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1.
MMWR Morb Mortal Wkly Rep ; 67(31): 868-871, 2018 Aug 10.
Artículo en Inglés | MEDLINE | ID: mdl-30091965

RESUMEN

Zika virus infection can occur as a result of mosquitoborne or sexual transmission of the virus. Infection during pregnancy is a cause of fetal brain abnormalities and other serious birth defects (1,2). CDC has updated the interim guidance for men with possible Zika virus exposure who 1) are planning to conceive with their partner, or 2) want to prevent sexual transmission of Zika virus at any time (3). CDC now recommends that men with possible Zika virus exposure who are planning to conceive with their partner wait for at least 3 months after symptom onset (if symptomatic) or their last possible Zika virus exposure (if asymptomatic) before engaging in unprotected sex. CDC now also recommends that for couples who are not trying to conceive, men can consider using condoms or abstaining from sex for at least 3 months after symptom onset (if symptomatic) or their last possible Zika virus exposure (if asymptomatic) to minimize their risk for sexual transmission of Zika virus. All other guidance for Zika virus remains unchanged. The definition of possible Zika virus exposure remains unchanged and includes travel to or residence in an area with risk for Zika virus transmission (https://wwwnc.cdc.gov/travel/page/world-map-areas-with-zika) or sex without a condom with a partner who traveled to or lives in an area with risk for Zika virus transmission. CDC will continue to update recommendations as new information becomes available.


Asunto(s)
Consejo Dirigido , Atención Preconceptiva , Complicaciones Infecciosas del Embarazo/prevención & control , Enfermedades Virales de Transmisión Sexual/prevención & control , Infección por el Virus Zika/prevención & control , Centers for Disease Control and Prevention, U.S. , Condones/estadística & datos numéricos , Femenino , Humanos , Masculino , Embarazo , Características de la Residencia/estadística & datos numéricos , Viaje/estadística & datos numéricos , Estados Unidos , Infección por el Virus Zika/transmisión
3.
MMWR Morb Mortal Wkly Rep ; 65(52): 1482-1488, 2017 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-28056005

RESUMEN

The introduction of Zika virus into the Region of the Americas (Americas) and the subsequent increase in cases of congenital microcephaly resulted in activation of CDC's Emergency Operations Center on January 22, 2016, to ensure a coordinated response and timely dissemination of information, and led the World Health Organization to declare a Public Health Emergency of International Concern on February 1, 2016. During the past year, public health agencies and researchers worldwide have collaborated to protect pregnant women, inform clinicians and the public, and advance knowledge about Zika virus (Figure 1). This report summarizes 10 important contributions toward addressing the threat posed by Zika virus in 2016. To protect pregnant women and their fetuses and infants from the effects of Zika virus infection during pregnancy, public health activities must focus on preventing mosquito-borne transmission through vector control and personal protective practices, preventing sexual transmission by advising abstention from sex or consistent and correct use of condoms, and preventing unintended pregnancies by reducing barriers to access to highly effective reversible contraception.


Asunto(s)
Centers for Disease Control and Prevention, U.S. , Práctica de Salud Pública , Infección por el Virus Zika/prevención & control , Logro , Predicción , Prioridades en Salud/tendencias , Humanos , Estados Unidos
4.
J Health Polit Policy Law ; 41(3): 393-421, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26921384

RESUMEN

Applying qualitative historical methods, we examined the consideration and implementation of school closures as a nonpharmaceutical intervention (NPI) in thirty US cities during the spring 2009 wave of the pA(H1N1) influenza pandemic. We gathered and performed close textual readings of official federal, state, and municipal government documents; media coverage; and academic publications. Lastly, we conducted oral history interviews with public health and education officials in our selected cities. We found that several local health departments pursued school closure plans independent of CDC guidance, that uncertainty of action and the rapidly evolving understanding of pA(H1N1) contributed to tension and pushback from the public, that the media and public perception played a significant role in the response to school closure decisions, and that there were some notable instances of interdepartmental communication breakdown. We conclude that health departments should continue to develop and fine-tune their action plans while also working to develop better communication methods with the public, and work more closely with education officials to better understand the complexities involved in closing schools. Lastly, state and local governments should work to resolve lingering issues of legal authority for school closures in times of public health crises.


