Elevated COVID-19 Case Rates of Government Employees, District of Columbia, 2020-2022.

OBJECTIVES: To estimate the rate ratio (RR) of reported Coronavirus Disease 2019 (COVID-19) cases among governmental employees from seven District of Columbia (D.C.) departments from March 2020 to February 2022. METHODS: Poisson regression models were used to estimate the RR by department, using D.C. residents as the reference and the person-day as the offset. The COVID-19 surveillance data and the full-time equivalent hours for each department were obtained from the D.C. governmental websites. RESULTS: Five of the seven departments had statistically significant higher COVID-19 case rates than D.C. residents. Stratified by four pandemic stages, RR of Fire and Emergency Medical Services (FEMS), Office of Unified Communication (OUC), and Metropolitan Police Department (MPD) were consistently >1: FEMS: 3.34 (95% confidence interval, CI [2.94, 3.77]), 2.39 (95% CI [2.06, 2.75]), 2.48 (95% CI [2.06, 2.95]), and 3.90 (95% CI [3.56, 4.26]), respectively; OUC: 1.47 (95% CI [0.92, 2.18]), 2.72 (95% CI [1.93, 3.69]), 1.85 (95% CI [1.09, 2.92]), and 2.18 (95% CI [1.62, 2.85]), respectively; and MPD: 2.33 (95% CI [2.11, 2.58]), 1.96 (95% CI [1.75, 2.18]), 1.52 (95% CI [1.29, 1.77]), and 1.76 (95% CI [1.60, 1.92]), respectively. CONCLUSIONS: The results suggested higher case rates for emergency responders and frontline personnel than for general population in D.C.

SARS-CoV-2 transmission potential and rural-urban disease burden disparities across Alabama, Louisiana, and Mississippi, March 2020 - May 2021.

PURPOSE: To quantify and compare SARS-CoV-2 transmission potential across Alabama, Louisiana, and Mississippi and selected counties. METHODS: To determine the time-varying reproduction number Rt of SARS-CoV-2, we applied the R package EpiEstim to the time series of daily incidence of confirmed cases (mid-March 2020 - May 17, 2021) shifted backward by 9 days. Median Rt percentage change when policies changed was determined. Linear regression was performed between log10-transformed cumulative incidence and log10-transformed population size at four time points. RESULTS: Stay-at-home orders, face mask mandates, and vaccinations were associated with the most significant reductions in SARS-CoV-2 transmission in the three southern states. Rt across the three states decreased significantly by ≥20% following stay-at-home orders. We observed varying degrees of reductions in Rt across states following other policies. Rural Alabama counties experienced higher per capita cumulative cases relative to urban ones as of June 17 and October 17, 2020. Meanwhile, Louisiana and Mississippi saw the disproportionate impact of SARS-CoV-2 in rural counties compared to urban ones throughout the study period. CONCLUSION: State and county policies had an impact on local pandemic trajectories. The rural-urban disparities in case burden call for evidence-based approaches in tailoring health promotion interventions and vaccination campaigns to rural residents.

Aiming for Zero: Reducing Transmission of Coronavirus Disease 2019 in the D.C. Department of Corrections.

BACKGROUND: Washington, District of Columbia lowered severe acute respiratory syndrome coronavirus 2 transmission in its large jail while community incidence was still high. METHODS: Coordinated clinical and operational interventions brought new cases to near zero. RESULTS: Aggressive infection control and underlying jail architecture can promote correctional coronavirus disease 2019 management. CONCLUSIONS: More intensive monitoring could help confirm that in-house transmission is truly zero.

Unplanned Closure of Public Schools in Michigan, 2015-2016: Cross-Sectional Study on Rurality and Digital Data Harvesting.

