Timothy M. Uyeki

Bio: Timothy M. Uyeki is an academic researcher from Centers for Disease Control and Prevention. The author has contributed to research in topics: Influenza A virus subtype H5N1 & Influenza A virus. The author has an hindex of 86, co-authored 309 publications receiving 42818 citations. Previous affiliations of Timothy M. Uyeki include National Center for Immunization and Respiratory Diseases & University of California, San Francisco.

Seroepidemiologic investigation of an outbreak of pandemic influenza A H1N1 2009 aboard a US Navy Vessel—San Diego, 2009

Abstract: Background During summer 2009, a US Navy ship experienced an influenza-like illness outbreak with 126 laboratory-confirmed cases of pandemic influenza A (H1N1) 2009 virus among the approximately 2000-person crew. Methods During September 24–October 9, 2009, a retrospective seroepidemiologic investigation was conducted to characterize the outbreak. We administered questionnaires, reviewed medical records, and collected post-outbreak sera from systematically sampled crewmembers. We used real-time reverse transcription-PCR or microneutralization assays to detect evidence of H1N1 virus infection. Results Retrospective serologic data demonstrated that the overall H1N1 virus infection attack rate was 32%. Weighted H1N1 virus attack rates were higher among marines (37%), junior-ranking personnel (34%), and persons aged 19–24 years (36%). In multivariable analysis, a higher risk of illness was found for women versus men (odds ratio [OR] = 2·2; 95% confidence interval [CI]: 1·1–4·4), marines versus navy personnel (OR = 1·7; 95% CI, 1·0–2·9), and those aged 19–24 versus ≥35 years (OR = 3·9; 95% CI, 1·2–12·8). Fifty-three percent of infected persons did not recall respiratory illness symptoms. Among infected persons, only 35% met criteria for acute respiratory illness and 11% for influenza-like illness. Conclusions Approximately half of H1N1 infections were asymptomatic, and thus, the attack rate was higher than estimated by clinical illness alone. Enhanced infection control measures including pre-embarkation illness screening, improved self-reporting of illness, isolation of ill and quarantine of exposed contacts, and prompt antiviral chemoprophylaxis and treatment might be useful in controlling shipboard influenza outbreaks.

Loperamide therapy for voluminous diarrhea in Ebola virus disease.

Abstract: The number of cases of Ebola virus disease (EVD) in West Africa has surpassed 19 000 [1]. Efforts to identify, isolate, and provide medical care to patients with EVD are ongoing, and efforts to improve clinical care must focus on improved management of massive gastrointestinal fluid loss. Gastrointestinal fluid losses, largely through diarrhea, are a hallmark manifestation of EVD that contribute to hypovolemic shock, severe electrolyte abnormalities, and high mortality [2, 3]. In contrast to cholera toxin–mediated diarrheal losses, in which oral rehydration solution alone dramatically reduces mortality [4], oral rehydration for patients with EVD is often insufficient to accomplish resuscitation or repletion of ongoing fluid losses. However, EVD is a systemic viral illness with profound and debilitating manifestations, including high fever, asthenia, myalgia, and delirium, that limit self-directed oral rehydration. New strategies are needed to limit mortality related to cholera-like gastrointestinal fluid losses in EVD. Massive gastrointestinal fluid and electrolyte losses may be successfully managed in resource-rich settings through careful estimation of volume losses, close laboratory monitoring of electrolytes and organ function, and replacement of fluid losses through balanced intravenous infusions over the course of illness [3]. This same level of intensive monitoring and care cannot be achieved in most EVD treatment units in West Africa, where high case loads, staffing shortages, and limited time in personal protective equipment because of the risk of heat exposure prohibit extended patient care interactions. In this setting, administration of antidiarrheal agents to limit gastrointestinal fluid and electrolyte losses may provide “a solution that prevents the problem at its source”. However, use of antidiarrheal agents for the management of EVD-mediated diarrhea is infrequently reported, and no safety and efficacy data to guide use in EVD exist. Although the mechanism of EVD-mediated diarrhea has not yet been characterized, the large volume of watery stool suggests a secretory process. Tolerance of enteral feeding when gastrointestinal symptoms are adequately controlled suggests that the small intestine structure and function remain intact. Autopsy studies of patients with EVD who died show mild inflammation of small intestinal lamina propria, suggesting the possibility of an inflammatory component to a secretory form of diarrhea, as well [5]. Clinically significant gastrointestinal bleeding observed in a small subset of patients with EVD, estimated to be <5% [2], raises the possibility that gastrointestinal inflammation may contribute to disease pathogenesis. Loperamide is a potent antidiarrheal agent with antiperistaltic and antisecretory effects [6]. Reducing EVD diarrheal losses with loperamide might allow for correction of negative fluid balance, reduce hypovolemic shock, limit electrolyte losses, and consequently improve survival. Recently, one author (D. S. C.) and colleagues reported that oral antiemetics and antidiarrheal therapy improved symptoms and reduced gastrointestinal fluid loss and environmental contamination in patients with EVD [2]. The reduction in environmental contamination may also lower the risk of nosocomial transmission to healthcare personnel and other patients under evaluation. There are limited data on the use of loperamide for EVD-mediated diarrhea [2]. Reluctance to use loperamide for EVD-mediated diarrhea may be based on the perception that it is of no benefit for the secretory diarrhea observed in cholera or concern about the risk of toxic megacolon when used to treat some bacterial inflammatory causes of diarrhea, such as Clostridium difficile infection [7]. Animal and human studies of shigellosis in the 1960s and subsequent case reports of adverse events raised concern that antimotility drug use in patients with infectious diarrhea might contribute to a worse outcome [8]. However, multiple randomized, placebo-controlled, double-blinded trials of loperamide in combination with antibiotic therapy for management of infectious diarrhea in adults have demonstrated its safety and efficacy [9]. A meta-analysis of 13 clinical trials of loperamide use in children aged ≤12 years with infectious diarrhea and predominantly mild dehydration demonstrated a decrease in the duration and frequency of diarrhea [10]. Serious adverse events associated with loperamide use, including death, ileus, or lethargy, were reported only in children <3 years of age. The Food and Drug Administration does not recommend loperamide use in children <24 months of age, and use is contraindicated in patients with dysentery (ie, stool with mucus or blood), but it may be used in combination with antibiotic treatment [11]. Loperamide should not be given to patients with suspected or documented ileus or intestinal paresis. Use of loperamide in patients with EVD to control gastrointestinal fluid losses and reduce environmental contamination appears rational, based on existing clinical observations and the available published data. However, controlled clinical trials of loperamide treatment of diarrhea in patients with EVD, in combination with oral rehydration solution, to assess safety and efficacy in adults and children, including its possible impact upon improving survival, are urgently needed. Until strategies to improve management of gastrointestinal fluid and electrolyte losses are refined and widely implemented in the management of EVD in West Africa, the presently observed high case-fatality will persist.

