≥ 14 physically unhealthy days, or ≥ 14 physically or mentally unhealthy days. Insurance coverage and the time since their last routine checkup were not significantly associated with any of the quality‐of‐life measures. These results show that three potentially modifiable factors (smoking status, physical activity, body mass index) are associated with quality of life among persons with asthma. Furthermore, among people with asthma, the elderly, women, poorly educated, and low‐income participants are especially likely to experience impaired quality of life.