Don Weiss

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

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Publications (41)149.93 Total impact

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    ABSTRACT: In late October 2014, Ebola virus disease (Ebola) was diagnosed in a humanitarian aid worker who recently returned from West Africa to New York City (NYC). The NYC Department of Health and Mental Hygiene (DOHMH) actively monitored three close contacts of the patient and 114 health care personnel. No secondary cases of Ebola were detected. In collaboration with local and state partners, DOHMH had developed protocols to respond to such an event beginning in July 2014. These protocols included safely transporting a person at the first report of symptoms to a local hospital prepared to treat a patient with Ebola, laboratory testing for Ebola, and monitoring of contacts. In response to this single case of Ebola, initial health care worker active monitoring protocols needed modification to improve clarity about what types of exposure should be monitored. The response costs were high in both human resources and money: DOHMH alone spent $4.3 million. However, preparedness activities that include planning and practice in effectively monitoring the health of workers involved in Ebola patient care can help prevent transmission of Ebola.
    MMWR. Morbidity and mortality weekly report 04/2015; 64(12):321-3.
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    ABSTRACT: This is a prospective intervention study conducted between 2007 and 2011 to evaluate whether an electronic alert can influence provider practice in treatment of skin and soft tissue infections (SSTIs). A best-practice alert (BPA) was programmed to appear for intervention ICD-9 SSTI diagnoses. Controls were patients who had other SSTI ICD-9 codes where the BPA was not programmed to fire. Rate of culture taken in patients was compared between patients in the intervention and control groups. We found that cultures were taken among 13.5% of the intervention group and 5.4% of the control group (p <.0001). A logistic regression analysis controlling for covariates showed the odds of the intervention group having a culture taken was 2.6 times that of the control group. The results of this study support the use of BPAs for improving the management of SSTIs.
    The Journal of medical practice management: MPM 11/2014; 30(3):203-7.
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    ABSTRACT: Background: To control an outbreak of invasive meningococcal disease (IMD) among men who have sex with men (MSM) in New York City (NYC), the NYC Department of Health and Mental Hygiene (DOHMH) recommended vaccination of all HIV-positive MSM and HIV-negative MSM with intimate contact with a man met through an online Web site, digital application or at a bar or party Methods: We used a decision analytic model to estimate the effectiveness and cost-effectiveness of the meningococcal quadrivalent conjugate vaccination campaign as compared to no vaccination. We estimated approximately 60,000 NYC MSM to be targeted through DOHMH recommendations based on NYC Community Health Survey and NYC HIV/AIDS surveillance registry data. Model inputs, including IMD incidence of 20.5 per 100,000 HIV-positive MSM (42% fatal) and 7.6 per 100,000 HIV-negative MSM (20% fatal), were from DOHMH data and published sources. Outcome measures included costs (2012 US dollars), IMD cases averted, IMD deaths averted, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios ($/QALY). Sensitivity analyses were performed on key inputs including herd immunity (base case 20% protection in all unvaccinated MSM). Results: Compared to no vaccination, the targeted vaccination campaign averted an estimated 2.7 IMD cases (modeled range 0.9-6.0) and 1.0 IMD deaths (modeled range 0.2-2.5) and had an incremental cost-effectiveness ratio of $60,100/QALY. At a cost-effectiveness threshold of $100,000/QALY, vaccination remained cost-effective at an IMD incidence as low as 10 per 100,000 persons or at a case fatality rate greater than 13% in all MSM. At a societal willingness to pay consistent with adopted meningococcal vaccination guidelines for adolescents ($230,000/QALY), vaccination was cost-effective at an IMD incidence as low as 5 per 100,000 persons. Results were sensitive to assumptions regarding herd immunity (Figure). Conclusion: Vaccination during a community-wide IMD outbreak among MSM in NYC was projected to avert IMD cases and deaths and had an incremental cost-effectiveness ratio less than $100,000/QALY. Cost-effectiveness was highly dependent on herd immunity.