Last data update: Sep 23, 2024. (Total: 47723 publications since 2009)
Records 1-27 (of 27 Records) |
Query Trace: Bermudez AT [original query] |
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Changes in screening test volume in the National Breast and Cervical Cancer Early Detection Program during the COVID-19 Pandemic, 2020-2022
Bermudez Y , DeGroff A , Miller J , Kenney K , Lockhart J , Joseph D , Richardson L . Int J Environ Res Public Health 2024 21 (7) INTRODUCTION: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) observed significant declines in screening volume early in the COVID-19 pandemic, January-June 2020, with variation by race/ethnicity and geography. We aimed to determine how screening in the NBCCEDP recovered from these early declines as it is important for monitoring the long-term impact on women served by the program. METHODS: Extending the previous analyses, we compared monthly breast (BC) and cervical cancer (CVC) screening volume in the NBCCEDP during 2020-2022, to five-year, pre-COVID-19 pandemic averages (2015-2019), and calculated percent change. Results were stratified by race/ethnicity and rurality groups. We employed multiple one-way ANOVA tests, which included multiple comparisons, to test for significant differences between groups. RESULTS: By December 2022, NBCCEDP breast and cervical cancer screening volumes had not fully recovered to pre-COVID-19 5-year averages, and recovery in breast cancer screening volume was slower than that of cervical cancer. Both BC and CVC screening among women in metro areas showed the smallest average monthly deficits (-8.8% BC and -4.9% CVC) compared to monthly pre-COVID-19 pandemic 5-year averages, and screening among women in rural areas showed the greatest deficits (-37.3% BC and -26.7% CVC). BC and CVC screening among Hispanic women showed the greatest improvements compared to the pre-COVID-19 averages (8.2% BC and 9.5% CVC), and cervical cancer screening among non-Hispanic Asian and Pacific Islander women showed the greatest deficits (-41.4% CVC). CONCLUSION: For increased intervention efforts, NBCCEDP recipients can focus on populations demonstrating greatest deficits in screening volume. |
Engaging community health workers in primary care practices: Provider understanding of roles, benefits, and barriers
Rohan EA , Townsend JS , Bermudez AT , Thompson HL , Holman DM , Reza A , Tharpe FS , Wennerstrom A . J Ambul Care Manage 2024 Community health workers (CHWs) are increasingly addressing health disparities in primary care settings; however, there is little information about how primary care practitioners (PCPs) interact with CHWs or perceive CHW roles. We examined PCP engagement with CHWs in adult primary care settings. Overall, 55% of 1504 PCPs reported working with CHWs; involvement with CHWs differed by some PCP demographic and practice-related factors. While PCPs perceived CHWs as engaging in most nationally endorsed CHW roles, they identified several barriers to integrating CHWs into care teams. Findings can inform ongoing efforts to advance health equity through integrating CHWs into primary care practices. |
Breast and cervical cancer programs' success in maintaining screening during periods of high COVID-19: A qualitative multi-case study analysis
Schlueter D , Bermudez Y , Debrot KF , Ross LW , Masud M , Melillo S , Hannon PA , Miller JW . Heliyon 2024 10 (8) e29223 OBJECTIVE: During the first year of the COVID-19 pandemic, most of the Centers for Disease Control and Prevention (CDC)'s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) funded programs (recipients) experienced significant declines in breast and cervical cancer screening volume. However, 6 recipients maintained breast and/or cervical cancer screening volume during July-December 2020 despite their states' high COVID-19 test percent positivity. We led a qualitative multi-case study to explore these recipients' actions that may have contributed to screening volume maintenance. METHODS: We conducted 22 key informant interviews with recipients, screening provider sites, and partner organizations. Interviews explored organizational and operational changes; screening barriers; actions taken to help maintain screening volume; and support for provider sites to continue screening. We documented contextual factors that may have influenced these actions, including program structures; clinic capacity; and state COVID-19 policies. RESULTS: Thematic analysis revealed crosscutting themes at the recipient, provider site, and partner levels. Recipients made changes to administrative processes to reduce burden on provider sites and delivered tailored technical assistance to support safe screening. Provider sites modified clinic protocols to increase patient safety, enhanced patient reminders for upcoming appointments, and increased patient education on the importance of timely screening during the pandemic. Partners worked with provider sites to identify and reduce patients' structural barriers to screening. CONCLUSION: Study findings provide lessons learned to inform emergency preparedness-focused planning and operations, as well as routine operations for NBCCEDP recipient programs, other cancer screening initiatives, primary care clinics, and chronic disease prevention programs. |
Are national breast and cervical cancer early detection program recipients providing services in counties heavily burdened by breast and cervical cancer?
