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Nuzzo JB, Golub JE, Chaulk P, Shah M. Analysis of latent tuberculosis infection treatment adherence among refugees and other patient groups referred to the Baltimore City Health Department TB clinic, February 2009-March 2011. J Immigr Minor Health 2016; 17:56-65. [PMID: 23907316 DOI: 10.1007/s10903-013-9882-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We sought to determine the proportion of refugee patients at the Baltimore City Health Department Tuberculosis program (BCHD-TB) successfully completing latent tuberculosis infection (LTBI) treatment, as compared to other referral groups, and to identify factors associated with treatment completion. We completed a retrospective cohort analysis of individuals referred to BCHD-TB program for LTBI care between February 1, 2009 and March 31, 2011. Among 841 patients evaluated by BCHD-TB and diagnosed with LTBI, 81% of refugees, 50% of non-refugee foreign-born, and 35% of US-born patients completed LTBI treatment. In multivariate analysis, refugees had greater odds of LTBI treatment completion (Adjusted Odds Ratio 7.2; 95% CI 4.2-12.4, p < 0.001) compared to US-born individuals adjusting for age, gender, and treatment regimen. Overall, LTBI treatment completion remains suboptimal. At BCHD-TB, LTBI treatment completion was significantly higher among refugees than other referral groups. Additional efforts are needed to optimize LTBI care, and future efforts may need to be tailored for different risk groups.
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Kilianski A, Nuzzo JB, Modjarrad K. Reply to Lipsitch. J Infect Dis 2016; 214:1285-6. [PMID: 27503366 PMCID: PMC7107386 DOI: 10.1093/infdis/jiw349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 07/14/2016] [Indexed: 11/15/2022] Open
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Nuzzo JB. Pandemic. Emerg Infect Dis 2016. [DOI: 10.3201/2210.160795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Nuzzo JB, Ravi S. Strengthening Surveillance for Health Security Threats: The Time Is Now. Health Secur 2016; 14:109-10. [PMID: 27314651 DOI: 10.1089/hs.2016.0051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kilianski A, Nuzzo JB, Modjarrad K. Gain-of-Function Research and the Relevance to Clinical Practice. J Infect Dis 2015; 213:1364-9. [PMID: 26416657 PMCID: PMC7107371 DOI: 10.1093/infdis/jiv473] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/02/2015] [Indexed: 11/13/2022] Open
Abstract
The ongoing moratorium on gain-of-function (GOF) research with highly pathogenic avian influenza virus, severe acute respiratory syndrome coronavirus, and Middle East respiratory syndrome coronavirus has drawn attention to the current debate on these research practices and the potential benefits and risks they present. While much of the discussion has been steered by members of the microbiology and policy communities, additional input from medical practitioners will be highly valuable toward developing a broadly inclusive policy that considers the relative value and harm of GOF research. This review attempts to serve as a primer on the topic for the clinical community by providing a historical context for GOF research, summarizing concerns about its risks, and surveying the medical products that it has yielded.
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Nuzzo JB, Cicero AJ, Waldhorn R, Inglesby TV. Travel bans will increase the damage wrought by ebola. Biosecur Bioterror 2015; 12:306-9. [PMID: 25397355 DOI: 10.1089/bsp.2014.1030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nuzzo JB, Golub JE, Chaulk P, Shah M. Postarrival Tuberculosis Screening of High-Risk Immigrants at a Local Health Department. Am J Public Health 2015; 105:1432-8. [PMID: 25602872 DOI: 10.2105/ajph.2014.302287] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to characterize postimmigration tuberculosis (TB) care for Class B immigrants and refugees at the Baltimore City Health Department TB program (BCHD), and to determine the proportion of immigrants with active TB or latent TB infection (LTBI) in this high-risk population. METHODS We conducted a retrospective chart review of Class B immigrants and refugees who reported to the BCHD for postimmigration TB evaluation from 2010 to 2012. RESULTS We reviewed the clinical records of 153 Class B immigrants; 4% were diagnosed with active TB and 53% were diagnosed with LTBI. Fifty percent of active TB cases were culture positive, and 67% were asymptomatic; 100% received and completed active TB therapy at the BCHD. Among those diagnosed with LTBI, 87% initiated LTBI therapy and 91% completed treatment. CONCLUSIONS The high prevalence of active TB and LTBI found among Class B immigrants underscore the importance for postarrival TB screening. The absence of reported symptoms among the majority of active cases identified during this study suggest that reliance on symptom-based screening protocols to prompt sputa testing may be inadequate for identifying active TB among this high-risk group.
