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#91 Counting the shots
AEP Vol. 12, No. 7 October 2002: 488–534
ABSTRACTS (ACE)
METHODS: We invited 738 students to participate. Students self-collected urine, throat, vaginal and anal orifice specimens, and completed a self-administered questionnaire. RESULTS: 216 men (47%) and 246 women (53%) participated in the study (462/738). 34% (82/241) of women and 20% (43/211) of men were colonized with GBS in at least one site. Women were twice as likely as men to be colonized with GBS at any site (p .001). Among the 141 roommate pairs studied, 10 (7%) roommates were both positive for GBS. Ever engaging in sexual activity yielded the strongest crude association with GBS colonization. Chicken, pork and fish consumption was associated with an increased risk of colonization in women, while milk consumption was associated with a decreased risk. Similar crude associations were not detected in men. CONCLUSION: GBS occurs frequently among otherwise healthy college students, and colonization is strongly associated with ever engaging in sexual activity. Direct contact that occurs during cohabitation, however, did not seem to influence GBS colonization, but various food items did. Prospective studies are required to differentiate risk factors for acquisition from those associated with persistent carriage. PII S1047-2797(02)00377-0
#90-S SENSITIVITY AND SPECIFICITY OF SYMPTOMOLOGY TO SCREEN FOR ELIGIBILITY FOR ANTI-RETROVIRAL THERAPY AMONG PREGNANT WOMEN RHN Nguyen, F Wabwire-Mangen, G Kigozi, D Serwadda, NK Sewankambo, TC Quinn, MJ Wawer, RH Gray, Department of Epidemiology, Johns Hopkins, Baltimore, MD PURPOSE: Maternal-To-Child-Transmission Plus programs have proposed to identify ART eligible women through antenatal care. Screening using AIDS-related symptoms is feasible in resource-poor settings. However among pregnant women attending antenatal care clinics, it is not known how well symptomology is correlated to CD4 count and HIV viral load (VL) which are traditionally used. METHODS: Using a population of HIV pregnant women from Rakai District, Uganda (n 325), we calculated the sensitivity, specificity, PPV, and NPV of identifying women for treatment using symptomology versus using the DHHS VL (55,000 cps/ml) criterion for initiation of treatment. For a sub-set of the pregnant women (n 86) we also analyzed the correlation between symptoms and CD4 count ( 350 cells/ml). Symptoms were selfreported and selected from 1993 WHO staging criteria. RESULTS: There was no association between WHO major or minor criteria and VL or CD4 cell count. Total number of symptoms was used to calculate the validity. Using the cutoffs of 1 and 3:
Cut-off 1 symptom
Sens (%) Spec (%)
Cut-off 3 symptoms
CD4 (cps/ml)
VL (cps/ml)
CD4 (cps/ml)
VL (cps/ml)
100.0 11.0
97.9 10.1
25.0 80.0
28.6 75.3
523
It is clear that pregnant women with zero symptoms have low VLs and high CD4 count. Treatment based solely on number of symptoms will over treat because the majority of women with symptoms would not have been eligible for treatment according to DHHS guidelines. CONCLUSION: CD4 or VL measurements are needed to identify HIV-positive pregnant women eligible for ART. Low-cost CD4 testing as a screen for treatment eligibility is urgently needed. PII S1047-2797(02)00378-2
#91 COUNTING THE SHOTS: A MODEL FOR IMMUNIZATION ASSESSMENT AND REFERRAL IN THE WIC SETTING DL Rickert, A Shefer, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA PURPOSE: Because children in poverty continue to be significantly under-immunized, WIC clinics, which are now the single largest point of access to these children, are crucial to assuring protection by vaccination. Realizing that comprehensive assessment of the immunization history of every child attending a WIC clinic exceeds the capacity of most local WIC clinics, a 7-member interagency collaboration led by the USDA and the CDC has proposed a simplified method in which the doses received of a single vaccine—the diphtheria-tetanus-pertussis (DTaP) series—are treated as a proxy for the entire 4-antigen 4:3:1:3 series (4 doses of DTaP, 3 of polio, 1 of measles-mumps-rubella, 3 of H influenza b). Because research has not yet shown whether children’s true immunization status can be assessed accurately in this way, we evaluated the validity of DTaP as a predictor of completion status for the universally recommended 4:3:1:3 series. METHODS: We analyzed 6,277 records of WIC-enrolled children from the National Immunization Survey 2000 to index parents’ reports of completion status for DTaP as shown on the handheld household record (Method 1); parents’ report of completion status for all immunizations in the 4:3:1:3 series (Method 2) based on the hand-held record; and providers’ report of completion status for the 4:3:1:3 series (child’s “true” immunization status). The comparative sensitivity, specificity, and overall test efficiency with which assessments based on Method 1 versus those based on Method 2 matched the provider-reported true immunization status were the main outcome measures. RESULTS: Although assessments based on the householdrecorded DTaP count alone were 9% less sensitive than those based on the household-reported entire 4:3:1:3 series (74% vs. 83%, respectively), they were 6% more specific (93% vs. 87%). Overall test efficiency for the two methods (88% vs. 86%) was not significantly different. CONCLUSIONS: Results will be discussed in terms of their implications for developing achievable health objectives for this vulnerable population through the WIC-Immunization partnership. PII S1047-2797(02)00379-4
