Local Health Officials Research Articles

Sosialisasi Pencegahan Covid-19 Pengguna Transportasi Laut Pada Wilayah Kepulauan

Ports as sea transportation infrastructure have a lot of social interactions because they are the entry and exit points for passengers traveling between islands. The form of anticipation for the prevention of Covid 19 is carried out in the form of socialization to passengers by maintaining distance, washing hands and distributing masks while traveling. Covid-19 Prevention and Control Efforts. The socialization of Covid-19 prevention at ports as a meeting point between land and sea transportation modes is expected to be able to provide understanding to the user or passenger community to continue to apply health protocols while in the port area as an effort to prevent and break the chain of the spread of Covid-19. Several protocols to prevent the spread of Covid-19 in public areas include terminals, ports. The contents of the protocol include ensuring that all public areas post health messages (proper hand washing and coughing / sneezing etiquette) in strategic places such as at the entrance. Inform visitors to use clean personal worship tools, provide means of washing hands with soap (CTPS) with running water in the toilet and providing hand sanitizers at each entrance. Check body temperature at each point of entry and observe the general condition of visitors. The role of the public area manager must be coordinating with the local health office on a regular basis.

Coping with Denialism: How Street-Level Bureaucrats Adapted and Responded to COVID-19 in Tanzania.

This article aims to highlight challenges and adaptations made by local health officials in Tanzania in working to contain and manage COVID-19. The study takes an inductive approach, drawing on the reported experiences of 40 officials at different levels of government across four purposefully selected regions in July 2020. Interviewees were asked about the guidance they received to contain COVID-19, the source of that guidance, their challenges and successes in implementing the guidance, and if and how they adapted the guidance to their particular setting. The interviews depict considerable challenges, including a lack of supplies and resources for implementing infection control, surveillance, and mitigation practices and dealing with fear and stigma. At the same time, they also provide evidence of innovation and adaptation among street-level bureaucrats. Respondents overwhelmingly praised the president, whose limited national response is seen as helpful for reducing fear and stigma. Other scholars have highlighted the potential dangers of street-level discretion if local officials "make policy" in ways that contradict their agencies' stated goals. In contrast, our study suggests benefits of autonomy at the street level-particularly in contexts where the central state was relatively weak and/or acting against the public interest.

Applying Genomic Epidemiology to Characterize a COVID-19 Outbreak in a Developmentally Disabled Adult Group Home Setting, Arizona.

Individuals living in congregate settings, including those in group homes, have been disproportionately impacted by COVID-19 and may be at increased risk of exposure or infection due to underlying illness. In mid-May 2020, local public health officials responded to an outbreak of COVID-19 among staff and residents associated with a multi-residential group home that provides care for adults with intellectual and developmental disabilities. Samples were collected at 16 of the homes. In four of the homes all the residents tested positive, and in the remaining 12 houses where samples were collected, all residents tested negative. Of the 152 individuals tested, 15/58 (25.9%) residents and 27/94 (28.7%) staff were positive for SARS-CoV-2, including eight hospitalizations and four deaths. Phylogenetic analysis of genomes from this outbreak in the context of genomes from Northern Arizona shows that very few mutations separate the samples from this outbreak. A potential transmission network was developed to illustrate person-place epidemiologic linkages and further demonstrates the dynamic connections between staff and residents with respect to each group home location. Epidemiologic and genomic evidence correlate, and suggest that asymptomatic infected staff likely introduced and spread COVID-19 in this setting. Implementation of public health prevention measures alongside rapid genomic analysis can help guide policy development and guide management efforts to prevent and mitigate future outbreaks.

Beware of Superbugs in a Post-COVID World.

Beware of Superbugs in a Post-COVID World.

Tick-Borne Encephalitis Vaccination Protects from Alimentary TBE Infection: Results from an Alimentary Outbreak.

In May 2017, a hospitalized index case of tick-borne encephalitis (TBE) was confirmed by Serology. The case was linked to alimentary infection by raw milk from a goat farm in the region of Tübingen, Baden-Württemberg, Germany, where no previous TBE cases in the area had been reported before. The TBE focus was confirmed by isolation of the TBE virus from ticks and Serological confirmation of past infection in one of the five flock goats. Additional investigations by the local public health office identified 27 consumers of goat milk at the putative period of exposure. For 20/27 exposed persons, anamnestic information was gained by the local public health office. Twelve/fourteen exposed and non-vaccinated people developed clinical illness and were confirmed as TBE cases by Serology. Five/six vaccinated and exposed people did not develop the disease. The one exposed and vaccinated person had their last TBE vaccination booster more than 15 years ago, and therefore a booster was more than 10 years overdue. None of the regularly vaccinated and exposed persons developed clinical overt TBE infection. We report the first known TBE outbreak, during which, protection by TBE vaccination against alimentary TBE infection was demonstrated.

