Kathleen F Gensheimer

Augusta Health, Fishersville, Virginia, United States

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Publications (12)40.25 Total impact

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    ABSTRACT: Among vulnerable populations during an influenza pandemic are persons with or at risk for HIV infection, tuberculosis, or chronic viral hepatitis. HIV-infected persons have higher rates of hospitalization, prolonged illness, and increased mortality from influenza compared with the general population. Persons with tuberculosis and chronic viral hepatitis may also be at increased risk of morbidity and mortality from influenza because of altered immunity and chronic illness. These populations also face social and structural barriers that will be exacerbated by a pandemic. Existing infrastructure should be expanded and pandemic planning should include preparations to reduce the risks for these populations.
    American Journal of Public Health 10/2009; 99 Suppl 2:S333-9. · 3.93 Impact Factor
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    ABSTRACT: This report outlines recommendations for postexposure interventions to prevent infection with hepatitis B virus, hepatitis C virus, or human immunodeficiency virus, and tetanus in persons wounded during bombings or other events resulting in mass casualties. Persons wounded during such events or in conjunction with the resulting emergency response might be exposed to blood, body fluids, or tissue from other injured persons and thus be at risk for bloodborne infections. This report adapts existing general recommendations on the use of immunization and postexposure prophylaxis for tetanus and for occupational and nonoccupational exposures to bloodborne pathogens to the specific situation of a mass-casualty event. Decisions regarding the implementation of prophylaxis are complex, and drawing parallels from existing guidelines is difficult. For any prophylactic intervention to be implemented effectively, guidance must be simple, straightforward, and logistically undemanding. Critical review during development of this guidance was provided by representatives of the National Association of County and City Health Officials, the Council of State and Territorial Epidemiologists, and representatives of the acute injury care, trauma and emergency response medical communities participating in CDC's Terrorism Injuries: Information, Dissemination and Exchange (TIIDE) project. The recommendations contained in this report represent the consensus of U.S. federal public health officials and reflect the experience and input of public health officials at all levels of government and the acute injury response community.
    MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control 09/2008; 57(RR-6):1-21; quiz CE1-4.
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    ABSTRACT: People wounded during bombings or other events resulting in mass casualties or in conjunction with the resulting emergency response may be exposed to blood, body fluids, or tissue from other injured people and thus be at risk for bloodborne infections such as hepatitis B virus, hepatitis C virus, human immunodeficiency virus, or tetanus. This report adapts existing general recommendations on the use of immunization and postexposure prophylaxis for tetanus and for occupational and nonoccupational exposures to bloodborne pathogens to the specific situation of a mass casualty event. Decisions regarding the implementation of prophylaxis are complex, and drawing parallels from existing guidelines is difficult. For any prophylactic intervention to be implemented effectively, guidance must be simple, straightforward, and logistically undemanding. Critical review during development of this guidance was provided by representatives of the National Association of County and City Health Officials, the Council of State and Territorial Epidemiologists, and representatives of the acute injury care, trauma, and emergency response medical communities participating in the Centers for Disease Control and Prevention's Terrorism Injuries: Information, Dissemination and Exchange project. There recommendations contained in this report represent the consensus of US federal public health officials and reflect the experience and input of public health officials at all levels of government and the acute injury response community.
    Disaster Medicine and Public Health Preparedness 08/2008; 2(3):150-65. · 1.14 Impact Factor
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    ABSTRACT: A hospital discovered a lapse in the reprocessing procedures for transrectal ultrasound-guided prostate biopsy equipment. An investigation was initiated to assess the risks of transmission of hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and bacteria during prostate biopsies. We offered testing for HBV, HCV, and HIV infection to patients who had undergone prostate biopsies from January 30, 2003, through January 27, 2006. We reviewed their medical records and obtained information on the reprocessing procedures that were in use at the time for the prostate biopsy equipment. A healthcare facility in Maine. Of the 528 patients exposed to improperly reprocessed prostate biopsy equipment, none tested positive for HIV or HCV. Sixteen patients (3%) tested positive for past HBV infection but had no prebiopsy HBV serologic test results available (ie, transmission from improperly reprocessed biopsy equipment was possible), and 11 (2%) had evidence of postbiopsy bacterial infections. The number of cases of HBV and bacterial infections were within reported ranges for this population and were not clustered in time. Review of the reprocessing procedures in use at the time revealed that the manufacturer-recommended brushes for cleaning the reusable biopsy needle guide were never used. Brushes did not come with the equipment and had to be ordered separately. Despite the lack of evidence of pathogen transmission in this investigation, it is critical to review the manufacturer's reprocessing recommendations and to establish appropriate procedures to avert potential pathogen transmission and subsequent patient concerns. This investigation provides a better understanding of the risks associated with improperly reprocessed transrectal ultrasound prostate biopsy equipment and serves as a methodologic tool for future investigations.
