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4.
MMWR Morb Mortal Wkly Rep ; 69(39): 1398-1403, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33001876

RESUMEN

Coronavirus disease 2019 (COVID-19) is a viral respiratory illness caused by SARS-CoV-2. During January 21-July 25, 2020, in response to official requests for assistance with COVID-19 emergency public health response activities, CDC deployed 208 teams to assist 55 state, tribal, local, and territorial health departments. CDC deployment data were analyzed to summarize activities by deployed CDC teams in assisting state, tribal, local, and territorial health departments to identify and implement measures to contain SARS-CoV-2 transmission (1). Deployed teams assisted with the investigation of transmission in high-risk congregate settings, such as long-term care facilities (53 deployments; 26% of total), food processing facilities (24; 12%), correctional facilities (12; 6%), and settings that provide services to persons experiencing homelessness (10; 5%). Among the 208 deployed teams, 178 (85%) provided assistance to state health departments, 12 (6%) to tribal health departments, 10 (5%) to local health departments, and eight (4%) to territorial health departments. CDC collaborations with health departments have strengthened local capacity and provided outbreak response support. Collaborations focused attention on health equity issues among disproportionately affected populations (e.g., racial and ethnic minority populations, essential frontline workers, and persons experiencing homelessness) and through a place-based focus (e.g., persons living in rural or frontier areas). These collaborations also facilitated enhanced characterization of COVID-19 epidemiology, directly contributing to CDC data-informed guidance, including guidance for serial testing as a containment strategy in high-risk congregate settings, targeted interventions and prevention efforts among workers at food processing facilities, and social distancing.


Asunto(s)
Centers for Disease Control and Prevention, U.S./organización & administración , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Administración en Salud Pública , Práctica de Salud Pública , Infecciones por Coronavirus/epidemiología , Humanos , Gobierno Local , Neumonía Viral/epidemiología , Gobierno Estatal , Estados Unidos/epidemiología
9.
Am J Public Health ; 110(7): 1092-1097, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32437281

RESUMEN

Objectives. To describe the ongoing collaboration of the Centers for Disease Control and Prevention's (CDC's) school vaccination assessment with state, local, and territorial immunization programs to provide data to monitor school entry vaccination.Methods. Departments of health and education partner to collect data from public school, private school, and homeschooled kindergartners in the 50 US states, the District of Columbia, 2 cities, and the US territories. Immunization programs submit vaccination coverage and exemption data to the CDC, and the CDC reports these data annually via multiple sources.Results. Among the 50 states and the District of Columbia, the number of programs using a census for vaccination coverage data increased from 39 to 41 during the school years 2012-2013 to 2017-2018 (which for most states was August or September through May or June), and the number using a census to collect exemption data increased from 40 to 46. The number of states that reported sharing their local-level vaccination coverage data online increased from 11 in 2012-2013 to 31 in 2017-2018.Conclusions. Coverage data can be used to address undervaccination among kindergartners to work with communities and schools that are susceptible to vaccine-preventable diseases. As more states publish local-level data online, access to improved data provides the public more valuable information.


Asunto(s)
Centers for Disease Control and Prevention, U.S./organización & administración , Programas de Inmunización/organización & administración , Cobertura de Vacunación/organización & administración , Vacunación/estadística & datos numéricos , Preescolar , Recolección de Datos , Humanos , Programas de Inmunización/estadística & datos numéricos , Instituciones Académicas , Estados Unidos
11.
Public Health Rep ; 135(3): 310-312, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32228126

RESUMEN

The Centers for Disease Control and Prevention (CDC) Global Rapid Response Team (GRRT) was launched in June 2015 to strengthen the capacity for international response and to provide an agency-wide roster of qualified surge-staff members who can deploy on short notice and for long durations. To assess GRRT performance and inform future needs for CDC and partners using rapid response teams, we analyzed trends and characteristics of GRRT responses and responders, for deployments of at least 1 day during October 1, 2018, through March 31, 2019. One hundred twenty deployments occurred during the study period, corresponding to 2645 person-days. The median deployment duration was 19 days (interquartile range, 5-30 days). Most deployments were related to emergency response (n = 2367 person-days, 90%); outbreaks of disease accounted for almost all deployment time (n = 2419 person-days, 99%). Most deployments were to Africa (n = 1417 person-days, 54%), and epidemiologists were the most commonly deployed technical advisors (n = 1217 person-days, 46%). This case study provides useful information for assessing program performance, prioritizing resource allocation, informing future needs, and sharing lessons learned with other programs managing rapid response teams. GRRT has an important role in advancing the global health security agenda and should continuously be assessed and adjusted to new needs.


