The Syphilis Epidemic Among Heterosexuals Is Accelerating: Evidence From King County, Washington
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PROVIDER: S-EPMC10578507 | biostudies-literature | 2023 Sep
REPOSITORIES: biostudies-literature
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Project description:Little is known about the frequency of ongoing HIV transmission within U.S. African immigrant communities. We used HIV surveillance and partner services data to describe African-born persons newly reported with HIV infection in King County (KC), WA from 1/1/2010 to 12/31/2013. We performed phylogenetic clustering analysis of HIV-1 pol to identify putative transmission events within this population. From 2010 to 2013, 1148 KC adults were reported with HIV, including 102 (9 %) born in Africa. Forty-one African-born cases were interviewed and reported diagnosis after arrival in the U.S. Fourteen (34 %) reported ≥1 negative test prior to diagnosis, and 9 (26 %) reported ≥1 negative test after U.S. arrival. Pol genotypes were available for seven of these nine. For two of these seven, a KC case was the nearest phylogenetic neighbor; two others were infected with subtype B virus. We found substantial evidence of ongoing HIV transmission in the African community of KC.
| S-EPMC5738028 | biostudies-literature
Project description:Relatively few epidemiologic studies have focused on narcolepsy, a disabling sleep disorder with a strong association with HLA-DQB1 *0602.We sought to estimate the prevalence of narcolepsy using multiple overlapping techniques to identify residents of King County, WA who were 18 years or older with physician-diagnosed narcolepsy. Patients were entered into a registry and recruited into an epidemiologic study entailing interview and buccal scrapings to determine HLA-DQB1 *0602 status. Missing values were imputed to allow prevalence to be estimated based on all 425 patients entered into the registry between 2001 and 2005, whether they were recruited into the epidemiologic study (n=279) or not (n=146).As of July 01, 2001, estimated prevalence per 100,000 of physician-diagnosed narcolepsy with cataplexy was 21.8 (95% confidence interval (CI): 18.8-24.8), similar to prior studies. The median age of onset was 14 (interquartile range: 10-18). For narcolepsy with HLA-DQB1 *0602, prevalence was 15.3 (95% CI: 12.8-17.9). Estimated prevalence was higher in women than men and in African-Americans than other racial groups.These differences could reflect problems in identification and recruitment or may provide etiologic clues about narcolepsy. This study illustrates the challenges in performing population-based studies of narcolepsy.
| S-EPMC2754568 | biostudies-literature
Project description:BACKGROUND:In King County, Washington, the HIV prevalence among men who have sex with men (MSM) who inject methamphetamine is high, while it is low among other people who inject drugs (PWID). Local drug problem indicators suggest that methamphetamine use is increasing. The extent to which this increase affects MSM and non-MSM, and whether MSM and non-MSM networks are connected through injection equipment sharing, is unknown. METHODS:We used data from two serial cross-sectional surveys of PWID including five biannual surveys of Public Health-Seattle and King County Needle and Syringe Exchange Program clients (NSEP, N=2135, 2009-2017) and three National HIV Behavioral Surveillance IDU surveys (NHBS, N=1709, 2009-2015). RESULTS:The proportion of non-MSM PWID reporting any recent methamphetamine injection increased significantly from approximately 20% in 2009 to 65% in 2017. Most of this increase was attributable to injecting methamphetamine in combination with heroin (goofballs). PWID who injected goofballs were more likely to be younger, homeless or unstably housed, report daily injection, and self-report an opioid overdose in the past year than other PWID. The majority of PWID who injected methamphetamine reported sharing any injection equipment. Among these PWID, 43% of MSM had last shared injection equipment with a non-MSM. Eight percent of non-MSM men and 15% of women had last shared equipment with an MSM. CONCLUSIONS:Given non-trivial rates of sharing injection equipment with methamphetamine-using MSM, a population with an HIV prevalence of 40%, non-MSM who inject methamphetamine could be an emerging population at risk for acquiring HIV.
