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D G Addiss

Publications and source records attributed to D G Addiss.

At least 37 records · Page 2Linked to original sources
PubMed1996

Factors influencing Cryptosporidium testing in Connecticut.

To describe patterns of testing for Cryptosporidium oocysts in stool samples, Connecticut laboratories were surveyed. Different detection methods were used. Most laboratories examined stools specifically for Cryptosporidium only on physician request. The rate of positive tests varted widely (0 to 28%). Higher rates of positivity were associated with the use of monoclonal antibody methods, the use of two or more staining procedures, and testing of stool specimens in addition to those requested by physicians.

Animals↗
PubMed1996

A survey of knowledge, attitudes, and perceptions (KAPs) of lymphatic filariasis, elephantiasis, and hydrocele among residents in an endemic area in Haiti.

To assess knowledge, attitudes, and perceptions about bancroftian filariasis, 104 residents of an endemic area in Haiti were interviewed. Questions focused on 1) whether people understood the relationship between infection and disease, 2) recognition of the role that mosquitoes play in transmission, 3) perceived importance of hydrocele and elephantiasis in relation to other recognized diseases, and 4) the willingness of the community to participate in a control program. Fewer than 50% of residents had heard of filariasis and only 6% of those surveyed knew that it was transmitted by mosquitoes. In contrast, all persons knew of the clinical conditions of hydrocele and elephantiasis. Hydrocele was thought to be caused by trauma (60%) or trapped gas (30%); elephantiasis by walking bare foot on soil or water (37%) or by use of ceremonial powder that had been sprinkled on the ground (23%). Of 76 respondents, 53% and 38% thought that hydrocele could be treated through surgery or a drug, respectively, whereas 86 respondents, 85% and 15% believed that either surgery or a drug could be used to treat elephantiasis. In this context, persons were not referring to a specific drug; rather, they believed a drug existed (possibly in some other country) that could cure these conditions. Hydrocele and elephantiasis ranked second to acquired immunodeficiency syndrome as perceived health problems, most likely because residents believed treatment for conditions such as malaria, intestinal worms, anemia, and diarrhea was easily obtained. Responses were influenced by age, sex, and symptoms, but none of these effects were statistically significant except that persons with hydrocele or elephantiasis were more likely to have sought treatment than persons without these conditions (P = 0.0006). The survey results indicate that awareness of the causes of disease, the relationship between infection and disease, and goals of treatment must be heightened through community-based education campaigns to increase the possibility of acceptance and support of control programs.

Adolescent↗
PubMed1996

Reduction of risk of watery diarrhea with point-of-use water filters during a massive outbreak of waterborne Cryptosporidium infection in Milwaukee, Wisconsin, 1993.

The occurrence of a massive waterborne outbreak of Cryptosporidium infection in Milwaukee, Wisconsin provided an opportunity to evaluate the effectiveness of point-of-use home water filters in preventing diarrheal illness associated with Cryptosporidium infection. Of 155 filter owners who responded to a televised request to contact the City of Milwaukee Health Department, 99 (64%) completed a self-administered questionnaire regarding their sources of drinking water, the characteristics of their home water filters, and diarrheal illness during the outbreak. Diarrhea among respondents was independently associated with residence in southern or central Milwaukee (the area served by the implicated South water treatment plant), having a home water filter with a pore diameter of greater than 1 micron, and drinking unfiltered tap water in a public building in southern Milwaukee. Among residents of southern and central Milwaukee, two (18%) of 11 persons who drank only submicron-filtered water at home and who did not drink unfiltered South plant water at work had watery diarrhea, compared with 50% (n = 2), 63% (n = 35), and 80% (n = 15) who reported drinking South plant water that was unfiltered or passed through a filter with a pore diameter > 1 micron at work only, home only, or both home and work, respectively (P = 0.02). The data indicate that use of submicron point-of-use water filters may reduce risk of waterborne cryptosporidiosis.

Adult↗
PubMed1995

Injuries from falls on playgrounds. Effects of day care center regulation and enforcement.

OBJECTIVES: To measure the incidence of playground fall injuries among children attending licensed US day care centers and to evaluate how injury incidence varies with center characteristics and with the regulatory and enforcement climate in which centers operate. DESIGN: Telephone surveys of directors of day care centers and enforcement agencies and review of written day care regulations. SETTING: Probability sample of licensed day care centers in 50 states and the District of Columbia. PARTICIPANTS: Children attending day care centers with playgrounds. MAIN OUTCOME MEASURES: Medically attended playground fall injuries. RESULTS: Among the 1740 day care centers studied, a weighted total of 89.2 injuries occurred during the 2-month study period (0.25/100,000 child-hours in day care). The most important risk factor for injury was height of the tallest piece of climbing equipment on the playground in both bivariate (P = .01) and multivariate (P = .02) analyses. Neither regulations addressing playground safety or playground surfaces nor enforcement patterns were associated with lower injury rates. CONCLUSIONS: Additional effort is needed to develop and evaluate regulations and enforcement that reduce injury risks for children while minimizing burden on day care centers. In the meantime, limiting climbing equipment heights may reduce playground injury rates.

