Chicago Department Of Public Health Research Articles

Respiratory Illness in Households of School-Dismissed Students during Pandemic (H1N1) 2009

Respiratory Illness in Households of School-Dismissed Students during Pandemic (H1N1) 2009

Leveraging Community Concerns Regarding Meningococcal Disease to Address Racial and Socioeconomic Disparities in Immunization Coverage

Following the death of 2 adolescents due to serogroup C invasive meningococcal disease (SCIMD) in April 2008, the Chicago Department of Public Health (CDPH) observed a high level of concern in 2 Chicago communities inferred to have low meningococcal vaccine (MCV) coverage rates. In response, CDPH promptly mobilized additional resources, administering 5,343 doses of MCV in 40 schools over 2 weeks and immunizing 44% of enrolled students aged 11 to 18 years. The number of eligible students vaccinated per school ranged from 9 to 466 (median, 112) and the proportion of age-eligible students receiving the vaccine ranged from 5% to 87% (median, 52%). The attributes of the SCIMD activity did not meet the definition of a community-based outbreak, but presented an opportunity to promptly intensify existing mechanisms for meningococcal vaccination of adolescents in the affected neighborhoods and overcome traditional barriers to vaccination.

(P2-24) The “Oxygen Bus”: Retrofitting a City Bus with Oxygen Resources to Respond to Hospital Evacuations and Other Disasters

Evacuation/Oxygen Bus The Chicago Fire Department (CFD) identified a need to treat multiple stable fire/inhalation victims who require oxygen, whether due to a previous medical condition or as the result of an acute event, such as evacuation of or fire in any building, hospital, or treatment facility. As a partner with the Chicago Department of Public Health (CDPH) and an active participant in the “Chicago Healthcare System Coalition for Preparedness and Response”, the CFD determined that a bus could be an adjunct in city responses and emergencies. With the support of the Coalition, the CFD approached the Chicago Transit Authority (CTA) to obtain a bus. Once the actual bus was given to the CFD, an operations order was written and the appropriate equipment was purchased. The Evacuation Committee of the Coalition identified equipment and supply needs. Supplies purchased and retrofitted for the bus include modulators for patient oxygen use, oxygen tanks, masks, nebulizers, automated external defibrillators (AEDs), first line advanced life support (ALS) medications, evacuation chairs for moving patients, and special emergency lighting. The bus is able to accommodate thirty five people who require treatment simultaneously. The use of the bus includes but not limited to: (1) hospital evacuation and treatment of stable patients with oxygen and nebulizers prior to transportation to an alternate facility; (2) long-term care facility evacuation and treatment of stable patients with oxygen needs prior to placement and transport to another facility; (3) responding to building fires to treat victims who may need oxygen and nebulizer treatments on site; (4) assisting with the evacuation of home-based, at-risk oxygen dependent patients; and (5) treating evacuated children from specialized treatment facilities who may be oxygen dependent. The outside of the bus has both CFD and CDPH logos to identify that this is a collaborative effort between city agencies and a Healthcare Coalition.

Preparing a People: Climate Change and Public Health

Almost 700 people died from heat-related stress during the catastrophic 1995 heat wave in Chicago, Illinois.1 The three-day weather event saw 24-hour mean average temperatures of 87.2°F; the heat reached triple digits on two days, and there was little relief at night.2 Many people succumbed to heart attack and dehydration, while others collapsed during severe episodes of existing respiratory conditions.3 The death toll in the summer of 1995 gave Chicagoans a clear picture of how a surge in hot weather can affect human health. A decade later, Mayor Richard Daley launched an extensive program that brought together city agencies, academics, and scientists to develop a Climate Change Action Plan to help reduce the city’s contribution to climate change.4 Much of the plan focuses on sustainable mitigation actions such as planting trees and training workers to install renewable energy technologies. Within that plan, however, is a climate change adaptation strategy with a goal of preparing the city and its residents for future unusual weather events associated with climate change.5 Chicago is one of several large cities with climate action plans in place—others include New York City, San Francisco, Sydney, and Mexico City.6 Like Chicago’s, these plans promote mitigation and sustainability. Much of the adaptation portion of these initiatives is aimed at the built environment—buildings, highways, and facilities. But officials in these cities are beginning to talk about the public health cobenefits from their action plans, and public health advocates are speaking up and pushing for programs designed to prepare for or prevent climate-sensitive disease and illness.

