Hours Of Notification Research Articles

Evaluation of WHO indicators for surveillance of acute flaccid paralysis in children: The case of Kenitra province, Morocco; from 1994 to 2018

Background Polio has not been detected in Morocco since 1989. The aim of this study was to examine the surveillance system for acute flaccid paralysis (AFP) in the province of Kenitra, assess its strengths and weaknesses, and suggest ways to improve it. Method & materials A qualitative and quantitative evaluation was carried out within the Kenitra Provincial Epidemiology Unit. The AFP case database was analyzed using the standards for evaluation of public health surveillance systems defined by the Centers for Disease Control and Prevention (CDC) in 2001 and WHO indicators. The surveillance system was found to be flexible and effective. Result The sensitivity of the system reached 50%, with an average notification rate of 3.04 cases. More than 40% of patients were reported within 7 days of onset of paralysis. Investigation time was approximately 70% within 48 hours of notification. 80% of stool samples were sent to the laboratory within 72 hours of collection. Conclusion: The AFP surveillance system in Kenitra is effective, adaptable and highly vigilant, allowing a rapid response. Maintaining AFP surveillance is essential until polio is eradicated worldwide. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1185-1196

Prospective Case-control Study of Contact Tracing Speed for Emergency Department-based Contact Tracers.

IntroductionIn Snohomish County, WA, the time from obtaining a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test and initiating contact tracing is 4–6 days. We tested whether emergency department (ED)-based contact tracing reduces time to initiation and completion of contact tracing investigations.MethodsAll eligible coronavirus disease 2019 (COVID-19)-positive patients were offered enrollment in this prospective case-control study. Contact tracers were present in the ED from 7 AM to 2 AM for 60 consecutive days. Tracers conducted interviews using the Washington State Department of Health’s extended COVID-19 reporting form, which is also used by the Snohomish Health District (SHD).ResultsEighty-one eligible SARS-CoV-2 positive patients were identified and 71 (88%) consented for the study. The mean time between positive COVID-19 test result and initiation of contact tracing investigation was 111 minutes with a median of 32 minutes (range: 1–1,203 minutes). The mean time from positive test result and completion of ED-based contact tracing investigation was 244 minutes with a median of 132 minutes (range: 23–1,233 minutes). In 100% of the enrolled cases, contact tracing was completed within 24 hours of a positive COVID-19 test result. For comparison, during this same period, SHD was able to complete contact tracing in 64% of positive cases within 24 hours of notification of a positive test result (P < 0.001). In the ED, each case identified a mean of 2.8 contacts as compared to 1.4 contacts identified by SHD-interviewed cases. There was no statistically significant difference between the percentage of contacts reached through ED contact tracing (82%) when compared to the usual practice (78%) (P = 0.16).ConclusionWhen contact tracing investigations occur at the point of diagnoses, the time to initiation and completion are reduced, there is higher enrollment, and more contacts are identified.

COVID-19 sample management: experiences of Harare City, 2021.

COVID-19 sample management is pivotal in controlling the pandemic. Results of 28/45 (62.2%) cases identified at a high school COVID-19 outbreak in Harare’s Northern district were not reported within the recommended 24 hours of notification. This leads to delayed patient management. We evaluated the sample management system for COVID-19 in Harare City. A descriptive cross-sectional study was conducted in Harare City. Health care workers involved in COVID-19 sample management at a high school outbreak in the Northern district namely clinicians, laboratory, environmental and administrative personnel were purposively sampled. Interviewer-administered questionnaires were used to collect data. Quantitative data were analyzed using Epi info version 7. Medians and proportions were generated. A 3-point Likert Scale was used to measure knowledge levels of health care workers on COVID-19 sample management. Thirty health care workers were interviewed and females were 20/30 (66%). Participants had not been trained in sample management. Overall knowledge level was good for 7/30 (23%) of the participants. Of the samples collected, 156/451 (34.6%) were wrongly sent to the national microbiology laboratory and 53/156 (34.0%) of the results were received. Sample management of COVID-19 samples in Harare City was found to affect patient management because of poor knowledge of healthcare workers, lack of transportation and communication means. The need for training cadres involved in the management process and availing adequate resources can improve turnaround time of results hence patient management.

