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  1. Article ; Online: Limitations of Reporting Requirements under California's Livestock Antimicrobial Restriction Law.

    Quaade, Sebastian / Casey, Joan A / Nachman, Keeve E / Tartof, Sara Y / Ho, Daniel E

    Environmental health perspectives

    2024  Volume 132, Issue 2, Page(s) 25001

    Abstract: Background: Antimicrobial use in livestock production is considered a key contributor to growing antimicrobial resistance in bacteria. In 2015, California became the first state to enact restrictions on routine antimicrobial use in livestock production ... ...

    Abstract Background: Antimicrobial use in livestock production is considered a key contributor to growing antimicrobial resistance in bacteria. In 2015, California became the first state to enact restrictions on routine antimicrobial use in livestock production via Senate Bill 27 (SB27). SB27 further required the California Department of Food and Agriculture (CDFA) to collect and disseminate data on antimicrobial use in livestock production.
    Objective: The goal of this report is to assess whether CDFA's data release allows us to evaluate how antimicrobial use changed after the implementation of SB27.
    Methods: We combine the CDFA data with feed drug concentration ranges from the Code of Federal Regulation to evaluate the spread of plausible antimicrobial use trends. We also estimate antimicrobial consumption rates using data from the National Agricultural Statistical Service (NASS) and compare these to changes in medicated feed production reported by the CDFA.
    Discussion: We show that CDFA's reported data are insufficient to reliably estimate whether antimicrobial usage has increased or decreased, most notably because no information is provided about the mass of antimicrobials approved for use or medicated feed drug concentrations. After incorporating additional external data on feed drug concentrations, one can at best provide uninformative bounds on the effect of SB27. We find some evidence that antimicrobial use has decreased by incorporating data on national sales of antimicrobials for food-producing animals, but the weakness of this inference underlines the need for improved data collection and dissemination, especially as other states seek to implement similar policies. We provide recommendations on how to improve reporting and data collection under SB27. https://doi.org/10.1289/EHP13702.
    MeSH term(s) Animals ; Livestock ; Anti-Infective Agents/pharmacology ; Anti-Infective Agents/therapeutic use ; Bacteria ; Animal Husbandry ; California ; Anti-Bacterial Agents/pharmacology
    Chemical Substances Anti-Infective Agents ; Anti-Bacterial Agents
    Language English
    Publishing date 2024-02-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 195189-0
    ISSN 1552-9924 ; 0091-6765 ; 1078-0475
    ISSN (online) 1552-9924
    ISSN 0091-6765 ; 1078-0475
    DOI 10.1289/EHP13702
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  2. Article ; Online: Obesity and Mortality Among Patients Diagnosed With COVID-19.

    Tartof, Sara Y / Murali, Sameer B / Malden, Debbie E

    Annals of internal medicine

    2021  Volume 174, Issue 6, Page(s) 887–888

    MeSH term(s) Body Mass Index ; COVID-19 ; Humans ; Obesity/complications ; SARS-CoV-2
    Language English
    Publishing date 2021-06-14
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 336-0
    ISSN 1539-3704 ; 0003-4819
    ISSN (online) 1539-3704
    ISSN 0003-4819
    DOI 10.7326/L21-0064
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  3. Article ; Online: Screening Practices and Risk Factors for Co-Infection with Latent Tuberculosis and Hepatitis B Virus in an Integrated Healthcare System - California, 2008-2019.

    Malden, Debbie E / Wong, Robert J / Chitnis, Amit S / Im, Theresa M / Tartof, Sara Y

    The American journal of medicine

    2023  Volume 137, Issue 3, Page(s) 258–265.e3

    Abstract: Background: Hepatitis B virus (HBV) and latent tuberculosis infection are associated with a significant global burden, but both are underdiagnosed and undertreated. We described the screening patterns and risk factors for co-infection with latent ... ...

