RESUMO
From 2015 to 2017, 11 confirmed brucellosis cases were reported in New York City, leading to 10 Brucella exposure risk events (Brucella events) in 7 clinical laboratories (CLs). Most patients had traveled to countries where brucellosis is endemic and presented with histories and findings consistent with brucellosis. CLs were not notified that specimens might yield a hazardous organism, as the clinicians did not consider brucellosis until they were notified that bacteremia with Brucella was suspected. In 3 Brucella events, the CLs did not suspect that slow-growing, small Gram-negative bacteria might be harmful. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), which has a limited capacity to identify biological threat agents (BTAs), was used during 4 Brucella events, which accounted for 84% of exposures. In 3 of these incidents, initial staining of liquid media showed Gram-positive rods or cocci, including some cocci in chains, suggesting streptococci. Over 200 occupational exposures occurred when the unknown isolates were manipulated and/or tested on open benches, including by procedures that could generate infectious aerosols. During 3 Brucella events, the CLs examined and/or manipulated isolates in a biological safety cabinet (BSC); in each CL, the CL had previously isolated Brucella Centers for Disease Control and Prevention recommendations to prevent laboratory-acquired brucellosis (LAB) were followed; no seroconversions or LAB cases occurred. Laboratory assessments were conducted after the Brucella events to identify facility-specific risks and mitigations. With increasing MALDI-TOF MS use, CLs are well-advised to adhere strictly to safe work practices, such as handling and manipulating all slow-growing organisms in BSCs and not using MALDI-TOF MS for identification until BTAs have been ruled out.
Assuntos
Brucella/isolamento & purificação , Brucelose/diagnóstico , Técnicas de Laboratório Clínico/normas , Infecção Laboratorial/microbiologia , Exposição Ocupacional/estatística & dados numéricos , Brucella/crescimento & desenvolvimento , Brucelose/etiologia , Contagem de Colônia Microbiana , Humanos , Cidade de Nova Iorque , Exposição Ocupacional/prevenção & controle , Fatores de Risco , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por MatrizRESUMO
New York City (NYC) was an epicenter of the coronavirus disease 2019 (COVID-19) outbreak in the United States during spring 2020 (1). During March-May 2020, approximately 203,000 laboratory-confirmed COVID-19 cases were reported to the NYC Department of Health and Mental Hygiene (DOHMH). To obtain more complete data, DOHMH used supplementary information sources and relied on direct data importation and matching of patient identifiers for data on hospitalization status, the occurrence of death, race/ethnicity, and presence of underlying medical conditions. The highest rates of cases, hospitalizations, and deaths were concentrated in communities of color, high-poverty areas, and among persons aged ≥75 years or with underlying conditions. The crude fatality rate was 9.2% overall and 32.1% among hospitalized patients. Using these data to prevent additional infections among NYC residents during subsequent waves of the pandemic, particularly among those at highest risk for hospitalization and death, is critical. Mitigating COVID-19 transmission among vulnerable groups at high risk for hospitalization and death is an urgent priority. Similar to NYC, other jurisdictions might find the use of supplementary information sources valuable in their efforts to prevent COVID-19 infections.
Assuntos
Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Betacoronavirus/isolamento & purificação , COVID-19 , Teste para COVID-19 , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , SARS-CoV-2 , Adulto JovemRESUMO
We describe the first case of cat-to-human transmission of influenza A(H7N2), an avian-lineage influenza A virus, that occurred during an outbreak among cats in New York City animal shelters. We describe the public health response and investigation.
