Assessing functional needs sheltering in Pike County, Kentucky: using a community assessment for public health emergency response.

OBJECTIVE: During 2009-2011, Pike County, Kentucky, experienced a series of severe weather events that resulted in property damage, insufficient potable water, and need for temporary shelters. A Community Assessment for Public Health Emergency Response (CASPER) survey was implemented for future planning. CASPER assesses household health status, preparedness level, and anticipated demand for shelters. METHODS: We used a 2-stage cluster sampling design to randomly select 210 representative households for in-person interviews. We estimated the proportion of households with children aged 2 years or younger; adults aged 65 years or older; and residents with chronic health conditions, visual impairments, physical limitations, and supplemental oxygen requirements. RESULTS: Of all households surveyed, 8% included children aged 2 years or younger, and 27% included adults aged 65 years or older. The most common chronic health conditions were heart disease (51%), diabetes (28%), lung disease (23%), and asthma (21%). Visual impairments were reported in 29% of households, physical limitations in 24%, and supplemental oxygen use in 12%. CONCLUSIONS: Pike County residents should be encouraged to maintain an adequate supply of medications and copies of their prescriptions. Emergency response plans should include transportation for persons with physical limitations; and shelter plans should include sufficient medically trained staff and adequate supplies of infant formula, pharmaceuticals, and supplemental oxygen. (Disaster Med Public Health Preparedness. 2013;7:597-602).

Tightly clustered outbreak of group A streptococcal disease at a long-term care facility.

OBJECTIVE: To describe investigation of a tightly clustered outbreak of invasive group A streptococcal (GAS) disease associated with a high mortality rate in a long-term care facility (LTCF). DESIGN: Cross-sectional carriage survey and epidemiologic investigation of LTCF resident and employee cohorts. SETTING: A 104-bed community LTCF between March 1 and April 7, 2004. PATIENTS: A cohort of LTCF residents with assigned beds at the time of the outbreak. INTERVENTIONS: Reinforcement of standard infection control measures and receipt of chemoprophylaxis by GAS carriers. RESULTS: Four confirmed and 2 probable GAS cases occurred between March 16 and April 1, 2004. Four case patients died. The final case occurred during the investigation, before the patient was determined to be a GAS carrier. No case occurred during the 6 months after the intervention. Disease was caused by type emm3 GAS; 16.5% of residents and 2.4% of employees carried the outbreak strain. Disease was clustered in 1 quadrant of the LTCF and associated with nonintact skin. GAS disease or carriage was associated with having frequent personal visitors. CONCLUSIONS: Widespread carriage of a virulent GAS strain likely resulted from inadequate infection control measures. Enhanced infection control and targeted prophylaxis for GAS carriers appeared to end the outbreak. In addition to employees, regular visitors to LTCFs should be trained in hand hygiene and infection control because of the potential for extended relationships over time, leading to interaction with multiple residents, and disease transmission in such residential settings. Specific attention to prevention of skin breaks and proper wound care may prevent disease. The occurrence of a sixth case during the investigation suggests urgency in addressing severe, large, or tightly clustered outbreaks of GAS infection in LTCFs.

Outbreak of poliomyelitis due to type 3 poliovirus, northern India, 1999-2000: injections a major contributing factor.

BACKGROUND: A large outbreak of poliomyelitis due to poliovirus type 3 (P3) occurred in India in 1999. This raised concerns about oral poliovirus vaccine (OPV) effectiveness, particularly the type 3 component, in preventing clinical disease and offered an opportunity to describe the epidemiology of a P3 outbreak. METHODS: We reviewed data collected by the National Polio Surveillance Project to describe the outbreak and conducted a case-control study to determine risk factors for the development of paralytic poliomyelitis. The P3 cases with paralysis onset in 2000 were enrolled with four controls per case, matched for age and neighbourhood. RESULTS: Of 1126 virologically confirmed poliomyelitis cases reported in 1999, 719 (64%) were due to P3. We enrolled 48 (80%) of 60 cases and 175 matched controls. Age (30.6 months, cases versus 30.4 months, controls) and vaccination status (median 5.8 OPV doses, cases versus 6.1 OPV doses, controls) were similar among cases and controls. The only significant difference between the groups was the proportion that received any injection in the last 30 days prior to paralysis onset or the corresponding reference date for controls (35.4% versus 12.3%, adjusted odds ratio [OR] = 3.9, 95% CI: 1.8-12.5). CONCLUSIONS: Cases and controls had similar vaccination histories. The only significant risk factor for paralytic illness was having received any injection in the 30 days before onset. Our study confirms that injections administered during the poliovirus incubation period can provoke paralytic poliomyelitis. Injections in polio-endemic countries should only be indicated when other therapeutic options have failed or are not available.

