County Response Research Articles

Detection and Response to an HIV Cluster: People Living Homeless and Using Drugs in Seattle, Washington

The HIV epidemic in King County, Washington has traditionally been highly concentrated among men who have sex with men, and incidence has gradually declined over 2 decades. In 2018, King County experienced a geographically concentrated outbreak of HIV among heterosexual people who inject drugs. Data sources to describe the 2018 outbreak and King County's response were partner services interview data, HIV case reports, syringe service program client surveys, hospital data, and data from a rapid needs assessment of homeless individuals and people who inject drugs. In 2020, the authors examined the impact of delays in molecular sequence analyses and cluster member size thresholds, for identifying genetically similar clusters, on the timing of outbreak identification. In 2018, the health department identified a North Seattle cluster, growing to 30 people with related HIV infections diagnosed in 2008-2019. In total, 70% of cluster members were female, 77% were people who inject drugs, 87% were homeless, and 27% reported exchanging sex. Intervention activities included a rapid needs assessment, 2,485 HIV screening tests in a jail and other outreach settings, provision of 87,488 clean syringes in the outbreak area, and public communications. A lower cluster size threshold and more rapid receipt and analyses of data would have identified this outbreak 4-16 months earlier. This outbreak shows the vulnerability of people who inject drugs to HIV infection, even in areas with robust syringe service programs and declining HIV epidemics. Although molecular HIV surveillance did not identify this outbreak, it may have done so with a lower threshold for defining clusters and more rapid receipt and analyses of HIV genetic sequences.

Patriotism, Courage, & Sacrifice

Review of: Patriotism, Courage, & Sacrifice: Warren County's Response to WW II by Jerry K. Beatty

One More Lesson From the Pandemic

One More Lesson From the Pandemic

Public Health Leadership and Management: Cases and Context

PART ONE: IMPROVING PUBLIC HEALTH LEADERSHIP AND MANAGEMENT Analyzing Public Health Cases Information Sources for Public Health Leaders Oral Presentations in Public Health Settings Financial Analysis in Health Care Organizations PART TWO: PUBLIC HEALTH - CONTEXT Industry Note 1 US Health Care System Industry Note 2 Public Health PART THREE: PUBLIC HEALTH - CASES Case 1 CDC and the Mantookan Blood Supply: A Tough Management Decision Case 2 AIDSCAP Nepal Case 3 The Indiana State Department of Public Health: Managing Strategically Case 4 Cooper Green Hospital and the Community Care Plan Case 5 InterMark: Designing UNICEF's Oral Rehydration Program in Zambia Case 6 The New York State West Nile Virus Outbreak: What Should Be Nassau County's Response? Case 7 The Indian Health Service: Creating a Climate for Change Case 8 Three Vexing Cases in Health Care Ethics Case 9 DeKalb County Board of Public Health: (A) and (B) Case 10 Red Tide and Red Ink in Escambia County, Florida Case 11 The New Mexico Meningococcal Outbreak Case 12 C W Williams Community Health Center Case 13 Building for the Future of Public Health in Alabama Case 14 Possible Bioterrorism in New Hampshire: A Public Health Response Case 15 Despierta! A Physician's Stark Encounter with the Grim Human Toll of a Preventable Public Health Problem

Captain Greenlee Davidson: Letters of a Virginia Soldier

CAPTAIN GREENLEE DAVIDSON: Letters of a Virginia Soldier Edited by Charles W. Turner James L. Kemper, former governor of Virginia, when awarding the first Jackson-Hope medals at the Virginia Military Institute, July 3, 1877, said in part: Let me here remind you that among the heroes furnished to Virginia in her great struggle, by this institution, there were many whose lives are worthy of your emulation . Among them are three whom I am especially proud to have known as friends. In life and death they were glorious, and their names will be cherished through all time and peculiar affection by the people of Rockbridge. They were Stonewall Jackson , General Frank Paxton and last but not least as least honored, one who was commissioned and chosen for a hero by the sagacity of my good and illustrious friend John Letcher, then governor. I allude to Colonel Greenlee Davidson, than whom no braver, knightlier, nobler Virginian gave his life in battle for his state.1 The third hero, Greenlee Davidson, son of James D. Davidson and Hannah Greenlee, was born in Lexington, Virginia on June 21, 1834. On both sides of the family he was descended from early Scots-Irish settlers of the Valley of Virginia. His kin included the McDowell's, Grigsby's, Dorman's and Paxton's—names distinguished in the Revolution, the War of 1812 and the War Between the States. After a pleasant childhood, he entered Washington College, September, 1852 and took his masters' degree in June, 1855. After graduation in 1857, he started law practice with his father, whose practice was one of the largest in the Valley. To the duties of the profession proper, he added the job of a Master Commissioner of Chancery. The records of the Court of Rockbridge abound with evidence of his industry, fidelity and ability. These services continued until the War of 1861.2 He wrote his cousin James Greenlee in April, 1861 about the county's response to the call for troops.3 Lexington, Va. April 20, '61 Dear Cousin James, Three volunteer companies of this county, consisting of the Rifles 1 A copy of Kemper's address is in the files of the Rockbridge Historical Society, Lexington, Virginia. (Hereinafter RHS files). 2 University Memorial Biographical Sketches of the Alumni of the University of Virginia Who Fought in the Confederate War, copy in the Rockbridge Historical Society files. 3 The letters included in this article are in the RHS files. 197 198CIVIL WAR HISTORY numbering over 100 men, and the two Cavalry Companies, numbering about 200 men, have marched for Harpers Ferry, and the Rockbridge Grays, number 90 members, are now quartered in this place and will march as soon as they are supplied with arms. Notwithstanding die fact, that about 400 volunteers are now in the field from this county, not one single field officer has been called into service. Col. Davidson,4 who is our senior Colonel feels that he has been grossly slighted. He and Col. Templeton had all the trouble of organizing the Militia, when the Militia Laws were re-enacted some three years ago, and in addition to this assisted in raising all of the volunteer compames of the county—yet four companies are called out of their regiments and they are left at home. Lou is a good, efficient officer, and is anxious to go into service, and I wish you to use your influence with Letcher to have a command assigned him at once.5 If he is called into service, I go as his Adjutant. If you don't succeed in securing a command for him, ask Letcher to give me some appointment, so that I can get into actual service at once. If you get a good situation, I would prefer being with you. I have my uniform, heavy clothing, saber, pistol and every thing prepared, so as to leave at a moments notice. If you fail in securing a command for Lou and a situation for me, I shall resign my place as Adjutant of our regiment and enlist as a private in one of the volunteer companies now forming, as I am determined to take a hand in...