Asunto(s)
Centers for Disease Control and Prevention, U.S./organización & administración , Centers for Disease Control and Prevention, U.S./estadística & datos numéricos , Planificación en Desastres/organización & administración , Brotes de Enfermedades/prevención & control , Salud Global , Fuerza Laboral en Salud/organización & administración , Humanos , Cooperación Internacional , Estados Unidos
12.
Medicine (Baltimore) ; 99(2): e18525, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914025

RESUMEN

Human immunodeficiency virus (HIV) testing is important for prevention and treatment. Ending the HIV epidemic is unattainable if significant proportions of people living with HIV remain undiagnosed, making HIV testing critical for prevention and treatment. The Centers for Disease Control and Prevention (CDC) recommends routine HIV testing for persons aged 13 to 64 years in all health care settings. This study builds on prior research by estimating the extent to which HIV testing occurs during physician office and emergency department (ED) post 2006 CDC recommendations.We performed an unweighted and weighted cross-sectional analysis using pooled data from 2 nationally representative surveys namely National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 2009 to 2014. We assessed routine HIV testing trends and predictive factors in physician offices and ED using multi-stage statistical survey procedures in SAS 9.4.HIV testing rates in physician offices increased by 105% (5.6-11.5 per 1000) over the study period. A steeper increase was observed in ED with a 191% (2.3-6.7 per 1000) increase. Odds ratio (OR) for HIV testing in physician offices were highest among ages 20 to 29 ([OR] 7.20, 99% confidence interval [CI: 4.37-11.85]), males (OR 1.34, [CI: 0.91-0.93]), African-Americans (OR 2.97, [CI: 2.05-4.31]), Hispanics (OR 1.80, [CI: 1.17-2.78]), and among visits occurring in the South (OR 2.06, [CI: 1.23-3.44]). In the ED, similar trends of higher testing odds persisted for African Americans (OR 3.44, 99% CI 2.50-4.73), Hispanics (OR 2.23, 99% CI 1.65-3.01), and Northeast (OR 2.24, 99% CI 1.10-4.54).While progress has been made in screening, HIV testing rates remains sub-optimal for ED visits. Populations visiting the ED for routine care may suffer missed opportunities for HIV testing, which delays their entry into HIV medical care. To end the epidemic, new approaches for increasing targeted routine HIV testing for populations attending health care settings is recommended.


Asunto(s)
Epidemias/prevención & control , Infecciones por VIH/epidemiología , VIH/aislamiento & purificación , Tamizaje Masivo/métodos , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Centers for Disease Control and Prevention, U.S./organización & administración , Estudios Transversales , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/etnología , Infecciones por VIH/prevención & control , Encuestas de Atención de la Salud/métodos , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Consultorios Médicos/estadística & datos numéricos , Pruebas Serológicas/métodos , Pruebas Serológicas/estadística & datos numéricos , Estados Unidos/epidemiología , Adulto Joven
13.
Am J Public Health ; 110(1): 27-31, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31725313

RESUMEN

The federal government has proposed an end to HIV transmission in the United States by 2030. Although the United States has made substantial overall progress in the fight against HIV/AIDS, data released by the Centers for Disease Control and Prevention have raised concerns about widening, yet largely unrecognized, HIV infection disparities among Hispanic and Latino populations.This commentary identifies underlying drivers of increasing new HIV infections among Hispanics/Latinos, discusses existing national efforts to fight HIV in Hispanic/Latino communities, and points to gaps in the federal response. Consideration of the underlying drivers of increased HIV incidence among Hispanics/Latinos is warranted to achieve the administration's 2030 HIV/AIDS goals.Specifically, the proposed reinforcement of national efforts to end the US HIV epidemic must include focused investment in four priority areas: (1) HIV stigma reduction in Hispanic/Latino communities, (2) the availability and accessibility of HIV treatment of HIV-positive Hispanics/Latinos, (3) the development of behavioral interventions tailored to Hispanic/Latino populations, and (4) the engagement of Hispanic/Latino community leaders.


