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Timothy J. Wade
Center for Public Health and Environmental Assessment, United States Environmental Protection Agency, Research Triangle Park, NC 27709, USA

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Journal article
Published: 28 May 2021 in International Journal of Environmental Research and Public Health
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Detecting environmental exposures and mitigating their impacts are growing global public health challenges. Antibody tests show great promise and have emerged as fundamental tools for large-scale exposure studies. Here, we apply, demonstrate and validate the utility of a salivary antibody multiplex immunoassay in measuring antibody prevalence and immunoconversions to six pathogens commonly found in the environment. The study aimed to assess waterborne infections in consenting beachgoers recreating at an Iowa riverine beach by measuring immunoglobulin G (IgG) antibodies against select pathogens in serially collected saliva samples. Results showed that nearly 80% of beachgoers had prior exposures to at least one of the targeted pathogens at the beginning of the study. Most of these exposures were to norovirus GI.1 (59.41%), norovirus GII.4 (58.79%) and Toxoplasma gondii (22.80%) and over half (56.28%) of beachgoers had evidence of previous exposure to multiple pathogens. Of individuals who returned samples for each collection period, 6.11% immunoconverted to one or more pathogens, largely to noroviruses (GI.1: 3.82% and GII.4: 2.29%) and T. gondii (1.53%). Outcomes of this effort illustrate that the multiplex immunoassay presented here serves as an effective tool for evaluating health risks by providing valuable information on the occurrence of known and emerging pathogens in population surveillance studies.

ACS Style

Swinburne Augustine; Tarsha Eason; Tim Wade; Shannon Griffin; Elizabeth Sams; Kaneatra Simmons; Malini Ramudit; Kevin Oshima; Alfred Dufour. Salivary Antibodies against Multiple Environmental Pathogens Found in Individuals Recreating at an Iowa Beach. International Journal of Environmental Research and Public Health 2021, 18, 5797 .

AMA Style

Swinburne Augustine, Tarsha Eason, Tim Wade, Shannon Griffin, Elizabeth Sams, Kaneatra Simmons, Malini Ramudit, Kevin Oshima, Alfred Dufour. Salivary Antibodies against Multiple Environmental Pathogens Found in Individuals Recreating at an Iowa Beach. International Journal of Environmental Research and Public Health. 2021; 18 (11):5797.

Chicago/Turabian Style

Swinburne Augustine; Tarsha Eason; Tim Wade; Shannon Griffin; Elizabeth Sams; Kaneatra Simmons; Malini Ramudit; Kevin Oshima; Alfred Dufour. 2021. "Salivary Antibodies against Multiple Environmental Pathogens Found in Individuals Recreating at an Iowa Beach." International Journal of Environmental Research and Public Health 18, no. 11: 5797.

Journal article
Published: 03 March 2020 in Preventive Medicine
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The beach environment creates many barriers to effective sun protection, putting beachgoers at risk for sunburn, a well-established risk factor for skin cancer. Our objective was to estimate incidence of sunburn among beachgoers and evaluate the relationship between sunburn incidence and sun-protective behaviors. A secondary analysis, of prospective cohorts at 12 locations within the U.S. from 2003 to 2009 (n = 75,614), were pooled to evaluate sunburn incidence 10–12 days after the beach visit. Behavioral and environmental conditions were cross-tabulated with sunburn incidence. Multivariable logistic regression was used to estimate the association between new sunburn and sun-protective behaviors. Overall, 13.1% of beachgoers reported sunburn. Those aged 13–18 years (16.5%), whites (16.0%), and those at beach locations along the Eastern Seaboard (16.1%), had the highest incidence of sunburn. For those spending ≥5 h in the sun, the use of multiple types of sun protection reduced odds of sunburn by 55% relative to those who used no sun protection (Odds Ratio = 0.45 (95% Confidence Interval:0.27–0.77)) after adjusting for skin type, age, and race. Acute health effects of sunburn tend to be mild and self-limiting, but potential long-term health consequences are more serious and costly. Efforts to encourage and support proper sun-protective behaviors, and increase access to shade, protective clothing, and sunscreen, can help prevent sunburn and reduce skin cancer risk among beachgoers.

ACS Style

Stephanie DeFlorio-Barker; Dawn Holman; Robert Landolfi; Benjamin F. Arnold; John M. Colford; Stephen B. Weisberg; Kenneth C. Schiff; Elizabeth A. Sams; Timothy J. Wade. Incidence and public health burden of sunburn among beachgoers in the United States. Preventive Medicine 2020, 134, 106047 .

AMA Style

Stephanie DeFlorio-Barker, Dawn Holman, Robert Landolfi, Benjamin F. Arnold, John M. Colford, Stephen B. Weisberg, Kenneth C. Schiff, Elizabeth A. Sams, Timothy J. Wade. Incidence and public health burden of sunburn among beachgoers in the United States. Preventive Medicine. 2020; 134 ():106047.

Chicago/Turabian Style

Stephanie DeFlorio-Barker; Dawn Holman; Robert Landolfi; Benjamin F. Arnold; John M. Colford; Stephen B. Weisberg; Kenneth C. Schiff; Elizabeth A. Sams; Timothy J. Wade. 2020. "Incidence and public health burden of sunburn among beachgoers in the United States." Preventive Medicine 134, no. : 106047.

Journal article
Published: 20 December 2019 in Scientific Reports
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Norovirus is one of the most common causes of gastroenteritis. Following infection, anti-norovirus salivary immunoglobulin G (IgG) rises steeply within 2 weeks and remains elevated for several months; this immunoconversion can serve as an indicator of infection. We used a multiplex salivary immunoassay to study norovirus infections among 483 visitors to a Lake Michigan beach in 2015. Saliva was collected on the day of the beach visit (S1); after 10–14 days (S2); and after 30–40 days (S3). Luminex microspheres were coupled to recombinant antigens of genogroup I (GI) and II (GII) noroviruses and incubated with saliva. Immunoconversion was defined as at least 4-fold increase in anti-norovirus IgG antibody response from S1 to S2 and a 3-fold increase from S1 to S3. Ten (2.1%) immunoconverted to either GI (2) or GII (8) norovirus. Among those who immunoconverted, 40% reported at least one gastrointestinal symptom and 33% reported diarrhea, compared to 15% (p = 0.06) and 8% (p = 0.04) among those who did not immunoconvert, respectively. The two participants who immunoconverted to GI norovirus both swallowed water during swimming (p = 0.08). This study demonstrated the utility of a non-invasive salivary immunoassay to detect norovirus infections and an efficient approach to study infectious agents in large cohorts.

