Last data update: Nov 04, 2024. (Total: 48056 publications since 2009)
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Query Trace: Luna-Pinto C[original query] |
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Factors that support public health infrastructure recovery in Puerto Rico and US Virgin Islands after Hurricanes Irma and Maria
Luna-Pinto SC , Ramos JI , Gonzalez Y , Cartagena NB , Taveras S . J Emerg Manag 2024 22 (2) 129-138 This paper describes the factors that support recovery of public health infrastructure (PHI), including conditions that facilitated or hindered recovery in United States (US) territories impacted by hurricanes Irma and Maria. A deductive approach was used to categorize data from five organizations that received crisis hurricane recovery (CHR) funds from the Centers for Disease Control and Prevention.* Spending was grouped into five infrastructure gaps: (1) human resources, (2) informatic upgrades, (3) equipment, (4) minor repairs, and (5) preventive maintenance. Unanticipated PHI costs, facilitators, and hinderances to PHI recovery were identified. Most (72 percent) of the $53,529,823 CHR funding was used to address infrastructure gaps in (1) human resources (56 percent), (2) informatics (16 percent), (3) equipment (13 percent), (4) minor repairs (10 percent), and (5) preventive maintenance (5 percent). Most of the requests (56 percent) to redirect funds were associated with unanticipated costs in initial work plans and budgets. The use of administrative partners, planning tools, dedicated staff, streamlined procedures, eg, contracts, and cost sharing facilitated PHI recovery. The most common hindrance to PHI recovery were delays in procurement and shipping. In summary, investments in dedicated funding to upgrade, repair, or replace critical structures and systems for infectious disease surveillance, laboratory capacity, vector control, environmental health inspections, and vaccine storage and administration in Puerto Rico and the US Virgin Islands after Hurricanes Irma and Maria contributed to their recovery capacity. These findings may inform funding and resource allocation considerations for PHI recovery in the US territories. |
A Scoping Review of Factors used to Explain Disparities in COVID-19 Vaccination Intentions and Uptake among People of Color-United States, December 1, 2020-April 30, 2021 (preprint)
Wilson RF , Kota KK , Sheats KJ , Luna-Pinto C , Owens C , Harrison DD , Razi S . medRxiv 2023 13 Background: Vaccine access, coupled with the belief that vaccines are important, beneficial, and safe, plays a pivotal role in achieving high levels of vaccination to reduce the spread and severity of COVID-19 in the United States (U.S.) and globally. Many factors can influence vaccine intentions and uptake. Method(s): We conducted a scoping review of factors (e.g., access-related factors, racism) known to influence vaccine intentions and uptake, using publications from various databases and websites published December 1, 2020-April 30, 2021. Descriptive statistics were used to present results. Result(s): Overall, 1094 publications were identified through the database search, of which 133 were included in this review. Among the publications included, over 60% included mistrust in vaccines and vaccine-safety concerns, 43% included racism/discrimination, 35% included lack of vaccine access (35%), and 8% had no contextual factors when reporting on vaccine intentions and disparities in vaccine uptake. Conclusion(s): Findings revealed during a critical period when there was a well-defined goal for adult COVID-19 vaccination in the U.S., some publications included several contextual factors while others provided limited or no contextual factors when reporting on disparities in vaccine intentions and uptake. Failing to contextualize inequities and other factors that influence vaccine intentions and uptake might be perceived as placing responsibility for vaccination status on the individual, consequently, leaving social and structural inequities that impact vaccination rates and vaccine confidence, among people of color, intact. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. This article is a US Government work. It is not subject to copyright under 17 USC 105 and is also made available for use under a CC0 license. |
Call out racism and inequity in reports on vaccine intentions
Wilson RF , Kota KK , Sheats KJ , Luna-Pinto C , Owens C , Harrison DD , Razi S . Nat Hum Behav 2023 7 (3) 300-302 The language used when reporting racial and ethnic disparities in vaccine intentions and uptake must evolve to reflect social and structural inequities. To achieve health equity, we must acknowledge the extent to which racism and health inequities serve as barriers to vaccine-seeking behaviours among people of colour. | | During the early stages of the rollout of COVID-19 vaccines in the USA, uptake of COVID-19 vaccines was higher among White, non-Hispanic persons as compared with people of colour (that is, American Indian or Alaska Native, non-Hispanic; Black, non-Hispanic; Hispanic; and Native Hawaiian or Pacific Islander, non-Hispanic persons). These early racial and ethnic disparities in vaccination rates led many news stories, journal articles and other reports to perpetuate a narrative that disparities in the uptake of COVID-19 vaccines among people of colour were largely driven by vaccine hesitancy, while neglecting to focus on health inequities and other factors as drivers of disparities in vaccine intentions and uptake. |
Promoting health equity during the COVID-19 pandemic, United States.
