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Karan A, Shah N, Garrigues JM, Alarcόn J, Hemarajata P, Finn LE, Poortinga K, Danza P, Kulkarni S, Kim M, Terashita D, Green NM, Balter S. Surveillance of Complicated Mpox Cases Unresponsive to Oral Tecovirimat in Los Angeles County, 2022. J Infect Dis 2024; 229:S249-S254. [PMID: 37995310 DOI: 10.1093/infdis/jiad517] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023] Open
Abstract
The Los Angeles County Department of Public Health established a surveillance system to identify complicated (advanced human immunodeficiency virus [HIV] or hospitalized) mpox cases. From 1 August to 30 November 2022, we identified 1581 mpox cases, of which 134 (8.5%) were complicated. A subset of 8 cases did not recover after either initiating or completing a course of oral tecovirimat. All 8 patients were HIV positive and had advanced HIV (CD4 count <200 cells/μL). We identified 8 distinct mutations previously associated with tecovirimat resistance in specimens collected from 6 patients. Ongoing surveillance of viral evolution requires close coordination between health departments and frontline providers.
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Affiliation(s)
- Abraar Karan
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California
| | - Naman Shah
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Jacob M Garrigues
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Jemma Alarcόn
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Peera Hemarajata
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Lauren E Finn
- Los Angeles County Department of Public Health, Los Angeles, California
| | | | - Phoebe Danza
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Sonali Kulkarni
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Moon Kim
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Dawn Terashita
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Nicole M Green
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Sharon Balter
- Los Angeles County Department of Public Health, Los Angeles, California
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Yomogida K, Kjemtrup A, Martínez-López B, Ibrahim M, Contreras Z, Ngo V, Halai UA, Balter S, Feaster M, Zahn M, Shearer E, Sorvillo R, Balanji N, Torres C, Prado B, Porse C, Kramer V. Surveillance of Flea-Borne Typhus in California, 2011-2019. Am J Trop Med Hyg 2024; 110:142-149. [PMID: 38109767 PMCID: PMC10793031 DOI: 10.4269/ajtmh.23-0272] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/19/2023] [Indexed: 12/20/2023] Open
Abstract
Flea-borne typhus (FBT), also referred to as murine typhus, is an acute febrile disease in humans caused by the bacteria Rickettsia typhi. Currently, cases of FBT are reported for public health surveillance purposes (i.e., to detect incidence and outbreaks) in a few U.S. states. In California, healthcare providers and testing laboratories are mandated to report to their respective local public health jurisdictions whenever R. typhi or antibodies reactive to R. typhi are detected in a patient, who then report cases to state health department. In this study, we characterize the epidemiology of flea-borne typhus cases in California from 2011 to 2019. A total of 881 cases were reported during this period, with most cases reported among residents of Los Angeles and Orange Counties (97%). Demographics, animal exposures, and clinical courses for case patients were summarized. Additionally, spatiotemporal cluster analyses pointed to five areas in southern California with persistent FBT transmission.
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Affiliation(s)
- Kyle Yomogida
- Center for Animal Disease Modeling and Surveillance, School of Veterinary Medicine, University of California, Davis, California
- Vector-Borne Disease Section, California Department of Public Health, Sacramento, California
| | - Anne Kjemtrup
- Vector-Borne Disease Section, California Department of Public Health, Sacramento, California
| | - Beatriz Martínez-López
- Center for Animal Disease Modeling and Surveillance, School of Veterinary Medicine, University of California, Davis, California
| | - Mireille Ibrahim
- Los Angeles County Department of Public Health, Acute Communicable Disease Control Program – Morbidity Unit, Los Angeles, California
| | - Zuelma Contreras
- Los Angeles County Department of Public Health, Acute Communicable Disease Control Program – Morbidity Unit, Los Angeles, California
| | - Van Ngo
- Los Angeles County Department of Public Health, Acute Communicable Disease Control Program – Morbidity Unit, Los Angeles, California
| | - Umme-Aiman Halai
- Los Angeles County Department of Public Health, Acute Communicable Disease Control Program – Morbidity Unit, Los Angeles, California
| | - Sharon Balter
- Los Angeles County Department of Public Health, Acute Communicable Disease Control Program – Morbidity Unit, Los Angeles, California
| | - Matt Feaster
- City of Pasadena Public Health Department, Pasadena, California
| | - Matthew Zahn
- Orange County Health Care Agency, Santa Ana, California
| | - Eric Shearer
- Orange County Health Care Agency, Santa Ana, California
| | | | - Nora Balanji
- Long Beach Department of Health and Human Services, Communicable Disease Control Program, Long Beach, California
| | - Cindy Torres
- Long Beach Department of Health and Human Services, Communicable Disease Control Program, Long Beach, California
| | - Belinda Prado
- Long Beach Department of Health and Human Services, Communicable Disease Control Program, Long Beach, California
| | - Charsey Porse
- Vector-Borne Disease Section, California Department of Public Health, Sacramento, California
| | - Vicki Kramer
- Vector-Borne Disease Section, California Department of Public Health, Sacramento, California
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Alarcón J, Sanosyan A, Contreras ZA, Ngo VP, Carpenter A, Hacker JK, Probert WS, Terashita D, Balter S, Halai UA. Fleaborne Typhus-Associated Deaths - Los Angeles County, California, 2022. MMWR Morb Mortal Wkly Rep 2023; 72:838-843. [PMID: 37535465 PMCID: PMC10414999 DOI: 10.15585/mmwr.mm7231a1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Fleaborne typhus (also known as murine typhus), a widely distributed vectorborne zoonosis caused by Rickettsia typhi, is a moderately severe, but infrequently fatal illness; among patients who receive doxycycline, the case-fatality rate is <1%. Fleaborne typhus is a mandated reportable condition in California. Reported fleaborne typhus cases in Los Angeles County have been increasing since 2010, with the highest number (171) reported during 2022. During June-October 2022, Los Angeles County Department of Public Health learned of three fleaborne typhus-associated deaths. This report describes the clinical presentation, illness course, and methods used to diagnose fleaborne typhus in these three cases. Severe fleaborne typhus manifestations among these cases included hemophagocytic lymphohistiocytosis, a rare immune hyperactivation syndrome that can occur in the infection setting; myocarditis; and septic shock with disseminated intravascular coagulation. Increased health care provider and public health awareness of the prevalence and severity of fleaborne typhus and of the importance of early doxycycline therapy is essential for prevention and treatment efforts.
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Jia KM, Kahn R, Fisher R, Balter S, Lipsitch M. Geographic Targeting of COVID-19 Testing to Maximize Detection in Los Angeles County. Open Forum Infect Dis 2023; 10:ofad331. [PMID: 37469616 PMCID: PMC10352645 DOI: 10.1093/ofid/ofad331] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/23/2023] [Indexed: 07/21/2023] Open
Abstract
Background Many severe acute respiratory syndrome coronavirus 2 infections have not been detected, reported, or isolated. For community testing programs to locate the most cases under limited testing resources, we developed and evaluated quantitative approaches for geographic targeting of increased coronavirus disease 2019 testing efforts. Methods For every week from December 5, 2021, to July 23, 2022, testing and vaccination data were obtained in ∼340 cities/communities in Los Angeles County, and models were developed to predict which cities/communities would have the highest test positivity 2 weeks ahead. A series of counterfactual scenarios were constructed to explore the additional number of cases that could be detected under targeted testing. Results The simplest model based on most recent test positivity performed nearly as well as the best model based on most recent test positivity and weekly tests per 100 persons in identifying communities that would maximize the average yield of cases per test in the following 2 weeks and almost as well as the perfect knowledge of the actual positivity 2 weeks ahead. In the counterfactual scenario, increasing testing by 1% 2 weeks ahead and allocating all tests to communities with the top 10% of predicted positivity would yield a 2% increase in detected cases. Conclusions Simple models based on current test positivity can predict which communities may have the highest positivity 2 weeks ahead and hence could be allocated with more testing resources.
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Affiliation(s)
- Katherine M Jia
- Correspondence: Katherine M. Jia, MSc, Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 ()
| | - Rebecca Kahn
- Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rebecca Fisher
- Los Angeles County Department of Public Health, Acute Communicable Disease Program, Los Angeles, California, USA
| | - Sharon Balter
- Los Angeles County Department of Public Health, Acute Communicable Disease Program, Los Angeles, California, USA
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5
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Chang AH, Kwon JJ, Shover CL, Greenwell L, Gomih A, Blake J, Del Rosario A, Jones PS, Fisher R, Balter S, Brosnan HK. COVID-19 Mortality Rates in Los Angeles County Among People Experiencing Homelessness, March 2020-February 2021. Public Health Rep 2022; 137:1170-1177. [PMID: 35989598 PMCID: PMC9548447 DOI: 10.1177/00333549221115658] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Understanding COVID-19-related mortality among the large population of people experiencing homelessness (PEH) in Los Angeles County (LA County) may inform public health policies to protect this vulnerable group. We investigated the impact of COVID-19 on PEH compared with the general population in LA County. METHODS We calculated crude COVID-19 mortality rates per 100 000 population and mortality rates adjusted for age, race, and sex/gender among PEH and compared them with the general population in LA County from March 1, 2020, through February 28, 2021. RESULTS Among adults aged ≥18 years, the crude mortality rate per 100 000 population among PEH was 20% higher than among the general LA County population (348.7 vs 287.6). After adjusting for age, the mortality rate among PEH was 570.7 per 100 000 population. PEH had nearly twice the risk of dying from COVID-19 as people in the general LA County population; PEH aged 18-29 years had almost 8 times the risk of dying compared with their peers in the general LA County population. PEH had a higher risk of mortality than the general population after adjusting for race (standardized mortality ratio [SMR] = 1.4; 95% CI, 1.2-1.6) and sex/gender (SMR = 1.3; 95% CI, 1.1-1.5). CONCLUSIONS A higher risk of COVID-19-related death among PEH compared with the general population indicates the need for public health policies and interventions to protect this vulnerable group.
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Affiliation(s)
- Alicia H. Chang
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Jennifer J. Kwon
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Chelsea L. Shover
- UCLA David Geffen School of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lisa Greenwell
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Ayodele Gomih
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Jerome Blake
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Aubrey Del Rosario
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Padma S. Jones
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Rebecca Fisher
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Sharon Balter
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Hannah K. Brosnan
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
- Hannah K. Brosnan, MPH, Los Angeles County Department of Public Health, Acute Communicable Disease Control Program, People Experiencing Homelessness COVID-19 Response Team, 313 N Figueroa St, Los Angeles, CA 90012, USA.
