Academic literature on the topic 'Jefferson County (Ky.)'

The number of cats and dogs impounded and euthanized at animal shelters in the USA has declined dramatically in recent decades. The Humane Society of the United States reported that in 1973 an estimated 13.5 million cats and dogs were euthanized nationwide; according to Best Friends Animal Society, in 2018 that number had been reduced to approximately 733,000. A disproportionate number of animals euthanized at shelters today are free-roaming feral and stray cats, who most often face euthanasia due to their temperament or a lack of shelter space. Over the past decade, two new management tactics—return-to-field (RTF) and targeted trap-neuter-return (TNR)—have exhibited the capacity to contribute to significant reductions in feline euthanasia and intake. The present study examines changes in feline euthanasia and intake, as well as impacts on additional metrics, at a municipal animal shelter in Jefferson County, KY, USA, after an RTF program was added to an ongoing community-based TNR program. A combined total of 24,697 cats were trapped, sterilized, vaccinated, and returned over 8 years as part of the concurrent RTF and TNR programs. Feline euthanasia at Louisville Metro Animal Services (LMAS) declined by 94.1% and feline intake dropped by 42.8%; the live-release rate (LRR) increased by 147.6% due primarily to reductions in both intake and euthanasia. The results of the present study corroborate prior research on the effectiveness of combining RTF and TNR and exemplify the flexibility available to communities in configuring such programs to align with their particular needs and resources.

ObjectiveTo conduct surveillance for acute Hepatitis A virus (HAV) infections in Veterans from states reporting outbreaks among high-risk individuals beginning in fiscal year (FY) 2017.IntroductionAlthough cases of acute HAV have declined in recent years, elevated numbers of HAV infections began to be reported by California and Michigan in the fall of 2016.1,2 Since this time, associated outbreaks have been reported in 9 additional states (Arizona, Utah, Kentucky, Missouri, Tennessee, Indiana, Ohio, Arkansas, and West Virginia).3 No common source of food, beverages or drugs have been identified and transmission appears to be primarily person-to-person with high-risk individuals including people experiencing homelessness, those who use illicit drugs and their close direct contacts. In June 2018, CDC issued a Health Alert Network Advisory providing additional guidance on identification and prevention of HAV and updates on the outbreaks.4 This prompted our office to more closely review our HAV surveillance, to identify Veterans who may be part of these outbreaks, and assess risk factors and outcomes of HAV infection.MethodsWe queried VA data sources starting in FY 2017 (October 1, 2016 – June 30, 2018) for HAV IgM laboratory tests and HAV-coded outpatient encounters and hospitalizations (ICD-10-CM: B15) to identify potential case patients. We performed a detailed chart review on all HAV IgM positive Veterans residing in or treated in an outbreak state during the identified outbreak time frame as reported by each state health department. Data elements collected included: (1) demographics; (2) risk factors, exposures and Hepatitis A vaccination status; (3) treatment locations (i.e. outpatient, Emergency Department, inpatient, intensive care unit); (4) presenting signs and symptoms; (5) laboratory data (including liver function tests (LFTs) and hepatitis testing); and (6) outcomes (i.e. deaths). County-level rates for positive HAV IgM test results were calculated using total unique users of VHA care for matching fiscal year time frames in each county as denominators.ResultsA total of 247 HAV IgM positive individuals were identified among 136,970 HAV IgM tests performed during the study period. Among these, 67 individuals resided in an outbreak state and were identified for further chart review. Additional laboratory review revealed that 5 of the 67 were positive for HAV Total Ab with no HAV IgM performed (all five patients came from a single facility and were asymptomatic at the time of testing). Based on review of clinical data for the remaining 62 HAV IgM positive patients, 22 (35%) did not meet the CSTE clinical case definition criteria5 of having signs or symptoms consistent with acute viral hepatitis plus either jaundice or elevated ALT/AST levels. These patients were either asymptomatic or had relevant symptoms that could be explained by other diagnoses. None had documented jaundice and only 4 had any LFT elevation, which was mild (ALT: 60-83 IU/L, AST: 36-103 IU/L). There was often no mention of the positive HAV IgM test result in the patient visit records. In the cases where the results were documented, it was thought to be a false positive or cross reactivity, related to recent receipt of HAV vaccination, or prolonged persistence of HAV IgM from a prior infection. Patient characteristics of the 40 patients meeting the case definition are summarized in Table 1. None of confirmed cases had documentation of HAV vaccination prior to their acute infection. The top 5 counties of residence among confirmed cases were Jefferson, KY (7, 18%), San Diego, CA (6, 15%), Wayne, MO (4, 10%), Butler, MO (3, 8%) and Macomb, MI (3, 8%). Additionally, the top three counties (Jefferson, San Diego and Wayne) were each noted to have clustering of cases of acute HAV with risk factors of homelessness, substance abuse and/or needle exposure. Incidence rates for HAV IgM+ test results were calculated for all reported outbreak counties and the 25 counties with the highest rates are shown in Figure 1.ConclusionsOccurrence of acute HAV infections among Veterans during October 2016 – June 2018 followed patterns reported by states with outbreaks during the same time frame, including high hospitalization rates. Risk factors of homelessness, substance abuse and/or needle exposures were noted in the Veteran population, similar to national HAV outbreak data. County-level clustering of cases in states with outbreaks was also observed among Veterans, with incidence rates of HAV IgM+ as high as 13 per 10,000 Veterans. Additional education of VA providers is needed regarding recognition of and appropriate testing for acute HAV infections. HAV IgM should not be ordered in asymptomatic patients with normal LFTs as the pretest probability of HAV infection is low, leading to false positives and confusion in interpreting test results. Improving Hepatitis A vaccination rates among Veterans is important, particularly among individuals who are at increased risk for infection or complications from HAV and in outbreak states to limit further spread of this outbreak.References1. Hepatitis A Outbreak in California. Available at: <a href="https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/Hepatitis-A-Outbreak.aspx">https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/Hepatitis-A-Outbreak.aspx</a>. Accessed September 18, 2018.2. Michigan Hepatitis A Outbreak. Available at: <a href="https://www.michigan.gov/mdhhs/0,5885,7-339-71550_2955_2976_82305_82310-447907--,00.html">https://www.michigan.gov/mdhhs/0,5885,7-339-71550_2955_2976_82305_82310-447907--,00.html</a>. Accessed September 18, 2018.3. CDC. 2017 – Outbreaks of hepatitis A in multiple states among people who use drugs and/or people who are homeless. Available at: <a href="https://www.cdc.gov/hepatitis/outbreaks/2017March-HepatitisA.htm">https://www.cdc.gov/hepatitis/outbreaks/2017March-HepatitisA.htm</a>. Accessed September 18, 2018.4. CDC . Health Alert Network Advisory: Outbreak of Hepatitis A Virus (HAV) Infections among Persons Who Use Drugs and Persons Experiencing Homelessness. June 11, 2018. Available at: <a href="https://emergency.cdc.gov/han/han00412.asp">https://emergency.cdc.gov/han/han00412.asp</a>. Accessed September 18, 2018.5. CSTE Position Statement. Hepatitis A, Acute 2012 Case Definition. Available at: <a href="https://wwwn.cdc.gov/nndss/conditions/hepatitis-a-acute/case-definition/2012/">https://wwwn.cdc.gov/nndss/conditions/hepatitis-a-acute/case-definition/2012/</a>. Accessed September 18, 2018.

