Hepatitis C Diagnoses in an American Indian Primary Care Population

BACKGROUND: Despite large disparities in the burden of chronic liver disease, data on hepatitis C virus (HCV) infection among American Indians (AIs) are lacking. We reviewed hepatitis C diagnoses in 35,712 AI/AN primary care patients. MAIN FINDINGS: At least one HCV-associated ICD-9 code was recorded in 251 (1%) patients between October 1, 2001 and September 30, 2003. An HCV enzyme-linked immunoassay (HCVEIA) was sent in 209 (83.0%); 206/209 (99%) were positive. Confirmatory testing was performed in 144/206 (70%) HCV-EIA positive patients; HCV infection was confirmed in 144 (100%). In the 90/144 (63%) charts with risk factor documentation, injection drug use was the most common risk factor (61/90, 68%). Deficiencies were present in hepatitis B and HIV testing, and hepatitis A and B vaccination. PRINCIPAL CONCLUSIONS: Improvements in laboratory workup of HCV and co-infections, risk factor ascertainment and documentation, and adult vaccination are needed to address HCV effectively in this population

Microsporidial Infections in Immunodeficient and Immunocompetent Patients

Microsporidia are obligate, intracellular, spore-forming protozoal parasites. Their host range is extensive and includes most invertebrates and all classes of vertebrates. Five microsporidial genera (Enterocytozoon, Encephalitozoon, Septata, Pleistophom, and Nosema) and unclassified microsporidia have been associated with human disease, which appears to manifest primarily in immunocompromised persons. The clinical manifestations of microsporidiosis are diverse and include intestinal, pulmonary, ocular, muscular, and renal disease. The majority of microsporidial infections in persons infected with human immunodeficiency virus (HIV) are attributed to Enterocytozoon bieneusi, an important cause of chronic diarrhea and wasting. Four cases of microsporidial infection among persons not infected with HIV who had documented or presumed cellular immunodeficiency and four cases of corneal stroma infection due to microsporidia in immunocompetent patients have been described. Furthermore, the first case of traveler's diarrhea due to E. bieneusi in an immunocompetent and otherwise healthy patient is reported in this issue. The sources of human microsporidial infections and modes of transmission are unknow

Vaccination Coverage Among American Indian and Alaska Native Children, 2006–2010

BACKGROUND AND OBJECTIVES: A previous study on vaccination coverage in the American Indian/Alaska Native (AI/AN) population found that disparities in coverage between AI/AN and white children existed from 2001 to 2004 but were absent in 2005. The objective of this study was to describe vaccination coverage levels for AI/AN children aged 19- 35 months in the United States between 2006 and 2010, examining whether gains found for AI/AN children in 2005 have been sustained. METHODS: Data from the 2006 through 2010 National Immunization Surveys were analyzed. Groups were defined as AI/AN (alone or in combination with any other race and excluding Hispanics) and white-only non-Hispanic children. Comparisons in demographics and vaccination coverage were made. RESULTS: Demographic risk factors often associated with underimmunization were significantly higher for AI/AN respondents compared with white respondents in most years studied. Overall, vaccination coverage was similar between the 2 groups in most years, although coverage with 4 or more doses of pneumococcal conjugate vaccine was lower for AI/AN children in 2008 and 2009, as was coverage with vaccine series measures the series in 2006 and 2009. When stratified by geographic regions, AI/AN children had coverage that was similar to or higher than that of white children for most vaccines in most years studied. CONCLUSIONS: The gains in vaccination coverage found in 2005 have been maintained. The absence of disparities in coverage with most vaccines between AI/AN children and white children from 2006 through 2010 is a clear success. These types of periodic reviews are important to ensure we remain vigilant

Disseminated Microsporidiosis Due to Encephalitozoon hellem: Pulmonary Colonization, Microhematuria, and Mild Conjunctivitis in a Patient with AIDS

Four genera of microsporidia have been associated with disease in humans, which predominantly affects immunocompromised persons. Systemic infection with a newly characterized microsporidian species, Encephalitozoon hellem, was recently reported in a patient with AIDS. This article describes a second patient with AIDS and disseminated E. hellem infection. In this case the parasite was detected in sputum, urine, and conjunctival swab specimens. Apart from recurrent mild conjunctivitis and asymptomatic microhematuria, the patient had no findings or symptoms that could be related to this parasite. Specifically, no microsporidian-associated pulmonary pathology was documented. Detection of E. hellem in the patient's sputum may have epidemiological implications in that this finding suggests transmission of microsporidia by the aerosol route. Because the patient died of unrelated complications, it remains unknown whether he was an asymptomatic carrier of microsporidia or whether microhematuria heralded early microsporidian disease, with the onset of cellular damage in the urinary trac

Multistate Assessment of Public Health Surveillance Relevant to American Indians and Alaska Natives, 2007