Demographic Characteristics and Survival With AIDS: Health Disparities in Chicago, 1993–2001

We examined correlations between survival and race/ethnicity, age, and gender among persons who died from AIDS-related causes. We estimated survival among 11 022 persons at 12, 36, and 60 months after diagnosis with AIDS in 1993 through 2001 and reported through 2003 to the Chicago Department of Public Health. We estimated hazard ratios (HRs) by demographic and risk characteristics. All demographic groups had higher 5-year survival rates after the introduction of highly active retroviral therapy (1996-2001) than before (1993-1995). The HR for non-Hispanic Blacks to Whites was 1.18 in 1993 to 1995 and 1.51 (P < .01) in 1996 to 2001. The HR for persons 50 years or older to those younger than 30 years was 1.63 in 1993-1995 and 2.28 (P < .01) in 1996-2001. The female-to-male HR was 0.90 in 1993-1995 and 1.20 (P < .02) in 1996-2001. The risk of death was higher for non-Hispanic Blacks and Hispanics than for non-Hispanic Whites. Interventions are needed to increase early access to care for disadvantaged groups.

Lessons Learned From Chicago's Emergency Response to Mass Evacuations Caused by Hurricane Katrina

We analyzed the response of the Chicago Department of Public Health with respect to its effectiveness in providing health care to Hurricane Katrina evacuees arriving in the city. Between September 12 and October 21, 2005, we conducted a real-time qualitative assessment of a medical unit in Chicago's Hurricane Victim Welcome and Relief Center. A semistructured guide was used to interview 33 emergency responders in an effort to identify key operational successes and failures. The medical unit functioned at a relatively high level, primarily as a result of the flexibility, creativity, and dedication of its staff and the presence of strong leadership. Chronic health care services and prescription refills were the most commonly mentioned services provided, and collaboration with a national pharmacy proved instrumental in reconstructing medication histories. The lack of a comprehensive and well-communicated emergency response plan resulted in several preventable inefficiencies. Our findings highlight the need for improved planning for care of evacuee populations after a major emergency event and the importance of ensuring continuity of care for the most vulnerable. We provide an emergency response preparedness checklist for local public health departments.

Decontamination with At-Risk Populations: Lessons Learned

“At-risk populations” are often excluded from emergency preparedness plans, despite their increased vulnerability. In August 2007, Sinai Health System (Chicago, IL) conducted a field exercise, a decontamination drill which incorporated people with physical disabilities, who are Deaf, and/or who have limited English proficiency. The planning team included staff from these populations. Three main adaptations were made to the decontamination plan: the use of accessible equipment for nonambulatory individuals (as appropriate), the inclusion of sign language and Spanish interpreters as decontamination staff, and the addition of physical therapists to the decontamination team. This article details what changes we made to our decontamination plan, how well each change worked, and the additional suggestions provided by participants on how to improve the process in the future. We share our lessons learned and recommendations for future disaster planning. Support: We would like to thank the Chicago Department of Public Health and the Office of the Assistant Secretary for Preparedness and Response for the funding of this project. Parts of this text have been reproduced with permission from the authors’ article “Decontamination of People with Spinal Cord Injury: Best Practices and Lessons Learned.” SCI Psychosocial Process. 21(1). pp. 15-24. http://www.aascipsw.org/pdf/sci-psychosocial-process-21.1. pdf.

