Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-22 (of 22 Records) |
Query Trace: Rakeman JL[original query] |
---|
The distribution and spread of susceptible and resistant Neisseria gonorrhoeae across demographic groups in a major metropolitan center (preprint)
Mortimer TD , Pathela P , Crawley A , Rakeman JL , Lin Y , Harris SR , Blank S , Schillinger JA , Grad YH . medRxiv 2020 2020.04.30.20086413 Background Genomic epidemiology studies of gonorrhea in the United States have primarily focused on national surveillance for antibiotic resistance, and patterns of local transmission between demographic groups of resistant and susceptible strains are unknown.Methods We analyzed a convenience sample of genome sequences, antibiotic susceptibility, and patient data from 897 gonococcal isolates cultured at the NYC Public Health Laboratory from NYC Department of Health and Mental Hygiene (DOHMH) Sexual Health Clinic (SHC) patients, primarily in 2012-13. We reconstructed the gonococcal phylogeny, defined transmission clusters using a 10 non-recombinant single nucleotide polymorphism threshold, tested for clustering of demographic groups, and placed NYC isolates in a global phylogenetic context.Results The NYC gonococcal phylogeny reflected global diversity with isolates from 22/23 of the prevalent global lineages (96%). Isolates clustered on the phylogeny by patient sexual behavior (p<0.001) and race/ethnicity (p<0.001).Minimum inhibitory concentrations were higher across antibiotics in isolates from men who have sex with men compared to heterosexuals (p<0.001) and white heterosexuals compared to black heterosexuals (p<0.01). In our dataset, all large transmission clusters (≥10 samples) of N. gonorrhoeae were susceptible to ciprofloxacin, ceftriaxone, and azithromycin and comprised isolates from patients across demographic groups.Conclusions All large transmission clusters were susceptible to gonorrhea therapies, suggesting that resistance to empiric therapy was not a main driver of spread, even as risk for resistance varied across demographic groups. Further study of local transmission networks is needed to identify drivers of transmission.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis work was supported by the National Institute of Allergy and Infectious Diseases at the National Institutes of Health [R01 AI132606 and 1 F32 AI145157-01] and the Wellcome Trust [098051].Author DeclarationsAll relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.YesAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesWhole genome sequencing data were deposited in the European Nucleotide Archive (ERA) under study accession PRJEB10016. All additional data and scripts are available at https://github.com/gradlab/GC_NYC. https://www.ebi.ac.uk/ena/data/view/PRJEB10016 https://github.com/gradlab/GC_NYC |
Use, Safety Assessment, and Implementation of Two Point-of-Care Tests for COVID-19 Testing.
Hahn M , Olsen A , Stokes K , Fowler RC , Gu R , Semple-Lytch S , DeVito A , Kurpiel P , Hughes S , Rakeman JL . Am J Clin Pathol 2021 156 (3) 370-380 OBJECTIVES: The Abbot ID NOW COVID-19 assay and Quidel Sofia 2 SARS Antigen FIA are point-of-care assays that offer rapid testing for severe acute respiratory syndrome coronavirus 2 viral RNA and nucleocapsid protein, respectively. Given the utility of these devices in the field, we investigated the feasibility and safety of using the ID NOW and Sofia assays in the public health response to the coronavirus disease 2019 pandemic and in future public health emergencies. METHODS: A combination of utilization and contamination testing in addition to a review of instrument workflows was conducted. RESULTS: Utilization testing demonstrated that both tests are intuitive, associated with high user test success (85%) in our study, and could be implemented by staff after minimal training. Contamination tests revealed potential biosafety concerns due to the open design of the ID NOW instrument and the transfer mechanisms with the Sofia. When comparing the workflow of the ID NOW and the Sofia, we found that the ID NOW was more user-friendly and that the transfer technology reduces the chance of contamination. CONCLUSIONS: The ID NOW, Sofia, and other emerging point-of-care tests should be used only after careful consideration of testing workflow, biosafety risk mitigations, and appropriate staff training. |
Prevalence of SARS-CoV-2 Antibodies in New York City Adults, June-October 2020: A Population-Based Survey.
