Digital Commons Network^™

The Impact Of Covid-19 On Backyard Poultry-Associated Salmonella In Connecticut, Laura Kasper

Public Health Theses

Introduction: Salmonellosis is the second leading bacterial foodborne illness in the United States, and is mainly characterized by symptoms of gastroenteritis and their consequences in afflicted individuals. Salmonella accounts for 1.35 million infections, 26,500 hospitalizations and 420 deaths in the United States every year. Live poultry act as a reservoir of Salmonella and causes an annual national outbreak. There has yet to be a published study on the impact of COVID-19 lockdowns on the incidence of Salmonella and on the percentage of cases tied to the national poultry outbreak. Methods: Active public health surveillance of Salmonella in Connecticut is conducted …

An Exploration Of Race Differences In Network Exposures To Mass Incarceration, Jessica Lee

Public Health Theses

A growing literature suggests that mass incarceration impacts not only the individual who is incarcerated, but also their partners, family members, and children. However, few studies have examined race differences in network exposure to mass incarceration. This study explores associations between race and various measures of network exposure to incarceration: relationships, interactions with the criminal legal system, and housing. We draw on data from the 2017-2018 baseline survey from the Justice, Housing, and Health Study. Descriptive statistics show that Black respondents are more likely to experience each event we examined compared to whites, except for parental incarceration and receiving threats …

Public Health And Natural Gas Policy In Connecticut, Cheyenne Liberti

Public Health Theses

Due to its adverse impacts on public health via contributions to global climate change and emissions of toxic substances throughout the life cycle, natural gas use should be eliminated as quickly as possible in Connecticut. This project aims to 1) identify the policies and programs concerning all stages of the natural gas life cycle, in and affecting Connecticut; 2) evaluate the capacity of these policies and programs to mitigate public health hazards, promote environmental justice, and achieve rapid elimination of natural gas use; and 3) recommend policy and program alternatives that would accomplish these goals in a more timely manner. …

Analyzing The Restriction Of Mass Gatherings And School Closures/Reopening In China And Iran During The Covid-19 Pandemic With A Public Health Ethics Framework, Esther Luo

Public Health Theses

The COVID-19 pandemic has undoubtedly elevated the status of public health. Concurrently, public health ethics has been brought to the forefront of the field and its practices in several ways. Over the past year, SARS-CoV-2 has affected nearly every country. In both high and low resource settings, policymakers turned to public health to ease the tension placed on health care systems by COVID-19. Governments implemented measures ranging from lockdown orders to mask mandates, all with the primary goal of curbing the spread of SARS-CoV-2. The effectiveness of these interventions has become a salient topic in public health research, and much …

Determinants For Approval And Reimbursement Of Orphan Products In China, Wenlan Mao

Public Health Theses

Rare disease definition varies among countries/regions. China has published The First National List of Rare Diseases, including 121 kinds of rare diseases in 2018. It was the first time that China has defined rare diseases officially. China has also started releasing a range of encouraging regulations regarding orphan drug development and approval in recent years. Nevertheless, the FDA has introduced Orphan Drug Act in the 1980s, Japan has launched a government-led support initiative in the 1990s, and the European Parliament has adopted the Orphan Regulation in 2000. Among the 121 rare diseases, 58 of them have approved treatments in the …

Co-Distribution Of Ambient Light At Night And Incidence Of Human Cancers And Covid-19, Yidan Meng

Public Health Theses

Introduction and BackgroundThere are increasing concerns about the effects of artificial lights on human health, including hormone-related disease and immune functions. In January 2020, the outbreak of COVID-19 disrupted everyone’s life, and people who infected have various severity. Thus, we want to analyze whether people exposed to different ambient light at night (LAN) levels make them more susceptible to COVID-19 for our summer research. Besides the effects of LAN on immune functions, we also discussed the association of LAN and multiple cancers in seven states of Northeastern U.S. We used similar statistical and geographic analysis methods and separate them into …

Impact Of Health Care Access On Delayed Or Missed Adolescent Vaccinations For Tdap, Meningococcal, And Hpv Vaccines Among U.S. Adolescents, Nis-Teen 2018, Maura Iko Nakahata

