Supporting Health Equity Through Data-Driven Decision-Making: A Local Health Department Response to COVID-19

COVID-19 highlights preexisting inequities that affect health outcomes and access to care for Black and Brown Americans. The Marion County Public Health Department in Indiana sought to address inequities in COVID-19 testing by using surveillance data to place community testing sites in areas with the highest incidence of disease. Testing site demographic data indicated that targeted testing reached populations with the highest disease burden, suggesting that local health departments can effectively use surveillance data as a tool to address inequities. (Am J Public Health. 2021;111(S3):S197–S200. https://doi.org/10.2105/AJPH.2021.306421 )

Imipenem-Relebactam Susceptibility and Genotypic Characteristics of Carbapenem-Resistant Enterobacterales (CRE) Identified during Population-Based Surveillance

Laboratories submit all carbapenem-resistant Enterobacter , Escherichia coli , and Klebsiella species to the Alameda County Public Health Department (ACPHD). ACPHD evaluated 75 isolates submitted during nine months for susceptibility to imipenem-relebactam (I-R) and identified β-lactamase genes using whole genome sequencing. Of 60 (80%) isolates susceptible to I-R, 8 (13%) had detectable carbapenemase genes, including four KPC, two NDM, and two OXA-48-like; we described the relationship between the presence of β-lactamase resistance genes and susceptibility to I-R.

Understanding the Los Angeles County Coronavirus Epidemic: The Critical Role of Intrahousehold Transmission

We tracked the course of the COVID-19 epidemic among the approximately 300 communities comprising Los Angeles County. The epidemic, we found, had three distinct phases. During Phase I, from early March through about April 4, initial seeding of infection in relatively affluent areas was followed by radial geographic extension to adjoining communities. During Phase II, lasting until about July 11, COVID-19 cases continued to rise at a slower rate, and became increasingly concentrated in four geographic foci of infection across the county. Those communities with larger reductions in social mobility during April - as measured by the proportion of smartphones staying at home and number of smartphones visiting a gym - reported fewer COVID-19 cases in May. During Phase III, COVID-19 incidence only gradually declined, remaining as high as the incidence seen at the end of Phase I. Across communities, the prevalence of households at high risk for intergenerational transmission was strongly correlated with the persistence of continued COVID-19 propagation. This association was even stronger in those communities with a higher rate of gym attendance in Phase II. The map of the prevalence of at-risk households in Los Angeles County coincided strikingly with the map of cumulative COVID-19 incidence. These findings, taken together, support the critical role of household structure in the persistent propagation of COVID-19 infections in Los Angeles County. Public health policy needs to be reoriented from a focus on protecting the individual to a focus on protecting the household.

Harris County Public Health Mosquito and Vector Control Division Emergency Response to Hurricane Harvey: Vector-Borne Disease Surveillance and Control

ABSTRACT Hurricane Harvey made a landfall on the Texas Gulf Coast on August 25, 2017, stalling over Harris County as a tropical storm for 4 days (August 26–29), dumping approximately 127 cm of rain. This tremendous amount of rainfall overwhelmed the county's natural and man-made drainage systems, resulting in unprecedented widespread flooding. Immediately following, Harris County Public Health Mosquito and Vector Control Division conducted a countywide emergency vector control response by integrating surveillance, control, and education strategies. This included landing rate counts, mosquito and avian surveillance, arbovirus testing, ground-based ultra-low volume (ULV) and aerial pesticide spraying, and community outreach. The immediate response lasted for 4 wk through September, resulting in 774 landing rates, 49,342 ha treated by ground-based ULV, 242,811 ha treated by aerial ULV, 83,241 mosquitoes collected, 1,807 mosquito pools tested, and 20 education/outreach sessions. Recovery activities of 3 additional education/outreach events continued through October while surveillance and control activities returned to routine status.

Leaving a Mobile Footprint: Utilizing Data to Combat the 2017 - 2018 Influenza Season