| S-EPMC6457905 | biostudies-literature
Project description:BackgroundRhinovirus (RV) is a common cause of respiratory illness in all people, including those experiencing homelessness. RV epidemiology in homeless shelters is unknown.MethodsWe analyzed data from a cross-sectional homeless shelter study in King County, Washington, October 2019-May 2021. Shelter residents or guardians aged ≥3 months reporting acute respiratory illness completed questionnaires and submitted nasal swabs. After 1 April 2020, enrollment expanded to residents and staff regardless of symptoms. Samples were tested by multiplex RT-PCR for respiratory viruses. A subset of RV-positive samples was sequenced.ResultsThere were 1066 RV-positive samples with RV present every month of the study period. RV was the most common virus before and during the coronavirus disease 2019 (COVID-19) pandemic (43% and 77% of virus-positive samples, respectively). Participants from family shelters had the highest prevalence of RV. Among 131 sequenced samples, 33 RV serotypes were identified with each serotype detected for ≤4 months.ConclusionsRV infections persisted through community mitigation measures and were most prevalent in shelters housing families. Sequencing showed a diversity of circulating RV serotypes, each detected over short periods of time. Community-based surveillance in congregate settings is important to characterize respiratory viral infections during and after the COVID-19 pandemic.Clinical trials registrationNCT04141917.
| S-EPMC9384451 | biostudies-literature
Project description:BackgroundSyringe services programs (SSPs) serve as key platforms to deliver harm reduction services to people who use drugs (PWUD). Changes in drug supply and drug consumption behaviors, particularly the increasing use of fentanyl through non-injection methods, may impact SSP utilization.Material and methodsWe collected routine program data from three SSPs in King County, Washington. Trends in the annual number of syringes distributed and client encounters were assessed using joinpoint regression analysis to determine when statistically significant changes in trends in annual totals occurred and annual percent change (APC) during each period.ResultsThe number of syringes distributed per year through King County SSPs reached a maximum of 8,733,413 in 2020 and then decreased sharply to 2,482,056 by 2023. Annual syringe distribution totals were stable or increasing during all periods from 1989 to 2020 (APC range: 2.0-35.3 %), and only developed a decreasing trend between 2020 and 2023 (APC=-32.8 %). Total number of SSP client encounters per year was stable between 2010 and 2023 (APC=0.7 %), but an increasing trend in encounters was identified starting in 2008 (APC=4.4 %) at a community-based SSP that distributed safer smoking supplies (pipes).DiscussionA precipitous decline in syringe distribution through King County SSPs began in 2020 and continued through 2023, which coincided with increasing availability of fentanyl in the local drug market. Nevertheless, the trends in client encounters highlight that PWUD continued to seek harm reduction services, with preliminary evidence that distribution of safer smoking supplies may increase the number of client visits.
| S-EPMC11625168 | biostudies-literature
Project description:BackgroundLong-term care facilities are high-risk settings for severe outcomes from outbreaks of Covid-19, owing to both the advanced age and frequent chronic underlying health conditions of the residents and the movement of health care personnel among facilities in a region.MethodsAfter identification on February 28, 2020, of a confirmed case of Covid-19 in a skilled nursing facility in King County, Washington, Public Health-Seattle and King County, aided by the Centers for Disease Control and Prevention, launched a case investigation, contact tracing, quarantine of exposed persons, isolation of confirmed and suspected cases, and on-site enhancement of infection prevention and control.ResultsAs of March 18, a total of 167 confirmed cases of Covid-19 affecting 101 residents, 50 health care personnel, and 16 visitors were found to be epidemiologically linked to the facility. Most cases among residents included respiratory illness consistent with Covid-19; however, in 7 residents no symptoms were documented. Hospitalization rates for facility residents, visitors, and staff were 54.5%, 50.0%, and 6.0%, respectively. The case fatality rate for residents was 33.7% (34 of 101). As of March 18, a total of 30 long-term care facilities with at least one confirmed case of Covid-19 had been identified in King County.ConclusionsIn the context of rapidly escalating Covid-19 outbreaks, proactive steps by long-term care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of Covid-19.
| S-EPMC7121761 | biostudies-literature
Project description:Determining the causes of biological impairment in urban stream settings presents unique challenges because there are many potential stressors associated with human development. A rigorous, scientifically based process is more likely to identify influential stressors that can be reduced to improve stream condition. We used the U.S. Environmental Protection Agency's (U.S. EPA) CADDIS (Causal Analysis/Decision Information System) stressor identification process to assess eight candidate causes in the urban Soos Creek Basin in Washington State. The eight candidate causes capable of negatively affecting the abundance and diversity of benthic macroinvertebrates are: flow alteration, increased fine sediments, reduced habitat complexity, elevated water temperature, low dissolved oxygen, elevated nutrients, increased ionic concentration, and toxic pollutants. We assembled multiple lines of evidence, as well as the consistency of that evidence and agreement with other assessments. We evaluated the influence of natural and cumulative anthropogenic stressors on macroinvertebrate communities by comparing various chemical, physical, and biological measures at sites in the Soos Creek Basin with regional reference sites. Of the stressors evaluated, flow alteration, increased fine sediments, and loss of habitat complexity were the most probable causes of biological impairment, with multiple biological metrics responding predictably across levels of impairment. Key findings from this study include: the use of specific community alterations as evidence in causal assessment, demonstration of links in a complete causal pathway, and the use of multiple models to show which pathway is likely stronger. In addition to the value to the specific case, the analyses increased our understanding of the responses of stream invertebrate communities in urban environments. Ultimately, demonstrating the utility of causal assessment in a practical situation provides greater confidence that mitigation efforts aimed at improving biological health of urban stream communities will have detectable desired effects while also providing a baseline from which the effectiveness of management practices can be evaluated.