Bermudez Y . Int J Environ Res Public Health 2024 21 (2) INTRODUCTION: Alignment of National Breast and Cervical Cancer Early Detection Program (NBCCEDP) clinical services with the spatial distribution of breast and cervical cancer burden is essential to maximizing programmatic impact and addressing cancer disparities. This study identified spatial clustering of breast and cervical cancer burden scores and assessed whether and to what extent NBCCEDP clinical services were associated with clusters for the 5-year period, 2015-2019. METHODS: We examined burden scores for spatial clustering using Local Indicators of Spatial Association (LISA) tests in GeoDA. We then used t-tests to compare the NBCCEDP 5-year average percentage of eligible women served clinical breast and cervical cancer services between hotspot (high burden) and coolspot clusters. RESULTS: There was statistically significant spatial clustering in the pattern of breast and cervical cancer burden scores across counties, with hotspot clusters mostly observed in the Southern region, Idaho and Nevada. For both breast and cervical cancer, higher percentages of eligible women received breast and cervical cancer clinical services in coolspot clusters compared to hotspot clusters during each year from 2015-2019. CONCLUSION: NBCCEDP clinical services can help reduce breast and cervical cancer burden. Yet, during 2015-2019, increased service delivery was not aligned with the spatial distribution of counties with greater breast and cervical cancer burdens. NBCCEDP recipients may improve their impact on breast and cervical cancer burden by prioritizing and consistently increasing service delivery in cancer burden hotspot clusters if they have not already maximized their resources in these areas. |
Community perceptions on challenges and solutions to implement an Aedes aegypti control project in Ponce, Puerto Rico (USA)
Pérez-Guerra CL , Rosado-Santiago C , Ramos SA , Marrero KM , González-Zeno G , Miranda-Bermúdez J , Ortíz-Ortíz M , Rivera-Amill V , Waterman S , Paz-Bailey G , Sánchez-González L . PLoS One 2023 18 (4) e0284430 This study characterizes community perceptions on a large-scale project seeking to reduce the population of Aedes aegypti mosquitoes and prevent arboviral disease transmission in Ponce, Puerto Rico; and to leverage on these perceptions to make modifications to ensure effective project implementation. In 2017-2018 the team conducted informal interviews, focus groups, and in-depth interviews with leaders and residents of the communities, focusing on challenges and potential solutions to the project implementation. Possible challenges to the project implementation included the lack of geographic consistency between clusters defined by researchers and the participants' description of the communities' geographic boundaries. Few children living in the communities could affect the ability of the project to adequately measure arboviral disease incidence. Also, population attrition due to out-migration, and lack of community leaders and communication channels after Hurricane Maria could affect participation in project activities. Lack of trust on strangers was an important challenge due to criminal activity involving violence and drug use in some community areas. Solutions to the identified challenges included identifying emerging leaders and implementing community meetings to promote project activities. The information that community members provided helped us to understand the natural disasters' impact on population attrition in these communities with a disproportionate impact in younger groups, resulting in an aging population. We identified lack of community organization and leadership and increasing number of abandoned houses that could turn into Aedes aegypti breeding sites. The formative work helped to better define the geographic areas that the study would cover, evaluate the acceptability of innovative vector control methods, and identify communication methods used by residents. With this information, challenges and potential solutions in recruiting participants were anticipated, and the community engagement and communications plans were developed. We recommend selecting clusters before research, because opinions towards mosquito control technologies could vary in added clusters. |
Community resources for contaminants of concern in private wells
Hubbard B , Sabogal R , Zarate-Bermudez M . J Environ Health 2023 85 (7) 36-39 In the U.S., approximately one in five water samples collected from private wells were found to be contaminated with at least one chemical at levels high enough to harm health. Given that one in eight U.S. residents obtain their water from a private well, access to safe drinking water is vital. Many private wells are not routinely tested for contaminants, which can be microbiological, chemical, or radiological. Environmental health practitioners serve as a valuable resource, helping their communities to increase well testing, identify contaminants of concern, and understand well water testing results. This month’s column highlights the work of the Centers for Disease Control and Prevention to improve drinking water in private wells. |
Geographic Examination of COVID-19 Test Percent Positivity and Proportional Change in Cancer Screening Volume, National Breast and Cervical Cancer Early Detection Program.
Bermudez Y , Scott LC , Beckman M , DeGroff A , Kenney K , Sun J , Rockwell T , Helsel W , Kammerer W , Sheu A , Miller J , Richardson LC . Prev Chronic Dis 2022 19 E59 INTRODUCTION: In 2020, the COVID-19 pandemic led to significant declines in cancer screening, including among women served by the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). This study examined the spatial association between state-based COVID-19 test percent positivity and proportional change in NBCCEDP screening volume. METHODS: Using the COVID-19 Diagnostic Laboratory Testing dataset, we calculated state-based monthly COVID-19 test percent positivity from July through December 2020 and categorized rates into low, medium, and high groups. We used data from 48 NBCCEDP state awardees to calculate the state-based monthly proportional change in screening volume and compared data for July-December 2020 with the previous 5-year average for those months. We categorized changes in screening volume into large decrease, medium decrease, and minimal change and created maps of the associations between variable subgroups by using bivariate mapping in QGIS. RESULTS: Bivariate relationships between COVID-19 test percent positivity and proportional change in cancer screening volume varied over time and geography. In 5 of 6 months, 4 states had high COVID-19 test percent positivity and minimal change in breast or cervical cancer screening volume; 2 states had high COVID-19 test percent positivity and minimal change in breast and cervical cancer screening volume. CONCLUSION: Some states maintained pre-COVID-19 screening volumes despite high COVID-19 test percent positivity. Follow-up research will be conducted to determine how these states differ from those with consistent decreases in screening volume and identify factors that may have contributed to differences. This information could be useful for planning to maximize NBCCEDP awardees' ability to maintain screening volume during future public health emergencies. |
Isolation and genetic characterization of a relapsing fever spirochete isolated from Ornithodoros puertoricensis collected in central Panama.
