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Miko S, Calderwood L, Dale AP, King RF, Maurer MB, Said MA, Gebhardt M, Dyer LP, Maurer W, Wikswo ME, Mirza SA. Acute Gastroenteritis Outbreak Among Colorado River Rafters and Backpackers in the Grand Canyon, 2022. Wilderness Environ Med 2024; 35:173-182. [PMID: 38613339 DOI: 10.1177/10806032241245093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
INTRODUCTION From April 1 to May 31, 2022, Grand Canyon National Park received increased acute gastroenteritis reports. Pooled portable toilet specimens identified norovirus genogroups I and II. We sought to determine outbreak transmission contributors and individual risk factors while rafting or backpacking in the park. METHODS Grand Canyon rafters and backpackers were surveyed online from June 13-July 8, 2022, and a Cox proportional hazards model was used to identify predictors associated with illness and adjusted for potential confounding factors. RESULTS Among 762 surveys, 119 cases and 505 well persons submitted complete survey data. Illness among rafters was associated with interaction with ill persons during the trip (adjusted hazard ratio [adjHR] = 3.4 [95%CI 2.3-5.0]) and lack of any hand hygiene (1.2 [0.7-1.9]) or use of only sanitizer or water (1.6 [1.04-2.6]) before snacks. Younger rafters had higher illness rates compared to those ≥60 y (1.5 [1.2-1.8] for ages 40-59 and 2.2 [1.4-3.5] for ages <40 y). CONCLUSIONS Person-to-person transmission likely accounted for the widespread outbreak. Future outbreak mitigation efforts on river trips could focus on symptom screening before the trip starts, prompt separation of ill and well passengers, strict adherence to hand hygiene with soap and water, minimizing social interactions among rafting groups, and widespread outbreak notices and education to all park users.
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Affiliation(s)
- Shanna Miko
- Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Atlanta, GA, USA
| | - Laura Calderwood
- Centers for Disease Control and Prevention, Atlanta, GA, USA
- Cherokee Nation Assurance, Atlanta, GA, USA
| | - Ariella P Dale
- Epidemic Intelligence Service, Atlanta, GA, USA
- Arizona Department of Health Services, Phoenix, AZ, USA
- Maricopa County Department of Public Health, Maricopa, AZ, USA
| | - Ronan F King
- National Park Service - Office of Public Health, Washington, DC, USA
| | - Matthew B Maurer
- Coconino County Health and Human Services, Coconino County, Flagstaff, AZ, USA
| | - Maria A Said
- National Park Service - Office of Public Health, Washington, DC, USA
| | - Marette Gebhardt
- Coconino County Health and Human Services, Coconino County, Flagstaff, AZ, USA
| | | | - Wendy Maurer
- Coconino County Health and Human Services, Coconino County, Flagstaff, AZ, USA
| | - Mary E Wikswo
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sara A Mirza
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Hecht G, Dale AP, Ruberto I, Adame G, Close R, Snyder SJ, Pink K, Lemmon N, Rudolfo J, Madsen M, Wiens AL, Cossaboom C, Shoemaker T, Choi MJ, Cannon D, Krapiunaya I, Whitmer S, Mobley M, Talundzic E, Klena JD, Venkat H. Detection of Hantavirus during the COVID-19 Pandemic, Arizona, USA, 2020. Emerg Infect Dis 2023; 29:1663-1667. [PMID: 37486231 PMCID: PMC10370831 DOI: 10.3201/eid2908.221808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
We identified 2 fatal cases of persons infected with hantavirus in Arizona, USA, 2020; 1 person was co-infected with SARS-CoV-2. Delayed identification of the cause of death led to a public health investigation that lasted ≈9 months after their deaths, which complicated the identification of a vector or exposure.
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Kretschmer M, Ruberto I, Townsend J, Zabel K, Will J, Maldonado K, Busser N, Damian D, Dale AP. Unprecedented Outbreak of West Nile Virus - Maricopa County, Arizona, 2021. Am J Transplant 2023; 23:848-853. [PMID: 37271566 DOI: 10.1016/j.ajt.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | | | - John Townsend
- Maricopa County Environmental Services Department, Vector Control Division, Phoenix, Arizona
| | - Karen Zabel
- Maricopa County Department of Public Health, Phoenix, Arizona
| | - James Will
- Maricopa County Environmental Services Department, Vector Control Division, Phoenix, Arizona
| | - Keila Maldonado
- Maricopa County Department of Public Health, Phoenix, Arizona
| | - Nicole Busser
- Maricopa County Environmental Services Department, Vector Control Division, Phoenix, Arizona
| | - Dan Damian
- Maricopa County Environmental Services Department, Vector Control Division, Phoenix, Arizona
| | - Ariella P Dale
- Maricopa County Department of Public Health, Phoenix, Arizona
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Howard BJ, Collins JE, Staab RN, Singh S, Lara E, Kretschmer M, Rehder L, Dellos A, White JR, Dale AP. Mpox Vaccine Interest Survey Prioritization and Data Flow: Maricopa County, Arizona, July-August 2022. Am J Public Health 2023; 113:504-508. [PMID: 36893362 PMCID: PMC10088967 DOI: 10.2105/ajph.2023.307224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 03/11/2023]
Abstract
With increasing mpox cases in Maricopa County, Arizona, the county's health department launched a survey on July 11, 2022, to gather eligibility and contact data and provide clinic information to those interested in JYNNEOS as postexposure prophylaxis (PEP) or expanded postexposure prophylaxis(PEP++). Survey data were matched to case and vaccination data. Overall, 343 of the 513 respondents (66.9%) who reported close contact with an mpox case patient received PEP and 1712 of the 3379 respondents (50.7%) who were unsure of their contact status received PEP++. This outreach intervention connected potential close contacts unknown to MCDPH with PEP or PEP++. (Am J Public Health. 2023;113(5):504-508. https://doi.org/10.2105/AJPH.2023.307224).
