High COVID-19 Attack Rate Among Attendees at Events at a Church - Arkansas, March 2020.

On March 16, 2020, the day that national social distancing guidelines were released (1), the Arkansas Department of Health (ADH) was notified of two cases of coronavirus disease 2019 (COVID-19) from a rural county of approximately 25,000 persons; these cases were the first identified in this county. The two cases occurred in a husband and wife; the husband is the pastor at a local church (church A). The couple (the index cases) attended church-related events during March 6-8, and developed nonspecific respiratory symptoms and fever on March 10 (wife) and 11 (husband).

Bloodstream Infections With a Novel Nontuberculous Mycobacterium Involving 52 Outpatient Oncology Clinic Patients-Arkansas, 2018.

Background: In July 2018, the Arkansas Department of Health (ADH) was notified by hospital A of 3 patients with bloodstream infections (BSIs) with a rapidly growing nontuberculous Mycobacterium (NTM) species; on 5 September 2018, 6 additional BSIs were reported. All were among oncology patients at clinic A. We investigated to identify sources and to prevent further infections.

Mumps in a highly vaccinated Marshallese community in Arkansas, USA: an outbreak report.

Background: During 2000-15, Arkansas Department of Health, Little Rock, AR, USA, investigated between one and six cases of mumps each year. From Aug 5, 2016, to Aug 5, 2017, the department received notification of more than 4000 suspected mumps cases in the second largest outbreak in the USA in the past 30 years.

Methods: Arkansas Department of Health investigated all reported cases of mumps to ascertain exposure, travel, and vaccination histories and identify close contacts.

Variation in Tularemia Clinical Manifestations-Arkansas, 2009-2013.

Background: , although naturally occurring in Arkansas, is also a Tier 1 select agent and potential bioterrorism threat. As such, tularemia is nationally notifiable and mandatorily reported to the Arkansas Department of Health. We examined demographic and clinical characteristics among reported cases and outcomes to improve understanding of the epidemiology of tularemia in Arkansas.

Electronic Nicotine Delivery Systems and Smoking Cessation in Arkansas, 2014.

Objectives: As of October 2015, evidence needed to make a recommendation about the use of electronic nicotine delivery systems (ENDS) for smoking cessation was limited. We used the 2014 Arkansas Behavioral Risk Factor Surveillance System with additional state-specific questions to determine the prevalence of ENDS use, the impact of ENDS use on smoking cessation, and beliefs about ENDS use in Arkansas. Our objectives were to determine if (1) ENDS use was associated with lower odds of quitting smoking, (2) ENDS users believed that ENDS use was not harmful to their health, and (3) ENDS users believed that switching to ENDS reduced their tobacco-related health risks.

Comparison of Office-Based Versus Outsourced Immunization Recall Services.

Objective: Given poor use of recall in primary care practices, we compared outsourced versus office-based recall systems.

Study Design: From 2011 to 2013, we enrolled 87 individual Arkansas providers in distinct practices treating their own patients <24 months of age which were randomized to usual care (A), office-based (B), or outsourced (C) recall groups.

Results: At the end of study, recall activity was 19.

Notes from the Field: Cluster of Tuberculosis Cases Among Marshallese Persons Residing in Arkansas - 2014-2015.

During early September 2014, the Arkansas Department of Health identified an increased number of tuberculosis (TB) cases among a unique population in a well-circumscribed geographical area in northwest Arkansas. The Compact of Free Association Act of 1985 (Public Law 99-239, amended in 2003 by Public Law 108-188) established the Republic of the Marshall Islands (RMI) as an independent nation, and persons from the RMI can travel freely (with valid RMI passport) to and from the United States as nonimmigrants without visas (1). Marshallese started settling in northwest Arkansas during the early 1990s because of employment and educational opportunities (2).

Airborne pathogen isolation capability in emergency departments of US children's hospitals.

The requirement for negative pressure isolation procedures has been an accepted component of pediatric care to protect patients and staff from highly infectious respiratory agents. Surveys regarding airborne isolation were distributed to 43 pediatric emergency departments at US children's hospitals with 26 responses. There was a median of 5 airborne isolation rooms, a median of 4 of those with negative pressure, and 61% without an ante-room.

Use of electronic nicotine delivery systems and recent initiation of smoking among US youth.

Objectives: We assessed whether the prevalence of recent (within a year) initiation of cigarette smoking was associated with reports of ever using electronic delivery systems (ENDS) in the National Youth Tobacco Survey (NYTS) and whether the association varied by age.

Methods: Weighted cross-sectional analysis of use of ENDS, cigarette smoking, age at interview and age at initiation of smoking collected systematically through the 2011-2013 NYTS cycles.

Results: In multivariate analyses those who ever used ENDS were twice as likely as nonusers of ENDS to have tried cigarette smoking in the last year (multivariate PR: 2.

Particulate Exposure at two Arkansas Racinos; Unsafe Environments?

The purpose of this pilot project was to initiate data collection on secondhand smoke (SHS) for two racinos (racetrack casinos) exempted from Arkansas' 2006 Clean Indoor Air Act. Air quality was assessed during regular hours in sites open to the public. All measurements of fine particulates (PM2.

Cluster of Cryptococcus neoformans Infections in Intensive Care Unit, Arkansas, USA, 2013.

We investigated an unusual cluster of 6 patients with infection at a community hospital in Arkansas during April–December 2013, to determine source of infection. Four patients had bloodstream infection and 2 had respiratory infection; 3 infections occurred within a 10-day period. Five patients had been admitted to the intensive care unit (ICU) with diagnoses other than cryptococcosis; none had HIV infection, and 1 patient had a history of organ transplantation.

Mobilizing a Statewide Network to Provide Ebola Education and Support.

Background: Healthcare providers require the latest information and procedures when a public health emergency arises. During the fall of 2014, when the Ebola virus was first identified in a patient in the United States, education about Ebola virus disease (EVD) and procedures for its identification and control needed widespread and immediate dissemination to healthcare providers. In addition, there was a need to allay fears and reassure the public and providers that a process was in place to manage Ebola should it arrive in Arkansas.

Influenza a outbreak in an ambulatory stem cell transplant center.

Background: In the era of cost-consciousness regarding healthcare , provision of medical services in an outpatient setting has become increasingly attractive. We report an influenza outbreak in an ambulatory stem cell transplant center in 2013 that highlights unique identification and infection control challenges in this setting.

Methods: Nasopharyngeal swabs were performed on patients with suspected influenza-like illnesses (ILI), defined by subjective fever or measured temperature of ≥37.

Vaccine policy and Arkansas childhood immunization exemptions: a multi-year review.

Background: An increase in total vaccine exemptions (medical, philosophic, and religious) occurred in Arkansas after a 2003 legislation added a philosophic category and used a new process for vaccine exemptions. By legislative requirement, the Arkansas Department of Health monitored exemptions through the 2009-2010 school year.

Purpose: The goal of the study was to determine the prevalence of vaccine exemption in 2003-2010 compared to the number of requests prior to the legislation enacted in 2003.

Prevalence and impact of short sleep duration in redeployed OIF soldiers.

Study Objectives: Short sleep duration (SSD) is common among deployed soldiers. The prevalence of SSD during redeployment, however, is unknown.

Design: Cross-sectional study of a brigade combat team (n = 3152 US Army soldiers) surveyed 90-180 days after completing a 6-15 month deployment to Iraq as part of Operation Iraqi Freedom (OIF).