Marci Layton

New York City Department of Health and Mental Hygiene, New York, United States

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Publications (10)139.65 Total impact

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    ABSTRACT: The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has operated a syndromic surveillance system based on emergency department (ED) chief-complaint data since November 2001. This system was created for early detection of infectious-disease outbreaks, either natural or intentional. However, limited documentation exists regarding epidemiologic field investigations conducted in response to syndromic surveillance signals. DOHMH conducted field investigations to characterize syndromic surveillance signals by person, place, and time and to determine whether signals represented true infectious-disease outbreaks. A DOHMH physician reviews ED-based syndromic surveillance results daily to look for signals. When necessary, field investigations are conducted and consist of a review of the patient line list, telephone interviews with hospital staff, chart reviews, interviews with patients, and collection and testing of specimens. In November 2002, a series of citywide signals for diarrhea and vomiting syndromes, which coincided with institutional outbreaks consistent with viral gastroenteritis, prompted DOHMH to send mass e-mail notification to NYC ED directors and institute collection of stool specimens. Three of four specimens collected were positive for norovirus. In December 2002, DOHMH investigated why an ED syndromic signal was not generated after 15 ill patients were transferred to a participating ED during a gastrointestinal outbreak at a nursing home. Field investigation revealed varying chief complaints, multiple dates of ED visits, and a coding error in a complementary DOHMH syndromic system, and confirmed a seasonal norovirus outbreak. During March 2003, the system generated a 4-day citywide respiratory signal and a simultaneous 1-day hospital-level fever signal in a predominantly Asian community. In those instances, epidemiologic investigation provided reassurance that severe acute respiratory syndrome was not present. Detailed field investigations of syndromic signals can identify the etiology of signals and determine why a given syndromic surveillance system failed to detect an outbreak captured through traditional surveillance. Validation of the utility of syndromic surveillance to detect infectious-disease outbreaks is necessary to justify allocating resources for this new public health tool.
    MMWR. Morbidity and mortality weekly report 10/2004; 53 Suppl:184-9.
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    ABSTRACT: Cutaneous anthrax is a rare zoonotic disease in the United States. The clinical diagnosis traditionally has been established by conventional microbiological methods, such as culture and gram staining. However, these methods often yield negative results when patients have received antibiotics. During the bioterrorism event of 2001, we applied two novel immunohistochemical assays that can detect Bacillus anthracis antigens in skin biopsy samples even after prolonged antibiotic treatment. These assays provided a highly sensitive and specific method for the diagnosis of cutaneous anthrax, and were critical in the early and rapid diagnosis of 8 of 11 cases of cutaneous anthrax during the outbreak investigation. Skin biopsies were obtained from 10 of these 11 cases, and histopathological findings included various degrees of ulceration, hemorrhage, edema, coagulative necrosis, perivascular inflammation, and vasculitis. Serology was also an important investigation tool, but the results required several weeks because of the need to test paired serum specimens. Other tests, including culture, special stains, and polymerase chain reaction assay, were less valuable in the diagnosis and epidemiological investigation of these cutaneous anthrax cases. This report underscores the critical role of pathology in investigating potential bioterrorism events and in guiding epidemiological studies, a role that was clearly demonstrated in 2001 when B. anthracis spores were intentionally released through the United States postal system.
    American Journal Of Pathology 11/2003; 163(5):1901-10. DOI:10.1016/S0002-9440(10)63548-1 · 4.60 Impact Factor
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    ABSTRACT: Objectives: To improve detection of clinical syndromes most indicative of WN virus infection in 2000, the New York City Department of Health (DOH) conducted passive (PS, n=40 hospitals) or active physician (APS, n= 26 hospitals) surveillance for patients with encephalitis and aseptic meningitis. Methods: Each hospital in New York City was classified as a PS or APS surveillance site. To compare the completeness of reporting of PS and APS surveillance sites for the 2000 WN season, capture-recapture analyses were conducted. DOH WN surveillance data were compared to hospital discharge data on patients identified as having viral meningitis or encephalitis using International Classification of Diseases, Ninth Revision (ICD-9) codes for PS and APS sites. Medical records of cases identified by hospital ICD-9 discharge data were reviewed to verify the diagnosis of encephalitis or viral meningitis and determine whether they met DOH suspected WN reporting criteria. Results: During the surveillance period (6/1/00-9/30/00), PS hospitals reported 131 cases meeting DOH criteria and APS hospitals reported 169 such cases; hospital ICD-9 discharge data review identified 197 patients meeting DOH criteria at PS sites and 187 such patients at APS sites. The estimated total numbers of encephalitis or aseptic meningitis cases meeting reporting criteria were 331 (95% CI 295-367) for PS sites and 326 (95% CI 297-355) for APS sites. Based on these estimates, the completeness of reporting to the DOH by PS was 40% and by APS was 52%. Of the 14 laboratory-confirmed WN positive cases reported for 2000, PS detected 3 (21%) and APS detected 11 (79%). Conclusions: Surveillance for clinical syndromes associated with a new or emerging disease is challenging. APS detected more suspected and positive WN cases than PS, but was more labor-intensive and time consuming. Many cases of encephalitis or aseptic meningitis may go unreported by provider-based surveillance, whether passive or active, even in an area with high provider and public awareness of WN virus.
