RESUMO
CONTEXT: The 2022 United States mpox outbreak disproportionately affected racial and ethnic minority gay, bisexual, and other men who have sex with men. PROGRAM: We utilized surveillance data and vaccination registries to determine whether populations most impacted by mpox in Alameda County received JYNNEOS vaccines and tecovirimat (TPOXX) during June 1-October 31, 2022. IMPLEMENTATION: Alameda County Public Health Department responded to the mpox epidemic through partnerships with local health care providers who serve communities disproportionately affected by mpox. EVALUATION: During June 1-October 31, 2022, a total of 242 mpox cases were identified in Alameda County. Mpox incidence rates per 100 000 were highest among Black/African American (35.7; 95% confidence interval [CI], 26.8-46.5) and Hispanic/Latinx (25.1; CI, 20.1-30.9) residents, compared to Asian (3.8; CI, 2.3-5.9) and White (10.5; CI, 7.7-13.9) residents. Most confirmed cases were identified as gay, lesbian, or same-gender-loving (134, 67.3%) and bisexual (31, 15.6%); 226 (93.8%) cases were male. Sixty-nine (28.5%) mpox patients received TPOXX. There were no statistically significant differences in demographic and clinical characteristics of mpox cases when compared by TPOXX receipt status. JYNNEOS vaccine was received by 8277 Alameda County residents. The largest proportion of vaccinees were White residents (40.2%). Administration rates per 100 000 men who have sex with men were lowest among Asian and Hispanic/Latinx individuals, at 8779 (CI, 8283-9296) and 14 953 (CI, 14 156-15 784), respectively. Black/African American and Hispanic/Latinx males had the lowest vaccination-to-case ratios at 16.7 and 14.8, respectively. DISCUSSION: Mpox disproportionately affected Black/African American and Hispanic/Latinx men who have sex with men in Alameda County. Strong partnerships with local health care providers ensured that persons with mpox received TPOXX treatment when indicated. However, higher JYNNEOS vaccine uptake in Black and Latinx communities needs improvement through ongoing and meaningful engagement with Black/African American and Hispanic/Latinx gay, bisexual, and transgender communities.
Assuntos
Homossexualidade Masculina , Humanos , Masculino , California/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Adulto , Pessoa de Meia-Idade , Feminino , Adolescente , COVID-19/epidemiologia , COVID-19/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Surtos de Doenças/prevenção & controle , Minorias Sexuais e de Gênero/estatística & dados numéricos , Incidência , SARS-CoV-2 , Vacinas contra COVID-19/uso terapêutico , IdosoRESUMO
CONTEXT: Coronavirus disease 2019 (COVID-19) incidence rates are 2- to 5-fold higher among persons incarcerated in the United States than in the general population. PROGRAM OR POLICY: We describe an outbreak investigation of COVID-19 at a jail (jail A) in Alameda County during March 2020-March 2021. IMPLEMENTATION: To prevent COVID-19 cases among incarcerated persons and employees, staff at jail A and the county public health department worked to develop and recommend infection control measures implemented by jail A including, but not limited to, face covering use among incarcerated persons and staff; cohorting incarcerated persons at a higher risk of severe COVID-19 in dedicated housing units; quarantining all newly detained individuals for 14 days; and offering testing for all symptomatic incarcerated persons, newly incarcerated persons at day 2 and day 10, and all persons who resided in a housing unit where a COVID-19 case was detected. EVALUATION: A total of 571 COVID-19 cases were detected among incarcerated persons at jail A during March 2020-March 2021, which represented a total incidence of 280 per 1000 population, 5 times higher than the rate in Alameda County. Of the 571 cases among incarcerated persons, 557 (98%) were male; 415 (73%) were aged 18 to 40 years; 249 (44%) were Latino; and 180 (32%) were African American; 354 (62%) were not symptomatic; and 220 (39%) had no comorbidities. Less than 2% of infected incarcerated persons were hospitalized, and no deaths were reported. DISCUSSION: COVID-19 disproportionately impacted persons incarcerated at jail A, with higher numbers among Latinos and African Americans. Implementation of COVID-19 infection control and testing measures, and collaboration between public health, law enforcement, and health care providers may have, in part, led to reductions in morbidity and mortality associated with COVID-19 at jail A.