Parrott JC , Maleki AN , Vassor VE , Osahan S , Hsin Y , Sanderson M , Fernandez S , Levanon Seligson A , Hughes S , Wu J , DeVito AK , LaVoie SP , Rakeman JL , Gould LH , Alroy KA . J Infect Dis 2021 224 (2) 188-195 BACKGROUND: Serosurveys help to ascertain burden of infection. Prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurveys in New York City (NYC) used nonrandom samples. During June-October 2020, the NYC Health Department conducted a population-based survey estimating SARS-CoV-2 antibody prevalence in NYC adults. METHODS: Participants were recruited from the NYC 2020 Community Health Survey. We estimated citywide and stratified antibody prevalence using a hybrid design: serum tested with the DiaSorin LIAISON SARS-CoV-2 S1/S2 IgG assay and self-reported antibody test results were used together. We estimated univariate frequencies and 95% confidence intervals (CI), accounting for complex survey design. Two-sided P values ≤ .05 were statistically significant. RESULTS: There were 1074 respondents; 497 provided blood and 577 provided only a self-reported antibody test result. Weighted prevalence was 24.3% overall (95% CI, 20.7%-28.3%). Latino (30.7%; 95% CI, 24.1%-38.2%; P < .01) and black (30.7%; 95% CI, 21.9%-41.2%; P = .02) respondents had a higher weighted prevalence compared with white respondents (17.4%; 95% CI, 12.5%-23.7%). CONCLUSIONS: By October 2020, nearly 1 in 3 black and 1 in 3 Latino NYC adults had SARS-CoV-2 antibodies, highlighting unequal impacts of the coronavirus disease 2019 (COVID-19) pandemic on black and Latino NYC adults. |
The distribution and spread of susceptible and resistant Neisseria gonorrhoeae across demographic groups in a major metropolitan center.
Mortimer TD , Pathela P , Crawley A , Rakeman JL , Lin Y , Harris SR , Blank S , Schillinger JA , Grad YH . Clin Infect Dis 2020 73 (9) e3146-e3155 BACKGROUND: Genomic epidemiology studies of gonorrhea in the United States have primarily focused on national surveillance for antibiotic resistance, and patterns of local transmission between demographic groups of resistant and susceptible strains are unknown. METHODS: We analyzed a convenience sample of genome sequences, antibiotic susceptibility, and patient data from 897 gonococcal isolates cultured at the NYC Public Health Laboratory from NYC Department of Health and Mental Hygiene (DOHMH) Sexual Health Clinic (SHC) patients, primarily in 2012-13. We reconstructed the gonococcal phylogeny, defined transmission clusters using a 10 non-recombinant single nucleotide polymorphism threshold, tested for clustering of demographic groups, and placed NYC isolates in a global phylogenetic context. RESULTS: The NYC gonococcal phylogeny reflected global diversity with isolates from 22/23 of the prevalent global lineages (96%). Isolates clustered on the phylogeny by patient sexual behavior (p&0.001) and race/ethnicity (p&0.001). Minimum inhibitory concentrations were higher across antibiotics in isolates from men who have sex with men compared to heterosexuals (p&0.001) and white heterosexuals compared to black heterosexuals (p&0.01). In our dataset, all large transmission clusters (≥10 samples) of N. gonorrhoeae were susceptible to ciprofloxacin, ceftriaxone, and azithromycin and comprised isolates from patients across demographic groups. CONCLUSIONS: All large transmission clusters were susceptible to gonorrhea therapies, suggesting that resistance to empiric therapy was not a main driver of spread, even as risk for resistance varied across demographic groups. Further study of local transmission networks is needed to identify drivers of transmission. |
Consequences of undervaccination - measles outbreak, New York City, 2018-2019
Zucker JR , Rosen JB , Iwamoto M , Arciuolo RJ , Langdon-Embry M , Vora NM , Rakeman JL , Isaac BM , Jean A , Asfaw M , Hawkins SC , Merrill TG , Kennelly MO , Maldin Morgenthau B , Daskalakis DC , Barbot O . N Engl J Med 2020 382 (11) 1009-1017 BACKGROUND: Measles was declared eliminated in the United States in 2000, but the risk of outbreaks owing to international importations remains. An outbreak of measles in New York City began when one unvaccinated child returned home from Israel with measles; onset of rash occurred on September 30, 2018, 9 days after the child returned home. METHODS: We investigated suspected cases of measles by conducting interviews, reviewing medical and