Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-21 (of 21 Records) |
Query Trace: Alroy K [original query] |
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Notes from the field: First reported U.S. Cases of tinea caused by Trichophyton indotineae - New York City, December 2021-March 2023
Caplan AS , Chaturvedi S , Zhu Y , Todd GC , Yin L , Lopez A , Travis L , Smith DJ , Chiller T , Lockhart SR , Alroy KA , Greendyke WG , Gold JAW . MMWR Morb Mortal Wkly Rep 2023 72 (19) 536-537 Tinea is a common, highly contagious, superficial infection of the skin, hair, or nails caused by dermatophyte molds.* During the past decade, an epidemic of severe, antifungal-resistant tinea has emerged in South Asia because of the rapid spread of Trichophyton indotineae,† a novel dermatophyte species; the epidemic has likely been driven by misuse and overuse of topical antifungals and corticosteroids§ (1,2). T. indotineae infections are highly transmissible and characterized by widespread, inflamed, pruritic plaques on the body (tinea corporis), the crural fold, pubic region, and adjacent thigh (tinea cruris), or the face (tinea faciei) (1). T. indotineae isolates are frequently resistant to terbinafine, a mainstay of tinea treatment (1,3). T. indotineae infections have been reported throughout Asia and in Europe and Canada but have not previously been described in the United States (3). | | On February 28, 2023, a New York City dermatologist notified public health officials of two patients who had severe tinea that did not improve with oral terbinafine treatment, raising concern for potential T. indotineae infection; these patients shared no epidemiologic links. Skin culture isolates from each patient were previously identified by a clinical laboratory as Trichophyton mentagrophytes and were subsequently forwarded to the Wadsworth Center, New York State Department of Health, for further review and analysis. Sanger sequencing of the internal transcribed spacer region of the ribosomal gene, followed by phylogenetic analysis performed during March 2023, identified the isolates as T. indotineae (Supplementary Figure; https://stacks.cdc.gov/view/cdc/127678). Activity related to this investigation was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.¶ |
Notes from the field: Posttreatment lesions after tecovirimat treatment for mpox - New York City, August-September 2022
Seifu L , Garcia E , McPherson TD , Lash M , Alroy KA , Foote M , Lee EH , Kwong J , Radix A , Riska P , Zucker J , Zuercher S , Wong M . MMWR Morb Mortal Wkly Rep 2023 72 (17) 471-472 Monkeypox virus is an orthopoxvirus that can cause substantial morbidity due to skin and mucosal lesions (1). During the 2022 multinational Monkeypox (mpox) outbreak, tecovirimat, an antiviral medication approved for the treatment of smallpox, was used as an investigational treatment for severe mpox. However, efficacy and optimal treatment duration are still being investigated (1,2). In a late 2022 assessment of the use of tecovirimat for treatment of mpox under the expanded access Investigational New Drug protocol, three patients were found to have developed new lesions after completing treatment (3). This report describes a series of patients in New York City (NYC) with mpox who also developed new lesions after completing tecovirimat treatment, suggesting that posttreatment lesions might occur more commonly than previously reported. | | A case of posttreatment mpox lesions was defined as the occurrence of new skin or mucosal lesions in an NYC resident with probable or confirmed mpox (4), emerging ≤30 days after completing the recommended 14-day tecovirimat treatment course, after improvement or resolution of initial mpox lesions. During August–September 2022, health care providers voluntarily reported 10 such cases to the NYC Department of Health and Mental Hygiene (DOHMH). Providers were asked to complete a survey detailing patient demographic and clinical characteristics and illness course. Descriptive analyses were performed on the nine surveys submitted. |
Notes from the field: Clinical and epidemiologic characteristics of mpox cases from the initial phase of the outbreak - New York city, May 19-July 15, 2022
Kyaw NTT , Kipperman N , Alroy KA , Baumgartner J , Crawley A , Peterson E , Ross A , Fowler RC , Ruiz VE , Leelawong M , Hughes S , Juste-Tranquille M , Lovingood K , Joe CD , Chase M , Shinall A , Ackelsberg J , Bergeron-Parent C , Badenhop B , Slavinski S , Reddy V , Lee EH . MMWR Morb Mortal Wkly Rep 2022 71 (5152) 1631-1633 Monkeypox virus (MPXV), an Orthopoxvirus that can cause monkeypox (mpox) disease in humans, was rarely seen outside Africa before 2022. Since May 2022, mpox has been reported in multiple countries and regions without endemic transmission, including the United States (1). New York City (NYC) quickly became one of the major foci of the 2022 outbreak after the first case in a NYC resident was diagnosed on May 19.