Emergency Medical Services for Children: Office Emergency and Disaster Readiness.

Pediatricians are resources for families to provide ongoing care, education, and guidance during emergencies. They must be prepared to handle both office emergencies and local disasters. In office emergencies, readiness should focus on stabilizing life-threats until patients can be transported to an emergency department. Preparedness must also focus on providing aid in the setting of large-scale disasters in conjunction with local public health officials, hospitals, health care coalitions, emergency medical services systems, and local emergency officials, and plans should address hazards local to the area. [Pediatr Ann. 2021;50(4):e160-e164.].

Responses to the COVID-19 Pandemic among the Amish of Northern Indiana

Retired sociologist and college administrator Victor Stoltzfus reflects on a series of meetings in 2020 between leaders of the large Elkhart-LaGrange Amish settlement and state and local public health officials seeking to mitigate the spread of COVID-19. Multiple sources of information, some of questionable provenance, worked against the reception and application of public health directives, as did the decentralized polity of the Amish church. The authority of medical science is not absolute in Amish circles and the Amish relationship with government includes elements of both obedience and distrust. The generally positive reputation the Amish enjoy in the wider public may be at risk as some non-Amish neighbors are dismayed by half-hearted Amish efforts to slow the spread of the pandemic. Stoltzfus concludes by noting the inconsistent mitigation practices on the part of the surrounding non-Amish population in northern Indiana.

Malaria Surveillance - United States, 2017.

Malaria Surveillance - United States, 2017.

Clusters of SARS-CoV-2 Infection Among Elementary School Educators and Students in One School District - Georgia, December 2020-January 2021.

In-person learning benefits children and communities (1). Understanding the context in which transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), occurs in schools is critical to improving the safety of in-person learning. During December 1, 2020-January 22, 2021, Cobb and Douglas Public Health (CDPH), the Georgia Department of Public Health (GDPH), and CDC investigated SARS-CoV-2 transmission in eight public elementary schools in a single school district. COVID-19 cases* among educators and students were either self-reported or identified by local public health officials. Close contacts (contacts)† of persons with a COVID-19 case received testing. Among contacts who received positive test results, public health investigators assessed epidemiologic links, probable transmission directionality, and the likelihood of in-school transmission.§ Nine clusters of three or more epidemiologically linked COVID-19 cases were identified involving 13 educators and 32 students at six of the eight elementary schools. Two clusters involved probable educator-to-educator transmission that was followed by educator-to-student transmission and resulted in approximately one half (15 of 31) of school-associated cases. Sixty-nine household members of persons with school-associated cases were tested, and 18 (26%) received positive results. All nine transmission clusters involved less than ideal physical distancing, and five involved inadequate mask use by students. Educators were central to in-school transmission networks. Multifaceted mitigation measures in schools, including promotion of COVID-19 precautions outside of school, minimizing in-person adult interactions at school, and ensuring universal and correct mask use and physical distancing among educators and students when in-person interaction is unavoidable, are important in preventing in-school transmission of SARS-CoV-2. Although not required for reopening schools, COVID-19 vaccination should be considered as an additional mitigation measure to be added when available.

COVID-19 Community Incidence and Associated Neighborhood-Level Characteristics in Houston, Texas, USA.

Central to developing effective control measures for the COVID-19 pandemic is understanding the epidemiology of transmission in the community. Geospatial analysis of neighborhood-level data could provide insight into drivers of infection. In the current analysis of Harris County, Texas, we used custom interpolation tools in GIS to disaggregate COVID-19 incidence estimates from the zip code to census tract estimates—a better representation of neighborhood-level estimates. We assessed the associations between 29 neighborhood-level characteristics and COVID-19 incidence using a series of aspatial and spatial models. The variables that maintained significant and positive associations with COVID-19 incidence in our final aspatial model and later represented in a geographically weighted regression model were the percentage of the Black/African American population, percentage of the foreign-born population, area derivation index (ADI), percentage of households with no vehicle, and percentage of people over 65 years old inside each census tract. Conversely, we observed negative and significant association with the percentage employed in education. Notably, the spatial models indicated that the impact of ADI was homogeneous across the study area, but other risk factors varied by neighborhood. The current findings could enhance decision making by local public health officials in responding to the COVID-19 pandemic. By understanding factors that drive community transmission, we can better target disease control measures.

