9 research outputs found

    Expanding U.S. Unintentional Drug Overdose Surveillance Using Novel Data Sources and Analyses

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    Unintentional drug overdose is a persistent and pervasive public health threat in the U.S. The current epidemic is driven mainly by opioids, especially synthetic opioids like fentanyl. However, the landscape of drug use is constantly shifting, with novel substances emerging and old threats, such as cocaine and psychostimulants, re-emerging. Additionally, overdose is preventable through harm reduction, supply interruption, addiction treatment, and other means of reducing drug use or making drug use safer. Public health requires tools to monitor these changes and even better, to predict what will happen next, in order to prevent overdose and other adverse effects of drug use. While current surveillance for overdose has evolved rapidly in a short time, gaps remain, mainly in the areas of timeliness and specificity. The studies in this dissertation attempt to fill these surveillance gaps. The first study introduces methods for analyzing a novel laboratory drug testing data source. This data source includes results from a large commercial clinical laboratory system with testing sites throughout the country. This system performs drug tests for a variety of reasons, including therapeutic and pain medication monitoring, addiction treatment, workplace testing, and prenatal and neonatal testing. Drug category positivity stratified by age, sex, and reason for order from the first year of available data are presented, along with a discussion of the best uses and limitations. The second study uses the same data set for a spatial analysis of counties in the U.S. Positivity rates for four drug categories are presented for the U.S. and selected states; hotspots of positivity are also identified. And finally, the third study explores the utility for predicting overdose mortality of a forecasting model that is typically used for short-term forecasts for infectious disease outbreaks. Forecasting future overdose activity is essential for public health to outmaneuver an epidemic that does not seem to be slowing down. The findings from these three studies will fill gaps for surveillance efforts by incorporating a new data source and new analyses that can be used to provide public health professionals with tools needed for timely situational awareness. This will ideally lead to more effective implementation of evidence-based interventions to prevent overdose

    The Evolution of the WHO/NREVSS Influenza Surveillance System: The Challenges and Opportunities that Accompany Electronic Laboratory Data

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    The WHO/NREVSS Influenza laboratory surveillance system has been in use for ~40 years. Through multiple reporting methods, partner labs can share their influenza laboratory testing data to the Influenza Divsion at CDC. Over time, this system has evolved in complexity, and the most recent enhancement has been the addition of HL7 laboratory messaging through the Public Health Laboratory Interoperability Project. This reporting has been challenging to implement, but  has added great value to the system, including an increased potential for new data analyses, increased functionality, and a braoder use of the resulting data

    The Evolution of the WHO/NREVSS Influenza Surveillance System: The Challenges and Opportunities that Accompany Electronic Laboratory Data

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    The WHO/NREVSS Influenza laboratory surveillance system has been in use for ~40 years. Through multiple reporting methods, partner labs can share their influenza laboratory testing data to the Influenza Divsion at CDC. Over time, this system has evolved in complexity, and the most recent enhancement has been the addition of HL7 laboratory messaging through the Public Health Laboratory Interoperability Project. This reporting has been challenging to implement, but  has added great value to the system, including an increased potential for new data analyses, increased functionality, and a braoder use of the resulting data

    Patterns and characteristics of methamphetamine use among adults- United States, 2015-2018.

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    Methamphetamine is a highly addictive central nervous system stimulant. Methamphetamine use is associated with a range of health harms, including psychosis and other mental disorders, cardiovascular and renal dysfunction, infectious disease transmission, and overdose (1,2). Although overall population rates of methamphetamine use have remained relatively stable in recent years (3), methamphetamine availability and methamphetamine-related harms (e.g., methamphetamine involvement in overdose deaths and number of treatment admissions) have increased in the United States* (4,5); however, analyses examining methamphetamine use patterns and characteristics associated with its use are limited. This report uses data from the 2015-2018 National Surveys on Drug Use and Health (NSDUHs) to estimate methamphetamine use rates in the United States and to identify characteristics associated with past-year methamphetamine use. Rates (per 1,000 adults aged ≥18 years) for past-year methamphetamine use were estimated overall, by demographic group, and by state. Frequency of past-year use and prevalence of other substance use and mental illness among adults reporting past-year use were assessed. Multivariable logistic regression examined characteristics associated with past-year use. During 2015-2018, the estimated rate of past-year methamphetamine use among adults was 6.6 per 1,000. Among adults reporting past-year methamphetamine use, an estimated 27.3% reported using on ≥200 days, 52.9% had a methamphetamine use disorder, and 22.3% injected methamphetamine. Controlling for other factors, higher adjusted odds ratios for past-year use were found among men; persons aged 26-34, 35-49, and ≥50 years; and those with lower educational attainment, annual household income <$50,000, Medicaid only or no insurance, those living in small metro and nonmetro counties, and those with co-occurring substance use and co-occurring mental illness. Additional efforts to build state and local prevention and response capacity, expand linkages to care, and enhance public health and public safety collaborations are needed to combat increasing methamphetamine harms

