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Biomedical subjects

Robert C Holman

Publications and source records attributed to Robert C Holman.

At least 19 recordsLinked to original sources
PubMed2006

Seasonal trends of human parainfluenza viral infections: United States, 1990-2004.

BACKGROUND: Human parainfluenza viruses (HPIVs) are important causes of upper and lower respiratory tract illness among children and adults. METHODS: We describe seasonal trends for individual HPIV serotypes and respiratory syncytial virus in the United States using data on the percentage of specimens with positive test results reported to the National Respiratory and Enteric Viruses Surveillance System during the period 1990-2004. Onset and conclusion dates for peaks in activity were determined with the Early Aberration Reporting System's cumulative sum method C2 by detecting periods when the number of positive HPIV test results was significantly greater than that observed for preceding weeks for each serotype. RESULTS: During the study period, increases in the percentage of positive HPIV-3 and HPIV-2 test results occurred annually during April-June and October-November, respectively. Increases in the percentage of positive HPIV-1 test results occurred biennially during September-December during odd-numbered years. During years when HPIV-1 was not circulating, more HPIV-3 activity was reported, either as a longer spring season or as a second smaller period of increased activity noted in the fall. Seasonal peaks in respiratory syncytial virus activity occurred annually during November-April. CONCLUSIONS: We provide a national perspective for HPIV activity during the 15-year study period and demonstrate distinct seasonal peaks in activity for HPIV-1, HPIV-2, and HPIV-3. In addition, our data suggest that there is an interaction between HPIV-3 and HPIV-1 activity, which may have implications in future prevention strategies.

Adult↗
PubMed2006

Clinical manifestations of human monkeypox influenced by route of infection.

BACKGROUND: In April 2003, an outbreak of monkeypox occurred in the United States following the importation of monkeypox virus (MPXV)-infected animals in a consignment of exotic pets from West Africa. Transmission of the virus to non-African captive species, including prairie dogs, preceded human disease. METHODS: We evaluated the influence of the route of infection on clinical illness for persons with confirmed and probable cases of human monkeypox. Exposures were categorized as being "noninvasive" (e.g., the person touched an infected animal, cleaned an infected animal's cage, and/or stood within 6 feet of an infected animal) or "complex" (e.g., invasive bite or scratch from an ill prairie dog plus potential noninvasive exposure), and associations between exposure, illness manifestation, and illness progression (i.e., elapsed time from first exposure to an ill prairie dog through various benchmarks of illness) were assessed. RESULTS: Patients with complex exposures were more likely than patients with noninvasive exposures to have experienced pronounced signs of systemic illness (49.1% vs. 16.7%; P=.041) and to have been hospitalized during illness (68.8% vs. 10.3%; P<.001). Complex exposures were also associated with shorter incubation periods (9 days for complex exposures vs. 13 days for noninvasive exposures) and the absence of a distinct febrile prodrome. CONCLUSIONS: The findings of this study indicate that route of infection can influence monkeypox illness manifestations.

Animals↗
PubMed2006

Rocky Mountain spotted fever in the United States, 1997-2002.

Rocky Mountain spotted fever (RMSF) is the most commonly reported fatal tick-borne disease in the United States. During 1997-2002, 3,649 cases of RMSF were reported to the Centers for Disease Control and Prevention via the National Electronic Telecommunications System for Surveillance; 2,589 case report forms, providing supplemental information, were also submitted. The average annual RMSF incidence during 1997-2002 was 2.2 cases/million persons. The annual incidence increased during 1997-2002 to a rate of 3.8 cases/million persons in 2002. The incidence was lowest among persons aged<5 and 10-29 years, and highest among adults aged 60-69 years. The overall case-fatality rate was 1.4%; the rate peaked in 1998 at 2.9% and declined to 0.7% in 2001 and 2002. Children<5 years of age had a case-fatality rate (5%) that was significantly greater than the rates for age groups<60 years of age, except for that for 40-49 years of age. Continued national surveillance is needed to assess the effectiveness of prevention efforts and early treatment in decreasing severe morbidity and mortality associated with RMSF.