SARS-CoV-2 Transmission Associated with High School Wrestling Tournaments - Florida, December 2020-January 2021.

On December 7, 2020, local public health officials in Florida county A were notified of a person with an antigen-positive SARS-CoV-2 test* result who had attended two high school wrestling tournaments held in the county on December 4 and 5. The tournaments included 10 participating high schools from three counties. The host school (school A in county A) participated in the tournaments on both days; five high school teams from two counties participated the first day only; four additional high school teams from the three counties participated the second day. A total of 130 wrestlers, coaches, and referees attended the tournaments (Table). During December 8-9, 13 wrestlers from school A received positive SARS-CoV-2 test results (Figure), including nine who were symptomatic, two who were asymptomatic, and two for whom symptom status at time of specimen collection was unknown. Local public health officials in the three counties initiated an investigation† and tested specimens from an additional 40 attendees from nine of the 10 participating schools. A total of 54 (41.5%) of the 130 tournament attendees received testing, and 38 cases of SARS-CoV-2 infection were identified; the minimum attack rate was 30.2% (38 of 126§), and 70.4% (38 of 54) of tests had a positive result. Among contacts of the 38 COVID-19 patients, 446 were determined by investigators to meet the CDC definition of a close contact,¶ including 62 who were household contacts and 384 who were in-school contacts (classmates, teachers, noncompeting wrestling team members, and other school athletic team members). Among these 446 contacts, five had received a diagnosis of COVID-19 during June-November and were excluded from attack rate calculations. Among 95 (21.3%) contacts who received SARS-CoV-2 testing, 41 (43.2%) received a positive test result (minimum attack rate=9.3% [41 of 441]); 21 (51.2%) persons with positive test results were symptomatic, eight (19.5%) were asymptomatic, and symptom status for 12 (29.3%) was unknown at the time of specimen collection. Among contacts, attack rates were highest among household members (30.0%) and wrestling team members who did not attend the tournament (20.3%), as were the percentages of positive test results (60.0% among household members and 54.2% among team members). Among all contacts, the odds of receiving a positive test result were highest among household contacts (odds ratio=2.7; 95% confidence interval=1.2-6.0). Local health authorities reported the death of one adult contact aged >50 years.

Academic libraries and research in flux: Global conversations in times of COVID-19

In March 2020, Alameda County, where the University of California (UC)-Berkeley is located, issued a shelter in place order as a response to the COVID-19 pandemic. The UC-Berkeley Library was one of the first libraries in the United States to deal effectively with the new normal that was mandated by local, state, and federal public health officials, shifting to the virtual provision of its services such as instruction, research consultation, and accelerated e-resource acquisition. Library administration encouraged staff to think creatively, to not only provide our services to faculty, users, and students, but also to bridge the physical gap through virtual media to foster collaboration among the community of international librarians.

Public Health Officials and COVID-19: Leadership, Politics, and the Pandemic.

Public Health Officials and COVID-19: Leadership, Politics, and the Pandemic.

Lessons Relearned? H1N1, COVID-19, and Vaccination Planning.

Lessons Relearned? H1N1, COVID-19, and Vaccination Planning.

Engaging Food Insecure Families on the Weekend to Improve Nutrition and Health.