Moore JT , Luna-Pinto C , Cox H , Razi S , St Louis ME , Ricaldi JN , Liburd L . Bull World Health Organ 2022 100 (2) 171-173 The United States of America has a diverse population of over 331 million people.1 Groups historically identified as racial and ethnic minorities (which make up more than one third of the US population)1 have been economically and socially marginalized, leading to lower access to education, health care and financial capital, therefore putting some of these groups at increased risk for poor health outcomes.2 The coronavirus disease 2019 (COVID-19) pandemic has amplified existing health inequities; disparities in COVID-19 cases, hospitalizations and deaths, and now vaccination rates, have been identified.3,4 Here, we provide a high-level summary of strategies implemented by the United States Centers for Disease Control and Prevention (CDC) to address COVID-19 inequities impacting racial and ethnic minority groups. |
Public health branch incident management and support as part of the Federal Government response during the emergency phase of Hurricanes Irma and Maria in Puerto Rico and the US Virgin Islands
Cruz MA , Rivera-González LO , Irvin-Barnwell E , Cabrera-Marquez J , Ellis E , Ellis B , Qi B , Maniglier-Poulet C , Gerding JA , Shumate A , Andujar A , Yoder J , Laco J , Santana A , Bayleyegn T , Luna-Pinto C , Rodriguez LO , Roth J , Bermingham J , Funk RH , Raheem M . J Emerg Manag 2021 19 (8) 63-77 On September 6 and 20, 2017, Hurricanes Irma and Maria made landfall as major hurricanes in the US Caribbean Territories of the Virgin Islands and Puerto Rico with devastating effects. As part of the initial response, a public health team (PHT) was initially deployed as part of the US Department of Health and Human Services Incident Response Coordination Team. As a result of increased demands for additional expertise and resources, a public health branch (PHB) was established for coordinating a broad spectrum of public health response activities in support of the affected territories. This paper describes the conceptual framework for organizing these activities; summarizes some key public health activities and roles; outlines partner support and coordination with key agencies; and defines best practices and areas for improvement in disaster future operations. © 2021 Weston Medical Publishing. All rights reserved. |
CDC Deployments to State, Tribal, Local, and Territorial Health Departments for COVID-19 Emergency Public Health Response - United States, January 21-July 25, 2020.
Dirlikov E , Fechter-Leggett E , Thorne SL , Worrell CM , Smith-Grant JC , Chang J , Oster AM , Bjork A , Young S , Perez AU , Aden T , Anderson M , Farrall S , Jones-Wormley J , Walters KH , LeBlanc TT , Kone RG , Hunter D , Cooley LA , Krishnasamy V , Fuld J , Luna-Pinto C , Williams T , O'Connor A , Nett RJ , Villanueva J , Oussayef NL , Walke HT , Shugart JM , Honein MA , Rose DA . MMWR Morb Mortal Wkly Rep 2020 69 (39) 1398-1403 Coronavirus disease 2019 (COVID-19) is a viral respiratory illness caused by SARS-CoV-2. During January 21-July 25, 2020, in response to official requests for assistance with COVID-19 emergency public health response activities, CDC deployed 208 teams to assist 55 state, tribal, local, and territorial health departments. CDC deployment data were analyzed to summarize activities by deployed CDC teams in assisting state, tribal, local, and territorial health departments to identify and implement measures to contain SARS-CoV-2 transmission (1). Deployed teams assisted with the investigation of transmission in high-risk congregate settings, such as long-term care facilities (53 deployments; 26% of total), food processing facilities (24; 12%), correctional facilities (12; 6%), and settings that provide services to persons experiencing homelessness (10; 5%). Among the 208 deployed teams, 178 (85%) provided assistance to state health departments, 12 (6%) to tribal health departments, 10 (5%) to local health departments, and eight (4%) to territorial health departments. CDC collaborations with health departments have strengthened local capacity and provided outbreak response support. Collaborations focused attention on health equity issues among disproportionately affected populations (e.g., racial and ethnic minority populations, essential frontline workers, and persons experiencing homelessness) and through a place-based focus (e.g., persons living in rural or frontier areas). These collaborations also facilitated enhanced characterization of COVID-19 epidemiology, directly contributing to CDC data-informed guidance, including guidance for serial testing as a containment strategy in high-risk congregate settings, targeted interventions and prevention efforts among workers at food processing facilities, and social distancing. |