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Tesema L, Sullivan D, Pulido M, Traub E, Escobar J, Moore L, Green N, Hemarajata P, Cruely M, Civen R, El-Togby A, Ohannessian G, Silas S, San Diego R, Terashita D, Balter S, Gounder P. Notes from the Field: Influenza A(H3N2) Outbreak Following a School Event — Los Angeles, California, March 2022. MMWR Morb Mortal Wkly Rep 2022; 71:745-746. [PMID: 35653298 PMCID: PMC9169524 DOI: 10.15585/mmwr.mm7122a4] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Danza P, Koo TH, Haddix M, Fisher R, Traub E, OYong K, Balter S. SARS-CoV-2 Infection and Hospitalization Among Adults Aged ≥18 Years, by Vaccination Status, Before and During SARS-CoV-2 B.1.1.529 (Omicron) Variant Predominance - Los Angeles County, California, November 7, 2021-January 8, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:177-181. [PMID: 35113851 PMCID: PMC8812833 DOI: 10.15585/mmwr.mm7105e1] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
COVID-19 vaccines are effective at preventing infection with SARS-CoV-2, the virus that causes COVID-19, as well as severe COVID-19-associated outcomes in real-world conditions (1,2). The risks for SARS-CoV-2 infection and COVID-19-associated hospitalization are lower among fully vaccinated than among unvaccinated persons; this reduction is even more pronounced among those who have received additional or booster doses (boosters) (3,4). Although the B.1.1.529 (Omicron) variant spreads more rapidly than did earlier SARS-CoV-2 variants, recent studies suggest that disease severity is lower for Omicron compared with that associated with the B.1.617.2 (Delta) variant; but the high volume of infections is straining the health care system more than did previous waves (5).*,† The Los Angeles County (LAC) Department of Public Health (LACDPH) used COVID-19 surveillance and California Immunization Registry 2 (CAIR2) data to describe age-adjusted 14-day cumulative incidence and hospitalization rates during November 7, 2021-January 8, 2022, by COVID-19 vaccination status and variant predominance. For the 14-day period ending December 11, 2021, the last week of Delta predominance, the incidence and hospitalization rates among unvaccinated persons were 12.3 and 83.0 times, respectively, those of fully vaccinated persons with a booster and 3.8 and 12.9 times, respectively, those of fully vaccinated persons without a booster. These rate ratios were lower during Omicron predominance (week ending January 8, 2022), with unvaccinated persons having infection and hospitalization rates 3.6 and 23.0 times, respectively, those of fully vaccinated persons with a booster and 2.0 and 5.3 times, respectively, those of fully vaccinated persons without a booster. In addition, during the entire analytic period, admission to intensive care units (ICUs), intubation for mechanical ventilation, and death were more likely to occur among unvaccinated persons than among fully vaccinated persons without or with a booster (p<0.001). Incidence and hospitalization rates were consistently highest for unvaccinated persons and lowest for fully vaccinated persons with a booster. Being up to date with COVID-19 vaccination is critical to protecting against SARS-CoV-2 infection and associated hospitalization.
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Affiliation(s)
- Phoebe Danza
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California
| | - Tae Hee Koo
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California
| | - Meredith Haddix
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California
| | - Rebecca Fisher
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California
| | - Elizabeth Traub
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California
| | - Kelsey OYong
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California
| | - Sharon Balter
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California
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Scobie HM, Johnson AG, Suthar AB, Severson R, Alden NB, Balter S, Bertolino D, Blythe D, Brady S, Cadwell B, Cheng I, Davidson S, Delgadillo J, Devinney K, Duchin J, Duwell M, Fisher R, Fleischauer A, Grant A, Griffin J, Haddix M, Hand J, Hanson M, Hawkins E, Herlihy RK, Hicks L, Holtzman C, Hoskins M, Hyun J, Kaur R, Kay M, Kidrowski H, Kim C, Komatsu K, Kugeler K, Lewis M, Lyons BC, Lyons S, Lynfield R, McCaffrey K, McMullen C, Milroy L, Meyer S, Nolen L, Patel MR, Pogosjans S, Reese HE, Saupe A, Sell J, Sokol T, Sosin D, Stanislawski E, Stevens K, Vest H, White K, Wilson E, MacNeil A, Ritchey MD, Silk BJ. Monitoring Incidence of COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Status - 13 U.S. Jurisdictions, April 4-July 17, 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1284-1290. [PMID: 34529637 PMCID: PMC8445374 DOI: 10.15585/mmwr.mm7037e1] [Citation(s) in RCA: 200] [Impact Index Per Article: 66.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
COVID-19 vaccine breakthrough infection surveillance helps monitor trends in disease incidence and severe outcomes in fully vaccinated persons, including the impact of the highly transmissible B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19. Reported COVID-19 cases, hospitalizations, and deaths occurring among persons aged ≥18 years during April 4-July 17, 2021, were analyzed by vaccination status across 13 U.S. jurisdictions that routinely linked case surveillance and immunization registry data. Averaged weekly, age-standardized incidence rate ratios (IRRs) for cases among persons who were not fully vaccinated compared with those among fully vaccinated persons decreased from 11.1 (95% confidence interval [CI] = 7.8-15.8) to 4.6 (95% CI = 2.5-8.5) between two periods when prevalence of the Delta variant was lower (<50% of sequenced isolates; April 4-June 19) and higher (≥50%; June 20-July 17), and IRRs for hospitalizations and deaths decreased between the same two periods, from 13.3 (95% CI = 11.3-15.6) to 10.4 (95% CI = 8.1-13.3) and from 16.6 (95% CI = 13.5-20.4) to 11.3 (95% CI = 9.1-13.9). Findings were consistent with a potential decline in vaccine protection against confirmed SARS-CoV-2 infection and continued strong protection against COVID-19-associated hospitalization and death. Getting vaccinated protects against severe illness from COVID-19, including the Delta variant, and monitoring COVID-19 incidence by vaccination status might provide early signals of changes in vaccine-related protection that can be confirmed through well-controlled vaccine effectiveness (VE) studies.
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Griffin JB, Haddix M, Danza P, Fisher R, Koo TH, Traub E, Gounder P, Jarashow C, Balter S. SARS-CoV-2 Infections and Hospitalizations Among Persons Aged ≥16 Years, by Vaccination Status - Los Angeles County, California, May 1-July 25, 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1170-1176. [PMID: 34437525 PMCID: PMC8389389 DOI: 10.15585/mmwr.mm7034e5] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Brihn A, Chang J, OYong K, Balter S, Terashita D, Rubin Z, Yeganeh N. Diagnostic Performance of an Antigen Test with RT-PCR for the Detection of SARS-CoV-2 in a Hospital Setting - Los Angeles County, California, June-August 2020. MMWR Morb Mortal Wkly Rep 2021; 70:702-706. [PMID: 33983916 PMCID: PMC8118154 DOI: 10.15585/mmwr.mm7019a3] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Contreras Z, Ngo V, Pulido M, Washburn F, Meschyan G, Gluck F, Kuguru K, Reporter R, Curley C, Civen R, Terashita D, Balter S, Halai UA. Industry Sectors Highly Affected by Worksite Outbreaks of Coronavirus Disease, Los Angeles County, California, USA, March 19-September 30, 2020. Emerg Infect Dis 2021; 27:1769-1775. [PMID: 33979564 PMCID: PMC8237894 DOI: 10.3201/eid2707.210425] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Worksites with on-site operations have experienced coronavirus disease (COVID-19) outbreaks. We analyzed data for 698 nonresidential, nonhealthcare worksite COVID-19 outbreaks investigated in Los Angeles County, California, USA, during March 19, 2020‒September 30, 2020, by using North American Industry Classification System sectors and subsectors. Nearly 60% of these outbreaks occurred in 3 sectors: manufacturing (n = 184, 26.4%), retail trade (n = 137, 19.6%), and transportation and warehousing (n = 73, 10.5%). The largest number of outbreaks and largest number and highest incidence rate of outbreak-associated cases occurred in manufacturing. Furthermore, 7 of the 10 industry subsectors with the highest incidence rates were within manufacturing. Approximately 70% of outbreak-associated case-patients reported Hispanic ethnicity. Facilities employing more on-site staff had larger and longer outbreaks. Identification of highly affected industry sectors and subsectors is necessary for targeted public health planning, outreach, and response, including ensuring vaccine access, to reduce burden of COVID-19 in vulnerable workers.
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Traub E, Amoon AT, Rollin-Alamillo L, Haddix M, Poortinga K, Ibrahim M, Feregrino G, Foo C, Itano A, Lee R, Fisher R, Jarashow C, Balter S, Gounder P. Excess Mortality Associated With the COVID-19 Pandemic-Los Angeles County, March-September 2020. J Public Health Manag Pract 2021; 27:233-239. [PMID: 33762539 DOI: 10.1097/phh.0000000000001344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To more comprehensively estimate COVID-19-related mortality in Los Angeles County by determining excess all-cause mortality and pneumonia, influenza, or COVID (PIC) mortality. DESIGN We reviewed vital statistics data to identify deaths registered in Los Angeles County between March 15, 2020, and August 15, 2020. Deaths with an ICD-10 (International Classification of Diseases, Tenth Revision) code for pneumonia, influenza, or COVID-19 listed as an immediate or underlying cause of death were classified as PIC deaths. Expected deaths were calculated using negative binomial regression. Excess mortality was determined by subtracting the expected from the observed number of weekly deaths. The Department of Public Health conducts surveillance for COVID-19-associated deaths: persons who died of nontraumatic/nonaccidental causes within 60 days of a positive COVID-19 test result were classified as confirmed COVID-19 deaths. Deaths without a reported positive SARS-Cov-2 polymerase chain reaction result were classified as probable COVID-19 deaths if COVID-19 was listed on their death certificate or the death occurred 60 to 90 days of a positive test. We compared excess PIC deaths with the number of confirmed and probable COVID-19 deaths ascertained by surveillance. SETTING Los Angeles County. PARTICIPANTS Residents of Los Angeles County who died. MAIN OUTCOME MEASURE Excess mortality. RESULTS There were 7208 excess all-cause and 5128 excess PIC deaths during the study period. The Department of Public Health also reported 5160 confirmed and 323 probable COVID-19-associated deaths. CONCLUSIONS The number of excess PIC deaths estimated by our model was approximately equal to the number of confirmed and probable COVID-19 deaths identified by surveillance. This suggests our surveillance definition for confirmed and probable COVID-19 deaths might be sufficiently sensitive for capturing the true burden of deaths caused directly or indirectly by COVID-19.
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Affiliation(s)
- Elizabeth Traub
- Acute Communicable Disease Control Program (Mss Traub, Haddix, Ibrahim, Foo, Itano, Lee, and Fisher, Mr Feregrino, and Drs Jarashow, Balter, and Gounder), Office of Health Assessment and Epidemiology (Dr Amoon and Ms Rollin-Alamillo), and Division of HIV and STD Programs (Ms Poortinga), Los Angeles County Department of Public Health, Los Angeles, California
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Alleyne L, Fitzhenry R, Mergen KA, Espina N, Amoroso E, Cimini D, Balter S, Fireteanu AM, Seeley A, Janus L, Gutelius B, Madison-Antenucci S, Thompson CN. Epidemiology of Cryptosporidiosis, New York City, New York, USA, 1995-2018 1. Emerg Infect Dis 2021; 26. [PMID: 32096465 PMCID: PMC7045836 DOI: 10.3201/eid2603.190785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cryptosporidiosis is a parasitic diarrheal infection that is transmitted by the fecal-oral route. We assessed trends in incidence and demographic characteristics for the 3,984 cases diagnosed during 1995-2018 in New York City, New York, USA, and reported to the New York City Department of Health and Mental Hygiene. Reported cryptosporidiosis incidence decreased with HIV/AIDS treatment rollout in the mid-1990s, but the introduction of syndromic multiplex diagnostic panels in 2015 led to a major increase in incidence and to a shift in the demographic profile of reported patients. Incidence was highest among men 20-59 years of age, who consistently represented most (54%) reported patients. In addition, 30% of interviewed patients reported recent international travel. The burden of cryptosporidiosis in New York City is probably highest among men who have sex with men. Prevention messaging is warranted for men who have sex with men and their healthcare providers, as well as for international travelers.
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14
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Yoder C, Balter S, Boice JD, Grogan H, Mumma M, Rothenberg LN, Passmore C, Vetter RJ, Dauer LT. Using personal monitoring data to derive organ doses for medical radiation workers in the Million Person Study-considerations regarding NCRP Commentary no. 30. J Radiol Prot 2021; 41:118-128. [PMID: 33264760 DOI: 10.1088/1361-6498/abcfcb] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
The study of low dose and low-dose rate exposure is of central importance in understanding the possible range of health effects from prolonged exposures to radiation. The One Million Person Study of Radiation Workers and Veterans (MPS) of low-dose health effects was designed to evaluate radiation risks among healthy American workers and veterans. The MPS is evaluating low-dose and dose-rate effects, intakes of radioactive elements, cancer and non-cancer outcomes, as well as differences in risks between women and men. Medical radiation workers make up a large group of individuals occupationally exposed to low doses of radiation from external x-ray/gamma exposures. For the MPS, about 100 000 United States medical radiation workers have been selected for study. The approach to the complex dosimetry circumstances for such workers over three to four decades of occupation were initially and broadly described in National Council on Radiation Protection and Measurements (NCRP) Report No. 178. NCRP Commentary No. 30 provides more detail and describes an optimum approach for using personal monitoring data to estimate lung and other organ doses applicable to the cohort and provides specific precautions/considerations applicable to the dosimetry of medical radiation worker organ doses for use in epidemiologic studies. The use of protective aprons creates dosimetric complexity. It is recommended that dose values from dosimeters worn over a protective apron be reduced by a factor of 20 for estimating mean organ doses to tissues located in the torso and that 15% of the marrow should be assumed to remain unshielded for exposure scenarios when aprons are worn. Conversion coefficients relating personal dose equivalent,Hp(10) in mSv, to mean absorbed doses to organs and tissues,DTin mGy, for females and males for six exposure scenarios have been determined and presented for use in the MPS. This Memorandum summarises several key points in NCRP Commentary No. 30.