    Abstract Background: Hepatitis B virus (HBV) and latent tuberculosis infection are associated with a significant global burden, but both are underdiagnosed and undertreated. We described the screening patterns and risk factors for co-infection with latent tuberculosis and HBV within a large healthcare system.
    Methods: Using data from Kaiser Permanente Southern California during 2008-2019, we described HBV infections, defined as a positive HBV surface antigen, e-antigen, or DNA test, and latent tuberculosis, defined as a positive Mantoux tuberculin skin test or interferon-gamma release assay test. We estimated adjusted odds ratios (aOR) for co-infection among screened adults with either infection.
    Results: Among 1997 HBV patients screened for latent tuberculosis, 23.1% were co-infected, and among 35,820 patients with latent tuberculosis screened for HBV, 1.3% were co-infected. Among HBV patients, co-infection risk was highest among Asians compared with White race/ethnicity (29.4% vs 5.7%, aOR 4.78; 95% confidence interval [CI], 2.75-8.31), and persons born in a high-incidence country compared with low-incidence countries (31.0% vs 6.6%; aOR 4.19; 95% CI, 2.61-6.73). For patients with latent tuberculosis, risk of co-infection was higher among Asian (aOR 9.99; 95% CI, 5.79-17.20), or Black race/ethnicity (aOR 3.33; 95% CI, 1.78-6.23) compared with White race/ethnicity. Persons born in high-incidence countries had elevated risk of co-infection compared with persons born in low-incidence countries (aOR 2.23; 95% CI, 1.42-3.50). However, Asians or persons born in high-incidence countries were screened at similar rates to other ethnicities or persons born in low-incidence countries.
    Conclusions: Latent tuberculosis risk is elevated among HBV patients, and vice versa. Risk of co-infection was highest among persons born in high-incidence countries and Asians. These findings support recent guidelines to increase HBV and tuberculosis screening, particularly among persons with either infection.
    MeSH term(s) Adult ; Humans ; Hepatitis B virus ; Latent Tuberculosis/diagnosis ; Latent Tuberculosis/epidemiology ; Coinfection/epidemiology ; Risk Factors ; Hepatitis B/complications ; Hepatitis B/diagnosis ; Hepatitis B/epidemiology ; California/epidemiology ; Delivery of Health Care, Integrated ; Prevalence
    Language English
    Publishing date 2023-11-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80015-6
    ISSN 1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
    ISSN (online) 1555-7162 ; 1873-2178
    ISSN 0002-9343 ; 1548-2766
    DOI 10.1016/j.amjmed.2023.10.031
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  4. Article ; Online: Assessing the difference in contamination of retail meat with multidrug-resistant bacteria using for-consumer package label claims that indicate on-farm antibiotic use practices- United States, 2016-2019.

    Stapleton, G Sean / Innes, Gabriel K / Nachman, Keeve E / Casey, Joan A / Patton, Andrew N / Price, Lance B / Tartof, Sara Y / Davis, Meghan F

    Journal of exposure science & environmental epidemiology

    2024  

    Abstract: Background: Antibiotic use in food-producing animals can select for antibiotic resistance in bacteria that can be transmitted to people through contamination of food products during meat processing. Contamination resulting in foodborne illness ... ...

