Assessing influenza vaccination coverage and predictors in persons living with HIV/AIDS in Louisiana, June 2002-June 2013.

Background: Despite the burden of disease and increased risk of influenza-associated morbidity and mortality among PLWHA, influenza vaccination has been understudied in this population. Methods: We built an 11-year cohort of HIV-infected adults from medical records of PLWHA seeking care within the Louisiana State University medical system from June 2002-June 2013. Influenza vaccination uptake among PLWHA was calculated overall and for each medical facility for each influenza season. Linear regression was used to assess influenza vaccination uptake over time both overall and by facility. Data were restricted to the final influenza season (2012-13) to assess predictors of PLWHA vaccination. Individuals were nested within medical facilities in order to assess the amount of variability in influenza vaccination rates across medical facilities. Results: Influenza vaccination uptake among PLWHA increased over the study period (p<0.01). The overall proportion of PLWHA vaccinated during the 2012-13 influenza season was 33.7%. 37.9% of the variability in the model occurred at the facility-level. Conclusions: Although there was an increase in influenza vaccination within the PLWHA cohort over the course of the study, vaccination rates remained low overall. Special efforts must be made to increase vaccination uptake among PLWHA, with particular focus on those within the population who are likely to be at highest risk. The substantial variability at the facility-level indicates that there are unmeasured facility-level factors that contribute significantly to PLWHA vaccination.&nbsp

The mediating effects of barriers to vaccination on the relationship between race/ethnicity and influenza vaccination status in a rural Southeastern Louisiana medical center.

Introduction: Persistent disparities in influenza vaccination rates exist between racial/ethnic minorities and Whites. The mechanisms that define this relationship are under-researched. Objectives: (1) To evaluate racial/ethnic disparities in influenza vaccination and (2) to assess the mediating effects of barriers to influenza vaccination on the relationship between race/ethnicity and receipt of influenza vaccination. Methods: Surveys assessing barriers to vaccination were administered to outpatients in a rural medical center in Southeastern Louisiana. Survey responses were matched to patient medical records. Likert-style statements were used to measure barriers to vaccination.. A mediation analysis assessing the relationship between race and influenza vaccination mediated by vaccination barriers was conducted.  Results: The self-reported influenza vaccination rate in those surveyed was 40.4%. Whites (45.5%) were more likely than racial/ethnic minorities (36.3%) to report receipt of an influenza vaccination (p=0.02). Racial/ethnic minorities reported significantly higher vaccination barrier scores (p<0.01). The relationship between race/ethnicity and vaccination was mediated by vaccination barriers, when controlling for provider recommendation and having at least one comorbid medical condition (natural indirect effect [NIE] p-value=0.02, proportion mediated=0.71). Conclusions: Barriers to vaccination mediates the relationship between race/ethnicity and vaccination status. Providers should focus on minimizing fears that the vaccine will cause illness and emphasize that the vaccine is safe and effective at preventing severe influenza-associated illness. Additional efforts should be made to improve accessibility of the influenza vaccine, including addressing costs of vaccination and expanding the number and types of settings where the vaccine is offered

Genetic diversity of Trypanosoma cruzi infecting raccoons (Procyon lotor) in 2 metropolitan areas of southern Louisiana: implications for parasite transmission networks

Trypanosoma cruzi, the aetiological agent of Chagas disease, exists as an anthropozoonosis in Louisiana. Raccoons are an important reservoir, as they demonstrate high prevalence and maintain high parasitaemia longer than other mammals. Given the complex nature of parasite transmission networks and importance of raccoons as reservoirs that move between sylvatic and domestic environments, detailing the genetic diversity of T. cruzi in raccoons is crucial to assess risk to human health. Using a next-generation sequencing approach targeting the mini-exon, parasite diversity was assessed in 2 metropolitan areas of Louisiana. Sequences were analysed along with those previously identified in other mammals and vectors to determine if any association exists between ecoregion and parasite diversity. Parasites were identified from discrete typing units (DTUs) TcI, TcII, TcIV, TcV and TcVI. DTUs TcII, TcV and TcVI are previously unreported in raccoons in the United States (US). TcI was the most abundant DTU, comprising nearly 80% of all sequences. All but 1 raccoon harboured multiple haplotypes, some demonstrating mixed infections of different DTUs. Furthermore, there is significant association between DTU distribution and level III ecoregion in Louisiana. Finally, while certain sequences were distributed across multiple tissues, others appeared to have tissue-specific tropism. Taken together, these findings indicate that ongoing surveillance of T. cruzi in the US should be undertaken across ecoregions to fully assess risk to human health. Given potential connections between parasite diversity and clinical outcomes, deep sequencing technologies are crucial and interventions targeting raccoons may prove useful in mitigating human health risk

The effect of area deprivation on COVID-19 risk in Louisiana.

BackgroundLouisiana in the summer of 2020 had the highest per capita case count for COVID-19 in the United States and COVID-19 deaths disproportionately affects the African American population. Neighborhood deprivation has been observed to be associated with poorer health outcomes. The purpose of this study was to examine the relationship between neighborhood deprivation and COVID-19 in Louisiana.MethodsThe Area Deprivation Index (ADI) was calculated and used to classify neighborhood deprivation at the census tract level. A total of 17 US census variables were used to calculate the ADI for each of the 1148 census tracts in Louisiana. The data were extracted from the American Community Survey (ACS) 2018. The neighborhoods were categorized into quintiles as well as low and high deprivation. The publicly available COVID-19 cumulative case counts by census tract were obtained from the Louisiana Department of Health website on July 31, 2020. Descriptive and Poisson regression analyses were performed.ResultsNeighborhoods in Louisiana were substantially different with respect to deprivation. The ADI ranged from 136.00 for the most deprived neighborhood and -33.87 in the least deprived neighborhood. We observed that individuals residing in the most deprived neighborhoods had almost a 40% higher risk of COVID-19 compared to those residing in the least deprived neighborhoods.ConclusionWhile the majority of previous studies were focused on very limited socio-environmental factors such as crowding and income, this study used a composite area-based deprivation index to examine the role of neighborhood environment on COVID-19. We observed a positive relationship between neighborhood deprivation and COVID-19 risk in Louisiana. The study findings can be utilized to promote public health preventions measures besides social distancing, wearing a mask while in public and frequent handwashing in vulnerable neighborhoods with greater deprivation

Fungal Endophthalmitis Associated with Compounded Products

Fungal endophthalmitis is a rare but serious infection. In March 2012, several cases of probable and laboratory-confirmed fungal endophthalmitis occurring after invasive ocular procedures were reported nationwide. We identified 47 cases in 9 states: 21 patients had been exposed to the intraocular dye Brilliant Blue G (BBG) during retinal surgery, and the other 26 had received an intravitreal injection containing triamcinolone acetonide. Both drugs were produced by Franck’s Compounding Lab (Ocala, FL, USA). Fusarium incarnatum-equiseti species complex mold was identified in specimens from BBG-exposed case-patients and an unopened BBG vial. Bipolaris hawaiiensis mold was identified in specimens from triamcinolone-exposed case-patients. Exposure to either product was the only factor associated with case status. Of 40 case-patients for whom data were available, 39 (98%) lost vision. These concurrent outbreaks, associated with 1 compounding pharmacy, resulted in a product recall. Ensuring safety and integrity of compounded medications is critical for preventing further outbreaks associated with compounded products. Download MP3  Length: 1:4