Evaluation of Early Warning, Alert and Response System for Ebola Virus Disease, Democratic Republic of the Congo, 2018-2020.

The 10th and largest Ebola virus disease epidemic in the Democratic Republic of the Congo (DRC) was declared in North Kivu Province in August 2018 and ended in June 2020. We describe and evaluate an Early Warning, Alert and Response System (EWARS) implemented in the Beni health zone of DRC during August 5, 2018–June 30, 2020. During this period, 194,768 alerts were received, of which 30,728 (15.8%) were validated as suspected cases. From these, 801 confirmed and 3 probable cases were detected. EWARS showed an overall good performance: sensitivity and specificity >80%, nearly all (97%) of alerts investigated within 2 hours of notification, and good demographic representativeness. The average cost of the system was US $438/case detected and US $1.8/alert received. The system was stable, despite occasional disruptions caused by political insecurity. Our results demonstrate that EWARS was a cost-effective component of the Ebola surveillance strategy in this setting.

REINVENTING INFLAMMATORY BOWEL DISEASE (IBD) CLINICAL TRIAL RECRUITMENT USING NOVEL DIGITAL MEDICINE TOOLS

Abstract Background Issues with patient recruitment and enrolment are the primary barriers for missed clinical trial timelines; 8 out of 10 clinical trials are delayed or unable to be completed because of the lack of timely patient recruitment. Current patient recruitment efforts are inefficient as they are typically dependent on the manual screening of patients during face-to-face visits. With the rapid development of digital communication platforms within healthcare and the broad consumer adoption of smartphones, there are increasing opportunities to overcome some of these barriers. Digital platforms have great potential for research and clinical care of chronic conditions, such as inflammatory bowel disease (IBD), an often debilitating disease that currently affects over three million adults in the United States. In this paper, we utilized a digital medicine platform (Trialengage, Rx.Health, New York, NY) to improve patient recruitment for an ongoing mindfulness trial which had limited success in face-face enrolment (16 patients over 6 months). Methods Patients enrolled in the Mount Sinai Crohn’s and Colitis Registry (MSCCR) were remotely outreached about enrolling in a mindfulness study for IBD patients. A text-based clinical rules engine was used to inform registry patients about the trial and to allow patients to indicate interest in participating via text message. Eligible IBD patients were bulk “prescribed” a notification through RxHealth’s digital medicine platform, RxUniverse. Characteristics of the enrolled population, characteristics of patients who responded, and timeliness of responses were analyzed. Results Of the 1364 patients in the MSCCR with available phone numbers, 270 patients affirmatively replied they wanted to participate in the study. Patients who opted-in to receiving more information about the study were more likely to have inadequate control of their IBD (25.64% vs 18.97%; P&amp;lt;.05) and more likely to have a recent history of depression based on a validated patient health questionnaire (15.38% vs 8.4%; P&amp;lt;.05) than those who opted-out. There were no significant differences in terms of race, gender, and age between the two groups. In terms of timeliness of response among those enrolled, the majority of patients responded within 2 hours of notification. Conclusion Digital medicine software platforms can facilitate large-scale, lower-effort recruitment of eligible patients for clinical trials. Future research should be done to explore their expanded use for recruitment, patient education, and study data collection. Additional technologies such as patient-powered networks, social media, e-recruiting bots, and other remote engagement platforms can aid clinical trials by saving time and reducing costs of patient recruitment.

