Chicago Department Of Public Health Research Articles

Sexual Orientation and Cervical Cancer Screening Among Cisgender Women.

Lesbian, gay, and bisexual populations face barriers accessing health care in Chicago, Illinois. To describe the prevalence of up-to-date cervical cancer screening among lesbian, gay, and bisexual vs heterosexual cisgender women in Chicago. This retrospective, cross-sectional, population-based study of cisgender women residing in Chicago was completed from 2020 to 2022 using data from the Healthy Chicago Survey, which is conducted annually by the Chicago Department of Public Health. Participants included cisgender women aged 25 to 64 years with no history of hysterectomy. Respondents who self-identified as lesbian, gay, or bisexual or other than straight, lesbian, or bisexual were coded as lesbian, gay, or bisexual (LGB). Respondents who self-identified as straight were coded as heterosexual. Those who reported having a Papanicolaou test within the past 3 years were considered up-to-date with cervical cancer screening. Data analysis was performed from June to October 2023. The primary exposure was sexual orientation. Covariates included age, income level, race, ethnicity, having a primary care practitioner (PCP), and insurance coverage. Prevalence ratios (PRs), log-based regression models, and interaction analysis were used to describe the association of sexual orientation with up-to-date screening. The sample included 5167 cisgender women (447 LGB and 4720 heterosexual), aged 25 to 64 years, with no history of hysterectomy. Among LGB cisgender women, 318 (71.14%) reported previous cervical cancer screening compared with 3632 (76.95%) heterosexual cisgender women. The prevalence of up-to-date screening was 10% lower in the LGB group compared with the heterosexual group (PR, 0.90; 95% CI, 0.82-1.00). In regression analysis, having a PCP (PR, 1.43; 95% CI, 1.29-1.59) was associated with up-to-date screening. In interaction analysis, LGB cisgender women with a PCP were 93% more likely to be up-to-date compared with those without a PCP (PR, 1.93; 95% CI, 1.37-2.72). In this cross-sectional study of cervical cancer screening rates between the heterosexual and LGB populations in Chicago, up-to-date cervical cancer screening was associated with having a PCP, regardless of sexual orientation, but this association was greater for LGB individuals. Although LGB populations were less likely to be screened, this disparity may be reduced with more consistent health care access and established care with PCPs.

Neighborhood-level factors associated with COVID-19 vaccination rates: a case study in Chicago

IntroductionChicago’s deeply-rooted racial and socioeconomic residential segregation is a pattern mirrored in other major cities, making it a prototype for studying the uptake of public health interventions across the US. Residential segregation is related to availability of primary care, sense of community, and trust in the healthcare system, components which are essential in the response to crises like Covid-19 in which vaccine rollout was primarily community-based. We aimed to evaluate the association between rates of access to primary care and community-belonging with Covid-19 vaccination within Chicago’s neighborhoods.MethodsData from Chicago Department of Public Health (12/2020-6/2022) on Covid-19 vaccination rates, race/ethnicity (% Black and % Hispanic/Latinx residents), age (% >65), gender (% female), socioeconomic status (% below the federal poverty line), access to needed care rate, and rate of self-reported sense of community-belonging on the neighborhood level were analyzed. Linear mixed models (LMMs) were used to study the impact of variables on vaccination; each neighborhood was added as a random effect to account for with-community association.ResultsThe average Covid-19 vaccination rates across Chicago’s neighborhoods was 79%, ranging from 37 to 100%, with median 81%. We found that Covid-19 vaccination rates were positively correlated with access to needed care (p < 0.001) and community-belonging (p < 0.001). Community areas that had lower vaccination rates had greater percentage of Black residents (p < 0.0001) and greater poverty rates (p < 0.0001). After adjusting for poverty, race, gender and age in the models, the association between vaccination rates and access to care or community-belonging were no longer significant, but % Black residents and poverty remained significant.ConclusionsThough access to needed primary care and community-belonging are correlated with vaccination rates, this association was not significant when controlling for demographic factors. The association between poverty, race and vaccination status remained significant, indicating that socioeconomic and racial disparities across Chicago drive Covid-19 vaccine recommendation adherence regardless of care access. Understanding how poverty, and its intersectional relation to race and primary care access, affects vaccination should be a priority for public health efforts broadly.

COVID-19 Vaccine Policy Implementation and Differential Vaccine Uptake Trajectories in Chicago Communities.

Since the onset of the COVID-19 pandemic, multiple public health interventions have been implemented to respond to the rapidly evolving pandemic and community needs. This article describes the scope, timing, and impact of coordinated strategies for COVID-19 vaccine uptake in Chicago for the first year of vaccine distribution. Using a series of interviews with public health officials and leaders of community-based organizations (CBOs) who participated in the implementation of the citywide COVID-19 vaccine outreach initiatives, we constructed a timeline of vaccine outreach initiatives. The timeline was matched to the vaccine uptake rates to explore the impact of the vaccine outreach initiatives by community area. Finally, we discussed the nature of policy initiatives and the level of vaccine uptake in relation to community characteristics. The Chicago Department of Public Health (CDPH) implemented myriad vaccine outreach strategies, including mass vaccination sites, improved access, and community-level vaccine campaigns. Protect Chicago+ was the primary vaccine outreach effort initiated by the CDPH, which identified 15 highly vulnerable community areas. More than 2.7 million (67%) Chicagoans completed the vaccine regimen by December 2021. Black (51.3%) Chicagoans were considerably less likely to be vaccinated than Asian (77.6%), White (69.8%), and Hispanic (63.6%) Chicago residents. In addition, there were significant spatial differences in the rate of COVID-19 vaccine completion: predominantly White and Hispanic communities, compared with Black communities, had higher rates of vaccine completion. The community outreach efforts to improve COVID-19 vaccine uptake in Chicago have shown the importance of community-engaged approaches in pandemic responses. Despite citywide efforts to build community infrastructure, Black communities had relatively lower levels of vaccine uptake than other communities. Broader social restructuring to mitigate disinvestment and residential segregation and to ameliorate medical mistrust will be needed to prepare for future pandemics and disasters.