Compatible poliomyelitis cases in India during 2000.

OBJECTIVE: To describe the characteristics of compatible poliomyelitis cases and to assess the programmatic implications of clusters of such cases in India. METHODS: We described the characteristics of compatible poliomyelitis cases, identified clusters of compatible cases (two or more in the same district or neighbouring districts within two months), and examined their relationship to wild poliovirus cases. FINDINGS: There were 362 compatible cases in 2000. The incidence of compatible cases was higher in districts with laboratory-confirmed poliomyelitis cases than in districts without laboratory-confirmed cases. Of 580 districts, 96 reported one compatible case and 72 reported two or more compatible cases. Among these 168 districts with at least one compatible case, 123 had internal or cross- border clusters of compatible cases. In 27 districts with clusters of compatible cases, no wild poliovirus was isolated either in the same district or in neighbouring districts. Three of these 27 districts presented laboratory-confirmed poliomyelitis cases during 2001. CONCLUSION: Most clusters of compatible cases occurred in districts identified as areas with continuing wild poliovirus transmission and where mopping-up vaccination campaigns were carried out. As certification nears, areas with compatible poliomyelitis cases should be investigated and deficiencies in surveillance should be corrected in order to ensure that certification is justified.

Predictors of virologically confirmed poliomyelitis in India, 1998-2000.

As we progress toward eradication of polio, a growing proportion of cases of acute flaccid paralysis (AFP) reported are due to causes other than polio. AFP surveillance data from India for 1998-2000 were analyzed to determine the sensitivity and specificity of signs and symptoms present at initial case investigation and of residual weakness (which is used to classify AFP cases) for virologically confirmed poliomyelitis. Sensitivity was highest for age of <5 years (93%-97%) and residual weakness (74%-96%). Residual weakness was more sensitive among children aged <5 years. Cases of AFP in patients aged <5 years who have fever and asymmetrical paralysis are most likely to be confirmed as poliomyelitis. In countries with suboptimal surveillance for AFP, these results may help to prioritize investigation of AFP cases. The high sensitivity of residual weakness demonstrates the importance of 60-day follow-up examination for all patients with AFP, particularly those for whom the initial case investigation was inadequate or delayed.

Vibrio Infections Associated with Raw Oyster Consumption in Florida, 1981-1994.

While the problem of raw-oyster-associated Vibrio vulnificus infection is well known, less is known about other Vibrio infections associated with raw oyster consumption. Case reports of 333 patients with raw-oyster-associated infections with V. vulnificus and other Vibrio species reported in Florida from 1981 through 1994 were reviewed to define the epidemiology of these infections. The average annual incidence of raw-oyster-associated Vibrio infection was 10.1 per 1,000,000 raw oyster-consuming adults (95% confidence interval: 8.3 to 11.9). Infection resulted in gastroenteritis for 231 (69%) patients, of whom 97 (42%) were hospitalized for a mean length of stay of 4.9 days, and 2 (1%) died. Vibrio species most often identified in patients with gastroenteritis included V. parahaemolyticus (29%), V. cholerae non-Ol (28%), V. hollisae (15%), and V.mimicus (12%). The remaining 102 (31 %) patients with raw-oyster-associated Vibrio infections developed primary septicemia and 50 (49%) died. Primary septicemia resulted from infection with V. vulnificus (80%), v. parahaemolyticus (9%), V. cholerae non-O1 (8%), and V. hollisae (3%). Non- V. vulnificus species accounted for 72% of all raw-oyster-associated Vibrio infections, and differed from infections with V. vulnificus in their lack of a seasonal distribution and the absence of underlying medical conditions in infected patients. These findings emphasize that Vibrio species other than V. vulnificus are more commonly associated with raw oyster consumption, are capable of producing significant morbidity, and may not be controlled by measures such as seasonal marketing restrictions and targeted education of high-risk? consumers that have been proposed to prevent infection with V. vulnificus.