bluuebunny/crossref_metadata_2025 huggingface dataset:
Whole-Genome Sequence of a Multidrug-Resistant Clinical Isolate of Acinetobacter lwoffii
Authors: Hu Yongfei , Zhang Wei , Liang Hui , Liu Liping , Peng Guojun , Pan Yuanlong , Yang Xi , Zheng Beiwen , Gao George F. , Zhu Baoli , Hu Hongyan
Published: July 2011

Acinetobacter lwoffii
has been considered an opportunistic pathogen that can cause nosocomial infections in humans. Here, we present the genome sequence of
A. lwoffii
WJ10621, a multidrug-resistant clinical isolate that carries a plasmid with the NDM-1 resistance gene.
Genome Sequence of
Rhodococcus
sp. Strain R04, a Polychlorinated-Biphenyl Biodegrader
Authors: Yang Xiuqing , Xue Rui , Shen Chong , Li Shuren , Gao Chong , Wang Qi , Zhao Xiaoxia
Published: July 2011

The genus
Rhodococcus
has proved to be a promising option for the cleanup of polluted sites and application of a microbial biocatalyst.
Rhodococcus
sp. strain R04, isolated from oil-contaminated soil, can biodegrade polychlorinated biphenyls. Here we report the draft genome sequence of
Rhodococcus
sp. strain R04, which could be used to predict genes for xenobiotic biodegradation and provide important insights into the applications of this strain.
Genome Sequence of the Newly Isolated Chemolithoautotrophic Bradyrhizobiaceae Strain SG-6C
Authors: Pearce Stephen L. , Pandey Rinku , Dorrian Susan J. , Russell Robyn J. , Oakeshott John G. , Pandey Gunjan
Published: July 2011

Strain SG-6C (DSM 23264, CCM 7827) is a chemolithoautotrophic bacterium of the familyBradyrhizobiaceae. It can also grow heterotrophically under appropriate environmental conditions. Here we report the annotated genome sequence of this strain in a single 4.3-Mb circular scaffold.
Genome Sequence of Lactobacillus cypricasei KCTC 13900
Authors: Kim Dae-Soo , Choi Sang-Haeng , Kim Dong-Wook , Kim Ryong Nam , Nam Seong-Hyeuk , Kang Aram , Kim Aeri , Park Hong-Seog
Published: July 2011

Lactobacillus cypricaseiKCTC 13900 is important in the generation of particular flavors and in other ripening processes associated with specific cheeses. Here, we announce the draft genome sequence ofLactobacillus cypricaseiKCTC 13900, isolated from cheeses, and describe major findings from its annotation.
Complete Genome Sequence of the Type Strain Cupriavidus necator N-1
Authors: Poehlein Anja , Kusian Bernhard , Friedrich Bärbel , Daniel Rolf , Bowien Botho
Published: July 2011

Here we announce the complete genome sequence of the copper-resistant bacterium
Cupriavidus necator
N-1, the type strain of the genus
Cupriavidus
. The genome consists of two chromosomes and two circular plasmids. Based on genome comparison, the chromosomes of
C. necator
N-1 share a high degree of similarity with the two chromosomal replicons of the bioplastic-producing hydrogen bacterium
Ralstonia eutropha
H16. The two strains differ in their plasmids and the presence of hydrogenase genes, which are absent in strain N-1.
Draft Genome Sequence of Lactobacillus mali KCTC 3596
Authors: Kim Dong-Wook , Choi Sang-Haeng , Kang Aram , Nam Seong-Hyeuk , Kim Dae-Soo , Kim Ryong Nam , Kim Aeri , Park Hong-Seog
Published: July 2011

We announce the draft genome sequence of the type strain
Lactobacillus mali
KCTC 3596 (2,652,969 bp, with a G+C content of 36.0%), which is one of the most prevalent lactic acid bacteria present during the manufacturing process of apple juice. The genome consists of 122 large contigs (>100 bp). All of the contigs were assembled by Newbler Assembler 2.3 (454 Life Science).
Collagen triple helix repeat containing 1 protein, periostin and versican in primary and metastatic breast cancer: an immunohistochemical study
Authors: Kharaishvili Gvantsa , Cizkova Magdalena , Bouchalova Katerina , Mgebrishvili Giorgi , Kolar Zdenek , Bouchal Jan
Published: July 2011

Background

Collagen triple helix repeat containing 1 (CTHRC1) affects Wnt signalling, collagen deposition and bone formation. It is an extracellular matrix protein which is also abnormally expressed in the tumour microenvironment. CTHRC1 has not been studied in breast cancer by immunohistochemistry.

Aims

To examine expression of CTHRC1 together with periostin and versican in breast cancer patients and investigate its association with clinicopathological characteristics.

Methods

The formalin-fixed paraffin-embedded tissues of 173 invasive carcinomas (classified into WHO histotypes and luminal, triple negative and Her2 subtypes), as well as normal tissues, precursor lesions and metastatic lymph nodes were stained by relevant antibodies, assessed semiquantitatively by histoscore and statistically evaluated.

Results

Expression of CTHRC1, versican and periostin was significantly higher in breast cancer than in normal tissue or precursor lesions. CTHRC1 stromal expression was enhanced in triple negative cases and also in patients with bone metastasis. Periostin expression was high in primary tumours, in particular triple negative ones, and also in their lymph node metastases. Cox regression analysis showed that in patients with high periostin, the risk of bone metastases increased with increased CTHRC1 expression.

