Essential Components of a Public Health Tuberculosis Prevention, Control, and Elimination Program: Recommendations of the Advisory Council for the Elimination of Tuberculosis and the National Tuberculosis Controllers Association.

This report provides an introduction and reference tool for tuberculosis (TB) controllers regarding the essential components of a public health program to prevent, control, and eliminate TB. The Advisory Council for the Elimination of Tuberculosis and the National Tuberculosis Controllers Association recommendations in this report update those previously published (Advisory Council for the Elimination of Tuberculosis. Essential components of a tuberculosis prevention and control program. Recommendations of the Advisory Council for the Elimination of Tuberculosis. MMWR Recomm Rep 1995;44[No. RR-11]). The report has been written collaboratively on the basis of experience and expert opinion on approaches to organizing programs engaged in diagnosis, treatment, prevention, and surveillance for TB at state and local levels.This report reemphasizes the importance of well-established priority strategies for TB prevention and control: identification of and completion of treatment for persons with active TB disease; finding and screening persons who have had contact with TB patients; and screening, testing, and treatment of other selected persons and populations at high risk for latent TB infection (LTBI) and subsequent active TB disease.Health departments are responsible for public safety and population health. To meet their responsibilities, TB control programs should institute or ensure completion of numerous responsibilities and activities described in this report: preparing and maintaining an overall plan and policy for TB control; maintaining a surveillance system; collecting and analyzing data; participating in program evaluation and research; prioritizing TB control efforts; ensuring access to recommended laboratory and radiology tests; identifying, managing, and treating contacts and other persons at high risk for Mycobacterium tuberculosis infection; managing persons who have TB disease or who are being evaluated for TB disease; providing TB training and education; and collaborating in the coordination of patient care and other TB control activities. Descriptions of CDC-funded resources, tests for evaluation of persons with TB or LTBI, and treatment regimens for LTBI are provided (Supplementary Appendices; https://stacks.cdc.gov/view/cdc/90289).

Rapid large-scale deployment of tuberculosis testing in a high school - Riverside County, California, 2013-2014.

Mycobacterium tuberculosis, the causative agent of tuberculosis (TB), can spread from person to person through the air, which can make contact investigations particularly complex in heavily populated settings such as schools. In November 2013, a student (the index patient) at a southern California high school with approximately 2,000 students and staff members was diagnosed with active pulmonary TB. Because of an unexpectedly high number of positive tuberculin skin test results in the initial contact investigation, testing was extended to the entire school population, which had to be completed before the end of the school term. A total of 1,806 persons were tested in 24 hours. The rapid testing of the entire population of a high school is unusual and led to widespread media attention and community concern, requiring close coordination among branches of the County of Riverside Department of Public Health, local governments, and the school district. The testing resulted in identification of two additional cases of TB; in addition, 72 persons underwent treatment for latent TB infection (LTBI). This incident demonstrates the importance of a coordinated emergency response in a large-scale deployment of rapid testing, including efficiently focused resources, organized testing operations, and effective media relations.

Overview of advances in educational and social supports for young persons with NCL disorders.

Vision loss, dementia, and motor and speech declines all impact the educational experience of individuals with Batten disease and can adversely impact effective learning. There are as yet limited data to support evidence-based approaches to meeting the educational needs of affected individuals. This paper provides an overview of recent work to evaluate and address educational issues with a life-long perspective relevant to individuals with juvenile-onset neuronal ceroid lipofuscinosis (JNCL) and the professionals that provide them with educational support. In particular, several main activities of the recently completed 'JNCL and Education' project are summarised, including a survey of parents, educational professionals and social/health workers, development of a formative assessment tool to identify and respond to an individual student's strengths and needs in the learning environment, and proposed strategies for prolonging literacy and language skills. A key concept that should be emphasised in the educational plan for students with JNCL is that of 'proactive' and 'hastened' learning, that is, providing an early emphasis on adaptive skills that will be required in the later stages of disease progression when new learning will be more difficult to achieve. An additional key concept is participation in real-life activities to maintain skills and quality of life, particularly in the later stages of disease progression.

Botulism from drinking pruno.

Foodborne botulism occurred among inmates at 2 prisons in California in 2004 and 2005. In the first outbreak, 4 inmates were hospitalized, 2 of whom required intubation. In the second event, 1 inmate required intubation. Pruno, an alcoholic drink made illicitly in prisons, was the novel vehicle for these cases.

Leucine Regulates Zoosporic Germination and Infection by Phytophthora erythroseptica.