* Epidemiologic profiles and clinical characteristics of mpox cases in the United States during this outbreak have been described (2,3), but previous summaries were limited by incomplete data or inclusion of only a subset of cases (2,3). Most case investigation data from mpox cases reported to the NYC Department of Health and Mental Hygiene (DOHMH) surveillance system have a high degree of completeness for gender, race or ethnicity, sexual orientation, and clinical signs and symptoms. To describe the characteristics of mpox in NYC, case investigation data for NYC residents with mpox diagnosed during May 19–July 15, 2022, were analyzed. Using a standardized form, DOHMH staff members attempted to interview all NYC residents with probable (a positive non-variola Orthopoxvirus polymerase chain reaction [PCR] test result)† or confirmed (a positive MPXV–specific PCR test result) mpox reported to DOHMH through mandated laboratory reporting. For patients who declined an interview or were unreachable, information obtained from medical care providers during DOHMH consultation calls was used. This activity was reviewed by CDC and conducted consistent with applicable federal law and CDC policy.§ |
Psychological and physical intimate partner violence, measured by the New York City Community Health Survey - New York City, 2018
Alroy KA , Wang A , Sanderson M , Gould LH , Stayton C . J Fam Violence 2022 1-12 PURPOSE: Intimate partner violence (IPV) can damage long-term physical and mental health, yet IPV prevalence in New York City (NYC) is unknown. We described prevalence and health correlates of psychological and physical IPV in NYC. METHOD: The 2018 NYC Community Health Survey, a representative telephone survey among adult residents, asked about lifetime psychological or physical IPV experiences. We estimated age-adjusted physical and psychological prevalence, stratified by demographic variables, and created log-linear multivariable models with 95% CIs to measure the association of each IPV type with health conditions and behaviors. RESULTS: Overall, 10,076 surveys were completed. We excluded responses with missing IPV values. Of 9,945 adults, 16.7% reported ever having experienced psychological IPV; higher prevalence among females (18.6%; CI:17.0-20.2) than males (14.5%; CI:13.1-16.2). Prevalence of not getting needed mental health treatment (PR: 4.5; CI:3.3-6.1) and current depression (PR:2.6 CI:2.1-3.1) was higher among adults who had ever experienced psychological IPV, compared with those who had not. Of 9,964 adults, 9.8% reported ever having experienced physical IPV; higher prevalence among females (12.4%; CI:11.1-13.8) than males (6.8%; CI:5.8-8.0). Prevalence of not getting needed mental health treatment (PR:3.9, CI:2.8-5.4) and current depression (PR:2.6, CI:2.1-3.2) was higher among adults who had ever experienced physical IPV, compared with those who had not. CONCLUSIONS: One in six (16.7%) and one in 10 (9.8%) NYC adults reported ever experiencing psychological IPV and ever experiencing physical IPV, respectively. Key implications suggest that IPV potentially underlies public health priority health conditions and behaviors. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10896-022-00442-1. |
Epidemiologic and clinical characteristics of Monkeypox cases - United States, May 17-July 22, 2022
Philpott D , Hughes CM , Alroy KA , Kerins JL , Pavlick J , Asbel L , Crawley A , Newman AP , Spencer H , Feldpausch A , Cogswell K , Davis KR , Chen J , Henderson T , Murphy K , Barnes M , Hopkins B , Fill MA , Mangla AT , Perella D , Barnes A , Hughes S , Griffith J , Berns AL , Milroy L , Blake H , Sievers MM , Marzan-Rodriguez M , Tori M , Black SR , Kopping E , Ruberto I , Maxted A , Sharma A , Tarter K , Jones SA , White B , Chatelain R , Russo M , Gillani S , Bornstein E , White SL , Johnson SA , Ortega E , Saathoff-Huber L , Syed A , Wills A , Anderson BJ , Oster AM , Christie A , McQuiston J , McCollum AM , Rao AK , Negrón ME . MMWR Morb Mortal Wkly Rep 2022 71 (32) 1018-1022 Monkeypox, a zoonotic infection caused by an orthopoxvirus, is endemic in parts of Africa. On August 4, 2022, the U.S. Department of Health and Human Services declared the U.S. monkeypox outbreak, which began on May 17, to be a public health emergency (1,2). After detection of the first U.S. monkeypox case), CDC and health departments implemented enhanced monkeypox case detection and reporting. Among 2,891 cases reported in the United States through July 22 by 43 states, Puerto Rico, and the District of Columbia (DC), CDC received case report forms for 1,195 (41%) cases by July 27. Among these, 99% of cases were among men; among men with available information, 94% reported male-to-male sexual or close intimate contact during the 3 weeks before symptom onset. Among the 88% of cases with available data, 41% were among non-Hispanic White (White) persons, 28% among Hispanic or Latino (Hispanic) persons, and 26% among non-Hispanic Black or African American (Black) persons. Forty-two