    Abstract Background: Antibiotic use in food-producing animals can select for antibiotic resistance in bacteria that can be transmitted to people through contamination of food products during meat processing. Contamination resulting in foodborne illness contributes to adverse health outcomes. Some livestock producers have implemented antibiotic use reduction strategies marketed to consumers on regulated retail meat packaging labels ("label claims").
    Objective: We investigated whether retail meat label claims were associated with isolation of multidrug-resistant organisms (MDROs, resistant to ≥3 classes of antibiotics) from U.S. meat samples.
    Methods: We utilized retail meat data from the U.S. Food and Drug Administration National Antimicrobial Resistance Monitoring System (NARMS) collected during 2016-2019 for bacterial contamination of chicken breast, ground turkey, ground beef, and pork chops. We used modified Poisson regression models to compare the prevalence of MDRO contamination among meat samples with any antibiotic restriction label claims versus those without such claims (i.e., conventionally produced).
    Results: In NARMS, 62,338 meat samples were evaluated for bacterial growth from 2016-2019. Of these, 24,446 (39%) samples had label claims that indicated antibiotic use was restricted during animal production. MDROs were isolated from 2252 (4%) meat samples, of which 71% (n = 1591) were conventionally produced, and 29% (n = 661) had antibiotic restriction label claims. Compared with conventional samples, meat with antibiotic restriction label claims had a statistically lower prevalence of MDROs (adjusted prevalence ratio: 0.66; 95% CI: 0.61, 0.73). This relationship was consistent for the outcome of any bacterial growth.
    Impact: This repeated cross-sectional analysis of a nationally representative retail meat surveillance database in the United States supports that retail meats labeled with antibiotic restriction claims were less likely to be contaminated with MDROs compared with retail meat without such claims during 2016-2019. These findings indicate the potential for the public to become exposed to bacterial pathogens via retail meat and emphasizes a possibility that consumers could reduce their exposure to environmental reservoirs of foodborne pathogens that are resistant to antibiotics.
    Language English
    Publishing date 2024-02-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2218551-3
    ISSN 1559-064X ; 1559-0631
    ISSN (online) 1559-064X
    ISSN 1559-0631
    DOI 10.1038/s41370-024-00649-y
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  5. Article ; Online: Outpatient visits and antibiotic use due to higher valency pneumococcal vaccine serotypes.

    King, Laura M / Andrejko, Kristin L / Kabbani, Sarah / Tartof, Sara Y / Hicks, Lauri A / Cohen, Adam L / Kobayashi, Miwako / Lewnard, Joseph A

    The Journal of infectious diseases

    2024  

    Abstract: Background: In 2022-2023, 15- and 20-valent pneumococcal conjugate vaccines (PCV15/PCV20) were recommended for infants. We aimed to estimate the incidence of outpatient visits and antibiotic prescriptions in U.S. children (≤17 years) from 2016-2019 for ... ...

    Abstract Background: In 2022-2023, 15- and 20-valent pneumococcal conjugate vaccines (PCV15/PCV20) were recommended for infants. We aimed to estimate the incidence of outpatient visits and antibiotic prescriptions in U.S. children (≤17 years) from 2016-2019 for acute otitis media, pneumonia, and sinusitis associated with PCV15- and PCV20-additional (non-PCV13) serotypes to quantify PCV15/20 potential impacts.
    Methods: We estimated the incidence of PCV15/20-additional serotype-attributable visits and antibiotic prescriptions as the product of all-cause incidence rates, derived from national healthcare surveys and MarketScan databases, and PCV15/20-additional serotype-attributable fractions. We estimated serotype-specific attributable fractions using modified vaccine-probe approaches incorporating incidence changes post-PCV13 and ratios of PCV13 versus PCV15/20 serotype frequencies, estimated through meta-analyses.
    Results: Per 1000 children annually, PCV15-additional serotypes accounted for an estimated 2.7 (95% confidence interval 1.8-3.9) visits and 2.4 (1.6-3.4) antibiotic prescriptions. PCV20-additional serotypes resulted in 15.0 (11.2-20.4) visits and 13.2 (9.9-18.0) antibiotic prescriptions annually per 1,000 children. PCV15/20-additional serotypes account for 0.4% (0.2-0.6%) and 2.1% (1.5-3.0%) of pediatric outpatient antibiotic use.
    Conclusions: Compared with PCV15-additional serotypes, PCV20-additional serotypes account for >5 times the burden of visits and antibiotic prescriptions. Higher-valency PCVs, especially PCV20, may contribute to preventing pediatric pneumococcal respiratory infections and antibiotic use.
    Language English
    Publishing date 2024-03-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3019-3
    ISSN 1537-6613 ; 0022-1899
    ISSN (online) 1537-6613
    ISSN 0022-1899
    DOI 10.1093/infdis/jiae142
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  6. Article ; Online: Association of SARS-CoV-2 BA.4/BA.5 Omicron lineages with immune escape and clinical outcome

    Lewnard, Joseph A / Hong, Vennis / Tartof, Sara Y

    medRxiv

    Abstract: Expansion of the SARS-CoV-2 BA.4/BA.5 Omicron lineages in populations with prevalent immunity from prior infection and vaccination has raised concerns about the association of these lineages with immune escape. Here we show that COVID-19 vaccination and ... ...

