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Discusses the findings of the surveillance system established by health authorities in New Orleans, Louisiana to detect outbreaks of disease and characterize injuries and illnesses after Hurricane Katrina. Target population for the surveillance system; Methods used to gather data on illness and injury trends; Number of persons with skin or wound infection after Hurricane Katrina from September 8-25, 2005.

Background: Precancerous cervical lesion (PCL) is common in working-age and minority women. In Louisiana, 98% of PCL cases were diagnosed at age 18-65 with over 90% of them being human papillomavirus (HPV)-related. PCL women represent those who may be immunocompromised from the precancerous condition and thus more vulnerable to SARS-CoV-2. Most studies evaluating racial disparities for COVID-19 infection have only used data prior to vaccine availability. This study assessed disparities by race/ethnicity and socioeconomic status (SES) in COVID-19 infections among working-age PCL women for pre- and post-COVID-19 vaccine availability., Methods: Louisiana women aged 18-65 with PCL diagnosed in 2009-2021 were linked with the Louisiana statewide COVID-19 database to identify those with positive COVID-19 test. Race/ethnicity was categorized as non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, and others. The census tract SES quintiles were created based on American Community Survey estimates. Logistic regression was employed to assess the racial/ethnic and SES differences in COVID-19 infections., Results: Of 14,669 eligible PCL women, 30% were tested COVID-19 positive. NHB had the highest percentage of COVID-19 infection (34.6%), followed by NHW (27.7%). The infection percentage was inversely proportional to SES, with 32.9% for women having the lowest SES and 26.8% for those with the highest SES. NHB women and those with lower SES had higher COVID-19 infection than their counterparts with an aOR of 1.37 (95% CI 1.25-1.49) and 1.21 (95% CI 1.07-1.37), respectively. In the pre-vaccine period, NHB and Hispanic women had higher odds of infection than NHW women. However, after the vaccine was implemented, the significant racial/ethnic and SES differences in COVID-19 infections still existed in PCL women residing in non-Greater New Orleans area., Conclusions: There are substantial variations in racial/ethnic and SES disparities in COVID-19 infections among working-age women with PCL, even after vaccine implementation. It is imperative to provide public health interventions and resources to reduce this unequal burden for this vulnerable population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Hsieh, Lefante, Straif-Bourgeois, Yi, Gomez, Shrestha, Chen and Wu.)

Louisiana ranks among the bottom five states for air pollution and mortality. Our objective was to investigate associations between race and Coronavirus Disease 2019 (COVID-19) hospitalizations, intensive care unit (ICU) admissions, and mortality over time and determine which air pollutants and other characteristics may mediate COVID-19-associated outcomes. In our cross-sectional study, we analyzed hospitalizations, ICU admissions, and mortality among positive SARS-CoV-2 cases within a healthcare system around the Louisiana Industrial Corridor over four waves of the pandemic from 1 March 2020 to 31 August 2021. Associations between race and each outcome were tested, and multiple mediation analysis was performed to test if other demographic, socioeconomic, or air pollution variables mediate the race-outcome relationships after adjusting for all available confounders. Race was associated with each outcome over the study duration and during most waves. Early in the pandemic, hospitalization, ICU admission, and mortality rates were greater among Black patients, but as the pandemic progressed, these rates became greater in White patients. However, Black patients were disproportionately represented in these measures. Our findings imply that air pollution might contribute to the disproportionate share of COVID-19 hospitalizations and mortality among Black residents in Louisiana.

Introduction: Persistent disparities in influenza vaccination rates exist between racial/ethnic minorities and Whites. The mechanisms that define this relationship are under-researched., Methods: Surveys assessing barriers to vaccination were administered to outpatients in a rural medical center in Southeastern Louisiana. Survey responses were matched to patient medical records. Likert-style statements were used to measure barriers to vaccination. A mediation analysis assessing the relationship between race and influenza vaccination mediated by vaccination barriers was conducted., Results: The self-reported influenza vaccination rate in those surveyed was 40.4%. Whites (45.5%) were more likely than racial/ethnic minorities (36.3%) to report receipt of an influenza vaccination (p = 0.02). Racial/ethnic minorities reported significantly higher vaccination barrier scores (p < 0.01). The relationship between race/ethnicity and vaccination was mediated by vaccination barriers, when controlling for provider recommendation and having at least one comorbid medical condition (natural indirect effect [NIE] p-value = 0.02, proportion mediated = 0.71)., Conclusions: Barriers to vaccination mediates the relationship between race/ethnicity and vaccination status. Providers should focus on minimizing fears that the vaccine will cause illness and emphasize that the vaccine is safe and effective at preventing severe influenza-associated illness. Additional efforts should be made to improve accessibility of the influenza vaccine, including addressing costs of vaccination and expanding the number and types of settings where the vaccine is offered., (©2022 Pacini Editore SRL, Pisa, Italy.)