    Infection Control and Hospital Epidemiology 05/2008; 29(4):289-93. · 4.02 Impact Factor
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    ABSTRACT: In June 2005, the Advisory Committee on Immunization Practices (ACIP) recommended administering a second dose of varicella vaccine during outbreaks, supplementing the routine 1-dose requirement. From October 2005 to January 2006, a varicella outbreak occurred in Maine in a highly vaccinated elementary school population. We investigated the outbreak, held a school-based vaccination clinic, and assessed costs in implementing ACIP's outbreak-response recommendation. Parents completed questionnaires and case investigation interviews. Personnel at the Maine Center for Disease Control and Prevention, the school in which the outbreak occurred ("school A"), and physician offices completed economic surveys. Forty-eight cases occurred, with no hospitalizations or deaths. Vaccine effectiveness was 86.6% (95% confidence interval, 82.0%-90.1%). Of 240 eligible students, 132 (55.0%) received second-dose vaccination. Implementing ACIP's outbreak-response recommendation was challenging and cost approximately $26,875. Additionally, the routine 1-dose varicella vaccination policy did not confer adequate population immunity to prevent this outbreak. These findings support ACIP's June 2007 recommendation for a routine 2-dose varicella vaccination program.
    The Journal of Infectious Diseases 04/2008; 197 Suppl 2:S101-7. · 5.85 Impact Factor
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    ABSTRACT: Multidrug-resistant Salmonella enterica serotype Typhimurium Definitive Type 104 (DT104) emerged in the 1990s and is associated with greater clinical severity than pansusceptible S. Typhimurium. Although infection with DT104 is common in the United States, it is rarely associated with outbreaks. From October to December 2003, a cluster of DT104 infections with indistinguishable pulsed-field gel electrophoresis patterns was identified in the northeastern United States. A case-control study that assessed exposures compared case patients to age- and geography-matched control subjects. Information on consumer purchasing and grocery store suppliers was used to trace the implicated food to its source. We identified 58 case patients in 9 states by pulsed-field gel electrophoresis. Representative isolates were phage type DT104 and were resistant to ampicillin, chloramphenicol, streptomycin, sulfamethoxazole, and tetracycline (R-type ACSSuT). Of 27 patients interviewed for the case-control study, 41% were hospitalized (median duration of hospitalization, 4 days). Compared with 71 healthy control subjects, case patients had more medical comorbidities (matched odds ratio, 4.3; 95% confidence interval, 1.5-12.7). Illness was associated with consuming store-bought ground beef prepared as hamburgers at home (matched odds ratio, 5.3; 95% confidence interval, 1.9-15.3) and with eating raw ground beef (P< or =.001). Seven case patients (27%), but no control subjects, ate raw ground beef. Product traceback linked cases to a single large ground beef manufacturer previously implicated in a multistate outbreak of highly drug-resistant Salmonella enterica Newport infections in 2002. This first multistate outbreak of highly drug-resistant S. Typhimurium DT104 infection associated with ground beef highlights the need for enhanced animal health surveillance and infection control, prudent use of antimicrobials for animals, improved pathogen reduction during processing, and better product tracking and consumer education.