Building a data warehouse for infection control

Recently, the convergence of several themes in health care has stimulated interest in exploiting data collected during clinical encounters to monitor and improve the quality of health care. Infection control departments can be supported by assembling previously collected electronic data into a data warehouse to monitor infections, report communicable diseases, and detect clusters of organisms. I present the rationale for constructing a data warehouse and describe the steps and challenges of developing a data warehouse to support infection control activities.

Sustainable collaboration for community outreach: lessons from the Spanish Access to Literature/Uso Directo (SALUD) project

Health sciences librarians have an active interest in community health information outreach projects [1–8]. Successful community partnerships are guided by each partner clearly defining goals. Accomplishing these goals requires time and personal contact to develop trust, active engagement of all partners, and careful planning [9, 10]. The investment required to develop partnerships makes project sustainability a desired outcome. The academic health sciences library exists to support the educational mission of the institution. By collaborating with other academic units, the library can meet its educational goals while building the sustainable relationships necessary for successful outreach projects. At the University of Illinois at Chicago (UIC), the Library of the Health Sciences (LHS) and College of Nursing (CON) developed an outreach project that directly supports the mission of the university while strengthening relationships between the library, CON, and surrounding community [11]. As part of a core course in the undergraduate nursing curriculum, CON faculty supervise students in clinical rotations at two Chicago Department of Public Health (CDPH) clinics in nearby neighborhoods, engaging them in the challenges and rewards of community practice. In the fall of 2005, CON and LHS faculty saw an opportunity for outreach. The resulting Spanish Access to Literature/ Uso Directo (SALUD) Public Health Information Pilot Project provided education on evaluating and using online health education materials by leveraging community health nursing students and existing relationships between these organizations. This paper describes the project's core activities with an emphasis on the project's techniques for sustainability.

Exposure assessment of young children living in Chicago communities with historic reports of ritualistic use of mercury

Objective. According to a 1997 finding, mercury was available for sale in several Chicago communities for use in spiritual or medicinal practice. Mercury used this way may impact the health of children. The Chicago Department of Public Health (CDPH) and the Centers for Disease Control and Prevention conducted a study to 1) quantify mercury exposure in biological specimens collected from a pediatric clinic or home visit in selected neighborhoods in Chicago, and 2) investigate possible sources of mercury exposure in homes. Methods. An exposure assessment study design was chosen to determine whether children living in Chicago communities that historically sold mercury were exposed to mercury vapor. We enrolled and collected biological samples from 306 children aged 2–10 years. In addition, we enrolled 42 children during a door-to-door survey of community residents. All the urine samples were analyzed for elemental or inorganic mercury. We also analyzed 43 blood samples to assess dietary mercury. Results. Overall geometric mean urine mercury was 0.26μg/L. Urine mercury levels did not differ among the three clinics or between the various participant groups. We did not find any association between ritualistic mercury use and exposure to mercury. Conclusions. Although pediatric mercury exposure does not appear to be problematic among our study population, mercury remains a potential health threat as long as it is readily available in communities. Healthcare providers should be aware of the potential for mercury exposure. Physicians and patients may call the National Poison Control Centers (1-800-222-1222) for information about diagnosis, testing, and treatment for all types of exposures, including exposure to mercury. Professionals are available 24 hours a day.

Use of Public School Immunization Data to Determine Community-Level Immunization Coverage

