Epidemiological investigation of a youth suicide cluster: Delaware 2012.

UNLABELLED: In the first quarter of 2012, eight youth (aged 13-21 years) were known to have died by suicide in Kent and Sussex counties, Delaware, twice the typical median yearly number. State and local officials invited the Centers for Disease Control and Prevention to assist with an epidemiological investigation of fatal and nonfatal youth suicidal behaviors in the first quarter of 2012, to examine risk factors, and to recommend prevention strategies. METHODS: Data were obtained from the Delaware Office of the Medical Examiner, law enforcement, emergency departments, and inpatient records. Key informants from youth-serving organizations in the community were interviewed to better understand local context and perceptions of youth suicide. RESULTS: Eleven fatal and 116 nonfatal suicide attempts were identified for the first quarter of 2012 in Kent and Sussex counties. The median age was higher for the fatalities (18 years) than the nonfatal attempts (16 years). More males died by suicide, and more females nonfatally attempted suicide. Fatal methods were either hanging or firearm, while nonfatal methods were diverse, led by overdose/poisoning and cutting. All decedents had two or more precipitating circumstances. Seventeen of 116 nonfatal cases reported that a peer/friend recently died by or attempted suicide. Local barriers to youth services and suicide prevention were identified. DISCUSSION: Several features were similar to previous clusters: Occurrence among vulnerable youth, rural or suburban setting, and precipitating negative life events. Distribution by sex and method were consistent with national trends for both fatalities and nonfatalities. References to the decedents in the context of nonfatal attempts support the concept of 'point clusters' (social contiguity to other suicidal youth as a risk factor for vulnerable youth) as a framework for understanding clustering of youth suicidal behavior. Recommended prevention strategies included: Training to identify at-risk youth and guide them to services; development of youth programs; monitoring trends in youth suicidal behaviors; reviewing evidence-based suicide prevention strategies; and continued implementation of CDC media guidelines for reporting on suicide.

Acceptance of 2009 H1N1 influenza vaccine among pregnant women in Delaware.

Due to disproportionately high mortality from 2009 H1N1 influenza, pregnant women were given highest priority for H1N1 vaccination. We surveyed postpartum women to determine vaccine uptake and reasons for lack of vaccination. We performed a cross-sectional survey of postpartum women delivering at our institution from February 1 to April 15, 2010. The 12-question survey ascertained maternal characteristics and vaccination concerns. Among 307 postpartum women, 191 (62%) had received H1N1 vaccination and 98 (32%) had declined. Factors associated with H1N1 vaccination included older age (relative risk [RR] 1.3, 95% confidence interval [CI] 1.1 to 1.5 for age ≥35 years compared with 20 to 34 years), at least college education (RR 1.5, 95% CI 1.3 to 1.8), prior influenza vaccination (RR 1.6, 95% CI 1.3 to 2.0), provider recommendation (RR 3.9, 95% CI 2.1 to 7.4), vaccination of family members (RR 1.6, 95% CI 1.3 to 1.9), and receipt of seasonal influenza vaccination (RR 2.2, 95% CI 1.7 to 2.9). Non-Hispanic black women were less likely to have been vaccinated (RR 0.6, 95% CI 0.5 to 0.8) than non-Hispanic white women. Safety concerns were cited by the majority (66%) of nonvaccinated women. H1N1 vaccine uptake among pregnant women was substantially higher than reported influenza vaccination rates during previous seasons. Safety concerns were the major barrier to vaccination.

State of Delaware response to novel H1N1 influenza: Division of Public Health's perspective.

The novel H1N1 influenza in 2009 and 2010 demonstrated the important relationship between medicine and public health. Delaware physicians may benefit from knowing how the state Division of Public Health (DPH) responded. One way to describe that response is to compare H1N1 influenza activities to the Ten Essential Public Health Services, adopted as standard practice by most public health agencies.

Notes from the field: outbreak of 2009 pandemic influenza A (H1N1) virus at a large public university in Delaware, April-May 2009.