Engaging Food Insecure Families on the Weekend to Improve Nutrition and Health Deepak Palakshappa, MD, MSHP, Melanie Tam, MD, Kimberly Montez, MD, MPH, Kimberly Dezern, Keena Moore, BS, CHES, Scott Best, MBA, and Joseph A. Skelton, MD, MS What Is the Purpose of This Study? • To evaluate the potential effect of a community-based program that delivers free meals to children and fresh produce to their families on the weekends combined with cooking classes. What Is the Problem? • Food insecurity is a major public health problem in the United States that has been associated with numerous negative health outcomes in children and adults. • Households with children are at higher risk of being food insecure. • The school meals program provides free and reduced priced meals for children during the week, but there is limited evidence on how to address the needs of families with food insecurity on the weekend. What Are the Findings? • We found that a community-based program that combines food delivery with cooking classes might be an effective strategy to assist food insecure families on the weekends. • Parents/guardians reported that the program provided some relief knowing that they had access to free produce. • The cooking classes helped them to eat healthier on a limited budget. • Because of the multiple generations involved in the care of children, parents/guardians did recommend using programs that include children, parents, and grandparents to more effectively address food insecure families' needs. • Additionally, parents and guardians felt broader policy changes were needed to provide sustainable access to low-cost healthy food. Who Should Care Most? • Community-based organizations focused on addressing food insecurity. • Partners involved in community-based participatory research to improve community health. • Local government and public health officials. • Health care providers. [End Page e11] Recommendations for Action • A community-based program that provides food delivery combined with cooking classes may be an effective strategy to assist food insecure families on the weekends. • Community or public health interventions should consider incorporating a multigenerational approach in addressing food insecurity. • Broader public health and policy changes that address the underlying causes of food insecurity maybe necessary to significantly improve adult and child health. • Despite working with local community leaders and members, retention in a study can be challenging among families with multiple competing demands. [End Page e12] Deepak Palakshappa Department of Internal Medicine, Wake Forest School of Medicine Department of Pediatrics, Wake Forest School of Medicine Division of Public Health Sciences, Wake Forest School of Medicine Wake Forest School of Medicine Melanie Tam Wake Forest School of Medicine Kimberly Montez Department of Pediatrics, Wake Forest School of Medicine Wake Forest School of Medicine Kimberly Dezern Division of Public Health Sciences, Wake Forest School of Medicine Keena Moore Wake Forest Clinical Translational Science Institute Program in Community Engagement Scott Best Help Our People Eat (H.O.P.E.) of Winston-Salem Joseph A. Skelton Department of Pediatrics, Wake Forest School of Medicine Division of Public Health Sciences, Wake Forest School of Medicine Wake Forest School of Medicine Copyright © 2021 Johns Hopkins University Press

Crisis Decision-Making at the Speed of COVID-19: Field Report on Issuing the First Regional Shelter-in-Place Orders in the United States.

In March, 2020, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causal agent of coronavirus disease 2019 (COVID-19), was spreading in the Bay Area, especially in Santa Clara County, causing increases in cases, hospitalizations, and deaths. The Association of Bay Area Health Officials (ABAHO) represents 13 Bay Area health jurisdictions. On March 15, 2020, the local health officers of 7 ABAHO members (counties of Alameda, Contra Costa, Marin, San Francisco, San Mateo, and Santa Clara and the city of Berkeley) decided to issue legal orders on March 16 for 6.7 million residents to shelter in place to prevent the spread of SARS-CoV-2, the causal agent of COVID-19. The Bay Area was the first region in the United States to shelter in place, and within days, other regions in the United States followed. Subsequent comparative analyses have confirmed that acting early in issuing shelter-in-place orders prevented a large number of cases, hospitalizations, and deaths in the Bay Area throughout the United States. The quality of a decision-in this case, for crisis decision making-cannot be judged by the outcome. A good decision can have a bad outcome, and a bad decision can have a good outcome. The quality of a decision depends only on the quality of the decision-making process at the time the decision was made. In this Field Report, we review how we made this collective decision. With the benefit of hindsight and reflection, we recount our story through the lens of public health legal authority, meta-leadership, and decision intelligence. Our purpose is to improve the crisis decision-making skills of public health officials by improving how we make high-stakes decisions each day in our continuing fight to contain the SARS-CoV-2 pandemic, to save lives, and to eliminate COVID-19 racial/ethnic inequities.

A diffused community tuberculosis outbreak that could be detected earlier using surveillance data, Japan, 2012-2014.

Early detection of an outbreak is a role of disease surveillance systems; however, tuberculosis (TB) surveillance systems were underutilized to detect the outbreaks. In mid-2015, a local health office of central Japan noticed the number of TB cases of city in 2012-2014 were well above the expected numbers. This study was conducted to determine whether and when a community TB outbreak could be detected and characterize the cases using the national surveillance data. The surveillance data of the A city and surrounding areas were retrospectively reviewed and analyzed for 2006-2018. The TB notification rates of the A city from 2012 to 2014 were 28.0 (95% confidence interval [CI]: 20.3-38.4), 26.0 (95%CI: 18.6-36.0), 28.2 (95%CI: 20.3-38.4) per 100,000 population, respectively, higher than that of the entire prefecture (13.6, 13.0, 13.3, respectively). Similarly, in the neighboring B city, the rates of 2012 and 2014 were 51.0 (95%CI: 27.2-87.2) and 51.2 (95%CI: 27.3-87.5), respectively, higher than that of its parent prefecture (13.4 and 12.7, respectively). By the end of July 2012 (A city) or August 2012 (B city), the accumulated numbers of TB cases exceeded the previous annual TB cases. The average TB notification rates of A and B cities for 2012-2014 were higher than the surrounding areas. A community TB outbreak without well-defined setting could be detected by monitoring TB surveillance data.