percent of persons with monkeypox with available data did not report the typical prodrome as their first symptom, and 46% reported one or more genital lesions during their illness; 41% had HIV infection. Data suggest that widespread community transmission of monkeypox has disproportionately affected gay, bisexual, and other men who have sex with men and racial and ethnic minority groups. Compared with historical reports of monkeypox in areas with endemic disease, currently reported outbreak-associated cases are less likely to have a prodrome and more likely to have genital involvement. CDC and other federal, state, and local agencies have implemented response efforts to expand testing, treatment, and vaccination. Public health efforts should prioritize gay, bisexual, and other men who have sex with men, who are currently disproportionately affected, for prevention and testing, while addressing equity, minimizing stigma, and maintaining vigilance for transmission in other populations. Clinicians should test patients with rash consistent with monkeypox,(†) regardless of whether the rash is disseminated or was preceded by prodrome. Likewise, although most cases to date have occurred among gay, bisexual, and other men who have sex with men, any patient with rash consistent with monkeypox should be considered for testing. CDC is continually evaluating new evidence and tailoring response strategies as information on changing case demographics, clinical characteristics, transmission, and vaccine effectiveness become available.(§). |
Adapting Survey Data Collection to Respond to the COVID-19 Pandemic: Experiences From a Local Health Department.
Seligson AL , Alroy KA , Sanderson M , Maleki AN , Fernandez S , Aviles A , Dumas SE , Perlman SE , Peebles K , Norman CC , Gwynn RC , Gould LH . Am J Public Health 2021 111 (12) 2176-2185 The New York City (NYC) Department of Health and Mental Hygiene ("Health Department") conducts routine surveys to describe the health of NYC residents. During the COVID-19 pandemic, the Health Department adjusted existing surveys and developed new ones to improve our understanding of the impact of the pandemic on physical health, mental health, and social determinants of health and to incorporate more explicit measures of racial inequities. The longstanding Community Health Survey was adapted in 2020 to ask questions about COVID-19 and recruit respondents for a population-based severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurvey. A new survey panel, Healthy NYC, was launched in June 2020 and is being used to collect data on COVID-19, mental health, and social determinants of health. In addition, 7 Health Opinion Polls were conducted from March 2020 through March 2021 to learn about COVID-19-related knowledge, attitudes, and opinions, including vaccine intentions. We describe the contributions that survey data have made to the emergency response in NYC in ways that address COVID-19 and the profound inequities of the pandemic. (Am J Public Health. 2021;111(12):2176-2185. https://doi.org/10.2105/AJPH.2021.306515). |
Prevalence of SARS-CoV-2 Antibodies in New York City Adults, June-October 2020: A Population-Based Survey.
Parrott JC , Maleki AN , Vassor VE , Osahan S , Hsin Y , Sanderson M , Fernandez S , Levanon Seligson A , Hughes S , Wu J , DeVito AK , LaVoie SP , Rakeman JL , Gould LH , Alroy KA . J Infect Dis 2021 224 (2) 188-195 BACKGROUND: Serosurveys help to ascertain burden of infection. Prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurveys in New York City (NYC) used nonrandom samples. During June-October 2020, the NYC Health Department conducted a population-based survey estimating SARS-CoV-2 antibody prevalence in NYC adults. METHODS: Participants were recruited from the NYC 2020 Community Health Survey. We estimated citywide and stratified antibody prevalence using a hybrid design: serum tested with the DiaSorin LIAISON SARS-CoV-2 S1/S2 IgG assay and self-reported antibody test results were used together. We estimated univariate frequencies and 95% confidence intervals (CI), accounting for complex survey design. Two-sided P values ≤ .05 were statistically significant. RESULTS: There were 1074 respondents; 497 provided blood and 577 provided only a self-reported antibody test result. Weighted prevalence was 24.3% overall (95% CI, 20.7%-28.3%). Latino (30.7%; 95% CI, 24.1%-38.2%; P < .01) and black (30.7%; 95% CI, 21.9%-41.2%; P = .02) respondents had a higher weighted prevalence compared with white respondents (17.4%; 95% CI, 12.5%-23.7%). CONCLUSIONS: By October 2020, nearly 1 in 3 black and 1 in 3 Latino NYC adults had SARS-CoV-2 antibodies, highlighting unequal impacts of the coronavirus disease 2019 (COVID-19) pandemic on black and Latino NYC adults. |
Population-based Estimates of COVID-19-like Illness, COVID-19 Illness, and Rates of Case Ascertainment, Hospitalizations, and Deaths - Non-Institutionalized New York City Residents, March-April 2020.
