Factors That Might Affect SARS-CoV-2 Transmission Among Foreign-Born and U.S.-Born Poultry Facility Workers - Maryland, May 2020.

Numerous recent assessments indicate that meat and poultry processing facility workers are at increased risk for infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1-4). Physical proximity to other workers and shared equipment can facilitate disease transmission in these settings (2-4). The disproportionate number of foreign-born workers employed in meat and poultry processing reflects structural, social, and economic inequities that likely contribute to an increased COVID-19 incidence in this population* (5). In May 2020, the Maryland Department of Health and CDC investigated factors that might affect person-to-person SARS-CoV-2 transmission among persons who worked at two poultry processing facilities.† A survey administered to 359 workers identified differences in risk factors for SARS-CoV-2 infection between workers born outside the United States and U.S.-born workers. Compared with U.S.-born workers, foreign-born workers had higher odds of working in fixed locations on the production floor (odds ratio [OR] for cutup and packaging jobs = 4.8), of having shared commutes (OR = 1.9), and of living with other poultry workers (OR = 6.0). They had lower odds of participating in social gatherings (OR for visits to family = 0.2; OR for visits to friends = 0.4), and they visited fewer businesses in the week before the survey than did their U.S.-born coworkers. Some workplace risk factors can be mitigated through engineering and administrative controls focused on the production floor, and this will be of particular benefit to the foreign-born workers concentrated in these areas. Employers and health departments can also partner with local organizations to disseminate culturally and linguistically tailored messages about risk reduction behaviors in community settings, including shared transportation§ and household members dwelling in close quarters.¶.

Update: COVID-19 Among Workers in Meat and Poultry Processing Facilities - United States, April-May 2020.

Meat and poultry processing facilities face distinctive challenges in the control of infectious diseases, including coronavirus disease 2019 (COVID-19) (1). COVID-19 outbreaks among meat and poultry processing facility workers can rapidly affect large numbers of persons. Assessment of COVID-19 cases among workers in 115 meat and poultry processing facilities through April 27, 2020, documented 4,913 cases and 20 deaths reported by 19 states (1). This report provides updated aggregate data from states regarding the number of meat and poultry processing facilities affected by COVID-19, the number and demographic characteristics of affected workers, and the number of COVID-19-associated deaths among workers, as well as descriptions of interventions and prevention efforts at these facilities. Aggregate data on confirmed COVID-19 cases and deaths among workers identified and reported through May 31, 2020, were obtained from 239 affected facilities (those with a laboratory-confirmed COVID-19 case in one or more workers) in 23 states.* COVID-19 was confirmed in 16,233 workers, including 86 COVID-19-related deaths. Among 14 states reporting the total number of workers in affected meat and poultry processing facilities (112,616), COVID-19 was diagnosed in 9.1% of workers. Among 9,919 (61%) cases in 21 states with reported race/ethnicity, 87% occurred among racial and ethnic minority workers. Commonly reported interventions and prevention efforts at facilities included implementing worker temperature or symptom screening and COVID-19 education, mandating face coverings, adding hand hygiene stations, and adding physical barriers between workers. Targeted workplace interventions and prevention efforts that are appropriately tailored to the groups most affected by COVID-19 are critical to reducing both COVID-19-associated occupational risk and health disparities among vulnerable populations. Implementation of these interventions and prevention efforts† across meat and poultry processing facilities nationally could help protect workers in this critical infrastructure industry.

Serial Hurricanes The 2017 Hurricane Public Health Responses: Case Studies Illustrating the Role of Centers for Disease Control and Prevention's Public Health Emergency Preparedness Program.

The Centers for Disease Control and Prevention (CDC), Division of State and Local Readiness (DSLR), Public Health Emergency Preparedness(PHEP) program funds 62 recipients to strengthen capability standards to prepare for and respond to public health emergencies. Recipients use these PHEP resources in addition to CDC's administrative and scientific guidance to support preparedness and response program planning and requirements. It is expected that public health agencies develop and maintain comprehensive emergency preparedness and response plans in preparation for disasters such as hurricanes. The 2017 historic hurricane season highlighted how emergency planning and collaborative operational execution is important for public health agencies to effectively prepare for and respond to both the immediate and long-term population health consequences of these disasters. In 2017, the southeastern United States (US) and US Caribbean territories experienced 3 Category 4 or higher Atlantic hurricanes (Harvey, Irma, and Maria) within a 5-week period. This paper highlights selected case studies that illustrate the contributions and impact of jurisdictional emergency management planning and operational capacity supported by capability standards during the 2017 hurricane season. Although the magnitude of the 2017 hurricanes required public health officials to seek additional assistance, the following case studies describe the use of public health preparedness systems and recovery resources supported by the PHEP program.

Passenger behaviors during norovirus outbreaks on cruise ships.