Bermúdez SE , Armstrong BA , Domínguez L , Krishnavajhala A , Kneubehl AR , Gunter SM , Replogle A , Petersen JM , Lopez JE . PLoS Negl Trop Dis 2021 15 (8) e0009642 Tick-borne relapsing fever (TBRF) spirochetes are likely an overlooked cause of disease in Latin America. In Panama, the pathogens were first reported to cause human disease in the early 1900s. Recent collections of Ornithodoros puertoricensis from human dwellings in Panama prompted our interest to determine whether spirochetes still circulate in the country. Ornithodoros puertoricensis ticks were collected at field sites around the City of Panama. In the laboratory, the ticks were determined to be infected with TBRF spirochetes by transmission to mice, and we report the laboratory isolation and genetic characterization of a species of TBRF spirochete from Panama. Since this was the first isolation of a species of TBRF spirochete from Central America, we propose to designate the bacteria as Borrelia puertoricensis sp. nov. This is consistent with TBRF spirochete species nomenclature from North America that are designated after their tick vector. These findings warrant further investigations to assess the threat B. puertoricensis sp. nov. may impose on human health. |
An evaluation of Bacillus thuringiensis israelensis (AM65-52) treatment for the control of Aedes aegypti using vehicle-mounted WALS application in a densely populated urban area of Puerto Rico
Harris AF , Sanchez Prats J , Nazario Maldonado N , Piovanetti Fiol C , García Pérez M , Ramírez-Vera P , Miranda-Bermúdez J , Ortiz M , DeChant P . Pest Manag Sci 2020 77 (4) 1981-1989 BACKGROUND: With a shortage of effective options for control of Aedes aegypti in Puerto Rico due to widespread resistance to conventional mosquito adulticides, an alternative approach was investigated to reduce vector populations. In two areas (totaling 144 ha) of the municipality of Bayamón, Puerto Rico, Bacillus thuringiensis israelensis (Bti) AM65-52 WDG was applied at a rate of 500 g/ha using vehicle-mounted aqueous wide-area larvicide spray applications weekly for 4 weeks and then every other week for a further 16 weeks. Bioassay jars were placed in the field to monitor for deposition of Bti droplets in open spaces, and under vegetation and building coverage. Autocidal gravid ovitraps were placed throughout the field site to monitor the population of adult female Ae. aegypti in both treatment and control sites. RESULTS: Larvicide spray was successfully deposited into jars in an array of open and covered locations, as confirmed by larval bioassays. After the fourth weekly spraying, differences in autocidal gravid ovitrap densities were observed between treatment and control sites resulting in 62% (P = 0.0001) and 28% (P < 0.0001) reductions in adult female Ae. aegypti numbers. CONCLUSION: Repeated wide-area larvicide spray application of Bti AM65-52 WDG to residential areas in Puerto Rico effectively suppressed dengue vector populations. The success of this trial has led to expansion of the WALS® program to a larger area of Bayamón and other municipalities in Puerto Rico. |
Phase II trial evaluating the clinical efficacy of cefixime for treatment of active syphilis in non-pregnant women in Brazil (CeBra)
Taylor MM , Kara EO , Araujo MAL , Silveira MF , Miranda AE , Branco Coelho IC , Bazzo ML , Mendes Pereira GF , Pereira Giozza S , Bermudez XPD , Mello MB , Habib N , Nguyen MH , Thwin SS , Broutet N . BMC Infect Dis 2020 20 (1) 405 BACKGROUND: Syphilis is a sexually and vertically transmitted infection caused by the bacteria Treponema pallidum for which there are few proven alternatives to penicillin for treatment. For pregnant women infected with syphilis, penicillin is the only WHO-recommended treatment that will treat the mother and cross the placenta to treat the unborn infant and prevent congenital syphilis. Recent shortages, national level stockouts as well as other barriers to penicillin use call for the urgent identification of alternative therapies to treat pregnant women infected with syphilis. METHODS: This prospective, randomized, non-comparative trial will enroll non-pregnant women aged 18 years and older with active syphilis, defined as a positive rapid treponemal and a positive non-treponemal RPR test with titer >/=1:16. Women will be a, domized in a 2:1 ratio to receive the oral third generation cephalosporin cefixime at a dose of 400 mg two times per day for 10 days (n = 140) or benzathine penicillin G 2.4 million units intramuscularly based on the stage of syphilis infection (n = 70). RPR titers will be collected at enrolment, and at three, six, and nine months following treatment. Participants experiencing a 4-fold (2 titer) decline by 6 months will be considered as having an adequate or curative treatment response. DISCUSSION: Demonstration of efficacy of cefixime in the treatment of active syphilis in this Phase 2 trial among non-pregnant women will inform a proposed randomized controlled trial to evaluate cefixime as an alternative treatment for pregnant women with active syphilis to evaluate prevention of congenital syphilis. TRIAL REGISTRATION: Trial identifier: www.Clinicaltrials.gov, NCT03752112. Registration Date: November 22, 2018. |
Etiology of Microcephaly and Central Nervous System Defects during the Zika Epidemic in Colombia.