Assuntos
Surtos de Doenças/veterinária , Vírus da Influenza A Subtipo H7N2/isolamento & purificação , Influenza Humana/transmissão , Infecções por Orthomyxoviridae/veterinária , Animais , Anticorpos Antivirais/sangue , Gatos , Humanos , Vírus da Influenza A Subtipo H7N2/genética , Vírus da Influenza A/imunologia , Influenza Humana/epidemiologia , Influenza Humana/virologia , Cidade de Nova Iorque/epidemiologia , Infecções por Orthomyxoviridae/epidemiologia , Infecções por Orthomyxoviridae/virologia , Reação em Cadeia da PolimeraseRESUMO
During 2013, the New York City Department of Health and Mental Hygiene (DOHMH) received reports of 6 hepatitis A cases among food handlers. We describe our decision-making process for public notification, type of postexposure prophylaxis (PEP) offered, and lessons learned. For 3 cases, public notification was issued and DOHMH offered only hepatitis A vaccine as PEP. Subsequent outbreaks resulted from 1 case for which no public notification was issued or PEP offered, and 1 for which public notification was issued and PEP was offered too late. DOHMH continues to use environmental assessments to guide public notification decisions and offer only hepatitis A vaccine as PEP after public notification but recognizes the need to evaluate each situation individually. The PEP strategy employed by DOHMH should be considered because hepatitis A vaccine is immunogenic in all age groups, can be obtained by local jurisdictions more quickly, and is logistically easier to administer in mass clinics than immunoglobulin.
Assuntos
Tomada de Decisões , Serviços de Alimentação , Hepatite A/epidemiologia , Saúde Pública/métodos , Surtos de Doenças/prevenção & controle , Serviços de Alimentação/normas , Hepatite A/tratamento farmacológico , Vacinas contra Hepatite A/uso terapêutico , Humanos , Governo Local , Cidade de Nova Iorque/epidemiologia , Profilaxia Pós-Exposição , Saúde Pública/estatística & dados numéricos , Recursos HumanosRESUMO
In late October 2014, Ebola virus disease (Ebola) was diagnosed in a humanitarian aid worker who recently returned from West Africa to New York City (NYC). The NYC Department of Health and Mental Hygiene (DOHMH) actively monitored three close contacts of the patient and 114 health care personnel. No secondary cases of Ebola were detected. In collaboration with local and state partners, DOHMH had developed protocols to respond to such an event beginning in July 2014. These protocols included safely transporting a person at the first report of symptoms to a local hospital prepared to treat a patient with Ebola, laboratory testing for Ebola, and monitoring of contacts. In response to this single case of Ebola, initial health care worker active monitoring protocols needed modification to improve clarity about what types of exposure should be monitored. The response costs were high in both human resources and money: DOHMH alone spent $4.3 million. However, preparedness activities that include planning and practice in effectively monitoring the health of workers involved in Ebola patient care can help prevent transmission of Ebola.
Assuntos
Altruísmo , Surtos de Doenças/prevenção & controle , Ebolavirus/isolamento & purificação , Pessoal de Saúde , Doença pelo Vírus Ebola/epidemiologia , África Ocidental/epidemiologia , Busca de Comunicante , Surtos de Doenças/economia , Doença pelo Vírus Ebola/economia , Doença pelo Vírus Ebola/prevenção & controle , Humanos , Masculino , Cidade de Nova Iorque/epidemiologiaRESUMO
In July 2014, as the Ebola virus disease (Ebola) epidemic expanded in Guinea, Liberia, and Sierra Leone, an air traveler brought Ebola to Nigeria and two American health care workers in West Africa were diagnosed with Ebola and later medically evacuated to a U.S. hospital. New York City (NYC) is a frequent port of entry for travelers from West Africa, a home to communities of West African immigrants who travel back to their home countries, and a home to health care workers who travel to West Africa to treat Ebola patients. Ongoing transmission of Ebolavirus in West Africa could result in an infected person arriving in NYC. The announcement on September 30 of an Ebola case diagnosed in Texas in a person who had recently arrived from an Ebola-affected country further reinforced the need in NYC for local preparedness for Ebola.