ACS Style

Timothy J. Wade; Shannon M. Griffin; Andrey I. Egorov; Elizabeth Sams; Edward Hudgens; Swinburne Augustine; Stephanie DeFlorio-Barker; Trevor Plunkett; Alfred P. Dufour; Jennifer N. Styles; Kevin Oshima. Application of a multiplex salivary immunoassay to detect sporadic incident norovirus infections. Scientific Reports 2019, 9, 19576 -7.

AMA Style

Timothy J. Wade, Shannon M. Griffin, Andrey I. Egorov, Elizabeth Sams, Edward Hudgens, Swinburne Augustine, Stephanie DeFlorio-Barker, Trevor Plunkett, Alfred P. Dufour, Jennifer N. Styles, Kevin Oshima. Application of a multiplex salivary immunoassay to detect sporadic incident norovirus infections. Scientific Reports. 2019; 9 (1):19576-7.

Chicago/Turabian Style

Timothy J. Wade; Shannon M. Griffin; Andrey I. Egorov; Elizabeth Sams; Edward Hudgens; Swinburne Augustine; Stephanie DeFlorio-Barker; Trevor Plunkett; Alfred P. Dufour; Jennifer N. Styles; Kevin Oshima. 2019. "Application of a multiplex salivary immunoassay to detect sporadic incident norovirus infections." Scientific Reports 9, no. 1: 19576-7.

Journal article
Published: 09 November 2019 in Water Research
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Recreational water epidemiology studies are rare in settings with minimal wastewater treatment where risk may be highest, and in tropical settings where warmer temperature influences the ecology of fecal indicator bacteria commonly used to monitor recreational waters. One exception is a 1999 study conducted in São Paulo Brazil. We compared the risk and exposure characteristics of these data with those conducted in the United Kingdom (UK) in the early 1990s that are the basis of the World Health Organization’s (WHO) guidelines on recreational water risks. We then developed adjusted risk difference models (excess gastrointestinal illness per swimming event) for children (<10 years of age) and non-children (≥10 years of age) across five Brazil beaches. We used these models along with beach water quality data from 2004 to 2015 to assess spatial and temporal trends in water quality and human risk. Risk models indicate that children in Brazil have as much as two times the risk of gastrointestinal illness than non-children. In Brazil, 11.8% of the weekly water samples from 2004 to 2015 exceeded 158 enterococci CFU/100 ml, the highest level of fecal streptococci concentration measured in the UK study. Risks associated with these elevated levels equated to median NEEAR-Gastrointestinal Illness (NGI) risks of 53 and 96 excess cases per 1000 swimmers in non-children and children, respectively. Two of the five beaches appear to drive the overall elevated NGI risks seen during this study. Distinct enteric pathogen profiles that exist in tropical settings as well as in settings with minimal wastewater treatment highlight the importance of regionally specific guideline development.

ACS Style

Marc P. Verhougstraete; Kristen Pogreba-Brown; Kelly A. Reynolds; Claudia Condé Lamparelli; Maria Inês Zanoli Sato; Timothy J. Wade; Joseph N.S. Eisenberg. A critical analysis of recreational water guidelines developed from temperate climate data and applied to the tropics. Water Research 2019, 170, 115294 -115294.

AMA Style

Marc P. Verhougstraete, Kristen Pogreba-Brown, Kelly A. Reynolds, Claudia Condé Lamparelli, Maria Inês Zanoli Sato, Timothy J. Wade, Joseph N.S. Eisenberg. A critical analysis of recreational water guidelines developed from temperate climate data and applied to the tropics. Water Research. 2019; 170 ():115294-115294.

Chicago/Turabian Style

Marc P. Verhougstraete; Kristen Pogreba-Brown; Kelly A. Reynolds; Claudia Condé Lamparelli; Maria Inês Zanoli Sato; Timothy J. Wade; Joseph N.S. Eisenberg. 2019. "A critical analysis of recreational water guidelines developed from temperate climate data and applied to the tropics." Water Research 170, no. : 115294-115294.

Journal article
Published: 23 August 2018 in BMC Infectious Diseases
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Toxoplasma gondii infection can be acquired through ingestion of infectious tissue cysts in undercooked meat or environmental oocysts excreted by cats. This cross-sectional study assessed environmental risk factors for T. gondii infections and an association between latent infections and a measure of physiologic dysregulation known as allostatic load. Serum samples from 206 adults in the Durham-Chapel Hill, North Carolina area were tested for immunoglobulin (IgG) responses to T. gondii using commercial ELISA kits. Allostatic load was estimated as a sum of 15 serum biomarkers of metabolic, neuroendocrine and immune functions dichotomized at distribution-based cutoffs. Vegetated land cover within 500 m of residences was estimated using 1 m resolution data from US EPA's EnviroAtlas. Handling soil with bare hands at least weekly and currently owning a cat were associated with 5.3 (95% confidence limits 1.4; 20.7) and 10.0 (2.0; 50.6) adjusted odds ratios (aOR) of T. gondii seropositivity, respectively. There was also a significant positive interaction effect of handling soil and owning cats on seropositivity. An interquartile range increase in weighted mean vegetated land cover within 500 m of residence was associated with 3.7 (1.5; 9.1) aOR of T. gondii seropositivity. Greater age and consumption of undercooked pork were other significant predictors of seropositivity. In turn, T. gondii seropositivity was associated with 61% (13%; 130%) greater adjusted mean allostatic load compared to seronegative individuals. In contrast, greater vegetated land cover around residence was associated with significantly reduced allostatic load in both seronegative (p < 0.0001) and seropositive (p = 0.004) individuals. Residents of greener areas may be at a higher risk of acquiring T. gondii infections through inadvertent ingestion of soil contaminated with cat feces. T. gondii infections may partially offset health benefits of exposure to the natural living environment.

