Infectious Disease

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.

During the past decade, public health practitioners have implemented various new syndromic and other advanced surveillance systems to supplement their existing laboratory testing and disease surveillance toolkit. While much of the development and widespread implementation of these systems had been supported by public health preparedness funding, the reduction of these monies has greatly constrained the ability of public health agencies to staff and maintain these systems. The appearance of H3N2v and other novel influenza A viruses, requires agencies to carefully choose which systems will provide the most cost-effective data to support their public health practice. The global emergence of influenza A H7N9, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and other viruses associated with high mortality, emphasize the importance of maintaining vigilance for the presence of emerging disease.

Objective

To review approaches used by public health agencies for alerting health care providers and enhancing surveillance systems to identify the presence of novel respiratory disease and to characterize their recent experience in searching for globally emerging viruses.

Rickettsiae are an important arthropod-borne pathogens widely distributed throughout the world that infects humans causing various types of clinical diseases. The clinical features of rickettsial diseases can often overlap with other tick-borne diseases, particularly with borrelioses. These organisms can share the same transmitting vector; co-infection in a single vector is possible, leading to further complication of the diagnosis and treatment of these diseases. Preliminary study showed a relatively high infection rate for spotted fever group Rickettsiae among ticks in Georgia. The prevalence of Borrelia in ticks has not been studied so far.

Objective

The primary goal of this study was to assess the prevalence of Rickettsia and Borellia in ticks collected from different regions of Georgia.