Infectious Disease

In 2012, an outbreak of Mycobacterium chelonae infections in tattoo recipients in Rochester, NY was found to be associated with premixed tattoo ink contaminated before distribution.1 In May 2012, a case of M. chelonae was reported in a New York City (NYC) resident who received a tattoo with ink alleged to have been diluted with tap water. When a second case of M. chelonae in a tattoo recipient was reported in March 2013, an investigation was initiated. M. chelonae is not reportable in NYC other than in clusters reported by providers or laboratories. To determine if there were additional tattoo-associated M. chelonae infections, we searched for cases using NYC ED syndromic surveillance.

Objective

To investigate tattoo-associated skin infections due to Mycobacterium chelonae using Emergency Department (ED) syndromic surveillance.

The 122 Cities Mortality Reporting System (CMRS) has been used for pneumonia and influenza monitoring in the U.S. since the early 20th century. The 122 CMRS is regarded as the timeliest source of mortality data, with the majority of deaths being reported to the system within two weeks. However, while it excels at timeliness it lacks detail, accuracy and completeness. Deaths are counted during the week that the death certificate was filed and not during the week in which the death occurred and the system only covers approximately 25% of the U.S. population. Also, while the standard case definition for 122 CMRS is a death in which pneumonia or influenza is listed anywhere on the death certificate; not all sites follow this definition (i.e. some sites only use pneumonia or influenza listed only as the underlying cause of death) [1]. 

Objective

To increase the accuracy, completeness, and detail of data as well as decrease the resources needed to conduct pneumonia and influenza mortality surveillance in the U.S.

Pandemic 2009 H1N1 influenza and recent H7N9 influenza outbreaks made the public aware of the threat of influenza infection. In fact, annual influenza epidemic caused heavy disease burden and high economic loss around the world [1, 2]. Although the virological surveillance provided the high sensitivity and specificity for testing results, the timeliness and the cost of the test were not feasible for extensive public health surveillance. In addition, traditional sentinel physician surveillance also encountered many challenges such as the representativeness and reporting bias. The seamless surveillance system without extra labor reporting would be the ideal approach. Taiwan had as high as 99% of health insurance coverage. The real-time monitoring of the ILI clinical visits in the communities could reflect the severity of influenza epidemics. In this study, we used an innovative two-stage approach for detecting aberrations during 2009 pandemic influenza in Taiwan.

Objective

This study proposed a two-stage approach for early detection of aberrations of influenza-like illness (ILI) using the small-area based claim data of outpatient and emergency room visit.

Clostridium difficile (CD) is an important cause of antibiotic and hospital-associated infection. This preventable infection also plays a major role in hospital readmissions, mostly in the elderly, leading to the CMS implementing rules to penalize hospitals with higher rates, in the Hospital Value Based Purchasing Program1.

Objective

To profile the demographic characteristics of the Medicare Advantage(MA) population with this infection and analyze trends in readmissions, mortality, emergency room(ER) visits and observation room(OR) stays from 2008-2011.

Symptoms of influenza-like illness (ILI) were reported daily by health workers via the integrated syndromic surveillance system in rural China (ISSC)(1).

Objective

To analyze the growth and variation of ILI reports using individual growth curve model.

Numerous studies have demonstrated a causal relationship between human papillomavirus (HPV) and cervical cancer1. By 2007 two vaccines targeting HPV were available in the United States. Both vaccines have shown close to 100% efficacy against HPV types 16 and 18, the cause of 70% of all cervical cancers2. It is hypothesized that with routine vaccination the prevalence of HPV and HPV-associated cancers should decline3. A need exists for surveillance with national coverage2. The purpose of this study is to present a method to estimate rate of change of high-risk HPV in the United States since 2004 in women using national reference laboratory data.

Objective

To establish and evaluate an HPV surveillance protocol and determine the rate of change of high-risk HPV in the United States since 2004 using archived reference laboratory data.

In 2003, the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia estimated that approximately 1 million people in the United States were living with HIV/AIDS, and that approximately 25% these were undiagnosed and unaware of their HIV infection. For many such patients the emergency department may be the only part of the health care system that is utilized. In 2006, the CDC revised their recommendations for HIV testing in a variety of care settings including the emergency department (ED). Early identification and treatment improves survival for patients with HIV. Earlier testing programs including those provided in the ED may lead to earlier detection and further reduction in the transmission of HIV in the United States. (1,2,3,4,5) High risk patients should recieve screening for HIV and those patients who have a lab test for GC/chlamydia represent a high risk patient popualtion.(4) While the ED is a frequent health care access point for patients seeking evaluation for sexually transmitted diseases, ED providers may not be following guidlines for HIV testing in high risk patients.

Objective

To assess compliance with CDC and USPSTF guidelines for HIV testing in a regional cohort of emergency departments.

In 2003, the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia estimated that approximately 1 million people in the United States were living with HIV/AIDS, and that approximately 25% these were undiagnosed and unaware of their HIV infection. For many such patients the emergency department may be the only part of the health care system that is utilized. In 2006, the CDC revised their recommendations for HIV testing in a variety of care settings including the emergency department (ED). Early identification and treatment improves survival for patients with HIV. Earlier testing programs including those provided in the ED will lead earlier detection and further reduction in the transmission of HIV in the United States. (1,2,3) The analysis was focused on ED providersÕ knowledge and attitudes towards routine HIV testing, perceived barriers to HIV testing.

Objective:

To evaluate ED staff attitudes and potential barriers towards ED based POC HIV testing in an urban academic ED prior to implementing an ED based POC HIV test.

Brucellosis is one of the world'•s most widespread zoonosis. It is caused by gram-negative bacilli of the genus Brucella.It is a risk to those occupationally exposed to animals such as farmers, veterinarians, laboratorians and butchers and to the public through the consumption of contaminated unprocessed milk, milk products and meats.The epidemiology of Brucella infections involves complex mechanisms which vary according to the disease determinants. Previous studies in Kenya have reported a prevalence range of between 5% - 45% in livestock as well as over 20% in humans in selected regions1. Therefore, risk factors observed in a particular agro-ecological region cannot easily be extrapolated to another area with different ecological settings and husbandry practices. A strategy for brucellosis control would greatly benefit from detailed knowledge of local epidemiology. The available data on brucellosis is not adequate enough to inform an effective control process. Decision makers frequently apply different strategies according to the prevalence and epidemiology of the disease. People who interact with livestock on a regular basis are thought to be at an increased risk of contracting zoonoses including Brucellosis. Previous studies on Brucellosis have focused either on human or animal disease. The current study simultaneously investigated the linkage in sero-prevalence between humans and their animals within the same household at the same time.

Objective

We determined the sero-prevalence and risk factors for brucellosis in humans and their animals in Kajiado and Kiambu Counties of Kenya. We also examined the linkage between the sero-status of humans and that of their livestock.

Monitoring trends of respiratory illnesses via syndromic surveillance in SC is performed on a daily basis. SC Syndromic Surveillance primarily utilizes emergency department data, and provides situational awareness regarding broad syndrome categories among hospitals in the state. Respiratory illnesses represent a significant public health burden, causing the second highest number of outbreaks reported in SC. Since syndromic surveillance can potentially serve as an earlier indicator of outbreaks,1 it is beneficial to assess seasonality of respiratory illnesses to identify illness clusters early to mobilize a rapid response.

Objective

To assess the temporal patterns of respiratory illnesses in South Carolina (SC) using syndromic surveillance emergency department (ED) data.