Christina Tan - Academia.edu (original) (raw)

Papers by Christina Tan

Clinical Infectious Diseases, Sep 1, 2007

Background. In contrast to pharmaceutical manufacturers, compounding pharmacies adhere to differe... more Background. In contrast to pharmaceutical manufacturers, compounding pharmacies adhere to different quality-control standards, which may increase the likelihood of undetected outbreaks. In 2005, the Centers for Disease Control and Prevention received reports of cases of Serratia marcescens bloodstream infection occurring in patients who underwent cardiac surgical procedures in Los Angeles, California, and in New Jersey. An investigation was initiated to determine whether there was a common underlying cause. Methods. A matched case-control study was conducted in Los Angeles. Case record review and environmental testing were conducted in New Jersey. The Centers for Disease Control and Prevention performed a multistate case-finding investigation; isolates were compared using pulsed-field gel electrophoresis analysis. Results. Nationally distributed magnesium sulfate solution (MgSO 4) from compounding pharmacy X was the only significant risk factor for S. marcescens bloodstream infection (odds ratio, 6.4; 95% confidence interval, 1.1-38.3) among 6 Los Angeles case patients and 18 control subjects. Five New Jersey case patients received MgSO 4 from a single lot produced by compounding pharmacy X; culture of samples from open and unopened 50-mL bags in this lot yielded S. marcescens. Seven additional case patients from 3 different states were identified. Isolates from all 18 case patients and from samples of MgSO 4 demonstrated indistinguishable pulsed-field gel electrophoresis patterns. Compounding pharmacy X voluntarily recalled the product. Neither the pharmacy nor the US Food and Drug Administration could identify a source of contamination in their investigations of compounding pharmacy X. Conclusions. A multistate outbreak of S. marcescens bloodstream infection was linked to contaminated MgSO 4 distributed nationally by a compounding pharmacy. Health care personnel should take into account the different quality standards and regulation of compounded parenteral medications distributed in large quantities during investigations of outbreaks of bloodstream infection. Compounding pharmacies were originated to provide "customized medication for an individual patient in response to a licensed practitioner's prescription" [1] and continue to serve an important role in patient care.

Recent emergence of a virulent strain of Clostridium difficile demonstrates the importance of tra... more Recent emergence of a virulent strain of Clostridium difficile demonstrates the importance of tracking C. difficile incidence locally. Our survey of New Jersey hospitals documented increases in the rates of C. difficile disease (by 2fold), C. difficile-associated complications (by 7-fold), and C. difficile outbreaks (by 12-fold) during 2000-2004. C lostridium difficile, a gram-positive organism, is the most common cause of nosocomial infectious diarrhea in the United States (1). In 2005, the Centers for Disease Control and Prevention (CDC) reported on a new, epidemic, toxin gene-variant strain of C. difficile on the basis of a study of isolates collected from hospitals in multiple states, including New Jersey. CDC recommended that inpatient healthcare facilities track the incidence of C. difficile-associated disease (CDAD), including the clinical outcomes of patients (2).

Rutgers University Press eBooks, Sep 17, 2021

Rutgers University Press eBooks, Sep 17, 2021

MMWR. Morbidity and mortality weekly report, Jan 20, 2009

Mumps is a vaccine-preventable viral infection characterized by fever and inflammation of the sal... more Mumps is a vaccine-preventable viral infection characterized by fever and inflammation of the salivary glands and whose complications include orchitis, deafness, and meningo-encephalitis. In August 2009, CDC was notified of the onset of an outbreak of mumps in a summer camp in Sullivan County, New York. The outbreak has spread and gradually increased in size and is now the largest U.S. mumps outbreak since 2006, when the United States experienced a resurgence of mumps with 6,584 reported cases. On August 18, public health departments in Sullivan County, New York state, and CDC began an investigation into the mumps outbreak, later joined by departments in New York City and other locales. As of October 30, a total of 179 confirmed or probable cases had been identified from multiple locations in New York and New Jersey, and an additional 15 cases had been reported from Canada. The outbreak primarily has affected members of a tradition-observant religious community; median age of the pa...