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Affiliation(s)
- C Yoder
- Landauer, Inc. Retired, Glenwood, IL, United States of America
| | - S Balter
- Columbia University, New York, NY, United States of America
| | - J D Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, United States of America
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - H Grogan
- Cascade Scientific, Bend, OR, United States of America
| | - M Mumma
- International Epidemiology Institute, Rockville, MD, United States of America
| | - L N Rothenberg
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - C Passmore
- Landauer, Inc., Glenwood, IL, United States of America
| | - R J Vetter
- Mayo Clinic, Rochester, MN, United States of America
| | - L T Dauer
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
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15
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Burke RM, Balter S, Barnes E, Barry V, Bartlett K, Beer KD, Benowitz I, Biggs HM, Bruce H, Bryant-Genevier J, Cates J, Chatham-Stephens K, Chea N, Chiou H, Christiansen D, Chu VT, Clark S, Cody SH, Cohen M, Conners EE, Dasari V, Dawson P, DeSalvo T, Donahue M, Dratch A, Duca L, Duchin J, Dyal JW, Feldstein LR, Fenstersheib M, Fischer M, Fisher R, Foo C, Freeman-Ponder B, Fry AM, Gant J, Gautom R, Ghinai I, Gounder P, Grigg CT, Gunzenhauser J, Hall AJ, Han GS, Haupt T, Holshue M, Hunter J, Ibrahim MB, Jacobs MW, Jarashow MC, Joshi K, Kamali T, Kawakami V, Kim M, Kirking HL, Kita-Yarbro A, Klos R, Kobayashi M, Kocharian A, Lang M, Layden J, Leidman E, Lindquist S, Lindstrom S, Link-Gelles R, Marlow M, Mattison CP, McClung N, McPherson TD, Mello L, Midgley CM, Novosad S, Patel MT, Pettrone K, Pillai SK, Pray IW, Reese HE, Rhodes H, Robinson S, Rolfes M, Routh J, Rubin R, Rudman SL, Russell D, Scott S, Shetty V, Smith-Jeffcoat SE, Soda EA, Spitters C, Stierman B, Sunenshine R, Terashita D, Traub E, Vahey GM, Verani JR, Wallace M, Westercamp M, Wortham J, Xie A, Yousaf A, Zahn M. Enhanced contact investigations for nine early travel-related cases of SARS-CoV-2 in the United States. PLoS One 2020; 15:e0238342. [PMID: 32877446 DOI: 10.1101/2020.04.27.20081901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/15/2020] [Indexed: 05/24/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), the respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China and has since become pandemic. In response to the first cases identified in the United States, close contacts of confirmed COVID-19 cases were investigated to enable early identification and isolation of additional cases and to learn more about risk factors for transmission. Close contacts of nine early travel-related cases in the United States were identified and monitored daily for development of symptoms (active monitoring). Selected close contacts (including those with exposures categorized as higher risk) were targeted for collection of additional exposure information and respiratory samples. Respiratory samples were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction at the Centers for Disease Control and Prevention. Four hundred four close contacts were actively monitored in the jurisdictions that managed the travel-related cases. Three hundred thirty-eight of the 404 close contacts provided at least basic exposure information, of whom 159 close contacts had ≥1 set of respiratory samples collected and tested. Across all actively monitored close contacts, two additional symptomatic COVID-19 cases (i.e., secondary cases) were identified; both secondary cases were in spouses of travel-associated case patients. When considering only household members, all of whom had ≥1 respiratory sample tested for SARS-CoV-2, the secondary attack rate (i.e., the number of secondary cases as a proportion of total close contacts) was 13% (95% CI: 4-38%). The results from these contact tracing investigations suggest that household members, especially significant others, of COVID-19 cases are at highest risk of becoming infected. The importance of personal protective equipment for healthcare workers is also underlined. Isolation of persons with COVID-19, in combination with quarantine of exposed close contacts and practice of everyday preventive behaviors, is important to mitigate spread of COVID-19.
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Affiliation(s)
- Rachel M Burke
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sharon Balter
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Emily Barnes
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Vaughn Barry
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Karri Bartlett
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Madison & Dane County, Madison, Wisconsin, United States of America
| | - Karlyn D Beer
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Isaac Benowitz
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Holly M Biggs
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hollianne Bruce
- The COVID-19 Close Contact Investigation Team, United States of America
- Snohomish Health District, Everett, Washington, United States of America
| | - Jonathan Bryant-Genevier
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jordan Cates
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kevin Chatham-Stephens
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nora Chea
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Howard Chiou
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Demian Christiansen
- The COVID-19 Close Contact Investigation Team, United States of America
- Cook County Department of Public Health, Oak Forest, Illinois, United States of America
| | - Victoria T Chu
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shauna Clark
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Seattle-King County, Seattle, Washington, United States of America
| | - Sara H Cody
- The COVID-19 Close Contact Investigation Team, United States of America
- County of Santa Clara, Public Health Department, San Jose, California, United States of America
| | - Max Cohen
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Erin E Conners
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Vishal Dasari
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Patrick Dawson
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Traci DeSalvo
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Matthew Donahue
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alissa Dratch
- The COVID-19 Close Contact Investigation Team, United States of America
- Orange County Healthcare Agency, Santa Ana, California, United States of America
| | - Lindsey Duca
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeffrey Duchin
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Seattle-King County, Seattle, Washington, United States of America
| | - Jonathan W Dyal
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Leora R Feldstein
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Marty Fenstersheib
- The COVID-19 Close Contact Investigation Team, United States of America
- San Benito County Public Health Services, Hollister, California, United States of America
| | - Marc Fischer
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rebecca Fisher
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Chelsea Foo
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Brandi Freeman-Ponder
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alicia M Fry
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jessica Gant
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Public Health Laboratories, Shoreline, Washington, United States of America
| | - Romesh Gautom
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Department of Health, Shoreline, Washington, United States of America
| | - Isaac Ghinai
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Prabhu Gounder
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Cheri T Grigg
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeffrey Gunzenhauser
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Aron J Hall
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - George S Han
- The COVID-19 Close Contact Investigation Team, United States of America
- County of Santa Clara, Public Health Department, San Jose, California, United States of America
| | - Thomas Haupt
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Michelle Holshue
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Washington State Department of Health, Shoreline, Washington, United States of America
| | - Jennifer Hunter
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mireille B Ibrahim
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Max W Jacobs
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - M Claire Jarashow
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Kiran Joshi
- The COVID-19 Close Contact Investigation Team, United States of America
- Cook County Department of Public Health, Oak Forest, Illinois, United States of America
| | - Talar Kamali
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Vance Kawakami
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Seattle-King County, Seattle, Washington, United States of America
| | - Moon Kim
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Hannah L Kirking
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amanda Kita-Yarbro
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Madison & Dane County, Madison, Wisconsin, United States of America
| | - Rachel Klos
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Miwako Kobayashi
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna Kocharian
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Misty Lang
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Public Health Laboratories, Shoreline, Washington, United States of America
| | - Jennifer Layden
- The COVID-19 Close Contact Investigation Team, United States of America
- Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Eva Leidman
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Scott Lindquist
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Department of Health, Shoreline, Washington, United States of America
| | - Stephen Lindstrom
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ruth Link-Gelles
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mariel Marlow
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Claire P Mattison
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America
| | - Nancy McClung
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tristan D McPherson
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Lynn Mello
- The COVID-19 Close Contact Investigation Team, United States of America
- San Benito County Public Health Services, Hollister, California, United States of America
| | - Claire M Midgley
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shannon Novosad
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Megan T Patel
- The COVID-19 Close Contact Investigation Team, United States of America
- Illinois Department of Public Health, Chicago, Illinois, United States of America
| | - Kristen Pettrone
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Satish K Pillai
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ian W Pray
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Heather E Reese
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Heather Rhodes
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Wyoming Department of Health, Cheyenne, Wyoming, United States of America
| | - Susan Robinson
- The COVID-19 Close Contact Investigation Team, United States of America
- Arizona Department of Health Services, Phoenix, Arizona, United States of America
| | - Melissa Rolfes
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Janell Routh
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rachel Rubin
- The COVID-19 Close Contact Investigation Team, United States of America
- Cook County Department of Public Health, Oak Forest, Illinois, United States of America
| | - Sarah L Rudman
- The COVID-19 Close Contact Investigation Team, United States of America
- County of Santa Clara, Public Health Department, San Jose, California, United States of America
| | - Denny Russell
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Public Health Laboratories, Shoreline, Washington, United States of America
| | - Sarah Scott
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Maricopa County Department of Public Health, Phoenix, Arizona, United States of America
| | - Varun Shetty
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sarah E Smith-Jeffcoat
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elizabeth A Soda
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christopher Spitters
- The COVID-19 Close Contact Investigation Team, United States of America
- Snohomish Health District, Everett, Washington, United States of America
| | - Bryan Stierman
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rebecca Sunenshine
- The COVID-19 Close Contact Investigation Team, United States of America
- Maricopa County Department of Public Health, Phoenix, Arizona, United States of America
| | - Dawn Terashita
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Elizabeth Traub
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Grace M Vahey
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennifer R Verani
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Megan Wallace
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthew Westercamp
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jonathan Wortham
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amy Xie
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna Yousaf
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthew Zahn
- The COVID-19 Close Contact Investigation Team, United States of America
- Orange County Healthcare Agency, Santa Ana, California, United States of America
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16
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Burke RM, Balter S, Barnes E, Barry V, Bartlett K, Beer KD, Benowitz I, Biggs HM, Bruce H, Bryant-Genevier J, Cates J, Chatham-Stephens K, Chea N, Chiou H, Christiansen D, Chu VT, Clark S, Cody SH, Cohen M, Conners EE, Dasari V, Dawson P, DeSalvo T, Donahue M, Dratch A, Duca L, Duchin J, Dyal JW, Feldstein LR, Fenstersheib M, Fischer M, Fisher R, Foo C, Freeman-Ponder B, Fry AM, Gant J, Gautom R, Ghinai I, Gounder P, Grigg CT, Gunzenhauser J, Hall AJ, Han GS, Haupt T, Holshue M, Hunter J, Ibrahim MB, Jacobs MW, Jarashow MC, Joshi K, Kamali T, Kawakami V, Kim M, Kirking HL, Kita-Yarbro A, Klos R, Kobayashi M, Kocharian A, Lang M, Layden J, Leidman E, Lindquist S, Lindstrom S, Link-Gelles R, Marlow M, Mattison CP, McClung N, McPherson TD, Mello L, Midgley CM, Novosad S, Patel MT, Pettrone K, Pillai SK, Pray IW, Reese HE, Rhodes H, Robinson S, Rolfes M, Routh J, Rubin R, Rudman SL, Russell D, Scott S, Shetty V, Smith-Jeffcoat SE, Soda EA, Spitters C, Stierman B, Sunenshine R, Terashita D, Traub E, Vahey GM, Verani JR, Wallace M, Westercamp M, Wortham J, Xie A, Yousaf A, Zahn M. Enhanced contact investigations for nine early travel-related cases of SARS-CoV-2 in the United States. PLoS One 2020; 15:e0238342. [PMID: 32877446 PMCID: PMC7467265 DOI: 10.1371/journal.pone.0238342] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/15/2020] [Indexed: 12/20/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), the respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China and has since become pandemic. In response to the first cases identified in the United States, close contacts of confirmed COVID-19 cases were investigated to enable early identification and isolation of additional cases and to learn more about risk factors for transmission. Close contacts of nine early travel-related cases in the United States were identified and monitored daily for development of symptoms (active monitoring). Selected close contacts (including those with exposures categorized as higher risk) were targeted for collection of additional exposure information and respiratory samples. Respiratory samples were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction at the Centers for Disease Control and Prevention. Four hundred four close contacts were actively monitored in the jurisdictions that managed the travel-related cases. Three hundred thirty-eight of the 404 close contacts provided at least basic exposure information, of whom 159 close contacts had ≥1 set of respiratory samples collected and tested. Across all actively monitored close contacts, two additional symptomatic COVID-19 cases (i.e., secondary cases) were identified; both secondary cases were in spouses of travel-associated case patients. When considering only household members, all of whom had ≥1 respiratory sample tested for SARS-CoV-2, the secondary attack rate (i.e., the number of secondary cases as a proportion of total close contacts) was 13% (95% CI: 4-38%). The results from these contact tracing investigations suggest that household members, especially significant others, of COVID-19 cases are at highest risk of becoming infected. The importance of personal protective equipment for healthcare workers is also underlined. Isolation of persons with COVID-19, in combination with quarantine of exposed close contacts and practice of everyday preventive behaviors, is important to mitigate spread of COVID-19.
