The San Francisco Health Systems Collaborative: Public Health and Health Care Delivery Systems' Response to the Covid-19 Pandemic.

The Covid-19 pandemic challenged health care delivery systems worldwide. Many acute care hospitals in communities that experienced surges in cases and hospitalizations had to make decisions such as rationing scarce resources. Hospitals serving low-income communities, communities of color, and those in other historically marginalized or vulnerable groups reported the greatest operational impacts of surges.

COVID-19, HIV, and Syphilis Contact Tracing: What Have We Learned and Where Are We Headed?

Contact tracing is a core public health intervention for a range of communicable diseases, in which the primary goal is to interrupt disease transmission and decrease morbidity. In this article, we present lessons learned from COVID-19, HIV, and syphilis in San Francisco to illustrate factors that shape the effectiveness of contact tracing programs and to highlight the value of investing in a robust disease intervention workforce with capacity to pivot rapidly in response to a range of emerging disease trends and outbreak response needs.

Contact-Tracing Outcomes Among Household Contacts of Fully Vaccinated Coronavirus Disease 2019 (COVID-19) Patients: San Francisco, California, 29 January-2 July 2021.

Background: The extent to which vaccinated persons diagnosed with coronavirus disease 2019 (COVID-19) can transmit to other vaccinated and unvaccinated persons is unclear.

Methods: Using data from the San Francisco Department of Public Health, this report describes outcomes of household contact tracing during 29 January-2 July 2021, where fully vaccinated patients with COVID-19 were the index case in the household.

Results: Among 248 fully vaccinated patients with breakthrough infections, 203 (82%) were symptomatic and 105 were identified as the index patient within their household.

Demographic and Epidemiological Characteristics Associated With Reduced Antimicrobial Susceptibility to Neisseria gonorrhoeae in the United States, Strengthening the US Response to Resistant Gonorrhea, 2018 to 2019.

Background: Jurisdictions participating in Strengthening the US Response to Resistant Gonorrhea (SURRG) implemented specimen collection for culture and antimicrobial susceptibility testing from a sample of persons of all genders (at multiple anatomic sites) attending sexually transmitted disease clinics and community clinics. We describe the percentage and characteristics of patients whose isolates demonstrated reduced susceptibility (RS) to azithromycin, ceftriaxone, or cefixime.

Methods: We included patients from clinics that participated in SURRG whose isolates underwent antimicrobial susceptibility testing by Etest.

Targeting Culture Criteria to Maximize Culture Positivity of Neisseria gonorrhoeae in 3 Sexual Health Clinic Settings.

Background: Although most gonorrhea (GC) cases in the United States are detected using nucleic acid amplification tests (NAATs), isolation of Neisseria gonorrhoeae (NG) using culture specimens is needed for antibiotic susceptibility testing (AST). We present data on NAATs and cultures collected before and during the Centers for Disease Control and Prevention demonstration project (Strengthening the US Response to Resistant Gonorrhea [SURRG]) to describe a process to define culture criteria for NG isolation for surveillance of NG with reduced susceptibility.

Methods: For sexually transmitted infection clinics in New York City, NY; San Francisco, CA; and Milwaukee, WI, we calculated NAAT positivity by anatomic site in 2016 (pre-SURRG) across 3 groups: (1) sex partners of persons with GC, (2) patients with symptoms (e.

Unnamed Partners From Syphilis Partner Services Interviews, 7 Jurisdictions.

Background: Reducing transmission depends on the percentage of infected partners treated; if many are missed, impact on transmission will be low. Traditional partner services metrics evaluate the number of partners found and treated. We estimated the proportion of partners of syphilis patients not locatable for intervention.

Pharyngeal Gonococcal Infections: A Cross-Sectional Study in a Network of Sexually Transmitted Disease Clinics; Sexually Transmitted Disease Surveillance Network-January 2016 to June 2018.

We conducted a cross-sectional analysis using sexually transmitted disease clinic data to determine test of cure rates among persons diagnosed with pharyngeal gonococcal infections who were treated with a nonceftriaxone, nonazithromycin therapy. Less than 10% returned for a test of cure, highlighting the need to understand factors that can lead to improved compliance.

Historical and Current Trends in the Epidemiology of Early Syphilis in San Francisco, 1955 to 2016.

Background: Seventeen years into a sustained epidemic, early syphilis (ES) rates in San Francisco (SF) are continuing to increase and the demographics of the affected population are changing. We provide a historical overview of ES in SF among men who have sex with men (MSM) and describe trends in the epidemiology and disease investigation outcomes.

Methods: We examined data from the SF Department of Public Health's patient-based registry of integrated STD surveillance, clinical, and field investigation data to describe demographic and behavioral characteristics of ES cases, as well as outcomes of syphilis partner services (PS).

Drinking water turbidity and emergency department visits for gastrointestinal illness in New York City, 2002-2009.

