Community Health Needs Assessment Data and Community Recovery From COVID-19.

INTRODUCTION: The COVID-19 pandemic has had a significant impact beyond physical morbidity and mortality. A mid-cycle Community Health Needs Assessment survey was administered in 1 community to generate data to evaluate change in community well-being since the beginning of the pandemic. METHODS: Surveys were mailed to 2,000 randomly selected residents in Olmsetd County, Minnesota. The surveys included the WHO Well-being Index (previously included in the 2018 Community Health Needs Assessment) and new subjective questions regarding behavior change. Changes in well-being were calculated using a propensity-matched cohort, and behavior change was reported as proportions of the whole. Data analysis was completed in 2021. RESULTS: Total survey respondents were 569 people in 2018 and 723 people in 2021. Well-being scores from the WHO Well-being Index showed a statistically significant decrease (score reduction of -8.44) from 2018 to 2021. All the 5 questions from the WHO Well-being Index also had an individual significant decrease; with the question regarding interest in life showing the greatest decrease. Individuals reported decreased subjective physical and mental well-being and increased substance use (alcohol, marijuana, and tobacco). Households also reported decreased household incomes and worse household finances since the start of the pandemic. CONCLUSIONS: Using the Community Health Needs Assessment infrastructure, 1 community was able to compare prepandemic with postpandemic data, which showed decreased well-being and increased substance use and financial stress. Other public health planners can similarly conduct interval surveys on the basis of their Community Health Needs Assessment questionnaires to tailor ongoing Community Health Improvement Plan programming to postpandemic needs and track community mental health and well-being recovery.

Evaluating Well-being at Community Level.

OBJECTIVE: To measure well-being at a community level using a valid instrument. PATIENTS AND METHODS: Written surveys were mailed to a random sample of residents in Olmsted County, Minnesota, in 2015 and 2019 including the 5-item World Health Organization Well-being Index (0-100; for which 100 is the best imaginable well-being or quality of life). Multivariable hierarchical regression was used to evaluate the association between well-being and demographic characteristics, comorbid conditions, and environmental factors. RESULTS: The survey was returned by 1232 of 4000 individuals (response rate, 30.80%). The average well-being score was 70.02. Impaired well-being was identified in 223/1187 individuals (18.79%). Adjusted regression models showed that impaired well-being was independently associated with household poverty, financial stress, reduced access to medical or mental health care, ever having depression diagnosed, living in an unsafe community, or being socially isolated. CONCLUSION: One in 5 people in a county in the US Midwest have impaired well-being. Well-being was associated with several modifiable factors. Data provide a rationale for policies that align transportation and housing and create opportunities for community members to connect and interact in a safe environment.

Measles Outbreak at a Privately Operated Detention Facility: Arizona, 2016.

BACKGROUND: We describe a measles outbreak and control measures implemented at a privately operated detention facility housing US Immigration and Customs Enforcement detainees in 2016. METHODS: Case-patients reported fever and rash and were either laboratory-confirmed or had an epidemiological link to a laboratory-confirmed case-patient. Immunoglobulin G (IgG) avidity and plaque reduction neutralization tests distinguished between primary acute and reinfection case-patients. Measles-specific IgG was measured to assess detainee immunity levels. We compared attack rates (ARs) among detainees and staff, between IgG-negative and IgG-positive detainees, and by detainee housing units and sexes. RESULTS: We identified 32 measles case-patients (23 detainees, 9 staff); rash onsets were during 6 May-26 June 2016. High IgG avidity and neutralizing-antibody titers >40000 to measles (indicating reinfection) were identified in 18 (95%) and 15 (84%) of 19 tested case-patients, respectively. Among 205 unit A detainees tested for presumptive immunity, 186 (91%) had detectable IgG. Overall, the AR was 1.65%. ARs were significantly higher among detainees in unit A (7.05%) compared with units B-F (0.59%), and among male (2.33%) compared with female detainees (0.38%); however, ARs were not significantly different between detainees and staff or between IgG-negative and IgG-positive detainees. Control measures included the vaccination of 1424 of 1425 detainees and 190 of 510 staff, immunity verification for 445 staff, case-patient isolation, and quarantine of affected units. CONCLUSIONS: Although ARs were low, measles outbreaks can occur in intense-exposure settings, despite a high population immunity, underscoring the importance of high vaccination coverage and containment in limiting measles transmission.

