Publications by authors named "Michael C Samuel"

36 Publications

Acute Fulminant Cerebral Edema: A Newly Recognized Phenotype in Children With Suspected Encephalitis.

J Pediatric Infect Dis Soc 2020 Jul 15. Epub 2020 Jul 15.

Pediatric Infectious Diseases, Kaiser Permanente, Oakland, California, USA.

Background: Encephalitis is a severe neurological syndrome associated with significant morbidity and mortality. The California Encephalitis Project (CEP) enrolled patients for more than a decade. A subset of patients with acute and fulminant cerebral edema was noted.

Methods: All pediatric encephalitis patients with cerebral edema referred to the CEP between 1998 and 2012 were reviewed. A case definition was developed for acute fulminant cerebral edema (AFCE) that included the CEP case definition for encephalitis and progression to diffuse cerebral edema on neuroimaging and/or autopsy, and no other recognized etiology for cerebral edema (eg, organic, metabolic, toxin). Prodromic features, demographic and laboratory data, neuroimaging, and outcomes were compared with non-AFCE encephalitis cases.

Results: Of 1955 pediatric cases referred to the CEP, 30 (1.5%) patients met the AFCE case definition. The median age for AFCE and non-AFCE cases was similar: 8.2 years (1-18 years) and 8.0 years (0.5-18 years), respectively. Asian-Pacific Islanders comprised a larger proportion of AFCE cases (44%) compared with non-AFCE cases (14%, P < .01). AFCE cases often had a prodrome of high fever, vomiting, and profound headache. Mortality among AFCE patients was significantly higher than among non-AFCE patients (80% vs 13%, P < .01). A confirmed etiology was identified in only 2 cases (enterovirus, human herpes virus type 6), while 10 others had evidence of a respiratory pathogen.Thirty pediatric patients referred to the California Encephalitis Project with a unique, and often fatal, form of encephalitis are reported. Demographic and clinical characteristics, possible etiologies and a proposed case definition for acute fulminant cerebral edema (AFCE) are described.

Conclusions: AFCE is a recently recognized phenotype of encephalitis with a high mortality. AFCE may be triggered by common pediatric infections. Here, we propose a case definition.
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http://dx.doi.org/10.1093/jpids/piaa063DOI Listing
July 2020

A Case of Persistent and Possibly Treatment Resistant Pharyngeal Gonorrhea.

Sex Transm Dis 2016 Apr;43(4):258-9

From the *San Mateo County Health System, San Mateo, CA; †Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA; ‡San Francisco Department of Public Health, San Francisco, CA; and Departments of §Obstetrics, Gynecology and Reproductive Sciences and ¶Family and Community Medicine, University of California, San Francisco, San Francisco, CA.

An HIV-negative man with pharyngeal gonorrhea had a positive test-of-cure (nucleic acid amplification test) result 7 days after treatment with ceftriaxone/azithromycin. Neisseria gonorrhoeae Multi-Antigen Sequencing Type 1407 and mosaic pen A (XXXIV) gene were identified in the test-of-cure specimen, and culture was negative. Retreatment with ceftriaxone 500 mg intramuscularly plus azithromycin 2 g orally yielded a negative test-of-cure result.
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http://dx.doi.org/10.1097/OLQ.0000000000000430DOI Listing
April 2016

Crystal Clear? The Relationship Between Methamphetamine Use and Sexually Transmitted Infections.

Health Econ 2016 Mar 29;25(3):292-313. Epub 2014 Dec 29.

Surveillance and Epidemiology Section, STD Control Branch, California Department of Public Health, Richmond, CA, USA.

Public health officials have cited methamphetamine control as a tool with which to decrease HIV and other sexually transmitted infections, based on previous research that finds a strong positive correlation between methamphetamine use and risky sexual behavior. However, the observed correlation may not be causal, as both methamphetamine use and risky sexual behavior could be driven by a third factor, such as a preference for risky behavior. We estimate the effect of methamphetamine use on risky sexual behavior using monthly data on syphilis diagnoses in California and quarterly data on syphilis, gonorrhea, and chlamydia diagnoses across all states. To circumvent possible endogeneity, we use a large exogenous supply shock in the US methamphetamine market that occurred in May 1995 and a later shock stemming from the Methamphetamine Control Act, which went into effect in October 1997. While the supply shocks had large negative effects on methamphetamine use, we find no evidence that they decreased syphilis, gonorrhea, or chlamydia rates. Our results have broad implications for public policies designed to decrease sexually transmitted infection rates.
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http://dx.doi.org/10.1002/hec.3140DOI Listing
March 2016

Gonorrhea treatment practices in the STD Surveillance Network, 2010-2012.

Sex Transm Dis 2015 Jan;42(1):6-12

From the *Public Health-Seattle & King County, Seattle, WA; †University of Washington Center for AIDS and STD, Seattle, WA; ‡US Centers for Disease Control and Prevention, Atlanta, GA; §Department of Public Health, San Francisco, CA; ¶Colorado Department of Public Health and Environment, Denver, CO; ∥Baltimore City Health Department, Baltimore, MD; **Johns Hopkins University School of Medicine, Baltimore, MD; ††California Department of Public Health, Richmond, CA; and ‡‡Chicago Department of Public Health, Chicago, IL.

Background: Replacing oral treatments with ceftriaxone is a central component of public health efforts to slow the emergence of cephalosporin-resistant Neisseria gonorrhoeae in the United States; US gonorrhea treatment guidelines were revised accordingly in 2010. However, current US gonorrhea treatment practices have not been well characterized.

Methods: Six city and state health departments in Cycle II of the STD Surveillance Network (SSuN) contributed data on all gonorrhea cases reported in 101 counties and independent cities. Treatment data were obtained through local public health surveillance and interviews with a random sample of patients. Cases were weighted to adjust for site-specific sample fractions and for differential nonresponse by age, sex, and provider type.