Conclusions

CTHRC1 and periostin play important roles in breast cancer progression. These preliminary results show that combined evaluation of CTHRC1 and periostin could serve as a potential marker for breast cancer bone metastasis; the other observations contribute to the description of the tumour microenvironment, with implications for lymph node and bone metastasis.
Retrospective case series analysis of penicillin allergy testing in a UK specialist regional allergy clinic
Authors: Richter A G , Wong G , Goddard S , Heslegrave J , Derbridge C , Srivastava S , Diwakar L , Huissoon A P , Krishna M T
Published: July 2011

Introduction

Penicillin allergy is the most common drug allergy. Skin testing for the major (PPL) and minor determinants (MDMs) of penicillin offers increased sensitivity and specificity overin vitrotesting alone. Following a worldwide absence of reagents, a new kit was licensed in the UK in 2008 (Diater, Spain) and this report evaluates its use in a UK specialist allergy clinic.

Methods

Prospective data on 50 consecutive patients tested with the new reagents were collected. The departmental protocol is adapted from the 2003 EAACI position paper.

Results

14% (7/50) and 12% (6/50) of patients were diagnosed with immediate and non-immediate reactions respectively. The negative predictive value of the PPL and MDM reagents at the neat concentration for an immediate reaction was 93% (true negatives 37, false negatives 3). Two patients experienced systemic reactions to DPT in the absence of demonstrable specific IgE. None of the patients were diagnosed using skin prick testing alone or at lower concentrations of IDT. Five patients were diagnosed at the IDT stage and two at the DPT stage in the absence of demonstrable specific IgE. Six patients were diagnosed with non-immediate reactions, two on IDT alone and four following IDT and DPT.

Conclusion

The new PPL and MDM determinants offer enhanced sensitivity when evaluating β-lactam hypersensitivity; however, there are limitations to the current testing regimens. The UK would benefit from local guidelines, which incorporate the new reagents and acknowledge the high amoxicillin prescription rate and the relatively lower specialist-to-patient ratio in this country.
S1.1 Improving the validity of sexual behaviour measurement: using computer-assisted methods
Authors: Cowan F M
Published: July 2011

Reporting of sexual behaviour is subject to bias, perhaps most importantly social desirability bias. This is a particular problem in communities where discussion of sex is considered taboo and when disclosure of sexual activity can have serious consequences for the individuals concerned (eg, for young people or those in same-sex relationships). Mis/under-reporting of sexual behaviours can result in the design of interventions being poorly informed as well as in intervention effectiveness being unreliably measured. There is increasing evidence to suggest that questionnaire delivery method (in addition to a host of other factors) can impact the validity of reported data and that validity can be improved by careful consideration of questionnaire delivery mode. Computer-assisted questionnaire delivery has been shown to increase reporting of socially sanctioned behaviours in many settings and even in rural, resource poor settings, where people traditionally have limited experience of using computers, have been shown to be highly acceptable and feasible to research participants.
S6.1 Evolution of the epidemiology among men who have sex with men (MSM) in low and moderate income countries
Authors: Sanchez J
Published: July 2011

HIV epidemic encompasses diverse scenarios among MSM around the world. Even when, prevalence and incidence data are lacking in more than 90 countries, available information shows that unprotected anal intercourse is the prominent exposure mode for HIV infection among MSM in Latin America, whereas intravenous drug use drives the epidemic in Asia. In the recent years, a previously neglected HIV epidemic has been recognised in settings where was initially thought was mainly heterosexual like in many countries in Africa. Although individual level risk factors for HIV acquisition have been clearly identified, structural level risk depends on stigma and discrimination. Promising biomedical intervention for HIV prevention depends on link to care which at the time are related to fear, denial or blackmail.
S6.2 Dangerous liaisons: risk in MSM in developed countries
Authors: Hart G J
Published: July 2011

Although there has been a reduction in incident HIV infection in some MSM communities in developed countries, in others new diagnoses and incident infections are increasing. Helping those who are HIV negative to remain negative remains a pressing concern. The number of men who are HIV positive is increasing because of successful ART, but the sexual health needs of positive MSM are rarely addressed. This presentation focuses on behavioural research in the era of ART, with particular reference to continuing transmission of HIV, current risk behaviour for HIV infection, and the challenging situation with regard to established and emerging STIs in MSM.
S6.3 Behavioural interventions among men who have sex with men (MSM): where do we go from here?
Authors: Golden M R
Published: July 2011

Over the last two and a half decades, researchers and public health agencies have invested substantial resources in developing and implementing counselling and behavioural interventions to decrease HIV transmission among men who have sex with men (MSM) in higher-income nations. Meanwhile, MSM have substantially altered their sexual risk behaviour, adapting to the HIV epidemic, as well as the technological revolution fuelled by the Internet. This presentation will review the evidence supporting the efficacy of behavioural interventions in MSM, discuss the challenges posed in bringing those interventions to scale, and suggest future research and prevention directions designed to move behavioural interventions from an efficacy to an effectiveness focus.
S6.4 Antiretroviral chemoprophylaxis: new opportunities and new challenges
Authors: Mayer K H
Published: July 2011