Restoring immunization services provided by the Vaccines for Children Program in Puerto Rico after Hurricanes Irma and Maria, 2017-2019
Luna-Pinto SC , Rivera A , Cardona I , Rijo C , Alvarez V , Rodriguez J , Yoerg B , Shapiro CN , Patel A . J Public Health Manag Pract 2020 27 (6) E228-E235 CONTEXT: In September 2017, Hurricanes Irma and Maria impacted Puerto Rico, causing significant disruption of immunization services and vaccine losses due to widespread infrastructure and electrical grid damage and resulting cold chain failures. OBJECTIVE: To describe posthurricane efforts undertaken to restore and strengthen immunization services provided by Puerto Rico's federally funded Vaccines for Children (VFC) Program, a network of clinics that provide vaccines to eligible children. DESIGN: Historical records were reviewed to characterize Puerto Rico's prehurricane immunization system. Site visits to assess VFC clinic posthurricane operational status were conducted by the Puerto Rico Department of Health, working with the Centers for Disease Control and Prevention and other partners. Infrastructure repair and acquisition of backup generators, temperature data loggers, and replacement vaccines were carried out to restore operations. RESULTS: Prior to the hurricanes, 224 VFC clinics throughout the island provided immunizations. An initial assessment 10 days after Hurricane Maria showed that only 11 (5%) of the clinics were operational. Reasons included ongoing power outages; difficulties in obtaining generator fuel; equipment or facility damage; and damaged vaccines. The VFC clinics were restored incrementally; 123 (55%) were operational by December 2017, 193 (86%) by May 2018, and 204 (91%) by May 2019. Long-term recovery activities are underway and focus on strengthening Puerto Rico's immunization system to withstand future disasters, including improving backup power systems. CONCLUSION: Through coordinated efforts of the Puerto Rico Department of Health, the Centers for Disease Control and Prevention, and other partners, the operational status of VFC clinics posthurricanes was assessed and operations restored. Emergency plans for vaccine storage and handling, which called for alternative vaccine storage locations and backup generators, were inadequate to address disasters of the magnitude of Hurricanes Irma and Maria; such plans need to consider the possibility of large-scale disasters that result in long-term power outages. |
COVID-19 Among Workers in Meat and Poultry Processing Facilities - 19 States, April 2020.
Dyal JW , Grant MP , Broadwater K , Bjork A , Waltenburg MA , Gibbins JD , Hale C , Silver M , Fischer M , Steinberg J , Basler CA , Jacobs JR , Kennedy ED , Tomasi S , Trout D , Hornsby-Myers J , Oussayef NL , Delaney LJ , Patel K , Shetty V , Kline KE , Schroeder B , Herlihy RK , House J , Jervis R , Clayton JL , Ortbahn D , Austin C , Berl E , Moore Z , Buss BF , Stover D , Westergaard R , Pray I , DeBolt M , Person A , Gabel J , Kittle TS , Hendren P , Rhea C , Holsinger C , Dunn J , Turabelidze G , Ahmed FS , deFijter S , Pedati CS , Rattay K , Smith EE , Luna-Pinto C , Cooley LA , Saydah S , Preacely ND , Maddox RA , Lundeen E , Goodwin B , Karpathy SE , Griffing S , Jenkins MM , Lowry G , Schwarz RD , Yoder J , Peacock G , Walke HT , Rose DA , Honein MA . MMWR Morb Mortal Wkly Rep 2020 69 (18) Congregate work and residential locations are at increased risk for infectious disease transmission including respiratory illness outbreaks. SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is primarily spread person to person through respiratory droplets. Nationwide, the meat and poultry processing industry, an essential component of the U.S. food infrastructure, employs approximately 500,000 persons, many of whom work in proximity to other workers (1). Because of reports of initial cases of COVID-19, in some meat processing facilities, states were asked to provide aggregated data concerning the number of meat and poultry processing facilities affected by COVID-19 and the number of workers with COVID-19 in these facilities, including COVID-19-related deaths. Qualitative data gathered by CDC during on-site and remote assessments were analyzed and summarized. During April 9-27, aggregate data on COVID-19 cases among 115 meat or poultry processing facilities in 19 states were reported to CDC. Among these facilities, COVID-19 was diagnosed in 4,913 (approximately 3%) workers, and 20 COVID-19-related deaths were reported. Facility barriers to effective prevention and control of COVID-19 included difficulty distancing workers at least 6 feet (2 meters) from one another (2) and in implementing COVID-19-specific disinfection guidelines.