Background: Studies have examined whether there is a relationship between drinking water turbidity and gastrointestinal (GI) illness indicators, and results have varied possibly due to differences in methods and study settings.

Objectives: As part of a water security improvement project we conducted a retrospective analysis of the relationship between drinking water turbidity and GI illness in New York City (NYC) based on emergency department chief complaint syndromic data that are available in near-real-time.

Methods: We used a Poisson time-series model to estimate the relationship of turbidity measured at distribution system and source water sites to diarrhea emergency department (ED) visits in NYC during 2002-2009.

Disparities in the severity of influenza illness: a descriptive study of hospitalized and nonhospitalized novel H1N1 influenza-positive patients in New York City: 2009-2010 influenza season.

Objective: To investigate the association between socioeconomic status (SES) and hospitalization for 2009 H1N1 influenza, independently of access to care and known risk factors for severe influenza illness, among New York City residents during the 2009-2010 influenza season.

Design: We used a 1:2 case-control study design, matching by age group and month of diagnosis. Cases were defined as laboratory-confirmed patients with 2009 H1N1 influenza who were hospitalized during their illness.

Evaluating the New York City Emergency Department Syndromic Surveillance for Monitoring Influenza Activity during the 2009-10 Influenza Season.

Objective: To use laboratory data to assess the specificity of syndromes used by the New York City emergency department (ED) syndromic surveillance system to monitor influenza activity.

Design: For the period from October 1, 2009 through March 31, 2010, we examined the correlation between citywide ED syndrome assignment and laboratory-confirmed influenza and respiratory syncytial virus (RSV). In addition, ED syndromic data from five select NYC hospitals were matched at the patient and visit level to corresponding laboratory reports of influenza and RSV.

Public health and environmental response to the first case of naturally acquired inhalational anthrax in the United States in 30 years: infection of a new york city resident who worked with dried animal hides.

In Pennsylvania on February 16, 2006, a New York City resident collapsed with rigors and was hospitalized. On February 21, the Centers for Disease Control and Prevention and the New York City Department of Health and Mental Hygiene were notified that Bacillus anthracis had been identified in the patient's blood. Although the patient's history of working with dried animal hides to make African drums indicated the likelihood of a natural exposure to aerosolized anthrax spores, bioterrorism had to be ruled out first.

Importance of travel in domestically acquired typhoid fever infections: opportunities for prevention and early detection.

Approximately 25% of Salmonella typhi infections in the US occur among nontravelers. Two S. typhi infections in a major US metropolitan city acquired domestically in 2005 were epidemiologically linked to a S.

Infrequent chlamydial testing among young adults: financial and regional differences.

Objectives: Chlamydia prevalence varies regionally but is highest in the South, which could be the result of regional differences in testing behavior. We describe the national and regional prevalence of self-reported chlamydial infection (Ct) testing and examine how financial resources might be associated with Ct testing.

Methods: We conducted a cross-sectional analysis of data from 12,334 sexually experienced young adults who participated in wave III of the National Longitudinal Study of Adolescent Health (2001-2002).

Population prevalence of reported and unreported HIV and related behaviors among the household adult population in New York City, 2004.

Background: Surveillance for HIV likely underestimates infection among the general population: 25% of US residents are estimated to be unaware of their HIV infection.

Objective: To determine the prevalence of HIV infection and risk behaviors among New York City (NYC) adults and compare these with surveillance findings.

Methods: The NYC Health and Nutrition Examination Survey (HANES) provided the first opportunity to estimate population-based HIV prevalence among NYC adults.

Benefits and barriers to electronic laboratory results reporting for notifiable diseases: the New York City Department of Health and Mental Hygiene experience.

Objectives: Despite national support for electronic laboratory reporting (ELR), the transition from paper to electronic reporting has been slow both nationally and locally. We assessed the ELR experience of New York City's surveillance programs to identify barriers to ELR implementation and generalizable lessons about automated electronic notifiable disease surveillance.

Methods: We conducted interviews with key staff of the New York City Department of Health and Mental Hygiene to evaluate ELR implementation.

HIV testing among young adults in the United States: associations with financial resources and geography.

We estimated prevalence and odds ratios for self-reported HIV testing among sexually experienced young adults using nationally representative data obtained from Wave III of the National Longitudinal Study of Adolescent Health (Add Health). The prevalence of testing in the past year was 18.8%.

Is anybody out there? Integrating HIV services in rural regions.

As the HIV epidemic has changed nationally, the parallel change in the Southern states has been a disproportionate increase in HIV infection among people of color and among women. Due to the limited and disjointed health care and social service resources in rural Southern regions, already marginalized groups have difficulty in accessing appropriate care and services to address their HIV infection seamlessly and with continuity. To ameliorate the limitations in the health care infrastructure, the North Carolina Services Integration Project collaborated with North Carolina medical and social service providers and state agencies to create a sustainable and replicable model of integrated care for HIV-positive, geographically dispersed residents.