ACS Style

Andrey I. Egorov; Reagan Converse; Shannon M. Griffin; Jennifer Styles; Elizabeth Klein; Elizabeth Sams; Edward Hudgens; Timothy J. Wade. Environmental risk factors for Toxoplasma gondii infections and the impact of latent infections on allostatic load in residents of Central North Carolina. BMC Infectious Diseases 2018, 18, 421 .

AMA Style

Andrey I. Egorov, Reagan Converse, Shannon M. Griffin, Jennifer Styles, Elizabeth Klein, Elizabeth Sams, Edward Hudgens, Timothy J. Wade. Environmental risk factors for Toxoplasma gondii infections and the impact of latent infections on allostatic load in residents of Central North Carolina. BMC Infectious Diseases. 2018; 18 (1):421.

Chicago/Turabian Style

Andrey I. Egorov; Reagan Converse; Shannon M. Griffin; Jennifer Styles; Elizabeth Klein; Elizabeth Sams; Edward Hudgens; Timothy J. Wade. 2018. "Environmental risk factors for Toxoplasma gondii infections and the impact of latent infections on allostatic load in residents of Central North Carolina." BMC Infectious Diseases 18, no. 1: 421.

Observational study
Published: 23 May 2018 in Water Research
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Quantifying sporadic waterborne infections in community settings can be challenging. Salivary antibody immunoassays are a promising non-invasive tool that can be used in prospective studies of common infections, especially those involving children. This study was conducted in a Massachusetts city, which uses a microbiologically contaminated river as its water source, during summer-early winter periods before and after construction of a new drinking water treatment plant. Monthly saliva samples (7480 samples from 1170 children and 816 adults) were analyzed for immunoglobulin G (IgG) responses to recombinant proteins of Cryptosporidium, one genogroup I (GI) and two GII noroviruses. Immunoconversion was defined as at least four-fold increase in specific antibody responses between two monthly samples with a post-conversion response above a flexible age-dependent cut-off. Episodes of gastroenteritis (diarrhea or vomiting or cramps) were associated with 3.2 (95% confidence limits 1.1; 9.5) adjusted odds ratio (aOR) of immunoconversion to Cryptosporidium; episodes of combined diarrhea and vomiting symptoms were associated with 3.5 (0.8; 15.0) and 4.6 (1.7; 12.6) aORs of an immunoconversion to GI and GII noroviruses, respectively. Swimming in natural water bodies or chlorinated pools was associated with 2.3 (0.4; 15.4) and 4.9 (1.6; 15.5) aORs of immunoconversion to Cryptosporidium, respectively. In a subset of study participants who did not use home water filters, consumption of at least some amount of non-boiled tap water reported in a monthly recall survey was associated with 11.1 (1.2; 100.0) and 0.6 (0.1; 2.5) aORs of immunoconversion to Cryptosporidium before and after the new water treatment plant construction, respectively. Among individuals who used home water filters, associations between non-boiled tap water consumption and Cryptosporidium immunoconversion were not significant before and after new plant construction with aORs of 0.8 (0.2; 3.3) and 0.3 (0.1; 1.6), respectively. The interaction effect of study phase and non-boiled tap water consumption on Cryptosporidium immunoconversions was statistically significant in the entire study population with aOR of 5.4 (1.1; 25.6). This was the first study that has used a salivary antibody immunoassay to demonstrate significant associations between gastrointestinal symptoms and Cryptosporidium and norovirus infections, and between water-related exposures and Cryptosporidium infections.

ACS Style

Andrey I. Egorov; Shannon M. Griffin; Honorine D. Ward; Kevin Reilly; G. Shay Fout; Timothy J. Wade. Application of a salivary immunoassay in a prospective community study of waterborne infections. Water Research 2018, 142, 289 -300.

AMA Style

Andrey I. Egorov, Shannon M. Griffin, Honorine D. Ward, Kevin Reilly, G. Shay Fout, Timothy J. Wade. Application of a salivary immunoassay in a prospective community study of waterborne infections. Water Research. 2018; 142 ():289-300.

Chicago/Turabian Style

Andrey I. Egorov; Shannon M. Griffin; Honorine D. Ward; Kevin Reilly; G. Shay Fout; Timothy J. Wade. 2018. "Application of a salivary immunoassay in a prospective community study of waterborne infections." Water Research 142, no. : 289-300.

Research article
Published: 28 March 2018 in PLOS ONE
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Swimming in fecally-contaminated waterbodies can result in gastrointestinal infections. However, the pathogenic microorganisms responsible are not well understood because sporadic cases of illness are not reported completely, exposure information is often not collected, and epidemiology studies rely on self-reported symptoms. Noroviruses are considered a likely cause because they are found in high densities in sewage, resistant to wastewater treatment and survive in the environment. In this study, saliva samples were collected from subjects at a beach in Puerto Rico and tested for evidence of norovirus-specific IgG responses as an indicator of incident norovirus infection. Saliva samples were collected from 1298 participants using an oral swab. Samples were collected on the day of the beach visit (S1); after 10–12 days (S2); and after three weeks (S3). Saliva was tested for IgG responses to GI.1 and GII.4 noroviruses using a microsphere based multiplex salivary immunoassay. Immunoconversion was defined as a four-fold increase in median fluorescence intensity (MFI) from S1 to S2 with the S3 sample at least three times above the S1 MFI. Thirty-four subjects (2.6%) immunoconverted to GI.1 or GII.4 norovirus. Swimmers who immersed their head in water had a higher rate of immunoconversion (3.4%), compared to either non-swimmers (0.0%, p = 0.003) or waders and non-swimmers combined (0.4%, Odds Ratio: 5.07, 95% Confidence Interval:1.48–17.00). Immunoconversion was not associated with gastrointestinal symptoms. This is the first study to demonstrate an association between swimming at a beach impacted by fecal contamination and asymptomatic norovirus infection. The findings implicate recreational water as potentially important transmission pathway for norovirus infection.

