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Background: Knowledge of the number of persons with chronic hepatitis C virus (HCV) infection in the United States is critical for public health and policy planning. Objective: To estimate the prevalence of chronic HCV infection between 2003 and 2010 and to identify factors associated with this condition. Design: Nationally representative household survey. Setting: U.S. noninstitutionalized civilian population. Participants: 30 074 NHANES (National Health and Nutrition Examination Survey) participants between 2003 and 2010. Measurements: Interviews to ascertain demographic characteristics and possible risks and exposures for HCV infection. Serum samples from participants aged 6 years or older were tested for antibody to HCV; if results were positive or indeterminate, the samples were tested for HCV RNA, which indicates current chronic infection. Results: Based on 273 participants who tested positive for HCV RNA, the estimated prevalence of HCV infection was 1.0% (95% CI, 0.8% to 1.2%), corresponding to 2.7 million chronically infected persons (CI, 2.2 to 3.2 million persons) in the U.S. noninstitutionalized civilian population. Infected persons were more likely to be aged 40 to 59 years, male, and non-Hispanic black and to have less education and lower family income. Factors significantly associated with chronic HCV infection were illicit drug use (including injection drugs) and receipt of a blood transfusion before 1992; 49% of persons with HCV infection did not report either risk factor. Limitation: Incarcerated and homeless persons were not surveyed. Conclusion: This analysis estimated that approximately 2.7 million U.S. residents in the population sampled by NHANES have chronic HCV infection, about 500 000 fewer than estimated in a similar analysis between 1999 and 2002. These data underscore the urgency of identifying the millions of persons who remain infected and linking them to appropriate care and treatment. [ABSTRACT FROM AUTHOR]

Background. Herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) are common infections with serious sequelae. HSV-1 is an increasingly important cause of genital herpes in industrialized countries. Methods. Using nationally representative data from the National Health and Nutrition Examination Survey (NHANES), we examined HSV-1 and HSV-2 seroprevalence among 14- to 49-year-olds in the United States. We estimated seroprevalence in 1999-2004 and 2005-2010, stratified by sociodemographic characteristics and sexual behaviors. We also reviewed HSV-1 and HSV-2 seroprevalence from 1976-1980 to 2005-2010. Results. In 2005-2010, the seroprevalence of HSV-1 was 53.9%, and the seroprevalence of HSV-2 was 15.7%. From 1999-2004 to 2005-2010, HSV-1 seroprevalence declined by nearly 7% (P < .01), but HSV-2 seroprevalence did not change significantly. The largest decline in HSV-1 seroprevalence from 1999-2004 to 2005-2010 was observed among adolescents aged 14-19 years, among whom seroprevalence declined by nearly 23%, from 39.0% to 30.1% (P < .01). In this age group, HSV-1 seroprevalence declined >29% from 1976-1980 to 2005-2010 (P < .01). Conclusions. An increasing number of adolescents lack HSV-1 antibodies at sexual debut. In the absence of declines in HSV-2 infections, the prevalence of genital herpes may increase. [ABSTRACT FROM AUTHOR]

Background. Herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) are common infections with serious sequelae. HSV-1 is an increasingly important cause of genital herpes in industrialized countries.Methods. Using nationally representative data from the National Health and Nutrition Examination Survey (NHANES), we examined HSV-1 and HSV-2 seroprevalence among 14- to 49-year-olds in the United States. We estimated seroprevalence in 1999–2004 and 2005–2010, stratified by sociodemographic characteristics and sexual behaviors. We also reviewed HSV-1 and HSV-2 seroprevalence from 1976–1980 to 2005–2010.Results. In 2005–2010, the seroprevalence of HSV-1 was 53.9%, and the seroprevalence of HSV-2 was 15.7%. From 1999–2004 to 2005–2010, HSV-1 seroprevalence declined by nearly 7% (P < .01), but HSV-2 seroprevalence did not change significantly. The largest decline in HSV-1 seroprevalence from 1999–2004 to 2005–2010 was observed among adolescents aged 14–19 years, among whom seroprevalence declined by nearly 23%, from 39.0% to 30.1% (P < .01). In this age group, HSV-1 seroprevalence declined >29% from 1976–1980 to 2005–2010 (P < .01).Conclusions. An increasing number of adolescents lack HSV-1 antibodies at sexual debut. In the absence of declines in HSV-2 infections, the prevalence of genital herpes may increase. [ABSTRACT FROM PUBLISHER]