Asunto(s)
Control de Enfermedades Transmisibles/historia , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/historia , Pandemias/historia , Administración en Salud Pública/historia , Instituciones Académicas/historia , Ciudades , Control de Enfermedades Transmisibles/métodos , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Salud Pública
5.
MMWR Morb Mortal Wkly Rep ; 64(3): 63-6, 2015 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-25632954

RESUMEN

Before the current Ebola epidemic in West Africa, there were few documented cases of symptomatic Ebola patients traveling by commercial airline, and no evidence of transmission to passengers or crew members during airline travel. In July 2014 two persons with confirmed Ebola virus infection who were infected early in the Nigeria outbreak traveled by commercial airline while symptomatic, involving a total of four flights (two international flights and two Nigeria domestic flights). It is not clear what symptoms either of these two passengers experienced during flight; however, one collapsed in the airport shortly after landing, and the other was documented to have fever, vomiting, and diarrhea on the day the flight arrived. Neither infected passenger transmitted Ebola to other passengers or crew on these flights. In October 2014, another airline passenger, a U.S. health care worker who had traveled domestically on two commercial flights, was confirmed to have Ebola virus infection. Given that the time of onset of symptoms was uncertain, an Ebola airline contact investigation in the United States was conducted. In total, follow-up was conducted for 268 contacts in nine states, including all 247 passengers from both flights, 12 flight crew members, eight cleaning crew members, and one federal airport worker (81 of these contacts were documented in a report published previously). All contacts were accounted for by state and local jurisdictions and followed until completion of their 21-day incubation periods. No secondary cases of Ebola were identified in this investigation, confirming that transmission of Ebola during commercial air travel did not occur.


Asunto(s)
Aeronaves , Brotes de Enfermedades/prevención & control , Fiebre Hemorrágica Ebola/prevención & control , Práctica de Salud Pública , Viaje , Trazado de Contacto , Personal de Salud , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Nigeria/epidemiología , Enfermedades Profesionales , Estados Unidos/epidemiología
6.
MMWR Morb Mortal Wkly Rep ; 63(49): 1163-7, 2014 Dec 12.
Artículo en Inglés | MEDLINE | ID: mdl-25503920

RESUMEN

In response to the largest recognized Ebola virus disease epidemic now occurring in West Africa, the governments of affected countries, CDC, the World Health Organization (WHO), and other international organizations have collaborated to implement strategies to control spread of the virus. One strategy recommended by WHO calls for countries with Ebola transmission to screen all persons exiting the country for "unexplained febrile illness consistent with potential Ebola infection." Exit screening at points of departure is intended to reduce the likelihood of international spread of the virus. To initiate this strategy, CDC, WHO, and other global partners were invited by the ministries of health of Guinea, Liberia, and Sierra Leone to assist them in developing and implementing exit screening procedures. Since the program began in August 2014, an estimated 80,000 travelers, of whom approximately 12,000 were en route to the United States, have departed by air from the three countries with Ebola transmission. Procedures were implemented to deny boarding to ill travelers and persons who reported a high risk for exposure to Ebola; no international air traveler from these countries has been reported as symptomatic with Ebola during travel since these procedures were implemented.


Asunto(s)
Aeropuertos , Epidemias/prevención & control , Fiebre Hemorrágica Ebola/prevención & control , Tamizaje Masivo/estadística & datos numéricos , Viaje , África Occidental/epidemiología , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Medición de Riesgo , Estados Unidos/epidemiología
7.
MMWR Morb Mortal Wkly Rep ; 63(19): 431-6, 2014 May 16.
Artículo en Inglés | MEDLINE | ID: mdl-24827411