immunization records, identifying exposed persons, and performing diagnostic testing. Measles-mumps-rubella (MMR) vaccine (given as either MMR or measles-mumps-rubella-varicella vaccine and collectively referred to as MMR vaccine) uptake was monitored with the use of the Citywide Immunization Registry. The total direct cost to the New York City Department of Health and Mental Hygiene was calculated. RESULTS: A total of 649 cases of measles were confirmed, with onsets of rash occurring between September 30, 2018, and July 15, 2019. A majority of the patients (93.4%) were part of the Orthodox Jewish community, and 473 of the patients (72.9%) resided in the Williamsburg area of Brooklyn, New York. The median age was 3 years; 81.2% of the patients were 18 years of age or younger, and 85.8% of the patients with a known vaccination history were unvaccinated. Serious complications included pneumonia (in 37 patients [5.7%]) and hospitalization (in 49 patients [7.6%]); among the patients who were hospitalized, 20 (40.8%) were admitted to an intensive care unit. As a result of efforts to promote vaccination, the percentage of children in Williamsburg who received at least one dose of MMR vaccine increased from 79.5% to 91.1% among children 12 to 59 months of age. As of September 9, 2019, a total of 559 staff members at the Department of Health and Mental Hygiene (7% of the agency) had been involved in the measles response. The cost of the Department of Health and Mental Hygiene response was $8.4 million. CONCLUSIONS: Importation of measles and vaccination delays among young children led to an outbreak of measles in New York City. The outbreak response was resource intensive and caused serious illness, particularly among unvaccinated children. |
Brucella exposure risk events in ten clinical laboratories, New York City, 2015 - 2017
Ackelsberg J , Liddicoat A , Burke T , Szymczak WA , Levi MH , Ostrowsky B , Hamula C , Patel G , Kopetz V , Saverimuttu J , Sordillo EM , D'Souza D , Mitchell EA , Lowe W , Khare R , Tang YW , Bianchi AL , Egan C , Perry MJ , Hughes S , Rakeman JL , Adams E , Kharod GA , Tiller R , Saile E , Lee S , Gonzalez E , Hoppe B , Leviton IM , Hacker S , Ni KF , Orsini RL , Jhaveri S , Mazariegos I , Dingle T , Koll B , Stoddard RA , Galloway R , Hoffmaster A , Fine A , Lee E , Dentinger C , Harrison E , Layton M . J Clin Microbiol 2019 58 (2) During 2015-2017, 11 confirmed brucellosis cases were reported in New York City, leading to 10 Brucella exposure risk events ("Brucella events") in 7 clinical laboratories (CLs). Most patients traveled to endemic countries and presented with histories and findings consistent with brucellosis. CLs were not notified that specimens might yield a hazardous organism, as clinicians did not consider brucellosis until notified that bacteremia with Brucella was suspected.In 3 Brucella events, CLs did not suspect that slow-growing, small Gram-negative bacteria might be harmful. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), with limited capacity to identify biological threat agents (BTAs), was used during 4 Brucella events that accounted for 84% of exposures. In 3 of these incidents, initial staining of liquid media showed Gram-positive rods or cocci, including some cocci in chains, suggesting streptococci. Over 200 occupational exposures occurred when the unknown isolates were manipulated and/or tested on open benches, including procedures that could generate infectious aerosols. During 3 Brucella events, CLs examined and/or manipulated isolates in a biological safety cabinet (BSC); in each, CLs had isolated Brucella previously.Centers for Disease Control and Prevention recommendations to prevent laboratory-acquired brucellosis (LAB) were followed; no seroconversions or LAB cases occurred.Laboratory assessments were conducted after Brucella events to identify facility-specific risks and mitigations. With increasing MALDI-TOF MS use, CLs are well-advised to adhere strictly to safe work practices, such as handling and manipulating all slow-growing organisms in BSCs and not using MALDI-TOF for identification until BTAs have been ruled out. |
Public health management of persons under investigation for Ebola virus disease in New York City, 2014-2016
