Case-control study to identify risk factors for SARS-CoV-2 infection among university students in the northeastern USA.

Curbing the coronavirus disease 2019 (COVID-19) pandemic requires a thorough understanding of risk factors for transmission of SARS-CoV-2, the etiologic agent. Institutions of higher education present unique challenges for controlling disease spread because of features inherent to these settings. Our objective was to determine risk factors for SARS-CoV-2 infection among a university student population in the northeastern USA during the spring and fall 2021 semesters, using the case-control study design. Cases were defined as students with a newly diagnosed SARS-CoV-2 infection detected either through the robust PCR-based surveillance testing program on campus or through healthcare testing if symptoms compatible with COVID-19 were present. Controls were defined as students with negative SARS-CoV-2 status, based on consistently negative PCR results at the time of selection. A comprehensive questionnaire was administered to each student enrolled in the study, covering a broad range of campus life activities. A total of 446 cases and 1,185 controls were included in this study. Multivariable logistic regression analysis showed that recent party attendance (adjusted OR = 2.3, p < .0001), recently visiting a bar (aOR = 1.6, p = .007), living in a campus residence hall (aOR = 1.6, p = .001), fraternity/sorority membership (aOR = 1.8, p = .002), and recent travel (aOR = 1.3, p = .04) were associated with being a COVID-19 case. Having an on-campus job was negatively associated with being a COVID-19 case (aOR = 0.6, p = .0003). Among cases, the most commonly reported symptoms were cough (43.9%), fatigue (38.1%) and sore throat (30.3%). These findings can be used to inform the development of COVID-19 mitigation strategies and public health outreach efforts in university settings, thus reducing SARS-CoV-2 transmission among students and helping to preserve the vital education and research missions of these institutions.

Integrated Surveillance System for Controlling COVID-19 on a University Campus, 2020‒2021.

To minimize the impacts of COVID-19 and to keep campus open, Cornell University's Ithaca, NY, campus implemented a comprehensive process to monitor COVID-19 spread, support prevention practices, and assess early warning indicators linked to knowledge, behaviors, and attitudes of campus community members. The integrated surveillance approach informed leadership and allowed for prompt adjustments to university policies and practices through evidence-based decisions. This approach enhanced healthy behaviors and promoted the well-being and safety of all community members. (Am J Public Health. 2022;112(7):980-984. https://doi.org/10.2105/AJPH.2022.306838).

School closures during the 2009 influenza pandemic: national and local experiences.

BACKGROUND: School closure is a non-pharmaceutical intervention that was considered in many national pandemic plans developed prior to the start of the influenza A(H1N1)pdm09 pandemic, and received considerable attention during the event. Here, we retrospectively review and compare national and local experiences with school closures in several countries during the A(H1N1)pdm09 pandemic. Our intention is not to make a systematic review of country experiences; rather, it is to present the diversity of school closure experiences and provide examples from national and local perspectives. METHODS: Data were gathered during and following a meeting, organized by the European Centres for Disease Control, on school closures held in October 2010 in Stockholm, Sweden. A standard data collection form was developed and sent to all participants. The twelve participating countries and administrative regions (Bulgaria, China, France, Hong Kong Special Administrative Region (SAR), Italy, Japan, New Zealand, Serbia, South Africa, Thailand, United Kingdom, and United States) provided data. RESULTS: Our review highlights the very diverse national and local experiences on school closures during the A(H1N1)pdm09 pandemic. The processes including who was in charge of making recommendations and who was in charge of making the decision to close, the school-based control strategies, the extent of school closures, the public health tradition of responses and expectations on school closure varied greatly between countries. Our review also discusses the many challenges associated with the implementation of this intervention and makes recommendations for further practical work in this area. CONCLUSIONS: The single most important factor to explain differences observed between countries may have been the different public health practises and public expectations concerning school closures and influenza in the selected countries.

A qualitative study of pandemic influenza preparedness among small and medium-sized businesses in New York City.