1618. Assessing and Improving Accurate Diagnosis and Reporting of Congenital Syphilis in a Tertiary Care Children's Hospital

Abstract Background Congenital syphilis (CS) occurs due to transplacental passage of active infection to the fetus during pregnancy. Clinical presentation ranges from asymptomatic to severe permanent disability. Nationally, the incidence and prevalence of syphilis among cisgender females ages 15-44 have increased, with proportional increases in rates of CS. In 2020, 19 cases of CS were reported to the Chicago Department of Public Health (CDPH), a 138% increase from 2019 (8 cases). There are circumstances where infants with a non-reactive rapid plasma reagin (RPR-) may potentially contract syphilis in the context of inadequate maternal treatment per national guidelines. (Figure 1) Currently, only infants with RPR reactivity (RPR+) are reported to CDPH, potentially underestimating the true incidence. Our project sought to identify RPR- infants who received treatment to improve reporting to CDPH, more accurately reflect the prevalence of CS in Chicago, and ultimately guide interventions to reduce and eliminate CS.Figure 1:2021 Center for Disease Control (CDC) Possible Congenital Syphilis Definition Methods Data was collected via electronic medical record (EMR) review for infants born at Comer Children’s Hospital in Chicago, IL between 2012 and 2022, filtered using ICD-9 code (090) and ICD-10 code (A50.9) for CS. Infants were excluded if diagnosis code was used in error, there was no RPR result, or diagnosis occurred at an outside institution. (Figure 2) Infants were stratified as having CS with RPR+ or RPR-. Retrospectively, each infant was also classified with a diagnosis of less likely CS, possible CS, and proven CS per national guidelines.Figure 2:Patient Stratification by ICD-9 and ICD-10 Code for Congenital Syphilis and RPR Reactivity. RPR = Rapid Plasma Reagin Results 68 infants with CS were identified. 57 infants received IV PCN with diagnoses of proven or possible CS (84%). 51 (75%) patients were RPR+ and 17 (25%) were RPR-. (Figure 3) Of the 17 RPR-, 11 had a diagnosis of possible CS (65%) and received IV PCN while 6 (35%) had less likely CS and received one dose of intramuscular (IM) PCN (Table 1). None of the RPR- infants were reported to CDPH.Figure 3:Total Number of Congenital Syphilis Cases Based on CDC Definition. CS = Congenital Syphilis, CDC = Center for Disease ControlTable 1:Total Number of Days of Intravenous or Intramuscular Penicillin Administration per RPR reactivity.. Aq PCN = Aqueous Penicillin G, Ben PCN = Benzathine Penicillin G, IM = Intramuscular, IV = Intravenous Conclusion In this retrospective analysis, reporting CS based solely on a reactive infant RPR leads to underreporting. As we confront the rising incidence of CS, (Figure 4) it is critical that we have a complete understanding of the epidemiology which may lead to increased support for public health initiatives focused on decreasing and eliminating CS.Figure 4:Timeline of Total CS and RPR- CS Cases at Hospital per Year. CS = Congenital Syphilis Disclosures Allison H. Bartlett, MD, MS, CVS/Caremark: Honoraria Jessica Ridgway, MD, Gilead Sciences: Expert Testimony

Breakthrough SARS-CoV-2 infections among recipients of tixagevimab-cilgavimab prophylaxis: A citywide real-world effectiveness study.

There are limited real-world data on the effectiveness of tixagevimab-cilgavimab as pre-exposure prophylaxis of COVID-19. We describe lessons learned when coordinating data collection and identifying breakthrough SARS-CoV-2 infections among patients across indications and institutions in a major US city. The Chicago Department of Public Health requested patient-level tixagevimab-cilgavimab administration data from all prescribing providers in Chicago, for treatments December 8, 2021 through June 30, 2022. Records were matched to COVID-19 vaccinations and laboratory-confirmed SARS-CoV-2 infections through December 31, 2022. Due to difficulty collecting data from all providers, targeted follow-up was conducted to improve completeness on key variables (demographics, vaccination status, clinical indication for prophylaxis). Over half of reported tixagevimab-cilgavimab administrations were to patients residing outside Chicago. Five hundred forty-four Chicago residents who received at least one dose of tixagevimab-cilgavimab were included in this analysis. Most were age 50 years or older (72%), Black non-Latinx (33%) or White non-Latinx (29%), and fully vaccinated (80%). Seventy-five patients (14%) had laboratory-confirmed COVID-19. Patients with and without breakthrough infections were demographically similar. Clinical indication was missing for >95% of cases, improved to 64% after follow-up; the most frequently specified was hematologic malignancy (10%). Severe outcomes were uncommon: 16% had documented COVID-19-related hospitalizations, one death was identified. Tixagevimab-cilgavimab recipients in Chicago had a lower rate of severe SARS-CoV-2 infection than reported among other untreated high-risk patients, including during predominance of non-neutralizing variants. Improving stakeholder collaboration is essential for generation of real-world effectiveness data, informing pandemic preparedness and optimizing use of medical countermeasures.