Alroy KA , Crossa A , Dominianni C , Sell J , Bartley K , Sanderson M , Fernandez S , Levanon Seligson A , Lim SW , Wang SM , Dumas SE , Perlman SE , Konty K , Olson DR , Gould LH , Greene SK . Clin Infect Dis 2021 73 (9) 1707-1710 Using a population-based, representative telephone survey, ~930,000 New York City residents had COVID-19 illness beginning March 20-April 30, 2020, a period with limited testing. For every 1000 persons estimated with COVID-19 illness, 141.8 were tested and reported as cases, 36.8 were hospitalized, and 12.8 died, varying by demographic characteristics. |
Etiology of severe acute respiratory infections, Bangladesh, 2017
Rahaman MR , Alroy KA , Van Beneden CA , Friedman MS , Kennedy ED , Rahman M , Balajee A , Muraduzzaman AKM , Shirin T , Flora MS , Azziz-Baumgartner E . Emerg Infect Dis 2021 27 (1) 324-326 In April 2017, surveillance detected a surge in severe acute respiratory infections (SARI) in Bangladesh. We collected specimens from SARI patients and asymptomatic controls for analysis with multipathogen diagnostic tests. Influenza A(H1N1)pdm09 was associated with the SARI epidemic, suggesting that introducing vaccines and empiric antiviral drugs could be beneficial. |
Factors associated with Candida auris colonization and transmission in skilled nursing facilities with ventilator units, New York, 2016-2018
Rossow J , Ostrowsky B , Adams E , Greenko J , McDonald R , Vallabhaneni S , Forsberg K , Perez S , Lucas T , Alroy K , Slifka KJ , Walters M , Jackson BR , Quinn M , Chaturvedi S , Blog D . Clin Infect Dis 2020 72 (11) e753-e760 BACKGROUND: Candida auris is an emerging, multidrug-resistant yeast that spreads in healthcare settings. People colonized with C. auris can transmit this pathogen and are at risk for invasive infections. New York State (NYS) has the largest U.S. burden (>500 colonized and infected people); many colonized individuals are mechanically ventilated or have tracheostomy and are residents of ventilator-capable skilled nursing facilities (vSNF). We evaluated factors associated with C. auris colonization among vSNF residents to inform prevention interventions. METHODS: During 2016-2018, the NYS Department of Health conducted point prevalence surveys (PPS) to detect C. auris colonization among residents of vSNFs. In a case-control investigation, we defined a case as C. auris colonization in a resident and identified up to four residents with negative swabs during the same PPS as controls. We abstracted data from medical records on facility transfers, antimicrobials, and medical history. RESULTS: We included 60 cases and 218 controls identified from 6 vSNFs. After controlling for potential confounders, the following characteristics were associated with C. auris colonization: being on a ventilator (aOR: 5.9; CI: 2.3-15.4), receiving carbapenem antibiotics in the prior 90 days (aOR: 3.5; CI: 1.6-7.6), having ≥1 acute care hospital visit in the prior six months (aOR: 4.2; CI: 1.9-9.6), and receiving systemic fluconazole in the prior 90 days (aOR: 6.0; CI: 1.6-22.6). CONCLUSIONS: Targeted screening of patients in vSNFs with the above risk factors for C. auris can help identify colonized patients and facilitate implementation of infection control measures. Antimicrobial stewardship may be an important factor in the prevention of C. auris colonization. |
Community-based surveillance in Cote d'Ivoire
Clara A , Ndiaye SM , Joseph B , Nzogu MA , Coulibaly D , Alroy KA , Gourmanon DC , Diarrassouba M , Toure-Adechoubou R , Houngbedji KA , Attiey HB , Balajee SA . Health Secur 2020 18 S23-s33 Community-based surveillance can be an important component of early warning systems. In 2016, the Cote d'Ivoire Ministry of Health launched a community-based surveillance project in 3 districts along the Guinea border. Community health workers were trained in detection and immediate reporting of diseases and events using a text-messaging platform. In December 2017, surveillance data from before and after implementation of community-based surveillance were analyzed in intervention and control districts. A total of 3,734 signals of priority diseases and 4,918 unusual health events were reported, of which 420 were investigated as suspect diseases and none were investigated as unusual health events. Of the 420 suspected cases reported, 23 (6%) were laboratory confirmed for a specific pathogen. Following implementation of community-based surveillance, 5-fold and 8-fold increases in reporting of suspected measles and yellow fever