Epidemiology Committee Research Articles

Children's Oncology Group's 2023 blueprint for research: Epidemiology.

The Children's Oncology Group (COG) Epidemiology Committee has a primary focus on better understanding the etiologies of childhood cancers. Over the past 10years, the committee has leveraged the Childhood Cancer Research Network, and now more recently Project:EveryChild (PEC), to conduct epidemiologic assessments of various childhood cancers, including osteosarcoma, neuroblastoma, germ cell tumors, Ewing sarcoma, rhabdomyosarcoma, and Langerhans cell histiocytosis. More recent studies have utilized questionnaire data collected as part of PEC to focus on specific characteristics and/or features, including the presence of congenital disorders and the availability of stored cord blood. Members of the COG Epidemiology Committee have also been involved in other large-scale National Institutes of Health efforts, including the Childhood Cancer Data Initiative and the Gabriella Miller Kids First Pediatric Research Program, which are improving our understanding of the factors associated with childhood cancer risk. Future plans will focus on addressing questions surrounding health disparities, utilizing novel biospecimens in COG epidemiology studies, exploring the role of environmental factors on the etiologies and outcomes of childhood cancer, collaborating with other COG committees to expand the role of epidemiology in childhood cancer research, and building new epidemiologic studies from the Molecular Characterization Initiative-all with the ultimate goal of developing novel prevention and intervention strategies for childhood cancer.

Risk Assessment of COVID-19 in the Iranian Health System.

The outbreak of coronavirus disease 2019 (COVID-19) has exerted unprecedented pressure on healthcare systems throughout the world. This study was designed to develop a national health emergency management program based on risk assessment for COVID-19. Mixed-methods research was used. Based on recommendations of the national epidemiology committee, 2 risk scenarios were used as basic scenarios for risk assessment. Two rounds of Focus Group Discussions (FGDs) were conducted between January and May 2020 with 30 representatives of the health system. The data were collected, analyzed, and integrated by the research team. In the risk matrix, "contamination of environment and individuals" and "burnout of medical staff" occupied the red zone (intolerable risk). "Defects in screening and admissions," "process disruption in medical care and rehabilitation," "increased mental disorders," "social dissatisfaction," "the decline in healthcare services," and "loss of medical staff" were identified as the orange zone (significant risk) of the matrix. The avoidance of environmental and individual contamination and healthcare worker burnout are the priorities in Iran. Attention to intersectoral cooperation, the involvement of non-governmental organizations and private center capacities, integration of information health systems, and developing evidence-based protocols are other measures that can improve the health system's capacity in the response COVID-19.

Iran COVID-19 Epidemiology Committee: A Review of Missions, Structures, Achievements, and Challenges.

Background: Since the beginning of the coronavirus disease 2019 (COVID-19) epidemic in Iran, the control and management of the epidemic were headed by the National Headquarter for the Control of COVID-19 Epidemic through setting up different scientific committees, including the COVID-19 National Epidemiology Committee. The present study reviews the missions, structures, achievements, and challenges of the Epidemiology Committee. Study design: A rapid review Methods: All relevant reports, documents, guidelines, published literature, and surveillance data related to the establishment, visions, missions, roles, activities, and outputs of the COVID-19 Epidemiology Committee were critically reviewed in this study. Results: The efforts of the committee’s working groups may have impacted improvements in data registration/usage, provincial data quality at provincial levels, and perception of the epidemic situation in the provinces. The committees have also played role in informing the policies in different stages of the epidemic through routine or problem-based data/evidence analyses, epidemic investigations, and mathematical modeling. Conclusions: The structure and experience gained by the committee can be used in similar situations within and outside the country. To further improve the impacts of our activities, it is essential to have effective interaction, collaboration, and data flow between the committee and a broad range of organizations within and outside the Ministry of Health and Medical Education.

Iran COVID-19 Epidemiology Committee: A Review of Missions, Structures, Achievements, and Challenges.

Background: Since the beginning of the coronavirus disease 2019 (COVID-19) epidemic in Iran, the control and management of the epidemic were headed by the National Headquarter for the Control of COVID-19 Epidemic through setting up different scientific committees, including the COVID-19 National Epidemiology Committee. The present study reviews the missions, structures, achievements, and challenges of the Epidemiology Committee. Study design: A rapid review Methods: All relevant reports, documents, guidelines, published literature, and surveillance data related to the establishment, visions, missions, roles, activities, and outputs of the COVID-19 Epidemiology Committee were critically reviewed in this study. Results: The efforts of the committee’s working groups may have impacted improvements in data registration/usage, provincial data quality at provincial levels, and perception of the epidemic situation in the provinces. The committees have also played role in informing the policies in different stages of the epidemic through routine or problem-based data/evidence analyses, epidemic investigations, and mathematical modeling. Conclusions: The structure and experience gained by the committee can be used in similar situations within and outside the country. To further improve the impacts of our activities, it is essential to have effective interaction, collaboration, and data flow between the committee and a broad range of organizations within and outside the Ministry of Health and Medical Education.