Asunto(s)
Infecciones por VIH/etnología , Hispanoamericanos , Vacunas contra el SIDA , Antirretrovirales/uso terapéutico , Centers for Disease Control and Prevention, U.S./organización & administración , Participación de la Comunidad/métodos , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Conductas Relacionadas con la Salud/etnología , Accesibilidad a los Servicios de Salud/organización & administración , Homosexualidad Masculina/etnología , Humanos , Liderazgo , Masculino , Profilaxis Pre-Exposición/métodos , Vigilancia en Salud Pública , Asunción de Riesgos , Estigma Social , Personas Transgénero , Estados Unidos/epidemiología
14.
Public Health Rep ; 135(1): 18-24, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31722186

RESUMEN

OBJECTIVES: Supplemental federal funding is allocated to state and local tuberculosis (TB) programs using a formula that considers only countable cases reported to the National Tuberculosis Surveillance System (NTSS). Health departments submit reports of cases, which are countable unless another (US or international) jurisdiction has already counted the case or the case represents a recurrence of TB diagnosed ≤12 months after completion of treatment for a previous TB episode. Noncountable cases are a resource burden, so in 2009, NTSS began accepting noncountable case reports as an indicator of program burden. We sought to describe the volume and completeness of noncountable case reports. METHODS: We analyzed 2010-2014 NTSS data to determine the number and distribution of noncountable cases reported. We also surveyed jurisdictions to determine the completeness of noncountable case reporting and obtain information on jurisdictions' experience in reporting noncountable cases. In addition, we prepared a hypothetical recalculation of the funding formula to evaluate the effect of including noncountable cases on funding allocations. RESULTS: Of 54 067 TB case reports analyzed, 1720 (3.2%) were noncountable; 47 of 60 (78.3%) jurisdictions reported ≥1 noncountable case. Of 60 programs surveyed, 34 (56.7%) responded. Of the 34 programs that responded, 24 (70.6%) had not reported all their noncountable cases to NTSS, and 11 (32.4%) stated that reporting noncountable cases was overly burdensome, considering the cases were not funded. CONCLUSIONS: Complete data on noncountable TB cases help support estimates of programmatic burden. Ongoing training and a streamlined reporting system to NTSS can facilitate noncountable case reporting.


Asunto(s)
Centers for Disease Control and Prevention, U.S./organización & administración , Notificación Obligatoria , Vigilancia de la Población/métodos , Tuberculosis/epidemiología , Centers for Disease Control and Prevention, U.S./normas , Humanos , Estados Unidos/epidemiología
15.
Acta Trop ; 201: 105219, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31614120

RESUMEN

As the only specialized institution for research and control of parasitic diseases at the national level in China for almost 70 years, the National Institute of Parasitic Diseases (NIPD) at the Chinese Center for Disease Control and Prevention (China CDC) has been instrumental in supporting the remarkable progress from high prevalence to transmission interruption or low endemicity of several diseases, lymphatic filariasis, malaria and schistosomiasis in particular. This has taken place through technical guidance, emergency response and scientific research as well as providing technical service, education, training, health promotion and international cooperation. With China's increasing involvement in international cooperation and the increased risk for (re)emerging tropical diseases in mind, the Chinese Government designated in 2017 a new Chinese Center for Tropical Disease Research to NIPD. Responding to the expanded responsibilities, the institute is scaling up its activities in several ways: from parasitic diseases to the wider area of tropical diseases; from disease control to disease elimination; from biological research to policy evidences accumulation; and from public health to global health. Based on this new vision and China's previous accomplishments in the areas mentioned, the institute is in a position to move forward with respect to global health and equitable development according to the central principles of the United Nations' Sustainable Development Goals.


Asunto(s)
Centers for Disease Control and Prevention, U.S./organización & administración , Enfermedades Transmisibles/epidemiología , Salud Global/normas , Cooperación Internacional , Enfermedades Parasitarias/epidemiología , Salud Pública/normas , Medicina Tropical/normas , Academias e Institutos , Animales , China/epidemiología , Humanos , Objetivos Organizacionales , Estados Unidos
16.
Clin Neuropsychol ; 34(2): 259-277, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31530221