* Among workers, socioeconomic challenges might contribute to working while feeling ill, particularly if there are management practices such as bonuses that incentivize attendance. Methods to decrease transmission within the facility include worker symptom screening programs, policies to discourage working while experiencing symptoms compatible with COVID-19, and social distancing by workers. Source control measures (e.g., the use of cloth face covers) as well as increased disinfection of high-touch surfaces are also important means of preventing SARS-CoV-2 exposure. Mitigation efforts to reduce transmission in the community should also be considered. Many of these measures might also reduce asymptomatic and presymptomatic transmission (3). Implementation of these public health strategies will help protect workers from COVID-19 in this industry and assist in preserving the critical meat and poultry production infrastructure (4). |
Lessons from the reestablishment of Public Health Laboratory activities in Puerto Rico after Hurricane Maria
Hardy MC , Stinnett RC , Kines KJ , Rivera-Nazario DM , Lowe DE , Mercante AM , Gonzalez Jimenez N , Cuevas Ruiz RI , Rivera Arbolay HI , Gonzalez Pena RL , Toro M , Trujillo AA , Pappas CL , Llewellyn AC , Candal F , Burgos Garay M , Gomez GA , Concepcion Acevedo J , Ansbro M , Moura H , Shaw MW , Muehlenbachs A , Romanoff LC , Sunshine BJ , Rose DA , Patel A , Shapiro CN , Luna-Pinto SC , Pillai SK , O'Neill E . Nat Commun 2019 10 (1) 2720 Public Health Laboratories (PHLs) in Puerto Rico did not escape the devastation caused by Hurricane Maria. We implemented a quality management system (QMS) approach to systematically reestablish laboratory testing, after evaluating structural and functional damage. PHLs were inoperable immediately after the storm. Our QMS-based approach began in October 2017, ended in May 2018, and resulted in the reestablishment of 92% of baseline laboratory testing capacity. Here, we share lessons learned from the historic recovery of the largest United States' jurisdiction to lose its PHL capacity, and provide broadly applicable tools for other jurisdictions to enhance preparedness for public health emergencies. |
Initial public health laboratory response after Hurricane Maria - Puerto Rico, 2017
Concepcion-Acevedo J , Patel A , Luna-Pinto C , Pena RG , Cuevas Ruiz RI , Arbolay HR , Toro M , Deseda C , De Jesus VR , Ribot E , Gonzalez JQ , Rao G , De Leon Salazar A , Ansbro M , White BB , Hardy MC , Georgi JC , Stinnett R , Mercante AM , Lowe D , Martin H , Starks A , Metchock B , Johnston S , Dalton T , Joglar O , Stafford C , Youngblood M , Klein K , Lindstrom S , Berman L , Galloway R , Schafer IJ , Walke H , Stoddard R , Connelly R , McCaffery E , Rowlinson MC , Soroka S , Tranquillo DT , Gaynor A , Mangal C , Wroblewski K , Muehlenbachs A , Salerno RM , Lozier M , Sunshine B , Shapiro C , Rose D , Funk R , Pillai SK , O'Neill E . MMWR Morb Mortal Wkly Rep 2018 67 (11) 333-336 Hurricane Maria made landfall in Puerto Rico on September 20, 2017, causing major damage to infrastructure and severely limiting access to potable water, electric power, transportation, and communications. Public services that were affected included operations of the Puerto Rico Department of Health (PRDOH), which provides critical laboratory testing and surveillance for diseases and other health hazards. PRDOH requested assistance from CDC for the restoration of laboratory infrastructure, surveillance capacity, and diagnostic testing for selected priority diseases, including influenza, rabies, leptospirosis, salmonellosis, and tuberculosis. PRDOH, CDC, and the Association of Public Health Laboratories (APHL) collaborated to conduct rapid needs assessments and, with assistance from the CDC Foundation, implement a temporary transport system for shipping samples from Puerto Rico to the continental United States for surveillance and diagnostic and confirmatory testing. This report describes the initial laboratory emergency response and engagement efforts among federal, state, and nongovernmental partners to reestablish public health laboratory services severely affected by Hurricane Maria. The implementation of a sample transport system allowed Puerto Rico to reinitiate priority infectious disease surveillance and laboratory testing for patient and public health interventions, while awaiting the rebuilding and reinstatement of PRDOH laboratory services. |
