Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-30 (of 31 Records) |
Query Trace: Cohen NJ[original query] |
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On alert for Ebola: public health risk assessment of travellers from Uganda to the U.S. during the 2022 outbreak
Fowler JJ , Preston LE , Gearhart SL , Figueroa A , LChristensen D , Mitchell C , Hernandez E , Grills AW , Morrison SM , Wilkinson M , Talib T , Marie Lavilla K , Watson T , Mitcham D , Nash R , Veguilla MAC , Hansen S , Cohen NJ , Nu Clarke SA , Smithson A , Shearer E , Pella DG , Morris JD , Meehan S , Aboukheir M , Adams K , Sunavala Z , Conley J , Abouattier M , Palo M , Pimentel LC , Berro A , Mainzer H , Byrkit R , Kim D , Katebi V , Alvarado-Ramy F , Roohi S , Wojno AE , Brown CM , Gertz AM . J Travel Med 2024 31 (5) BACKGROUND: On 20 September 2022, the Ugandan Ministry of Health declared an outbreak of Ebola disease caused by Sudan ebolavirus. METHODS: From 6 October 2022 to 10 January 2023, Centers for Disease Control and Prevention (CDC) staff conducted public health assessments at five US ports of entry for travellers identified as having been in Uganda in the past 21 days. CDC also recommended that state, local and territorial health departments ('health departments') conduct post-arrival monitoring of these travellers. CDC provided traveller contact information, daily to 58 health departments, and collected health department data regarding monitoring outcomes. RESULTS: Among 11 583 travellers screened, 132 (1%) required additional assessment due to potential exposures or symptoms of concern. Fifty-three (91%) health departments reported receiving traveller data from CDC for 10 114 (87%) travellers, of whom 8499 (84%) were contacted for monitoring, 1547 (15%) could not be contacted and 68 (1%) had no reported outcomes. No travellers with high-risk exposures or Ebola disease were identified. CONCLUSION: Entry risk assessment and post-arrival monitoring of travellers are resource-intensive activities that had low demonstrated yield during this and previous outbreaks. The efficiency of future responses could be improved by incorporating an assessment of risk of importation of disease, accounting for individual travellers' potential for exposure, and expanded use of methods that reduce burden to federal agencies, health departments, and travellers. |
Clinical and laboratory findings of the first imported case of Middle East respiratory syndrome coronavirus to the United States.
Kapoor M , Pringle K , Kumar A , Dearth S , Liu L , Lovchik J , Perez O , Pontones P , Richards S , Yeadon-Fagbohun J , Breakwell L , Chea N , Cohen NJ , Schneider E , Erdman D , Haynes L , Pallansch M , Tao Y , Tong S , Gerber S , Swerdlow D , Feikin DR . Clin Infect Dis 2014 59 (11) 1511-8 ![]() BACKGROUND: The Middle East respiratory syndrome coronavirus (MERS-CoV) was discovered September 2012 in the Kingdom of Saudi Arabia (KSA). The first US case of MERS-CoV was confirmed on 2 May 2014. METHODS: We summarize the clinical symptoms and signs, laboratory and radiologic findings, and MERS-CoV-specific tests. RESULTS: The patient is a 65-year-old physician who worked in a hospital in KSA where MERS-CoV patients were treated. His illness onset included malaise, myalgias, and low-grade fever. He flew to the United States on day of illness (DOI) 7. His first respiratory symptom, a dry cough, developed on DOI 10. On DOI 11, he presented to an Indiana hospital as dyspneic, hypoxic, and with a right lower lobe infiltrate on chest radiography. On DOI 12, his serum tested positive by real-time reverse transcription polymerase chain reaction (rRT-PCR) for MERS-CoV and showed high MERS-CoV antibody titers, whereas his nasopharyngeal swab was rRT-PCR negative. Expectorated sputum was rRT-PCR positive the following day, with a high viral load (5.31 × 10(6) copies/mL). He was treated with antibiotics, intravenous immunoglobulin, and oxygen by nasal cannula. He was discharged on DOI 22. The genome sequence was similar (>99%) to other known MERS-CoV sequences, clustering with those from KSA from June to July 2013. CONCLUSIONS: This patient had a prolonged nonspecific prodromal illness before developing respiratory symptoms. Both sera and sputum were rRT-PCR positive when nasopharyngeal specimens were negative. US clinicians must be vigilant for MERS-CoV in patients with febrile and/or respiratory illness with recent travel to the Arabian Peninsula, especially among healthcare workers. |
Use of US Public Health Travel Restrictions during COVID-19 Outbreak on Diamond Princess Ship, Japan, February-April 2020.
Medley AM , Marston BJ , Toda M , Kobayashi M , Weinberg M , Moriarty LF , Jungerman MR , Surpris ACA , Knust B , Acosta AM , Shockey CE , Daigle D , Schneider ZD , Charles J , Ishizumi A , Stewart A , Vonnahme LA , Brown C , White S , Cohen NJ , Cetron M . Emerg Infect Dis 2021 27 (3) 710-718 Public health travel restrictions (PHTR) are crucial measures during communicable disease outbreaks to prevent transmission during commercial airline travel and mitigate cross-border importation and spread. We evaluated PHTR implementation for US citizens on the Diamond Princess during its coronavirus disease (COVID-19) outbreak in Japan in February 2020 to explore how PHTR reduced importation of COVID-19 to the United States during the early phase of disease containment. Using PHTR required substantial collaboration among the US Centers for Disease Control and Prevention, other US government agencies, the cruise line, and public health authorities in Japan. Original US PHTR removal criteria were modified to reflect international testing protocols and enable removal of PHTR for persons who recovered from illness. The impact of PHTR on epidemic trajectory depends on the risk for transmission during travel and geographic spread of disease. Lessons learned from the Diamond Princess outbreak provide critical information for future PHTR use. |
Risk Assessment and Management of COVID-19 Among Travelers Arriving at Designated U.S. Airports, January 17-September 13, 2020.