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COVID-19 , Prisões Locais , California/epidemiologia , Humanos , Masculino , Prisões , Quarentena , SARS-CoV-2 , Estados UnidosRESUMO
Laboratories submit all carbapenem-resistant Enterobacter, Escherichia coli, and Klebsiella species to the Alameda County Public Health Department (ACPHD). ACPHD evaluated 75 isolates submitted during 9 months for susceptibility to imipenem-relebactam (I-R) and, using whole-genome sequencing, identified ß-lactamase genes. Of 60 (80%) isolates susceptible to I-R, 8 (13%) had detectable carbapenemase genes, including 4 KPC, two NDM, and two OXA-48-like; we described the relationship between the presence of ß-lactamase resistance genes and susceptibility to I-R.
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Carbapenêmicos , Farmacorresistência Bacteriana , Gammaproteobacteria , Imipenem , Antibacterianos/farmacologia , Compostos Azabicíclicos , Proteínas de Bactérias/genética , Carbapenêmicos/farmacologia , Gammaproteobacteria/efeitos dos fármacos , Gammaproteobacteria/genética , Imipenem/farmacologia , Testes de Sensibilidade Microbiana , beta-Lactamases/genéticaRESUMO
Recovery from enteric bacterial illness often includes a phase of organismal shedding over a period of days to months. The monitoring of this process through laboratory testing forms the foundation of public health action to prevent further transmission. Regulations in most jurisdictions in the United States exclude individuals who continue to shed certain organisms from sensitive occupations and situations, such as food handling, providing direct patient care, or attending day care. The burden that this creates for recovering patients and their families/coworkers is great, so any effort to provide efficiency to the testing process would be of significant benefit. We sought to assess the ability of PCR for the detection of Salmonella enterica shedding and to compare that ability to culture-based testing. PCR would be faster than culture and would allow results to be generated more quickly. Herein, we show data that indicate that, while PCR and culture testing agree in the majority of cases, there are incidents of discordance between the two tests, whereupon PCR shows positive results when culture indicates lack of detectable viable organisms. Using culture-based testing as the standard, the negative predictive value of PCR was found to be 100%, while the positive predictive value was 79%. The nature of this discordance is briefly investigated. We found that it is possible that PCR may not only detect nonviable organisms in stool but also viable organisms that remain undetectable by standard culture methods.
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Salmonella enterica , Enterobacteriaceae , Fezes , Humanos , Reação em Cadeia da Polimerase , Salmonella enterica/genéticaRESUMO
Colorectal cancer screening is a life-saving intervention, but screening rates are low. The authors implemented and evaluated the Spokane Colorectal Cancer Screening Program-a novel worksite intervention to promote colorectal cancer screening that used a combination of evidence-based strategies recommended by the Guide to Community Preventive Services, as well as additional strategies. Over a period of approximately 3 months, participating worksites held one or more physician-led seminars about colorectal cancer screening for employees. They also distributed free fecal immunochemical tests at the worksite to employees 50 years and older, and they provided test results to employees and their primary care physician. The authors measured attendance at seminars, test kits taken and returned, employee awareness of the program, and colorectal cancer screening rates in participating and comparison worksites. It is estimated that 9% of eligible employees received kits at the worksite, and 4% were screened with these kits. The Spokane Colorectal Cancer Screening Program was a promising pilot test of an innovative worksite screening program that successfully translated evidence-based strategies into practical use in a brief period of time, and it merits a larger study to be able to test its effects more rigorously.
