Infectious Disease

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.

In November of 2011, the local Public Health unit responsible for the Edmonton area (population 1.2mil) was alerted to an individual meeting the case definition for measles in the ED. A key part of the management strategy was to identify contacts to the index case, perform a risk assessment and, if applicable, inform them of the risk. Given the transmission characteristics, the risk for this group was defined as those present within the geographic area/environment of the index case within a specified time period. Public Health utilized the established manual lookup of hospital records and piloted an automated data query through the syndromic surveillance system, ARTSSN. This served as opportunity to validate the ability to generate a contact list, based on risk geography and time, of the ARTSSN system, and to compare the timeliness of each result.

Objective

Following a clinical case of measles presenting to an urban emergency department (ED), the local health authority sought to identify all patients that might be at risk for disease. This list of contacts was generated through a manual search of hospital records and through a piloted automated data query of the health authority's syndromic surveillance system, Alberta Real Time Syndromic Surveillance Net (ARTSSN). The purpose of this pilot study was to: 1) compare the completeness of the two lookup methods and, 2) describe the time requirements needed for each method.

The incidence of cryptococcosis is increasing with the global emergence of AIDS and this now represents a major life-threatening fungal infection in HIV-AIDS patients (1). Cryptococcal meningitis is a leading cause of death in AIDS patients and contributes substantially to the high early mortality in antiretroviral treatment (ART) programs in low-resource settings (1). Relatively high prevalence of cryptococcal infection has been reported in low-resource country like Nigeria (2). In more affluent countries, the incidence of HIV-associated cryptococcosis has decreased dramatically (3). Cryptococcal infections in HIV/AIDS patients contribute substantially to the high early mortality in antiretroviral treatment (ART) programs in low-resource countries (1).

Objective

Screening of a targeted group of HIV patients on antiretroviral therapy (ART) for early detection of cryptococcal infection.

Disease surveillance is an epidemiological practice by which the spread of disease is mentioned in order to establish patterns of progression. The main role of Priority Communicable Disease Surveillance (PCDS) is to predict, observe, and minimize the harm caused by outbreak, epidemic, and pandemic situations, as well as increase our knowledge to what factors might contribute to such circumstances. A key part of modern disease surveillance is the practice of disease case reporting.

Objective

Surveillance of priority communicable diseases started with a view to build up an early warning system for certain important public health important diseases in Bangladesh, namely: (1) Diarrheal disease (acute watery diarrhea and bloody dysentery); (2) Malaria; (3) Kala-azar; (4) Tuberculosis; (5) Leprosy; (6) Encephalitis; (7) Unknown diseases of public health concern.

Fungal infections (FI) are a leading cause of morbidity and mortality among patients undergoing allo-SCT. The newer anti-fungal agents, the echinocandins and extended spectrum azoles, have offered alternatives to Amphotericin B and fluconazole. Data from large patient samples evaluating the magnitude of benefit with the newer anti-fungal agents are lacking.

Objective

We analyzed the Nationwide Inpt Sample (NIS) database from Healthcare Cost and Utilization project to evaluate the trends in the incidence of FI and to evaluate the potential impact of newer anti-fungal agents on in-hospital mortality (IHM) among allo-SCT recipients.

Immigrants and refugees are required to undergo tuberculosis (TB) screening before entering the United States (US)(1). Nearly 700 overseas panel physicians designated by the US Department of State, perform these screenings (2). Over 450,000 new immigrants and nearly 80,000 refugees arrive in the US each year with their medical documentation (3). Those with culture positive or smear positive TB are treated prior to arrival in the US; those with radiographic or symptomatic TB but negative smears and culture may enter the US with Class B TB(4). After arrival, CDC's Electronic Disease Notification system (EDN) notifies the health departments of the results of overseas examinations.

Objective

To conduct preliminary assessment of the US destination locations among newly arriving immigrants and refugees with tuberculosis classifications

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.