Results: From 2010 to 2012, 135,984 gonorrhea cases were reported in participating areas, 15,246 (11.2%) of which were randomly sampled. Of these, 7,851 (51.5%) patients were interviewed. Among patients with complete treatment data, 76.8% received ceftriaxone, 16.4% received an oral cephalosporin, and 6.9% did not receive a cephalosporin; 51.9% of persons were treated with a regimen containing ceftriaxone and either doxycycline or azithromycin. Ceftriaxone treatment increased significantly by year (64.1% of patients in 2010, 79.3% in 2011, 85.4% in 2012; P = 0.0001). Ceftriaxone use varied widely by STD Surveillance Network site (from 44.6% to 95.1% in 2012).

Conclusions: Most persons diagnosed as having gonorrhea between 2010 and 2012 in the United States received ceftriaxone, and its use has increased since the release of the 2010 Centers for Disease Control and Prevention STD Treatment Guidelines.
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http://dx.doi.org/10.1097/OLQ.0000000000000217DOI Listing
January 2015

Neighborhoods at risk: estimating risk of higher Neisseria gonorrhoeae incidence among women at the census tract level.

Sex Transm Dis 2014 Nov;41(11):649-55

From the *Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; †California Department of Public Health, Sacramento, CA; ‡Philadelphia Department of Public Health, Philadelphia, PA; §Virginia Department of Health, Richmond, VA; ¶Chicago Department of Public Health, Chicago, IL; ∥New York City Department of Health and Mental Hygiene, New York, NY; **Colorado Department of Public Health and Environment, Denver, CO; ††Johns Hopkins University School of Medicine/Baltimore City Health Department, Baltimore, MD; and ‡‡Washington State Department of Health, Tumwater, WA.

Background: The association between area-based social factors and sexually transmitted diseases has been demonstrated in numerous studies. Such associations have not previously been explored for their potential to quantify likelihood of higher transmission of gonorrhea in small geographic areas.

Methods: Aggregate census tract-level sociodemographic factors in 4 domains (demographics, educational attainment, household income, and housing characteristics) were merged with female gonorrhea incidence data from 113 counties in 10 US states. Multivariate models were constructed, and a tract-level composite gonorrhea risk index was calculated. This composite risk index was validated against gonorrhea incidence among women from 2 independent states.

Results: Seven tract-level factors were found to be most strongly correlated with female gonorrhea incidence: educational attainment, proportion of female headed households, annual household income below US $20,000, proportion of population non-Hispanic black, proportion of housing units currently vacant, proportion of population reporting moving in last year, and proportion of households that are nonfamily units. Composite index was highly correlated with female gonorrhea in the study area and validated with independent data.

Conclusions: Social factors predict gonorrhea incidence at the census tract level and identify small areas at risk for higher morbidity. These data may be used by health departments and health care practices to develop geographically based disease prevention and control efforts. This is especially useful because gonorrhea incidence data are not routinely available below the county level in many states.
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http://dx.doi.org/10.1097/OLQ.0000000000000195DOI Listing
November 2014

Risk, Feasibility, and Cost Evaluation of a Prisoner Condom Access Pilot Program in One California State Prison.

J Correct Health Care 2014 Jul 16;20(3):184-194. Epub 2014 Jun 16.

Public Health Unit, California Correctional Health Care Services, Elk Grove, CA, USA.

This study evaluated the safety and security impact, feasibility, and cost of a program to provide condoms to inmates. A 1-year pilot study of wall-mounted condom dispensing machines in one California state prison compared pre- and post-intervention rates of penal code violations related to sexual misconduct, contraband, controlled substances, and violence. The rates of penal code violations were unchanged or decreased compared to the pre-pilot year. Discreetly located condom dispensers were vandalized less frequently than those in plain view (p < .05). Distributing condoms using the pilot model would cost less than $2 per inmate annually. Results suggest that the use of discreetly located dispensing machines is an acceptable, feasible, low-cost option to prevent the transmission of sexually transmitted diseases and poses no safety or security risk in a typical medium-security prison setting.
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http://dx.doi.org/10.1177/1078345814530869DOI Listing
July 2014

Variation in adherence to the treatment guidelines for Neisseria gonorrhoeae by clinical practice setting, California, 2009 to 2011.

Sex Transm Dis 2014 May;41(5):338-44

From the *School of Public Health, University of California, Berkeley, CA; †Sexually Transmitted Disease Control Branch, California Department of Public Health, Richmond, CA; and ‡Sexually Transmitted Disease, Prevention and Control Services, San Francisco Department of Public Health, San Francisco, CA.

Background: Declining susceptibility of Neisseria gonorrhoeae to available antimicrobial agents has prompted repeated updates of the Centers for Disease Control and Prevention (CDC) treatment guidelines. The only regimen currently recommended as first-line treatment is dual therapy consisting of an intramuscular dose of ceftriaxone together with azithromycin or doxycycline. The objective of this analysis is to identify how adherence to the CDC guidelines varies by clinical practice setting.

Methods: A geographically representative random sample of N. gonorrhoeae cases reported from 2009 to 2011 was analyzed. Weighted generalized linear models were fit to calculate cumulative incidence ratios for receipt of non-recommended treatment regimen in relation to clinical practice setting, adjusted for age, race, and whether or not the participant was a man who has sex with men.

Results: Data from 3178 participants were available for analysis. Overall, 14.9% (weighted) of participants received non-recommended treatment. Among participants with gonorrhea identified by surveillance data as having received non-recommended treatment, the largest proportions were treated at private physicians' offices or health maintenance organizations (34.7% of participants receiving non-recommended treatment), family planning facilities (22.3%), and emergency departments/urgent care centers (12.8%).