Assuntos
Epidemias/prevenção & controle , Doença pelo Vírus Ebola/prevenção & controle , Vigilância da População , Doença pelo Vírus Ebola/epidemiologia , Humanos , Cidade de Nova Iorque/epidemiologiaRESUMO
OBJECTIVE: To investigate the association between socioeconomic status (SES) and hospitalization for 2009 H1N1 influenza, independently of access to care and known risk factors for severe influenza illness, among New York City residents during the 2009-2010 influenza season. DESIGN: We used a 1:2 case-control study design, matching by age group and month of diagnosis. Cases were defined as laboratory-confirmed patients with 2009 H1N1 influenza who were hospitalized during their illness. Controls were defined as nonhospitalized laboratory-confirmed influenza A patients. Participants were contacted for a telephone interview to collect relevant clinical and demographic data. We used conditional logistic regression to analyze the association between SES and hospitalization. SETTING: New York City. PARTICIPANTS: Of the 171 hospitalized cases who were identified between October 2009 and February 2010, a total of 128 completed telephone interviews. A total of 640 nonhospitalized controls were contacted, and of these, 337 completed interviews. MAIN OUTCOME MEASURES: The main outcome of interest was whether or not a patient was hospitalized during his or her 2009 H1N1 influenza illness. Socioeconomic status was measured using education and neighborhood poverty. RESULTS: We identified a gradient in the odds of hospitalization for 2009 H1N1 influenza by education level among adults. This association could not be entirely explained by access to care and underlying risk factors. An inverse association between odds of hospitalization and neighborhood poverty was also identified among adults and children. CONCLUSIONS: This study suggests that individuals of lower SES were more vulnerable to severe illness during the 2009 H1N1 pandemic. Additional research is needed to help guide interventions to protect this population during future influenza pandemics.
Assuntos
Hospitalização/estatística & dados numéricos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Surtos de Doenças , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Fatores de Risco , Índice de Gravidade de Doença , Fatores Socioeconômicos , Adulto JovemRESUMO
BACKGROUND. When the 2009 H1N1 influenza A virus emerged in the United States, epidemiologic and clinical information about severe and fatal cases was limited. We report the first 47 fatal cases of 2009 H1N1 influenza in New York City. METHODS. The New York City Department of Health and Mental Hygiene conducted enhanced surveillance for hospitalizations and deaths associated with 2009 H1N1 influenza A virus. We collected basic demographic and clinical information for all patients who died and compared abstracted data from medical records for a sample of hospitalized patients who died and hospitalized patients who survived. RESULTS. From 24 April through 1 July 2009, 47 confirmed fatal cases of 2009 H1N1 influenza were reported to the New York City Department of Health and Mental Hygiene. Most decedents (60%) were ages 18-49 years, and only 4% were aged 65 years. Many (79%) had underlying risk conditions for severe seasonal influenza, and 58% were obese according to their body mass index. Thirteen (28%) had evidence of invasive bacterial coinfection. Approximately 50% of the decedents had developed acute respiratory distress syndrome. Among all hospitalized patients, decedents had presented for hospitalization later (median, 3 vs 2 days after illness onset; P < .05) and received oseltamivir later (median, 6.5 vs 3 days; P < .01) than surviving patients. Hospitalized patients who died were less likely to have received oseltamivir within 2 days of hospitalization than hospitalized patients who survived (61% vs 96%; P < .01). CONCLUSIONS. With community-wide transmission of 2009 H1N1 influenza A virus, timely medical care and antiviral therapy should be considered for patients with severe influenza-like illness or with underlying risk conditions for complications from influenza.
Assuntos
Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/mortalidade , Influenza Humana/virologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Comorbidade , Feminino , Hospitalização , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Obesidade/complicações , Pneumonia Bacteriana/complicações , Síndrome do Desconforto Respiratório/epidemiologia , Fatores de Risco , Adulto JovemRESUMO
During 2014-2016, the largest outbreak of Ebola virus disease (EVD) in history occurred in West Africa. The New York City Department of Health and Mental Hygiene (DOHMH) worked with health care providers to prepare for persons under investigation (PUIs) for EVD in New York City. From July 1, 2014, through December 29, 2015, we classified as a PUI a person with EVD-compatible signs or symptoms and an epidemiologic risk factor within 21 days before illness onset. Of 112 persons who met PUI criteria, 74 (66%) sought medical care and 49 (44%) were hospitalized. The remaining 38 (34%) were isolated at home with daily contact by DOHMH staff members. Thirty-two (29%) PUIs received a diagnosis of malaria. Of 10 PUIs tested, 1 received a diagnosis of EVD. Home isolation minimized unnecessary hospitalization. This case study highlights the importance of developing competency among clinical and public health staff managing persons suspected to be infected with a high-consequence pathogen.