Public Health Theses

Background: Adolescent vaccination coverage varies considerably between Tdap, meningococcal, and HPV vaccines. While evidence suggests that health care access affects vaccination coverage, evidence does not explain whether access drives delayed or no vaccination. This study evaluates whether measures of health care access are associated with delayed vaccination or not being vaccinated by age 17 years for Tdap, meningococcal, and HPV vaccines when controlling for sociodemographic factors as proxies for vaccine hesitancy. The secondary objective assesses whether health care access measures had consistent associations across the different vaccines. Methods: Using current ACIP recommendations, ‘on-time’, ‘delayed’, and ‘missed’ status by age 17 …

Impact Of Covid-19 On Participants Of A Fruit And Vegetable Program, Christabelle Ong

Public Health Theses

Objective: To investigate the impact of COVID-19 on the participants of a multi-city fruit and vegetable incentive program.Design: A six-month cohort study was conducted. Pre-program and post-program data were collected using an online survey platform. Setting: Eight cities across the United States. Participants: A total of 822 individuals were recruited through local site partners to participate in a fruit and vegetable incentive program (n=822; 79.4% women, 20.6% men; median age: 57 years old). Intervention: Participants received $50 monthly fruit and vegetable vouchers, a sneaker gift card or gift basket, and access to a weight loss app. Main Outcome Measures: The …

The Role Of Histone Demethylase Kdm6a In Mouse Coronavirus Infection, Sonam Patel

Public Health Theses

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of acute respiratory coronavirus disease 2019 (COVID-19), a disease that erupted into a global pandemic in March of 2020.2 Recently, a genome wide CRISPR screen was performed on SARS-lineage coronaviruses and two additional recombinant viruses; the screen revealed host genes essential to coronavirus pathogenesis and entry.7 The screen identified KDM6A, a histone demethylase, as an important pro-viral gene.7 Building upon this observation, in this thesis, I explore the role of Kdm6a in murine hepatitis virus (MHV), a type of mouse coronavirus. MHV is the prototypical model for studying SARS-CoV-2 …

An Agenda-Setting Report: Biome Monitoring For Human Health, Peter Roumeliotis

Public Health Theses

In light of the COVID-19 pandemic and the increasing frequency with which zoonotic diseases of pandemic potential have emerged in recent decades, it is vital to seek new methods of preventing disease outbreaks before they occur. Novel information age technologies have the potential to change the game for infectious disease outbreak monitoring. This paper addresses the overall opportunity that exists for biome surveillance as a means for health monitoring, particularly the way that the domains of technological and biological sciences can unite to prevent the next pandemic before it gets a chance to take hold. This report outlines the numerous …

Determining The Relationship Between Sars-Cov-2 Infection And Streptococcus Pneumoniae In Clinical Saliva Samples, Anne Watkins

Public Health Theses

Background. Streptococcus pneumoniae is a commonly found upper respiratory tract colonizer that can progress to more severe disease forms such as pneumonia. Interactions with respiratory viruses other than SARS-CoV-2 have been previously identified such that S. pneumoniae may sometimes enhance disease or occur as a secondary or co-infection. With the recent emergence of SARS-CoV-2 there is limited data available describing this specific pathogen relationship that could play a role in the breadth and severity of the pandemic. Methods. Inpatients and healthcare workers testing positive for SARS-CoV-2 March 2020-August 2020 were tested for S. pneumoniae through saliva culture enrichment and RT-qPCR …

Vector-Host Interactions Of Culex Pipiens Mosquitoes And Their Role In Arbovirus Transmission In The Mid-Atlantic United States, Karen Jane Yuan

Public Health Theses

As the primary vector for the West Nile virus in the United States, members of the Culex pipiens complex have caused illnesses and deaths in the human population since its discovery in 1937. The potential contribution of Cx. pipiens to transmission and enzootic amplification of WNV can be influenced by multiple aspects, including their interactions with various vertebrate hosts as an important factor. By using blood meal analysis and virus testing, this study further investigated the role of Cx. pipiens in WNV transmission and amplification. With 91% of blood meals identified from avian species, birds remain the most frequent source …

Eastern Equine Encephalitis Amplification And Spillover In New England, Aaron Hentoff

Public Health Theses

Introduction: Eastern Equine Encephalitis (EEE) is an alphavirus spread by the Culiseta melanura mosquitoe. While extremely rare, infection can lead to severe mental sequala and death, making it a public health concern for affected communities. Over the past two decades EEE outbreaks have become more frequent in occurrence and larger in size in the Northeast Region of the United States.