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: BACKGROUND: Mycobacterium marinum, a bacterium found in both freshwater and saltwater, has been reported to cause infections among persons working with fish or who have contact with aquariums. During January–February 2014, the New York City Department of Health and Mental Hygiene (NYCDOHMH) was notified of 25 cases of suspected M. marinum infection among persons purchasing raw or live fish or seafood from Chinese markets. METHODS: A confirmed case was skin or soft-tissue infection of the upper extremity in a person who had handled fish from a NYC market, with symptom onset after June 1, 2013, and evidence of M. marinum by culture, immunohistochemical stain, or polymerase chain reaction. A possible case met clinical and epidemiologic criteria but lacked laboratory confirmation. NYCDOHMH alerted local providers and requested reporting of suspected or confirmed cases. RESULTS: As of March 7, 2014, a total of 35 cases (5 confirmed) had been identified among patrons of 11 Chinese markets in 2 different areas of NYC. Of 23 patients interviewed, median age was 66 years (range: 52–82 years); 18 (78%) were female; and all spoke Cantonese or Mandarin. Twenty patients (87%) reported infection onset during August–November 2013. All patients had prepared live or raw fish or seafood for cooking before symptoms began; 4 (17%) had worn gloves when preparing fish or seafood, and 13 (57%) had purchased live fish from tanks. CONCLUSIONS: This is the first reported M. marinum outbreak among persons purchasing live fish from markets. Persons handling live or raw fish or seafood should wear waterproof gloves. An environmental investigation is ongoing to identify a common distributor or aquafarm and to recommend interventions for disease prevention.
    2014 Council of State and Territorial Epidemiologists Annual Conference; 06/2014
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    ABSTRACT: We diagnosed invasive meningococcal disease by using immunohistochemical staining of embalmed tissue and PCR of vitreous humor from 2 men in New York City. Because vitreous humor is less subject than other body fluids to putrefaction, it is a good material for postmortem analysis.
    Emerging Infectious Diseases 03/2014; 2014(3). DOI:10.3201/eid2003.131245 · 7.33 Impact Factor
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    ABSTRACT: Objectives. We compared school nurse visit syndromic surveillance system data to emergency department (ED) visit data for monitoring illness in New York City schoolchildren. Methods. School nurse visit data recorded in an electronic health record system are used to conduct daily surveillance of influenza-like illness, fever-flu, allergy, asthma, diarrhea, and vomiting syndromes. We calculated correlation coefficients to compare the percentage of syndrome visits to the school nurse and ED for children aged 5 to 14 years, from September 2006 to June 2011. Results. Trends in influenza-like illness correlated significantly (correlation coefficient = 0.89; P < .001) and 72% of school signals occurred on days that ED signaled. Trends in allergy (correlation coefficient = 0.73; P < .001) and asthma (correlation coefficient = 0.56; P < .001) also correlated and school signals overlapped with ED signals on 95% and 51% of days, respectively. Substantial daily variation in diarrhea and vomiting visits limited our ability to make comparisons. Conclusions. Compared with ED syndromic surveillance, the school nurse system identified similar trends in influenza-like illness, allergy, and asthma syndromes. Public health practitioners without school-based surveillance may be able to use age-specific analyses of ED syndromic surveillance data to monitor illness in schoolchildren. (Am J Public Health. Published online ahead of print November 14, 2013: e1-e7. doi:10.2105/AJPH.2013.301411).
