Faculty Bibliography

Ascaris is a soil transmitted helminth infection that is estimated to affect one sixth of the world's population. Current diagnosis of ascariasis is made using the Kato Katz method of microscopic examination of stool specimens. This is time and labor intensive, varies in sensitivity and specifcity depending on the examiner. In addition, diagnosis via stool examination is not possible until one month into the infection when the life cycle is complete. Serological assays have been unreliable because of differences in host responses to Ascaris antigens. The development of an assay that could detect Ascaris antigen in host bodily fuids in the early phase of infection would have wide applicability and utility. Immunoscreening of an A. suum infective larval stage 2 cDNA library was performed using sera from infected swine. Nitrocellulose membranes were rinsed, blocked and incubated with primary antibody followed by secondary antibody incubation with anti-pig IgG. BCIP/NBT Sigma Fast was used for staining immune complexes. Only two cDNA clones were strongly recognized by the immune sera. The clones were plaque-purifed and their inserts sequenced. These were found to encode different portions of the ABA-1 open reading frame. ABA-1 is an Ascaris antigen that has previously been described as a component of the Ascaris ES (excretory-secretory) protein which is produced and excreted by all stages of the parasite. Knowledge of the immunodominance of this antigen expressed in early L2 phase of infection will be used to screen timed specimens for the presence of this protein. Recombinant ABA-1 protein obtained from the ABA-1 containing clones will be quantifed and used as a control. Mutiple body fuids from infected and control swine will be screened. ABA-1 protein is also expressed by A. lumbricoides which infects humans, which makes it an ideal target for use in identifying early infection. The results and their implication for the development of new diagnostic tests of Ascaris infection will also be present!

Chronic hepatitis B affects Asian Americans at a much higher rate than the general US population. Appropriate care can limit morbidity and mortality from hepatitis B. However, access to care for many Asian Americans and other immigrant groups is limited by their lack of knowledge about the disease, as well as cultural, linguistic, and financial challenges. This article describes the results of BfreeNYC, a New York City pilot program that, from 2004 to 2008, provided hepatitis B community education and awareness, free screening and vaccinations, and free or low-cost treatment primarily to immigrants from Asia, but also to residents from other racial and ethnic minority groups. The program was the largest citywide screening program in the United States, reaching nearly 9,000 people, and the only one providing comprehensive care to those who were infected. During the program, new hepatitis B cases reported annually from predominantly Asian neighborhoods in the city increased 34 percent. More than two thousand people were vaccinated, and 1,162 of the 1,632 people who tested positive for hepatitis B received care from the program's clinical services. Our analysis found that the program was effective in reaching the target population and providing care. Although follow-up care data will be needed to demonstrate long-term cost-effectiveness, the program may serve as a useful prototype for addressing hepatitis B disparities in communities across the United States

Chronic hepatitis B affects between 800,000 and two million people in the United States and causes 4,000 deaths each year. Yet the costs and benefits of treatment have not been fully evaluated. Using a model that simulates disease progression, we compare treatment programs for hepatitis B that start at an early stage of the disease to treatment that begins at a late stage. Our analysis concludes that early hepatitis B care can improve health, reduce premature deaths, and prevent expensive complications, making it highly cost-effective in the long term. Our results demonstrate the importance of screening for hepatitis B among at-risk groups and then linking screening to treatment. They also illustrate how predictive models can be used to evaluate strategies for improving access to care

Objectives: To examine the therapeutic effects, the frequency of viral resistance and safety after prolonged ADV therapy in children with chronic hepatitis B (CHB.) Background: The safety and efficacy of adefovir dipivoxil (ADV) for CHB in children was reported several years ago after a randomized, doubleblind placebo (PLB)-controlled trial. Subsequently, ADV was licensed in the United States for use in children age 12 and older. The cohort of children and adolescents in the placebocontrolled study was followed for an additional 4 years, and many of the children remained on ADV for all or part of this time. This is the only report of the use of adefovir dipivoxil longterm in a pediatric cohort. Methods: After 48 weeks of doubleblind treatment, all placebo-treated subjects who did not exhibit HBeAg seroconversion at week 44, and all ADV-treated subjects, were offered open-label ADV for up to an additional 192 weeks. Treatment was discontinued if there was no virologic effect, except for adolescents with previous lamivudine exposure, in whom lamivudine was added to ADV. Subjects who achieved HBeAg seroconversion were followed in order to assess durability of seroconversion. Annual resistance surveillance was conducted for all subjects who had detectable HBV DNA levels. Result: Of the 170 subjects who completed the 48- week study, 162 participated in the open-label study. ADV was discontinued in 61 of 162 due to virologic failure. In subjects who continued treatment, either as monotherapy or with lamivudine, continued viral suppression and ALT normalization were noted. HBeAg seroconversions were observed in 54 subjects, and HBsAg seroconversion in 5 children. ADV was safe and well-tolerated. Resistance to ADV was observed in 1 child on ADV monotherapy. Nine treatment-experienced subjects entered the study with mutations associated with lamivudine. All nine subjects responded to ADV therapy. Conclusions: ALT normalization was common and continued HBeAg and HBsAg seroconversions were observed in children who received ADV for up to 5 years. Prolonged ADV treatment is safe in children. ADV may have utility in the treatment of chronic HBV infection in children. It should be reserved for those with virologic response

