Use of electronic death certificates for influenza death surveillance.

Surveillance for influenza deaths has been used to gauge the severity of influenza seasons. Traditional surveillance, which relies on medical records review and laboratory testing, might not be sustainable during a pandemic. We examined whether electronic death certificates might provide a surveillance alternative. We compared information retrieved from electronic death certificates that listed influenza (or a synonym) with information retrieved from medical charts on which influenza deaths were reported by traditional means in Los Angeles County, California, USA, during the 2009 influenza A(H1N1) pandemic and 2 subsequent influenza seasons. Electronic death certificate surveillance provided timely information, matched the demographics and epidemiologic curve of that obtained from traditional influenza-related death surveillance, and had a moderately positive predictive value. However, risk factors were underreported on death certificates. Because surveillance by electronic death certificates does not require obtaining and reviewing medical records, it requires fewer resources and is less burdensome on public health staff.

Risk factors for infection and colonization with community-associated methicillin-resistant Staphylococcus aureus in the Los Angeles County jail: a case-control study.

BACKGROUND: Community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections and outbreaks occur in correctional facilities, such as jails and prisons. Spread of these infections can be extremely difficult to control. Development of effective prevention protocols requires an understanding of MRSA risk factors in incarcerated persons. METHODS: We performed a case-control study investigating behavioral risk factors associated with MRSA infection and colonization. Case patients were male inmates with confirmed MRSA infection. Control subjects were male inmates without skin infection. Case patients and control subjects completed questionnaires and underwent collection of nasal swab samples for culture for MRSA. Microbiologic analysis was performed to characterize recovered MRSA isolates. RESULTS: We enrolled 60 case patients and 102 control subjects. Of the case patients, 21 (35%) had MRSA nasal colonization, compared with 11 control subjects (11%) (P .001). Among MRSA isolates tested, 100% were the USA300 strain type. Factors associated with MRSA skin infection included MRSA nares colonization, lower educational level, lack of knowledge about "Staph" infections, lower rate of showering in jail, recent skin infection, sharing soap with other inmates, and less preincarceration contact with the health care system. Risk factors associated with MRSA colonization included antibiotic use in the previous year and lower rate of showering. CONCLUSIONS: We identified several risks for MRSA infection in male inmates, many of which reflected preincarceration factors, such as previous skin infection and lower educational level. Some mutable factors, such as showering frequency, knowledge about Staph, and soap sharing, may be targets for intervention to prevent infection in this vulnerable population.