JAMA, 2004

Context Little is known about potential long-term health effects of bioterrorismrelated Bacillus ... more Context Little is known about potential long-term health effects of bioterrorismrelated Bacillus anthracis infection. Objective To describe the relationship between anthrax infection and persistent somatic symptoms among adults surviving bioterrorism-related anthrax disease approximately 1 year after illness onset in 2001. Design, Setting, and Participants Cross-sectional study of 15 of 16 adult survivors from September through December 2002 using a clinical interview, a medical reviewof-system questionnaire, 2 standardized self-administered questionnaires, and a review of available medical records. Main Outcome Measures Health complaints summarized by the body system affected and by symptom categories; psychological distress measured by the Revised 90-Item Symptom Checklist; and health-related quality-of-life indices by the Medical Outcomes Study 36-Item Short-Form Health Survey (version 2). Results The anthrax survivors reported symptoms affecting multiple body systems, significantly greater overall psychological distress (PϽ.001), and significantly reduced health-related quality-of-life indices compared with US referent populations. Eight survivors (53%) had not returned to work since their infection. Comparing disease manifestations, inhalational survivors reported significantly lower overall physical health than cutaneous survivors (mean scores, 30 vs 41; P=.02). Available medical records could not explain the persisting health complaints. Conclusion The anthrax survivors continued to report significant health problems and poor life adjustment 1 year after onset of bioterrorism-related anthrax disease.

Recent emergence of a virulent strain of Clostridium difficile demonstrates the importance of tra... more Recent emergence of a virulent strain of Clostridium difficile demonstrates the importance of tracking C. difficile incidence locally. Our survey of New Jersey hospitals documented increases in the rates of C. difficile disease (by 2-fold), C. difficile–associated complications (by 7-fold), and C. difficile outbreaks (by 12-fold) during 2000–2004. Clostridium difficile, a gram-positive organism, is the most common cause of nosocomial infectious diarrhea in the United States (1). In 2005, the Centers for Disease Control and Prevention (CDC) reported on a new, epidemic, toxin gene–variant strain of C. difficile on the basis of a study of isolates collected from hospitals in multiple states, including New Jersey. CDC recommended that inpatient healthcare facilities track the incidence of C. difficile–associated disease (CDAD), including the clinical outcomes of patients (2). The Study To estimate the incidence of CDAD in hospitalized patients in New Jersey, we conducted a retrospective...

Infection Control & Hospital Epidemiology, 2019

Background:In March 2017, the New Jersey Department of Health received reports of 3 patients who ... more Background:In March 2017, the New Jersey Department of Health received reports of 3 patients who developed septic arthritis after receiving intra-articular injections for osteoarthritis knee pain at the same private outpatient facility in New Jersey. The risk of septic arthritis resulting from intra-articular injection is low. However, outbreaks of septic arthritis associated with unsafe injection practices in outpatient settings have been reported.Methods:An infection prevention assessment of the implicated facility’s practices was conducted because of the ongoing risk to public health. The assessment included an environmental inspection of the facility, staff interviews, infection prevention practice observations, and a medical record and office document review. A call for cases was disseminated to healthcare providers in New Jersey to identify patients treated at the facility who developed septic arthritis after receiving intra-articular injections.Results:We identified 41 patien...

Disaster Medicine and Public Health Preparedness, 2019

ABSTRACTObjectives:Hurricane Harvey left a path of destruction in its wake, resulting in over 100... more ABSTRACTObjectives:Hurricane Harvey left a path of destruction in its wake, resulting in over 100 deaths and damaging critical infrastructure. During a disaster, public health surveillance is necessary to track emerging illnesses and injuries, identify at-risk populations, and assess the effectiveness of response efforts. The Centers for Disease Control and Prevention (CDC) and American Red Cross collaborate on shelter surveillance to monitor the health of the sheltered population and help guide response efforts.Methods:We analyzed data collected from 24 Red Cross shelters between August 25, 2017, and September 14, 2017. We described the aggregate morbidity data collected during Harvey compared with previous hurricanes (Gustav, Ike, and Sandy).Results:Over one-third (38%) of reasons for visit were for health care maintenance; 33% for acute illnesses, which includes respiratory conditions, gastrointestinal symptoms, and pain; 19% for exacerbation of chronic disease; 7% for mental hea...