283. Epidemiology and Clinical Significance of Persistent Bacteremia in Severely Burned Patients

BackgroundRecent literature questions the utility of follow-up blood cultures (FUBC), especially for gram-negative bloodstream infections (BSIs). This has yet to be evaluated in the burn intensive care unit (BICU), where many BSIs are gram-negative. We evaluated the FUBC frequency, positivity rate, and clinical significance of persistent BSI (p-BSI) in BICU patients.MethodsPatients ≥ 18 years old admitted to the US Army Institute of Surgical Research for combat-related thermal burns from 1/2003–6/2014 were included. P-BSI was defined as the same organism isolated from initial and FUBC (within 1–5 days). Non-p-BSI (np-BSI) included patients without subsequent isolation of the same organism between 1–5 days post-positive blood culture. Exclusion criteria were initial blood culture with usual skin flora, polymicrobial BSI, fungemia, and death within 24 hours of notification of initial positive blood culture. Those factors significantly associated with mortality on univariate analysis were evaluated with binomial logistic regression (BLR).ResultsOf 126 patients meeting inclusion criteria with BSI, 53 (42.1%) had p-BSI and 73 (57.9%) had np-BSI (table 1). 50 (67.6%) np-BSI patients had FUBC. P-BSI and np-BSI patients did not differ in age, gender, or race, but p-BSI and np-BSI patients had median total body surface area (TBSA) burns of 47 (IQR 34–63) and 35.3 (IQR 23.3–56.6), respectively (p=0.021). P-BSI patients had longer hospitalizations, ICU stays, and intubations (p< 0.01; table 1). Microbiology did not differ between p-BSI and np-BSI (p=0.517). Notably, 20 (37.7%) p-BSI patients died compared to 8 (10.8%) np-BSI patients (p< 0.001; table 2). BLR revealed that p-BSI (p=0.031), TBSA (p< 0.001), ISS (p=0.008), and length of ICU stay (p=0.002) and intubation (p< 0.001) were independently significantly associated with mortality.Table 1: Clinical characteristics of burn patients with and without persistent bacteremia Table 2: Univariate analysis evaluating associations with mortality in burn patients with bacteremia ConclusionP-BSI was common in this burn population. Severe burns and longer duration of hospitalization, ICU stays, and intubation, but not microbiology were associated with p-BSI. However, p-BSI (in addition to more traditionally identified risk factors like TBSA and duration of hospitalization, ICU, and ventilator days), was independently associated with increased mortality. FUBC may serve as an additional prognostic factor in burn patients with BSI.Disclosures All Authors: No reported disclosures

Early clinical response to a high consequence infectious disease outbreak: insights from COVID-19.

Early clinical response to a high consequence infectious disease outbreak: insights from COVID-19.

The Acute Flaccid Paralysis (AFP) Surveillance System in Yemen, 2010-2015: Descriptive Study Based on Secondary Data Analysis.

BackgroundAcute flaccid paralysis (AFP) surveillance is an essential strategy for poliovirus eradication.ObjectiveThis study aimed to evaluate the performance of the AFP surveillance system in Yemen from 2010 to 2015, identify components that require strengthening, and compare the indicators by year and governorates.MethodsThis descriptive study was based on secondary analysis of AFP surveillance data reported during 2010-2015 from all Yemeni governorates. The World Health Organization (WHO) minimum performance standards were used to evaluate the performance of the AFP surveillance system.ResultsA total of 3019 AFP cases were reported between January 2010 and December 2015. At the national level, AFP surveillance achieved WHO targets throughout the evaluating period for the nonpolio AFP rate of cases per 100,000 members of the population younger than 15 years of age, proportion of AFP cases reported within 7 days, proportion of AFP cases investigated within 48 hours of notification, proportion of AFP cases with two adequate stool specimens, and proportion of stool specimens from which nonpolio enterovirus was isolated. However, the proportion of specimens that arrived at the central level within 3 days of the first sample collection and the proportion of stool specimens with results sent from the reference laboratory within 28 days of receipt did not reach targets in 2011 and 2015, respectively.ConclusionsThe AFP surveillance system in Yemen has met most of the WHO indicator levels. Nevertheless, the evaluation showed areas of weakness regarding the arrival of specimens at the central level within 3 days of the first sample collection and delays in processing of the results and submitting feedback by the laboratory. Therefore, there is a need to strengthen the follow-up of specimens submitted to the laboratory.