Dry eye prevalence and main risk factors among undergraduate students

Introduction: Dry Eye (DE) is a common, complex, and multifactorial disease of the ocular surface and tear film that results in discomfort and visual disturbance. Prevalence varies from 5 to 50%, according to criteria, age, sex, and population studied. A meta-analysis was conducted to determine the prevalence of DE for different diagnostic criteria stratified by age and sex and reported by the TFOS DEWS II (Tear Film Ocular Surface Dry Eye Workshop) epidemiology committee showing relevant higher n umber among youth. The prevalence of symptomatic and clinically diagnosed DE varied by age, and sex, but only one study included young participants. Objective: This study aims to evaluate DE among a sample of undergraduate students from 2 major universities in Brazil, to comprehend symptoms, clinical signs presentation and most associated risk factors. Methodology: Cross-sectional survey that included 2,140 students (1,649 from UNICAMP and 491 from UNIFESP). Three fields of knowledge were included:1,128 from biological; 699 from exact; and 313 from human area. All participants completed 2 self-applicable questionnaires about dry eye symptoms: Ocular Surface Disease Index (OSDI) and short questionnaire used in the Women Heath Study (WHS), both previously translated and validated to Portuguese. DE symptoms were considered positive if OSDI score >22 or reported severe symptoms and/or previous history of clinical diagnosis at WHS questionnaire. Indeed, a list of risk factors such as contact lens wear, medications, ocular surgery, and systemic disease associated to DE was presented. Participants who fulfilled criteria for DE symptoms underwent a complete clinical evaluation for signs of the disease evaporative and aqueous deficient DE: such as tear meniscus height, hyperemia, non-invasive tear break up time, ocular surface staining with fluorescein and lisamine green and Schimmer test. Results: 2,140 participants aged 23.4±5.2 years old, 56.1% female and 43.9% male were enrolled. OSDI score was 19.4±16.2; 34.4% had OSDI had >22 and according to WHS 23.5% presented severe symptoms and/or previous history of clinical diagnosis. DE prevalence showed consistent sex differences, according OSDI scores 69.29% (510/736) female and 30.71% (226/736) male and with WHS questionnaire 64.8% (326/503) were female and 35.2% (177/503) were male (p<.0001). Most common risk factors were visual display use (50.1%), less than 6 hours of sleep/day (37.0%), oral contraceptive use (21.9%), contact lens wear (16.3%) and antiallergic use (15.1%). Univariate and multivariate analysis demonstrated that female sex, contact lens wear, ocular surgery, use of electronic devices over 6 hours/day, oral contraceptive, anti-depressant, anti-allergic, sleep less than 6 hours/day as relevant related factors. Clinical evaluation demonstrated mild signs of ocular surface dysfunction, normal tear volume, tear film instability and evaporative DE, such as tear film instability: Schimer test <10mm 14.8%; TBUT <10sec 61.1%; Fluorescein >4 5.6%; and Lisamine green >3 1.9%.Conclusion: Dry eye is prevalent condition among undergraduate students. In this Brazilian youth sample, rates were higher than data recently published, that showed in the general Brazilian population over 40 years old, the overall rate was 12.8%. However, further investigation might be addressed to better understand related risk factors and clinical presentation.

Central-line–Associated Bloodstream Infections Among Adult Intensive Care Unit Patients in Canadian Hospitals, 2011–2018