Conclusions: Barriers to adherence to the CDC treatment guidelines for gonorrhea seem to be experienced in a variety of clinical practice settings. Despite only moderate rates of nonadherence, interventions targeting private physicians/health maintenance organizations and family planning facilities may produce the largest absolute reductions in guideline-discordant treatment.
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http://dx.doi.org/10.1097/OLQ.0000000000000113DOI Listing
May 2014

Comparison of Neisseria gonorrhoeae MICs obtained by Etest and agar dilution for ceftriaxone, cefpodoxime, cefixime and azithromycin.

J Microbiol Methods 2013 Dec;95(3):379-80

We evaluated Neisseria gonorrhoeae Etest minimum inhibitory concentrations (MICs) relative to agar dilution MICs for 664 urethral isolates for ceftriaxone (CRO) and azithromycin (AZM), 351 isolates for cefpodoxime (CPD) and 315 isolates for cefixime (CFM). Etest accurately determined CPD, CFM and AZM MICs, but resulted in higher CRO MICs.
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December 2013

Neuraminidase inhibitors for critically ill children with influenza.

Pediatrics 2013 Dec 25;132(6):e1539-45. Epub 2013 Nov 25.

California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA 94804.

Objective: Timely treatment with neuraminidase inhibitor (NAI) drugs appears to improve survival in adults hospitalized with influenza. We analyzed California surveillance data to determine whether NAI treatment improves survival in critically ill children with influenza.

Methods: We analyzed data abstracted from medical records to characterize the outcomes of patients aged 0 to 17 years hospitalized in ICUs with laboratory-confirmed influenza from April 3, 2009, through September 30, 2012.

Results: Seven hundred eighty-four influenza cases aged <18 years hospitalized in ICUs had information on treatment. Ninety percent (532 of 591) of cases during the 2009 H1N1 pandemic (April 3, 2009-August 31, 2010) received NAI treatment compared with 63% (121 of 193) of cases in the postpandemic period (September 1, 2010-September 30, 2012; P < .0001). Of 653 cases NAI-treated, 38 (6%) died compared with 11 (8%) of 131 untreated cases (odds ratio = 0.67, 95% confidence interval: 0.34-1.36). In a multivariate model that included receipt of mechanical ventilation and other factors associated with disease severity, the estimated risk of death was reduced in NAI-treated cases (odds ratio 0.36, 95% confidence interval: 0.16-0.83). Treatment within 48 hours of illness onset was significantly associated with survival (P = .04). Cases with NAI treatment initiated earlier in illness were less likely to die.

Conclusions: Prompt treatment with NAIs may improve survival of children critically ill with influenza. Recent decreased frequency of NAI treatment of influenza may be placing untreated critically ill children at an increased risk of death.
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http://dx.doi.org/10.1542/peds.2013-2149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6637754PMC
December 2013

Neisseria gonorrhoeae outbreak: unintended consequences of electronic medical records and using an out-of-state laboratory-California, July 2009-February 2010.

Sex Transm Dis 2013 Jul;40(7):556-8

Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Twenty of 37 gonorrhea cases identified during an outbreak were diagnosed at one health care organization that used an out-of-state laboratory. The results were transmitted into electronic medical records without provider notification. Delays in treatment and reporting were identified. Systems should be implemented to ensure provider notification of electronic laboratory results.
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http://dx.doi.org/10.1097/OLQ.0b013e3182927c8cDOI Listing
July 2013

Sex, drugs (methamphetamines), and the Internet: increasing syphilis among men who have sex with men in California, 2004-2008.

Am J Public Health 2013 Aug 15;103(8):1450-6. Epub 2012 Nov 15.

California Department of Public Health, STD Control Branch, 850 Marina Bay Parkway, Bldg P, 2nd Floor, Richmond, CA 94804, USA.

Objectives: We examined primary and secondary syphilis cases among men who have sex with men (MSM) in California, and the association of methamphetamine use and Internet use to meet sex partners (Internet use) with number of sex partners.

Methods: We analyzed California surveillance data for MSM who were diagnosed with syphilis between 2004 and 2008, to assess differences in the mean number of sex partners by methamphetamine use and mutually exclusive groups of patients reporting Internet use (Internet users).

Results: Large proportions of patients reported methamphetamine use (19.2%) and Internet use (36.4%). From 2006 through 2008, Adam4Adam was the most frequently reported Web site statewide, despite temporal and regional differences in Web site usage. Methamphetamine users reported more sex partners (mean = 11.7) than nonmethamphetamine users (mean = 5.6; P < .001). Internet users reported more sex partners (mean = 9.8) than non-Internet users (mean = 5.0; P < .001). Multivariable analysis of variance confirmed an independent association of methamphetamine and Internet use with increased numbers of sex partners.

Conclusions: Higher numbers of partners among MSM syphilis patients were associated with methamphetamine and Internet use. Collaboration between currently stand-alone interventions targeting methamphetamine users and Internet users may offer potential advances in sexually transmitted disease control efforts.
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http://dx.doi.org/10.2105/AJPH.2012.300808DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4007854PMC
August 2013

Syphilis outbreak at a California men's prison, 2007-2008: propagation by lapses in clinical management, case management, and public health surveillance.

J Correct Health Care 2013 Jan 18;19(1):54-64. Epub 2012 Sep 18.

Sexually Transmitted Disease Control Branch, California Department of Public Health, Richmond, CA 94804, USA.