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Affiliation(s)
- Brandon J Howard
- The authors are with the Maricopa County Department of Public Health, Phoenix, AZ
| | - Jennifer E Collins
- The authors are with the Maricopa County Department of Public Health, Phoenix, AZ
| | - R Nicholas Staab
- The authors are with the Maricopa County Department of Public Health, Phoenix, AZ
| | - Sonia Singh
- The authors are with the Maricopa County Department of Public Health, Phoenix, AZ
| | - Erika Lara
- The authors are with the Maricopa County Department of Public Health, Phoenix, AZ
| | - Melissa Kretschmer
- The authors are with the Maricopa County Department of Public Health, Phoenix, AZ
| | - Lori Rehder
- The authors are with the Maricopa County Department of Public Health, Phoenix, AZ
| | - Anne Dellos
- The authors are with the Maricopa County Department of Public Health, Phoenix, AZ
| | - Jessica R White
- The authors are with the Maricopa County Department of Public Health, Phoenix, AZ
| | - Ariella P Dale
- The authors are with the Maricopa County Department of Public Health, Phoenix, AZ
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Kretschmer M, Ruberto I, Townsend J, Zabel K, Will J, Maldonado K, Busser N, Damian D, Dale AP. Unprecedented Outbreak of West Nile Virus - Maricopa County, Arizona, 2021. MMWR Morb Mortal Wkly Rep 2023; 72:452-457. [PMID: 37104168 DOI: 10.15585/mmwr.mm7217a1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
West Nile virus (WNV) is a mosquitoborne disease primarily transmitted through bites of infected Culex species mosquitos (1). In the United States, WNV is the leading domestically acquired arboviral disease; it can cause severe illness affecting the brain and spinal cord with an associated case fatality rate of 10% (2,3). On September 2, 2021, Maricopa County Environmental Services Department, Vector Control Division (MCESD-VCD) notified the Maricopa County Department of Public Health (MCDPH) and the Arizona Department of Health Services (ADHS) that the WNV vector index (VI), a measure of infected Culex mosquitoes, was substantially elevated. By that date, at least 100 WNV cases had already been reported among Maricopa County residents to MCDPH by health care providers and laboratories. Within 2 weeks, the VI reached its highest ever recorded level (53.61), with an associated tenfold increase in the number of human disease cases. During 2021, a total of 1,487 human WNV cases were identified; 956 (64.3%) patients had neuroinvasive disease, and 101 (6.8%) died. MCESD-VCD conducted daily remediation efforts to mitigate elevated VI and address mosquito-related complaints from residents (i.e., large numbers of outdoor mosquitoes from an unknown source and unmaintained swimming pools potentially breeding mosquitoes). MCDPH increased outreach to the community and providers through messaging, education events, and media. This was the largest documented focal WNV outbreak in a single county in the United States (4). Despite outreach efforts to communities and health care partners, clinicians and patients reported a lack of awareness of the WNV outbreak, highlighting the need for public health agencies to increase prevention messaging to broaden public awareness and to ensure that health care providers are aware of recommended testing methods for clinically compatible illnesses.
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Kretschmer M, Collins J, Dale AP, Garrett B, Koski L, Zabel K, Staab RN, Turnbow K, Nativio J, Andrews K, Smith WE, Townsend J, Busser N, Will J, Burr K, Jones FK, Santiago GA, Fitzpatrick KA, Ruberto I, Fitzpatrick K, White JR, Adams L, Sunenshine RH. Notes From the Field: First Evidence of Locally Acquired Dengue Virus Infection - Maricopa County, Arizona, November 2022. MMWR Morb Mortal Wkly Rep 2023; 72:290-291. [PMID: 36928186 PMCID: PMC10027408 DOI: 10.15585/mmwr.mm7211a5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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Kretschmer M, Dale AP, Ruberto I, Zabel K, Maldonado K, Townsend J, Will J, Busser N, Damian D, Venkat H, Sunenshine R. 1372. Unprecedented West Nile Virus Outbreak — Maricopa County, Arizona, 2021. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
West Nile virus (WNV) causes a mosquito-borne disease that can lead to permanent paralysis or death. WNV became endemic in Maricopa County in 2003. The Maricopa County Department of Public Health (MCDPH) and Environmental Services Department Vector Control (MCESD VC) and Arizona Department of Health Services (ADHS) collaborated to monitor and respond to mosquito surveillance and human WNV cases. We describe an unprecedented WNV outbreak in 2021.
Methods
MCESD VC monitored vector complaints, mosquito vector positive traps, and vector index (VI) data. Reported human cases (using the CSTE/CDC case definition) were interviewed by MCDPH. MCDPH and ADHS sent surveillance alerts to healthcare providers regarding WNV symptomology and clinical testing guidance. MCDPH consulted with providers and/or Infection Preventionists during case investigations.
Results
The first WNV-positive mosquito trap occurred the week of May 1 (VI=0.235); VI peaked the week of September 11 at 53.608; the last positive trap was the week of November 20. MCESD VC fogged >400,000 acres (∼2x the 10-year average) with adulticide, applied larvicide to ∼25,000 sites, and received ∼9,500 mosquito complaints (40% more than prior season). During the 2021 WNV season, 1,487 cases were reported, of which 960 (64.6%) had neuroinvasive illnesses (WNND) and 101 (6.8%) died (all were WNND cases). Median case age was 66 (IQR=53–75) years; for deaths, it was 79 (IQR=71-83) years. In total, 1,017 (68.4%) cases were hospitalized with a median length of stay (LOS) of 7 (IQR=4–10) days. WNND cases accounted for 91.2% of hospitalizations. Median LOS for hospitalized WNND cases was 7 (IQR=4-11) days, compared to 4 (IQR=2-6) days for non-neuroinvasive cases. Despite 3 surveillance alerts sent to providers and media coverage, providers were not consistently aware of the WNV outbreak or that serum can be tested for WNV.
Conclusion
This was the largest WNV outbreak in Maricopa County. It taxed an already stressed healthcare system during the COVID-19 pandemic with over 1,000 hospitalized cases, including nearly 100 in people without WNND. During WNV season, clinicians should consider WNV testing of both serum and CSF in severely ill patients with and without evidence of neuroinvasive disease.
Disclosures
Ariella P. Dale, PhD, MPH, Infectious Disease Society of America - Arizona Chapter: Honoraria Karen Zabel, MSN RN, Express Scripts: Immediate family member employment.
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Affiliation(s)
| | - Ariella P Dale
- Centers for Disease Control and Prevention and Maricopa County Department of Public Health , Peoria, Arizona
| | - Irene Ruberto
- Arizona Department of Health Services , Phoenix, Arizona
| | - Karen Zabel
- Maricopa County Department of Public Health , Phoenix, Arizona
| | - Keila Maldonado
- Maricopa County Department of Public Health , Phoenix, Arizona
| | | | - James Will
- Maricopa County Environmental Services Vector Control , Phoenix, Arizona
| | | | | | - Heather Venkat
- Centers for Disease Control and Prevention , Phoenix, Arizona
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Dale AP, Miko S, Calderwood LE, King RF, Maurer M, Dyer L, Gebhardt M, Maurer W, Crosby S, Wikswo ME, Said MA, Mirza SA. Outbreak of Acute Gastroenteritis Among Rafters and Backpackers in the Backcountry of Grand Canyon National Park, April–June 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1207-1211. [PMID: 36136954 PMCID: PMC9531568 DOI: 10.15585/mmwr.mm7138a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Dale AP, Almendares O, Howard B, Burnett E, Prasai S, Arons M, Collins J, Duffy N, Pandit U, Brady S, White J, Garrett B, Kirking HL, Sunenshine R, Tate JE, Scott SE. Investigation of a Severe Acute Respiratory Syndrome Coronavirus 2 Delta (B.1.617.2) Variant Outbreak Among Residents of a Skilled Nursing Facility and Vaccine Effectiveness Analysis: Maricopa County, Arizona, June-July 2021. Clin Infect Dis 2022; 75:e20-e26. [PMID: 35413107 PMCID: PMC9047249 DOI: 10.1093/cid/ciac240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Short-term rehabilitation units present unique infection control challenges because of high turnover and medically complex residents. In June 2021, the Maricopa County Department of Public Health was notified of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta outbreak in a skilled nursing facility short-term rehabilitation unit. We describe the outbreak and assess vaccine effectiveness (VE). METHODS Facility electronic medical records were reviewed for residents who spent > 1 night on the affected unit between June 10 and July 23, 2021, to collect demographics, SARS-CoV-2 test results, underlying medical conditions, vaccination status, and clinical outcomes. Coronavirus disease 2019 VE estimates using Cox proportional hazards models were calculated. RESULTS Forty (37%) of 109 short-stay rehabilitation unit residents who met inclusion criteria tested positive for SARS-CoV-2. SARS-CoV-2-positive case-patients were mostly male (58%) and White (78%) with a median age of 65 (range, 27-92) years; 11 (27%) were immunocompromised. Of residents, 39% (10 cases, 32 noncases) received 2 doses and 9% (4 cases, 6 noncases) received 1 dose of messenger RNA (mRNA) vaccine. Among nonimmunocompromised residents, adjusted 2-dose primary-series mRNA VE against symptomatic infection was 80% (95% confidence interval, 15-95). More cases were hospitalized (33%) or died (38%) than noncases (10% hospitalized; 16% died). CONCLUSIONS In this large SARS-CoV-2 Delta outbreak in a high-turnover short-term rehabilitation unit, a low vaccination rate and medically complex resident population were noted alongside severe outcomes. VE of 2-dose primary-series mRNA vaccine against symptomatic infection was the highest in nonimmunocompromised residents. Health departments can use vaccine coverage data to prioritize facilities for assistance in preventing outbreaks.