Background: Community coalitions are increasingly recognized as important strategies for addressing health disparities. By providing the opportunity to pool resources, they provide a means to develop and sustain innovative approaches to affect community health. Objectives: This article describes the challenges and lessons learned in building the Asian American Hepatitis B Program (AAHBP) coalition to conduct a community-based participatory research (CBPR) initiative to address hepatitis B (HBV) among New York City Asian-American communities. Methods: Using the stages of coalition development as a framework, a comprehensive assessment of the process of developing and implementing the AAHBP coalition is presented. Lessons Learned: Findings highlight the importance of developing a sound infrastructure and set of processes to foster a greater sense of ownership, shared vision, and investment in the program. Conclusion: Grassroots community organizing and campus-community partnerships can be successfully leveraged to address and prevent a significant health disparity in an underserved and diverse community

SETTING: Recent reports indicate a role of chemokine inducible protein 10 (IP-10) in Mycobacterium tuberculosis infection substantiated by the detection of elevated levels in plasma and at infection foci in individuals infected with M. tuberculosis. OBJECTIVE: To evaluate IP-10 as a potential marker for the diagnosis of M. tuberculosis infection in children living in a region of low tuberculosis (TB) prevalence. DESIGN: IP-10 levels were obtained after whole blood stimulation with M. tuberculosis-specific antigens in 127 children. IP-10 results were evaluated upon gradations of exposure risk to M. tuberculosis and correlation with tuberculin skin test and an interferon-gamma release assay (IGRA). RESULTS: IP-10 reactivity correlated well to risk of exposure to M. tuberculosis in children. There was a strong correlation between IP-10 and IGRA results. IP-10 responses, unlike interferon-gamma (IFN-gamma), were not age-dependent and detected more positive results in children aged <5 years. In the children with active disease, the IGRA was more sensitive than IP-10 at detecting M. tuberculosis infection. CONCLUSION: Our findings suggest that IP-10 in combination with IFN-gamma may enhance the diagnostic performance of IGRAs in detecting M. tuberculosis infection, especially in young children

BACKGROUND: The QuantiFERON-TB Gold test was the first blood test to be approved for the diagnosis of latent tuberculosis infection. Although it has been shown to be sensitive and specific in adults, limited data on its performance in children are available. METHODS: This was a prospective study of children receiving health care in New York, New York. Each child was assessed for risk factors for Mycobacterium tuberculosis infection, underwent tuberculin skin testing, and had a QuantiFERON-TB Gold In-Tube test performed. The concordance between tuberculin skin test and QuantiFERON-TB Gold In-Tube test results was calculated, and the results were analyzed according to the likelihood of exposure to M tuberculosis. RESULTS: Data for 207 children with valid tuberculin skin test and QuantiFERON-TB Gold In-Tube test results were analyzed. There was excellent correlation between negative tuberculin skin test results and negative QuantiFERON-TB Gold In-Tube test results; however, only 23% of children with positive tuberculin skin test results had positive QuantiFERON-TB Gold In-Tube test results. Positive QuantiFERON-TB Gold In-Tube test results were associated with increased likelihood of M tuberculosis exposure, and interferon gamma levels were higher in children with known recent exposure to M tuberculosis, compared with children with older exposure histories. Younger children produced lower interferon gamma levels in response to the mitogen (phytohemagglutinin) control used in the QuantiFERON-TB Gold In-Tube test, but indeterminant results were low for children of all ages. Performance characteristics were similar across all age groups. CONCLUSION: The QuantiFERON-TB Gold In-Tube test is a specific test for M tuberculosis exposure in children, with performance characteristics similar to those for adults residing in regions with low levels of endemic disease. Concerns about test sensitivity, especially for children <2 years of age, will require additional prospective long-term evaluation