MEchanical DIlatation of the Cervix­­ in a Scarred uterus (MEDICS): the study protocol of a randomised controlled trial comparing a single cervical catheter balloon and prostaglandin PGE2 for cervical ripening and labour induction following caesarean delivery

IntroductionLabour induction in women with a previous caesarean delivery currently uses vaginal prostaglandin E2 (PGE2), which carries the risks of uterine hyperstimulation and scar rupture. We aim to compare the...

Reinventing Inflammatory Bowel Disease (IBD) Clinical Trial Recruitment Using Novel Digital Medicine Tools

Background: Issues with patient recruitment and enrollment are the primary barriers for missed clinical trial timelines; 8 out of 10 clinical trials are delayed or unable to be completed because of lack of timely patient recruitment. Current patient recruitment efforts are inefficient and time-consuming, since they are typically dependent on manually screening patients during face-to-face visits to the clinic or hospital. With the rapid development of digital communication platforms within health care and the broad consumer adoption of smartphones, there are increasing opportunities to overcome some of these barriers. These platforms have particularly great potential for research and clinical care of chronic conditions, such as inflammatory bowel disease (IBD), an often debilitating disease which currently affects over three million adults in the United States. Objective: To integrate and utilize a digital medicine platform to improve patient recruitment and enrollment processes in clinical trials. Methods: Patients enrolled in the Mount Sinai Crohn’s and Colitis Registry (MSCCR) were remotely approached about enrolling in a mindfulness study for IBD patients. A text-based clinical rules engine was used to inform registry patients about the trial and to allow patients to indicate interest in participating via text message. Eligible IBD patients were bulk “prescribed” a notification through RxHealth’s digital medicine platform, RxUniverse. Characteristics of the enrolled population, characteristics of patients who responded, and timeliness of responses were analyzed. Results: Of the 1364 patients in the MSCCR with available phone numbers, 270 patients affirmatively replied they wanted to participate in to the study. Patients who opted into receiving more information about the study were more likely to have inadequate control of their IBD (25.64% vs 18.97%; P<.05) and more likely to have a recent history of depression based on a validated patient health questionnaire (15.38% vs 8.4%; P<.05) than those who opted out. Furthermore, patients who opted in tended to be younger, were more likely to be female, and less likely to have ulcerative colitis, though these trends did not reach statistical significance. Patient race did not significantly differ between those who opted in and opted out. In terms of timeliness of response among those enrolled, the majority of patients responded within 2 hours of notification. Conclusions: Digital medicine software platforms can facilitate large-scale, lower-effort recruitment of eligible patients for clinical trials. Future research should be done to explore their expanded use for recruitment, patient education, and study data collection. Additional technologies such as patient-powered networks, social media, e-recruiting bots, and other remote engagement platforms can aid clinical trials by saving time and reducing costs of patient recruitment.

Utilizing Rapid DCD Cases to Increase Number of Transplants

Introduction Intermountain Donor Services (IDS) is an organ procurement organization serving a population of 3.6 million people in Utah, southeastern Idaho, western Wyoming, and a small portion of Nevada. In the United States, ethical guidelines indicate families should not be approached about organ donation after cardiac death (DCD) until after the decision to withdraw ventilator support. In 2012, IDS set a goal to facilitate DCD cases in situations of donor instability and requests by families to withdraw support immediately. IDS identified minimum requirements needed before completing a DCD recovery and worked with transplant centers, hospitals, and recovery personnel to implement a program to recover organs within two hours of consent. Methods IDS identified two hours from consent to withdrawal as the minimum time to complete needed tests and gather required information before organ recovery. Protocols were developed within IDS and between local recovery surgeons to ensure availability of a recovery surgeon despite this short time frame. Training was completed with donor hospitals and applicable personnel on how to offer this service when families want to withdraw support immediately. Additionally, IDS staff negotiated for as much time as possible to increase the opportunity for liver transplants, when applicable. Results During 2013-2016, twenty-five DCDs were completed within 0-3 hours of notification and organ recovery. Of these, 48 kidneys and five livers were transplanted. Thirty-one DCDs were attempted within 3-6 hours of notification and organ recovery. Of these, 44 kidneys and two livers were transplanted. This represents 47% of all DCD cases during this four-year period. The DCD rate for IDS as a percent of all donors was 24.2%. Although the time frame could be taxing to IDS staff and transplant recovery teams, the positive outcomes of those receiving transplants and fulfilling the wishes of the donors and their families outweighed any challenges. Conclusion IDS teams and recovery staff can respond within short time frames that were once considered impossible due to logistical issues. The opportunity for IDS staff to meet directly with donor families who want to withdraw immediately provides a window to negotiate longer time frames. Donor hospitals have seen the success of rapid DCD and have improved on providing timely referrals and a window for IDS staff to arrive before withdrawing support.