With the success of the CAPRISA 004 study of 1% tenofovir vaginal gel in South African women, and the iPrEx study of the use of oral co-formulated tenofovir-emtricitabine in an international cohort of MSM, it is clear that chemoprophylaxis may be able to enhance current HIV prevention efforts. However, multiple questions remain, including which mode of drug delivery is likely to be most effective for each population, and which drugs are the preferred ones to use. Other major questions include the feasibility of using a rectal formulation to prevent HIV transmission, and what is the most parsimonious way to dose these medications, in order to save costs and to minimise toxicities. This presentation will review the data from recently completed trials, will summarise the status of other studies underway, will discuss the gaps in our knowledge, and will discuss the responses of medical care providers and high risk populations to the news of PreP efficacy. Clearly, the field is in its infancy, but offers promises for epidemic control.
S8.4 Laboratory harmonisation and quality-assurance issues: challenges and opportunities
Authors: Ison C
Published: July 2011

There are significant gaps in gonococcal susceptibility data particularly in high-burden countries. Laboratory detection of gonococci with reduced susceptibility to azithromycin and cephalosporins is of particular concern. Coordinated and standardised laboratory testing approaches that ensure quality assurance are vital to detect emerging resistance and optimise treatment.

This presentation will explore current gaps and identify opportunities, including roles of laboratory networks, in building regional diagnostic capacity.
S8.5 Global action plan to combat antimicrobial resistance inNeisseria gonorrhoeae: challenges and opportunities
Authors: Ndowa F J
Published: July 2011

The WHO is drafting a strategic response to the threat of untreatableNeisseria gonorrhoeae. The main objective of the Global Action Plan to combat AMR inN gonorrhoeaeis to devise nationally and regionally appropriate public health actions to address this global threat. This includes technical and programmatic guidance to countries, regions and global stakeholders.

This presentation will discuss the basic elements of the draft WHO Action Plan.
S10.3 Sexual health in MSM—coordination and agenda setting in Europe
Authors: Van de Laar M
Published: July 2011

The European Centre for Disease Prevention and Control (ECDC) has a strong mandate with respect to surveillance of communicable disease in the European Union but a less strong mandate regarding prevention and control as this remains the responsibility of individual Member States. However, ECDC has produced several guidance documents and user-friendly toolkits to support public health decision makers and experts in the Member States to strengthen available prevention and control activities.

In the light of (1) increasing trends of STI and the continuous rise in the number of newly diagnosed HIV infections among MSM and (2) the evidence for increased high-risk sexual behaviour and the widespread sexual mixing among MSM in Western Europe, ECDC has assessed effectiveness of behavioural and psychosocial HIV/STI prevention interventions for MSM in Europe and concluded that there is an overall deficit in outcome evaluations of interventions aimed at reducing HIV/STI risk behaviour among MSM in Europe.

Following this background, ECDC has launched an additional project to include a review and assessment of the following: interventions aiming at knowledge, attitudes and beliefs and influencing psychological and social risk correlates (eg, media campaigns, interpersonal education programmes, sexual health education, safer sex promotion, detached education, outreach work, prevention counselling, peer education, community level interventions). Interventions aiming at lowering the risk of behaviour (eg, condom distribution, provision of paraphernalia for safer sex) The final report contains a compilation and summary of publications regarding outbreaks and increasing trends of HIV and STI, an update of different prevention interventions targeted at MSM as well of interventions planned and carried out within the framework of programmatic responses to the HIV epidemic as well as interventions following outbreaks or other events, a review of evaluation of different interventions and synthesis the evidence base for preventive interventions, and a synopsis of identified knowledge gaps.

Based on the review and the assessment, a platform for multidisciplinary expert consultation will be organised in August 2011 (including epidemiologists, prevention experts, social behaviour scientists, representatives of civil society, Member States, NGOs, and other key stakeholders) to discuss the needs and challenges for coordination at EU level.
S13.1 Respondent-driven sampling: uses, assumptions, limits and prospects
Authors: Frost S
Published: July 2011

Respondent-driven sampling (RDS) is widely used to obtain estimates of quantities such as HIV prevalence, but is also used to examine correlates of infection, and less frequently, to help characterise social networks of individuals in “hidden” populations. The popularity of RDS stems in part from the often rapid recruitment of individuals from the target population as well as from the potential to obtain (asymptotically) unbiased estimates using information only from the sample. I will review the assumptions required for this potential to be realised, whether these assumptions are broken in practice, and the impact of breaking assumptions on statistical inference. I will also discuss improvements to the design and analysis of RDS studies, including schemes for giving out coupons, obtaining absolute sizes of at-risk populations using capture-recapture, and the utility of detailed social network inventories.
S13.3 An empirical evaluation of respondent-driven sampling
Authors: McCreesh N , Frost S , Seeley J , Katongole J , Tarsh M Ndagire , Ndungutse R , Jichi F , Maher D , Sonnenberg P , Copas A , Hayes R J , White R G
Published: July 2011

Objective

Respondent-driven sampling (RDS) is an increasingly widely used variant of snowball sampling, that proponents claim can provide unbiased estimates. RDS has not been rigorously evaluated in the field. This study evaluated RDS by comparing estimates from an RDS survey with total-population data.

Methods

Total-population data on age, tribe, religion, socioeconomic status, sexual activity and HIV status were available on a population of 2402 male household-heads from an open cohort in rural Uganda. An RDS survey was carried out in this population, employing current RDS methods of sampling (RDS-sample) and statistical inference (RDS-estimates). Analyses were repeated for the full RDS sample and a small sample of the first 250 recruits (including 10 seeds).

