Infectious Disease

Dengue fever is endemic in over 100 countries and there are an estimated 50 - 100 million cases annually. There is no vaccine for dengue fever yet, and the mortality rate of the severe form of the disease, dengue hemorrhagic fever, ranges from 10-20% but may be greater than 40% if dengue shock occurs. A predictive method for dengue fever would forecast when and where an outbreak will occur before its emergence. This is a challenging task and truly predictive models for emerging infectious diseases are still in their infancy.

Objective

This paper addresses the problem of predicting high incidence rates of dengue fever in Peru several weeks in advance.

Recent events have focused on the role of emerging and re-emerging diseases not only as a significant public health threat but also as a serious threat to the economy and security of nations. The lead time to detect and contain a novel emerging disease or events with public health importance has become much shorter, making developing countries particularly vulnerable to both natural and man-made threats. There is a need to develop disease surveillance systems flexible enough to adapt to the local existing infrastructure of developing countries but which will still be able to provide valid alerts and early detection of significant public health threats.

Objective

To determine system usefulness of the ESSENCE Desktop Edition in detecting increases in the number of dengue cases in the Philippines.

The Veterans Health Administration (VHA) is the VA organization responsible for providing healthcare to over 5 million patients annually at 153 medical centers and over 900 outpatient clinics across the United States and U.S. territories. The VA Subject Matter Expertise Center for Biological Events (SMEC-bio) aims to leverage data in the extensive VHA electronic health records system and other sources to provide decision support to leadership for emerging infectious disease threats. Initial SMEC-bio work to examine this capability suggested that the increased incidence of dengue disease in the VHA patient population in PR in 2010 may be related to increased rainfall (see reference). This present work analyzes dengue incidence in the PR VHA patient population over time to understand disease trends and contribute to a framework for predictive analysis. This paper describes trend analyses of dengue and dengue-like illness in VHA patient data in Puerto Rico (PR) with the goal of developing mechanisms for improved early warning and situational awareness of infectious disease threats.

Local data focused on the injection drug using (IDU) population was analyzed using representative samples from three years, 2005, 2009, and 2012, to garner an understanding of high-risk behavior associated with disease transmission.

Objective

The objective of this study is to present findings from the National HIV Behavioral Surveillance (NHBS) in New Orleans.

There are currently no federal laws mandating the reporting of infectious diseases to public health authorities. Reporting requirements reside at the state level and such laws do not apply to federal agencies including the VA. Heretofore, VA's reporting of infectious diseases to public health authorities has been strictly voluntary, and has been accomplished via traditional methods (phone, mail, and fax) that are highly prone to human error, create a significant administrative burden, and do not adequately safeguard the privacy of Veterans' data. Previously, without a reporting mandate applicable to VA facilities, public health authorities have had an incomplete picture of the VA contribution to the overall infectious disease burden existing in the larger population. Moreover, at a national level, the VA has not had the ability to monitor the prevalence of the various infectious diseases within its own 151 hospitals and 827 community-based outpatient clinics. Nor has the VA been able to meet the spirit of the Health Information Technology for Clinical and Economic Health Act's Meaningful Use requirements, mandating electronic exchange of information.

Objective

In June 2013, in anticipation of the passage of proposed federal legislation (S 875 and HR 1792), the Department of Veterans Affairs (VA) issued a Directive requiring mandatory reporting of infectious diseases to various public health authorities (VHA Directive 2013-008). In terms of implementation strategies, the ideal is to build on an existing technology, optimize the quality and completeness of reporting, and minimize additional work burdens on VA staff.

Late in September 2012, the Tennessee Department of Health (TDH) identified a cluster of fungal infections following epidural injection of methylprednisolone acetate (MPA) from a single compounding pharmacy. This presented a public health imperative to contact, educate and monitor approximately 1,100 Tennessee residents who received injections from contaminated MPA lots that were shipped to three clinics in Tennessee. There was no precedent to accomplish this rapidly and efficiently. To accomplish this goal a secure, web-based application designed by TDH for emergency patient management was deployed. 