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Affiliation(s)
- Ariella P Dale
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Maricopa County Department of Public Health, Phoenix, AZ, United States
- Arizona Department of Health Services, Phoenix, AZ, United States
| | | | - Brandon Howard
- Maricopa County Department of Public Health, Phoenix, AZ, United States
| | | | - Siru Prasai
- Maricopa County Department of Public Health, Phoenix, AZ, United States
| | - Melissa Arons
- CDC COVID-19 Response, Atlanta, Georgia, United States
| | - Jennifer Collins
- Maricopa County Department of Public Health, Phoenix, AZ, United States
| | | | - Urvashi Pandit
- Maricopa County Department of Public Health, Phoenix, AZ, United States
| | - Shane Brady
- Arizona Department of Health Services, Phoenix, AZ, United States
| | - Jessica White
- Maricopa County Department of Public Health, Phoenix, AZ, United States
| | - Brenna Garrett
- Arizona Department of Health Services, Phoenix, AZ, United States
| | | | - Rebecca Sunenshine
- Maricopa County Department of Public Health, Phoenix, AZ, United States
- CDC COVID-19 Response, Atlanta, Georgia, United States
| | | | - Sarah E Scott
- Maricopa County Department of Public Health, Phoenix, AZ, United States
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Dale AP, Hudson MJ, Armenta D, Friebus H, Ellingson KD, Davis K, Cullen T, Brady S, Komatsu KK, Stone ND, Uyeki TM, Slifka KJ, Perez-Velez CM, Keaton AA. Clinical Outcomes of Monoclonal Antibody Therapy During a COVID-19 Outbreak in a Skilled Nursing Facility-Arizona, 2021. J Am Geriatr Soc 2022; 70:960-967. [PMID: 35141874 PMCID: PMC9115062 DOI: 10.1111/jgs.17705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/23/2021] [Accepted: 01/23/2022] [Indexed: 12/05/2022]
Abstract
Background Adult residents of skilled nursing facilities (SNF) have experienced high morbidity and mortality from SARS‐CoV‐2 infection and are at increased risk for severe COVID‐19 disease. Use of monoclonal antibody (mAb) treatment improves clinical outcomes among high‐risk outpatients with mild‐to‐moderate COVID‐19, but information on mAb effectiveness in SNF residents with COVID‐19 is limited. We assessed outcomes in SNF residents with mild‐to‐moderate COVID‐19 associated with an outbreak in Arizona during January–February 2021 that did and did not receive a mAb. Methods Medical records were reviewed to describe the effect of bamlanivimab therapy on COVID‐19 mortality. Secondary outcomes included referral to an acute care setting and escalation of medical therapies at the SNF (e.g., new oxygen requirements). Residents treated with bamlanivimab were compared to residents who were eligible for treatment under the FDA's Emergency Use Authorization (EUA) but were not treated. Multivariable logistic regression was used to determine association between outcomes and treatment status. Results Seventy‐five residents identified with COVID‐19 during this outbreak met eligibility for mAb treatment, of whom 56 received bamlanivimab. Treated and untreated groups were similar in age and comorbidities associated with increased risk of severe COVID‐19 disease. Treatment with bamlanivimab was associated with reduced 21‐day mortality (adjusted OR = 0.06; 95% CI: 0.01, 0.39) and lower odds of initiating oxygen therapy (adjusted OR = 0.07; 95% CI: 0.02, 0.34). Referrals to acute care were not significantly different between treated and untreated residents. Conclusions mAb therapy was successfully administered to SNF residents with COVID‐19 in a large outbreak setting. Treatment with bamlanivimab reduced 21‐day mortality and reduced initiation of oxygen therapy. As the COVID‐19 pandemic evolves and newer immunotherapies gain FDA authorization, more studies of the effectiveness of mAb therapies for treating emerging SARS‐CoV‐2 variants of concern in high‐risk congregate settings are needed.
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Affiliation(s)
- Ariella P Dale
- Epidemic Intelligence Service, Centers for Disease Control and Prevention.,Arizona Department of Health Services
| | - Matthew J Hudson
- Epidemic Intelligence Service, Centers for Disease Control and Prevention
| | | | | | | | - Kat Davis
- Pima County Department of Public Health
| | | | | | | | - Nimalie D Stone
- Centers for Disease Control and Prevention COVID-19 Response Team
| | - Timothy M Uyeki
- Centers for Disease Control and Prevention COVID-19 Response Team
| | | | | | - Amelia A Keaton
- Centers for Disease Control and Prevention COVID-19 Response Team
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Dale AP, Scott SE, Sunenshine R. COVID-19 Outbreaks Associated With Youth Club Sports: Maricopa County, Arizona, September-November 2020. Am J Public Health 2022; 112:216-219. [PMID: 35080951 PMCID: PMC8802581 DOI: 10.2105/ajph.2021.306579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Maricopa County Department of Public Health in Arizona investigated three COVID-19 outbreaks associated with club sports, two in tournaments and one in a hockey league. During September through November 2020, 195 team-associated and 69 secondary household contact cases were identified among 2093 athletes, coaches, and staff members; the team attack rate ranged from 6% to 72%. Outbreaks occurred during high community transmission periods in Maricopa County. Identification of contacts and characterization of prevention strategies were challenging because of limited cooperation from athletes, families, and staff. (Am J Public Health. 2022;112(2):216-219. https://doi.org/10.2105/AJPH.2021.306579).
