PubMed Health⌕ Search

Biomedical subjects

Cynthia G Whitney

Publications and source records attributed to Cynthia G Whitney.

At least 73 records · Page 4Linked to original sources
PubMed2003

Infections in international pregnancy study: performance of the optical immunoassay test for detection of group B streptococcus.

We evaluated the Strep B optical immunoassay (OIA; ThermoBiostar, Inc.) for detecting light and heavy group B streptococcus colonization in 1,306 pregnant women. The women were examined at 20 to 32 weeks gestation and were from six countries. Compared to culture, the sensitivity and specificity of OIA were 13.3 and 98.4%, respectively, for light colonization and 41.5 and 97.7%, respectively, for heavy colonization.

Female↗
PubMed2003

Clonal distribution of invasive pneumococcal isolates from children and selected adults in the United States prior to 7-valent conjugate vaccine introduction.

Theseven-valent pneumococcal conjugated polysaccharide vaccine PC7V was licensed for use among children in 2000. Since 90 serotypes of pneumococci exist, an increase in nonvaccine serotypes could occur through immune selection for capsular type switching. Eleven hundred sixty-eight invasive isolates (24 serotypes), recovered primarily from pediatric patients (855 isolates = 73%) and 22 reference strains of known multilocus sequence types (STs) were subjected to macrorestriction profiling (pulsed-field gel electrophoresis [PFGE]). The correlation of 187 ST results (including 49 newly discovered STs) with the PFGE data assigned 1,042 (89.2%) study isolates to 46 defined clonal complexes or genetic lineages based on related multilocus STs (BURST). Seventeen clonal complexes were represented by 2 to 10 related allelic profiles (STs), while 33 lineages (including reference strains) consisted of single STs with 4 or fewer allelic identities to other STs found in the study. Expansion of the BURST analysis to a global analysis of all known pneumococcal STs (as of 27 November 2002) reduced the number of single ST lineages from 33 to 8, and the number of multi-ST clonal complexes was reduced from 17 to 13. In this work, we established the basic genetic structure within individual serotypes prior to PC7V use. The resultant database will be useful for detecting potential selective effects of this vaccine in postvaccine surveillance.

Adult↗
PubMed2003

Patient education strategies to improve pneumococcal vaccination rates: randomized trial.

BACKGROUND: The pneumococcal vaccine is widely underused. Patient education is one mechanism not widely explored for increasing vaccination rates. OBJECTIVE: To evaluate the effects of a culturally appropriate patient education videotape on pneumococcal vaccination rates among the clinic population of an inner-city public hospital. METHODS: Randomized, controlled trial comparing (1) a videotape-brochure group who both viewed the videotape and received a low-literacy brochure, (2) a videotape only group, and (3) a control group. RESULTS: Of 2,962 charts reviewed, 558 patients were randomized. The study population was 94% black, 73% female, and elderly (mean age 63.0 years) and 64% had less than a high school education. Patients in the videotape-brochure group were 2.5 (1.8, 3.5 95% CI) times more likely to discuss the vaccine with their physician (p < .001) and 3.5 (1.9, 6.5 95% CI) times more likely to receive the vaccine (p < .001) than the control group. The videotape-brochure group was 1.6 (1.2, 2.1 95% CI) times more likely to discuss the vaccine (p < .001) and 2.3 (1.4, 3.8 95% CI) times more likely to receive the vaccine (p = .002) than the video only group. Patients in the video only group were 1.6 (1.1, 2.3 95% CI) times more likely to discuss the vaccine with their physician than the control group (p = .041) but were not more likely to receive the vaccine. CONCLUSION: A culturally appropriate videotape along with a low-literacy brochure significantly increased pneumococcal vaccination rates and physician-patient discussion about the vaccine. These significant outcomes were not observed with use of videotape alone and were likely attributable to the effect of the brochure. We recommend that patient education initiatives to increase vaccination rates not focus solely on audiovisual media.

Aged↗
PubMed2003

Seasonal patterns of invasive pneumococcal disease.