Purpose: To evaluate the association of body size-captured via whole-body dual-energy X-ray absorptiometry (DXA) and physical measurement-with serum sex steroid hormones and sex hormone binding globulin (SHBG), we utilized cross-sectional data and serum samples from the National Health and Nutrition Examination Survey (NHANES; 1999-2004).Methods: Testosterone, androstanediol glucuronide (3-alpha-diol-G), estradiol, and SHBG were measured via immunoassay in serum samples from a total of 898 adult men (ages 20-90) participating in the morning examination. As part of the NHANES data collection, DXA scans and measurements of weight, height, and waist circumference were performed by trained staff. Linear regression was used to estimate associations between body size and hormone levels adjusted for potential confounders and NHANES sampling procedures.Results: Total bone area (cm(2)) was inversely associated with total testosterone (ng/mL) [beta = -0.12; p value < 0.01], while bone mineral density (g/cm(2)) was inversely associated with SHBG (nmol/L) [beta = -17.16; p value = 0.01]. Increased percent body fat was associated with lower concentrations of total testosterone [beta = -0.16; p value < 0.01] and SHBG [beta = -1.11; p value < 0.01] and higher concentrations of free estradiol (fg/mL) [beta = 12.52; p value < 0.01].Conclusions: Clinical measures of body fat (measured via DXA scan) and anthropometric measures of body fat (BMI and waist circumference) provided similar inferences regarding the association between increased body fat and hormone levels in men. Increased body fat was associated with lower circulating levels of testosterone (total and free) and SHBG and higher circulating levels of free estradiol in men, while decreased bone mineral density was associated with higher circulating levels of SHBG. [ABSTRACT FROM AUTHOR]

Objectives. We described seroprevalence of antibody to hepatitis A virus (anti- HAV) in the United States during 1999-2006 and compared it with seroprevalence before the availability of vaccine. Methods. We analyzed data from the 1988-1994 and 1999-2006 National Health and Nutrition Examination Survey (NHANES) to obtain estimates of anti- HAV seroprevalence for the U.S. household population. We grouped region of residence based on the 1999 Advisory Committee on Immunization Practices recommendations into 17 states with any recommendation (vaccinating) and 33 states without any recommendation (non-vaccinating). Results. During 1999-2006, the overall seroprevalence of anti-HAV was 34.9% (95% confidence interval [CI] 33.1, 36.7). During 1999-2006, U.S.-born children living in vaccinating states (33.8%, 95% CI 26.2, 42.2) had a higher seroprevalence than children in non-vaccinating states (11.0%, 95% CI 9.4, 12.8; p<0.001). Seroprevalence among children increased from 8.0% (95% CI 6.3, 10.1) during 1988-1994 to 20.2% (95% CI 16.0, 24.8) during 1999-2006 (p<0.001). For U.S.-born children aged 6-19 years, the strongest factor associated with seroprevalence was residence in vaccinating states. Among U.S.-born adults aged >19 years, the overall age-adjusted seroprevalence of. anti-HAV was 29.9% (95% CI 28.3, 31.5) during 1999-2006, which was not significantly different from the seroprevalence during 1988-1994 (32.2%, 95% CI 30.1, 34.4). Conclusions. Increases in seroprevalence among children in vaccinating states suggest a positive effect of the 1999 vaccination recommendations. [ABSTRACT FROM AUTHOR]

Objective. We estimated the varicella seroprevalence among the U.S. Population aged 6-49 years based on retested National Health and Nutrition Examination Survey (NHANES) specimens collected between 1999 and 2004—originally tested using a method unsuitable for detecting vaccine-induced immunity—and compared it with historical estimates. Methods. We performed a confirmatory test suitable for, detecting vaccine-induced immunity on all available specimens from 6- to 19-year-olds who originally tested negative (n=633), and on 297 randomly selected specimens that had tested positive. Retest results superseded original results for determining seroprevalence. We assessed seroprevalence for the entire sample aged 6-49 years (n=16,050) by participant demographic characteristics and compared it with historical estimates (NHANES 1988-1994). Results. The percentage of false-negative results for the original test was higher for specimens from younger children (6-11 years of age: 27.5%; 12-19 years of age: 13.3%) and for specimens collected most recently (2001-2004: 26.0%; 1999-2000: 12.6%). The age-adjusted rate of varicella seroprevalence for 1999-2004 was 93.6% for 6- to 19-year-olds and 98.0% for adults aged 20-49 years compared with 90.0% and 98.1%, respectively, for 1988-1994. We found an increase in seropositivity between the survey periods, from 93.2% to 97.2% (p<0.001) among 12- to 19-year-olds. For children, non-Hispanic black ethnicity and younger age were associated with lower seroprevalence in both survey periods. Conclusions. Varicella seroprevalence increased with age among children and was uniformly high in the U.S. adult population between 1999 and 2004. The original testing produced false-negative seroprevalence results among children's specimens collected between 1999 and 2004 from 6- to 19-year-olds. [ABSTRACT FROM AUTHOR]