| S-EPMC6688635 | biostudies-literature
Project description:Individual-level Coronavirus Disease 2019 (COVID-19) case data suggest that certain populations may be more impacted by the pandemic. However, few studies have considered the communities from which positive cases are prevalent, and the variations in testing rates between communities. In this study, we assessed community factors that were associated with COVID-19 testing and test positivity at the census tract level for the Seattle, King County, Washington region at the summer peak of infection in July 2020. Multivariate Poisson regression was used to estimate confirmed case counts, adjusted for testing numbers, which were associated with socioeconomic status (SES) indicators such as poverty, educational attainment, transportation cost, as well as with communities with high proportions of people of color. Multivariate models were also used to examine factors associated with testing rates, and found disparities in testing for communities of color and communities with transportation cost barriers. These results demonstrate the ability to identify tract-level indicators of COVID-19 risk and specific communities that are most vulnerable to COVID-19 infection, as well as highlight the ongoing need to ensure access to disease control resources, including information and education, testing, and future vaccination programs in low-SES and highly diverse communities.
| S-EPMC7767300 | biostudies-literature
Project description:ObjectiveSchool-Based Health Centers (SBHCs) can reduce barriers to accessing care for school-aged children and adolescents. However, current practices related to screening for and responding to social determinants of health (SDOH) in SBHCs are unknown. Our study sought to understand SBHC staff's knowledge related to SDOH, and their screening and referral practices for addressing SDOH.MethodsThis study was conducted with all SBHCs in King County, Washington (n = 30 clinics operated by n = 8 agencies) between January-March 2022. Data were collected using a web-based questionnaire, distributed to all provider and clinical care staff (n = 222) in these SHBCs.ResultsWhile respondents had strong generalized knowledge regarding SDOH and how they impact health, they were less confident about the specific SDOH impacting the students they serve. Many health limiting and promoting factors are screened for by respondents; however, there was no standardization related to screening and referral practices across SBHCs or agencies. Respondents had suggestions on how to improve screening methodology and ensure that existing practices adequately assess the SDOH impacting student's lives. There was no clearly identified mechanism for making and following up on referrals. Respondents felt that there were either not or only sometimes enough resources available to meet student's needs.ConclusionSBHCs advance health and educational outcomes for students, yet SDOH are inconsistently assessed and addressed within SBHCs in King County. Standardizing processes for SDOH assessment and referral can help SBHCs develop practices that are in the best service of equity for their student populations.
| S-EPMC10959698 | biostudies-literature
Project description:Projections of the near future of daily case incidence of COVID-19 are valuable for informing public policy. Near-future estimates are also useful for outbreaks of other diseases. Short-term predictions are unlikely to be affected by changes in herd immunity. In the absence of major net changes in factors that affect reproduction number (R), the two-parameter exponential model should be a standard model â€" indeed, it has been standard for epidemiological analysis of pandemics for a century but in recent decades has lost popularity to more complex compartmental models. Exponential models should be routinely included in reports describing epidemiological models as a reference, or null hypothesis. Exponential models should be fitted separately for each epidemiologically distinct jurisdiction. They should also be fitted separately to time intervals that differ by any major changes in factors that affect R. Using an exponential model, incidence-count half-life ( t 1/2 ) is a better statistic than R. Here an example of the exponential model is applied to King County, Washington during Spring 2020. During the pandemic, the parameters and predictions of this model have remained stable for intervals of one to four months, and the accuracy of model predictions has outperformed models with more parameters. The COVID pandemic can be modeled as a series of exponential curves, each spanning an interval ranging from one to four months. The length of these intervals is hard to predict, other than to extrapolate that future intervals will last about as long as past intervals.
| S-EPMC9216716 | biostudies-literature