Background: Nosocomial central-line–associated bloodstream infections (CLABSIs) are an important cause of morbidity and mortality in hospitalized patients. CLABSI surveillance establishes rates for internal and external comparison, identifies risk factors, and allows assessment of interventions. Objectives: To determine the frequency of CLABSIs among adult patients admitted to intensive care units (ICUs) in CNISP hospitals and evaluate trends over time. Methods: CNISP is a collaborative effort of the Canadian Hospital Epidemiology Committee, the Association of Medical Microbiologists and Infectious Disease Canada and the Public Health Agency of Canada. Since 1995, CNISP has conducted hospital-based sentinel surveillance of healthcare-associated infections. Overall, 55 CNISP hospitals participated in ≥1 year of CLABSI surveillance. Adult ICUs are categorized as mixed ICUs or cardiovascular (CV) surgery ICUs. Data were collected using standardized definitions and collection forms. Line-day denominators for each participating ICU were collected. Negative-binomial regression was used to test for linear trends, with robust standard errors to account for clustering by hospital. We used the Fisher exact test to compare binary variables. Results: Each year, 28–42 adult ICUs participated in surveillance (27–37 mixed, 6–8 CV surgery). In both mixed ICUs and CV-ICUs, rates remained relatively stable between 2011 and 2018 (Fig. 1). In mixed ICUs, CLABSI rates were 1.0 per 1,000 line days in 2011, and 1.0 per 1,000 line days in 2018 (test for linear trend, P = .66). In CV-ICUs, CLABSI rates were 1.1 per 1,000 line days in 2011 and 0.8 per 1,000 line days in 2018 (P = .19). Case age and gender distributions were consistent across the surveillance period. The 30-day all-cause mortality rate was 29% in 2011 and in 2018 (annual range, 29%–35%). Between 2011 and 2018, the percentage of isolated microorganisms that were coagulase-negative staphylococci (CONS) decreased from 31% to 18% (P = .004). The percentage of other gram-positive organisms increased from 32% to 37% (P = .34); Bacillus increased from 0% to 4% of isolates and methicillin-susceptible Staphylococcus aureus from 2% to 6%). The gram-negative organisms increased from 21% to 27% (P = .19). Yeast represented 16% in 2011 and 18% in 2018; however, the percentage of yeast that were Candida albicans decreased over time (58% of yeast in 2011 and 30% in 2018; P = .04). Between 2011 and 2018, the most commonly identified species of microorganism in each year were CONS (18% in 2018) and Enterococcus spp (18% in 2018). Conclusions: Ongoing CLABSI surveillance has shown stable rates of CLABSI in adult ICUs from 2011 to 2018. The causative microorganisms have changed, with CONS decreasing from 31% to 18%.Funding: CNISP is funded by the Public Health Agency of Canada.Disclosures: Allison McGeer reports funds to her for studies, for which she is the principal investigator, from Pfizer and Merck, as well as consulting fees from Sanofi-Pasteur, Sunovion, GSK, Pfizer, and Cidara.

Impact of New Treatments on Hospitalisation, Surgery, Infection, and Mortality in IBD: a Focus Paper by the Epidemiology Committee of ECCO.

The medical management of inflammatory bowel disease has changed considerably over time with wider use of immunosuppressant therapy and the introduction of biological therapy. To what extent this change of medical paradigms has influenced and modified the disease course is incompletely known. To address this issue, an extensive review of the literature has been carried out on time trends of hospitalization, surgery, infections, cancer, and mortality rates in inflammatory bowel disease [IBD] patients. Preference was given to population-based studies but, when data from these sources were limited, large cohort studies and randomised controlled trials were also considered. In general, data on hospitalisation rates are strikingly heterogeneous and conflicting. In contrast, the consistent drop in surgery/colectomy rates suggests that the growing use of immunosuppressants and biological agents has had a positive impact on the course of IBD. Most clinical trial data indicate that the risk of serious infections is not increased in patients treated with anti-tumour necrosis factor alpha [TNFα] agents, but a different picture emerges from cohort studies. The use of thiopurines increases the risk for non-melanoma skin cancers and to a lesser extent for lymphoma and cervical cancer [absolute risk: low], whereas no clear increase in the cancer risk has been reported for anti-TNF agents. Finally, the majority of studies reported in the literature do not reveal any increase in mortality with immunosuppressant therapy or biologicals/anti-TNF agents.