Background. In 2006, the largest mumps outbreak in the United States in 20 years occurred. To understand prior mumps seroprevalence and factors associated with the presence of antibody to mumps virus, data from the 1999–2004 National Health and Nutrition Examination Survey (NHANES) were analyzed.Methods. A mumps virus-specific enzyme immunoassay was used to measure the seroprevalence of serum immunoglobulin G (IgG) antibody among NHANES participants aged 6–49 years. Participants were grouped on the basis of 10-year birth cohorts, 95% confidence intervals (CIs) were calculated using SUDAAN software, and logistic regression was used to identify independent predictors.Results. The overall age-adjusted seroprevalence of IgG antibody to mumps virus during 1999–2004 was 90.0% (95% CI, 88.8%–91.1%). Seroprevalence was higher among US-born non-Hispanic blacks (96.4% [95% CI, 95.5%–97.2%]) and non-US-born Mexican Americans (93.7% [95% CI, 92.0%–95.2%]). Seroprevalence was significantly lower in the 1967–1976 birth cohort (85.7% [95% CI, 83.5%–87.8%]). The variables sex, education, and race/ethnicity/birthplace were independent predictors in at least 1 of the birth cohorts.Conclusions. The overall estimate of 90.0% is at the lower end of the estimated population immunity (90%–92%) needed to achieve herd immunity. Lower seroprevalence among groups suggest that they represent populations at an increased risk. For mumps control, high vaccine coverage and high population immunity must be achieved and maintained. [ABSTRACT FROM PUBLISHER]

Background. Hepatitis E virus (HEV) is prevalent and causes disease worldwide, but its epidemiological profile is only partially understood. Methods. We used an enzyme immunoassay to measure anti-HEV immunoglobulin G antibodies in 18,695 serum samples collected in the Third National Health and Nutrition Examination Survey. We calculated estimates of HEV seroprevalence and examined associations with putative risk factors. Results. The seroprevalence of HEV in the civilian noninstitutionalized United States (US) population during the period from 1988 through 1994 was 21.0% (95% confidence interval [CI], 19.0%-22.9%). Among US-born individuals, males, non-Hispanic whites, and individuals residing in the Midwest and/or in metropolitan areas had the highest seroprevalence estimates. Having a pet in the home (odds ratio [OR], 1.19 [95% CI, 1.01-1.40]) and consuming liver or other organ meats more than once per month (OR, 1.38 [95% CI, 1.01-1.88]) were significantly associated with increased odds of HEV seropositivity. Conclusions. Exposure to HEV is common in the US population, although hepatitis E is rarely reported. Having pets and consuming organ meats may play a role in HEV transmission in the United States, but other mechanisms of transmission may also exist. HEV may be considered a possible etiologic agent of acute and chronic hepatitis in US patients reporting no travel history. [ABSTRACT FROM AUTHOR]

Background. Endemic measles transmission was declared eliminated in the United States in 2000. To ensure that elimination can be maintained, high population immunity must be sustained and monitored. Testing for measles antibody was included in the National Health and Nutrition Examination Survey (NHANES), a nationally representative survey, conducted during 1999-2004. Methods. A measles-specific immunoassay was used to measure the seroprevalence of measles antibody in NHANES participants 6-49 years of age. For analysis, participants were grouped by birth cohort. Results. During 1999-2004, the rate of measles seropositivity in the population overall was 95.9% (95% confidence interval [CI], 95.1%-96.5%). The highest seroprevalence of measles antibody was in non-Hispanic blacks (98.6% [95% CI, 98.0%-99.1%]). Those born during 1967-1976 had significantly lower levels of measles antibody (92.4% [95% CI, 90.8%-93.9%]) than did the other birth cohorts. Independent predictors of measles seropositivity in the 1967-1976 birth cohort were non-Hispanic/black race/ethnicity, more than a high school education, having health insurance, and birth outside the United States. Conclusions. Measles seropositivity was uniformly high in the US population during 1999-2004. Nearly all population subgroups had evidence of measles seropositivity levels greater than the estimated threshold necessary to sustain measles elimination. Non-Hispanic whites and Mexican Americans born during 1967-1976 had the lowest measles seropositivity levels and represent populations that might be at increased risk for measles disease if the virus were reintroduced into the United States. [ABSTRACT FROM AUTHOR]

