Public Health Coordination Research Articles

Downward trend in male reproductive health and fertility in Eastern Iran.

This study aimed to assess the ten-year trend in semen quality among couples referred to the Infertility Center in Kerman between 2008 and 2017. The study included 2952 semen samples from men 18 to 60 years old referred to the infertility center as infertile couples living in Kerman province, Iran, whether they had normal or abnormal semen analysis. A total of 2952 sperm samples were included. Statistically significant changes were observed in semen parameters. Particularly, significant changes were observed for volume (-0.08 mL/year), sperm concentration (-2.34 (mio/mL)/year), total sperm count (-13.17 (mio/ejaculate)/year), progressive motility (-2.62%/year), non-progressive motility (-0.59%/year), immotile sperm (2.49%/year), and normal morphology (-0.134%/year). In bivariate analysis, the prevalence of oligozoospermia in this study showed a statistically significant association with age (OR = 1.019; 95% CI = 1.007-1.032; p = 0.003). Likewise, there was a statistically significant association with the year (OR = 1.087; 95% CI = 1.050-1.125; p = 0.000). Semen quality parameters showed a downtrend during the last 10 years in this study, emphasizing the importance of male reproductive health monitoring and warning public health coordinators to pay more attention to this important issue.

The Role of Chief Medical officers in making Public Health Overview Documents in Norwegian Municipalities. A qualitative Study

AimsTo investigate how Chief Medical Officers experience their role in the municipalities´ work with making the public health overview documents, demanded by the Norwegian Public Health Act from 2012.MethodsA qualitative study with semi-structured focus group interviews with 21 Chief Medical Officers from 20 different municipalities in Norway. The interviews were conducted in 2017. The data were analyzed thematically.ResultsThe Chief Medical Officers were mainly positive to participating in making public health overview documents. They took on roles as leaders of the work, medical advisors, data collectors towards local GPs and listening post to other sectors. Organizational factors like too small positions and a lack of tradition to involve the CMO in public health work were experienced as barriers to their involvement. The collaboration with the public health coordinators was said to be rewarding, and the intersectoral process involved employees from other sectors in a new way in public health. Although there were some positive experiences, several CMOs considered the use and impact of the public health overview document as limited.ConclusionThere was a large variation in the amount and the type of involvement the Chief Medical Officers had in making the public health overview documents in Norwegian municipalities. More research is needed to understand if this has any consequences for the quality of public health work in the municipalities and whether it is a sign of a changing role of the Chief Medical Officers.

Evaluation of BIZI, a new Spanish-language online program for community-based suicide preventionAvaliação do BIZI, um novo programa on-line em espanhol para prevenção de suicídio com base na comunidade

To evaluate the BIZI program, a Spanish-language gatekeeper training program with a novel online self-learning format that is brief and open-access. It was developed as part of the suicide prevention strategy in Euskadi (Spain) to improve community-based suicide prevention. A group of experts from different fields created the program and tested its usability in a preliminary phase. A single-group design was used for the evaluation, with repeated measurements (before, immediately after, and after three months). Online questionnaires were used to evaluate the program's impact on core competencies for gatekeepers, as well as adherence to content and user satisfaction. Community agents (educators and social workers, among others) who responded to an invitation sent by regional public health coordinators were included in the study. In total, 728 people accessed the training, and 86% completed it; 569 people completed the assessment (81.2% women, mean age 41.4 years). The core gatekeeper competencies of attitude, self-efficacy, and knowledge improved significantly, and improvement was sustained ≥3 months in a subsample (P = 0.0001). The results are promising and suggest that BIZI is useful in improving the capacity and willingness of community agents to identify people at risk and refer them to specialized resources. Its novel format gives it important advantages over other more common gatekeeper training programs, facilitating its dissemination in low-resource environments. It is the first program of its kind whose effectiveness has been demonstrated and also the first available in Spanish.

A Case of Multidrug-Resistant Tuberculosis in an Active Duty Military Health Care Worker.