Assuntos
Surtos de Doenças , Doença pelo Vírus Ebola/epidemiologia , Administração em Saúde Pública , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/fisiopatologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Vigilância da População , Medição de Risco , Adulto JovemRESUMO
Strong working relationships between infectious disease (ID) physicians and public health have resulted in the early detection of emerging infectious threats. From May 6 through June 5, 2015, we surveyed ID physicians in the Infectious Diseases Society of America's Emerging Infections Network about communications with public health. A total of 688 of 1491 (46%) members completed the survey, 624 (91%) of whom knew how to reach their health department directly for an urgent issue. Only 38 (6%) described communications with their health department as poor. Interest in newer technologies (eg, mobile smartphone applications) showed mixed results. Interest in a smartphone application differed significantly by years of ID experience, with 81 of 146 (55%) respondents with <5 years of ID experience, 172 of 359 (48%) respondents with 5 to 24 years of ID experience, and 61 of 183 (33%) respondents with ≥25 years of ID experience in favor of a smartphone application (P < .001). As more physicians adopt newer communication technologies, health departments should be prepared to incorporate these tools to communicate with ID physicians.
Assuntos
Doenças Transmissíveis/epidemiologia , Comunicação , Infectologia/métodos , Médicos , Administração em Saúde Pública/métodos , Correio Eletrônico , Humanos , Internet , Aplicativos Móveis , Vigilância em Saúde Pública/métodos , Estados UnidosRESUMO
OBJECTIVE: We describe an effort to reduce transmission of a multidrug-resistant Streptococcus pneumoniae (MDRSP) in a long-term-care facility (LTCF). DESIGN: Longitudinal cross-sectional study. SETTING: An LTCF in New York City with ongoing disease due to an MDRSP strain among residents with AIDS since a 1995 outbreak. The MDRSP outbreak strain was susceptible to vancomycin but not to other antimicrobials tested, including fluoroquinolones. PARTICIPANTS: Residents and staff members of the LTCF during 1999 through 2001. INTERVENTION: Implementing standard infection control measures, and developing and implementing "enhanced standard" infection control measures, modified respiratory droplet prevention measures to reduce inter-resident transmission. RESULTS: Before the intervention, nasopharyngeal carriage of the MDRSP outbreak strain was detected in residents with AIDS and residents with tracheostomies who were not dependent on mechanical ventilation. The prevalence of nasopharyngeal carriage of the MDRSP outbreak strain was 7.8% among residents who had AIDS and 14.6% among residents with tracheostomies. After training sessions on standard and enhanced standard infection control measures, the staff appeared to have good knowledge and practice of the infection control measures. After the intervention, new transmission among residents with tracheostomies was prevented; however, these residents were prone to persistent tracheal carriage and needed ongoing enhanced standard infection control measures. Ongoing transmission among residents with AIDS, a socially active group, was documented, although fewer cases of disease due to the outbreak strain occurred. CONCLUSIONS: Infection control contributed to less transmission of MDRSP in the LTCE Additional strategies are needed to reduce transmission and carriage among certain resident populations.