Background. Human herpesvirus 8 (HHV-8) causes Kaposi sarcoma. In the United States, transmission routes for HHV-8 are uncertain. Methods. The National Health and Nutrition Examination Survey III sampled individuals from the US general population (1988-1994). We used enzyme immunoassays (EIAs) to measure HHV-8 antibodies (K8.1 and open reading frame [ORF] 73 antigens) in 13,894 surveyed adults. HHV-8 seroprevalence was examined according to sexual history and viral coinfection markers. Results. Overall, seroprevalence was low when a highly specific cutoff was used (K8.1, 1.6%; ORF73, 1.5%) but was higher when a less-specific cutoff was used (K8.1, 7.1%; ORF73, 7.4%). When the more-specific approach was used, K8.1 seroprevalence was similar in men and women. Men who have sex with men (MSM) had a higher K8.1 seroprevalence (8.2%). Among other men, K8.1 seroprevalence was marginally associated with duration of heterosexual activity (P = .1) and was positively associated with the lifetime number of sex partners (P = .04) and with coinfections with hepatitis B virus (6.1% vs. 1.2% without coinfection; P < .001) and herpes simplex virus 2 (2.7% vs. 1.0%; P = .1). Among women, K8.1 seroprevalence was not significantly related to duration of sexual activity, the lifetime number of sex partners, or viral coinfections. The ORF73 EIA revealed similar but less clear-cut patterns. Conclusions. Among men, HHV-8 transmission may occur through sexual activity, particularly sex with other men. No evidence was observed for heterosexual transmission to women. [ABSTRACT FROM AUTHOR]

After the 1989–1991 rubella resurgence, rubella vaccination efforts targeted children and women of childbearing age. Utilizing National Health and Nutrition Examination Survey data collected during 1988-1994 and 1999- 2004, we assessed whether US levels of rubella seropositivity are consistent with rubella elimination and whether changes are consistent with immunization efforts. Serum samples with rubella antibody levels ⩾10 IU tested by rubella immunoglobulin G enzyme immunoassay were considered to be positive. In 1999–2004, the overall age-adjusted rubella seropositivity level was 91.3% (95% confidence interval [CI], 90.5%–92.1%), a significant increase from 88.1% (95% CI, 86.9%–89.1%) in 1988-1994 (P < .001). Among children, seropositivity was highest in children 6–11 years of age (96.2%), followed by adolescents 12–19 years of age (93.7%). Both groups showed significant increases in immunity levels, in comparison with those in 1988–1994 (P < .001). Among adults, seropositivity among women increased (from 88.9% to 91.5%; P = .015), and there was no change among men (from 87.8% to 88.0%; P = .84). In 1999–2004, population rubella immunity levels were at or above the modeled threshold for elimination of rubella virus transmission. Increases in immunity levels are consistent with vaccination efforts. [ABSTRACT FROM AUTHOR]

After the 1989–1991 rubella resurgence, rubella vaccination efforts targeted children and women of childbearing age. Utilizing National Health and Nutrition Examination Survey data collected during 1988–1994 and 1999–2004, we assessed whether US levels of rubella seropositivity are consistent with rubella elimination and whether changes are consistent with immunization efforts. Serum samples with rubella antibody levels ⩾10 IU tested by rubella immunoglobulin G enzyme immunoassay were considered to be positive. In 1999–2004, the overall age-adjusted rubella seropositivity level was 91.3% (95% confidence interval [CI], 90.5%–92.1%), a significant increase from 88.1% (95% CI, 86.9%–89.1%) in 1988–1994 (P<.001). Among children, seropositivity was highest in children 6–11 years of age (96.2%), followed by adolescents 12-19 years of age (93.7%). Both groups showed significant increases in immunity levels, in comparison with those in 1988-1994 (P < .001). Among adults, seropositivity among women increased (from 88.9% to 91.5%; P = .015), and there was no change among men (from 87.8% to 88.0%; P = .84). In 1999–2004, population rubella immunity levels were at or above the modeled threshold for elimination of rubella virus transmission. Increases in immunity levels are consistent with vaccination efforts. [ABSTRACT FROM AUTHOR]