Cases of active tuberculosis (TB) in the U.S. Military have fallen over the last century in large part due to improved screening and treatment options. The subset of multidrug-resistant TB (MDR-TB) is almost nonexistent within the U.S. Military. We present a case of MDR-TB in an active duty U.S. Military health care worker and discuss several considerations for treatment that may present challenges for U.S. Military medical practitioners. A 30-year-old active duty Soldier was referred to Army public health services after a bronchoscopy sample was positive for Mycobacterium tuberculosis complex. Sputum smears were negative for acid-fast bacilli, suggesting lower risk for community spread. One month after initiation of the standard 4-drug regimen for active TB, genetic susceptibility testing found the patient's M. tuberculosis isolate to be resistant to rifampin, isoniazid, and pyrazinamide. Contact investigation efforts among co-workers and family members fortunately found no new interferon-gamma release assay conversions. Coordination of public health assets to ensure a successful treatment regimen occurred across varied local, state, and federal agencies. Atypical medications required coordination with the FDA for procurement. An extensive surveillance plan for medication adverse effects was required. Finally, questions of public health authority versus patient autonomy arose requiring multidisciplinary input and ethical discussions.

Development, piloting, and dissemination of a suicide prevention brief online course for non-health professionals

Introduction: The use of online gatekeeper training resources facilitates the dissemination of useful knowledge and skills for suicide prevention with an integrated care perspective and a focus in the community, especially in a context of a pandemic and of limited human and economic resources. 
 Aim: To develop and evaluate the impact of a short online gatekeeper training course in Spanish for non-health professionals in the community. To disseminate the course among this group of professionals as a free and easy to access online resource. 
 Methods: An expert panel developed the training after the review of the evidence and available programs. Evaluation was carried out in two phases (Pilot 1&2). In the 2nd pilot a greater variety of professional fields was included and the evaluation questionnaire was shortened. In both cases, a single group design of repeated measures (before, immediate post and 3 months post) was used as well as a one-factor analysis of variance with repeated measures. Participants responded to an ad-hoc online questionnaire which evaluated satisfaction, knowledge, self-confidence (pilot 1&2), and attitudes (pilot 2). We consecutively recruited all interested professionals in the community who responded to an invitation email sent by the public health coordinators in the counties. A dissemination plan in 4 stages has been developed in coordination with Public Health coordinators. 
 Results: Sample for the pilot was made up of 272 (53+219) professionals. Improvements in self-confidence, knowledge about suicide and attitudes were found, with statistically significant differences. Overall satisfaction with the training was 8.5 out of a maximum of 10. The dissemination phase is now starting. The aim is to reach as many professionals working with vulnerable groups as possible. Results of this phase will be available by May 2023. 
 Conclusions: Results of the evaluation pilot are promising and suggest the usefulness of this training to improve professionals' self-confidence and knowledge about suicide prevention. The challenge is to make this training available to the greatest possible number of community professionals.

Cross-border collaboration and capacity-building for improved health emergency response planning in Southern Africa

Background Many countries were ill prepared for the COVID-19 pandemic and the sudden border closures introduced to stem contagion. To address this planning and response gap, Health Systems Trust and the US Centers for Disease Control and Prevention’s Division of Global Migration and Quarantine jointly implemented a capacity-building project among eight Southern African countries during 2022. The intention was to strengthen collaboration among the countries in implementing public health emergency response strategies. Shared analysis of cross-border movement patterns, and building neighbouring countries’ capacity to identify priority areas for such response planning, strengthened relationships for communicating health risks and events. Approach This chapter presents findings from project participants’ perspectives on whether and how the project supported improved regional collaboration for emergency responses to public health events, and their perceptions of how the project strengthened their border health systems. Country delegates were convened in multi-sectoral regional and sub-regional meetings and workshops to facilitate cross-border public health information-sharing and co-ordination, and to align surveillance for emergency preparedness and response. They drafted procedures to: strengthen cross-border and multi-sectoral communication; prioritise points of entry for cross-border co-ordination; map population movement patterns; and identify national and regional border health priorities. Training focused on points of entry to enhance planning for future disease outbreaks by introducing the Population Connectivity Across Borders Toolkit for analysing population movement data to guide the design of public health interventions. Conclusions Collaboration with global and regional institutions strengthened the countries’ ability to comply with International Health Regulations in responding to communicable disease outbreaks. The outcomes indicate that sustained engagement, refinement of standard operating procedures, and multilateral agreements that ensure balancing of country priorities with global health requirements, can be achieved. Continued analysis of and reflection on country work plans are needed to assess similarities and differences in priority identification, which will guide future training and development of regional strategies to build stronger border health systems.