Background: Despite the burden of disease and increased risk of influenza-associated morbidity and mortality among PLWHA, influenza vaccination has been understudied in this population., Methods: We built an 11-year cohort of HIV-infected adults from medical records of PLWHA seeking care within the Louisiana State University medical system from June 2002-June 2013. Influenza vaccination uptake among PLWHA was calculated overall and for each medical facility for each influenza season. Linear regression was used to assess influenza vaccination uptake over time, both overall and by facility. Data were restricted to the final influenza season (2012-13) to assess predictors of PLWHA vaccination. Individuals were nested within medical facilities in order to assess the amount of variability in influenza vaccination rates across medical facilities., Results: Influenza vaccination uptake among PLWHA increased over the study period (p < 0.01). The overall proportion of PLWHA vaccinated during the 2012-13 influenza season was 33.7%. 37.9% of the variability in the model occurred at the facility-level., Conclusions: Although there was an increase in influenza vaccination within the PLWHA cohort over the course of the study, vaccination rates remained low overall. Special efforts must be made to increase vaccination uptake among PLWHA, with particular focus on those within the population who are likely to be at highest risk. The substantial variability at the facility-level indicates that there are unmeasured facility-level factors that contribute significantly to PLWHA vaccination., Competing Interests: Conflict of interest statement None of the authors report any conflict of interest., (©2022 Pacini Editore SRL, Pisa, Italy.)

Context: The August 2016 Louisiana flood marked the second 500-year flood in the state in 1 year., Objective: The aim of this study was to identify private well user needs in the aftermath of the flood and to develop disaster planning and recovery recommendations for flood-prone well-reliant communities., Design: A descriptive cross-sectional study was conducted to collect information from a convenience sample of flood-impacted well users via surveys and water sampling kits, which were distributed to well users 9 to 11 weeks after floodwaters receded (n = 106)., Setting: Surveys and kits were distributed at roadside flood response and recovery stations set up by local churches in French Settlement, Livingston Parish, Louisiana, an area at the epicenter of the flood-impacted area., Participants: Subjects were included if they self-reported having a flood-impacted well., Main Outcome Measures: Surveys collected information to characterize knowledge gaps, risk perceptions, flood impacts, resource accessibility, and well maintenance barriers. Well water tests evaluated total coliform and Escherichia coli., Results: Among those in low-risk flood zones (n = 22), 27% were in areas designated as having flooded. Among flood-impacted wells that were shock chlorinated after the flood (n = 16), 31.3% tested positive for total coliform and 12.5% for E coli. Only 26% of respondents received well-related information after the disaster., Conclusions: Results highlight critical needs for disaster planning and well user education in flood-prone areas, changes to flood risk maps, and concerns with the efficacy of disinfection strategies. Information and resources needs for flood-impacted well users are presented and recommendations on how to improve flood preparedness and recovery are made., Competing Interests: The authors declare no conflict of interests., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: This article presents the Louisiana Hepatitis C Elimination Program's evaluation protocol underway at the Louisiana State University Health Sciences Center-New Orleans. With the availability of direct-acting antiviral (DAA) agents, the elimination of Hepatitis C (HCV) has become a possibility. The HCV Elimination Program was initiated by the Louisiana Department of Health (LDH) Office of Public Health (OPH), LDH Bureau of Health Services Financing (Medicaid), and the Louisiana Department of Public Safety and Corrections (DPSC) to provide HCV treatment through an innovative pricing arrangement with Asegua Therapeutics, whereby a fixed cost is set for a supply of treatment over five years., Materials and Methods: A cross-sectional study design will be used. Data will be gathered from two sources: 1) an online survey administered via REDCap to a sample of Medicaid members who are receiving HCV treatment, and 2) a de-identified data set that includes both Medicaid claims data and OPH surveillance data procured via a Data Use Agreement between LSUHSC-NO and Louisiana Medicaid., Discussion: The evaluation will contribute to an understanding of the scope and reach of this innovative treatment model, and as a result, an understanding of areas for improvement. Further, this evaluation may provide insight for other states considering similar contracting mechanisms and programs., Competing Interests: The authors have declared that no competing interests exist.