Polio Eradication in Bangladesh: Evaluation of AFP Surveillance Indicators, 2011-2015

As per recommendation from WHO, Bangladesh began a comprehensive plan for AFP (Acute Flaccid Paralysis) and EPI (Expanded Program on Immunisation) disease surveillance from 1997. The country has been maintaining key performance indicators for AFP surveillance for the past ten years. Bangladesh has been declared polio free on 27th March 2014. The aim of this paper is to evaluate and describe results of AFP surveillance indicators for Bangladesh showing the progress made over time as well as identifying areas, which needs further improvements to maintain the polio free status. This retrospective study has been conducted using the surveillance data routinely collected from AFP cases on demographic characteristics and clinical & laboratory examination. Data of 7480 children less than 15 years old reported between January 2011 to December 2015 have been included in this study. Among all reported cases 59.22% cases were male children with a male: female ratio of 1.45:1. 54% of the reported AFP cases within the study period belong to 1-4 years of age. Among all reported cases, 56% have been diagnosed with Guillain-Barre Syndrome or GBS. Annual Non-Polio AFP rate has been successfully achieved nationally for each study year. Completeness and Timeliness of passive reporting from facilities have been satisfactory. 98% or more of all reported AFP cases within the study period has been investigated within 48 hours of notification. For over 95% of all reported AFP cases two stool samples were collected within 14 days of case reporting. 60 plus day follow up has been performed for at least 99% reported AFP cases within the study period. All epidemiological and laboratory surveillance indicators were successfully met for AFP surveillance. However it is important for Bangladesh to maintain long-term AFP case based surveillance along with introduction of Environmental surveillance due to the risk of poliovirus importation before global polio eradication.

Notes from the Field: Clostridium perfringens Gastroenteritis Outbreak Associated with a Catered Lunch - North Carolina, November 2015.

During November 2015, the North Carolina Division of Public Health was notified by the Pitt County Health Department (PCHD) that approximately 40 persons who attended a catered company Thanksgiving lunch the previous day were ill with diarrhea and abdominal pain. The North Carolina Division of Public Health and PCHD worked together to investigate the source of illness and implement control measures. Within hours of notification, investigators developed and distributed an online survey to all lunch attendees regarding symptoms and foods consumed and initiated a cohort study. A case of illness was defined as abdominal pain or diarrhea in a lunch attendee with illness onset <24 hours after the event. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated for all menu items. Among 80 attendees, 58 (73%) completed the survey, including 44 respondents (76%) who reported illnesses meeting the case definition; among these, 41 (93%) reported diarrhea, and 40 (91%) reported abdominal pain. There were no hospitalizations. Symptom onset began a median of 13 hours after lunch (range=1-22 hours). Risk for illness among persons who ate turkey or stuffing (38 of 44; 86%), which were plated and served together, was significantly higher than risk for illness among those who did not eat turkey or stuffing (six of 14; 43%) (RR=2.02; 95% CI=1.09-3.73).