Adolescent↗
PubMed2006

Kawasaki syndrome and risk factors for coronary artery abnormalities: United States, 1994-2003.

BACKGROUND: Kawasaki syndrome (KS) causes significant morbidity among children in the United States and other countries and can result in a range of cardiac and noncardiac complications. METHODS: To describe the occurrence of KS in the United States and risk factors for the development of coronary artery abnormalities (CAA), national KS surveillance data were analyzed for patients with KS onset during 1994-2003. The surveillance is a passive system, and information is collected on a standardized case report form. RESULTS: During 1994 through 2003, 3115 patients who met the KS case definition were reported to the national KS surveillance system. The median age of KS patients was 32 months; the male-female ratio was 1.5:1. Nearly one-third (31.8%) of the cumulative number of KS cases occurred during January through March. During the study period, 362 (12.9%) of 2798 KS patients had CAA. The proportion of patients with CAA increased from 10.0% in 1994 to 17.8% in 2003. Age younger than 1 year and 9-17 years, male sex, Asian and Pacific Islander race and Hispanic ethnicity (a previously unidentified risk factor) were significantly associated with the development of CAA. CONCLUSIONS: The increase in CAA was attributed to widespread use of the criteria of de Zorzi et al, resulting in increased recognition of coronary artery dilatations. The factors contributing to a higher risk of CAA, such as delayed treatment, particularly among Hispanics, need to be investigated.

Adolescent↗
PubMed2006

Temporal and geographic trends of rotavirus activity in the United States, 1997-2004.

Rotavirus (RV) has a characteristic seasonal pattern in the 48 contiguous states of the continental United States, and climatologic factors have been implicated though not confirmed. Since 1997, three significant events occurred, including strong El Niño and La Niña climatologic phenomena, and the brief introduction of a rotavirus (RV) vaccine. We examined trends in RV activity in the continental United States between 1997 and 2004, using data from a network of over 70 laboratories that voluntarily report weekly RV detection rates within the National Respiratory and Enteric Virus Surveillance System (NREVSS). Analysis of NREVSS data indicates characteristic winter activity that begins in the Southwest in December or January, moves across the country, and ends in the Northeast in April or May. This pattern was not affected by the brief use of RV vaccine nor by periods of climate change associated with the El Niño and La Niña phenomena. The temporal and geographic pattern of RV spread in the United States has persisted since its initial description and defies easy explanation. An impact of the RV vaccine was not observed, either because of the limited uptake of the vaccine or the inherent variability of the system. NRVESS permits a gross assessment of RV geographic and temporal trends in the United States, but underscores the need for additional assessment mechanisms.

Humans↗
PubMed2006

Hospitalizations associated with rotavirus gastroenteritis in the United States, 1993-2002.

BACKGROUND: In the United States, rotavirus gastroenteritis remains a common disease of children that results in many hospitalizations, clinic visits and medical costs. It is a common cause of morbidity and is associated with a high economic burden in developing countries. Prevention of hospitalizations is the primary target of rotavirus vaccines. METHODS: To update estimates of rotavirus hospitalization rates in the United States, we conducted a retrospective analysis of 10 years of national hospitalization data associated with gastroenteritis and used both direct and indirect methods to estimate the percentage of cases associated with rotavirus gastroenteritis. RESULTS: During 1993-2002, an average of 18% of all hospitalizations with gastroenteritis among children <5 years old were associated with rotavirus infection as determined by the rotavirus-specific International Classification of Diseases, 9th revision, Clinical Modification code. The annual proportion of rotavirus-associated hospitalizations increased from 15% in 1993-1995 to 21% in 2000-2002. Hospitalizations associated with rotavirus and those associated with nonspecific gastroenteritis had a marked winter-time seasonality and similar age distribution, which peaked among children between 3 and 24 months old. Using indirect estimation methods, 58,000 to 70,000 rotavirus-associated hospitalizations were estimated to occur each year in the United States. CONCLUSIONS: Rotavirus gastroenteritis remains an important cause of hospitalizations in the United States, and the rate has not declined from 1993 through 2002.

