scholarly journals 966. Infectious Diseases among US Resident Student Travelers after Return to the United States: A GeoSentinel Analysis, 2007–2017

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S36-S36
Author(s):  
Kristina M Angelo ◽  
Jean Haulman ◽  
Anne Terry ◽  
Daniel Leung ◽  
Lin H Chen ◽  
...  
Keyword(s):  
United States ◽  
Infectious Diseases ◽  
The United States ◽  
International Travel ◽  
Sub Saharan Africa ◽  
Global Network ◽  
Vaccine Preventable Diseases ◽  
Common Diagnosis ◽  
Vector Borne ◽  
Few Data

Abstract Background The number of US students studying abroad has more than tripled over the past 20 years. As study abroad programs diversify their destinations, more students are traveling to developing regions, increasing their risk of infectious diseases. Few data exist describing infections acquired by US students while traveling internationally. We describe the spectrum of disease among students who have returned from international travel and suggest how to reduce illness among these travelers. Methods GeoSentinel is a global network of travel and tropical medicine providers that monitors travel-related morbidity. Records of US resident student travelers, 17–24 years old, who returned to the United States and were given a confirmed travel-related diagnosis at one of 15 US GeoSentinel sites during 2007–2017. Those without ascertainable exposure regions were excluded. Records were analyzed to describe demographic and travel characteristics and diagnoses. Results There were 432 students included. The median age was 21 years; 69% were female. Over 70% had a pretravel consultation with a healthcare provider. The most common exposure region was sub-Saharan Africa (112 travelers; 26%); the most common exposure countries were India (44 students; 11%), Ecuador (28; 7%), Ghana (25; 6%), and China (24; 6%). Students presented to a GeoSentinel site a median of 8 days (range: 0–181) after travel; 98% were outpatients. The most common diagnosis categories were gastrointestinal (45%) and dermatologic (17%). Of 581 confirmed diagnoses, diarrheal illnesses were most common (165; 28%). Thirty-one (7%) students had a vector-borne disease; 14 (41%) of these were diagnosed with malaria (13 had a pretravel consultation) and 11 (32%) with dengue. Two students were diagnosed with acute HIV. Three had a vaccine-preventable disease (two typhoid; one hepatitis A). Conclusion Students experienced travel-related infections despite a large proportion receiving pretravel consultations. Students (especially those traveling to a less developed region) should receive specific pretravel instructions (including suggestions for behavioral modification, vaccination, and medication prophylaxis when applicable) to prevent gastrointestinal, vector-borne, sexually transmitted, and vaccine-preventable diseases. Disclosures All authors: No reported disclosures.

scholarly journals Impact of El Niño Southern Oscillation on infectious disease hospitalization risk in the United States

2016 ◽  
Vol 113 (51) ◽  
pp. 14589-14594 ◽  
Author(s):  
David N. Fisman ◽  
Ashleigh R. Tuite ◽  
Kevin A. Brown
Keyword(s):  
Infectious Disease ◽  
United States ◽  
Infectious Diseases ◽  
El Nino ◽  
Southern Oscillation ◽  
The United States ◽  
Enteric Disease ◽  
Vector Borne Disease ◽  
Vector Borne ◽  
The Impact