Improving the health of American Indian and Alaska Native (AI/AN) populations involves multiple agencies, levels of government, and jurisdictions. We assessed collaboration between state health departments and AI/AN Tribes and agencies through an online survey of State Epidemiologists. Frequencies and percentages of responses were examined by univariate and bivariate analyses. Among 39 states with federally recognized or state-recognized Tribes or federally funded urban Indian health centers, 25 (64%) participated. Nineteen had discussed public health surveillance with an AI/ AN government or nongovernment entity in the past 2 years (10 (53%) of these had ongoing, regular discussions about public health surveillance; nine (47%) had these discussions as needed). Nine (36%) responding states have a point person for working with AI/AN communities and/or agencies on public health surveillance. Four (16%) states have an active memorandum of understanding or other formal agreement with an AI/AN government or nongovernment entity regarding surveillance. To prepare for public health emergencies, six (24%) states involve the Indian Health Service, and eight (47%) involve another AI/AN entity. Functional relationships between state health departments and AI/AN agencies have not been consistently established. Strengthening these relationships will facilitate surveillance and response capacity to address continuing and emerging public health problems

Surveillance of Infectious Diseases Among American Indians and Alaska Natives

We assessed participation in public health surveillance networks among Indian Health Service, tribal, and urban (I/T/U) Indian health facilities for a group of infectious diseases, and barriers to participation. We conducted surveys of I/T/U facilities and key informant interviews with representatives of tribal, urban, and national American Indian/Alaska Native (AI/AN) agencies. For the surveys, frequencies and percentages of responses in each response category were calculated. Qualitative methods were used to analyze interview content. The proportion of facilities participating in case reporting is suboptimal across facility types and diseases. Even when reporting is occurring, there is little feedback to tribal agencies. Lack of trust between tribal authorities and state/local governments, lack of feedback on surveillance efforts, and gaps in coordination of activities were identified as barriers to participation in surveillance. Our findings indicate weaknesses in surveillance systems for monitoring infectious diseases among AI/AN people, and have implications for addressing health disparities

The Naturalistic Flight Deck System: An Integrated System Concept for Improved Single-Pilot Operations

This paper reviews current and emerging operational experiences, technologies, and human-machine interaction theories to develop an integrated flight system concept designed to increase the safety, reliability, and performance of single-pilot operations in an increasingly accommodating but stringent national airspace system. This concept, know as the Naturalistic Flight Deck (NFD), uses a form of human-centered automation known as complementary-automation (or complemation) to structure the relationship between the human operator and the aircraft as independent, collaborative agents having complimentary capabilities. The human provides commonsense knowledge, general intelligence, and creative thinking, while the machine contributes specialized intelligence and control, extreme vigilance, resistance to fatigue, and encyclopedic memory. To support the development of the NFD, an initial Concept of Operations has been created and selected normal and non-normal scenarios are presented in this document

Cassini RADAR Sequence Planning and Instrument Performance

The Cassini RADAR is a multimode instrument used to map the surface of Titan, the atmosphere of Saturn, the Saturn ring system, and to explore the properties of the icy satellites. Four different active mode bandwidths and a passive radiometer mode provide a wide range of flexibility in taking measurements. The scatterometer mode is used for real aperture imaging of Titan, high-altitude (around 20 000 km) synthetic aperture imaging of Titan and Iapetus, and long range (up to 700 000 km) detection of disk integrated albedos for satellites in the Saturn system. Two SAR modes are used for high- and medium-resolution (300-1000 m) imaging of Titan's surface during close flybys. A high-bandwidth altimeter mode is used for topographic profiling in selected areas with a range resolution of about 35 m. The passive radiometer mode is used to map emission from Titan, from Saturn's atmosphere, from the rings, and from the icy satellites. Repeated scans with differing polarizations using both active and passive data provide data that can usefully constrain models of surface composition and structure. The radar and radiometer receivers show very good stability, and calibration observations have provided an absolute calibration good to about 1.3 dB. Relative uncertainties within a pass and between passes can be even smaller. Data are currently being processed and delivered to the planetary data system at quarterly intervals one year after being acquired

Climatic and environmental patterns associated with hantavirus pulmonary syndrome, Four Corners region, United States.

To investigate climatic, spatial, temporal, and environmental patterns associated with hantavirus pulmonary syndrome (HPS) cases in the Four Corners region, we collected exposure site data for HPS cases that occurred in 1993 to 1995. Cases clustered seasonally and temporally by biome type and geographic location, and exposure sites were most often found in pinyon-juniper woodlands, grasslands, and Great Basin desert scrub lands, at elevations of 1,800 m to 2,500 m. Environmental factors (e.g., the dramatic increase in precipitation associated with the 1992 to 1993 El Niño) may indirectly increase the risk for Sin Nombre virus exposure and therefore may be of value in designing disease prevention campaigns