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Neoplasias Colorretais/diagnóstico , Programas de Rastreamento , Saúde Ocupacional , Desenvolvimento de Programas/métodos , Neoplasias Colorretais/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , WashingtonRESUMO
INTRODUCTION: Little research exists on the prevalence of evidence-based tobacco cessation practices in workplaces, employer promotion of state-sponsored quitlines and predictors of these practices. METHODS: Cross-sectional analysis of the 2008 Healthy Worksite Survey, a telephone survey administered to Washington employers with 50 or more employees (n=693). The objectives were to describe workplaces' implementation of evidence-based tobacco cessation practices and identify key predictors of implementation in order to highlight opportunities for interventions. RESULTS: Among these employers, 38.6% promoted quitting tobacco, and 33.8% offered insurance coverage for cessation medications and counselling, 27.5% referred no-smoking violators to cessation services, and 5.7% included the state-sponsored quitline in health promotion messages. Larger workplaces and workplaces with a wellness staff, committee or coordinator had greater insurance coverage for tobacco cessation, communications promoting tobacco cessation, and promotion of the state-sponsored quitline (p<0.01). Workplaces with a wellness staff, committee or coordinator referred more violators of no-smoking policies to cessation services (p<0.01). CONCLUSIONS: In Washington State workplaces do little to promote tobacco cessation by their employees. The lack of tobacco cessation promoting practices at small businesses, restaurants and bars, and businesses without wellness personnel indicates an opportunity for finding and reaching current smokers at businesses with limited resources. By adopting inexpensive prevention efforts, such as promoting the state-sponsored tobacco cessation quitline, employers can help employees quit smoking and, thereby, assist in improving employee health and lower medical costs.
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Promoção da Saúde/normas , Serviços de Saúde do Trabalhador/normas , Abandono do Hábito de Fumar/métodos , Local de Trabalho , Estudos Transversais , Medicina Baseada em Evidências , Promoção da Saúde/métodos , Promoção da Saúde/organização & administração , Linhas Diretas , Humanos , Serviços de Saúde do Trabalhador/métodos , Serviços de Saúde do Trabalhador/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Prevenção do Hábito de Fumar , WashingtonRESUMO
INTRODUCTION: It is well established that socially marginalized groups experience worse health than dominant groups. However, many questions remain about the health of members of multiple marginalized groups, such as black sexual minority women. The purpose of this study was to examine the relationship between health-related quality of life (HRQOL), race, and sexual orientation identity among a general population sample of black and white women and to assess additive interaction between sexual orientation identity and race. METHODS: This study used cross-sectional 2014 and 2015 Behavioral Risk Factor Surveillance System data from 154,995 women residing in 20 U.S. states. G-computation was used to estimate age-adjusted prevalence differences for nine dichotomized measures of HRQOL. The HRQOL of black sexual minority women was compared with the HRQOL of black heterosexual women, white sexual minority women, and white heterosexual women. Analyses were conducted in 2017. RESULTS: Age-adjusted prevalence differences for all measures suggested worse HRQOL among black sexual minority women, compared with most of the other groups (e.g., frequent poor mental health comparing black lesbian and heterosexual women: 0.083, 95% CI= -0.017, 0.183); HRQOL among black bisexual women was often similar to or worse than white bisexual women. Most prevalence differences comparing black sexual minority women with white heterosexual women suggested additive interaction that led to stronger or weaker associations than expected. Although many point estimates suggested meaningful differences, many 95% CIs for prevalence differences, and when assessing for interaction, included 0. CONCLUSIONS: Having two marginalized identities compared with one is often associated with worse HRQOL. In addition, race and sexual orientation identity may interact in their relationship to HRQOL, such that black sexual minority women have worse or better HRQOL than expected.
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Negro ou Afro-Americano/estatística & dados numéricos , Qualidade de Vida/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , População Branca/estatística & dados numéricos , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Adulto JovemRESUMO
Epidemiologic studies have consistently found elevated rates of alcohol and other substance use among sexual minority women (SMW), and despite calls for "LGBT-specific" services and culturally-tailored interventions, few such services exist. This study involved qualitative interviews with directors from substance use treatment programs (N=10) about how they addressed the needs of SMW. Strategies implemented primarily focused on creating a safe and welcoming environment for sexual minority clients. Findings highlight challenges involved in meeting the treatment needs of SMW and provide guidance to researchers and service providers on how to improve the quality of care for them.