clusters, respectively, were documented. Reporting incidence rates in intervention districts for suspected measles, yellow fever, and acute flaccid paralysis were significantly higher after implementation, with a difference of 29.2, 19.0, and 2.5 cases per 100,000 person-years, respectively. All rate differences were significantly higher in intervention districts (p < 0.05); no significant increase in reporting was noted in control districts. These findings suggest that community-based surveillance strengthened detection and reporting capacity for several suspect priority diseases and events. However, the surveillance program was very sensitive, resulting in numerous false-positives. Learning from the community-based surveillance implementation experience, the ministry of health is revising signal definitions to reduce sensitivity and increase specificity, reviewing training materials, considering scaling up sustainable reporting platforms, and standardizing community health worker roles. |
Strengthening timely detection and reporting of unusual respiratory events from health facilities in Yaounde, Cameroon
Alroy KA , Gwom LC , Ndongo CB , Kenmoe S , Monamele G , Clara A , Whitaker B , Manga H , Tayimetha CY , Tseuko D , Etogo B , Pasi O , Etoundi AG , Seukap E , Njouom R , Balajee A . Influenza Other Respir Viruses 2020 14 (2) 122-128 BACKGROUND: The International Health Regulations state that early detection and immediate reporting of unusual health events is important for early warning and response systems. OBJECTIVE: To describe a pilot surveillance program established in health facilities in Yaounde, Cameroon in 2017 which aimed to enable detection and reporting of public health events. METHODS: Cameroon's Ministry of Health, in partnership with the US Centers for Disease Control and Prevention, Cameroon Pasteur Center, and National Public Health Laboratory, implemented event-based surveillance (EBS) in nine Yaounde health facilities. Four signals were defined that could indicate possible public health events, and a reporting, triage, and verification system was established among partner organizations. A pre-defined laboratory algorithm was defined, and a series of workshops trained health facilities, laboratory, and public health staff for surveillance implementation. RESULTS: From May 2017 to January 2018, 30 signals were detected, corresponding to 15 unusual respiratory events. All health facilities reported a signal at least once, and more than three-quarters of health facilities reported >/=2 times. Among specimens tested, the pathogens detected included Klebsiella pneumoniae, Moraxella catarrhalis, Streptococcus pneumoniae, Haemophilus influenza, Staphylococcus aureus, Pneumocystis jiroveci, influenza A (H1N1) virus, rhinovirus, and adenovirus. CONCLUSIONS: The events detected in this pilot were caused by routine respiratory bacteria and viruses, and no novel influenza viruses or other emerging respiratory threats were identified. The surveillance system, however, strengthened relationships and communication linkages between health facilities and public health authorities. Astute clinicians can play a critical role in early detection and EBS is one approach that may enable reporting of emerging outbreaks and public health events. |
Notes from the field: Interventions to reduce measles virus exposures in outpatient health care facilities - New York City, 2018
Alroy KA , Vora NM , Arciuolo RJ , Asfaw M , Isaac BM , Iwamoto M , Jean A , Benkel DH , Blaney K , Crouch B , Geevarughese A , Graham KA , Lash M , Daskalakis D , Zucker JR , Rosen JB . MMWR Morb Mortal Wkly Rep 2019 68 (36) 791-792 Strengthening health care facility infection control is crucial to preventing infectious disease transmission. Guidelines to prevent or minimize airborne pathogen spread in outpatient health care facilities exist (1); however, few reports describe practical implementation when engineering controls, such as recommended airborne infection isolation rooms (negative pressure rooms), are unavailable* (2). On September 30, 2018, a person with measles, a highly contagious respiratory illness characterized by fever and rash, that is spread by airborne transmission, was detected in New York City (NYC),† and as of December 10, 42 laboratory or epidemiologically linked cases had been confirmed. By September 3, 2019, with 654 confirmed cases, this measles outbreak had become the largest in the United States since 1992, well before endemic domestic measles transmission was declared eliminated in 2000§,¶ (3,4). Interventions used in 15 outpatient health care facilities to attempt to prevent health care facility exposure from patients with suspected measles were evaluated. |