    Infectious Diseases Society of America 2003 Annual Meeting; 10/2003
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    ABSTRACT: Since 1998, the New York City Department of Health has used New York City Emergency Medical Services (EMS) ambulance dispatch data to monitor for a communitywide rise in influenzalike illness (ILI) as an early detection system for bioterrorism. A clinical validation study was conducted during peak influenza season at six New York City emergency departments (EDs) to compare patients with ILI brought in by ambulance with other patients to examine potential biases associated with ambulance dispatch-based surveillance. We also examined the utility of 4 EMS call types (selected from 52) for case detection of ILI. Clinical ILI was defined as fever (temperature higher than 100 degrees F) on history or exam, along with either cough or sore throat. Of the 2,294 ED visits reviewed, 522 patients (23%) met the case definition for ILI, 64 (12%) of whom arrived by ambulance. Patients with ILI brought in by ambulance were older, complained of more severe symptoms, and were more likely to undergo diagnostic testing, be diagnosed with pneumonia, and be admitted to the hospital than patients who arrived by other means. The median duration of symptoms prior to presenting to the ED, however, was the same for both groups (48 hours). The selected call types had a sensitivity of 58% for clinical ILI, and a predictive value positive of 22%. Individuals with symptoms consistent with the prodrome of inhalational anthrax were likely to utilize the EMS system and usually did so early in the course of illness. While EMS-based surveillance is more sensitive for severe illness and for illness affecting older individuals, there is not necessarily a loss of timeliness associated with EMS-based (versus ED-based) surveillance.
    Journal of Urban Health 07/2003; 80(2 Suppl 1):i50-6. DOI:10.1007/PL00022315 · 1.94 Impact Factor
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    ABSTRACT: To develop consensus-based recommendations for measures to be taken by medical and public health professionals if hemorrhagic fever viruses (HFVs) are used as biological weapons against a civilian population. The Working Group on Civilian Biodefense included 26 representatives from academic medical centers, public health, military services, governmental agencies, and other emergency management institutions. MEDLINE was searched from January 1966 to January 2002. Retrieved references, relevant material published prior to 1966, and additional sources identified by participants were reviewed. Three formal drafts of the statement that synthesized information obtained in the evidence-gathering process were reviewed by the working group. Each draft incorporated comments and judgments of the members. All members approved the final draft. Weapons disseminating a number of HFVs could cause an outbreak of an undifferentiated febrile illness 2 to 21 days later, associated with clinical manifestations that could include rash, hemorrhagic diathesis, and shock. The mode of transmission and clinical course would vary depending on the specific pathogen. Diagnosis may be delayed given clinicians' unfamiliarity with these diseases, heterogeneous clinical presentation within an infected cohort, and lack of widely available diagnostic tests. Initiation of ribavirin therapy in the early phases of illness may be useful in treatment of some of these viruses, although extensive experience is lacking. There are no licensed vaccines to treat the diseases caused by HFVs.
    JAMA The Journal of the American Medical Association 06/2002; 287(18):2391-405. DOI:10.1001/jama.287.18.2391 · 30.39 Impact Factor
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    ABSTRACT: Concern for potential bioterrorist attacks causing mass casualties has increased recently. Particular attention has been paid to scenarios in which a biological agent capable of person-to-person transmission, such as smallpox, is intentionally released among civilians. Multiple public health interventions are possible to effect disease containment in this context. One disease control measure that has been regularly proposed in various settings is the imposition of large-scale or geographic quarantine on the potentially exposed population. Although large-scale quarantine has not been implemented in recent US history, it has been used on a small scale in biological hoaxes, and it has been invoked in federally sponsored bioterrorism exercises. This article reviews the scientific principles that are relevant to the likely effectiveness of quarantine, the logistic barriers to its implementation, legal issues that a large-scale quarantine raises, and possible adverse consequences that might result from quarantine action. Imposition of large-scale quarantine-compulsory sequestration of groups of possibly exposed persons or human confinement within certain geographic areas to prevent spread of contagious disease-should not be considered a primary public health strategy in most imaginable circumstances. In the majority of contexts, other less extreme public health actions are likely to be more effective and create fewer unintended adverse consequences than quarantine. Actions and areas for future research, policy development, and response planning efforts are provided.