Galang RR , Avila GA , Valencia D , Daza M , Tong VT , Bermudez AJ , Gilboa SM , Rico A , Cates J , Pacheco O , Winfield CM , Prieto F , Honein MA , Cortes LJ , Moore CA , Ospina ML . J Pediatr 2020 222 112-119 e3 OBJECTIVE: To estimate the prevalence of microcephaly and central nervous system (CNS) defects during the Zika virus (ZIKV) epidemic in Colombia and proportion attributable to congenital ZIKV infection. STUDY DESIGN: Clinical and laboratory data for cases of microcephaly and/or CNS defects reported to national surveillance between 2015 and 2017 were reviewed and classified by a panel of clinical subject matter experts. Maternal and fetal/infant biologic specimens were tested for congenital infection and chromosomal abnormalities. Infants/fetuses with microcephaly and/or CNS defects (cases) were classified into broad etiologic categories (teratogenic, genetic, multifactorial, and unknown). Cases classified as potentially attributable to congenital ZIKV infection were stratified by strength of evidence for ZIKV etiology (strong, moderate, or limited) using a novel strategy considering birth defects unique or specific to ZIKV or other infections and laboratory evidence. RESULTS: Among 858 reported cases with sufficient information supporting a diagnosis of microcephaly or CNS defects, 503 were classified as potentially attributable to congenital ZIKV infection. Of these, the strength of evidence was considered strong in 124 (24.7%) cases; moderate in 232 (46.1%) cases; and limited in 147 (29.2%). Of the remaining, 355 (41.4%) were attributed to etiologies other than ZIKV infection (syphilis, toxoplasmosis, rubella, cytomegalovirus, herpes 1 and herpes 2 viruses only, n = 32 [3.7%]; genetic, n = 16 [1.9%]; multifactorial, n = 42 [4.9%]; unknown, n = 265 [30.9%]). CONCLUSIONS: Fifty-eight percent of cases of microcephaly and/or CNS defects were potentially attributable to congenital ZIKV infection; however, the strength of evidence varied considerably. This surveillance protocol might serve as a model approach for investigation and etiologic classification of complex congenital conditions. |
Perpetration of intimate partner violence and mental health outcomes: sex- and gender-disaggregated associations among adolescents and young adults in Nigeria
Stark L , Seff I , Weber AM , Cislaghi B , Meinhart M , Bermudez LG , Atuchukwu V , Onotu D , Darmstadt GL . J Glob Health 2020 10 (1) 010708 Background: The association between intimate partner violence (IPV) victimisation and poor mental health outcomes is well established. Less is known about the correlation between IPV perpetration and mental health, particularly among adolescents and young adults. Using data from the nationally representative Violence Against Children Survey, this analysis examines the association between IPV perpetration and mental health for male and female adolescents and young adults in Nigeria. Methods: Multivariate logistic regression models were used to examine associations between ever-perpetration of IPV and four self-reported mental health variables: severe sadness, feelings of worthlessness, suicide ideation, and alcohol use. Models were sex-disaggregated, controlled for age, marital status, and schooling, and tested with and without past exposure to violence. Standard errors were adjusted for sampling stratification and clustering. Observations were weighted to be representative of 13-24 year-olds in Nigeria. Results: Males were nearly twice as likely as females to perpetrate IPV (9% v. 5%, respectively; P < 0.001), while odds of perpetration for both sexes were higher for those ever experiencing IPV (adjusted odds ratio (aOR) = 4.60 for males; aOR = 2.71 for females). Female perpetrators had 2.73 higher odds of reporting severe sadness (95% confidence interval CI = 1.44, 5.17; P = 0.002) and 2.72 times greater odds of reporting suicide ideation (1.28, 5.79; P = 0.010) than non-perpetrating females, even when controlling for past-year violence victimisation. In contrast, male perpetrators had 2.65 times greater odds of feeling worthless (1.09, 6.43; P = 0.031), and 2.36 times greater odds of reporting alcohol use in the last 30 days (1.50, 3.73; P < 0.001), as compared to non-perpetrating males. Conclusions: Among adolescents and young adults in Nigeria, IPV perpetration and negative mental health outcomes are associated but differ for males and females. Mindful of the cross-sectional nature of the data, it is possible that socially determined gender norms may shape the ways in which distress from IPV perpetration is understood and expressed. Additional research is needed to clarify these associations and inform violence prevention efforts. |
Tuberculosis surveillance and control, Puerto Rico, 1898-2015
Dirlikov E , Thomas D , Yost D , Tejada-Vera B , Bermudez M , Joglar O , Chorba T . Emerg Infect Dis 2019 25 (3) 538-546 The World Health Organization recognizes Puerto Rico as an area of low tuberculosis (TB) incidence, where TB elimination is possible by 2035. To describe the current low incidence of reported cases, provide key lessons learned, and detect areas that may affect progress, we systematically reviewed the literature about the history of TB surveillance and control in Puerto Rico and supplemented this information with additional references and epidemiologic data. We reviewed 3 periods: 1898-1946 (public health efforts before the advent of TB chemotherapy); 1947-1992 (control and surveillance after the introduction of TB chemotherapy); and 1993-2015 (expanded TB control and surveillance). Although sustained surveillance, continued care, and use of newly developed strategies occurred concomitantly with decreased incidence of reported TB cases and mortality rates, factors that may affect progress remain poorly understood and include potential delayed diagnosis and underreporting, the effects of government debt and Hurricane Maria, and poverty. |