Strengthening laboratory capacity for detection of respiratory viral pathogens through the Global Health Security Agenda (GHSA) framework
Whitaker B , Alroy KA , Guthrie E , Schildecker S , Hiers S , Woodard J , Balajee SA . Afr J Lab Med 2019 8 (1) 861 Background: Endemic and emerging respiratory viruses are a threat to public health, and a robust public health laboratory system is essential to ensure global health security. Objective: This program sought to expand molecular laboratory testing capacity to detect a broad range of respiratory pathogens in clinical respiratory specimens collected during disease surveillance and outbreak investigations. Methods: As a part of the Global Health Security Agenda (GHSA), the United States Centers for Disease Control and Prevention utilised the equipment and training infrastructure already in place at the World Health Organization National Influenza Centers to expand testing capacity for respiratory viruses in laboratories in GHSA partner countries. This was done through the provision of quality assured reagents, including multiplex platforms and technical guidance for laboratory staff, as well as the assessment of laboratory testing accuracy. Conclusion: Early findings illustrated that GHSA laboratories have been able to expand testing capacity using specimens from routine surveillance, as well as from outbreak situations. |
Comparison of FTD(R) respiratory pathogens 33 and a singleplex CDC assay for the detection of respiratory viruses: A study from Cameroon
Kenmoe S , Tcharnenwa C , Monamele GC , Kengne CN , Ripa MN , Whitaker B , Alroy KA , Balajee SA , Njouom R . Diagn Microbiol Infect Dis 2019 94 (3) 236-242 INTRODUCTION: This study compares the detection of 14 common respiratory viruses by two different real-time reverse transcription polymerase chain reaction (rRT-PCR) methods: in house singleplex tests developed by the Centers for Disease Control and Prevention and the commercially available Fast Track Diagnostic (FTD(R)) Respiratory Pathogens 33 multiplex test. METHODS: A total of 217 nasopharyngeal swabs were analyzed using CDC singleplex rRT-PCR and FTD(R) Respiratory Pathogens 33 multiplex assays, for the detection of 14 respiratory viruses. RESULTS: The results showed that 179/217 (82.5%) samples were positive with the singleplex method and 183/217 (84.3%) with the FTD(R) Respiratory Pathogens 33 multiplex test. Excellent or satisfactory agreement was obtained for all viruses (k>0.6) except Parainfluenzavirus 4 (k=0.24) and influenza B (k=0.51). CONCLUSION: Although the multiplex FTD kits were more expensive than the singleplex assay, the FTD kits yielded rapid results in a shorter timeframe, increasing efficiency of diagnosis. |
Factors influencing community event-based surveillance: Lessons learned from pilot implementation in Vietnam
Clara A , Dao ATP , Do TT , Tran PD , Tran QD , Ngu ND , Ngo TH , Phan HC , Nguyen TTP , Bernadotte-Schmidt C , Nguyen HT , Alroy KA , Balajee SA , Mounts AW . Health Secur 2018 16 S66-s75 Community event-based surveillance aims to enhance the early detection of emerging public health threats and thus build health security. The Ministry of Health of Vietnam launched a community event-based surveillance pilot program in 6 provinces to improve the early warning functions of the existing surveillance system. An evaluation of the pilot program took place in 2017 and 2018. Data from this evaluation were analyzed to determine which factors were associated with increased detection and reporting. Results show that a number of small, local events were detected and reported through community event-based surveillance, supporting the notion that it would also facilitate the rapid detection and reporting of potentially larger events or outbreaks. The study showed the value of supportive supervision and monitoring to sustain community health worker reporting and the importance of conducting evaluations for community event-based surveillance programs to identify barriers to effective implementation. |
Expanding severe acute respiratory infection (SARI) surveillance beyond influenza: The process and data from 1 year of implementation in Vietnam