This field report describes an investigation to identify cases to control a syphilis outbreak in a prison and determine whether clinical, case management, and surveillance practices influenced the outbreak occurrence, detection, or management. Key performance measures were assessed to evaluate timeliness and quality of clinical and case management activities and surveillance practices. Thirty cases were found. Prior to the investigation, median times for clinical and reporting/surveillance measures were 15 days from primary and secondary (P&S) symptom onset to exam, 7 days from P&S exam to treatment, and 63 days from serologic test to the state's receipt of case. After the investigation, these measures improved to 8, 4.5, and 28 days, respectively. Lack of adherence to surveillance and clinical management protocols likely contributed to this outbreak, which was curtailed by aggressive control measures.
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http://dx.doi.org/10.1177/1078345812458088DOI Listing
January 2013

HIV testing among patients infected with Neisseria gonorrhoeae: STD Surveillance Network, United States, 2009-2010.

AIDS Behav 2013 Mar;17(3):1205-10

Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis,STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-02, Atlanta, GA, 30333, USA.

We used data from the STD Surveillance Network to estimate HIV testing among patients being tested or treated for gonorrhea. Of 1,845 gonorrhea-infected patients identified through nationally notifiable disease data, only 51% were tested for HIV when they were tested or treated for gonorrhea. Among the 10 geographic sites in this analysis, the percentage of patients tested for HIV ranged from 22-63% for men and 20-79% for women. Nearly 33% of the un-tested patients had never been previously HIV-tested. STD clinic patients were more likely to be HIV-tested than those in other practice settings.
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http://dx.doi.org/10.1007/s10461-012-0304-0DOI Listing
March 2013

Treatment with neuraminidase inhibitors for critically ill patients with influenza A (H1N1)pdm09.

Clin Infect Dis 2012 Nov 26;55(9):1198-204. Epub 2012 Jul 26.

California Department of Public Health, 850 Marina Bay Pkwy., Richmond, CA 94804, USA.

Background: Neuraminidase inhibitor (NAI) antiviral drugs can shorten the duration of uncomplicated influenza when administered early (<48 hours after illness onset) to otherwise healthy outpatients, but the optimal timing of effective therapy for critically ill patients is not well established.

Methods: We analyzed California surveillance data to characterize the outcomes of patients in intensive care units (ICUs) treated with NAIs for influenza A(H1N1)pdm09 (pH1N1). Demographic and clinical data were abstracted from medical records, using standardized case report forms.

Results: From 3 April 2009 through 10 August 2010, 1950 pH1N1 cases hospitalized in ICUs were reported. Of 1859 (95%) with information available, 1676 (90%) received NAI treatment, and 183 (10%) did not. The median age was 37 years (range, 1 week-93 years), 1473 (79%) had ≥1 comorbidity, and 492 (26%) died. The median time from symptom onset to starting NAI treatment was 4 days (range, 0-52 days). NAI treatment was associated with survival: 107 of 183 untreated case patients (58%) survived, compared with 1260 of 1676 treated case patients (75%; P ≤ .0001). There was a trend toward improved survival for those treated earliest (P < .0001). Treatment initiated within 5 days after symptom onset was associated with improved survival compared to those never treated (P < .05).

Conclusions: NAI treatment of critically ill pH1N1 patients improves survival. While earlier treatment conveyed the most benefit, patients who started treatment up to 5 days after symptom onset also were more likely to survive. Further research is needed about whether starting NAI treatment >5 days after symptom onset may also convey benefit.
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http://dx.doi.org/10.1093/cid/cis636DOI Listing
November 2012

Repeat syphilis among men who have sex with men in California, 2002-2006: implications for syphilis elimination efforts.

Am J Public Health 2012 Jan 28;102(1):e1-8. Epub 2011 Nov 28.

Center for AIDS Prevention Studies, San Francisco, CA, USA.

Objectives: We examined rates of and risk factors for repeat syphilis infection among men who have sex with men (MSM) in California.

Methods: We analyzed 2002 to 2006 California syphilis surveillance system data.

Results: During the study period, a mean of 5.9% (range: 4.9%-7.1% per year) of MSM had a repeat primary or secondary (PS) syphilis infection within 2 years of an initial infection. There was no significant increase in the annual proportion of MSM with a repeat syphilis infection (P = .42). In a multivariable model, factors associated with repeat syphilis infection were HIV infection (odds ratio [OR] = 1.65; 95% confidence interval [CI] = 1.14, 2.37), Black race (OR = 1.84; 95% CI = 1.12, 3.04), and 10 or more recent sex partners (OR = 1.99; 95% CI = 1.12, 3.50).

Conclusions: Approximately 6% of MSM in California have a repeat PS syphilis infection within 2 years of an initial infection. HIV infection, Black race, and having multiple sex partners are associated with increased odds of repeat infection. Syphilis elimination efforts should include messages about the risk for repeat infection and the importance of follow-up testing. Public health attention to individuals repeatedly infected with syphilis may help reduce local disease burdens.
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http://dx.doi.org/10.2105/AJPH.2011.300383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3490561PMC
January 2012

A review of adult mortality due to 2009 pandemic (H1N1) influenza A in California.

PLoS One 2011 Apr 5;6(4):e18221. Epub 2011 Apr 5.

California Department of Public Health, Richmond, California, United States of America.

Background: While children and young adults had the highest attack rates due to 2009 pandemic (H1N1) influenza A (2009 H1N1), studies of hospitalized cases noted high fatality in older adults. We analyzed California public health surveillance data to better characterize the populations at risk for dying due to 2009 H1N1.