American journal of public health, Aug 1, 2017

To describe changes in mortality after Hurricane Sandy made landfall in New Jersey on October 29,... more To describe changes in mortality after Hurricane Sandy made landfall in New Jersey on October 29, 2012. We used electronic death records to describe changes in all-cause and cause-specific mortality overall, in persons aged 76 years or older, and by 3 Sandy impact levels for the month and quarter following Hurricane Sandy compared with the same periods in earlier years adjusted for trends. All-cause mortality increased 6% (95% confidence interval [CI] = 2%, 11%) for the month, 5%, 8%, and 12% by increasing Sandy impact level; and 7% (95% CI = 5%, 10%) for the quarter, 5%, 8%, and 15% by increasing Sandy impact level. In elderly persons, all-cause mortality rates increased 10% (95% CI = 5%, 15%) and 13% (95% CI = 10%, 16%) in the month and quarter, respectively. Deaths that were cardiovascular disease-related increased by 6% in both periods, noninfectious respiratory disease-related by 24% in the quarter, infection-related by 20% in the quarter, and unintentional injury-related by 23...

Disaster medicine and public health preparedness, Dec 29, 2017

We characterized evacuations related to Hurricane Sandy, which made landfall in New Jersey on Oct... more We characterized evacuations related to Hurricane Sandy, which made landfall in New Jersey on October 29, 2012. We analyzed data from the 2014 New Jersey Behavioral Risk Factor Survey. The proportion of respondents reporting evacuation was used to estimate the number of New Jersey adults who evacuated. We determined evacuation rates in heavily impacted and less-impacted municipalities, as well as evacuation rates for municipalities under and not under mandatory evacuation orders. We tested associations between demographic and health factors, such as certain chronic health conditions, and evacuation. Among respondents, 12.7% (95% CI: 11.8%-13.6%) reported evacuating, corresponding to approximately 880,000 adults. In heavily impacted municipalities, 17.0% (95% CI: 15.2%-18.7%) evacuated, compared with 10.1% (95% CI: 9.0%-11.2%) in less-impacted municipalities. In municipalities under mandatory evacuation orders, 42.5% (95% CI: 35.1%-49.8%) evacuated, compared with 11.8% (95% CI: 10.9%...

Medical Economics, Nov 20, 2000

Early in her career, the author struggled to make sense of a woman&s multiple symptoms. The t... more Early in her career, the author struggled to make sense of a woman&s multiple symptoms. The truth shocked and humbled her.

Disaster Medicine and Public Health Preparedness, 2016

ObjectiveEvacuation and damage following a widespread natural disaster may affect short-term acce... more ObjectiveEvacuation and damage following a widespread natural disaster may affect short-term access to medical care. We estimated medical care needs in New Jersey following Hurricane Sandy in 2012.MethodsHurricane Sandy-related questions regarding medical needs included in the Behavioral Risk Factor Surveillance System survey were administered to survey respondents living in New Jersey when Sandy occurred.ResultsRecently arrived foreign-born residents were more likely than US-born residents to need medical care following Sandy. Others with greater medical needs included the uninsured and evacuees. Persons who evacuated or lived in areas that experienced the greatest hurricane impact were less likely to be able to fill a prescription. Only 15% of New Jerseyans were aware of the Emergency Pharmaceutical Assistance Program (EPAP), a federal program which allows prescription refills for the uninsured following a disaster. Recently arrived foreign-born residents and the uninsured were le...

MMWR. Morbidity and Mortality Weekly Report, 2015

BACKGROUND: In September 2012, the New Jersey Department of Health (NJDOH) was notified of 6 faci... more BACKGROUND: In September 2012, the New Jersey Department of Health (NJDOH) was notified of 6 facilities that received 1443 vials of contaminated methylprednisolone acetate (MPA) from the New England Compounding Company (NECC), associated with fungal infections. To manage the scope of this outbreak, NJDOH formed an outbreak investigation team and initiated the Incident Command Structure (ICS) with section leads (ie clinical, surveillance, logistics) to manage identification of persons potentially exposed to MPA and to perform surveillance for associated infections. METHODS: NJDOH reached out to facilities that received MPA along with local health departments (LHDs) and epidemiologists. Facilities were asked to account for all vials of MPA received, and to identify and notify exposed patients with assistance of LHDs. NJDOH provided line-lists, data-collection templates and talking points to facilitate notification, symptom assessment, and patient tracking. NJDOH provided written guida...