Context: Herpes simplex virus type 1 (HSV-1) and type 2 are common infections worldwide. Herpes simplex virus type 2 (HSV-2) is the cause of most genital herpes and is almost always sexually transmitted. In contrast, HSV-1 is usually transmitted during childhood via nonsexual contacts. Preexisting HSV-1 antibodies can alleviate clinical manifestations of subsequently acquired HSV-2. Furthermore, HSV-1 has become an important cause of genital herpes in some developed countries.Objective: To examine trends in HSV-1 and HSV-2 seroprevalence in the United States in 1999-2004 compared with 1988-1994.Design, Settings, and Participants: Cross-sectional, nationally representative surveys (US National Health and Nutrition Examination Surveys [NHANES]), were used to compare national seroprevalence estimates from 1999-2004 with those from 1988-1994, and changes in HSV-1 and HSV-2 seroprevalence since 1976-1980 were reviewed. Persons aged 14 to 49 years were included in these analyses.Main Outcome Measures: Seroprevalence of HSV-1 and HSV-2 antibodies based on results from type-specific immunodot assays; diagnosis of genital herpes.Results: The overall age-adjusted HSV-2 seroprevalence was 17.0% (95% confidence interval [CI], 15.8%-18.3%) in 1999-2004 and 21.0% (95% CI, 19.1%-23.1%) in 1988-1994, a relative decrease of 19.0% between the 2 surveys (95% CI, -28.6% to -9.5%; P<.001). Decreases in HSV-2 seroprevalence were especially concentrated in persons aged 14 to 19 years between 1988 and 2004. In adolescents aged 17 to 19 years and young adults, the decreases in HSV-2 seroprevalence were significant even after adjusting for changes in sexual behaviors. Among those infected with HSV-2, the percentage who reported having been diagnosed with genital herpes was statistically different (14.3% in 1999-2004 and 9.9% in 1988-1994; P = .02). Seroprevalence of HSV-1 decreased from 62.0% (95% CI, 59.6%-64.6%) in 1988-1994 to 57.7% (95% CI, 55.9%-59.5%) in 1999-2004, a relative decrease of 6.9% between the 2 surveys (95% CI, -11.6% to -2.3%; P = .006). Among persons infected with HSV-1 but not with HSV-2, a higher percentage reported having been diagnosed with genital herpes in 1999-2004 compared with 1988-1994 (1.8% vs 0.4%, respectively; P<.001).Conclusions: These data show declines in HSV-2 seroprevalence, suggesting that the trajectory of increasing HSV-2 seroprevalence in the United States has been reversed. Seroprevalence of HSV-1 decreased but the incidence of genital herpes caused by HSV-1 may be increasing. [ABSTRACT FROM AUTHOR]

Context Herpes simplex virus type 1 (HSV-1) and type 2 are common infections worldwide. Herpes simplex virus type 2 (HSV-2) is the cause of most genital herpes and is almost always sexually transmitted. In contrast, HSV-1 is usually transmitted during childhood via nonsexual contacts. Preexisting HSV-1 antibodies can alleviate clinical manifestations of subsequently acquired HSV-2. Furthermore, HSV-1 has become an important cause of genital herpes in some developed countries. Objective To examine trends in HSV-1 and HSV-2 seroprevalence in the United States in 1999-2004 compared with 1988-1994. Design, Settings, and Participants Cross-sectional, nationally representative surveys (US National Health and Nutrition Examination Surveys [NHANES]), were used to compare national seroprevalence estimates from 1999-2004 with those from 1988-1994, and changes in HSV-1 and HSV-2 seroprevalence since 1976-1980 were reviewed. Persons aged 14 to 49 years were included in these analyses. Main Outcome Measures Seroprevalence of HSV-1 and HSV-2 antibodies based on results from type-specific immunodot assays; diagnosis of genital herpes. Results The overall age-adjusted HSV-2 seroprevalence was 17.0% (95% confidence interval [CI], 15.8%-18.3%) in 1999-2004 and 21.0% (95% CI, 19.1%-23.1%) in 1988-1994, a relative decrease of 19.0% between the 2 surveys (95% CI, −28.6% to −9.5%; P<.001). Decreases in HSV-2 seroprevalence were especially concentrated in persons aged 14 to 19 years between 1988 and 2004. In adolescents aged 17 to 19 years and young adults, the decreases in HSV-2 seroprevalence were significant even after adjusting for changes in sexual behaviors. Among those infected with HSV-2, the percentage who reported having been diagnosed with genital herpes was statistically different (14.3% in 1999-2004 and 9.9% in 1988-1994; P = .02). Seroprevalence of HSV-1 decreased from 62.0% (95% CI, 59.6%-64.6%) in 1988-1994 to 57.7% (95% CI, 55.9%-59.5%) in 1999-2004, a relative decrease of 6.9% between the 2 surveys (95% CI, −11.6% to −2.3%; P = .006). Among persons infected with HSV-1 but not with HSV-2, a higher percentage reported having been diagnosed with genital herpes in 1999-2004 compared with 1988-1994 (1.8% vs 0.4%, respectively; P<.001). Conclusions These data show declines in HSV-2 seroprevalence, suggesting that the trajectory of increasing HSV-2 seroprevalence in the United States has been reversed. Seroprevalence of HSV-1 decreased but the incidence of genital herpes caused by HSV-1 may be increasing. [ABSTRACT FROM AUTHOR]