Methods And Findings: A case was an adult ≥20 years who died with influenza-like symptoms and laboratory results indicative of 2009 H1N1. Demographic and clinical data were abstracted from medical records using a standardized case report form. From April 3, 2009-August 10, 2010, 541 fatal cases ≥20 years with 2009 H1N1 were reported. Influenza fatality rates per 100,000 population were highest in persons 50-59 years (3.5; annualized rate = 2.6) and 60-69 years (2.3; annualized rate = 1.7) compared to younger and older age groups (0.4-1.9; annualized rates = 0.3-1.4). Of 486 cases hospitalized prior to death, 441 (91%) required intensive care unit (ICU) admission. ICU admission rates per 100,000 population were highest in adults 50-59 years (8.6). ICU case-fatality ratios among adults ranged from 24-42%, with the highest ratios in persons 70-79 years. A total of 425 (80%) cases had co-morbid conditions associated with severe seasonal influenza. The prevalence of most co-morbid conditions increased with increasing age, but obesity, pregnancy and obstructive sleep apnea decreased with age. Rapid testing was positive in 97 (35%) of 276 tested. Of 482 cases with available data, 384 (80%) received antiviral treatment, including 49 (15%) of 328 within 48 hours of symptom onset.

Conclusions: Adults aged 50-59 years had the highest fatality due to 2009 H1N1; older adults may have been spared due to pre-existing immunity. However, once infected and hospitalized in intensive care, case-fatality ratios were high for all adults, especially in those over 60 years. Vaccination of adults older than 50 years should be encouraged.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0018221PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3071719PMC
April 2011

A novel risk factor for a novel virus: obesity and 2009 pandemic influenza A (H1N1).

Clin Infect Dis 2011 Feb 4;52(3):301-12. Epub 2011 Jan 4.

Division of Communicable Disease Control, California Department of Public Health, Richmond, California94804, USA.

Background: many critically ill patients with 2009 pandemic influenza A (H1N1) (2009 H1N1) infection were noted to be obese, but whether obesity, rather than its associated co-morbidities, is an independent risk factor for severe infection is unknown.

Methods: using public health surveillance data, we analyzed demographic and clinical characteristics of California residents hospitalized with 2009 H1N1 infection to assess whether obesity (body mass index [BMI] ≥ 30) and extreme obesity (BMI ≥ 40) were an independent risk factor for death among case patients ≥ 20 years old.

Results: during the period 20 April-11 August 2009, 534 adult case patients with 2009 H1N1 infection for whom BMI information was available were observed. Two hundred twenty-eight patients (43%) were ≥ 50 years of age, and 378 (72%) had influenza-related high-risk conditions recognized by the Advisory Committee on Immunization Practices as risk factors for severe influenza. Two hundred and seventy-four (51%) had BMI ≥ 30, which is 2.2 times the prevalence of obesity among California adults (23%) and 1.5 times the prevalence among the general population of the United States (33%). Of the 92 case patients who died (17%), 56 (61%) had BMI ≥ 30 and 28 (30%) had BMI ≥ 40. In multivariate analysis, BMI ≥ 40 (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.4-5.9) and BMI ≥ 45 (OR, 4.2; 95% CI, 1.9-9.4), age ≥ 50 years (OR, 2.1; 95% CI, 1.2-3.7), miscellaneous immunosuppressive conditions (OR, 3.9; 95% CI, 1.6-9.5), and asthma (OR, 0.5; 95% CI, 0.3-0.9) were associated with death.

Conclusion: half of Californians ≥ 20 years of age hospitalized with 2009 H1N1 infection were obese. Extreme obesity was associated with increased odds of death. Obese adults with 2009 H1N1 infection should be treated promptly and considered in prioritization of vaccine and antiviral medications during shortages.
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http://dx.doi.org/10.1093/cid/ciq152DOI Listing
February 2011

Children hospitalized with 2009 novel influenza A(H1N1) in California.

Arch Pediatr Adolesc Med 2010 Nov;164(11):1023-31

California Department of Public Health, 850 Marina Bay Pkwy., Richmond, CA 94804, USA.

Objective: To describe clinical and epidemiologic features of 2009 novel influenza A(H1N1) in children.

Design: Analysis of data obtained from standardized report forms and medical records.

Setting: Statewide public health surveillance in California.

Participants: Three hundred forty-five children who were hospitalized with or died of 2009 novel influenza A(H1N1).

Main Exposure: Laboratory-confirmed 2009 novel influenza A(H1N1).

Main Outcome Measures: Hospitalization and death.

Results: From April 23 to August 11, 2009, 345 cases in children younger than 18 years were reported. The median age was 6 years. The hospitalization rate per 100 000 per 110 days was 3.5 (0.97 per 100 000 person-months), with rates highest in infants younger than 6 months (13.9 per 100 000 or 3.86 per 100 000 person-months). Two-thirds (230; 67%) had comorbidities. More than half (163 of 278; 59%) had pneumonia, 94 (27%) required intensive care, and 9 (3%) died; in 3 fatal cases (33%), children had secondary bacterial infections. More than two-thirds (221 of 319; 69%) received antiviral treatment, 44% (88 of 202) within 48 hours of symptom onset. In multivariate analysis, congenital heart disease (odds ratio [OR], 5.0; 95% confidence interval [CI], 1.9-13.5) and cerebral palsy/developmental delay (OR, 3.5; 95% CI, 1.7-7.4) were associated with increased likelihood of intensive care unit admission and/or death; likelihood was decreased in Hispanic (OR, 0.4; 95% CI, 0.2-0.8) and black (OR, 0.3; 95% CI, 0.1-1.0) children compared with white children.

Conclusions: More than one-quarter of children hospitalized with 2009 novel influenza A(H1N1) reported to the California Department of Public Health required intensive care and/or died. Regardless of rapid test results, when 2009 novel influenza A(H1N1) is circulating, clinicians should maintain a high suspicion in children with febrile respiratory illness and promptly treat those with underlying risk factors, especially infants.
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http://dx.doi.org/10.1001/archpediatrics.2010.203DOI Listing
November 2010

Socioeconomic gradients in sexually transmitted diseases: a geographic information system-based analysis of poverty, race/ethnicity, and gonorrhea rates in California, 2004-2006.