The Effects of Interpersonal Violence on Sleep Following the COVID-19 Stay-at-Home Order.

Lack of sleep is a harm that can lead to chronic diseases ranging from diabetes to heart disease. We examined the exposure to interpersonal violence and its association with sleep, following the COVID-19 stay-at-home order. Cross-sectional. Surveys were completed online and via paper-and-pencil in English and Spanish (N = 2049; RR = 68.4%). Respondents were 18+ and residing in Chicago. The Chicago Department of Public Health's "2022 Healthy Chicago Survey COVID-19 Social Impact Survey". We developed two weighted models. Model 1 examined the effects of neighborhood violence on meeting the national sleep recommendation. Model 2 examined the effects of violence in the home among friends or family on meeting the sleep recommendation, incorporating additional predictors: victimization, stress, gender, race/ethnicity, household income, and general health. Odds ratios were estimated using multivariate logistic regression. Exposure to neighborhood violence and sleep was not significant, but knowing a friend or family member who experienced violence or mistreatment in their home affected the odds of meeting the sleep recommendation (OR = .61, 95% CI = .44-.84). Non-Hispanic Blacks had 52% lower odds of meeting sleep recommendations (OR = .48, 95% CI = .37-.63). Addressing the harms to sleep that followed COVID-19 should engage diverse stakeholders in implementing culturally responsive interventions to promote adequate sleep and prevent chronic disease.

Financial, Social, and Health Impacts from the COVID-19 Pandemic: Findings from the Healthy Chicago Survey.

This study examines self-reported impacts of the COVID-19 pandemic among Chicago residents and disparities of these impacts across demographic characteristics. Six logistic regression models were developed to identify demographic and socioeconomic factors associated with each COVID-19 impact. The study used de-identified and weighted data from the 2020 Healthy Chicago Survey (HCS). HCS is an annual survey using an address-based random sampling method administered by the Chicago Department of Public Health (CDPH) across the city of Chicago on adults aged 18 or older living between July 17 and November 11, 2020, and received 4517 responses. Chicago residents with lower socioeconomic status had a higher likelihood of food and housing insecurity. Non-Hispanic (NH) Black residents were more likely to report being unable to obtain food (OR: 2.996; 95% CI: 2.268-2.324); being unable to pay for rent, mortgage, or bills (OR: 2.352; 95% CI: 2.325-2.380); and grief from a loss of someone to COVID-19 (OR: 2.037; 95% CI: 2.013-2.061) compared to NH White residents. NH White residents were more likely than other racial/ethnic groups to report loss of social connections, worsened mental health, and canceling or postponing medical care. The analysis showed higher odds of social contact loss and worsened mental health from COVID-19 in NH White and higher education populations. By implementing strategies to address specific challenges faced by different racial groups, Chicago may effectively mitigate pandemic's adverse effects. These strategies can promote a more inclusive approach to distributing COVID investments for programs and policies.

COVID-19 vaccination requirements, encouragement and hesitancy among non-health care, non-congregate workers in Chicago: results from the WEVax survey

BackgroundWhile frontline and essential workers were prioritized for COVID-19 vaccination in the United States, coverage rates and encouragement strategies among non-health care workers have not been well-described. The Chicago Department of Public Health surveyed non-health care businesses to fill these knowledge gaps and identify potential mechanisms for improving vaccine uptake.MethodsThe Workplace Encouragement for COVID-19 Vaccination in Chicago survey (WEVax Chicago) was administered using REDCap from July 11 to September 12, 2022, to businesses previously contacted for COVID-19 surveillance and vaccine-related outreach. Stratified random sampling by industry was used to select businesses for phone follow-up; zip codes with low COVID-19 vaccine coverage were oversampled. Business and workforce characteristics including employee vaccination rates were reported. Frequencies of requirement, verification, and eight other strategies to encourage employee vaccination were assessed, along with barriers to uptake. Fisher’s exact test compared business characteristics, and Kruskal–Wallis test compared numbers of encouragement strategies reported among businesses with high (> 75%) vs. lower or missing vaccination rates.ResultsForty-nine businesses completed the survey, with 86% having 500 or fewer employees and 35% in frontline essential industries. More than half (59%) reported high COVID-19 vaccination rates among full-time employees; most (75%) workplaces reporting lower coverage were manufacturing businesses with fewer than 100 employees. Verifying vaccination was more common than requiring vaccination (51% vs. 28%). The most frequently reported encouragement strategies aimed to improve convenience of vaccination (e.g., offering leave to be vaccinated (67%) or to recover from side effects (71%)), while most barriers to uptake were related to vaccine confidence (concerns of safety, side effects, and other skepticism). More high-coverage workplaces reported requiring (p = 0.03) or verifying vaccination (p = 0.07), though the mean and median numbers of strategies used were slightly greater among lower-coverage versus higher-coverage businesses.ConclusionsMany WEVax respondents reported high COVID-19 vaccine coverage among employees. Vaccine requirement, verification and addressing vaccine mistrust may have more potential to improve coverage among working-age Chicagoans than increasing convenience of vaccination. Vaccine promotion strategies among non-health care workers should target low-coverage businesses and assess motivators in addition to barriers among workers and businesses.

Recognizing Local Champions in Infection Prevention and Control.

