Abstract
Background
Recent studies demonstrated higher influenza-associated hospitalization rates among individuals living in high-poverty neighborhoods. We explored the further impact of ...neighborhood-level poverty and individual, poverty-associated factors, on severe outcomes among hospitalized patients with influenza.
Methods
We linked 2012–2015 data on hospitalized adults from the influenza hospitalization surveillance network (FluSurv-NET), by census tract, to the American Community Survey’s federal poverty estimates. High-poverty neighborhoods were defined as census tracts with ≥20% of households in poverty and low-poverty neighborhoods, <5%. We explored univariate associations between neighborhood-level poverty and influenza vaccination, tobacco use, alcohol abuse, and extreme obesity. Using logistic regression and clustering by census tract, we examined the independent association of these factors with intensive care unit (ICU) admission and death, controlling for age, race, sex, comorbid conditions, antiviral treatment, season, and time from symptom onset to hospitalization.
Results
Among 26,106 patients, 4,194 (16%) required ICU admission and 669 (3%) died. Those who currently used tobacco, abused alcohol, were extremely obese, or were unvaccinated were more likely to live in high-poverty (38%, 40%, 37%, 33%) compared with low-poverty neighborhoods (12%, 13%, 13%, 16%; P < .01), respectively. Living in a high-poverty neighborhood was not independently associated with ICU admission (OR: 0.97, CI: 0.87–1.10) or death (OR: 0.82, CI: 0.63–1.08). Being unvaccinated (OR: 1.24, CI: 1.15–1.35), tobacco use (OR: 1.31, CI: 1.19–1.45), and alcohol abuse (OR: 1.68, CI: 1.41–2.00) increased odds of ICU admission; extreme obesity increased odds of death (OR: 1.35, CI: 1.02–1.78).
Conclusion
Poverty-associated factors, but not neighborhood-level poverty, were independently associated with severe outcomes among patients hospitalized with influenza. Increased vaccination and reductions in tobacco use, alcohol abuse, and extreme obesity could reduce severe influenza-associated outcomes.
Disclosures
E. J. Anderson, AbbVie: Consultant, Consulting fee; NovaVax: Research Contractor, Research support; Regeneron: Research Contractor, Research grant; MedImmune: Research Contractor, Research grant and Research support; W. Schaffner, Pfizer: Scientific Advisor, Consulting fee; Merck: Scientific Advisor, Consulting fee; Novavax: Consultant, Consulting fee; Dynavax: Consultant, Consulting fee; Sanofi-pasteur: Consultant, Consulting fee; GSK: Consultant, Consulting fee; Seqirus: Consultant, Consulting fee
The purpose of the study was to determine whether participation in WV 4-H agricultural judging teams impacted life skills development. This study measured the current life skill abilities of past 4-H ...state judging team winners from 1995 to 2006, determined their perception of the influence involvement on a judging team had on that ability, and compared that with the importance of the various life skills in participants' current jobs. A descriptive survey was sent to the target population, who were winners of West Virginia state 4-H agricultural judging team competitions between the years of 1995 and 2006 and competed in the national contest. 4-H judging team participation was found to influence education and career decisions and positively affect development of life skills, including many of those that respondents listed as being highly important in their current jobs. Problem solving, self-motivation, and self-responsibility were seen as having the highest importance in jobs; beyond these, 4-H judging teams also developed skills in learning to learn, teamwork, and decision making.
Most ill travelers returning from Ebola-affected countries have not had Ebola. However, institutions and public health departments need to be prepared. We present our experience triaging, evaluating ...and managing 25 ill returned travelers from these countries.
Background.
The 2014–2015 Ebola epidemic in West Africa had global impact beyond the primarily affected countries of Guinea, Liberia, and Sierra Leone. Other countries, including the United States, encountered numerous patients who arrived from highly affected countries with fever or other signs or symptoms consistent with Ebola virus disease (EVD).
Methods.
We describe our experience evaluating 25 travelers who met the US Centers for Disease Control and Prevention case definition for a person under investigation (PUI) for EVD from July 20, 2014 to January 28, 2015. All patients were triaged and evaluated under the guidance of institutional protocols to the emergency department, outpatient tropical medicine clinic, or Emory's Ebola treatment unit. Strict attention to infection control and early involvement of public health authorities guided the safe evaluation of these patients.
Results.
None were diagnosed with EVD. Respiratory illnesses were common, and 8 (32%) PUI were confirmed to have influenza. Four patients (16%) were diagnosed with potentially life-threatening infections or conditions, including 3 with Plasmodium falciparum malaria and 1 with diabetic ketoacidosis.
Conclusions.
In addition to preparing for potential patients with EVD, Ebola assessment centers should consider other life-threatening conditions requiring urgent treatment, and travelers to affected countries should be strongly advised to seek pretravel counseling. Furthermore, attention to infection control in all aspects of PUI evaluation is paramount and has presented unique challenges. Lessons learned from our evaluation of potential patients with EVD can help inform preparations for future outbreaks of highly pathogenic communicable diseases.
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