Exposure to contaminants among private well users in north Carolina: Enhancing the role of public health
Jackson CLP , Zarate-Bermudez M . J Environ Health 2019 81 (8) 36-38 North Carolina has the second highest number of residents who rely on private wells for their drinking water supply. Studies report that about 3.3 million North Carolina residents (35% of the population) use private wells, with the highest county having 85.4% of the residents using private wells. Unlike public water systems that benefit from the regulatory safeguards of the Safe Drinking Water Act, there are no federal regulations for private wells in the U.S. Testing, treating, maintaining, and managing private wells are up to well owners, often with little to no technical or financial support. | | In 2015, the Private Well and Health Program (PWHP) of the North Carolina Department of Health and Human Services received funding from the Centers for Disease Control and Prevention's Safe Water for Community Health (Safe WATCH) Program to enhance services to private well users. PWHP was understaffed, had limited access to water quality data, and lacked established partnerships, which prevented it from enhancing services for private well users to better protect their health. | | This month's column highlights how PWHP used the funding to address vulnerabilities in its private wells and water quality, as well as initiatives to close the gaps in ensuring safe drinking water for its residents. |
Benefits of collaboration between a county health department and a local university in North Carolina
Dye S , Zarate-Bermudez M . J Environ Health 2018 81 (3) 32-35 Groundwater quality is of great importance in the U.S. to protect public health. In Gaston County, North Carolina, more than 8,000 households use private wells for their drinking water supplies. The Gaston County Department of Health and Human Services (GCDHHS) implements and enforces state rules and regulations on private wells. To address resource constraints, GCDHHS is working with partners to evaluate groundwater quality and protect human health. Through a funding opportunity from the Centers for Disease Control and Prevention's Safe Water for Community Health (Safe WATCH) Program, GCDHHS is working with the University of North Carolina at Charlotte to enhance its ability to assess and manage groundwater issues. The goal is to help private well users reduce exposures to potential contaminants in their water. This month's column explores the collaboration, the challenges faced, and the achievements to date. |
Adapting the Get Yourself Tested Campaign to reach black and Latino sexual-minority youth
Garbers S , Friedman A , Martinez O , Scheinmann R , Bermudez D , Silva M , Silverman J , Chiasson MA . Health Promot Pract 2016 17 (5) 739-50 BACKGROUND: Culturally appropriate efforts are needed to increase sexually transmitted disease (STD) testing and care among Black and Latino sexual-minority youth, who are at high risk for STDs. Get Yourself Tested, a national testing campaign, has demonstrated success among youth, but it has yet to be assessed for relevance or impact among this population. METHOD: This effort included (1) formative and materials-testing research through focus groups; (2) adaptation of existing Get Yourself Tested campaign materials to be more inclusive of Black and Latino sexual-minority youth; (3) a 3-month campaign in four venues of New York City, promoting STD testing at events and through mobile testing and online and social media platforms; (4) process evaluation of outreach activities; and (5) an outcome evaluation of testing at select campaign venues, using a preexperimental design. RESULTS: During the 3-month campaign period, the number of STD tests conducted at select campaign venues increased from a comparable 3-month baseline period. Although testing uptake through mobile vans remained low in absolute numbers, the van drew a high-prevalence sample, with positivity rates of 26.9% for chlamydia and 11.5% for gonorrhea. This article documents the process and lessons learned from adapting and implementing a local campaign for Black and Latino sexual-minority youth. |
Fate and transport of enteric microbes from septic systems in a coastal watershed
Schneeberger CL , O'Driscoll M , Humphrey C , Henry K , Deal N , Seiber K , Hill VR , Zarate-Bermudez M . J Environ Health 2015 77 (9) 22-30 Onsite wastewater treatment systems (OWTS) are commonly used in coastal areas to treat household wastewater. These systems represent potential sources of fecal pollution of groundwater and nearby surface water. OWTS are expected to reduce microbial concentrations in wastewater; however, system and environmental factors can affect treatment efficiency and impacts on ground and surface water. In the study of OWTS described in this article, the authors sampled septic tanks and groundwater at two households in coastal North Carolina between October 2009 and October 2011. Samples were tested for the fecal indicator microbes E. coli, enterococci, and Clostridium perfringens. Microbial source tracking was also performed in year two. Results showed that enteric microbe concentrations in groundwater significantly decreased with distance from the OWTS. Human markers of fecal contamination were also detected in the OWTS and downgradient groundwater, indicating that OWTS can impact the microbial quality of shallow groundwater. |