Assuntos
Portador Sadio/microbiologia , Infecção Hospitalar/microbiologia , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Antibioticoprofilaxia , Antibióticos Antituberculose/farmacologia , Vacinas Bacterianas/imunologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Estudos Transversais , Farmacorresistência Bacteriana/efeitos dos fármacos , Farmacorresistência Bacteriana/imunologia , Resistência a Múltiplos Medicamentos/efeitos dos fármacos , Resistência a Múltiplos Medicamentos/imunologia , Fluoroquinolonas/farmacologia , Instalações de Saúde , Humanos , Assistência de Longa Duração , Estudos Longitudinais , Doenças Nasofaríngeas/epidemiologia , Doenças Nasofaríngeas/microbiologia , Doenças Nasofaríngeas/prevenção & controle , New York/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Infecções Pneumocócicas/transmissão , Prevalência , Rifampina/farmacologia , Fatores de Risco , Sorotipagem , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/imunologia , Resultado do TratamentoRESUMO
OBJECTIVES: To characterize risk factors associated with pneumococcal disease and asymptomatic colonization during an outbreak of multidrug-resistant Streptococcus pneumoniae (MDRSP) among AIDS patients in a long-term-care facility (LTCF), evaluate the efficacy of antimicrobial prophylaxis in eliminating MDRSP colonization, and describe the emergence of fluoroquinolone resistance in the MDRSP outbreak strain. DESIGN: Epidemiologic investigation based on chart review and characterization of SP strains by antimicrobial susceptibility testing and PFGE and prospective MDRSP surveillance. SETTING: An 80-bed AIDS-care unit in an LTCF PARTICIPANTS: Staff and residents on the unit. RESULTS: From April 1995 through January 1996, 7 cases of MDRSP occurred. A nasopharyngeal (NP) swab survey of all residents (n=65) and staff (n=70) detected asymptomatic colonization among 6 residents (9%), but no staff. Isolates were sensitive only to rifampin, ofloxacin, and vancomycin. A 7-day course of rifampin and ofloxacin was given to eliminate colonization among residents: NP swab surveys at 1, 4, and 10 weeks after prophylaxis identified 1 or more colonized residents at each follow-up with isolates showing resistance to one or both treatment drugs. Between 1996 and 1999, an additional 6 patients were diagnosed with fluoroquinolone-resistant (FQ-R) MDRSP infection, with PFGE results demonstrating that the outbreak strain had persisted 3 years after the initial outbreak was recognized. CONCLUSIONS: Chemoprophylaxis likely contributed to the development of a FQ-R outbreak strain that continued to be transmitted in the facility through 1999. Long-term control of future MDRSP outbreaks should rely primarily on vaccination and strict infection control measures.
Assuntos
Infecção Hospitalar/microbiologia , Surtos de Doenças/prevenção & controle , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/microbiologia , Adulto , Antibioticoprofilaxia , Vacinas Bacterianas/imunologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , DNA Bacteriano/análise , DNA Bacteriano/genética , Farmacorresistência Bacteriana/efeitos dos fármacos , Farmacorresistência Bacteriana/imunologia , Resistência a Múltiplos Medicamentos/efeitos dos fármacos , Resistência a Múltiplos Medicamentos/imunologia , Eletroforese em Gel de Campo Pulsado , Feminino , Instalações de Saúde , Humanos , Tempo de Internação , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Doenças Nasofaríngeas/epidemiologia , Doenças Nasofaríngeas/microbiologia , Doenças Nasofaríngeas/prevenção & controle , New York/epidemiologia , Infecções Pneumocócicas/complicações , Infecções Pneumocócicas/epidemiologia , Fatores de Risco , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/imunologiaRESUMO
BACKGROUND AND OBJECTIVES: In October 2008, an investigation was conducted into a cluster of gram-negative bloodstream infections after invasive pain management procedures at an outpatient facility to identify additional cases and determine the source of illness. METHODS: We conducted a retrospective cohort study to determine exposures associated with illness. Eligible patients had an invasive procedure in the 4 days before or after the procedure date of the initial case-patients. Infection control assessments were made, and environmental specimens collected. RESULTS: Four laboratory-confirmed case-patients (3 with Klebsiella pneumoniae and 1 with Enterobacter aerogenes) and 5 suspect case-patients were identified. In addition to the 9 confirmed and suspect case-patients, 45 patients were interviewed. All confirmed and suspect case-patients had a sacroiliac joint steroid injection procedure; injection into the sacroiliac joint was associated with illness (9/22 versus 0/31; P < 0.0001). Multiple breaches in infection control were noted including the reuse of single-use vials for multiple patients. The 3 K. pneumoniae with positive blood cultures were indistinguishable by pulse-field gel electrophoresis, and the E. aerogenes-positive blood culture was indistinguishable by pulse-field gel electrophoresis to the culture from an open vial of 100-mL iodixanol contrast solution. CONCLUSION: Infection was associated with pain management procedures, specifically those involving injection to the sacroiliac joint. Lapses in infection control likely led to the contamination of single-use vials that were then used for multiple patients. Reuse of medication vials should be restricted, and affordable single-dose vials should be made available.
