Marta Guerra | Centers for Disease Control and Prevention (original) (raw)

Papers by Marta Guerra

Journal of Travel Medicine, Sep 1, 2006

Journal of Clinical Microbiology, Sep 1, 2013

Safety and health at work, Dec 1, 2015

Journal of Clinical Microbiology, Jul 1, 2000

Serum samples obtained from healthy, asymptomatic dogs in areas of Wisconsin and northern Illinoi... more Serum samples obtained from healthy, asymptomatic dogs in areas of Wisconsin and northern Illinois where Lyme disease is endemic or nonendemic were assayed for antibodies to Borrelia burgdorferi by enzyme-linked immunosorbent assay (ELISA), and positive results were confirmed by immunoblot assay. We found that 56.9% (562 of 1,077) of the samples were positive by ELISA and 82.0% (461 of 562) were positive by immunoblotting. A logistic regression model was developed to distinguish between nonvaccinated dogs naturally infected with B. burgdorferi from areas where the disease is endemic and dogs from areas where the disease is nonendemic that were vaccinated against Lyme disease. Of the 18 protein bands analyzed, 8 were found to be significantly different (P < 0.05) between the two groups. p93, p34, p31, and p28 occurred with increased frequency in vaccinated dogs, while p58, p37, p35, and p30 occurred more frequently in naturally infected dogs. The logistic regression equation obtained was used to determine the probability of natural infection among vaccinated dogs residing in areas where the disease is endemic. Of 125 samples, 87.2% had a very low probability of natural infection and only 2.4% were highly likely to be infected. Logistic regression is a useful method for distinguishing between vaccinated and naturally infected dogs and predicting the serological status of vaccinated dogs from areas where Lyme disease is endemic.

Emerging Infectious Diseases, Aug 1, 2014

Emerging Infectious Diseases, Sep 1, 2003

PLoS ONE, 2014

Crimean-Congo hemorrhagic fever (CCHF) is an acute, tick borne disease often associated with hemo... more Crimean-Congo hemorrhagic fever (CCHF) is an acute, tick borne disease often associated with hemorrhagic presentations and high case fatality rate. Kosovo is a highly endemic area for CCHF, with a significant case fatality rate. The aim of our study was to determine the prevalence of CCHF in Kosovo. We tested 1105 serum samples from healthy population in both endemic and non-endemic areas in the country. Our results revealed a seroprevalence of 4.0% (range 0-9.3%) which is comparable to the seroprevalence in other countries. We show that seroprevalence is correlated to the disease incidence in each studied municipality. We also tested 401 animal sera (353 cow, 30 sheep, 10 goat and 8 chicken) in four endemic municipalities in Kosovo. We detected specific antibodies in all animals except in chicken. Seroprevalence in cows is comparable to other endemic areas and correlates to the seroprevalence in humans. No CCHF RNA could be detected in 105 tick samples obtained in 2012 and 2013. Sequencing of CCHFV positive ticks from 2001 revealed that the virus is most closely related to viral strains that were detected in CCHF patients from Kosovo. Results suggest that mild CCHF cases are most probably underdiagnosed and consequently that the burden of disease is higher than reported. Our study provides key information for CCHF surveillance and raises awareness for possible imported cases in CCHF non-endemic countries.

Journal of Clinical Microbiology, 2000

New England Journal of Medicine, 2001

The American Journal of Tropical Medicine and Hygiene

A retrospective analysis was conducted of human cases and outbreaks of tularemia in the Republic ... more A retrospective analysis was conducted of human cases and outbreaks of tularemia in the Republic of Armenia from 1996 to 2012 utilizing geographic information system software. A total of 266 human cases of tularemia were recorded in Armenia from 1996 to 2012, with yearly incidence ranging from 0 to 5.5 cases per 100,000 people. Cases predominantly affected the male population (62.8%), 11-20 year age group (37.2%), agricultural workers (49.6%), and persons residing in rural areas (93.6%). In 2003, a waterborne outbreak involving 158 cases occurred in Kotayk Marz, and in 2007, a foodborne outbreak with 17 cases occurred in Gegharkunik Marz, attributed to exposure of food products to contaminated hay. Geospatial analysis of all cases showed that the majority were associated with the steppe vegetation zone, elevations between 1,400 and 2,300 m, and the climate zone associated with dry, warm summers, and cold winters. Characterization of these environmental factors were used to develop a predictive risk model to improve surveillance and outbreak response for tularemia in Armenia.