To evaluate whether immunization data collected on a child's entry into kindergarten, i.e., Chicago Public School Immunization Data (PSID), was comparable to coverage levels determined by the National Immunization Survey (NIS) and to use these data to identify community areas with consistently low immunization coverage. The Chicago Department of Public Health obtained four years of PSID (2000-2003); these data included demographic information, home address, and immunization records. Coverage levels were determined in two ways: (1) one dose of measles-containing vaccine (MCV) and (2) four doses of diphtheria and tetanus toxoids and pertussis vaccine, three doses of poliovirus vaccine, and one dose of measles-containing vaccine (the 4:3:1 series), stratified by racial/ethnic group; these levels were compared to NIS estimates for the respective time periods. We used geographic information system software to illustrate variations in coverage levels between distinct community areas within Chicago. Year 2000 MCV coverage levels determined from PSID closely approximated NIS estimates (84.6% vs. 87.2% +/- 4.6%, respectively). MCV coverage levels determined by race/ethnicity from PSID were within the 95% confidence intervals (CI) for all racial categories (white, 89.5% vs. 92.2% +/- 6.4%; black, 79.0% vs. 83.5% +/- 9.4%; Hispanic, 89.5% vs. 87.5% +/- 5.8%). Comparison of PSID and NIS 4:3:1 coverage levels revealed similar findings. For each study year, PSID identified 12 community areas with consistently low MCV coverage levels, i.e., < 80%. PSID closely approximated NIS coverage estimates for MCV and 4:3:1 immunization. These methods can be used by state and city health departments to identify and direct resources to communities at greatest need.

Management of Outbreaks of Methicillin-ResistantStaphylococcus aureusInfection in the Neonatal Intensive Care Unit: A Consensus Statement

In 2002, the Chicago Department of Public Health (CDPH; Chicago, Illinois) convened the Chicago-Area Neonatal MRSA Working Group (CANMWG) to discuss and compare approaches aimed at control of methicillin-resistant Staphylococcus aureus (MRSA) in neonatal intensive care units (NICUs). To better understand these issues on a regional level, the CDPH and the Evanston Department of Health and Human Services (EDHHS; Evanston, Illinois) began an investigation. Survey to collect demographic, clinical, microbiologic, and epidemiologic data on individual cases and clusters of MRSA infection; an additional survey collected data on infection control practices. Level III NICUs at Chicago-area hospitals. Neonates and healthcare workers associated with the level III NICUs. From June 2001 through September 2002, the participating hospitals reported all clusters of MRSA infection in their respective level III NICUs to the CDPH and the EDHHS. Thirteen clusters of MRSA infection were detected in level III NICUs, and 149 MRSA-positive infants were reported. Infection control surveys showed that hospitals took different approaches for controlling MRSA colonization and infection in NICUs. The CANMWG developed recommendations for the prevention and control of MRSA colonization and infection in the NICU and agreed that recommendations should expand to include future data generated by further studies. Continuing partnerships between hospital infection control personnel and public health professionals will be crucial in honing appropriate guidelines for effective approaches to the management and control of MRSA colonization and infection in NICUs.

Shigella Flexneri Serotype 3 Infections Among Men Who Have Sex With Men—Chicago, Illinois, 2003-2004

During 2003-2004, the Chicago Department of Public Health (CDPH) investigated an increase in reported Shigella flexneri serotype 3 infections among adult males. This report summarizes the investigation into those cases and underscores the potential for sexual transmission of enteric infections among men who have sex with men (MSM).

Outbreak of Catheter-Associated Klebsiella oxytoca and Enterobacter cloacae Bloodstream Infections in an Oncology Chemotherapy Center

In March 2004, the Chicago Department of Public Health was notified of a cluster of bloodstream infections with Klebsiella oxytoca and Enterobacter cloacae at a chemotherapy center. Our purpose was to identify the source of the outbreak and prevent further cases. The investigation included 103 oncology patients seen at an outpatient oncology chemotherapy center in Chicago during the 16 days before its closure. The outbreak investigation included case identification, retrospective cohort study, review of medical records, microbiologic testing of blood specimens, environmental cultures, and pulsed-field gel electrophoresis. The main outcome measure was infection with K oxytoca, E cloacae, or both, and the Mantel-Haenszel chi(2) test was used to assess risk of infection in relation to presence of central venous catheter. Among the 103 patients, risk of infection was associated with the presence of central venous catheter (relative risk undefined, P<.001). Twenty-seven patients had blood cultures that grew K oxytoca, E cloacae, or both, and all had central venous catheters that were flushed with isotonic sodium chloride solution at the clinic from February 17 through March 3, 2004. Isolates of K oxytoca and E cloacae were matched by pulsed-field gel electrophoresis to K oxytoca and E cloacae isolates obtained from multiple predrawn syringes and from the intravenous fluid and administration set in use in the clinic at the time of its closing. The injection of contaminated isotonic sodium chloride solution through the venous catheters of attendees at the clinic likely provided the opportunity for bloodstream infections in these 27 case patients. This outbreak highlights the need for continued emphasis on safe injection practices and suggests the need for guidelines and recommendations tailored to outpatient settings.

