Screening Yield of HIV Antigen/Antibody Combination and Pooled HIV RNA Testing for Acute HIV Infection in a High-Prevalence Population

Although acute HIV infection contributes disproportionately to onward HIV transmission, HIV testing has not routinely included screening for acute HIV infection. To evaluate the performance of an HIV antigen/antibody (Ag/Ab) combination assay to detect acute HIV infection compared with pooled HIV RNA testing. Multisite, prospective, within-individual comparison study conducted between September 2011 and October 2013 in 7 sexually transmitted infection clinics and 5 community-based programs in New York, California, and North Carolina. Participants were 12 years or older and seeking HIV testing, without known HIV infection. All participants with a negative rapid HIV test result were screened for acute HIV infection with an HIV Ag/Ab combination assay (index test) and pooled human immunodeficiency virus 1 (HIV-1) RNA testing. HIV RNA testing was the reference standard, with positive reference standard result defined as detectable HIV-1 RNA on an individual RNA test. Number and proportion with acute HIV infections detected. Among 86,836 participants with complete test results (median age, 29 years; 75.0% men; 51.8% men who have sex with men), established HIV infection was diagnosed in 1158 participants (1.33%) and acute HIV infection was diagnosed in 168 participants (0.19%). Acute HIV infection was detected in 134 participants with HIV Ag/Ab combination testing (0.15% [95% CI, 0.13%-0.18%]; sensitivity, 79.8% [95% CI, 72.9%-85.6%]; specificity, 99.9% [95% CI, 99.9%-99.9%]; positive predictive value, 59.0% [95% CI, 52.3%-65.5%]) and in 164 participants with pooled HIV RNA testing (0.19% [95% CI, 0.16%-0.22%]; sensitivity, 97.6% [95% CI, 94.0%-99.4%]; specificity, 100% [95% CI, 100%-100%]; positive predictive value, 96.5% [95% CI, 92.5%-98.7%]; sensitivity comparison, P < .001). Overall HIV Ag/Ab combination testing detected 82% of acute HIV infections detectable by pooled HIV RNA testing. Compared with rapid HIV testing alone, HIV Ag/Ab combination testing increased the relative HIV diagnostic yield (both established and acute HIV infections) by 10.4% (95% CI, 8.8%-12.2%) and pooled HIV RNA testing increased the relative HIV diagnostic yield by 12.4% (95% CI, 10.7%-14.3%). In a high-prevalence population, HIV screening using an HIV Ag/Ab combination assay following a negative rapid test detected 82% of acute HIV infections detectable by pooled HIV RNA testing, with a positive predictive value of 59%. Further research is needed to evaluate this strategy in lower-prevalence populations and in persons using preexposure prophylaxis for HIV prevention

Data capture and visualization for a canine influenza outbreak — New York City, 2018

