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At least 19 records

Addressing delayed case reporting in infectious disease forecast modeling

Infectious disease forecasting is of great interest to the public health community and policymakers, since forecasts can provide insight into disease dynamics in the near future and inform interventions. Due to delays in case reporting, however, forecasting models may often underestimate the current and future disease burden. In this paper, we propose a general framework for addressing reporting delay in disease forecasting efforts with the goal of improving forecasts. We propose strategies for leveraging either historical data on case reporting or external internet-based data to estimate the amount of reporting error. We then describe several approaches for adapting general forecasting pipelines to account for under- or over-reporting of cases. We apply these methods to address reporting delay in data on dengue fever cases in Puerto Rico from 1990 to 2009 and to reports of influenza-like illness (ILI) in the United States between 2010 and 2019. Through a simulation study, we compare method performance and evaluate robustness to assumption violations. Our results show that forecasting accuracy and prediction coverage almost always increase when correction methods are implemented to address reporting delay. Some of these methods required knowledge about the reporting error or high quality external data, which may not always be available. Provided alternatives include excluding recently-reported data and performing sensitivity analysis. This work provides intuition and guidance for handling delay in disease case reporting and may serve as a useful resource to inform practical infectious disease forecasting efforts.

59 BASIC BIOLOGICAL SCIENCES↗

Case report: Fatal Legionella infection diagnosed via by metagenomic next-generation sequencing in a patient with chronic myeloid leukemia

Legionella is an aerobic, gram-negative, intracellular pathogen and is an important cause of community-acquired pneumonia. Legionella pneumophila is the most common causative agent of Legionella pneumonia. Clinical diagnosis of Legionella pneumonia is challenging due to the lack of specific clinical manifestations and the low positive rates of conventional pathogen detection methods. In this study, we report a case of a patient with chronic myeloid leukemia who developed rigors and high fever after chemotherapy and immunotherapy. Chest computed tomography revealed consolidation in the left lower lobe of the lung and ground-glass opacities in both lower lobes. Multiple blood cultures showed Escherichia coli , Staphylococcus aureus , Bacillus licheniformis , and positive results in the β-D-glucan test (G test). The patient was treated with various sensitive antimicrobial agents, including meropenem plus fluconazole, meropenem plus carpofungin, and vancomycin. Unfortunately, the patient’s condition gradually worsened and eventually resulted in death. On the following day of death, metagenomic next-generation sequencing (mNGS) of 1whole blood revealed L. pneumophila pneumonia with concurrent bloodstream infection (blood mNGS reads 114,302). These findings suggest that when conventional empirical antimicrobial therapy proves ineffective for critically ill patients with pneumonia, the possibility of combined Legionella infection must be considered, and mNGS can provide a diagnostic tool in such cases.

Bu, Chunhong↗

Case Report: Differential diagnosis of hematuria in the emergency department: emphasizing double J stent-inferior vena cava fistula

Introduction Hematuria, a common clinical indicator of genitourinary tract pathology, arises from diverse etiologies including calculi, infections, malignancies, trauma, and iatrogenic causes. Initial evaluation requires hemodynamic assessment, identification of underlying causes, and urinary drainage optimization. This report highlights a rare case of iatrogenic hematuria secondary to double-J stent migration into the inferior vena cava. Case presentation A Chinese male presented with acute left flank pain and gross hematuria persisting for 4 h. Diagnostic imaging revealed a left ureteral stone, prompting double-J stent placement at a local hospital. Despite intervention, hematuria worsened, necessitating abdominal CT. Imaging identified proximal migration of the left double-J stent into the inferior vena cava, with no evidence of vascular injury. Due to concerns regarding inadequate drainage and infection risk, conservative management without catheter clamping was initiated prior to referral. Definitive treatment involved ureteroscopic stent removal under direct visualization at our institution, resulting in rapid symptom resolution. Conclusion This case emphasizes three critical clinical insights: (1) Persistent postoperative hematuria warrants consideration of iatrogenic causes, particularly following urologic device placement. (2) Imaging modalities, especially CT, are indispensable for detecting atypical stent migration. (3) Comprehensive history-taking must include prior urologic interventions to guide differential diagnosis. While double-J stent migration into major vessels remains exceptionally rare, its recognition prevents delayed management of potentially life-threatening complications. Clinicians should maintain heightened vigilance for device-related hematuria in patients with refractory symptoms post-procedurally, ensuring prompt imaging evaluation and multidisciplinary intervention when indicated.