Infection Prevention and Control (IPC) describes a set of practices that aim to prevent the spread of infections, including health care–associated infections (HAIs) and emerging infectious diseases—like COVID-19—in health care facilities and other congregate settings. IPC includes hand hygiene, use of personal protective equipment (PPE), safe injection practices, and proper environmental cleaning. The National Association of County and City Health Officials' (NACCHO) IPC Champion recognition aims to highlight the IPC achievements of local health departments (LHDs) and honor the staff leading this work. NACCHO IPC Champions are passionate, well-versed, and respected individuals working in local public health who are advancing infection prevention and control capacity, activities, guidelines, and engagement. They are knowledgeable and enthusiastic about infection prevention and control. They promote and lead HAI prevention initiatives by educating colleagues and partners, preventing and responding to outbreaks, solving problems, and leveraging lessons learned to improve policies and practices. IPC champions: Build and strengthen partnerships between local public health and facilities (health care and other congregate settings) in their communities to build trust and to develop a reputation as a community IPC resource; Facilitate communication between and across facilities to identify and stop interfacility transmission; Identify and respond to outbreaks in facilities of HAIs, including COVID-19; Strategize to proactively prevent infections and improve IPC efforts; Engage and educate internal staff and external partners to increase their buy-in and awareness of IPC; Apply lessons learned to improve policies and practices in their community—and potentially, across the state/country; and Speak up to illustrate the needs of LHDs in this work and to share experiences and insights. To date, NACCHO has featured the IPC work of health departments in Mobile County, Alabama, Prince George's County, Maryland, Fairfax County, Virginia, and DuPage County, Illinois. Individual spotlights have also recognized Dr Stephanie R. Black, Medical Director of the Communicable Disease Program at the Chicago Department of Public Health; Dr Matt Zahn, Medical Director for the Epidemiology, Assessment, and Immunization Program at the Orange County Health Care Agency in California; and Dr Dawn Terashita, Associate Director for the Acute Communicable Disease Control Program at the Los Angeles County Department of Public Health, for their impact promoting IPC practices in their community and beyond. Mobile County Health Department During the height of the COVID-19 pandemic, the Mobile County Health Department's (MCHD) Infection Prevention Team (IPT) utilized a community-centered approach to combat the spread of the virus in Alabama. They partnered with community organizations, local health care providers, K-12 schools, and other high-risk congregate settings to better understand the needs of underserved communities and provide essential epidemiological resources (eg, case investigations, contact tracing, data entry and surveillance, outbreak testing, and infection prevention education resources). They also worked with county-employed dentists to provide IPC information to facility partners early in the pandemic to support nursing homes and other congregate care settings. The IPT conducted more than 30 community-wide outreach events, which included the provision of more than 2500 rapid COVID-19 tests, as well as lodging and food for 700 COVID-positive members of the homeless community when local shelters were unable to provide isolated facilities. When staffing shortages, testing, and personal protective equipment (PPE) resource scarcity impacted long-term care facilities (LTCFs), the Mobile County stepped in to provide PPE and utilized their partnership with an ambulance service to provide tests. In addition to responding once an outbreak occurred, Mobile County's IPT worked to help LTCFs prepare more proactively for outbreaks by keeping regular contact on guidance updates, supply needs, and reporting regulations. Their efforts to strengthen relationships in this way have allowed partner facilities to request and receive support more frequently from the MCHD. Prince George's County Health Department The Fostering Local Infection Prevention Control & Capacity (FLIP-CC) Project Team was established as a cross-collaborative effort across the Health and Wellness Division, the Communicable and Vector-borne Disease Control Program, and the Public Health Emergency Preparedness Team at Prince George's County Health Department in Maryland. They credit the resultant diversity in skills and experiences with IPC as a major factor in their success mitigating the impact of the COVID-19 pandemic within their community. Throughout the pandemic, the FLIP-CC Team provided high-risk facilities with ongoing assessments, facilitated frequent meetings and communications, reviewed data to inform outbreak status protocols, and provided customized technical assistance on IPC for frontline workers. FLIP-CC also worked with the LHD's strike team to improve vaccination rates for the most vulnerable populations in their community, resulting in remarkable decreases in COVID-19 case rates and hospitalizations. Another significant accomplishment was the low to zero bloodstream infection rates reported from local dialysis facilities during this time, indicating that IPC practices communicated by FLIP-CC were in place and being followed properly. In utilizing direct feedback from local health care teams in dialysis, nursing homes, and assisted living facilities, the FLIP-CC Team was able to design specialized technical assistance and capacity-building activities. Facility directors also became more aware of the services provided by the LHD and viewed them as a reliable and trusted source of information that they could request resources from. Fairfax County Health Department In collaboration with state and national partners, the Fairfax County Health Department's Acute Communicable and Emerging Diseases (ACED) Program strategically built and maintained partnerships with local care facilities to disseminate IPC resources and guidance in Virginia. These partnerships fostered peer-to-peer sharing of best practices and lessons learned in Fairfax County such that they could inform and advise state-level stakeholders on measures to optimize IPC measures within their health care facilities. During the COVID-19 pandemic response, ACED's interactions with facilities expanded to include surveillance and reporting, more frequent site visits with an emphasis on ensuring compliance with mitigation measures, assessment of PPE use and other infection prevention measures, outbreak investigations, and support for tests and vaccinations. In addition to on-site communication, they expanded outreach to include monthly webinar meetings with LTCF partners to provide COVID-19, HAI, and antimicrobial resistance updates. The team's IPC work has also expanded to include collaborations and consultations with the County's correctional facility, homeless services programs, and shelters. The results of their efforts include improved disease reporting from LTCFs, resulting in the investigation of cases and prevention of further infection. The ACED Program's investment in building partnerships has also led to greater success in collecting data from local facilities. These partnerships have resulted in improved collaboration and involvement with activities such as Infection Control Assessment and Response visits, PPE training, and respiratory fit testing. LTCF staff and residents in Fairfax County also exceeded the national rates for early COVID-19 first-dose vaccination coverage as reported by the Centers for Disease Control and Prevention (CDC) in a Morbidity and Mortality Weekly Report released on February 5, 2021. DuPage County Health Department The DuPage County Health Department's HAI team was established in 2012 with support from NACCHO and the CDC to better identify and understand the impact of HAIs, multidrug-resistant organisms, and extensively drug-resistant organisms within their jurisdiction. Since then, they have had extensive on-site and remote engagement with local LTCFs to conduct point-prevalence surveys, infection control audits, and follow-up visits and provide educational support and infection prevention guidance resources in conjunction with the Illinois Department of Public Health staff. When the COVID-19 pandemic arose, the HAI team quickly shifted and expanded their focus to COVID-19 surveillance, investigation, and prevention and control activities in congregate health care facilities, educational settings, and business/workplaces in DuPage County, Illinois. They have improved relationships and responsiveness through regular outreach efforts and by continuing to identify partners and their team roles (eg, medical director, infection prevention designee, director of nursing, environmental services) in their consultation and outreach efforts toward multidisciplinary engagement. Internally, DuPage County Health Department functioned as a hub to receive and provide PPE to facilities in their jurisdiction, particularly LTCFs that experienced extreme PPE shortages for several months. Beyond infection prevention and control challenges, the DuPage County Health Department is also committed to addressing health inequities. The DuPage County COVID-19 Health Equity and Access Response Team (HEART) was established through a partnership between the DuPage Health Coalition, DuPage Federation for Human Services Reform, Impact DuPage, and the DuPage County Health Department. HEART provides a countywide voice for health equity and access, ensuring that all residents of DuPage County reach the highest level of health possible. Their most recent priorities include supporting and coordinating vaccination clinics through community outreach, multilingual COVID-19 vaccine surveys to assess COVID-19 vaccine hesitancy and build confidence, and the recruitment of Health Ambassadors for public service announcements, interviews, and town hall meetings. These LHDs serve as role models for their innovative approaches to reduce the burden of infectious disease in their communities. For more information on characteristics of NACCHO's IPC Champions, or to nominate yourself or a colleague for consideration, visit https://www.naccho.org/programs/community-health/infectious-disease/infectious-disease-prevention-and-control/infection-prevention-and-control-champions.