RESUMEN

Since mid-March 2014, the frequency with which cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported has increased, with the majority of recent cases reported from Saudi Arabia and United Arab Emirates (UAE). In addition, the frequency with which travel-associated MERS cases have been reported and the number of countries that have reported them to the World Health Organization (WHO) have also increased. The first case of MERS in the United States, identified in a traveler recently returned from Saudi Arabia, was reported to CDC by the Indiana State Department of Health on May 1, 2014, and confirmed by CDC on May 2. A second imported case of MERS in the United States, identified in a traveler from Saudi Arabia having no connection with the first case, was reported to CDC by the Florida Department of Health on May 11, 2014. The purpose of this report is to alert clinicians, health officials, and others to increase awareness of the need to consider MERS-CoV infection in persons who have recently traveled from countries in or near the Arabian Peninsula. This report summarizes recent epidemiologic information, provides preliminary descriptions of the cases reported from Indiana and Florida, and updates CDC guidance about patient evaluation, home care and isolation, specimen collection, and travel as of May 13, 2014.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Coronavirus/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Infecciones por Coronavirus/prevención & control , Femenino , Guías como Asunto , Humanos , Lactante , Control de Infecciones , Masculino , Persona de Mediana Edad , Medio Oriente , Aislamiento de Pacientes , Guías de Práctica Clínica como Asunto , Administración en Salud Pública , Viaje , Estados Unidos/epidemiología , Adulto Joven
9.
J Public Health Manag Pract ; 19(1): 70-6, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23169406

RESUMEN

OBJECTIVES: We assessed local health departments' (LHDs') ability to provide data on nonpharmaceutical interventions (NPIs) for the mitigation of 2009 H1N1 influenza during the pandemic response. DESIGN: Local health departments voluntarily participated weekly in a National Association of County and City Health Officials Web-based survey designed to provide situational awareness to federal partners about NPI recommendations and implementation during the response and to provide insight into the epidemiologic context in which recommendations were made. SETTING: Local health departments during the fall 2009 H1N1 pandemic response. PARTICIPANTS: Local health departments that voluntarily participated in the National Association of County and City Health Officials Sentinel Surveillance Network. MAIN OUTCOME MEASURES: Local health departments were asked to report data on recommendations for and the implementation of NPIs from 7 community sectors. Data were also collected on influenza outbreaks; closures, whether recommended by the local health department or not; absenteeism of students in grades K-12; the type(s) of influenza viruses circulating in the jurisdiction; and the health care system capacity. RESULTS: One hundred thirty-nine LHDs participated. Most LHDs issued NPI recommendations to their community over the 10-week survey period with 70% to 97% of LHDs recommending hand hygiene and cough etiquette and 51% to 78% voluntary isolation of ill patients. However, 21% to 48% of LHDs lacked information of closure, absenteeism, or outbreaks in schools, and 28% to 50% lacked information on outpatient clinic capacity. CONCLUSIONS: Many LHDs were unable to monitor implementation of NPI (recommended by LHD or not) within their community during the 2009 H1N1 influenza pandemic. This gap makes it difficult to adjust recommendations or messaging during a public health emergency response. Public health preparedness could be improved by strengthening NPI monitoring capacity.


Asunto(s)
Defensa Civil/organización & administración , Defensa Civil/estadística & datos numéricos , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/epidemiología , Gobierno Local , Pandemias/estadística & datos numéricos , Salud Pública , Absentismo , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Higiene de las Manos/estadística & datos numéricos , Humanos , Máscaras/estadística & datos numéricos , Cuarentena/estadística & datos numéricos , Instituciones Académicas/estadística & datos numéricos
10.
Emerg Infect Dis ; 18(7): 1047-53, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22709566

RESUMEN

Under the current International Health Regulations, 194 states parties are obligated to report potential public health emergencies of international concern to the World Health Organization (WHO) within 72 hours of becoming aware of an event. During July 2007-December 2011, WHO assessed and posted on a secure web portal 222 events from 105 states parties, including 24 events from the United States. Twelve US events involved human influenza caused by a new virus subtype, including the first report of influenza A(H1N1)pdm09 virus, which constitutes the only public health emergency of international concern determined by the WHO director-general to date. Additional US events involved 5 Salmonella spp. outbreaks, botulism, Escherichia coli O157:H7 infections, Guillain-Barré syndrome, contaminated heparin, Lassa fever, an oil spill, and typhoid fever. Rapid information exchange among WHO and member states facilitated by the International Health Regulations leads to better situation awareness of emerging threats and enables a more coordinated and transparent global response.