Dollard P , Griffin I , Berro A , Cohen NJ , Singler K , Haber Y , de la Motte Hurst C , Stolp A , Atti S , Hausman L , Shockey CE , Roohi S , Brown CM , Rotz LD , Cetron MS , Alvarado-Ramy F . MMWR Morb Mortal Wkly Rep 2020 69 (45) 1681-1685 ![]() In January 2020, with support from the U.S. Department of Homeland Security (DHS), CDC instituted an enhanced entry risk assessment and management (screening) program for air passengers arriving from certain countries with widespread, sustained transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). The objectives of the screening program were to reduce the importation of COVID-19 cases into the United States and slow subsequent spread within states. Screening aimed to identify travelers with COVID-19-like illness or who had a known exposure to a person with COVID-19 and separate them from others. Screening also aimed to inform all screened travelers about self-monitoring and other recommendations to prevent disease spread and obtain their contact information to share with public health authorities in destination states. CDC delegated postarrival management of crew members to airline occupational health programs by issuing joint guidance with the Federal Aviation Administration.* During January 17-September 13, 2020, a total of 766,044 travelers were screened, 298 (0.04%) of whom met criteria for public health assessment; 35 (0.005%) were tested for SARS-CoV-2, and nine (0.001%) had a positive test result. CDC shared contact information with states for approximately 68% of screened travelers because of data collection challenges and some states' opting out of receiving data. The low case detection rate of this resource-intensive program highlighted the need for fundamental change in the U.S. border health strategy. Because SARS-CoV-2 infection and transmission can occur in the absence of symptoms and because the symptoms of COVID-19 are nonspecific, symptom-based screening programs are ineffective for case detection. Since the screening program ended on September 14, 2020, efforts to reduce COVID-19 importation have focused on enhancing communications with travelers to promote recommended preventive measures, reinforcing mechanisms to refer overtly ill travelers to CDC, and enhancing public health response capacity at ports of entry. More efficient collection of contact information for international air passengers before arrival and real-time transfer of data to U.S. health departments would facilitate timely postarrival public health management, including contact tracing, when indicated. Incorporating health attestations, predeparture and postarrival testing, and a period of limited movement after higher-risk travel, might reduce risk for transmission during travel and translocation of SARS-CoV-2 between geographic areas and help guide more individualized postarrival recommendations. |
Research ethics and refugee health: a review of reported considerations and applications in published refugee health literature, 2015-2018
Seagle EE , Dam AJ , Shah PP , Webster JL , Barrett DH , Ortmann LW , Cohen NJ , Marano NN . Confl Health 2020 14 39 Introduction: Public health investigations, including research, in refugee populations are necessary to inform evidence-based interventions and care. The unique challenges refugees face (displacement, limited political protections, economic hardship) can make them especially vulnerable to harm, burden, or undue influence. Acute survival needs, fear of stigma or persecution, and history of trauma may present challenges to ensuring meaningful informed consent and establishing trust. We examined the recently published literature to understand the application of ethics principles in investigations involving refugees. Methods: We conducted a preliminary review of refugee health literature (research and non-research data collections) published from 2015 through 2018 available in PubMed. Article inclusion criteria were: participants were refugees, topic was health-related, and methods used primary data collection. Information regarding type of investigation, methods, and reported ethics considerations was abstracted. Results: We examined 288 articles. Results indicated 33% of investigations were conducted before resettlement, during the displacement period (68% of these were in refugee camps). Common topics included mental health (48%) and healthcare access (8%). The majority (87%) of investigations obtained consent. Incentives were provided less frequently (23%). Most authors discussed the ways in which community stakeholders were engaged (91%), yet few noted whether refugee representatives had an opportunity to review investigational protocols (8%). Cultural considerations were generally limited to gender and religious norms, and 13% mentioned providing some form of post-investigation support. Conclusions: Our analysis is a preliminary assessment of the application of ethics principles reported within the recently published refugee health literature. From this analysis, we have proposed a list of best practices, which include stakeholder engagement, respect for cultural norms, and post-study support. Investigations conducted among refugees require additional diligence to ensure respect for and welfare of the participants. Development of a refugee-specific ethics framework with ethics and refugee health experts that addresses the need for stakeholder involvement, appropriate incentive use, protocol review, and considerations of cultural practices may help guide future investigations in this population. |
Public Health Responses to COVID-19 Outbreaks on Cruise Ships - Worldwide, February-March 2020.