Objective

The purpose was to facilitate real-time information sharing and data visualization for incident management during the Fungal Infections Outbreak in Tennessee.

The National Biosurveillance Integration Center (NBIC) has the responsibility to integrate, analyze, and share the nationÍs biosurveillance information provided from capabilities distributed across the public and private sectors. The integration of information enables early warning and shared situational awareness of biological events so that critical decisions directing response and recovery efforts are well-informed and, ultimately, save lives. Emerging infectious diseases may disseminate internationally to the DHS workforce and/or domestic U.S. population. The growth of air travel facilitates rapid movement of people over international boundaries, enabling infected persons to travel great distances while potentially infectious to others. A large number of DHS personnel work in ports of entry in airports seaports and U.S. border states, encountering thousands of travelers a day and often encountering potentially infectious people in the course of their duties. The NBIC obtained intra- and interagency information to examine patterns of direct air travel to the U.S. from areas of activity for H7N9 flu and MERS-CoV in order to identify airports where U.S. personnel may more likely encounter potentially infectious travelers.

Objective

NBIC drew upon multiple sources of information to study ports of entry at higher risk for travelers who may have been exposed to emerging pandemic viruses, specifically Middle Eastern coronavirus (MERS-CoV) and (H7N9) Influenza A.

Influenza is associated with significant morbidity and mortality nationally each year and VA's large elderly population is at particular risk. VA Office of Public Health (OPH) has monitored influenza and influenza-like-illness (ILI) activity using the VA's biosurveillance system since 2009 (1,2). VA influenza surveillance capacity has expanded significantly in recent years to include inpatient influenza data, telephone triage data, laboratory testing data and enhanced geospatial mapping capabilities.

Objective

Herein we summarize our ongoing influenza surveillance activities and describe the 2012-2013 influenza season activity in VA.

In 2007, the United Nations recommended provision of VMMC in settings with high HIV prevalence and low rates of male circumcision (MC). This recommendation was based on randomized studies in Africa, which demonstrated that MMC reduces HIV acquisition by 38%_66% [1]. Tanzania was among 13 countries selected for early implementation. In response, IntraHealth International, through the US PresidentÍs Emergency Plan for AIDS Relief (PEPFAR) and Centers for Disease Control and Prevention (CDC) supported the Ministry of Health and Social Welfare (MOHSW) to launch a VMMC program in Shinyanga and Simiyu regions where HIV prevalence is high (7.4%) and VMMC is low (30-32%). Older men age 30-49 have the highest risk of contracting HIV and, thus, are in greater need of the protective effects of VMMC; however, significant cultural and attitudinal barriers hinder MC acceptance and uptake in this population. For example, from Oct 2010-Sep 2012, 65,812 males in Tanzania were circumcised, yet only 7.1% were men over 20 years. To maximize impact, the project implemented an intensive social mobilization initiative using mobile text messaging (SMS) and community sensitization activities targeting men over 20 years.

Objective

To describe the success of mobile text messaging and community sensitization activities to increase the number of men 20 years and above accessing VMMC services in Tanzania.

Although U.S. Mother to Child transmission (MCT) rates of HIV have been reduced from approximately 25% to less than 2%, transmissions continue to occur.1 This reduction comes in a large part from treating pregnant mothers with antiretroviral medications.2 Despite these efforts, Louisiana has one of the highest rates of MCT of HIV in the U.S.3 Real-time identification of pregnancy status would allow high risk HIV-infected pregnant women to be targeted for follow-up. In Louisiana, laboratories are required to report positive HIV tests to SHP, most of which are received in electronic lab reporting (ELR) format. Although pregnancy status is not a variable provided on lab reports, some reports do contain information that is useful in identifying pregnancy status.

Objective

To identify, in real-time, pregnancy status of HIV-infected women through information found in laboratory reports received by the STD/HIV Program (SHP) at the Louisiana Office of Public Health. This identification will be used for targeted follow-up.