Cardiovascular surgery for congenital heart disease associated with trisomy 18

Trisomy 18 (T18) is the second most common autosomal trisomy after trisomy 21 (T21). More than 90% of patients with T18 have congenital heart disease (CHD). Patients with T18 also have multiple malformations and severe psychomotor retardation, and their 1-year survival rate is 5%–10%. No criteria for surgical treatment of CHD in patients with T18 have been established. The prognosis of patients with T21 has been signifi cantly improved as surgical treatment of CHD for these patients has become common. However, the prognosis of patients with T18 is still poor, and it has been believed that surgical treatment does not improve their survival. Thus, CHD in this patient population has been managed conservatively. However, since 1990s, cases of heart surgery in patients with T18 have been reported in and outside Japan, and Graham et al. have evaluated the outcome of surgery in many patients with T18 (Table 1). Recently, indications for surgical treatment of CHD in patients with T18 have been discussed more extensively. In patients with T18, the risk of complications associated with surgical treatment of CHD is high, as is the risk of early death due to causes other than CHD. Because no well-defi ned criteria for heart surgery are available for patients with T18, physicians often experience diffi culty when determining whether heart surgery should be performed. In reports advocating surgical treatment of CHD for patients with T18, including that by Kobayashi et al. in this issue, authors have suggested that surgical treatment, when performed with full understanding of the disease by the parents and with their hope for improving their children’s condition, may contribute to improving the life expectancy of patients, discharge from hospital, and improving the quality of life (QOL) of both patients and their family. Opinions supportive of aggressive surgical treatment of CHD for patients with T18 may be based on recent advances in neonatal care. Kosho et al. reported that mechanical ventilation, surgical correction of gastrointestinal and respiratory complications, and active medical treatment of CHD in 24 patients with T18 improved the 1-year survival to 25%. Although these 24 patients did not undergo heart surgery, the fi ndings suggest that multimodality therapy for complications related to T18 may improve at least short-term survival. However, such reports remain scanty. A larger number of cases must be accumulated, as in the above-mentioned report by Kobayashi et al, for development of guidelines for treating these patients. The Genetics & Epidemiology Committee of the Japan Society of Pediatric Cardiology and Cardiac Surgery, of which the author is the chairperson, developed a survey plan to investigate the conditions of patients with T18 in Japan. Some of the results obtained from 15 institutions by the end of 2008 are briefl y summarized as follows.

A Thank you to Dr Nicolle, A Welcome to Dr Conly and a New Chapter for The Canadian Journal of Infectious Diseases & Medical Microbiology

The year 2009 will mark many milestones for The Canadian Journal of Infectious Diseases & Medical Microbiology. We will celebrate the 20th Anniversary of the Journal and Dr Lindsay Nicolle’s role as Editor-in-Chief. It will also mark the completion of Dr Nicolle’s term and the beginning for our new Editor-in-Chief. On behalf of Pulsus Group, I would like to express our heartfelt thanks and recognition of the enormous amount of work and dedication that Dr Nicolle has infused into the Journal over the years. At the same time, we are also grateful that Dr John Conly has agreed to take on what promises to be the difficult but rewarding role of Editor-in-Chief. Dr Conly has been a distinguished member of The Canadian Journal of Infectious Diseases & Medical Microbiology Editorial Board (Section Editor) for many years. He is a Professor and the Head of the Department of Medicine at the University of Calgary and in the Calgary Health Region. He is trained as a specialist in Infectious Diseases and is a founding Co-Chair of the Canadian Hospital Epidemiology Committee, former President of the Canadian Infectious Disease Society and is the former Chairman of the Canadian Committee on Antibiotic Resistance. He has published over 150 papers and has received numerous honours, including a Distinguished Service Award from the Canadian Infectious Diseases Society. Dr Conly possesses the powerful combination of expertise, creativity, tenacity and enthusiasm, which will be necessary to move the Journal forward. Pulsus Group is also celebrating its 25th Anniversary in 2009. We have had 25 years of successfully publishing many Canadian medical peer-review journals, often utilizing the profits of one title to offset the losses in another. The Canadian Journal of Infectious Diseases & Medical Microbiology, unfortunately, falls into the latter category. When launched in 1990 as the third Pulsus journal, it was hailed as an important step in publishing research in this critical therapeutic area. While its contents provide the latest in infectious disease research, society guidelines, reviews, case reports, etc, and its readership goes well beyond the specialists, there has never been strong enough advertising support to make the Journal profitable. Pulsus Group is committed to doing everything in our power to support all of our journals and will continue to explore all possible avenues to find a financial model that will support the Journal well into the future. We welcome Dr Conly’s energy, creative thinking and commitment to excellence and look forward to working with him to bring new and innovative ideas for the Journal to fruition.