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Affiliation(s)
- Ariella P. Dale
- Ariella P. Dale is with the Centers for Disease Control and Prevention, Atlanta, GA, and the Maricopa County Department of Public Health and Arizona Department of Health Services, Phoenix. Sarah E. Scott is with the Maricopa County Department of Public Health (MCDPH). Rebecca Sunenshine is with the Centers for Disease Control and Prevention and MCDPH
| | - Sarah E. Scott
- Ariella P. Dale is with the Centers for Disease Control and Prevention, Atlanta, GA, and the Maricopa County Department of Public Health and Arizona Department of Health Services, Phoenix. Sarah E. Scott is with the Maricopa County Department of Public Health (MCDPH). Rebecca Sunenshine is with the Centers for Disease Control and Prevention and MCDPH
| | - Rebecca Sunenshine
- Ariella P. Dale is with the Centers for Disease Control and Prevention, Atlanta, GA, and the Maricopa County Department of Public Health and Arizona Department of Health Services, Phoenix. Sarah E. Scott is with the Maricopa County Department of Public Health (MCDPH). Rebecca Sunenshine is with the Centers for Disease Control and Prevention and MCDPH
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Jehn M, Pandit U, Sabin S, Tompkins C, White J, Kaleta E, Dale AP, Ross HM, Mac McCullough J, Pepin S, Kenny K, Sanborn H, Heywood N, Schnall AH, Lant T, Sunenshine R. Accuracy of Case-Based Seroprevalence of SARS-CoV-2 Antibodies in Maricopa County, Arizona. Am J Public Health 2022; 112:38-42. [PMID: 34936397 PMCID: PMC8713634 DOI: 10.2105/ajph.2021.306568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 11/04/2022]
Abstract
We conducted a community seroprevalence survey in Arizona, from September 12 to October 1, 2020, to determine the presence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We used the seroprevalence estimate to predict SARS-CoV-2 infections in the jurisdiction by applying the adjusted seroprevalence to the county's population. The estimated community seroprevalence of SARS-CoV-2 infections was 4.3 times greater (95% confidence interval = 2.2, 7.5) than the number of reported cases. Field surveys with representative sampling provide data that may help fill in gaps in traditional public health reporting. (Am J Public Health. 2022;112(1):38-42. https://doi.org/10.2105/AJPH.2021.306568).
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Affiliation(s)
- Megan Jehn
- Megan Jehn and Camila Tompkins are with the School of Human Evolution and Social Change, Arizona State University (ASU), Tempe. Urvashi Pandit, Rebecca Sunenshine, and Jessica White are with the Maricopa County Department of Public Health, Phoenix, AZ. Susanna Sabin is with the Center for Evolution and Medicine, ASU. Erin Kaleta is with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ. Ariella P. Dale is with the Centers for Disease Control and Prevention (CDC) assigned to Maricopa County Department of Public Health. Heather M. Ross, Katherine Kenny, Heidi Sanborn, and Natalie Heywood are with the Edson College of Nursing and Health Innovation, ASU. J. Mac McCullough is with the College of Health Solutions, ASU. Susan Pepin is with Knowledge Enterprise, ASU. Amy H. Schnall is with the National Center for Environmental Health, CDC, Atlanta, GA. Timothy Lant is with the Biodesign Institute, ASU
| | - Urvashi Pandit
- Megan Jehn and Camila Tompkins are with the School of Human Evolution and Social Change, Arizona State University (ASU), Tempe. Urvashi Pandit, Rebecca Sunenshine, and Jessica White are with the Maricopa County Department of Public Health, Phoenix, AZ. Susanna Sabin is with the Center for Evolution and Medicine, ASU. Erin Kaleta is with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ. Ariella P. Dale is with the Centers for Disease Control and Prevention (CDC) assigned to Maricopa County Department of Public Health. Heather M. Ross, Katherine Kenny, Heidi Sanborn, and Natalie Heywood are with the Edson College of Nursing and Health Innovation, ASU. J. Mac McCullough is with the College of Health Solutions, ASU. Susan Pepin is with Knowledge Enterprise, ASU. Amy H. Schnall is with the National Center for Environmental Health, CDC, Atlanta, GA. Timothy Lant is with the Biodesign Institute, ASU
| | - Susanna Sabin
- Megan Jehn and Camila Tompkins are with the School of Human Evolution and Social Change, Arizona State University (ASU), Tempe. Urvashi Pandit, Rebecca Sunenshine, and Jessica White are with the Maricopa County Department of Public Health, Phoenix, AZ. Susanna Sabin is with the Center for Evolution and Medicine, ASU. Erin Kaleta is with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ. Ariella P. Dale is with the Centers for Disease Control and Prevention (CDC) assigned to Maricopa County Department of Public Health. Heather M. Ross, Katherine Kenny, Heidi Sanborn, and Natalie Heywood are with the Edson College of Nursing and Health Innovation, ASU. J. Mac McCullough is with the College of Health Solutions, ASU. Susan Pepin is with Knowledge Enterprise, ASU. Amy H. Schnall is with the National Center for Environmental Health, CDC, Atlanta, GA. Timothy Lant is with the Biodesign Institute, ASU
| | - Camila Tompkins
- Megan Jehn and Camila Tompkins are with the School of Human Evolution and Social Change, Arizona State University (ASU), Tempe. Urvashi Pandit, Rebecca Sunenshine, and Jessica White are with the Maricopa County Department of Public Health, Phoenix, AZ. Susanna Sabin is with the Center for Evolution and Medicine, ASU. Erin Kaleta is with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ. Ariella P. Dale is with the Centers for Disease Control and Prevention (CDC) assigned to Maricopa County Department of Public Health. Heather M. Ross, Katherine Kenny, Heidi Sanborn, and Natalie Heywood are with the Edson College of Nursing and Health Innovation, ASU. J. Mac McCullough is with the College of Health Solutions, ASU. Susan Pepin is with Knowledge Enterprise, ASU. Amy H. Schnall is with the National Center for Environmental Health, CDC, Atlanta, GA. Timothy Lant is with the Biodesign Institute, ASU
| | - Jessica White
- Megan Jehn and Camila Tompkins are with the School of Human Evolution and Social Change, Arizona State University (ASU), Tempe. Urvashi Pandit, Rebecca Sunenshine, and Jessica White are with the Maricopa County Department of Public Health, Phoenix, AZ. Susanna Sabin is with the Center for Evolution and Medicine, ASU. Erin Kaleta is with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ. Ariella P. Dale is with the Centers for Disease Control and Prevention (CDC) assigned to Maricopa County Department of Public Health. Heather M. Ross, Katherine Kenny, Heidi Sanborn, and Natalie Heywood are with the Edson College of Nursing and Health Innovation, ASU. J. Mac McCullough is with the College of Health Solutions, ASU. Susan Pepin is with Knowledge Enterprise, ASU. Amy H. Schnall is with the National Center for Environmental Health, CDC, Atlanta, GA. Timothy Lant is with the Biodesign Institute, ASU
| | - Erin Kaleta
- Megan Jehn and Camila Tompkins are with the School of Human Evolution and Social Change, Arizona State University (ASU), Tempe. Urvashi Pandit, Rebecca Sunenshine, and Jessica White are with the Maricopa County Department of Public Health, Phoenix, AZ. Susanna Sabin is with the Center for Evolution and Medicine, ASU. Erin Kaleta is with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ. Ariella P. Dale is with the Centers for Disease Control and Prevention (CDC) assigned to Maricopa County Department of Public Health. Heather M. Ross, Katherine Kenny, Heidi Sanborn, and Natalie Heywood are with the Edson College of Nursing and Health Innovation, ASU. J. Mac McCullough is with the College of Health Solutions, ASU. Susan Pepin is with Knowledge Enterprise, ASU. Amy H. Schnall is with the National Center for Environmental Health, CDC, Atlanta, GA. Timothy Lant is with the Biodesign Institute, ASU