Age Distribution↗
PubMed2006

Necrotising enterocolitis hospitalisations among neonates in the United States.

The objective of this study was to estimate the rate and describe the epidemiology of necrotising enterocolitis (NEC) among neonates (infants <1 month of age) hospitalised in the United States. Hospital discharge records for neonates with an NEC diagnosis and an in-hospital death or routine discharge were selected for analysis from the 2000 Kids' Inpatient Database. An estimated 4463 (SE = 219) hospitalisations associated with NEC occurred among neonates in the United States during the year 2000, resulting in a hospitalisation rate of 109.9 [95% CI 97.2, 122.6] per 100 000 livebirths. The rate of NEC hospitalisations was highest among non-Hispanic Black neonates. The median hospital length of stay was 49 days. The in-hospital fatality rate was 15.2% (SE = 1.0%). Neonates who underwent a surgical procedure during hospitalisation were more likely to have a longer length of stay and to die than were those who did not have surgical intervention. Low-birthweight (LBW) neonates with NEC were more likely than LBW neonates hospitalised with other diagnoses to be very LBW (VLBW), non-Hispanic Black and male. In addition, compared with LBW neonates hospitalised with other diagnoses, LBW neonates with NEC had higher hospital charges and longer lengths of stay, and were more likely to die during hospitalisation. This study provides the first national estimate of the rate of hospitalisation for NEC among neonates in the United States. During 2000, there was one NEC hospitalisation per 1000 livebirths, with approximately 1 in 7 NEC hospitalisations ending in death. NEC accounts for substantial morbidity; thus, the development of prevention strategies and effective therapies continues to be an important issue.

Enterocolitis, Necrotizing↗
PubMed2006

Rocky mountain spotted fever in the United States, 1997-2002.

The increased incidence of Rocky Mountain spotted fever (RMSF) in 1997-2002 compared with previous years may be related to enhanced awareness and reporting of RMSF as well as changes in human-vector interaction. However, reports on RMSF mortality underscore the need for physician vigilance in considering a diagnosis of RMSF for febrile individuals potentially exposed to ticks and stress the importance of treating such persons regardless of the presence of a rash.

Adolescent↗
PubMed2006

Asthma hospitalizations among American Indian and Alaska Native people and for the general US population.

STUDY OBJECTIVES: Asthma is one of the most common chronic diseases in the United States. High rates of asthma hospitalization have been reported for some ethnic minorities; however, asthma hospitalization rates for American Indian/Alaska Native (AI/AN) populations of all ages have not been studied. In this study, we examined and compared hospitalization rates for AI/AN populations and the general population in the United States. DESIGN: Hospital discharge records with a first-listed diagnosis of asthma were evaluated for AI/AN populations and the US general population of all ages from 1988 to 2002. RESULTS: The asthma hospitalization rate for AI/AN populations decreased from 17.8/10,000 per year in 1988 to 1990 to 12.9/10,000 per year in 2000 to 2002. The overall age-adjusted rate for 2000 to 2002 was slightly lower than that for the general US population (12.9/10,000 and 16.4/10,000, respectively). However, AI/AN populations living in the Southwest region (17.6/10,000) had the highest asthma hospitalization rate among the Indian Health Service regions and the rate from 2000 to 2002 was similar to that for the general US population. The 2000 to 2002 asthma hospitalization rate for AI/AN populations < 1 year of age (infants) was higher than that in US infants, and the rates for AI/AN age groups > or = 1 year were similar to or lower than those for the general US population. CONCLUSIONS: While asthma was rarely reported among AI/AN populations before 1975, the average annual age-adjusted asthma hospitalization rate was only slightly lower for AI/AN populations than that for the US general population from 2000 to 2002. Furthermore, the asthma hospitalization rates for AI/AN populations living in the Southwest and East regions were similar to the rate for the general US population. Efforts to further increase asthma awareness and symptom recognition among AI/AN populations should be implemented to help to reduce asthma hospitalizations.

Adolescent↗
PubMed2006

Diarrhea- and rotavirus-associated hospitalizations among children less than 5 years of age: United States, 1997 and 2000.

