Infectious Disease

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.

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