Objectives: The main objectives of this study are to 1) measure the association between mosquito abundance, infection rate, and disease incidence 2) characterize the relationship between seasonal climate variability in New England with Cs. melanura abundance, infection rates, and incidence …

Phylogeographic Insights Into Zika Virus In Puerto Rico, Chaney Christine Kalinich

Public Health Theses

During the larger epidemic in the Americas, Puerto Rico experienced an epidemic of Zika virus (ZIKV) between November 2015 and December 2016. During this period, 39,717 residents tested positive, or 1.1% of the population. Our team sequenced 84 ZIKV genomes directly from archived ZIKV-positive clinical samples from throughout the epidemic period, and from distinct regions of the island, in order to reconstruct the introduction(s) to and geographic spread of ZIKV in Puerto Rico. We found that ZIKV was circulating in the Greater Antilles by April (95% CI: February-June) of 2015, and was introduced to Puerto Rico by August (95% CI: …

Antimicrobial Resistance And Molecular Epidemiology Of Escherichia Coli Isolated From Urban And Rural River Systems, Christopher Robert Jossart

Public Health Theses

Antimicrobial resistance (AMR) is an emerging public health issue that threatens the efficacy of antibiotic treatment for bacterial infections and human health. Sources of antimicrobial resistance genes (ARGs) in the environment include wastewater treatment plants and animal feeding operations that discharge waste into waterways, such as rivers and streams. This retrospective descriptive study describes the presence of AMR, and specific ARGs in Escherichia coli isolates from two distinct watersheds, rural and urban, with the use of antimicrobial susceptibility testing, whole-genome sequencing (WGS) to detect ARGs, and multi-locus sequence typing. Antimicrobial susceptibility testing was performed for 143 E. coli isolates, 73 …

Molecular Epidemiology Of Hookworm Infection In The Ashanti Region, Ghana., Emma Allen

Public Health Theses

INTRODUCTION: Parasitic helminth infections have persisted in resource-limited settings around the world, leading to greater numbers of people experiencing sequelae including malnutrition, anemia, and impaired growth and cognitive function among children. Despite periodic deworming efforts, a high burden of disease remains in sub-Saharan Africa. Establishing baseline prevalence of these infections can inform local and national deworming campaign objectives as well as tailor additional interventions accordingly. Here we describe our efforts to determine baseline prevalence and analyze potential risk factors for infection in Ashanti Region, Ghana.

OBJECTIVES: The primary objective of this study was to characterize the molecular epidemiology of hookworm …

The Impact Of Medicaid Expansion On Childhood Vaccination Rates, 2010-2018, Chandra K. Couzens

Public Health Theses

Background

The relationship between coverage expansions and vaccination coverage is not well characterized, through previous work as linked coverage expansions with insurance rates and insurance rates with vaccination completion. We examined whether Medicaid expansions implemented by the end of 2015 in 29 states and D.C. were associated with changes in MMR vaccination and 7-series vaccination completion among low income children from 2010-2018.

Methods

Changes in mean vaccination coverage were compared between the four years before expansion (2010-2013) and the four years post expansion (2015-2018), using data from the 2010-2018 National Immunization Child Survey. The final study sample (N=36,591) included children …

Human Granulocytic Anaplasmosis In Connecticut, 2014-2019: An Analysis Of Surveillance Data And Future Recommendations, Taylor Eisenstein

Public Health Theses

Human granulocytic anaplasmosis is a tickborne zoonosis caused by the bacterium Anaplasma phagocytophilum and first became a nationally notifiable human disease in 1999. In 2008, the Connecticut Department of Public Health (CT DPH) added it to the list of reportable diseases for the state. In 2019, there was a three-fold increase in case counts compared to previous years. To understand trends in anaplasmosis and generate hypotheses regarding this increase, descriptive analyses were performed on confirmed cases reported to the CT DPH from 2014 to 2019. Percentage of cases by gender, age, county, and month were calculated for each year, and …

Evaluation Of Connecticut Medical Providers Concordance With 2017 Idsa/Shea Clostridioides Difficile Treatment Guidelines In New Haven County, 2017-2019, Casey Morgan Luc

Public Health Theses

Background: Treatment guidelines for Clostridioides difficile infection (CDI) were updated by the Infectious Disease Society of America (IDSA) & the Society for Healthcare Epidemiology of America (SHEA) in 2017 making various modifications, most notably for disease severity & treatment recommendations. Our objectives were to assess Connecticut medical providers’ concordance (2017-2019) to the 2017 SHEA/IDSA clinical treatment guidelines. The effect of guideline concordance on the risk of CDI recurrence was also assessed.

