RESUMEN
On June 7, 2013, a man was diagnosed in a Texas hospital with rabies. He had been detained in a U.S. detention facility during his infectious period. To identify persons exposed to rabies who might require rabies postexposure prophylaxis (PEP), CDC and the Texas Department of State Health Services (DSHS) conducted investigations at four detention facilities, one medical clinic, and two hospitals. In all, 25 of 742 persons assessed for rabies exposure were advised to receive PEP. Early diagnosis of rabies is essential for implementation of appropriate hospital infection control measures and for rapid assessment of potential contacts for PEP recommendations.
Asunto(s)
Exposición a Riesgos Ambientales/efectos adversos , Prisiones , Rabia/diagnóstico , Adulto , Resultado Fatal , Guatemala/etnología , Humanos , Masculino , Profilaxis Posexposición , Práctica de Salud Pública , Rabia/prevención & control , Medición de Riesgo , TexasRESUMEN
OBJECTIVE: We analyzed and evaluated enhanced chronic hepatitis C virus (HCV) surveillance in New York City (NYC), which involved detailed investigations on a sample of newly reported HCV patients. METHODS: Beginning in July 2009, we generated a simple random sample bimonthly from all patients newly reported with a positive HCV test. We administered questionnaires to clinicians and patients to collect clinical and epidemiological information on patients diagnosed from April 2009 to January 2011 and evaluated the staff resources required to conduct enhanced surveillance. RESULTS: Of 205 patients meeting inclusion criteria, 40 (19.5%) tested HCV ribonucleic acid (RNA) negative. For the remaining 165 patients, questionnaires were completed by 164 clinicians (99.4%) and 77 patients (46.7%). Many patients (54.0%) were born between 1945 and 1964, and most patients were Hispanic (32.7%) or non-Hispanic black (32.7%). Common risk factors were injection (43.0%) and intranasal (33.9%) drug use. One-third of patients were diagnosed in nontraditional medical settings including substance abuse/detoxification centers (25.0%), jail/prison (6.7%), and psychiatric facilities (1.8%). Of 98 patients with positive HCV RNA tests, 38.8% were immune to hepatitis A and 39.8% were immune to hepatitis B. Investigators required approximately 3.5 hours to complete each investigation and averaged 50 days from assignment to completion. CONCLUSIONS: Although conducting enhanced HCV surveillance requires significant resources, investigating a representative sample provides detailed information about NYC's HCV population. Surveillance data have been used to plan educational initiatives for clinicians and patients, which may have led to increased awareness of HCV status, improved patient support, and better overall care.
Asunto(s)
Hepatitis C Crónica/epidemiología , Vigilancia de la Población/métodos , Adulto , Anciano , Femenino , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/etiología , Hepatitis C Crónica/inmunología , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Factores de Riesgo , Muestreo , Abuso de Sustancias por Vía Intravenosa/complicaciones , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Approximately 25% of Salmonella typhi infections in the US occur among nontravelers. Two S. typhi infections in a major US metropolitan city acquired domestically in 2005 were epidemiologically linked to a S. typhi-infected Haitian traveler through their congregation meetings. This investigation highlighted the importance of integrating multiple methods of obtaining epidemiologic information, including laboratory evidence and multiple individual and group interviews. Physicians should consider typhoid fever in their differential diagnosis in communities with close ties to endemic areas. Education of communities whose residents travel regularly to typhoid-endemic areas can reduce infection and transmission risk.