Winters A , Iqbal M , Benowitz I , Baumgartner J , Vora NM , Evans L , Link N , Munjal I , Ostrowsky B , Ackelsberg J , Balter S , Dentinger C , Fine AD , Harper S , Landman K , Laraque F , Layton M , Slavinski S , Weiss D , Rakeman JL , Hughes S , Varma JK , Lee EH . Public Health Rep 2019 134 (5) 33354919870200 During 2014-2016, the largest outbreak of Ebola virus disease (EVD) in history occurred in West Africa. The New York City Department of Health and Mental Hygiene (DOHMH) worked with health care providers to prepare for persons under investigation (PUIs) for EVD in New York City. From July 1, 2014, through December 29, 2015, we classified as a PUI a person with EVD-compatible signs or symptoms and an epidemiologic risk factor within 21 days before illness onset. Of 112 persons who met PUI criteria, 74 (66%) sought medical care and 49 (44%) were hospitalized. The remaining 38 (34%) were isolated at home with daily contact by DOHMH staff members. Thirty-two (29%) PUIs received a diagnosis of malaria. Of 10 PUIs tested, 1 received a diagnosis of EVD. Home isolation minimized unnecessary hospitalization. This case study highlights the importance of developing competency among clinical and public health staff managing persons suspected to be infected with a high-consequence pathogen. |
Neonatal conjunctivitis caused by Neisseria meningitidis US urethritis clade, New York, USA, August 2017
Kretz CB , Bergeron G , Aldrich M , Bloch D , Del Rosso PE , Halse TA , Ostrowsky B , Liu Q , Gonzalez E , Omoregie E , Chicaiza L , Zayas G , Tha B , Liang A , Wang JC , Levi M , Hughes S , Musser KA , Weiss D , Rakeman JL . Emerg Infect Dis 2019 25 (5) 972-975 We characterized a case of neonatal conjunctivitis in New York, USA, caused by Neisseria meningitidis by using whole-genome sequencing. The case was a rare occurrence, and the isolate obtained belonged to an emerging clade (N. meningitidis US nongroupable urethritis) associated with an increase in cases of urethritis since 2015. |
Notes from the Field: Botulism outbreak associated with home-canned peas - New York City, 2018
Bergeron G , Latash J , Da Costa-Carter CA , Egan C , Stavinsky F , Kileci JA , Winstead A , Zhao B , Perry MJ , Chatham-Stephens K , Sarpel D , Hughes S , Conlon MA , Edmunds S , Mohanraj M , Rakeman JL , Centurioni DA , Luquez C , Chiefari AK , Harper S . MMWR Morb Mortal Wkly Rep 2019 68 (10) 251-252 On June 6, 2018, at 1:30 p.m., the New York City Department of Health and Mental Hygiene was notified of three related women who had arrived at a hospital 4 hours earlier for evaluation for acute nausea, dizziness, blurred vision, slurred speech, ptosis, thick-feeling tongue, and shortness of breath. Two patients developed respiratory failure, requiring intubation and mechanical ventilation in the emergency department, and the third patient was intubated at 7 p.m. that evening. The combination of cranial nerve palsies and respiratory failure in multiple patients suggested botulism, a paralytic illness caused by botulinum neurotoxin (BoNT), most commonly produced by Clostridium botulinum. |
Zika virus infection among pregnant women and their neonates in New York City, January 2016-June 2017
Conners EE , Lee EH , Thompson CN , McGibbon E , Rakeman JL , Iwamoto M , Cooper H , Vora NM , Limberger RJ , Fine AD , Liu D , Slavinski S . Obstet Gynecol 2018 132 (2) 487-495 OBJECTIVE: To describe and compare differences in the epidemiologic, clinical, and laboratory characteristics of pregnant women with confirmed or probable Zika virus infection and to compare the risk of having a neonate with laboratory evidence of Zika virus infection with that of having a neonate without evidence of Zika virus infection by maternal characteristics. METHODS: We conducted a retrospective cohort study of women with Zika virus infection who completed pregnancy in New York City from January 1, 2016 to June 30, 2017. Confirmed Zika virus infection was defined as 1) nucleic acid amplification test-detected Zika virus, or 2) a nonnegative enzyme-linked immunosorbent assay test result and a plaque-reduction neutralization test result positive for Zika virus but negative for dengue virus, or 3) delivery of a neonate with laboratory evidence of Zika virus infection. Probable infection was defined as a nonnegative enzyme-linked immunosorbent assay test result and a positive plaque-reduction neutralization test result for Zika virus and dengue virus. RESULTS: We identified 390 women with confirmed (28%) or probable (72%) Zika virus