RESUMEN

Objective: In 2018, the Centers for Disease Control Prevention (CDC) published an evidence-based guideline on the diagnosis and management of mild traumatic brain injury (mTBI) among children. This commentary summarizes the key recommendations in the CDC Pediatric mTBI Guideline most relevant for neuropsychologists and discusses research gaps and topics that should receive attention in future iterations of the Guideline.Method: We described the methods used to develop the Guideline, which included a comprehensive Systematic Review. We also distilled and presented key practice strategies reflected in Guideline.Results: To optimize care of pediatric patients with mTBI, neuropsychologists should: use validated, age-appropriate symptom scales, assess evidence-based risk factors for prolonged recovery, provide patients with instructions on return to activity customized to their symptoms, and counsel patients to return gradually to nonsports activities after a short period of rest. Future iterations of the Guideline should encompass a review and guidance on care of patients with psychiatric and psychological difficulties, as well as the potential use of imaging to assess patients with persistent symptoms. Expanded research on mTBI among girls, children age 8 and under, and effective treatments for pediatric mTBI will be beneficial to inform care practices.Conclusions: Recommendations in the CDC Pediatric mTBI Guideline highlight multiple opportunities for neuropsychologists to take action to improve the care of young patients with mTBI and to advance research in the field. Multiple resources and tools are available to support implementation of these recommendations into clinical practice.


Asunto(s)
Lesiones Traumáticas del Encéfalo/diagnóstico , Centers for Disease Control and Prevention, U.S./organización & administración , Pruebas Neuropsicológicas/normas , Neuropsicología/organización & administración , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Factores de Riesgo , Estados Unidos
17.
J Public Health Manag Pract ; 26(2): 109-115, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-30789597

RESUMEN

CONTEXT: In response to numerous mumps outbreaks reported throughout the United States in 2016 and 2017, the Advisory Committee on Immunization Practices (ACIP) recommended a third dose of measles, mumps, and rubella (MMR) vaccine for groups of persons determined by public health authorities to be at increased risk for acquiring mumps because of an outbreak. OBJECTIVE: To provide guidance for health departments when implementing the ACIP recommendation. DESIGN: Draft guidance was developed by Centers for Disease Control and Prevention subject matter experts based on technical consultations with health departments and review of published and unpublished data regarding mumps outbreaks. The guidance was finalized based on input from experts from the ACIP Mumps Work Group and local and state epidemiologists through the Council of State and Territorial Epidemiologists and the National Association of County and City Health Officials. RESULTS: We developed guidance to assist public health authorities when determining which groups are at increased risk for acquiring mumps and should receive a third dose of MMR vaccine. During outbreaks, public health authorities identify groups of persons with known or likely close contact exposure to a mumps patient. Then, evidence of transmission and likelihood of transmission in a group's setting can be used to determine whether these groups are at increased risk. Additional epidemiologic and implementation factors may also be considered. All persons in the group at increased risk for acquiring mumps should receive a dose of MMR vaccine, including those with unknown vaccination status or those who have evidence of presumptive immunity other than documented 2 doses of MMR vaccine; no additional dose is recommended for persons who had received 3 or more doses before the outbreak. CONCLUSION: This guidance provides a framework for public health authorities to use when considering a third dose of MMR in response to mumps outbreaks while maintaining flexibility to incorporate local factors related to individual outbreaks.


Asunto(s)
Centers for Disease Control and Prevention, U.S./tendencias , Vacuna contra el Sarampión-Parotiditis-Rubéola/administración & dosificación , Centers for Disease Control and Prevention, U.S./organización & administración , Brotes de Enfermedades/prevención & control , Relación Dosis-Respuesta a Droga , Guías como Asunto , Humanos , Esquemas de Inmunización , Vacuna contra el Sarampión-Parotiditis-Rubéola/uso terapéutico , Estados Unidos
18.
Lupus ; 28(12): 1441-1451, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31594456

RESUMEN

OBJECTIVE: Lupus is a chronic, autoimmune disease that disproportionately affects African Americans. We adapted the Centers for Disease Control and Prevention's Popular Opinion Leader model to implement an intervention tailored for African American individuals that leverages an academic-community partnership and community-based social networks to disseminate culturally appropriate lupus education. METHODS: Academic rheumatologists, social scientists, and researchers in Boston, MA and Chicago, IL partnered with local lupus support groups, community organizations, and churches in neighborhoods with higher proportions of African Americans to develop curriculum and recruit community leaders with and without lupus (Popular Opinion Leaders; POLs). POLs attended four training sessions focused on lupus education, strategies to educate others, and a review of research methods. POLs disseminated information through their social networks and recorded their impact, which was mapped using a geographic information system framework. RESULTS: We trained 18 POLs in greater Boston and 19 in greater Chicago: 97% were African American, 97% were female; and the mean age was 57 years. Fifty-nine percent of Boston POLs and 68% of Chicago POLs had lupus. POLs at both sites engaged members of their social networks and communities in conversations about lupus, health disparities, and the importance of care. Boston POLs documented 97 encounters with 547 community members reached. Chicago POLs documented 124 encounters with 4083 community members reached. CONCLUSIONS: An adapted, community-based POL model can be used to disseminate lupus education and increase awareness in African American communities. Further research is needed to determine the degree to which this may begin to reduce disparities in access to care and outcomes.