Am J Public Health 2010 Jun 15;100(6):1060-7. Epub 2010 Apr 15.

Sexually Transmitted Disease Control Branch, California Department of Public Health, Richmond, USA.

Objectives: We quantified the relationship between gonorrheal infection rates in California and a measure of poverty status and investigated how this relationship and the spatial dispersion of cases varied among the 4 dominant racial/ethnic groups in the state.

Methods: We geocoded gonorrhea cases reported in California between 2004 and 2006, and estimated the poverty status of each case by using the percentage of residents living below poverty in the census tract of residence. We calculated infection rates for African American, Asian, Hispanic, and White cases in each of 4 poverty strata. We mapped cases to visualize the patterns of spatial dispersion associated with each race/ethnicity-poverty combination.

Results: There was a strong positive relationship between poverty and infection, but racial/ethnic disparities in infection, driven by a disproportionate level of gonorrhea among African Americans, eclipsed this differential. The degree of spatial aggregation varied substantially among groups and was especially pronounced for African Americans with gonorrhea in the highest poverty category.

Conclusions: Prevention efforts should target low-income neighborhood "hot spots" to reach the largest numbers of cases, particularly among African Americans.
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http://dx.doi.org/10.2105/AJPH.2009.172965DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866613PMC
June 2010

A closer look at age: deconstructing aggregate gonorrhea and chlamydia rates, California, 1998-2007.

Sex Transm Dis 2010 May;37(5):328-34

University of California, Berkeley, USA.

Background: Risk of gonorrheal (GC) and chlamydial (CT) infection is highly associated with age. Case rates typically are reported in 5-year categories. Highest rates are seen consistently in the 15- to 19-year and 20- to 24-year age groups for both genders. It is not clear how aggregate, age-specific rates mask finer differences in risk by single age across and within racial/ethnic groups.

Methods: California case-based surveillance data for 1998 through 2007 were used to calculate GC and CT rates by single age at diagnosis. The distribution of single gender and age-specific rates was compared with 5-year age-specific rates. Descriptive statistics for age by race/ethnicity were calculated, and trends over time were assessed.

Results: Female, single-age-specific GC and CT rates for 2007 increased strikingly during adolescence and then declined quickly. Male, single-age-specific GC rates declined more gradually than did CT rates. The rate for the aggregate 15- to 19-year-old age group fit the single-age rates poorly, particularly for females, who in 2007 had a peak rate at age 19 for GC (497 per 100,000) and for CT (3640 per 100,000), though the highest aggregate rate was for ages 20 to 24. Blacks had the youngest mean age for both GC and CT. Mean ages increased significantly from 1998 through 2007 for female GC and CT cases, as well as for male CT cases.

Conclusions: Age and race/ethnicity data should be examined in finer detail than the 5-year aggregate data, in order to target sexually transmitted disease prevention and control interventions more effectively.
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http://dx.doi.org/10.1097/OLQ.0b013e3181c53363DOI Listing
May 2010

Factors associated with death or hospitalization due to pandemic 2009 influenza A(H1N1) infection in California.

JAMA 2009 Nov;302(17):1896-902

California Department of Public Health, 850 Marina Bay Pkwy, Richmond, CA 94804, USA.

Context: Pandemic influenza A(H1N1) emerged rapidly in California in April 2009. Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A(H1N1) disproportionately affects younger ages and causes generally mild disease.

Objective: To describe the clinical and epidemiologic features of pandemic 2009 influenza A(H1N1) cases that led to hospitalization or death.

Design, Setting, And Participants: Statewide enhanced public health surveillance of California residents who were hospitalized or died with laboratory evidence of pandemic 2009 influenza A(H1N1) infection reported to the California Department of Public Health between April 23 and August 11, 2009.

Main Outcome Measure: Characteristics of hospitalized and fatal cases.

Results: During the study period there were 1088 cases of hospitalization or death due to pandemic 2009 influenza A(H1N1) infection reported in California. The median age was 27 years (range, <1-92 years) and 68% (741/1088) had risk factors for seasonal influenza complications. Sixty-six percent (547/833) of those with chest radiographs performed had infiltrates and 31% (340/1088) required intensive care. Rapid antigen tests were falsely negative in 34% (208/618) of cases evaluated. Secondary bacterial infection was identified in 4% (46/1088). Twenty-one percent (183/884) received no antiviral treatment. Overall fatality was 11% (118/1088) and was highest (18%-20%) in persons aged 50 years or older. The most common causes of death were viral pneumonia and acute respiratory distress syndrome.

Conclusions: In the first 16 weeks of the current pandemic, the median age of hospitalized infected cases was younger than is common with seasonal influenza. Infants had the highest hospitalization rates and persons aged 50 years or older had the highest mortality rates once hospitalized. Most cases had established risk factors for complications of seasonal influenza.
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http://dx.doi.org/10.1001/jama.2009.1583DOI Listing
November 2009

Methamphetamine and cocaine use among Mexican migrants in California: the California-Mexico Epidemiological Surveillance Pilot.

AIDS Educ Prev 2009 Oct;21(5 Suppl):34-44

California HIV/AIDS Research Program, University of California, Office of the President, Oakland, USA.

