Primary amebic meningoencephalitis--Arizona, Florida, and Texas, 2007

Primary amebic meningoencephalitis (PAM) is a rare but nearly always fatal disease caused by infection with Naegleria fowleri, a thermophilic, free-living ameba found in freshwater environments. Infection results from water containing N. fowleri entering the nose, followed by migration of the amebae to the brain via the olfactory nerve. In 2007, six cases of PAM in the United States were reported to CDC; all six patients died. This report summarizes the investigations of the cases, which occurred in three southern tier states (Arizona, Florida, and Texas) during June-September and presents preliminary results from a review of PAM cases during 1937-2007. Because deaths from PAM often prompt heightened concern about the disease among the public, an updated and consistent approach to N. fowleri risk reduction messages, diagnosis and treatment, case reporting, and environmental sampling is needed.     

Pulsed-field Gel Electrophoresis for Salmonella Infection Surveillance, Texas, USA, 2007

To identify sources of transmission for area clusters, in 2007 the Houston Department of Health and Human Services conducted an 8-month study of enhanced surveillance of Salmonella infection. Protocol included patient interviews and linking the results of interviews to clusters of pulsed-field gel electrophoresis patterns detected by the local PulseNet laboratory.     

Multistate measles outbreak associated with an international youth sporting event--Pennsylvania, Michigan, and Texas, August-September 2007

Measles, a highly infectious viral illness, is no longer endemic in the United States because of high coverage rates with an effective vaccine. However, imported cases continue to cause illness and outbreaks among susceptible U.S. residents. In August 2007, a participant in an international youth sporting event who traveled from Japan to the United States became ill with measles. Because he traveled while infectious to an event with thousands of participants and spectators, an outbreak investigation was conducted in multiple states by state and local health departments in coordination with CDC, using standard measles surveillance case definitions and classifications. This report summarizes the results of that investigation, which identified six additional measles cases that were linked epidemiologically to the index case and two generations of secondary transmission. Viral genotyping supported a single chain of transmission; six of the seven cases were linked by genetic sequencing. U.S. organizers of large-scale events attended by international travelers, especially youths, should consider documentation of adequate participant vaccination. This outbreak highlights the need to maintain the highest possible vaccination coverage in the United States, along with disease surveillance and outbreak-containment capabilities.     

Peer Reviewed: Implementing and Disseminating an Evidence-Based Program to Prevent Falls in Older Adults,Texas, 2007-2009

Introduction

Falls are a public health problem for the growing population of older adults. We describe a statewide effort to implement and disseminate A Matter of Balance/Volunteer Lay Leader model, an evidence-based fall-prevention program.

Methods

We analyzed 2 secondary databases: 1) a centralized administrative data set to document implementation processes and structures for delivering the program and 2) a common set of outcome measures for assessing the effect of the program on older Texans. We used multivariate analyses to examine changes on key outcome variables, controlling for major covariates.

Results

From 2007 through 2009, we reached 3,092 older Texas residents. Program capacity was built by certifying 98 master trainers and 402 lay leaders and delivering the program in 227 classes through the Area Agency on Aging network. Immediate outcome results were positive, which indicates a pathway to promote more successful aging: 1) increases in falls efficacy, 2) improvements in overall physical activity levels, and 3) reductions in interference with everyday normal routines.

Conclusion

Widespread dissemination of a program to prevent falls can promote active aging among people who would otherwise be at risk for a downward cycle of health and functionality. Creating partnerships among different delivery sectors is needed for building community infrastructure to enhance the health of older adults.     

Peer Reviewed: Socioeconomic Status and Prevalence of Obesity and Diabetes in a Mexican American Community,Cameron County,Texas, 2004-2007

Introduction

Mexican Americans are at increased risk for obesity and diabetes. We established a cohort on the United States-Mexico border to determine the prevalence of obesity and diabetes in this Mexican American population and to see whether minor economic advantages had any effect on health.

Methods

We randomly selected and extensively documented 810 people aged 35 to 64 years. Weighted data were analyzed to establish prevalence of obesity and diabetes and other markers of poor health such as elevated glycated hemoglobin levels.

Results

Rates of obesity (body mass index ≥30 kg/m²) were 57% in the first (lower) of 4 socioeconomic strata by income and were 55.5% in the third (higher). People in the higher socioeconomic stratum were significantly less likely to have undiagnosed diabetes (2% vs 9%). Among people aged 55 to 64 years, rates of diabetes were significantly higher among those in the lower socioeconomic stratum than among those in the higher stratum. Rates of undiagnosed diabetes had similar differences. Approximately three-fourths of the respondents reported having no health insurance, and we found no difference between people in different socioeconomic strata.