    American Journal of Public Health 11/2013; 104(1). DOI:10.2105/AJPH.2013.301411 · 4.23 Impact Factor
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    ABSTRACT: An association between HIV and invasive meningococcal disease (IMD) has been suggested by several previous studies but has not been fully described in the era of highly active antiretroviral therapy in the United States. To estimate the risk for IMD and death in people living with HIV/AIDS (PLWHA) in New York City (NYC) and the contribution of CD4+ cell count and viral load (VL) to IMD risk. Comparison of the incidence rate of IMD among PLWHA with that in HIV-uninfected persons. Surveillance data on IMD for patients aged 15 to 64 years from 2000 to 2011 were matched to the death and HIV registries to calculate IMD risk and case-fatality ratios. A subset of PLWHA who had a CD4+ cell count and VL measurement near the time of their IMD infection was included in age-matched case-control analyses to assess HIV markers and IMD risk. Retrospective cohort from communicable disease surveillance. 265 persons aged 15 to 64 years with IMD during 2000 to 2011. Meningococcal and HIV data abstracted from surveillance and registry databases, including CD4+ cell counts and VL. The average annual incidence rate of IMD was 0.39 cases per 100 000 persons. The relative risk for IMD among PLWHA in NYC during 2000 to 2011 was 10.0 (95% CI, 7.2 to 14.1). Among PLWHA, patients with IMD were 5.3 times (CI, 1.4 to 20.4 times) as likely as age-matched control patients to have CD4+ counts less than 0.200 × 109 cells/L. Missing data on smoking status and comorbidity. People living with HIV/AIDS in NYC are at increased risk for IMD. Cost-effectiveness and vaccine efficacy studies are needed to evaluate the value of a national recommendation for routine meningococcal vaccination of PLWHA. New York City Tax Levy.
    Annals of internal medicine 10/2013; DOI:10.7326/0003-4819-160-1-201401070-00731 · 16.10 Impact Factor
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    ABSTRACT: We describe the first report of temporally-related cases of Bordetella holmesii bacteremia. Demographic and clinical data were collected through chart abstraction and case-patient interviews. Twenty-two cases were identified from six states. Symptom onset dates ranged from April, 2010 to January, 2011. Median age of cases was 17.1 years and 64% of cases had functional or anatomic asplenia. PFGE profiles of a sample of isolates were identical. These cases occurred during a peak in pertussis outbreaks with documented cases of B. holmesii/B.pertussis respiratory co-infection; whether there is a link between B. holmseii respiratory and bloodstream infection is unknown.
    Clinical Infectious Diseases 10/2013; DOI:10.1093/cid/cit669 · 9.42 Impact Factor
  • MMWR. Morbidity and mortality weekly report 09/2013; 62(38):777.
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    Annals of internal medicine 06/2013; 159(4). DOI:10.7326/0003-4819-159-4-201308200-00674 · 16.10 Impact Factor
  • 2013 Council of State and Territorial Epidemiologists Annual Conference; 06/2013
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    ABSTRACT: Objective Show the benefits of using a generalized linear mixed model (GLMM) to examine long-term trends in asthma syndrome data. Introduction Over the last decade, the application of syndromic surveillance systems has expanded beyond early event detection to include long-term disease trend monitoring. However, statistical methods employed for analyzing syndromic data tend to focus on early event detection. Generalized linear mixed models (GLMMs) may be a useful statistical framework for examining long-term disease trends because, unlike other models, GLMMs account for clustering common in syndromic data, and GLMMs can assess disease rates at multiple spatial and temporal levels (1). We show the benefits of the GLMM by using a GLMM to estimate asthma syndrome rates in New York City from 2007 to 2012, and to compare high and low asthma rates in Harlem and the Upper East Side (UES) of Manhattan. Methods Asthma related emergency department (ED) visits, and patient age and ZIP code were obtained from data reported daily to the NYC Department of Health and Mental Hygiene. Demographic data were obtained from 2010 US Census. ZIP codes that represented high and low asthma rates in Harlem and the UES of Manhattan were chosen for closer inspection. The ratio of weekly asthma syndrome visits to total ED visits was modeled with a Poisson GLMM with week and ZIP code random intercepts (2). Age and ethnicity were adjusted for because of their association with asthma rates (3). Results The GLMM showed citywide asthma rates remained stable from 2007 to 2012, but seasonal differences and significant inter-ZIP code variation were present. The Harlem ZIP code asthma rate that was estimated with the GLMM was significantly higher (5.83%, 95% CI: 3.65%, 9.49%) than the asthma rate in UES ZIP code (0.78%, 95% CI: 0.50%, 1.21%). A linear time component to the GLMM showed no appreciable change over time despite the seasonal fluctuations in asthma rate. GLMM based asthma rates are shown over time (Figure 1). Conclusions GLMMs have several strengths as statistical frameworks for monitoring trends including: Disease rates can be estimated at multiple spatial and temporal levels,Standard error adjustment for clustering in syndromic data allows for accurate, statistical assessment of changes over time and differences between subgroups,“Strength borrowed” (4) from the aggregated data informs small subgroups and smooths trends,Integration of covariate data reduces bias in estimated rates. GLMMs have previously been suggested for early event detection with syndromic surveillance data (5), but the versatility of GLMM makes them useful for monitoring long-term disease trends as well. In comparison to GLMMs, standard errors from single level GLMs do not account for clustering and can lead to inaccurate statistical hypothesis testing. Bayesian hierarchical models (6), share many of the strengths of GLMMS, but are more complicated to fit. In the future, GLMMs could provide a framework for grouping similar ZIP codes based on their model estimates (e.g. seasonal trends and influence on overall trend), and analyzing long-term disease trends with syndromic data.