Examining Associations Between Discrimination, Social Cohesion, and Health among White LGBT versus POC LGBT Chicagoans

Consistent with the minority stress perspective, lesbian/gay, bisexual, and transgender (LGBT) individuals on average report worse health than heterosexual individuals in several domains, for example, general health, mental health, physical health, and healthcare access. Intersectionality‐based research shows that LGBT people of color (POC) are, on average, at even greater risk for adverse health outcomes. Discrimination and social cohesion may be two mechanisms underlying these between‐ and within‐group disparities, given that both constructs are frequently reported within marginalized populations, and that both broadly relate to health. This study used data from the Chicago Department of Public Health to examine broad health differences between White LGBT and LGBT POC, and to test specific models in which social cohesion mediated links between discrimination and health. LGBT POC reported experiencing worse general health, lower access to health care, more experiences of discrimination, and lower feelings of social cohesion than did White LGBT individuals. No mediation effects emerged; however, there was a direct effect of experiencing discrimination on mental health distress. Discrimination exposure inversely related to the feelings of social cohesion.

Chicago providing individual counseling to expand MH services

The Chicago Department of Public Health (CDPH) is partnering with Chicago Public Libraries (CPL) to increase access to no‐barrier mental health services by offering mental health care in select library branches, the city of Chicago reported in a news release on March 24. The program is part of the recent expansion of mental health services by CDPH and partner agencies to all 77 community areas in Chicago as part of the #All77 campaign. “By including CPL branches in our robust network of community‐based mental health centers, we will further lower the barriers around critical mental health services for all Chicagoans,” Mayor Lori E. Lightfoot stated. The services are staffed by CDPH mental health clinicians and are an outgrowth of CDPH's effort to expand services outside the walls of clinics and into community‐based settings. Services are available to everyone ages 13 and older, regardless of insurance, immigration status or ability to pay.