BACKGROUND: Norovirus causes a majority of outbreaks of gastrointestinal (GI) illness on cruise ships calling on the United States. Control measures include patient isolation, hand washing, and facility closure. Little is known about the behaviors and practices of people who have become ill with norovirus GI illness compared to those who remained well during an outbreak. METHODS: Passenger surveys were distributed during three cruise ship outbreaks caused by norovirus. Surveys inquired about illness symptoms, ill contacts, illness reporting status, hand sanitation beliefs and practices, and availability of public hand sanitizer. A case was a passenger reporting three or more episodes of loose stool in a 24-hour period, three or more episodes of vomiting in a 24-hour period, or one or more episodes each of loose stool and vomiting in a 24-hour period. Controls reported that they were not ill during the cruise. RESULTS: In total, 1,323 responses were compared. All ships had passengers who were ill prior to embarkation. Most cases delayed or did not report their illness to the ship's infirmary because they did not believe it was serious (43%-70% of responses). Cases were less likely to believe that isolation was effective in preventing disease spread [Mann-Whitney-Wilcoxon (MWW) p value <0.0001]. Cases were less likely to believe that hand washing or hand sanitizer are effective means of preventing disease spread (MWW p values 0.002 and 0.04, respectively), wash their hands after restroom use (MWW p value 0.02), or believe that hand sanitizer was available for public use prior to/after knowing about an outbreak (MWW p values 0.002 and 0.03, respectively). CONCLUSIONS: Prevention and control of norovirus GI illness may be improved by routine screening of embarking passengers, education about GI illness and its impact on public health, a focus on improving hand-washing practices, and identification of public hand sanitizer dispensing locations.

Beyond compliance: environmental health problem solving, interagency collaboration, and risk assessment to prevent waterborne disease outbreaks.

A systems approach to environmental health problem solving was used to investigate two waterborne norovirus outbreaks in Wyoming and can serve in the development of improved prevention strategies. An interagency collaboration to prevent waterborne disease involving local, state, and federal partners was designed to coordinate response to outbreak investigations. Improved risk assessment and reporting procedures were also integrated to ensure better availability of necessary data. Public health entities should implement sustainable intersectoral interventions to prevent waterborne disease that not only improve regulatory compliance but also have a positive impact on community health outcomes. Collaborative preventive health and water system protection activities should receive priority attention for implementation in state and local jurisdictions.

Impact of 2003 power outages on public health and emergency response.

INTRODUCTION: In 2003, a major power outage occurred in the midwest and northeast United States affecting some 50 million people. The power outages affected multiple systems in state and local municipalities and, in turn, affected public health. METHODS: Semi-structured interviews were conducted using open-ended questionnaires, with a convenience sample of state- and locally selected subject matter experts from Ohio, Michigan, and New York. Respondents were interviewed in groups representing one of five areas of interest, including: (1) emergency preparedness; (2) hospital and emergency medical services; (3) municipal environmental systems; (4) public health surveillance and epidemiology; and (5) psychosocial and behavioral issues. The reported positive and negative impacts of the power outage on public health, medical services, and emergency preparedness and response were documented. Responses were categorized into common themes and recommendations were formulated. RESULTS: The amount of time that the respondents' locations were without power ranged from <1 hour to 52 hours. Many common themes emerged from the different locations, including communications failures, alternate power source problems, manpower and training issues, and psychosocial concerns. There was minimal morbidity and mortality reported that could be attributed to the event. CONCLUSION: Power outages negatively impacted multiple municipal infra-structures, and affected medical services, emergency response, and public health efforts. Previous federal funding positively impacted public health and emergency response capabilities. Recommendations were made based upon the common themes identified by the respondents. Recommendations may assist state and local health departments, medical service providers, and emergency responders in planning for future power outage problems.

Training the veterinary public health workforce: a review of educational opportunities in US veterinary schools.

This article presents the results of an Internet-based review conducted in January and February 2003 to assess the educational opportunities available in veterinary public health, epidemiology, and preventive medicine at the 27 veterinary schools in the United States. Most professional veterinary curricula are designed to train students for careers as highly qualified private practitioners, although there is an increased need for veterinary perspectives and contributions in the public health sector. The future of veterinary public health relies on the opportunities available in education to teach and encourage students to pursue a career of public service. The results of this review indicate the availability of a wide variety of required courses, electives, and post-graduate training programs to veterinary students in the United States. Veterinary students are exposed to a median of 60 hours of public health, epidemiology, and preventive medicine in required stand-alone courses in these areas. Four veterinary schools also have required rotations for senior students in public health, preventive medicine, or population medicine. Contact time for required public health, epidemiology, and preventive medicine courses ranges from 30 to 150 contact hours. Advanced training was available in these subjects at 79% of the 27 schools. Greater collaboration between veterinary schools, schools of public health, and the professional public health community will increase exposure to and opportunities in public health to all future veterinarians.

A waterborne outbreak of Norwalk-like virus among snowmobilers-Wyoming, 2001.

