A lottery test of the effect of dispensaries on emergency room visits in Arizona

In August 2012, the Arizona Department of Health Services conducted a lottery to allocate licenses for the state's first medical marijuana dispensaries. The lottery randomly selected an applicant within each of 69 contested Community Health Analysis Areas to open a dispensary. By comparing 36 zip codes with winning applications to 48 zip codes with losing applications and weighting using propensity scores based on the true probability of winning, we estimate the causal effect of the allocation of a dispensary on the emergency room visits of residents of that zip code. Outcomes of interest are emergency room visits for acute symptoms caused by cannabis, opioids, alcohol, and cocaine. Using emergency room discharge data from 2010 to 2016, we find evidence of an increase in visits for acute cannabis‐related causes for the winning set of zip codes and weak evidence of an increase in visits for opioid‐related causes. The results indicate that in the four years following the lottery, emergency room visits for acute cannabis causes rose by approximately 45% in allocated zip codes relative to non‐allocated zip codes. Because of the high likelihood of spillovers to neighboring zip codes, these effects are likely underestimates.     

Epidemiology and Investigation of Melioidosis, Southern Arizona

Burkholderia pseudomallei is a bacterium endemic to Southeast Asia and northern Australia, but it has not been found to occur endemically in the United States. We report an ostensibly autochthonous case of melioidosis in the United States. Despite an extensive investigation, the source of exposure was not identified.     

Hospitalizations associated with disseminated coccidioidomycosis, Arizona and california, USA

We analyzed hospitalization databases from Arizona and California for disseminated coccidioidomycosis-associated hospitalizations among immunocompetent persons. Racial/ethnic disease ratios were characterized by a higher incidence of hospitalization among blacks compared with other groups. This finding suggests that HIV infection, AIDS, and primary immune conditions are not a major factor in this disparity.     

Binational study of pediatric blood lead levels along the United States/Mexico border

To evaluate lead exposure among children living in border communities, the states of Arizona and New Mexico in the United States (US), and the states of Sonora and Chihuahua in Mexico collaboratively requested that the Centers for Disease Control and Prevention (CDC) provide technical assistance to document pediatric blood lead levels (BLLs) in children living along this part of the US/Mexico border. Two studies were conducted to evaluate BLLs of children aged 1-6 years. In 1998, 1210 children were tested in the Arizona/Sonora study; in 1999, 874 children were tested in New Mexico/Chihuahua. Overall geometric mean BLL was 32.5 microg/l (95% Confidence Interval 31.5-33.5) with BLLs ranging from below limit of detection to 320.0 microg/l. Mean BLLs were higher among children living on the Mexican side of the border (43.2 microg/l) compared to those on the US side (22.3 microg/l). Mean BLLs ranged from 14.9 to 31.2 microg/l at the US sites and from 26.9 to 55.2 microg/l at the Mexican sites. This study used a convenience sample and cannot be considered representative of the general population. Nonetheless, the range of mean BLLs among the sites and especially the higher mean BLLs among children living in the border communities in Mexico suggests different exposures to lead and warrants further attention.     

中国≤15岁人群乙型病毒性肝炎发病流行病学分析

目的分析不同监测系统报告≤15岁人群乙型病毒性肝炎(乙肝)发病情况,评价免疫规划监测信息管理系统运转工作。方法对比免疫规划监测信息管理系统和法定传染病报告系统乙肝病例报告情况,并对资料进行分析。结果免疫规划监测信息管理系统报告≤15岁人群乙肝发病数远低于法定传染病报告系统,报告人员对乙肝病例定义未完全掌握。结论建立中国乙肝监测系统,对≤15岁人群急性乙肝病例进行监测是非常必要的。     

中国2011～2013年麻疹监测信息报告管理系统监测病例分类情况分析

目的分析中国2011～2013年麻疹监测信息报告管理系统（未包括香港、澳门特别行政区和台湾地区,下同）监测病例的分类情况,为加强麻疹监测提供参考。方法采用描述流行病学方法,分析监测病例分类与初次报告病种、实验室检测结果的相互关系,血标本采集和检测情况等。结果监测病例分类为麻疹的病例中,〉97％来自初次报告为麻疹的病例,〈2％来源为初次报告为风疹的病例。初次报告为麻疹的病例,或最终分类为麻疹的病例,〉90％有麻疹的实验室检测结果。初次报告为风疹的病例,或最终分类为风疹的病例,约20％有麻疹、风疹实验室检测结果,且各省（自治区、直辖市）间差异较大。排除了麻疹和风疹,且分类为其他法定报告传染病的监测病例,有麻疹检测结果的比例明显低于分类为无明确病名的病例。分类为麻疹的病例中,有流行病学联系的病例所占比例较低。初次报告为麻疹的病例,约50％的首份血标本于出疹后3d内采集,存在6％～16％的假阴性,仅10％～13％采集了第二份血标本。结论初次报告为风疹的监测病例的实验室检测工作有待加强。对麻疹病例应开展传播链调查,明确有流行病学联系的病例。分类为其他法定传染病的监测病例,应进行麻疹和风疹实验室检测,有依据地排除麻疹和风疹。血标本于出疹3d内采集时实验室检测存在一定的假阴性,建议及早采集监测病例的血标本和病原学标本,将核酸检测结果作为病例分类的依据。     