Pink rot (Phytophthora erythroseptica) of potato is a major concern in many potato production regions. The pathogen produces zoospores that serve as a primary inoculum for infection. To understand how the pink rot incidence is related to pathogen population, qualitative, and quantitative chemical analyses were conducted. It was demonstrated that P. erythroseptica zoospores required a minimal population of 103 zoospores/ml (threshold) for initiating germination and the subsequent infection; the percentage of zoosporic germination was positively correlated with the density of zoospores above the threshold. To elucidate the density-dependent behavior, zoospore exudate (ZE) was extracted from high-density (105/ml) zoospore suspension. Zoosporic inocula of P. erythroseptica at different concentrations were inoculated on potato tubers. Necrotic lesions were caused by inoculum with 100 zoospores per inoculation site; 5 zoospores per site did not cause lesions on the tuber. However, five zoospores did cause lesions when they were placed in ZE, suggesting ZE contained chemical compounds that regulate germination of zoospores. ZE was collected and analyzed using liquid chromatography mass spectroscopy (LC-MS). Results showed that the amino acid leucine was associated with zoosporic germination. Therefore, zoosporic germination and infection of P. erythroseptica were mediated by signaling molecules secreted from zoospores.

Modeling and Surveillance of Reporting Delays of Mosquitoes and Humans Infected With West Nile Virus and Associations With Accuracy of West Nile Virus Forecasts.

Importance: West Nile virus (WNV) is the leading cause of domestically acquired arboviral disease. Objective: To develop real-time WNV forecasts of infected mosquitoes and human cases. Design, Setting, and Participants: Real-time forecasts of WNV in 4 geographically dispersed locations in the United States were generated using a WNV model-inference forecasting system previously validated with retrospective data. Analysis was performed to evaluate how observational reporting delays of mosquito WNV assay results and human medical records were associated with real-time forecast accuracy. Exposures: Mosquitoes positive for WNV and human cases. Main Outcomes and Measures: Delays in reporting mosquito WNV assay results and human medical records and the association of these delays with real-time WNV forecast accuracy. Results: Substantial delays in data reporting exist for both infected mosquitoes and human WNV cases. For human cases, confirmed data (n = 37) lagged behind the onset of illness by a mean (SD) of 5.5 (2.3) weeks (range, 2-14 weeks). These human case reporting lags reduced mean forecast accuracy for the total number of human cases over the season in 110 simulated outbreaks for 2 forecasting systems by 26% and 14%, from 2 weeks before to 3 weeks after the predicted peak of infected mosquitoes. This period is the time span during which 47% of human cases are reported. Of 7064 mosquito pools, 500 (7%) tested positive; the reporting lag for these data associated with viral testing at a state laboratory was a mean (SD) of 6.6 (2.6) days (range, 4-11 days). This reporting lag was associated with decreased mean forecast accuracy for the 3 mosquito infection indicators, timing, magnitude, and season, by approximately 5% for both forecasting systems. Conclusions and Relevance: Delays in reporting human WNV disease and infected mosquito information are associated with difficulties in outbreak surveillance and decreased real-time forecast accuracy. Infected mosquito lags were short enough that skillful forecasts could still be generated for mosquito infection indicators, but the human WNV case lags were too great to support accurate forecasting in real time. Forecasting WNV is potentially an important evidence-based decision support tool for public health officials and mosquito abatement districts; however, to operationalize real-time forecasting, more resources are needed to reduce human case reporting lags between illness onset and case confirmation.

2004 California pediatric West Nile virus case series.

Relatively few pediatric West Nile virus cases have been recognized in the United States since the virus was first identified in 1999. We reviewed the clinical characteristics of 23 cases in pediatric patients that occurred in California in 2004 to better understand the infection in this population.

Parental bonding and depressive affect: the mediating role of coping resources.

Ordinarily, when stressors are encountered, a cascade of cognitive and behavioural responses is evoked that serves to protect the individual from compromised well-being. When coping resources or skills are limited or ineffective, then psychological disturbances, such as depression, may ensue (Paykel, 2001). Although any number of factors could account for variations of stress resilience, this paper argues that early life experiences and relationships, and particularly those with parents or primary caregivers, may contribute to the development of appropriate styles of coping, which, in turn, influence affective responses in the face of stressors encountered in adulthood.

Seroprevalence of hepatitis C among a juvenile detention population.

The seroprevalence and determinants of hepatitis C virus (HCV) infection among adolescents in juvenile detention centers in Riverside County was assessed. Among 728 participants, 16 (2.2%, 95% CI 1.1%, 3.3%) demonstrated serologic evidence of HCV infection. Adolescents with a history of injection drug use (adjusted OR = 10.8, 95% CI 2.6, 45.3, P < .001) were more likely to be HCV seropositive, however the frequency of reported injection drug use was just 4%, and only 12% of HCV infection could be attributable to injecting drugs in this population. Additional information is needed on risk factors for HCV infection in adolescent populations. The relatively low level of HCV infection observed in this juvenile detention population underscores the opportunity for implementation of targeted intervention efforts.