infection. Fever, rash, arthralgia, or conjunctivitis was reported by 31% of women and were more common among women with confirmed than with probable infection (43% vs 26%, P=.001). Of 366 neonates born to these women, 295 (81%) were tested for Zika virus and 22 (7%) had laboratory-diagnosed congenital Zika virus infection. The relative risk (RR) for having a neonate with laboratory evidence of Zika virus infection was greater among women with fever (RR 4.8, 95% CI 2.1-10.7), tingling (RR 4.8, CI 1.7-13.7), or numbness (RR 6.9, CI 2.6-18.2) during pregnancy or the periconception period. However, the RR did not differ whether the mother had confirmed or probable Zika virus infection (RR 1.6, CI 0.7-4.1). CONCLUSION: In New York City, a greater proportion of women had probable Zika virus infection than confirmed infection. Women with some symptoms during pregnancy or periconceptionally were more likely to have a neonate with laboratory evidence of Zika virus infection. Neonates born to women with confirmed or probable Zika virus infection should be tested for Zika virus infection. |
Detection of avian influenza A(H7N2) virus infection among animal shelter workers using a novel serological approach-New York City, 2016-2017
Poirot E , Levine MZ , Russell K , Stewart RJ , Pompey JM , Chiu S , Fry AM , Gross L , Havers FP , Li ZN , Liu F , Crossa A , Lee CT , Boshuizen V , Rakeman JL , Slavinski S , Harper S , Gould LH . J Infect Dis 2018 219 (11) 1688-1696 Background: In 2016, an influenza A(H7N2) virus outbreak occurred in cats in New York City's municipal animal shelters. One human infection was initially detected. Methods: We conducted a serological survey using a novel approach to rule out cross-reactive antibodies to other seasonal influenza viruses to determine whether additional A(H7N2) human infections had occurred and to assess exposure risk. Results: Of 121 shelter workers, one had serological evidence of A(H7N2) infection, corresponding to a seroprevalence of 0.8% (95% confidence interval, .02%-4.5%). Five persons exhibited low positive titers to A(H7N2) virus, indicating possible infection; however, we could not exclude cross-reactive antibody responses to seasonal influenza viruses. The remaining 115 persons were seronegative. The seropositive person reported multiple direct cat exposures without using personal protective equipment and mild illness with subjective fever, runny nose, and sore throat. Conclusions: We identified a second case of A(H7N2) infection from this outbreak, providing further evidence of cat-to-human transmission of A(H7N2) virus. |
Zika virus preparedness and response efforts through the collaboration between a health care delivery system and a local public health department
Madad S , Tate A , Rand M , Quinn C , Vora NM , Allen M , Cagliuso NV , Rakeman JL , Studer S , Masci J , Varma JK , Wilson R . Disaster Med Public Health Prep 2018 12 (6) 1-3 The Zika virus was largely unknown to many health care systems before the outbreak of 2015. The unique public health threat posed by the Zika virus and the evolving understanding of its pathology required continuous communication between a health care delivery system and a local public health department. By leveraging an existing relationship, NYC Health+Hospitals worked closely with New York City Department of Health and Mental Hygiene to ensure that Zika-related processes and procedures within NYC Health+Hospitals facilities aligned with the most current Zika virus guidance. Support given by the public health department included prenatal clinical and laboratory support and the sharing of data on NYC Health+Hospitals Zika virus screening and testing rates, thus enabling this health care delivery system to make informed decisions and practices. The close coordination, collaboration, and communication between the health care delivery system and the local public health department examined in this article demonstrate the importance of working together to combat a complex public health emergency and how this relationship can serve as a guide for other jurisdictions to optimize collaboration between external partners during major outbreaks, emerging threats, and disasters that affect public health. (Disaster Med Public Health Preparedness. 2018;page 1 of 3). |
Legionnaires' Disease Outbreak Caused by Endemic Strain of Legionella pneumophila, New York, New York, USA, 2015.