Similar cefoxitin-resistance plasmids circulating in Escherichia coli from human and animal sources

The aim of this study was to determine the molecular epidemiology of cefoxitin-resistance Escherichia coli identified in cattle entering feedlots and determine if there were any similarities to E. coli causing human infections in Canadian hospitals. A total of 51 E. coli were isolated from a total of 2483 cattle entering four feedlots in southern Alberta, Canada. DNA fingerprinting using pulsed-field gel electrophoresis revealed thirty-two unique patterns with two major clusters observed comprised of Cluster A (11 strains) and Cluster B (7 strains). PCR and sequence analysis revealed 38 isolates (74.5%) harboured bla CMY-2, whereas the remainder were found to contain mutations in the promoter region of the chromosomal ampC gene, which has been previously associated with cefoxitin resistance. No resistance to nalidixic acid, ciprofloxacin, or amikacin was observed in the clinical isolates. bla CMY-2 harbouring plasmids were transferred to E. coli DH10B. All of the plasmids carrying bla CMY-2 contained the A/C replicon and also harboured other resistance genes. Plasmid fingerprinting using BglII revealed 17 unique patterns with all but one clustering within 70% similarity. Comparison of the plasmid fingerprints to those isolated from human clinically significant E. coli in Canada during a similar time period [Mulvey, M.R., Bryce, E., Boyd, D.A., Ofner-Agostini, M., Land, A.M., Simor, A.E, Paton, S., 2005. The Canadian Hospital Epidemiology Committee, and The Canadian Nosocomial Infection Surveillance Program, Health Canada. Molecular characterization of cefoxitin resistant Escherichia coli from Canadian hospitals. Antimicrob. Agents Chemother. 49, 358–365] revealed four strains that harboured bla CMY-2 A/C replicon type plasmid with fingerprint similarities of greater than 90% to the ones identified in E. coli from the cattle in this study. These findings highlight the potential linkage of multidrug resistant organisms in food producing animals and human infections in Canadian hospitals. The plasmids conferred resistance to multiple antibiotics which could limit options for the treatment of infections caused by these strains.

The 5th I. E. Melhus Graduate Student Symposium: Today's Students Preparing to Meet Tomorrow's Challenges in Epidemiology and Plant Disease Management

The Irving E. Melhus Graduate Student Symposium is a prestigious annual event that takes place as part of the American Phytopathology Society (APS) annual meeting and is co-sponsored by the APS Epidemiology Committee and the APS Foundation. The I.E. Melhus symposia feature graduate students competitively chosen to present their thesis research results. Criteria for selection include evaluation of the significance of the contribution towards improving our understanding of plant pathology, their communication skills, and letters of nomination. Accepted for publication 24 April 2007. Published 26 July 2007.

ＨＩＶにおける真菌症

Recent situation of HIV-related mycosis was discussed in this paper, with the analysis of 1) annual report of HIV trends in Japan by the AIDS epidemiology committee, 2) report of HIV-related opportunistic infections (OIs) collected by the AIDS-OIs research group funded by the Ministry of Health, Labour and Welfare, and 3) 17 cases of HIV-related aspergillosis collected by the author. Annual AIDS cases were increasing, and their major diseases were included with the following mycosis: pneumosystis pneumonia 35.7%, candidiasis 19.1%, and cryptococcosis 2.4%. There were two foreigner's cases of histoplasmosis and no coccidioidosis. Candidiasis was likely to be shown in Japanese patients and cryptococcosis was in foreigners. Outcome of cryptococcosis was very poor as 32.7% of patients died. There were 17 HIV-related aspergillosis, which consisted of 13 cases of lung diseases, 2 of brain lesions, and one each of sinus and stomach disease. Remarkable risk factor of HIV-related aspergillosis was decrease of CD4 cell count less than 10/microl, in addition to the usual risk factors of aspergillosis. Outcome of aspergillosis was very poor, as all treated cases died except one recent case treated with voriconazole.

Implementation of dermato-epidemiology curriculum at Case Western Reserve University dermatology program

Dermato-epidemiology curriculum has been identified by the American Academy of Dermatology (AAD) as an important foundation for dermatology residency training. However, no one has yet reported implementation of dermato-epidemiology curriculum. To evaluate and relate our experience carrying out a dermato-epidemiology resident education initiative, based on recommendations by the AAD Epidemiology Committee. Monthly lectures based on topics suggested by the AAD Epidemiology Curriculum. Pre- and post-test multiple choice and free-form question measures were employed to examine performance, assess resident enthusiasm, and solicit feedback from the initiative. Quantitative achievement on multiple-choice items improved slightly, but insignificantly, from 53 percent to 58 percent. Resident level of enthusiasm and perceived efficacy for the intervention varied from 3.3 to 4.0 on a 5-point Likert scale where "1" indicates strongly disagree and "5" indicates strongly agree with measures of effectiveness. Dermato-epidemiology curriculum is desirable and achievable even in dermatology programs without full-time epidemiologists. A successful epidemiology curriculum should be clinically and board-examination relevant, incorporating aspects of problem-based, interactive learning.