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Affiliation(s)
- Rachel M. Burke
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sharon Balter
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Emily Barnes
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Vaughn Barry
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Karri Bartlett
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Madison & Dane County, Madison, Wisconsin, United States of America
| | - Karlyn D. Beer
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Isaac Benowitz
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Holly M. Biggs
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hollianne Bruce
- The COVID-19 Close Contact Investigation Team, United States of America
- Snohomish Health District, Everett, Washington, United States of America
| | - Jonathan Bryant-Genevier
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jordan Cates
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kevin Chatham-Stephens
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nora Chea
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Howard Chiou
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Demian Christiansen
- The COVID-19 Close Contact Investigation Team, United States of America
- Cook County Department of Public Health, Oak Forest, Illinois, United States of America
| | - Victoria T. Chu
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shauna Clark
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Seattle–King County, Seattle, Washington, United States of America
| | - Sara H. Cody
- The COVID-19 Close Contact Investigation Team, United States of America
- County of Santa Clara, Public Health Department, San Jose, California, United States of America
| | - Max Cohen
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Erin E. Conners
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Vishal Dasari
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Patrick Dawson
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Traci DeSalvo
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Matthew Donahue
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alissa Dratch
- The COVID-19 Close Contact Investigation Team, United States of America
- Orange County Healthcare Agency, Santa Ana, California, United States of America
| | - Lindsey Duca
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeffrey Duchin
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Seattle–King County, Seattle, Washington, United States of America
| | - Jonathan W. Dyal
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Leora R. Feldstein
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Marty Fenstersheib
- The COVID-19 Close Contact Investigation Team, United States of America
- San Benito County Public Health Services, Hollister, California, United States of America
| | - Marc Fischer
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rebecca Fisher
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Chelsea Foo
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Brandi Freeman-Ponder
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alicia M. Fry
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jessica Gant
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Public Health Laboratories, Shoreline, Washington, United States of America
| | - Romesh Gautom
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Department of Health, Shoreline, Washington, United States of America
| | - Isaac Ghinai
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Prabhu Gounder
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Cheri T. Grigg
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeffrey Gunzenhauser
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Aron J. Hall
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - George S. Han
- The COVID-19 Close Contact Investigation Team, United States of America
- County of Santa Clara, Public Health Department, San Jose, California, United States of America
| | - Thomas Haupt
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Michelle Holshue
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Washington State Department of Health, Shoreline, Washington, United States of America
| | - Jennifer Hunter
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mireille B. Ibrahim
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Max W. Jacobs
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - M. Claire Jarashow
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Kiran Joshi
- The COVID-19 Close Contact Investigation Team, United States of America
- Cook County Department of Public Health, Oak Forest, Illinois, United States of America
| | - Talar Kamali
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Vance Kawakami
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Seattle–King County, Seattle, Washington, United States of America
| | - Moon Kim
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Hannah L. Kirking
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amanda Kita-Yarbro
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Madison & Dane County, Madison, Wisconsin, United States of America
| | - Rachel Klos
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Miwako Kobayashi
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna Kocharian
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Misty Lang
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Public Health Laboratories, Shoreline, Washington, United States of America
| | - Jennifer Layden
- The COVID-19 Close Contact Investigation Team, United States of America
- Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Eva Leidman
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Scott Lindquist
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Department of Health, Shoreline, Washington, United States of America
| | - Stephen Lindstrom
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ruth Link-Gelles
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mariel Marlow
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Claire P. Mattison
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America
| | - Nancy McClung
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tristan D. McPherson
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Lynn Mello
- The COVID-19 Close Contact Investigation Team, United States of America
- San Benito County Public Health Services, Hollister, California, United States of America
| | - Claire M. Midgley
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shannon Novosad
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Megan T. Patel
- The COVID-19 Close Contact Investigation Team, United States of America
- Illinois Department of Public Health, Chicago, Illinois, United States of America
| | - Kristen Pettrone
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Satish K. Pillai
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ian W. Pray
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Heather E. Reese
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Heather Rhodes
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Wyoming Department of Health, Cheyenne, Wyoming, United States of America
| | - Susan Robinson
- The COVID-19 Close Contact Investigation Team, United States of America
- Arizona Department of Health Services, Phoenix, Arizona, United States of America
| | - Melissa Rolfes
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Janell Routh
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rachel Rubin
- The COVID-19 Close Contact Investigation Team, United States of America
- Cook County Department of Public Health, Oak Forest, Illinois, United States of America
| | - Sarah L. Rudman
- The COVID-19 Close Contact Investigation Team, United States of America
- County of Santa Clara, Public Health Department, San Jose, California, United States of America
| | - Denny Russell
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Public Health Laboratories, Shoreline, Washington, United States of America
| | - Sarah Scott
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Maricopa County Department of Public Health, Phoenix, Arizona, United States of America
| | - Varun Shetty
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sarah E. Smith-Jeffcoat
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elizabeth A. Soda
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christopher Spitters
- The COVID-19 Close Contact Investigation Team, United States of America
- Snohomish Health District, Everett, Washington, United States of America
| | - Bryan Stierman
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rebecca Sunenshine
- The COVID-19 Close Contact Investigation Team, United States of America
- Maricopa County Department of Public Health, Phoenix, Arizona, United States of America
| | - Dawn Terashita
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Elizabeth Traub
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Grace M. Vahey
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennifer R. Verani
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Megan Wallace
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthew Westercamp
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jonathan Wortham
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amy Xie
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna Yousaf
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthew Zahn
- The COVID-19 Close Contact Investigation Team, United States of America
- Orange County Healthcare Agency, Santa Ana, California, United States of America
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17
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Hartmann S, Rubin Z, Sato H, OYong K, Terashita D, Balter S. Coronavirus 2019 (COVID-19) Infections Among Healthcare Workers, Los Angeles County, February - May 2020. Clin Infect Dis 2020; 73:e1850-e1854. [PMID: 32803237 PMCID: PMC7454348 DOI: 10.1093/cid/ciaa1200] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/12/2020] [Indexed: 11/22/2022] Open
Abstract
Across the world, healthcare workers (HCW) are at a greater risk of infection by the novel coronavirus 2019 (COVID-19) due to the nature of their work. The Los Angeles County Department of Public Health (LAC DPH) set out to understand the impact of COVID-19 on healthcare facilities and HCWs by tracking and analyzing data from case-patient interviews of HCWs. As of May 31st, over three months into the pandemic, nearly 5,500 positive HCWs were reported to LAC DPH, representing 9.6% of all cases. Cases reported working in 27 different setting types, including outpatient medical offices, correctional facilities, emergency medical services, etc., with the highest proportion from long-term care facilities (46.6%) and hospitals (27.7%). Case-patients included both clinical and non-clinical roles, with nearly half (49.4%) of positive HCWs being nurses. Over two-thirds of HCWs (68.6%) worked at some point during their infectious period and nearly half (47.9%) reported a known exposure to a positive patient and/or co-worker within their facility. Overall, compared to all LAC cases, HCWs reported lower rates of hospitalization (5.3% vs. 12.2%) and death (0.7% vs. 4.3%) from COVID-19. There are many factors that increase HCWs risk of infection, including high risk work environment, limited supply of personal protective equipment, and even pressure to help and work during a pandemic. In response to these data, LAC DPH created resources and provided guidance for healthcare facilities to best protect their patients and staff during the COVID-19 pandemic.
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Affiliation(s)
- Stacy Hartmann
- Acute Communicable Disease Control, Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Zachary Rubin
- Acute Communicable Disease Control, Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Heidi Sato
- Acute Communicable Disease Control, Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Kelsey OYong
- Acute Communicable Disease Control, Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Dawn Terashita
- Acute Communicable Disease Control, Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Sharon Balter
- Acute Communicable Disease Control, Los Angeles County Department of Public Health, Los Angeles, California, United States of America
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18
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Kujawski SA, Wong KK, Collins JP, Epstein L, Killerby ME, Midgley CM, Abedi GR, Ahmed NS, Almendares O, Alvarez FN, Anderson KN, Balter S, Barry V, Bartlett K, Beer K, Ben-Aderet MA, Benowitz I, Biggs H, Binder AM, Black SR, Bonin B, Brown CM, Bruce H, Bryant-Genevier J, Budd A, Buell D, Bystritsky R, Cates J, Charles EM, Chatham-Stephens K, Chea N, Chiou H, Christiansen D, Chu V, Cody S, Cohen M, Conners E, Curns A, Dasari V, Dawson P, DeSalvo T, Diaz G, Donahue M, Donovan S, Duca LM, Erickson K, Esona MD, Evans S, Falk J, Feldstein LR, Fenstersheib M, Fischer M, Fisher R, Foo C, Fricchione MJ, Friedman O, Fry AM, Galang RR, Garcia MM, Gerber SI, Gerrard G, Ghinai I, Gounder P, Grein J, Grigg C, Gunzenhauser JD, Gutkin GI, Haddix M, Hall AJ, Han G, Harcourt J, Harriman K, Haupt T, Haynes A, Holshue M, Hoover C, Hunter JC, Jacobs MW, Jarashow C, Jhung MA, Joshi K, Kamali T, Kamili S, Kim L, Kim M, King J, Kirking HL, Kita-Yarbro A, Klos R, Kobayashi M, Kocharian A, Komatsu KK, Koppaka R, Layden JE, Li Y, Lindquist S, Lindstrom S, Link-Gelles R, Lively J, Livingston M, Lo K, Lo J, Lu X, Lynch B, Madoff L, Malapati L, Marks G, Marlow M, Mathisen GE, McClung N, McGovern O, McPherson TD, Mehta M, Meier A, Mello L, Moon SS, Morgan M, Moro RN, Murray J, Murthy R, Novosad S, Oliver SE, O'Shea J, Pacilli M, Paden CR, Pallansch MA, Patel M, Patel S, Pedraza I, Pillai SK, Pindyck T, Pray I, Queen K, Quick N, Reese H, Rha B, Rhodes H, Robinson S, Robinson P, Rolfes M, Routh J, Rubin R, Rudman SL, Sakthivel SK, Scott S, Shepherd C, Shetty V, Smith EA, Smith S, Stierman B, Stoecker W, Sunenshine R, Sy-Santos R, Tamin A, Tao Y, Terashita D, Thornburg NJ, Tong S, Traub E, Tural A, Uehara A, Uyeki TM, Vahey G, Verani JR, Villarino E, Wallace M, Wang L, Watson JT, Westercamp M, Whitaker B, Wilkerson S, Woodruff RC, Wortham JM, Wu T, Xie A, Yousaf A, Zahn M, Zhang J. Clinical and virologic characteristics of the first 12 patients with coronavirus disease 2019 (COVID-19) in the United States. Nat Med 2020; 26:861-868. [PMID: 32327757 DOI: 10.1101/2020.03.09.20032896] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/06/2020] [Indexed: 05/28/2023]
Abstract
Data on the detailed clinical progression of COVID-19 in conjunction with epidemiological and virological characteristics are limited. In this case series, we describe the first 12 US patients confirmed to have COVID-19 from 20 January to 5 February 2020, including 4 patients described previously1-3. Respiratory, stool, serum and urine specimens were submitted for SARS-CoV-2 real-time reverse-transcription polymerase chain reaction (rRT-PCR) testing, viral culture and whole genome sequencing. Median age was 53 years (range: 21-68); 8 patients were male. Common symptoms at illness onset were cough (n = 8) and fever (n = 7). Patients had mild to moderately severe illness; seven were hospitalized and demonstrated clinical or laboratory signs of worsening during the second week of illness. No patients required mechanical ventilation and all recovered. All had SARS-CoV-2 RNA detected in respiratory specimens, typically for 2-3 weeks after illness onset. Lowest real-time PCR with reverse transcription cycle threshold values in the upper respiratory tract were often detected in the first week and SARS-CoV-2 was cultured from early respiratory specimens. These data provide insight into the natural history of SARS-CoV-2. Although infectiousness is unclear, highest viral RNA levels were identified in the first week of illness. Clinicians should anticipate that some patients may worsen in the second week of illness.