ObjectiveDuring this session, participants will be able to understand how Harris County Public Health utilized data to make informed decisions on how to combat the influenza season.IntroductionThe 2017 – 2018 influenza season was classified by the Centers for Disease Control and Prevention (CDC) as ‘high severity’ across all age groups. Furthermore, CDC noted that this was the first year to be categorized as such, with the highest peak percentage of influenza-like-illnesses (ILI), since 2009. In Harris County alone, there were 2,665 positive flu tests reported in comparison to the previous season at 1,395 positive tests. In response to the severity of this year’s flu season, Harris County Public Health (HCPH) collaborated across the department to deploy five pop up influenza vaccination events utilizing our Mobile Fleets open to the general public.HCPH epidemiologists are able to collect influenza data from multiple systems and compile it into useful reports/tools. These data include latitudinal and longitudinal data, allowing us to create highly localized maps of where influenza has had impacted communities the hardest. This granular data allowed HCPH to target 5 areas with our Mobile Fleet that had a) high levels of influenza and b) generally limited healthcare/public health infrastructure.Our Mobile Fleet is made up of 8 different Recreational Vehicles that have been retrofitted to offer various public health services including: immunizations, medical visits, dental visits, pet adoptions, mosquito and vector control education, and a fresh food market. The Fleet allows HCPH to offer a full menu of public health services anywhere within the County. While our efforts for this abstract were focused on controlling the influenza outbreak, we leveraged the opportunity to engage with the public on multiple issues such as environmental, veterinary, mosquito control, dental health, and accessible healthy food options.MethodsAs positive flu reports mounted, our epidemiology program provided surveillance data of influenza and ILI in Harris County. Data was obtained through multiple sources including: National Electronic Disease Surveillance System (NEDSS), which includes electronic laboratory reporting; National Respiratory Enteric Virus Surveillance System (NREVSS), which includes all flu tests done in laboratories in Houston; and last, the Flu Portal, which school nurses in Harris County upload school absenteeism rates due to ILI. Once collected and compiled, our Geographic Information System (GIS) team used the data to generate spatial maps of Harris County illustrating the disproportionally high rates. Specifically, our GIS team was able to utilize ArcGIS, and cross layer them with the flu data provided from the epidemiologists. Utilizing these maps, HCPH leadership mobilized the preparedness team to lead a data driven response in five different zip codes throughout the county to hold the influenza vaccination events.ResultsThe Mobile Fleet was operational on five separate dates in five separate zip codes during February and March of 2018. Overall, 477 individuals were provided the influenza vaccine. Of those 477, 304 were 18 years or older, with 173 being under 18 years of age.ConclusionsHaving timely and actionable data is an essential first step to understand and stop an outbreak of any size. However, surveillance data alone won't prevent an outbreak from spreading. That data must be married to effective public health action. Our Mobile Fleet is able to deliver precision public health services by targeting communities most affected and vulnerable to the spread of disease. As surveillance geospatial data becomes more granular so too must our public health service delivery modes become more precise and targeted.

Mass Gathering Surveillance: New ESSENCE Report and Collaboration Win Gold in OR

ObjectiveTo streamline production of a daily epidemiology report includingsyndromic surveillance, notifiable disease, and outbreak data duringa mass gatheringIntroductionThe 2016 U.S. Olympic Track and Field Team Trials were heldJuly 1-10 in Eugene, OR. This mass gathering included over 1,000athletes, 1,500 volunteers, and 175,000 spectators. The Oregon PublicHealth Division (PHD) and Lane County Public Health (LCPH)participated in pre-event planning and collaborated to produce adaily epidemiology report for the Incident Management Team (IMT)during the event. The state and county public health agencies hadcollaborated on surveillance for prior mass gatherings, including the2012 Trials. However, 2016 was the first opportunity to use completestate and county syndromic surveillance data.MethodsPHD staff developed an ESSENCE report, highlighting sevenpriority health outcomes: total emergency department visits; injury,gastrointestinal, respiratory, and fever syndromes; and asthma-like and heat-related illness queries. The report included side-by-side comparisons of county and state time series graphs, a tablesummarizing reportable diseases, and space to narratively describeoutbreaks. PHD staff did a virtual demonstration and in-persontutorial for LCPH staff on how to run the report. ESSENCE accesspermissions had to be modified so that county users could see andproduce state time-series graphs but not data details for non-LaneCounty visits. Emphasis was placed on interpretation of likelyscenarios, i.e., one or two days with a warning that was not indicativeof an incident of public health importance.ResultsDuring the event, LCPH staff were able to run the reportsuccessfully, i.e., there were no technical glitches. For the first fewdays, LCPH staff consulted with PHD staff about epidemiologicalinterpretation. State data were of specific interest since data detailswere suppressed. Additionally, increases were seen in the injurysyndrome in the days preceding the July 4 holiday. Stratification bykey demographic factors and looking at subsyndrome breakdownson warning and alert days provided the needed information withoutrequiring the use of the detail details.ConclusionsAfter the event, there were three main recommendations forimproving the process.LCPH suggested that the side-by-side visualization of countyand state time series graphs was useful to see trends but the relativescale of the number of visits was unclear due to size and placement(see figure 1). Solutions for future reports include additionalexplanatory text, limiting the report to only county data, and alternativevisualizations that highlight the differences in visit magnitude.As part of the IMT process, the LCPH lead felt that her efforts tophysically go to the Emergency Operations Center to run the reporthelped facilitate communication with partners. However, it is notclear if this effort directly translated into IMT use of the report, whichwas posted to the online event management system and not includedin the daily situation status reports. While LCPH leadership and staffreported anecdotally that they found the report to be very useful,no formal evaluation of use was done with either public health orIMT staff. In advance of the next event, state and county staff shouldprepare evaluation metrics.The report feature in ESSENCE is a bit cumbersome to set up, butit allows for easy production of appealing and customizable reports.This template can be modified for future mass gatherings, includingathletic competitions and county fairs. PHD staff will continueto collaborate with LCPH to repurpose and improve the report foruse in Lane and other counties. Fostering local user comfort withinterpreting ESSENCE data and generating summaries for local useis a priority of the OR ESSENCE team.