Although the global climate is changing at an unprecedented rate, links between weather and infectious disease have received little attention in high income countries. The “El Niño Southern Oscillation” (ENSO) occurs irregularly and is associated with changing temperature and precipitation patterns. We studied the impact of ENSO on infectious diseases in four census regions in the United States. We evaluated infectious diseases requiring hospitalization using the US National Hospital Discharge Survey (1970–2010) and five disease groupings that may undergo epidemiological shifts with changing climate: (i) vector-borne diseases, (ii) pneumonia and influenza, (iii) enteric disease, (iv) zoonotic bacterial disease, and (v) fungal disease. ENSO exposure was based on the Multivariate ENSO Index. Distributed lag models, with adjustment for seasonal oscillation and long-term trends, were used to evaluate the impact of ENSO on disease incidence over lags of up to 12 mo. ENSO was associated more with vector-borne disease [relative risk (RR) 2.96, 95% confidence interval (CI) 1.03–8.48] and less with enteric disease (0.73, 95% CI 0.62–0.87) in the Western region; the increase in vector-borne disease was attributable to increased risk of rickettsioses and tick-borne infectious diseases. By contrast, ENSO was associated with more enteric disease in non-Western regions (RR 1.12, 95% CI 1.02–1.15). The periodic nature of ENSO may make it a useful natural experiment for evaluation of the impact of climatic shifts on infectious disease risk. The impact of ENSO suggests that warmer temperatures and extreme variation in precipitation events influence risks of vector-borne and enteric disease in the United States.

Nonviral Vector-Borne Zoonoses Associated with Mammals in the United States

1995 ◽  
Vol 76 (3) ◽  
pp. 695 ◽  
Author(s):  
Kenneth L. Gage ◽  
Richard S. Ostfeld ◽  
James G. Olson
Keyword(s):  
United States ◽  
The United States ◽  
Nonviral Vector ◽  
Vector Borne

scholarly journals Verification of Healthcare Personnel Immunity as a Strategy for Measles Preparedness

2020 ◽  
Vol 41 (S1) ◽  
pp. s431-s432
Author(s):  
Rachael Snyders ◽  
Hilary Babcock ◽  
Christopher Blank
Keyword(s):  
Infectious Diseases ◽  
Multidisciplinary Team ◽  
The United States ◽  
Transmission Risk ◽  
Healthcare Personnel ◽  
Serological Tests ◽  
Preparedness Plan ◽  
Vaccine Preventable Diseases ◽  
Measles Outbreaks ◽  
Centralized Database

Background: Immunization resistance is fueling a resurgence of vaccine-preventable diseases in the United States, where several large measles outbreaks and 1,282 measles cases were reported in 2019. Concern about these measles outbreaks prompted a large healthcare organization to develop a preparedness plan to limit healthcare-associated transmission. Verification of employee rubeola immunity and immunization when necessary was prioritized because of transmission risk to nonimmune employees and role of the healthcare personnel in responding to measles cases. Methods: The organization employs ∼31,000 people in diverse settings. A multidisciplinary team was formed by infection prevention, infectious diseases, occupational health, and nursing departments to develop the preparedness plan. Immunity was monitored using a centralized database. Employees without evidence of immunity were asked to provide proof of vaccination, defined by the CDC as 2 appropriately timed doses of rubeola-containing vaccine, or laboratory confirmation of immunity. Employees were given 30 days to provide documentation or to obtain a titer at the organization’s expense. Staff with negative titers were given 2 weeks to coordinate with the occupational heath department for vaccination. Requests for medical or religious accommodations were evaluated by occupational heath staff, the occupational heath medical director, and the human resources department. All employees were included, though patient-interfacing employees in departments considered higher risk were prioritized. These areas were the emergency, dermatology, infectious diseases, labor and delivery, obstetrics, and pediatrics departments. Results: At the onset of the initiative in June 2019, 4,009 employees lacked evidence of immunity. As of November 2019, evidence of immunity had been obtained for 3,709 employees (92.5%): serological evidence of immunity was obtained for 2,856 (71.2%), vaccine was administered to 584 (14.6%), and evidence of previous vaccination was provided by 269 (6.7%). Evidence of immunity has not been documented for 300 (7.5%). The organization administered 3,626 serological tests and provided 997 vaccines, costing ∼$132,000. Disposition by serological testing is summarized in Table 1. Conclusions: A measles preparedness strategy should include proactive assessment of employees’ immune status. It is possible to expediently assess a large number of employees using a multidisciplinary team with access to a centralized database. Consideration may be given to prioritization of high-risk departments and patient-interfacing roles to manage workload.Funding: NoneDisclosures: None