ACS Style

Timothy J. Wade; Swinburne A. J. Augustine; Shannon M. Griffin; Elizabeth A. Sams; Kevin H. Oshima; Andrey I. Egorov; Kaneatra J. Simmons; Tarsha N. Eason; Alfred P. Dufour. Asymptomatic norovirus infection associated with swimming at a tropical beach: A prospective cohort study. PLOS ONE 2018, 13, e0195056 .

AMA Style

Timothy J. Wade, Swinburne A. J. Augustine, Shannon M. Griffin, Elizabeth A. Sams, Kevin H. Oshima, Andrey I. Egorov, Kaneatra J. Simmons, Tarsha N. Eason, Alfred P. Dufour. Asymptomatic norovirus infection associated with swimming at a tropical beach: A prospective cohort study. PLOS ONE. 2018; 13 (3):e0195056.

Chicago/Turabian Style

Timothy J. Wade; Swinburne A. J. Augustine; Shannon M. Griffin; Elizabeth A. Sams; Kevin H. Oshima; Andrey I. Egorov; Kaneatra J. Simmons; Tarsha N. Eason; Alfred P. Dufour. 2018. "Asymptomatic norovirus infection associated with swimming at a tropical beach: A prospective cohort study." PLOS ONE 13, no. 3: e0195056.

Journal article
Published: 17 October 2017 in Environmental Health
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Influenza peaks during the wintertime in temperate regions and during the annual rainy season in tropical regions – however reasons for the observed differences in disease ecology are poorly understood. We hypothesize that episodes of extreme precipitation also result in increased influenza in the Northeastern United States, but this association is not readily apparent, as no defined ‘rainy season’ occurs. Our objective was to evaluate the association between extreme precipitation (≥ 99th percentile) events and risk of emergency room (ER) visit for influenza in Massachusetts during 2002–2008. A case-crossover analysis of extreme precipitation events and influenza ER visits was conducted using hospital administrative data including patient town of residence, date of visit, age, sex, and associated diagnostic codes. Daily precipitation estimates were generated for each town based upon data from the National Oceanic and Atmospheric Administration. Odds ratio (OR) and 95% confidence intervals (CI) for associations between extreme precipitation and ER visits for influenza were estimated using conditional logistic regression. Extreme precipitation events were associated with an OR = 1.23 (95%CI: 1.16, 1.30) for ER visits for influenza at lag days 0–6. There was significant effect modification by race, with the strongest association observed among Blacks (OR = 1.48 (1.30, 1.68)). We observed a positive association between extreme precipitation events and ER visits for influenza, particularly among Blacks. Our results suggest that influenza is associated with extreme precipitation in a temperate area; this association could be a result of disease ecology, behavioral changes such as indoor crowding, or both. Extreme precipitation events are expected to increase in the Northeastern United States as climate change progresses. Additional research exploring the basis of this association can inform potential interventions for extreme weather events and influenza transmission.

ACS Style

Genee S. Smith; Kyle P. Messier; James L. Crooks; Timothy J. Wade; Cynthia J. Lin; Elizabeth D. Hilborn. Extreme precipitation and emergency room visits for influenza in Massachusetts: a case-crossover analysis. Environmental Health 2017, 16, 108 -108.

AMA Style

Genee S. Smith, Kyle P. Messier, James L. Crooks, Timothy J. Wade, Cynthia J. Lin, Elizabeth D. Hilborn. Extreme precipitation and emergency room visits for influenza in Massachusetts: a case-crossover analysis. Environmental Health. 2017; 16 (1):108-108.

Chicago/Turabian Style

Genee S. Smith; Kyle P. Messier; James L. Crooks; Timothy J. Wade; Cynthia J. Lin; Elizabeth D. Hilborn. 2017. "Extreme precipitation and emergency room visits for influenza in Massachusetts: a case-crossover analysis." Environmental Health 16, no. 1: 108-108.

Journal article
Published: 02 October 2017 in Environmental Health
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Fecal indicator bacteria used to assess illness risks in recreational waters (e.g., Escherichia coli, Enterococci) cannot discriminate among pollution sources. To address this limitation, human-associated Bacteroides markers have been proposed, but the risk of illness associated with the presence of these markers in recreational waters is unclear. Our objective was to estimate associations between human-associated Bacteroides markers in water and self-reported illness among swimmers at 6 U.S. beaches spanning 2003–2007. We used data from a prospectively-enrolled cohort of 12,060 swimmers surveyed about beach activities and water exposure on the day of their beach visit. Ten to twelve days later, participants reported gastroinestinal, diarrheal, and respiratory illnesses experienced since the visit. Daily water samples were analyzed for the presence of human-associated Bacteroides genetic markers: HF183, BsteriF1, BuniF2, HumM2. We used model-based standardization to estimate risk differences (RD) and 95% confidence intervals (CI). We assessed whether the presence of Bacteroides markers were modifiers of the association between general Enterococcus and illness among swimmers using interaction contrast. Overall we observed inconsistent associations between the presence of Bacteroides markers and illness. There was a pattern of increased risks of gastrointestinal (RD = 1.9%; 95% CI: 0.1%, 3.7%), diarrheal (RD = 1.3%; 95% CI: -0.2%, 2.7%), and respiratory illnesses (RD = 1.1%; 95% CI: -0.2%, 2.5%) associated with BsteriF1. There was no evidence that Bacteroides markers acted as modifiers of Enterococcus and illness. Patterns were similar when stratified by water matrix. Quantitative measures of fecal pollution using Bacteroides, rather than presence-absence indicators, may be necessary to accurately assess human risk specific to the presence of human fecal pollution.

ACS Style

Melanie D. Napier; Richard Haugland; Charles Poole; Alfred P. Dufour; Jill R. Stewart; David J. Weber; Manju Varma; Jennifer S. Lavender; Timothy J. Wade. Exposure to human-associated fecal indicators and self-reported illness among swimmers at recreational beaches: a cohort study. Environmental Health 2017, 16, 103 -103.

