Tuberculosis Outbreak Investigations in the United States, 2002–2008

To understand circumstances of tuberculosis transmission that strain public health resources, we systematically reviewed Centers for Disease Control and Prevention (CDC) staff reports of US outbreaks in which CDC participated during 2002–2008 that involved >3 culture-confirmed tuberculosis cases linked by genotype and epidemiology. Twenty-seven outbreaks, representing 398 patients, were reviewed. Twenty-four of the 27 outbreaks involved primarily US-born patients; substance abuse was another predominant feature of outbreaks. Prolonged infectiousness because of provider- and patient-related factors was common. In 17 outbreaks, a drug house was a notable contributing factor. The most frequently documented intervention to control the outbreak was prioritizing contacts according to risk for infection and disease progression to ensure that the highest risk contacts were completely evaluated. US-born persons with reported substance abuse most strongly characterized the tuberculosis outbreaks in this review. Substance abuse remains one of the greatest challenges to controlling tuberculosis transmission in the United States

Viviano (image)

Spring Issuehttp://deepblue.lib.umich.edu/bitstream/2027.42/61132/1/3801.pd

Kyra Gaunt (image)

Fall Issuehttp://deepblue.lib.umich.edu/bitstream/2027.42/61142/1/3803.pd

First Case of 2019 Novel Coronavirus in the United States

An outbreak of novel coronavirus (2019-nCoV) that began in Wuhan, China, has spread rapidly, with cases now confirmed in multiple countries. We report the first case of 2019-nCoV infection confirmed in the United States and describe the identification, diagnosis, clinical course, and management of the case, including the patient’s initial mild symptoms at presentation with progression to pneumonia on day 9 of illness. This case highlights the importance of close coordination between clinicians and public health authorities at the local, state, and federal levels, as well as the need for rapid dissemination of clinical information related to the care of patients with this emerging infection

A case-control study of risk factors for death from 2009 pandemic influenza A(H1N1): Is American Indian racial status an independent risk factor?

Historically, American Indian/Alaska Native ( AI/AN ) populations have suffered excess morbidity and mortality from influenza. We investigated the risk factors for death from 2009 pandemic influenza A( H1N1 ) in persons residing in five states with substantial AI/AN populations. We conducted a case-control investigation using pandemic influenza fatalities from 2009 in Alaska, Arizona, New Mexico, Oklahoma and Wyoming. Controls were outpatients with influenza. We reviewed medical records and interviewed case proxies and controls. We used multiple imputation to predict missing data and multivariable conditional logistic regression to determine risk factors. We included 145 fatal cases and 236 controls; 22% of cases were AI/AN. Risk factors ( P 45 years vs. < 18 years], pre-existing medical conditions ( mOR 7·1 ), smoking ( mOR 3·0 ), delayed receipt of antivirals ( mOR 6·5 ), and barriers to healthcare access ( mOR 5·3 ). AI/AN race was not significantly associated with death. The increased influenza mortality in AI/AN individuals was due to factors other than racial status. Prevention of influenza deaths should focus on modifiable factors ( smoking, early antiviral use, access to care ) and identifying high-risk persons for immunization and prompt medical attention