Results

927 household-heads were recruited (including 10 seeds). Full and small RDS-samples were largely representative of the total-population for most variables, but under-represented men who were younger, of higher socioeconomic status, and with unknown sexual activity and HIV status. RDS statistical inference methods failed to reduce these biases. Only 31–37% (depending on method and sample size) of RDS-estimates were closer to the true population proportions than the RDS-sample proportions. Only 50–74% of RDS bootstrap 95% CIs included the population proportion.

Conclusions

RDS produced a generally representative sample of this well-connected non-hidden population. However, current RDS inference methods failed to reduce bias when it occurred. Whether RDS can collect the data required to reliably remove bias and measure precision during analysis is unresolved. As such, although RDS may be a feasible and cost-effective method for sampling hidden or hard-to-reach populations, RDS should still be regarded as a (potentially superior) form of convenience sample, and caution is required when interpreting findings from RDS studies.
S2.2 Increasing access to HIV and syphilis screening in remote areas using rapid tests
Authors: Benzaken A , Pinto V M , Carvalho C H , Peeling R
Published: July 2011

Background

Syphilis continues to be a public health problem in Brazil, particularly among populations with limited access to health services. Indigenous populations, who live in remote locations in the interior of the Amazon forest, are of even greater concern. Traditional laboratory tests for the diagnosis of syphilis are scarce in these regions. The objective of this presentation is to describe the implementation of rapid tests (RT) in the Amazon region.

Methods

We trained health professionals of 9 Special Indigenous Health Districts (DSEI) to screen the sexually active population (over 10 years of age) for syphilis and HIV using RT with Quality Assurance (QA).

Results

In total, 509 health professionals were trained and 160 units participated in the screening efforts. From a sexually active population of 83 311 indigenous people 38 799 (47%) were tested, of whom 594 (1.5%) tested positive for syphilis. 44/3650 pregnant women (1.3%) tested positive for syphilis, and 3 for HIV (0.1%). There is extensive variation between the rate of syphilis and HIV positivity between DSEIs (Abstract S2.2 table 1). The external QA performance was important in assuring correct results as initial scores were 77.1% for the HIV test and 61.5% for the syphilis test.

Abstract S2.2 Table 1

Syphilis and HIV screening progress

DSEI# Screened / sexually active population (%)Syphilis prevalence in sexually active populationHIV prevalence in sexually active populationSyphilis prevalence in pregnant womenHIV prevalence in pregnant womenManaus5.957/10.980 (54.2%)1.51%0.08%3/327 (0.93%)0/323 (0.0%)Yanomani1.757/4.317 (40.7%)0.06%0.17%1/284 (0.35%)2/284 (0.70%)Leste roraima2.666/4.038 (66.0%)0.41%0.08%2/567 (0.40%)0/472 (0.0%)Alto solimões19.147/25.322 (75.6%)1.90%0.13%30/1.412 (2.27%)0/1.272 (0.0%)Parintins2.324/4.904 (47.4%)0.34%0.04%1/254 (0.39%)0/253 (0.0%)Alto rio Negro4.892/19.872 (24.6%)0.72%0.08%4/639 (0.72%)0/561 (0.0%)Médio solimões580/9.092 (6.4%)2.59%0.0%0/77 (0.0%)0/76 (0.0%)Médio purus330/2.950 (11.2%)0%0.0%0/20 (0.0%)0/20 (0.0%)Vale do javari1.147/2.563 (44.7%)6.10%0.17%3/70 (4.29%)1/70 (1.43%)Total38.799/83.311 (46.6%)594/38.799 (1.53%)41/38.799 (0.11%)44/3.650 (1.29%)3/3.650 (0.09%)

Conclusions

This project has demonstrated to policy makers in Brazil the existence of syphilis and HIV among indigenous people and the feasibility of addressing it. As a result of this work, it is now government policy to use RT to screen for HIV and syphilis with QA in remote regions of Brazil. This project provided a model for the introduction of point of care tests supported by a QA programme in remote regions.
P1-S2.46 Is group sex a setting for increased risk for HIV and other STI among HIV-negative men who have sex with men?
Authors: Heuker J , Stolte I , Davidovich U
Published: July 2011

Background

Transmission of HIV and other Sexually Transmitted Infections (STI) is ongoing in Western populations of Men who have Sex with Men (MSM). The main indicator of sexual risk is unprotected anal intercourse (UAI) with casual sex partners. It was suggested that group sex might be a high risk setting for HIV and STI transmission. Aim of the present study is to identify differences in sexual risk behaviour and STI-rates among MSM engaging in group sex compared to one-on-one casual sex.

Methods

We used cross-sectional data derived through 6-monthly questionnaires and STI screening (infectious syphilis, gonorrhoea or Chlamydia) from the Amsterdam Cohort Studies (ACS) between December 2008 and December 2009. The study population (n=310) consisted of HIV-negative MSM who reported having engaged in both group sex and one-on-one sex (n=119) and MSM reporting one-on-one sex only (n=191). To identify differences in sexual risk behaviour and STI-rates between MSM engaging in group sex and one-on-one sex, we used χ2tests, Mann−Whitney U tests and logistic regression analyses, corrected for repeated measures.