滁州市2004年法定传染病网络直报疫情分析

目的了解滁州市传染病流行特征及防治效果,为今后预防控制传染病提供科学依据。方法用描述流行病学方法分析2004年滁州市传染病疫情。结果2004年滁州市传染病报告发病率154.50/10万,发病率与2003年相比上升6.24%。2004年发病以肺结核(56.01/10万)、病毒性肝炎(51.86/10万)、痢疾(21.94/10万)、疟疾(8.36/10万)、淋病(6.95/10万)为主,占发病总数的88.51%。结论传染病疫情总体趋势平稳,应加强疫情监测,突出重点传染病防治,有针对性地采取防治措施。     

Infection of Kissing Bugs with Trypanosoma cruzi,Tucson, Arizona,USA

Triatomine insects (Hemiptera: Reduviidae), commonly known as kissing bugs, are a potential health problem in the southwestern United States as possible vectors of Trypanosoma cruzi, the causative agent of Chagas disease. Although this disease has been traditionally restricted to Latin America, a small number of vector-transmitted autochthonous US cases have been reported. Because triatomine bugs and infected mammalian reservoirs are plentiful in southern Arizona, we collected triatomines inside or around human houses in Tucson and analyzed the insects using molecular techniques to determine whether they were infected with T. cruzi. We found that 41.5% of collected bugs (n = 164) were infected with T. cruzi, and that 63% of the collection sites (n = 22) yielded >1 infected specimens. Although many factors may contribute to the lack of reported cases in Arizona, these results indicate that the risk for infection in this region may be higher than previously thought.     

Arsenic drinking water exposure and urinary excretion among adults in the Yaqui Valley, Sonora, Mexico

The objective of this study was to determine arsenic exposure via drinking water and to characterize urinary arsenic excretion among adults in the Yaqui Valley, Sonora, Mexico. A cross-sectional study was conducted from July 2001 to May 2002. Study subjects were from the Yaqui Valley, Sonora, Mexico, residents of four towns with different arsenic concentrations in their drinking water. Arsenic exposure was estimated through water intake over 24 h. Arsenic excretion was assessed in the first morning void urine. Total arsenic concentrations and their species arsenate (As V), arsenite (As III), monomethyl arsenic (MMA), and dimethyl arsenic (DMA) were determined by HPLC/ICP-MS. The town of Esperanza with the highest arsenic concentration in water had the highest daily mean intake of arsenic through drinking water, the mean value was 65.5 microg/day. Positive correlation between total arsenic intake by drinking water/day and the total arsenic concentration in urine (r = 0.50, P < 0.001) was found. Arsenic excreted in urine ranged from 18.9 to 93.8 microg/L. The people from Esperanza had the highest geometric mean value of arsenic in urine, 65.1 microg/L, and it was statistically significantly different from those of the other towns (P < 0.005). DMA was the major arsenic species in urine (47.7-67.1%), followed by inorganic arsenic (16.4-25.4%), and MMA (7.5-15%). In comparison with other reports the DMA and MMA distribution was low, 47.7-55.6% and 7.5-9.7%, respectively, in the urine from the Yaqui Valley population (except the town of Cocorit). The difference in the proportion of urinary arsenic metabolites in those towns may be due to genetic polymorphisms in the As methylating enzymes of these populations.     

Co-circulation of West Nile Virus Variants,Arizona, USA, 2010

Molecular analysis of West Nile virus (WNV) isolates obtained during a 2010 outbreak in Maricopa County, Arizona, USA, demonstrated co-circulation of 3 distinct genetic variants, including strains with novel envelope protein mutations. These results highlight the continuing evolution of WNV in North America and the current complexity of WNV dispersal and transmission.     

The changing epidemiology of hepatitis A in Arizona following intensive immunization programs (1988-2007)

Introduction

Arizona had the highest hepatitis A incidence of any U.S. state during 1987–1997. In 1995, the first hepatitis A vaccines became available in the U.S. A series of hepatitis A vaccination policies and recommendations were implemented in 1996–2006. Our objective was to examine the shifting epidemiologic patterns in hepatitis A in Arizona from 1988 to 2007.

Methods

Passive surveillance reports to the Arizona Department of Health Services were used to compare hepatitis A rates by age, race/ethnicity and geographic area, before and after widespread vaccination. Reported risk factors and possible sources of infection were compared for two time periods. Age-adjusted incidence during three periods was mapped.