Knowledge, attitude, and behavioral intention about oral cancer among public health students in Southeast Georgia

Oral cancer (OC) is a significant public health problem; however, the degree to which the future public health workforce is aware of this issue is not well researched. The purpose of this study is to explore the level of knowledge, attitudes, and behavioral intentions about OC among public health students.A sequential exploratory mixed-method research design was employed for this study. Using quantitative and qualitative measures, a survey was administered to 129 public health students. Subsequently, to understand the quantitative findings, two follow-up focus groups were conducted with survey participants.We found that participants had some knowledge about OC risk factors, but they were not aware of survival rate of it. About 58.9% of the participants responded the survival rate for OC is ‘more than 61%’. The majority of the respondents (67%) had never heard about OC exams. In the focus group, four major themes were identified: lack of knowledge, strategies to educate the community about OC, current public health practices around OC prevention, and role of public health professionals in this. Participants felt the need for collaboration between oral health and public health to raise awareness about OC in the community.Participants’ knowledge and awareness about OC was encouraging but at the same time, it raised a concern about their competency in OC prevention interventions. Ensuring holistic oral health education through the coordination of public health and oral healthcare services can play a critical role in preparing future public health workforce for OC prevention.

The role of organisational resources for integrating health surveillance data into municipal action in Norway

ABSTRACT Making sure that health surveillance data are integrated into public health planning and decision-making is demanding. Politicians and their administration may lack knowledge, interest, or will to take it into account. Politics is at its core solution-driven, and this need for imminent action may outweigh the importance of solid knowledge. This paper focuses on Norwegian municipalities and fleshes out two factors that may provide an enabling environment for educating relevant personnel in health surveillance data; i) the existence of a public health coordinator and ii) the set-up of inter-sectoral working groups. We have anticipated that those organisational resources play an important role in linking the bodies of information provided in the municipalities’ health surveillance document ; the municipal health profile ; and the health promotion priorities. The findings confirm the anticipated centrality of organisational resources. Having dedicated and inter-sectoral organizational resources working as boundary spanners – such as public health coordinators – is decisive to meeting the demands of current public health challenges. Moreover, dedication is useless unless there is a critical volume of the coordinator’s work. It is only when she/he is in a full position that the profile is fully integrated. The study further identifies other conducive conditions for integration. For example, does knowledge on health determinants resides not only in statistical data, but also in qualitative experiences of people and professional practitioners. Of interest for further research is to explore how to educate such organisations to integrate such experiences into health promotion action.

Carbapenem-Resistant Actinetobacter Baumannii Transmission Containment in a Ventilator Skilled Nursing Facility

