Communicable Disease Screening Research Articles

DIEP Flap Transplantation in Monozygotic Twins for Breast Reconstruction: A Case Report and Literature Review

Abstract Background Composite tissue allotransplants are performed for various defects when local, or distant reconstructive options are limited. Though this type of transplant replaces similar tissue, it is complicated by immunosuppression. This limitation may be avoided in monozygotic twins since they share identical genetic code. Free soft tissue transplantation across identical twins has been reported for breast, scalp, and thoracic reconstruction when autologous tissues were insufficient. We present a case of a successful deep inferior epigastric artery perforator (DIEP) flap transplantation in monozygotic twins. Methods The recipient twin was a patient with history of breast cancer and failed prosthetic reconstruction. She desired autologous reconstruction with a DIEP flap but had insufficient donor tissue. She refused alternative sites; however, she had an identical twin willing to donate her excess abdominal tissue. The twins underwent deoxyribonucleic acid testing, human leukocyte antigen/blood type testing, and screening for communicable diseases. Results The twins were found to have greater than 99.99% probability of being monozygotic twins. A bipedicled conjoined DIEP was harvested from donor twin and transplanted to recipient twin. Immunosuppressive regimen was not utilized. Patients healed uneventfully and are currently 5 years postop without long-term complications. Conclusion Isogeneic flap transplant is a viable option to consider when autologous tissues are restricted, and monozygotic twins are present. Appropriate counseling of twins is critical for a successful and satisfactory outcome.

Assessment of Kentucky's Local Health Department Cross-Jurisdictional Sharing: Strategy for Maximizing Efficiency.

Objective:The purpose of this study was to examine patterns of cross-jurisdictional sharing across the 61 local public health jurisdictions (LHJs) in Kentucky. The opportunities to reduce the cost-of-service delivery for Kentucky's LHJs via cross-jurisdictional sharing present a mechanism to address financial instability across the state by achieving economies of scale, especially among smaller jurisdictions.Design:A cross-sectional study design was used to examine patterns of cross-jurisdictional sharing across the 61 LHJs in Kentucky. The survey tool utilized was designed by the Center for Sharing Public Health Services, an initiative managed by the Kansas Health Institute with support from the Robert Wood Johnson Foundation.Results:Seventy-two percent of the 61 LHJs in Kentucky responded to the survey. The majority of responding jurisdictions sharing services were rural, single-county jurisdictions, utilizing service-related informal sharing arrangements. The majority of health departments, when asked to identify which programmatic areas shared service arrangements were focused in, listed those services requiring intensive staff training such as Health Access Nurturing Development Services (HANDS) and epidemiology. Of particular interest were the services most infrequently shared such as communicable disease screening and treatment.Conclusions:This study suggests that, pre-COVID-19, a core group of primarily rural, single-county Kentucky local health departments has experience with cross-jurisdictional sharing. Among this group, engagement in informal arrangements was the form of cross-jurisdictional sharing predominantly used, with few jurisdictions reporting shared functions with joint oversight. When considering the potential benefits and efficiencies that cross-jurisdictional sharing can provide to public health departments and their communities, for some, COVID-19 may have been a catalyst to engage in sharing across health department jurisdictional lines.

Cost-Effectiveness of Population Screening Programs for Cardiovascular Diseases and Diabetes in Low- and Middle-Income Countries: A Systematic Review

