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1.  Two Clusters of HIV-1 Infection, Rural Idaho, USA, 2008 
Emerging Infectious Diseases  2010;16(11):1807-1809.
PMCID: PMC3294533  PMID: 21029556
Viruses; HIV; epidemiology; rural population; Idaho; men who have sex with men; MSM; intravenous substance abuse; infectious disease transmission; Idaho; letter
2.  Survey of State Practices During the 2004–2005 Influenza Vaccine Shortage 
Public Health Reports  2007;122(3):311-318.
To describe state-level actions and policies during the 2004–2005 influenza vaccine shortage and determine whether these or other factors were related to vaccination coverage, we surveyed all state health departments (including the District of Columbia). We included 2004–2005 Behavioral Risk Factor Surveillance System data to examine whether state-level actions, policies, or other factors like vaccine supply were related to changes in vaccination coverage in adults aged ≥65 years from the previous non-shortage year. We found that 96% (n=49) of states reported adopting or recommending adherence to the initial national interim influenza vaccination recommendations. Of these, at some point during the season, 22% (n=11) reported local public health agencies issued prioritization recommendations that differed from the state health department's guidance. Eighty percent (n=41) initiated at least one emergency response activity and 43% (n=22) referred to or implemented components of their pandemic influenza plans. In 35% (n=18), emergency or executive orders were issued or legislative action occurred.
In a multivariable linear regression model, the availability and use of practitioner contact lists and having a relatively high vaccine supply in early October 2004 were associated with smaller decreases in coverage for adults aged ≥65 years from the previous non-shortage season (p=0.003, r2=0.26). States overwhelmingly followed national vaccination prioritization guidelines and used a range of activities to manage the 2004–2005 vaccine shortage. The availability and use of practitioner contact lists and having a relatively high vaccine supply early in the season were associated with smaller decreases in coverage from the previous non-shortage season.
PMCID: PMC1847493  PMID: 17518302
3.  Field assessment of a model tuberculosis outbreak response plan for low-incidence areas 
BMC Public Health  2007;7:307.
For a regional project in four low-incidence states, we designed a customizable tuberculosis outbreak response plan. Prior to dissemination of the plan, a tuberculosis outbreak occurred, presenting an opportunity to perform a field assessment of the plan. The purpose of the assessment was to ensure that the plan included essential elements to help public health professionals recognize and respond to outbreaks.
We designed a semi-structured questionnaire and interviewed all key stakeholders involved in the response. We used common themes to assess validity of and identify gaps in the plan. A subset of participants provided structured feedback on the plan.
We interviewed 11 public health and six community stakeholders. The assessment demonstrated that (1) almost all of the main response activities were reflected in the plan; (2) the plan added value by providing a definition of a tuberculosis outbreak and guidelines for communication and evaluation. These were areas that lacked written protocols during the actual outbreak response; and (3) basic education about tuberculosis and the interpretation and use of genotyping data were important needs. Stakeholders also suggested adding to the plan questions for evaluation and a section for specific steps to take when an outbreak is suspected.
An interactive field assessment of a programmatic tool revealed the value of a systematic outbreak response plan with a standard definition of a tuberculosis outbreak, guidelines for communication and evaluation, and response steps. The assessment highlighted the importance of education and training for tuberculosis in low-incidence areas.
PMCID: PMC2194699  PMID: 17963502
4.  Alfalfa Seed Decontamination in Salmonella Outbreak 
Emerging Infectious Diseases  2003;9(4):474-479.
Based on in vitro data, the U.S. Food and Drug Administration recommends chemical disinfection of raw sprout seeds to reduce enteric pathogens contaminating the seed coats. However, little is known about the effectiveness of decontamination at preventing human disease. In 1999, an outbreak of Salmonella enterica serotype Mbandaka occurred in Oregon, Washington, Idaho, and California. Based on epidemiologic and pulsed-field gel electrophoresis evidence from 87 confirmed cases, the outbreak was linked to contaminated alfalfa seeds grown in California’s Imperial Valley. Trace-back and trace-forward investigations identified a single lot of seeds used by five sprout growers during the outbreak period. Cases of salmonellosis were linked with two sprout growers who had not employed chemical disinfection; no cases were linked to three sprout growers who used disinfection. This natural experiment provides empiric evidence that chemical disinfection can reduce the human risk for disease posed by contaminated seed sprouts.
PMCID: PMC2957971  PMID: 12702229
Alfalfa; seed sprouts; salmonellosis; foodborne illness; salmonella outbreak; Oregon; seed disinfection; food safety
5.  Coordinated Response to Reports of Possible Anthrax Contamination, Idaho, 2001 
Emerging Infectious Diseases  2002;8(10):1093-1095.
In 2001, the intentional release of anthrax spores in the eastern United States increased concern about exposure to anthrax nationwide, and residents of Idaho sought assistance. Response from state and local agencies was required, increasing the strain on epidemiologists, laboratorians, and communications personnel. In late 2001, Idaho’s public health communications system handled 133 calls about suspicious powders. For each call, a multiagency bridge call was established, and participants (public health officials, epidemiologists, police, Federal Bureau of Investigation personnel, hazardous materials officials, and others) determined which samples would be tested by the state public health laboratory. A triage system for calls helped relieve the burden on public safety and health systems.
PMCID: PMC2730284  PMID: 12396922
anthrax; bioterrorism; Idaho
6.  Comparative Study of Different Standardization Concepts in Quantitative Competitive Reverse Transcription-PCR Assays 
Journal of Clinical Microbiology  1998;36(3):628-633.
Four different standardization approaches based on a competitive reverse transcription (RT)-PCR assay were compared with a noncompetitive assay based on an external standard curve. Criteria for assessment were accuracy in quantitation, correctness of recovery, sensitivity, dynamic range, reproducibility, throughput, and convenience of sample handling. As a model system, we used the 5′-noncoding region of hepatitis C virus (HCV) for amplification in all quantitative RT-PCRs. A computer program that allowed parallel data processing was developed. Surprisingly, all methods were found suitable for accurate quantitation and comparable with respect to the criterion correctness of recovery. All results differed only by a factor of about 2. The reason for this finding might be that all of our mimics, as well as the wild-type genome of HCV, exhibited exactly the same amplification and hybridization efficacy. Moreover, minimal competition occurred in our experiments over a 5-log dynamic range. A further topic of our investigation was the comparison of two different competitive RNA fragments, mimics, with regard to their suitability as internal standards. One was a heterologous mimic, in which only the primer binding sites were identical to the wild type. The second one was a homologous mimic identical to the wild type except for a small region used for differential hybridization, which was replaced by a permutated sequence of the same length. Both the homologous and heterologous internal mimics were found appropriate for an accurate competitive RT-PCR assay, provided that amplification efficacy, as well as capture efficacy, is proven identical for both analyte and mimic.
PMCID: PMC104598  PMID: 9508285

Results 1-6 (6)