Postdisaster health communication and information sources: the Iowa flood scenario.

BACKGROUND: During June 2008, heavy precipitation and 500-year flood events resulted in the displacement of thousands of families throughout eastern Iowa. The objectives of this study were to assess the effectiveness and preferred sources of health messages communicated to the public following the disaster. METHODS: Three hundred twenty-seven households were surveyed in 4 counties hit hardest by the flooding. A 48-item questionnaire containing items on demographics, housing, health information sources, and 8 specific health issues was administered. RESULTS: Almost all of the participants (99.0%) received information on at least 1 of the health topics covered by the survey. Most participants received information regarding vaccination (84.1%), mold (79.5%), safe use of well water (62.7%), respirator use (58.7%), or stress (53.8%). Television was the primary (54.7%) and preferred (60.2%) source of health information for most people, followed by the Internet (11.0% and 30.3% as source and preference, respectively). CONCLUSIONS: Public health messages were received by a wide audience in the flood-affected communities. Along with more traditional health communication channels such as television, radio, or newspapers, continued emphasis on the development of health information Web sites and other technological alternatives may result in useful and effective health communication in similar situations.

Recent resurgence of mumps in the United States.

BACKGROUND: The widespread use of a second dose of mumps vaccine among U.S. schoolchildren beginning in 1990 was followed by historically low reports of mumps cases. A 2010 elimination goal was established, but in 2006 the largest mumps outbreak in two decades occurred in the United States. METHODS: We examined national data on mumps cases reported during 2006, detailed case data from the most highly affected states, and vaccination-coverage data from three nationwide surveys. RESULTS: A total of 6584 cases of mumps were reported in 2006, with 76% occurring between March and May. There were 85 hospitalizations, but no deaths were reported; 85% of patients lived in eight contiguous midwestern states. The national incidence of mumps was 2.2 per 100,000, with the highest incidence among persons 18 to 24 years of age (an incidence 3.7 times that of all other age groups combined). In a subgroup analysis, 83% of these patients reported current college attendance. Among patients in eight highly affected states with known vaccination status, 63% overall and 84% between the ages of 18 and 24 years had received two doses of mumps vaccine. For the 12 years preceding the outbreak, national coverage of one-dose mumps vaccination among preschoolers was 89% or more nationwide and 86% or more in highly affected states. In 2006, the national two-dose coverage among adolescents was 87%, the highest in U.S. history. CONCLUSIONS: Despite a high coverage rate with two doses of mumps-containing vaccine, a large mumps outbreak occurred, characterized by two-dose vaccine failure, particularly among midwestern college-age adults who probably received the second dose as schoolchildren. A more effective mumps vaccine or changes in vaccine policy may be needed to avert future outbreaks and achieve the elimination of mumps.

The duration of mumps virus shedding after the onset of symptoms.

To determine how long people shed virus after the onset of mumps, we used logistic regression modeling to analyze data from the 2006 outbreak of mumps in Iowa. Our model establishes that the probability of mumps virus shedding decreases rapidly after the onset of symptoms. However, we estimate that 8%-15% of patients will still be shedding the virus 5 days after the onset of symptoms and, thus, may still be contagious during this period.

The cost of containing one case of measles: the economic impact on the public health infrastructure--Iowa, 2004.

BACKGROUND: In February 2004, students from a college in Iowa, with a high proportion of nonmedical exemptions to vaccination, traveled to India; one fourth of the students contracted measles while there. One exposed, susceptible student returned home during his infectious period, necessitating 2 months of containment efforts in Iowa. OBJECTIVE: The objective of this study was to measure the direct costs of measles containment from a public health system perspective. METHODS: We evaluated activities performed, personnel time/materials allocated, and direct costs incurred in 2004 US dollars by the Iowa public health infrastructure. The study period was defined as March 5, 2004 (when the Iowa Department of Public Health was first contacted about the case), through May 12, 2004 (when a final meeting was held on the containment effort). RESULTS: A total of 2525 hours of personnel time were expended to review flight manifests, contact exposed passengers, set up vaccination clinics, trace >1000 potentially exposed contacts, and institute and enforce quarantine orders for vaccination refusers. Two thousand twenty-five phone calls were received from the public, and 2243 miles were driven by staff. The temporal distribution of personnel time was characterized by marked peaks at the report of potential secondary cases. The total estimated cost was 142452 dollars. CONCLUSIONS: The direct cost to the public health infrastructure of containing 1 case of measles was far greater than the estimated cost of uncomplicated individual illness (less than 100 dollars). Economic analyses of vaccine-preventable diseases may need to go beyond the costs of individual illness to account for the costs of protecting society.

U.S. medical students' rotations in epidemiology and public health at state and local health departments.

Elective rotations in health departments expose medical students to public health practice and career opportunities in applied epidemiology and preventive medicine. State and county epidemiologists and health officers can serve as excellent role models for medical students. In 2000-2001, the authors identified such electives by consulting medical schools' Web sites and by contacting state epidemiologists, teachers of preventive medicine, and medical school associate deans. The authors found that electives were offered in nine state and five local health departments; these are described in detail. Those electives usually focused on infectious diseases, involved students in outbreak investigations when possible, lasted four or more weeks, were open to other students and medical residents, and were overseen by a health department preceptor with a medical school faculty appointment and a commitment to train students. Some electives included more didactic components, encouraged the student to publish a manuscript, or were coordinated by a preventive medicine residency director. The authors observe that health departments can benefit from training enthusiastic medical students via such electives; these students bring fresh ideas to the departments. Medical school catalogs, Web sites, and word of mouth are important means for promoting these electives. Ideally, in the future every medical school will offer a state or local health department elective so that all medical students will become aware of epidemiology and public health career options. The electives reported in this article can help guide additional medical schools and health departments as they initiate such rotations.

A pseudo-outbreak of Chlamydia trachomatis in a state residential facility: implications for diagnostic testing.

In December 1998, an outbreak of Chlamydia trachomatis genital infections was reported among 18 residents of a state residential facility housing 392 mentally retarded clients. The initial patient tested positive by ligase chain reaction (LCR); 17 others tested positive by culture. Serologic test results for C. trachomatis antibodies in patients who had tested positive by culture were negative. Further testing showed that C. trachomatis DNA could not be detected in the LCR specimen or in any reportedly positive culture specimens. At the original culture laboratory, C. trachomatis culture was infrequently performed, and positive controls were not adequately prepared. This pseudo-outbreak highlights problems that may occur with C. trachomatis testing. As experience with C. trachomatis culture declines, laboratories performing this test should ensure quality and consider confirmatory testing. For C. trachomatis screening tests, the need for confirmatory testing depends on individual patient considerations (including medical-legal implications) and prevalence of infection in the tested population.