OBJECTIVE: A new rotavirus vaccine may be licensed in the United States in early 2006. Estimates of the burden of severe rotavirus disease, particularly hospitalizations, will help evaluate the potential benefits of a national rotavirus immunization program. DESIGN: The Kids' Inpatient Database, a robust sample of 10% of the uncomplicated births and 80% of other pediatric discharges was used to estimate the number and rate of diarrhea- and rotavirus-associated hospitalizations among US children <5 years of age in 1997 and 2000. RESULTS: In 1997 and 2000, diarrhea was coded in 13% of all childhood hospitalizations, for an estimated cumulative incidence of 1 diarrhea hospitalization per 23 to 27 children by age 5. Most diarrhea-associated hospitalizations (62%) were coded as unspecified etiology, and 35% as viral. Rotavirus was the most common pathogen recorded for 18% and 19% of diarrhea-associated hospitalizations in 1997 and 2000, respectively. Diarrhea-associated hospitalizations coded as unspecified or viral exhibited a marked winter peak similar to that of hospitalizations coded as rotavirus, suggesting that the rotavirus-specific code captures a fraction of all rotavirus hospitalizations. Using indirect methods, we estimated that rotavirus was associated with 51142-60155 and 46839-56820 hospitalizations in 1997 and 2000, respectively. By these estimates, rotavirus is associated with 4% to 5% of all childhood hospitalizations, and 1 in 67 to 1 in 85 children will be hospitalized with rotavirus by 5 years of age. CONCLUSIONS: Diarrhea is an important cause of hospitalization in US children, and rotavirus is the most important etiology. Disease burden estimates have remained stable during the past decade. An effective rotavirus vaccine will likely reduce substantially the burden of severe rotavirus disease, estimated to account for 4% to 5% of all hospitalizations and approximately 30% of hospitalizations for watery diarrhea among children <5 years of age.

Child, Preschool↗
PubMed2006

National surveillance and the epidemiology of human Q fever in the United States, 1978-2004.

Although Q fever is considered enzootic in the United States, surveillance for human Q fever has been historically limited. From 1978 through 1999, 436 cases (average = 20 per year) of human Q fever were reported. After Q fever became nationally reportable in 1999, 255 human Q fever cases (average = 51 per year) were reported with illness onset during 2000 through 2004. The median age of cases was 51 years, and most cases were male (77%). The average annual incidence of Q fever was 0.28 cases per million persons, and was highest in persons 50-59 years of age (0.39 cases per million). State-specific incidence ranged from a high of 2.40 cases per million persons in Wyoming, to 0 cases in some states. Since Q fever became reportable, case reports have increased by more than 250%. Surveillance for Q fever is essential to establish the distribution and magnitude of disease and to complement U.S. bioterrorism preparedness activities.

Adolescent↗
PubMed2006

Rocky mountain spotted fever hospitalizations among American Indians.

To describe the epidemiology of Rocky Mountain spotted fever (RMSF) among American Indians/Alaska Natives (AI/ANs), we conducted a retrospective analysis of hospitalization records with an RMSF diagnosis using Indian Health Service (IHS) hospital discharge data for calendar years 1980-2003. A total of 261 RMSF hospitalizations were reported among AIs, for an average annual hospitalization rate of 1.21 per 100,000 persons; two deaths were reported (0.8%). Most hospitalizations (88.5%) occurred in the Southern Plains region, where the rate was 4.23 per 100,000 persons. Children 1-4 years of age had the highest age-specific hospitalization rate of 2.50 per 100,000 persons. The overall annual RMSF hospitalization rate declined during the study period. Understanding the epidemiology of RMSF among AI/ANs and educating IHS/tribal physicians on the diagnosis of tick-borne diseases remain important for the prompt treatment of RMSF and the reduction of the disease occurrence among AI/ANs, particularly in high-risk areas.

Adolescent↗
PubMed2005

Trends in hospitalizations for pneumonia among persons aged 65 years or older in the United States, 1988-2002.