Accidental Falls↗
PubMed1995

Massive outbreak of waterborne cryptosporidium infection in Milwaukee, Wisconsin: recurrence of illness and risk of secondary transmission.

Contamination of the public water supply in Milwaukee during March and April 1993 resulted in a massive outbreak of cryptosporidium infection. We investigated the clinical and epidemiological features of visitors to the Milwaukee area in whom cryptosporidiosis developed, and we conducted a telephone survey of Milwaukee County households to evaluate the risk of recurrent illness and secondary transmission. Cryptosporidium infection during this outbreak generally seemed more severe than cases described in previous reports of large case series. The risk of secondary transmission within a household was low (5%) when the index case involved an adult. The recurrence of watery diarrhea after apparent recovery was a frequent occurrence among visitors with laboratory-confirmed cryptosporidium infection (39%) and among visitors and Milwaukee County residents with clinical infection (21%). The interval between the initial recovery and the onset of recurrence was prolonged (> or = 5 days) in 6%-8% of persons. This pattern of recurrence and its impact on transmission and our understanding of the pathophysiological mechanisms of cryptosporidium infection merit further investigation.

Adolescent↗
PubMed1995

Clinical, parasitologic, and immunologic observations of patients with hydrocele and elephantiasis in an area with endemic lymphatic filariasis.

Hydrocele and elephantiasis, major clinical manifestations of bancroftian filariasis, are thought to share a common pathogenesis. The characteristics of 121 patients with hydrocele or elephantiasis in Leogane, Haiti, were compared: 39% of 57 men with hydrocele and 3% of 64 persons with lymphedema of the leg were microfilaria-positive (P < .001). Circulating filarial antigen, presumably from the adult worm, was detected in 15 (43%) microfilaria-negative men with hydrocele and 9 (15%) microfilaria-negative persons with leg edema (P = .004). Microfilaria-positive men had lower levels of filaria-specific IgG1 and hydroceles of significantly smaller volume and shorter duration than did microfilaria-negative men; hydrocele volume was inversely associated with microfilarial density (P = .001). In contrast, filarial antigen but not microfilariae was associated with filaria-specific IgG4 and decreased lymphocyte proliferation. Antigen status was not associated with severity of leg edema. In this filariasis-endemic area, men with hydrocele are more immunologically and parasitologically heterogeneous than are persons with elephantiasis.

Adolescent↗
PubMed1994

A massive outbreak in Milwaukee of cryptosporidium infection transmitted through the public water supply.

BACKGROUND: Early in the spring of 1993 there was a widespread outbreak of acute watery diarrhea among the residents of Milwaukee. METHODS: We investigated the two Milwaukee water-treatment plants, gathered data from clinical laboratories on the results of tests for enteric pathogens, and examined ice made during the time of the outbreak for cryptosporidium oocysts. We surveyed residents with confirmed cryptosporidium infection and a sample of those with acute watery diarrhea consistent with cryptosporidium infection. To estimate the magnitude of the outbreak, we also conducted a survey using randomly selected telephone numbers in Milwaukee and four surrounding counties. RESULTS: There were marked increases in the turbidity of treated water at the city's southern water-treatment plant from March 23 until April 9, when the plant was shut down. Cryptosporidium oocysts were identified in water from ice made in southern Milwaukee during these weeks. The rates of isolation of other enteric pathogens remained stable, but there was more than a 100-fold increase in the rate of isolation of cryptosporidium. The median duration of illness was 9 days (range, 1 to 55). The median maximal number of stools per day was 12 (range, 1 to 90). Among 285 people surveyed who had laboratory-confirmed cryptosporidiosis, the clinical manifestations included watery diarrhea (in 93 percent), abdominal cramps (in 84 percent), fever (in 57 percent), and vomiting (in 48 percent). We estimate that 403,000 people had watery diarrhea attributable to this outbreak. CONCLUSIONS: This massive outbreak of watery diarrhea was caused by cryptosporidium oocysts that passed through the filtration system of one of the city's water-treatment plants. Water-quality standards and the testing of patients for cryptosporidium were not adequate to detect this outbreak.

Adolescent↗
PubMed1994

Risk factors for recurrent Chlamydia trachomatis infections in women.

