County Public Health Department Research Articles

Linking Maternal and Child Health Data to Enhance Public Health Surveillance in Indiana

Indiana faces significant challenges in maternal and infant health, ranking 45th worst in infant mortality with a rate of 6.5 deaths per 1,000 live-births, and 21st in stillbirths. Indiana further has the 3rd highest rate of maternal mortality with 44 deaths per 100,000 live-births. Despite these alarming statistics, comprehensive surveillance of maternal and infant health is absent, and data often remains fragmented across disparate information systems. In response, the Indiana University Fairbanks School of Public Health and Regenstrief Institute secured a cooperative agreement through the CDC's Pregnant People-Infant Linked Longitudinal Surveillance (PILLARS) program, collaborating with the Indiana Health Information Exchange, Indiana Department of Health, and Marion County Public Health Department. The initiative aims to enhance Indiana's infrastructure for surveillance of maternal and child health (MCH) using electronic health records (EHRs), public health, and administrative data. Key efforts have included development, validation, and application of linkage algorithms across records for mothers and children; integration of case data across data sources; design of routine surveillance reports; and design of longitudinal studies to examine determinants and outcomes in MCH populations. Using deterministic linkage algorithms, we have created over 800,000 mother-infant dyads; this number will expand with the implementation of probabilistic approaches. We also have developed a computational phenotype for identifying cases of pregnancy in the EHR even when not explicitly flagged in the EHR. Future efforts will build on this infrastructure to draw from additional public health data sources and/or expand surveillance efforts to include prioritized MCH outcomes.

Epidemiology of Mpox Cases, and Tecovirimat and JYNNEOS Utilization, Alameda County, California, June-October 2022.

The 2022 United States mpox outbreak disproportionately affected racial and ethnic minority gay, bisexual, and other men who have sex with men. We utilized surveillance data and vaccination registries to determine whether populations most impacted by mpox in Alameda County received JYNNEOS vaccines and tecovirimat (TPOXX) during June 1-October 31, 2022. Alameda County Public Health Department responded to the mpox epidemic through partnerships with local health care providers who serve communities disproportionately affected by mpox. During June 1-October 31, 2022, a total of 242 mpox cases were identified in Alameda County. Mpox incidence rates per 100 000 were highest among Black/African American (35.7; 95% confidence interval [CI], 26.8-46.5) and Hispanic/Latinx (25.1; CI, 20.1-30.9) residents, compared to Asian (3.8; CI, 2.3-5.9) and White (10.5; CI, 7.7-13.9) residents. Most confirmed cases were identified as gay, lesbian, or same-gender-loving (134, 67.3%) and bisexual (31, 15.6%); 226 (93.8%) cases were male. Sixty-nine (28.5%) mpox patients received TPOXX. There were no statistically significant differences in demographic and clinical characteristics of mpox cases when compared by TPOXX receipt status. JYNNEOS vaccine was received by 8277 Alameda County residents. The largest proportion of vaccinees were White residents (40.2%). Administration rates per 100 000 men who have sex with men were lowest among Asian and Hispanic/Latinx individuals, at 8779 (CI, 8283-9296) and 14 953 (CI, 14 156-15 784), respectively. Black/African American and Hispanic/Latinx males had the lowest vaccination-to-case ratios at 16.7 and 14.8, respectively. Mpox disproportionately affected Black/African American and Hispanic/Latinx men who have sex with men in Alameda County. Strong partnerships with local health care providers ensured that persons with mpox received TPOXX treatment when indicated. However, higher JYNNEOS vaccine uptake in Black and Latinx communities needs improvement through ongoing and meaningful engagement with Black/African American and Hispanic/Latinx gay, bisexual, and transgender communities.

The Solutions in Health Analytics for Rural Equity Across the Northwest (SHARE-NW) Dashboard for Health Equity in Rural Public Health: Usability Evaluation.

