Infectious Disease

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.

Chartered by the 'Implementing Recommendations of the 9/11 Commission Act of 2007' ® (Public Law 110-53), the National Biosurveillance Integration Center (NBIC) is housed within the Department of Homeland Security. The mission of NBIC is to enable early warning and shared situational awareness of acute biological events and support better decisions by federal agency partners and the agencies of state, local, and tribal governments. It does this through the rapid identification, characterization, localization, and tracking of biological events worldwide (whether they occur in the human, animal, plant, or environmental realms) that may have an impact on the U.S. homeland. During the spring of 2013 there were human disease outbreaks caused by two emerging novel viruses: Avian Influenza A (H7N9) virus in China and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in multiple countries in the Middle East and Europe. During these two events NBIC leveraged its expertise in enhancing collaboration and shared situational awareness among federal agencies.

Objective

To demonstrate NBIC's innovative approach in facilitating information sharing among U.S. federal agencies during the recent outbreaks of H7N9 influenza and MERS-CoV.

Since April 2012, an integrated syndromic surveillance system (ISSC) has been established in health facilities, pharmacies and primary schools in two rural counties of Jiangxi Province, China (1). The objective of ISSC is to integrate syndromic surveillance with case report system for infectious disease to improve the early detection of disease outbreak in rural China. Varicella is a common respiratory infectious disease among children. In most cases, it is mild but it might cause severe complications including, pneumonia, meningitis, even death (2). In this study, varicella related school absenteeism and outpatient visits in health facilities in the surveillance sites of ISSC were collected and analyzed.

Objective

To describe the features of varicella outbreak in rural primary schools and the impacts of school absenteeism surveillance on early detection of infectious disease outbreak.

MOH's national sentinel surveillance programme for influenza is part of the WHO international laboratory-based surveillance network to detect the emergence and spread of new antigenic variants of influenza viruses. Virological sample collection is on-going and is carried out during both outbreak and non-outbreak periods.In 2011 and 2012, the sentinel surveillance programme involved a total of 169 sites (18 government primary care clinics and 151 private/general practitioner [GP] clinics).

Objective

 We evaluated the Singapore Ministry of Health's sentinel surveillance system for influenza virus, which included the monitoring of virological samples from patients with influenza-like illness (ILI) seen at government primary care clinics and private general practitioner clinics in 2011-12.

Chlamydia, a sexually transmitted infection which can lead to adverse reproductive health outcomes if untreated, is the most commonly reported nationally notifable disease in the United States.[1] Complete and valid demographic, geographic, and diagnosis-related data are needed to identify trends, describe populations most impacted by disease, identify inequities, and inform and evaluate prevention activities.

Objective

To assess the completeness of key variables included in Chlamydia trachomatis (chlamydia) case report data submitted to the Centers for Disease Control and Prevention (CDC) during 2012.

We describe age- and syndrome-specific emergency department (ED) visit patterns for diarrhea and vomiting associated with periods of confirmed epidemic rotavirus and presumed epidemic norovirus in New York City (NYC).