Background: Defining the primary characteristics of persons infected with hepatitis C virus (HCV) enables physicians to more easily identify persons who are most likely to benefit from testing for the disease. Objective: To describe the HCV-infected population in the United States. Design: Nationally representative household survey. Setting: U.S. civilian, noninstitutionalized population. Participants: 15 079 participants in the National Health and Nutrition Examination Survey between 1999 and 2002. Measurements: All participants provided medical histories, and those who were 20 to 59 years of age provided histories of drug use and sexual practices. Participants were tested for antibodies to HCV (anti-HCV) and HCV RNA, and their serum alanine aminotransferase (ALT) levels were measured. Results: The prevalence of anti-HCV in the United States was 1.6% (95% CI, 1.3% to 1.9%), equating to an estimated 4.1 million (CI, 3.4 million to 4.9 million) anti-HCV-positive persons nationwide; 1.3% or 3.2 million (CI, 2.7 million to 3.9 million) persons had chronic HCV infection. Peak prevalence of anti-HCV (4.3%) was observed among persons 40 to 49 years of age. A total of 48.4% of anti-HCV-positive persons between 20 and 59 years of age reported a history of injection drug use, the strongest risk factor for HCV infection. Of all persons reporting such a history, 83.3% had not used injection drugs for at least 1 year before the survey. Other significant risk factors included 20 or more lifetime sex partners and blood transfusion before 1992. Abnormal serum ALT levels were found in 58.7% of HCV RNA-positive persons. Three characteristics (abnormal serum ALT level, any history of injection drug use, and history of blood transfusion before 1992) identified 85.1% of HCV RNA-positive participants between 20 and 59 years of age. Limitations: Incarcerated and homeless persons were not included in the survey. Conclusions: Many Americans are infected with HCV. Most were born between 1945 and 1964 and can be identified with current screening criteria. History of injection drug use is the strongest risk factor for infection. [ABSTRACT FROM AUTHOR]

Objectives. We examined racial/ethnic differences in the seroprevalence of selected infectious agents in analyses stratified according to risk categories to identify patterns and to determine whether demographic, socioeconomic, and behavioral characteristics explain these differences. Methods. We analyzed data from the third National Health and Nutrition Examination Survey, comparing differences among groups in regard to the prevalence of infection with hepatitis A, B, and C viruses, Toxoplasma gondii, Helicobacter pylori, and herpes simplex virus type 2. Results. Racial/ethnic differences were greater among those in the low-risk category. In the case of most infectious agents, odds associated with race/ethnicity were almost 2 times greater in that category than in the high-risk category. Conclusions. Stratification and adjustment for socioeconomic factors reduced or eliminated racial/ethnic differences in the prevalence of infection in the high-risk but not the low-risk group, wherein race/ethnicity remained significant and might have been a surrogate for unmeasured risk factors. (Am J Public Health. 2004;94:1952-1958). [ABSTRACT FROM AUTHOR]

Infection with human papillomavirus (HPV) type 16 accounts for about half of cervical cancers worldwide. This study investigated the seroepidemiology of HPV-16 infection in the United States by using a population-based survey. Serum samples and questionnaire data were collected from 1991 to 1994 for the National Health and Nutrition Examination Surveys. HPV-16-specific IgG antibody was detected by use of an HPV-16 virus-like particle ELISA. HPV-16 seropositivity in the US population aged 12-59 years was 13.0% (95% confidence interval, 11.5%-14.7%). Seroprevalence was higher in women (17.9%) than in men (7.9%). Age, race/ethnicity, and number of lifetime sex partners were associated with HPV seropositivity in women. Race/ethnicity, age at first intercourse, urban/nonurban residence, years of sexual activity, and having had sex with a man were associated with HPV seropositivity in men. Information on HPV-16 seroepidemiology will be important for designing prevention efforts including vaccine programs. [ABSTRACT FROM AUTHOR]