Moriarty LF , Plucinski MM , Marston BJ , Kurbatova EV , Knust B , Murray EL , Pesik N , Rose D , Fitter D , Kobayashi M , Toda M , Canty PT , Scheuer T , Halsey ES , Cohen NJ , Stockman L , Wadford DA , Medley AM , Green G , Regan JJ , Tardivel K , White S , Brown C , Morales C , Yen C , Wittry B , Freeland A , Naramore S , Novak RT , Daigle D , Weinberg M , Acosta A , Herzig C , Kapella BK , Jacobson KR , Lamba K , Ishizumi A , Sarisky J , Svendsen E , Blocher T , Wu C , Charles J , Wagner R , Stewart A , Mead PS , Kurylo E , Campbell S , Murray R , Weidle P , Cetron M , Friedman CR . MMWR Morb Mortal Wkly Rep 2020 69 (12) 347-352 ![]() ![]() An estimated 30 million passengers are transported on 272 cruise ships worldwide each year* (1). Cruise ships bring diverse populations into proximity for many days, facilitating transmission of respiratory illness (2). SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) was first identified in Wuhan, China, in December 2019 and has since spread worldwide to at least 187 countries and territories. Widespread COVID-19 transmission on cruise ships has been reported as well (3). Passengers on certain cruise ship voyages might be aged >/=65 years, which places them at greater risk for severe consequences of SARS-CoV-2 infection (4). During February-March 2020, COVID-19 outbreaks associated with three cruise ship voyages have caused more than 800 laboratory-confirmed cases among passengers and crew, including 10 deaths. Transmission occurred across multiple voyages of several ships. This report describes public health responses to COVID-19 outbreaks on these ships. COVID-19 on cruise ships poses a risk for rapid spread of disease, causing outbreaks in a vulnerable population, and aggressive efforts are required to contain spread. All persons should defer all cruise travel worldwide during the COVID-19 pandemic. |
Laboratory-based respiratory virus surveillance pilot project on select cruise ships in Alaska, 2013-15
Rogers KB , Roohi S , Uyeki TM , Montgomery D , Parker J , Fowler NH , Xu X , Ingram DJ , Fearey D , Williams SM , Tarling G , Brown CM , Cohen NJ . J Travel Med 2017 24 (6) Background: Influenza outbreaks can occur among passengers and crews during the Alaska summertime cruise season. Ill travellers represent a potential source for introduction of novel or antigenically drifted influenza virus strains to the United States. From May to September 2013-2015, the Alaska Division of Public Health, the Centers for Disease Control and Prevention (CDC), and two cruise lines implemented a laboratory-based public health surveillance project to detect influenza and other respiratory viruses among ill crew members and passengers on select cruise ships in Alaska. Methods: Cruise ship medical staff collected 2-3 nasopharyngeal swab specimens per week from passengers and crew members presenting to the ship infirmary with acute respiratory illness (ARI). Specimens were tested for respiratory viruses at the Alaska State Virology Laboratory (ASVL); a subset of specimens positive for influenza virus were sent to CDC for further antigenic characterization. Results: Of 410 nasopharyngeal specimens, 83% tested positive for at least one respiratory virus; 71% tested positive for influenza A or B virus. Antigenic characterization of pilot project specimens identified strains matching predominant circulating seasonal influenza virus strains, which were included in the northern or southern hemisphere influenza vaccines during those years. Results were relatively consistent across age groups, recent travel history, and influenza vaccination status. Onset dates of illness relative to date of boarding differed between northbound (occurring later in the voyage) and southbound (occurring within the first days of the voyage) cruises. Conclusions: The high yield of positive results indicated that influenza was common among passengers and crews sampled with ARI. This finding reinforces the need to bolster influenza prevention and control activities on cruise ships. Laboratory-based influenza surveillance on cruise ships may augment inland influenza surveillance and inform control activities. However, these benefits should be weighed against the costs and operational limitations of instituting laboratory-based surveillance programs on ships. |
Conveyance contact investigation for imported Middle East Respiratory Syndrome cases, United States, May 2014
Lippold SA , Objio T , Vonnahme L , Washburn F , Cohen NJ , Chen TH , Edelson PJ , Gulati R , Hale C , Harcourt J , Haynes L , Jewett A , Jungerman R , Kohl KS , Miao C , Pesik N , Regan JJ , Roland E , Schembri C , Schneider E , Tamin A , Tatti K , Alvarado-Ramy F . Emerg Infect Dis 2017 23 (9) 1585-1589 In 2014, the Centers for Disease Control and Prevention conducted conveyance contact investigations for 2 Middle East respiratory syndrome cases imported into the United States, comprising all passengers and crew on 4 international and domestic flights and 1 bus. Of 655 contacts, 78% were interviewed; 33% had serologic testing. No secondary cases were identified. |
Tracing airline travelers for a public health investigation: Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection in the United States, 2014
Regan JJ , Robynne Jungerman M , Lippold SA , Washburn F , Roland E , Objio T , Schembri C , Gulati R , Edelson PJ , Alvarado-Ramy F , Pesik N , Cohen NJ . Public Health Rep 2016 131 (4) 552-559 Objective. CDC routinely conducts contact investigations involving travelers on commercial conveyances, such as aircrafts, cargo vessels, and cruise ships. Methods. The agency used established systems of communication and partnerships with other federal agencies to quickly provide accurate traveler contact information to states and jurisdictions to alert contacts of potential exposure to two travelers with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) who had entered the United States on commercial flights in April and May 2014. Results. Applying the same process used to trace and notify travelers during routine investigations, such as those for tuberculosis or measles, CDC was able to notify most travelers of their potential exposure to MERS-CoV during the first few days of each investigation. Conclusion. To prevent the introduction and spread of newly emerging infectious diseases, travelers need to be located and contacted quickly. © 2016, Association of Schools of Public Health. All rights reserved. |