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19
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Effland T, Lawson A, Balter S, Devinney K, Reddy V, Waechter H, Gravano L, Hsu D. Discovering foodborne illness in online restaurant reviews. J Am Med Inform Assoc 2019; 25:1586-1592. [PMID: 29329402 DOI: 10.1093/jamia/ocx093] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 09/25/2017] [Indexed: 11/14/2022] Open
Abstract
Objective We developed a system for the discovery of foodborne illness mentioned in online Yelp restaurant reviews using text classification. The system is used by the New York City Department of Health and Mental Hygiene (DOHMH) to monitor Yelp for foodborne illness complaints. Materials and Methods We built classifiers for 2 tasks: (1) determining if a review indicated a person experiencing foodborne illness and (2) determining if a review indicated multiple people experiencing foodborne illness. We first developed a prototype classifier in 2012 for both tasks using a small labeled dataset. Over years of system deployment, DOHMH epidemiologists labeled 13 526 reviews selected by this classifier. We used these biased data and a sample of complementary reviews in a principled bias-adjusted training scheme to develop significantly improved classifiers. Finally, we performed an error analysis of the best resulting classifiers. Results We found that logistic regression trained with bias-adjusted augmented data performed best for both classification tasks, with F1-scores of 87% and 66% for tasks 1 and 2, respectively. Discussion Our error analysis revealed that the inability of our models to account for long phrases caused the most errors. Our bias-adjusted training scheme illustrates how to improve a classification system iteratively by exploiting available biased labeled data. Conclusions Our system has been instrumental in the identification of 10 outbreaks and 8523 complaints of foodborne illness associated with New York City restaurants since July 2012. Our evaluation has identified strong classifiers for both tasks, whose deployment will allow DOHMH epidemiologists to more effectively monitor Yelp for foodborne illness investigations.
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Affiliation(s)
- Thomas Effland
- Computer Science Department, Data Science Institute, Columbia University, New York, NY, USA
| | - Anna Lawson
- Computer Science Department, Data Science Institute, Columbia University, New York, NY, USA
| | - Sharon Balter
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Katelynn Devinney
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Vasudha Reddy
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - HaeNa Waechter
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Luis Gravano
- Computer Science Department, Data Science Institute, Columbia University, New York, NY, USA
| | - Daniel Hsu
- Computer Science Department, Data Science Institute, Columbia University, New York, NY, USA
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20
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Vugia DJ, Richardson J, Tarro T, Vareechon C, Pannaraj PS, Traub E, Cope JR, Balter S. Notes from the Field: Fatal Naegleria fowleri Meningoencephalitis After Swimming in Hot Spring Water - California, 2018. MMWR Morb Mortal Wkly Rep 2019; 68:793-794. [PMID: 31513557 PMCID: PMC6753969 DOI: 10.15585/mmwr.mm6836a3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Winters A, Iqbal M, Benowitz I, Baumgartner J, Vora NM, Evans L, Link N, Munjal I, Ostrowsky B, Ackelsberg J, Balter S, Dentinger C, Fine AD, Harper S, Landman K, Laraque F, Layton M, Slavinski S, Weiss D, Rakeman JL, Hughes S, Varma JK, Lee EH. Public Health Management of Persons Under Investigation for Ebola Virus Disease in New York City, 2014-2016. Public Health Rep 2019; 134:477-483. [PMID: 31424330 PMCID: PMC6852072 DOI: 10.1177/0033354919870200] [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: 11/17/2022] Open
Abstract
During 2014-2016, the largest outbreak of Ebola virus disease (EVD) in history occurred in West Africa. The New York City Department of Health and Mental Hygiene (DOHMH) worked with health care providers to prepare for persons under investigation (PUIs) for EVD in New York City. From July 1, 2014, through December 29, 2015, we classified as a PUI a person with EVD-compatible signs or symptoms and an epidemiologic risk factor within 21 days before illness onset. Of 112 persons who met PUI criteria, 74 (66%) sought medical care and 49 (44%) were hospitalized. The remaining 38 (34%) were isolated at home with daily contact by DOHMH staff members. Thirty-two (29%) PUIs received a diagnosis of malaria. Of 10 PUIs tested, 1 received a diagnosis of EVD. Home isolation minimized unnecessary hospitalization. This case study highlights the importance of developing competency among clinical and public health staff managing persons suspected to be infected with a high-consequence pathogen.
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Affiliation(s)
- Ann Winters
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
| | - Maryam Iqbal
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
| | - Isaac Benowitz
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Baumgartner
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
| | - Neil M. Vora
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Nate Link
- Bellevue Hospital Center, New York, NY, USA
| | - Iona Munjal
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx,
NY, USA
| | - Belinda Ostrowsky
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx,
NY, USA
| | - Joel Ackelsberg
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
| | - Sharon Balter
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
| | - Catherine Dentinger
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anne D. Fine
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
| | - Scott Harper
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Keren Landman
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
| | - Fabienne Laraque
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
| | - Marcelle Layton
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
| | - Sally Slavinski
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
| | - Don Weiss
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
| | - Jennifer L. Rakeman
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
| | - Scott Hughes
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
| | - Jay K. Varma
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ellen H. Lee
- New York City Department of Health and Mental Hygiene, Division of Disease
Control, Queens, NY, USA
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22
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Balter S, Lin G, Leyden KM, Paul BM, McDonald CR. Neuroimaging correlates of language network impairment and reorganization in temporal lobe epilepsy. Brain Lang 2019; 193:31-44. [PMID: 27393391 PMCID: PMC5215985 DOI: 10.1016/j.bandl.2016.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/27/2016] [Accepted: 06/15/2016] [Indexed: 06/02/2023]
Abstract
Advanced, noninvasive imaging has revolutionized our understanding of language networks in the brain and is reshaping our approach to the presurgical evaluation of patients with epilepsy. Functional magnetic resonance imaging (fMRI) has had the greatest impact, unveiling the complexity of language organization and reorganization in patients with epilepsy both pre- and postoperatively, while volumetric MRI and diffusion tensor imaging have led to a greater appreciation of structural and microstructural correlates of language dysfunction in different epilepsy syndromes. In this article, we review recent literature describing how unimodal and multimodal imaging has advanced our knowledge of language networks and their plasticity in epilepsy, with a focus on the most frequently studied epilepsy syndrome in adults, temporal lobe epilepsy (TLE). We also describe how new analytic techniques (i.e., graph theory) are leading to a refined characterization of abnormal brain connectivity, and how subject-specific imaging profiles combined with clinical data may enhance the prediction of both seizure and language outcomes following surgical interventions.
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Affiliation(s)
- S Balter
- Department of Neurology, University of California, San Francisco, CA, United States; UCSF Comprehensive Epilepsy Center, United States
| | - G Lin
- Palo Alto University, Palo Alto, CA, United States
| | - K M Leyden
- Multimodal Imaging Laboratory, University of California, San Diego, CA, United States
| | - B M Paul
- Department of Neurology, University of California, San Francisco, CA, United States; UCSF Comprehensive Epilepsy Center, United States
| | - C R McDonald
- Multimodal Imaging Laboratory, University of California, San Diego, CA, United States; Department of Psychiatry, University of California, San Diego, CA, United States.
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McKinnell JA, Bhaurla S, Marquez-Sung P, Pucci A, Baron M, Kamali T, Bugante J, Schwartz B, Balter S, Terashita D, Butler-Wu S, Gunzenhauser J, Hindler J, Humphries RM. Public Health Efforts Can Impact Adoption of Current Susceptibility Breakpoints, but Closer Attention from Regulatory Bodies Is Needed. J Clin Microbiol 2019; 57:e01488-18. [PMID: 30567751 PMCID: PMC6425187 DOI: 10.1128/jcm.01488-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Received: 09/13/2018] [Accepted: 12/11/2018] [Indexed: 11/20/2022] Open
Abstract
Microbiological testing, including interpretation of antimicrobial susceptibility testing results using current breakpoints, is crucial for clinical care and infection control. Continued use of obsolete Enterobacteriaceae carbapenem breakpoints is common in clinical laboratories. The purposes of this study were (i) to determine why laboratories failed to update breakpoints and (ii) to provide support for breakpoint updates. The Los Angeles County Department of Public Health conducted a 1-year outreach program for 41 hospitals in Los Angeles County that had reported, in a prior survey of California laboratories, using obsolete Enterobacteriaceae carbapenem breakpoints. In-person interviews with hospital stakeholders and customized expert guidance and resources were provided to aid laboratories in updating breakpoints, including support from technical representatives from antimicrobial susceptibility testing device manufacturers. Forty-one hospitals were targeted, 7 of which had updated breakpoints since the prior survey. Of the 34 remaining hospitals, 27 (79%) assumed that their instruments applied current breakpoints, 17 (50%) were uncertain how to change breakpoints, and 10 (29%) lacked resources to perform a validation study for off-label use of the breakpoints on their systems. Only 7 hospitals (21%) were familiar with the FDA/CDC Antibiotic Resistance Isolate Bank. All hospitals launched a breakpoint update process; 16 (47%) successfully updated breakpoints, 12 (35%) received isolates from the CDC in order to validate breakpoints on their systems, and 6 (18%) were planning to update within 1 year. The public health intervention was moderately successful in identifying and overcoming barriers to updating Enterobacteriaceae carbapenem breakpoints in Los Angeles hospitals. However, the majority of targeted hospitals continued to use obsolete breakpoints despite 1 year of effort. These findings have important implications for the quality of patient care and patient safety. Other public health jurisdictions may want to utilize similar resources to bridge the patient safety gap, while manufacturers, the FDA, and others determine how best to address this growing public health issue.