2218. Spatial Epidemiology of Gonorrhea Incidence Among Women in Chicago

Abstract Background Neisseria gonorrhea is the second most prevalent sexually transmitted infection (STI) in the US with increasing incidence. Untreated, it leads to devastating sequelae for nonpregnant women, pregnant women, and their neonates. Geographic clustering of gonorrhea coincides with clustering of other risk factors and may help guide interventions. We utilize Geographic Information Systems (GIS) software to map gonorrhea incidence among women in Chicago, and examine factors associated with the spatial distribution of infection. Methods Chicago Department of Public Health data sets and shape files were available through the Chicago Data Portal. ArcGIS was utilized for map illustrating and data analysis. Ordinary Least Squares (OLS) Regression was utilized using the dependent variable of Gonorrhea incidence in women per Chicago Community Area (CCA), with various explanatory variables. Within the OLS, the Koenker Statistic (KS) was reported and from this a Geographically Weighted Regression (GWR) tool was run for combinations with statistically significant KS. Results The highest incidence is shown in the southern and western CCA’s, with hospitals clustered in the northern and southeastern CCA’s &amp; clinics with gaps primarily noted in the southern and northwestern CCA’s. (Figure 1.) Teen pregnancy incidence (TP), infant mortality (IM), and first trimester prenatal care, had statistical significance of the robust probability for all of their explanatory variables, and VIF’s less than 2 for all explanatory variables, JBS were not statistically significant, and AICc were approximately 1170 demonstrating stable OLS. (Figure 2&amp;3) TP &amp; IM did have a statistically significant KS and GWR was run demonstrating random spatial pattern. This confirms TP &amp; IM as predictors for gonorrheal incidence had variable predictability throughout the CCA’s and GWR improves the model outcome. Both combinations spatially explain gonorrhea incidence. Map of Gonorrhea Incidence among Females in 2006-2010 Figure 1:The data of the incidence of gonorrhea in females was mapped with 5 separate classifications created and displayed in the form of a map. Also included on the map were hospitals in the city, and Chicago Department of Public Health clinic locations where free STI management could take place. illustrates gonorrhea incidence rates (per 100,000) within the 77 Chicago Community Areas (CCA) of the city. The darker shades of green correspond with higher incidence. The highest incidence is shown to be greatest in the southern and western CCA’s. Also illustrated are the locations of the hospitals within the city in addition to CDPH clinics that are Federally Qualified Health Clinics (FQHC) that offer services for treatment at a reduced or free cost depending on health insurance status. The majority of the hospitals are shown to clustered in the northern and southeastern CCA’s. The clinics are more evenly spaced out with gaps primarily noted in the southern and northwestern CCA’s. The Ordinary Least Squares (OLS) regression results are illustrated in Table 1 above. The results are shown for six separate regressions: chlamydia incidence, Natality (teen pregnancy incidence [TP], percent of live births that were preterm [Preterm], fetal low birth percentage [LBW], prenatal care in the 1st trimester rate [PNC 1T], infant mortality rate [IM]), poverty (total # below poverty line per 100,000), poverty &amp; chlamydia, TP &amp; IM, TP &amp; IM &amp; PNC 1T, and all coefficients (natality incidence, poverty incidence, chlamydia incidence, fertility rate). Utilizing ArcGIS software, OLS Regression was mapped with the 77 Chicago Community Areas (CCA) with Gonorrhea Infection Incidence per CCA as the dependent variable and Teen Pregnancy (TP), Infant Mortality (IM) and 1st trimester prenatal care (1TM) incidence per CCA as the explanatory variables. Regression reported with standard deviation (SD) and color coded based off quantity of SD. Map shapefile is of the 77 CCA’s. Overlying are Hospitals and Chicago Department of Public Health (CDPH) clinic locations as made available through CDPH public domain website. Conclusion Teen pregnancy rates, infant mortality rates, and prenatal care in the first trimester explain some of the spatial patterns of gonorrhea incidence of females in Chicago. Identification of these factors identified should prompt providers to ensure enhanced testing of gonorrhea and other STI’s to reduce burden in areas of high incidence. Disclosures All Authors: No reported disclosures.

248. Change in Incidence of Multisystem Inflammatory Syndrome in Children Across the COVID-19 Pandemic in Chicago — March 2020 – March 2022

Abstract Background Peak counts of multisystem inflammatory syndrome in children (MIS-C) have followed each COVID-19 peak by 2–5 weeks. Fewer cases of MIS-C occurred after the Delta-predominant period compared to early waves of the pandemic. The Chicago Department of Public Health analyzed the ratio of MIS-C to pediatric COVID-19 hospitalization by period of variant predominance from March 2020 – mid-March 2022 to evaluate differences by variant. Methods MIS-C in Chicago residents was reported using the standard CDC MIS-C case report form. Four periods of COVID-19 infection were identified with dates defined by variant predominance (≥50%); date ranges for corresponding MIS-C periods were defined as starting 21 days after the COVID-19 period (Table 1). MIS-C cases were compared to hospitalizations as a measure of COVID-19 disease activity in children (rather than case counts which are more subject biases inherent in disease testing) among confirmed and probable COVID-19 cases in children ≤21 years reported to CDPH. Ratios of MIS-C cases per 100 corresponding pediatric hospitalizations for each variant period were calculated. Proportions of MIS-C hospitalizations with intensive care unit (ICU) admission, mechanical ventilation (MV), and receipt of vasopressors (VP) were calculated as markers of disease severity in MIS-C for each wave. Results 90 cases of MIS-C and 1,597 pediatric COVID-19 hospitalizations were reported (Table 2). The overall ratio was 5.6 MIS-C cases/100 pediatric COVID-19 hospitalizations. The first period with predominance of the original lineage had a ratio of 10.2; subsequent periods with variant predominance all had lower ratios. The Delta period had the second highest ratio which was 68% of the first period. Across waves, 74% of MIS-C patients were admitted to ICU (range, 67–82%); 11% underwent MV (range, 0–14%); and 52% received VP (range, 45–71%). Conclusion The ratio of MIS-C to pediatric COVID-19 hospitalizations varied by period of SARS-CoV-2 variant predominance. The ratio was highest in the early pandemic. There was no consistent change in MIS-C severity. Further study is needed to determine if the change in ratio is due to increased immunologic exposure (vaccination or previous infection) or if it is variant dependent. Disclosures All Authors: No reported disclosures.

Assessing Changes in Insurance Status and Access to Care Among Patients Attending Chicago Sexually Transmitted Infection Specialty Clinics From 2013 to 2019.