Qi, Wenqi↗

SARS-CoV-2 Cases Reported on International Arriving and Domestic Flights: United States, January 2020–December 2021

Objectives. To describe trends in the number of air travelers categorized as infectious with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2; the virus that causes COVID-19) in the context of total US COVID-19 vaccinations administered, and overall case counts of SARS-CoV-2 in the United States. Methods. We searched the Quarantine Activity Reporting System (QARS) database for travelers with inbound international or domestic air travel, a positive SARS-CoV-2 lab result, and a surveillance categorization of SARS-CoV-2 infection reported during January 2020 to December 2021. Travelers were categorized as infectious during travel if they had arrival dates from 2 days before to 10 days after symptom onset or a positive viral test. Results. We identified 80 715 persons meeting our inclusion criteria; 67 445 persons (83.6%) had at least 1 symptom reported. Of 67 445 symptomatic passengers, 43 884 (65.1%) reported an initial symptom onset date after their flight arrival date. The number of infectious travelers mirrored the overall number of US SARS-CoV-2 cases. Conclusions. Most travelers in the study were asymptomatic during travel, and therefore unknowingly traveled while infectious. During periods of high community transmission, it is important for travelers to stay up to date with COVID-19 vaccinations and consider wearing a high-quality mask to decrease the risk of transmission. (Am J Public Health. 2023;113(8):904–908. https://doi.org/10.2105/AJPH.2023.307325 )

Public, Environmental & Occupational Health↗

Treatment of refractory oral lichen planus using direct antiviral agents in a patient with chronic hepatitis C: A case report

Abstract Oral lichen planus (OLP) is a chronic inflammatory and immunologically mediated mucocutaneous disease with a high prevalence in hepatitis C virus (HCV)‐infected patients. Interferon (IFN)‐free direct‐acting antiviral drugs (DAA) have been recommended for the treatment of patients with extrahepatic manifestations of HCV infection. Herein, we present the case of a 65‐year‐old woman who was diagnosed with OLP and chronic hepatitis C. She received DAA treatment with sofosbuvir (SOF) and ribavirin (RBA) at 75 years of age, which led to partial disappearance of the OLP and complete eradication of HCV. Thus, the patient was effectively treated without any major side effects.

Harada, Koji↗

Urbanization may enhance tornado potential: A single case report

Tornadoes pose a risk of catastrophic economic loss and casualty in the United States. Modification of land use by urbanization alters the meteorological conditions that may impact tornado formation and intensification processes. Here we explored the simulated impact of Kansas City urbanization on the tornado potential of a supercell storm. In this studied case, we found that urbanization might enhance tornado potential by a) strengthening the low-level streamwise vorticity in the storm inflow region, thus forming stronger rotating updrafts; and b) intensifying near-surface horizontal vorticity near the boundary of the forward-flank cold pool which increases the ingestion, tilting, and stretching of streamwise horizontal vorticity into vertical vorticity. The former results from the stronger east-to-west pressure perturbation gradient due to the faster, stronger outflow boundary, and the latter is mainly a result of stronger cold fronts and a better alignment of storm-relative inflow with the horizontal vorticity vector. We emphasize that our conclusions only represent one possibility of how urbanization would affect tornado potential, and a more systematic examination is needed to achieve a more general conclusion.

54 ENVIRONMENTAL SCIENCES↗

Powering the Blue Economy - Ocean Observing Use Cases Report

The "Powering the Blue Economy" (PBE) Report identified ocean observing and autonomous underwater vehicle (AUV) recharge as near-term markets with significant potential for marine energy integration when specified qualitative and quantitative assessment criteria were used. The ocean observing market (including AUVs) scored high relative to other markets analyzed in the PBE Report with respect to market size, marine renewable energy (MRE) compatibility with functional requirements, competitive positioning (i.e., MRE versus other power sources), path to market, and alignment to the Department of Energy Water Power Technologies Office (WPTO) and other agencies' objectives. Based on this scoring, Pacific Northwest National Laboratory (PNNL) and the National Renewable Energy Laboratory (NREL) pursued the development of five use cases that represent a spectrum of ocean observation platforms, fixed and mobile, to explore the present and future power needs that might be satisfied by marine energy. The use cases were described and analyzed for this potential by examining current missions and future needs, evaluating the mix of renewable energy sources that might satisfy those needs at sea, and understanding the overall cost drivers that might enable this application.

14 SOLAR ENERGY↗

Spatio-temporal Estimates of Disease Transmission Parameters for COVID-19 with a Fully-Coupled, County-Level Model of the United States

Sandia National Laboratories has developed a capability to estimate parameters of epidemiological models from case reporting data to support responses to the COVID-19 pandemic. A differentiating feature of this work is the ability to simultaneously estimate county-specific disease transmission parameters in a nation-wide model that considers mobility between counties. The approach is focused on estimating parameters in a stochastic SEIR model that considers mobility between model patches (i.e., counties) as well as additional infectious compartments. The inference engine developed by Sandia includes (1) reconstruction and (2) transmission parameter inference. Reconstruction involves estimating current population counts within each of the compartments in a modified SEIR model from reported case data. Reconstruction produces input for the inference formulations, and it provides initial conditions that can be used in other modeling and planning efforts. Inference involves the solution of a large-scale optimization problem to estimate the time profiles for the transmission parameters in each county. These provide quantification of changes in the transmission parameter over time (e.g., due to impact of intervention strategies). This capability has been implemented in a Python-based software package, epi_inference, that makes extensive use of Pyomo [5] and IPOPT [10] to formulate and solve the inference formulations.