Notes from the Field: Varicella fatality on a cargo vessel - Puerto Rico, 2015
Ellis M , Luna-Pinto C , George T , Regan JJ , Marin M , Lopez A , Rivera-Garcia B , Tardivel K . MMWR Morb Mortal Wkly Rep 2017 66 (15) 410 The U.S. Code of Federal Regulations (42 §71.21) requires that the master of a ship destined to a U.S. port of entry report certain illnesses, as well as any death onboard to the nearest CDC Quarantine Station (1). On December 30, 2015, the U.S. Coast Guard notified CDC of the death of a crew member of a foreign cargo vessel off the coast of Puerto Rico. Four days earlier, on December 26, the patient, a man aged 50 years from India, developed abdominal pain, headache, and fever (103.0°F [39.4°C]), followed by loose stools and pruritus. On December 28, a vesicular rash appeared on his face, neck, and shoulders. Medical consultants suspected varicella and recommended shipboard isolation. On December 29, the vesicles had begun to dry and scab, and he developed a nonproductive cough and reported chest congestion. On December 30, he had difficulty breathing and collapsed; cardiopulmonary resuscitation was unsuccessful. The Puerto Rico Department of Health was contacted to liaise with the medical examiner. Lung tissue and skin lesion specimens collected at autopsy were positive for varicella-zoster virus DNA by polymerase chain reaction at CDC. The cause of death was reported as varicella pneumonia. No other medical conditions were reported. | Per CDC recommendations, all 24 shipmates were considered contacts of the index patient; the master of the ship instituted daily temperature and rash surveillance for 21 days (i.e., one incubation period) after the death. On days 13 and 16 of surveillance, two crew members were sent home because of emergencies unrelated to varicella. San Juan and Houston CDC Quarantine Stations coordinated varicella vaccination for the 22 remaining and five new crew members boarding after the end of the 21-day surveillance, all of whom had unknown varicella immunity. Acyclovir was procured by the ship for treatment of possible additional cases; however, none occurred. |
Notes from the field: Imported cases of malaria - Puerto Rico, July-October 2015
Dirlikov E , Rodriguez C , Morales S , Martinez LC , Mendez JB , Sanchez AC , Burgos JH , Santiago Z , Cuevas-Ruis RI , Camacho SA , Mercado ER , Guzman JF , Ryff K , Luna-Pinto C , Arguin PM , Chenet SM , Silva-Flannery L , Ljolje D , Velazquez JC , Thomas D , Garcia BR . MMWR Morb Mortal Wkly Rep 2016 65 (12) 326-327 On July 16 2015, the Puerto Rico Department of Health (PRDH) was notified of a case of malaria, diagnosed by a hospital parasitology laboratory in a student who had traveled to Punta Cana, Dominican Republic, during late June for a school-organized graduation trip. Malaria is a mosquito-borne parasitic infection, characterized by fever, shaking chills, headaches, muscle pains, nausea, general malaise, and vomiting. Malaria can be clinically difficult to distinguish from other acute febrile illnesses, and a definitive diagnosis requires demonstration of malaria parasites using microscopy or molecular diagnostic tests. The student's initial diagnosis on July 10 was suspected dengue virus infection. Puerto Rico eliminated local malaria transmission during the mid-1950s; however, reintroduction remains a risk because of the presence of a competent vector (Anopheles albimanus) and ease of travel to areas where the disease is endemic, including Hispaniola, the island shared by the Dominican Republic and Haiti, and the only island in the Caribbean with endemic malaria. During 2014, the Dominican Republic reported 496 confirmed malaria cases and four associated deaths; Haiti reported 17,662 confirmed cases and nine deaths. During 2000-2014, Puerto Rico reported a total of 35 imported malaria cases (range = 0-7 per year); three cases were imported from Hispaniola. During June-August 2015, eight confirmed malaria cases among travelers to the Dominican Republic were reported to CDC's National Malaria Surveillance System (CDC, unpublished data, 2015). |
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