The American Phytopathological Society 3rd I. E. Melhus Graduate Student Symposium: New Thesis Research Contributions to Plant Disease Epidemiology

The I. E. Melhus Fund was established in The American Phytopathological Society Foundation with gifts from Dr. and Mrs. William C. Paddock, Mr. and Mrs. Walter Goeppinger, and Dr. and Mrs. Jack Wallin and enhanced by additional funds from the Foundation. Irving E. Melhus was a renowned teacher, an innovative researcher, and an outstanding departmental administrator at Iowa State University. His breadth of experience, contributions to the practical application of disease control, classic work on root pathogens of Iowa crops, and his visionary work on corn improvement epitomize a truly pioneer plant pathologist. In 1939, he coauthored the well-written textbook, The Elements of Plant Pathology, with Dr. G. C. Kent. His service to The American Phytopathological Society further exemplified his leadership in and commitment to the profession of phytopathology. He was president of APS in 1926 and was elected a Fellow in 1965. He was a member of the Iowa Academy of Sciences, the Botanical Society of America, and a fellow of the American Association for the Advancement of Science. Dr. Melhus was not only an outstanding plant pathologist, he was an inspiring mentor and an engaging personality with a keen sense of humor. Initially used to sponsor individual speakers (I. E. Melhus student speakers presented in 1997, 1998, and 2000), the first symposium, sponsored by the Epidemiology Committee, was funded in 1999. The second student speaker symposium, organized by the Plant Disease Losses Committee, was held in 2001 and published in 2002. The papers published here are two of the three papers presented in the 3rd I. E. Melhus Graduate Student Symposium: New Thesis Research Contributions to Plant Disease Epidemiology. These speakers were chosen through a competitive process by the Epidemiology Committee and presented their papers at the 2002 Annual Meeting of The American Phytopathological Society. Effective for 2003, selection of the committees to organize the annual I. E. Melhus symposium is now the responsibility of the APS Scientific Programs Board.

The American Phytopathological Society 2nd I.E. Melhus Graduate Student Symposium: New Frontiers in Plant Disease Losses and Disease Management

The I.E. Melhus Fund was established in The American Phytopathological Society Foundation with gifts from Dr. and Mrs. William C. Paddock, Mr. and Mrs. Walter Goeppinger, and Dr. and Mrs. Jack Wallin and enhanced by additional funds from the Foundation. Irving E. Melhus was a renowned teacher, an innovative researcher, and an outstanding departmental administrator at Iowa State University. His breadth of experience, contributions to the practical application of disease control, classic work on root pathogens of Iowa crops, and his visionary work on corn improvement epitomize a truly pioneer plant pathologist. In 1939, he coauthored the well-written textbook, The Elements of Plant Pathology, with Dr. G. C. Kent. His service to The American Phytopathological Society further exemplified his leadership in and commitment to the profession of phytopathology. He was president of APS in 1926 and was elected a Fellow in 1965. He was a member of the Iowa Academy of Sciences, the Botanical Society of America, and a Fellow of the American Association for the Advancement of Science. Dr. Melhus was not only an outstanding plant pathologist, he was an inspiring mentor and an engaging personality with a keen sense of humor. Initially used to sponsor individual speakers (I.E. Melhus student speakers presented in 1997, 1998, and 2000), the first symposium, sponsored by the Epidemiology Committee, was funded in 1999. The second student speaker symposium, organized by the Plant Disease Losses Committee, was held in 2001. The papers published here are from those presented in the 2nd I.E. Melhus Student Symposium: New Frontiers in Plant Disease Losses and Disease Management at the APS meeting in August 2001. These speakers were chosen by a competitive process chaired by the Pacific Division Councilor. The responsibility for overseeing the selection process is being rotated alphabetically through the Divisions. The I.E. Melhus Fund has grown to the point that it will sponsor an annual student speaker symposium; effective for 2003, selection of the committees to organize the symposium will now be the responsibility of the APS Scientific Programs Board.

Morbidity, mortality, and healthcare burden of nosocomial Clostridium difficile-associated diarrhea in Canadian hospitals.