Background: Louisiana in the summer of 2020 had the highest per capita case count for COVID-19 in the United States and COVID-19 deaths disproportionately affects the African American population. Neighborhood deprivation has been observed to be associated with poorer health outcomes. The purpose of this study was to examine the relationship between neighborhood deprivation and COVID-19 in Louisiana., Methods: The Area Deprivation Index (ADI) was calculated and used to classify neighborhood deprivation at the census tract level. A total of 17 US census variables were used to calculate the ADI for each of the 1148 census tracts in Louisiana. The data were extracted from the American Community Survey (ACS) 2018. The neighborhoods were categorized into quintiles as well as low and high deprivation. The publicly available COVID-19 cumulative case counts by census tract were obtained from the Louisiana Department of Health website on July 31, 2020. Descriptive and Poisson regression analyses were performed., Results: Neighborhoods in Louisiana were substantially different with respect to deprivation. The ADI ranged from 136.00 for the most deprived neighborhood and -33.87 in the least deprived neighborhood. We observed that individuals residing in the most deprived neighborhoods had almost a 40% higher risk of COVID-19 compared to those residing in the least deprived neighborhoods., Conclusion: While the majority of previous studies were focused on very limited socio-environmental factors such as crowding and income, this study used a composite area-based deprivation index to examine the role of neighborhood environment on COVID-19. We observed a positive relationship between neighborhood deprivation and COVID-19 risk in Louisiana. The study findings can be utilized to promote public health preventions measures besides social distancing, wearing a mask while in public and frequent handwashing in vulnerable neighborhoods with greater deprivation., Competing Interests: The authors have declared that no competing interests exist.

Baylisascaris procyonis , the raccoon roundworm, is considered an emerging zoonotic disease in the United States after being identified in raccoons captured in different US regions and metropolitan areas. Humans can become infected with B. procyonis after ingesting mature roundworm eggs, sometimes resulting in fatal disease or severe sequelae in these patients. The first reported human Baylisascaris case in New Orleans raised concerns that very little was known about this zoonotic disease in the increasing urban raccoon population. Therefore, the study aim was to estimate the prevalence of Baylisascaris -infected raccoons in New Orleans, LA. Raccoons were trapped based on nuisance calls from the public and in areas where raccoons had been sighted. Necropsies were performed to identify B. procyonis adult worms in intestines and fecal samples were examined for roundworm ova. Study findings showed that 38.5% of New Orleans raccoons were infected with B. procyonis , defined by the presence of adult B. procyonis worms or Baylisascaris ova in their feces. Twenty-four of 65 raccoons (36.9%) had raccoon roundworms in their intestines and 31.7% of the fecal samples were positive for B. procyonis eggs. Mapping B. procyonis -infected raccoons by trapping location showed that infected raccoons were found throughout the city. In conclusion, the high prevalence rate of B. procyonis in New Orleans raccoons demonstrates the importance of educating the public and health care professionals about potential health risks and providing resources to prevent exposure to infective eggs from raccoon latrines. Furthermore, this emerging disease should be further studied to examine human risk of infection in increasing raccoon populations in metropolitan areas.

The order Piroplasmida contains a diverse group of intracellular parasites, many of which can cause significant disease in humans, domestic animals, and wildlife. Two piroplasm species have been reported from raccoons ( Procyon lotor ), Babesia lotori ( Babesia sensu stricto clade) and a species related to Babesia microti (called B. microti -like sp.). The goal of this study was to investigate prevalence, distribution, and diversity of Babesia in raccoons. We tested raccoons from selected regions in the United States and Canada for the presence of Babesia sensu stricto and Babesia microti -like sp. piroplasms. Infections of Babesia microti -like sp. were found in nearly all locations sampled, often with high prevalence, while Babesia sensu stricto infections had higher prevalence in the Southeastern United States (20-45% prevalence). Co-infections with both Babesia sp. were common. Sequencing of the partial 18S rRNA and cytochrome oxidase subunit 1 ( cox1 ) genes led to the discovery of two new Babesia species, both found in several locations in the eastern and western United States. One novel Babesia sensu stricto sp. was most similar to Babesia gibsoni while the other Babesia species was present in the 'western piroplasm' group and was related to Babesia conradae . Phylogenetic analysis of the cox1 sequences indicated possible eastern and western genetic variants for the three Babesia sensu stricto species. Additional analyses are needed to characterize these novel species; however, this study indicates there are now at least four species of piroplasms infecting raccoons in the United States and Canada ( Babesia microti -like sp., Babesia lotori, a novel Babesia sensu stricto sp., a novel western Babesia sp.) and a possible fifth species ( Babesia sensu stricto) in raccoons in Japan.