Given the dearth of resources to support rural public health practice, the solutions in health analytics for rural equity across the northwest dashboard (SHAREdash) was created to support rural county public health departments in northwestern United States with accessible and relevant data to identify and address health disparities in their jurisdictions. To ensure the development of useful dashboards, assessment of usability should occur at multiple stages throughout the system development life cycle. SHAREdash was refined via user-centered design methods, and upon completion, it is critical to evaluate the usability of SHAREdash. This study aims to evaluate the usability of SHAREdash based on the system development lifecycle stage 3 evaluation goals of efficiency, satisfaction, and validity. Public health professionals from rural health departments from Washington, Idaho, Oregon, and Alaska were enrolled in the usability study from January to April 2022. The web-based evaluation consisted of 2 think-aloud tasks and a semistructured qualitative interview. Think-aloud tasks assessed efficiency and effectiveness, and the interview investigated satisfaction and overall usability. Verbatim transcripts from the tasks and interviews were analyzed using directed content analysis. Of the 9 participants, all were female and most worked at a local health department (7/9, 78%). A mean of 10.1 (SD 1.4) clicks for task 1 (could be completed in 7 clicks) and 11.4 (SD 2.0) clicks for task 2 (could be completed in 9 clicks) were recorded. For both tasks, most participants required no prompting-89% (n=8) participants for task 1 and 67% (n=6) participants for task 2, respectively. For effectiveness, all participants were able to complete each task accurately and comprehensively. Overall, the participants were highly satisfied with the dashboard with everyone remarking on the utility of using it to support their work, particularly to compare their jurisdiction to others. Finally, half of the participants stated that the ability to share the graphs from the dashboard would be "extremely useful" for their work. The only aspect of the dashboard cited as problematic is the amount of missing data that was present, which was a constraint of the data available about rural jurisdictions. Think-aloud tasks showed that the SHAREdash allows users to complete tasks efficiently. Overall, participants reported being very satisfied with the dashboard and provided multiple ways they planned to use it to support their work. The main usability issue identified was the lack of available data indicating the importance of addressing the ongoing issues of missing and fragmented public health data, particularly for rural communities.

Impact of COVID-19 pandemic and vaccine perceptions on HPV vaccine hesitancy

ObjectiveThis study evaluated the impact of the COVID-19 pandemic and vaccine perceptions on Human Papillomavirus (HPV) vaccine hesitancy. Secondary endpoints included comparing COVID-19 and HPV vaccination trends regarding time, community of residence, and unmet social needs. MethodsThis was a survey-based, cross-sectional study that included 101 participants who were recruited through the Wyandotte County Public Health Department. Participants were eligible for inclusion in this study if they were a parent/guardian of one or more children aged 13 to 17; English- or Spanish-speaking. This study took place in Wyandotte County, Kansas. Descriptive statistics and chi-square analyses were utilized. ResultsThere was no difference in completion of COVID-19 and HPV vaccines (p = 0.0975). Significantly more individuals started and did not finish the HPV vaccine series compared to the COVID-19 vaccine series (p = 0.0004). Most participants indicated their opinion on the HPV vaccine had not changed due to the pandemic (71.3 %). Participants who felt familiar with HPV had higher rates of HPV vaccine completion. While 77 % of participants felt extremely or moderately familiar with HPV, 61.4 % were unaware of its association with oropharyngeal cancer. ConclusionThere was minimal change in parents' perception of the HPV vaccine due to the COVID-19 pandemic despite decreased rates of vaccination during this time. HPV vaccine series completion was significantly lower than COVID-19 vaccine series completion, highlighting a need to improve HPV vaccine completion counseling. Additionally, patient education should address the knowledge gap discovered regarding the link between HPV infection and oropharyngeal cancer.

Effective population size of Culex quinquefasciatus under insecticide-based vector management and following Hurricane Harvey in Harris County, Texas.