To assess the healthcare burden, morbidity, and mortality of nosocomial Clostridium difficile-associated diarrhea (N-CDAD) in Canadian hospitals. Laboratory-based prevalence study. Nineteen acute-care Canadian hospitals belonging to the Canadian Hospital Epidemiology Committee surveillance program. Hospitalized patients in the participating centers. Laboratory-based surveillance was conducted for C. difficile toxin in stool among 19 Canadian hospitals from January to April 1997, for 6 continuous weeks or until 200 consecutive diarrhea stool samples had been tested at each site. Patients with N-CDAD had to fulfill the case definition. Data collected for each case included patient demographics, length of stay, extent of diarrhea, complications of CDAD, CDAD-related medical interventions, patient outcome, and details of death. We found that 371 (18%) of 2,062 tested patients had stools with positive results for C difficile toxin, of whom 269 (13%) met the case definition for nosocomial CDAD. Of these, 250 patients (93%) had CDAD during their hospitalization, and 19 (7%) were readmitted because of CDAD (average readmission stay, 13.6 days). Forty-one patients (15.2%) died, of whom 4 (1.5% of the total) were considered to have died directly or indirectly of N-CDAD. The following N-CDAD-related morbidity was noted: dehydration, 3%; hypokalemia, 2%; gastrointestinal hemorrhage requiring transfusion, 1%; bowel perforation, 0.4%; and secondary sepsis, 0.4%. The cost of N-CDAD readmissions alone was estimated to be a minimum of $128,200 (Canadian dollars) per year per facility. N-CDAD is a common and serious nosocomial infectious complication in Canada, is associated with substantial morbidity and mortality, and imposes an important financial burden on healthcare institutions.

N‐CDAD in Canada: Results of the Canadian Nosocomial Infection Surveillance Program 1997 N‐CDAD Prevalence Surveillance Project

A 1996 preproject survey among Canadian Hospital Epidemiology Committee (CHEC) sites revealed variations in the prevention, detection, management and surveillance of Clostridium difficile-associated diarrhea (CDAD). Facilities wanted to establish national rates of nosocomially acquired CDAD (N-CDAD) to understand the impact of control or prevention measures, and the burden of N-CDAD on health care resources. The CHEC, in collaboration with the Laboratory Centre for Disease Control (Health Canada) and under the Canadian Nosocomial Infection Surveillance Program, undertook a prevalence surveillance project among selected hospitals throughout Canada. To establish national prevalence rates of N-CDAD. For six weeks in 1997, selected CHEC sites tested all diarrheal stools from inpatients for either C difficile toxin or C difficile bacteria with evidence of toxin production. Questionnaires were completed for patients with positive stool assays who met the case definitions. Nineteen health care facilities in eight provinces participated in the project. The overall prevalence of N-CDAD was 13.0% (95% CI 9.5% to 16.5%). The mean number of N-CDAD cases were 66.3 cases/100,000 patient days (95% CI 37.5 to 95.1) and 5.9 cases/1000 patient admissions (95% CI 3.4 to 8.4). N-CDAD was found most frequently in older patients and those who had been hospitalized for longer than two weeks in medical or surgical wards. This national prevalence surveillance project, which established N-CDAD rates, is useful as 'benchmark' data for Canadian health care facilities, and in understanding the patterns and impact of N-CDAD.