Small businesses need to engage in continuity planning to assure delivery of goods and services and to sustain the economy during an influenza pandemic. This is especially true in New York City, where 98 per cent of businesses have fewer than 100 employees. It was an objective therefore, to determine pandemic influenza business continuity practices and strategies suitable for small and medium-sized NYC businesses. The study design used focus groups, and the participants were owners and managers of businesses with fewer than 500 employees in New York City. The main outcome measures looked for were the degree of pandemic preparedness, and the feasibility of currently proposed business continuity strategies. Most participants reported that their businesses had no pandemic influenza plan. Agreement with feasibility of specific business continuity strategies was influenced by the type of business represented, cost of the strategy, and business size. It was concluded that recommendations for pandemic-related business continuity plans for small and medium-sized businesses should be tailored to the type and size of business and should highlight the broad utility of the proposed strategies to address a range of business stressors.

Public health and environmental response to the first case of naturally acquired inhalational anthrax in the United States in 30 years: infection of a new york city resident who worked with dried animal hides.

In Pennsylvania on February 16, 2006, a New York City resident collapsed with rigors and was hospitalized. On February 21, the Centers for Disease Control and Prevention and the New York City Department of Health and Mental Hygiene were notified that Bacillus anthracis had been identified in the patient's blood. Although the patient's history of working with dried animal hides to make African drums indicated the likelihood of a natural exposure to aerosolized anthrax spores, bioterrorism had to be ruled out first. Ultimately, this case proved to be the first case of naturally occurring inhalational anthrax in 30 years. This article describes the epidemiologic and environmental investigation to identify other cases and persons at risk and to determine the source of exposure and scope of contamination. Because stricter regulation of the importation of animal hides from areas where anthrax is enzootic is difficult, public healthcare officials should consider the possibility of future naturally occurring anthrax cases caused by contaminated hides. Federal protocols are needed to assist in the local response, which should be tempered by our growing understanding of the epidemiology of naturally acquired anthrax. These protocols should include recommended methods for reliable and efficient environmental sample collection and laboratory testing, and environmental risk assessments and remediation.

Pandemic influenza as 21st century urban public health crisis.

The percentage of the world's population living in urban areas will increase from 50% in 2008 to 70% (4.9 billion) in 2025. Crowded urban areas in developing and industrialized countries are uniquely vulnerable to public health crises and face daunting challenges in surveillance, response, and public communication. The revised International Health Regulations require all countries to have core surveillance and response capacity by 2012. Innovative approaches are needed because traditional local-level strategies may not be easily scalable upward to meet the needs of huge, densely populated cities, especially in developing countries. The responses of Mexico City and New York City to the initial appearance of influenza A pandemic (H1N1) 2009 virus during spring 2009 illustrate some of the new challenges and creative response strategies that will increasingly be needed in cities worldwide.

Does integrating viral hepatitis services into a public STD clinic attract injection drug users for care?

OBJECTIVE: Injection drug users (IDUs) are at high risk for multiple health problems, including human immunodeficiency virus (HIV), viral hepatitis, and sexually transmitted diseases (STDs), and are likely to have poor access to health care. To more effectively serve high-risk clients, experts recommend that programs accessed by such client populations offer integrated services. In 2000, the New York City Department of Health and Mental Hygiene integrated viral hepatitis services (vaccine and screening) into a publicly funded STD clinic. We evaluated integrated service delivery to high-risk IDUs at this clinic. METHODS: Hepatitis data were reviewed to identify clients who self-reported as IDUs. STD medical records of these clients were abstracted to ascertain primary reason for clinic visit, STD/HIV services received, and diagnoses made. RESULTS: Between May 2000 and March 2004, 8,778 individuals received hepatitis services, of whom 3% (279/8,778) reported injection drug use. Nearly 60% (161/279) of IDUs reported availability of hepatitis services as the primary reason for the clinic visit. Of these 161 clients, 103 (64%) also received other services; 54% (55/103) had an STD exam (yielding 12 new STD diagnoses), and 59% (61/103) had HIV counseling and testing (yielding two new HIV cases). Of these 103 clients, 31 (30%) were referred to the clinic for hepatitis services from a drug treatment center, and 77% (24/31) tested positive for the antibody to hepatitis C virus. CONCLUSIONS: Integrated hepatitis services appeared to attract IDUs to this STD clinic, where many also benefited from STD/HIV exams, testing, treatment, and referrals they may not have received otherwise.