A systems analysis of irrigation water quality in an environmental assessment of an E. coli O157: H7 outbreak in the United States linked to iceberg lettuce
Gelting RJ , Baloch MA , Zarate-Bermudez M , Hajmeer MN , Yee JC , Brown T , Yee BJ . Agric Water Manag 2015 150 (3) 111-118 A foodborne Escherichia coli O157:H7 outbreak in December 2006 included 77 illnesses reported in Iowa and Minnesota. Epidemiologic investigations by health departments in those states and the U.S. Centers for Disease Control and Prevention (CDC) identified shredded iceberg lettuce (Lactuca sativa L.) as the vehicle of transmission. The U.S. Food and Drug Administration (FDA) and Minnesota and California public health agencies traced the lettuce to several growing regions in California based on information from a lettuce processor in Minnesota.Samples from an environmental investigation initiated by the California Food Emergency Response Team (CalFERT) revealed a genetic match between the outbreak strain and environmental samples from a single farm, leading to an in-depth systems-based analysis of the irrigation water system on that farm. This paper presents findings from that systems-based analysis, which assessed conditions on the farm potentially contributing to contamination of the lettuce. The farm had three sources of irrigation water: groundwater from onsite wells, surface water delivered by a water management agency and effluent from wastewater lagoons on nearby dairy farms. Wastewater effluent was blended with the other sources and used only to irrigate animal feed crops. However, water management on the farm, including control of wastewater blending, appeared to create potential for cross-contamination. Pressure gradients and lack of backflow measures in the irrigation system might have created conditions for cross-contamination of water used to irrigate lettuce. The irrigation network on the farm had evolved over time to meet various needs, without an overall analysis of how that evolution potentially created vulnerabilities to contamination of irrigation water. The type of systems analysis described here is one method for helping to ensure that such vulnerabilities are identified and addressed. A preventive, risk-based management approach, such as the Water Safety Plan process for drinking water, may also be useful in managing irrigation water quality. |
Meteorological influences on nitrogen dynamics of a coastal onsite wastewater treatment system
O'Driscoll MA , Humphrey CP , Deal NE , Lindbo DL , Zarate-Bermudez MA . J Environ Qual 2014 43 (6) 1873-1885 On-site wastewater treatment systems (OWTS) can contribute nitrogen (N) to coastal waters. In coastal areas with shallow groundwater, OWTS are likely affected by meteorological events. However, the meteorological influences on temporal variability of N exports from OWTS are not well documented. Hydrogeological characterization and seasonal monitoring of wastewater and groundwater quality were conducted at a residence adjacent to the Pamlico River Estuary, North Carolina, during a 2-yr field study (October 2009-2011). Rainfall was elevated during the first study year, relative to the annual mean. In the second year, drought was followed by extreme precipitation from Hurricane Irene. Recent meteorological conditions influenced N speciation and concentrations in groundwater. Groundwater total dissolved nitrogen (TDN) beneath the OWTS drainfield was dominated by nitrate during the drought; during wetter periods, ammonium and organic N were common. Effective precipitation (precipitation [P] minus evapotranspiration [ET]) affected OWTS TDN exports because of its influence on groundwater recharge and discharge. Groundwater nitrate-N concentrations beneath the drainfield were typically higher than 10 mg/L when total biweekly precipitation was less than evapotranspiration (precipitation deficit: P < ET). Overall, groundwater TDN concentrations were elevated above background concentrations at distances > 15 m downgradient of the drainfield. Although OWTS nitrate inputs caused elevated groundwater nitrate concentrations between the drainfield and the estuary, the majority of nitrate was attenuated via denitrification between the OWTS and 48 m to the estuary. However, DON originating from the OWTS was mobile and contributed to elevated TDN concentrations along the groundwater flowpath to the estuary. |
Onsite wastewater system nitrogen contributions to groundwater in coastal North Carolina
Humphrey Jr C , O'Driscoll M; , Deal N , Lindbo D , Thieme S , Zarate-Bermudez M . J Environ Health 2013 76 (5) 16-22 The objective of the study described in this article was | to evaluate the nitrogen contributions from two onsite wastewater systems (sites 1 and 2) to groundwater and adjacent surface waters in coastal Beaufort County, North Carolina. Groundwater levels and water quality parameters including total nitrogen, nitrogen species, temperature, and pH were monitored from October 2009 to May 2010. Nitrogen was also tested in groundwater from deeper irrigation or drinking water wells from the two sites and six additional neighboring residences. Mean total nitrogen concentrations | in groundwater beneath onsite wastewater systems 1 and 2 were | 34.3 ± 16.7 mg/L and 12.2 ± 2.9 mg/L, respectively, and significantly higher than background groundwater concentrations (<1 mg/L). Groundwater in the deeper wells appeared not to be influenced by the onsite systems. Groundwater nitrogen concentrations typically decreased with distance down-gradient from the systems, but were still elevated relative to background conditions more than 15 m from the systems and near the estuary. This was a pioneering effort to better understand the link of onsite systems, the fate of nitrogen in the environment, and public health. |