Origins and consequences of economic globalization: moving beyond a flawed orthodoxy

2021 ◽  
pp. 135406612098342
Author(s):  
Syed Javed Maswood
Keyword(s):  
United States ◽  
Economic Globalization ◽  
The United States ◽  
Global Network ◽  
New Production ◽  
Supply Chain Networks ◽  
Geographically Dispersed ◽  
Production Processes ◽  
Technological Advances ◽  
Liberal Trade

Contemporary economic globalization is typically seen as a product of both trade and economic liberalization after the Second World War and of technological advances that have made it possible to overcome coordination and management of geographically dispersed production units. Trade liberalization and technological advances were certainly important variables, but I argue that it was neo-protectionist American policies of the early 1980s that provided the initial catalyst for globally networked production processes. American protectionism encouraged Japanese investment in the United States that allowed US car manufacturers to learn the essentials of network manufacturing as practiced by Japanese transplants in the United States. In the next stage of global network manufacturing, liberal trade played a much more pivotal role because the global supply chains could not obviously be maintained without liberal trade. In this paper, I also discuss the likelihood of a reversal and suggest that globalization is unlikely to reversed in a significant way. Liberal trade is essential to the integrity of global supply chain networks, but these new production processes have themselves created a firewall against future systemic protectionism.

scholarly journals Learning to Detain Asylum Seekers and the Growth of Mass Immigration Detention in the United States

2021 ◽  
pp. 1-29
Author(s):  
Smita Ghosh ◽  
Mary Hoopes
Keyword(s):  
United States ◽  
Infectious Diseases ◽  
Cognitive Dissonance ◽  
Media Coverage ◽  
Asylum Seekers ◽  
Ad Hoc ◽  
The United States ◽  
Critical Component ◽  
Immigration Detention ◽  
Important Shift

Drawing upon an analysis of congressional records and media coverage from 1981 to 1996, this article examines the growth of mass immigration detention. It traces an important shift during this period: while detention began as an ad hoc executive initiative that was received with skepticism by the legislature, Congress was ultimately responsible for entrenching the system over objections from the agency. As we reveal, a critical component of this evolution was a transformation in Congress’s perception of asylum seekers. While lawmakers initially decried their detention, they later branded them as dangerous. Lawmakers began describing asylum seekers as criminals or agents of infectious diseases in order to justify their detention, which then cleared the way for the mass detention of arriving migrants more broadly. Our analysis suggests that they may have emphasized the dangerousness of asylum seekers to resolve the dissonance between their theoretical commitments to asylum and their hesitance to welcome newcomers. In addition to this distinctive form of cognitive dissonance, we discuss a number of other implications of our research, including the ways in which the new penology framework figured into the changing discourse about detaining asylum seekers.

scholarly journals Emergency Department Visits From 2014 to 2018 for Head Injuries in Youth Non-Tackle Football Compared With Other Sports

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097540
Author(s):  
Jessica M. Zendler ◽  
Ron Jadischke ◽  
Jared Frantz ◽  
Steve Hall ◽  
Grant C. Goulet
Keyword(s):  
United States ◽  
Emergency Department ◽  
Head Injury ◽  
Head Injuries ◽  
The United States ◽  
Emergency Department Visits ◽  
Head Region ◽  
Cerebral Contusion ◽  
Common Diagnosis ◽  
Tackle Football