    Mapping of the US Domestic Influenza Virologic Surveillance Landscape

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    Influenza virologic surveillance is critical each season for tracking influenza circulation, following trends in antiviral drug resistance, detecting novel influenza infections in humans, and selecting viruses for use in annual seasonal vaccine production. We developed a framework and process map for characterizing the landscape of US influenza virologic surveillance into 5 tiers of influenza testing: outpatient settings (tier 1), inpatient settings and commercial laboratories (tier 2), state public health laboratories (tier 3), National Influenza Reference Center laboratories (tier 4), and Centers for Disease Control and Prevention laboratories (tier 5). During the 2015–16 season, the numbers of influenza tests directly contributing to virologic surveillance were 804,000 in tiers 1 and 2; 78,000 in tier 3; 2,800 in tier 4; and 3,400 in tier 5. With the release of the 2017 US Pandemic Influenza Plan, the proposed framework will support public health officials in modeling, surveillance, and pandemic planning and response

    Nonfatal drug overdoses treated in emergency departments - United States, 2016-2017.

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    In 2017, drug overdoses caused 70,237 deaths in the United States, a 9.6% rate increase from 2016 (1). Monitoring nonfatal drug overdoses treated in emergency departments (EDs) is also important to inform community prevention and response activities. Analysis of discharge data provides insights into the prevalence and trends of nonfatal drug overdoses, highlighting opportunities for public health action to prevent overdoses. Using discharge data from the Healthcare Cost and Utilization Project's (HCUP) Nationwide Emergency Department Sample (NEDS), CDC identified nonfatal overdoses for all drugs, all opioids, nonheroin opioids, heroin, benzodiazepines, and cocaine and examined changes from 2016 to 2017, stratified by drug type and by patient, facility, and visit characteristics. In 2017, the most recent year for which population-level estimates of nonfatal overdoses can be generated, a total of 967,615 nonfatal drug overdoses were treated in EDs, an increase of 4.3% from 2016, which included 305,623 opioid-involved overdoses, a 3.1% increase from 2016. From 2016 to 2017, the nonfatal overdose rates for all drug types increased significantly except for those involving benzodiazepines. These findings highlight the importance of continued surveillance of nonfatal drug overdoses treated in EDs to inform public health actions and, working collaboratively with clinical and public safety partners, to link patients to needed recovery and treatment resources (e.g., medication-assisted treatment)

    Burden of influenza-associated respiratory hospitalizations in the Americas, 2010-2015.

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    BACKGROUND:Despite having influenza vaccination policies and programs, countries in the Americas underutilize seasonal influenza vaccine, in part because of insufficient evidence about severe influenza burden. We aimed to estimate the annual burden of influenza-associated respiratory hospitalizations in the Americas. METHODS:Thirty-five countries in the Americas with national influenza surveillance were invited to provide monthly laboratory data and hospital discharges for respiratory illness (International Classification of Diseases 10th edition J codes 0-99) during 2010-2015. In three age-strata (<5, 5-64, and ≥65 years), we estimated the influenza-associated hospitalizations rate by multiplying the monthly number of respiratory hospitalizations by the monthly proportion of influenza-positive samples and dividing by the census population. We used random effects meta-analyses to pool age-group specific rates and extrapolated to countries that did not contribute data, using pooled rates stratified by age group and country characteristics found to be associated with rates. RESULTS:Sixteen of 35 countries (46%) contributed primary data to the analyses, representing 79% of the America's population. The average pooled rate of influenza-associated respiratory hospitalization was 90/100,000 population (95% confidence interval 61-132) among children aged <5 years, 21/100,000 population (13-32) among persons aged 5-64 years, and 141/100,000 population (95-211) among persons aged ≥65 years. We estimated the average annual number of influenza-associated respiratory hospitalizations in the Americas to be 772,000 (95% credible interval 716,000-829,000). CONCLUSIONS:Influenza-associated respiratory hospitalizations impose a heavy burden on health systems in the Americas. Countries in the Americas should use this information to justify investments in seasonal influenza vaccination-especially among young children and the elderly
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