    Abstract Expansion of the SARS-CoV-2 BA.4/BA.5 Omicron lineages in populations with prevalent immunity from prior infection and vaccination has raised concerns about the association of these lineages with immune escape. Here we show that COVID-19 vaccination and documented prior infection are associated with reduced protection against infection with BA.4/BA.5. Compared to time-matched BA.2 cases, BA.4/BA.5 cases had 9% (95% confidence interval: 2-17%) and 27% (15-41%) higher adjusted odds of having received 3 and 4 COVID-19 vaccine doses, respectively, and 55% (39-71%) higher adjusted odds of documented infection ≥90 days previously. However, BA.4/BA.5 infection was not associated with differential risk of emergency department presentation, hospital admission, or intensive care unit admission following an initial outpatient diagnosis. This finding held after correcting for potential exposure misclassification resulting from unascertained prior infections. Despite increased risk of BA.4/BA.5 breakthrough infection observed among previously vaccinated or infected individuals, the reduced severity associated with prior (BA.1 and BA.2) Omicron lineages has persisted with BA.4/BA.5.
    Keywords covid19
    Language English
    Publishing date 2022-08-02
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2022.07.31.22278258
    Database COVID19

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  7. Article ; Online: Predictors of hepatitis A immunity in adults in California in order to better utilize hepatitis A vaccine.

    Lewin, Bruno J / Rodriguez, Janelle / Yang, Su-Jau / Tartof, Sara Y

    Vaccine

    2021  Volume 39, Issue 39, Page(s) 5484–5489

    Abstract: Background: Hepatitis A vaccine recommendations now include homelessness, illegal drug use, and HIV, as well as traditional risk factors and travel to areas endemic for hepatitis A. We examined a large diverse population for predictors of Hepatitis A ... ...

    Abstract Background: Hepatitis A vaccine recommendations now include homelessness, illegal drug use, and HIV, as well as traditional risk factors and travel to areas endemic for hepatitis A. We examined a large diverse population for predictors of Hepatitis A immunity in order to better utilize Hepatitis A vaccine.
    Methods: We performed a cross-sectional descriptive study of members of a large integrated health plan with a test for Hepatitis A Immunoglobulin G (IgG) between January 1st, 2007, and December 31st, 2017. Exclusion criteria included age <18 years, <6 months of continuous enrollment, and Hepatitis A vaccine prior to Hepatitis A test. Variables of interest were age, gender, primary language spoken, ethnicity/race, neighborhood household income, and history of travel or history of jaundice. Multivariable logistic regression was performed to evaluate the association of risk factors on Hepatitis A immunity.
    Results: Of the 318,170 persons ≥ 18 years tested for Hepatitis A immunity, 155, 842 persons had a reactive Hepatitis A IgG test (49%). The lowest prevalence was for Whites at 28.1% followed by Blacks at 35.8%. Hispanics and Asian/Pacific Islanders had prevalence rates of 63% and 68.2% respectively. In adjusted analyses, Asian/Pacific Islanders, Hispanics and Blacks were 5.17, 3.44 and 1.42 times more likely to have Hepatitis A immunity than Whites. Those that spoke Spanish or language other than English or Spanish as their primary preferred language were 6.11 and 3.27 time more likely to have immunity than English speakers. Known travel history conferred a 2.16 likelihood of Hepatitis A immunity.
    Conclusions: Persons of Hispanic and Asian/Pacific Islander background as well as persons with a preferred spoken language other than English have a high prevalence of Hepatitis A immunity. Testing for Hepatitis A immunity prior to vaccination should be considered for these groups.
    MeSH term(s) Adolescent ; Adult ; California/epidemiology ; Cross-Sectional Studies ; European Continental Ancestry Group ; Hepatitis A/epidemiology ; Hepatitis A/prevention & control ; Hepatitis A Vaccines ; Humans
    Chemical Substances Hepatitis A Vaccines
    Language English
    Publishing date 2021-08-25
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605674-x
    ISSN 1873-2518 ; 0264-410X
    ISSN (online) 1873-2518
    ISSN 0264-410X
    DOI 10.1016/j.vaccine.2021.08.056
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  8. Article ; Online: Clinical outcomes associated with SARS-CoV-2 Omicron (B.1.1.529) variant and BA.1/BA.1.1 or BA.2 subvariant infection in Southern California.