Background: Non-tackle football (ie, flag, touch, 7v7) is purported to be a lower-risk alternative to tackle football, particularly in terms of head injuries. However, data on head injuries in non-tackle football are sparse, particularly among youth participants. Purpose: To describe the epidemiology of  emergency department visits for head injuries due to non-tackle football among youth players in the United States and compare the data with basketball, soccer, and tackle football. Study Design: Descriptive epidemiology study. Methods: Injury data from 2014 to 2018 were obtained from the National Electronic Injury Surveillance System database. Injury reports coded for patients aged 6 to 18 years and associated with basketball, football, or soccer were extracted. Data were filtered to include only injuries to the head region, specifically, the head, ear, eyeball, mouth, or face. Football injuries were manually assigned to “non-tackle” or “tackle” based on the injury narratives. Sports & Fitness Industry Association data were used to estimate annual sport participation and calculate annual injury rates per 100,000 participant-years. Results: A total of 26,770 incident reports from 2014 to 2018 were analyzed. For head region injuries in non-tackle football, the head was the most commonly injured body part, followed by the face; the most common diagnosis was a laceration, followed by concussion and internal injury (defined as an unspecified head injury or internal head injury [eg, subdural hematoma or cerebral contusion]). The most common contacting object was another player. The projected national rate of head region injuries was lowest for non-tackle football across the 4 sports. In particular, the projected rate of injuries to the head for non-tackle football (78.0 per 100,000 participant-years) was less than one-fourth the rates for basketball (323.5 per 100,000 participant-years) and soccer (318.2 per 100,000 participant-years) and less than one-tenth the rate for tackle football (1478.6 per 100,000 participant-years). Conclusion: Among youth in the United States aged 6 to 18 years who were treated in the emergency department for injuries related to playing non-tackle football, the most common diagnosis for injuries to the head region was a laceration, followed by a concussion. Head region injuries associated with non-tackle football occurred at a notably lower rate than basketball, soccer, or tackle football.

scholarly journals EPIDEMIOLOGY OF PEDIATRIC CARTILAGE RESTORATION PROCEDURES IN THE UNITED STATES: INSURANCE AND GEOGRAPHY PLAY A ROLE

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0024
Author(s):  
Tyler B. Hall ◽  
Max J. Hyman ◽  
Neeraj M. Patel
Keyword(s):  
United States ◽  
Children And Adolescents ◽  
Statistical Significance ◽  
Private Insurance ◽  
Univariate Analysis ◽  
The United States ◽  
National Database ◽  
The West ◽  
Cartilage Restoration ◽  
Common Diagnosis

Background: A number of surgical options are available for sizeable articular cartilage lesions of the knee. These include osteochondral autograft (OAU) or allograft (OAL) transfer, or autologous chondrocyte implantation (ACI). In the pediatric population, there is little data on the patients undergoing these procedures or evidence to support one technique over another, which may lead to variation in preferred practice. Hypothesis/Purpose: The purpose of this study is to analyze the epidemiology of children and adolescents undergoing OAU, OAL, and ACI in the United States, with attention to variation along the lines of demographic and geographic factors. Methods: The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients undergoing OAU, OAL, and ACI between 2012 and 2018. Demographic information was collected for each subject. United States Census guidelines were used to categorize hospitals geographically into regions. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 809 subjects with a mean age of 15.4±2.4 years were included in the analysis. Of these, 393 (48.6%) underwent OAL, 339 (41.9%) underwent OAU, and 77 (9.5%) underwent ACI. The most common diagnosis at the time of surgery was osteochondritis dissecans in 360 patients (44.5%) followed by an associated cruciate ligament injury in 126 (15.6%) and patellar instability in 98 (12.1%). After adjusting for confounders in a multivariate model, ACI was more 3.4 times more likely to be performed in patients with private insurance than those that were publicly insured (95% CI 1.5-7.5, p=0.002). Furthermore, a patient in this Northeast was 29.3 times more likely to undergo ACI than in the West (95% CI 4.0-217.4, p=0.001). OAU was performed most frequently in the West and Midwest (52.4% and 51.8% of the time, respectively; p<0.001). Univariate analysis also revealed differences along the lines of race, but these findings did not maintain statistical significance in multivariate analysis. Conclusion: In the United States, there is substantial variation in the procedures performed for cartilage restoration in children and adolescents. Though ACI is the least commonly selected operation overall, it is significantly more likely to be performed on patients with private insurance and those in the Northeast. OAU is the most commonly performed procedure in the West and Midwest.

Sign in / Sign up

Export Citation Format

Share Document