    04/2013; 5(1).
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    ABSTRACT: BACKGROUND: Hospitalizations with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection have increased in New York City, with substantial geographic variation across neighborhoods. While individual-level risk factors, such as age, sex, HIV infection, and diabetes have been described, the role of neighborhood-level factors (e.g., neighborhood HIV prevalence or income) has not been examined. METHODS: To explore plausible neighborhood-level factors associated with CA-MRSA-related hospitalizations, a retrospective analysis was conducted using New York City hospital discharges from 2006 and New York City-specific survey and health department surveillance data. CA-MRSA-related hospitalizations were identified using diagnosis codes and admission information. Associations were determined by using sex-specific multilevel logistic regression. RESULTS: The CA-MRSA hospitalization rate varied by more than six-fold across New York City neighborhoods. Females hospitalized with CA-MRSA had more than twice the odds of residing in neighborhoods in the highest quintile of HIV prevalence (adjusted odds ratio [AOR]Q5 vs. Q1 2.3, 95%CI: 1.2-2.7). Both males and females hospitalized with CA-MRSA had nearly twice the odds of residing in neighborhoods with moderately high proportion of men who have sex with men (MSM) residing in the neighborhood (males: AORQ4 vs. Q1 1.7, 95%CI: 1.1-2.7; females: AORQ4 vs. Q1 2.0, 95%CI: 1.1-3.6); but this association did not hold for neighborhoods in the highest quintile proportion of MSM (males: AORQ5 vs. Q1 1.2, 95%CI: 0.76-1.8; females: AORQ5 vs. Q1 1.5, 95%CI: 0.82-2.7). CONCLUSIONS: Neighborhood characteristics were associated with CA-MRSA hospitalization odds, independent of individual-level risk factors, and may contribute to the population-level burden of CA-MRSA infection.
    BMC Infectious Diseases 02/2013; 13(1):84. DOI:10.1186/1471-2334-13-84 · 2.56 Impact Factor
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    ABSTRACT: Children are important transmitters of influenza in the community and a number of non-pharmaceutical interventions (NPIs), including hand washing and use of hand sanitizer, have been recommended to mitigate the transmission of influenza, but limited information is available regarding schools' ability to implement these NPIs during an influenza outbreak. We evaluated implementation of NPIs during fall 2009 in response to H1N1 pandemic influenza (pH1N1) by New York City (NYC) public schools. From January 25 through February 9, 2010, an online survey was sent to all the 1,632 NYC public schools and principals were asked to participate in the survey or to designate a school nurse or other school official with knowledge of school policies and characteristics to do so. Of 1,633 schools, 376(23%) accessed and completed the survey. Nearly all respondents (99%) implemented at least two NPIs. Schools that had a Flu Response Team (FRT) as a part of school emergency preparedness plan were more likely to implement the NPI guidelines recommended by NYC public health officials than schools that did not have a FRT. Designation of a room for isolating ill students, for example, was more common in schools with a FRT (72%) than those without (53%) (p<0.001). Implementing an NPI program in a large school system to mitigate the effects of an influenza outbreak is feasible, but there is potential need for additional resources in some schools to increase capacity and adherence to all recommendations. Public health influenza-preparedness plans should include school preparedness planning and FRTs.