Low prevalence of hepatitis C virus antibody in men who have sex with men who do not inject drugs.

OBJECTIVE: It is well documented that injection drug users (IDUs) have a high prevalence of antibodies to hepatitis C virus (HCV). Sexual transmission of HCV can occur, but studies have shown that men who have sex with men (MSM) without a history of injection drug use are not at increased risk for infection. Still, some health-care providers believe that all MSM should be routinely tested for HCV infection. To better understand the potential role of MSM in risk for HCV infection, we compared the prevalence of antibody to HCV (anti-HCV) in non-IDU MSM with that among other non-IDU men at sexually transmitted disease (STD) clinics and human immunodeficiency virus (HIV) counseling and testing sites in three cities. METHODS: During 1999-2003, public health STD clinics or HIV testing programs in Seattle, San Diego, and New York City offered counseling and testing for anti-HCV for varying periods to all clients. Sera were tested using enzyme immunoassays, and final results reported using either the signal-to-cutoff ratio or recombinant immunoblot assay results. Age, sex, and risk information were collected. Prevalence ratios and 95% confidence intervals were calculated. RESULTS: Anti-HCV prevalence among IDUs (men and women) was between 47% and 57% at each site, with an overall prevalence of 51% (451/887). Of 1,699 non-IDU MSM, 26 (1.5%) tested anti-HCV positive, compared with 126 (3.6%) of 3,455 other non-IDU men (prevalence ratio 0.42, 95% confidence interval 0.28, 0.64). CONCLUSION: The low prevalence of anti-HCV among non-IDU MSM in urban public health clinics does not support routine HCV testing of all MSM.

Predictors of acceptance of hepatitis B vaccination in an urban sexually transmitted diseases clinic.

BACKGROUND: Individuals who use sexually transmitted disease (STD) clinics are at high risk for hepatitis B virus (HBV). While HBV vaccine is frequently offered to clients in this setting, reported vaccination rates are low. More information is needed about HBV vaccine knowledge, attitudes, beliefs, and behavior among high risk populations. The current study assesses these issues at an urban STD clinic. METHODS: A survey assessing knowledge, attitudes, and beliefs concerning HBV vaccine was administered to individuals seeking services at an STD clinic before seeing the physician. Immediately after the clinical visit these individuals were interviewed and asked whether they had accepted vaccination and their reasons for acceptance or rejection. RESULTS: Fifty percent of unvaccinated study subjects elected to receive an HBV vaccine dose at the current visit. Significant predictors in a multiple logistic regression model for choosing to be vaccinated were: having a vaccinated acquaintance, perceived risk of disease, perceived healthfulness of vaccine, and clinician's recommendation. Knowledge regarding hepatitis B risks and outcomes was not related to vaccine choices. Patients expressed concern about vaccine safety and provider motivation. CONCLUSIONS: The role of acquaintances and the physician are central to the decision to be vaccinated, as are risk perception and familiarity with the vaccine. Mistrust of the medical establishment and of vaccines is a barrier to acceptance of HBV vaccine.

Developing a collaborative community, academic, health department partnership for STD prevention: the Gonorrhea Community Action Project in Harlem.

Community interventions are rare in the field of sexually transmitted disease (STD) control and prevention. The goals of the Gonorrhea Community Action Project are to design and implement interventions for the reduction of gonorrhea in high-prevalence areas and to increase the appropriateness and effectiveness of STD care in the participating formative research and developing the interventions was the creation of a community-academic-health department collaborative partnership. Using a staged model, this article presents a case study of collaboration development in the community of Harlem, New York.

Investigation of bioterrorism-related anthrax, United States, 2001: epidemiologic findings.