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McNabb SJN, Shaikh AT, Nuzzo JB, Zumla AI, Heymann DL. Triumphs, trials, and tribulations of the global response to MERS coronavirus. THE LANCET RESPIRATORY MEDICINE 2014; 2:436-7. [PMID: 24794576 PMCID: PMC7129523 DOI: 10.1016/s2213-2600(14)70102-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Balkhy HH, Miller TL, Ali S, Nuzzo JB, Kentenyants K, El-Saed A, McNabb SJN. Compliance with postexposure screening and treatment of latent tuberculosis infection among healthcare workers in a tertiary care hospital in Saudi Arabia. Infect Control Hosp Epidemiol 2013; 35:176-81. [PMID: 24442081 DOI: 10.1086/674855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Controlling tuberculosis (TB) infection among occupationally exposed healthcare workers (HCWs) may be challenging. METHODS We retrospectively reviewed clinical records of HCWs who were exposed to patients diagnosed with infectious TB at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between 2008 and 2010. The collected data included baseline tuberculin skin test (TST) status, potential predictors of TST positivity, postexposure diagnosis of latent TB infection (LTBI), and postexposure compliance with LTBI therapy. RESULTS Thirteen patients were diagnosed with infectious pulmonary TB during the study period. A total of 298 HCWs met our definition for exposure. Exposed HCWs tended to be female (62.9%), non-Saudi (83.9%), nurses (68.6%), or respiratory therapists (24.0%) working in critical care locations (72.8%). Baseline (preemployment) TST documentation existed for 41.3% (123/298). Among those with documented baseline TSTs, 51.2% (63/123) were positive, representing 21.1% (63/298) of all HCWs. Only 48.9% (115/235) of exposed HCWs who had negative or unknown preexposure TST status had their TST tested after exposure. Approximately 46.1% (53/115) of them were diagnosed with postexposure LTBI, and 92.5% (49/53) of them were prescribed LTBI therapy. Among those, 93.9% (46/49) started LTBI therapy; however, 82.6% (38/46) failed to complete the recommended course. CONCLUSIONS We found low rates of baseline TST documentation and postexposure screening among exposed HCWs. Compliance with initiating postexposure isoniazid prophylaxis among HCWs was fair, but only a small fraction of those who started prophylaxis completed the recommended course of therapy. These findings suggest substantial opportunities to implement administrative measures to enhance LTBI management among HCWs.
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Toner ES, Adalja AA, Nuzzo JB, Inglesby TV, Henderson DA, Burke DS. Assessment of serosurveys for H5N1. Clin Infect Dis 2013; 56:1206-12. [PMID: 23386633 DOI: 10.1093/cid/cit047] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND It has been suggested that the true case-fatality rate of human H5N1 influenza infection is appreciably less than the figure of approximately 60% that is based on official World Health Organization (WHO)-confirmed case reports because asymptomatic cases may have been missed. A number of seroepidemiologic studies have been conducted in an attempt to identify such missed cases. METHODS We conducted a comprehensive literature review of all English-language H5N1 human serology surveys with detailed attention to laboratory methodology used (including whether investigators used criteria set by the WHO to define positive cases), laboratory controls used, and the clades/genotypes involved. RESULTS Twenty-nine studies were included in the analysis. Few reported using unexposed control groups and one-third did not apply WHO criteria. Of studies that used WHO criteria, only 4 found any seropositive results to clades/genotypes of H5N1 that are currently circulating. No studies reported seropositive results to the clade 2/genotype Z viruses that have spread throughout Eurasia and Africa. CONCLUSIONS This review suggests that the frequency of positive H5 serology results is likely to be low; therefore, it is essential that future studies adhere to WHO criteria and include unexposed controls in their laboratory assays to limit the likelihood of false-positive results.