ObjectiveThe objectives of this project were to rapidly build and deploy a web-based reporting platform in response to a canine influenza H3N2 outbreak in New York City (NYC) and provide aggregate data back to the veterinary community as an interactive dashboard.IntroductionData-driven decision-making is a cornerstone of public health emergency response; therefore, a highly-configurable and rapidly deployable data capture system with built-in quality assurance (QA; e.g., completeness, standardization) is critical.1 Additionally, to keep key stakeholders informed of developments during an emergency, data need to be shared in a timely and effective manner. Dynamic data visualization is a particularly useful means of sharing data with healthcare providers and the public.2During Spring 2018, detection of canine influenza H3N2 among dogs in NYC caused concern in the veterinary community. Canine influenza is a highly contagious respiratory infection caused by an influenza A virus.3 However, no central database existed in NYC to monitor the outbreak and no single agency was responsible for data capture. Our team at the NYC Department of Health and Mental Hygiene (DOHMH) partnered with the NYC Veterinary Medical Association (VMA) to monitor the canine influenza H3N2 outbreak by building a web-based reporting platform and interactive dashboard.MethodsThe NYC DOHMH built and deployed a web-based reporting platform to aid veterinarians in reporting cases of canine influenza. We leveraged REDCap Cloud, a cloud-based graphical user interface data capture and management software. REDCap Cloud collected information regarding the provider, owner, dog, residence of dog, illness history, and influenza testing. We leveraged REDCap QA functionality in the form of mandatory questions to ensure data completeness. Several different field types — including dropdown menus, mutually exclusive radio buttons, and multi-select check boxes — were used to ensure data standardization. Skip logic was incorporated to guide users through unique sequences of questions based on the answers they entered. Reporting was voluntary.ResultsAfter requirements were gathered, the REDCap web-based reporting platform was rapidly deployed in approximately two business days. Over the course of one week, multiple versions of the dashboard were produced and the final iteration was completed. The entire system was built on server-side software that is available as free or open-source for individual licenses. The dashboard can be found at the following link: http://www.vmanyc.org/canine_influenza_dashboard.html.A total of 28 cases were reported by 6 providers during June–August 2018. All of the 28 cases were reported from 2 of the 5 NYC counties (boroughs); 17/28 (60.7%) were reported from Brooklyn and 11/28 (39.3%) were reported from Manhattan. We were able to collect mostly complete data by leveraging REDCap QA functionality. The reporting facility was listed in all cases, and an owner was listed in all but two cases. All reported cases used a PCR test for the detection of canine influenza H3N2. One reported case indicated polymerase chain reaction (PCR) test results as “not detected” which suggests that one negative case was reported through the system.ConclusionsUsing REDCap Cloud and R, we were able to rapidly build and deploy a web-based reporting platform and dynamic data visualization during an emergency response to an outbreak of canine influenza H3N2. Our system was used by veterinarians to report 28 cases of canine influenza. Future emergency responses for human disease outbreaks will likely benefit from the experience our team gained during our partnership with the NYC VMA.References1. Centers for Disease Control and Prevention. Public Health Emergency Response Guide for State, Local, and Tribal Public Health Directors. https://emergency.cdc.gov/planning/pdf/cdcresponseguide.pdf.2. Meyer M. The Rise of Healthcare Data Visualization. http://journal.ahima.org/2017/12/21/the-rise-of-healthcare-data-visualization/.3. American Veterinary Medical Association. Canine Influenza FAQ. https://www.avma.org/KB/Resources/FAQs/Pages/Control-of-Canine-Influenza-in-Dogs.aspx.4. Wickham H. R packages. http://r-pkgs.had.co.nz/

Community-setting pneumonia-associated hospitalizations by level of urbanization-New York City versus other areas of New York State, 2010-2014.

BackgroundNew York City (NYC) reported a higher pneumonia and influenza death rate than the rest of New York State during 2010-2014. Most NYC pneumonia and influenza deaths are attributed to pneumonia caused by infection acquired in the community, and these deaths typically occur in hospitals.MethodsWe identified hospitalizations of New York State residents aged ≥20 years discharged from New York State hospitals during 2010-2014 with a principal diagnosis of community-setting pneumonia or a secondary diagnosis of community-setting pneumonia if the principal diagnosis was respiratory failure or sepsis. We examined mean annual age-adjusted community-setting pneumonia-associated hospitalization (CSPAH) rates and proportion of CSPAH with in-hospital death, overall and by sociodemographic group, and produced a multivariable negative binomial model to assess hospitalization rate ratios.ResultsCompared with non-NYC urban, suburban, and rural areas of New York State, NYC had the highest mean annual age-adjusted CSPAH rate at 475.3 per 100,000 population and the highest percentage of CSPAH with in-hospital death at 13.7%. NYC also had the highest proportion of CSPAH patients residing in higher-poverty-level areas. Adjusting for age, sex, and area-based poverty, NYC residents experienced 1.3 (95% confidence interval [CI], 1.2-1.4), non-NYC urban residents 1.4 (95% CI, 1.3-1.6), and suburban residents 1.2 (95% CI, 1.1-1.3) times the rate of CSPAH than rural residents.ConclusionsIn New York State, NYC as well as other urban areas and suburban areas had higher rates of CSPAH than rural areas. Further research is needed into drivers of CSPAH deaths, which may be associated with poverty

Avian Influenza A(H7N2) Virus in Human Exposed to Sick Cats, New York, USA, 2016

An outbreak of influenza A(H7N2) virus in cats in a shelter in New York, NY, USA, resulted in zoonotic transmission. Virus isolated from the infected human was closely related to virus isolated from a cat; both were related to low pathogenicity avian influenza A(H7N2) viruses detected in the United States during the early 2000s