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Curran K.G.,Epidemic Intelligence Service | Curran K.G.,National Center for Emerging and Zoonotic | Gibson J.J.,Center for Global Health | Marke D.,Sierra Leone Ministry of Health and Sanitation | And 6 more authors.
Morbidity and Mortality Weekly Report | Year: 2016

What is already known about this topic? Ebola Virus Disease (Ebola) is transmitted person-to-person through direct contact with blood, body fluids, or contaminated clothing and other personal items of symptomatic or deceased patients. Traditional funeral practices, including washing and touching the corpse, pose a substantial risk for Ebola transmission. What is added by this report? A single, traditional funeral of a prominent pharmacist was associated with a sharp increase in the number of reported Ebola cases in a previously low-incidence district of Sierra Leone. Twenty-eight laboratory-confirmed cases occurred in persons who reported attending the pharmacist’s funeral. Sixteen (57%) patients had direct contact days or weeks before the funeral, 21 (75%) reported touching the corpse, and eight (29%) died. Rapid and effective outbreak control limited the second and third generations to four cases each, including one death. What are the implications for public health practice? Because of the potential for high levels of transmission from a single patient or event, vigilant Ebola surveillance and rapid response are essential, and immediate, safe, dignified burials by trained teams are critical to interrupting transmission and controlling Ebola. Enhanced community-based surveillance strategies, such as a community event-based surveillance system, will be critical to quickly identify high-risk events and prevent ongoing transmission. © 2016, Department of Health and Human Services. All rights reserved.


Nett R.J.,Office of Public Health Preparedness and Response | Helgerson S.D.,Room B | Anderson A.D.,Centers for Disease Control and Prevention
Vector-Borne and Zoonotic Diseases | Year: 2013

Background: Coxiella burnetii is an endemic bacterial pathogen in the United States and the causative agent of Q fever. Two outbreaks of Q fever occurred in Montana during 2011, which led to the issuance of a health alert urging clinicians to test patients with Q fever-compatible illnesses for C. burnetii infection. Methods: We retrospectively evaluated the medical records of patients hospitalized for fever, pneumonia, chest pain, and viral infection of unknown etiologies during the two Q fever outbreaks and following the health alert. Results: A total of 103 patients were included in the analysis. Clinicians assessed<1% of patients suffering illnesses compatible with Q fever for known risk factors or C. burnetii infection. Only 1 patient had Q fever excluded as a diagnosis. Conclusion: Clinicians should assess for Q fever risk factors and consider the diagnosis in patients hospitalized with Q fever-compatible illnesses when the etiology of illness is unknown. Work is warranted to evaluate the effectiveness of current healthcare alert practices for zoonotic diseases. © Copyright 2013, Mary Ann Liebert, Inc. 2013.


Yu Y.,National Center for Emerging and Zoonotic Infectious Diseases | Garg S.,National Center for Immunization and Respiratory Diseases | Yu P.A.,National Center for Emerging and Zoonotic Infectious Diseases | Kim H.-J.,National Center for Emerging and Zoonotic Infectious Diseases | And 4 more authors.
Clinical Infectious Diseases | Year: 2012

Background. In response to the influenza A(H1N1)pdm09 (pH1N1) pandemic, peramivir, an investigational intravenous neuraminidase inhibitor, was made available for treatment of hospitalized patients with pH1N1 in the United States under an Emergency Use Authorization (EUA). The Centers for Disease Control and Prevention (CDC) implemented a program to manage peramivir distribution to requesting clinicians under EUA. We describe results of the CDC's peramivir program and 3 related surveys.Methods.We analyzed data on peramivir requests made by clinicians to the CDC through an electronic request system. Three surveys were administered to enhance clinician compliance with adverse event reporting, to conduct product accountability, and to collect data on peramivir-treated patients. Descriptive analyses were performed, and 2-source capture-recapture analysis based on the 3 surveys was used to estimate the number of patients who received peramivir through the EUA.Results.From 23 October 2009 to 23 June 2010, CDC received 1371 clinician requests for peramivir and delivered 2129 five-day adult treatment course equivalents of peramivir to 563 hospitals. Based on survey responses, at least 1274 patients (median age, 43 years; range, 0-92 years; 49 male) received ≥1 doses of peramivir (median duration, 6 days). Capture-recapture analysis yielded estimates for the potential total number of peramivir recipients ranging from 1185 (95 confidence interval [CI], 1076-1293) to 1490 (95 CI, 1321-1659). Conclusions. Approximately 1274 hospitalized patients received peramivir through EUA program during the pH1N1 pandemic. Further analyses are needed to assess the clinical effectiveness of peramivir treatment of hospitalized patients with pH1N1. © 2012 The Author.