This study describes Parkinson Disease hospitalizations and deaths in the Louisiana population during the years 1999-2012. Data from the Louisiana Hospitalization Discharge Database (LAHIDD) were collected and analyzed by age, race, and gender and also compared to length of hospital stay and daily hospitalization cost.

This report is a purely descriptive study of firearm-related deaths occurring in Louisiana from 1999 to 2010. Mortality data were collected from death certificates from this 12-year period to describe firearm fatalities by year, race, gender, age group, and manner of death (accident, homicide, suicide). Louisiana data were also compared to national data. Race, sex, and age were important factors influencing mortality rates and the death manner. Rates were higher in males than in females and higher in African-Americans than in Whites. The highest rates were observed for homicides among African-American males. The ratio of Louisiana age/race-adjusted firearm mortality rates over the US rates were 1.8. Both Louisiana and the US mortality rates remained fairly constant over the 12-year period. Parish level data showed a wide variation in firearm mortality rates with some urban and some rural parishes having the highest rates. Data obtained from death certificates have limitations due to the limited number of variables available.

Fungal endophthalmitis is a rare but serious infection. In March 2012, several cases of probable and laboratory-confirmed fungal endophthalmitis occurring after invasive ocular procedures were reported nationwide. We identified 47 cases in 9 states: 21 patients had been exposed to the intraocular dye Brilliant Blue G (BBG) during retinal surgery, and the other 26 had received an intravitreal injection containing triamcinolone acetonide. Both drugs were produced by Franck's Compounding Lab (Ocala, FL, USA). Fusarium incarnatum-equiseti species complex mold was identified in specimens from BBG-exposed case-patients and an unopened BBG vial. Bipolaris hawaiiensis mold was identified in specimens from triamcinolone-exposed case-patients. Exposure to either product was the only factor associated with case status. Of 40 case-patients for whom data were available, 39 (98%) lost vision. These concurrent outbreaks, associated with 1 compounding pharmacy, resulted in a product recall. Ensuring safety and integrity of compounded medications is critical for preventing further outbreaks associated with compounded products.

This report is a descriptive study on suicide deaths in Louisiana occurring in the years 1999 to 2010. Mortality data was collected from death certificates from this 12-year period to describe suicide mortality by year, race, sex, age group, and methods of suicide. Data were also compared to national data. Rates and methods used to commit suicide vary greatly according to sex, race, and age. The highest rates were observed in white males, followed by black males, white females, and black females. Older white males had the highest suicide rates. The influence of age was modulated by the sex and race categories. Firearm was the most common method used in all four categories. Other less common methods were hanging/strangulation/suffocation (HSS) and drugs/alcohol. Although no parish-level data were systematically analyzed, a comparison of suicide rates post-Katrina versus pre-Katrina was done for Orleans Parish, the rest of the Greater New Orleans area, and a comparison group. It appears that rates observed among whites, particularly males, were higher after Katrina. Data based on mortality do not give a comprehensive picture of the burden of suicide, and their interpretation should be done with caution.

Since the new flu strain--named A(H1N1) or Swine Origin Influenza Virus (SOIV) to differentiate it from the seasonal H1N1--first emerged in Mexico and the United States in April, it has spread to 74 countries around the globe. The objectives of this article are to describe the initial stages of the epidemic in Louisiana and to draw some epidemiologic lessons for the future, which could be particularly useful if the pandemic continues during the winter season 2009-2010. Between April 22, 2009 (date when the first specimen was collected) to May 31, 2009, a six week period, there were 133 cases of SOIV infection detected in Louisiana. Cases were diagnosed in late April in several regions of the state, showing that when the first cases had been identified in Mexico and California, the infection was already widespread in Louisiana. The most affected age group was between the ages of five and 25.