Methamphetamine and cocaine use have been associated with a vulnerability to HIV infection among men who have sex with men and among men who have sex with women but not specifically among Mexican migrants in the United States. The California-Mexico Epidemiological Surveillance Pilot was a venue-based targeted survey of male and female Mexican migrants living in rural and urban areas in California. Among men (n = 985), the percentage of methamphetamine/cocaine use in the past year was 21% overall, 20% in male work venues, 19% in community venues, and 25% in high-risk behavior venues. Among women, 17% reported methamphetamine/cocaine use in high-risk behavior venues. Among men, methamphetamine/cocaine use was significantly associated with age less than 35 years, having multiple sex partners, depressive symptoms, alcohol use, sexually transmitted infections (including HIV), and higher acculturation. Prevention interventions in this population should be targeted to specific migrant sites and should address alcohol, methamphetamine, and cocaine use in the context of underlying psychosocial and environmental factors.
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http://dx.doi.org/10.1521/aeap.2009.21.5_supp.34DOI Listing
October 2009

California Gonorrhea Surveillance System: Methodologic Aspects and Key Results of a Sample-Based System.

Public Health Rep 2009 ;124 Suppl 2:87-97

California Department of Public Health, STD Control Branch, Richmond, CA.

Objectives: This article describes findings from the California Gonorrhea Surveillance System (CGSS), developed in response to the need for detailed risk behavior data and clinical data required to control increasing gonorrhea (GC) infections in California.

Methods: CGSS is a sample-based surveillance system implemented throughout California in 2007. In 34 of 61 local health jurisdictions (LHJs), 10% of GC cases are sampled for interview; in the other 27 LHJs, all cases are followed. A standardized case investigation record collects case-reported risk data and provider-reported clinical data, and is electronically prepopulated with available contact data. Exclusion criteria include age younger than 14 years, a GC diagnosis within the previous 30 days, and provider request that patient not be contacted. Analyses are weighted to account for sample design.

Results: In 2007, 31,192 cases of GC were reported in California. Of these, 5,388 were sampled for follow-up and 2,715 were interviewed, for a response rate of 54.2%. Of those interviewed, 49.6% were female, 28.8% were heterosexual males, and 21.6% were men who have sex with men (MSM). CGSS collects a wide range of behavioral and clinical data for targeted programmatic action. Findings from the 2007 CGSS included data on the following areas: incarceration (highest among heterosexual males [22.4%]); methamphetamine use (high overall [12.2%] and lower among African Americans [4.6%]); co-infection with human immunodeficiency virus (high among MSM [31.9%] and very low among heterosexual males and females [<0.5%]); and improper antibiotic use (8.3% overall; 25.6% among patients attending urgent care clinics).

Conclusion: CGSS, an innovative sample-based surveillance system, is effective and flexible. The system provides actionable data on an ongoing basis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775405PMC
http://dx.doi.org/10.1177/00333549091240S213DOI Listing
July 2016

Assessment of the Association of Chlamydia trachomatis Infection and Adverse Perinatal Outcomes with the Use of Population-Based Chlamydia Case Report Registries and Birth Records.

Public Health Rep 2009 ;124 Suppl 2:24-30

California Department of Public Health, Center for Infectious Diseases, Division of Communicable Disease Control, STD Control Branch, Richmond, CA.

Objective: We assessed the relationship between Chlamydia trachomatis (CT) infections identified during pregnancy and adverse perinatal birth outcomes (including premature rupture of membranes, preterm delivery, and low birthweight) by matching CT reports and birth records.

Methods: We merged California birth records from 1997, 1998, and 1999 with California CT reports from the same years to determine the proportion of birth records matched to a female CT report, using maternal last name, first name, date of birth, and county of residence. We used logistic regression to assess the crude and adjusted association between a CT report less than 10 months before the birth record date and premature rupture of membranes, preterm delivery, and low birthweight. These results were adjusted for age, race/ethnicity, level of education, and prenatal care.

Results: Of 675,786 birth records and 101,296 female CT reports, 14,039 women had a CT case report and a birth record; 10,917 birth records (1.6%) were matched to a CT report during pregnancy, and 10,940 (10.8%) of CT reports were matched to a birth record date 10 months after date of diagnosis/report. For premature rupture of membranes, the adjusted odds ratio (AOR) was 1.2, 95% confidence interval (CI) 1.0, 1.3; for low birthweight, the AOR was 1.2, 95% CI 1.1, 1.3. The reduction in birthweight associated with prenatal CT infection was 31.7 grams.

Conclusions: The increased risk of adverse perinatal outcomes associated with prenatal CT infection supports current prenatal CT screening guidelines. Matching of surveillance and vital statistics data sources was an efficient method to assess this association.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775397PMC
http://dx.doi.org/10.1177/00333549091240S205DOI Listing
July 2016

Practical Considerations for Matching STD and HIV Surveillance Data with Data from Other Sources.

Public Health Rep 2009 ;124 Suppl 2:7-17

STD/TB Surveillance, Ohio Department of Health, Columbus, OH.

Data to guide programmatic decisions in public health are needed, but frequently epidemiologists are limited to routine case report data for notifiable conditions such as sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). However, case report data are frequently incomplete or provide limited information on comorbidity or risk factors. Supplemental data often exist but are not easily accessible, due to a variety of real and perceived obstacles. Data matching, defined as the linkage of records across two or more data sources, can be a useful method to obtain better or additional data, using existing resources. This article reviews the practical considerations for matching STD and HIV surveillance data with other data sources, including examples of how STD and HIV programs have used data matching.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775395PMC
http://dx.doi.org/10.1177/00333549091240S203DOI Listing
July 2016

Sexually transmitted diseases and risk behaviors among California farmworkers: results from a population-based survey.

J Rural Health 2008 ;24(3):279-84

Sexually Transmitted Disease Control Branch, Division of Communicable Disease Control, California Department of Public Health, Richmond, California 94804-6403, USA.

Context: The prevalence of sexually transmitted diseases and associated risk behaviors among California farmworkers is not well described.

Purpose: To estimate the prevalence of sexually transmitted diseases (STDs) and associated risk behaviors among California farmworkers.