Introduction: Culex quinquefasciatus is a mosquito species of significant public health importance due to its ability to transmit multiple pathogens that can cause mosquito-borne diseases, such as West Nile fever and St. Louis encephalitis. In Harris County, Texas, Cx. quinquefasciatus is a common vector species and is subjected to insecticide-based management by the Harris County Public Health Department. However, insecticide resistance in mosquitoes has increased rapidly worldwide and raises concerns about maintaining the effectiveness of vector control approaches. This concern is highly relevant in Texas, with its humid subtropical climate along the Gulf Coast that provides suitable habitat for Cx. quinquefasciatus and other mosquito species that are known disease vectors. Therefore, there is an urgent and ongoing need to monitor the effectiveness of current vector control programs. Methods: In this study, we evaluated the impact of vector control approaches by estimating the effective population size of Cx. quinquefasciatus in Harris County. We applied Approximate Bayesian Computation to microsatellite data to estimate effective population size. We collected Cx. quinquefasciatus samples from two mosquito control operation areas; 415 and 802, during routine vector monitoring in 2016 and 2017. No county mosquito control operations were applied at area 415 in 2016 and 2017, whereas extensive adulticide spraying operations were in effect at area 802 during the summer of 2016. We collected data for eighteen microsatellite markers for 713 and 723 mosquitoes at eight timepoints from 2016 to 2017 in areas 415 and 802, respectively. We also investigated the impact of Hurricane Harvey's landfall in the Houston area in August of 2017 on Cx. quinquefasciatus population fluctuation. Results: We found that the bottleneck scenario was the most probable historical scenario describing the impact of the winter season at area 415 and area 802, with the highest posterior probability of 0.9167 and 0.4966, respectively. We also detected an expansion event following Hurricane Harvey at area 802, showing a 3.03-fold increase in 2017. Discussion: Although we did not detect significant effects of vector control interventions, we found considerable influences of the winter season and a major hurricane on the effective population size of Cx. quinquefasciatus. The fluctuations in effective population size in both areas showed a significant seasonal pattern. Additionally, the significant population expansion following Hurricane Harvey in 2017 supports the necessity for post-hurricane vector-control interventions.

Tecovirimat use among patients with monkeypox (mpox) in Alameda County, California, June–October 2022

Background: Tecovirimat (TPOXX) is an antiviral drug only available via an Expanded Access Program (EAP) investigational new drug protocol and is recommended for treatment of select patients with monkeypox (mpox) infection. Alameda County Public Health Department prioritizes health equity but does not have a dedicated public health clinic. Therefore, we partnered closely with local healthcare providers that serve communities disproportionally impacted by mpox to ensure there was access to TPOXX. Using data collected during the outbreak we assessed whether populations in Alameda County most affected by mpox received treatment. Methods: We describe Alameda County patients with confirmed or probable mpox who received TPOXX during June–October 2022. Data were collected from case investigation interviews with patients and state-wide reportable disease database(s), which included demographic, clinical, and behavioral information. Confidence intervals (CIs) were calculated using the exact method for Poisson counts. We compared characteristics of mpox patients who received and did not receive TPOXX using the Pearson χ2 or Fisher exact test. P < .05 was considered significant. Results: Mpox case rates in Alameda County were highest among Black or African-American residents (35.6 per 100,000, 95% CI, 26.7–46.4) and Hispanic or Latinx residents (25.2, 95% CI, 20.2–31.0) compared to Asian residents (3.9, 95% CI, 2.3–6.1) and white residents (10.4, 95% CI, 7.7–13.9) residents. Among 242 mpox patients, 69 patients (28.5%) received TPOXX. The distribution of demographic and clinical characteristics among patients who received TPOXX was not significantly different than among those who did not, including residents aged 31–40 years (36.2% vs 34.7%), Black or African-American residents (20% vs 26.3%), Hispanic or Latinx residents (38.5% vs 41%), male residents (89.9% vs 95.3%), gay, lesbian, or same-gender loving residents (67.2% vs 67.4%) in the city of Oakland (63.2% vs 61.5%), or residents with human immunodeficiency virus infection (43.5% vs 36.6%). Conclusions: During the Alameda County mpox outbreak, nearly one-third of patients received TPOXX. Demographic and clinical characteristics were similar among TPOXX recipients and nonrecipients. A proactive approach to obtaining TPOXX in Alameda County and strong relationships with local providers may have allowed for treatment to be accessible to mpox patients. Regular review of outbreak data can inform public health activities, ensure health equity, and help refine local response efforts.Disclosures: None

Environmental Policy and Solid waste management. A case of Lodwar Municipality, Turkana County, Kenya.

