(49/585) Update: Investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy, October 2001.
Since October 3, 2001, CDC and state and local public health authorities have been investigating cases of bioterrorism-related anthrax. This report updates previous findings, provides new information on case investigations in two additional areas, presents the susceptibility patterns of Bacillus anthracis isolates, and provides interim recommendations for managing potential threats and exposures and for treating anthrax. (+info)
(50/585) Update: Investigation of bioterrorism-related anthrax and interim guidelines for clinical evaluation of persons with possible anthrax.
Since October 3, 2001, CDC and state and local public health authorities have been investigating cases of bioterrorism-related anthrax. This report updates findings as of October 31, and includes interim guidelines for the clinical evaluation of persons with possible anthrax. A total of 21 cases (16 confirmed and five suspected) of bioterrorism-related anthrax have been reported among persons who worked in the District of Columbia, Florida, New Jersey, and New York City (Figure 1). Until the source of these intentional exposures is eliminated, clinicians and laboratorians should be alert for clinical evidence of Bacillus anthracis infection. Epidemiologic investigation of these cases and surveillance to detect new cases of bioterrorism-associated anthrax continues. (+info)
(51/585) Using a dynamic hydrology model to predict mosquito abundances in flood and swamp water.
We modeled surface wetness at high resolution, using a dynamic hydrology model, to predict flood and swamp water mosquito abundances. Historical meteorologic data, as well as topographic, soil, and vegetation data, were used to model surface wetness and identify potential fresh and swamp water breeding habitats in two northern New Jersey watersheds. Surface wetness was positively associated with the subsequent abundance of the dominant floodwater mosquito species, Aedes vexans, and the swamp water species, Anopheles walkeri. The subsequent abundance of Culex pipiens, a species that breeds in polluted, eutrophic waters, was negatively correlated with local modeled surface wetness. These associations permit real-time monitoring and forecasting of these floodwater and nonfloodwater species at high spatial and temporal resolution. These predictions will enable public health agencies to institute control measures before the mosquitoes emerge as adults, when their role as transmitters of disease comes into play. (+info)
(52/585) Outbreak of pneumococcal pneumonia among unvaccinated residents of a nursing home--New Jersey, April 2001.
On April 24,2001, seven cases of pneumococcal pneumonia with bacteremia among residents of a nursing home were reported to the Hamilton Township Department of Health, New Jersey; all seven diagnoses were confirmed with blood cultures positive for Streptococcus pneumoniae. Illness onset among the residents occurred during April 3-24; four residents died. The New Jersey Department of Health and Senior Services (NJDHSS) was notified on April 24 and initiated an investigation to identify additional cases and implement control efforts. This report summarizes results of the investigation, which underscore the importance of providing pneumococcal polysaccharide vaccine (PPV) to elderly residents of long-term care facilities (LTCFs). (+info)
(53/585) Update: adverse events associated with anthrax prophylaxis among postal employees--New Jersey, New York City, and the District of Columbia metropolitan area, 2001.
Antimicrobial prophylaxis to prevent inhalational anthrax has been recommended for persons potentially exposed to Bacillus anthracis as a result of the recent bioterrorist attacks. During October 26-November 6, 2001, an epidemiologic evaluation to detect adverse events associated with antimicrobial prophylaxis was conducted among 8,424 postal employees who had been offered antimicrobial prophylaxis for 60 days in New Jersey (NJ), New York City (NYC), and one postal facility in the District of Columbia (DC). This report summarizes preliminary results of that evaluation, which found that few employees receiving antimicrobial prophylaxis sought medical attention for symptoms that may have been associated with anaphylaxis. Persons with exposures to B. anthracis related to the bioterrorist attacks should complete the full 60-day course of antimicrobial prophylaxis. (+info)
(54/585) Surviving a merger: how four hospital libraries created a unified system.