Results

MSM engaging in both group sex and one-on-one sex had less anal intercourse (AI) during group sex (79/119; 66.4%) compared to during one-on-one sex (106/119; 89.1%). Moreover, they were less likely to have UAI during group sex compared to one-on-one sex (OR adj 0.44; 95% CI 0.26 to 0.74). Men engaging in one-on-one sex only reported less AI (129/191; 67.5 %), while UAI-levels were similar (OR adj1.47; 95% CI 0.82 to 2.62) compared to one-on-one sex of men who also engage in group sex. Drug use during sex was associated with UAI (OR adj1.78; 95% CI 1.03 to 3.09), independent of whether sex took place in a group sex or one-on-one sex setting. Finally, men engaging in group sex were more likely to be diagnosed with any STI (13.4% vs 5.1%; p=0.013) compared to men engaging in one-on-one sex only. For men engaging in one-on-one sex only, but not for men engaging in group sex, UAI was associated with being diagnosed with any STI (OR 8.44; 95 % CI 2.0 to 35.2).

Conclusions

The group sex setting might not pose a threat for HIV-infection in MSM, as UAI-rates were lower during group sex compared to one-on-one sex. However, although they did not report more UAI, men engaging in group sex had higher STI-rates than men engaging in one-on-one sex only. This indicates that men engaging in group sex practice other sexual techniques than AI that contribute to acquiring STI.
P1-S2.49 Chlamydia and gonorrhoea transmission among men who have sex with men in Amsterdam, is independent of network factors or partnership characteristics
Authors: Matser A , Heijman T , Geskus R , de Vries H , Fennema H , van der Loeff M S
Published: July 2011

Background

Partnerships are essential for transmission of sexually transmitted infections (STI). Among MSM, variation in partnerships is common. We have analysed risk factors for STI by studying partnerships.

Methods

The study population was recruited from the STI outpatient clinic of the public health service of Amsterdam, the Netherlands. Inclusion criteria were male gender, having had sexual contact with men in the past 6 months, age ≥18 years, and understanding of written Dutch or English. Recruitment occurred from July 2008 to August 2009. Participants were screened for chlamydia (CT), gonorrhoea (NG), syphilis, and HIV (opting-out strategy). Participants completed a questionnaire including demographics and detailed questions about sexual behaviour in self-defined relationships with a steady partner and the last three other partners within the previous 6 months. Logistic regression analysis was used to identify risk factors for CT and NG.

Results

2731 MSM reporting 7397 partnerships were included; median age was 39 years (IQR 31–45). CT prevalence was 12.5% (n=342), NG prevalence was 11.1% (n=303), and CT/NG coinfection was found in 2.6% (n=71) of the MSM. Meeting partners online was common (53% met at least one of the partners online), but not associated with STI (CT—OR 1.2 95% CI 0.95 to 1.5 and NG—OR 1.2 95% CI 0.9 to 1.5), just as having concurrent partnerships (CT—OR 3.2 95% CI 0.4 to 23.6 and NG—OR 1.3 95% CI 0.3 to 5.6). In multivariable analysis, independent predictors of CT were having =5 known partners in the last 6 months (OR 1.7 95% CI 1.2 to 2.3), receptive unprotected anal intercourse (OR 2.1 95% CI 1.5 to 2.8), NG coinfection (OR 2.0 95% CI 1.5 to 2.8), and HIV coinfection (OR 1.8 95% CI 1.4 to 2.4). Independent predictors of NG were group sex (OR 1.5 95% CI 1.1 to 2.1), being in a different 10-year age category than the partner (OR 1.4 95% CI 1.04 to 1.8), CT coinfection (OR 2.1 95% CI 1.5 to 2.8), and HIV coinfection (2.2 95% CI 1.6 to 2.9). Age =45 years (OR 0.4 95% CI 0.2 to 0.6) and being bear type (OR 0.4 95% CI 0.2 to 0.9) were associated with lower NG risk.

Conclusions

CT and NG infections are associated with positive HIV status and other STI coinfections. We confirmed the association between NG and CT and several known risk factors of the index patient; surprisingly, none of the partnership factors (eg, concurrency, meeting place, or partner's HIV status) , except age difference, were associated with NG or CT.
P1-S2.57 Using an online survey to investigate risk behaviours and social networks in a syphilis outbreak among men who have sex with men in Toronto
Authors: Shahin R , Rank C , Kinniburgh B , Jolly A , Al-Bargash D , Clarke B , Ofner M , Gilbert M L
Published: July 2011

Background

An outbreak of infectious syphilis among men who have sex with men (MSM) in Toronto began in 2002 and peaked in 2009 when 579 cases were reported. We developed an internet-based enhanced surveillance tool to investigate HIV coinfection, sexual risk behaviours, and social networks among a sample of cases in 2010.

Methods

Males with infectious syphilis in Toronto from 15 April 2010 to 30 June 2010 were invited to complete a self-administered online survey. Data were collected on sexual partners, risk behaviours, condom use, and venues where respondents looked for sex partners in the 6 months before syphilis infection. We assessed key survey variables by HIV status, and carried out social network analyses to examine links between cases, sexual contacts and venues.