    Clinical Infectious Diseases 04/2006; 42(6):747-52. · 9.37 Impact Factor
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    ABSTRACT: Increased Clostridium difficile-associated disease (CDAD) in a hospital and an affiliated long-term care facility continued despite infection control measures. We investigated this outbreak to determine risk factors and transmission settings. The CDAD cases were compared according to where the disease was likely acquired based on health care exposure and characterization of isolates from case patients, asymptomatic carriers, and the environment. Antimicrobial susceptibility testing, strain typing using pulsed-field gel electrophoresis, and toxinotyping were performed, and toxins A and B, binary toxin, and deletions in the tcdC gene were detected using polymerase chain reaction. Risk factors were examined in a case-control study, and overall antimicrobial use was compared at the hospital before and during the outbreak. Significant increases were observed in hospital-acquired (0.19 vs 0.86; P < .001) and long-term care facility-acquired (0.04 vs 0.31; P = .004) CDAD cases per 100 admissions as a result of transmission of a toxinotype III strain at the hospital and a toxinotype 0 strain at the long-term care facility. The toxinotype III strain was positive for binary toxin, an 18-base pair deletion in tcdC, and increased resistance to fluoroquinolones. Independent risk factors for CDAD included use of fluoroquinolones (odds ratio [OR], 3.22; P = .04), cephalosporins (OR, 5.19; P = .006), and proton pump inhibitors (OR, 5.02; P = .02). A significant increase in fluoroquinolone use at the hospital took place during the outbreak (185.5 defined daily doses per 1000 patient-days vs 200.9 defined daily doses per 1000 patient-days; P < .001). The hospital outbreak of CDAD was caused by transmission of a more virulent, fluoroquinolone-resistant strain of C difficile. More selective fluoroquinolone and proton pump inhibitor use may be important in controlling and preventing such outbreaks.
    Archives of Internal Medicine 01/2006; 166(22):2518-24. · 11.46 Impact Factor
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    ABSTRACT: During December 2002 to January 2003, a varicella outbreak occurred in an elementary school in Maine. Just 1 month before detecting the outbreak, Maine implemented varicella vaccine requirements for child care but did not require vaccination for school entry. We investigated this outbreak to examine reasons for its occurrence, including vaccine failure. A self-administered questionnaire was sent to all students' parents to determine student disease status, medical conditions, and vaccination status, which was further confirmed by review of medical records. Parental reporting of chickenpox/varicella that occurred since September 1, 2002, in a student who attended the school was used to define a case. Parents of cases were interviewed by telephone about disease characteristics. Disease severity was classified on the basis of the number of skin lesions and the occurrence of complications. Vaccine effectiveness was calculated by comparing varicella attack rates for any disease, for moderate to severe disease, and for severe disease among vaccinated and unvaccinated students. We obtained complete information for 296 (81%) of 364 students. Varicella vaccine coverage was 74% overall and decreased by grade, from 90% in kindergarten to 60% in third grade. Attack rates increased significantly from 14% in kindergarten to 37% in third grade. Of the 53 varicella cases, 36 (68%) were unvaccinated, 12 (22%) were vaccinated, and 5 (10%) had previous disease history. Vaccine effectiveness was 89% (95% confidence interval [CI]: 79-94%) against disease of any severity, 96% (95% CI: 88-99%) against moderate to severe disease, and 100% (95% CI: undefined) against severe disease. Twenty-two percent of unvaccinated students had severe disease and 1 was hospitalized for a skin infection, whereas none of the vaccinated cases reported severe disease. This outbreak was attributable primarily to failure to vaccinate, especially among children in grades 1 through 3. Catch-up vaccination of susceptible older children and adolescents is especially important to prevent accumulation of susceptibility in these groups, in which the natural disease is more severe. School entry requirements will contribute to a more rapid implementation of the existing recommendations for vaccination.
    PEDIATRICS 05/2005; 115(4):900-5. · 4.47 Impact Factor
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    ABSTRACT: Background: Maine has low tuberculosis (TB) incidence and has averaged one case among homeless persons annually since 1993. Between June 2002 and July 2003, eight men linked through residence in homeless shelters or the county jail were diagnosed with TB in Portland, Maine. We investigated the extent of the outbreak and transmission patterns. Methods: We reviewed medical records at health departments, hospitals and jail, interviewed patients, and screened for TB disease and latent infection (LTBI). Persons living or working with a TB patient within three months prior to diagnosis were defined as exposed contacts; exposure sites were identified and grouped by setting type. Induration >=5 mm defined a positive tuberculin skin test (TST) result. Genotyping comprised of spoligotyping, mycobacterial interspersed repetitive units analysis, and IS6110-based restriction fragment length polymorphism analysis was performed on M. tuberculosis isolates. Results: The investigation identified 1066 contacts to eight cases at eleven sites; 692 (65%) received a TST. Fifty-nine (8.5%) had a positive TST; risk factors included exposure to a smear-positive case (OR=2.5; CI 1.1, 5.7) and exposure in shelters versus other service settings (OR 2.3; CI 1.2, 4.4). Five of the eight patients had isolates with identical genotypes (“outbreak strain”). The first of these 5 patients had radiographic evidence of TB 36 months prior to diagnosis. Conclusions: Risk for a positive TST result was associated with (1) exposure to a smear-positive case and (2) exposure in a shelter versus other settings. Medical records corroborated by genotyping results suggest that prolonged infectiousness due to delayed diagnosis in the first patient diagnosed with the outbreak strain contributed to TB transmission. This investigation illustrates the need for low-incidence states to improve early detection of TB among high-risk populations.