Results

Overall hepatitis A incidence in Arizona fell from 58 cases per 100,000 in 1988 to 2 per 100,000 in 2007. The proportion of reported cases among children dropped from 62% in 1994–1995 to 32% in 2006–2007. Racial/ethnic disparities between American Indians and non-Hispanic White populations have been eliminated. The geographic distribution of cases within the state has shifted. Earlier cases were likely to report contact with another hepatitis A case or childcare facilities, while later cases indicated recent international travel.

Conclusion

A major shift in the overall burden of hepatitis A and hepatitis A transmission has occurred in Arizona since the widespread implementation of immunization policies and the concomitant rise in vaccination rates in the state. Current transmission has shifted to older age groups and disparities by race/ethnicity are now highest in Hispanic populations. Future strategies to further reduce hepatitis A transmission may require broadening recommendations to include general adult populations without previous vaccination history.     

Cross-Sectional Study of Clinical Predictors of Coccidioidomycosis,Arizona, USA

Demographic and clinical indicators have been described to support identification of coccidioidomycosis; however, the interplay of these conditions has not been explored in a clinical setting. In 2019, we enrolled 392 participants in a cross-sectional study for suspected coccidioidomycosis in emergency departments and inpatient units in Coccidioides-endemic regions. We aimed to develop a predictive model among participants with suspected coccidioidomycosis. We applied a least absolute shrinkage and selection operator to specific coccidioidomycosis predictors and developed univariable and multivariable logistic regression models. Univariable models identified elevated eosinophil count as a statistically significant predictive feature of coccidioidomycosis in both inpatient and outpatient settings. Our multivariable outpatient model also identified rash (adjusted odds ratio 9.74 [95% CI 1.03–92.24]; p = 0.047) as a predictor. Our results suggest preliminary support for developing a coccidioidomycosis prediction model for use in clinical settings.     

云南省2003年急性弛缓性麻痹病例监测系统运转情况分析

目的　为做好急性弛缓性麻痹 (AFP)病例监测 ,巩固无脊髓灰质炎 (脊灰 )成果。方法　对云南省 2 0 0 3年AFP病例监测资料进行描述性流行病学分析。结果　云南省 2 0 0 3年AFP病例监测系统报告AFP病例 2 2 5例 ,<1 5岁儿童非脊灰AFP病例报告发病率为 2.0 9/ 1 0万。以省为单位 ,除脊灰病毒阳性分离物送达及时率 (64.2 8% )未达到要求外 ,其余各项监测指标均达到监测要求。结论　继续保持AFP病例监测系统敏感性 ,提高及时性。     

山东省1999年麻疹疑似病例监测分析

自 1994年山东省利用急性弛缓性麻痹 (AFP)病例监测系统开展麻疹监测以来 ,该系统在运行过程中不断改进和完善。1999年 ,经该专报系统共报告麻疹疑似病例 1776例 ,多于常规传染病报告系统 13 2 6 % ,尽管较以前报告病例数有所增加 ,但其敏感性仍不够理想。通过对监测工作各环节监测指标的分析 ,发现存在的问题 ,为今后麻疹监测工作的改善具有重要的指导意义     

2005～2006年大连市麻疹病例资料分析

[目的]了解大连市麻疹流行特点,为控制和消除麻疹提供科学依据.[方法]采用描述流行病学方法对大连市2005～2006年麻疹病例资料进行分析.[结果]2005～2006年共确诊麻疹病例379例,平均发病率为3.33/10万.其中,2005年发病率为2.28/10万,2006年发病率为4.37/10万,两年发病率的比较差异有统计学意义(P<0.01).全市11个县区均有发病,金州区发病率最高,为15.76/10万;瓦房店市最低,为0.58/10万.不同地区发病率的比较差异有统计学意义(P<0.01);4～5月为发病高峰,占62.80%;发病呈现两端集中趋势,≤8个月和15岁以上分别占8.71%和51.98%;外来人口发病占57.78%.[结论]大连市麻疹疫情有回升趋势,应提高人群免疫力,减少麻疹易感人群.     

用AFP监测方法实施麻风病可疑线索监测效果评价

目的比较安徽省实施可疑线索报告筛查前后早期发现麻风病人的效果,为控制麻风病提供依据。方法运用急性弛缓性麻痹监测的方法,对麻风病可疑线索进行监测。结果实施可疑线索报告筛查后2年,麻风病平均发现率为0.05/10万,较实施前2年的0.0375/10万明显增长（2χ=17.85,P〈0.01）,平均延迟期较前2年缩短了2.3个月,各早发现指标均有明显改进。结论在麻风低流行地区实施可疑线索报告筛查工作可有效提高麻风病病例发现效果。     

Cutaneous Leishmaniasis Caused by an Unknown Leishmania Strain,Arizona, USA

We investigated an autochthonous case of cutaneous leishmaniasis caused by a genetically different Leishmania sp. in a patient in Arizona, USA. This parasite was classified into the subgenus Leishmania on the basis of multilocus DNA sequence and phylogenetic analyses of the rRNA locus and 11 reference genes.