Background Actinetobacter baumannii are Gram-negative bacteria that can cause urinary, bloodstream, lung, wound, and other infections. In August 2020, the Louisiana Department of Health (LDH) was notified of three patients who were infected with carbapenem-resistant A. baumannii and were hospitalized at an acute care hospital within four weeks. They originated from the same ventilator skilled nursing facility (vSNF). LDH epidemiologists initiated a response consistent with CDC's national containment strategy to combat antibiotic resistant threats. Methods An in-person infection control assessment and response (ICAR) survey with rounding was conducted within five days of notification of the cluster. Interim infection control recommendations included implementing a policy for the removal of gel polish and acrylic nails, auditing of environmental cleaning practices, and reinforcing infection control competencies. Isolates were forwarded to the CDC Southeast Antibiotic Resistance Laboratory (ARLN) for pulse field gel electrophoresis and enhanced sensitivity testing. The facility agreed to colonization screening for the ventilator unit where all of the cases were previously housed. Swabs shipment was coordinated, and candidate screening patients were identified. Results Preliminary comparisons of antibiotic sensitivity results of cases showed similar resistance patterns for nine antibiotics, of which one was a carbapenem (meropenem). Two of the three index cases were confirmed for pan-resistant A. baumannii and positive for the OXA-23 gene on the CDC assay from respiratory and bronchiolar lavage specimens. Two rounds of colonization screenings were conducted greater than two weeks apart among four testing candidates each. No additional cases of A. baumannii, or any other multi drug-resistant pathogen, were identified. Conclusions Swift public health coordination is necessary for the containment of multi drug-resistant threats when introduced into congregate healthcare settings. While colonization screening results for this facility were encouraging, infection control recommendations and policy interventions were needed to prevent the spread of additional pathogens among vulnerable ventilated and non-ventilated patients. Actinetobacter baumannii are Gram-negative bacteria that can cause urinary, bloodstream, lung, wound, and other infections. In August 2020, the Louisiana Department of Health (LDH) was notified of three patients who were infected with carbapenem-resistant A. baumannii and were hospitalized at an acute care hospital within four weeks. They originated from the same ventilator skilled nursing facility (vSNF). LDH epidemiologists initiated a response consistent with CDC's national containment strategy to combat antibiotic resistant threats. An in-person infection control assessment and response (ICAR) survey with rounding was conducted within five days of notification of the cluster. Interim infection control recommendations included implementing a policy for the removal of gel polish and acrylic nails, auditing of environmental cleaning practices, and reinforcing infection control competencies. Isolates were forwarded to the CDC Southeast Antibiotic Resistance Laboratory (ARLN) for pulse field gel electrophoresis and enhanced sensitivity testing. The facility agreed to colonization screening for the ventilator unit where all of the cases were previously housed. Swabs shipment was coordinated, and candidate screening patients were identified. Preliminary comparisons of antibiotic sensitivity results of cases showed similar resistance patterns for nine antibiotics, of which one was a carbapenem (meropenem). Two of the three index cases were confirmed for pan-resistant A. baumannii and positive for the OXA-23 gene on the CDC assay from respiratory and bronchiolar lavage specimens. Two rounds of colonization screenings were conducted greater than two weeks apart among four testing candidates each. No additional cases of A. baumannii, or any other multi drug-resistant pathogen, were identified. Swift public health coordination is necessary for the containment of multi drug-resistant threats when introduced into congregate healthcare settings. While colonization screening results for this facility were encouraging, infection control recommendations and policy interventions were needed to prevent the spread of additional pathogens among vulnerable ventilated and non-ventilated patients.

Governing a pandemic: A case study of South Africa’s coordination and management structures used to respond to the COVID-19 pandemic

During a public health emergency, coordination and management are essential for ensuring timeous, decisive, and harmonised leadership. In this paper, the governance structures utilised in South Africa (SA) during the COVID-19 pandemic are recorded and the key strengths and weaknesses of response in the country are discussed. A qualitative methodology is used for the case study and comprises insights from stakeholders who were at the forefront of SA’s response as well as from documentation that was used to guide the response. Structured, transparent, science-based and agile coordination and management systems are necessary to gain the public’s trust during a public health emergency. This case study contributes to the literature on governing a pandemic and shares lessons learned from the COVID-19 response. The lessons learned by the stakeholders within the SA governance structures can be leveraged in future public health emergencies within SA and other low- and middle-income countries.

Prioritizing Global Public Health Investments for COVID-19 Response in Real Time: Results from a Delphi Exercise.

In the first months of the COVID-19 pandemic, there was a lack of guidance on how to channel the unprecedented amount of health financing toward the pandemic response. We employed a multistep, interactive Delphi process to reach consensus on a “menu” of priority COVID-19 response interventions. In all, 27 health security experts—representing national governments, bilateral and multilateral organizations, academia, technical agencies, and nongovernmental organizations—participated in the exercise. The experts rated 11 technical investment areas and 37 interventions on a 5-point scale in terms of their importance to COVID-19 response. Initial findings were discussed at a virtual meeting where experts suggested modifications. A group of 19 experts then rated a revised list of 11 technical areas and 39 interventions. Consensus was defined as at least 80% of experts agreeing on the importance of a technical area or intervention; stability of scores across the rounds was identified using Wilcoxon matched-pairs and unpaired signed rank tests. Between the initial and final menu, 3 technical areas and 7 interventions were slightly modified, 3 interventions were added, and 1 intervention was removed. Consensus was reached on all 11 technical areas and 35 of the final 39 interventions, and between 34 and 37 interventions were stable across rounds depending on the test used. In this exercise, the health security experts agreed that COVID-19 response financing should prioritize interventions that enhance a country's capacity to test, trace, and treat high-risk populations. Simultaneously, supportive systems (eg, risk communication, community engagement, public health infrastructure, information systems, policy and coordination, workforce capacity, other social protections) should be developed to ensure that nonpharmaceutical and medical interventions can maximize the effectiveness of these systems.