BACKGROUND: For pandemic preparedness, researchers used online systematic searches to track unplanned school closures (USCs). We determine if Twitter provides complementary data. METHODS: Twitter handles of Michigan public schools and school districts were identified. All tweets associated with these handles were downloaded. USC-related tweets were identified using 5 keywords. Descriptive statistics and multivariable logistic regression were performed in R. RESULTS: Among 3469 Michigan public schools, 2003 maintained their own active Twitter accounts or belonged to school districts with active Twitter accounts. Of these 2003 schools, in 2015-2016 school year, at least 1 USC announcement was identified for 349 schools via the current method only, 678 schools via Twitter only, and 562 schools via both methods. No USC announcements were identified for 414 schools. Rural schools were less likely than city schools to have active Twitter coverage (adjusted relative risk [adjRR] = 0.3956, 95% confidence interval [CI] 0.3312-0.4671), and to announce USCs on Twitter (adjRR = 0.5692, 95% CI 0.4645-0.6823), but more likely to have USCs identified by the current method (adjRR = 1.4545, 95% CI 1.3545-1.5490). CONCLUSIONS: Each method identified USCs that were missed by the other. Our results suggested that identifying USCs on Twitter is complementary to the current method.

The clinical interpretation of viral blips in HIV patients receiving antiviral treatment: are we ready to infer poor adherence?

OBJECTIVES: Viral blips may be an indication of poor adherence to antiretroviral treatment. This article studies how the variations of the definitions of viral blips and that of the choice of sampling frame in studies investigating viral blips may contribute to the uncertainty of the associations between viral blips and possible causes. DESIGN: Mathematical modeling study allows us to study the impact of different sampling frames and different definitions of blips upon study results that are usually not feasible in clinical settings. METHODS: Using a previously published mathematical model, scenarios of different drug adherence levels and viral blips, with different sampling frames, were modeled. RESULTS: In the case of viral blips as a result of nonadherence to combinational antiretroviral therapy, rather than calculating the incidence of blips directly from the number of blips observed in a given period of time, it is better to report the proportion of observations in a given period of time that are ≥50 copies per milliliter. Therefore, as the denominator, the number of observations in a given period of time is important. However, the proportion of blips is not very informative on the drug adherence level. CONCLUSIONS: We should standardize definitions of viral blips and the choice of sampling frame and to report the proportion of observations of a given sampling frame in a given period of time that are ≥50 copies per milliliter, so that comparable data can be generated across different populations.

Interventions to improve disposal of human excreta for preventing diarrhoea.

BACKGROUND: Diarrhoeal diseases are a leading cause of mortality and morbidity, especially among young children in low-income countries, and are associated with exposure to human excreta. OBJECTIVES: To assess the effectiveness of interventions to improve the disposal of human excreta for preventing diarrhoeal diseases. SEARCH STRATEGY: We searched the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in The Cochrane Library; MEDLINE; EMBASE; LILACS; the metaRegister of Controlled Trials (mRCT); and Chinese-language databases available under the Wan Fang portal, and the China National Knowledge Infrastructure (CNKI-CAJ). We also handsearched relevant conference proceedings, and contacted researchers and organizations working in the field, as well as checking references from identified studies. SELECTION CRITERIA: Randomized, quasi-randomized, and non-randomized controlled trials (RCTs) were selected, comparing interventions aimed at improving the disposal of human excreta to reduce direct or indirect human contact with no such intervention. Cluster (eg at the level of household or community) controlled trials were included. DATA COLLECTION AND ANALYSIS: We determined study eligibility, extracted data, and assessed methodological quality in accordance with the methods prescribed by the protocol. We described the results and summarized the information in tables. Due to substantial heterogeneity among the studies in terms of study design and type of intervention, no pooled effects were calculated. MAIN RESULTS: Thirteen studies from six countries covering over 33,400 children and adults in rural, urban, and school settings met the review's inclusion criteria. In all studies the intervention was allocated at the community level. While the studies reported a wide range of effects, 11 of the 13 studies found the intervention was protective against diarrhoea. Differences in study populations and settings, in baseline sanitation levels, water, and hygiene practices, in types of interventions, study methodologies, compliance and coverage levels, and in case definitions and outcome surveillance limit the comparability of results of the studies included in this review. The validity of most individual study results are further compromised by the non-random allocation of the intervention among study clusters, an insufficient number of clusters, the lack of adjustment for clustering, unclear loss to follow-up, potential for reporting bias and other methodological shortcomings. AUTHORS' CONCLUSIONS: This review provides some evidence that interventions to improve excreta disposal are effective in preventing diarrhoeal disease. However, this conclusion is based primarily on the consistency of the evidence of beneficial effects. The quality of the evidence is generally poor and does not allow for quantification of any such effect. The wide range of estimates of the effects of the intervention may be due to clinical and methodological heterogeneity among the studies, as well as to other important differences, including exposure levels, types of interventions, and different degrees of observer and respondent bias. Rigorous studies in multiple settings are needed to clarify the potential effectiveness of excreta disposal on diarrhoea.