Seasonal Patterns in Human A (H5N1) Virus Infection: Analysis of Global Cases

Abstract: Background Human cases of highly pathogenic avian influenza (HPAI) A (H5N1) have high mortality. Despite abundant data on seasonal patterns in influenza epidemics, it is unknown whether similar patterns exist for human HPAI H5N1 cases worldwide. Such knowledge could help decrease avian-to-human transmission through increased prevention and control activities during peak periods. Methods We performed a systematic search of published human HPAI H5N1 cases to date, collecting month, year, country, season, hemisphere, and climate data. We used negative binomial regression to predict changes in case incidence as a function of season. To investigate hemisphere as a potential moderator, we used AIC and the likelihood-ratio test to compare the season-only model to nested models including a main effect or interaction with hemisphere. Finally, we visually assessed replication of seasonal patterns across climate groups based on the Koppen-Geiger climate classification. Findings We identified 617 human cases (611 with complete seasonal data) occurring in 15 countries in Southeast Asia, Africa, and the Middle East. Case occurrence was much higher in winter (n = 285, p = 0.03) than summer (n = 64), and the winter peak occurred across diverse climate groups. There was no significant interaction between hemisphere and season. Interpretation Across diverse climates, HPAI H5N1 virus infection in humans increases significantly in winter. This is consistent with increased poultry outbreaks and HPAI H5N1 virus transmission during cold and dry conditions. Prioritizing prevention and control activities among poultry and focusing public health messaging to reduce poultry exposures during winter months may help to reduce zoonotic transmission of HPAI H5N1 virus in resource-limited settings.

Use of Postexposure Prophylaxis After Occupational Exposure to Zaire ebolavirus

Abstract: From September 2014 to April 2015, 6 persons who had occupational exposures to Zaire ebolavirus in West Africa received investigational agent rVSV-ZEBOV or TKM-100802 for postexposure prophylaxis and were monitored in the United States. All patients experienced self-limited symptoms after postexposure prophylaxis; none developed Ebola virus disease.

What We Are Watching-Top Global Infectious Disease Threats, 2013-2016: An Update from CDC's Global Disease Detection Operations Center.

Abstract: To better track public health events in areas where the public health system is unable or unwilling to report the event to appropriate public health authorities, agencies can conduct event-based surveillance, which is defined as the organized collection, monitoring, assessment, and interpretation of unstructured information regarding public health events that may represent an acute risk to public health. The US Centers for Disease Control and Prevention's (CDC's) Global Disease Detection Operations Center (GDDOC) was created in 2007 to serve as CDC's platform dedicated to conducting worldwide event-based surveillance, which is now highlighted as part of the "detect" element of the Global Health Security Agenda (GHSA). The GHSA works toward making the world more safe and secure from disease threats through building capacity to better "Prevent, Detect, and Respond" to those threats. The GDDOC monitors approximately 30 to 40 public health events each day. In this article, we describe the top threats to public health monitored during 2012 to 2016: avian influenza, cholera, Ebola virus disease, and the vector-borne diseases yellow fever, chikungunya virus, and Zika virus, with updates to the previously described threats from Middle East respiratory syndrome-coronavirus (MERS-CoV) and poliomyelitis.

Clinical Characteristics of Coronavirus Disease 2019 in China.

Abstract: Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of...

Standards of Medical Care in Diabetes

Abstract: XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.