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Affiliation(s)
- James A McKinnell
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
- Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - S Bhaurla
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - P Marquez-Sung
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - A Pucci
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - M Baron
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - T Kamali
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - J Bugante
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - B Schwartz
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - S Balter
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - D Terashita
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - S Butler-Wu
- University of Southern California, Los Angeles, California, USA
| | - J Gunzenhauser
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - J Hindler
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - R M Humphries
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Jarashow MC, Terashita D, Balter S, Schwartz B. Notes from the field: Mycobacteria chimaera
infections associated with heater-cooler unit use during cardiopulmonary bypass surgery - Los Angeles County, 2012-2016. Am J Transplant 2019. [DOI: 10.1111/ajt.15249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Claire Jarashow
- Los Angeles County Department of Public Health; Los Angeles California
- Division of Scientific Education and Professional Development; Center for Surveillance, Epidemiology and Laboratory Services; Centers for Disease Control; Atlanta Georgia
| | - Dawn Terashita
- Los Angeles County Department of Public Health; Los Angeles California
| | - Sharon Balter
- Los Angeles County Department of Public Health; Los Angeles California
| | - Benjamin Schwartz
- Los Angeles County Department of Public Health; Los Angeles California
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Jarashow MC, Terashita D, Balter S, Schwartz B. Notes from the Field: Mycobacteria chimaera Infections Associated with Heater-Cooler Unit Use During Cardiopulmonary Bypass Surgery - Los Angeles County, 2012-2016. MMWR Morb Mortal Wkly Rep 2019; 67:1428-1429. [PMID: 30605444 PMCID: PMC6334825 DOI: 10.15585/mmwr.mm675152a4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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26
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Halai UA, Terashita D, Kim M, Green N, Kalb SR, Chatham-Stephens K, Balter S. Notes from the Field: Intestinal Colonization and Possible Iatrogenic Botulism in Mouse Bioassay-Negative Serum Specimens - Los Angeles County, California, November 2017. MMWR Morb Mortal Wkly Rep 2018; 67:1221-1222. [PMID: 30383741 PMCID: PMC6319802 DOI: 10.15585/mmwr.mm6743a6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Balter S, Myoung S, Doshi D, Karmpaliotis D, Kirtane AJ, Parikh M, Grossberg Y, Liao M, Moses JW. TCT-245 A Significant Reduction in the Frequency of Substantial-Dose Interventional Coronary Procedures from 2007 to 2017. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tran OC, Lucero DE, Balter S, Fitzhenry R, Huynh M, Varma JK, Vora NM. Sensitivity and Positive Predictive Value of Death Certificate Data Among Deaths Caused by Legionnaires' Disease in New York City, 2008-2013. Public Health Rep 2018; 133:578-583. [PMID: 30005174 DOI: 10.1177/0033354918782494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Death certificates are an important source of information for understanding life expectancy and mortality trends; however, misclassification and incompleteness are common. Although deaths caused by Legionnaires' disease might be identified through routine surveillance, it is unclear whether Legionnaires' disease is accurately recorded on death certificates. We evaluated the sensitivity and positive predictive value of death certificates for identifying deaths from confirmed or suspected Legionnaires' disease among adults in New York City. METHODS We deterministically matched death certificate data from January 1, 2008, through December 31, 2013, on New York City residents aged ≥18 years to surveillance data on confirmed and suspected cases of Legionnaires' disease from January 1, 2008, through October 31, 2013. We estimated sensitivity and positive predictive value by using surveillance data as the reference standard. RESULTS Of 294 755 deaths, 27 (<0.01%) had an underlying cause of death of Legionnaires' disease and 33 (0.01%) had any mention of Legionnaires' disease on the death certificate. Of 1211 confirmed or suspected cases of Legionnaires' disease, 267 (22.0%) matched to a record in the death certificate data set. The sensitivity of death certificates that listed Legionnaires' disease as the underlying cause of death was 17.3% and of death certificates with any mention of Legionnaires' disease was 20.9%. The positive predictive value of death certificates that listed Legionnaires' disease as the underlying cause of death was 70.4% and of death certificates with any mention of Legionnaires' disease was 69.7%. CONCLUSIONS Death certificates had limited ability to identify confirmed or suspected deaths with Legionnaires' disease. Provider trainings on the diagnosis of Legionnaires' disease, particularly hospital settings, and proper completion of death certificates might improve the sensitivity of death certificates for people who die of Legionnaires' disease.
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Affiliation(s)
- Olivia C Tran
- 1 Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA.,2 Clinical Research and Development, Evolent Health, Arlington, VA, USA
| | - David E Lucero
- 1 Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA.,3 Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sharon Balter
- 4 Enteric, Waterborne and Hepatitis Health Education Unit, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Robert Fitzhenry
- 4 Enteric, Waterborne and Hepatitis Health Education Unit, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Mary Huynh
- 5 Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Jay K Varma
- 1 Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA.,6 National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Neil M Vora
- 1 Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA.,7 Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Tsapaki V, Balter S, Cousins C, Holmberg O, Miller DL, Miranda P, Rehani M, Vano E. The International Atomic Energy Agency action plan on radiation protection of patients and staff in interventional procedures: Achieving change in practice. Phys Med 2018; 52:56-64. [PMID: 30139610 DOI: 10.1016/j.ejmp.2018.06.634] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Received: 04/01/2018] [Revised: 05/22/2018] [Accepted: 06/15/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The International Atomic Energy Agency (IAEA) organized the 3rd international conference on radiation protection (RP) of patients in December 2017. This paper presents the conclusions on the interventional procedures (IP) session. MATERIAL AND METHODS The IAEA conference was conducted as a series of plenary sessions followed by various thematic sessions. "Radiation protection of patients and staff in interventional procedures" session keynote speakers presented information on: 1) Risk management of skin injuries, 2) Occupational radiation risks and 3) RP for paediatric patients. Then, a summary of the session-related papers was presented by a rapporteur, followed by an open question-and-answer discussion. RESULTS Sixty-seven percent (67%) of papers came from Europe. Forty-four percent (44%) were patient studies, 44% were occupational and 12% were combined studies. Occupational studies were mostly on eye lens dosimetry. The rest were on scattered radiation measurements and dose tracking. The majority of patient studies related to patient exposure with only one study on paediatric patients. Automatic patient dose reporting is considered as a first step for dose optimization. Despite efforts, paediatric IP radiation dose data are still scarce. The keynote speakers outlined recent achievements but also challenges in the field. Forecasting technology, task-specific targeted education from educators familiar with the clinical situation, more accurate estimation of lens doses and improved identification of high-risk professional groups are some of the areas they focused on. CONCLUSIONS Manufacturers play an important role in making patients safer. Low dose technologies are still expensive and manufacturers should make these affordable in less resourced countries. Automatic patient dose reporting and real-time skin dose map are important for dose optimization. Clinical audit and better QA processes together with more studies on the impact of lens opacities in clinical practice and on paediatric patients are needed.
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Affiliation(s)
- V Tsapaki
- Konstantopoulio General Hospital, Agias Olgas 3-5, 14233 Nea Ionia, Greece.
| | - S Balter
- Department of Radiology and Medicine, Columbia University, New York, USA.
| | - C Cousins
- FRCP, FRCR, Chair ICRP, 280 Slater Street, Ottawa, Ontario K1P 5S9, Canada.
| | - O Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna International Center, Vienna, Austria.
| | - D L Miller
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, USA.
| | - P Miranda
- Hemodynamic Department, Cardiovascular Service, Luis Calvo Mackenna Hospital, Santiago, Chile.
| | - M Rehani
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - E Vano
- Radiology Department, Medical School, Complutense University, 28040 Madrid, Spain.
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Fitzhenry R, Weiss D, Cimini D, Balter S, Boyd C, Alleyne L, Stewart R, McIntosh N, Econome A, Lin Y, Rubinstein I, Passaretti T, Kidney A, Lapierre P, Kass D, Varma JK. Legionnaires' Disease Outbreaks and Cooling Towers, New York City, New York, USA. Emerg Infect Dis 2018; 23. [PMID: 29049017 PMCID: PMC5652439 DOI: 10.3201/eid2311.161584] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Surveillance will determine whether a new law regulating cooling towers reduces the incidence of Legionnaires’ disease. The incidence of Legionnaires’ disease in the United States has been increasing since 2000. Outbreaks and clusters are associated with decorative, recreational, domestic, and industrial water systems, with the largest outbreaks being caused by cooling towers. Since 2006, 6 community-associated Legionnaires’ disease outbreaks have occurred in New York City, resulting in 213 cases and 18 deaths. Three outbreaks occurred in 2015, including the largest on record (138 cases). Three outbreaks were linked to cooling towers by molecular comparison of human and environmental Legionella isolates, and the sources for the other 3 outbreaks were undetermined. The evolution of investigation methods and lessons learned from these outbreaks prompted enactment of a new comprehensive law governing the operation and maintenance of New York City cooling towers. Ongoing surveillance and program evaluation will determine if enforcement of the new cooling tower law reduces Legionnaires’ disease incidence in New York City.
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Benowitz I, Fitzhenry R, Boyd C, Dickinson M, Levy M, Lin Y, Nazarian E, Ostrowsky B, Passaretti T, Rakeman J, Saylors A, Shamoonian E, Smith TA, Balter S. Rapid Identification of a Cooling Tower-Associated Legionnaires' Disease Outbreak Supported by Polymerase Chain Reaction Testing of Environmental Samples, New York City, 2014-2015. J Environ Health 2018; 80:8-12. [PMID: 29780175 PMCID: PMC5956537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We investigated an outbreak of eight Legionnaires' disease cases among persons living in an urban residential community of 60,000 people. Possible environmental sources included two active cooling towers (air-conditioning units for large buildings) <1 km from patient residences, a market misting system, a community-wide water system used for heating and cooling, and potable water. To support a timely public health response, we used real-time polymerase chain reaction (PCR) to identify Legionella DNA in environmental samples within hours of specimen collection. We detected L. pneumophila serogroup 1 DNA only at a power plant cooling tower, supporting the decision to order remediation before culture results were available. An isolate from a power plant cooling tower sample was indistinguishable from a patient isolate by pulsed-field gel electrophoresis, suggesting the cooling tower was the outbreak source. PCR results were available <1 day after sample collection, and culture results were available as early as 5 days after plating. PCR is a valuable tool for identifying Legionella DNA in environmental samples in outbreak settings.
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Affiliation(s)
- Isaac Benowitz
- Epidemic Intelligence Service, Centers for Disease Control and Prevention
| | | | | | | | | | - Ying Lin
- New York City Department of Health and Mental Hygiene
| | | | | | | | | | | | | | | | - Sharon Balter
- New York City Department of Health and Mental Hygiene
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Murray K, Reddy V, Kornblum JS, Waechter H, Chicaiza LF, Rubinstein I, Balter S, Greene SK, Braunstein SL, Rakeman JL, Dentinger CM. Increasing Antibiotic Resistance in Shigella spp. from Infected New York City Residents, New York, USA. Emerg Infect Dis 2018; 23:332-335. [PMID: 28098543 PMCID: PMC5324786 DOI: 10.3201/eid2302.161203] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Approximately 20% of Shigella isolates tested in New York City, New York, USA, during 2013–2015 displayed decreased azithromycin susceptibility. Case-patients were older and more frequently male and HIV infected than those with azithromycin-susceptible Shigella infection; 90% identified as men who have sex with men. Clinical interpretation guidelines for azithromycin resistance and outcome studies are needed.
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Tan S, Makela S, Heller D, Konty K, Balter S, Zheng T, Stark JH. A Bayesian evidence synthesis approach to estimate disease prevalence in hard-to-reach populations: hepatitis C in New York City. Epidemics 2018; 23:96-109. [PMID: 29666018 DOI: 10.1016/j.epidem.2018.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/16/2016] [Revised: 01/10/2018] [Accepted: 01/20/2018] [Indexed: 12/19/2022] Open
Abstract
Existing methods to estimate the prevalence of chronic hepatitis C (HCV) in New York City (NYC) are limited in scope and fail to assess hard-to-reach subpopulations with highest risk such as injecting drug users (IDUs). To address these limitations, we employ a Bayesian multi-parameter evidence synthesis model to systematically combine multiple sources of data, account for bias in certain data sources, and provide unbiased HCV prevalence estimates with associated uncertainty. Our approach improves on previous estimates by explicitly accounting for injecting drug use and including data from high-risk subpopulations such as the incarcerated, and is more inclusive, utilizing ten NYC data sources. In addition, we derive two new equations to allow age at first injecting drug use data for former and current IDUs to be incorporated into the Bayesian evidence synthesis, a first for this type of model. Our estimated overall HCV prevalence as of 2012 among NYC adults aged 20-59 years is 2.78% (95% CI 2.61-2.94%), which represents between 124,900 and 140,000 chronic HCV cases. These estimates suggest that HCV prevalence in NYC is higher than previously indicated from household surveys (2.2%) and the surveillance system (2.37%), and that HCV transmission is increasing among young injecting adults in NYC. An ancillary benefit from our results is an estimate of current IDUs aged 20-59 in NYC: 0.58% or 27,600 individuals.