| | - Ariella P Dale
- Megan Jehn and Camila Tompkins are with the School of Human Evolution and Social Change, Arizona State University (ASU), Tempe. Urvashi Pandit, Rebecca Sunenshine, and Jessica White are with the Maricopa County Department of Public Health, Phoenix, AZ. Susanna Sabin is with the Center for Evolution and Medicine, ASU. Erin Kaleta is with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ. Ariella P. Dale is with the Centers for Disease Control and Prevention (CDC) assigned to Maricopa County Department of Public Health. Heather M. Ross, Katherine Kenny, Heidi Sanborn, and Natalie Heywood are with the Edson College of Nursing and Health Innovation, ASU. J. Mac McCullough is with the College of Health Solutions, ASU. Susan Pepin is with Knowledge Enterprise, ASU. Amy H. Schnall is with the National Center for Environmental Health, CDC, Atlanta, GA. Timothy Lant is with the Biodesign Institute, ASU
| | - Heather M Ross
- Megan Jehn and Camila Tompkins are with the School of Human Evolution and Social Change, Arizona State University (ASU), Tempe. Urvashi Pandit, Rebecca Sunenshine, and Jessica White are with the Maricopa County Department of Public Health, Phoenix, AZ. Susanna Sabin is with the Center for Evolution and Medicine, ASU. Erin Kaleta is with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ. Ariella P. Dale is with the Centers for Disease Control and Prevention (CDC) assigned to Maricopa County Department of Public Health. Heather M. Ross, Katherine Kenny, Heidi Sanborn, and Natalie Heywood are with the Edson College of Nursing and Health Innovation, ASU. J. Mac McCullough is with the College of Health Solutions, ASU. Susan Pepin is with Knowledge Enterprise, ASU. Amy H. Schnall is with the National Center for Environmental Health, CDC, Atlanta, GA. Timothy Lant is with the Biodesign Institute, ASU
| | - J Mac McCullough
- Megan Jehn and Camila Tompkins are with the School of Human Evolution and Social Change, Arizona State University (ASU), Tempe. Urvashi Pandit, Rebecca Sunenshine, and Jessica White are with the Maricopa County Department of Public Health, Phoenix, AZ. Susanna Sabin is with the Center for Evolution and Medicine, ASU. Erin Kaleta is with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ. Ariella P. Dale is with the Centers for Disease Control and Prevention (CDC) assigned to Maricopa County Department of Public Health. Heather M. Ross, Katherine Kenny, Heidi Sanborn, and Natalie Heywood are with the Edson College of Nursing and Health Innovation, ASU. J. Mac McCullough is with the College of Health Solutions, ASU. Susan Pepin is with Knowledge Enterprise, ASU. Amy H. Schnall is with the National Center for Environmental Health, CDC, Atlanta, GA. Timothy Lant is with the Biodesign Institute, ASU
| | - Susan Pepin
- Megan Jehn and Camila Tompkins are with the School of Human Evolution and Social Change, Arizona State University (ASU), Tempe. Urvashi Pandit, Rebecca Sunenshine, and Jessica White are with the Maricopa County Department of Public Health, Phoenix, AZ. Susanna Sabin is with the Center for Evolution and Medicine, ASU. Erin Kaleta is with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ. Ariella P. Dale is with the Centers for Disease Control and Prevention (CDC) assigned to Maricopa County Department of Public Health. Heather M. Ross, Katherine Kenny, Heidi Sanborn, and Natalie Heywood are with the Edson College of Nursing and Health Innovation, ASU. J. Mac McCullough is with the College of Health Solutions, ASU. Susan Pepin is with Knowledge Enterprise, ASU. Amy H. Schnall is with the National Center for Environmental Health, CDC, Atlanta, GA. Timothy Lant is with the Biodesign Institute, ASU
| | - Katherine Kenny
- Megan Jehn and Camila Tompkins are with the School of Human Evolution and Social Change, Arizona State University (ASU), Tempe. Urvashi Pandit, Rebecca Sunenshine, and Jessica White are with the Maricopa County Department of Public Health, Phoenix, AZ. Susanna Sabin is with the Center for Evolution and Medicine, ASU. Erin Kaleta is with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ. Ariella P. Dale is with the Centers for Disease Control and Prevention (CDC) assigned to Maricopa County Department of Public Health. Heather M. Ross, Katherine Kenny, Heidi Sanborn, and Natalie Heywood are with the Edson College of Nursing and Health Innovation, ASU. J. Mac McCullough is with the College of Health Solutions, ASU. Susan Pepin is with Knowledge Enterprise, ASU. Amy H. Schnall is with the National Center for Environmental Health, CDC, Atlanta, GA. Timothy Lant is with the Biodesign Institute, ASU
| | - Heidi Sanborn
- Megan Jehn and Camila Tompkins are with the School of Human Evolution and Social Change, Arizona State University (ASU), Tempe. Urvashi Pandit, Rebecca Sunenshine, and Jessica White are with the Maricopa County Department of Public Health, Phoenix, AZ. Susanna Sabin is with the Center for Evolution and Medicine, ASU. Erin Kaleta is with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ. Ariella P. Dale is with the Centers for Disease Control and Prevention (CDC) assigned to Maricopa County Department of Public Health. Heather M. Ross, Katherine Kenny, Heidi Sanborn, and Natalie Heywood are with the Edson College of Nursing and Health Innovation, ASU. J. Mac McCullough is with the College of Health Solutions, ASU. Susan Pepin is with Knowledge Enterprise, ASU. Amy H. Schnall is with the National Center for Environmental Health, CDC, Atlanta, GA. Timothy Lant is with the Biodesign Institute, ASU
| | - Natalie Heywood
- Megan Jehn and Camila Tompkins are with the School of Human Evolution and Social Change, Arizona State University (ASU), Tempe. Urvashi Pandit, Rebecca Sunenshine, and Jessica White are with the Maricopa County Department of Public Health, Phoenix, AZ. Susanna Sabin is with the Center for Evolution and Medicine, ASU. Erin Kaleta is with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ. Ariella P. Dale is with the Centers for Disease Control and Prevention (CDC) assigned to Maricopa County Department of Public Health. Heather M. Ross, Katherine Kenny, Heidi Sanborn, and Natalie Heywood are with the Edson College of Nursing and Health Innovation, ASU. J. Mac McCullough is with the College of Health Solutions, ASU. Susan Pepin is with Knowledge Enterprise, ASU. Amy H. Schnall is with the National Center for Environmental Health, CDC, Atlanta, GA. Timothy Lant is with the Biodesign Institute, ASU
| | - Amy H Schnall
- Megan Jehn and Camila Tompkins are with the School of Human Evolution and Social Change, Arizona State University (ASU), Tempe. Urvashi Pandit, Rebecca Sunenshine, and Jessica White are with the Maricopa County Department of Public Health, Phoenix, AZ. Susanna Sabin is with the Center for Evolution and Medicine, ASU. Erin Kaleta is with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ. Ariella P. Dale is with the Centers for Disease Control and Prevention (CDC) assigned to Maricopa County Department of Public Health. Heather M. Ross, Katherine Kenny, Heidi Sanborn, and Natalie Heywood are with the Edson College of Nursing and Health Innovation, ASU. J. Mac McCullough is with the College of Health Solutions, ASU. Susan Pepin is with Knowledge Enterprise, ASU. Amy H. Schnall is with the National Center for Environmental Health, CDC, Atlanta, GA. Timothy Lant is with the Biodesign Institute, ASU
| | - Timothy Lant