Methods: Cross-sectional analysis of population-based survey data from 6 California agricultural regions was performed for participants tested for Chlamydia trachomatis (CT), Neisseria gonorrhea (GC), and syphilis, and who completed an interviewer-administered behavioral risk factor survey.

Findings: Among the 403 males and 234 females examined and interviewed, males (29.3%) were more likely than females (9.6%) to have had 2 or more sex partners in the past 5 years. Forty-two percent of males ever had sex with a commercial sex worker; unmarried males were more likely than married males to report sex with a commercial sex worker in the past 2 years. Twelve percent of males and 5% of females reported ever having had an STD. Most participants did not report any methods to protect against STDs. Of 192 males and 178 females tested for CT, 3 males and no females were positive. No cases of GC were found. Of 387 males and 194 females tested for syphilis, 4 males and 1 female had positive rapid plasma reagin (RPR) and Treponema pallidum particle agglutination (TPPA) results.

Conclusions: In this population-based survey among agricultural workers, there was low STD prevalence but high prevalence of sexual risk behaviors, particularly among males.
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http://dx.doi.org/10.1111/j.1748-0361.2008.00169.xDOI Listing
October 2008

Neonatal herpes morbidity and mortality in California, 1995-2003.

Sex Transm Dis 2008 Jan;35(1):14-8

Department of Health Services, Sexually Transmitted Disease Control Branch of the California, Richmond, California 94804-6403, USA.

Background: Neonatal herpes infections can have serious consequences. Methods for monitoring the incidence of neonatal herpes have not been standardized.

Objectives: To use existing data to examine neonatal herpes-related morbidity in California.

Methods: California hospital discharge and mortality data were used to identify neonatal herpes cases, defined as a herpes-related discharge diagnosis with an admitting age of 42 days or less, and neonatal herpes-related deaths. California birth data were used to identify pregnancies complicated by herpes and to determine cesarean section rates.

Results: The overall incidence of neonatal herpes was 12.1 per 100,000 live births per year, with no observable change from 1995 to 2003. Neonatal herpes-related mortality, which was estimated to be 0.8 deaths per 100,000 live births, also did not show significant change over time. Between 1995 and 2002, herpes complication in labor declined steadily from 0.23% to 0.09% of all labors (P <0.0001). Among pregnancies with herpes as a complication of labor, cesarean section rates increased from 72.2% to 78.3% (P = 0.01), whereas overall cesarean rates increased from 20.0% to 26.0% (P <0.0001).

Conclusions: Existing data can be used to monitor the morbidity and mortality of neonatal herpes. Because the rate of neonatal herpes cases and deaths was stable from 1995 to 2003 despite a decrease in herpes complications in labor and an increase in cesarean rates, new interventions are needed to prevent neonatal herpes.
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January 2008

An evaluation of the relative sensitivities of the venereal disease research laboratory test and the Treponema pallidum particle agglutination test among patients diagnosed with primary syphilis.

Sex Transm Dis 2007 Dec;34(12):1016-1018

California Department of Health Services, Sexually Transmitted Diseases (STD) Control Branch, 300 Frank H Ogawa Plaza, Suite 520, Oakland, CA 94612-2032, USA.

Background: Because definitive methods for diagnosing primary syphilis are limited, it is important to optimize the sensitivity of serodiagnosis.

Objective: To determine the most sensitive testing approach to the diagnosis of primary syphilis, using the commonly available serologic tests: the Venereal Disease Research Laboratory (VDRL) test and the Treponema pallidum particle agglutination (TP-PA) test.

Methods: Sensitivities of 2 serologic testing strategies for primary syphilis were compared among 106 darkfield-confirmed cases treated in San Francisco from January 2002 through December 2004.

Results: The sensitivity of the diagnostic strategy using VDRL confirmed by TP-PA was 71% (95% CI, 61%-79%). Substituting Rapid Plasma Reagin test for VDRL in a subset of 51 patients produced the same sensitivity (71%; 95% CI, 56%-83%). The sensitivity of TP-PA as the first-line diagnostic test was 86% (95% CI, 78%-92%). The sensitivity of the former approach was significantly lower among HIV-positive patients, compared with HIV-negative patients (55% vs. 77%, P = 0.05).

Conclusions: The TP-PA test as the first-line diagnostic test yielded higher sensitivity for primary syphilis than did the use of the currently recommended strategy.
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December 2007

Trends in the use of sexually transmitted disease diagnostic technologies in California, 1996-2003.

Sex Transm Dis 2007 Jul;34(7):513-8

California Department of Health Services, STD Control Branch, Richmond, CA 94804, USA.

Objective: To describe trends in STD diagnostic test volume and test technology in California from 1996 to 2003.

Study: A self-administered survey was mailed annually to licensed clinical laboratories in California that performed STD testing. Data were collected on volume and diagnostic test type for chlamydia, gonorrhea, syphilis, chancroid, HIV, hepatitis B, herpes simplex virus (HSV), and human papilloma virus (HPV). Data were analyzed for trends over time.

Results: Response rates ranged from 77% to 99% per survey year. The total number of chlamydia, gonorrhea, and syphilis tests increased from 8.1 to 9.3 million annually. The proportion of chlamydia and gonorrhea tests performed using nucleic acid amplification testing increased from 5% to 66% and from 1% to 59%, respectively. Gonorrhea culture testing decreased from 42% to 10% of all gonorrhea tests. HIV test volume increased from 2.4 to 3.1 million tests. Newer technology tests for HSV and HPV were less common but increased in use. Non-public health laboratories conducted over 90% of all STD testing.

Conclusions: Analyzing trends in diagnostic technologies enhances our understanding of the epidemiology of STDs and monitoring laboratory capacity and practices facilitates implementation of STD control activities.
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http://dx.doi.org/10.1097/01.olq.0000253346.41123.7cDOI Listing
July 2007