    PLoS ONE 01/2013; 8(1):e50916. DOI:10.1371/journal.pone.0050916 · 3.53 Impact Factor
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    ABSTRACT: 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. 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. The matched dataset was used to evaluate syndrome assignment by disease and to calculate the sensitivity and specificity of the influenza-like illness (ILI) syndrome. Citywide ED visits for ILI correlated well with influenza laboratory diagnoses (R=0.92). From October 1, 2009, through March 31, 2010, there were 264,532 ED visits at the five select hospitals, from which the NYC Department of Health and Mental Hygiene (DOHMH) received confirmatory laboratory reports of 655 unique cases of influenza and 1348 cases of RSV. The ED visit of most (56%) influenza cases had been categorized in the fever/flu syndrome; only 15% were labeled ILI. Compared to other influenza-related syndromes, ILI had the lowest sensitivity (15%) but the highest specificity (90%) for laboratory-confirmed influenza. Sensitivity and specificity varied by age group and influenza activity level. The ILI syndrome in the NYC ED syndromic surveillance system served as a specific but not sensitive indicator for influenza during the 2009-2010 influenza season. Despite its limited sensitivity, the ILI syndrome can be more informative for tracking influenza trends than the fever/flu or respiratory syndromes because it is less likely to capture cases of other respiratory viruses. However, ED ILI among specific age groups should be interpreted alongside laboratory surveillance data. ILI remains a valuable tool for monitoring influenza activity and trends as it facilitates comparisons nationally and across jurisdictions and is easily communicated to the public.
    08/2012; 4:e500563f3ea181. DOI:10.1371/500563f3ea181
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    ABSTRACT: In August 2010, the New York City Department of Health and Mental Hygiene (DOHMH) conducted an investigation to identify and provide antibiotic prophylaxis to close contacts of a patient who had died of invasive meningococcal disease. Traditional contact tracing, which relies on interviews with the patient's close associates, identified 3 persons meeting prophylaxis criteria. In addition, DOHMH learned of an Internet site used by the patient to arrange anonymous sexual encounters. By working with the Internet site administrator through a liaison, DOHMH sent notification to 15 additional persons potentially at risk for meningococcal disease; of those, at least 1 met prophylaxis criteria. The Internet has been used previously for partner notification by sexually transmitted disease control programs. This case report illustrates how the Internet can aid contact investigations for other communicable diseases, especially when identifying potential contacts is urgent, patients have died, or contacts are unknown to the patient's associates.
    Journal of public health management and practice: JPHMP 07/2012; 18(4):379-81. DOI:10.1097/PHH.0b013e31823e9569 · 1.47 Impact Factor
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    ABSTRACT: To describe trends in hospitalizations with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in New York City over 10 years and to explore the demographics and comorbidities of patients hospitalized with CA-MRSA infections. Retrospective analysis of hospital discharges from New York State's Statewide Planning and Research Cooperative System database from 1997 to 2006. All patients greater than 1 year of age admitted to New York hospitals with diagnosis codes indicating MRSA who met the criteria for CA-MRSA on the basis of admission information and comorbidities. We determined hospitalization rates and compared demographics and comorbidities of patients hospitalized with CA-MRSA versus those hospitalized with all other non-MRSA diagnoses by multivariable logistic regression. Of 18,226 hospitalizations with an MRSA diagnosis over 10 years, 3,579 (20%) were classified as community-associated. The CA-MRSA hospitalization rate increased from 1.47 to 10.65 per 100,000 people overall from 1997 to 2006. Relative to non-MRSA hospitalizations, men, children, Bronx and Manhattan residents, the homeless, patients with human immunodeficiency virus (HIV) infection, and persons with diabetes had higher adjusted odds of CA-MRSA hospitalization. The CA-MRSA hospitalization rate appeared to increase between 1997 and 2006 in New York City, with residents of the Bronx and Manhattan, men, and persons with HIV infection or diabetes at increased odds of hospitalization with CA-MRSA. Further studies are needed to explore how changes in MRSA incidence, access to care, and other factors may have impacted these rates.