- Megan Jehn and Camila Tompkins are with the School of Human Evolution and Social Change, Arizona State University (ASU), Tempe. Urvashi Pandit, Rebecca Sunenshine, and Jessica White are with the Maricopa County Department of Public Health, Phoenix, AZ. Susanna Sabin is with the Center for Evolution and Medicine, ASU. Erin Kaleta is with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ. Ariella P. Dale is with the Centers for Disease Control and Prevention (CDC) assigned to Maricopa County Department of Public Health. Heather M. Ross, Katherine Kenny, Heidi Sanborn, and Natalie Heywood are with the Edson College of Nursing and Health Innovation, ASU. J. Mac McCullough is with the College of Health Solutions, ASU. Susan Pepin is with Knowledge Enterprise, ASU. Amy H. Schnall is with the National Center for Environmental Health, CDC, Atlanta, GA. Timothy Lant is with the Biodesign Institute, ASU
| | - Rebecca Sunenshine
- Megan Jehn and Camila Tompkins are with the School of Human Evolution and Social Change, Arizona State University (ASU), Tempe. Urvashi Pandit, Rebecca Sunenshine, and Jessica White are with the Maricopa County Department of Public Health, Phoenix, AZ. Susanna Sabin is with the Center for Evolution and Medicine, ASU. Erin Kaleta is with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ. Ariella P. Dale is with the Centers for Disease Control and Prevention (CDC) assigned to Maricopa County Department of Public Health. Heather M. Ross, Katherine Kenny, Heidi Sanborn, and Natalie Heywood are with the Edson College of Nursing and Health Innovation, ASU. J. Mac McCullough is with the College of Health Solutions, ASU. Susan Pepin is with Knowledge Enterprise, ASU. Amy H. Schnall is with the National Center for Environmental Health, CDC, Atlanta, GA. Timothy Lant is with the Biodesign Institute, ASU
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Jehn M, McCullough JM, Dale AP, Gue M, Eller B, Cullen T, Scott SE. Association Between K-12 School Mask Policies and School-Associated COVID-19 Outbreaks - Maricopa and Pima Counties, Arizona, July-August 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1372-1373. [PMID: 34591830 PMCID: PMC8486387 DOI: 10.15585/mmwr.mm7039e1] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
CDC recommends universal indoor masking by students, staff members, faculty, and visitors in kindergarten through grade 12 (K-12) schools, regardless of vaccination status, to reduce transmission of SARS-CoV-2, the virus that causes COVID-19 (1). Schools in Maricopa and Pima Counties, which account for >75% of Arizona's population (2), resumed in-person learning for the 2021-22 academic year during late July through early August 2021. In mid-July, county-wide 7-day case rates were 161 and 105 per 100,000 persons in Maricopa and Pima Counties, respectively, and 47.6% of Maricopa County residents and 59.2% of Pima County residents had received at least 1 dose of a COVID-19 vaccine. School districts in both counties implemented variable mask policies at the start of the 2021-22 academic year (Table). The association between school mask policies and school-associated COVID-19 outbreaks in K-12 public noncharter schools open for in-person learning in Maricopa and Pima Counties during July 15-August 31, 2021, was evaluated.
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Dale AP, Kretschmer M, Ruberto I, Wagner DM, Solomon C, Komatsu K, Venkat H. Notes from the Field: Delays in Identification and Treatment of a Case of Septicemic Plague - Navajo County, Arizona, 2020. MMWR Morb Mortal Wkly Rep 2021; 70:1063-1064. [PMID: 34351879 PMCID: PMC8367317 DOI: 10.15585/mmwr.mm7031a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Dale AP, Hudson MJ, Cullen T, Ellingson KD, Davis K, Armenta D, Friebus H, Currie C, Bhattarai R, Brady S, Komatsu K, Stone ND, Uyeki TM, Slifka KJ, Perez-Velez C, Keaton AA. Administration of Bamlanivimab to Skilled Nursing Facility Residents During a COVID-19 Outbreak, January-February 2021, Arizona. J Am Med Dir Assoc 2021; 22:1357-1358. [PMID: 34000267 PMCID: PMC8096193 DOI: 10.1016/j.jamda.2021.04.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ariella P Dale
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; Arizona Department of Health Services, Phoenix, AZ, USA; Maricopa County Department of Public Health, Phoenix, AZ, USA
| | - Matthew J Hudson
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Kat Davis
- Pima County Health Department, Tucson, AZ, USA
| | | | | | - Chase Currie
- Arizona Department of Health Services, Phoenix, AZ, USA
| | | | - Shane Brady
- Arizona Department of Health Services, Phoenix, AZ, USA
| | - Ken Komatsu
- Arizona Department of Health Services, Phoenix, AZ, USA
| | - Nimalie D Stone
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, GA, USA
| | - Timothy M Uyeki
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, GA, USA
| | - Kara Jacobs Slifka
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, GA, USA
| | | | - Amelia A Keaton
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, GA, USA
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16
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Prince-Guerra JL, Almendares O, Nolen LD, Gunn JKL, Dale AP, Buono SA, Deutsch-Feldman M, Suppiah S, Hao L, Zeng Y, Stevens VA, Knipe K, Pompey J, Atherstone C, Bui DP, Powell T, Tamin A, Harcourt JL, Shewmaker PL, Medrzycki M, Wong P, Jain S, Tejada-Strop A, Rogers S, Emery B, Wang H, Petway M, Bohannon C, Folster JM, MacNeil A, Salerno R, Kuhnert-Tallman W, Tate JE, Thornburg NJ, Kirking HL, Sheiban K, Kudrna J, Cullen T, Komatsu KK, Villanueva JM, Rose DA, Neatherlin JC, Anderson M, Rota PA, Honein MA, Bower WA. Evaluation of Abbott BinaxNOW Rapid Antigen Test for SARS-CoV-2 Infection at Two Community-Based Testing Sites - Pima County, Arizona, November 3-17, 2020. MMWR Morb Mortal Wkly Rep 2021; 70:100-105. [PMID: 33476316 PMCID: PMC7821766 DOI: 10.15585/mmwr.mm7003e3] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Thompson JM, Eick SM, Dailey C, Dale AP, Mehta M, Nair A, Cordero JF, Welton M. Relationship Between Pregnancy-Associated Malaria and Adverse Pregnancy Outcomes: a Systematic Review and Meta-Analysis. J Trop Pediatr 2020; 66:327-338. [PMID: 31598714 DOI: 10.1093/tropej/fmz068] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pregnancy-associated malaria (PAM) has been associated with adverse pregnancy outcomes like preterm birth (PTB) and low birthweight (LBW), which are among the leading causes of infant mortality globally. Rates of PTB and LBW are high in countries with a high burden of malaria. PAM may be a contributing factor to PTB and LBW, but is not well understood. METHODS We conducted a systematic review and meta-analysis of studies examining the relationship between PAM and PTB or LBW using PubMed. The title and abstract of all studies were screened by two reviewers, and the full text of selected studies was reviewed to ensure they met inclusion criteria. Information regarding study characteristics and of PTB and LBW births among women with and without PAM was abstracted for included studies. RESULTS Our search terms yielded 2237 articles, of which 18 met our final inclusion criteria. Eight studies examined associations between PAM and PTB, and 10 examined associations between PAM and LBW (population size ranging from 35 to 9956 women). The overall risk of LBW was 63% higher among women with PAM compared with women without PAM (95% CI = 1.48-1.80) and the risk of PTB was 23% higher among women with PAM compared with women without PAM (95% CI = 1.07-1.41). CONCLUSIONS These results indicate that infection with PAM is associated with PTB and LBW. Further understanding of the pathogenesis of disease and the immunologic changes that occur during pregnancy is essential for reducing the disproportional effects this disease has on this vulnerable population.