CONTEXT: Pneumonia causes significant mortality and morbidity among persons aged 65 years or older. However, few studies have explored trends according to age groups, which may affect intervention strategies. OBJECTIVES: To examine trends in hospitalizations for pneumonia among persons aged 65 years or older and to compare characteristics, outcomes, and comorbid diagnoses. DESIGN, SETTING, AND PATIENTS: Data from 1988 through 2002 on pneumonia and comorbid diagnoses among patients aged 65 to 74 years, 75 to 84 years, and 85 years or older from the National Hospital Discharge Survey. MAIN OUTCOME MEASURES: Hospitalization rates by first-listed and any-listed discharge codes for pneumonia; proportions of hospitalizations reporting comorbid diagnoses for the 3 age groups (65-74 years, 75-84 years, > or =85 years). RESULTS: Hospitalization rates by both first-listed and any-listed discharge codes for pneumonia increased by 20% from 1988-1990 to 2000-2002 for patients aged 65 to 74 years (P = .01) and for patients aged 75 to 84 years (P<.001). Rates of hospitalization for pneumonia were 2-fold higher for patients aged 85 years or older (51 per 1000 population for first-listed discharge code of pneumonia; 95% confidence interval [CI], 46-55 per 1000 population) than among patients aged 75 to 84 years (26 per 1000 population; 95% CI, 24-28 per 1000 population), but did not significantly increase from 1988-1990 to 2000-2002. The proportion of patients aged 65 years or older diagnosed with pneumonia and a chronic cardiac disease, chronic pulmonary disease, or diabetes mellitus increased from 66% (SE, 1.0%) in 1988-1990 to 77% (SE, 0.8%) in 2000-2002. The risk of death during a hospitalization for pneumonia compared with the risk of death during a hospital stay for the 10 other most frequent causes of hospitalization was 1.5 (95% CI, 1.4-1.7) and remained constant from 1988-1990 to 2000-2002. CONCLUSIONS: Hospitalization rates for pneumonia have increased among US adults aged 64 to 74 years and aged 75 to 84 years during the past 15 years. Among those aged 85 years or older, at least 1 in 20 patients were hospitalized each year due to pneumonia. Concomitantly, the proportion of comorbid chronic diseases has increased. Efforts to prevent pneumonia should include reducing preventable comorbid conditions and improving vaccine effectiveness and vaccination programs in elderly persons.

Aged↗
PubMed2005

Infectious disease hospitalizations among older adults in the United States from 1990 through 2002.

BACKGROUND: To understand conditions associated with substantial morbidity among older adults (aged > or = 65 years), we describe hospitalization rates and trends for overall infectious disease (ID) and for specific ID groups among older adults in the United States from January 1, 1990, through December 31, 2002. METHODS: The National Hospital Discharge Survey was used to generate hospitalization estimates from 1990 through 2002 for the US population of older adults. By using a comprehensive list of International Classification of Diseases, Ninth Revision, Clinical Modification codes associated with IDs, we identified and analyzed hospitalizations associated with specific ID and ID-related categories. RESULTS: There were approximately 21.4 million (SE, 636 000) ID hospitalizations among older adults from 1990 through 2002, and between 1990 through 1992 and 2000 through 2002, the ID hospitalization rate increased 13% from 449.4 to 507.9 hospitalizations per 10 000 older adults (P = .01). This increase was caused in part by the increasing relative contributions of patients aged 75 through 84 years and 85 years or older to the older adult ID hospitalization rate. Almost half of ID hospitalizations (46% [SE, 0.7%]) and ID-related hospital deaths (48% [SE, 1.6%]) among older adults were associated with lower respiratory tract infections from 2000 through 2002. CONCLUSIONS: The hospitalization rate for IDs increased slightly among the older adult US population during the 13-year study and was associated with the aging of the older adult population. The reduction of ID hospitalization rates among older adults could help attenuate the anticipated increase in the number of hospitalizations among older adults and should be a high priority given the projected population growth among older adults in the United States.

Age Distribution↗
PubMed2005

Amyotrophic lateral sclerosis mortality in the United States, 1979-2001.