Public sexually transmitted infection (STI) clinics are safety net providers for uninsured and underinsured individuals but are at risk for closure due to declining budgets and shifting priorities. This study sought to assess changes in insurance status and access to preventive care among public STI clinic patients after immediate and long-term implementation of the Affordable Care Act (ACA). Patients receiving care in STI clinics administered by Chicago Department of Public Health were asked to complete an anonymous survey in 2013, 2014, and 2019. We estimated the prevalence rate ratio (PRR) of (1) being insured and (2) having access to preventive care over time, adjusted for age, race, and gender/sexual orientation, and employment status. Among 1711 respondents, compared with 2013 patients, patients were 1.41 (adjusted PRR [aPRR]) times more likely to report being insured in 2014 (95% confidence interval, 1.11-1.77) and 1.24 (aPRR) times more likely to report being insured in 2019 (95% confidence interval, 0.99-1.55). After adjusting for other significant variables (age, sex and orientation, and insurance status), reported access to preventive care increased by 34% among respondents in 2019 as compared with 2013 (aPRR, 1.34). Unsurprisingly, being insured was associated with increased preventive care access (aPRR, 1.78). Even after the implementation of the Affordable Care Act, a survey of public STI clinic patients in Chicago found a sizeable proportion of individuals without insurance, and many lacked access to preventive care, highlighting the continued need for these safety net clinics to provide STI care.

School-Based Delivery of Vision Care in Chicago Public Schools.

In 2012, Chicago Public Schools and the Chicago Department of Public Health partnered together to create the Chicago School-Based Vision Program (CSBVP). This ongoing, city-wide program provides school-based vision services (eye examinations, eyeglasses provision, and eye care referrals) to students with limited access. Descriptive analysis of the program operations from 2012 to 2020, including number of students served and exam findings during 2017-2020, as well as lessons learned and recommendations for reproducing the successes of the CSBVP in other contexts. During its first 8 years, the CSBVP provided eye examinations to over 350,000 students. During the years 2017-2020, this included 126,238 eye exams and provision of eyeglasses to 73,751 students. The CSBVP is built upon strong community and school relationships. The program offers vision services, equitably, to all students across the district. The lessons learned through the implementation of the CSBVP may provide guidance for future district-wide vision programs.

Structural Inequality and COVID-19 Mortality in Chicago: An Ecological Analysis.

Prior studies establish that Black neighborhoods and older persons experience higher rates of COVID-19 death than white neighborhoods and younger persons. However, such works point to the effect of age on COVID-19 mortality and the racial and ethnic inequalities present in COVID-19 deaths as independent vectors of inequality, neglecting to consider the multiplicative impact of structural conditions. Using weekly ZIP code counts of deaths from March 2020 through July 2021 from the Chicago Department of Public Health (n = 4168) and measures of structural characteristics derived from the 5-year estimates of the 2019 American Community Survey, the current study examined how place, racial composition, and the age structure of communities act in tandem to shape the number of deaths due to COVID-19. We used STATA to estimate negative binomial models predictive of COVID-19 mortality. Findings from our statistical analysis revealed that in predominately Black neighborhoods, racial composition amplified the association of age structure (65 +) on COVID-19 mortality by 40%. Neighborhoods that were not predominately black did not show this multiplicative risk of death. Our findings underscore that the elevated risk of death in in older Black communities is attributed to historic and contemporary structural inequality. Although society typically frames pandemics as natural disasters, doing such undermines dimensions of marginalization that amplify vulnerability among select populations. To begin eliminating such inequalities, the USA must deal with the entrenched limitations of institutions that render unequal attention and care to sectors of its population.

Unified Response to COVID-19 Case Investigation and Contact Tracing, Chicago, December 2020-April 2021.

We evaluated 2 innovative approaches that supported COVID-19 case investigation and contact tracing (CI/CT) in Chicago communities: (1) early engagement of people diagnosed with COVID-19 by leveraging the existing Healthcare Alert Network to send automated telephone calls and text messages and (2) establishment of a network of on-site case investigators and contact tracers within partner health care facilities (HCFs) and community-based organizations (CBOs). The Chicago Department of Public Health used Healthcare Alert Network data to calculate the proportion of people with confirmed COVID-19 who successfully received an automated telephone call or text message during December 27, 2020-April 24, 2021. The department also used CI/CT data to calculate the proportion of cases successfully interviewed and named contacts successfully notified, as well as the time to successful case interview and to successful contact notification. Of 67 882 people with COVID-19, 94.3% (n = 64 011) received an automated telephone call and 91.7% (n = 62 239) received a text message. Of the 65 470 COVID-19 cases pulled from CI/CT data, 24 450 (37.3%) interviews were completed, including 6212 (61.3%) of the 10 126 cases diagnosed in HCFs. The median time from testing to successful case interview was 3 days for Chicago Department of Public Health investigators and 4 days for HCF investigators. Overall, 34 083 contacts were named; 13 117 (38.5%) were successfully notified, including 9068 (36.6%) of the 24 761 contacts assigned to CBOs. The median time from contact elicitation to completed notification by CBOs was <24 hours. Partnerships with HCFs and CBOs helped deliver timely CI/CT during the COVID-19 pandemic, suggesting a potential benefit of engaging non-public health institutions in CI/CT for existing and emerging diseases.