Almost all low- and middle-income countries (LMICs) have instated a program to control and manage non-communicable diseases (NCDs). Population screening is an integral component of this strategy and requires a substantial chunk of investment. Therefore, testing the screening program for economic along with clinical effectiveness is essential. There is significant proof of the benefits of incorporating economic evidence in health decision-making globally, although evidence from LMICs in NCD prevention is scanty. This systematic review aims to consolidate and synthesize economic evidence of screening programs for cardiovascular diseases (CVD) and diabetes from LMICs. The study protocol is registered on PROSPERO (CRD42021275806). The review includes articles from English and Chinese languages. An initial search retrieved a total of 2,644 potentially relevant publications. Finally, 15 articles (13 English and 2 Chinese reports) were included and scrutinized in detail. We found 6 economic evaluations of interventions targeting cardiovascular diseases, 5 evaluations of diabetes interventions, and 4 were combined interventions, i.e., screening of diabetes and cardiovascular diseases. The study showcases numerous innovative screening programs that have been piloted, such as using mobile technology for screening, integrating non-communicable disease screening with existing communicable disease screening programs, and using community health workers for screening. Our review reveals that context is of utmost importance while considering any intervention, i.e., depending on the available resources, cost-effectiveness may vary—screening programs can be made universal or targeted just for the high-risk population.

Asylum seekers and inequalities in healthcare: a mixed-method research in Emilia-Romagna region

Abstract Background In the past few years more than 30,000 asylum seekers arrived in Emilia-Romagna region. Guidelines were developed to screen the newly arrived, mainly focused on communicable diseases (CDs). However, asylum seekers who are out of the institutional reception system do not have access to such screenings. In order to assess the implementation and reach of these guidelines with respect to the target population, in 2019 a mixed-method survey was carried out. Methods A questionnaire with 35 closed and 11 open questions, based on a synthesis of the regional and national guidelines, was carried out with referents of the regional clinics that provide healthcare to asylum seekers. The collected questionnaires were processed through descriptive statistical analysis for the closed questions and text analysis for the open questions. Results Questionnaires were collected from 14 clinics. All clinics provide first visit and screening for CDs upon arrival, following the regional guidelines. However, enrolment in the national healthcare system was found to be delayed for periods of up to 6 months, resulting in discontinuity of care. Administrative and cultural barriers in accessing health and social services were repeatedly reported, the latter often linked to lack of cultural mediation services. Financial barriers were also reported, particularly with respect to dental care and pharmaceuticals. Results also show that asylum seekers within the institutional reception system can more easily overcome the reported barriers compared to those out of the system. Such inequality in accessing healthcare is reported also for the TB screening process. Conclusions Even if access to healthcare for asylum seekers is regulated by norms and guidelines, barriers are consistently reported. Moreover, asylum seekers within or outside the reception system face different barriers in accessing healthcare services. Such local evidence can be very relevant to inform actions that improve health equity. Key messages Even if access to healthcare for asylum seekers is regulated by law, barriers are consistently reported and impact disproportionately on those who are out of the institutional reception system. A mixed-method approach that generates local evidence on the barriers that asylum seekers face in accessing healthcare and on their causes is key to inform actions that improve health equity.

Examination of a Canadian provincial prenatal HIV screening program: 2010 to 2014.

Universal prenatal screening in the Canadian province of Alberta employs an 'opt-out' HIV screening strategy. We examined all women giving birth in the province and determined the frequency and characteristics of women having and not having HIV screening. All livebirths in Alberta from January 1, 2010 to December 31, 2014 were compiled from the Vital Statistics database and linked to HIV screening data to determine maternal demographic and prenatal care characteristics. Correlates associated with prenatal HIV screening, opting out of HIV screening, and not having any prenatal communicable disease screening were determined by multivariable statistics. Of the 256,280 live births, 94.2% had prenatal HIV screening, 1.9% declined prenatalHIV screening, and 3.9% had no record of any prenatal communicable disease testing. Compared with those who had HIV screening, those who opted out of prenatalHIV screening were more likely to be over 40years of age (adjusted odds ratio (AOR), 2.83 [2.12-3.78]) and less likely to be single (AOR, 0.67 [0.62-0.73]) and First Nations (AOR, 0.67 [0.56-0.82]). Those who received no prenatal communicable disease screening were less likely to be over 40years of age (AOR, 0.81 [0.69-0.95]) and more likely to be single (AOR, 1.27 [1.21-1.33]) and have received no prenatal care (AOR, 6.78 [6.40-7.19]). Both the HIV decliners and prenatal non-testers were more likely to have used a midwife (AOR, 4.52 [3.83-5.35] and AOR, 2.44 [2.03-2.92], respectively). Demographic and prenatal care characteristics differ by a pregnant woman's prenatal screening status. Policies to improve HIV screening coverage should take these variations into account.