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Affiliation(s)
- Julie M Thompson
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 30605 Athens, GA, USA.,College of Veterinary Medicine, University of Georgia, 30602 Athens, GA, USA
| | - Stephanie M Eick
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Services, University of California, San Francisco, 94158 San Francisco, CA, USA
| | - Cody Dailey
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 30605 Athens, GA, USA.,Odum School of Ecology, University of Georgia, 30602 Athens, GA, USA
| | - Ariella P Dale
- Colorado Department of Public Health & Environment, 80246 Denver, CO, USA
| | - Mansi Mehta
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 30605 Athens, GA, USA
| | - Anjali Nair
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 30605 Athens, GA, USA
| | - José F Cordero
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 30605 Athens, GA, USA
| | - Michael Welton
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 30605 Athens, GA, USA
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18
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Idubor O, Alden NB, Nanduri S, Ogundimu A, Tanwar SSS, Reese H, Odongo W, Herlihy R, Johnston H, Burakoff A, Burdorf A, Dale AP, Nichols J, Bamberg WM, Cilwick A, Barter D, Brousseau G, Chochua S, Stone ND, Van Beneden C. 1891. Invasive Group A Streptococcus Infections Among Residents of Multiple Nursing Homes—Denver, Colorado, 2017–2018. Open Forum Infect Dis 2019. [PMCID: PMC6809078 DOI: 10.1093/ofid/ofz359.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Older adults residing in nursing homes (NH) are at increased risk for invasive group A Streptococcus (GAS) infections due to advanced age, presence of wounds, and comorbidities; approximately one-third of infected patients die. Beginning in 2015, increasing numbers of GAS infections in NH residents and several NH clusters were reported from the Denver metropolitan area. Colorado Department of Public Health and Environment (CDPHE) and CDC investigated to characterize cases and assess if outbreaks resulted from interfacility transmission. Methods We reviewed data from Active Bacterial Core surveillance (ABCs) in the 5-county Denver area from January 2017 to June 2018. We defined a case as isolation of GAS from a normally sterile site in an NH resident. GAS isolates underwent whole-genome sequencing (WGS) at CDC’s Streptococcus Laboratory to determine emm types for genotyping. Among isolates with the same emm type, pairwise single-nucleotide polymorphism (SNP) distances were calculated using Nucmer software. In October 2018, a CDPHE-CDC team assessed infection control at NHs with cases of the most common emm type. Results Over 18 months, among >100 NHs in the Denver area, ≥1 GAS case was identified in 29 NHs, with 6 having ≥3 cases. During this period, 68 cases in NH residents were identified. WGS identified 17 emm types among isolates from these cases; most common was emm11.10 (34%, n = 22), a rare subtype in ABCs. All emm11.10 isolates had nearly identical genomes (average pairwise SNP distance: 3.2), and were isolated from 10 NHs, with 2 NHs having ≥ 4 cases. Multiple infection control lapses were noted during site visits to 8 NHs. Conclusion Multiple outbreaks due to GAS were noted in 5-county Denver area NHs in 2017–2018. WGS of surveillance isolates identified a rarely seen emm subtype 11.10 from multiple facilities with temporal and genomic clustering suggesting interfacility GAS transmission. ![]()
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Disclosures All Authors: No reported Disclosures.
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Affiliation(s)
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado
| | | | | | | | - Heather Reese
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wycliffe Odongo
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rachel Herlihy
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Alexis Burakoff
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - April Burdorf
- Colorado Department of Public Health and Environment, Denver, Colorado
| | | | - Janell Nichols
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Wendy M Bamberg
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Alana Cilwick
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Devra Barter
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Geoff Brousseau
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Sopio Chochua
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nimalie D Stone
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Marchello CS, Dale AP, Pisharody S, Crump JA. Using hospital-based studies of community-onset bloodstream infections to make inferences about typhoid fever incidence. Trop Med Int Health 2019; 24:1369-1383. [PMID: 31633858 PMCID: PMC6916262 DOI: 10.1111/tmi.13319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objectives Hospital-based studies of community-onset bloodstream infections (CO-BSI) are less resource-intensive to carry out than population-based incidence studies. We examined several metrics capturing the potential role of Salmonella Typhi as a cause of CO-BSI for making inferences about incidence. Methods We systematically reviewed three databases for hospital-based studies of CO-BSI. We determined, by study, the prevalence and rank order of Salmonella among pathogenic bloodstream isolates, and the prevalence ratio of Salmonella Typhi to Escherichia coli (S:E ratio). We then describe these hospital-based study metrics in relation to population-based typhoid fever incidence data from a separate systematic review. Results Forty-four studies met the inclusion criteria, of which 23 (52.3%) isolated Salmonella Typhi at least once. Among studies isolating Salmonella Typhi, the median (interquartile range) prevalence and rank order of Salmonella Typhi compared to other pathogens isolated in BSI was 8.3% (3.2–37.9%) and 3 (1–6), respectively. The median (interquartile range) S:E ratio was 1.0 (0.4–3.0). With respect to incidence, in Pemba Island, Tanzania, prevalence, rank order, S:E ratio, and incidence was 64.8%, 1, 9.2 and 110 cases per 100 000, respectively, and in Boulkiemdé, Burkina Faso, was 13.3%, 3, 2.3 and 249 cases per 100 000. Conclusions We describe considerable variation in place and time for Salmonella Typhi prevalence, rank order, and S:E ratio among hospital-based studies of CO-BSI. Data from simultaneous typhoid prevalence and incidence studies are limited. We propose that hospital-based study metrics warrant evaluation for making inference about typhoid incidence and as covariates in typhoid incidence models.
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Affiliation(s)
| | - Ariella P Dale
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | | | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
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Marchello CS, Ebell MH, Dale AP, Harvill ET, Shen Y, Whalen CC. Signs and Symptoms That Rule out Community-Acquired Pneumonia in Outpatient Adults: A Systematic Review and Meta-Analysis. J Am Board Fam Med 2019; 32:234-247. [PMID: 30850460 PMCID: PMC7422644 DOI: 10.3122/jabfm.2019.02.180219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND A systematic review of clinical decision rules to identify patients at low risk for community-acquired pneumonia (CAP) has not been previously presented in the literature. METHODS A systematic review of MEDLINE for prospective studies that used at least 2 signs, symptoms, or point-of-care tests to determine the likelihood of CAP. We included studies that enrolled adults and adolescents in the outpatient setting where all or a random sample of patients received a chest radiograph as the reference standard. We excluded retrospective studies and studies that recruited primarily patients with hospital-acquired CAP. RESULTS Our search identified 974 articles, 12 of which were included in the final analysis. The simple heuristic of normal vital signs (temperature, respiratory rate, and heart rate) to identify patients at low risk for CAP was reported by 4 studies and had a summary estimate of the negative likelihood ratio (LR-) of 0.24 (95% CI, 0.17 to 0.34) and a sensitivity of 0.89 (95% CI, 0.79 to 0.94). The simple heuristic of normal vital signs combined with a normal pulmonary examination to identify patients at low risk for CAP was reported by 3 studies, and had a summary estimate of LR- of 0.10 (95% CI, 0.07 to 0.13) with an area under the receiver operating characteristic curve of 0.92. CONCLUSIONS Adults with an acute respiratory infection who have normal vital signs and a normal pulmonary examination are very unlikely to have CAP. Given a baseline CAP risk of 4%, these patients have only a 0.4% likelihood of CAP.