Asunto(s)
Control de Enfermedades Transmisibles/legislación & jurisprudencia , Enfermedades Transmisibles/epidemiología , Notificación de Enfermedades/legislación & jurisprudencia , Síndrome de Guillain-Barré/epidemiología , Contaminación por Petróleo/estadística & datos numéricos , Notificación de Enfermedades/métodos , Humanos , Vigilancia de la Población/métodos , Salud Pública/legislación & jurisprudencia , Estados Unidos/epidemiología , Organización Mundial de la Salud
11.
BMC Med Inform Decis Mak ; 7: 3, 2007 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-17295907

RESUMEN

BACKGROUND: The Institute of Medicine has identified patient safety as a key goal for health care in the United States. Detecting vaccine adverse events is an important public health activity that contributes to patient safety. Reports about adverse events following immunization (AEFI) from surveillance systems contain free-text components that can be analyzed using natural language processing. To extract Unified Medical Language System (UMLS) concepts from free text and classify AEFI reports based on concepts they contain, we first needed to clean the text by expanding abbreviations and shortcuts and correcting spelling errors. Our objective in this paper was to create a UMLS-based spelling error correction tool as a first step in the natural language processing (NLP) pipeline for AEFI reports. METHODS: We developed spell checking algorithms using open source tools. We used de-identified AEFI surveillance reports to create free-text data sets for analysis. After expansion of abbreviated clinical terms and shortcuts, we performed spelling correction in four steps: (1) error detection, (2) word list generation, (3) word list disambiguation and (4) error correction. We then measured the performance of the resulting spell checker by comparing it to manual correction. RESULTS: We used 12,056 words to train the spell checker and tested its performance on 8,131 words. During testing, sensitivity, specificity, and positive predictive value (PPV) for the spell checker were 74% (95% CI: 74-75), 100% (95% CI: 100-100), and 47% (95% CI: 46%-48%), respectively. CONCLUSION: We created a prototype spell checker that can be used to process AEFI reports. We used the UMLS Specialist Lexicon as the primary source of dictionary terms and the WordNet lexicon as a secondary source. We used the UMLS as a domain-specific source of dictionary terms to compare potentially misspelled words in the corpus. The prototype sensitivity was comparable to currently available tools, but the specificity was much superior. The slow processing speed may be improved by trimming it down to the most useful component algorithms. Other investigators may find the methods we developed useful for cleaning text using lexicons specific to their area of interest.


Asunto(s)
Algoritmos , Procesamiento de Lenguaje Natural , Unified Medical Language System , Vacunas , Diccionarios como Asunto , Vigilancia de Productos Comercializados , Seguridad , Sensibilidad y Especificidad , Vacunas/efectos adversos
12.
Health Secur ; 15(3): 261-267, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28636446

RESUMEN

The International Health Regulations (IHR), an international law under the auspices of the World Health Organization (WHO), mandates that countries notify other countries of "travelers under public health observation." Between November 10, 2014, and July 12, 2015, the US Centers for Disease Control and Prevention (CDC) made 2,374 notifications to the National IHR Focal Points in 114 foreign countries of travelers who were monitored by US health departments because they had been to an Ebola-affected country in West Africa. Given that countries have preidentified focal points as points of contacts for sharing of public health information, notifications could be made by CDC to a trusted public health recipient in another country within 24 hours of receipt of the traveler's information from a US health department. The majority of US health departments used this process, offered by CDC, to notify other countries of travelers intending to leave the United States while being monitored in their jurisdiction.