Results

Of 84 eligible cases, 46 were successfully contacted and 27 completed the survey. Three of 27 respondents (11%) identified sexual contacts and 16 (59%) reported having multiple sex partners during routine case follow-up. In the online survey, almost all men (n=26) reported at least one male sex partner in the six months before syphilis infection (median 5 partners; IQR 2–12). HIV prevalence among respondents was 70% (vs 35% among non-respondents, p<0.01). Predominant risk behaviours were anonymous sex (64%), group sex (56%), and 55% indicated participation in barebacking (63% of HIV-positive and 33% of HIV-negative men). Of 19 HIV-positive respondents, 17 (89%) had at least one HIV-positive partner; condom use with HIV-positive partners was low (16% and 28% used condoms all or most times during receptive and insertive anal sex, respectively). Among 25 cases who provided information on venues where they looked for sex partners, most sought partners online (88%), at bathhouses (60%) or bars (36%); 22 cases were linked by six common venues—three websites, two bathhouses and one bar.

Conclusions

A substantial proportion of men in our sample reported multiple sex partners and low condom use. As respondents were predominantly HIV-positive MSM with seroconcordant sex partners, risk behaviours, venue attendance and patterns of condom use may not be representative of all MSM with syphilis in Toronto. Nevertheless, collection of behavioural data using an online survey allowed for enhanced descriptive analyses beyond the scope of routine surveillance. In addition to social network analyses, these data are useful to inform targeted prevention and control efforts.
P1-S2.63 Association between Age and STI among men who have sex with men (MSM) in Jamaica
Authors: Weir S , Figueroa P , Jones-Cooper C , Hylton-Kong T , Hobbs M , Rich K , Byfield L
Published: July 2011

Background

In 2007, 201 men who have sex with men were recruited at social venues and through peer referral in five urban areas of Jamaica for an exploratory study of the prevalence of sexually transmitted infection in the population and identification of risk factors.

Objective

To describe the association between age and current infection with HIV, syphilis, and chlamydia and explore reasons for the differences.

Methods

MSM were invited to participate in a survey and testing. Urine and blood samples were collected at the time of the interview and later tested for evidence of HIV, syphilis, gonorrhoea and chlamydia. Men were given options about where to obtain results.

Results

Of the three infections, HIV had the strongest positive association with age; syphilis a weaker positive association; and chlamydia a weak negative association. Risk factors varied somewhat by age and infection see Abstract P1-S2.63 Figure 1. For example, not using a condom in the past 4 weeks was associated with chlamydia infection among MSM age 15−19 but not for older MSM. Having a main sexual partner was associated with HIV infection for MSM age 15−19 but not for older MSM.

Abstract P1-S2.63 Figure 1

Conclusion

Strategies for prevention of transmission need to be aware of differences in risk by age and by infection.
P1-S3.03 Mortality among men who have sex with men seen in std clinic patients: high rates of suicide and low rates of anal cancer death
Authors: Glick S , Kerani R , Golden M
Published: July 2011

Background

Because men who have sex with men (MSM) are not identifiable at a population level, there are few data on cause-specific mortality rates among MSM. MSM are more likely to report suicide attempts than heterosexuals, but it is not known if suicide mortality is higher among MSM. Likewise, although anal cancer is more common among MSM than among heterosexuals, the absolute risk of anal cancer death among MSM is not known. We compared suicide and anal cancer mortality rates among MSM and heterosexual males and females in an STD clinic population.

Methods

We enumerated all Public Health-Seattle and King County STD Clinic attendees from 1993-2007 (n=86,807). Using 1993−2008 mortality data from Washington State (n=702 850), we identified STD clinic attendees who had died and their underlying cause of death. We calculated suicide and anal cancer mortality rates for MSM, heterosexual men, and women, and standardised these rates using the age, race, and gender distribution of King County residents (US Census, 2000). We calculated adjusted incidence rate ratios (IRR) among STD clinic attendees using Poisson regression. To compare mortality rates among STD clinic attendees to the general population, we calculated rates in King County.

Results

Among STD clinic attendees, 14% were MSM, 52% were heterosexual men, and 34% were women. For the period between 1993 and 2008, we matched 1901 Washington state deaths to STD clinic attendees for an overall unadjusted mortality rate of 1.8 deaths per 1000 person-years. The standardised suicide mortality rate among MSM was 0.20 per 1000 person-years, compared with 0.11 among heterosexual men and 0.09 among all women. Adjusted for age and race, among STD clinic attendees, MSM were 1.6 times more likely to die from suicide than heterosexual men (IRRadj=1.6, 95% CI 1.02 to 2.61) and nearly four times more likely than women (IRRadj=3.9, 95% CI 2.14 to 7.24. The suicide mortality rate among MSM in the STD clinic was higher than the rate among all men in King County (standardised rate ratio=1.5), adjusted for age and race. We identified no deaths due to anal cancer in any subpopulation (95% CI 0 to 0.4 per 100 000 person-years).

Conclusions

These data suggest that, at least among STD clinic attendees, MSM are approximately twice as likely to die from suicide as heterosexual men, and these rates are higher than the general population. Anal cancer death rates among King County MSM appear to be low.
P1-S3.06 Prevalence and determinants ofNeiseria gonorhoeaand chlamydia infections among gynaecological patients with pelvic inflammatory disease at University Teaching Hospital, Lusaka
Authors: Yassa P
Published: July 2011

Methodology

This was a descriptive cross sectional study conducted on women presenting clinically with pelvic inflammatory disease to the outpatient department of obstetrics and gynaecology at University Teaching Hospital in Lusaka. Behavioural and demographic variable were collected through questionnaire. Endo-cervical smear was obtained and screened for gonorrhoea and Chlamydia using respective rapid test and gram stain for gonorrhoea.