See I.,Centers for Disease Control and Prevention | Chang J.,University of California at Los Angeles | Gualandi N.,Centers for Disease Control and Prevention | Buser G.L.,Centers for Disease Control and Prevention | And 11 more authors.
Infection Control and Hospital Epidemiology | Year: 2016

OBJECTIVE To determine the clinical diagnoses associated with the National Healthcare Safety Network (NHSN) pneumonia (PNEU) or lower respiratory infection (LRI) surveillance events DESIGN Retrospective chart review SETTING A convenience sample of 8 acute-care hospitals in Pennsylvania PATIENTS All patients hospitalized during 2011-2012 METHODS Medical records were reviewed from a random sample of patients reported to the NHSN to have PNEU or LRI, excluding adults with ventilator-associated PNEU. Documented clinical diagnoses corresponding temporally to the PNEU and LRI events were recorded. RESULTS We reviewed 250 (30%) of 838 eligible PNEU and LRI events reported to the NHSN; 29 reported events (12%) fulfilled neither PNEU nor LRI case criteria. Differences interpreting radiology reports accounted for most misclassifications. Of 81 PNEU events in adults not on mechanical ventilation, 84% had clinician-diagnosed pneumonia; of these, 25% were attributed to aspiration. Of 43 adult LRI, 88% were in mechanically ventilated patients and 35% had no corresponding clinical diagnosis (infectious or noninfectious) documented at the time of LRI. Of 36 pediatric PNEU events, 72% were ventilator associated, and 70% corresponded to a clinical pneumonia diagnosis. Of 61 pediatric LRI patients, 84% were mechanically ventilated and 21% had no corresponding clinical diagnosis documented. CONCLUSIONS In adults not on mechanical ventilation and in children, most NHSN-defined PNEU events corresponded with compatible clinical conditions documented in the medical record. In contrast, NHSN LRI events often did not. As a result, substantial modifications to the LRI definitions were implemented in 2015. Infect Control Hosp Epidemiol 2016;37:818-824. © 2016 by The Society for Healthcare Epidemiology of America. All rights reserved.


Rubin S.E.,National Association of County and City Health Officials | Schulman R.M.,National Association of County and City Health Officials | Roszak A.R.,National Association of County and City Health Officials | Herrmann J.,National Association of County and City Health Officials | And 2 more authors.
Biosecurity and Bioterrorism | Year: 2014

Response to public health emergencies requires coordination across multiple sectors and effective use of existing resources in communities.With the expanded role of community pharmacists in public health during the past decade, their participation in response to emergencies has become increasingly important.Local health departments play a lead role in local public health emergency responses, and their ability to develop and leverage partnerships has become increasingly vital given their funding and personnel shortages.This article offers insight and recommendations on how local health departments can most effectively develop and maintain relationships with community pharmacies and pharmacists that will allow for a more coordinated and resourceful public health response to emergencies, and specifically to pandemic influenza outbreaks.Additionally, state and local health departments should reach out to pharmacies in a synchronized way to incorporate them into their pandemic influenza planning and response efforts.As pharmacists continue to expand their role as part of the public health system, pharmacy staff can be active participants with public health agencies to improve community public health emergency response.© 2014 Mary Ann Liebert, Inc.

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