Browsing by Subject "Disease outbreaks"
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Item Altered standards of care for health care providers in the pandemic influenza(Indiana University, 2009) Kinney, Eleanor D.; McCabe, Heather A.; Gilbert, Amy Lewis; Shisler, Janna JoPandemic influenza will pose tremendous challenges to health care providers, state public health authorities, and the public. All will have to conduct business under the most adverse of circumstances. It will be difficult for providers to meet the customary legal standards of care imposed by state and federal regulatory authorities, as well as the common law tort system. This white paper will explore the legal issues associated with altered standards of care in pandemic influenza.Item Epidemiologic and Clinical Features of Children and Adolescents Aged <18 Years with Monkeypox — United States, May 17–September 24, 2022(Center for Disease Control, 2022-11-04) Hennessee, Ian; Shelus, Victoria; McArdle, Cristin E.; Wolf, Maren; Schatzman, Sabrina; Carpenter, Ann; Minhaj, Faisal S.; Petras, Julia K.; Cash-Goldwasser, Shama; Maloney, Meghan; Sosa, Lynn; Jones, Sydney A.; Mangla, Anil T.; Harold, Rachel E.; Beverley, Jason; Saunders, Katharine E.; Adams, Jeremy N.; Stanek, Danielle R.; Feldpausch, Amanda; Pavlick, Jessica; Cahill, Megan; O'Dell, Victoria; Kim, Moon; Alarcón, Jemma; Finn, Lauren E.; Goss, Maura; Duwell, Monique; Crum, David A.; Williams, Thelonious W.; Hansen, Katrina; Heddy, Megan; Mallory, Krystle; McDermott, Darby; Cuadera, Mervin Keith Q.; Adler, Eric; Lee, Ellen H.; Shinall, Amanda; Thomas, Carlen; Ricketts, Erin K.; Koonce, Tammy; Rynk, Dana B.; Cogswell, Kelly; McLafferty, Meagan; Perella, Dana; Stockdale, Catherine; Dell, BreeAnna; Roskosky, Mellisa; White, Stephen L.; Davis, Kenneth R.; Milleron, Rania S.; Mackey, Skyler; Barringer, L. Anna; Bruce, Hollianne; Barrett, Debra; D'Angeli, Marisa; Kocharian, Anna; Klos, Rachel; Dawson, Patrick; Ellington, Sascha R.; Mayer, Oren; Godfred-Cato, Shana; Labuda, Sarah M.; McCormick, David W.; McCollum, Andrea M.; Rao, Agam K.; Salzer, Johanna S.; Kimball, Anne; Gold, Jeremy A. W.; California Department of Public Health Monkeypox Pediatric Working Group; CDC Monkeypox Pediatric Working Group; Pediatrics, School of MedicineData on monkeypox in children and adolescents aged <18 years are limited (1,2). During May 17–September 24, 2022, a total of 25,038 monkeypox cases were reported in the United States,† primarily among adult gay, bisexual, and other men who have sex with men (3). During this period, CDC and U.S. jurisdictional health departments identified Monkeypox virus (MPXV) infections in 83 persons aged <18 years, accounting for 0.3% of reported cases. Among 28 children aged 0–12 years with monkeypox, 64% were boys, and most had direct skin-to-skin contact with an adult with monkeypox who was caring for the child in a household setting. Among 55 adolescents aged 13–17 years, most were male (89%), and male-to-male sexual contact was the most common presumed exposure route (66%). Most children and adolescents with monkeypox were non-Hispanic Black or African American (Black) (47%) or Hispanic or Latino (Hispanic) (35%). Most (89%) were not hospitalized, none received intensive care unit (ICU)–level care, and none died. Monkeypox in children and adolescents remains rare in the United States. Ensuring equitable access to monkeypox vaccination, testing, and treatment is a critical public health priority. Vaccination for adolescents with risk factors and provision of prevention information for persons with monkeypox caring for children might prevent additional infections.Item Epidemiologic Features of the Monkeypox Outbreak and the Public Health Response — United States, May 17–October 6, 2022(Center for Disease Control, 2022-11-11) Kava, Christine Marie; Rohraff, Dallas M.; Wallace, Bailey; Mendoza-Alonzo, Jennifer L.; Currie, Dustin W.; Munsey, Anna E.; Roth, Nicole M.; Bryant-Genevier, Jonathan; Kennedy, Jordan L.; Weller, Daniel L.; Christie, Athalia; McQuiston, Jennifer H.; Hicks, Peter; Strid, Penelope; Sims, Emily; Negron, Maria E.; Iqbal, Kashif; Ellington, Sascha; Smith, Dawn K.; Pediatrics, School of MedicineOn May 17, 2022, the Massachusetts Department of Health announced the first suspected case of monkeypox associated with the global outbreak in a U.S. resident. On May 23, 2022, CDC launched an emergency response (1,2). CDC's emergency response focused on surveillance, laboratory testing, medical countermeasures, and education. Medical countermeasures included rollout of a national JYNNEOS vaccination strategy, Food and Drug Administration (FDA) issuance of an emergency use authorization to allow for intradermal administration of JYNNEOS, and use of tecovirimat for patients with, or at risk for, severe monkeypox. During