Results

43 (37%) of a total 116 respondents had gonorrhoea but no Chlamydia was isolated. 114 (98.3) had sexual partners. 101 had steady sexual partners, 19 had casual partners and 9 had anonymous sexual partners with 37 (36.6%), 10 (52.6%) and 6 (66.7%) gonorrhoea isolation respectively. Some had multiple sexual partners. Gonorrhoea was isolated from 4 (28.6%) of the 14 respondents who had one new sexual partner, and all who had two or more sexual partners had gonorrhoea isolated. Gonorrhoea isolation in relation to frequency of sexual intercourse per week was as follows: once 1/13 (7.7%), twice 2/11 (18.2%), thrice 3/11 (27.3%) and more than three times 32/65 (49.2). Gonorrhoea was also higher in those who had sex with casual or anonymous sexual partner under influence of alcohol 6/11 (54.5%) or obtained anonymous sexual partner from Market, shopping canter 4/5 (80%), street, bar, disco, or night club 7/9 (77.8%). Gonorrhoea detection was as follows: 18/36 (50.0 %) for those with adnexial tenderness, 21/45 (46.7%) with inflamed cervix, 37/92 (40.2%) with lower abdominal tenderness and 32/87 (36.8%) with normally appearing cervix.

Conclusion

The prevalence ofNeiseria gonorrhoeawas 37% detected. There was no Chlamydia isolated. Low socio-economic status and young age were the higher risk. The sexual risk behaviours associated were; the number of casual or anonymous sexual partners, and non-use of condoms. Lower abdominal pain and tenderness with cervical motion and adnexial tenderness were the major sign.
P1-S3.11 Factors associated with death among infants with neonatal herpes reported in New York City, 2006−2010
Authors: Schillinger J , Handel S , Washburn K , Klingler E , Blank S , Pathela P
Published: July 2011

Background

Neonatal herpes simplex virus infection (nHSV) has a high case fatality rate. In New York City (NYC), healthcare providers (HCP) and laboratories report nHSV to the Health Department; incidence is highest among infants born to black non-Hispanic (NH), and young women. We analysed nHSV cases to identify factors associated with death.

Methods

nHSV cases in infants <60 days were investigated by HCP interview and abstraction of labour and delivery, outpatient, inpatient, vital records. Bivariate and multivariate models estimated associations between death and demographic, clinical, and provider factors.

Results

During 2006−2010, 71 laboratory-confirmed nHSV cases were reported; 43/71 (55%) were male, 29/71 (41%) HSV type 1, 28/71 (39%) HSV type 2, and 14/71 (20%) untyped. Among 58 cases with recorded maternal race/ethnicity, 19 (33%) were white NH, 25 (43%) were black NH, and 15 (26%) were Hispanic. Fourteen of the 71 (20%) cases died; 10 of the deaths (71%) were among infants born to black NH women. There was a significant association between death and disseminated disease (vs skin/eye/mucous membrane, central nervous system, or congenital infection) (OR 25.8, 95% CI 4.5 to 148.9), black NH maternal race (OR 10.0, 95% CI 2.4 to 41.0), preterm birth (OR 7.1, 95% CI 1.9 to 26.5), age <7 days at first symptom (OR 5.8, 95% CI 1.5 to 23.3), maternal age <26 (OR 3.02, 95% CI 0.8 to 10.86), vaginal delivery (OR 0.2, 95% CI 0.1 to 0.8), and presence of infant herpes lesions (OR 0.2, 95% CI 0.04 to 0.6). Infant sex, fever, viral type, admitting hospital type (academic vs non-academic), illness within 24 h of birth, and duration rupture of membranes were not associated with death. After adjusting for preterm birth, black NH maternal race remained associated with a significantly higher risk for death (OR 7.2 95% CI 1.6—to 31.4, p=0.009). Disseminated disease also remained significantly associated with death after adjusting for preterm birth, and age at first symptom (OR 26.6, 95% CI 3.6 to 196.5, p=0.001).

Conclusions

Our data suggest a significant racial disparity in nHSV fatality, only partly explained by preterm births among black NH mothers. Further investigation should examine if care-seeking or provider characteristics contribute to these disparities. Black NH maternal race may be a marker for recently acquired herpes infection, with a high organism load at delivery. Disseminated disease is strongly, and independently, associated with fatality.
P1-S4.11 The use of the historical limits method of outbreak surveillance to retrospectively detect a syphilis outbreak among American Indians in Arizona
Authors: Winscott M , Betancourt A , Ereth R
Published: July 2011

Background

In April 2007, an Indian Nation located in Southern Arizona declared an outbreak of syphilis among its tribe members. The Arizona Department of Health Services Sexually Transmitted Diseases Control Program (ADHS STDCP) was first alerted by the tribe about the increase in syphilis cases during January 2007, 6 months after the occurrence of the first case in the outbreak. At the time, the ADHS STDCP did not have a method in place to monitor surveillance data for the detection of an outbreak of any sexually transmitted disease occurring within the state.

Methods

In January 2009, the Arizona Department of Health Services STD Control Program developed a syphilis outbreak detection system based upon a Historical Limits Comparison Method (HLCM) to monitor reported syphilis-related labs. The Southern Arizona Indian Nation outbreak was then retrospectively evaluated using the state surveillance database and the HLCM outbreak detection system.