In October 2001, the first inhalational anthrax case in the United States since 1976 was identified in a media company worker in Florida. A national investigation was initiated to identify additional cases and determine possible exposures to Bacillus anthracis. Surveillance was enhanced through health-care facilities, laboratories, and other means to identify cases, which were defined as clinically compatible illness with laboratory-confirmed B. anthracis infection. From October 4 to November 20, 2001, 22 cases of anthrax (11 inhalational, 11 cutaneous) were identified; 5 of the inhalational cases were fatal. Twenty (91%) case-patients were either mail handlers or were exposed to worksites where contaminated mail was processed or received. B. anthracis isolates from four powder-containing envelopes, 17 specimens from patients, and 106 environmental samples were indistinguishable by molecular subtyping. Illness and death occurred not only at targeted worksites, but also along the path of mail and in other settings. Continued vigilance for cases is needed among health-care providers and members of the public health and law enforcement communities.

HIV infection in men who have sex with men, New York City Department of Health sexually transmitted disease clinics, 1990-1999: a decade of serosurveillance finds that racial disparities and associations between HIV and gonorrhea persist.

BACKGROUND: Previous data indicating wide racial disparities in HIV seroprevalence, associations between sentinel sexually transmitted diseases (STDs) and HIV infection, and recent reports of STD outbreaks among men who have sex with men (MSM) have raised concerns that HIV may be resurgent among MSM. GOAL: To measure trends in HIV seroprevalence and describe racial disparities among MSM presenting to New York City Department of Health STD clinics, 1990-1999 (n = 4076). STUDY DESIGN: This blinded HIV-1 serosurvey used remnant serum originally drawn for routine serologic tests for syphilis. Demographic, risk factor, clinical and laboratory data were abstracted from clinic charts of patients whose medical records documented sexual contact with men or with both men and women ("bisexual" men). Data were matched to the specimens, and all personal identifiers were removed before testing. Patients were not interviewed. RESULTS: The sample was 41% black, 20% Hispanic, 31% white, and 9% of other or mixed race/ethnicity. Sixty-one percent of the patients were >30 years of age; 21% were > or = 40 years of age. One-third had sex with women as well as men. For 60%, laboratory-confirmed STD diagnosis was made on the serosurvey visit. Overall, HIV seroprevalence declined from 47% in 1990 to 18% in 1999 (P < 0.01). Seroprevalence declined from 34% to 11% among white men (n = 1250), from 47% to 19% among Hispanic men (n = 795), from 56% to 28% among black men (n = 1656), and from 43% to 14% among men who had sex with both men and women (n = 1447). Seroprevalence among MSM with gonorrhea (n = 507) declined but remained high (57-34%; P < 0.05). In contrast, seroprevalence among MSM with nongonococcal urethritis (n = 953) declined from 36% to 16% (P < 0.01), and seroprevalence among MSM who had no STD (n = 1650) dropped from 48% to 12% (P < 0.01). Gonorrhea was diagnosed almost twice as frequently among seropositive versus seronegative MSM (19% versus 10%; P < 0.05). Black MSM were not more or less likely to have been tested for HIV or to be diagnosed with acute STD than were MSM in the other-race/ethnicity group. Positive serostatus was associated with black race/ethnicity (odds ratio [OR], 2.5; 95% CI, 2.1-2.9), age >25 years (OR, 2.5; 95% CI, 1.9-3.1), and a diagnosis of gonorrhea (OR, 2.4; 95% CI, 2.0-2.8). Sixty percent of seropositive MSM knew their serostatus from confidential or anonymous HIV testing at this or a previous visit. Two thirds of the known seropositive men had a new STD diagnosed at the serosurvey visit. CONCLUSION: Seroprevalence in this racially diverse sample of MSM declined significantly during the study period. However, wide racial disparities in seroprevalence were observed that were not attributable to disparities in risk factors such as STD, bisexuality, or acceptance of HIV testing. This finding suggests that the observed differences may reflect racial differences in the background seroprevalences, such as those seen in all New York City serosurvey samples and the population-based AIDS case rates. High prevalence associated with gonorrhea and new STD in known seropositive men of any race suggests that continued efforts to control the incidence of STD, increased encouragement of MSM to accept HIV counseling and testing, and prevention-focused counseling of seropositive men are needed.