Notes from the Field: Strongyloidiasis at a Long-Term-Care Facility for the Developmentally Disabled - Arizona, 2015.

Strongyloides stercoralis is an intestinal nematode endemic in the tropics and subtropics. Infection is usually acquired through skin contact with contaminated soil, or less commonly, from person to person through fecal contamination of the immediate environment. Infections are often asymptomatic, but can result in a pruritic rash, respiratory symptoms (e.g., cough or wheeze), and gastrointestinal symptoms (e.g., diarrhea and vomiting). Immunosuppressed persons can develop strongyloides hyperinfection syndrome, which can be fatal (1). In June 2015, the Pinal County Public Health Services District in Arizona was notified of a suspected strongyloidiasis infection in a resident of a long-term-care facility for developmentally disabled persons. The patient had anemia and chronic eosinophilia. The patient's serum tested positive for S. stercoralis-specific immunoglobulin G (IgG) by a commercial enzyme-linked immunosorbent assay (ELISA) and at CDC by a crude antigen ELISA, a quantitative assay for detection of IgG against S. stercoralis. An investigation was conducted to determine the infection source and identify additional cases.

Outbreak of Botulism After Consumption of Illicit Prison-Brewed Alcohol in a Maximum Security Prison--Arizona, 2012.

The authors investigated the second botulism outbreak to occur in a maximum security prison in Arizona within a 4-month period. Botulism was confirmed in eight men aged 20 to 35 years who reported sharing a single batch of pruno made with potatoes. Initial symptoms included blurred vision, slurred speech, muscle weakness, ptosis, and dysphagia. All patients received heptavalent botulinum antitoxin, seven required mechanical ventilation, and all survived. The median incubation period was 29 hours. Sera from all patients and leftover pruno tested positive for botulinum toxin type A. Botulism should be considered among prisoners with cranial nerve palsies and descending, symmetric flaccid paralysis. Prison-brewed alcohol, particularly when made with potatoes, can be a vehicle for botulism and is associated with outbreaks of botulism in prisons.

Alcohol Production, Prevention Strategies, and Inmate Knowledge About the Risk for Botulism From Pruno Consumption in a Correctional Facility--Arizona, 2013.

During July to November 2012, two botulism outbreaks (12 cases total) occurred in one all-male prison; both were associated with illicitly brewed alcohol (pruno) consumption. Inmate surveys were conducted to evaluate and develop prevention and education strategies. Qualitative surveys with open-ended questions were performed among inmates from rooms where outbreaks occurred to learn about pruno consumption. Quantitative surveys assessed knowledge gained after the outbreaks and preferred information sources. For the quantitative surveys, 250 inmates were randomly selected by bed from across the correctional facility and 164 inmates were interviewed. Only 24% of inmates reported any botulism knowledge before the outbreaks and education outreach, whereas 73% reported knowledge after the outbreaks (p < .01). Preferred information sources included handouts/fliers (52%) and the prison television channel (32%).

Modifiable risk factors for West Nile virus infection during an outbreak--Arizona, 2010.

West Nile virus (WNV) is the leading cause of mosquito-borne disease in the United States; however, risk factors for infection are poorly defined. We performed a case-control study to identify modifiable risk factors for WNV infection. Case-patients (N = 49) had laboratory evidence of recent WNV infection, whereas control-subjects (N = 74) had negative WNV serology. We interviewed participants, surveyed households, and assessed environmental data. WNV infection was associated with living in or near Water District X within Gilbert Township (adjusted odds ratio [aOR] 5.2; 95% confidence interval [95% CI] = 1.5-18.1), having water-holding containers in their yard (aOR 5.0; 95% CI = 1.5-17.3), and not working or attending school outside the home (aOR 2.4; 95% CI = 1.1-5.5). During this outbreak, WNV infection was likely primarily acquired peri-domestically with increased risk associated with potential mosquito larval habitats around the home and neighborhood.