Results

Retrospective analysis of the HLCM system of the syphilis outbreak in Arizona indicates that, had this system been in place at the outset of the outbreak, the ADHS STDCP would have been alerted to the increase in syphilis-related labs reported from the tribal Indian Health Service centers between 10 and 12 weeks earlier.

Conclusions

The use of the HLCM system of syphilis outbreak detection in Arizona would have alerted the state health department earlier to an increase in syphilis cases occurring on the tribal lands in Southern Arizona. Earlier awareness of the increase in cases would have allowed for earlier intervention and collaboration with the tribe to control the outbreak. The ADHS STDCP has since instituted this method of outbreak detection among identified high morbidity or high risk surveillance sites for both syphilis and gonorrhoea.
P1-S4.12 Using neighbourhood-level population data to guide gonorrhoea intervention, MontrÉal, QuÉbec, Canada, 2002−2009
Authors: Khalil N , Allard R
Published: July 2011

Background

The reported incidence rate of gonorrhoea has more than doubled between 2000 and 2010 in Montréal, increasing in both genders and all age groups; however, it was particularly high in females aged 15 to 24. As the reasons for the increases among young women are not fully understood, we wanted to determine whether neighbourhood-level population characteristics were associated with incidence rates among them, to help target intervention strategies.

Methods

Incident gonorrhoea cases were female residents of Montréal, aged 15 to 24, who met Québec's provincial gonorrhoea surveillance definition, with a notification date between 2002 and 2009. The unit of analysis was neighbourhoods—111 non-administrative boundaries defined by the Montréal Public Health Department, by grouping census tracts to maximise homogeneity of population characteristics. The dependent variable was the neighbourhood gonorrhoea incidence rate based on all reported cases and the neighbourhood population, for females aged 15 to 24; the independent variables included material and social deprivation indices, their combination and components, and ethnic origin. Adjusted incidence rate ratios (IRR) were estimated by negative binomial regression after exponentiation of the regression coefficients and show the change in the incidence of gonorrhoea for each unit increase in the independent variable. In the final model, independent variables were normalised to facilitate comparison of their IRR which represents the change in gonorrhoea incidence rate associated with an increase of one SD in the percentage of residents of a given ethnic origin.

Results

A total of 837 cases were reported (cumulative incidence rate 5.6 per 100 000). Higher proportions of three ethnic origin groups were associated with higher neighbourhood gonorrhoea rates, even when deprivation indices were considered (Abstract P1-S4.12 table 1).

Abstract P1-S4.12 Table 1

Population characteristics associated with gonorrhoea rates among female residents of Montréal aged 15–24, 2002–2009

Independent variableIncidence Rate Ratio (95% CI)p value% of the population whose origin is African1.34 (1.20 to 1.49)0.000% of the population whose origin is Aboriginal1.32 (1.19 to 1.46)0.000% of the population whose origin is Caribbean1.19 (1.07 to 1.33)0.001

Conclusions

Customary methods for gonorrhoea surveillance consider individual characteristics of cases as risk factors for disease. However, gonorrhoea is clustered in neighbourhoods that have high proportions of African, Aboriginal and Caribbean populations. The ecological approach used in this study suggests that certain phenomena exist at the population level that may not exist at the individual level, which can be used to target population-level prevention programs.
P1-S4.21 Calibration of an individual-based model of STI transmission in Uganda: a novel ABC-Bayesian Emulation hybrid approach
Authors: Johnson H , Edmunds W John , White R
Published: July 2011

Introduction

The complexity of dynamic epidemic systems has led to the use of large-scale stochastic models for prediction purposes. However, methods for robustly calibrating and analysing these models can be prohibitively inefficient. We propose an algorithm for fitting complex models that incorporates elements of both Approximate Bayesian Computation (ABC) and Bayesian Emulation. ABC enables inference about model parameters without needing to calculate a likelihood function, by generating approximations from repeated model runs. However, each model run might take hours. Emulation methods are being developed in the fields of cosmology and meteorological modelling. The complex model function is summarised as an “emulator”: a stochastic function that represents global behaviour of the function as a linear regression model and local deviations from this behaviour as Gaussian processes. The emulator acts as a cheap proxy for the complex model, allowing both calibration and sensitivity analysis to be conducted in a fraction of the time.

Methods

We report the initial application of an emulation-based calibration algorithm to an individual-based stochastic model of STI transmission in Uganda. Starting with uninformative priors for 19 behavioural and biological input parameters, we “trained” an emulator with 200 sampled parameter sets and their corresponding model output (point estimates of HIV prevalence). Sampling a further 10 000 parameter sets from the priors, we used the emulator to make output predictions over a large area of input parameter space. Weighting each parameter set by goodness of fit to observed data, we identified promising areas of parameter space for complex model evaluation. A more accurate emulator was then trained, incorporating this additional complex model output. The process was repeated as in sequential ABC methods.

Results

The use of emulators allowed evaluation of large areas of parameter space due to increased computational efficiency. Processing time for one prevalence point estimate was reduced from over 15 min on an HPC cluster to less than 0.1 s on a PC. Even the first two waves of such an algorithm provided helpful insight into the most influential parameters.

Conclusions

The development of an ABC—Bayesian Emulation hybrid approach to complex model calibration is promising. Emulators offer large advantages in computational efficiency. However, further research is needed regarding weighting, tolerance levels and covariance.