AMA Style

Melanie D. Napier, Richard Haugland, Charles Poole, Alfred P. Dufour, Jill R. Stewart, David J. Weber, Manju Varma, Jennifer S. Lavender, Timothy J. Wade. Exposure to human-associated fecal indicators and self-reported illness among swimmers at recreational beaches: a cohort study. Environmental Health. 2017; 16 (1):103-103.

Chicago/Turabian Style

Melanie D. Napier; Richard Haugland; Charles Poole; Alfred P. Dufour; Jill R. Stewart; David J. Weber; Manju Varma; Jennifer S. Lavender; Timothy J. Wade. 2017. "Exposure to human-associated fecal indicators and self-reported illness among swimmers at recreational beaches: a cohort study." Environmental Health 16, no. 1: 103-103.

Journal article
Published: 26 July 2016 in BMC Public Health
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Advocates for environmental justice, local, state, and national public health officials, exposure scientists, need broad-based health indices to identify vulnerable communities. Longitudinal studies show that perception of current health status predicts subsequent mortality, suggesting that self-reported health (SRH) may be useful in screening-level community assessments. This paper evaluates whether SRH is an appropriate surrogate indicator of health status by evaluating relationships between SRH and sociodemographic, lifestyle, and health care factors as well as serological indicators of nutrition, health risk, and environmental exposures. Data were combined from the 2003–2006 National Health and Nutrition Examination Surveys for 1372 nonsmoking 20–50 year olds. Ordinal and binary logistic regression was used to estimate odds ratios and 95 % confidence intervals of reporting poorer health based on measures of nutrition, health condition, environmental contaminants, and sociodemographic, health care, and lifestyle factors. Poorer SRH was associated with several serological measures of nutrition, health condition, and biomarkers of toluene, cadmium, lead, and mercury exposure. Race/ethnicity, income, education, access to health care, food security, exercise, poor mental and physical health, prescription drug use, and multiple health outcome measures (e.g., diabetes, thyroid problems, asthma) were also associated with poorer SRH. Based on the many significant associations between SRH and serological assays of health risk, sociodemographic measures, health care access and utilization, and lifestyle factors, SRH appears to be a useful health indicator with potential relevance for screening level community-based health and environmental studies.

ACS Style

Jane E. Gallagher; Adrien A. Wilkie; Alissa Cordner; Edward E. Hudgens; Andrew J. Ghio; Rebecca J. Birch; Timothy J. Wade. Factors associated with self-reported health: implications for screening level community-based health and environmental studies. BMC Public Health 2016, 16, 640 .

AMA Style

Jane E. Gallagher, Adrien A. Wilkie, Alissa Cordner, Edward E. Hudgens, Andrew J. Ghio, Rebecca J. Birch, Timothy J. Wade. Factors associated with self-reported health: implications for screening level community-based health and environmental studies. BMC Public Health. 2016; 16 (1):640.

Chicago/Turabian Style

Jane E. Gallagher; Adrien A. Wilkie; Alissa Cordner; Edward E. Hudgens; Andrew J. Ghio; Rebecca J. Birch; Timothy J. Wade. 2016. "Factors associated with self-reported health: implications for screening level community-based health and environmental studies." BMC Public Health 16, no. 1: 640.

Journal article
Published: 11 February 2016 in Environmental Health
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Experimental animal studies, in vitro experiments, and clinical assessments have shown that metal toxicity can impair immune responses. We analyzed data from a United States representative National Health and Nutrition Examination Survey (NHANES) to explore associations between chronic infections and elevated blood concentrations of lead and cadmium among non-smoking NHANES participants. NHANES data from 1999 to 2012 were examined and weighted to represent the United States population. Multivariable logistic regression was used to estimate adjusted odds ratios (AOR) and 95 % confidence intervals (CI) for heavy metal associations with seropositivity for Helicobacter pylori, Toxoplasma gondii, and Hepatitis B virus (HBV) infections. Available 2-year survey cycles for infection seroprevalence varied by pathogen, from 1 to 7 cycles. Available sample size, disease seroprevalence, and participant age range also varied by pathogen of interest. After controlling for demographic characteristics and general health condition, an elevated blood lead level above the survey population median was significantly associated with seropositivity for all three pathogens (AORs = 1.2–1.5). In addition, an elevated blood cadmium level above the median was significantly associated with HBV (AOR = 1.5; 95 % CI = 1.2–2.0) and H. pylori (AOR = 1.5; 95 % CI = 1.2–1.7) seropositivity. Age-specific analyses for H. pylori and T. gondii indicated stronger associations among children under 13 years of age, particularly for lead exposure and H. pylori seropositivity, and weaker associations among those over 35 years of age. The results of this cross-sectional human health survey suggest that the immunological effects of lead and cadmium toxicity may be associated with an increased susceptibility to chronic infections.

ACS Style

Whitney S. Krueger; Timothy J. Wade. Elevated blood lead and cadmium levels associated with chronic infections among non-smokers in a cross-sectional analysis of NHANES data. Environmental Health 2016, 15, 16 .

AMA Style

Whitney S. Krueger, Timothy J. Wade. Elevated blood lead and cadmium levels associated with chronic infections among non-smokers in a cross-sectional analysis of NHANES data. Environmental Health. 2016; 15 (1):16.

Chicago/Turabian Style

Whitney S. Krueger; Timothy J. Wade. 2016. "Elevated blood lead and cadmium levels associated with chronic infections among non-smokers in a cross-sectional analysis of NHANES data." Environmental Health 15, no. 1: 16.

Journal article
Published: 01 December 2015 in Water Research
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Regulating recreational water exposure to pathogens within the tropics is a major public health and economic concern. Although numerous epidemiological studies estimating the risk to recreational marine water exposure have been conducted since the 1950s, few studies have been done in the tropics. Furthermore, many have suggested that the use of fecal indicator bacteria for monitoring recreational water quality in temperate regions is not appropriate in the tropics. We analyzed a large cohort study of five beaches in Sao Paulo, Brazil, conducted during consecutive weekends in the summer of 1999 that estimated risk to water, sand, and food exposures. Enterococci and Escherichia coli concentrations were measured each day of the study. Elevated risks were estimated for both swimming (OR = 1.36 95% CI: 1.05-1.58) and sand contact (OR = 1.29 95% CI 1.05-1.58). A 1 log increase in enterococci concentration was associated with an 11% increase in risk (OR = 1.11 95% CI: 1.04-1.19). For E. coli a 1-log increase in concentration was associated with 19% increase in risk (OR = 1.19 95% CI: 1.14-1.28). Most countries with beaches in the tropics are lower or middle income countries (LMIC) and rely on tourism as a major source of income. We present data that suggests fecal indicator bacteria such as enterococci are an appropriate indicator of risk in tropical urban settings where contamination is coming from predominantly human sources. Additional studies in tropical settings could help inform and refine guidelines for safe use of recreational waters.