Methods: Using data from the Connecticut Emerging Infections Program’s CDI surveillance in New Haven County, severity & concordance were defined for CDI cases. For severity, white blood cell count …

Screening For Legionnaires’ Disease: A Predictive Model For Improving Health And Economic Outcomes, Alyssa K. Amick

Public Health Theses

Introduction: Legionnaires’ disease (LD), caused by the Legionella bacterium, is a rare but serious atypical pneumonia that is often underdiagnosed in the clinical setting. Recent guideline changes by the American Thoracic Society limited use of the urinary Legionella tests, the primary form of diagnosis, due to the excessive costs of regular testing. Delays in testing and diagnosis of LD result in increased cost of treatment and risk of death.

Objective: To develop a predictive model to estimate a patient’s probability of having LD. This model would serve as a screen to better target diagnostic efforts, prevent misdiagnosis, and reduce the …

A Literature Review Of Current Tuberculosis Prophylaxis Strategies For Plhiv In Namibia, Anumita Bajpai

Public Health Theses

INTRODUCTION: The HIV and TB co-epidemic remains a big obstacle in reducing PLHIV mortality and morbidity in Namibia. The solution to that has been the implementation of isoniazid preventative therapy (IPT) alongside ART for PLHIV to prevent the development of active tuberculosis. As newer shorter regimens of IPT (3HP) are released it is important to Namibia’s Ministry of Health to evaluate the efficacy of these newer IPT regimens prior to their implementation.

OBJECTIVES: The objective of this review is to compare the benefit of 3HP to that of 6-month or continuous (36-month) daily IPT for PLHIV to make future TB …

Effect Of Antiretroviral Drug Dolutegravir On Mitochondrial Function, Anthony Chui

Public Health Theses

Background: Though antiretroviral therapy (ART) regimens have become progressively less toxic, ART-associated toxicity is still pervasive. Dolutegravir (DTG) is an HIV integrase strand transfer inhibitor (INSTI), a class of antiretrovirals that are generally well-tolerated by patients. However, in the clinic there are reports of unexpectedly high rates of toxicity in cohorts of pregnant women such as neural tube defects, and in older patients’ adverse effects such as neuropsychiatric disorders. We hypothesized that these adverse effects could be due to DTG-induced mitochondrial toxicity in the central nervous system.

Methods: Human neuroblastoma cells were treated with ART regimens that are currently considered …

Use Of Shotgun Metagenomic Sequencing To Determine How The Human Gut Microbiome And Antibiotic Resistome Influence The Risk Of Recurrent Clostridioides Difficile Infection, Maria Alexandra Correa

Public Health Theses

Clostridioides difficile is an opportunistic enteric pathogen that can cause a range of symptoms in humans from diarrhea to pseudomembranous colitis. The risk of recurrence of C. difficile infection after initial treatment with antibiotics is high. Although prior studies have sought to understand the link between the human gut microbiome and the risk of recurrence, none have utilized shotgun metagenomic sequencing methods to establish a relationship between microbiota diversity and recurrence risk. In this study, stool samples were obtained from 47 patients at Yale New Haven Hospital who tested positive for an incident C. difficile infection. Shotgun metagenomic sequencing was …

An Impact Evaluation Of The Rollout Of The Pneumococcal Conjugate Vaccine In Uttar Pradesh State, India. 2017-2019, Elizabeth Edgerley

Public Health Theses

This paper is aimed toward examining whether methods currently being rolled out to administer the Pneumococcal Conjugate Vaccine to children in the Indian state of Uttar Pradesh is effectively reducing morbidity and mortality. The fundamental question regarding this current effort is if it proves to be useful at reducing the prevalence of Streptococcus Pneumoniae and whether the surveillance methods examining the efficacy of healthcare interventions are helpful. Both rural and urban India are troubling areas for public health surveillance to reach, though many diseases of poverty and respiratory illnesses such as pneumonia flourish there. With no true quantification of burden, …

Trends In Cyclosporiasis In Connecticut, 1997—2019, Alexandra Edmundson

Public Health Theses

Introduction: Cyclosporiasis is a foodborne, parasitic infection, causing prolonged debilitating diarrhea, especially in immunosuppressed persons. Exposure to Cyclospora occurs mainly through ingestion of contaminated fresh produce, often during international travel. Nationally, it has been increasing in the United States. Connecticut surveillance data have yet to be systematically analyzed.