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Toner ES, Nuzzo JB. Acting on the lessons of SARS: what remains to be done? Biosecur Bioterror 2011; 9:169-74. [PMID: 21612366 DOI: 10.1089/bsp.2010.0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Toner ES, Nuzzo JB, Watson M, Franco C, Sell TK, Cicero A, Inglesby TV. Biosurveillance where it happens: state and local capabilities and needs. Biosecur Bioterror 2011; 9:321-30. [PMID: 21905878 DOI: 10.1089/bsp.2011.0049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In recent years, improved biosurveillance has become a bipartisan national security priority. As has been pointed out by the National Biosurveillance Advisory Subcommittee and others, building a national biosurveillance enterprise requires having strong biosurveillance systems at the state and local levels, and additional policies are needed to strengthen their biosurveillance capabilities. Because of the foundational role that state and local health departments play in biosurveillance, we sought to determine to what extent state and local health departments have the right capabilities in place to provide the information needed to detect and manage an epidemic or public health emergency-both for state and local outbreak management and for reporting to federal agencies during national public health crises. We also sought to identify those policies or actions that would improve state and local biosurveillance and make recommendations to federal policymakers who are interested in improving national biosurveillance capabilities.
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Henderson DA, Courtney B, Inglesby TV, Toner E, Nuzzo JB. Public health and medical responses to the 1957-58 influenza pandemic. Biosecur Bioterror 2010; 7:265-73. [PMID: 19656012 DOI: 10.1089/bsp.2009.0729] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
As the U.S. prepares to respond this fall and winter to pandemic (H1N1) 2009, a review of the 1957-58 pandemic of Asian influenza (H2N2) could be useful for planning purposes because of the many similarities between the 2 pandemics. Using historical surveillance reports, published literature, and media coverage, this article provides an overview of the epidemiology of and response to the 1957-58 influenza pandemic in the U.S., during which an estimated 25% of the population became infected with the new pandemic virus strain. While it cannot be predicted with absolute certainty how the H1N1 pandemic might play out in the U.S. this fall, lessons from the 1957-58 influenza pandemic provide useful and practical insights for current planning and response efforts.
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Nuzzo JB, Mair M, Franco C. Preserving Gains from Public Health Emergency Preparedness Cooperative Agreements. Biosecur Bioterror 2009; 7:35-6. [DOI: 10.1089/bsp.2009.1005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Schoch-Spana M, Courtney B, Franco C, Norwood A, Nuzzo JB. Community resilience roundtable on the implementation of Homeland Security Presidential Directive 21 (HSPD-21). Biosecur Bioterror 2009; 6:269-78. [PMID: 18795837 DOI: 10.1089/bsp.2008.0809] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Mair M, Norwood A, Courtney B, Nuzzo JB. Comments from the Center for Biosecurity of UPMC on Draft Guidances for Pandemic Influenza Planning. Biosecur Bioterror 2008; 6:279-81. [DOI: 10.1089/bsp.2008.0729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Schoch-Spana M, Franco C, Nuzzo JB, Usenza C. Community engagement: leadership tool for catastrophic health events. Biosecur Bioterror 2007; 5:8-25. [PMID: 17437348 DOI: 10.1089/bsp.2006.0036] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Disasters and epidemics are immense and shocking disturbances that require the judgments and efforts of large numbers of people, not simply those who serve in an official capacity. This article reviews the Working Group on Community Engagement in Health Emergency Planning's recommendations to government decision makers on why and how to catalyze the civic infrastructure for an extreme health event. Community engagement--defined here as structured dialogue, joint problem solving, and collaborative action among formal authorities, citizens at-large, and local opinion leaders around a pressing public matter--can augment officials' abilities to govern in a crisis, improve application of communally held resources in a disaster or epidemic, and mitigate community wide losses. The case of limited medical options in an influenza pandemic serves to demonstrate the civic infrastructure's preparedness, response, and recovery capabilities and to illustrate how community engagement can improve pandemic contingency planning.