Background: Mumps, a vaccine-preventable disease, is characterized by fever and inflammation of t... more Background: Mumps, a vaccine-preventable disease, is characterized by fever and inflammation of the salivary glands; complications include orchitis, oophoritis, deafness, and meningoencephalitis. In September 2009, we identified a mumps outbreak in NJ linked to a larger outbreak of >400 cases in NY and Canada and associated with a tradition-observant religious community. The index case for the larger outbreak was in a NY child who had traveled to the United Kingdom where genotype G mumps virus was circulating. Objectives: We investigated the NJ outbreak to identify the source, characterize the outbreak, and develop control measures. Methods: We defined a probable case as a clinically-compatible illness; a confirmed case had either laboratory-confirmation or an epidemiologic link to another confirmed or probable case. We interviewed patients and their physicians by telephone and collected laboratory information. Results: As of December 3, a total of 80 confirmed and probable cases...

Background: On December 31, 2007, local authorities notified Ocean County Health Department and t... more Background: On December 31, 2007, local authorities notified Ocean County Health Department and the New Jersey Department of Health and Senior Services (OCHD/NJDHSS) of intentional inappropriate vaccination practices (IVPs) by a Vaccines for Children (VFC) provider. VFC provides no-cost vaccines for eligible populations of children. IVPs can result in susceptibility to vaccine-preventable diseases (VPDs), necessitate revaccination campaigns, and cost $20 million/year. OCHD/NJDHSS investigated the physician's practice to identify the affected population and ascertain the need for a revaccination campaign. Methods: OCHD/NJDHSS analyzed 20012007 county-level VPD incidence data to identify trends; data before 2001 were unavailable. Using the physician's medical records, investigators identified recorded vaccination events (RVE) during 19992007, which were matched to VFC distribution records to obtain vaccine expiration dates. Non-VFC distribution records were unavailable. Result...

Clinical Infectious Diseases, Sep 1, 2007

Background. In contrast to pharmaceutical manufacturers, compounding pharmacies adhere to differe... more Background. In contrast to pharmaceutical manufacturers, compounding pharmacies adhere to different quality-control standards, which may increase the likelihood of undetected outbreaks. In 2005, the Centers for Disease Control and Prevention received reports of cases of Serratia marcescens bloodstream infection occurring in patients who underwent cardiac surgical procedures in Los Angeles, California, and in New Jersey. An investigation was initiated to determine whether there was a common underlying cause. Methods. A matched case-control study was conducted in Los Angeles. Case record review and environmental testing were conducted in New Jersey. The Centers for Disease Control and Prevention performed a multistate case-finding investigation; isolates were compared using pulsed-field gel electrophoresis analysis. Results. Nationally distributed magnesium sulfate solution (MgSO 4) from compounding pharmacy X was the only significant risk factor for S. marcescens bloodstream infection (odds ratio, 6.4; 95% confidence interval, 1.1-38.3) among 6 Los Angeles case patients and 18 control subjects. Five New Jersey case patients received MgSO 4 from a single lot produced by compounding pharmacy X; culture of samples from open and unopened 50-mL bags in this lot yielded S. marcescens. Seven additional case patients from 3 different states were identified. Isolates from all 18 case patients and from samples of MgSO 4 demonstrated indistinguishable pulsed-field gel electrophoresis patterns. Compounding pharmacy X voluntarily recalled the product. Neither the pharmacy nor the US Food and Drug Administration could identify a source of contamination in their investigations of compounding pharmacy X. Conclusions. A multistate outbreak of S. marcescens bloodstream infection was linked to contaminated MgSO 4 distributed nationally by a compounding pharmacy. Health care personnel should take into account the different quality standards and regulation of compounded parenteral medications distributed in large quantities during investigations of outbreaks of bloodstream infection. Compounding pharmacies were originated to provide "customized medication for an individual patient in response to a licensed practitioner's prescription" [1] and continue to serve an important role in patient care.