May 17-October 6, 2022, a total of 26,384 probable and confirmed* U.S. monkeypox cases were reported to CDC. Daily case counts peaked during mid-to-late August. Among 25,001 of 25,569 (98%) cases in adults with information on gender identity,† 23,683 (95%) occurred in cisgender men. Among 13,997 cisgender men with information on recent sexual or close intimate contact,§ 10,440 (75%) reported male-to-male sexual contact (MMSC) ≤21 days preceding symptom onset. Among 21,211 (80%) cases in persons with information on race and ethnicity,¶ 6,879 (32%), 6,628 (31%), and 6,330 (30%) occurred in non-Hispanic Black or African American (Black), Hispanic or Latino (Hispanic), and non-Hispanic White (White) persons, respectively. Among 5,017 (20%) cases in adults with information on HIV infection status, 2,876 (57%) had HIV infection. Prevention efforts, including vaccination, should be prioritized among persons at highest risk within groups most affected by the monkeypox outbreak, including gay, bisexual, and other men who have sex with men (MSM); transgender, nonbinary, and gender-diverse persons; racial and ethnic minority groups; and persons who are immunocompromised, including persons with advanced HIV infection or newly diagnosed HIV infection.Item International outbreaks of Monkeypox virus infection with no established travel: A public health concern with significant knowledge gap(Elsevier, 2022) Al-Tawfiq, Jaffar A.; Barry, Mazin; Memish, Ziad A.; Medicine, School of MedicineItem Measles Outbreaks in the Eastern Mediterranean Region: Urgent Need for Strengthened Vaccination Efforts(Springer, 2024) Al‑Tawfiq, Jaffar A.; Memish, Ziad A.; Medicine, School of MedicineItem MERS-CoV recently re-emerged in Qatar, Saudi Arabia, its feasible global health risks amid FIFA world cup 2022 and salient counteracting strategies – an update(Wolters Kluwer, 2023-02-01) Chopra, Hitesh; Islam, Md Aminul; Chandran, Deepak; Emran, Talha B.; El-Shall, Nahed A.; Al-Tawfiq, Jaffar A.; Dhama, Kuldeep; Medicine, School of MedicineItem Middle East Respiratory Syndrome Coronavirus(Thieme, 2021) Al-Tawfiq, Jaffar A.; Azhar, Esam I.; Memish, Ziad A.; Zumla, Alimuddin; Medicine, School of MedicineThe past two decades have witnessed the emergence of three zoonotic coronaviruses which have jumped species to cause lethal disease in humans: severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1), Middle East respiratory syndrome coronavirus (MERS-CoV), and SARS-CoV-2. MERS-CoV emerged in Saudi Arabia in 2012 and the origins of MERS-CoV are not fully understood. Genomic analysis indicates it originated in bats and transmitted to camels. Human-to-human transmission occurs in varying frequency, being highest in healthcare environment and to a lesser degree in the community and among family members. Several nosocomial outbreaks of human-to-human transmission have occurred, the largest in Riyadh and Jeddah in 2014 and South Korea in 2015. MERS-CoV remains a high-threat pathogen identified by World Health Organization as a priority pathogen because it causes severe disease that has a high mortality rate, epidemic potential, and no medical countermeasures. MERS-CoV has been identified in dromedaries in several countries in the Middle East, Africa, and South Asia. MERS-CoV-2 causes a wide range of clinical presentations, although the respiratory system is predominantly affected. There are no specific antiviral treatments, although recent trials indicate that combination antivirals may be useful in severely ill patients. Diagnosing MERS-CoV early and implementation infection control measures are critical to preventing hospital-associated outbreaks. Preventing MERS relies on avoiding unpasteurized or uncooked animal products, practicing safe hygiene habits in health care settings and around dromedaries, community education and awareness training for health workers, as well as implementing effective control measures. Effective vaccines for MERS-COV are urgently needed but still under development.Item Public Health and Epidemiology Informatics: Recent Research and Trends in the United States(Thieme, 2015) Dixon, Brian E.; Kharrazi, H.; Lehmann, H. P.; Epidemiology, School of Public HealthObjectives To survey advances in public health and epidemiology informatics over the past three years. Methods We conducted a review of English-language research works conducted in the domain of public health informatics (PHI), and published in MEDLINE between January 2012 and December 2014, where information and communication technology (ICT) was a primary subject, or a main component of the study methodology. Selected articles were synthesized using a thematic analysis using the Essential Services of Public Health as a typology. Results Based on themes that emerged, we organized the advances into a model where