A total of 1,007 Vibrio infections were reported to the Infectious Disease Epidemiology Department at the Louisiana Office of Public Heath, between 1980 and 2005. The most common were Vibrio vulnificus (257 infections), Vibrio parahemolyticus (249 infections), and Vibrio cholerae non O1 (200 cases). Other species were much less common. Vibrio vulnificus infections, which are associated with consumption of raw seafood (particularly oysters) or contact with sea water, and severe immuno-suppression or liver disease were increasing. Septicemia and blood stream infections are the main manifestations of this infection. The number of infections due to Vibrio parahemolyticus on the other hand, causing mostly gastroenteritis, has remained stable. Vibrio cholerae infections are less common and almost always associated with consumption of partially cooked or contaminated crabs.

Objectives: Thousands of Louisiana residents were asked to boil water because of widespread disruptions in electricity and natural gas services after Hurricane Rita. We sought to assess awareness of boil water orders and familiarity with household water disinfection techniques other than boiling., Methods: We conducted a cross-sectional survey in randomly selected mobile home communities in Louisiana., Results: We interviewed 196 respondents from 8 communities, which had boil water orders instituted. Of 97 who were home while communities were still under orders to boil water, 30 (31%) were aware of the orders and, of those, 24 (80%) said the orders were active while they were living at home; of the 24, 10 (42%) reported boiling water. Overall, 163 (83%) respondents were aware of a method of water disinfection at the household level: boiling (78%), chlorination (27%), and filtration (25%); 87% had a container of chlorine bleach at home., Conclusions: Few hurricane-affected respondents were aware of boil water orders and of alternate water disinfection techniques. Most had access to chlorine and could have practiced household chlorination if disruption in natural gas and electricity made boiling impossible.

West Nile virus (WNV) was first detected in Louisiana during August of 2001. An outbreak of 204 human cases of neuro-invasive disease (NID) and 25 deaths occurred in 2002. In the 2 years following, lower numbers of human cases were identified (101 NID cases in 2003 and 84 in 2004) but intense localized foci were observed. The incidence of NID has been particularly high in the elderly (65 years and older). The distribution of West Nile cases has consisted of sporadic cases with a few very intense foci. Annually, human cases have occurred from June through December, with a peak number of new cases in August. As compared with other WNV serosurveys conducted in the United States, it appears that the WNV seroprevalence in Louisiana is not elevated.

Between 1992 and 2004, 118 cases of malaria were reported to the Louisiana Office of Public Health. Case surveillance data were collected in response to these case reports. These data are presented and analyzed here. All cases reported in Louisiana were imported from malaria-endemic regions. Despite the fact that malaria is a preventable and treatable disease, deaths due to malaria continue to occur. Counseling for travelers to malaria-endemic areas needs to be improved. In particular, region-specific prophylaxis guidelines published by the CDC are infrequently implemented. A travel history should be elicited from all patients who present with fever in the United States. If a history of travel to malaria-endemic areas is present, blood films should be obtained and examined for malaria parasites.

Estimating a prevalence of 1.8% of hepatitis C in the general population, there are in Louisiana about 81,000 individuals who have been infected with the hepatitis C virus. In 2002, the incidence of reported cases of acute hepatitis C was 2.2/100,000 versus 0.64 in the USA. The case register maintained by the Louisiana Office of Public Health has 22,000 cases. Building up a register of hepatitis C past or present infections is an important tool that may be used to resolve some important questions about the epidemiology of hepatitis C or be used for future preventive actions. Physicians and hospitals are encouraged to report hepatitis C infection including sufficient information to distinguish acute hepatitis C from hepatitis C past or present infection.

In 2002, 329 cases of West Nile illness were reported in Louisiana, including 204 cases of West Nile meningoencephalitis and 125 cases of West Nile fever. Clinical presentation of meningoencephalitis or of West Nile fever was confirmed serologically. There were 24 deaths. Age group distribution showed predominance among persons aged 45 years or older. The epidemic curve, based on date of diagnosis, showed numerous foci progressing in successive waves. The first cases occurred in mid-June. A peak was reached by the first week of August, after which the epidemic progressively subsided.