OBJECTIVE: We evaluated risk factors for recurrent Chlamydia trachomatis infections in women. STUDY DESIGN: We used a retrospective cohort design to examine predictors of recurrent infection in the 38,866 female residents of Wisconsin whose first reported C. trachomatis infection occurred between 1985 and 1989. RESULTS: Young age at first reported infection was the strongest predictor of recurrent C. trachomatis infection, after adjustment for covariates. Adolescents < 15 years old had an eightfold increased risk, those 15 to 19 years old had a fivefold increased risk, and women 20 to 29 years old had a twofold increased risk of recurrent C. trachomatis infection, compared with that among women 30 to 44 years old. In 54% of those aged < 15 at initial infection and 30% of those aged 15 to 19, recurrence developed. Other characteristics associated with recurrence included black race, residence in Milwaukee County, coinfection with gonorrhea, and past sexually transmitted diseases; receiving care in a family-planning clinic appeared protective. CONCLUSIONS: Implementation of strategies to reduce the markedly elevated risk of recurrent chlamydia infections is urgently needed in female adolescents.

Adolescent↗
PubMed1994

Severe giardiasis in the United States.

Giardia lamblia is a common gastrointestinal pathogen but is not generally appreciated as a cause of severe illness. To describe the epidemiology of severe giardiasis, we reviewed data on hospital discharges from the United States and the state of Michigan and compared results for giardiasis with those for shigellosis. From 1979 to 1988, an estimated 4,600 persons were hospitalized for giardiasis annually in the United States; the incidence of giardiasis was 2.0 hospitalizations per 100,000 persons, compared with 2.4 hospitalizations per 100,000 persons for shigellosis. Rates of giardiasis were highest among children younger than 5 years old and women of childbearing age; the median length of hospital stay was 4 days (annual total, 23,238 days). Among residents of Michigan from 1983 to 1987, the average annual incidence of hospitalization was 1.4 per 100,000 persons for giardiasis, compared with 1.0 per 100,000 persons for shigellosis. Volume depletion was the most frequently listed codiagnosis (33.2%); 18.7% of children younger than 5 years old who had severe giardiasis had failure to thrive. Physicians should consider the diagnosis of giardiasis for persons with severe gastrointestinal illness.

Adolescent↗
PubMed1994

Differential proliferative and interleukin-10 responses to fractionated filarial antigens: preferential recognition by patients with chronic lymphatic dysfunction.

To characterize filarial antigens that may be associated with the development of chronic lymphatic dysfunction in persons with lymphatic filariasis, T cell responsiveness to Brugia pahangi adult worm extracts and SDS-PAGE antigen fractions were examined among Haitians from an area in which Wuchereria bancrofti is endemic. Greater T cell proliferation and interleukin-10 (IL-10) production were observed in amicrofilaremic patients with hydrocele or elephantiasis than in amicrofilaremic or microfilaremic asymptomatic persons. Antigen fractions that stimulated the highest proliferative responses (in the 25-49 kDa range) and IL-10 production were not identical. Further separation of an immunodominant 30- to 38-kDa fraction by ion exchange high-pressure liquid chromatography identified several subfractions, including a 32-kDa protein band, that elicited T cell responses from patients with elephantiasis or hydrocele. By immunoblot, these patients also had markedly greater humoral reactivity to parasite antigens of approximately 52, 43, 32, and 30 kDa.

Adolescent↗
PubMed1994

The compliance of licensed US child care centers with national health and safety performance standards.

The American Public Health Association and the American Academy of Pediatrics recently published health and safety guidelines for child care centers. A survey was conducted to determine the extent to which practices in US child care centers are reflective of these guidelines. Compliance with 16 guidelines ranged from 19.5% to 98.6%, varied considerably by state, and was not consistently associated with selected center characteristics. Prevention efforts should focus on practices for which compliance is low and on those that have the greatest disease- and injury-reducing potential.

Child Day Care Centers↗
PubMed1994

Cryptosporidiosis in child care settings: a review of the literature and recommendations for prevention and control.

Trends in child care have affected the epidemiology of many infectious diseases. Although once considered rare Cryptosporidium is now recognized as a significant pathogen in child care settings. Although the major impact of cryptosporidiosis in child care settings is economic in terms of parental time lost from work due to a child's illness, the possibility of transmission to immunocompromised individuals and health effects of cryptosporidiosis underscore the significance of this pathogen. Our understanding of the epidemiology of cryptosporidiosis in child care settings is hampered by the lack of information from both cross-sectional and prospective studies. Such studies coupled with the use of newer diagnostic techniques and methods that are currently under development for identifying Cryptosporidium in environmental samples are sorely needed. Information is also needed on the effectiveness of prevention and control strategies. Although prevention strategies may be based on findings from broad based studies that do not focus on any one agent, differences in duration of excretion, rates of asymptomatic infection, availability of treatment and survival in the environment suggest that control strategies for specific pathogens should be evaluated.

Child↗