ObjectiveTo describe the epidemiology of hepatitis A virus (HAV) within the Veterans Health Administration (VHA).IntroductionSince hepatitis A vaccination became widely recommended in the US in the mid-1990’s, rates of acute hepatitis A virus (HAV) infection have steadily declined, however, since 2011, incidence of new cases of HAV appears to be increasing1, often linked with foodborne outbreaks and socio-economic trends such as homelessness and substance abuse.2 In 2016, the CDC reported vaccination coverage among adults aged > 19 was 9.5%, 19-49 was 13.4%, and > 50 was 5.4%3. CDC issued a Health Alert Network Advisory in June 2018 with additional guidance on identification and prevention of HAV and updates on outbreaks in multiple states4 which prompted our program to conduct a more formal review of HAV infections in VHA. Herein we describe recent trends in HAV infection, vaccination and associated risk factors among Veterans.MethodsWe queried VA data sources from October 1, 2016 – June 30, 2018 for HAV IgM laboratory tests, HAV-coded outpatient encounters and hospitalizations (ICD-10-CM: B15), and pharmacy data for hepatitis A vaccinations administered in VHA outpatient and inpatient settings. Patients with coded HAV encounter or hospitalization were compared to individuals with HAV IgM positive results to determine Positive Predictive Value (PPV) of HAV outpatient and inpatient diagnostic codes. A total of 30 (20 outpatient and 10 inpatient HAV encounters across both fiscal years) were randomly selected for detailed chart review to determine if patients were properly coded. Additionally, patients with positive HAV IgM results were analyzed for ICD-10-CM coded outpatient and inpatient encounters indicative of homelessness (ICD-10-CM: Z59.0) and/or substance abuse (ICD-10-CM: F1x, excluding nicotine and cannabis). Rates were calculated using total unique users of VHA care for matching fiscal year time frames and geographic area as denominators. We reviewed a sample of 10 electronic medical records (EMR) of patients from Hawaii to determine vaccine indications in the setting of a state-wide outbreak.ResultsA total of 136,970 HAV IgM tests were performed between October 1, 2016 – June 30, 2018. We identified 247 unique patients with positive HAV IgM. The overall incidence during the study time period was 2.05 per 100,000 population of unique users of VHA care. The state with the highest incidence was West Virginia (9.49 per 100,000) (Figure 1). The overall percent positivity of patients tested for HAV IgM was 0.18% (highest of 1.16% for Kentucky). There were 1,085 HAV-coded outpatient encounters (680 unique patients) but only 58 patients had a positive HAV IgM result (PPV= 8.5%). There were 371 HAV-coded hospitalizations (335 unique patients) but only 39 patients had a positive HAV IgM result (PPV=11.6%). Among these encounters, 270 outpatients had HAV documented as the principal diagnosis for the visit (40 of these were HAV IgM+) and 38 hospitalized patients had HAV as the principal discharge diagnosis code (25 of these were HAV IgM+). Therefore, the PPV when HAV was the principal diagnosis code improved to 14.8% for outpatient encounters and 65.8% for inpatients. Chart review of 30 randomly selected outpatient and inpatient HAV-coded EMR found that only 3 (10%) were correctly coded. Of the remaining 27, 14 (47%) had a positive HAV IgG or HAV Total test result, but negative or no HAV IgM testing, 3 (10%) had a remote history of HAV, 3 (10%) were rule-out HAV but testing was negative, 2 (7%) were miscodes of hepatitis B (HBV) or hepatitis C Virus (HCV) infections, and 5 (17%) were other miscodes. The median vaccination rate during the study time frame was 0.31% [range: 0.11% (Puerto Rico) to 3.48% (Hawaii)]. Additional states with vaccination rates above the median included Kentucky, Michigan, West Virginia, and California (1.05%, 1.02%, 0.93%, 0.67%, respectively). Review of 10 sample EMR of patients from Hawaii, the state with highest vaccination rate, indicated that during their vaccination peak, patients were receiving the 2nd in their 2-dose HAV series, the first having been given in August 2016 at the time of a state-wide outbreak associated with raw scallops. Of 247 patients with positive HAV IgM, 91 (37%) had presence of ICD-10-CM encounter codes for one or more of the following risk factors associated with HAV outbreaks (in order of frequency): substance abuse (63/247; 26%), homelessness (36/247; 15%), HCV (30/247; 12%), and HBV (2/247; 0.8%). Wayne County, MI, Jefferson County, KY, and San Diego County, CA all had clustering of 4 or more cases of acute HAV with risk factors of homelessness, substance abuse, and HCV.ConclusionsAcute HAV was identified in the VHA patient population in states associated with recognized outbreaks during the study time frame. Associated risk factors of substance abuse, homelessness, and HCV found in the Veteran population also matched national HAV outbreak data, including clustering in specific counties where outbreaks occurred. Overall, PPV for HAV-coded encounters was low for both inpatients and outpatients due to frequent miscoding. PPV was improved among inpatients with a principal discharge diagnosis of acute HAV. Vaccination rates were likely underestimated as data prior to the study time period was not evaluated and patients may have received vaccine outside of VA, however rates tended to be above the median in states with known outbreaks, possibly indicating ongoing response. In the case of Hawaii, EMR review indicated that a strong public health response demonstrated by a high post-outbreak vaccination rate with Veterans being monitored and brought back for their 2nd of 2 vaccine series occurred following the August 2016 HAV outbreak associated with raw scallops.2 Additional education of VA providers is warranted regarding the timely recognition of, proper testing for, and coding of acute HAV infections and improving vaccination rates, particularly among individuals who are at increased risk for infection or complications from HAV.References1. CDC. Progress Toward Eliminating Hepatitis A Disease in the United States. MMWR Morb Mortal Wkly Rep. 2016; 65(1): 29-31.2. CDC. Hepatitis A Outbreaks. https://www.cdc.gov/hepatitis/outbreaks/hepatitisaoutbreaks.htm. Accessed September 6, 2018.3. CDC. National Health Interview Survey, Atlanta, GA: US Department of Health and Human Services, CDC; 2016. https://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/pubs-resources/NHIS-2016.html#hepA. Accessed September 12, 2018.4. CDC. Health Alert Network Advisory: Outbreak of Hepatitis A Virus (HAV) Infections among Persons Who Use Drugs and Persons Experiencing Homelessness. June 11, 2018. https://emergency.cdc.gov/han/han00412.asp. Accessed September 6, 2018.