Food Environment Inequalities and Moderating Effects of Obesity on Their Relationships with COVID-19 in Chicago

The COVID-19 outbreak has raised challenges for people with health problems. Obesity is a global issue related to COVID-19. The Centers for Disease Control (CDC) finds that obesity worsens COVID-19 outcomes. As body mass index increases, the COVID-19 death risk increases. Additionally, due to different restriction policies, the pandemic has transformed our food environment. Thus, it is important to develop an antivirus-enabled paradigm to decrease the COVID-19 spreading rate in neighborhoods with obesity concerns and design a sustainable and healthy food environment. It is found that both COVID-19 and obesity inequalities are associated with food environment inequalities, but few studies have examined the moderating effects of obesity and food environment on COVID-19. According to the Chicago Department of Public Health, more than 30% of the Chicago adult population is obese. Additionally, Chicago has 340,676 COVID-19 cases during the period between 1 March 2020 and 26 November 2021. This study uses regression models to examine the moderating effects of obesity and food environment on COVID-19 in Chicago. Besides food environment factors, green spaces and transportation access are considered. The results show COVID-19 is concentrated in areas with a high obesity rate and low food access. A 1 percent increase in obesity rate is associated with a 2.83 percent increase in COVID-19 death rate in a community. Additionally, the moderating effects of obesity on the association between food environment and COVID-19 are shown in the results.

Outbreak investigation of CRAB at an acute-care hospital ICU during the COVID-19 pandemic–Chicago, Illinois, March 2020–September 2021

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is primarily associated with hospital-acquired infections and is an urgent public health threat due to its ability to contaminate the environment and cause severe disease. In 2019, Illinois began pilot surveillance for CRAB requiring select laboratories to submit specimens for molecular characterization. On July 17, 2020, the Chicago Department of Public Health (CDPH) was notified of an increase in CRAB infections in a 20-bed ICU at an acute-care hospital in Chicago (hospital A) during the initial COVID-19 surge. We summarize the outbreak investigation findings and infection control recommendations. Methods: Clinical cultures were collected from patients in hospital A, and CRAB-positive isolates were sent to the Wisconsin State Laboratory of Hygiene for mechanism of resistance and antibiotic susceptibility testing. On-site assessments and remote follow-ups were conducted by CDPH infection preventionists to evaluate infection control practices including environmental cleaning, hand hygiene compliance, and use of personal protective equipment (PPE). The Illinois Department of Public Health and CDPH summarized the testing results, facilitated a containment response, and provided recommendations for infection control. Results: From March 18, 2020, to September 30, 2021, 56 patients with CRAB infections were identified from hospital A, and 33 (59%) of these cases were pan-nonsusceptible. Most specimen sources were sputum (n = 30, 54%), followed by blood (n = 13, 23%), urine (n = 6, 11%) and other (n = 7, 13%). Among isolates with mechanism testing (n = 54), 45 (83%) were positive for OXA-24/40 and 9 (17%) were positive for OXA-23. Of the CRAB-positive patients, 28 (50%) were previously positive for SARS-CoV-2. To date, 25 of these patients (45%) have been discharged and 31 (55%) have died. Two onsite visits and 7 remote-assistance sessions were conducted as part of the investigation. In response to increased COVID-19 hospitalizations, hospital A moved to crisis-capacity PPE use and encountered staffing shortages, which led to compromised infection control measures. Cleaning agents (Quat disinfectant cleaner) were also found to be ineffective against CRAB and required long contact times. Conclusions: In response to the CRAB outbreak at hospital A, CDPH recommended that the hospital stop crisis-capacity protocols for PPE, conduct admission screening and point-prevalence testing for CRAB, implement a hand hygiene campaign, and use an EPA-registered List K product for environmental cleaning. These recommendations were implemented in May 2021, and no CRAB cases have been reported since July 2021. To reduce CRAB transmission during the pandemic, facility leadership must commit resources to educate staff on effective infection control practices including conventional use of PPE, appropriate cleaning agents, and improved hand hygiene.Funding: NoneDisclosures: None

Tracking Changes in SARS-CoV-2 Transmission with a Novel Outpatient Sentinel Surveillance System in Chicago, Illinois, USA

PurposePublic health indicators typically used for monitoring the COVID-19 epidemic can be biased or lag behind changing community transmission patterns. Hospital admissions lag infection by 10 – 17 days, and test positivity rate is sensitive to changing availability of, access to, and demand for diagnostic testing. The U.S. city of Chicago investigated whether sentinel surveillance of recently symptomatic individuals receiving an outpatient diagnostic test for SARS-CoV-2 could provide early warning of increasing transmission.Methods & MaterialsFrom May 2020 to June 2021, the Chicago Department of Public Health (CDPH) and Illinois Department of Public Health (IDPH) established community-based SARS-CoV-2 diagnostic testing sites throughout Chicago. From November 2020, these sites collected and reported patient data on symptom status and symptom onset date to CDPH and IDPH. Symptomatic individuals residing in Chicago who reported symptom onset within four days of diagnostic test were included in the sentinel population. COVID-19 case counts among the sentinel population were used to calculate the instantaneous reproductive number R(t) over time, which was compared to R(t) curves calculated from COVID-like illness (CLI) hospital admissions, CLI emergency department visits, and COVID-19-diagnosed emergency department visits. Pearson correlation between time-shifted sentinel case counts and each of these indicators was used to estimate the potential lead time provided by outpatient sentinel surveillance.ResultsFrom November 1, 2020, to June 13, 2021, IDPH and CDPH collected a total of 15,023 sentinel samples at community-based testing sites, an average of ∼470 samples per week. Trends in sentinel COVID-19 cases preceded CLI hospital admissions by 10 to 14 days. R(t) calculated from sentinel cases tracked well with R(t) calculated from CLI hospital admissions, CLI emergency department visits, and COVID-19-diagnosed emergency department visits. Adjusting case counts to account for changing testing volume over time improved correlation with other indicators.ConclusionOutpatient sentinel surveillance of recently symptomatic individuals accurately captures trends in SARS-CoV-2 community transmission and provides early warning of increases in transmission rate. The reliability of outpatient sentinel surveillance can be limited by low testing volume, slow test turnaround time, and delays in reporting.