Binational outbreak of Guillain-Barre syndrome associated with Campylobacter jejuni infection, Mexico and USA, 2011
Jackson BR , Zegarra JA , Lopez-Gatell H , Sejvar J , Arzate F , Waterman S , Nunez AS , Lopez B , Weiss J , Cruz RQ , Murrieta DY , Luna-Gierke R , Heiman K , Vieira AR , Fitzgerald C , Kwan P , Zarate-Bermudez M , Talkington D , Hill VR , Mahon B . Epidemiol Infect 2013 142 (5) 1-11 SUMMARY: In June 2011, a cluster of suspected cases of Guillain-Barre syndrome (GBS), which can follow Campylobacter jejuni infection, was identified in San Luis Rio Colorado (SLRC), Sonora, Mexico and Yuma County, Arizona, USA. An outbreak investigation identified 26 patients (18 from Sonora, eight from Arizona) with onset of GBS 4 May-21 July 2011, exceeding the expected number of cases (n = 1-2). Twenty-one (81%) patients reported antecedent diarrhoea, and 61% of 18 patients tested were seropositive for C. jejuni IgM antibodies. In a case-control study matched on age group, sex, ethnicity, and neighbourhood of residence, all Arizona GBS patients travelled to SLRC during the exposure period vs. 45% of matched controls (matched odds ratio 8.1, 95% confidence interval 1.5-infinity). Exposure information and an environmental assessment suggested that GBS cases resulted from a large outbreak of C. jejuni infection from inadequately disinfected tap water in SLRC. Binational collaboration was essential in investigating this cross-border GBS outbreak, the first in mainland North America since 1976. |
Outbreak of cryptosporidiosis associated with a man-made chlorinated lake--Tarrant County, Texas, 2008
Cantey PT , Kurian AK , Jefferson D , Moerbe MM , Marshall K , Blankenship WR , Rothbarth GR , Hwang J , Hall R , Yoder J , Brunkard J , Johnston S , Xiao L , Hill VR , Sarisky J , Zarate-Bermudez MA , Otto C , Hlavsa MC . J Environ Health 2012 75 (4) 14-19 In July 2008, clusters of laboratory-confirmed cryptosporidiosis cases and reports of gastrointestinal illness in persons who visited a lake were reported to Tarrant County Public Health. In response, epidemiologic, laboratory, and environmental health investigations were initiated. A matched case-control study determined that swallowing the lake water was associated with illness (adjusted odds ratio = 16.3; 95% confidence interval: 2.5-infinity). The environmental health investigation narrowed down the potential sources of contamination. Laboratory testing detected Cryptosporidium hominis in case-patient stool specimens and Cryptosporidium species in lake water. It was only through the joint effort that epidemiologic, laboratory, and environmental health investigators could determine that >1 human diarrheal fecal incidents in the lake likely led to contamination of the water. This same collaborative effort will be needed to develop and maintain an effective national Model Aquatic Health Code. |
Utility of the tourniquet test and the white blood cell count to differentiate dengue among acute febrile illnesses in the emergency room
Gregory CJ , Lorenzi OD , Colon L , Sepulveda Garcia A , Santiago LM , Cruz Rivera R , Cuyar Bermudez LJ , Ortiz Baez F , Vazquez Aponte D , Tomashek KM , Gutierrez J , Alvarado L . PLoS Negl Trop Dis 2011 5 (12) e1400 Dengue often presents with non-specific clinical signs, and given the current paucity of accurate, rapid diagnostic laboratory tests, identifying easily obtainable bedside markers of dengue remains a priority. Previous studies in febrile Asian children have suggested that the combination of a positive tourniquet test (TT) and leucopenia can distinguish dengue from other febrile illnesses, but little data exists on the usefulness of these tests in adults or in the Americas. We evaluated the diagnostic accuracy of the TT and leucopenia (white blood cell count <5000/mm(3)) in identifying dengue as part of an acute febrile illness (AFI) surveillance study conducted in the Emergency Department of Saint Luke's Hospital in Ponce, Puerto Rico. From September to December 2009, 284 patients presenting to the ED with fever for 2-7 days and no identified source were enrolled. Participants were tested for influenza, dengue, leptospirosis and enteroviruses. Thirty-three (12%) patients were confirmed as having dengue; 2 had dengue co-infection with influenza and leptospirosis, respectively. An infectious etiology was determined for 141 others (136 influenza, 3 enterovirus, 2 urinary tract infections), and 110 patients had no infectious etiology identified. Fifty-two percent of laboratory-positive dengue cases had a positive TT versus 18% of patients without dengue (P<0.001), 87% of dengue cases compared to 28% of non-dengue cases had leucopenia (P<0.001). The presence of either a positive TT or leucopenia correctly identified 94% of dengue patients. The specificity and positive predictive values of these tests was significantly higher in the subset of patients without pandemic influenza A H1N1, suggesting improved discriminatory performance of these tests in the absence of concurrent dengue and influenza outbreaks. However, even during simultaneous AFI outbreaks, the absence of leucopenia combined with a negative tourniquet test may be useful to rule out dengue. |
Rocky Mountain spotted fever in Panama: a cluster description