Root-knot nematodes (RKNs), Meloidogyne spp., are some of the most economically important pathogens of cultivated plants. Meloidogyne javanica is one of the most destructive RKN species and is well known for its broad host range and the severe damage it causes to plant roots (Perry et al. 2009). In Feb 2018, four mature dead and dying hybrid lavender plants (Lavandula ×intermedia ‘Phenomenal’) were collected in Edgefield County, South Carolina, and suspected of having Phytophthora root and crown rot (Dlugos and Jeffers 2018). Greenhouse-grown plants had been transplanted in Dec 2016 and Jan 2017 into a sandy loam soil on a site that had been fallow or in pasture for over 30 years. Some plants began to turn gray and die in summer 2017, and approximately 40% of 1230 plants were symptomatic or dead by Feb 2018. Phytophthora spp. were not isolated from the collected plants but were isolated from plants collected on subsequent visits. Instead, all four plants had small, smooth galls on the roots. Lavender roots were examined microscopically (30-70×), and egg masses of RKNs were observed on the galls. Mature, sedentary RKN females were handpicked from galled roots, and perineal patterns of 10 specimens were examined and identified as M. javanica. Juveniles and eggs were extracted from lavender roots by the method of Coolen and D’herde (1972). To confirm species identification, DNA was extracted from 10 individual juveniles, and a PCR assay was conducted using species-specific primers for M. javanica, Fjav/Rjav (Zijlstra et al. 2000). A single amplicon was produced with the expected size of approximately 720 bp, which confirmed identity as M. javanica. To determine pathogenicity, M. javanica from lavender roots were inoculated onto susceptible tomato plants for multiplication, and severe gall symptoms occurred on tomato roots 60 days later. Nematodes were extracted from tomato roots and inoculated onto healthy, rooted cuttings of ‘Phenomenal’ lavender plants growing in pots of soilless medium in a greenhouse. Plants were inoculated with 0, 1000, 2000, 5000, or 10000 eggs and juveniles of M. javanica. Five single-plant replicates were used for each treatment, and plants were randomized on a greenhouse bench. Plants were assessed 60 days after inoculation, and nematodes were extracted from roots and counted. The reproduction factor was 0, 43.8, 40.9, 9.1, 7.7, and 2.6 for initial nematode populations 0, 1000, 2000, 5000, and 10000, respectively, which confirmed pathogenicity (Hussey and Janssen 2002). Meloidogyne javanica also was recovered in Mar 2018 from galled roots on a ‘Munstead’ (L. angustifolia) lavender plant from Kentucky (provided by the Univ. of Kentucky Plant Disease Diagnostic Laboratories), and an unidentified species of Meloidogyne was isolated in Aug 2020 from a ‘Phenomenal’ plant grown in Florida. COI mtDNA sequences from the SC (MZ542457) and KY (MZ542458) populations were submitted to Genbank. M. javanica previously was found associated with field-grown lavender (hybrid and L. angustifolia) in Brazil, but pathogenicity was not studied (Pauletti and Echeverrigaray 2002). To our knowledge, this is the first report of M. javanica pathogenic to L. ×intermedia in the USA, and the first time RKNs have been proven to be pathogenic to Lavandula spp. following Koch’s Postulates. Further studies are needed to investigate the geographic distribution of M. javanica on lavender and the potential threat this nematode poses to lavender production in the USA.