Water, sanitation and hygiene for the prevention of diarrhoea.

BACKGROUND: Ever since John Snow's intervention on the Broad St pump, the effect of water quality, hygiene and sanitation in preventing diarrhoea deaths has always been debated. The evidence identified in previous reviews is of variable quality, and mostly relates to morbidity rather than mortality. METHODS: We drew on three systematic reviews, two of them for the Cochrane Collaboration, focussed on the effect of handwashing with soap on diarrhoea, of water quality improvement and of excreta disposal, respectively. The estimated effect on diarrhoea mortality was determined by applying the rules adopted for this supplement, where appropriate. RESULTS: The striking effect of handwashing with soap is consistent across various study designs and pathogens, though it depends on access to water. The effect of water treatment appears similarly large, but is not found in few blinded studies, suggesting that it may be partly due to the placebo effect. There is very little rigorous evidence for the health benefit of sanitation; four intervention studies were eventually identified, though they were all quasi-randomized, had morbidity as the outcome, and were in Chinese. CONCLUSION: We propose diarrhoea risk reductions of 48, 17 and 36%, associated respectively, with handwashing with soap, improved water quality and excreta disposal as the estimates of effect for the LiST model. Most of the evidence is of poor quality. More trials are needed, but the evidence is nonetheless strong enough to support the provision of water supply, sanitation and hygiene for all.

Citation of non-English peer review publications--some Chinese examples.

Articles published in English language journals with citations of non-English peer reviewed materials are not very common today. However, as epidemiologists are becoming more aware of data and information being readily available and accessible in the non-English literature, the question of whether non-English materials can be cited in English language journals and if so, how should they be cited, has become an increasingly important issue. Bringing together personal insights from the author's familiarity with both the English and Chinese language epidemiological literature and results from a survey on the use of citations of non-English peer reviewed materials across a sample of epidemiology and public health journals, this commentary discusses the different ways authors cite non-English articles in different English language journals and the different methods used by journals to handle non-Latin scripts (e.g. transliteration). This commentary will be useful to both epidemiologists and editors alike.

Does language matter? A case study of epidemiological and public health journals, databases and professional education in French, German and Italian.

Epidemiology and public health are usually context-specific. Journals published in different languages and countries play a role both as sources of data and as channels through which evidence is incorporated into local public health practice. Databases in these languages facilitate access to relevant journals, and professional education in these languages facilitates the growth of native expertise in epidemiology and public health. However, as English has become the lingua franca of scientific communication in the era of globalisation, many journals published in non-English languages face the difficult dilemma of either switching to English and competing internationally, or sticking to the native tongue and having a restricted circulation among a local readership. This paper discusses the historical development of epidemiology and the current scene of epidemiological and public health journals, databases and professional education in three Western European languages: French, German and Italian, and examines the dynamics and struggles they have today.

Chinese journals: a guide for epidemiologists.

Chinese journals in epidemiology, preventive medicine and public health contain much that is of potential international interest. However, few non-Chinese speakers are acquainted with this literature. This article therefore provides an overview of the contemporary scene in Chinese biomedical journal publication, Chinese bibliographic databases and Chinese journals in epidemiology, preventive medicine and public health. The challenge of switching to English as the medium of publication, the development of publishing bibliometric data from Chinese databases, the prospect of an Open Access publication model in China, the issue of language bias in literature reviews and the quality of Chinese journals are discussed. Epidemiologists are encouraged to search the Chinese bibliographic databases for Chinese journal articles.