Pneumococcal infections increase each winter, a phenomenon that has not been well explained. We conducted population-based active surveillance for all cases of invasive pneumococcal disease in seven states; plotted annualized weekly rates by geographic location, age, and latitude; and assessed correlations by time-series analysis. In all geographic areas, invasive pneumococcal disease exhibited a distinct winter seasonality, including an increase among children in the fall preceding that for adults and a sharp spike in incidence among adults each year between December 24 and January 7. Pneumococcal disease correlated inversely with temperature (r -0.82 with a 1-week lag; p<0.0001), but paradoxically the coldest states had the lowest rates, and no threshold temperature could be identified. The pattern of disease correlated directly with the sinusoidal variations in photoperiod (r +0.85 with a 5-week lag; p<0.0001). Seemingly unrelated seasonal phenomena were also somewhat correlated. The reproducible seasonal patterns in varied geographic locations are consistent with the hypothesis that nationwide seasonal changes such as photoperiod-dependent variation in host susceptibility may underlie pneumococcal seasonality, but caution is indicated in assigning causality as a result of such correlations.

Adolescent↗
PubMed2003

Aggregated antibiograms and monitoring of drug-resistant Streptococcus pneumoniae.

Community-specific antimicrobial susceptibility data may help monitor trends among drug-resistant Streptococcus pneumoniae and guide empiric therapy. Because active, population-based surveillance for invasive pneumococcal disease is accurate but resource intensive, we compared the proportion of penicillin-nonsusceptible isolates obtained from existing antibiograms, a less expensive system, to that obtained from 1 year of active surveillance for Georgia, Tennessee, California, Minnesota, Oregon, Maryland, Connecticut, and New York. For all sites, proportions of penicillin-nonsusceptible isolates from antibiograms were within 10 percentage points (median 3.65) of those from invasive-only isolates obtained through active surveillance. Only 23% of antibiograms distinguished between isolates intermediate and resistant to penicillin; 63% and 57% included susceptibility results for erythromycin and extended-spectrum cephalosporins, respectively. Aggregating existing hospital antibiograms is a simple and relatively accurate way to estimate local prevalence of penicillin-nonsusceptible pneumococcus; however, antibiograms offer limited data on isolates with intermediate and high-level penicillin resistance and isolates resistant to other agents.

Clinical Laboratory Techniques↗
PubMed2003

Preventing pneumococcal disease. ACIP recommends pneumococcal polysaccharide vaccine for all adults age > or = 65.

Streptococcus pneumoniae remains the most common cause of community-acquired pneumonia and bacterial meningitis in older adults. Current recommendations from CDC's Advisory Committee on Immunization Practices suggest providing pneumococcal polysaccharide vaccine to all adults age 65 and older and to persons age 2 to 64 with chronic illnesses that place them at higher risk for pneumococcal disease. In addition, vaccination status should be assessed for residents of nursing homes and long-term care facilities on admission and vaccine administered as needed. Although the polysaccharide vaccine is safe, effective against invasive disease, and cost-effective, many older adults have not yet received the vaccine. Use of standing orders is encouraged as a way to improve vaccine delivery. Research into new vaccines to prevent pneumococcal disease in older adults is ongoing.

Aged↗
PubMed2002

Comparing potential benefits of new pneumococcal vaccines with the current polysaccharide vaccine in the elderly.

We compared the hypothetical effects of the 23-valent polysaccharide pneumococcal vaccine with new vaccines on preventing invasive and noninvasive pneumococcal disease in persons >or=65 years. We estimated how much disease would occur if no polysaccharide vaccine were in use and used this baseline to compare the polysaccharide, a 7-valent conjugate vaccine, and hypothetical common antigen vaccine. The polysaccharide, conjugate, and common antigen vaccines prevented 10.6, 10.7, and 17.7% of invasive disease and 4.3, 5.6, and 10.0% of pneumonia, respectively. Superior effectiveness of new vaccines was dependent upon a presumed longer duration of protection than the 23V-PPV and effectiveness against noninvasive pneumonia. Our results suggest that new vaccines could improve disease prevention.

Aged↗
PubMed2002

Association between antimicrobial resistance among pneumococcal isolates and burden of invasive pneumococcal disease in the community.

Treatment of infections with drug-resistant strains of Streptococcus pneumoniae (pneumococcus) may fail; whether drug resistance is associated with an increase in the number of serious infections in the community is unknown. We evaluated the relationship between the proportion of antimicrobial-resistant S. pneumoniae isolates and the number of cases of invasive pneumococcal disease. Linear regression models included 1996 county-level data from 38 counties participating in the US Centers for Disease Control and Prevention's Active Bacterial Core Surveillance. Separate models evaluated hospitalized children aged <5 years, nonhospitalized children aged <5 years, adults aged 18-64 years, and adults aged >64 years. The proportion of isolates resistant to > or =3 drug classes was associated with invasive disease in both hospitalized (P=.06) and nonhospitalized (P=.001) children. The proportion of multidrug-resistant pneumococcal isolates did not predict invasive cases among adults. The increasing prevalence of multidrug-resistant pneumococci among children may be leading to an increase in invasive disease.