Reflection and observation: cell-based screening failing to detect HBV in HUMSCs derived from HBV-infected mothers underscores the importance of more stringent donor eligibility to reduce risk of transmission of infectious diseases for stem cell-based medical products

BackgroundIn cell-based therapy, the transmission of communicable diseases imposes a substantial threat to recipients. In this study, we investigated whether cell-based screening could detect hepatitis B virus (HBV) in human umbilical cord-derived mesenchymal stem cells (HUMSCs) isolated from HBV-infected donors to understand the susceptibility of HUMSCs to HBV infection.MethodsHBV assay was performed in HUMSCs derived from healthy and HBV-infected donors with enzyme-linked immunosorbent assay (ELISA), fluorescence quantitative PCR (FQ-PCR) assay, and droplet digital PCR (ddPCR) assay. Further, HBV DNA was assayed in HUMSCs derived from healthy donors after incubation with human sera containing a high titer of HBV using FQ-PCR.ResultsHBV antigen/antibody and DNA failed to be detected using ELISA, FQ-PCR, and ddPCR. After incubation with HBV infection sera, HBV DNA could be detected, but below the valid titer of the assay kit. The HBV DNA levels in HBV-incubated HUMSCs gradually decreased with medium change every 2 days and then significantly decreased, not even detected after passage.ConclusionsThe current cell-based screening methods could not detect HBV in HUMSCs derived from HBV-infected donors, indicating the importance of more stringent donor eligibility to reduce the risk of transmission of communicable diseases in cell-based therapy. To solve the problem of an occult HBV window period in donor eligibility determination, we recommend that the donors undergo another HBV serological test 3 months after the first serological communicable disease screening.

Pre-notification of healthcare responders reduces the risk of exposure to infectious diseases

Background: The ambulance service communication center is the first access point of the public to the health care services in the state of Qatar. It's receiving between 400 and 600 emergency calls per day which are processed through a very robust and consistent workflow, for the aim to triage the emergency incidents and distinguish high and low acuity patients and send an adequate response. Within these emergency calls there are cases that will be recognized as associated with communicable diseases where the healthcare responders are at high risk of exposure. Aims: Protecting healthcare workers from infectious diseases and controlling exposure by implementing an attentive communication network. Methods: HMC-AS communications center implemented a communicable disease screening procedure for calls coming from Primary health centers, Hospitals and community. To identify potential infectious patients and PRE-NOTIFY: The responding crew and prompt the use of proper Personal Protective Equipment; The receiving facility to activate their procedure. Summary of results: The Screening procedure played an important role in minimizing the exposure of the pre-hospital care responders and improved the hospital preparedness in receiving infectious patients. Conclusion: The communication officer's compliance to the screening criteria showed an improvement and this ensured that the PRE-NOTIFICATION is done properly in a timely manner.

Unintended Consequences of Screening for Ebola.

Ebola virus disease (EVD) reached the United States in September 2014, leading the Centers for Disease Control and Prevention to publish screening guidelines to identify patients with high-risk exposures at their first point of contact with the health care system. In West Africa, the burden of EVD is superimposed on the trauma of decades of civil war, violence, and poverty. Therefore, an important consideration in implementing screening procedures in the United States is the potential to unintentionally exacerbate posttraumatic stress disorder, or add additional stress from stigma and discrimination, among the West African diaspora. We recommend rigorous research to develop and implement evidence-based, trauma-informed approaches to screening for communicable diseases during outbreaks, using principles of community-engaged or community-based participatory research.