Methods: Active surveillance of cyclosporiasis in Connecticut has been conducted since 1997, including follow up of laboratory-confirmed cases by chart review and interview. Data collected include patient demographics, symptoms, severity of illness, and exposures. Data from 1997-2019 were analyzed to identify trends in incidence and changing demographics and sources of exposure.

Results: …

Covid-19 Risk Among Temporary Protected Status Beneficiaries, Diana Estefania Estrada Alamo

Public Health Theses

The current federal response of the United States to the COVID-19 pandemic has created conditions and resulted in unintended consequences that may be disproportionately increasing the risk of COVID-19 infection and sequelae for immigrant populations. This investigative thesis explores whether states with a greater percentage of Temporary Protected Status beneficiaries experience more COVID-19 related deaths as compared to the rest of the United States. Using a multiple linear regression model for statistical analysis, covariates under consideration include the number of COVID-19 confirmed cases, tests performed, hospitalizations reported, as well as the population density of each state and the proportion of …

Ethnic Differences And Risk Of Early-Onset Hodgkin Lymphoma, Connor Ashton Graham

Public Health Theses

Ethnic differences in the risk of early-onset Hodgkin lymphoma (HL) have been understudied. We evaluated potential associations between birth characteristics and early-onset HL in the California Linkage Study of Early-onset Cancers, a population-based case-control study that included a large number of non-Hispanic white and Hispanic subjects. This analysis included 2,819 HL cases (non-Hispanic white: 1651, Hispanic: 1168) diagnosed at the age of 0-37 years in California during 1988-2015 and 140,950 controls matched on race/ethnicity and year of birth. Odds ratios (OR) and 95% confidence intervals (CI) were estimated from multivariable logistic regression models. Among non-Hispanic whites, a birthweight of ≥4,000g …

“Malicious Medicine”: A Qualitative Study Of Medical Mistrust And Prep Perceptions For African American And Hispanic Men And Women In New Haven, Ct, Alexandra Lee Grimaldi

Public Health Theses

Objective: To understand how medical mistrust impacts perceptions of PrEP and willingness to use PrEP for African American and Hispanic men and women in New Haven, Connecticut.

Methods: This qualitative study utilized semi-structured interviews to examine medical mistrust, PrEP awareness, and willingness to use PrEP amongst African American and Hispanic men and women in New Haven, Connecticut.

Results: The majority of participants did not know about PrEP before their first interview of this study and the majority of participants did not decide to use PrEP over the course of this study. For those who are not interested in using PrEP, …

Creating An Antibody Digestive Curve In Cx. Quinquefasciatus Mosquitoes, Christina Ann Harden

Public Health Theses

Eastern Equine Encephalitis virus (EEEV) is an endemic arbovirus of increasing importance

in the United States. It is perpetuated via an enzootic cycle between Culiseta melanura

mosquitoes and avian reservoirs. In the northeast, transmission has distinct seasonality

and its overwintering mechanism is unknown. Xenosurveillance has been identified as a

possible way to elucidate viral circulation dynamics in states such as Connecticut that are

experiencing a resurgence of human EEE cases, potentially exacerbated by factors

associated with global climate change. This study sought to experimentally create an

antibody digestive curve for both mammalian and avian bloodmeals in Cx. quinquefasciatus

mosquitoes. Using …

Measuring Tb Stigma In Kampala, Uganda, Amber James

Public Health Theses

Tuberculosis (TB) is one of the leading causes of death worldwide and adversely affects persons living with HIV. TB is a highly stigmatizing disease and has been shown to interfere in household TB contact investigation. The objective of this study was to investigate the severity and characteristics of TB stigma through a multiple methods approach. Quantitative methods involved distributing Van Rie Stigma Scales validated in Southeast to household contacts of Index TB patients during routine household TB contact investigation. Qualitative methods involved interviewing household contacts about their attitudes towards household contact investigation, knowledge of TB transmission and treatment, and perceptions …