Ambivalence towards the Protection of Refugee Children: A Developmental Relational Approach.

In this paper we analyze the contemporary ambivalence to child migration identified by Jacqueline Bhabha and propose a developmental relational approach that repositions child refugees as active participants and rights-bearers in society. Ambivalence involves tensions between protection of refugee children and protection of national borders, public services and entrenched images. Unresolved ambivalence supports failures to honor the rights of refugee children according to international law and the UN Convention on the Rights of the Child. There is failure to protect and include them in national public services and in international coordination of public health and wellbeing. We identify misrepresentations of childhood and refugeeness that lie behind ambivalence and the equitable organization and delivery of public services for health and wellbeing. With illustrative studies, we propose a developmental relational framework for understanding refugee children’s contributions in the sociocultural environment. Contrary to the image of passive victims, refugee children interact with other people and institutions in the co-construction of situated encounters. A developmental relational understanding of children’s ‘co-actions’ in the social environment provides a foundation for addressing misrepresentations of childhood and refugeeness that deny refugee children protection and inclusion as rights-bearers. We point to directions in research and practice to recognize their rights to thrive and contribute to society.

Surveillance and laboratory collaboration in response to an outbreak of Vibrio parahaemolyticus, Plesiomonas shigelloides, and Aeromonas hydrophila in Sekondi-Takoradi, Ghana: a case series

BackgroundThe detection of epidemic-prone pathogens is important in strengthening global health security. Effective public health laboratories are critical for reliable, accurate, and timely testing results in outbreak situations. Ghana received funding as one of the high-risk non-Ebola affected countries to build and strengthen public health infrastructure to meet International Health Regulation core capacities. A key objective was to build laboratory capacities to detect epidemic-prone diseases.Case presentationIn June 2018, a local hospital received eight patients who presented with acute diarrhea. A sample referral system for Ghana has not been established, but the Sekondi Zonal Public Health Laboratory staff and mentors collaborated with Disease Surveillance Officers (DSOs) to collect, package, and transport stool specimens from the outbreak hospital to the Public Health Laboratory for laboratory testing. The patients included seven females and one male, of Fante ethnicity from the Fijai township of Sekondi-Takoradi Municipality. The median age of the patients was 20 years (interquartile range: 20–29 years). Vibrio parahaemolyticus was identified within 48 hours from four patients, Plesiomonas shigelloides from one patient, and Aeromonas hydrophila from another patient. There was no bacteria growth from the samples from the two other patients. All patients were successfully treated and discharged.ConclusionThis is the first time these isolates have been identified at the Sekondi Zonal Public Health Laboratory, demonstrating how rapid response, specimen transportation, laboratory resourcing, and public health coordination are important in building capacity towards achieving health security. This capacity building was part of the United States Centers for Disease Control and Prevention engagement of international and local partners to support public health laboratories with supplies, diagnostic equipment, reagents, and logistics.

‘Health in All Policies’ and the Urge for Coordination: The Work of Public Health Coordinators and Their Impact and Influence in Local Public Health Policies: A Cross-Sectional Study

Building heavily on the Health in All Policies (HiAP) approach, Norway implemented the Public Health Act in 2012 to reduce social inequalities in health. Local public health coordinators (PHCs) at municipal levels were seen as tools to provide local intersectoral public health work. In this study, we examine factors related to intersectoral agency and if intersectoral work is understood as relevant to securing social justice in local policy outcomes. A national web-based survey in 2019 of all Norwegian PHCs (n = 428) was conducted with a response rate of 60%. Data were analysed through multiple linear regression, hierarchical regression modelling and structural equation modelling. Neither factors relating to community contexts nor individual characteristics were associated with intersectoral agency. Organisational factors, especially position size, being organised at the top level and having a job description, were significantly associated with perceptions of intersectoral agency. PHCs seeing themselves as intersectoral agents also found themselves able to affect annual budgets and policy outcomes. We conclude that municipal PHC positions can be important HiAP tools in local public health policies. However, organisational factors affect how PHCs perceive their influence and role in the municipal organisation and thereby their possibilities to influence local policymaking through intersectoral agency.