Background: Serologic data on diseases that are preventable by vaccine are useful to evaluate the success of immunization programs and to identify susceptible subgroups. Objective: To provide national estimates of immunity to diphtheria and tetanus by measurement of serum antibody levels. Design: Examination of data from the Third National Health and Nutrition Examination Survey, a representative cross-sectional sample of the U.S. population. Setting: 89 randomly selected locations throughout the United States. Participants: 18 045 persons 6 years of age or older who were examined from 1988 to 1994. Measurements: Serum samples obtained at a single time point were tested for diphtheria and tetanus antitoxin. Results: Overall, 60.5% of Americans 6 years of age or older had fully protective levels of diphtheria antibody (≥0.10 IU/mL) and 72.3% had protective levels of tetanus antibody (>0.15 IU/mL). Ninety-one percent of Americans 6 to 11 years of age had protective levels of both diphtheria and tetanus antibody; this proportion decreased to approximately 30% among persons 70 years of age (29.5% for diphtheria and 31.0% for tetanus). Adult Mexican-Americans were slightly less likely to have protective levels of antibody to both toxins. Only 47% of persons 20 years of age or older had levels that were protective against both diseases, and only 63% of adults who were protected against tetanus were also protected against diphtheria. Conclusions: A substantial proportion of adults in the United States do not have antibody levels that are protective against diphtheria and tetanus. In addition, although the recommended vaccine is a combination of tetanus and diphtheria, only 63% of adults with protective antibody to tetanus also had protective antibody to diphtheria. [ABSTRACT FROM AUTHOR]

Determines the epidemiology of rubella seropositivity in the United States from 1988 to 1994. Rate of seropositivity in persons aged 6 to 11 years; Overall rubella herd immunity during the period; Approaches to eliminate rubella and congenital rubella syndrome; Barriers to improving rubella vaccination.

Context: Population-based estimates of the prevalence of disease-associated mutations, such as hemochromatosis (HFE) gene mutations, are needed to determine the usefulness of genetic screening.Objective: To estimate the prevalence of the HFE mutations C282Y and H63D in the US population.Design: Cross-sectional population-based study of samples in the DNA bank from phase 2 of the Third National Health and Nutrition Examination Survey conducted from 1992 to 1994.Setting and Participants: Genotyped samples of cells from a total of 5171 participants, cross-classified by sex, age, and race/ethnicity in the analysis.Main Outcome Measures: Estimates of the prevalence of C282Y and H63D mutations.Results: The prevalence of C282Y homozygosity is estimated to be 0.26% (95% confidence interval [CI], 0.12%-0.49%); 1.89% (95% CI, 1.48%-2.43%) for H63D homozygosity; and 1.97% (95% CI, 1.54%-2.49%) for compound heterozygosity. The prevalence estimates for C282Y heterozygosity (C282Y/wild type) are 9.54% among non-Hispanic whites, 2.33% among non-Hispanic blacks, and 2.75% among Mexican-Americans. The prevalence estimates of the C282Y mutation in the US population are 5.4% (95% CI, 4.7%-6.2%) and 13.5% (95% CI, 12.5%-14.8%) for the H63D mutation.Conclusions: Estimates of prevalence of HFE mutations are within the expected range for non-Hispanic whites and blacks but the estimated prevalence of the C282Y mutation among Mexican-Americans is less than expected. Mutation data now need to be linked to clinically relevant indices, such as transferrin saturation level. [ABSTRACT FROM AUTHOR]

Between the time that two large, national surveys were conducted, the Second National Health and Nutrition Examination Survey (1976–1980) and the Third National Health and Nutrition Examination Survey (1988–1994), prevalence of herpes simplex virus type 2 (HSV-2) infection in the United States increased by 30%. From these survey data, the authors estimated the incidence of HSV-2 infection in the civilian, noninstitutionalized population aged ≥12 years by means of a mathematical model that allowed overall incidence to increase linearly with time but required the shape of the age-specific incidence curve to remain constant. From 1970 to 1985, annual incidence of HSV-2 infection in HSV-2-seronegative persons increased by 82%, from 4.6 per 1,000 (95% confidence interval: 4.2, 5.0) to 8.4 per 1,000 (95% confidence interval: 7.7, 9.1). Incidence in 1985 was higher in women than in men (9.9 vs. 6.9 per 1,000), higher in Blacks than in Whites (20.4 vs. 6.3 per 1,000), and highest in the group aged 20–29 years (14.6 and 22.5 per 1,000 in men and women, respectively). Thus, by 1985, approximately 1,640,000±150,000 persons (730,000 men and 910,000 women) were being infected annually with HSV-2. [ABSTRACT FROM PUBLISHER]

Presents a study to test whether overweight and obesity are associated with low-grade systematic inflammation as measured by serum C-reactive protein (CRP) level. Context; Design and setting; Participants; Main outcome measures; Results; Conclusion.