MAPP in Chicago

The Chicago Department of Public Health's (CDPH's) community planning efforts came from a city-wide strategic plan that called for the establishment of a city-wide network of community partnerships that focus on community needs and resource assessment and program development. Using Mobilizing for Action through Planning and Partnerships as a framework for planning at the community level, the CDPH supports five community coalitions through the Chicago Center for Community Partnerships. The overall goal of the Center is to increase community capacity, build new partnerships, provide coalitions with access to decision makers, and inform the role of local public health agencies in supporting this type of work. Bringing together a wide spectrum of stakeholders, coalition members work to conduct assessments and develop and implement strategies. While coalitions demonstrate outcomes related to specific strategies, they also exhibit infrastructure-level results, with increased levels of community organizing, leveraging of existing resources, and new systems for information dissemination. Simultaneously, the CDPH has gained new partners in public health, increased collaboration, and more information about communities. These outcomes are contingent on certain elements of success: (1) committed leadership; (2) commitment to a new way of doing business; (3) prepared public health workforces; and (4) community readiness.

Comparative Analysis of Shigella boydii 18 Foodborne Outbreak Isolate and Related Enteric Bacteria: Role of rpoS and adiA in Acid Stress Response

Shigella boydii CDPH (Chicago Department of Public Health) serotype 18 was implicated in an outbreak of foodborne illness in 1998. The suspected food vehicles were parsley and cilantro imported from Mexico used to prepare bean salad. Previous studies revealed that S. boydii CDPH serotype 18 can survive in bean salad, which contains organic acids and whose pH decreases over time. Acid challenge assays in acidified tryptic soy broth at pH 4.5, acidified Luria-Bertani broth at pH 4.5, and acidified M9 minimal salts medium at pH 2.5 containing amino acids, arginine, or glutamic acid were performed using S. boydii CDPH, S. boydii ATCC 35966, S. flexneri 3136, Escherichia coli O157:H7 dd8872, and E. coli O157:H7 dd642 to compare differences in acid tolerance. Differences in survival of exponential-phase cells were detected in acidified tryptic soy broth and Luria-Bertani broth at pH 4.5. In acidified minimal medium containing arginine, S. boydii strains were able to survive at pH 2.5. The arginine decarboxylase gene (adiA) present in S. boydii is involved in survival at extremely low pH. The discovery of adiA expression in S. boydii serotype 18 by use of an acidified minimal medium challenge and arginine decarboxylase biochemical assay is significant because arginine decarboxylase activity was thought to be unique to E. coli. Sequencing of the rpoS gene from the S. boydii outbreak strain indicates that it is 99% conserved compared with the E. coli K-12 rpoS gene and plays a vital role in survival under acidic conditions.

Outbreak of Food-borne Illness Associated with Plant Material Containing Raphides

Background. Many botanicals, particularly ornamental houseplants, contain crystals of calcium oxalate called raphides. Raphides have known toxic effects when chewed, including painful edema, vesicle formation, and dysphagia. We report a food-borne illness outbreak associated with ingestion of raphides. Methods. On February 24, 2003, the Chicago Department of Public Health was notified of multiple cases of oral burning and facial edema associated with lunch in an office cafeteria on February 21. The investigation included a case-control study, interviews with kitchen staff, an environmental inspection, and laboratory analysis of leftover foods. Results. Ten cases were identified, including one admitted to the Intensive Care Unit for potential airway obstruction secondary to severe edema, and another seen by Emergency Department staff for oral edema and pain. Ten of 10 case-patients reported oral stinging and burning, and 8 of 10 reported dysphagia. Four of 10 case-patients continued to have symptoms 2 weeks later. Food from the cafeteria's international buffet was consumed by 10 of 10 case-patients and by 1 of 22 control subjects (odds ratio = undefined); each of the 10 case-patients reported consumption of a Chinese vegetable entrée from the international buffet and had no other foods in common. Plant material from the Chinese vegetable entrée contained raphides. Conclusion. This outbreak was associated with consumption of raphides resembling those from common botanicals. Clinicians and public health practitioners should be aware of raphide-containing plants as a potential cause of food-borne illness.

