Infectious Disease

People usually celebrate holidays by inviting family and friends to have food at home, or by gathering and eating at restaurants or in other public venues. This increased exposure to food with a common source can create conditions for outbreaks of gastrointestinal illnesses. Holidays can also be targeted by bioterrorists who seek to maximize physical damage, psychological impact, and publicity around dates of patriotic or religious significance. They might aim at contaminating food and water supplies, especially with CDC-defined category B agents that can cause diseases such as salmonellosis, shigellosis, cholera, crytosporidiosis, as well as infections with Escherichia coli O157:H7 and the Epsilon toxin of Clostridium perfringens. Hence, there is a need to quantify whether gastrointestinal illnesses increase around holidays. This can also help determine a baseline of the incidence to which future holiday periods should be compared to. This research does not focus on specific reportable diseases. That will be the purpose of forthcoming research. Instead, ED visits with gastrointestinal symptoms are used to leverage the capability of syndromic surveillance for early detection.

Objective

To quantify Emergency Department (ED) visits with gastrointestinal symptoms during Federal holidays in Miami-Dade.

Public health officials and epidemiologists have been attempting to eradicate syphilis for decades, but national incidence rates are again on the rise. It has been suggested that the syphilis epidemic in the US is a "rare example of unforced, endogenous oscillations in disease incidence, with an 8-11-yr period that is predicted by the natural dynamics of syphilis infection, to which there is partially protective immunity." While the time series of aggregate case counts seems to support this claim, between 1990 and 2010 there seems to have been a significant change in the spatial distribution of the syphilis epidemic. It is unclear if this change can also be attributed to "endogenous" factors or whether it is due to exogenous factors such as behavioral changes (e.g., the widespread use of the internet for anonymous sexual encounters). For example, it is pointed out that levels of syphilis in 1989 were abnormally high in counties in North Carolina (NC) immediately adjacent to highways. The hypothesis was that this may be due truck drivers and prostitution, and/or the emerging cocaine market. Our results indicate that syphilis distribution in NC has changed since 1989, diffusing away from highway counties.

Objective

To study the spatial distribution of syphilis at the county level for specific states and nationally, and to determine how this might have changed over time in order to improve disease surveillance.

Seasonality has a major effect on the spatial and temporal (i.e. spatiotemporal) dynamics of natural systems and their populations (1). Although the seasonality of influenza in temperate countries is widely recognized, inter-regional spread of influenza in the United States has not been well characterized.

Objective

To study the seasonality of influenza in the United States between 1972 and 2007 through the evaluation of the timing, velocity, and spatial spread of annual epidemic cycles.

Unpublished statewide 2009 H1N1 epidemiological data suggests that rates of lab-confirmed H1N1-related hospitalization were three to four times higher in Black and Hispanic populations compared to White, non-Hispanic populations (Alfred DeMaria, MDPH, personal communication, 2010). There is an absence of socioeconomic data in most public health surveillance systems, and population-based statewide descriptions of H1N1-related hospitalizations according to race/ethnic group and SES have not been described.

Objective

1) Investigate 2009 H1N1-related ICU admissions in Massachusetts by race/ethnic group;

2) Investigate the association between ICU stay and race/ethnic group adjusted for socioeconomic status (SES).

Noroviruses are the single most common cause of epidemic, non-bacterial gastroenteritis worldwide. NoVs cause an estimated 68-80% of gastroenteritis outbreaks in industrialized countries and possibly more in developing countries.

Objective

The purpose of this study was to identify global epidemiologic trends in human norovirus (NoV) outbreaks by transmission route and setting, and describe relationships between these characteristics, attack rates and the occurrence of genogroup I (GI) or genogroup II (GII) strains in outbreaks.

While norovirus is the leading cause of gastroenteritis in the United States, leading to an estimated 21 million illnesses per year [1], timely surveillance data are limited. Google Insights for Search (GIfS) is a new application that allows users to track specific Google search queries during specified time periods and geographic regions [2].

Objective

We compared norovirus syndromic search query trends with existing surveillance data in the United States in order to assess whether GIfS data can be used to monitor norovirus disease.

In March-April, 2011, Salt Lake Valley Health Department (SLVHD) investigated an outbreak of measles (N=9) resulting from a single imported case from Europe. Syndromic surveillance was used to identify measles-like illness (MLI) and enhance early case detection, which is crucial for proper public health intervention [1].

Objective

To detect measles cases during an outbreak using syndromic surveillance.

After the 2009 H1N1 influenza pandemic, CDC initiated community-based surveillance of self-reported influenza-like illness (ILI)[1], defined as the presence of fever with cough or sore throat. Although ILI is frequently attributed to other pathogens, including rhinovirus, routine surveillance of ILI at the population level does aid in the detection of nascent influenza outbreaks. In the United States, approximately 90% of influenza-related deaths occur among adults aged 65 years and older[2]. We explored the association of influenza vaccination with ILI, among this vulnerable age group.

Objective

To explore the association of influenza vaccination with Influenza-like illness ( ILI) among adults aged 65 years and older

Influenza is a major cause of mortality. In developed countries, mortality is at its highest during winter months, not only as a result of deaths from influenza and pneumonia but also as a result of deaths attributed to other diseases (e.g. cardiovascular disease). Understandably, much of the surveillance of influenza follows predefined geographic regions (e.g. census regions or state boundaries). However, the spread of influenza and its resulting mortality does not respect such boundaries.

Objective

To cluster cities in the United States based on their levels of mortality from influenza and pneumonia.

The threat of epidemics due to non-human strains of influenza A viruses is ever present1. Surveillance is a critical aspect of pandemic preparedness for early case detection2. Identification of the index cases of a pandemic virus can trigger public health mitigation efforts3. To develop an appropriate surveillance process, it is important to understand the two possibilities of pandemic evolution. A new pandemic may begin with mild cases, during which surveillance should be concentrated on work/school absenteeism and in physician offices. The other possibility begins with severe cases, characterized by sCAP, respiratory failure, and ICU admission. As the syndrome of pneumonia is not reportable to health agencies for public health surveillance, a year-round, hospital-based surveillance mechanism may be an important tool for early case detection in the event of an epidemic of sCAP. To fill these gaps, we developed a statewide, hospital-based surveillance network for sCAP surveillance in Kentucky.

Objective

To present the development and implementation of the SIPS project, a statewide, hospital-based surveillance system for severe community-acquired pneumonia (sCAP) in Kentucky.