Objectives. Data from 2 National Health and Nutrition Examination Surveys (NHANES), NHANES II (1976-1980) and NHANES II (1998-1994), were analyzed to examine trends in the prevalence of hepatitis B infection in the United States. Methods. Serum specimens were tested for makers of hepatitis B virus infection, and risk factors were determined from questionnaires. Results. The overall age-adjusted prevalence of hepatitis B virus infection was 5.5% (95% confidence interval [CI]=4.8, 6.2) in NHANES II, as compared with 4.9% (95% CI=4.3, 5.6) in NHANES III. In both surveys, Black participants had the highest prevalence of infection (NHANES II, 15.8%; NHANES III, 11.9%). No difference in infection were found in the major racial groups between surveys, except for a decrease among those older than 50 years. Black race, increasing number of lifetime sexual partners, and foreign birth had the strongest independent associations with hepatitis B virus infection. Conclusions. Testing of participants in 2 national surveys demonstrates no significant decrease in hepatitis B virus infection, despite the availability of hepatitis B vaccine. [ABSTRACT FROM AUTHOR]

Precise estimates of the incidence of hepatitis B virus (HBV) infection are required to assess the impact of immunization and other prevention strategies in the United States. Race- and age-specific prevalence data obtained from the second and third National Health and Nutrition Examination Surveys (NHANES II, 1976–1980, and NHANES III, 1988–1994) were used to estimate the annual incidence of HBV infection by catalytic modeling. During the period covered by NHANES II, an estimated 323,462 persons were infected annually, and 334,863 were infected annually during the period covered by NHANES III. No statistically significant declines in prevalence of HBV infection occurred between the two surveys, a period during which hepatitis B vaccination targeted only limited numbers of high-risk adults. [ABSTRACT FROM PUBLISHER]

To provide more accurate estimates of Helicobacter pylori infection in the US population, IgG antibody levels were measured in serum from 2581 persons aged 6–19 years examined during phase 1 of the third National Health and Nutrition Examination Survey. Overall, 24.8% of participants had evidence of H. pylori infection. Infection was strongly associated with increasing age (X 2trend, P < .01) and being nonwhite (17.0% of non-Hispanic whites vs. 40.1% of non-Hispanic blacks and 42.0% of Mexican Americans infected). In a multivariate logistic regression model, H. pylori infection was significantly associated with increasing age (odds ratio [OR] = 1.07/year), being nonwhite (non-Hispanic black OR = 2.6 or Mexican American OR = 1.8), poverty (OR = 1.5), crowding (OR = 5.6), and- head of household education level (OR = 1.8). In Mexican Americans, infection was associated with birth outside the United States or Canada in the univariate analyses but was not significantly associated after adjustment for age, poverty, crowding, and head of household education level. [ABSTRACT FROM PUBLISHER]

Objectives. The Dallas County study of a proposed national household seroprevalence survey was designed to assess the feasibility of conducting a national survey and to estimate the prevalence of human immunodeficiency virus (HIV) and hepatitis B virus infection for Dallas County. Risk behavior data were collected and correlated with HIV infection. Methods. Participants in this survey represented a probability sample of the county. A self-administered questionnaire on demographic characteristics and HIV risk behavior was completed and a blood sample was obtained. Results. Of the 1724 adults eligible for the survey, 1446 completed the questionnaire and 1374 provided a blood sample. The prevalence estimates were 0.4% for HIV and 7.3% for hepatitis B virus. A strong relationship was observed between HIV and hepatitis B status and risk behavior. Conclusions. In this study population, receptive anal intercourse and increasing numbers of male partners had the strongest correlation with the prevalence of HIV and hepatitis B virus infection in men. The high level of risk reporting for individuals positive for HIV or hepatitis B suggests that survey participants who engage in risk behaviors were willing to report those behaviors. [ABSTRACT FROM AUTHOR]

A chart is presented that shows the percentage of adults aged 18 to 59 years who have been tested for HIV according to the number of lifetime sex partners and sex from 2007 to 2010 from the National Health and Nutrition Examination Survey in the U.S.

A chart is presented that reveals the percentage of U.S. adults age 18 to 59 years old who underwent HIV testing from 2003 to 2006 and 2007 to 2010.