International journal of occupational and environmental health, Jan 17, 2017

Leptospirosis is postulated as a possible cause of Mesoamerican Nephropathy (MeN) in Central Amer... more Leptospirosis is postulated as a possible cause of Mesoamerican Nephropathy (MeN) in Central American workers. Investigate job-specific Leptospira seroprevalence and its association with kidney disease biomarkers. In 282 sugarcane workers, 47 sugarcane applicants and 160 workers in other industries, we measured anti-leptospiral antibodies, serum creatinine, and urinary injury biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), and N-acetyl-D-glucosaminidase (NAG). Leptospira seroprevalence differed among job categories and was highest among sugarcane cutters (59%). Seropositive sugarcane workers had higher NGAL concentrations (relative mean: 1.28; 95% CI: 0.94-1.75) compared to those who were seronegative, with similar findings among field and non-field workers. Leptospira seroprevalence varied by job category. There was some indication that seropositivity was associated with elevated biomarker levels, but results were inconsistent. Addit...

PLoS neglected tropical diseases, 2016

Leptospirosis is a potentially fatal bacterial zoonosis that is endemic throughout the tropics an... more Leptospirosis is a potentially fatal bacterial zoonosis that is endemic throughout the tropics and may be misdiagnosed as dengue. Delayed hospital admission of leptospirosis patients is associated with increased mortality. During a concurrent dengue/leptospirosis epidemic in Puerto Rico in 2010, suspected dengue patients that tested dengue-negative were tested for leptospirosis. Fatal and non-fatal hospitalized leptospirosis patients were matched 1:1-3 by age. Records from all medical visits were evaluated for factors associated with fatal outcome. Among 175 leptospirosis patients identified (4.7 per 100,000 residents), 26 (15%) were fatal. Most patients were older males and had illness onset during the rainy season. Fatal case patients first sought medical care earlier than non-fatal control patients (2.5 vs. 5 days post-illness onset [DPO], p < 0.01), but less frequently first sought care at a hospital (52.4% vs. 92.2%, p < 0.01). Although fatal cases were more often diagnos...

MMWR. Morbidity and Mortality Weekly Report, 2015

This site also includes summary publications from previous years. The Highlights section presents... more This site also includes summary publications from previous years. The Highlights section presents noteworthy epidemiologic and prevention information for 2013 for selected infectious diseases and conditions and additional information to aid in the interpretation of surveillance and infectious diseasesand conditions-trend data. Part 1 contains tables showing incidence data for the nationally notifiable infectious diseases and conditions reported during 2013; these tables do not include rows for conditions with zero cases reported in 2013.* The tables provide the number of cases reported to CDC for 2013 and the distribution of cases by month, geographic location, and patients' demographic characteristics (e.g., age, sex, race, and ethnicity). Part 1 also includes a table with the reported incidence of notifiable diseases during 2003-2013 and a table enumerating deaths associated with specified notifiable infectious diseases and conditions reported to CDC's National Center for Health Statistics (NCHS) during 2005-2011. Part 2 contains graphs and maps that depict summary data for selected notifiable infectious diseases and conditions described in tabular form in Part 1. Historical notifiable disease data, annotated as Part 3 in previous releases of this summary will no longer be included beginning with this report. Historical notifiable disease data during 1944-2012 are available online in previous years' summaries (http:// www.cdc.gov/mmwr/mmwr_nd). Efforts are underway to post finalized data for years 2004-2012 on CDC WONDER (http://wonder.cdc.gov). The Selected Reading section presents general and disease-specific references for notifiable infectious diseases and conditions. These references provide additional information on surveillance and epidemiologic concerns, diagnostic concerns, and infectious disease-control activities. Comments and suggestions from readers are welcome. To increase the usefulness of future editions, comments regarding the current report and descriptions of how information is or could be used are invited. Comments should be e-mailed to NNDSSweb@cdc.gov with the following subject line: "Annual Summary".

Journal of the American Veterinary Medical Association

Leptospirosis has recently been classified as an emerging disease because of large clusters of ca... more Leptospirosis has recently been classified as an emerging disease because of large clusters of cases resulting from exposure during recreational activities and natural disasters. In addition to their involvement in the prevention, diagnosis, and treatment of leptospirosis in animals, veterinarians serve an important role in public health by providing guidance and information on risk factors and prevention and control measures.

Safety and Health at Work, 2015

Background: In 2012, the Alaska Section of Epidemiology investigated personnel potentially expose... more Background: In 2012, the Alaska Section of Epidemiology investigated personnel potentially exposed to a Brucella suis isolate as it transited through three laboratories. Methods: We summarize the first implementation of the United States Centers for Disease Control and Prevention 2013 revised recommendations for monitoring such exposures: (1) risk classification; (2) antimicrobial postexposure prophylaxis; (3) serologic monitoring; and (4) symptom surveillance. Results: Over 30 people were assessed for exposure and subsequently monitored for development of illness. No cases of laboratory-associated brucellosis occurred. Changes were made to gaps in laboratory biosafety practices that had been identified in the investigation. Conclusion: Achieving full compliance for the precise schedule of serologic monitoring was challenging and resource intensive for the laboratory performing testing. More refined exposure assessments could inform decision making for follow-up to maximize likelihood of detecting persons at risk while not overtaxing resources.