Lapierre P , Nazarian E , Zhu Y , Wroblewski D , Saylors A , Passaretti T , Hughes S , Tran A , Lin Y , Kornblum J , Morrison SS , Mercante JW , Fitzhenry R , Weiss D , Raphael BH , Varma JK , Zucker HA , Rakeman JL , Musser KA . Emerg Infect Dis 2017 23 (11) 1784-1791 During the summer of 2015, New York, New York, USA, had one of the largest and deadliest outbreaks of Legionnaires' disease in the history of the United States. A total of 138 cases and 16 deaths were linked to a single cooling tower in the South Bronx. Analysis of environmental samples and clinical isolates showed that sporadic cases of legionellosis before, during, and after the outbreak could be traced to a slowly evolving, single-ancestor strain. Detection of an ostensibly virulent Legionella strain endemic to the Bronx community suggests potential risk for future cases of legionellosis in the area. The genetic homogeneity of the Legionella population in this area might complicate investigations and interpretations of future outbreaks of Legionnaires' disease. |
Outbreak of influenza A(H7N2) among cats in an animal shelter with cat-to-human transmission - New York City, 2016
Lee CT , Slavinski S , Schiff C , Merlino M , Daskalakis D , Liu D , Rakeman JL , Misener M , Thompson C , Leung YL , Varma JK , Fry A , Havers F , Davis T , Newbury S , Layton M . Clin Infect Dis 2017 65 (11) 1927-1929 We describe the first case of cat-to-human transmission of influenza A(H7N2), an avian-lineage influenza A virus, that occurred during an outbreak among cats in New York City animal shelters. We describe the public health response and investigation. |
Rubella surveillance and diagnostic testing among a low-prevalence population, New York City, 2012-2013
Isaac BM , Zucker JR , Giancotti FR , Abernathy E , Icenogle J , Rakeman JL , Rosen JB . Clin Vaccine Immunol 2017 24 (9) The New York City Department of Health and Mental Hygiene (DOHMH) receives clinical and laboratory reports for rubella. Because rubella immunoglobulin M (IgM) assays may produce false positive results and rubella infections may be asymptomatic, interpretation of positive IgM results can be challenging. Rubella reports received by DOHMH in 2012-2013 were reviewed. Rubella IgM testing purpose was determined through case investigation. Results of IgM testing by indirect enzyme-linked immunosorbent assay (ELISA) and capture enzyme immunoassay (EIA) were compared to determine positive predictive value (PPV) and specificity. DOHMH received 199 rubella reports; 2 were true cases. Of all reports, 77.9% were tested for rubella IgM erroneously, 19.6% were tested for diagnostic purposes, 2.0% had unknown test purpose, and 0.5% were not tested. PPV of indirect ELISA was 6% overall, 14% for diagnostic tests, and 0% for tests ordered erroneously. PPV of capture EIA was 29% overall, 50% for diagnostic tests, and 0% for tests ordered erroneously. Overall, specificity was 52% for indirect ELISA and 85% for capture EIA. Limiting rubella IgM testing to patients for whom rubella diagnosis is suspected and using a more specific IgM assay have the potential to reduce false positive rubella IgM results. |
Increasing antibiotic resistance in Shigella spp. from infected New York City Residents, New York, USA
Murray K , Reddy V , Kornblum JS , Waechter H , Chicaiza LF , Rubinstein I , Balter S , Greene SK , Braunstein SL , Rakeman JL , Dentinger CM . Emerg Infect Dis 2017 23 (2) 332-335 Approximately 20% of Shigella isolates tested in New York City, New York, USA, during 2013-2015 displayed decreased azithromycin susceptibility. Case-patients were older and more frequently male and HIV infected than those with azithromycin-susceptible Shigella infection; 90% identified as men who have sex with men. Clinical interpretation guidelines for azithromycin resistance and outcome studies are needed. |
A Large Community Outbreak of Legionnaires' Disease Associated With a Cooling Tower in New York City, 2015.