Travel and border health measures to prevent the international spread of Ebola
Cohen NJ , Brown CM , Alvarado-Ramy F , Bair-Brake H , Benenson GA , Chen TH , Demma AJ , Holton NK , Kohl KS , Lee AW , McAdam D , Pesik N , Roohi S , Smith CL , Waterman SH , Cetron MS . MMWR Suppl 2016 65 (3) 57-67 During the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa, CDC implemented travel and border health measures to prevent international spread of the disease, educate and protect travelers and communities, and minimize disruption of international travel and trade. CDC staff provided in-country technical assistance for exit screening in countries in West Africa with Ebola outbreaks, implemented an enhanced entry risk assessment and management program for travelers at U.S. ports of entry, and disseminated information and guidance for specific groups of travelers and relevant organizations. New and existing partnerships were crucial to the success of this response, including partnerships with international organizations, such as the World Health Organization, the International Organization for Migration, and nongovernment organizations, as well as domestic partnerships with the U.S. Department of Homeland Security and state and local health departments. Although difficult to assess, travel and border health measures might have helped control the epidemic's spread in West Africa by deterring or preventing travel by symptomatic or exposed persons and by educating travelers about protecting themselves. Enhanced entry risk assessment at U.S. airports facilitated management of travelers after arrival, including the recommended active monitoring. These measures also reassured airlines, shipping companies, port partners, and travelers that travel was safe and might have helped maintain continued flow of passenger traffic and resources needed for the response to the affected region. Travel and border health measures implemented in the countries with Ebola outbreaks laid the foundation for future reconstruction efforts related to borders and travel, including development of regional surveillance systems, cross-border coordination, and implementation of core capacities at designated official points of entry in accordance with the International Health Regulations (2005). New mechanisms developed during this response to target risk assessment and management of travelers arriving in the United States may enhance future public health responses. The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html). |
Exportations of symptomatic cases of MERS-CoV infection to countries outside the Middle East
Carias C , O'Hagan JJ , Jewett A , Gambhir M , Cohen NJ , Haber Y , Pesik N , Swerdlow DL . Emerg Infect Dis 2016 22 (3) 723-5 In 2012, an outbreak of infection with Middle East respiratory syndrome coronavirus (MERS-CoV), was detected in the Arabian Peninsula. Modeling can produce estimates of the expected annual number of symptomatic cases of MERS-CoV infection exported and the likelihood of exportation from source countries in the Middle East to countries outside the region. |
US college and university student health screening requirements for tuberculosis and vaccine-preventable diseases, 2012
Jewett A , Bell T , Cohen NJ , Buckley K , Leino EV , Even S , Beavers S , Brown C , Marano N . J Am Coll Health 2016 64 (5) 0 OBJECTIVE: Colleges are at risk for communicable disease outbreaks because of the high degree of person-to-person interactions and relatively crowded dormitory settings. This report describes the U.S. college student health screening requirements among U.S. resident and international students for tuberculosis (TB) and vaccine-preventable diseases (VPD) as it relates to the American College Health Association (ACHA) Guidelines. METHODS/PARTICIPANTS: In April 2012, U.S. college health administrators (N = 2858) were sent online surveys to assess their respective school's TB screening and immunization requirements. RESULTS: Surveys were completed by 308 (11%) schools. Most schools were aware of the ACHA immunization (78%) and TB screening (76%) guidelines. Schools reported having policies related to immunization screening (80.4%), immunization compliance (93%), TB screening (55%), and TB compliance (87%). CONCLUSION: Most colleges were following ACHA guidelines. However, there are opportunities for improvement to fully utilize the recommendations and prevent outbreaks of communicable diseases among students in colleges. |
Lack of transmission among close contacts of patient with case of Middle East Respiratory Syndrome imported into the United States, 2014
Breakwell L , Pringle K , Chea N , Allen D , Allen S , Richards S , Pantones P , Sandoval M , Liu L , Vernon M , Conover C , Chugh R , DeMaria A , Burns R , Smole S , Gerber SI , Cohen NJ , Kuhar D , Haynes LM , Schneider E , Kumar A , Kapoor M , Madrigal M , Swerdlow DL , Feikin DR . Emerg Infect Dis 2015 21 (7) 1128-34 In May 2014, a traveler from the Kingdom of Saudi Arabia was the first person identified with Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the United States. To evaluate transmission risk, we determined the type, duration, and frequency of patient contact among health care personnel (HCP), household, and community contacts by using standard questionnaires and, for HCP, global positioning system (GPS) tracer tag logs. Respiratory and serum samples from all contacts were tested for MERS-CoV. Of 61 identified contacts, 56 were interviewed. HCP exposures occurred most frequently in the emergency department (69%) and among nurses (47%); some HCP had contact with respiratory secretions. Household and community contacts had brief contact (e.g., hugging). All laboratory test results were negative for MERS-CoV. This contact investigation found no secondary cases, despite case-patient contact by 61 persons, and provides useful information about MERS-CoV transmission risk. Compared with GPS tracer tag recordings, self-reported contact may not be as accurate. |
Evaluation of emergency drug releases from the Centers for Disease Control and Prevention Quarantine Stations
Roohi S , Grinnell M , Sandoval M , Cohen NJ , Crocker K , Allen C , Dougherty C , Jolly J , Pesik N . J Emerg Manag 2015 13 (1) 19-23 The Centers for Disease Control and Prevention (CDC) Quarantine Stations distribute select lifesaving drug products that are not commercially available or are in limited supply in the United States for emergency treatment of certain health conditions. Following a retrospective analysis of shipment records, the authors estimated an average of 6.66 hours saved per shipment when drug products were distributed from quarantine stations compared to a hypothetical centralized site from CDC headquarters in Atlanta, GA. This evaluation supports the continued use of a decentralized model which leverages CDC's regional presence and maximizes efficiency in the distribution of lifesaving drugs. |
Airport exit and entry screening for Ebola - August-November 10, 2014
Brown CM , Aranas AE , Benenson GA , Brunette G , Cetron M , Chen TH , Cohen NJ , Diaz P , Haber Y , Hale CR , Holton K , Kohl K , Le AW , Palumbo GJ , Pearson K , Phares CR , Alvarado-Ramy F , Roohi S , Rotz LD , Tappero J , Washburn FM , Watkins J , Pesik N . MMWR Morb Mortal Wkly Rep 2014 63 (49) 1163-7 In response to the largest recognized Ebola virus disease epidemic now occurring in West Africa, the governments of affected countries, CDC, the World Health Organization (WHO), and other international organizations have collaborated to implement strategies to control spread of the virus. One strategy recommended by WHO calls for countries with Ebola transmission to screen all persons exiting the country for "unexplained febrile illness consistent with potential Ebola infection." Exit screening at points of departure is intended to reduce the likelihood of international spread of the virus. To initiate this strategy, CDC, WHO, and other global partners were invited by the ministries of health of Guinea, Liberia, and Sierra Leone to assist them in developing and implementing exit screening procedures. Since the program began in August 2014, an estimated 80,000 travelers, of whom approximately 12,000 were en route to the United States, have departed by air from the three countries with Ebola transmission. Procedures were implemented to deny boarding to ill travelers and persons who reported a high risk for exposure to Ebola; no international air traveler from these countries has been reported as symptomatic with Ebola during travel since these procedures were implemented. |
Nowcasting the spread of chikungunya virus in the Americas
Johansson MA , Powers AM , Pesik N , Cohen NJ , Staples JE . PLoS One 2014 9 (8) e104915 BACKGROUND: In December 2013, the first locally-acquired chikungunya virus (CHIKV) infections in the Americas were reported in the Caribbean. As of May 16, 55,992 cases had been reported and the outbreak was still spreading. Identification of newly affected locations is paramount to intervention activities, but challenging due to limitations of current data on the outbreak and on CHIKV transmission. We developed models to make probabilistic predictions of spread based on current data considering these limitations. METHODS AND FINDINGS: Branching process models capturing travel patterns, local infection prevalence, climate dependent transmission factors, and associated uncertainty estimates were developed to predict probable locations for the arrival of CHIKV-infected travelers and for the initiation of local transmission. Many international cities and areas close to where transmission has already occurred were likely to have received infected travelers. Of the ten locations predicted to be the most likely locations for introduced CHIKV transmission in the first four months of the outbreak, eight had reported local cases by the end of April. Eight additional locations were likely to have had introduction leading to local transmission in April, but with substantial uncertainty. CONCLUSIONS: Branching process models can characterize the risk of CHIKV introduction and spread during the ongoing outbreak. Local transmission of CHIKV is currently likely in several Caribbean locations and possible, though uncertain, for other locations in the continental United States, Central America, and South America. This modeling framework may also be useful for other outbreaks where the risk of pathogen spread over heterogeneous transportation networks must be rapidly assessed on the basis of limited information. |
Knowledge, attitudes, and practices among border crossers during temporary enforcement of a formal entry requirement for Mexican-style soft cheeses, 2009
Nguyen AV , Cohen NJ , Gao H , Fishbein DB , Keir J , Ocana JM , Senini L , Flores A , Waterman SH . J Food Prot 2014 77 (9) 1571-8 Mexican-style soft cheese known as queso fresco (QF), which is often unpasteurized, has been implicated in outbreaks of foodborne illness in the United States. The U.S. Food and Drug Administration (FDA) exercises discretion in enforcement of noncommercial importation of cheese. To test control measures aimed at decreasing unlawful QF importation, in 2009 the FDA temporarily enforced a requirement for formal commercial entry for all cheeses over 5 lb (2.3 kg) at the San Diego-Tijuana border. Enforcement was combined with educational outreach. Border crossers importing cheese and those not importing cheese were surveyed at the beginning and end of the temporary enforcement period. Data collected included participant demographic information, knowledge of QF-associated health risks, and attitudes and practices regarding QF consumption and importation. We surveyed 306 importers and 381 nonimporters. Compared with nonimporters, importers had a lower level of knowledge regarding QF-associated health risks (P < 0.0001). Border crossers carrying cheese were more likely to have less education, be U.S. or dual residents, consume QF more frequently, and cross the border less often. Importation and consumption of unpasteurized QF remained prevalent among border crossers during the temporary enforcement period, and the level of knowledge regarding QF-associated risks remained low among these crossers. More vigorous, sustained messaging targeted at high-risk groups is needed to change behaviors. Definition and consistent enforcement of limits will likely be needed to reduce QF importation and the risk of QF-associated diseases along the U.S.-Mexico border; however, public health benefits will need to be balanced against the cost of enforcement. |
Notes from the field: investigation of infectious disease risks associated with a nontransplant anatomical donation center - Arizona, 2014
de Perio MA , Bernard BP , Delaney LJ , Pesik N , Cohen NJ . MMWR Morb Mortal Wkly Rep 2014 63 (17) 384-5 CDC is investigating reports of potential occupational exposure to human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and Mycobacterium tuberculosis among workers performing preparation and dissection procedures on human nontransplant anatomical materials at a nontransplant anatomical donation center in Arizona. CDC is working with Arizona public health officials to inform persons exposed to these potentially infected materials. Nontransplant anatomical centers around the United States process thousands of donated cadavers annually. These materials (which might be fresh, frozen, or chemically preserved) are used by universities and surgical instrument and pharmaceutical companies for medical education and research. The American Association of Tissue Banks has developed accreditation policies for nontransplant anatomical donation organizations. It also has written standards that specify exclusion criteria for donor material, as well as use of proper environmental controls and safe work practices to prevent transmission of infectious agents during receipt and handling of nontransplant anatomical materials. At the center under investigation, which is now closed, these standards might not have been consistently implemented. |
Prevention and control of rabies in an age of global travel: a review of travel- and trade-sssociated rabies events - United States, 1986-2012
Lankau EW , Cohen NJ , Jentes ES , Adams LE , Bell TR , Blanton JD , Buttke D , Galland GG , Maxted AM , Tack DM , Waterman SH , Rupprecht CE , Marano N . Zoonoses Public Health 2013 61 (5) 305-16 Rabies prevention and control efforts have been successful in reducing or eliminating virus circulation regionally through vaccination of specific reservoir populations. A notable example of this success is the elimination of canine rabies virus variant from the United States and many other countries. However, increased international travel and trade can pose risks for rapid, long-distance movements of ill or infected persons or animals. Such travel and trade can result in human exposures to rabies virus during travel or transit and could contribute to the re-introduction of canine rabies variant or transmission of other viral variants among animal host populations. We present a review of travel- and trade-associated rabies events that highlight international public health obligations and collaborative opportunities for rabies prevention and control in an age of global travel. Rabies is a fatal disease that warrants proactive coordination among international public health and travel industry partners (such as travel agents, tour companies and airlines) to protect human lives and to prevent the movement of viral variants among host populations. |
Influenza A(H1N1)pdm09 during air travel
Neatherlin J , Cramer EH , Dubray C , Marienau KJ , Russell M , Sun H , Whaley M , Hancock K , Duong KK , Kirking HL , Schembri C , Katz JM , Cohen NJ , Fishbein DB . Travel Med Infect Dis 2013 11 (2) 110-8 ![]() The global spread of the influenza A(H1N1)pdm09 virus (pH1N1) associated with travelers from North America during the onset of the 2009 pandemic demonstrates the central role of international air travel in virus migration. To characterize risk factors for pH1N1 transmission during air travel, we investigated travelers and airline employees from four North American flights carrying ill travelers with confirmed pH1N1 infection. Of 392 passengers and crew identified, information was available for 290 (74%) passengers were interviewed. Overall attack rates for acute respiratory infection and influenza-like illness 1-7 days after travel were 5.2% and 2.4% respectively. Of 43 individuals that provided sera, 4 (9.3%) tested positive for pH1N1 antibodies, including 3 with serologic evidence of asymptomatic infection. Investigation of novel influenza aboard aircraft may be instructive. However, beyond the initial outbreak phase, it may compete with community-based mitigation activities, and interpretation of findings will be difficult in the context of established community transmission. |
Mass screening for fever in children: a comparison of 3 infrared thermal detection systems
Selent MU , Molinari NM , Baxter A , Nguyen AV , Siegelson H , Brown CM , Plummer A , Higgins A , Podolsky S , Spandorfer P , Cohen NJ , Fishbein DB . Pediatr Emerg Care 2013 29 (3) 305-13 OBJECTIVES: Infrared thermal detection systems (ITDSs) have been used with limited success outside the United States to screen for fever during recent outbreaks of novel infectious diseases. Although ITDSs are fairly accurate in detecting fever in adults, there is little information about their utility in children. METHODS: In a pediatric emergency department, we compared temperatures of children (<18 years old) measured using 3 ITDSs (OptoTherm Thermoscreen, FLIR ThermoVision 360, and Thermofocus 0800H3) to standard, age-appropriate temperature measurements (confirmed fever defined as ≥38.0 degrees C [oral or rectal], ≥37.0 degrees C [axillary]). Measured temperatures were compared with parental reports of fever using descriptive, multivariate, and receiver operating characteristic analyses. RESULTS: Of 855 patients, 400 (46.8%) had parent-reported fever, and 306 (35.8%) had confirmed fever. At optimal fever thresholds, OptoTherm and FLIR had sensitivity (83.0% and 83.7%, respectively) approximately equal to parental report (83.9%) and greater than Thermofocus (76.8%), and specificity (86.3% and 85.7%) greater than parental report (70.8%) and Thermofocus (79.4%). Correlation coefficients between traditional thermometry and ITDSs were 0.78 (OptoTherm), 0.75 (FLIR), and 0.66 (Thermofocus). CONCLUSIONS: Compared with traditional thermometry, FLIR and OptoTherm were reasonably accurate in detecting fever in children and better predictors of fever than parental report. These findings suggest that ITDSs could be a useful noninvasive screening tool for fever in the pediatric age group. |
Impact of port of entry referrals on initiation of follow-up evaluations for immigrants with suspected tuberculosis: Illinois
Bell TR , Molinari NM , Blumensaadt S , Selent MU , Arbisi M , Shah N , Christiansen D , Philen R , Puesta B , Jones J , Lee D , Vang A , Cohen NJ . J Immigr Minor Health 2013 15 (4) 673-9 US-bound immigrants with suspected non-infectious TB are encouraged to be medically re-evaluated after arrival in the United States. We evaluated the Centers for Disease Control and Prevention's immigrant referral process, designed to facilitate timely post-arrival evaluations. Over 1,200 immigrants with suspected TB arriving during October 1, 2008-September 30, 2010 were identified. In 2011, differences in days to evaluation initiation were assessed by referral type using survival analysis and Cox proportional hazard models. Among those receiving any referral, median time to post-arrival evaluation was significantly lower compared with immigrants receiving no referral (16 vs. 69 days, respectively; p < 0.0001). After adjusting for the covariates, immigrants receiving any referral initiated follow-up at 4 times the rate (adjusted hazard ratio = 4.0; p < 0.0001) of those receiving no referral. Implementing a referral system at US ports of entry will improve timeliness and increase the proportion of immigrants initiating domestic evaluation. |
Malaria prevention knowledge, attitudes, and practices (KAP) among international flying pilots and flight attendants of a US commercial airline
Selent M , de Rochars VMB , Stanek D , Bensyl D , Martin B , Cohen NJ , Kozarsky P , Blackmore C , Bell TR , Marano N , Arguin PM . J Travel Med 2012 19 (6) 366-372 BACKGROUND: In 2010, malaria caused approximately 216 million infections in people and 655,000 deaths. In the United States, imported malaria cases occur every year, primarily in returning travelers and immigrants from endemic countries. In 2010, five Plasmodium falciparum malaria cases occurred among crew members of one US commercial airline company (Airline A). This investigation aimed to assess the malaria prevention knowledge, attitudes, and practices (KAP) of Airline A crew members to provide information for potential interventions. METHODS: The web link to a self-administered on-line survey was distributed by internal company communications to Airline A pilots and flight attendants (FA) eligible for international travel. The survey collected demographic information as well as occupation, work history, and malaria prevention education. RESULTS: Of approximately 7,000 nonrandomly selected crew members, 220 FA and 217 pilots completed the survey (6%). Respondents correctly identified antimalarial medication (91% FA, 95% pilots) and insect repellents (96% FA, 96% pilots) as effective preventive measures. While in malaria-intense destinations, few FA and less than half of pilots always took antimalarial medication (4% FA, 40% pilots) yet many often spent greater than 30 minutes outdoors after sundown (71% FA, 66% pilots). Less than half in both groups always used insect repellents (46% FA, 47% pilots). Many respondents were unaware of how to get antimalarial medications (52% FA, 30% pilots) and were concerned about their side effects (61% FA, 31% pilots). CONCLUSION: Overall, FA and pilots demonstrated good knowledge of malaria prevention, but many performed risky activities while practicing only some recommended malaria preventive measures. Malaria prevention education should focus on advance notification if traveling to a malaria-endemic area, how to easily obtain antimalarial medications, and the importance of practicing all recommended preventive measures. (2012 International Society of Travel Medicine, 1195-1982.) |
Preventing maritime transfer of toxigenic Vibrio cholerae
Cohen NJ , Slaten DD , Marano N , Tappero JW , Wellman M , Albert RJ , Hill VR , Espey D , Handzel T , Henry A , Tauxe RV . Emerg Infect Dis 2012 18 (10) 1680-2 ![]() Organisms, including Vibrio cholerae, can be transferred between harbors in the ballast water of ships. Zones in the Caribbean region where distance from shore and water depth meet International Maritime Organization guidelines for ballast water exchange are extremely limited. Use of ballast water treatment systems could mitigate the risk for organism transfer. |
Exposure of US travelers to rabid zebra, Kenya, 2011
Lankau EW , Montgomery JM , Tack DM , Obonyo M , Kadivane S , Blanton JD , Arvelo W , Jentes ES , Cohen NJ , Brunette GW , Marano N , Rupprecht CE . Emerg Infect Dis 2012 18 (7) 1202-4 TO THE EDITOR: Rabies is an acute progressive encephalitis caused by infection with a lyssavirus (genus Lyssavirus, family Rhabdoviridae). Most human infections are caused by bites from rabid animals, but the virus also can be transmitted by contact of open wounds or mucous membranes with animal saliva. Prompt administration of postexposure prophylaxis (PEP) is recommended to prevent rabies. Canids are common sources of human exposures in many regions of Africa, Asia, and Latin America. However, all mammals are susceptible, including herbivores such as horses, cattle, and antelope. |
Travel health alert notices and Haiti cholera outbreak, Florida, USA, 2011
Selent MU , McWhorter A , Beau De Rochars VM , Myers R , Hunter DW , Brown CM , Cohen NJ , Molinari NA , Warwar K , Robbins D , Heiman KE , Newton AE , Schmitz A , Oraze MJ , Marano N . Emerg Infect Dis 2011 17 (11) 2169-2171 To enhance the timeliness of medical evaluation for cholera-like illness during the 2011 cholera outbreak in Hispaniola, printed Travel Health Alert Notices (T-HANs) were distributed to travelers from Haiti to the United States. Evaluation of the T-HANs' influence on travelers' health care-seeking behavior suggested T-HANs might positively influence health care-seeking behavior. |
Respiratory illness in households of school-dismissed students during influenza pandemic, 2009
Cohen NJ , Callahan DB , Gonzalez V , Balaban V , Wang RT , Pordell P , Beato R , Oyervides O , Huang WT , Massoudi MS . Emerg Infect Dis 2011 17 (9) 1756-7 TO THE EDITOR: In response to the emergence of pandemic (H1N1) 2009 virus (1), the Centers for Disease Control and Prevention (CDC) issued interim guidance for preventing spread of the pandemic virus in schools. Initial guidance recommended that dismissal of students be considered for schools with confirmed cases of pandemic (H1N1) 2009 infection. The guidance was subsequently revised to recommend monitoring for respiratory illness and exclusion of ill students until they were noninfectious, rather than dismissal. |
The impact of adulticide applications on mosquito density in Chicago, 2005
Mutebi JP , Delorey MJ , Jones RC , Plate DK , Gerber SI , Gibbs KP , Sun G , Cohen NJ , Paul WS . J Am Mosq Control Assoc 2011 27 (1) 69-76 The city of Chicago used ground ultra-low volume treatments of sumithrin (ANVIL 10+10) in areas with high West Nile virus infection rates among Culex mosquitoes. Two sequential treatments in Morbidity and Mortality Weekly Reports wk 31 and 32 decreased mean mosquito density by 54% from 2.5 to 1.1 mosquitoes per trap-day, whereas mosquito density increased by 153% from 1.3 to 3.3 mosquitoes per trap-day at the nonsprayed sites. The difference between these changes in mosquito density was statistically significant (confidence intervals for the difference in change: -4.7 to -1.9). Sequential adulticide treatments in September (wk 34 and 35) had no effect on mosquito density, probably because it was late in the season and the mosquitoes were presumably entering diapause and less active. Overall, there was significant decrease in mosquito density at the trap sites treated in all 4 wk (wk 31, 32, 34, and 35), suggesting that sustained sequential treatments suppressed mosquito density. Maximum likelihood estimates (MLE) of infection rate estimates varied independently of adulticide treatments, suggesting that the adulticide treatments had no direct effect on MLE. Mosquito trap counts were low, which was probably due to large numbers of alternative oviposition sites, especially catch basins competing with the gravid traps. |
Effect of school closure from pandemic (H1N1) 2009, Chicago, Illinois, USA
Jarquin VG , Callahan DB , Cohen NJ , Balaban V , Wang R , Beato R , Pordell P , Oyervides O , Huang WT , Lipman H , Fishbein D , Massoudi MS . Emerg Infect Dis 2011 17 (4) 751-3 TO THE EDITOR: On April 28, 2009, the Chicago Department of Public Health received notification of 1 student at an elementary school with a probable pandemic (H1N1) 2009 virus infection; the infection was subsequently laboratory confirmed. This case was one of the first pandemic (H1N1) 2009 cases in Chicago. To prevent transmission of influenza and with guidance from the Chicago Department of Public Health, the school closed on April 29; it reopened on May 6 after the Centers for Disease Control and Prevention (CDC) revised its recommendations (1). We conducted an investigation to evaluate psychosocial and economic effects of the school closure on the students' families and to assess whether students complied with mitigation recommendations. In the early pandemic, Chicago's number of pandemic (H1N1) 2009 cases was one of the highest in the United States (2). |
Comparison of 3 infrared thermal detection systems and self-report for mass fever screening
Nguyen AV , Cohen NJ , Lipman H , Brown CM , Molinari NA , Jackson WL , Kirking H , Szymanowski P , Wilson TW , Salhi BA , Roberts RR , Stryker DW , Fishbein DB . Emerg Infect Dis 2010 16 (11) 1710-7 Despite limited evidence regarding their utility, infrared thermal detection systems (ITDS) are increasingly being used for mass fever detection. We compared temperature measurements for 3 ITDS (FLIR ThermoVision A20M [FLIR Systems Inc., Boston, MA, USA], OptoTherm Thermoscreen [OptoTherm Thermal Imaging Systems and Infrared Cameras Inc., Sewickley, PA, USA], and Wahl Fever Alert Imager HSI2000S [Wahl Instruments Inc., Asheville, NC, USA]) with oral temperatures (≥ 100 degrees F = confirmed fever) and self-reported fever. Of 2,873 patients enrolled, 476 (16.6%) reported a fever, and 64 (2.2%) had a confirmed fever. Self-reported fever had a sensitivity of 75.0%, specificity 84.7%, and positive predictive value 10.1%. At optimal cutoff values for detecting fever, temperature measurements by OptoTherm and FLIR had greater sensitivity (91.0% and 90.0%, respectively) and specificity (86.0% and 80.0%, respectively) than did self-reports. Correlations between ITDS and oral temperatures were similar for OptoTherm (rho = 0.43) and FLIR (rho = 0.42) but significantly lower for Wahl (rho = 0.14; p < 0.001). When compared with oral temperatures, 2 systems (OptoTherm and FLIR) were reasonably accurate for detecting fever and predicted fever better than self-reports. |
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