Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America

Introduction -- Scientific Basis of TB Control -- Principles and Practice of TB Control -- Recommended Roles and Responsibilities for TB Control -- Essential Components of TB Control in the United States -- Control of TB Among Populations at Risk -- Control of TB in Health-Care Facilities and Other High-Risk Environments -- Research Needs to Enhance TB Control -- Graded Recommendations for the Control and Prevention of Tuberculosis (TB) -- Acknowledgments -- References"November 4, 2005."Cover title."Corresponding preparers: Zachary Taylor, MD, National Center for HIV, STD, and TB Prevention, CDC; Charles M. Nolan, MD, Seattle-King County Department of Public Health, Seattle, Washington; Henry M. Blumberg, MD, Emory University School of Medicine, Atlanta, Georgia. " - p. 1.Also available via the World Wide Web.Includes bibliographical references (p. 69-80)

Making up for lost time: Forging new connections between health and community development

New trends in the today’s public health world are making an important case for bringing public health and community development efforts together. These include the changing nature of 21st century preventable disease, the increasing link between health disparities and place, and the early positive evidence from early adopters of combined health and development strategies. Read about specific examples of efforts from King County, Washington that are capitalizing on these changes and simultaneously advancing both health and community development.Community development ; Health

A simulation study comparing aberration detection algorithms for syndromic surveillance

BACKGROUND: The usefulness of syndromic surveillance for early outbreak detection depends in part on effective statistical aberration detection. However, few published studies have compared different detection algorithms on identical data. In the largest simulation study conducted to date, we compared the performance of six aberration detection algorithms on simulated outbreaks superimposed on authentic syndromic surveillance data. METHODS: We compared three control-chart-based statistics, two exponential weighted moving averages, and a generalized linear model. We simulated 310 unique outbreak signals, and added these to actual daily counts of four syndromes monitored by Public Health – Seattle and King County's syndromic surveillance system. We compared the sensitivity of the six algorithms at detecting these simulated outbreaks at a fixed alert rate of 0.01. RESULTS: Stratified by baseline or by outbreak distribution, duration, or size, the generalized linear model was more sensitive than the other algorithms and detected 54% (95% CI = 52%–56%) of the simulated epidemics when run at an alert rate of 0.01. However, all of the algorithms had poor sensitivity, particularly for outbreaks that did not begin with a surge of cases. CONCLUSION: When tested on county-level data aggregated across age groups, these algorithms often did not perform well in detecting signals other than large, rapid increases in case counts relative to baseline levels

Pandemic Flu Preparedness: Lessons From the Frontlines

Outlines early lessons from the 2009 H1N1 influenza outbreak and recommendations for strengthening the U.S. core public health capacity, including vaccine stockpile and development, planning and coordination, infrastructure, and surge capacity and care

King County Equity and Social Justice Annual Report - November 2014

This report shows how King County is building equity by increasing access to health care, creating communities of opportunity, embedding equity in the budget process, becoming a more equitable and diverse employer, and more

Green Housing = Improved Health: A Winning Combination

The case studies in this paper explore the relationship between housing and health. It explains how building affordable green housing provides health benefits to low-income residentsand it identifies the benefits of green housing for the environment and energy efficiency

The Road Map Project: 2014 Results Report

The Road Map Project's annual report card shows data on 29 indicators of student success, which are important measures related to student achievement from cradle through college. Data in the report are often disaggregated by district, student race/ethnicity or income level to illustrate the region's challenges and progress.The Road Map Project is a region-wide collective impact effort aiming to dramatically improve education results in South King County and South Seattle, the county's areas of greatest need. The project's goal is to double the number of students who are on track to graduate from college or earn a career credential by 2020, and to close opportunity gaps. Seven school districts -- Auburn, Kent, Federal Way, Highline, Renton, Seattle (south-end only) and Tukwila -- are among the hundreds of partners working together toward the Road Map Project's 2020 goal. The 2014 results report includes a special focus on whether the region is on track to reach the goal

Incentivized HIV Testing--Is It Needed and Effective? Developing an Evaluation Tool

The following is a case study of agencies in Seattle, WA who provide HIV testing followed by an evaluation tool for the agencies to determine the role of incentivizing HIV testing. Some agencies I interviewed provide incentives for the testing and others do not. This Capstone will focus on six agencies currently providing HIV testing and provides a tool for agencies to use to attempt to answer the following question: In the face of reduced funding for HIV prevention and a mandate to continue to push for increasingly getting more Men who have Sex with Men (MSM) tested for HIV, what role does providing an incentive play? Through key informant interviews with implementing agency staff it was discovered that none of the agencies are evaluating the effectiveness of providing an incentive for HIV testing. However all of them felt if funding were to be reduced the first thing to be cut would be the HIV testing incentive. None of the agencies interviewed were interested in implementing a monitoring and evaluation plan, inclusive of log-frames and budget. They all agreed that they did not have the time, budget or expertise to monitor a plan. They were also clear that they would not be interested if this plan was not going to be required by Public Health Seattle-King County, who funds most of the programs. Through discussions with the agencies that were interviewed and contract monitoring staff with Public Health, they all felt that if they had a simple tool to measure the effectiveness of incentivized HIV testing it would be valuable in their program planning. With feedback from implementing agencies, the author has developed a short, client administered survey in both English and Spanish, that will assist Community Based Organizations (CBOs) in determining the effectiveness of a client receiving an incentive, free testing or donation request for HIV testing. Knowing that most of the CBOs do not have extra funding, staff or expertise to implement a large-scale evaluation, the tool that has been developed does not require extra staff time, expertise or funding. This analysis links the author’s professional, graduate school course-work and practicum experience. Recommendations include utilizing the evaluation tool to determine the effectiveness of incentivized HIV testing. Question: In the face of reduced HIV prevention funding and pressure to continue to test MSM, especially Latino and Black MSM, does providing an incentive for testing increase the likelihood that MSM will get tested for HIV