Vancomycin-Resistant Enterococci in Canada Revisited

B Lynn Johnston MD FRCPC, John M Conly MD FRCPC In the July/August 1997 issue of the The Canadian Journal of Infectious Diseases, the Adult Infectious Disease Notes was entitled “The emerging epidemiology of vancomycin-resistant enterococci (VRE) in Canada”(1). At that time, it was acknowledged that VRE’s Canadian epidemiology was not fully elucidated. The first isolate of VRE had been reported in Edmonton in 1993, and the first outbreak of VRE in Canada occurred in Toronto in 1995 (1). This outbreak was presented as “A casecontrol analysis of the ‘call bell’ outbreak” (2). This was in reference to the contaminated call bells, a previously unrecognized reservoir and potential vector. But was it also alluding to a wake-up call for Canada to the emergence of VRE in its hospitals? In response to the need for more data describing the epidemiology of VRE in Canada, the Canadian Nosocomial Infection Surveillance Program (CNISP), a collaborative effort of the Canadian Hospital Epidemiology Committee (CHEC), a subcommittee of the Canadian Infectious Disease Society, and the Laboratory Centre for Disease Control (LCDC), Health Canada undertook several initiatives including two-point prevalence surveys, establishment of the Passive Reporting Network (PRN) for VRE occurrences in Canada and the VRE Incidence Surveillance Project for determining the incidence rate of VRE in CHEC facilities. What have we learned about VRE since 1997? Four major phenotypes of VRE are now recognized: van A, van B, van C and van D (3). The van A phenotype is characterized by high level resistance to both vancomycin and teicoplanin. It has been found in a number of enterococcal species. The van B phenotype has low to moderate level resistance to vancomycin with preserved teicoplanin susceptibility. It is seen primarily in Enterococcus faecalis and Enterococcus faecium. Van C resistance, found in non-E faecalis and non-E faecium, is nontransferrable (constitutive) and exhibits low level resistance to vancomycin. Finally, the van D phenotype is characterized by low to moderate level resistance to both vancomycin and teicoplanin. In the United States, data from the National Nosocomial Infection Surveillance System (NNIS) of the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, have revealed a dramatic national outbreak of VRE. Between 1989 and 1997, the percentage of enterococci isolated from nosocomial infections in intensive care unit (ICU) patients that were resistant to vancomycin rose from 0.4% to 23.2% and the percentage from non-ICU patients rose from 0.3% to 15.4% (5). From January to December 1999, VRE accounted for 25.2% of enterococci associated with nosocomial infections in ICU patients participating in NNIS, a 43% increase in resistance over the previous five years (5). Rates of vancomycin resistance in enterococci remained lower in non-ICU inpatient areas (11.7%) and in outpatient areas (3.6%) (4). Initially found mainly in large hospitals, VRE is now found in American hospitals of all sizes (4). At the 4th Decennial International Conference on Nosocomial and Healthcare-associated Infections, held March 5 to 9, 2000, a number of American centres described their experience with VRE. Dialysis patients remain a group with increased rates of VRE colonization. Tokars et al (6) found a prevalence of 9.2% at seven outpatient dialysis centres in Virginia and Maryland where patients were screened over several months in early 1998. During 1997 and 1998, VRE was isolated from 15.6% of dialysis patients screened within two days of admission to hospital in Atlanta, Georgia (7). For the nine outpatient clinics from where more than 20 patients were cultured in this study, VRE carriage ranged from 10% to 23% (7). While adult ICUs have previously been recognized as high prevalence settings for VRE, De Santis et al (8) reported an

Recruitment of minority students to U.S. epidemiology degree programs

PURPOSE: African-, Hispanic-, and Native Americans are underrepresented in the field of epidemiology including degree programs. As part of the assessment component of its mandate, the American College of Epidemiology Committee on Minority Affairs conducted a survey of minority recruitment activities of U.S. epidemiology degree programs. METHODS: The survey, containing questions related to marketing activities, institutional infrastructure, financial support, academic offerings, and receptive/supportive environment, was mailed to all programs identified in Episource as offering epidemiology degrees. Separate responses were requested concerning activities at the department and school levels. RESULTS: Fifty-two completed questionnaires were received (response rate of 79%). All but two institutions had at least one activity conducted by either the department or the school. However, all activities were more common at the school- than at the department-level. Indeed, some activities [a written minority student recruitment plan (6% of departments and 52% of schools), personnel with minority recruitment responsibilities (4% of departments and 73% of schools)] were almost exclusively school-sponsored. Although marketing-type activities were the most common minority recruitment tool used by departments, only 21% made visits to minority schools, 17% visited other colleges specifically to recruit minorities, and 12% produced materials targeted to ethnic/racial minorities. Six percent of the departments and 19% of the schools offered financial support (grants, fellowships, scholarships) to almost all underrepresented minority students. CONCLUSIONS: Even though individual epidemiology degree programs may not see a need for general recruitment activities in order to maintain the size of their applicant pool, minority-specific recruitment activities should be undertaken to enhance and diversify that pool. We recommend that epidemiology departments develop, adopt, and implement comprehensive written plans for the recruitment of underrepresented minority students into their programs.

Racial and ethnic distribution of faculty, students, and fellows in US epidemiology degree programs, 1992. Committee on Minority Affairs of the American College of Epidemiology.

The American College of Epidemiology Committee on Minority Affairs assessed the racial/ethnic distribution of faculty, students, and postdoctoral fellows in epidemiology degree programs in the United States in 1992. Fifty-six programs in schools of public health, medicine, or veterinary medicine completed a one-page anonymous questionnaire (85% response rate). Of 711 faculty members (median of 8 per program), 46 (6%) were minorities (US black, Hispanic, or Asian/Pacific Islander). Of 2142 students (1206 masters, 862 doctoral, 74 postdoctoral: median of 17 per program), 293 (14% of all students; 17% of US citizen students) were minorities. In the 46 doctoral programs, there were 36 black students (in 20 doctoral programs), 15 Hispanic students (in 9 programs), and no Native Americans. There were three minority postdoctoral fellows, all blacks (4% of all postdoctoral fellows). Determined, consistent, and sustained efforts will be required to boost the representation of blacks, Hispanics, and Native Americans in epidemiology.