Developing a CASPER Survey to Assess the Prevalence of Risk Factors for Neglected Tropical Diseases in Texas

Microcephaly inpatient hospitalization and potential Zika outbreak in Texas: A cost and predicted economic burden analysis

OBJECTIVE

Estimate inpatient hospitalization costs for patients with microcephaly, and predict cost increases due to a potential Zika virus outbreak.

METHODS

We identified Texas-wide inpatient hospitalization discharge records (2008-2015), for newborns and non-newborns with microcephaly. We estimated the cost of each hospitalization by applying cost-to-charge ratios on the actual hospitalization charge. For comparison, newborn visits for patients without microcephaly were also identified, and hospital costs were compared between patients with and without microcephaly. We estimated costs for microcephaly during the first year of life following a Zika outbreak (possible 1-50% increase in birth prevalence) in Texas.

RESULTS

There were 8005 microcephaly hospitalizations ($203,899,042; total cost). The median admission cost for newborns with microcephaly (N = 1393) was higher compared to those without microcephaly ($6751 vs $725, p < 0.001). Microcephaly hospitalizations of newborns had a lower median cost compared to non-newborns ($6751 vs $9754, p < 0.001). Based on these observed hospitalization costs, we estimated that a potential Zika virus outbreak in Texas could result in an additional $1-6 million per year for hospitalizations.

CONCLUSION

Hospitalizations of patients with microcephaly are associated with high costs. An increase in microcephaly prevalence due to a Zika outbreak in Texas could have a considerable impact on health care costs.

Use of the Community Assessment for Public Health Response (CASPER) Method by Public Health Agencies in Texas, 2001-2015

Objectives

The use of the Community Assessment for Public Health Emergency Response (CASPER) method in disaster and non-disaster settings continues to grow. While CASPERs flexibility has been well demonstrated, the documentation of specific actions that have resulted from the utilization of CASPER data has been limited. We attempted to document changes in emergency preparedness planning and policy based on CASPER data.

Methods

Written reports from 19 CASPERs conducted in Texas between 2001 and 2015 were collected. Key informant interviews were conducted with 9 public health staff knowledgeable about the CASPERs. Written reports and interview transcripts were coded and analyzed for themes.

Results

Few specific outcomes could be documented beyond a single successful grant application. Respondents felt CASPER data was not duplicative and was useful for improving existing plans. CASPER is seen as an effective way to enhance relationships with communities and partnerships with agencies including Emergency Management.

Conclusion

As the use of CASPER grows, it is increasingly important to document any specific and measurable benefits, actions, and changes to planning or policy taken as the result of data collected using the CASPER method. Without measurable outputs and outcomes, support for the use of CASPER from decision-makers may begin to wane. (Disaster Med Public Health Preparedness. 2018;12:680-684)

Use of the Community Assessment for Public Health Response (CASPER) method to assess influenza vaccination and activity in Brazos County, Texas

OBJECTIVES

Based on an increase in influenza cases in Brazos County, Texas, a Community Assessment for Public Health Emergency Response (CASPER) was conducted by the Brazos County Health Department (BCHD) and the Texas A&M School of Public Health's EpiAssist program. The goal of the CASPER was to supplement other data sources to assess vaccination rates and influenza prevalence in the community during a period of high influenza activity nationwide.

METHODS

Using the Centers for Disease Control and Prevention's (CDC) CASPER toolkit, 30 census blocks in Brazos County were selected probability proportionate to population size. Seven interviews were attempted in each selected census block by an interview team. The survey contained 21 questions in 5 domains, including demographics, general infection control knowledge, prior infection with influenza, prior experience with influenza vaccine, and attitudes towards influenza vaccination. Survey results were entered into a database for the calculation of frequencies, crude odds ratios (OR), and 95% confidence intervals (CI).

RESULTS

Two-hundred and seven households completed the survey. Estimated vaccination rates in Brazos County adults were higher than Texas adults overall, but rates did not differ among children. Forty-two (20.4%) of respondents reported having influenza illness during the month of December 2017. Overall, respondents were knowledgeable of influenza transmission and prevention and reported few barriers and objections to the vaccine; however, some responses suggest misinformation that could be addressed through communication from local health departments exists. African American/Black respondents were less likely to receive a vaccine than respondents of other races, while individuals age 65 and over as well as those who believed the vaccine to be effective were more likely to be vaccinated.

CONCLUSION

CASPER should be considered a tool for assessing influenza vaccine and disease status of communities and has potential for providing information useful in the development of public health initiatives.