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Affiliation(s)
- Sarah Tan
- Cornell University Department of Statistics, USA.
| | | | - Daliah Heller
- City University of New York Graduate School of Public Health and Health Policy, USA
| | - Kevin Konty
- New York City Department of Health and Mental Hygiene, USA
| | | | - Tian Zheng
- Columbia University Department of Statistics, USA
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Latash J, Dorsinville M, Del Rosso P, Antwi M, Reddy V, Waechter H, Lawler J, Boss H, Kurpiel P, Backenson PB, Gonzalez C, Rowe S, Poissant T, Lin Y, Xia GL, Balter S. Notes from the Field: Increase in Reported Hepatitis A Infections Among Men Who Have Sex with Men - New York City, January-August 2017. MMWR Morb Mortal Wkly Rep 2017; 66:999-1000. [PMID: 28934181 PMCID: PMC5657783 DOI: 10.15585/mmwr.mm6637a7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Mary T Bassett
- 1 New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Sharon Balter
- 1 New York City Department of Health and Mental Hygiene, Queens, NY, USA
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Ngai S, Weiss D, Fitzhenry R, Braunstein S, Balter S. HIV Infection and Legionnaires' Disease in New York City, 2006–2015. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1122] [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: 11/13/2022] Open
Affiliation(s)
- Stephanie Ngai
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Don Weiss
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Robert Fitzhenry
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Sarah Braunstein
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, NY
| | - Sharon Balter
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Long Island City, NY
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Abstract
A primary function of the radiologist is that of extracting sufficient information from images, in a finite time, so as to arrive at a patient management decision. Clinically important information must be present in the images and this information must be correctly perceived. This essay discusses the work of the diagnostician viewing prerecorded images. The potentials for enhancing this work by means of different image display techniques are examined. The application of stimulable phosphor computed radiographic techniques are discussed in detail as an example of a technology which clearly separates crucial portions of the imaging process. This separation of functions might improve general radiology in the near future. The principals of the discussion are not specific to any imaging modality or to any individual display technology.
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Affiliation(s)
- S. Balter
- From Philips Medical Systems, Inc, Shelton, Connecticut, USA. Accepted for publication 7 September 1987
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Samandari T, Malakmadze N, Balter S, Perz JF, Khristova M, Swetnam L, Bornschlegel K, Phillips MS, Poshni IA, Nautiyal P, Nainan OV, Bell BP, Williams IT. A Large Outbreak of Hepatitis B Virus Infections Associated With Frequent Injections at a Physician's Office. Infect Control Hosp Epidemiol 2016; 26:745-50. [PMID: 16209380 DOI: 10.1086/502612] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AbstractObjectives:To determine whether hepatitis B virus (HBV) transmission occurred among patients visiting a physician's office and to evaluate potential transmission mechanisms.Design:Serologic survey, retrospective cohort study, and observation of infection control practices.Setting:Private medical office.Patients:Those visiting the office between March 1 and December 26, 2001.Results:We identified 38 patients with acute HBV infection occurring between February 2000 and February 2002. The cohort study, limited to the 10 months before outbreak detection, included 91 patients with serologic test results and available charts representing 18 case-patients and 73 susceptible patients. Overall, 67 patients (74%) received at least one injection during the observation period. Case-patients received a median of 14 injections (range, 2-25) versus 2 injections (range, 0-17) for susceptible patients (P < .001). Acute infections occurred among 18 (27%) of 67 who received at least one injection versus none of 24 who received no injections (RR, 13.6; CI95, 2.4-undefined). Risk of infection increased 5.2-fold (CI95, 0.6-47.3) for those with 3 to 6 injections and 20.0-fold (CI95, 2.8-143.5) for those with more than 6 injections. Typically, injections consisted of doses of atropine, dexamethasone, vitamin B12, or a combination of these mixed in one syringe. HBV DNA genetic sequences of 24 patients with acute infection and 4 patients with chronic infection were identical in the 1,500-bp region examined. Medical staff were seronegative for HBV infection markers. The same surface was used for storing multidose vials, preparing injections, and dismantling used injection equipment.Conclusion:Administration of unnecessary injections combined with failure to separate clean from contaminated areas and follow safe injection practices likely resulted in patient-to-patient HBV transmission in a private physician's office.
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Affiliation(s)
- Taraz Samandari
- Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Benowitz I, Fitzhenry R, Boyd C, Dickinson M, Levi M, Lin Y, Nazarian E, Ostrowsky B, Passaretti T, Rakeman J, Shamoonian E, Saylors A, Balter S, Smith TA. Rapid Detection of a Winter Outbreak of Legionellosis—New York City, 2014–2015. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Living in low-income areas and working in certain occupations may increase risk. Incidence of Legionnaires’ disease in the United States is increasing. We reviewed case records to determine the the epidemiology of and risk factors for the 1,449 cases reported to the New York City Department of Health and Mental Hygiene, New York, New York, USA, during 2002–2011. The highest incidence (2.74 cases/100,000 population) occurred in 2009; this incidence was higher than national incidence for that year (1.15 cases/100,000 population). Overall, incidence of Legionnaires’ disease in the city of New York increased 230% from 2002 to 2009 and followed a socioeconomic gradient, with highest incidence occurring in the highest poverty areas. Among patients with community-acquired cases, the probability of working in transportation, repair, protective services, cleaning, or construction was significantly higher for those with Legionnaires’ disease than for the general working population. Further studies are required to clarify whether neighborhood-level poverty and work in some occupations represent risk factors for this disease.
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Affiliation(s)
- Andrea Farnham
- Current affiliation: University of Zurich, Zurich, Switzerland
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41
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Yacisin K, Balter S, Fine A, Weiss D, Ackelsberg J, Prezant D, Wilson R, Starr D, Rakeman J, Raphael M, Quinn C, Toprani A, Clark N, Link N, Daskalakis D, Maybank A, Layton M, Varma JK. Ebola virus disease in a humanitarian aid worker - New York City, October 2014. MMWR Morb Mortal Wkly Rep 2015; 64:321-3. [PMID: 25837242 PMCID: PMC4584529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In late October 2014, Ebola virus disease (Ebola) was diagnosed in a humanitarian aid worker who recently returned from West Africa to New York City (NYC). The NYC Department of Health and Mental Hygiene (DOHMH) actively monitored three close contacts of the patient and 114 health care personnel. No secondary cases of Ebola were detected. In collaboration with local and state partners, DOHMH had developed protocols to respond to such an event beginning in July 2014. These protocols included safely transporting a person at the first report of symptoms to a local hospital prepared to treat a patient with Ebola, laboratory testing for Ebola, and monitoring of contacts. In response to this single case of Ebola, initial health care worker active monitoring protocols needed modification to improve clarity about what types of exposure should be monitored. The response costs were high in both human resources and money: DOHMH alone spent $4.3 million. However, preparedness activities that include planning and practice in effectively monitoring the health of workers involved in Ebola patient care can help prevent transmission of Ebola.
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Affiliation(s)
- Kari Yacisin
- Epidemic Intelligence Service, CDC,New York City Department of Health and Mental Hygiene,Corresponding author: Kari Yacisin, , 347-396-4070
| | - Sharon Balter
- New York City Department of Health and Mental Hygiene
| | - Annie Fine
- New York City Department of Health and Mental Hygiene
| | - Don Weiss
- New York City Department of Health and Mental Hygiene
| | | | | | - Ross Wilson
- New York City Health and Hospitals Corporation
| | - David Starr
- New York City Department of Health and Mental Hygiene
| | | | | | - Celia Quinn
- New York City Department of Health and Mental Hygiene,Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC
| | - Amita Toprani
- New York City Department of Health and Mental Hygiene
| | - Nancy Clark
- New York City Department of Health and Mental Hygiene
| | | | | | | | | | - Jay K. Varma
- New York City Department of Health and Mental Hygiene
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42
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Abstract
Increases in prescription opioid misuse, injection drug use, and hepatitis C infections have been reported among youth and young adults in the USA, particularly in rural and suburban areas. To better understand these trends in New York City and to characterize demographics and risk factors among a population who, by virtue of their age, are more likely to be recently infected with hepatitis C, we analyzed routine hepatitis C surveillance data from 2009 to 2013 and investigated a sample of persons 30 and younger newly reported with hepatitis C in 2013. Between 2009 and 2013, 4811 persons 30 and younger were newly reported to the New York City Department of Health and Mental Hygiene with hepatitis C. There were high rates of hepatitis C among persons 30 and younger in several neighborhoods that did not have high rates of hepatitis C among older people. Among 402 hepatitis C cases 30 and younger investigated in 2013, the largest proportion (44 %) were white, non-Hispanic, and the most commonly reported risk factor for hepatitis C was injection drug use, mostly heroin. Hepatitis C prevention and harm reduction efforts in NYC focused on young people should target these populations, and surveillance for hepatitis C among young people should be a priority in urban as well as rural and suburban settings.
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Affiliation(s)
- Catharine Prussing
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA,
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43
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Ridpath AD, Bregman B, Jones L, Reddy V, Waechter H, Balter S. Challenges to implementing communicable disease surveillance in New York City evacuation shelters after Hurricane Sandy, November 2012. Public Health Rep 2015; 130:48-53. [PMID: 25552754 DOI: 10.1177/003335491513000106] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hurricane Sandy hit New York City (NYC) on October 29, 2012. Before and after the storm, 73 temporary evacuation shelters were established. The total census of these shelters peaked at approximately 6,800 individuals. Concern about the spread of communicable diseases in shelters prompted the NYC Department of Health and Mental Hygiene (DOHMH) to rapidly develop a surveillance system to report communicable diseases and emergency department transports from shelters. We describe the implementation of this system. Establishing effective surveillance in temporary shelters was challenging and required in-person visits by DOHMH staff to ensure reporting. After system establishment, surveillance data were used to identify some potential disease clusters. For the future, we recommend pre-event planning for disease surveillance.
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Affiliation(s)
- Alison D Ridpath
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA ; New York City Department of Health and Mental Hygiene, New York, NY
| | - Brooke Bregman
- New York City Department of Health and Mental Hygiene, New York, NY
| | - Lucretia Jones
- New York City Department of Health and Mental Hygiene, New York, NY
| | - Vasudha Reddy
- New York City Department of Health and Mental Hygiene, New York, NY
| | - HaeNa Waechter
- New York City Department of Health and Mental Hygiene, New York, NY
| | - Sharon Balter
- New York City Department of Health and Mental Hygiene, New York, NY
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44
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Hanson H, Hancock WT, Harrison C, Kornstein L, Waechter H, Reddy V, Luker J, Malavet M, Huth P, Gieraltowski L, Balter S. Creating student sleuths: how a team of graduate students helped solve an outbreak of Salmonella Heidelberg infections associated with kosher broiled chicken livers. J Food Prot 2014; 77:1390-3. [PMID: 25198602 PMCID: PMC6874488 DOI: 10.4315/0362-028x.jfp-13-564] [Citation(s) in RCA: 5] [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: 11/11/2022]
Abstract
Since 2009, the New York City Department of Health and Mental Hygiene (DOHMH) has received FoodCORE funding to hire graduate students to conduct in-depth food exposure interviews of salmonellosis case patients. In 2011, an increase in the number of Salmonella Heidelberg infections with pulsed-field gel electrophoresis Xba I pattern JF6X01.0022 among observant Jewish communities in New York and New Jersey was investigated. As this pattern is common nationwide, some cases identified were not associated with the outbreak. To reduce the number of background cases, DOHMH focused on the community initially identified in the outbreak and defined a case as a person infected with the outbreak strain of Salmonella Heidelberg with illness onset from 1 April to 17 November 2011 and who consumed a kosher diet, spoke Yiddish, or self-identified as Jewish. Nationally, 190 individuals were infected with the outbreak strain of Salmonella Heidelberg; 63 New York City residents met the DOHMH case definition. In October 2011, the graduate students (Team Salmonella) interviewed three case patients who reported eating broiled chicken livers. Laboratory testing of chicken liver samples revealed the outbreak strain of Salmonella Heidelberg. Although they were only partially cooked, the livers appeared fully cooked, and consumers and retail establishment food handlers did not cook them thoroughly before eating or using them in a ready-to-eat spread. This investigation highlighted the need to prevent further illnesses from partially cooked chicken products. Removing background cases helped to focus the investigation. Training graduate students to collect exposure information can be a highly effective model for conducting foodborne disease surveillance and outbreak investigations for local and state departments of public health.