Alroy KA , Do TT , Tran PD , Dang TQ , Vu LN , Le NTH , Dang AD , Ngu ND , Ngo TH , Hoang PMV , Phan LT , Nguyen TV , Nguyen LT , Nguyen TV , Vien MQ , Le HX , Dao AT , Nguyen TB , Pham DT , Nguyen VTT , Pham TN , Phan BH , Whitaker B , Do TTT , Dao PA , Balajee SA , Mounts AW . Influenza Other Respir Viruses 2018 12 (5) 632-642 BACKGROUND: In 2016, as a component of the Global Health Security Agenda, the Vietnam Ministry of Health expanded its existing influenza sentinel surveillance for severe acute respiratory infections (SARI) to include testing for 7 additional viral respiratory pathogens. This article describes the steps taken to implement expanded SARI surveillance in Vietnam and reports data from 1 year of expanded surveillance. METHOD: The process of expanding the suite of pathogens for routine testing by real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) included laboratory trainings, procurement/distribution of reagents, and strengthening and aligning SARI surveillance epidemiology practices at sentinel sites and regional institutes (RI). RESULTS: Surveillance data showed that of 4,003 specimens tested by the RI laboratories, 20.2% (n = 810) were positive for influenza virus. Of the 3,193 influenza-negative specimens, 41.8% (n = 1,337) were positive for at least 1 non-influenza respiratory virus, of which 16.2% (n = 518), 13.4% (n = 428), and 9.6% (n = 308) tested positive for respiratory syncytial virus, rhinovirus, and adenovirus, respectively. CONCLUSIONS: The Government of Vietnam has demonstrated that expanding respiratory viral surveillance by strengthening and building upon an influenza platform is feasible, efficient, and practical. This article is protected by copyright. All rights reserved. |
Large Outbreak of Hepatitis C Virus Associated With Drug Diversion by a Healthcare Technician.
Alroy-Preis S , Daly ER , Adamski C , Dionne-Odom J , Talbot EA , Gao F , Cavallo SJ , Hansen K , Mahoney JC , Metcalf E , Loring C , Bean C , Drobeniuc J , Xia GL , Kamili S , Montero JT . Clin Infect Dis 2018 67 (6) 845-853 Background: In May 2012, the New Hampshire (NH) Division of Public Health Services (DPHS) was notified of 4 persons with newly diagnosed hepatitis C virus (HCV) infection at hospital X. Initial investigation suggested a common link to the hospital cardiac catheterization laboratory (CCL) because the infected persons included 3 CCL patients and a CCL technician. NH DPHS initiated an investigation to determine the source and control the outbreak. Methods: NH DPHS conducted site visits, case patient and employee interviews, medical record and medication use review, and employee and patient HCV testing using enzyme immunoassay for anti-HCV, reverse-transcription polymerase chain reaction for HCV RNA, nonstructural 5B (NS5B) and hypervariable region 1 (HVR1) sequencing, and quasispecies analysis. Results: HCV HVR1 analysis of the first 4 cases confirmed a common source of infection. HCV testing identified 32 of 1074 CCL patients infected with the outbreak strain, including 3 patients coinfected with >1 HCV strain. The epidemiologic investigation revealed evidence of drug diversion by the HCV-infected technician, evidenced by gaps in controlled medication control, higher fentanyl use during procedures for confirmed cases, and building card key access records documenting the presence of the technician during days when transmission occurred. The employee's status as a traveling technician led to a multistate investigation, which identified additional cases at prior employment sites. Conclusions: This is the largest laboratory-confirmed drug diversion-associated HCV outbreak published to date. Recommendations to reduce drug diversion risk and to conduct outbreak investigations are provided. |
Sustainable model for public health emergency operations centers for global settings
Balajee SA , Pasi OG , Etoundi AGM , Rzeszotarski P , Do TT , Hennessee I , Merali S , Alroy KA , Phu TD , Mounts AW . Emerg Infect Dis 2017 23 (13) S190-5 Capacity to receive, verify, analyze, assess, and investigate public health events is essential for epidemic intelligence. Public health Emergency Operations Centers (PHEOCs) can be epidemic intelligence hubs by 1) having the capacity to receive, analyze, and visualize multiple data streams, including surveillance and 2) maintaining a trained workforce that can analyze and interpret data from real-time emerging events. Such PHEOCs could be physically located within a ministry of health epidemiology, surveillance, or equivalent department rather than exist as a stand-alone space and serve as operational hubs during nonoutbreak times but in emergencies can scale up according to the traditional Incident Command System structure. |