Conclusion

Rates of obesity and diabetes in this border community are among the highest in the United States. Belonging to the lower socioeconomic stratum significantly increased the likelihood of having undiagnosed diabetes and, in patients too young to be eligible for Medicare, the overall risk of developing diabetes. Modest improvement in income has a beneficial effect on health in this racial/ethnic minority community.     

Underdiagnosis of dengue--Laredo, Texas, 1999

Dengue outbreaks have been reported in communities along the Mexico-U.S. border since 1980; however, during 1987-July 1999, no cases were reported from Laredo, Texas (1999 population: 162,000). During January-July 1999, approximately 300-325 dengue cases were reported from Nuevo Laredo, Tamaulipas, Mexico (1999 population: 274,000), a city across the Rio Grande from Laredo. To determine whether undiagnosed or unreported dengue cases had occurred in Laredo, the Texas Department of Health (TDH) reviewed medical records from five Laredo health facilities (the two city hospitals and the three largest of five community clinics). This report summarizes the findings of the review, which indicated that during July 23-August 20, 1999, 50% of suspected case-patients had undiagnosed dengue infection. Recognition of the diagnosis of dengue can be improved through heightened surveillance, professional and public education, and prompt reporting of cases by the health-care providers to local or state health departments.     

Probable transfusion-transmitted malaria--Houston, Texas, 2003

Malaria transmitted by blood transfusion is rare in the United States, with an estimated incidence of <0.3 cases per million transfused blood units. The last reported case of transfusion-transmitted malaria occurred in April 2002 (1); before that a total of 12 cases were identified during 1990--1998(2) [corrected]. This report summarizes a case of malaria in Houston, Texas, that was likely transmitted from a blood donor. Because no laboratory test exists in the United States to screen donated blood for malaria, this case highlights the importance of effective donor screening to help prevent transfusion-transmitted malaria.     

Control and Prevention of Anthrax,Texas, USA, 2019

The zoonotic disease anthrax is endemic to most continents. It is a disease of herbivores that incidentally infects humans through contact with animals that are ill or have died from anthrax or through contact with Bacillus anthracis–contaminated byproducts. In the United States, human risk is primarily associated with handling carcasses of hoofstock that have died of anthrax; the primary risk for herbivores is ingestion of B. anthracis spores, which can persist in suitable alkaline soils in a corridor from Texas through Montana. The last known naturally occurring human case of cutaneous anthrax associated with livestock exposure in the United States was reported from South Dakota in 2002. Texas experienced an increase of animal cases in 2019 and consequently higher than usual human risk. We describe the animal outbreak that occurred in southwest Texas beginning in June 2019 and an associated human case. Primary prevention in humans is achieved through control of animal anthrax.     

Bat rabies, Texas, 1996-2000

Bats submitted to the Texas Department of Health (1996-2000) were speciated and tested for rabies virus antigen by direct immunofluorescence microscopy. Antigenic analysis of rabies virus-positive specimens was performed with monoclonal antibodies against the nucleoprotein of the virus; atypical or unexpected results were confirmed by genetic analysis of nucleoprotein sequence.     

Marketplace Ministries,Inc., Dallas,Texas

SUMMARY

Health care chaplaincy should become a research-informed profession in the next ten years. This article describes my rationale for this statement and outlines a plan for accomplishing it. This means that all professional health care chaplains will value the contributions that research can make to their ministry and some chaplains will be engaged in research that informs the profession. Becoming a research-informed profession does not mean losing our emphasis on compassion, faith, presence, self-awareness, or any of the other rich resources of our tradition. It does mean supplementing those resources with the information research provides. I conclude that the question that professional health care chaplains face is not whether to become a research-informed profession, but how to get there.     

West Nile Virus,Texas, USA, 2012

During the 2012 West Nile virus outbreak in Texas, USA, 1,868 cases were reported. Male patients, persons >65 years of age, and minorities were at highest risk for neuroinvasive disease. Fifty-three percent of counties reported a case; 48% of case-patients resided in 4 counties around Dallas/Fort Worth. The economic cost was >$47.6 million.     

The Foundation for Interfaith Research and Ministry, Houston, Texas

The Foundation for Interfaith Research and Ministry (FIRM) promotes, sponsors, and conducts interfaith and interdisciplinary programs of scholarship, research, education, and service.