ACS Style

Claudia Condé Lamparelli; Kristen Pogreba-Brown; Marc Verhougstraete; Maria Inês Zanoli Sato; Antonio De Castro Bruni; Timothy J. Wade; Joseph N.S. Eisenberg. Are fecal indicator bacteria appropriate measures of recreational water risks in the tropics: A cohort study of beach goers in Brazil? Water Research 2015, 87, 59 -68.

AMA Style

Claudia Condé Lamparelli, Kristen Pogreba-Brown, Marc Verhougstraete, Maria Inês Zanoli Sato, Antonio De Castro Bruni, Timothy J. Wade, Joseph N.S. Eisenberg. Are fecal indicator bacteria appropriate measures of recreational water risks in the tropics: A cohort study of beach goers in Brazil? Water Research. 2015; 87 ():59-68.

Chicago/Turabian Style

Claudia Condé Lamparelli; Kristen Pogreba-Brown; Marc Verhougstraete; Maria Inês Zanoli Sato; Antonio De Castro Bruni; Timothy J. Wade; Joseph N.S. Eisenberg. 2015. "Are fecal indicator bacteria appropriate measures of recreational water risks in the tropics: A cohort study of beach goers in Brazil?" Water Research 87, no. : 59-68.

Journal article
Published: 17 June 2015 in International Journal of Environmental Research and Public Health
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Clostridium difficile is a bacterium that can spread by water. It often causes acute gastrointestinal illness in older adults who are hospitalized and/or receiving antibiotics; however, community-associated infections affecting otherwise healthy individuals have become more commonly reported. A case-crossover study was used to assess emergency room (ER) and outpatient visits for C. difficile infection following flood events in Massachusetts from 2003 through 2007. Exposure status was based on whether or not a flood occurred prior to the case/control date during the following risk periods: 0–6 days, 7–13 days, 14–20 days, and 21–27 days. Fixed-effects logistic regression was used to estimate the risk of diagnosis with C. difficile infection following a flood. There were 129 flood events and 1575 diagnoses of C. difficile infection. Among working age adults (19–64 years), ER and outpatient visits for C. difficile infection were elevated during the 7–13 days following a flood (Odds Ratio, OR = 1.69; 95% Confidence Interval, CI: 0.84, 3.37). This association was more substantial among males (OR = 3.21; 95% CI: 1.01–10.19). Associations during other risk periods were not observed (p < 0.05). Although we were unable to differentiate community-associated versus nosocomial infections, a potential increase in C. difficile infections should be considered as more flooding is projected due to climate change.

ACS Style

Cynthia J. Lin; Timothy J. Wade; Elizabeth D. Hilborn. Flooding and Clostridium difficile Infection: A Case-Crossover Analysis. International Journal of Environmental Research and Public Health 2015, 12, 6948 -6964.

AMA Style

Cynthia J. Lin, Timothy J. Wade, Elizabeth D. Hilborn. Flooding and Clostridium difficile Infection: A Case-Crossover Analysis. International Journal of Environmental Research and Public Health. 2015; 12 (6):6948-6964.

Chicago/Turabian Style

Cynthia J. Lin; Timothy J. Wade; Elizabeth D. Hilborn. 2015. "Flooding and Clostridium difficile Infection: A Case-Crossover Analysis." International Journal of Environmental Research and Public Health 12, no. 6: 6948-6964.

Journal article
Published: 12 April 2015 in Environmental Health
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Millions of people are at risk from the adverse effects of arsenic exposure through drinking water. Increasingly, non-cancer effects such as cardiovascular disease have been associated with drinking water arsenic exposures. However, most studies have been conducted in highly exposed populations and lacked individual measurements. To evaluate the association between cardiovascular disease and well-water arsenic exposure. We conducted a hospital based case control study in Inner Mongolia, China. Cases and controls were prospectively identified and enrolled from a large hospital in the Hangjin Hou area. Cases were patients diagnosed with cardiovascular disease and controls were patients free from cardiovascular disease, admitted for conditions unrelated to arsenic exposure. Water from the primary water source and toenail samples were collected from each subject and tested for inorganic arsenic. Arsenic exposures were moderate with mean and median arsenic exposures of 8.9 μg/L and 13.1 μg/L, respectively. A total of 298 cases and 275 controls were enrolled. The adjusted odds ratio (AOR) and corresponding 95% confidence interval (95% CI) for a 10 μg/L increase in water arsenic were 1.19 (95% CI: 1.03, 1.38). Compared to exposures less than 10 μg/L, the AOR for water arsenic exposures above 40 μg/L was 4.05 (95% CI: 1.1-14.99, p = 0.04). Nail arsenic above 1.38 μg/g was also associated with an increased risk of cardiovascular disease. By using standardized case definitions and collecting individual measurements of arsenic, this study addressed several limitations of previous studies. The results provide further evidence of the association between cardiovascular disease and arsenic at moderate exposures.

ACS Style

Timothy J Wade; Yajuan Xia; Judy Mumford; Kegong Wu; X Chris Le; Elizabeth Sams; William E Sanders. Cardiovascular disease and arsenic exposure in Inner Mongolia, China: a case control study. Environmental Health 2015, 14, 1 -10.

AMA Style

Timothy J Wade, Yajuan Xia, Judy Mumford, Kegong Wu, X Chris Le, Elizabeth Sams, William E Sanders. Cardiovascular disease and arsenic exposure in Inner Mongolia, China: a case control study. Environmental Health. 2015; 14 (1):1-10.