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Affiliation(s)
- Heather Hanson
- New York City Department of Health and Mental Hygiene, New York, New York 11101, USA
| | - W Thane Hancock
- Centers for Disease Control and Prevention, Atlanta, Georgia 30329, USA
| | - Cassandra Harrison
- New York City Department of Health and Mental Hygiene, New York, New York 11101, USA
| | - Laura Kornstein
- New York City Department of Health and Mental Hygiene, New York, New York 11101, USA
| | - HaeNa Waechter
- New York City Department of Health and Mental Hygiene, New York, New York 11101, USA.
| | - Vasudha Reddy
- New York City Department of Health and Mental Hygiene, New York, New York 11101, USA
| | - John Luker
- New York State Department of Agriculture and Markets, Albany, New York 12235, USA
| | | | - Paula Huth
- New York State Department of Health, Albany, New York 12237, USA
| | | | - Sharon Balter
- New York City Department of Health and Mental Hygiene, New York, New York 11101, USA
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45
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Harrison C, Jorder M, Stern H, Stavinsky F, Reddy V, Hanson H, Waechter H, Lowe L, Gravano L, Balter S. Using online reviews by restaurant patrons to identify unreported cases of foodborne illness - New York City, 2012-2013. MMWR Morb Mortal Wkly Rep 2014; 63:441-5. [PMID: 24848215 PMCID: PMC4584915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
While investigating an outbreak of gastrointestinal disease associated with a restaurant, the New York City Department of Health and Mental Hygiene (DOHMH) noted that patrons had reported illnesses on the business review website Yelp (http://www.yelp.com) that had not been reported to DOHMH. To explore the potential of using Yelp to identify unreported outbreaks, DOHMH worked with Columbia University and Yelp on a pilot project to prospectively identify restaurant reviews on Yelp that referred to foodborne illness. During July 1, 2012-March 31, 2013, approximately 294,000 Yelp restaurant reviews were analyzed by a software program developed for the project. The program identified 893 reviews that required further evaluation by a foodborne disease epidemiologist. Of the 893 reviews, 499 (56%) described an event consistent with foodborne illness (e.g., patrons reported diarrhea or vomiting after their meal), and 468 of those described an illness within 4 weeks of the review or did not provide a period. Only 3% of the illnesses referred to in the 468 reviews had also been reported directly to DOHMH via telephone and online systems during the same period. Closer examination determined that 129 of the 468 reviews required further investigation, resulting in telephone interviews with 27 reviewers. From those 27 interviews, three previously unreported restaurant-related outbreaks linked to 16 illnesses met DOHMH outbreak investigation criteria; environmental investigation of the three restaurants identified multiple food-handling violations. The results suggest that online restaurant reviews might help to identify unreported outbreaks of foodborne illness and restaurants with deficiencies in food handling. However, investigating reports of illness in this manner might require considerable time and resources.
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Affiliation(s)
- Cassandra Harrison
- New York City Department of Health and Mental Hygiene,CDC/CSTE Applied Epidemiology Fellow
| | | | | | | | - Vasudha Reddy
- New York City Department of Health and Mental Hygiene,Corresponding author: Vasudha Reddy, , 347-396-2676
| | | | | | | | | | - Sharon Balter
- New York City Department of Health and Mental Hygiene
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Drezner K, Bornschlegel K, McGibbon E, Balter S. Enhanced chronic hepatitis C surveillance in New York City, April 2009-January 2011. Public Health Rep 2014; 128:510-8. [PMID: 24179262 DOI: 10.1177/003335491312800610] [Citation(s) in RCA: 5] [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: 11/15/2022] Open
Abstract
OBJECTIVE We analyzed and evaluated enhanced chronic hepatitis C virus (HCV) surveillance in New York City (NYC), which involved detailed investigations on a sample of newly reported HCV patients. METHODS Beginning in July 2009, we generated a simple random sample bimonthly from all patients newly reported with a positive HCV test. We administered questionnaires to clinicians and patients to collect clinical and epidemiological information on patients diagnosed from April 2009 to January 2011 and evaluated the staff resources required to conduct enhanced surveillance. RESULTS Of 205 patients meeting inclusion criteria, 40 (19.5%) tested HCV ribonucleic acid (RNA) negative. For the remaining 165 patients, questionnaires were completed by 164 clinicians (99.4%) and 77 patients (46.7%). Many patients (54.0%) were born between 1945 and 1964, and most patients were Hispanic (32.7%) or non-Hispanic black (32.7%). Common risk factors were injection (43.0%) and intranasal (33.9%) drug use. One-third of patients were diagnosed in nontraditional medical settings including substance abuse/detoxification centers (25.0%), jail/prison (6.7%), and psychiatric facilities (1.8%). Of 98 patients with positive HCV RNA tests, 38.8% were immune to hepatitis A and 39.8% were immune to hepatitis B. Investigators required approximately 3.5 hours to complete each investigation and averaged 50 days from assignment to completion. CONCLUSIONS Although conducting enhanced HCV surveillance requires significant resources, investigating a representative sample provides detailed information about NYC's HCV population. Surveillance data have been used to plan educational initiatives for clinicians and patients, which may have led to increased awareness of HCV status, improved patient support, and better overall care.
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Affiliation(s)
- Kate Drezner
- New York City Department of Health and Mental Hygiene, Queens, NY ; Current affiliation: Philadelphia Department of Public Health, Philadelphia, PA
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47
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Gounder P, Beers R, Bornschlegel K, Hinterland K, Balter S. Medication injection safety knowledge and practices among anesthesiologists: New York State, 2011. J Clin Anesth 2013; 25:521-8. [PMID: 24008193 DOI: 10.1016/j.jclinane.2013.04.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 07/28/2012] [Revised: 02/28/2013] [Accepted: 04/02/2013] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To survey anesthesiologists to assess medication injection safety knowledge and practices, and to improve infection control programs of the New York City Department of Health and Mental Hygiene and the New York State Society of Anesthesiologists (NYSSA). DESIGN Survey instrument. SETTING Scientific Educational and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA. MEASUREMENTS A confidential, 23-question survey was emailed to a total of 2,310 NYSSA members. Data from the survey were culled from the responses of NYSSA members who practiced in New York State only. MAIN RESULTS Of the 607 survey respondents, 595 met inclusion criteria (response rate 26%). Of these, 94% to 99% correctly answered 4 categories of questions about injection-contamination mechanisms. Respondents reported unacceptable practices (eg, not using a new needle and syringe for each new patient [3%]; not using a new needle and syringe to access medication vials [28%]; and combining vial content leftovers [11%]). Resident physicians reported these unacceptable practices more often than attending physicians. Use of medication vials for multiple patients (permitted for multi-dose vials but a potentially high-risk practice) was reported by 49% of respondents and was more common among those who worked in outpatient settings. Reported barriers to using a new medication vial for each new patient were medication shortages (44%), reduction of waste (44%), and cost (27%). Unacceptable or potentially high-risk practices were more common among respondents who reported ≥ one barrier. CONCLUSIONS Although they were not necessarily representative of all anesthesiologists in New York State, unacceptable or high-risk injection practices were common among respondents despite widespread knowledge regarding injection-contamination mechanisms. System barriers contribute to the use of medication vials for multiple patients.
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Affiliation(s)
- Prabhu Gounder
- Scientific Educational and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, NY 11101, USA.
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48
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McGibbon E, Bornschlegel K, Balter S. Half a diagnosis: gap in confirming infection among hepatitis C antibody-positive patients. Am J Med 2013; 126:718-22. [PMID: 23786667 DOI: 10.1016/j.amjmed.2013.01.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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] [Received: 11/20/2012] [Revised: 01/14/2013] [Accepted: 01/17/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND Recent guidelines recommend testing all individuals born during 1945-1965 for hepatitis C virus (HCV) antibody. For antibody-positive patients, subsequent RNA testing is necessary to determine current infection status. This study aimed to assess whether clinicians order HCV RNA tests as recommended for antibody-positive patients and to identify barriers to such testing. METHODS We sampled individuals newly reported to the New York City Department of Health and Mental Hygiene's HCV surveillance system and collected information from clinicians. For patients without RNA test results, we asked the reason an RNA test was not ordered and requested that the clinician order the test. RESULTS Of 245 antibody-positive patients, 67% were tested for HCV RNA (for 21% of these, the test was ordered only after our request); 33% had no RNA testing despite our request. Patients without RNA testing were seen in medical facilities (47%), detox facilities (30%), and jail/prison (15%). Reasons RNA testing was not done were that the patient did not return for follow-up (35%), the facility does not do RNA testing (22%), and the patient was tested in jail (15%). CONCLUSIONS In our study, one third of patients did not get complete testing for accurate diagnosis of HCV, which is essential for medical management. Additional education for clinicians about the importance of RNA testing may help. However, with improved antiviral treatments now available for HCV, it is time for reflex HCV RNA testing for positive antibody tests to become routine, just as reflex Western blot testing is standard for human immunodeficiency virus.
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Affiliation(s)
- Emily McGibbon
- New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA
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49
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Balter S, Schueler B, Jones A. WE-A-144-01: The Management and Reporting of Imaging Procedure Dose 1: Interventional Radiology/Cardiology. Med Phys 2013. [DOI: 10.1118/1.4815519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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50
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Abstract
Chronic hepatitis B virus (HBV) infection is a preventable cause of liver failure, cirrhosis, and liver cancer; estimated chronic HBV infection prevalence is 0.3-0.5% in the U.S.A. Prevalence in New York City (NYC) is likely higher because foreign-born persons, who represent 36% of NYC's population versus 11% nationwide, bear a disproportionate burden of chronic HBV infection. However, because no comprehensive, population-based survey of chronic HBV infection has been conducted in NYC, a reliable prevalence estimate is unavailable. We used two approaches to estimate chronic HBV infection prevalence in NYC: (1) a census-based estimate, combining local and national prevalence data for specific populations, and (2) a surveillance-based estimate, using data from NYC's Department of Health and Mental Hygiene Hepatitis B Surveillance Registry and adjusting for out-migration and deaths. Results from both the census-based estimate and the surveillance-based estimate were similar, with an estimated prevalence of chronic HBV in NYC of 1.2%. This estimate is two to four times the estimated prevalence for the U.S.A. as a whole. According to the census-based estimate, >93% of all cases in NYC are among persons who are foreign-born, and approximately half of those are among persons born in China. These findings underscore the importance of local data for tailoring programmatic efforts to specific foreign-born populations in NYC. In particular, Chinese-language programs and health education materials are critical. Reliable estimates are important for policymakers in local jurisdictions to better understand their own population's needs and can help target primary care services, prevention materials, and education.
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Affiliation(s)
- Anne Marie France
- Epidemic Intelligence Service, Office of Workforce and Career Development, Atlanta, GA, USA
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