BACKGROUND: In October 2022, the Uganda Ministry of Health (MoH) confirmed the first case of a Sudan Virus Disease (SVD) outbreak in the Kampala Metropolitan area (KMA). A multicomponent infection prevention and control (IPC) strategy was implemented to control the spread of Orthoebolavirus sudanense (SUDV) in KMA. We describe the deployment of this strategy, its effect on IPC capacities, and the successful control of the SVD outbreak in KMA during the 2022 outbreak. METHODOLOGY: The multicomponent IPC strategy included (1) IPC pillar coordination: an IPC task force convened by government and health partner representatives and designated focal persons at the district level (2) Ring IPC: intense and targeted IPC support was developed to provide support to healthcare facilities (HCFs) and communities around each confirmed case, (3) IPC in HCFs: HCFs were assessed using a modified WHO SVD IPC scorecard rapid assessment tool that measured 15 IPC capacity domains, mentorship and IPC supplies were provided to HCFs with low scores on the rapid assessment. RESULTS: A KMA task force was established, and 13 IPC Rings were activated; 790 HCFs were assessed for IPC readiness, and 2,235 healthcare workers (HCWs) were trained. The mean (± standard-deviation) IPC score was 59.2% (± 18.6%) at baseline and increased to 65.5% (± 14.7%) at follow-up after 2 weeks (p < 0.001) of support. The mean IPC scores at baseline were lowest for primary HCFs (57%) and private-for-profit HCFs (47.1%). Similar gaps were revealed across all HCFs, with eight out of 15 (53.3%) IPC capacity areas assessed, resulting in scores < 50% at baseline. At follow-up, only four out of 15 (26.7%) capacity areas (26.7%) were below this threshold. CONCLUSION: The IPC strategy enhanced the IPC capacities at HCFs and could be adopted for future outbreaks. Leadership commitment and resource allocation to IPC during non-outbreak periods are critical for preparedness, rapid response, and access to safe care.

OBJECTIVE: To assess the relationship between the Childhood Opportunity Index (COI), a comprehensive measurement of social determinants of health (SDOH), and specific COI domains on patient-specific outcomes following congenital cardiac surgery in the metropolitan region of Atlanta, Georgia. STUDY DESIGN: In this retrospective chart review, we included patients who underwent an index operation for congenital heart disease (CHD) between 2010 and 2020 in a single pediatric health care system. Patients' addresses were geocoded and mapped to census tracts. Descriptive statistics, univariable analysis, and multivariable regression models were employed to assess associations between variables and outcomes. RESULTS: Of the 7460 index surgeries, 3798 (51%) met eligibility criteria. Presence of an adverse outcome, defined as either mortality or one of several other major post-operative morbidities, was significantly associated with COI in the univariable model (p=0.008), but not the multivariable regression model (p=0.39). Postoperative hospital length of stay (PHLOS) was significantly associated with COI (p<0.001) in univariable and multivariable regression models. There was no significant association between COI and readmission within 30 days of hospital discharge in univariable (p<0.094) and multivariable (p=0.49) models. CONCLUSION: COI is associated with PHLOS but not all outcomes in patients after congenital heart surgery. By understanding the role of COI in outcomes related to cardiac surgery, targeted interventions can be developed to improve health equity.

BACKGROUND: Hepatitis B vaccine birth dose (HepB-BD) was introduced in Lao People's Democratic Republic (Lao-PDR) to prevent perinatal hepatitis B virus transmission. HepB-BD, which is labeled for storage between 2 and 8 degrees C, is not available at all health facilities, because of some lack of functional cold chain; however, previous studies show that HepB-BD is stable if stored outside the cold chain (OCC). A pilot study was conducted in Lao-PDR to evaluate impact of OCC policy on HepB-BD coverage. METHODS: During the six month pilot, HepB-BD was stored OCC for up to 28 days in two intervention districts and stored in cold chain in two comparison districts. In the intervention districts, healthcare workers were educated about HepB-BD and OCC storage. A post-pilot survey compared HepB-BD coverage among children born during the pilot (aged 2-8 months) and children born 1 year before (aged 14-20 months). FINDINGS: In the intervention districts, 388 children aged 2-8 months and 371 children aged 14-20 months were enrolled in the survey; in the comparison districts, 190 children aged 2-8 months and 184 children aged 14-20 months were enrolled. Compared with the pre-pilot cohort, a 27% median increase in HepB-BD (interquartile range [IQR] 58%, p<0.0001) occurred in the pilot cohort in the intervention districts, compared with a 0% median change (IQR 25%, p=0.03) in comparison districts. No adverse reactions were reported. INTERPRETATION: OCC storage improved HepB-BD coverage with no increase in adverse reactions. Findings can guide Lao-PDR on implementation and scale-up options of OCC policy.

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