Reaching Diverse Communities During a Local Public Health COVID-19 Vaccination Response Through a Mobile Clinic Compared to Mass Vaccination Sites.

During the COVID-19 vaccine rollout, local public health agencies were responsible for vaccinating a wide variety of communities. Dakota County Public Health (Dakota County, Minnesota) implemented a program that offered COVID-19 vaccines in a variety of settings, such as county public health buildings, community sites, in-home, mass vaccination clinics, and a mobile clinic unit. The purpose of this analysis is to compare the demographics of vaccinations administered at Dakota County COVID-19 vaccination clinics based on clinic site. More than half (52.5%) of vaccinations administered at mobile clinic sites were administered to Hispanic or Latino clients, while at the mass vaccination clinic site, 5.4% of vaccinations were administered to Hispanic or Latino clients. In addition, 59.6% of in-home vaccinations were administered to adults 65 years and older. Offering COVID-19 vaccination clinics in a variety of clinic settings strategically throughout the community helped increase vaccine reach to diverse communities.

Neuraminidase H275Y and hemagglutinin D222G mutations in a fatal case of 2009 pandemic influenza A (H1N1) virus infection.

Oseltamivir-resistant 2009 H1N1 influenza virus infections associated with neuraminidase (NA) H275Y have been identified sporadically. Strains possessing the hemagglutinin (HA) D222G mutation have been detected in small numbers of fatal 2009 H1N1 cases. We report the first clinical description of 2009 H1N1 virus infection with both NA-H275Y and HA-D222G mutations detected by pyrosequencing of bronchioalveolar lavage fluid obtained on symptom day 19. The 59-year-old immunosuppressed patient had multiple conditions conferring higher risk of prolonged viral replication and severe illness and died on symptom day 34. Further investigations are needed to determine the significance of infection with strains possessing NA-H275Y and HA-D222G.

Pandemic (H1N1) 2009-associated deaths detected by unexplained death and medical examiner surveillance.

During the pandemic (H1N1) 2009 outbreak, Minnesota, New Mexico, and Oregon used several surveillance methods to detect associated deaths. Surveillance using unexplained death and medical examiner data allowed for detection of 34 (18%) pandemic (H1N1) 2009-associated deaths that were not detected by hospital-based surveillance.

rotavirus-coded deaths in children, United States, 1999-2007.

The introduction of specific International Classification of Diseases-10th revision code for rotavirus in 1999 prompted us to examine the US mortality data for 1999-2007 to validate rotavirus-coded deaths. Of 38 rotavirus-coded deaths identified in the national multiple cause-of-death database, results of laboratory testing could be obtained for 21 deaths, all of which had confirmation of rotavirus by either microbiologic or histopathologic testing.

Cost of screening intensive care unit patients for methicillin-resistant Staphylococcus aureus in hospitals.

BACKGROUND: The objective of this study is to determine the costs per hospital admission of screening intensive care unit patients for methicillin-resistant Staphylococcus aureus (MRSA) and isolating those who are colonized. METHODS: Data on the costs of the intervention come from the Minneapolis Veterans Affairs Medical Center, a 279-bed teaching hospital and outpatient facility. A microcosting approach is used to determine the intervention costs for 3 different laboratory testing protocols. The costs of caring for MRSA-infected patients come from the experience of 241 Minneapolis Veterans Affairs Medical Center patients with MRSA infections in 2004 through 2006. The effectiveness of the intervention comes from the extant literature. To capture the effect of screening on reducing transmission of MRSA to other patients and its effect on costs, a Markov simulation model was employed. RESULTS: The intervention was cost saving compared with no intervention for all 3 laboratory processes evaluated and for all of the 1-way sensitivity analyses considered. CONCLUSION: Because of the high cost of caring for a MRSA patient, interventions that reduce the spread of infections-such as screening intensive care unit patients upon admission studied here-are likely to pay for themselves.

Epidemiologic investigation of immune-mediated polyradiculoneuropathy among abattoir workers exposed to porcine brain.

