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1.  Evidence-based Tool for Triggering School Closures during Influenza Outbreaks 
Emerging Infectious Diseases  2010;15(2):1841-3.
PMCID: PMC2958033  PMID: 20113593
Influenza A; subtype H1N1; pandemic; surveillance; influenza outbreak; school closure; viruses; expedited; Japan; letter
2.  Use of Hospital Discharge Data to Evaluate Notifiable Disease Reporting to Colorado's Electronic Disease Reporting System 
Public Health Reports  2011;126(1):100-106.
Notifiable disease surveillance systems are critical for communicable disease control, and accurate and timely reporting of hospitalized patients who represent the most severe cases is important. A local health department in metropolitan Denver used inpatient hospital discharge (IHD) data to evaluate the sensitivity, timeliness, and data quality of reporting eight notifiable diseases to the Colorado Electronic Disease Reporting System (CEDRS).
Using IHD data, we detected hospitalized patients admitted from 2003 through 2005 with a discharge diagnosis associated with one of eight notifiable diseases. Initially, we compared all cases identified through IHD diagnoses fields with cases reported to CEDRS. Second, we chose four diseases and conducted medical record review to confirm the IHD diagnoses before comparison with CEDRS cases.
Relying on IHD diagnoses only, shigellosis, salmonellosis, and Neisseria meningitidis invasive disease had high sensitivity (≥90%) and timeliness (≥75%); legionellosis, pertussis, and West Nile virus infection were intermediate; and hepatitis A and Haemophilus influenzae (H. influenzae) invasive disease had low sensitivity (≥90% and timeliness to ≥80% for H. influenza invasive disease, legionellosis, and pertussis; however, hepatitis A retained suboptimal sensitivity (67%) and timeliness (25%).
Hospital discharge data are useful for evaluating notifiable disease surveillance systems. Limitations encountered by using discharge diagnoses alone can be overcome by conducting medical record review. Public health agencies should conduct periodic surveillance system evaluations among hospitalized patients and reinforce notifiable disease reporting among the people responsible for this activity.
PMCID: PMC3001805  PMID: 21337935
3.  Assessment of Missing Immunizations and Immunization-Related Barriers Among WIC Populations at the Local Level 
Public Health Reports  2007;122(5):602-606.
Low childhood immunization rates have been a challenge in Colorado, an issue that was exacerbated by a diphtheria-tetanus-acellular pertussis (DTaP) vaccine shortage that began in 2001. To combat this shortage, the locally based Tri-County Health Department conducted a study to assess immunization-related barriers among children in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a population at risk for undervaccination.
This study assessed characteristics and perceptions of WIC mothers in conjunction with their children's immunization status in four clinics.
Results indicated poor immunization rates, which improved with assessment and referral. The uninsured were at higher risk for undervaccination. DTaP was the most commonly missing vaccine, and discrepancies existed between the children's perceived and actual immunization status, particularly regarding DTaP. Targeted interventions were initiated as a result of this study.
Local health departments should target immunization-related interventions by assessing their own WIC populations to identify unique vaccine-related deficiencies, misperceptions, and high-risk subpopulations.
PMCID: PMC1936967  PMID: 17877307
4.  Internet- versus Telephone-based Local Outbreak Investigations 
Emerging Infectious Diseases  2008;14(6):975-977.
We compared 5 locally conducted, Internet-based outbreak investigations with 5 telephone-based investigations. Internet-based surveys required less completion time, and response rates were similar for both investigation methods. Participant satisfaction with Internet-based surveys was high.
PMCID: PMC2600312  PMID: 18507919
Internet; disease outbreaks; local government; dispatch
5.  Environmental Predictors of Human West Nile Virus Infections, Colorado 
Emerging Infectious Diseases  2007;13(11):1788-1790.
To determine whether environmental surveillance of West Nile virus–positive dead birds, mosquito pools, equines, and sentinel chickens helped predict human cases in metropolitan Denver, Colorado, during 2003, we analyzed human surveillance data and environmental data. Birds successfully predicted the highest proportion of human cases, followed by mosquito pools, and equines.
PMCID: PMC3375805  PMID: 18217573
West Nile virus; epidemic; predictors; space-time; dispatch
6.  Follow-up of 2003 Human West Nile Virus Infections, Denver, Colorado 
Emerging Infectious Diseases  2006;12(7):1129-1131.
Tri-County Health Department and Boulder County Public Health conducted a follow-up study of all nonfatal West Nile virus (WNV) cases reported during 2003 in 4 metropolitan Denver, Colorado, counties. Self-reported patient information was obtained ≈6 months after onset. A total of 656 (81.2%) eligible WNV patients are included in this study.
PMCID: PMC3291048  PMID: 16836833
West Nile virus; epidemic; meningitis; encephalitis; fever
7.  Escherichia coli O157:H7 outbreak associated with consumption of ground beef, June-July 2002. 
Public Health Reports  2005;120(2):174-178.
OBJECTIVE: A case-control and environmental study tested the hypothesis that purchasing and eating ground beef from a specific source was the cause of a cluster of cases of hemolytic uremic syndrome (HUS) and Escherichia coli (E. coli) O157:H7 gastroenteritis. METHODS: A case-control study comparing risk factors was conducted over the telephone on nine case-patients with 23 selected controls. An environmental investigation was conducted that consisted of reviewing beef handling practices at a specific local supermarket and obtaining ground beef samples from the store and two households with case-patients. RESULTS: The analysis of the case-control study showed that eight case-patients (89%) purchased ground beef at Grocery Chain A compared with four controls who did not develop illness (17%) (matched odds ratio=undefined; 95% confidence interval 2.8, infinity; p=0.006). The environmental investigation showed that Grocery Chain A received meat from Meatpacker A. Laboratory analysis of meat samples from Meatpacker A and Grocery Chain A and stool samples from some patients recovered an identical strain of E. coli O157:H7 according to pulse-field gel electrophoresis. CONCLUSIONS: Both the case-control and environmental studies showed that purchasing ground beef at Grocery Chain A, which received ground beef from Meatpacker A, was the major risk factor for illness in eight case-patients; the ninth case-patient was found to be unrelated to the outbreak. Furthermore, meat from Meatpacker A was associated with a nationwide outbreak of E. coli O157:H7 illness that resulted in the second largest recall of beef in U.S. history at the time.
PMCID: PMC1497708  PMID: 15842119

Results 1-7 (7)