BELUM TERCAPAINYA INDIKATOR STANDAR PELAYANAN MINIMAL PROGRAM KESEHATAN IBU DAN ANAK (KIA) Studi Kualitatif di Puskesmas Sei Rampah, Kabupaten Serdang Bedagai, Tahun 2021)

The purpose of this research is to explore more deeply about all matters related to the lack Minimum Service Standards (MSS) indicators for Maternal and Child Health Program (KIA) at Sei Rampah Public Health Center, Serdang Bedagai Regency. This research is a qualitative research. The research instrument is the researcher himself who is subjective, so the data obtained is checked for validity using the triangulation technique, namely by extending the time ,source triangulation and triangulation of data collection methods. The informant is the head of the public health center, Coordinator midwives, implementing midwives, nurses and pregnant mother. Data analysis was carried out using the Miles and Hubberman method. The results of research showed the indicators for the Minimum Service Standards for the Maternal and Child Health Program (KIA) at the Sei Rampah Health Center had not reached the 100% target and the lowest indicator coverage was the Indicator Detection of Risk Factors and Complications 17,3%. The reason for not achieveing the SPM for KIA program because the People are hesitant to check their health at the Public health center during the Covic-19 pandemic. The efforts made by the Public health centre management are by increasing the number of midwives, doing home-care, providing information to the community, either by banners or leaflet about the implementation of health services at the puskesmas, carrying out health shipping in accordance with the Covid 19 health protocol procedures. This study produces a Theoritical Framework based on results of data collection, processing and analysis.

An Investigation into the Bill Part of Healthcare Professional in Clinical Health during COVID-19 Lockdown

In December 2019, a new coronavirus outbreak was recorded in Wuhan, China. This has expanded across the world to date, posing a host of major obstacles for healthcare professionals. They have been on the front lines of the epidemic reaction, and as a result, they are vulnerable to a variety of risks, including a significant risk of complications. Long and erratic duty periods in a highly restricted setting will lead to elevated anxiety levels and, eventually, burnout. HCWs can experience fear, hyperarousal, sleep disruption, unwanted recollections and memories, distress, and sadness as a result of seeing physical pain and mortality of patients with an immediate threat to one's protection. They will experience several external stress factors in the coming weeks and months. It is critical that concerted attempts are taken to reduce the pandemic's effects. To plan for a pandemic or some other public health crisis, psychological assistance, encouragement, and coordination are necessary. Pandemic readiness is a scarce financial and technological capability in developing countries. They still encounter several special and complex challenges, making pandemic preparedness much more challenging. This article discusses the problems posed by HCWs in developed countries during pandemics such as Covid-19, and also the steps required to protect workplace protection and psychological fellow human.

An Investigation into the Bill Part of Healthcare Professional in Clinical Health during COVID-19 Lockdown

In December 2019, a new coronavirus outbreak was recorded in Wuhan, China. This has expanded across the world to date, posing a host of major obstacles for healthcare professionals. They have been on the front lines of the epidemic reaction, and as a result, they are vulnerable to a variety of risks, including a significant risk of complications. Long and erratic duty periods in a highly restricted setting will lead to elevated anxiety levels and, eventually, burnout. HCWs can experience fear, hyperarousal, sleep disruption, unwanted recollections and memories, distress, and sadness as a result of seeing physical pain and mortality of patients with an immediate threat to one's protection. They will experience several external stress factors in the coming weeks and months. It is critical that concerted attempts are taken to reduce the pandemic's effects. To plan for a pandemic or some other public health crisis, psychological assistance, encouragement, and coordination are necessary. Pandemic readiness is a scarce financial and technological capability in developing countries. They still encounter several special and complex challenges, making pandemic preparedness much more challenging. This article discusses the problems posed by HCWs in developed countries during pandemics such as Covid-19, and also the steps required to protect workplace protection and psychological fellow human.