    Lewnard, Joseph A / Hong, Vennis X / Patel, Manish M / Kahn, Rebecca / Lipsitch, Marc / Tartof, Sara Y

    Nature medicine

    2022  Volume 28, Issue 9, Page(s) 1933–1943

    Abstract: Epidemiologic surveillance has revealed decoupling of Coronavirus Disease 2019 (COVID-19) hospitalizations and deaths from case counts after emergence of the Omicron (B.1.1.529) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant ... ...

    Abstract Epidemiologic surveillance has revealed decoupling of Coronavirus Disease 2019 (COVID-19) hospitalizations and deaths from case counts after emergence of the Omicron (B.1.1.529) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant globally. However, assessment of the relative severity of Omicron variant infections presents challenges because of differential acquired immune protection against Omicron and prior variants and because longer-term changes have occurred in testing and healthcare practices. Here we show that Omicron variant infections were associated with substantially reduced risk of progression to severe clinical outcomes relative to time-matched Delta (B.1.617.2) variant infections within a large, integrated healthcare system in Southern California. Adjusted hazard ratios (aHRs) for any hospital admission, symptomatic hospital admission, intensive care unit admission, mechanical ventilation and death comparing individuals with Omicron versus Delta variant infection were 0.59 (95% confidence interval: 0.51-0.69), 0.59 (0.51-0.68), 0.50 (0.29-0.87), 0.36 (0.18-0.72) and 0.21 (0.10-0.44), respectively. This reduced severity could not be explained by differential history of prior infection among individuals with Omicron or Delta variant infection and was starkest among individuals not previously vaccinated against COVID-19 (aHR = 0.40 (0.33-0.49) for any hospital admission and 0.14 (0.07-0.28) for death). Infections with the Omicron BA.2 subvariant were not associated with differential risk of severe outcomes in comparison to BA.1/BA.1.1 subvariant infections. Lower risk of severe clinical outcomes among individuals with Omicron variant infection should inform public health response amid establishment of the Omicron variant as the dominant SARS-CoV-2 lineage globally.
    MeSH term(s) COVID-19/epidemiology ; California/epidemiology ; Humans ; Public Health ; SARS-CoV-2/genetics
    Language English
    Publishing date 2022-06-08
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 1220066-9
    ISSN 1546-170X ; 1078-8956
    ISSN (online) 1546-170X
    ISSN 1078-8956
    DOI 10.1038/s41591-022-01887-z
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  9. Article ; Online: Wildfire Exposure and Health Care Use Among People Who Use Durable Medical Equipment in Southern California.

    McBrien, Heather / Rowland, Sebastian T / Benmarhnia, Tarik / Tartof, Sara Y / Steiger, Benjamin / Casey, Joan A

    Epidemiology (Cambridge, Mass.)

    2023  Volume 34, Issue 5, Page(s) 700–711

    Abstract: Background: People using electricity-dependent durable medical equipment (DME) may be vulnerable to health effects from wildfire smoke, residence near wildfires, or residence in evacuation zones. To our knowledge, no studies have examined their ... ...