42 ENGINEERING↗

Case studies of robots and automation as health/safety interventions in small manufacturing enterprises

This article reviews the experiences of 63 case studies of small businesses (<250 employees) with manufacturing automation equipment acquired through a health/safety intervention grant program. The review scope included equipment technologies classified as industrial robots (n = 17), computer numerical control (CNC) machining (n = 29), or other programmable automation systems (n = 17). Descriptions of workers' compensation (WC) claim injuries and identified risk factors that motivated the acquisition of the equipment were extracted from grant applications. Other aspects of the employer experiences, including qualitative and quantitative assessment of effects on risk factors for musculoskeletal disorders (MSD), effects on productivity, and employee acceptance of the intervention were summarized from the case study reports. Case studies associated with a combination of large reduction in risk factors, lower cost per affected employee, and reported increases in productivity were CNC stone cutting system, CNC/vertical machining system, automated system for bottling, CNC/routing system for plastics products manufacturing, and a CNC/Cutting system for vinyl/carpet. Six case studies of industrial robots reported quantitative reductions in MSD risk factors in these diverse manufacturing industries: snack foods; photographic film, paper, plate, and chemical; machine shops; leather goods and allied products; plastic products; and iron and steel forging. Furthermore, this review of health/safety intervention case studies indicates that advanced (programmable) manufacturing automation, including industrial robots, reduced workplace musculoskeletal risk factors, and improved process productivity in most cases.

42 ENGINEERING↗

Coccidioidomycosis Osteoarticular Dissemination

Valley fever or coccidioidomycosis is a pulmonary infection caused by species of Coccidioides fungi that are endemic to California and Arizona. Skeletal coccidioidomycosis accounts for about half of disseminated infections, with the vertebral spine being the preferred site of dissemination. Most cases of skeletal coccidioidomycosis progress to bone destruction or spread to adjacent structures such as joints, tendons, and other soft tissues, causing significant pain and restricting mobility. Manifestations of such cases are usually nonspecific, making diagnosis very challenging, especially in non-endemic areas. The lack of basic knowledge and research data on the mechanisms defining susceptibility to extrapulmonary infection, especially when it involves bones and joints, prompted us to survey available clinical and animal data to establish specific research questions that remain to be investigated. In this review, we explore published literature reviews, case reports, and case series on the dissemination of coccidioidomycosis to bones and/or joints. We highlight key differential features with other conditions and opportunities for mechanistic and basic research studies that can help develop novel diagnostic, prognostic, and treatment strategies.

59 BASIC BIOLOGICAL SCIENCES↗

COVID-19 Lead Time: Evaluating the timeliness and reliability of reported COVID-19 cases and hospitalizations as leading indicators of hospitalizations and death in the US

The COVID-19 pandemic prompted a reliance on real-time data sources to understand the global spread and impact of the SARS-CoV-2 virus. Reported cases were presumed leading indicators for hospitalizations, while hospitalizations were considered predictive of deaths. However, studies have questioned the consistency of reported cases as leading indicators. This study systematically assesses the reliability of United States (US) reported cases and hospitalizations as leading indicators for hospitalizations and deaths respectively, examining the first 2.5 years of the pandemic (January 2020 - June 2022) across different phases of the pandemic and states. Using correlation analysis, population data, and forecasting accuracy measures, we investigate the temporal relationships and identify possible determinants of lead time variability. Notably, we found that the average lead time between reported cases and hospitalizations across US states is relatively short at 1.76 days, implying that reported cases might not be as effective a leading indicator for hospitalizations as previously believed. Populations with higher comorbidity burdens, such as proportion of smokers, are expected on average to have shorter lead times, possibly due to shorter time to hospitalization among these vulnerable populations.

59 BASIC BIOLOGICAL SCIENCES↗

Daily Forecasting of Regional Epidemics of Coronavirus Disease with Bayesian Uncertainty Quantification, United States

To increase situational awareness and support evidence-based policymaking, we formulated a mathematical model for coronavirus disease transmission within a regional population. This compartmental model accounts for quarantine, self-isolation, social distancing, a nonexponentially distributed incubation period, asymptomatic persons, and mild and severe forms of symptomatic disease. We used Bayesian inference to calibrate region-specific models for consistency with daily reports of confirmed cases in the 15 most populous metropolitan statistical areas in the United States. We also quantified uncertainty in parameter estimates and forecasts. This online learning approach enables early identification of new trends despite considerable variability in case reporting.