Weiss D , Boyd C , Rakeman JL , Greene SK , Fitzhenry R , McProud T , Musser K , Huang L , Kornblum J , Nazarian EJ , Fine AD , Braunstein SL , Kass D , Landman K , Lapierre P , Hughes S , Tran A , Taylor J , Baker D , Jones L , Kornstein L , Liu B , Perez R , Lucero DE , Peterson E , Benowitz I , Lee KF , Ngai S , Stripling M , Varma JK . Public Health Rep 2017 132 (2) 33354916689620 OBJECTIVES: Infections caused by Legionella are the leading cause of waterborne disease outbreaks in the United States. We investigated a large outbreak of Legionnaires' disease in New York City in summer 2015 to characterize patients, risk factors for mortality, and environmental exposures. METHODS: We defined cases as patients with pneumonia and laboratory evidence of Legionella infection from July 2 through August 3, 2015, and with a history of residing in or visiting 1 of several South Bronx neighborhoods of New York City. We describe the epidemiologic, environmental, and laboratory investigation that identified the source of the outbreak. RESULTS: We identified 138 patients with outbreak-related Legionnaires' disease, 16 of whom died. The median age of patients was 55. A total of 107 patients had a chronic health condition, including 43 with diabetes, 40 with alcoholism, and 24 with HIV infection. We tested 55 cooling towers for Legionella, and 2 had a strain indistinguishable by pulsed-field gel electrophoresis from 26 patient isolates. Whole-genome sequencing and epidemiologic evidence implicated 1 cooling tower as the source of the outbreak. CONCLUSIONS: A large outbreak of Legionnaires' disease caused by a cooling tower occurred in a medically vulnerable community. The outbreak prompted enactment of a new city law on the operation and maintenance of cooling towers. Ongoing surveillance and evaluation of cooling tower process controls will determine if the new law reduces the incidence of Legionnaires' disease in New York City. |
Using a call center to coordinate Zika virus testing-New York City, 2016
Jacobs-Wingo J , Ezeoke I , Saffa A , Tate A , Lee D , Johnson K , Whittemore K , Illescas A , Collins A , Rand M , Rakeman JL , Varma JK , Vora NM . J Emerg Manag 2016 14 (6) 391-395 BACKGROUND: After local testing criteria for Zika virus expanded to include asymptomatic pregnant women who traveled to areas with active Zika virus transmission while pregnant, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) experienced a surge in test requests and subsequent testing delays due to factors such as incorrectly completed laboratory requisition forms. The authors describe how DOHMH addressed these issues by establishing the Zika Testing Call Center (ZTCC). METHODS: Using a case study approach, the authors illustrate how DOHMH leveraged protocols, equipment, and other resources used previously during DOHMH&s Ebola emergency response to meet NYC's urgent Zika virus testing needs. To request Zika virus testing, providers call the ZTCC; if patients meet testing criteria, the ZTCC collects data necessary to complete requisition forms and sends the forms back to providers. The ZTCC also provides guidance on specimens needed for Zika virus testing. Providers submit completed requisition forms and appropriate specimens to DOHMH for testing. RESULTS: During March 21 through July 21, 2016, testing for 3,866 patients was coordinated through the ZTCC. CONCLUSION: The ZTCC exemplifies how a health department, using previous emergency response experiences, can quickly address local testing needs for an emerging infectious disease. |
Notes from the Field: use of social media as a communication tool during a mumps outbreak - New York City, 2015
Isaac BM , Zucker JR , MacGregor J , Asfaw M , Rakeman JL , Fu J , Deocharan B , Liu D , Rosen JB . MMWR Morb Mortal Wkly Rep 2017 66 (2) 60-61 On August 16, 2015, a case of parotitis in a resident of the Rockaways neighborhood of Queens, New York City (NYC), was reported to the NYC Department of Health and Mental Hygiene (DOHMH) as a suspected mumps case. Subsequent investigations by DOHMH discovered an outbreak of mumps in the Rockaways, with 52 confirmed and probable mumps cases. DOHMH conducted a Facebook advertisement campaign providing information about mumps and the outbreak, which was targeted to Facebook users in the Rockaways neighborhood. The advertisement was shown to 86,111 persons during an approximately 2-week period and provided a timely and inexpensive means of effectively communicating with a large, targeted population. |
Preparing the health system to respond to Ebola Virus Disease in New York City, 2014
