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The COVID-19 pandemic challenged critical services to maintain operations while facing a highly transmissible human pathogen. As public health officials worked to manage the crisis, initial guidelines focused on the continuation of services in the human health care setting. However, through state-mandated stay-at-home orders, the Michigan State University veterinary teaching hospital remained open to provide emergency services to both large and small animal patients. This was accomplished by distilling pertinent safety information from the available human health care guidance to safely maintain operation. Challenges faced when pivoting the delivery of veterinary education from in-person to virtual format were addressed and in-person clinical rotations were resumed as soon as possible. Strategies to effectively communicate information that is both immediately critical and broadly applicable should be considered and planned before they are needed. Infection control and disaster management plans should be revisited often to ensure they include all known risks and potential challenges. Plans to maintain staffing capacity and student safety when faced with an unexpected surge in patients should be laid out with clearly defined metrics on which to act. The lessons we have learned from the pandemic would improve the delivery of care and teaching in a veterinary teaching hospital in both day-to-day circumstances and future emergencies.

Background: Acquired immunodeficiency syndrome (AIDS) is a continuing global public health threat affecting millions of individuals. In 2009, 33.3 million people worldwide were living with human immunodeficiency virus (HIV) infection. HIV-infected individuals are at an increased risk of acquiring hepatitis B and hepatitis C viral (HBV, HCV)infections because of shared transmission routes. The purpose of this study was to identify geographical clusters of HIV-(HBV/HCV) co-infection in the State of Michigan., Methods: Retrospective cohort data on HIV-infected individuals were matched to all hepatitis B and C cases in Michigan during the period of January 1, 2006 through December 31, 2009. A prevalence map of HIV infection was created and spatial clusters of HIV-hepatitis B or C co-infection were detected using GeoDa's bivariate local Moran's I and SaTScan's discrete Poisson model., Results: A bivariate cluster of high prevalence HIV and hepatitis B or C was identified in the Detroit Metropolitan Area and surrounding counties. A Poisson cluster of HIV-hepatitis B or C co-infection was identified, relative risk (RR) = 1.38 (p = 0.029) in the western and northwestern counties of Lower Michigan, controlling for sex, race, and AIDS status., Conclusion: This study identified elevated HIV-hepatitis B or C co-infection unexplained by sex, race or AIDS status in counties outside of the Detroit Metropolitan Area where HIV prevalence was highest in Michigan. The findings from this study may be used to target future public health policy and healthcare interventions for HIV-hepatitis co-infection in these areas.

We sought to estimate mortality and associated factors in HIV-hepatitis co-infected individuals in Michigan using a retrospective cohort study. For the study period of 1 January 2006 to 31 December 2009, all HIV-infected individuals were matched to hepatitis B and C cases. In the final Cox proportional hazards regression model, individuals of other [hazard ratio (HR) 2·2, 95% confidence interval (CI) 1·4-3·2] and black (HR 1·3, 95% CI 1·1-1·6) race had decreased survival compared to white race. Similarly, injecting drug users (IDUs) (HR 2·1, 95% CI 1·6-2·6), men who have sex with men (MSM)/IDUs (HR 1·5, 95% CI 1·1-2·2), individuals with undetermined risk (HR 1·5, 95% CI 1·2-1·9) and heterosexual practices (HR 1·4, 95% CI 1·1-1·8) had decreased survival compared to MSM. Additionally, an interaction was found between current HIV status and co-infection. Mortality in HIV-hepatitis co-infected individuals remains a continuing problem. Our study can help in planning interventions to reduce mortality in HIV-infected individuals.

A retrospective cohort study was conducted from 1 January 2006 to 31 December 2009 in Michigan to estimate the prevalence of HIV and hepatitis co-infection and identify associated factors. The prevalence of co-infection was 4.1% [95% confidence interval (CI) 3.8-4.5]. Multivariable logistic regression analysis revealed a significant association between co-infection and being male and: of Black race [odds ratio (OR) 2.0, 95% CI 1.2-3.6] and of Other race (OR 3.5, 95% CI 1.7-7.0) compared to Hispanic race. A significant association was found between co-infection and risk categories of blood products (OR 11.1, 95% CI 6.2-20.2), injecting drug user (IDU) (OR 3.6, 95% CI 2.7-4.8) and men who have sex with men/IDU (OR 3.4, 95% CI 2.4-4.9) in addition to two interactions; one between sex and current HIV status and the other between current HIV status and age at HIV diagnosis. Our results document the changing epidemiology of HIV-hepatitis co-infection which can guide preventive measures and interventions to reduce the prevalence of hepatitis co-infection.