Transmission of Primary and Secondary Syphilis by Oral Sex—Chicago, Illinois, 1998-2002

During 1998-2002, the STD/HIV Prevention and Care Program of the Chicago Department of Public Health (CDPH) recorded 1,582 cases of primary and secondary (P&S) syphilis, the most of any U.S. city. Although case numbers and overall rates remained stable in Chicago during this period, patterns of transmission changed substantially. Throughout most of the 1990s, P&S syphilis was reported almost exclusively among heterosexuals. During 1998-2000, however, men who have sex with men (MSM) accounted for approximately 15% of Chicago's P&S syphilis morbidity. Since 2001, MSM have accounted for nearly 60% of patients with P&S syphilis. During 2000-2002, CDPH conducted interviews with persons with syphilis; some MSM reported they had engaged in only oral sex and were surprised to have acquired syphilis. In response, CDPH began collecting information on oral sex from persons with syphilis. To assess the role of oral sex in the transmission of P&S syphilis in Chicago, CDPH analyzed surveillance data and interview responses. This report summarizes the results of these analyses, which suggested that a substantial proportion (13.7%) of syphilis cases were attributed to oral sex, particularly among MSM. Persons who are not in a long-term monogamous relationship and who engage in oral sex should use barrier protection (e.g., male condoms or other barrier methods) to reduce the risk for sexually transmitted disease (STD) transmission.

Bioterrorism Drill in Illinois: A Systemwide Evaluation

BACKGROUND: In May 2003, the U.S. Department of Homeland Security conducted a bioterrorism drill. It was the first drill since September 11, 2001. Sixty-four hospitals in Illinois participated in this bioterrorism drill. METHODS: The infection control experiences of eight acute-care hospitals in one healthcare system in the Chicago area were collated from a questionnaire sent to the infection control professionals. RESULTS: The healthcare system consists of three community teaching hospitals and five community hospitals with an average daily census ranging from 79 to 586. The hospitals report to two independent federal health jurisdictions (Chicago Department of Public Health and the Illinois Department of Public Health) and three county health departments. The surge of patients seriously challenged the capacities of the hospitals. More than 300 patients (human and paper) were sent to the eight Emergency Departments during the drill. Approximately one-third of the patients had symptoms consistent with pneumonic plague. A number of patients were dead on arrival or expired soon after. All hospitals initiated appropriate isolation precautions. Symptomatic patients were placed on airborne precautions in negative-pressure rooms, and personnel wore N95 particulate respirators. Most hospitals switched to surgical masks once the health departments identified the agent. One site recorded an inadequate supply of personal protective equipment. Infection Control or Employee Health gave prophylaxis to exposed patients and personnel. Communication was a serious problem. The drill was primarily confined to the Emergency Departments, and communication with other departments, including Infection Control, was poor or nonexistent at most sites. Health departments and other outside agencies provided confusing and sometimes contradictory information. CONCLUSIONS: The major lesson learned was that there was inadequate communication to and from the health departments and within the hospitals. Confusion existed, despite advance knowledge of the biological agent. The drill interfered with actual patient care; however the experience was beneficial in preparing hospitals for a real bioterrorism event.

West Nile virus: a brief review.

Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA (JTW); and Chicago Department of Public Health (SIG, JTW), Chicago, IL