Asunto(s)
Centers for Disease Control and Prevention, U.S. , Fiebre Hemorrágica Ebola/prevención & control , Vigilancia en Salud Pública , Viaje , África Occidental , Monitoreo Epidemiológico , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Cooperación Internacional , Internacionalidad , Vigilancia de Guardia , Estados Unidos , Organización Mundial de la Salud
13.
MMWR Suppl ; 65(3): 57-67, 2016 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-27390092

RESUMEN

During the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa, CDC implemented travel and border health measures to prevent international spread of the disease, educate and protect travelers and communities, and minimize disruption of international travel and trade. CDC staff provided in-country technical assistance for exit screening in countries in West Africa with Ebola outbreaks, implemented an enhanced entry risk assessment and management program for travelers at U.S. ports of entry, and disseminated information and guidance for specific groups of travelers and relevant organizations. New and existing partnerships were crucial to the success of this response, including partnerships with international organizations, such as the World Health Organization, the International Organization for Migration, and nongovernment organizations, as well as domestic partnerships with the U.S. Department of Homeland Security and state and local health departments. Although difficult to assess, travel and border health measures might have helped control the epidemic's spread in West Africa by deterring or preventing travel by symptomatic or exposed persons and by educating travelers about protecting themselves. Enhanced entry risk assessment at U.S. airports facilitated management of travelers after arrival, including the recommended active monitoring. These measures also reassured airlines, shipping companies, port partners, and travelers that travel was safe and might have helped maintain continued flow of passenger traffic and resources needed for the response to the affected region. Travel and border health measures implemented in the countries with Ebola outbreaks laid the foundation for future reconstruction efforts related to borders and travel, including development of regional surveillance systems, cross-border coordination, and implementation of core capacities at designated official points of entry in accordance with the International Health Regulations (2005). New mechanisms developed during this response to target risk assessment and management of travelers arriving in the United States may enhance future public health responses. The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).


Asunto(s)
Brotes de Enfermedades/prevención & control , Fiebre Hemorrágica Ebola/prevención & control , Internacionalidad , Tamizaje Masivo , Viaje , África Occidental/epidemiología , Aeropuertos , Centers for Disease Control and Prevention, U.S./organización & administración , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Cooperación Internacional , Rol Profesional , Medición de Riesgo , Estados Unidos
14.
Vaccine ; 34(49): 5998-6006, 2016 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-27481360

RESUMEN

Vaccination during pregnancy is increasingly being used as an effective approach for protecting both young infants and their mothers from serious infections. Drawing conclusions from published studies in this area can be difficult because of the inability to compare vaccine trial results across different studies and settings due to the heterogeneity in the definitions of terms used to assess the safety of vaccines in pregnancy and the data collected in such studies. The guidelines proposed in this document have been developed to harmonize safety data collection in all phases of clinical trials of vaccines in pregnant women and apply to data from the mother, fetus and infant. Guidelines on the prioritization of the data to be collected is also provided to allow applicability in various geographic, cultural and resource settings, including high, middle and low-income countries.


Asunto(s)
Ensayos Clínicos como Asunto , Embarazo , Vacunación/efectos adversos , Vacunas/efectos adversos , Femenino , Humanos , Lactante , Complicaciones Infecciosas del Embarazo/prevención & control , Estadística como Asunto , Vacunas/administración & dosificación
15.
J Am Coll Health ; 53(5): 211-7, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-15813231

RESUMEN

The authors' objectives in this study were to describe the proportion of schools providing and the percentage of students with access to HIV and sexually transmitted disease (STD) education, treatment, and prevention services at 2-year and 4-year US colleges and universities. The authors mailed self-administered questionnaires to a stratified random sample (n = 910) of the 2,755 US schools with an enrollment of more than 500 students; 736 (81%) returned the survey. Four hundred seventy-four schools (60%) had a health center, representing 73% of students. Schools with a health center or housing for students were more likely to provide STD education; 52% of the schools made condoms available to students. Sixty percent of schools with health centers could test for both Chlamydia trachomatis and Neisseria gonorrhoeae, but only 67% of these schools screened women for these infections. Although most schools provided some prevention education, access to prevention, testing, and education should be increased at schools where these services are possible but not available.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Enfermedades de Transmisión Sexual/prevención & control , Enfermedades de Transmisión Sexual/terapia , Servicios de Salud para Estudiantes/provisión & distribución , Promoción de la Salud/estadística & datos numéricos , Humanos , Conducta Sexual/estadística & datos numéricos
16.
Clin Infect Dis ; 39(3): 389-94, 2004 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-15307007