Purpose: The formulation of Environment Policy 2018 of Turkana County is based on the requirement by the (Constitution of Kenya; 2010 and the County Governments Act, 2013) which gives powers to the county government to formulate policies and enact laws. It is this provision that Turkana County sort to formulate policy to address the management of waste in Lodwar municipality and its environment. The purpose of this article was to determine the influence of the Environmental Policy on Solid waste management in a case of Lodwar Municipality, Turkana County, Kenya. The objectives of the study were; To establish impact of private-public partnership on sustainable waste management in Lodwar Municipality, Turkana County; To assess the impact of political good will on solid waste management in Lodwar Municipality, Turkana County; To determine adoption of emission-reducing technologies on solid management in Lodwar municipality, Turkana county and to assess the level of integration of environmental policy with socio-economic policies to boost solid waste management in Lodwar Municipality, Turkana County, Kenya.
 Methodology: A cross-sectional descriptive study design was adopted to target residents of Lodwar town, management and municipal workers, traders, fisherfolks, county National Environment Management Authority officers and public health department officers at the county level. Furthermore, the descriptive research design was employed and utilized structured and semi structure questionnaires. Out of the population of 110 target groups the sample size used for the study was 33 as stated by Mugenda and Mugenda 2008 that when a population is below 10000 the sample size should be 10% or 30% of the target population hence 30% was ideal for the study. The quantitative and qualitative data were analyzed using frequencies, percentages, mean scores, and content thematic respectively.
 Findings: The findings of the study indicated that, there were no monitoring framework in place to determine the effectiveness of the policy, lack of awareness of existence of the policy amongst the municipality employees, lack of political good will and lack of waste regulating system.
 Unique Contribution to Theory, Policy and Practice: In this regard, the study recommends the need for municipality to establish monitoring system to measure the effectiveness of the environmental policy in addressing the solid waste management issues; there was need of the county government to provide enough resources to support the strategies lied by the policies for environmental sustainability; The community members , municipality and county government staff need to be sensitized on the existence of the environmental policy; a legal framework ought to be developed to provide the regulatory and fiscal instruments needed to achieve Turkana environment policy objectives.

Mpox Case Reports in an Urban Homeless Population and a Proof of Concept for a Street-Based Mobile Mpox Vaccination Clinic.

Mpox is a new public health outbreak that particularly threatens the homeless population. Street Medicine Phoenix (SMP) is a student-led interprofessional volunteer organization that provides medical care and other essential services to individuals experiencing homelessness in Phoenix, Arizona. In addition to core services such as wound care; health screenings (blood pressure and blood glucose.); vision screenings; HIV testing; naloxone education and distribution; flu, COVID-19, and Hepatitis A vaccinations; and community resource referrals, SMP began offering mpox education and vaccination at outreach events. During an outreach event shortly after the onset of the mpox outbreak, SMP identified 2 suspected mpox cases. Accordingly, SMP has partnered with the Maricopa County Public Health Department to set up mobile mpox vaccination clinics on the streets outside of Phoenix Arizona's largest homeless shelter. We share the details of these 2 cases along with our early efforts vaccinating individuals experiencing homelessness for mpox via our mobile vaccination clinic. Our experiences demonstrate the importance of community agencies providing direct outreach to underserved populations where they are at, particularly the homeless population, to address public health concerns such as emerging disease outbreaks like mpox. In addition, these cases highlight the potential significant impact that street medicine programs can have on their respective homeless communities in the context of infectious disease mitigation and emphasize the importance of partnerships with local health departments.

2038. Epidemiology of Carbapenem-Resistant Organisms in Alameda County, California (July 2019 - June 2021)

Abstract Background Carbapenem-resistant Enterobacterales (CREs) and some Carbapenem-resistant organisms (CROs) are considered urgent threats by the CDC. Since 2017, the Alameda County Public Health Department has mandated the reporting of CRE and encouraged voluntary reporting of non-CRE CROs. Surveillance data from these cases were analyzed to describe the epidemiology of infections and to target local public health interventions. Methods Healthcare facilities in Alameda County reported cases of CROs to the public health department directly to staff or through Electronic Laboratory Reporting and submitted isolates to the public health laboratory for ascertainment of carbapenemase genes by whole genome sequencing on the Illumina MiSeq platform; deaths were recorded via the California Electronic Death Registration System. Surveillance data were analyzed for cases July 2019 – June 2021 identified by the clinical laboratory as resistant to one or more carbapenems. Results From July 2019 – June 2021, 444 cases of CROs were reported to Alameda County from 409 patients. The county case rate for CROs over the two-year period was 29 cases per 100,000 population. Of the reported cases, 218 (49%) were CRE species: Escherichia coli, Klebsiella spp., and Enterobacter spp. Of the remaining cases, 157 (35%) were carbapenem-resistant Pseudomonas aeruginosa, 46 (10%) were carbapenem-resistant Acinetobacter baumannii (CRAB), and 23 (5%) were other carbapenem-resistant species. Cases by carbapenemase status are described in Table 1. Of the cases, 192 (43%) were among residents of long-term care facilities or long-term acute care hospitals; 340 (77%) cases were identified in patients over >50 years, and 168 (38%) cases have a death on record through January 2022. Among isolates with a carbapenemase gene (n = 129), KPC (32%) was the most commonly identified (Table 2). Conclusion The high burden of CROs in Alameda County highlights the need for continued partnership on reporting, testing and infection prevention measures to limit the spread of resistant organisms. A large proportion of cases were identified in vulnerable long-term care residents and 104 (24%) cases were identified as carbapenemase-producing, with a higher percentage among CRAB isolates, informing future targeted public health interventions. Disclosures All Authors: No reported disclosures.