Tribaldos M , Zaldivar Y , Bermudez S , Samudio F , Mendoza Y , Martinez AA , Villalobos R , Eremeeva ME , Paddock CD , Page K , Smith RE , Pascale JM . J Infect Dev Ctries 2011 5 (10) 737-41 Rocky Mountain spotted fever (RMSF) is a tick-borne infection caused by Rickettsia rickettsii. We report a cluster of fatal cases of RMSF in 2007 in Panama, involving a pregnant woman and two children from the same family. The woman presented with a fever followed by respiratory distress, maculopapular rash, and an eschar at the site from which a tick had been removed. She died four days after disease onset. This is the second published report of an eschar in a patient confirmed by PCR to be infected with R. rickettsii. One month later, the children presented within days of one another with fever and rash and died three and four days after disease onset. The diagnosis was confirmed by immunohistochemistry, PCR and sequencing of the genes of R. rickettsii in tissues obtained at autopsy. |
Irrigation water issues potentially related to the 2006 multistate E. coli O157:H7 outbreak associated with spinach
Gelting RJ , Baloch MA , Zarate-Bermudez MA , Selman C . Agric Water Manag 2011 98 (9) 1395-1402 A multistate Escherichia coli O157:H7 outbreak in August and September 2006 was found to be associated with consumption of fresh bagged spinach traced to California. The California Food Emergency Response Team (CALFERT), consisting of personnel from the California Department of Public Health Food and Drug Branch (FDB) and the U.S. Food and Drug Administration (FDA) undertook an environmental investigation to determine how and why the spinach became contaminated. At the invitation of FDA and FDB, the Centers for Disease Control and Prevention (CDC) also participated in the environmental investigation. This paper presents findings from the portion of the environmental investigation focusing on environmental factors related to irrigation water that may have contributed to contamination of the spinach and hence to the outbreak. Analysis of the available data suggests that depths to groundwater and groundwater-surface water interactions may pose risks to ready-to-eat crops. These risks should be further evaluated and quantified to understand and identify the factors that contributed to this and similar outbreaks. One implication of this analysis is the need to continue to conceptually broaden the scope of produce-related outbreak investigations. Where feasible, investigation strategies should integrate possible contamination sources beyond those actually found on the farms that are identified as sources of produce involved in outbreaks. |
Spotted fever rickettsiae, Ehrlichia and Anaplasma, in ticks from peridomestic environments in Panama
Eremeeva ME , Karpathy SE , Levin ML , Caballero CM , Bermudez S , Dasch GA , Motta JA . Clin Microbiol Infect 2009 15 12-4 Rickettsiae and rickettsial diseases have been known in Panama since the 1950s, when five cases of Rocky Mountain spotted fever (RMSF) were reported from the vicinity of Ollas Arriba, Trans-Isthmus Highway and Panama City (reviewed in [1]). In the following 20 years, Rickettsia rickettsii was isolated from two patients who died of RMSF and pools of Amblyomma cajennense. Serosurveillance conducted in nine provinces of Panama during the 1980s established a relatively high seroprevalence (5.4–15.2%) by complement fixation using R. rickettsii antigen [2], a prevalence that greatly exceeds the low frequency of RMSF cases recognised in Panama. Inoculation of several pools of Amblyomma caused seroconversion to spotted fever group (SFG) rickettsiae in guinea pigs; however, R. rickettsii was not isolated from infected guinea pigs, suggesting that other rickettsial agents may be present in Panama. The importance of the tick-borne rickettsial diseases in Panama emerged recently after several fatal cases were repeatedly reported in the rural area, west of the Panama canal ([1]; J. Motta, 2007, personal communication). The purpose of this work was to assess the presence and prevalence of Rickettsia and Anaplasmataceae in ticks from peridomestic sites in Panama. |
Enhancing the public health perspective on onsite wastewater systems
Zarate-Bermudez MA . J Environ Health 2009 72 (3) 59-61 In 2007, approximately 20% of U.S. | households—60 to 65 million Americans— | were served by some type of onsite | wastewater (OWW) system (American | Housing Survey, 2008). We expect these | systems to safely disperse treated household | wastewater into the soil and help to recharge | aquifers. But these systems have been associated with groundwater contamination and | are possibly a threat to public health. Our | knowledge of the performance of OWW | systems remains inadequate. Thus, we need | to enhance the public health perspective | on OWW systems by better understanding | their performance through | developing monitoring methodologies, | and | conducting epidemiologic studies to determine their impact on human health. | Most OWW systems in the United States | are conventional systems (see Figure 1). | Data on performance of these systems and | their components are limited. Hoover, Rubin, & Humenik (1998) reported that OWW | systems result in desirable levels of treatment. Only a few researchers, however, have | reported on the quality of wastewater entering or leaving septic tanks without assessing | performance of these systems (Valiela et al., | 1992; Viraraghavan & Hashem, 1986). Levels of solids, organic matter, nutrients, microorganisms, and other constituents of raw | wastewaters and effluents are unknown for | conventional and alternative OWW systems, | making it difficult to determine the overall | performance of these systems. |
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