Chicago/Turabian Style

Timothy J Wade; Yajuan Xia; Judy Mumford; Kegong Wu; X Chris Le; Elizabeth Sams; William E Sanders. 2015. "Cardiovascular disease and arsenic exposure in Inner Mongolia, China: a case control study." Environmental Health 14, no. 1: 1-10.

Journal article
Published: 10 December 2014 in BMC Gastroenterology
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Trends in gastroenteritis-associated mortality are changing over time with development of antibiotic resistant strains of certain pathogens, improved diagnostic methods, and changing healthcare. In 1999, ICD-10 coding was introduced for mortality records which can also affect trends. We assess trends in gastroenteritis-associated mortality and changes associated with coding. Trends in gastroenteritis-associated mortality rates in the United States were examined using the National Center for Health Statistics Multiple Cause-of-Death Mortality databases for 1985–2005. All deaths with the underlying cause or any contributing cause included gastroenteritis were included. Cases were selected based on ICD9 (pre-1999) and ICD10 (1999–2005) codes and all analyses were stratified by ICD usage. Annual trends in age adjusted mortality rates were assessed using linear regression spline analysis. Relative risks and 95% confidence intervals (CIs) were calculated using Poisson regression adjusted for age group, sex, race, and region. There were a total of 190,674 deaths related to gastroenteritis in the U.S. from 1985–2005 with an average of 9,080 per year. During this time the percent of deaths related to gastroenteritis more than tripled, increasing from 0.25% to 0.80% of all deaths. Though the time periods varied in length, we demonstrate a significant increase in slope from a 0.0054% annual increase during the period 1985–1998, when ICD-9 coding was used, to a 0.0550% annual increase during 1999–2005, when ICD-10 coding was used. For both time periods, the oldest age group (75+ years) demonstrated the highest risk of death due to gastroenteritis. Additionally, males demonstrated higher risk than females and blacks were at higher risk than whites for death due to gastroenteritis. This analysis demonstrates the public health burden of gastroenteritis-associated mortality in the United States and changes in trends due to change from ICD-9 to ICD-10 coding. The overall rate of gastroenteritis-associated mortality has more than tripled over the 21-year period from 1985 to 2005 and the primary burden of deaths due to gastroenteritis is in the elderly population.

ACS Style

Jyotsna S Jagai; Genee S Smith; Judith E Schmid; Timothy J Wade. Trends in gastroenteritis-associated mortality in the United States, 1985–2005: variations by ICD-9 and ICD-10 codes. BMC Gastroenterology 2014, 14, 211 .

AMA Style

Jyotsna S Jagai, Genee S Smith, Judith E Schmid, Timothy J Wade. Trends in gastroenteritis-associated mortality in the United States, 1985–2005: variations by ICD-9 and ICD-10 codes. BMC Gastroenterology. 2014; 14 (1):211.

Chicago/Turabian Style

Jyotsna S Jagai; Genee S Smith; Judith E Schmid; Timothy J Wade. 2014. "Trends in gastroenteritis-associated mortality in the United States, 1985–2005: variations by ICD-9 and ICD-10 codes." BMC Gastroenterology 14, no. 1: 211.

Journal article
Published: 10 July 2014 in BMC Public Health
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Toxoplasma gondii imparts a considerable burden to public health. Human toxoplasmosis can be life-threatening in immunocompromised individuals, has been associated with psychiatric disorders, and can cause severe congenital pathologies, spontaneous abortion, or stillbirth. Environmental modes of transmission contributing to the incidence of human toxoplasmosis are poorly understood. We sought to examine National Health and Nutrition Examination Survey (NHANES) data for risk factors associated with T. gondii seroprevalence.

ACS Style

Whitney S Krueger; Elizabeth D Hilborn; Reagan R Converse; Timothy J Wade. Drinking water source and human Toxoplasma gondii infection in the United States: a cross-sectional analysis of NHANES data. BMC Public Health 2014, 14, 711 -711.

AMA Style

Whitney S Krueger, Elizabeth D Hilborn, Reagan R Converse, Timothy J Wade. Drinking water source and human Toxoplasma gondii infection in the United States: a cross-sectional analysis of NHANES data. BMC Public Health. 2014; 14 (1):711-711.

Chicago/Turabian Style

Whitney S Krueger; Elizabeth D Hilborn; Reagan R Converse; Timothy J Wade. 2014. "Drinking water source and human Toxoplasma gondii infection in the United States: a cross-sectional analysis of NHANES data." BMC Public Health 14, no. 1: 711-711.

Journal article
Published: 21 August 2013 in Environmental Health
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Earaches and outer ear infections are commonly associated with swimming. In this study, we estimated the excess risk and health burden of earaches due to swimming in natural fresh and marine waters using results from a survey of over 50,000 beachgoers at nine beaches across the United States.

ACS Style

Timothy J Wade; Elizabeth A Sams; Michael J Beach; Sarah A Collier; Alfred P Dufour. The incidence and health burden of earaches attributable to recreational swimming in natural waters: a prospective cohort study. Environmental Health 2013, 12, 67 -67.

AMA Style

Timothy J Wade, Elizabeth A Sams, Michael J Beach, Sarah A Collier, Alfred P Dufour. The incidence and health burden of earaches attributable to recreational swimming in natural waters: a prospective cohort study. Environmental Health. 2013; 12 (1):67-67.

Chicago/Turabian Style

Timothy J Wade; Elizabeth A Sams; Michael J Beach; Sarah A Collier; Alfred P Dufour. 2013. "The incidence and health burden of earaches attributable to recreational swimming in natural waters: a prospective cohort study." Environmental Health 12, no. 1: 67-67.

Journal article
Published: 10 May 2013 in BMC Public Health
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The United States Environmental Protection Agency (USEPA) and its predecessors have conducted three distinct series of epidemiological studies beginning in 1948 on the relationship between bathing water quality and swimmers’ illnesses. Keeping pace with advances in microbial technologies, these studies differed in their respective microbial indicators of water quality. Another difference, however, has been their specific health endpoints. The latest round of studies, the National Epidemiological Assessment of Recreational (NEEAR) Water studies initiated in 2002, used a case definition, termed “NEEAR GI illness” (NGI), for gastrointestinal illness corresponding closely to classifications employed by contemporary researchers, and to that proposed by the World Health Organization. NGI differed from the previous definition of “highly credible gastrointestinal illness” (HCGI) upon which the USEPA’s 1986 bathing water criteria had been based, primarily by excluding fever as a prerequisite.