A measurement invariance analysis of selected Opioid Overdose Knowledge Scale (OOKS) items among bystanders and first responders.

The Opioid Overdose Knowledge Scale (OOKS) is widely used as an adjunct to opioid education and naloxone distribution (OEND) for assessing pre- and post-training knowledge. However, the extent to which the OOKS performs comparably for bystander and first responder groups has not been well determined. We used exploratory structural equation modeling (ESEM) to assess the measurement invariance of an OOKS item subset when used as an OEND training pre-test. We used secondary analysis of pre-test data collected from 446 first responders and 1,349 bystanders (N = 1,795) attending OEND trainings conducted by two county public health departments. Twenty-four items were selected by practitioner/trainer consensus from the original 45-item OOKS instrument with an additional 2 removed owing to low response variation. We used exploratory factor analysis (EFA) followed by ESEM to identify a factor structure, which we assessed for configural, metric, and scalar measurement invariance by participant group using the 22 dichotomous items (correct/incorrect) as factor indicators. EFA identified a 3-factor model consisting of items assessing: basic overdose risk information, signs of an overdose, and rescue procedures/advanced overdose risk information. Model fit by ESEM estimation versus confirmatory factor analysis showed the ESEM model afforded a better fit. Measurement invariance analyses indicated the 3-factor model fit the data across all levels of invariance per standard fit statistic metrics. The reduced set of 22 OOKS items appears to offer comparable measurement of pre-training knowledge on opioid overdose risks, signs of an overdose, and rescue procedures for both bystanders and first responders.

Utilizing Healthy People 2030 to Engage Leadership, Key Constituents, and the Public Across Multiple Sectors: Opportunities for Local Health Departments and Community Partners.

Utilizing Healthy People 2030 to Engage Leadership, Key Constituents, and the Public Across Multiple Sectors: Opportunities for Local Health Departments and Community Partners.

Power-building Partnerships for Health: Lessons From Santa Barbara About Building Power to Protect Farmworker Health and Advance Health Equity.

The distribution of power in society is "upstream of the upstream" social determinants of health, and community organizers redistribute power to change social and political systems that shape health. Power-building Partnerships for Health (PPH) was launched in 2018 and pairs local public health departments and community organizing groups to support transformational health equity work, prioritizing trust and relationship building as precursors for action. Through PPH, the Santa Barbara County Public Health Department partnered with 2 grassroots organizations, CAUSE and MICOP. This partnership led to their launching a Latinx Indigenous Migrant Health COVID-19 Task Force and to the passing of a first-of-its-kind Health Officer Order on safety in farmworker housing. This practice brief discusses the importance of relationship building and key activities within PPH, and the roles of both the health department and community organizers in taking action to advance health equity in Santa Barbara County during the pandemic.

World Without Masks

World Without Masks

Plastic Handling and Pollution, a Study on the Effect of “Polluter Pays” Principle in Lodwar Town, Turkana County, Kenya