The etiology of nonfamilial amyotrophic lateral sclerosis (ALS) remains unknown. Earlier studies have suggested an increase in the incidence of ALS over time. We performed a retrospective analysis of ALS-associated death rates and trends in the United States for 1979-2001 using death records from the national multiple cause-of-death database. The US average annual age-adjusted ALS death rate was 1.84 per 100,000 persons for 1979 through 1998. Most deaths were among adults > or =65 years of age and the median age at death was 67 years. A small overall increase in the death rate was observed primarily between 1979 and 1983, with a subsequent plateau. This slight change in the overall rate reflected apparent increases in the rates among those persons > or =65 years of age, particularly women, and persons in the 20- to 49-year-old age group. The ALS-associated death rate appeared to differ by geographic area, with a higher occurrence among most northern states. Our findings suggest that the epidemiology of ALS-associated deaths in the United States demonstrated small increases in the overall age-adjusted death rate and in the death rates among elderly women and adults 20-49 years of age. Subpopulations at higher risk for ALS were males, whites, persons > or =65 years of age, and residents of northern states. This study provides information for further studies to examine the epidemiology and risk factors associated with ALS.

Adolescent↗
PubMed2005

Lower respiratory tract infections among american Indian and Alaska Native children and the general population of U.S. Children.

BACKGROUND AND OBJECTIVE: Lower respiratory tract infections (LRTIs) cause substantial childhood morbidity. This study characterizes and compares LRTI-associated morbidity among American Indian/Alaska Native (AI/AN) children and the general population of U.S. children. METHODS: Hospitalization and outpatient records with a diagnosis indicating LRTIs were evaluated for children aged younger than 5 years during 1990-2001. RESULTS: For 1999-2001, the LRTI-associated hospitalization rate was significantly higher for AI/AN children than for U.S. children (116.1 versus 63.2/1000, respectively), with the disparity being greater for infants than for 1- to 4-year-old children. Also the rate of LRTI-associated outpatient visits among AI/AN infants was higher than that for all U.S. infants (737.7 versus 207.2/1000, respectively). LRTI hospitalization and outpatient visit rates were highest in the Alaska and Southwest Indian Health Service regions. During 1990-2001, the LRTI hospitalization rate among AI/AN infants in the Alaska region and among the general U.S. infant population increased. Bronchiolitis-associated hospitalization rates increased for AI/AN and U.S. infants, whereas the pneumonia-associated hospitalization rate decreased among AI/AN infants and remained stable among U.S. infants. CONCLUSIONS: LRTIs continue to be an important cause of morbidity in children, especially among AI/AN infants in the Alaska and Southwest regions. Strategies to reduce LRTI hospitalizations and outpatient visits are warranted for all infants, but the greatest potential impact would be among AI/AN infants.

Age Distribution↗
PubMed2005

Kawasaki syndrome in Hawaii.

OBJECTIVE: To describe the incidence and epidemiology of Kawasaki syndrome (KS) in Hawaii. METHODS: Retrospective analysis of the State Inpatient Database for Hawaii residents hospitalized with KS during 1996 through 2001. RESULTS: During 1996 through 2001, 267 persons younger than 18 years of age living in Hawaii were hospitalized with KS; 226 (84.6%) were younger than 5 years of age. The average annual incidence for KS was 45.2 per 100,000 children younger than 5 years of age. The incidence was higher for children younger than 1 year of age than for those 1-4 years of age (74.3 and 37.5 per 100,000). The KS incidence for Asian and Pacific Islander children and for White children was 70.9 and 35.3 per 100,000, respectively. Incidence was highest among Japanese American children living in Hawaii (197.7 per 100,000). Honolulu County had the most KS patients (85.0%) and the highest incidence (53.1 per 100,000) among Hawaii counties. For children younger than 5 years of age hospitalized with KS, the median length of stay was 2 days, and the median hospital charge was $9379. CONCLUSION: During 1996 through 2001, the annual incidence rate for KS among children younger than 5 years of age in Hawaii was the highest in the United States. The incidence among Japanese American children in Hawaii was higher than that among other racial groups in the state and when compared with children living in Japan.

Adolescent↗