Recent emergence of a virulent strain of Clostridium difficile demonstrates the importance of tra... more Recent emergence of a virulent strain of Clostridium difficile demonstrates the importance of tracking C. difficile incidence locally. Our survey of New Jersey hospitals documented increases in the rates of C. difficile disease (by 2fold), C. difficile-associated complications (by 7-fold), and C. difficile outbreaks (by 12-fold) during 2000-2004. C lostridium difficile, a gram-positive organism, is the most common cause of nosocomial infectious diarrhea in the United States (1). In 2005, the Centers for Disease Control and Prevention (CDC) reported on a new, epidemic, toxin gene-variant strain of C. difficile on the basis of a study of isolates collected from hospitals in multiple states, including New Jersey. CDC recommended that inpatient healthcare facilities track the incidence of C. difficile-associated disease (CDAD), including the clinical outcomes of patients (2).

Rutgers University Press eBooks, Sep 17, 2021

Rutgers University Press eBooks, Sep 17, 2021

MMWR. Morbidity and mortality weekly report, Jan 20, 2009

Mumps is a vaccine-preventable viral infection characterized by fever and inflammation of the sal... more Mumps is a vaccine-preventable viral infection characterized by fever and inflammation of the salivary glands and whose complications include orchitis, deafness, and meningo-encephalitis. In August 2009, CDC was notified of the onset of an outbreak of mumps in a summer camp in Sullivan County, New York. The outbreak has spread and gradually increased in size and is now the largest U.S. mumps outbreak since 2006, when the United States experienced a resurgence of mumps with 6,584 reported cases. On August 18, public health departments in Sullivan County, New York state, and CDC began an investigation into the mumps outbreak, later joined by departments in New York City and other locales. As of October 30, a total of 179 confirmed or probable cases had been identified from multiple locations in New York and New Jersey, and an additional 15 cases had been reported from Canada. The outbreak primarily has affected members of a tradition-observant religious community; median age of the pa...

JAMA, 2004

Context Little is known about potential long-term health effects of bioterrorismrelated Bacillus ... more Context Little is known about potential long-term health effects of bioterrorismrelated Bacillus anthracis infection. Objective To describe the relationship between anthrax infection and persistent somatic symptoms among adults surviving bioterrorism-related anthrax disease approximately 1 year after illness onset in 2001. Design, Setting, and Participants Cross-sectional study of 15 of 16 adult survivors from September through December 2002 using a clinical interview, a medical reviewof-system questionnaire, 2 standardized self-administered questionnaires, and a review of available medical records. Main Outcome Measures Health complaints summarized by the body system affected and by symptom categories; psychological distress measured by the Revised 90-Item Symptom Checklist; and health-related quality-of-life indices by the Medical Outcomes Study 36-Item Short-Form Health Survey (version 2). Results The anthrax survivors reported symptoms affecting multiple body systems, significantly greater overall psychological distress (PϽ.001), and significantly reduced health-related quality-of-life indices compared with US referent populations. Eight survivors (53%) had not returned to work since their infection. Comparing disease manifestations, inhalational survivors reported significantly lower overall physical health than cutaneous survivors (mean scores, 30 vs 41; P=.02). Available medical records could not explain the persisting health complaints. Conclusion The anthrax survivors continued to report significant health problems and poor life adjustment 1 year after onset of bioterrorism-related anthrax disease.

Recent emergence of a virulent strain of Clostridium difficile demonstrates the importance of tra... more Recent emergence of a virulent strain of Clostridium difficile demonstrates the importance of tracking C. difficile incidence locally. Our survey of New Jersey hospitals documented increases in the rates of C. difficile disease (by 2-fold), C. difficile–associated complications (by 7-fold), and C. difficile outbreaks (by 12-fold) during 2000–2004. Clostridium difficile, a gram-positive organism, is the most common cause of nosocomial infectious diarrhea in the United States (1). In 2005, the Centers for Disease Control and Prevention (CDC) reported on a new, epidemic, toxin gene–variant strain of C. difficile on the basis of a study of isolates collected from hospitals in multiple states, including New Jersey. CDC recommended that inpatient healthcare facilities track the incidence of C. difficile–associated disease (CDAD), including the clinical outcomes of patients (2). The Study To estimate the incidence of CDAD in hospitalized patients in New Jersey, we conducted a retrospective...