Adolescent↗
PubMed2002

Emergence of a novel penicillin-nonsusceptible, invasive serotype 35B clone of Streptococcus pneumoniae within the United States.

Monitoring antibiotic-resistant pneumococcal strains not covered by the 7-valent conjugate vaccine is an important priority. The Centers for Disease Control and Prevention's Active Bacterial Core Surveillance identified 68 invasive penicillin-nonsusceptible serotype 35B (PN35B) isolates recovered from 1995 to 2001 from patients residing in the states of California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, Oregon, Tennessee, and Texas. Nonsusceptible isolates accounted for 69% of all serotype 35B isolates recovered during this time. Twelve (18%) of the 68 PN35B isolates recovered since 1995 were obtained from pediatric patients. These 68 isolates exhibited penicillin MICs of 0.25-2 microg/mL and reduced susceptibility to cefotaxime. Representative PN35B isolates exhibited a common chromosomal macrorestriction profile and identical penicillin-binding-protein gene restriction profiles characteristic of penicillin-resistant strains, and they shared a unique 7-locus sequence type that included 3 new alleles. The mosaic pbp2b and divergent ddl sequences were suggestive of interspecies recombination at the ddl-pbp2b chromosomal region.

Adolescent↗
PubMed2002

Recurrent invasive pneumococcal disease in individuals with human immunodeficiency virus infection.

The proportion of relapses and reinfections that are potentially preventable by vaccine in human immunodeficiency virus (HIV)-infected persons with recurrent pneumococcal disease is unknown. Isolates from HIV-infected individuals from Baltimore with recurrent pneumococcal invasive disease were collected from 1 January 1995 through 31 December 2000. Serotyping and pulsed-field gel electrophoresis were performed. From 1 January 1995 through 31 December 1998, 14.9% (404/2717) of those who had a pneumococcal infection were HIV infected. The recurrence rate among HIV-infected individuals was 6.4-fold higher than that among individuals without HIV infection (P<.01). Among recurrent infections in 41 individuals, there were 42 reinfections and 6 relapses. All relapses and 91% (70/77) of reinfections were due to serotypes covered by the 23-valent pneumococcal polysaccharide vaccine. Reinfection was more common than relapse among HIV-infected individuals with recurrent pneumococcal disease. Although a substantial proportion of recurrent pneumococcal infections was potentially preventable by vaccine, creating an effective vaccine may be challenging for this population.

Adult↗
PubMed2002

Distribution of penicillin-nonsusceptible pneumococcal clones in the Baltimore metropolitan area and variables associated with drug resistance.

We assessed the distribution of the clonal groups (as determined by pulsed-field gel electrophoresis) of penicillin-nonsusceptible Streptococcus pneumoniae that caused invasive pneumococcal infection in the Baltimore metropolitan area during 1995 and 1996. Although S. pneumoniae caused invasive disease in individuals from a variety of demographic groups and locations, strains isolated during the season in which respiratory infections are most common were more likely to be from clonal groups associated with penicillin resistance than from other groups.

Adolescent↗
PubMed2002

A systematic approach for increasing pneumococcal vaccination rates at an inner-city public hospital.

BACKGROUND: While the Advisory Committee on Immunization Practices recommends a standing order as the most effective mechanism to increase pneumococcal and influenza vaccination rates, Georgia's Medical Practice Act does not authorize nurses to screen, order, and administer adult vaccines in inpatient settings. METHODS: The setting was a 1000-bed public teaching hospital in metropolitan Atlanta. A 1-month intervention (INT1) included four wards randomized to intervention or control. A 5-month hospital-wide intervention (INT2) followed INT1. The intervention used was provider reminder with in-service training. Chart review was the measure used. The main outcome was pneumococcal vaccination prior to discharge. RESULTS: During INT1, 534 patients (296 intervention and 238 control) were discharged. Of the 534 patients, 475 (89.0%) were African American, 188 (35.2%) were uninsured, and the median age was 48 (range 19 to 96). Of the 205 intervention patients with vaccine indications and no contraindications, 78 of 205 (38%) were vaccinated compared to 7 of 143 (4.9%) of the control patients (p<0.001). During INT2, 879 patient charts were reviewed. Patient demographics were similar to INT1. However, of 554 eligible patients, 16% were vaccinated, significantly higher than control floors during INT1 (p<0.001). Although nurses initiated the form almost 70% of the time, physicians assessed fewer than 35% of patients with indications. CONCLUSIONS: Significantly higher proportions of high-risk patients were vaccinated through the use of a preprinted nurse screening and physician order form. However, a significant percentage of patients did not receive the vaccine owing to the physician's failure to order it. In these cases, use of standing orders would have further increased vaccination rates while also promoting a more sustainable program.