International Journal of Medicine and Public Health,2022,12,2,39-45.DOI:10.5530/ijmedph.2022.2.9Published:April 2022Type:Review ArticlePlastic Handling and Pollution, a Study on the Effect of “Polluter Pays” Principle in Lodwar Town, Turkana County, KenyaNakusi Peter, Stanslaus Kiilu Musyoki, and Alexander M Mbeke Nakusi Peter1,*, Stanslaus Kiilu Musyoki1, Alexander M Mbeke2 1School of Health Sciences, Kisii University, Kisii, KENYA. 2School of Health Sciences, Laikipia University, KENYA. Abstract:Aim/Background: The rapid growth of population in many developing countries has led to an increased generation of waste notably plastic and this has led to a serious environmental problem, which is of great public health concern. Unacceptable plastic waste disposal, due to insufficient human and financial capacity, is a challenge facing Kenya and other developing countries. This study investigated the effect of “polluter pay” principle on plastic handling and pollution in Lodwar town Turkana County. Materials and Methods: A cross-sectionaldescriptive study design targeting residents of Lodwar town, municipal workers, county National Environment Management Authority officers and public health department officers at the county was adopted. Data were then analyzed with descriptive and inferential statistics with the aid of Statistical Package for Social Sciences version 26. Results: The findings reveal that majority (48.1%) of the residents disagreed that the municipality sets certain fee and charges to the residents for residual waste per household, per square metre living space. In addition, majority (53.9%) also disagreed that Tax system has been put in place for landfill tax for contaminated site remediation. Majority (71.9%) of the residents agreed that Deposit System has been put in place waste types (for example glass bottles, plastic bottles. However, majority (43.2%) of the residents disagreed that there is producer responsibility driven systems for packaging, electric/electronic waste. From the chi-square analysis the “Polluter Pays” Principle is statistically significantly (X2=93.572) associated with plastic waste handling. Conclusion: The study concludes that “polluter pays” principle have a significant effect on plastic waste handling in Lodwar municipality. Contrary the municipality has not put in place for landfill tax for contaminated site remediation. Recommendation: The study recommends that County administration should put in place mechanisms to attract and leverage public private partnership as a vehicle to mobilize resources and enhance private sector participation in sustainable waste management and circular economy development activities. Keywords:Financial resources, Influence, Lodwar municipality, Plastic waste, Waste handlingView:PDF (131.03 KB)

Epidemiology of Coronavirus Disease 2019 at a County Jail-Alameda County, California, March 2020-March 2021.

Coronavirus disease 2019 (COVID-19) incidence rates are 2- to 5-fold higher among persons incarcerated in the United States than in the general population. We describe an outbreak investigation of COVID-19 at a jail (jail A) in Alameda County during March 2020-March 2021. To prevent COVID-19 cases among incarcerated persons and employees, staff at jail A and the county public health department worked to develop and recommend infection control measures implemented by jail A including, but not limited to, face covering use among incarcerated persons and staff; cohorting incarcerated persons at a higher risk of severe COVID-19 in dedicated housing units; quarantining all newly detained individuals for 14 days; and offering testing for all symptomatic incarcerated persons, newly incarcerated persons at day 2 and day 10, and all persons who resided in a housing unit where a COVID-19 case was detected. A total of 571 COVID-19 cases were detected among incarcerated persons at jail A during March 2020-March 2021, which represented a total incidence of 280 per 1000 population, 5 times higher than the rate in Alameda County. Of the 571 cases among incarcerated persons, 557 (98%) were male; 415 (73%) were aged 18 to 40 years; 249 (44%) were Latino; and 180 (32%) were African American; 354 (62%) were not symptomatic; and 220 (39%) had no comorbidities. Less than 2% of infected incarcerated persons were hospitalized, and no deaths were reported. COVID-19 disproportionately impacted persons incarcerated at jail A, with higher numbers among Latinos and African Americans. Implementation of COVID-19 infection control and testing measures, and collaboration between public health, law enforcement, and health care providers may have, in part, led to reductions in morbidity and mortality associated with COVID-19 at jail A.

Supporting Health Equity Through Data-Driven Decision-Making: A Local Health Department Response to COVID-19.

COVID-19 highlights preexisting inequities that affect health outcomes and access to care for Black and Brown Americans. The Marion County Public Health Department in Indiana sought to address inequities in COVID-19 testing by using surveillance data to place community testing sites in areas with the highest incidence of disease. Testing site demographic data indicated that targeted testing reached populations with the highest disease burden, suggesting that local health departments can effectively use surveillance data as a tool to address inequities. (Am J Public Health. 2021;111(S3):S197-S200. https://doi.org/10.2105/AJPH.2021.306421).

Imipenem-Relebactam Susceptibility and Genotypic Characteristics of Carbapenem-Resistant Enterobacterales Identified during Population-Based Surveillance.