Disaster Medical Assistance Teams During Earthquake Crisis in Iran: Propose a Localized Model

BackgroundIn the past 10 years, 13 fatal earthquakes have occurred in Iran and led to death of 30,000 people whom most of them were killed in the earlier hours of the disaster. Disaster Medical Assistance Teams are groups of trained medical and non-medical personnel with various combinations that on the optimal conditions are deployed just within 8 hours of notification and are able to work self-sufficiently for at least 72 hours without any outside help and can treat up to 250 patients per day. Currently there are no such rapid-response teams in case of unexpected events in Iran, which causes the responses to such disasters, not to be organized or practiced. For instance, there were many rescue forces in 2003 Bam earthquake but not enough skilled ones to cope with; consequently they themselves became a problem in crisis management instead of solving the problem.ObjectivesIn this study, we have investigated which of the following is more efficient: changing the size and combination of the team depending on the type of disaster and environmental conditions or, determine a fixed combination team.Materials and MethodsTotally, several reasons for dynamic combination and size of the teams are presented. later, earthquake disaster is divided into 3 phases in terms of time including the acute phase (1st to 4th day after disaster), the sub-acute phase (5th to 14thday) and the recovery phase (after the 14th day), and finally the appropriate team combinations in every phases are offered.ResultsRegarding to introduction and considering the existing statistics in different legal Iranian resources and by division of the earthquake disaster to three phases including acute phase (1st to the 4th day after disaster), sub-acute phase (5th to 14th day) and recovery phase (after the 14th day)ConclusionsThe countries pioneer in disaster medical assistance teams, now are inclined to deploy different teams consistent with each kind of disasters or with other effective components on the combination of system. Every disaster has its own condition and would require different combination of relief and medical forces. For example, people’s health needs in flood is different from the earthquake

Sexually Transmitted Infections Among Patients With Acute HIV in North Carolina

Sexually transmitted infections (STIs) have a well-established synergistic relationship with HIV infection. Co-infection with HIV and an STI can increase the probability of HIV transmission to an uninfected partner by increasing HIV concentrations in genital lesions, genital secretions, or both.[1, 2] STI infection can also increase the likelihood of HIV acquisition by interrupting mucosal barriers, increasing the access to and concentration of HIV receptor cells, and, in women, changing the vaginal microflora to favor HIV infection.[3–6] Among patients with acute HIV (AHI), the 4–6 week interval in the HIV disease course when the virus can be detected in the blood prior to seroconversion, co-infection with an STI may be common.[7] More than 70% of AHI patients had an STI co-infection in a Malawian sexually transmitted disease (STD) clinic in two separate studies.[8, 9] However, little is known about the frequency of STI and acute HIV infection co-infection outside of the STD clinic setting.

Responding to Katrina: A Veterans Affairs pharmacist’s experience

After Hurricane Katrina made landfall on August 29, 2005, I volunteered for the federal disaster relief effort. At the time, I was told to be ready to deploy within 24 hours of notification. On October 4, I arrived at the Veterans Affairs medical center in Marlin, Texas, which had closed several

Acute flaccid paralysis

Poliomyelitis is an acute viral infection caused by RNA virus. It is primarily an infection of the human alimentary tract but the virus may infect the central nervous system in a very small percentage (1%) of cases resulting in varying degrees of paralysis, and possibly death [1]. The extensive use of polio vaccines since 1954 has virtually eliminated the disease in developed countries. The South East Asia Region (SEAR) contains the largest remaining reservoir of wild polio virus in the world. The incidence of reported poliomyelitis cases has declined by 90% [2]. In this era of eradication of polio, even a single case is treated as an outbreak and preventive measures should be initiated, usually within 48 hours of notification of the case [3]. One of the most important and major objectives of Nation wide Polio Eradication programme is to ensure timely and complete reporting of cases of acute flaccid paralysis (AFP) and to collect stool specimen within 14 days and conduct outbreak response immunisation (ORI) as early as possible. Here we report one case of AFP which was diagnosed, notified, investigated and managed within 8 hours and stool specimen collected within 48 hours of reporting of the case. The case was epidemiologically investigated as per the Ministry of Health and Family Welfare and WHO guidelines and ORI was conducted in the community next day. The response in this case not only shows coordinated effort of curative and preventive medicine but how health teams of civil and army should function in cohesion to curb any public health problem.