Assuntos
Analgesia/efeitos adversos , Bacteriemia/epidemiologia , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Enterobacter aerogenes/isolamento & purificação , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/isolamento & purificação , Esteroides/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgesia/métodos , Bacteriemia/microbiologia , Infecção Hospitalar/microbiologia , Equipamentos Descartáveis/microbiologia , Infecções por Enterobacteriaceae/microbiologia , Contaminação de Equipamentos , Reutilização de Equipamento , Feminino , Humanos , Controle de Infecções , Injeções Intra-Articulares , Infecções por Klebsiella/microbiologia , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Clínicas de Dor , Guias de Prática Clínica como Assunto , Saúde Pública , Estudos Retrospectivos , Articulação Sacroilíaca , Fatores de TempoAssuntos
Bioterrorismo , Doenças Transmissíveis/epidemiologia , Saúde Pública , Antraz/epidemiologia , Planejamento em Desastres , Surtos de Doenças , Humanos , Influenza Humana/prevenção & controle , Vacinação em Massa/organização & administração , Cidade de Nova Iorque , Vigilância da População , Ataques Terroristas de 11 de Setembro , Síndrome Respiratória Aguda Grave/epidemiologia , Varíola/epidemiologiaRESUMO
The recent outbreaks of influenza A/H5N1 and 'swine influenza' A/H1N1 have caused global concern over the potential for a new influenza pandemic. Although it is impossible to predict when the next pandemic will occur, appropriate planning is still needed to maximize efficient use of resources and to minimize loss of life and productivity. Many tools now exist to assist countries in evaluating their plans but there is little to aid in writing of the plans. This study discusses the process of drafting a pandemic influenza preparedness plan for developing countries that conforms to the International Health Regulations of 2005 and recommendations of the World Health Organization. Stakeholders from many sectors should be involved in drafting a comprehensive pandemic influenza plan that addresses all levels of preparedness.
Assuntos
Defesa Civil/organização & administração , Controle de Doenças Transmissíveis/métodos , Surtos de Doenças/prevenção & controle , Política de Saúde , Influenza Humana/prevenção & controle , Influenza Humana/virologia , Defesa Civil/métodos , Humanos , Vírus da Influenza A Subtipo H1N1/imunologia , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Virus da Influenza A Subtipo H5N1/imunologia , Virus da Influenza A Subtipo H5N1/isolamento & purificaçãoRESUMO
OBJECTIVES: We investigated increases in diarrheal illness detected through syndromic surveillance after a power outage in New York City on August 14, 2003. METHODS: The New York City Department of Health and Mental Hygiene uses emergency department, pharmacy, and absentee data to conduct syndromic surveillance for diarrhea. We conducted a case-control investigation among patients presenting during August 16 to 18, 2003, to emergency departments that participated in syndromic surveillance. We compared risk factors for diarrheal illness ascertained through structured telephone interviews for case patients presenting with diarrheal symptoms and control patients selected from a stratified random sample of nondiarrheal patients. RESULTS: Increases in diarrhea were detected in all data streams. Of 758 patients selected for the investigation, 301 (40%) received the full interview. Among patients 13 years and older, consumption of meat (odds ratio [OR]=2.7, 95% confidence interval [CI]=1.2, 6.1) and seafood (OR=4.8; 95% CI=1.6, 14) between the power outage and symptom onset was associated with diarrheal illness. CONCLUSIONS: Diarrhea may have resulted from consumption of meat or seafood that spoiled after the power outage. Syndromic surveillance enabled prompt detection and systematic investigation of citywide illness that would otherwise have gone undetected.
Assuntos
Diarreia/epidemiologia , Surtos de Doenças , Eletricidade , Centrais Elétricas , Vigilância de Evento Sentinela , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Saúde PúblicaRESUMO
After being notified that 2 high school football teammates from New York City were hospitalized with confirmed or suspected invasive group A streptococcal infections, we conducted an investigation of possible spread among other team members. This investigation highlights a need for guidelines on management of streptococcal and other infectious disease outbreaks in team sport settings.