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Maldin-Morgenthau B, Toner E, Waldhorn R, Nuzzo JB, Franco C, Press D, O'Toole T, Inglesby TV. Roundtable: Promoting Partnerships for Regional Healthcare Preparedness and Response. Biosecur Bioterror 2007; 5:180-5. [PMID: 17608605 DOI: 10.1089/bsp.2007.0906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Inglesby TV, Nuzzo JB, O'Toole T, Henderson DA. Disease mitigation measures in the control of pandemic influenza. Biosecur Bioterror 2007; 4:366-75. [PMID: 17238820 DOI: 10.1089/bsp.2006.4.366] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The threat of an influenza pandemic has alarmed countries around the globe and given rise to an intense interest in disease mitigation measures. This article reviews what is known about the effectiveness and practical feasibility of a range of actions that might be taken in attempts to lessen the number of cases and deaths resulting from an influenza pandemic. The article also discusses potential adverse second- and third-order effects of mitigation actions that decision makers must take into account. Finally, the article summarizes the authors' judgments of the likely effectiveness and likely adverse consequences of the range of disease mitigation measures and suggests priorities and practical actions to be taken.
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Schoch-Spana M, Chamberlain A, Franco C, Gross J, Lam C, Mulcahy A, Nuzzo JB, Toner E, Usenza C. Disease, disaster, and democracy: the public's stake in health emergency planning. Biosecur Bioterror 2007; 4:313-9. [PMID: 16999593 DOI: 10.1089/bsp.2006.4.313] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Nuzzo JB, Henderson DA, O'Toole T, Inglesby TV. Comments from the Center for Biosecurity of UPMC on Proposed Revisions to Federal Quarantine Rules. Biosecur Bioterror 2006; 4:204-6. [PMID: 16792489 DOI: 10.1089/bsp.2006.4.204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
On November 30, 2005, the U.S. Centers for Disease Control and Prevention (CDC) proposed changes to federal quarantine regulations (42 CFR Parts 70 and 71). As stated in the proposed rules, the intent of changes is "to clarify and strengthen existing procedures to enable CDC to respond more effectively to current and potential communicable disease threats." Parts 70 and 71 of 42 CFR authorize the Secretary of the Department of Health and Human Services (HHS) to make and enforce regulations "as in his judgement are necessary to prevent the introduction, transmission, and spread of communicable diseases" from foreign countries (Part 71) and between states (Part 70). The Center for Biosecurity of UPMC reviewed the proposed revisions to the quarantine regulations and submitted to CDC the following analysis as its official comments on the revised rules.
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Toner E, Waldhorn R, Maldin B, Borio L, Nuzzo JB, Lam C, Franco C, Henderson DA, Inglesby TV, O'Toole T. Hospital Preparedness for Pandemic Influenza. Biosecur Bioterror 2006; 4:207-17. [PMID: 16792490 DOI: 10.1089/bsp.2006.4.207] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nuzzo JB. The Biological Threat to U.S. Water Supplies: Toward a National Water Security Policy. Biosecur Bioterror 2006; 4:147-59. [PMID: 16792482 DOI: 10.1089/bsp.2006.4.147] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In addition to providing potable drinking water, U.S. water systems are critical to the maintenance of many vital public services, such as fire suppression and power generation. Disruption of these systems would produce severe public health and safety risks, as well as considerable economic losses. Thus, water systems have been designated as critical to national security by the U.S. government. Previous outbreaks of waterborne disease have demonstrated the vulnerability of both the water supply and the public's health to biological contamination of drinking water. Such experiences suggest that a biological attack, or even a credible threat of an attack, on water infrastructure could seriously jeopardize the public's health, its confidence, and the economic vitality of a community. Despite these recognized vulnerabilities, protecting water supplies from a deliberate biological attack has not been sufficiently addressed. Action in this area has suffered from a lack of scientific understanding of the true vulnerability of water supplies to intentional contamination with bioweapons, insufficient tools for detecting biological agents, and a lack of funds to implement security improvements. Much of what is needed to address the vulnerability of the national water supply falls outside the influence of individual utilities. This includes developing a national research agenda to appropriately identify and characterize waterborne threats and making funds available to implement security improvements.
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