Asunto(s)
Afroamericanos/educación , Concienciación , Redes Comunitarias/organización & administración , Lupus Eritematoso Sistémico/epidemiología , Adulto , Afroamericanos/psicología , Anciano , Centers for Disease Control and Prevention, U.S./organización & administración , Enfermedad Crónica , Redes Comunitarias/tendencias , Femenino , Sistemas de Información Geográfica/instrumentación , Promoción de la Salud/métodos , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Difusión de la Información/métodos , Liderazgo , Lupus Eritematoso Sistémico/prevención & control , Masculino , Persona de Mediana Edad , Opinión Pública , Proyectos de Investigación , Estados Unidos/etnología
19.
J Emerg Med ; 57(5): 597-602, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31594747

RESUMEN

BACKGROUND: The number of unintentional deaths due to prescription drug overdose has risen in recent years due to the increased utilization of opioid analgesics. Pain is one of the most common reasons for patients to visit an emergency department (ED) and is often treated with opioid analgesics. In 2016, the Centers for Disease Control and Prevention (CDC) released guidelines for primary care providers on prescribing opioids for chronic pain. OBJECTIVES: The objective of this study was to determine if release of the 2016 CDC guidelines for prescribing opioids for chronic pain was associated with changes in prescribing habits in the ED of an academic medical center. METHODS: The data were extracted from patient electronic health records between January 2015 and June 2017. The primary endpoint of the study was average morphine equivalent daily dose (MEDD) for the pre- and postguideline cohorts. RESULTS: A total of 8652 patients were included in the analysis (4389 in the preguideline cohort and 4263 in the postguideline cohort). The average MEDD decreased significantly from 30.6 ± 20.2 MEDD in the preguideline cohort to 29.8 ± 19.5 MEDD in the postguideline cohort (p = 0.0460). There was also a significant decrease in the rate of concomitant opioid and benzodiazepine prescribing as well as average days' supply per prescription in the postguideline cohort, as compared with the preguideline cohort. CONCLUSIONS: The average MEDD prescribed in the ED of an academic medical center decreased after the release of the CDC guidelines on opioid prescribing for chronic pain.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Dolor Crónico/tratamiento farmacológico , Guías como Asunto , Pautas de la Práctica en Medicina/normas , Adulto , Centers for Disease Control and Prevention, U.S./organización & administración , Centers for Disease Control and Prevention, U.S./estadística & datos numéricos , Estudios de Cohortes , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos
20.
Am J Public Health ; 109(11): 1548-1556, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31577488

RESUMEN

This article examines the rise of the Centers for Disease Control and Prevention's (CDC's) small but influential program on the human toxicology of synthetic pesticides after World War II. For nearly 20 years, scientists working in the CDC's Toxicology Section conducted a range of laboratory, field, and clinical studies to assess whether pesticides, such as dichlorodiphenyltrichloroethane (DDT), caused harm to humans. Applying an industrial hygiene approach to study pesticide toxicity, the team used the symptoms of poisoning as their criteria for harm and consistently found that, when used as intended, pesticides were generally safe for humans. In the post-Silent Spring era, these findings were increasingly challenged as the field of toxicology developed and different ways of understanding pesticide toxicity gained greater acceptance. While it is easy to dismiss the CDC's findings as excessively narrow, examining how the team arrived at their conclusions provides an instructive lesson about the powerful ways conceptual frameworks shape scientific inquiry and the unexpected ways data can be reinterpreted in different problem contexts. (Am J Public Health. 2019;109:1548-1556. doi: 10.2105/AJPH.2019.305260).


Asunto(s)
Centers for Disease Control and Prevention, U.S./historia , Centers for Disease Control and Prevention, U.S./organización & administración , Plaguicidas/toxicidad , DDT/envenenamiento , Historia del Siglo XX , Humanos , Plaguicidas/farmacología , Investigación/organización & administración , Estados Unidos
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