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author:("shia, Rita")
1.  Epidemiologic Similarities in Pediatric Community-Associated Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus in the San Francisco Bay Area 
Risk factors differentiating methicillin-resistant Staphylococcus aureus (MRSA) from methicillin-sensitive S aureus (MSSA) infections in the pediatric community have been unclear.
We performed a prospective case-comparison investigation of clinical, epidemiological, and molecular factors in pediatric community–associated (CA) MRSA and MSSA cases in the San Francisco Bay Area. Chart reviews were conducted in 270 CA-MRSA and 313 CA-MSSA cases. Fifty-eight CA-MRSA (21.4%) and 95 CA-MSSA (30.4%) cases were interviewed. Molecular typing was performed on 111 isolates.
MSSA represented 53.7% of CA cases and was more likely to cause invasive disease (6.2% vs 1.1%, P = .004). Few potential epidemiologic risk factors distinguished CA-MRSA from CA-MSSA. No differences were found in factors related to crowding, cleanliness, or prior antibiotic use. Compromised skin integrity due to eczema (24.3% vs 13.5%, P = .001) was associated with CA-MSSA. Many exposures to potentially infected or colonized contacts or contaminated objects were assessed; only three were associated with CA-MSSA: having a household contact who had surgery in the past year (18.9% vs 6.0%, P = .02), and regular visits to a public shower (9.1% vs 2.0%, P = .01) or gym (12.6% vs 3.3%, P = .04). Molecular typing identified clonal complex 8 as the predominant genetic lineage among CA-MRSA (96.4%) and CA-MSSA (39.3%) isolates.
In the context of recent heightened focus on CA-MRSA, the burden of serious disease caused by CA-MSSA among children should not be overlooked. MRSA and MSSA may be growing epidemiologically similar; thus, research, clinical, and public health efforts should focus on S aureus as a single entity.
PMCID: PMC3656541  PMID: 23687577
Epidemiology; MRSA; MSSA; Pediatrics; S aureus
2.  San Francisco Hep B Free: A Grassroots Community Coalition to Prevent Hepatitis B and Liver Cancer 
Journal of Community Health  2010;36(4):538-551.
Chronic hepatitis B is the leading cause of liver cancer and the largest health disparity between Asian/Pacific Islanders (APIs) and the general US population. The Hep B Free model was launched to eliminate hepatitis B infection by increasing hepatitis B awareness, testing, vaccination, and treatment among APIs by building a broad, community-wide coalition. The San Francisco Hep B Free campaign is a diverse public/private collaboration unifying the API community, health care system, policy makers, businesses, and the general public in San Francisco, California. Mass-media and grassroots messaging raised citywide awareness of hepatitis B and promoted use of the existing health care system for hepatitis B screening and follow-up. Coalition partners reported semi-annually on activities, resources utilized, and system changes instituted. From 2007 to 2009, over 150 organizations contributed approximately $1,000,000 in resources to the San Francisco Hep B Free campaign. 40 educational events reached 1,100 healthcare providers, and 50% of primary care physicians pledged to screen APIs routinely for hepatitis B. Community events and fairs reached over 200,000 members of the general public. Of 3,315 API clients tested at stand-alone screening sites created by the campaign, 6.5% were found to be chronically infected and referred to follow-up care. A grassroots coalition that develops strong partnerships with diverse organizations can use existing resources to successfully increase public and healthcare provider awareness about hepatitis B among APIs, promote routine hepatitis B testing and vaccination as part of standard primary care, and ensure access to treatment for chronically infected individuals.
PMCID: PMC3130910  PMID: 21125320
Hepatitis B; Liver cancer; Asian Americans; Pacific Islander Americans; Community networks; Healthcare coalitions
3.  Review of syndromic surveillance: implications for waterborne disease detection 
Syndromic surveillance is the gathering of data for public health purposes before laboratory or clinically confirmed information is available. Interest in syndromic surveillance has increased because of concerns about bioterrorism. In addition to bioterrorism detection, syndromic surveillance may be suited to detecting waterborne disease outbreaks. Theoretical benefits of syndromic surveillance include potential timeliness, increased response capacity, ability to establish baseline disease burdens, and ability to delineate the geographical reach of an outbreak. This review summarises the evidence gathered from retrospective, prospective, and simulation studies to assess the efficacy of syndromic surveillance for waterborne disease detection. There is little evidence that syndromic surveillance mitigates the effects of disease outbreaks through earlier detection and response. Syndromic surveillance should not be implemented at the expense of traditional disease surveillance, and should not be relied upon as a principal outbreak detection tool. The utility of syndromic surveillance is dependent on alarm thresholds that can be evaluated in practice. Syndromic data sources such as over the counter drug sales for detection of waterborne outbreaks should be further evaluated.
PMCID: PMC2563943  PMID: 16698988
syndromic surveillance; waterborne disease; surveillance
4.  Organochlorine Pesticides and Male Genital Anomalies in the Child Health and Development Studies 
Environmental Health Perspectives  2004;113(2):220-224.
Increasing rates of cryptorchidism and hypospadias in human populations may be caused by exogenous environmental agents. We conducted a case–control study of serum levels of p,p′-dichlorodiphenyltrichloroethane (DDT) and its major metabolite, p,p′-dichlorodiphenyldichloroethylene (DDE), and cryptorchidism and hypospadias in the Child Health and Development Study, a longitudinal cohort of pregnancies that occurred between 1959 and 1967, a period when DDT was produced and used in the United States. Serum was available from the mothers of 75 male children born with cryptorchidism, 66 with hypospadias, and 4 with both conditions. We randomly selected 283 controls from the cohort of women whose male babies were born without either of these conditions. Overall, we observed no statistically significant relationships or trends between outcomes and serum measures. After adjusting for maternal race, triglyceride level, and cholesterol level, compared with boys whose mothers had serum DDE levels < 27.0 ng/mL, boys whose mothers had serum DDE levels ≥61.0 ng/mL had odds ratios of 1.34 [95% confidence interval (CI), 0.51–3.48] for cryptorchidism and 1.18 (95% CI, 0.46–3.02) for hypospadias. For DDT, compared with boys whose mothers had serum DDT levels < 10.0 ng/mL, boys whose mothers had serum DDT levels ≥20.0 ng/mL had adjusted odds ratios of 1.01 (95% CI, 0.44–2.28) for cryptorchidism and 0.79 (95% CI, 0.33–1.89) for hypospadias. This study does not support an association of DDT or DDE and hypospadias or cryptorchidism.
PMCID: PMC1277868  PMID: 15687061
cryptorchidism; DDE; DDT; hypospadias; insecticides; male genital anomalies; organochlorine; pregnancy

Results 1-4 (4)