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Affiliation(s)
- Christian S Marchello
- From the Department of Epidemiology and Biostatistics, College of Public Health, (CSM, MHE, APD, YS, CCW), Department of Infectious Diseases, College of Veterinary Medicine (EH), University of Georgia, Athens, GA.
| | - Mark H Ebell
- From the Department of Epidemiology and Biostatistics, College of Public Health, (CSM, MHE, APD, YS, CCW), Department of Infectious Diseases, College of Veterinary Medicine (EH), University of Georgia, Athens, GA
| | - Ariella P Dale
- From the Department of Epidemiology and Biostatistics, College of Public Health, (CSM, MHE, APD, YS, CCW), Department of Infectious Diseases, College of Veterinary Medicine (EH), University of Georgia, Athens, GA
| | - Eric T Harvill
- From the Department of Epidemiology and Biostatistics, College of Public Health, (CSM, MHE, APD, YS, CCW), Department of Infectious Diseases, College of Veterinary Medicine (EH), University of Georgia, Athens, GA
| | - Ye Shen
- From the Department of Epidemiology and Biostatistics, College of Public Health, (CSM, MHE, APD, YS, CCW), Department of Infectious Diseases, College of Veterinary Medicine (EH), University of Georgia, Athens, GA
| | - Christopher C Whalen
- From the Department of Epidemiology and Biostatistics, College of Public Health, (CSM, MHE, APD, YS, CCW), Department of Infectious Diseases, College of Veterinary Medicine (EH), University of Georgia, Athens, GA
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Abstract
INTRODUCTION Both non-Group A streptococcal (non-GAS) pharyngitis and Group A streptococcal (GAS) pharyngitis are commonly found in patients with sore throat. It is not known whether or not they present with similar signs and symptoms compared to patients with non-streptococcal pharyngitis. METHODS MEDLINE was searched for prospective studies that reported throat culture for both GAS and non-GAS as a reference standard, and reported at least one sign, symptom, or the Centor score. Summary estimates of sensitivity, specificity, likelihood ratios (LR+ and LR-), and diagnostic odds ratios (DOR) were calculated using a bivariate random effects model. Summary receiver operating characteristic (ROC) curves were created for key signs and symptoms. RESULTS Eight studies met our inclusion criteria. Tonsillar exudate had the highest LR+ for both GAS and non-GAS pharyngitis (1.53 versus 1.71). The confidence intervals of sensitivity, LR+, LR-, and DOR for all signs, symptoms, and the Centor score between two groups overlapped, with the relative difference between sensitivities within 15% for arthralgia or myalgia, fever, injected throat, tonsillar enlargement, and tonsillar exudate. Larger differences in sensitivities were observed for sore throat, cervical adenopathy, and lack of a cough, although the difference for lack of a cough largely due to a single outlier. DISCUSSION Signs and symptoms of patients with GAS and non-GAS pharyngitis are generally similar. No signs or symptoms clearly distinguish GAS from non-GAS infection. Further work is needed to determine whether Group C streptococcus is a pathogen that should be treated.
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Affiliation(s)
- Thuy N Thai
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, USA
| | - Ariella P Dale
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, USA
| | - Mark H Ebell
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, USA
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22
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Saeed K, Dale AP, Leung E, Cusack T, Mohamed F, Lockyer G, Arnaudov S, Wade A, Moran B, Lewis G, Dryden M, Cecil T, Cepeda JA. Procalcitonin levels predict infectious complications and response to treatment in patients undergoing cytoreductive surgery for peritoneal malignancy. Eur J Surg Oncol 2015; 42:234-43. [PMID: 26560024 DOI: 10.1016/j.ejso.2015.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/05/2015] [Accepted: 10/16/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cytoreductive-surgery for peritoneal-malignancy (PM) involves extensive intra-abdominal surgery and a massive post-operative systemic-inflammatory-response (SIRS). It is often challenging to differentiate SIRS that are solely surgery-associated from those of post-operative infections. White-Cell-Counts (WCC) and C-Reactive-Protein (CRP) are routinely used as markers for infection, but are non-specific and their elevation is often delayed in PM cases. Other markers need to be evaluated to assist early identification/prediction of post-operative infections. METHODOLOGY Prospective evaluation of serum procalcitonin (PCT), CRP and WCC in 50 patients pre-operatively (Day0), and on post-operative days (POD) 1, 3 & 6, following cytoreductive-surgery with or without splenectomy. RESULTS Day0 PCT, CRP and WCC values were within normal limits, but increasing physiologically in post-operative period without infection, with noticeable higher PCT in splenectomized patients. In our cohort post-operative infections were diagnosed in 14 patients, often within 48 h. There was a trend for faster rise in serum PCT on POD1 compared to CRP and WCC, and faster PCT decline following appropriate therapy on POD3 and POD6 when infected cases were clinically resolving while WCC and CRP continued to rise, particularly in non-spelenectomised patients. The AUC on POD1 was significantly higher for PCT (0.689) vs. WCC (0.476) and CRP (0.477) (p = 0.04). Sensitivity, specificity, positive-predictive-value and negative-predictive-values for PCT ranged between (57%-100%), (22%-74%), (33%-47%) & (81%-100%), for CRP (28%-78%), (5.5%-86%), (18%-44.4%) & (40%-75.5%) and for WCC (14%-26.5%), (65.5-80.5%), (22%-25%), (67%-70%) respectively. CONCLUSION PCT, like WCC and CRP, needs to be interpreted with extreme cautions in the context of infections post-cytoreductive-surgery and should only be used in association with other clinical and investigational findings.
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Affiliation(s)
- K Saeed
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK; University of Southampton Medical School, Tremona Road, Southampton, SO16 6YD, UK.
| | - A P Dale
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK
| | - E Leung
- Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - T Cusack
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK
| | - F Mohamed
- Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - G Lockyer
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK
| | - S Arnaudov
- Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - A Wade
- Department of Intensive Care Unit, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - B Moran
- Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - G Lewis
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK
| | - M Dryden
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK; University of Southampton Medical School, Tremona Road, Southampton, SO16 6YD, UK
| | - T Cecil
- Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - J A Cepeda
- Department of Microbiology, Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, Surrey, KT2 7QB, UK
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23
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Zhu X, Dale AP. Identifying Opportunities for Decision Support Systems in Support of Regional Resource Use Planning: An Approach Through Soft Systems Methodology. Environ Manage 2000; 26:371-384. [PMID: 10954800 DOI: 10.1007/s002670010094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
/ Regional resource use planning relies on key regional stakeholder groups using and having equitable access to appropriate social, economic, and environmental information and assessment tools. Decision support systems (DSS) can improve stakeholder access to such information and analysis tools. Regional resource use planning, however, is a complex process involving multiple issues, multiple assessment criteria, multiple stakeholders, and multiple values. There is a need for an approach to DSS development that can assist in understanding and modeling complex problem situations in regional resource use so that areas where DSSs could provide effective support can be identified, and the user requirements can be well established. This paper presents an approach based on the soft systems methodology for identifying DSS opportunities for regional resource use planning, taking the Central Highlands Region of Queensland, Australia, as a case study.
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Affiliation(s)
- X Zhu
- CSIRO Tropical Agriculture, Cunningham Laboratory, 306 Carmody Road, St. Lucia, Qld 4067, Australia
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