Studies Needed to Address Public Health Challenges of the 2009 H1N1 Influenza Pandemic: Insights from Modeling

In light of the 2009 influenza pandemic and potential future pandemics, Maria Van Kerkhove and colleagues anticipate six public health challenges and the data needed to support sound public health decision making.The authors acknowledge support from the Bill & Melinda Gates Foundation (MDVK, CF, NMF); Royal Society (CF); Medical Research Council (MDVK, CF, PJW, NMF); EU FP7 programme (NMF); UK Health Protection Agency (PJW); US National Institutes of Health Models of Infectious Disease Agent Study program through cooperative agreement 1U54GM088588 (ML); NIH Director's Pioneer Award, DP1-OD000490-01 (DS); EU FP7 grant EMPERIE 223498 (DS); the Wellcome Trust (DS); 3R01TW008246-01S1 from Fogerty International Center and RAPIDD program from Fogerty International Center with the Science & Technology Directorate, Department of Homeland Security (SR); and the Institut de Veille Sanitaire Sanitaire funded by the French Ministry of Health (J-CD). The funders played no role in the decision to submit the article or in its preparation

Asymptomatic and presymptomatic SARS-CoV-2 infections in residents of a long-term care skilled nursing facility \u2014 King County, Washington, March 2020

What is already known about this topic?: Once SARS-CoV-2 is introduced in a long-term care skilled nursing facility (SNF), rapid transmission can occur.What is added by this report?: Following identification of a case of coronavirus disease 2019 (COVID-19) in a health care worker, 76 of 82 residents of an SNF were tested for SARS-CoV-2; 23 (30.3%) had positive test results, approximately half of whom were asymptomatic or presymptomatic on the day of testing.What are the implications for public health practice?: Symptom-based screening of SNF residents might fail to identify all SARS-CoV-2 infections. Asymptomatic and presymptomatic SNF residents might contribute to SARS-CoV-2 transmission. Once a facility has confirmed a COVID-19 case, all residents should be cared for using CDC-recommended personal protective equipment (PPE), with considerations for extended use or reuse of PPE as needed.Older adults are susceptible to severe coronavirus disease 2019 (COVID-19) outcomes as a consequence of their age and, in some cases, underlying health conditions (1). A COVID-19 outbreak in a long-term care skilled nursing facility (SNF) in King County, Washington that was first identified on February 28, 2020, highlighted the potential for rapid spread among residents of these types of facilities (2). On March 1, a health care provider at a second long-term care skilled nursing facility (facility A) in King County, Washington, had a positive test result for SARS-CoV-2, the novel coronavirus that causes COVID-19, after working while symptomatic on February 26 and 28. By March 6, seven residents of this second facility were symptomatic and had positive test results for SARS-CoV-2. On March 13, CDC performed symptom assessments and SARS-CoV-2 testing for 76 (93%) of the 82 facility A residents to evaluate the utility of symptom screening for identification of COVID-19 in SNF residents. Residents were categorized as asymptomatic or symptomatic at the time of testing, based on the absence or presence of fever, cough, shortness of breath, or other symptoms on the day of testing or during the preceding 14 days. Among 23 (30%) residents with positive test results, 10 (43%) had symptoms on the date of testing, and 13 (57%) were asymptomatic. Seven days after testing, 10 of these 13 previously asymptomatic residents had developed symptoms and were recategorized as presymptomatic at the time of testing. The reverse transcription\u2013polymerase chain reaction (RT-PCR) testing cycle threshold (Ct) values indicated large quantities of viral RNA in asymptomatic, presymptomatic, and symptomatic residents, suggesting the potential for transmission regardless of symptoms. Symptom-based screening in SNFs could fail to identify approximately half of residents with COVID-19. Long-term care facilities should take proactive steps to prevent introduction of SARS-CoV-2 (3). Once a confirmed case is identified in an SNF, all residents should be placed on isolation precautions if possible (3), with considerations for extended use or reuse of personal protective equipment (PPE) as needed (4).Suggested citation for this article: Kimball A, Hatfield KM, Arons M, et al. Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility \u2014 King County, Washington, March 2020. MMWR Morb Mortal Wkly Rep. ePub: 27 March 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6913e1Diamond Princess -- Grand Princess -- Additional Ships -- Discussion -- Acknowledgments.2020856