In February 2001, episodes of acute gastroenteritis were reported to the Wyoming Department of Health from persons who had recently vacationed at a snowmobile lodge in Wyoming. A retrospective cohort study found a significant association between water consumption and illness, and testing identified Norwalk-like virus (NLV) in 8 of 13 stool samples and 1 well. Nucleotide sequences from the positive well-water specimen and 6 of the positive stool samples were identical. This multistrain NLV outbreak investigation illustrates the importance of NLV as a cause of waterborne illness and should encourage monitoring for NLVs in drinking water.

Do beliefs of inner-city parents about disease and vaccine risks affect immunization?

OBJECTIVE: The objective of this study was to understand how low income, inner-city parents of preschool children think about childhood diseases and prevention and the impact that this has on late receipt of vaccines. METHODS: Parents of all children born between January 1, 1991, and May 31, 1995, whose child received medical assistance and health care at one of four inner-city, primary care clinics in Pittsburgh, PA, completed a telephone interview and gave consent for a vaccine record review. The main outcome measures were lateness for first and third diphtheria and tetanus toxoids and pertussis vaccines (DTP) and not receiving at least four DTP, three polio virus containing and one measles, mumps and rubella (MMR) doses by 19 months. RESULTS: A total of 483 parents participated. Fifteen percent of children were late for the first DTP, 52% for the third DTP, and 40% had not received at least four DTP, three polio and one MMR by 19 months of age. Statistically significant factors associated with lateness at 19 months included: having three or more children, having two children, beliefs regarding the severity of immunization side effects, and being African American. CONCLUSIONS: The results of this study indicate that a combination of life circumstances, as well as cognitive factors were associated with late immunization.

Understanding physician agreement with varicella immunization guidelines.

BACKGROUND: Although varicella vaccine was licensed in 1995, immunization rates are only moderate. This study identifies factors associated with physician self-reported likelihood of recommending varicella vaccination to patients. METHODS: Two hundred eighty-one Minnesota and Pennsylvania primary care physicians who participated in surveys on barriers to vaccination in 1990-1991 and 1993 were surveyed in 1999, assessing physicians' beliefs about varicella disease and vaccine and their self-reported likelihood of recommending varicella vaccine to three age groups of children. RESULTS: Most (79, 80, and 83%) were likely to recommend varicella vaccine for 12- to 18-month old, 4- to 6-year-old, and 11- to 12-year old children, respectively, and most (78%) agreed with national recommendations to vaccinate. If physicians believed that the vaccine would fail, they were less likely to recommend varicella vaccination for 12- to 18-month-old (70% vs 85%, P = 0.001) and 4- to 6-year-old (83% vs 85%, P = 0.001) children, than if they believed in its efficacy. Pediatricians were more likely to recommend varicella vaccine than were family physicians and general practitioners (P < 0.01). CONCLUSIONS: Physicians, especially pediatricians, report that they recommend varicella vaccination when they agree with national recommendations, believe in the efficacy of the vaccine, and perceive that parents want the vaccine for their children.

Frequency and causes of vaccine wastage.

UNLABELLED: Assessing the frequency of vaccine wastage and the relative magnitude of its various causes may help to target efforts to reduce these losses and to husband funds for increasingly expensive vaccines. METHODS: As a preliminary overview of wastage in the United States, 64 public-sector state and local health department immunization programs were polled in 1998 and 1999 for wastage recording practices. Actual wastage data were collected from a non-random subset of five states. Data on returns of wasted vaccine to manufacturers were analyzed from routine national biologics surveillance and from an ad-hoc survey. Excise tax credit requests for such returns between 1994 and 1999 were reviewed. RESULTS: Rates of wastage among the five states ranged from about 1 to 5% in 1998, with an overall rate of 2.6% among 57 immunization programs in 1999. Categories of wastage used by the health departments varied widely, with overlapping classifications. The major causes appeared to be refrigeration (cold chain) lapses, followed by expiration. Overall rates of vaccine returns varied up to 8% by manufacturer, and from 1 to 50% by vaccine type, with higher return rates generally found for lesser-used vaccines. CONCLUSIONS: If these wastage estimates of 1-5% applied nationally, in 1998 there would have been approximately US dollars 6-31 million worth of unused vaccine in the public sector alone. The two most common forms of wastage reveal the potential value of developing vaccines with improved heat stability and longer shelf lives. We propose six main classifications of vaccine wastage for use in routine monitoring and reporting.

New approaches to safe drinking water.

Up to half the population of some states in the United States drink water from small systems not regulated by the Safe Drinking Water Act. The quality of the drinking water from these systems is generally unknown and may be suspect. In many jurisdictions, private wells are the primary source of water. In some instances, construction of wells may have met regulatory requirements but may not have adequately prevented disease transmission. Anecdotal information, periodic water-borne outbreaks, and recent well surveys suggest that there are public health concerns associated with these and similar systems. This article provides an assessment of the need for governmental oversight (regulatory and non-regulatory) of drinking water supplies, describes how a "systems-based" approach might be used to evaluate water supply systems and to identify and prevent possible contamination, and presents case studies describing the systems-based approach as well as a comprehensive approach to environmental health that includes drinking water regulation.