Molecular typing and whole genome next generation sequencing of human adenovirus 8 strains recovered from four 2012 outbreaks of keratoconjunctivitis in New York State

Ocular infections caused by human adenovirus (HAdV) are highly contagious. The most severe are usually caused by members of species HAdV‐D (types HAdV8, 19, 37, 53, 54, and 56) and can manifest as epidemic keratoconjunctivitis (EKC), often resulting in prolonged impairment of vision. During the early months of 2012, EKC outbreaks occurred in neonatal intensive care units (NICUs) in 3 hospitals in New York State (New York and Suffolk Counties). A total of 32 neonates were affected. For 14 of them, HAdV8 was laboratory‐confirmed as the causative agent. Nine healthcare workers were also affected with 3 laboratory‐confirmed, HAdV‐positive EKC. A fourth EKC outbreak was documented among patients attending a private ophthalmology practice in Ulster County involving a total of 35 cases. Epidemiological linkage between the neonatal intensive care unit outbreaks was demonstrated by molecular typing of virus isolates with restriction enzyme analysis and next generation whole genome sequencing. The strain isolated from the ophthalmology clinic was easily distinguishable from the others by restriction enzyme analysis.     

Fine‐scale geographic clustering pattern of human T‐cell leukemia virus type 1 infection among blood donors in Kyushu‐Okinawa,Japan

Human T‐cell leukemia virus type I (HTLV‐1) infection is endemic in Japan, particularly clustered in the southwestern district, Kyushu‐Okinawa, which consists of eight prefectures that further consist of 274 municipalities. However, no information is available about the fine‐scale distribution of HTLV‐1 infection within Kyushu‐Okinawa. To assess the municipal‐level distribution of people with HTLV‐1 infection in Kyushu‐Okinawa, we performed a cross‐sectional study using a fine‐scale geographic information system map based on HTLV‐1 screening test results from the Japanese Red Cross database from September 2012 to February 2014. Of the 881 871 (646 914 male, 234 957 female) screened blood donors, 981 were seropositive for HTLV‐1 by confirmatory test. The seroprevalence was 0.11% (95% confidence interval [CI] 0.10%‐0.12%) for all, 0.094% (95% CI, 0.09%‐0.10%) for male, and 0.16% (95% CI, 0.14%‐0.18%) for female individuals. The sex‐ and age‐specific HTLV‐1 seroprevalence varied significantly across municipalities; particularly, the seroprevalence among women aged 50 years was significantly higher than that of men in both the mainland of Kyushu‐Okinawa and the satellite island, in all of which the seroprevalence of HTLV‐1 was more than 1.2%. These results show that, even in the Kyushu‐Okinawa district, there are endemic clusters of HTLV‐1 in small areas. This suggests that public health education programs are needed to eliminate new HTLV‐1 infection in these areas.     

Evaluation of a traditional birth attendant training programme in Bangladesh

Background and context

the 1997 Safe Motherhood Initiative effectively eliminated support for training traditional birth attendants (TBAs) in safe childbirth. Despite this, TBAs are still active in many countries such as Bangladesh, where 88% of deliveries occur at home. Renewed interest in community-based approaches and the urgent need to improve birth care has necessitated a re-examination of how provider training should be conducted and evaluated.

Objective

to demonstrate how a simple evaluation tool can provide a quantitative measure of knowledge acquisition and intended behaviour following a TBA training program.

Design

background data were collected from 45 TBAs attending two separate training sessions conducted by Bangladeshi non-governmental organization (NGO) Gonoshasthaya Kendra (GK). A semi-structured survey was conducted before and after each training session to assess the TBAs’ knowledge and reported practices related to home-based management of childbirth.

Setting

two training sessions conducted in Vatshala and Sreepur in rural Bangladesh.

Participants

45 active TBAs were recruited for this training evaluation.

Findings

there were significant improvements following the training sessions regarding how TBAs reported they would: (a) measure blood loss, (b) handle an apneic newborn, (c) refer women with convulsions and (d) refer women who are bleeding heavily. A greater degree of improvement, and higher scores overall, were observed among TBAs with no prior training and with less birth experience.

Key conclusions and recommendations for practice

as the Safe Motherhood community strives to improve safe childbirth care, the quality of care in pregnancy and childbirth for women who rely on less-skilled providers should not be ignored. These communities need assistance from governments and NGOs to help improve the knowledge and skill levels of the providers upon which they depend. Gonoshasthaya Kendra's extensive efforts to train and involve TBAs, with the aim of improving the quality of care provided to Bangladeshi women, is a good example of how to effectively integrate TBAs into safe motherhood efforts in resource-poor settings. The evaluation methodology described in this paper demonstrates how trainees’ prior experiences and beliefs may affect knowledge acquisition, and highlights the need for more attention to course content and pedagogic style.     

Who Receives Outpatient Monitoring During High‐Risk Depression Treatment Periods?

OBJECTIVES: To examine the intensity of monitoring received by important patient subgroups during high‐risk periods (the 12 weeks after psychiatric hospitalization and after new antidepressant starts). DESIGN: Retrospective secondary analysis of data from the Veterans Affairs (VA) National Registry for Depression using patients aged 65 and older receiving depression treatment from 1999 to 2004. SETTING: VA healthcare system. PARTICIPANTS: VA patients in depression treatment between April 1, 1999, and September 30, 2004, who had psychiatric inpatient stays (n=73,137) or new antidepressant starts (n=421,536). MEASUREMENTS: The relationship between the number of outpatient visits for each group and patient characteristics in the 12‐week period after psychiatric hospitalizations and antidepressant starts. RESULTS: The characteristic associated with significantly lower rates of monitoring for both high‐risk treatment periods was aged 65 and older. White race and living in the south or northeast were also associated with significantly lower rates of monitoring after new antidepressant starts and inpatient stays, respectively. Substance abuse disorders were associated with greater monitoring after both types of depression events but did not seem to interact with other patient characteristics in determining levels of monitoring. CONCLUSION: VA patients who are older, white, and living in the south or northeast receive less‐intensive monitoring during high‐risk treatment periods for suicide. This is of concern, given that older patients appear to be at higher risk for suicide, particularly after inpatient stays, and may need particular attention during this time frame. Adapted interventions and proactive outreach may be needed that target this patient group.