Infection Control & Hospital Epidemiology, 2019

Background:In March 2017, the New Jersey Department of Health received reports of 3 patients who ... more Background:In March 2017, the New Jersey Department of Health received reports of 3 patients who developed septic arthritis after receiving intra-articular injections for osteoarthritis knee pain at the same private outpatient facility in New Jersey. The risk of septic arthritis resulting from intra-articular injection is low. However, outbreaks of septic arthritis associated with unsafe injection practices in outpatient settings have been reported.Methods:An infection prevention assessment of the implicated facility’s practices was conducted because of the ongoing risk to public health. The assessment included an environmental inspection of the facility, staff interviews, infection prevention practice observations, and a medical record and office document review. A call for cases was disseminated to healthcare providers in New Jersey to identify patients treated at the facility who developed septic arthritis after receiving intra-articular injections.Results:We identified 41 patien...

Disaster Medicine and Public Health Preparedness, 2019

ABSTRACTObjectives:Hurricane Harvey left a path of destruction in its wake, resulting in over 100... more ABSTRACTObjectives:Hurricane Harvey left a path of destruction in its wake, resulting in over 100 deaths and damaging critical infrastructure. During a disaster, public health surveillance is necessary to track emerging illnesses and injuries, identify at-risk populations, and assess the effectiveness of response efforts. The Centers for Disease Control and Prevention (CDC) and American Red Cross collaborate on shelter surveillance to monitor the health of the sheltered population and help guide response efforts.Methods:We analyzed data collected from 24 Red Cross shelters between August 25, 2017, and September 14, 2017. We described the aggregate morbidity data collected during Harvey compared with previous hurricanes (Gustav, Ike, and Sandy).Results:Over one-third (38%) of reasons for visit were for health care maintenance; 33% for acute illnesses, which includes respiratory conditions, gastrointestinal symptoms, and pain; 19% for exacerbation of chronic disease; 7% for mental hea...

American journal of public health, Aug 1, 2017

To describe changes in mortality after Hurricane Sandy made landfall in New Jersey on October 29,... more To describe changes in mortality after Hurricane Sandy made landfall in New Jersey on October 29, 2012. We used electronic death records to describe changes in all-cause and cause-specific mortality overall, in persons aged 76 years or older, and by 3 Sandy impact levels for the month and quarter following Hurricane Sandy compared with the same periods in earlier years adjusted for trends. All-cause mortality increased 6% (95% confidence interval [CI] = 2%, 11%) for the month, 5%, 8%, and 12% by increasing Sandy impact level; and 7% (95% CI = 5%, 10%) for the quarter, 5%, 8%, and 15% by increasing Sandy impact level. In elderly persons, all-cause mortality rates increased 10% (95% CI = 5%, 15%) and 13% (95% CI = 10%, 16%) in the month and quarter, respectively. Deaths that were cardiovascular disease-related increased by 6% in both periods, noninfectious respiratory disease-related by 24% in the quarter, infection-related by 20% in the quarter, and unintentional injury-related by 23...

Disaster medicine and public health preparedness, Dec 29, 2017

We characterized evacuations related to Hurricane Sandy, which made landfall in New Jersey on Oct... more We characterized evacuations related to Hurricane Sandy, which made landfall in New Jersey on October 29, 2012. We analyzed data from the 2014 New Jersey Behavioral Risk Factor Survey. The proportion of respondents reporting evacuation was used to estimate the number of New Jersey adults who evacuated. We determined evacuation rates in heavily impacted and less-impacted municipalities, as well as evacuation rates for municipalities under and not under mandatory evacuation orders. We tested associations between demographic and health factors, such as certain chronic health conditions, and evacuation. Among respondents, 12.7% (95% CI: 11.8%-13.6%) reported evacuating, corresponding to approximately 880,000 adults. In heavily impacted municipalities, 17.0% (95% CI: 15.2%-18.7%) evacuated, compared with 10.1% (95% CI: 9.0%-11.2%) in less-impacted municipalities. In municipalities under mandatory evacuation orders, 42.5% (95% CI: 35.1%-49.8%) evacuated, compared with 11.8% (95% CI: 10.9%...