Varma JK , Prezant DJ , Wilson R , Quinn C , Asaeda G , Cagliuso NV , Rakeman JL , Raphael M . Disaster Med Public Health Prep 2016 11 (3) 1-5 The world's largest outbreak of Ebola virus disease began in West Africa in 2014. Although few cases were identified in the United States, the possibility of imported cases led US public health systems and health care facilities to focus on preparing the health care system to quickly and safely identify and respond to emerging infectious diseases. In New York City, early, coordinated planning among city and state agencies and the health care delivery system led to a successful response to a single case diagnosed in a returned health care worker. In this article we describe public health and health care system preparedness efforts in New York City to respond to Ebola and conclude that coordinated public health emergency response relies on joint planning and sustained resources for public health emergency response, epidemiology and laboratory capacity, and health care emergency management. |
Prolonged detection of Zika virus RNA in pregnant women
Meaney-Delman D , Oduyebo T , Polen KN , White JL , Bingham AM , Slavinski SA , Heberlein-Larson L , St George K , Rakeman JL , Hills S , Olson CK , Adamski A , Culver Barlow L , Lee EH , Likos AM , Munoz JL , Petersen EE , Dufort EM , Dean AB , Cortese MM , Santiago GA , Bhatnagar J , Powers AM , Zaki S , Petersen LR , Jamieson DJ , Honein MA . Obstet Gynecol 2016 128 (4) 724-730 OBJECTIVE: Zika virus infection during pregnancy is a cause of microcephaly and other fetal brain abnormalities. Reports indicate that the duration of detectable viral RNA in serum after symptom onset is brief. In a recent case report involving a severely affected fetus, Zika virus RNA was detected in maternal serum 10 weeks after symptom onset, longer than the duration of RNA detection in serum previously reported. This report summarizes the clinical and laboratory characteristics of pregnant women with prolonged detection of Zika virus RNA in serum that were reported to the U.S. Zika Pregnancy Registry. METHODS: Data were obtained from the U.S. Zika Pregnancy Registry, an enhanced surveillance system of pregnant women with laboratory evidence of confirmed or possible Zika virus infection. For this case series, we defined prolonged detection of Zika virus RNA as Zika virus RNA detection in serum by real-time reverse transcription-polymerase chain reaction (RT-PCR) 14 or more days after symptom onset or, for women not reporting signs or symptoms consistent with Zika virus disease (asymptomatic), 21 or more days after last possible exposure to Zika virus. RESULTS: Prolonged Zika virus RNA detection in serum was identified in four symptomatic pregnant women up to 46 days after symptom onset and in one asymptomatic pregnant woman 53 days postexposure. Among the five pregnancies, one pregnancy had evidence of fetal Zika virus infection confirmed by histopathologic examination of fetal tissue, three pregnancies resulted in live births of apparently healthy neonates with no reported abnormalities, and one pregnancy is ongoing. CONCLUSION: Zika virus RNA was detected in the serum of five pregnant women beyond the previously estimated timeframe. Additional real-time RT-PCR testing of pregnant women might provide more data about prolonged detection of Zika virus RNA and the possible diagnostic, epidemiologic, and clinical implications for pregnant women. |
Zika virus surveillance and preparedness - New York City, 2015-2016
Lee CT , Vora NM , Bajwa W , Boyd L , Harper S , Kass D , Langston A , McGibbon E , Merlino M , Rakeman JL , Raphael M , Slavinski S , Tran A , Wong R , Varma JK . MMWR Morb Mortal Wkly Rep 2016 65 (24) 629-35 Zika virus has rapidly spread through the World Health Organization's Region of the Americas since being identified in Brazil in early 2015. Transmitted primarily through the bite of infected Aedes species mosquitoes, Zika virus infection during pregnancy can cause spontaneous abortion and birth defects, including microcephaly (1,2). New York City (NYC) is home to a large number of persons who travel frequently to areas with active Zika virus transmission, including immigrants from these areas. In November 2015, the NYC Department of Health and Mental Hygiene (DOHMH) began developing and implementing plans for managing Zika virus and on February 1, 2016, activated its Incident Command System. During January 1-June 17, 2016, DOHMH coordinated diagnostic laboratory testing for 3,605 persons with travel-associated exposure, 182 (5.0%) of whom had confirmed Zika virus infection. Twenty (11.0%) confirmed patients were pregnant at the time of diagnosis. In addition, two cases of Zika virus-associated Guillain-Barre syndrome were diagnosed. DOHMH's response has focused on 1) identifying and diagnosing suspected cases; 2) educating the public and medical providers about Zika virus risks, transmission, and prevention strategies, particularly in areas with large populations of immigrants from areas with ongoing Zika virus transmission; 3) monitoring pregnant women with Zika virus infection and their fetuses and infants; 4) detecting local mosquito-borne transmission through both human and mosquito surveillance; and 5) modifying existing Culex mosquito control measures by targeting Aedes species of mosquitoes through the use of larvicides and adulticides. |
- Page last reviewed:Feb 1, 2024
- Page last updated:May 13, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure