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Highlights • We created a COVID-19 an outbreak management team (OMT) and used video surveillance for contact tracing. • Medical and Nursing completed more than 150 PPE training sessions for staff. • Video review and contact tracing lead to 602 and 314 medical isolation days for infected employees and residents and 3060 and 4170 quarantine days for close contacts. • Prompt diagnosis and contact tracing by OMT lead to low primary attack and positivity rates for both employees and residents., We describe the use of video technology to enhance case interviews, identify COVID-19 contacts, and determine exposures risk within a large juvenile temporary detention center. We created a COVID-19 outbreak management protocol which included the formation of an outbreak management team (OMT) and enhanced infection control practices using video surveillance. Currently, our institution's positivity rate remains low for both staff and residents largely because of the OMT. Video technology combined with enhanced infection control practices can be a useful technique to reduce COVID-19 infections in custodial settings.

Although prisoners are considered a vulnerable population, no data repository currently exists to monitor the COVID-19 incidence in Nigerian prisons. To better understand the impact of COVID-19 within the Nigerian prison system, prisons should develop detailed COVID-19 response protocols, implement enhanced point-of-care testing, and initiate contact tracing with meticulous data collection.

BackgroundEarly data from the COVID-19 pandemic suggests that the disease has had a disproportionate impact on communities of color causing higher infection and mortality rates within those communities.MethodsThis study used demographic data from the 2018 US census estimates, mortality data from the Cook County Medical Examiner’s office, and testing results from the Illinois Department of Public Health to perform both bivariate and multivariate regression analyses to explore the role race plays in COVID-19 outcomes at the individual and community levels.ResultsPrincipal findings show that: 1) while Black Americans make up 22% of Cook County’s population, they account for 36% of the county’s COVID-19 related deaths; 2) the average age of death from COVID-19 is seven years younger for minorities compared to Non-Hispanic White (White) decedents; 3) minorities were more likely than Whites to have seven of the top 10 co-morbidities at death; 4) residents of predominantly minority areas were twice as likely to test positive for COVID-19 (p = 0.0001, IRR 1.94, 95% CI 1.50, 2.50) than residents of predominantly White areas; and 5) residents of predominantly minority areas were 1.43 times more likely to die of COVID-19 than those in predominantly White areas (p = 0.03).ConclusionsThere are notable differences in COVID-19 related outcomes between racial and ethnic groups at individual and community levels. We hope that this study will scientifically illustrate the health disparities experienced by communities of color and help to address the underlying systemic inequalities still prevalent within our country.

The COVID-19 pandemic caused by the SARS-CoV-2 virus has led to substantial morbidity and mortality world-wide. Evidence suggests that ethnic and racial minorities have been disproportionately affected in the United States, particularly within major population centers. In this study, we evaluated the effect of the COVID-19 pandemic in Cook County, Illinois, and found that the rate of years of potential life lost (YPLL) was 4.8 times greater in the most affected racial group (YPLL: 2289/100,000 population in Hispanic people) than in the least affected group (YPLL: 480/100,000 population in Asian people).

The recent US measles outbreak is the largest since 1992. It is just a matter of time before measles is introduced into a juvenile custodial setting. Are we prepared? Should we be prepared? This short article addresses steps institutional settings should take to prevent the spread of measles in a contained setting.

Megan Ward,1 Peter Nguyen,1 Simi Akintorin,2 Rosibell Arcia,1 Kenneth Soyemi1,3 1Department of Pediatrics, Cook County Health, and Hospitals System, The John H. Stroger Jr. Hospital, Chicago, IL, USA; 2Keck School of Medicine, University of Southern California Medical School, Los Angeles, CA, USA; 3Department of Emergency Medicine, Cook County Health, and Hospitals System, The John H. Stroger Jr. Hospital, Chicago, IL, USA Introduction: Our study objective was to determine the health care provider liver enzyme screening testing (LEST) rates in obese pediatric patients at risk for nonalcoholic fatty liver disease (NAFLD), with the goal of improving NAFLD LEST after specific system-wide provider intervention.Methods: We conducted a bi-phased retrospective electronic medical record review of health care practitioner encounters to determine LEST in overweight/obese (body mass index≥25) patients between ages 2 and 18 years in our outpatient clinics. Intervention activities included lectures to staff and residents, fliers distributed to providers, monthly email reminders, and computer stickers placed on all terminals. From both phases, samples of simple random samples were drawn from the selected electronic medical records and reviewed for LEST screening; after intervention from this pool of patients, a random sample was chosen for LEST rate analysis. LEST rates were calculated per 100 patient encounters.Results: We screened 2,979 and 2,634 pre and postintervention pediatric encounters from which we obtained a simple random sample of patients for LEST analysis. Overall of the 264 preintervention patients, 65 (24.4%) patients received LEST translating to 24/100 encounters. Of the 65 who received screening, 53 (81%) were classified as overweight/obese. Screening rate was higher for overweight/obese patients (32/100 encounters), when compared with normal weight patients’ crude OR 3.8 (11/100 encounters; 95% CI: 1.9–7.6, P

Kenneth Soyemi,1,2 Teddy Muisyo,1,3 Yaa KariKari,1,4 Kun-UK David Lee,5 Peter Nguyen,1 Karen E Simpson,1 Kevin Regis,2 Lisa Henry Reid1 1Department of Pediatrics, Cook County Health and Hospitals System, John H Stroger Jr Hospital, Chicago, IL, USA; 2Department of Emergency Medicine, Cook County Health and Hospitals System, John H Stroger Jr Hospital, Chicago, IL, USA; 3Division of Critical Care, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA; 4Department of Pediatrics, Division of Cardiology, Advocate Christ Hospital, Chicago, IL, USA; 5School of Medicine, Rosalind Franklin Medical School, North Chicago, IL,USA Abstract: HIV testing in the Pediatric Emergency Department (PED) is a novel concept as adolescents, and young adults, use the PED as point of care or first point of contact with the health care system. Our objective was to study the HIV nontesting data and factors that influenced testing decision among patients receiving care in our PED. We designed a survey that inquired about testing acceptance, reasons for rejection, satisfaction with testing conditions, and understanding of the consequence of HIV test results. We approached 500 patients across all shifts in the PED; for analysis, categorical variables were created using demographic data (race, age, ethnicity, marital status, level of education). Forward conditional binary logistic regression was used to explore the effect of various independent predictors on HIV testing rejection with the strength of association measured with adjusted odds ratio (OR), and their 95% CIs. We conducted model fitting by plotting residuals, Hosmer and Lemeshow test statistic, and area under the curve completed using predicted probabilities. We used SPSS Version 25™, Microsoft Excel 2016™ for data preparation and analysis. Of the 500 patients approached, 423 (84.6%) completed the survey, median (interquartile) age of survey participants was 19 (17–20) years, 158 (37.4%) rejected HIV testing, 284 (67.1%) were older than 18 years of age, 200 (47.3%) were males, 154 (36.4%) were white, and 127 (30%) were of Hispanic origin. The most common reason for rejecting HIV was low risk perception declared by 79 (50%) respondents. In multivariate analysis, age

Osteogenesis imperfecta can be commonly mistaken for child abuse because of similar pattern of injuries. AA is a 3-week-old baby who presented to our emergency department with excessive crying. Skeletal survey revealed subacute spiral fracture of the right humerus, right posterior eighth and ninth ribs, acute fracture of the left femur, bowing of tibia and femur, and osteopenia. Subsequent geneticist examination and genetic testing noted blue sclera and heterozygosity for a variant of COL1A gene.

Aim: To present the methods and outcomes of stakeholder engagement in the development of interventions for children presenting to the emergency department (ED) for uncontrolled asthma. Methods: We engaged stakeholders (caregivers, physicians, nurses, administrators) from six EDs in a three-phase process to: define design requirements; prototype and refine; and evaluate. Results: Interviews among 28 stakeholders yielded themes regarding in-home asthma management practices and ED discharge experiences. Quantitative and qualitative evaluation showed strong preference for the new discharge tool over current tools. Conclusion: Engaging end-users in contextual inquiry resulted in CAPE (CHICAGO Action Plan after ED discharge), a new stakeholder-balanced discharge tool, which is being tested in a multicenter comparative effectiveness trial.

BackgroundRetinopathy of prematurity (ROP) is a significant morbidity in preterm babies. Multiple risk factors for severe ROP have been extensively studied, however, only a few studies have included maternal diabetes mellitus (MDM) in their assessment. ROP and diabetic retinopathy are both retinal vascular diseases in which there is leakage and/or neovascularization from damaged retinal vessels. Diabetes may affect ROP development; however, there are conflicting results on the association between MDM and ROP.ObjectiveTo determine if MDM is an independent risk factor for clinically significant ROP (ROP > Stage II) in neonates weighing less than 1500g.Design/methodWe conducted a retrospective cohort study of neonates weighing ResultsWe extracted 883 paired maternal-neonatal data. The mean (standard deviation) gestational age and birthweight were 28.5 (2.9) weeks and 1052.7 (300.9) grams, respectively. Of the 883 mothers, 72 (8.2%) had DM. The incidence of ROP and severe ROP was 42.4% (374/883) and 6.5% (57/883) respectively. The odds ratio comparing MDM and severe ROP was 3.47 [95% CI: 1.51-7.96]; pConclusionMaternal diabetes is associated with ROP and the strength of association increased with increasing severity of ROP.

Nigeria has an estimated population of 186 million with 23% of eligible children aged 12-23 months fully immunized. Government spending on routine immunization per surviving infant has declined since 2006 meaning the immunization budget needs to improve. By 2020, Nigeria will be ineligible for additional Global Alliance for Vaccination and Immunization (Gavi) grants and will be facing an annual vaccine bill of around US$426.3m. There are several potential revenue sources that could be utilized to fill the potential funding gap, these are however subject to timely legislation and appropriation of funds by the legislative body. Innovative funding sources that should be considered include tiered levies on tele-communications, airline, hotel, alcohol, tobacco, sugar beverage taxes, lottery sales, crowd-sourcing, optimized federal state co-financing etc. To demonstrate monthly income that will be derived from a single tax revenue source, we modelled using Monte Carlo simulation trials the Communication Service Tax that is being introduced by the National Assembly. We used number of active telephone subscribers, penetration ratio, monthly charges, and percent of immunization levy as model scenario inputs and dollars generated monthly as output. The simulation generated a modest mean (SD) monthly amount of $3,649,289.38 ($1,789,651); 88% certainty range $1,282,719.90 to $7,450,906.26. The entire range for the simulation was $528,903.26 to $7,966,287.26 with a standard error of mean of $17,896.52. Sensitivity analysis revealed that percentage of immunization levy contributed 97.9 percent of the variance in the model, number of active subscribers and charges per month contributed 1.5%, and 0.6% respectively. Our modest simulation analysis demonstrated the potential to raise revenue from one possible tax source; when combined, the revenue sources will potentially surpass Nigeria's long-term financing needs. The ROI of vaccine should supersede all other considerations and prompt urgent activities to cover the impending finance coverage gap.

In response to recent pertussis resurgence, a multi-agency recommendation that students receive a one-time Tdap vaccine was introduced. Post mandate there was sequential increase in the Tdap vaccine uptake in the targeted population.

Pertussis incidence has increased in recent years; we obtained incidence data from 1990-2014 from the Illinois Department of Public Health Web site. We analyzed the crude incidence rates using Joinpoint regression software. Four joinpoints were observed (2001, 2004, 2007, and 2012). Disease modeling can be used for disease control and planning by extrapolating the trend in the incidence data and applying to annual population estimates.

Objective.To evaluate hepatitis B vaccination coverage and documentation of vaccine-induced immunity.Design.Retrospective cohort analysis.Setting.Graduate school in the United States with programs in osteopathic medicine, dentistry, and allied health.Methods.Data collected included demographics, dates of hepatitis B vaccine doses, and postvaccination concentrations of antibody to hepatitis B surface antigen (anti-HBs), with dates. The proportions of students with anti-HBs of 10 IU/L or more by demographics, age at vaccination, interval since completion of the primary series, and response to additional vaccine doses were compared.Results.Of 3,452 students who matriculated during 2004–2009, 2,643 had complete data; 2,481 (93.9%) received 3 primary doses. Most were women (64.6%), US-born (85.6%), and white (63.2%); median age at receipt of the primary series was 14.5 years (interquartile range, 11.6–20.2 years) and at postvaccination testing was 23.2 years (interquartile range, 22.1–24.8 years). Of those who received 3 primary doses, 2,306 (92.9%) had an anti-HBs postvaccination concentration of 10 IU/L or more. Younger age at vaccination and longer time interval from vaccination to anti-HBs testing were associated with a postvaccination concentration of less than 10 IU/L (P < .001 and P = .0185, respectively, Cochran-Armitage test for trend). Almost all students (98.2%) who initially had less than 10 IU/L of anti-HBs, but then received at least 1 additional dose, had a follow-up anti-HBs concentration of 10 IU/L or more.Conclusions.Almost all students had serologic evidence of protection against hepatitis B virus infection; most were vaccinated as adolescents and were tested more than 10 years after vaccination. Among students with anti-HBs concentrations of less than 10 IU/L, nearly all had 10 IU/L or more after at least 1 additional vaccine dose.

During the winter in 2008, Iowa experienced an increase in sudden unexplained infant deaths (SUIDs). SUIDs and infectious causes of infant deaths generally average 3 monthly (SD = 1.0) in Iowa. However, in January 2008, 9 infant deaths were reported to the Iowa Department of Public Health and the Iowa Office of the State Medical Examiner. Between January and March of 2008, joint investigation of 22 SUIDs was conducted. The investigations required the involvement of multiple medical examiners from various jurisdictions, testing for pathogens at the University Hygienic Laboratory, epidemiologic support from the Iowa Department of Public Health, and consultation with the Centers for Disease Control and Prevention. The preliminary hypotheses for the increase in the infant mortality included viral respiratory disease and/or possible novel respiratory viral infections being the cause. Collaboration between public health and the medical examiner offices resulted in timely assessment of the cases. While no single causative agent was responsible for the increase seen in the number of infant deaths, respiratory pathogens played a role in the deaths of 15 of 22 children.

1. Kenneth Soyemi, MD, MPH* 1. *Voluntary Attending, Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, IL. Realizing that the degree of familiarity with and understanding of statistics encompasses a wide spectrum among our readers, this detailed overview of statistical tests will serve different functions for different readers. Those engaged in research will be comfortable with the information provided and may gain deeper insights. Readers who are not familiar with these methods will find a wide spectrum of definitions that will facilitate a better understanding of the studies that provide the evidence we use to direct clinical care. During journal club, a resident says to you, “I see several statistical tests in the medical literature. They do not mean much to me. What is the right statistical test to perform for a particular study?” How will you respond? The purpose of many studies is to collect data from a sample of individuals that represents the population of interest; statistics help to summarize and analyze these data. A variable is anything that can be measured and is observed to vary. Studies generally have two variable types: the response variable (also called the outcome or dependent variable) and the explanatory variable (also called a covariate or independent variable). For example, in a study designed to show which of several antibiotics will cause a bacteriologic cure, the response variable is negative cultures and the explanatory variables are the specific antibiotics. Data are described as either quantitative or qualitative. Table 1 provides examples of variables that have different characteristics. Quantitative data are measured on a numerical scale and may take the form of discrete integer values or points on a continuous scale. A discrete variable may take on only a countable number of …

In Sweden, leishmaniasis is an imported disease and its epidemiology and incidence were not known until now. We conducted a retrospective, nationwide, epidemiological study from 1993 to 2016. Probable cases were patients with leishmaniasis diagnoses reported to the Swedish Patient registry, collecting data on admitted patients in Swedish healthcare since 1993 and out-patient visits since 2001. Confirmed cases were those with a laboratory test positive for leishmaniasis during 1993-2016. 299 probable cases and 182 confirmed cases were identified. Annual incidence ranged from 0.023 to 0.35 per 100 000 with a rapid increase in the last 4 years. Of 182 laboratory-verified cases, 96 were diagnosed from 2013 to 2016, and in this group, almost half of the patients were children under 18 years. Patients presented in different healthcare settings in all regions of Sweden. Cutaneous leishmaniasis was the most common clinical manifestation and the majority of infections were acquired in Asia including the Middle East, specifically Syria and Afghanistan. Leishmania tropica was responsible for the majority of cases (42%). A combination of laboratory methods increased the sensitivity of diagnosis among confirmed cases. In 2016, one-tenth of the Swedish population were born in Leishmania-endemic countries and many Swedes travel to these countries for work or vacation. Swedish residents who have spent time in Leishmania-endemic areas, could be at risk of developing disease some time during their lives. Increased awareness and knowledge are needed for correct diagnosis and management of leishmaniasis in Sweden.

During the investigation of an outbreak of Escherichia coli O157:H7 in a child care center, illness logs were reviewed and parents interviewed to identify classroom and household exposures. Costs incurred by the center and the public health laboratory were estimated from self-administered questionnaires. We conclude that household transmission played a role in this outbreak and estimate the cost of investigation and intervention at over $6,000 per case.

1. Izaskun Melania Iglesias, MD, MBA* 2. Alexander Fernandez* 3. Eduardo Smith-Singares, MD, FACS* 4. Kenneth Soyemi, MD, MPH, MBA* 5. Rosibell Arcia, MD* 1. *John H Stroger Hospital of Cook County, Chicago, IL. A 12-year-old girl presents to the emergency department with a 5-hour history of abdominal pain, nausea, and vomiting. The pain is periumbilical, radiating to the left lower quadrant, colicky, and rated 5/10 at the onset. In the emergency department, she rates the pain as 8/10 and has two nonbloody, nonbilious episodes of emesis. She denies any fever, constipation, or diarrhea. She is not sexually active, had menarche 2 months ago, and had her last menstrual period end 3 days ago. She denies dysmenorrhea. She has no allergies, hospitalizations, or previous surgeries. On physical examination, the patient is in severe distress, afebrile, and pale. Mucous membranes are moist, and the girl has hyperpigmented perioral and intraoral mucosal lesions, freckles on her face, and macules on the tips of the fingers. Her abdomen is soft, nondistended, and tender to palpation on bilateral lower quadrants with rebound tenderness. No masses are palpable and the Rovsing sign is positive. …

During late April 2009, the first cases of 2009 pandemic influenza A (H1N1) (pH1N1) in Illinois were reported. On-going, sustained local transmission resulted in an estimated 500,000 infected persons. We conducted a mixed method analysis using both quantitative (surveillance) and qualitative (interview) data; surveillance data was used to analyze demographic distribution of hospitalized cases and follow-up interview data was used to assess health seeking behavior. Invitations to participate in a telephone interview were sent to 120 randomly selected Illinois residents that were hospitalized during April-December 2009. During April-December 2009, 2,824 pH1N1 hospitalizations occurred in Illinois hospitals; median age (interquartile range) at admission was 24 (range: 6-49) years. Hospitalization rates/100,000 persons for blacks and Hispanics, regardless of age or sex were 2-3 times greater than for whites (blacks, 36/100,000 (95% Confidence Interval ([95% CI], 33-39)); Hispanics, 35/100,000 [95%CI,32-37] (; whites, 13/100,000[95%CI, 12-14); p

During January 2010, 2 infants from an Amish community in east-central Illinois were hospitalized with pertussis. The local health department (LDH) intervened to control disease transmission, identify contributing factors, and determine best communications methods to improve vaccination coverage.A retrospective cohort study was conducted using public health surveillance data to determine the extent of the outbreak; the standard Centers for Disease Control and Prevention and Council of State and Territorial Epidemiologists case definition for pertussis was used. The standardized Illinois Department of Public Health pertussis patient interview form was used to collect demographic, symptom, vaccination history, and treatment history information. To control disease transmission, LDH staff worked with the Amish community to promote a vaccination campaign during February 6-April 30, 2010.Forty-seven cases were identified, with onsets during December 2009-March 2010. Median age was 7 (interquartile range 1-12) years. Nineteen (40%) patients were male; 39 (83%) were aged18 years; 37 (79%) had not received any pertussis-containing vaccine. Presenting symptoms did not differ substantially between vaccinated and unvaccinated patients. Duration of cough was longer among unvaccinated than vaccinated patients (32 vs. 15.5 days, P = .002). Compared with vaccinated patients, proportionately more unvaccinated patients reported secondary household transmission (30% vs. 72%; P = .012). Through enhanced vaccination campaigns, 251 (∼10%) Amish community members were administered 254 pertussis-containing vaccines.Targeted health communication and outreach resulted in a successful vaccine campaign and long-running monthly vaccination clinic. Amish do not universally reject vaccines, and their practices regarding vaccination are not static.

Background Variant influenza virus infections are rare but may have pandemic potential if person-to-person transmission is efficient. We describe the epidemiology of a multistate outbreak of an influenza A(H3N2) variant virus (H3N2v) first identified in 2011. Methods We identified laboratory-confirmed cases of H3N2v and used a standard case report form to characterize illness and exposures. We considered illness to result from person-to-person H3N2v transmission if swine contact was not identified within 4 days prior to illness onset. Results From 9 July to 7 September 2012, we identified 306 cases of H3N2v in 10 states. The median age of all patients was 7 years. Commonly reported signs and symptoms included fever (98%), cough (85%), and fatigue (83%). Sixteen patients (5.2%) were hospitalized, and 1 fatal case was identified. The majority of those infected reported agricultural fair attendance (93%) and/or contact with swine (95%) prior to illness. We identified 15 cases of possible person-to-person transmission of H3N2v. Viruses recovered from patients were 93%-100% identical and similar to viruses recovered from previous cases of H3N2v. All H3N2v viruses examined were susceptible to oseltamivir and zanamivir and resistant to adamantane antiviral medications. Conclusions In a large outbreak of variant influenza, the majority of infected persons reported exposures, suggesting that swine contact at an agricultural fair was a risk for H3N2v infection. We identified limited person-to-person H3N2v virus transmission, but found no evidence of efficient or sustained person-to-person transmission. Fair managers and attendees should be aware of the risk of swine-to-human transmission of influenza viruses in these settings.

Macrolide-resistant Mycoplasma pneumoniae is an increasing problem worldwide but is not well documented in the United States. We report a cluster of macrolide-resistant M. pneumoniae cases among a mother and two daughters.

Summary Objectives The purpose of this study was to measure the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) and the rates and factors associated with their over-treatment (OT) and under-treatment (UT). Methods A retrospective chart review was performed of patients aged 13–24 years who were screened for GC/CT in the emergency department (ED) of a public hospital. Descriptive statistics were obtained for all variables, and multivariate log binomial regression was performed to ascertain the factors associated with OT and UT. Results Seven hundred and ninety-seven adolescents and young adults were screened for GC/CT. The overall sexually transmitted infection (STI) positivity rate was 21.6%; 136 (21.6%) subjects were over-treated and 74 (43.4%) subjects were under-treated. Patients presenting with STI exposure or genito-urinary symptoms were more likely to be OT. Additionally, females aged 18–19 years or with a prior history of STIs were more likely to be OT. Females (83.6%) were more likely to be UT, while STI exposure, genito-urinary symptoms, and a prior history of STI were protective of UT . Conclusion Adolescents and young adults screened for STIs have a high prevalence of GC/CT. A significant proportion of these patients end up over-treated and an even higher proportion are under-treated.