Adolescent↗
PubMed2002

Rapid response to a conjunctivitis outbreak: the use of technology to leverage information.

When an outbreak of conjunctivitis was identified at a rural New England college early in 2002, the college health center medical staff used various information management and communication systems to alert the community to the situation. They called upon the state Department of Human Services and the Centers for Disease Control and Prevention to help them understand and manage the outbreak. Technological systems already in place at the college allowed for rapid collection of data by means of a survey delivered over the Internet and a carriage study facilitated by a Web-based appointment and communication system. Within days, the data were collected and analyzed and an immediate response to contain the outbreak was launched.

Adult↗
PubMed2002

The potential of pneumococcal conjugate vaccines for children.

In contrast to earlier pneumococcal vaccines, conjugate vaccines hold promise for reducing pneumococcal morbidity and mortality in infants and young children. The first commercially available conjugate vaccine formulation, which targets seven serotypes, was licensed in the US and other countries in 2000; this vaccine is now part of routine infant immunization in the US. Demand has been high and greater than vaccine supply. Clinical trials indicate that conjugate vaccines are highly efficacious against invasive pneumococcal disease and modestly efficacious against otitis media and pneumonia. In carriage studies conjugate vaccines reduced vaccine-type carriage but led to an increase in carriage of other serotypes. Remaining questions include whether less frequent transmission of vaccine serotypes will mean less disease in unvaccinated children and adults or if nonvaccine serotypes will begin to cause more disease. Monitoring disease burden after widespread use in the US is critical for understanding the effects of the vaccine. In addition making pneumococcal vaccines available for children in developing countries should be a high priority.

Bacteremia↗
PubMed2002

Sentinel surveillance: a reliable way to track antibiotic resistance in communities?

We used population-based data to evaluate how often groups of randomly selected clinical laboratories accurately estimated the prevalence of resistant pneumococci and captured trends in resistance over time. Surveillance for invasive pneumococcal disease was conducted in eight states from 1996 to 1998. Within each surveillance area, we evaluated the proportion of all groups of three, four, and five laboratories that estimated the prevalence of penicillin-nonsusceptible pneumococci (%PNSP) and the change in %PNSP over time. We assessed whether sentinel groups detected emerging fluoroquinolone resistance. Groups of five performed best. Sentinel groups accurately predicted %PNSP in five states; states where they performed poorly had high between-laboratory variation in %PNSP. Sentinel groups detected large changes in prevalence of nonsusceptibility over time but rarely detected emerging fluoroquinolone resistance. Characteristics of hospital-affiliated laboratories were not useful predictors of a laboratory's %PNSP. Sentinel surveillance for resistant pneumococci can detect important trends over time but rarely detects newly emerging resistance profiles.

Anti-Infective Agents↗
PubMed2001

Geographic, demographic, and seasonal differences in penicillin-resistant Streptococcus pneumoniae in Baltimore.

We examined the epidemiology of invasive penicillin-resistant Streptococcus pneumoniae (PRSP) infections among residents of the Baltimore metropolitan area from 1995 through 1997. During this period, the proportion PRSP cases increased 42%, from 5.7% to 8.1% of cases. PRSP rates were highest among persons aged <5 and > or =65 years, black patients, and urban dwellers. However, the proportion of PRSP cases was higher among white persons (10%) than it was among black persons (5%) and among residents of suburban counties (10%) versus urban counties (6%). PRSP cases were more common in November-April (8%) than they were in May-October (5%), particularly for persons aged > or =65 years (10% vs. 1%). By use of logistic regression, white race, suburban residence, and winter respiratory season were found to be independent predictors of infection with PRSP. The incidence of PRSP is increasing in Baltimore, and the seasonality of PRSP suggests that recent antibiotic use, which is more common in winter months, may rapidly affect the prevalence of resistant pneumococcal infections.

Adolescent↗