ACS Style

Larry J Wymer; Timothy J Wade; Alfred P Dufour. Equivalency of risk for a modified health endpoint: a case from recreational water epidemiology studies. BMC Public Health 2013, 13, 1 -459.

AMA Style

Larry J Wymer, Timothy J Wade, Alfred P Dufour. Equivalency of risk for a modified health endpoint: a case from recreational water epidemiology studies. BMC Public Health. 2013; 13 (1):1-459.

Chicago/Turabian Style

Larry J Wymer; Timothy J Wade; Alfred P Dufour. 2013. "Equivalency of risk for a modified health endpoint: a case from recreational water epidemiology studies." BMC Public Health 13, no. 1: 1-459.

Journal article
Published: 22 February 2013 in Sustainability
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Waste and materials management, land use planning, transportation and infrastructure including water and energy can have indirect or direct beneficial impacts on the environment and public health. The potential for impact, however, is rarely viewed in an integrated fashion. To facilitate such an integrated view in support of community-based policy decision making, we catalogued and evaluated associations between common, publically available, Environmental (e), Health (h), and Sustainability (s) metrics and sociodemographic measurements (n = 10) for 50 populous U.S. cities. E, H, S indices combined from two sources were derived from component (e) (h) (s) metrics for each city. A composite EHS Index was derived to reflect the integration across the E, H, and S indices. Rank order of high performing cities was highly dependent on the E, H and S indices considered. When viewed together with sociodemographic measurements, our analyses further the understanding of the interplay between these broad categories and reveal significant sociodemographic disparities (e.g., race, education, income) associated with low performing cities. Our analyses demonstrate how publically available environmental, health, sustainability and socioeconomic data sets can be used to better understand interconnections between these diverse domains for more holistic community assessments.

ACS Style

Jane E. Gallagher; Elaine Cohen Hubal; Laura Jackson; Jefferson Inmon; Edward Hudgens; Ann H. Williams; Danelle Lobdell; John Rogers; Timothy Wade. Sustainability, Health and Environmental Metrics: Impact on Ranking and Associations with Socioeconomic Measures for 50 U.S. Cities. Sustainability 2013, 5, 789 -804.

AMA Style

Jane E. Gallagher, Elaine Cohen Hubal, Laura Jackson, Jefferson Inmon, Edward Hudgens, Ann H. Williams, Danelle Lobdell, John Rogers, Timothy Wade. Sustainability, Health and Environmental Metrics: Impact on Ranking and Associations with Socioeconomic Measures for 50 U.S. Cities. Sustainability. 2013; 5 (2):789-804.

Chicago/Turabian Style

Jane E. Gallagher; Elaine Cohen Hubal; Laura Jackson; Jefferson Inmon; Edward Hudgens; Ann H. Williams; Danelle Lobdell; John Rogers; Timothy Wade. 2013. "Sustainability, Health and Environmental Metrics: Impact on Ranking and Associations with Socioeconomic Measures for 50 U.S. Cities." Sustainability 5, no. 2: 789-804.

Conference paper
Published: 01 November 2011 in Proceedings of The 1st World Sustainability Forum
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Health, socioeconomic, education, and environmental (e.g. air and water quality) indicators are often correlated and may serve as markers for other underlying community issues. These diverse measurements are usually not fully integrated and rarely evaluated in the context of sustainability metrics. We derived an integrated community health index (ICHI) for 50 of the most populous cities in the US using extant environmental, health and sustainability metrics and assessed relationships with sociodemographic measures. To derive the ICHI we used data from two sources: 1) SustainLane\'s (www.sustainlane.com) 2008 report card on urban sustainability which includes metrics such as energy and climate change policy, metro street congestion, metro transit ridership, and natural disaster risk, and 2) Earth Day Network\'s (www.eathday.net) Urban environmental report including a health metric which incorporates asthma, cardiovascular disease, diabetes, and obesity rates; and three environmental variables a) toxics and waste b) air quality c) drinking and surface water quality. Using these metrics we developed three separate indicators for health, sustainability and environment for each city. The ICHI was created by averaging across these three indicators. We used data from the 2010 Census (median family income, % of persons below the poverty level, % with a high school degree, % with college degree, and racial diversity (% White, nonwhite Black, Asian, and Hispanic) to assess relationships between the ICHI and sociodemographic characteristics. We compare mean values for various demographic measures for those cities with the "best" integrated community health index (highest 25th percentile) with those cities in the lower 25th percentile using t-tests. Cities with the better ICHI demonstrated 1) a higher % of persons with health insurance (20.1 vs 13.4 %; pth percentile) with those cities in the lowest 25thpercentile demonstrated 1) a lower score for toxic and waste (2.85 vs. 3.48; p

ACS Style

Jane Gallagher; Timothy Wade; Laura Jackson; Danelle Lobdell; Jyotsna Jagai; Jefferson Inmon; Elaine Cohen-Hubal. Correlates of Health, Sustainability and Environmental Metrics for 50 of the Most Populous U.S. Cities. Proceedings of The 1st World Sustainability Forum 2011, 1 .

AMA Style

Jane Gallagher, Timothy Wade, Laura Jackson, Danelle Lobdell, Jyotsna Jagai, Jefferson Inmon, Elaine Cohen-Hubal. Correlates of Health, Sustainability and Environmental Metrics for 50 of the Most Populous U.S. Cities. Proceedings of The 1st World Sustainability Forum. 2011; ():1.

Chicago/Turabian Style

Jane Gallagher; Timothy Wade; Laura Jackson; Danelle Lobdell; Jyotsna Jagai; Jefferson Inmon; Elaine Cohen-Hubal. 2011. "Correlates of Health, Sustainability and Environmental Metrics for 50 of the Most Populous U.S. Cities." Proceedings of The 1st World Sustainability Forum , no. : 1.