Assuntos
Futebol Americano , Instituições Acadêmicas , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/transmissão , Streptococcus pyogenes/isolamento & purificação , Adolescente , Adulto , Antibacterianos/farmacologia , Bacteriemia/diagnóstico , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Eletroforese em Gel de Campo Pulsado , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pioderma/diagnóstico , Pioderma/epidemiologia , Pioderma/microbiologia , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes/classificação , Streptococcus pyogenes/efeitos dos fármacos , Streptococcus pyogenes/genética , Inquéritos e Questionários , Tromboflebite/diagnóstico , Tromboflebite/epidemiologia , Tromboflebite/microbiologiaRESUMO
In 1998, the New York City Department of Health and the Mayor's Office of Emergency Management began monitoring the volume of ambulance dispatch calls as a surveillance tool for biologic terrorism. We adapted statistical techniques designed to measure excess influenza mortality and applied them to outbreak detection using ambulance dispatch data. Since 1999, we have been performing serial daily regressions to determine the alarm threshold for the current day. In this article, we evaluate this approach by simulating a series of 2,200 daily regressions. In the influenza detection implementation of this model, there were 71 (3.2%) alarms at the 99% level. Of these alarms, 64 (90%) occurred shortly before or during a period of peak influenza in each of six influenza seasons. In the bioterrorism detection implementation of this methodology, after accounting for current influenza activity, there were 24 (1.1%) alarms at the 99% level. Two occurred during a large snowstorm, 1 is unexplained, and 21 occurred shortly before or during a period of peak influenza activity in each of six influenza seasons. Our findings suggest that this surveillance system is sensitive to communitywide respiratory outbreaks with relatively few false alarms. More work needs to be done to evaluate the sensitivity of this approach for detecting nonrespiratory illness and more localized outbreaks.
Assuntos
Ambulâncias/estatística & dados numéricos , Influenza Humana/epidemiologia , Vigilância da População/métodos , Informática em Saúde Pública , Bioterrorismo , Doenças Transmissíveis , Surtos de Doenças , Sistemas de Comunicação entre Serviços de Emergência , Serviços Médicos de Emergência/estatística & dados numéricos , Humanos , Cidade de Nova Iorque/epidemiologiaRESUMO
Study of the epidemiologic trends in meningococcal disease is important in understanding infection dynamics and developing timely and appropriate public health interventions. We studied surveillance data from the New York City Department of Health and Mental Hygiene, which showed that during 1989-2000 a decrease occurred in both the proportion of patients with serogroup B infection (from 28% to 13% of reported cases; p<0.01) and the rate of serogroup B infection (from 0.25/100,000 to 0.08/100,000; p<0.01). We also noted an increased proportion (from 3% to 39%; p<0.01) and rate of serogroup Y infection (from 0.02/100,000 to 0.23/100,000; p<0.01). Median patient age increased (from 15 to 30 years; p<0.01). The case-fatality rate for the period was 17%. As more effective meningococcal vaccines become available, recommendations for their use in nonepidemic settings should consider current epidemiologic trends, particularly changes in age and serogroup distribution of meningococcal infections.
Assuntos
Meningite Meningocócica/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Incidência , Lactente , Masculino , Meningite Meningocócica/mortalidade , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologiaRESUMO
Relatively little is known about the long-term prognosis for patients with clinical West Nile virus (WNV) infection. We conducted a study to describe the recovery of New York City residents infected during the 1999 WNV encephalitis outbreak. Patients were interviewed by telephone on self-perceived health outcomes 6, 12, and 18 months after WNV illness onset. At 12 months, the prevalence of physical, functional, and cognitive symptoms was significantly higher than that at baseline, including muscle weakness, loss of concentration, confusion, and lightheadedness. Only 37% achieved a full recovery by 1 year. Younger age at infection was the only significant predictor of recovery. Efforts aimed at preventing WNV infection should focus on elderly populations who are at increased risk for neurologic manifestations and more likely to experience long-term sequelae of WNV illness. More studies are needed to document the long-term sequelae of this increasingly common infection.