Human and Canine Pulmonary Blastomycosis, North Carolina, 2001–2002

We investigated a cluster of blastomycosis in 8 humans and 4 dogs in a rural North Carolina community. Delayed diagnosis, difficulty isolating Blastomyces dermatitidis in nature, and lack of a sensitive and specific test to assess exposure make outbreaks of this disease difficult to study

Evaluation of Public Health Response to Hurricanes Finds North Carolina Better Prepared for Public Health Emergencies

Reviews of state public health preparedness improvements have been primarily limited to measuring funds expenditures and achievement of cooperative agreement benchmarks. Such reviews fail to assess states' actual capacity for meeting the challenges they may face during an emergency, as evidenced by activities undertaken during the various phases of a disaster. This article examines North Carolina's public health preparedness and response performance during two hurricanes, Hurricane Floyd in 1999 and Hurricane Isabel in 2003, as well as capacity building activities in the intervening years. North Carolina created new infrastructures, enhanced laboratory capacity, and strengthened communications after Hurricane Floyd. These activities facilitated implementation of functional capabilities through effective centralized communication, command and control incident management, and a rapid needs assessment and medical surveillance during Hurricane Isabel. North Carolina continues to implement these capabilities in public health emergencies. Measuring and implementing functional capabilities during exercises or real events facilitates achievement of preparedness performance standards, goals, and objectives

Improvements in Timeliness Resulting from Implementation of Electronic Laboratory Reporting and an Electronic Disease Surveillance System

Electronic laboratory reporting (ELR) reduces the time between communicable disease diagnosis and case reporting to local health departments (LHDs). However, it also imposes burdens on public health agencies, such as increases in the number of unique and duplicate case reports. We assessed how ELR affects the timeliness and accuracy of case report processing within public health agencies

Identifying People with Acute HIV Infection (AHI) – Demographic Features, Risk Factors, and Use of Health Care among Individuals with AHI in North Carolina

Identifying and counseling individuals with Acute HIV Infection (AHI) offers a critical opportunity to avert preventable HIV transmission, however opportunities to recognize these individuals may be missed. We surveyed 32 adults diagnosed with AHI during voluntary HIV testing from 1/1/03 to 2/28/05 in publicly funded testing sites in NC to describe their clinical, social, and behavioral characteristics. Eighty-one percent of participants were men; 59% were African American. Seventy-five percent experienced symptoms consistent with acute retroviral syndrome; although 83% sought medical care for these symptoms, only 15% were appropriately diagnosed at that initial medical visit, suggesting opportunities to diagnose these individuals earlier were missed. Eighty-five percent of the men engaged in sex with men. More than 50% of the participants thought they were infected with HIV by a steady partner. This study yields important information to assist in identifying populations at risk for or infected with AHI and designing both primary and secondary prevention interventions

Social support and delays seeking care after HIV diagnosis, North Carolina, 2000–2006

Many adults in the United States enter primary care late in the course of HIV infection, countering the clinical benefits of timely HIV services and missing opportunities for risk reduction. Our objective was to determine if perceived social support was associated with delay entering care after an HIV diagnosis. Two hundred sixteen patients receiving primary care at a large, university-based HIV outpatient clinic in North Carolina were included in the study. Dimensions of functional social support (emotional/informational, tangible, affectionate and positive social interaction) were quantified with a modified Medical Outcomes Study Social Support Scale and included in proportional hazard models to determine their effect on delays seeking care. The median delay between diagnosis and entry to primary care was 5.9 months. Levels of social support were high but only positive social interaction was moderately associated with delayed presentation in adjusted models. The effect of low perceived positive social interaction on the time to initiation of primary care differed by history of alcoholism (no history of alcoholism, hazard ratio (HR): 1.43, 95% confidence interval (CI): 0.88, 2.34; history of alcoholism, HR: 0.71, 95% CI: 0.40, 1.28). Ensuring timely access to HIV care remains a challenge in the southeastern United States. Affectionate, tangible, and emotional/informational social support were not associated with the time from diagnosis to care. The presence of positive social interaction may be an important factor influencing care seeking behavior after diagnosis

Barriers and facilitators to HIV testing and linkage to primary care: narratives of people with advanced HIV in the Southeast

Persons with unrecognized HIV infection forgo timely clinical intervention and may unknowingly transmit HIV to partners. However, in the United States, unrecognized infection and late diagnosis are common. To understand barriers and facilitators to HIV testing and care, we conducted a qualitative study of 24 HIV infected persons attending a Southeastern HIV clinic who presented with clinically advanced illness. The primary barrier to HIV testing prior to diagnosis was perception of risk; consequently, most participants were diagnosed after the onset of clinical symptoms. While most patients were anxious to initiate care rapidly after diagnosis, some felt frustrated by the passive process of connecting to specialty care. The first visit with an HIV care provider was identified as critical in the coping process for many patients. Implications for the implementation of recent CDC HIV routine screening guidelines are discussed

Integration of Syndromic Surveillance Data into Public Health Practice at State and Local Levels in North Carolina

We sought to describe the integration of syndromic surveillance data into daily surveillance practice at local health departments (LHDs) and make recommendations for the effective integration of syndromic and reportable disease data for public health use

Completeness of Communicable Disease Reporting, North Carolina, USA, 1995–1997 and 2000–2006

Reporting proportions were <50% for 49 of the 53 diseases evaluated

Team Epi-Aid: Graduate Student Assistance with Urgent Public Health Response

Team Epi-Aid provides graduate students with practical public health experience through participation in outbreak investigations and other applied projects with state and local health departments in North Carolina. It is an initiative of the North Carolina Center for Public Health Preparedness in the North Carolina Institute for Public Health at the University of North Carolina School of Public Health. The program allows state and local health departments access to volunteers and technical expertise from the university when they need assistance. It requires close collaboration with state and county health departments. Team Epi-Aid provides the opportunity for integrated learning with students and faculty within the departments of the School of Public Health, and through recent expansion, within the schools of Medicine and Pharmacy. Orientations are conducted each semester and formal training is provided as needed. Team Epi-Aid has been popular, with 58 active student participants contributing 1,465 hours of service during the initiative's first 21 months

Review of the UNC Team Epi-Aid Graduate Student Epidemiology Response Program Six Years After Implementation

Service learning is one way that academia can contribute to assuring the public's health. The University of North Carolina's Team Epi-Aid service-learning program started in 2003. Since then, 145 graduate student volunteers have contributed 4,275 hours working with the state and local health departments during 57 activities, including outbreak investigations, community health assessments, and emergency preparedness and response. Survey data from student participants and public health partners indicates that the program is successful in meeting its goal of creating effective partnerships among the university, the North Carolina Center for Public Health Preparedness, and state and local health departments; supplying needed surge capacity to health departments; and providing students with applied public health experience and training. In this article, we discuss the programmatic lessons learned around administration, maintaining student interest, program sustainability, and challenges since program implementation