59 BASIC BIOLOGICAL SCIENCES↗

Exploring the environmental drivers of human blastomycosis cases in the Midwestern United States

Blastomycosis is a fungal infection endemic to the eastern United States (US) and Canada caused by the inhalation of the fungi Blastomyces spp. Currently, the environmental drivers of disease dynamics are poorly understood. The goal of our work was to explore what environmental conditions are associated with the annual presence of blastomycosis cases, and therefore are potentially explanatory of the ecological niche of Blastomyces. We examined the relationships between reported cases of blastomycosis in three Midwestern US states (Michigan, Minnesota, and Wisconsin) from 2007–2017 in relation to eleven hypothesized environmental conditions, including climate, stream and soil mineral content, and land cover variables. Then, we fit logistic regression models to explore the relationships between the environmental variables and yearly blastomycosis case occurrence. Mean soil moisture, stream sediment mercury content, percent of water within the county, and woody wetlands land cover were all positively associated with the presence of annual cases, with woody wetlands having the most consistent signal across the three states. We also found significant differences in the likelihood of case presence between US states that were not explained by the variables in our model, suggesting state-level differences in case reporting and disease awareness. Our results provide a perspective on potential biological hypotheses to further test regarding environmental controls on the life cycle and ecological niche of Blastomyces.

54 ENVIRONMENTAL SCIENCES↗

A modified Susceptible-Infected-Recovered model for observed under-reported incidence data

Fitting Susceptible-Infected-Recovered (SIR) models to incidence data is problematic when not all infected individuals are reported. Assuming an underlying SIR model with general but known distribution for the time to recovery, this paper derives the implied differential-integral equations for observed incidence data when a fixed fraction of newly infected individuals are not observed. The parameters of the resulting system of differential equations are identifiable. Using these differential equations, we develop a stochastic model for the conditional distribution of current disease incidence given the entire past history of reported cases. We estimate the model parameters using Bayesian Markov Chain Monte-Carlo sampling of the posterior distribution. We use our model to estimate the transmission rate and fraction of asymptomatic individuals for the current Coronavirus 2019 outbreak in eight American Countries: the United States of America, Brazil, Mexico, Argentina, Chile, Colombia, Peru, and Panama, from January 2020 to May 2021. Our analysis reveals that the fraction of reported cases varies across all countries. For example, the reported incidence fraction for the United States of America varies from 0.3 to 0.6, while for Brazil it varies from 0.2 to 0.4.

60 APPLIED LIFE SCIENCES↗

Geo-temporal patterns to design cost-effective interventions for zoonotic diseases -the case of brucellosis in the country of Georgia

Control of zoonosis can benefit from geo-referenced procedures. Focusing on brucellosis, here the ability of two methods to distinguish disease dissemination patterns and promote cost-effective interventions was compared. Geographical data on bovine, ovine and human brucellosis reported in the country of Georgia between 2014 and 2019 were investigated with (i) the Hot Spot (HS) analysis and (ii) a bio-geographical (BG) alternative. More than one fourth of all sites reported cases affecting two or more species. While ruminant cases displayed different patterns over time, most human cases described similar geo-temporal features, which were associated with the route used by migrant shepherds. Other human cases showed heterogeneous patterns. The BG approach identified small areas with a case density twice as high as the HS method. The BG method also identified, in 2018, a 2.6–2.99 higher case density in zoonotic (human and non-human) sites than in non-zoonotic sites (which only reported cases affecting a single species) –a finding that, if corroborated, could support cost-effective policy-making. Three dissemination hypotheses were supported by the data: (i) human cases induced by sheep-related contacts; (ii) human cases probably mediated by contaminated milk or meat; and (iii) cattle and sheep that infected one another. This proof-of-concept provided a preliminary validation for a method that may support cost-effective interventions oriented to control zoonoses. To expand these findings, additional studies on zoonosis-related decision-making are recommended.

60 APPLIED LIFE SCIENCES↗

Large-scale Nonlinear Approaches for Inference of Reporting Dynamics and Unobserved SARS-CoV-2 Infections

This work focuses on estimation of unknown states and parameters in a discrete-time, stochastic, SEIR model using reported case counts and mortality data. An SEIR model is based on classifying individuals with respect to their status in regards to the progression of the disease, where S is the number individuals who remain susceptible to the disease, E is the number of individuals who have been exposed to the disease but not yet infectious, I is the number of individuals who are currently infectious, and R is the number of recovered individuals. For convenience, we include in our notation the number of infections or transmissions, T, that represents the number of individuals transitioning from compartment S to compartment E over a particular interval. Similarly, we use C to represent the number of reported cases.

59 BASIC BIOLOGICAL SCIENCES↗