    Infectious Diseases Society of America 2004 Annual Meeting; 10/2004
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    ABSTRACT: Background: Unexplained increases in Clostridium difficile - associated disease (CDAD) in acute care hospitals have recently been reported. To determine the role of the community and of long term care facilities (LTCFs) in transmission and the impact of community-wide control measures, we investigated an increase in CDAD at a community hospital. Methods: A case of CDAD was defined as diarrhea and a positive toxin A assay during the pre-outbreak (September, 2002 - April, 2003) or outbreak (May - December, 2003) periods. Pre-outbreak and outbreak cases were compared regarding the setting in which C. difficile was likely acquired; antimicrobial use at the hospital was also compared. To confirm the etiology and assess the role of asymptomatic carriage, C. difficile was isolated from samples of patients with and without diarrhea. Results: Cases increased from 1.1 per 1,000 patient days during the pre-outbreak to 3.4 (P <0.001). Antibiotic usage did not significantly increase (682 vs. 685 defined daily doses/1,000 patient days). During the pre-outbreak and outbreak periods, respectively, 10 cases vs. 36 were acquired in the hospital, 3 vs. 15 in LTCFs, and 6 vs. 9 in the community. C. difficile was isolated in 36 (69%) of 52 sampled cases. C. difficile carriage was found in 6 (14%) of asymptomatic hospital patients and LTCF residents. All isolates were toxin A and B positive. Control measures consisting of Contact Precautions for patients with diarrhea, removal of reusable rectal thermometers, hand washing with soap and water, and enhanced environmental cleaning with 1:10 bleach solution were instituted at the hospital and associated LTCFs. Although rates of CDAD have decreased following implementation of these measures (3.4 to 2.5 per 1,000 patient days, P>0.05), the rate of CDAD remains elevated over the pre-outbreak baseline (2.5 vs. 1.1 per 1,000 patient days, P<0.01). Conclusions: CDAD outbreaks may involve a community-wide increase in the number of cases without apparent change in antimicrobial use. The involvement of multiple settings and prevalence of C. difficile carriage suggest the need to develop new broadly applied measures for controlling such outbreaks.
    Infectious Diseases Society of America 2004 Annual Meeting; 10/2004
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    ABSTRACT: Background: Varicella vaccine was licensed for use in the United States in 1995. Pre- and post- licensure studies demonstrated the vaccine to be 70%-100% effective in preventing varicella. However, a 2002 outbreak investigation in New Hampshire found vaccine effectiveness of only 44%, raising questions about vaccine performance. We assessed vaccine effectiveness in a varicella outbreak in an elementary school in Maine in 2002-03. Methods: All students' parents received a standard questionnaire to determine student disease status, medical conditions, and vaccination status, that was further confirmed by review of medical records. Any student with an acute maculopapulovesicular rash without other cause between October 12, 2002 and January 28, 2003 was considered a case. Parents of cases were interviewed by phone about disease characteristics. Disease severity was classified based on the number of skin lesions and the occurrence of complications. Vaccine effectiveness was calculated by comparing varicella attack rates for any disease, and for moderate-to-severe disease among vaccinated and unvaccinated students. Students with a history of disease were excluded. Results: Of the 364 students, 315 (87%) returned the questionnaire. Varicella vaccine coverage was 74%, and declined by increasing grade from 89% in Kindergarten to 60% in third grade. Varicella occurred in 36 (69%) of 52 unvaccinated students and 12 (8%) of 150 vaccinated students. Vaccine effectiveness was 88% (95% confidence interval (CI): 79%-93%) against any disease and 96% (95% CI: 88%-99%) against moderate-to-severe disease. Vaccinated cases were significantly less likely to have severe disease than unvaccinated cases (relative risk=3.4, 95% CI: 1.7-6.8). Conclusion: Varicella vaccine effectiveness was in the upper limits of pre-licensure estimates. This outbreak was due to failure to vaccinate rather than vaccination failure. School requirements for varicella vaccine will ensure immunity for older children and will reduce future outbreaks.
    Infectious Diseases Society of America 2003 Annual Meeting; 10/2003
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