Seek, and ye shall find: accessing the global epidemiological literature in different languages.

The thematic series 'Beyond English: Accessing the global epidemiological literature' in Emerging Themes in Epidemiology highlights the wealth of epidemiological and public health literature in the major languages of the world, and the bibliographic databases through which they can be searched and accessed. This editorial suggests that all systematic reviews in epidemiology and public health should include literature published in the major languages of the world and that the use of regional and non-English bibliographic databases should become routine.

Open access for the non-English-speaking world: overcoming the language barrier.

This editorial highlights the problem of language barrier in scientific communication in spite of the recent success of Open Access Movement. Four options for English-language journals to overcome the language barrier are suggested: 1) abstracts in alternative languages provided by authors, 2) Wiki open translation, 3) international board of translator-editors, and 4) alternative language version of the journal. The Emerging Themes in Epidemiology announces that with immediate effect, it will accept translations of abstracts or full texts by authors as Additional files. Editorial note: In an effort towards overcoming the language barrier in scientific publication, ETE will accept translations of abstracts or the full text of published articles. Each translation should be submitted separately as an Additional File in PDF format. ETE will only peer review English-language versions. Therefore, translations will not be scrutinized in the review-process and the responsibility for accurate translation rests with the authors.

Modelling the impact and cost-effectiveness of the HIV intervention programme amongst commercial sex workers in Ahmedabad, Gujarat, India.

BACKGROUND: Ahmedabad is an industrial city in Gujarat, India. In 2003, the HIV prevalence among commercial sex workers (CSWs) in Ahmedabad reached 13.0%. In response, the Jyoti Sangh HIV prevention programme for CSWs was initiated, which involves outreach, peer education, condom distribution, and free STD clinics. Two surveys were performed among CSWs in 1999 and 2003. This study estimates the cost-effectiveness of the Jyoti Sangh HIV prevention programme. METHODS: A dynamic mathematical model was used with survey and intervention-specific data from Ahmedabad to estimate the HIV impact of the Jyoti Sangh project for the 51 months between the two CSW surveys. Uncertainty analysis was used to obtain different model fits to the HIV/STI epidemiological data, producing a range for the HIV impact of the project. Financial and economic costs of the intervention were estimated from the provider's perspective for the same time period. The cost per HIV-infection averted was estimated. RESULTS: Over 51 months, projections suggest that the intervention averted 624 and 5,131 HIV cases among the CSWs and their clients, respectively. This equates to a 54% and 51% decrease in the HIV infections that would have occurred among the CSWs and clients without the intervention. In the absence of intervention, the model predicts that the HIV prevalence amongst the CSWs in 2003 would have been 26%, almost twice that with the intervention. Cost per HIV infection averted, excluding and including peer educator economic costs, was USD 59 and USD 98 respectively. CONCLUSION: This study demonstrated that targeted CSW interventions in India can be cost-effective, and highlights the importance of replicating this effort in other similar settings.

How often do you wash your hands? A review of studies of hand-washing practices in the community during and after the SARS outbreak in 2003.

We reviewed evidence of hand-washing compliance in community settings during the 2003 SARS outbreak. Literature was searched through PubMed, Cochrane Library, Wan Fang database and Google. English and Chinese papers were reviewed. Studies containing data on hand-washing, self-reported or directly observed, in community settings were selected. Case-control studies and studies in healthcare settings were excluded. Fourteen studies were reviewed. Self-reported hand-washing compliance increased in the first phase of the SARS outbreak and maintained a high level 22 months after the outbreak. The decline of hand-washing in Hong Kong after SARS was relatively slow. A significant gender difference in hand-washing compliance (female > male) was found in eight studies. The importance of family support and 'significant female others' in hand hygiene promotion are noted. The impact of education is uncertain. Perceived susceptibility to and severity of SARS, and perceived efficacy of hand-washing in preventing SARS, also predicted self-reported hand-washing compliance.