Laboratories submit all carbapenem-resistant Enterobacter, Escherichia coli, and Klebsiella species to the Alameda County Public Health Department (ACPHD). ACPHD evaluated 75 isolates submitted during 9 months for susceptibility to imipenem-relebactam (I-R) and, using whole-genome sequencing, identified β-lactamase genes. Of 60 (80%) isolates susceptible to I-R, 8 (13%) had detectable carbapenemase genes, including 4 KPC, two NDM, and two OXA-48-like; we described the relationship between the presence of β-lactamase resistance genes and susceptibility to I-R.

Public Health Expenditures and Clinical and Social Complexity of Tuberculosis Cases-Alameda County, California, July-December 2017.

Alameda County, California, is a high tuberculosis (TB) burden county that reported a TB incidence rate of 8.1 per 100 000 during 2017. It is the only high TB burden California county that does not have a public health-funded TB clinic. To describe TB public health expenditures and clinical and social complexities of TB case-patients. Public health surveillance of confirmed and possible TB case-patients reported to Alameda County Public Health Department during July 1, 2017, to December 31, 2017. Social complexity status was categorized for all case-patients using surveillance data; clinical complexity status, either by surveillance definition or by the Charlson Comorbidity Index (CCI), was categorized only for confirmed TB case-patients. Total public health and per patient expenditures were stratified by insurance status. Cohen's kappa assessed concordance between clinical complexity definitions. All comparisons were conducted using Fisher's exact or Kruskal-Wallis tests. Of 81 case-patients reported, 68 (84%) had confirmed TB, 29 (36%) were socially complex, and 15 (19%) were uninsured. Total public health expenditures were $487 194, and 18% of expenditures were in nonlabor domains, 57% of which were for TB treatment, diagnostics, and insurance, with insured patients also incurring such expenditures. Median per patient expenditures were significantly higher for uninsured and government-insured patients than for privately insured patients ($7007 and $5045 vs $3704; P = .03). Among confirmed TB case-patients, 72% were clinically complex by surveillance definition and 53% by the CCI; concordance between definitions was poor (κ = 0.25; 95% confidence interval, 0.03-0.46). Total public health expenditures approached $500 000. Most case-patients were clinically complex, and about 20% were uninsured. While expenditures were higher for uninsured case-patients, insured case-patients still incurred TB treatment, diagnostic, and insurance-related expenditures. State and local health departments may be able to use our expenditure estimates by insurance status and description of clinically complex TB case-patients to inform efforts to allocate and secure adequate funding.

Methods to Conduct a Health Impact Assessment Learning Collaborative

Background: Indiana University Richard M. Fairbanks School of Public Health (IU FSPH) and the Health and Hospital Corporation of Marion County, through the Marion County Public Health Department (MCPHD), created a Health Impact Assessment (HIA) Learning Collaborative. The purpose of the HIA Learning Collaborative was to strengthen the capacity of both the academic and community partners to carry out HIAs. Entities recognize the value of creating a collaborative team to assure personnel are trained and available to provide time and expertise for plan reviews, formal feedback, data reports, literature summaries, and input in potential health/social impacts related to projects, which can ensure these impacts are considered in development work. In addition, the MCPHD and IU FSHP intend to increase HIA capacity in Indiana and remain committed to including health impact data into non-health sector decision making.
 Methods: The group planned to meet monthly over the year with the following learning objectives. A survey was created in Survey Monkey in order to evaluate the overall HIA Learning Collaborative experience and to assess whether or not the learning objectives were met. The survey consisted of 11 questions: nine were multiple choice and two were open-ended.
 Results: The majority of the objectives were met.
 Conclusion: There is interest in conducting HIAs in the future and several ideas were generated.

Multipronged Approach to Controlling a Tuberculosis Outbreak Among Persons Experiencing Homelessness.

In May 2009, the Marion County Public Health Department in Indiana declared a tuberculosis (TB) outbreak among persons experiencing homelessness in Marion County, began active case finding to detect additional cases, and formed a TB outbreak response team to plan and coordinate outbreak activities. Outbreak-associated cases had 1 of 2 outbreak genotypes and either reported experiencing homelessness themselves or had an epidemiologic link to a shelter or a person experiencing homelessness. The last of 53 outbreak-associated cases was detected in 2019 after more than 2 years without a case. The Marion County Public Health Department continues to address TB-related issues and implement prevention measures at homeless shelters and among persons experiencing homelessness in 2019. This example, in addition to other published guidance, can be used by jurisdictions to plan and implement their own TB outbreak prevention and response activities among persons experiencing homelessness.