applications that support the Essential Services are, in turn, supported by a socio-technical infrastructure that relies on government policies and ethical principles. That infrastructure, in turn, depends upon education and training of the public health workforce, development that creates novel or adapts existing infrastructure, and research that evaluates the success of the infrastructure. Finally, the persistence and growth of infrastructure depends on financial sustainability. Conclusions Public health informatics is a field that is growing in breadth, depth, and complexity. Several Essential Services have benefited from informatics, notably, “Monitor Health,” “Diagnose & Investigate,” and “Evaluate.” Yet many Essential Services still have not yet benefited from advances such as maturing electronic health record systems, interoperability amongst health information systems, analytics for population health management, use of social media among consumers, and educational certification in clinical informatics. There is much work to be done to further advance the science of PHI as well as its impact on public health practice.Item Substitution of Nonpharmacologic Therapy With Opioid Prescribing for Pain During the COVID-19 Pandemic(American Medical Association, 2021) Lee, Byungkyu; Yang, Kai-Cheng; Kaminski, Patrick; Peng, Siyun; Odabas, Meltem; Gupta, Sumedha; Green, Harold D., Jr.; Ahn, Yong-Yeol; Perry, Brea L.; Economics, School of Liberal ArtsImportance: During the pandemic, access to medical care unrelated to COVID-19 was limited because of concerns about viral spread and corresponding policies. It is critical to assess how these conditions affected modes of pain treatment, given the addiction risks of prescription opioids. Objective: To assess the trends in opioid prescription and nonpharmacologic therapy (ie, physical therapy and complementary medicine) for pain management during the COVID-19 pandemic in 2020 compared with the patterns in 2019. Design, setting, and participants: This retrospective, cross-sectional study used weekly claims data from 24 million US patients in a nationwide commercial insurance database (Optum's deidentified Clinformatics Data Mart Database) from January 1, 2019, to September 31, 2020. Among patients with diagnoses of limb, extremity, or joint pain, back pain, and neck pain for each week, patterns of treatment use were identified and evaluated. Data analysis was performed from April 1, 2021, to September 31, 2021. Main outcomes and measures: The main outcomes of interest were weekly rates of opioid prescriptions, the strength and duration of related opioid prescriptions, and the use of nonpharmacologic therapy. Transition rates between different treatment options before the outbreak and during the early months of the pandemic were also assessed. Results: A total of 21 430 339 patients (mean [SD] age, 48.6 [24.0] years; 10 960 507 [51.1%] female; 909 061 [4.2%] Asian, 1 688 690 [7.9%] Black, 2 276 075 [10.6%] Hispanic, 11 192 789 [52.2%] White, and 5 363 724 [25.0%] unknown) were enrolled during the first 3 quarters in 2019 and 20 759 788 (mean [SD] age, 47.0 [23.8] years; 10 695 690 [51.5%] female; 798 037 [3.8%] Asian; 1 508 023 [7.3%] Black, 1 976 248 [9.5%] Hispanic, 10 059 597 [48.5%] White, and 6 417 883 [30.9%] unknown) in the first 3 quarters of 2020. During the COVID-19 pandemic, the proportion of patients receiving a pain diagnosis was smaller than that for the same period in 2019 (mean difference, -15.9%; 95% CI, -16.1% to -15.8%). Patients with pain were more likely to receive opioids (mean difference, 3.5%; 95% CI, 3.3%-3.7%) and less likely to receive nonpharmacologic therapy (mean difference, -6.0%; 95% CI, -6.3% to -5.8%), and opioid prescriptions were longer and more potent during the early pandemic in 2020 relative to 2019 (mean difference, 1.07 days; 95% CI, 1.02-1.17 days; mean difference, 0.96 morphine milligram equivalents; 95% CI, 0.76-1.20). Analysis of individuals' transitions between treatment options for pain found that patients were more likely to transition out of nonpharmacologic therapy, replacing it with opioid prescriptions for pain management during the COVID-19 pandemic than in the year before. Conclusions and relevance: Nonpharmacologic therapy is a benign treatment for pain often recommended instead of opioid therapy. The decrease in nonpharmacologic therapy and increase in opioid prescription during the COVID-19 pandemic found in this cross-sectional study, especially given longer days of prescription and more potent doses, may exacerbate the US opioid epidemic. These findings suggest that it is imperative to investigate the implications of limited medical access on treatment substitution, which may increase patient risk, and implement policies and guidelines to prevent those substitutions.