RESUMEN

Fever is a common clinical complaint in adults and children with a variety of infectious illnesses, as well as a frequently reported adverse event following immunization. Although the level of measured temperature indicative of a "fever" was first defined in 1868, it remains unclear what role fever has as a physiologic reaction to invading substances, how best to measure body temperature and compare measurements from different body sites, and, consequently, how to interpret fever data derived from vaccine safety trials or immunization safety surveillance. However, even with many aspects of the societal, medical, economic, and epidemiologic meanings of fever as an adverse event following immunization (AEFI) still elusive, it is a generally benign--albeit common--clinical sign. By standardizing the definition and means of assessment of fever in vaccine safety studies, thereby permitting comparability of data, we hope to arrive at an improved understanding of its importance as an AEFI.


Asunto(s)
Fiebre/etiología , Vacunación/efectos adversos , Adulto , Niño , Fiebre/complicaciones , Fiebre/fisiopatología , Humanos , Lactante , Convulsiones Febriles/etiología
17.
Obstet Gynecol Clin North Am ; 30(4): 637-58, 2003 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-14719842

RESUMEN

Many studies have evaluated selective screening criteria for women in various settings. Most have concluded and all guidelines recommend that all women aged < 25 be screened yearly for C. trachomatis infection. Behavioral criteria, such as the number of sex partners, new or more than one sex partners, and previous infection, also can serve as criteria for screening women aged > 25. Because re-infection rates are high and occur within a few months, complications may be reduced further if partners are treated and women rescreened 4 to 6 months after initial infection. Revised recommendations for C. trachomatis screening programs have stated that more frequent screening may be considered among women < 20 and those with recent infection. Screening in nontraditional settings and careful evaluation of local prevalence and risk factor information should be encouraged. Private providers and emergency room providers should discuss screening recommendations and adopt a C. trachomatis screening policy for the population they serve. The HEDIS measure should serve to encourage at least annual screening of 15- to 25-year-old sexually active females through providers linked to managed care organizations. In general, high yields (ie, percentage of tests that are positive) in nontraditional settings and enhanced feasibility and acceptability of urine-based tests may encourage further innovative approaches to reach and screen populations at risk. Several issues remain to be addressed to increase the effectiveness of screening efforts. If more sensitive amplification tests are used widely, more infected persons will be identified and treated, and transmission patterns may change, particularly if partner treatment also occurs. Current screening criteria should continue to be re-evaluated. An important issue that affects testing methods includes the possible need for confirmation testing when using NAATs if the prevalence of C. trachomatis is less than 2%. If the sensitivity of an NAAT is 85% and specificity is 99%, in a hypothetical population of 10,000 with a prevalence of 2%, the positive predictive value is 170/268 (63%). A second important issue affecting testing methods and feasibility of using NAATs for screening large numbers of individuals is the pooling of urine specimens, which has been evaluated in several studies and found to be very effective for reducing costs. A research issue for pooling is the determination of the most cost-effective prevalence levels for pooling. An additional research question is in which populations should a NAAT be used for detection of C. trachomatis and N. gonorrhoeae. There are no recommendations for the routine screening of men because of the paucity of data showing that this strategy can reduce sequelae. The CDC is conducting a multisite study to examine the feasibility, acceptability, and usefulness of screening of asymptomatic men. There are a few studies have determining cost-effective prevalence threshold levels, particularly with NAATs. A recently developed decision analysis model by CDC designed to maximize the effectiveness of screening strategies for C. trachomatis infections may be useful for decision makers. It is intended to serve as an easy and flexible tool to determine cost effectiveness at a local level and takes into account positivity rates and test performance characteristics (SOCRATES). It is unclear if recurrent infection is caused by true re-infection by the same or a different partner or recurrence of initial infection. Recurrence may be caused by persistence of C. trachomatis or antibiotic resistance. This distinction is of scientific interest because the appropriate intervention differs (eg, identification of risk factors for the former and microbiologic investigations for the latter). Effective partner management and retesting are critical to reducing sequelae of C. trachomatis infection. Screening for C. trachomatis infection remains an essential component of C. trachomatis control. It is cost effective, most infections are asymptomatic, and symptom-based health care seeking and testing identify few of those infected. The likelihood that opportunities for screening are missed is high particularly in non-STD clinic settings. Local studies using NAATs to determine C. trachomatis prevalence and risk factors are helpful to health care providers so they can make evidence-based decisions on who to screen. The use of nontraditional, non-clinic-based test settings should be explored further. We have focused on summarizing the medical evidence regarding recommendations for screening for C. trachomatis. High-risk populations for C. trachomatis infection may overlap with populations for other STDs, and comprehensive STD prevention programs that involve a range of STD service providers are needed to successfully reduce the STD-related health burden in the population.


Asunto(s)
Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis , Infecciones por Chlamydia/complicaciones , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Tamizaje Masivo/economía , Embarazo , Salud Pública , Factores de Riesgo , Enfermedades de Transmisión Sexual/diagnóstico
18.
Public Health Rep ; 127(6): 565-71, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-23115381

RESUMEN

Shortly after the influenza A (H1N1) 2009 pandemic began, the U.S. government provided guidance to state and local authorities to assist decision-making for the use of nonpharmaceutical strategies to minimize influenza spread. This guidance included recommendations for flexible decision-making based on outbreak severity, and it allowed for uncertainty and course correction as the pandemic progressed. These recommendations build on a foundation of local, collaborative planning and posit a series of questions regarding epidemiology, the impact on the health-care system, and locally determined feasibility and acceptability of nonpharmaceutical strategies. This article describes -recommendations and key questions for decision makers.


Asunto(s)
Control de Enfermedades Transmisibles/métodos , Subtipo H1N1 del Virus de la Influenza A/patogenicidad , Gripe Humana/prevención & control , Conducta Cooperativa , Toma de Decisiones , Comunicación en Salud , Directrices para la Planificación en Salud , Humanos , Gripe Humana/epidemiología , Gripe Humana/transmisión , Pandemias , Estados Unidos
19.
Lancet Infect Dis ; 12(11): 845-50, 2012 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23041199

RESUMEN

BACKGROUND: Many important strategies to reduce the spread of pandemic influenza need public participation. To assess public receptivity to such strategies, we compared adoption of preventive behaviours in response to the 2009 H1N1 influenza pandemic among the public in five countries and examined whether certain non-pharmaceutical behaviours (such as handwashing) were deterrents to vaccination. We also assessed public support for related public health recommendations. METHODS: We used data from simultaneous telephone polls (mobile telephone and landline) in Argentina, Japan, Mexico, the UK, and the USA. In each country, interviews were done in a nationally representative sample of adults, who were selected by the use of random digit dial techniques. The questionnaire asked people whether or not they had adopted each of various preventive behaviours (non-pharmaceutical--such as personal protective and social distancing behaviour--or vaccinations) to protect themselves or their family from H1N1 at any point during the pandemic. Two-tailed t tests were used for statistical analysis. FINDINGS: 900 people were surveyed in each country except the USA where 911 people were contacted. There were wide differences in the adoption of preventive behaviours between countries, although certain personal protective behaviours (eg, handwashing) were more commonly adopted than social distancing behaviours (eg, avoiding places where many people gather) across countries (53-89%vs 11-69%). These non-pharmaceutical behaviours did not reduce the likelihood of getting vaccinated in any country. There was also support across all countries for government recommendations related to school closure, avoiding places where many people gather, and wearing masks in public. INTERPRETATION: There is a need for country-specific approaches in pandemic policy planning that use both non-pharmaceutical approaches and vaccination. FUNDING: US Centers for Disease Control and Prevention and the National Public Health Information Coalition.


Asunto(s)
Control de Enfermedades Transmisibles/métodos , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Pandemias , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Argentina , Femenino , Humanos , Gripe Humana/virología , Entrevistas como Asunto , Japón , Masculino , México , Persona de Mediana Edad , Encuestas y Cuestionarios , Reino Unido , Estados Unidos , Adulto Joven
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