Background: A varicella outbreak occurred among 5,000 Liberian refugees encamped in Cote d’Ivoire... more Background: A varicella outbreak occurred among 5,000 Liberian refugees encamped in Cote d’Ivoire as they awaited resettlement to the U.S. To stop the outbreak and expedite resettlement, a vaccination campaign was performed. We describe the epidemiology of the outbreak and impact of the campaign. Methods: Suspected varicella cases were interviewed upon onset and after resolution of illness. Selected cases underwent confirmatory testing by PCR, and genetic analysis of the circulating virus was done. Serologic testing of a convenience sample of 1028 refugees ≥15 years of age was conducted to estimate baseline varicella susceptibility. A vaccination campaign for refugees ≥12 months of age was implemented. Results: There were 100 suspected varicella cases identified from December 3 - March 31, 2004; 84 cases were interviewed, and 18 were confirmed by PCR. Ages ranged from 4 months to 70 years; 41% of cases were >18 years. Average rash duration was 5 days; 61 (73%) cases had <50 bl...

BACKGROUND: On April 26, 2012, a three-year-old child presented to a New York City (NYC) emergenc... more BACKGROUND: On April 26, 2012, a three-year-old child presented to a New York City (NYC) emergency department with fever and dyspnea. The child was hospitalized, diagnosed with bronchiolitis, and discharged on April 28 without antibiotics. On May 10 the admission blood culture was reported positive for Brucella canis. METHODS: Several public health agencies collaborated to investigate the case. RESULTS: The child, who had been asymptomatic since discharge, was treated with 45 days of antibiotics. Post-exposure prophylaxis was recommended for 19 laboratory workers, none of whom developed symptoms. The child’s family had purchased an eight-week-old male Yorkshire terrier from a NYC store in March 2012; the child had had frequent contact with it. Though the puppy was asymptomatic, its blood also grew B. canis, and it was subsequently euthanized. Both isolates were compared by multiple-locus variable-number tandem repeat analysis (MLVA); genetic similarity was close. The puppy originate...

American Journal of Tropical Medicine and Hygiene, 2015

Brucellosis is a common bacterial zoonotic infection but data on the prevalence among humans and ... more Brucellosis is a common bacterial zoonotic infection but data on the prevalence among humans and animals is limited in Kenya. A cross-sectional survey was conducted in three counties practicing different livestock production systems to simultaneously assess the seroprevalence of, and risk factors for brucellosis among humans and their livestock (cattle, sheep, camels, and goats). A two-stage cluster sampling method with random selection of sublocations and households was conducted. Blood samples were collected from humans and animals and tested for Brucella immunoglobulin G (IgG) antibodies. Human and animal individual seroprevalence was 16% and 8%, respectively. Household and herd seroprevalence ranged from 5% to 73% and 6% to 68%, respectively. There was a 6-fold odds of human seropositivity in households with a seropositive animal compared with those without. Risk factors for human seropositivity included regular ingestion of raw milk (adjusted odds ratio [aOR] = 3.5, 95% confidence interval [CI] = 2.8-4.4), exposure to goats (herding, milking, and feeding) (aOR = 3.1, 95% CI = 2.5-3.8), and handling of animal hides (aOR = 1.8, 95% CI = 1.5-2.2). Attaining at least high school education and above was a protective factor for human seropositivity (aOR = 0.3, 95% CI = 0.3-0.4). This linked study provides evidence of a strong association between human and animal seropositivity at the household level.

Emerging infectious diseases, 2014

A small percentage of persons with leptospirosis, a reemerging zoonosis, experience severe compli... more A small percentage of persons with leptospirosis, a reemerging zoonosis, experience severe complications that require hospitalization. The number of leptospirosis cases in the United States is unknown. Thus, to estimate the hospitalization rate for this disease, we analyzed US hospital discharge records for 1998-2009 for the total US population by using the Nationwide Inpatient Sample. During that time, the average annual rate of leptospirosis-associated hospitalizations was 0.6 hospitalizations/1,000,000 population. Leptospirosis-associated hospitalization rates were higher for persons >20 years of age and for male patients. For leptospirosis-associated hospitalizations, the average age of patients at admission was lower, the average length of stay for patients was longer, and hospital charges were higher than those for nonleptospirosis infectious disease-associated hospitalizations. Educating clinicians on the signs and symptoms of leptospirosis may result in earlier diagnosis ...