BACKGROUND: In October 2007, a cluster of patients experiencing a novel polyradiculoneuropathy was identified at a pork abattoir (Plant A). Patients worked in the primary carcass processing area (warm room); the majority processed severed heads (head-table). An investigation was initiated to determine risk factors for illness. METHODS AND RESULTS: Symptoms of the reported patients were unlike previously described occupational associated illnesses. A case-control study was conducted at Plant A. A case was defined as evidence of symptoms of peripheral neuropathy and compatible electrodiagnostic testing in a pork abattoir worker. Two control groups were used - randomly selected non-ill warm-room workers (n = 49), and all non-ill head-table workers (n = 56). Consenting cases and controls were interviewed and blood and throat swabs were collected. The 26 largest U.S. pork abattoirs were surveyed to identify additional cases. Fifteen cases were identified at Plant A; illness onsets occurred during May 2004-November 2007. Median age was 32 years (range, 21-55 years). Cases were more likely than warm-room controls to have ever worked at the head-table (adjusted odds ratio [AOR], 6.6; 95% confidence interval [CI], 1.6-26.7), removed brains or removed muscle from the backs of heads (AOR, 10.3; 95% CI, 1.5-68.5), and worked within 0-10 feet of the brain removal operation (AOR, 9.9; 95% CI, 1.2-80.0). Associations remained when comparing head-table cases and head-table controls. Workers removed brains by using compressed air that liquefied brain and generated aerosolized droplets, exposing themselves and nearby workers. Eight additional cases were identified in the only two other abattoirs using this technique. The three abattoirs that used this technique have stopped brain removal, and no new cases have been reported after 24 months of follow up. Cases compared to controls had higher median interferon-gamma (IFNgamma) levels (21.7 pg/ml; vs 14.8 pg/ml, P<0.001). DISCUSSION: This novel polyradiculoneuropathy was associated with removing porcine brains with compressed air. An autoimmune mechanism is supported by higher levels of IFNgamma in cases than in controls consistent with other immune mediated illnesses occurring in association with neural tissue exposure. Abattoirs should not use compressed air to remove brains and should avoid procedures that aerosolize CNS tissue. This outbreak highlights the potential for respiratory or mucosal exposure to cause an immune-mediated illness in an occupational setting.

Excess costs and utilization associated with methicillin resistance for patients with Staphylococcus aureus infection.

OBJECTIVE: To determine differences in healthcare costs between cases of methicillin-susceptible Staphylococcus aureus (MSSA) infection and methicillin-resistant S. aureus (MRSA) infection in adults. DESIGN: Retrospective study of all cases of S. aureus infection. SETTING: Department of Veterans Affairs hospital and associated clinics. PATIENTS: There were 390 patients with MSSA infections and 335 patients with MRSA infections. METHODS: We used medical records, accounting systems, and interviews to identify services rendered and costs for Minneapolis Veterans Affairs Medical Center patients with S. aureus infection with onset during the period from January 1, 2004, through June 30, 2006. We used regression analysis to adjust for patient characteristics. RESULTS: Median 6-month unadjusted costs for patients infected with MRSA were $34,657, compared with $15,923 for patients infected with MSSA. Patients with MRSA infection had more comorbidities than patients with MSSA infection (mean Charlson index 4.3 vs 3.2; P < .001). For patients with Charlson indices of 3 or less, mean adjusted 6-month costs derived from multivariate analysis were $51,252 (95% CI, $46,041-$56,464) for MRSA infection and $30,158 (95% CI, $27,092-$33,225) for MSSA infection. For patients with Charlson indices of 4 or more, mean adjusted costs were $84,436 (95% CI, $79,843-$89,029) for MRSA infection and $59,245 (95% CI, $56,016-$62,473) for MSSA infection. Patients with MRSA infection were also more likely to die than were patients with MSSA infection (23.6% vs 11.5%; P < .001). MRSA infection was more likely to involve the lungs, bloodstream, and urinary tract, while MSSA infection was more likely to involve bones or joints; eyes, ears, nose, or throat; surgical sites; and skin or soft tissue (P < .001). CONCLUSIONS: Resistance to methicillin in S. aureus was independently associated with increased costs. Effective antimicrobial stewardship and infection prevention programs are needed to prevent these costly infections.

Explaining the unexplained: identifying infectious causes of critical illness and death in Minnesota.

The Minnesota Department of Health began its unexplained critical illness and death due to possible infectious etiologies (UNEX) project in 1995. In 2006, it also began surveillance for all possible infectious disease-related and unexplained deaths investigated by medical examiners (MED-X). Surveillance for unexplained critical illness and death is focused on determining the etiology of an acute illness in a previously healthy person 50 years of age or younger whose illness is suggestive of an infectious disease. This article describes how the programs operate and how they have been able to identify the causes of a number of unexplained deaths in Minnesota. It also discusses the need for specimen collection, laboratory technologies used to identify infectious agents, and the importance of identifying etiologies of unexplained illnesses and deaths in order to prevent potential outbreaks in the greater population.