Infectious Disease

Although residents of LTCFs have high morbidity and mortality associated with ARIs, there is very limited information on the virology of ARI in LTCFs.[1,2] Moreover, most virological testing of LCTF residents is reactive and is triggered by a resident meeting selected surveillance criteria. We report on incidental findings from a prospective trial of introducing rapid influenza diagnostic testing (RIDT) in ten Wisconsin LTCFs over a two-year period with an approach of testing any resident with ARI.

Objective: To assess the feasibility of conducting respiratory virus surveillance for residents of long term care facilities (LTCF) using simple nasal swab specimens and to describe the virology of acute respiratory infections (ARI) in LCTFs.

Lyme disease (LD), a multisystem infection that is manifested by progressive stages (1), is emerging in central and eastern provinces of Canada due to northward expansion of the geographic range of Ixodes scapularis, the main vector in these regions (2). In 2004, approximately 40 human cases of LD were reported in Canada. In 2009, LD disease became nationally notifiable, with provincial and territorial health departments reporting clinician-diagnosed cases to the Public Health Agency of Canada (PHAC). This study summarizes seven years (2009-2015) of national surveillance data for LD in Canada.

Objective: This study aims to describe incidence over time, geographic and seasonal distribution, demographic and clinical characteristics of Lyme disease cases in Canada.

Rift Valley fever (RVF) is a mosquito-borne viral zoonosis. This study aimed to estimate the prevalence of antibodies to RVF virus (RVFV) in cattle, sheep, and goats in South Africa, near the 2010-2011 outbreak epicenter and identify factors associated with seropositivity.

Objective: The objective of this study was to estimate the prevalence of antibodies to RVFV in domestic cattle, sheep, and goats in a study area in the central interior of South Africa, and to identify factors associated with seropositivity.

Hepatitis C virus (HCV) infections are increasing nationwide and are of particular concern in Tennessee, especially among individuals of reproductive age.1,2 Maternal HCV status reported on the birth certificate reveals that the rate of HCV among women giving birth in TN increased 163% from 2009-2014.3 Further, a 2017 TN Department of Health (TDH) study found that 30% of reproductive aged women with newly reported chronic HCV in TN were determined to be pregnant. While current treatment options are not recommended for children under 12, it is critical to identify an infant’s HCV status in order for him/her to receive proper care. Given the high rates of pregnancy reported among women with newly diagnosed HCV, we sought to expand viral hepatitis surveillance efforts to quantify the extent of the burden of HCV among women giving birth in TN, utilizing surveillance data in lieu of standalone birth certificate data.

Objective: 1. To quantify the burden of perinatal hepatitis C (HCV) exposure and examine the geographic variation in Tennessee (TN). 2. Develop new surveillance strategies for retrospective tracking of perinatal HCV exposures.

Hepatitis C virus (HCV) infection is the most common blood-borne disease in the US and the leading cause of liver-related morbidity and mortality. Approximately 3.5 million individuals in the US were estimated to have been living with hepatitis C in 2010 and approximately half of them were unaware that they were infected. Among HCV infected individuals, those born between 1945 and 1965 (usually referred to as the baby boomer cohort) represents approximately 75% of current cases. Because of the substantial burden of disease among this age group, CDC expanded its existing hepatitis C risk-based testing recommendations to include a one-time HCV antibody test for all persons born between 1945 and 1965. The United States Preventive Services Task Force (USPSTF) subsequently made the same recommendation in June 2013.

Objective: Using a large nationally representative dataset, we estimated the prevalence of self-reported hepatitis C testing among individuals who were recommended to be tested (i.e., baby boomer cohort born between 1945 and 1965) by the CDC and United States Preventive Services Task Force.

Military service members and their families work and live around the world where both endemic and emerging infectious diseases are common. Timely infectious disease surveillance helps to inform medical and policy decisions which ensure mission readiness and beneficiary health. The EpiData Center (EDC) at the Navy and Marine Corps Public Health Center has performed public health surveillance, including routine infectious disease monitoring among service members, their families, and others eligible for military medical benefits for the Department of the Navy (DON) and Department of Defense (DOD) since 2005. The EDC stores and maintains 15 databases totaling over 20 terabytes of health and administrative data. These include administrative data from outpatient encounters and inpatient admissions, Health Level-7 (HL7) formatted ancillary services data, and medical event reports. These data provide the potential for robust surveillance methodologies to monitor diseases of interest and identify trends and outbreaks. The primary intent and design of these data sources is not for disease surveillance, but rather for administrative and billing purposes. However, due to the availability of this data, it is routinely used by academic organizations, private industry, health systems, and government organizations to conduct health surveillance and research. Ancillary services data in particular can be very powerful for near-real time infectious disease surveillance in the DOD as the aggregated data is available within 1 to 2 days after processing. The EDC has demonstrated the value of using laboratory data for surveillance through outbreak detection and longitudinal health trends for specific diseases among select populations. The fact that this data is not designed for surveillance does present several pitfalls in regards to analysis, from issues ranging from free text interpretation to changing testing practices. These pitfalls can be mitigated through standardized processes and detailed quality assurance testing. The EDC has harnessed the power of available administrative health data to improve health outcomes and influence policy among military beneficiaries.

