RESUMO
CONTEXT: While the New York City Department of Health and Mental Hygiene (DOHMH) can use agency-wide emergency activation to respond to a hepatitis A virus-infected food handler, there is a need to identify alternative responses that conserve scarce resources. OBJECTIVE: To compare the costs incurred by DOHMH of responding to a hepatitis A case in restaurant food handlers using an agency-wide emergency activation (2015) versus the cost of collaborating with a private network of urgent care clinics (2017). DESIGN: We partially evaluate the costs incurred by DOHMH of responding to a hepatitis A case in a restaurant food handler using agency-wide emergency activation (2015) with the cost of collaborating with a private network of urgent care clinics (2017) estimated for a scenario in which DOHMH incurred the retail cost of services rendered. RESULTS: Costs incurred by DOHMH for emergency activation were $65 831 ($238 per restaurant employee evaluated) of which DOHMH personnel services accounted for 85% ($55 854). Costs of collaboration would have totaled $50 914 ($253 per restaurant employee evaluated) of which personnel services accounted for 6% ($3146). CONCLUSIONS: Accounting for incident size, collaborating with the clinic network was more expensive than agency-wide emergency activation, though required fewer DOHMH personnel services.
Assuntos
Custos e Análise de Custo/métodos , Hepatite A/economia , Saúde Pública/economia , Custos e Análise de Custo/estatística & dados numéricos , Surtos de Doenças/estatística & dados numéricos , Manipulação de Alimentos , Hepatite A/epidemiologia , Vírus da Hepatite A/patogenicidade , Humanos , Cidade de Nova Iorque/epidemiologia , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Restaurantes/organização & administração , Restaurantes/estatística & dados numéricosRESUMO
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 2009, the New York City Department of Health and Mental Hygiene delivered influenza A(H1N1)pdm09 (pH1N1) vaccine to health care providers, who were required to report all administered doses to the Citywide Immunization Registry. Using data from this registry and a provider survey, we estimated the number of all pH1N1 vaccine doses administered. Of 2.8 million doses distributed during October 1, 2009-March 4, 2010, a total of 988,298 doses were administered and reported; another 172,289 doses were administered but not reported, for a total of 1,160,587 doses administered during this period. Reported doses represented an estimated 80%-85% of actual doses administered. Reporting by a wide range of provider types was feasible during a pandemic. Pediatric-care providers had the highest reporting rate (93%). Other private-care providers who routinely did not report vaccinations indicated that they had few, if any, problems, thereby suggesting that mandatory reporting of all vaccines would be feasible.
Assuntos
Vírus da Influenza A Subtipo H1N1/imunologia , Vacinas contra Influenza/administração & dosagem , Influenza Humana/imunologia , Influenza Humana/prevenção & controle , Vacinação/estatística & dados numéricos , Pessoal de Saúde , Humanos , Cidade de Nova Iorque , Vacinação/métodosRESUMO
Individuals exposed to spores of B. anthracis must take a course of antibiotics as postexposure prophylaxis (PEP) to prevent inhalation anthrax. During an anthrax event, public health authorities are responsible for conducting dispensing operations to offer PEP to exposed individuals. Jurisdictions have developed antibiotic PEP screening algorithms to determine which antibiotic is appropriate for each individual. Variability exists with regard to screening questions and dispensing decisions based on responses to those questions. It is likely that individuals with similar profiles will receive different antibiotics based solely on the jurisdiction in which they receive their PEP. This lack of consistency among jurisdictions may lead to a loss of confidence in the public health response among the public, the healthcare community, the media, and government leaders, which could compromise the response itself. We present New York City's planning assumptions, screening algorithm, a rationale for our screening questions, and our reasons for excluding screening questions asked by other jurisdictions. We hope that our efforts may assist others in developing and refining their algorithms and associated public messaging and encourage standardization with neighboring jurisdictions where appropriate.
Assuntos
Antraz/prevenção & controle , Antibioticoprofilaxia/normas , Guias como Assunto , Profilaxia Pós-Exposição/normas , Infecções Respiratórias/prevenção & controle , Antibacterianos/uso terapêutico , Bacillus anthracis , Humanos , Cidade de Nova IorqueRESUMO
To date, few evaluations have examined issues specific to children's asthma management in their homes. This study examined the characteristics, risk factors, and needs of children with asthma, and the impact of home health nurses on improving parents'/family caregivers' knowledge about asthma triggers and management. The medical records of children, =19 years, residing in New York City, who were admitted to home care with asthma in 1999 (n = 1,007) were reviewed retrospectively to collect a wide range of data. The majority of children with asthma in home care were =5 years, male, racial/ethnic minorities, and hospital referred. Approximately one in four children with asthma suffered from additional comorbidities. Home environmental triggers included dust/dust mites, animal dander, mold, perfumes/detergents, and cigarette smoke. Notable psychosocial triggers were family tensions, physical activity, anxiety/stress, and friends/peer pressure. Most parents/family caregivers had inadequate knowledge about recognition of asthma attacks and its triggers and management. Discharge assessments suggested that home health nurses can help improve caregivers' knowledge about asthma management. Children with asthma in home care have diverse needs, receive few nurse home visits, and have parents/family caregivers in need of more intensive education on asthma symptom recognition and management.