    Infection Control and Hospital Epidemiology 07/2012; 33(7):725-31. DOI:10.1086/666329 · 3.94 Impact Factor
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    ABSTRACT: In May 2001, The New York City Department of Health and Mental Hygiene was informed of a cluster of 4 patients treated at an outpatient gastroenterology center who developed acute hepatitis C virus infection. An investigation identified a total of 12 clinic-associated hepatitis C virus transmissions and the outbreak and was traced to unsafe handling of multidose anesthetic vials and possible re-use of contaminated needles. This report typifies the types of outbreaks that continue to occur despite safe injection guidelines.
    American journal of infection control 05/2012; 41(1). DOI:10.1016/j.ajic.2012.01.022 · 2.33 Impact Factor
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    ABSTRACT: The effects of individual school dismissal on influenza transmission have not been well studied. During the spring 2009 novel H1N1 outbreak, New York City implemented an individual school dismissal policy intended to limit influenza transmission at schools with high rates of influenza-like illness (ILI). Active disease surveillance data collected by the New York City Health Department on rates of ILI in schools were used to evaluate the impact. Sixty-four schools that met the Health Department's criteria for considering dismissal were included in the analysis. Twenty-four schools that met criteria subsequently dismissed all classes for approximately 1 school week. A regression model was fit to these data, estimating the effect of school dismissal on rates of in-school ILI following reconvening, adjusting for potential confounders. The model estimated that, on average, school dismissal reduced the rate of ILI by 7.1% over the entire average outbreak period. However, a large proportion of in-school ILI occurred before dismissal criteria were met. A separate model estimated that school absenteeism rates were not significantly affected by dismissal. Results suggest that individual school dismissal could be considered in situations where schools have a disproportionate number of high-risk students or may be unable to implement recommended preventive or infection control measures. Future work should focus on developing more sensitive indicators of early outbreak detection in schools and evaluating the impact of school dismissal on community transmission.
    Journal of School Health 03/2012; 82(3):123-30. DOI:10.1111/j.1746-1561.2011.00675.x · 1.66 Impact Factor
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    ABSTRACT: Academic literature has recorded increased microbial resistance in the United States and recent news media has adversely portrayed men who have sex with men (MSM) at increased risk for community associated methicillin resistant Staphylococcus aureus (CA-MRSA) transmission. CA-MRSA is a specific type of bacteria resistant to certain antibiotics, which limits treatment options for those needing clinical care. Infection can manifest as painful abscesses and can cause severe illness. With increased CA-MRSA infections overall, and attention given to MSM populations regarding CA-MRSA, as well as the fact that limited data on sociocultural factors that may facilitate transmission, we undertook a qualitative study to explore contextual influences that may fuel infection among MSM in New York City so that public health professionals can better recognize, and respond appropriately to, potential future outbreaks. In-depth interviews were used to qualitatively investigate perceptions and beliefs regarding transmission, as well as community understandings of treatment options. Participants included thirteen MSM who reported a previous CA-MRSA infection and nine community practitioners. A thematic content analysis of these interviews was conducted and data suggests that behaviors and exposures associated with transmission of CA-MRSA are common in certain MSM networks. Specifically, sociocultural influences and methamphetamine use activities were found to contribute to CA-MRSA transmission. We underscore the role of public health and health services practitioners in providing appropriate CA-MRSA awareness and education to MSM populations.
    Journal of Community Health 08/2011; 37(2):458-67. DOI:10.1007/s10900-011-9463-6 · 1.28 Impact Factor