SEIR-SEI-EnKF: A New Model for Estimating and Forecasting Dengue Outbreak Dynamics

Dengue fever is an acute mosquito-borne viral infection that results in a heavy social burden in many tropical and subtropical regions. Accurate forecasts of dengue outbreak allow the local health officials to take proactive action such as positioning mosquito control equipment or preparing medical resources. We developed a new model for dengue outbreak estimation and forecast that adopts the vector-borne disease model SEIR-SEI with compartments Susceptible-Exposed-Infectious-Recovered (for host) and Susceptible-Exposed-Infectious (for vector) into the ensemble Kalman filtering (EnKF) assimilation method. The SEIR-SIR-EnKF model was first validated using synthetic dengue outbreak in twin experiments. Then, the model produced good performance when applied to estimate and forecast the dengue outbreak dynamics with real historical time-series cases in 3 different cities. Furthermore, we compared the accuracy of the real-time predictions between SEIR-SEI-EnKF model, SEIR-EnKF model, and SIR-EnKF model; we found the SEIR-SEI-EnKF model had the most accurate predictions.

Continued Counseling for the Relationship Between State-Level Medicine and Public Health

Public health and organized medicine have operated somewhat independently of each other since the early 1900s. In the wake of the COVID-19 pandemic, the necessity of healing any divide between organized medicine and state and local health officials seems self-evident. Using the recommendations abstracted from a 2005 article by Dr. Ronald Davis, "Marriage Counseling for Medicine and Public Health," this cross-sectional study explores the formal relationships that existed between state-level public health and medical practice across the U.S. at the end of 2019. A questionnaire was distributed to every state's senior public health official and medical society executive (N=104) between August and December 2019 to examine the extent of these entities' partnerships. Analysis was completed in January 2020. Among the respondents, 40%-63.1% (n=65) currently engage in the recommended activities, with 1 exception: state health departments infrequently invite medical society executives to speak at major conferences or meetings (26.2%). The majority of respondents (71.1%-85.9%) judged that each recommended activity would improve the practices of medicine and public health. Survey results illustrate a desire for reconciliation, but poor implementation of recommended strategies aimed at building a healthy marriage between the 2 sectors. More formal efforts are needed among state medical and public health organizations to capitalize on the current climate of rapprochement. The burden of COVID-19 on the national health system could provide a worthy cause around which these efforts would coalesce.

FAKTOR POSITIVE DEVIANCE KARAKTERISTIK KELUARGA MISKIN DENGAN STATUS GIZI ANAK USIA 0-24 BULAN DI WILAYAH KERJA PUSKESMAS MEDAN AMPLAS TAHUN 2019

The critical condition of the growth and development of a child aged 0 – 24 months is called a “critical period” because in this age the child undergoes very fast physical growth and brain development so that he needs good nutrition. Positive deviance is used to explain some factors which influence the growth and good nutrition status of children who live in poor families and in poor environment, where most of them undergo abnormal growth and development with malnutrition condition. 
 The objective of the research was to analyze factors influence the nutrition status of child aged 0 – 24 months by positive deviance in quantitative study with complement qualitative with a survey by cross sectional approach, to collect data of characteristic of family, characteristic of child and the behavior of parent in care the child and its influence to the nutrition status with positive deviance review and to study efforts of parent in order to increase the nutrition status of child aged 0 – 24 months in Amplas Puskesmas. The number of sample in this research for qualitative study is 100 respondents taken by proportional sampling method from 10 villages. The data were analyzed by using bivariate statistic analysis with Chi-square test in confidential level of 95% and multivariate analysis with logistic regression test with OR (CI 95%), and 5 mothers as informant for qualitative data. 
 The result of research showed that based on mother characteristic, child characteristic and mother’s behavior in taking care of child it was found from the results of statistic test that variables of education, occupation, birth weight, knowledge, attitude and interaction of mother and child have influence to the nutrition status of child aged 0 – 24 months from the poor family in AmplasPuskesmas, Districts Medan Amplas 2019 in which the dominant variable is a knowledge of mother with Exp (B) or Odd Ratio (OR) is 11.254 in Confidence Interval 95% in rage of 1.365 up to 52.754. 
 It is recommended to the local health office and Puskesmas to support the society/mothers in pay attention to the nutrition of the child and to increase the role of local posyandu to provide socialization, extension and counseling about the nutrition status of child that related to the nutrition status of child and to increase the knowledge of mother about health issue and how to care the child in order to increase the behavior and attitude of mother in maintain the nutrition status of child not based on education and occupation of the mother.