Objective: Discuss the power of utilizing DOD clinical ancillary services data for infectious disease surveillance, the steps used to mitigate pitfalls which may occur during the surveillance process, and the potential of adapting this data for surveillance of emerging infectious diseases.

Neonatal tetanus (NT) though a preventable disease, remains a disturbing cause of neonatal morbidity and mortality particularly in low income countries where maternal and child care are substandard and antitetanus immunization coverage is still poor. The disease, which is mostly fatal, is particularly common in hard to reach and rural areas where deliveries take place at home or with untrained attendants without adequate sterile procedures and in unclean environment. Since eliminating NT became a global target, significant reductions in NT deaths have been reported. The most recent estimates by WHO (2015) put death of newborns due to NT at 34,019, a 96% reduction from the situation in the late 1980s. All countries are committed to œelimination of maternal and neonatal tetanus (MNT), i.e., a reduction of NT incidence to below one case per 1000 live births per year in every district. A strong neonatal tetanus surveillance (NTS) is however required to achieve this. As of March 2018, only 14 countries were yet to eliminate MNT and this includes Nigeria. The different types of NTS recommended are conducted to varying degrees of efficiency and effectiveness in Nigeria under the major surveillance strategy  the Integrated Disease Surveillance and Response (IDSR). These include routine monthly surveillance, zero reporting, active surveillance and retrospective record review. Nigeria comprises six geopolitical zones, 36 states and a Federal Capital territory (FCT), and is made up of 774 Local Government areas (LGA) (districts) an LGA being the lowest administrative level. This study was conducted in Bayelsa state one of the six states in the south zone. It is made up of eight LGAs, more than half of which are riverine and consists of many hard-to-reach communities, where formal functional health facilities are few and far between. Health workers are in short supply and funding of health care delivery is poor in the state.

Objective: To assess the performance of neonatal tetanus surveillance in Bayelsa state of Nigeria.

Routine surveillance is an important global strategy for malaria control. However, there have been few studies comparing routine indicators of burden, including test positivity rate (TPR) and test-confirmed malaria case rates (CMCR), over spatial and temporal scales.

Objective: To evaluate the relationship between test positivity rate and test-confirmed malaria case rate both in time and space, to provide better understanding of the utility and representativeness of HMIS data for changing malaria burden in endemic settings.

Mongolia is one of countries in the WHO Western Pacific Region with a high TB burden. The National Stop TB Strategy 2010-2015 implemented and developed strong surveillance and response system in the country. However, new TB incidence and deaths have not decreased significantly.Political commitment is critical for effective TB surveillance and that commitment can be demonstrated by a country's legal framework, which governs the practice of prevention and control. Therefore, this study is aimed at investigating the legal underpinnings for disease surveillance to help identify what policy changes have occurred in Tuberculosis surveillance.

Objective: In order to track progress towards TB goals, weinvestigated the legal framework for disease surveillance, specifically policy changes for TB surveillance in Mongolia during the MDGs and the SDGs era.

The 2017 - 2018 influenza season was classified by the Centers for Disease Control and Prevention (CDC) as "high severity"™ across all age groups. Furthermore, CDC noted that this was the first year to be categorized as such, with the highest peak percentage of influenza-like-illnesses (ILI), since 2009. In Harris County alone, there were 2,665 positive flu tests reported in comparison to the previous season at 1,395 positive tests. In response to the severity of this year's flu season, Harris County Public Health (HCPH) collaborated across the department to deploy five pop up influenza vaccination events utilizing our Mobile Fleets open to the general public. HCPH epidemiologists are able to collect influenza data from multiple systems and compile it into useful reports/tools. These data include latitudinal and longitudinal data, allowing us to create highly localized maps of where influenza has had impacted communities the hardest. This granular data allowed HCPH to target 5 areas with our Mobile Fleet that had a) high levels of influenza and b) generally limited healthcare/public health infrastructure. Our Mobile Fleet is made up of 8 different Recreational Vehicles that have been retrofitted to offer various public health services including: immunizations, medical visits, dental visits, pet adoptions, mosquito and vector control education, and a fresh food market. The Fleet allows HCPH to offer a full menu of public health services anywhere within the County. While our efforts for this abstract were focused on controlling the influenza outbreak, we leveraged the opportunity to engage with the public on multiple issues such as environmental, veterinary, mosquito control, dental health, and accessible healthy food options.

Objective: During this session, participants will be able to understand how Harris County Public Health utilized data to make informed decisions on how to combat the influenza season.