Antibody banding patterns of the Enzyme-linked Immunoelectrotransfer Blot (EITB) and brain imaging findings in patients with neurocysticercosis
Arroyo G , Rodriguez S , Lescano AG , Alroy K , Bustos JA , Santivanez S , Gonzales I , Saavedra H , Pretell EJ , Gonzalez AE , Gilman RH , Tsang VCW , Garcia HH . Clin Infect Dis 2017 66 (2) 282-288 Background: The enzyme-linked immunoelectrotransfer blot (EITB) assay is the reference serological test for neurocysticercosis (NCC). A positive result on EITB does not always correlate with the presence of active infections in the central nervous system (CNS), and patients with a single viable brain cyst may be EITB negative. Nonetheless, EITB antibody banding patterns appears to be related with the expression of three protein families of Taenia solium, and in turn with the characteristics of NCC in the CNS (type, stage and burden of viable cysts). Methods: We evaluated EITB antibody banding patterns and brain imaging findings of 548 NCC cases. Similar banding patterns were grouped into homogeneous classes using latent class analysis. The association between classes and brain imaging findings was assessed. Results: Four classes were identified. Class 1 (patients negative or only positive to the GP50 band, related to the protein family of the same name) was associated with non-viable or single viable parenchymal cysticerci; class 2 (patients positive to bands GP42-39 and GP24, related to the T24-42 protein family, with or without anti-GP50 antibodies) was associated with intraparenchymal viable and non-viable infections; classes 3 and 4 (positive to GP50, GP42-39 and GP24 but also responding to low molecular weight bands GP21, GP18, GP14 and GP13, related to the 8kDa protein family) were associated with extraparenchymal and intraparenchymal multiple viable cysticerci. Conclusions/significance: EITB antibody banding patterns correlate with brain imaging findings and complement imaging information for the diagnosis of NCC and for staging NCC patients. |
Prevalence and transmission of Trypanosoma cruzi in people of rural communities of the high jungle of northern Peru
Alroy KA , Huang C , Gilman RH , Quispe-Machaca VR , Marks MA , Ancca-Juarez J , Hillyard M , Verastegui M , Sanchez G , Cabrera L , Vidal E , Billig EM , Cama VA , Naquira C , Bern C , Levy MZ . PLoS Negl Trop Dis 2015 9 (5) e0003779 BACKGROUND: Vector-borne transmission of Trypanosoma cruzi is seen exclusively in the Americas where an estimated 8 million people are infected with the parasite. Significant research in southern Peru has been conducted to understand T. cruzi infection and vector control, however, much less is known about the burden of infection and epidemiology in northern Peru. METHODOLOGY: A cross-sectional study was conducted to estimate the seroprevalence of T. cruzi infection in humans (n=611) and domestic animals [dogs (n=106) and guinea pigs (n=206)] in communities of Cutervo Province, Peru. Sampling and diagnostic strategies differed according to species. An entomological household study (n=208) was conducted to identify the triatomine burden and species composition, as well as the prevalence of T. cruzi in vectors. Electrocardiograms (EKG) were performed on a subset of participants (n=90 T. cruzi infected participants and 170 age and sex-matched controls). The seroprevalence of T. cruzi among humans, dogs, and guinea pigs was 14.9% (95% CI: 12.2 - 18.0%), 19.8% (95% CI: 12.7- 28.7%) and 3.3% (95% CI: 1.4 - 6.9%) respectively. In one community, the prevalence of T. cruzi infection was 17.2% (95% CI: 9.6 - 24.7%) among participants < 15 years, suggesting recent transmission. Increasing age, positive triatomines in a participant's house, and ownership of a T. cruzi positive guinea pig were independent correlates of T. cruzi infection. Only one species of triatomine was found, Panstrongylus lignarius, formerly P. herreri. Approximately forty percent (39.9%, 95% CI: 33.2 - 46.9%) of surveyed households were infested with this vector and 14.9% (95% CI: 10.4 - 20.5%) had at least one triatomine positive for T. cruzi. The cardiac abnormality of right bundle branch block was rare, but only identified in seropositive individuals. CONCLUSIONS: Our research documents a substantial prevalence of T. cruzi infection in Cutervo and highlights a need for greater attention and vector control efforts in northern Peru. |
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