Test Uptake and Case Detection of Syphilis, HIV, and Hepatitis C Among Women Undergoing Prenatal Screening in British Columbia, 2007 to 2011

ObjectiveTest uptake and case detection trends for rubella, syphilis, HIV, and hepatitis C (HCV) were compared among the 2007 to 2011 cohort of women undergoing prenatal testing in British Columbia. Analysis involved linkage of provincially centralized laboratory and surveillance data to assess prenatal test uptake and rates of newly diagnosed versus prevalent infections. MethodsWe included prenatal specimens submitted from BC women aged 16 to 45years in 2007 to 2011. Laboratory records were linked to provincial surveillance systems to identify confirmed maternal syphilis and HIV cases. Previous positive status was determined for HIV and HCV if a prior confirmed case was identified from laboratory records. We determined rates of HIV and HCV newly identified at prenatal screening (new diagnoses per 100 000 per year). Prevalence for HIV and HCV was the sum of all new and prior diagnoses (prevalence per 100 000 per year). ResultsOf 233 203 women, 96.9% were screened for rubella, 93.3% for syphilis, 93.8% for HIV, and 21.5% for HCV. From 2007 to 2011, the overall rates of new diagnoses were 15.4, 5.1, and 82.8 cases per 100 000 per year for syphilis, HIV, and HCV, respectively. The overall prevalence was 45.9 and 551.5 cases per 100 000 per year for HIV and HCV, respectively (0.05% and 0.6%). From 2007 to 2011, new diagnoses of HCV decreased 40% from 106.0 to 62.1 cases per 100 000 per year. HCV prevalence did not change and increased with maternal age. ConclusionThis study links surveillance and laboratory data to provide a provincial picture of prenatal screening test uptake and case detection, with the advantage of distinguishing new from prior diagnoses. This information can help guide prenatal communicable disease screening policy.

4th generation HIV screening in Massachusetts: A partnership between laboratory and program

BackgroundThe Massachusetts Department of Public Health's (MDPH) Office of HIV/AIDS (OHA) and Hinton State Laboratory Institute (HSLI) have offered HIV screening since 1985. Point-of-care screening and serum collection for laboratory-based testing is conducted at clinic and non-clinic-based sites across Massachusetts as part of an integrated communicable disease screening intervention. Objectives and project designMDPH aimed to transition to a 4th generation HIV screening-based algorithm for testing all serum specimens collected at OHA-funded programs and submitted to the HSLI to detect acute HIV infections, detect and differentiate HIV-1 and HIV-2 infections, eliminate indeterminate results, reduce cost and turnaround time, and link newly diagnosed HIV+ individuals to care. The HSLI and OHA created a joint project management team to plan and lead the transition. ResultsThe laboratory transitioned successfully to a 4th generation screening assay as part of a revised diagnostic algorithm. In the 12 months since implementation, a total of 7984 serum specimens were tested with 258 (3.2%) positive for HIV-1 and one positive for HIV-2. Eight were reported as acute HIV-1 infections. These individuals were linked to medical care and partner services in a timely manner. Turnaround time was reduced and the laboratory realized an overall cost savings of approximately 15%. ConclusionsThe identification of eight acute HIV infections in the first year underscores the importance of using the most sensitive screening tests available. A multi-disciplinary program and laboratory team was critical to the success of the transition, and the lessons learned may be useful for other jurisdictions.

Protection or Prevention: Testing the Prisoner Population for Communicable Diseases

Prisoners, because of both pre-incarceration and confinement lifestyles and living conditions, are at greater risk for contracting communicable, often lethal, diseases than are non-incarcerated persons. Despite current knowledge about the numbers of inmates who are infected with HIV-AIDS, tuberculosis, and other communicable diseases, legislators and correctional administrators have resisted making policy decisions mandating routine communicable disease screening of all inmates. Moreover, in the name of protection of inmate rights, several prisoner suits have been brought on both sides of this issue: Some prisoners have challenged mandatory wholesale screening policies while others have challenged the absence of mandatory screening procedures. This article explores the constitutional arguments that surround the issue of communicable disease screening and the operational difficulties that are a consequence of mandatory screening procedures. It is contended that correctional authorities have an ethical duty to include such screening in their medical treatment protocols.