Librarians are acknowledged as leaders in providing information and knowledge management. They recognize the importance of maintaining an awareness of the most cutting-edge information and technology to meet the challenges of new business practices and changes that inevitably occur. Working as a team, the AHS librarians have achieved a level of communication and cooperation that is an example to other departments in the system. The success of the merged libraries has created new opportunities for leadership and growth and an optimistic future. (+info)
(55/585) Initiation and continuation of newer antiretroviral treatments among medicaid recipients with AIDS.
OBJECTIVE: To examine initiation of newer antiretroviral treatments across sociodemographic subgroups during the 3 years following the introduction of these treatments, and explore persistence on treatment and its association with patient characteristics. DESIGN: Merged Medicaid paid claims and HIV/AIDS surveillance data were used to analyze use of protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) over time. Survival analysis techniques were used to analyze initiation of PI/NNRTI use. Ordinary least squares and logistic regression were used to determine predictors of persistence on PI/NNRTI therapy. SETTING AND PARTICIPANTS: The study population consisted of 2,459 New Jersey non-HMO adult Medicaid beneficiaries with AIDS, identified through a match between HIV/AIDS Registry and Medicaid files. Their PI/NNRTI use was followed from March 1996, when the first PI was licensed, to the end of 1998. MEASUREMENTS AND MAIN RESULTS: African Americans initiated treatment on average 8 months later than non-Hispanic whites; initiation of treatment was also slower for injection drug users and for those who did not receive case management through a Medicaid waiver program. These bivariate findings were confirmed with a multivariate time-to-treatment analysis using proportional hazards regression. Among those initiating PI/NNRTI use, 35% had discontinued it by the end of follow-up. Bivariate analyses of treated individuals found that PI/NNRTI use as a proportion of follow-up time was lower for African Americans and Hispanics, and higher for older individuals and for those receiving case management through a Medicaid waiver program, while injection drug use history was not associated with persistence. These findings were confirmed by a regression analysis, which found that controlling for other characteristics, African-American race, and Hispanic ethnicity were each associated with a significant 8% reduction in the proportion of time on PI/NNRTIs following initiation of treatment. Alternative approaches for modeling persistence produced similar results. CONCLUSIONS: Results suggest that consistent longitudinal use is difficult for many patients. Persistence of use was lower for minority beneficiaries despite comparable coverage for pharmacy and other health services through Medicaid. Our findings suggest the need to examine nonfinancial barriers to appropriate use of highly active antiretroviral therapy, and to develop and test programmatic strategies for supporting patients in remaining on these regimens consistently. (+info)
(56/585) Changes in related drug class utilization after market withdrawal of cisapride.
BACKGROUND: Recent Food and Drug Administration-mandated and company-initiated withdrawals of drug products from the marketplace have had an impact on utilization in related drug classes. OBJECTIVE: To investigate the impact of withdrawal of the prokinetic agent cisapride (Propulsid) on utilization of other gastrointestinal (GI) agents. STUDY DESIGN: A longitudinal, retrospective study using electronic prescription data from a state-funded geriatric prescription benefit program. PATIENTS AND METHODS: Prescription claims for 2644 patients using cisapride between January 10, 2000, and October 1, 2000, were analyzed with respect to points in time at which (1) prospective drug utilization review edits were implemented denying reimbursement of cisapride because of drug interactions, (2) the manufacturer announced its intent to cease production, and (3) the agent was withdrawn from the market. Prevalence of use, claims volume, and expenditures were compared for cisapride, proton pump inhibitors, histamine-2 receptor antagonists, and the prokinetic agent metoclopramide during these periods. RESULTS: Use of cisapride decreased precipitately even before implementation of a "medical exception only" reimbursement policy. After the change in policy, metoclopramide use increased, although this increase was not proportional to cisapride's decline. Although total GI expenditures declined within the cisapride cohort, this change had little impact on overall program GI expenditures. CONCLUSIONS: The loss of cisapride did not significantly affect program-wide costs for GI drugs. However, the withdrawal of cisapride appears to have resulted in increased use of metoclopramide, a medication with a more serious adverse effect profile than cisapride. Further study is needed to evaluate the long-term clinical impact of such therapy changes. (+info)