    JAMA The Journal of the American Medical Association 01/2002; 286(21):2711-7. DOI:10.1001/jama.286.21.2711 · 30.39 Impact Factor
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    American Journal of Public Health 09/2000; 90(8):1327-8. DOI:10.2105/AJPH.90.8.1327 · 4.23 Impact Factor
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    ABSTRACT: The Working Group on Civilian Biodefense has developed consensus-based recommendations for measures to be taken by medical and public health professionals following the use of plague as a biological weapon against a civilian population. The working group included 25 representatives from major academic medical centers and research, government, military, public health, and emergency management institutions and agencies. MEDLINE databases were searched from January 1966 to June 1998 for the Medical Subject Headings plague, Yersinia pestis, biological weapon, biological terrorism, biological warfare, and biowarfare. Review of the bibliographies of the references identified by this search led to subsequent identification of relevant references published prior to 1966. In addition, participants identified other unpublished references and sources. Additional MEDLINE searches were conducted through January 2000. The first draft of the consensus statement was a synthesis of information obtained in the formal evidence-gathering process. The working group was convened to review drafts of the document in October 1998 and May 1999. The final statement incorporates all relevant evidence obtained by the literature search in conjunction with final consensus recommendations supported by all working group members. An aerosolized plague weapon could cause fever, cough, chest pain, and hemoptysis with signs consistent with severe pneumonia 1 to 6 days after exposure. Rapid evolution of disease would occur in the 2 to 4 days after symptom onset and would lead to septic shock with high mortality without early treatment. Early treatment and prophylaxis with streptomycin or gentamicin or the tetracycline or fluoroquinolone classes of antimicrobials would be advised.
    JAMA The Journal of the American Medical Association 06/2000; 283(17):2281-90. · 30.39 Impact Factor
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    ABSTRACT: To develop consensus-based recommendations for measures to be taken by medical and public health professionals following the use of smallpox as a biological weapon against a civilian population. The working group included 21 representatives from staff of major medical centers and research, government, military, public health, and emergency management institutions and agencies. Evidence The first author (D.A.H.) conducted a literature search in conjunction with the preparation of another publication on smallpox as well as this article. The literature identified was reviewed and opinions were sought from experts in the diagnosis and management of smallpox, including members of the working group. The first draft of the consensus statement was a synthesis of information obtained in the evidence-gathering process. Members of the working group provided formal written comments that were incorporated into the second draft of the statement. The working group reviewed the second draft on October 30, 1998. No significant disagreements existed and comments were incorporated into a third draft. The fourth and final statement incorporates all relevant evidence obtained by the literature search in conjunction with final consensus recommendations supported by all working group members. Specific recommendations are made regarding smallpox vaccination, therapy, postexposure isolation and infection control, hospital epidemiology and infection control, home care, decontamination of the environment, and additional research needs. In the event of an actual release of smallpox and subsequent epidemic, early detection, isolation of infected individuals, surveillance of contacts, and a focused selective vaccination program will be the essential items of an effective control program.
    JAMA The Journal of the American Medical Association 07/1999; 281(22):2127-37. · 30.39 Impact Factor
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    ABSTRACT: Wide geographic variation in the prevalence of drug-resistant Streptococcus pneumoniae demonstrates the importance of tracking antimicrobial resistance locally. This survey of hospital microbiology laboratories in New York City found that penicillin resistance (MIC > or = 2.0 micrograms/ml) increased from 1.5% of S. pneumoniae isolates in 1993 to 6.3% in 1995 and that in 1995, one-third of isolates nonsusceptible to penicillin (MIC > or = 0.1 microgram/ml) were also nonsusceptible to an extended-spectrum cephalosporin (MIC > or = 1 microgram/ml).
    Emerging infectious diseases 01/1998; 4(1):113-6. DOI:10.3201/eid0401.980116 · 7.33 Impact Factor