BACKGROUND: In late April 2009, the first documented 2009 pandemic influenza A (pH1N1) virus infection outbreak in a university setting occurred in Delaware, with large numbers of students presenting with respiratory illness. At the time of this investigation, little was known about the severity of illness, effectiveness of the vaccine, or transmission factors of pH1N1 virus infection. We characterized illness, determined the impact of this outbreak, and examined factors associated with transmission. METHODS: Health clinic records were reviewed. An online survey was administered to all students, staff, and faculty to assess influenza-like illness (ILI), defined as documented or subjective fever with cough or sore throat. RESULTS: From 26 April-2 May 2009, the health clinic experienced a sharp increase in visits for respiratory illness, with 1080 such visits among a total of 1430 student visits, and then a return to baseline visit levels within 2 weeks. More than 500 courses of oseltamivir were distributed, and 24 cases of influenza A (pH1N1) virus infection were confirmed. Of 29,000 university students and faculty/staff, 7450 (30%) responded to the survey. ILI was reported by 604 (10%) of the students and 73 (5%) of the faculty/staff. Travel to Mexico (relative risk [RR], 2.9; 95% confidence interval [CI], 1.8-4.7) and participation in "Greek Week" activities (RR, 2.2; 95% CI, 1.8-2.8) were associated with ILI. Recipients of the 2008-2009 seasonal influenza vaccine had the same risk of ILI as nonrecipients (RR, 1.0). Four (3%) of the students with ILI were hospitalized; there were no deaths. CONCLUSIONS: pH1N1 spread rapidly through the University of Delaware community with a surge in illness over a 2-week period. Although initial cases appear to be associated with travel to Mexico, a rapid increase in cases was likely facilitated by increased student interactions during Greek Week. No protective effect from receiving seasonal influenza vaccine was identified. Although severe illness was rare, the outbreak caused a substantial burden and challenge to the university health care system. Preparedness efforts in universities and similar settings should include enhancing health care surge capacity.

Efficacy of nonsteroidal anti-inflammatory medications for prevention of atrial fibrillation following coronary artery bypass graft surgery.

This study was designed to test whether nonsteroidal anti-inflammatory medications could reduce the frequency of atrial fibrillation after coronary artery bypass graft surgery. The study was designed as an open-label, randomized trial. Patients undergoing first-time coronary artery bypass graft surgery were considered eligible. Patients with a history of atrial fibrillation, serum creatinine >2.0 mg/dL, on antiarrhythmic treatment, and those undergoing concomitant valvular surgery were excluded. The study was conducted in a single, university-affiliated community hospital. The researchers' role in the study was restricted to randomizing the patients and collecting data. The primary clinical care team made all decisions regarding patient care. One hundred patients were randomized to two groups: one received 30 mg ketorolac intravenously every 6 hours until able to take oral medications, at which point the patients were switched to 600 mg ibuprofen orally three times a day; the other group received conventional treatment. The primary end point of the study was incidence of atrial fibrillation in the immediate postoperative period. Atrial fibrillation occurred in 14 patients (28.6%) in the conventional treatment group vs. five patients (9.8%) in the ibuprofen group (p<0.017). Nonsteroidal anti-inflammatory medications were relatively safe and effective in significantly reducing the incidence of atrial fibrillation after coronary artery bypass graft surgery.

Swine flu in college: early campus response to outbreak control measures.

OBJECTIVES: To describe student and faculty attitudes towards and adherence to nonpharmaceutical control measures during the first-known university outbreak of 2009 pandemic influenza A (H1N1). METHODS: Preferred information sources, control measure adherence and likelihood of adherence during future out-breaks, and perceived illness risk, were explored through focus groups and patient interviews. RESULTS: We conducted 7 focus groups (N=48) and 9 patient inter- views. Measures (eg, hand hygiene, self-isolation while ill) were initially heeded. Limited information regarding A(H1N1) pdm09, insufficient understanding of university decisions, and perceived university alert overuse led to reports that future outbreaks would be regarded less seriously. CONCLUSIONS: Reported concern and commitment to recommendations decreased rapidly. Initial university messaging and response was critical in shaping participants' later perceptions.