Penyebaran Penyakit Brucellosis di Wilayah Koasistensi Administrasi Dinas dan Kesmavet

Brucellosis is a Brucella bacterial infectious disease that is spread from animals to humans, generally through consumption of milk, especially unpasteurized milk, or other dairy products. Veterinary public health has an important role in preventing transmission of disease to humans through both animals and foodstuffs of animal origin or other animal origin ingredients. Brucellosis is one of the problems often faced by the Animal Husbandry Department, especially at the Animal Health Unit. Handling and controlling about Brucellosis is very vital to maintain animal health and reduce the level of economic losses of farmers due to Brucellosis experienced by livestock owned. This study aims to determine the spread of Brucellosis disease by mapping in the Administrative and Service Coordination areas, to know the handling and control actions carried out by the Animal Husbandry Service throughout the implementation of the Administrative Coordination Office and Veterinary Public Health. The results of the mapping of the spread of Brucellosis in the District of Veterinary Public Health and Public Service Administration Coordination can be divided into 3 groups with the number of cases <10, 10 - 66, and> 66. The number of cases between the range of 10 - 66 there are 3 regions, while the number of cases> 66 there are 2 regions. Keywords : Brucellosis; Mapping; Handling and Control; Descriptive Statistics

Multidisciplinary Community-Based Investigation of a COVID-19 Outbreak Among Marshallese and Hispanic/Latino Communities - Benton and Washington Counties, Arkansas, March-June 2020.

By June 2020, Marshallese and Hispanic or Latino (Hispanic) persons in Benton and Washington counties of Arkansas had received a disproportionately high number of diagnoses of coronavirus disease 2019 (COVID-19). Despite representing approximately 19% of these counties' populations (1), Marshallese and Hispanic persons accounted for 64% of COVID-19 cases and 57% of COVID-19-associated deaths. Analyses of surveillance data, focus group discussions, and key-informant interviews were conducted to identify challenges and propose strategies for interrupting transmission of SARS-CoV-2, the virus that causes COVID-19. Challenges included limited native-language health messaging, high household occupancy, high employment rate in the poultry processing industry, mistrust of the medical system, and changing COVID-19 guidance. Reducing the COVID-19 incidence among communities that suffer disproportionately from COVID-19 requires strengthening the coordination of public health, health care, and community stakeholders to provide culturally and linguistically tailored public health education, community-based prevention activities, case management, care navigation, and service linkage.

Characterization of community-wide transmission of SARS-CoV-2 in congregate living settings and local public health-coordinated response during the initial phase of the COVID-19 pandemic.

BackgroundClusters of COVID‐19 cases amplify the pandemic and are critical targets for intervention, but comprehensive cluster‐level data are not collected systematically by federal or most state public health entities. This analysis characterizes COVID‐19 clusters among vulnerable populations housed in congregate living settings across an entire community and describes early mitigation efforts.MethodsThe Cuyahoga County Board of Health identified and interviewed COVID‐19 cases and exposed contacts, assessing possible connections to congregate living facilities within its jurisdiction from March 7, 2020, to May 15, 2020, during the first phase of the pandemic, while state of Ohio stay‐at‐home orders were in effect. A multi‐disciplinary team‐based response network was mobilized to support active case finding and develop facility‐focused containment strategies.ResultsWe identified a cascade of 45 COVID‐19 clusters across community facilities (corrections, nursing, assisted living, intermediate care, extended treatment, shelters, group homes). Attack rates were highest within small facilities (P < .01) and large facilities requiring extensive support to implement effective containment measures. For 25 clusters, we identified an index case who frequently (88%) was a healthcare worker. Engagement of clinical, community, and government partners through public health coordination efforts created opportunities to rapidly develop and coordinate effective response strategies to support the facilities facing the dawning impact of the pandemic.ConclusionsActive cluster investigations can uncover the dynamics of community transmission affecting both residents of congregate settings and their caregivers and help to target efforts toward populations with ongoing challenges in access to detection and control resources.