    Abstract Background: People using electricity-dependent durable medical equipment (DME) may be vulnerable to health effects from wildfire smoke, residence near wildfires, or residence in evacuation zones. To our knowledge, no studies have examined their healthcare utilization during wildfires.
    Methods: We obtained 2016-2020 counts of residential Zip Code Tabulation Area (ZCTA) level outpatient, emergency department (ED), and inpatient visits made by DME-using Kaiser Permanente Southern California members 45+. We linked counts to daily ZCTA-level wildfire particulate matter (PM) 2.5 and wildfire boundary and evacuation data from the 2018 Woolsey and 2019 Getty wildfires. We estimated the association of lagged (up to 7 days) wildfire PM 2.5 and residence near a fire or in an evacuation zone and healthcare visit frequency with negative binomial and difference-in-differences models.
    Results: Among 236,732 DME users, 10 µg/m 3 increases in wildfire PM 2.5 concentration were associated with the reduced rate (RR = 0.96; 95% confidence interval [CI] = 0.94, 0.99) of all-cause outpatient visits 1 day after exposure and increased rate on 4 of 5 subsequent days (RR range 1.03-1.12). Woolsey Fire proximity (<20 km) was associated with reduced all-cause outpatient visits, whereas evacuation and proximity were associated with increased inpatient cardiorespiratory visits (proximity RR = 1.45; 95% CI = 0.99, 2.12, evacuation RR = 1.72; 95% CI = 1.00, 2.96). Neither Getty Fire proximity nor evacuation was associated with healthcare visit frequency.
    Conclusions: Our results support the hypothesis that wildfire smoke or proximity interrupts DME users' routine outpatient care, via sheltering in place. However, wildfire exposures were also associated with increased urgent healthcare utilization in this vulnerable group.
    MeSH term(s) Humans ; Wildfires ; Air Pollutants/analysis ; Durable Medical Equipment ; Hospitalization ; Environmental Exposure/adverse effects ; Particulate Matter/analysis ; Smoke/adverse effects ; California/epidemiology
    Chemical Substances Air Pollutants ; Particulate Matter ; Smoke
    Language English
    Publishing date 2023-05-26
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1053263-8
    ISSN 1531-5487 ; 1044-3983
    ISSN (online) 1531-5487
    ISSN 1044-3983
    DOI 10.1097/EDE.0000000000001634
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  10. Article ; Online: Association of SARS-CoV-2 BA.4/BA.5 Omicron lineages with immune escape and clinical outcome.

    Lewnard, Joseph A / Hong, Vennis / Kim, Jeniffer S / Shaw, Sally F / Lewin, Bruno / Takhar, Harpreet / Tartof, Sara Y

    Nature communications

    2023  Volume 14, Issue 1, Page(s) 1407

    Abstract: Expansion of the SARS-CoV-2 BA.4 and BA.5 Omicron subvariants in populations with prevalent immunity from prior infection and vaccination, and associated burden of severe COVID-19, has raised concerns about epidemiologic characteristics of these lineages ...

    Abstract Expansion of the SARS-CoV-2 BA.4 and BA.5 Omicron subvariants in populations with prevalent immunity from prior infection and vaccination, and associated burden of severe COVID-19, has raised concerns about epidemiologic characteristics of these lineages including their association with immune escape or severe clinical outcomes. Here we show that BA.4/BA.5 cases in a large US healthcare system had at least 55% (95% confidence interval: 43-69%) higher adjusted odds of prior documented infection than time-matched BA.2 cases, as well as 15% (9-21%) and 38% (27-49%) higher adjusted odds of having received 3 and ≥4 COVID-19 vaccine doses, respectively. However, after adjusting for differences in epidemiologic characteristics among cases with each lineage, BA.4/BA.5 infection was not associated with differential risk of emergency department presentation, hospital admission, or intensive care unit admission following an initial outpatient diagnosis. This finding held in sensitivity analyses correcting for potential exposure misclassification resulting from unascertained prior infections. Our results demonstrate that the reduced severity associated with prior (BA.1 and BA.2) Omicron lineages, relative to the Delta variant, has persisted with BA.4/BA.5, despite the association of BA.4/BA.5 with increased risk of breakthrough infection among previously vaccinated or infected individuals.
    MeSH term(s) Humans ; SARS-CoV-2/genetics ; COVID-19/epidemiology ; COVID-19 Vaccines ; Breakthrough Infections
    Chemical Substances COVID-19 Vaccines
    Language English
    Publishing date 2023-03-14
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 2553671-0
    ISSN 2041-1723 ; 2041-1723
    ISSN (online) 2041-1723
    ISSN 2041-1723
    DOI 10.1038/s41467-023-37051-5
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