ABSTRACTS (ACE)
METHODS: We invited 738 students to participate. Students self-collected urine, throat, vaginal and anal orifice specimens, and completed a self-administered questionnaire. RESULTS: 216 men (47%) and 246 women (53%) participated in the study (462/738). 34% (82/241) of women and 20% (43/211) of men were colonized with GBS in at least one site. Women were twice as likely as men to be colonized with GBS at any site (p .001). Among the 141 roommate pairs studied, 10 (7%) roommates were both positive for GBS. Ever engaging in sexual activity yielded the strongest crude association with GBS colonization. Chicken, pork and fish consumption was associated with an increased risk of colonization in women, while milk consumption was associated with a decreased risk. Similar crude associations were not detected in men. CONCLUSION: GBS occurs frequently among otherwise healthy college students, and colonization is strongly associated with ever engaging in sexual activity. Direct contact that occurs during cohabitation, however, did not seem to influence GBS colonization, but various food items did. Prospective studies are required to differentiate risk factors for acquisition from those associated with persistent carriage. PII S1047-2797(02)00377-0
#90-S SENSITIVITY AND SPECIFICITY OF SYMPTOMOLOGY TO SCREEN FOR ELIGIBILITY FOR ANTI-RETROVIRAL THERAPY AMONG PREGNANT WOMEN RHN Nguyen, F Wabwire-Mangen, G Kigozi, D Serwadda, NK Sewankambo, TC Quinn, MJ Wawer, RH Gray, Department of Epidemiology, Johns Hopkins, Baltimore, MD PURPOSE: Maternal-To-Child-Transmission Plus programs have proposed to identify ART eligible women through antenatal care. Screening using AIDS-related symptoms is feasible in resource-poor settings. However among pregnant women attending antenatal care clinics, it is not known how well symptomology is correlated to CD4 count and HIV viral load (VL) which are traditionally used. METHODS: Using a population of HIV pregnant women from Rakai District, Uganda (n 325), we calculated the sensitivity, specificity, PPV, and NPV of identifying women for treatment using symptomology versus using the DHHS VL (55,000 cps/ml) criterion for initiation of treatment. For a sub-set of the pregnant women (n 86) we also analyzed the correlation between symptoms and CD4 count ( 350 cells/ml). Symptoms were selfreported and selected from 1993 WHO staging criteria. RESULTS: There was no association between WHO major or minor criteria and VL or CD4 cell count. Total number of symptoms was used to calculate the validity. Using the cutoffs of 1 and 3:
Cut-off 1 symptom
Sens (%) Spec (%)
Cut-off 3 symptoms
CD4 (cps/ml)
VL (cps/ml)
CD4 (cps/ml)
VL (cps/ml)
100.0 11.0
97.9 10.1
25.0 80.0
28.6 75.3
523
It is clear that pregnant women with zero symptoms have low VLs and high CD4 count. Treatment based solely on number of symptoms will over treat because the majority of women with symptoms would not have been eligible for treatment according to DHHS guidelines. CONCLUSION: CD4 or VL measurements are needed to identify HIV-positive pregnant women eligible for ART. Low-cost CD4 testing as a screen for treatment eligibility is urgently needed. PII S1047-2797(02)00378-2
#91 COUNTING THE SHOTS: A MODEL FOR IMMUNIZATION ASSESSMENT AND REFERRAL IN THE WIC SETTING DL Rickert, A Shefer, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA PURPOSE: Because children in poverty continue to be significantly under-immunized, WIC clinics, which are now the single largest point of access to these children, are crucial to assuring protection by vaccination. Realizing that comprehensive assessment of the immunization history of every child attending a WIC clinic exceeds the capacity of most local WIC clinics, a 7-member interagency collaboration led by the USDA and the CDC has proposed a simplified method in which the doses received of a single vaccine—the diphtheria-tetanus-pertussis (DTaP) series—are treated as a proxy for the entire 4-antigen 4:3:1:3 series (4 doses of DTaP, 3 of polio, 1 of measles-mumps-rubella, 3 of H influenza b). Because research has not yet shown whether children’s true immunization status can be assessed accurately in this way, we evaluated the validity of DTaP as a predictor of completion status for the universally recommended 4:3:1:3 series. METHODS: We analyzed 6,277 records of WIC-enrolled children from the National Immunization Survey 2000 to index parents’ reports of completion status for DTaP as shown on the handheld household record (Method 1); parents’ report of completion status for all immunizations in the 4:3:1:3 series (Method 2) based on the hand-held record; and providers’ report of completion status for the 4:3:1:3 series (child’s “true” immunization status). The comparative sensitivity, specificity, and overall test efficiency with which assessments based on Method 1 versus those based on Method 2 matched the provider-reported true immunization status were the main outcome measures. RESULTS: Although assessments based on the householdrecorded DTaP count alone were 9% less sensitive than those based on the household-reported entire 4:3:1:3 series (74% vs. 83%, respectively), they were 6% more specific (93% vs. 87%). Overall test efficiency for the two methods (88% vs. 86%) was not significantly different. CONCLUSIONS: Results will be discussed in terms of their implications for developing achievable health objectives for this vulnerable population through the WIC-Immunization partnership. PII S1047-2797(02)00379-4