Medical Economics, Nov 20, 2000

Early in her career, the author struggled to make sense of a woman&s multiple symptoms. The t... more Early in her career, the author struggled to make sense of a woman&s multiple symptoms. The truth shocked and humbled her.

Disaster Medicine and Public Health Preparedness, 2016

ObjectiveEvacuation and damage following a widespread natural disaster may affect short-term acce... more ObjectiveEvacuation and damage following a widespread natural disaster may affect short-term access to medical care. We estimated medical care needs in New Jersey following Hurricane Sandy in 2012.MethodsHurricane Sandy-related questions regarding medical needs included in the Behavioral Risk Factor Surveillance System survey were administered to survey respondents living in New Jersey when Sandy occurred.ResultsRecently arrived foreign-born residents were more likely than US-born residents to need medical care following Sandy. Others with greater medical needs included the uninsured and evacuees. Persons who evacuated or lived in areas that experienced the greatest hurricane impact were less likely to be able to fill a prescription. Only 15% of New Jerseyans were aware of the Emergency Pharmaceutical Assistance Program (EPAP), a federal program which allows prescription refills for the uninsured following a disaster. Recently arrived foreign-born residents and the uninsured were le...

MMWR. Morbidity and Mortality Weekly Report, 2015

BACKGROUND: In September 2012, the New Jersey Department of Health (NJDOH) was notified of 6 faci... more BACKGROUND: In September 2012, the New Jersey Department of Health (NJDOH) was notified of 6 facilities that received 1443 vials of contaminated methylprednisolone acetate (MPA) from the New England Compounding Company (NECC), associated with fungal infections. To manage the scope of this outbreak, NJDOH formed an outbreak investigation team and initiated the Incident Command Structure (ICS) with section leads (ie clinical, surveillance, logistics) to manage identification of persons potentially exposed to MPA and to perform surveillance for associated infections. METHODS: NJDOH reached out to facilities that received MPA along with local health departments (LHDs) and epidemiologists. Facilities were asked to account for all vials of MPA received, and to identify and notify exposed patients with assistance of LHDs. NJDOH provided line-lists, data-collection templates and talking points to facilitate notification, symptom assessment, and patient tracking. NJDOH provided written guida...

Background: Mumps, a vaccine-preventable disease, is characterized by fever and inflammation of t... more Background: Mumps, a vaccine-preventable disease, is characterized by fever and inflammation of the salivary glands; complications include orchitis, oophoritis, deafness, and meningoencephalitis. In September 2009, we identified a mumps outbreak in NJ linked to a larger outbreak of >400 cases in NY and Canada and associated with a tradition-observant religious community. The index case for the larger outbreak was in a NY child who had traveled to the United Kingdom where genotype G mumps virus was circulating. Objectives: We investigated the NJ outbreak to identify the source, characterize the outbreak, and develop control measures. Methods: We defined a probable case as a clinically-compatible illness; a confirmed case had either laboratory-confirmation or an epidemiologic link to another confirmed or probable case. We interviewed patients and their physicians by telephone and collected laboratory information. Results: As of December 3, a total of 80 confirmed and probable cases...

Background: On December 31, 2007, local authorities notified Ocean County Health Department and t... more Background: On December 31, 2007, local authorities notified Ocean County Health Department and the New Jersey Department of Health and Senior Services (OCHD/NJDHSS) of intentional inappropriate vaccination practices (IVPs) by a Vaccines for Children (VFC) provider. VFC provides no-cost vaccines for eligible populations of children. IVPs can result in susceptibility to vaccine-preventable diseases (VPDs), necessitate revaccination campaigns, and cost $20 million/year. OCHD/NJDHSS investigated the physician's practice to identify the affected population and ascertain the need for a revaccination campaign. Methods: OCHD/NJDHSS analyzed 20012007 county-level VPD incidence data to identify trends; data before 2001 were unavailable. Using the physician's medical records, investigators identified recorded vaccination events (RVE) during 19992007, which were matched to VFC distribution records to obtain vaccine expiration dates. Non-VFC distribution records were unavailable. Result...