Erika C Austhof

Interests

Teaching

one health; environmental health; epidemiology

Research

foodborne disease; enteric disease; waterborne disease; salmonella; campylobacter; climate change; extreme weather; one health

Courses

Scholarly Contributions

Journals/Publications

• Austhof, E. C., Brown, H. E., Ferguson, D. B., & Jernberg, J. (2024).

  What burns in a wildfire influences cardiovascular health outcomes: a systematic review and meta-analysis. 

  . Environmental Health Perspectives.
• Austhof, E., Brown, H. E., Ferguson, D., & Jernberg, J. B. (2025). What burns in a wildfire influences cardiovascular health outcomes: A systematic review and meta-analysis. Ecotoxicology and Environmental Safety, 303(Issue). doi:10.1016/j.ecoenv.2025.118751
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  The goal of this systematic review and meta-analysis is to understand cardiovascular health outcomes following wildfire and determine if fuel type clarifies variation in the association. The systematic review included English, peer-reviewed, primary data analysis studies that explored wildfire exposures with associated cardiovascular morbidity or mortality health outcomes published up to October 17, 2023 and identified through five databases (PROSPERO Protocol #CRD42024589994). We extracted article details, fire exposure metrics, cardiovascular health outcome metrics, study design, measures of association (risk ratio [RRs], incidence rate ratios [IRRs] and 95 % confidence intervals [CIs]), covariates, confounding factors, and stratified analyses from each article. Risk of bias was assessed using the Cochrane tool. Random effects meta-analyses, stratified by natural or structure/peat fuel types were conducted. Pooled estimates for all cardiovascular disease (pRR:1.04, 95 % CI: 1.01, 1.07), dysrhythmia (pRR:1.05, 95 % CI: 1.01, 1.09), and hypertensive disease (pRR:1.04, 95 % CI: 1.01, 1.07) were significantly associated with fire exposure. There were significant between group differences between wildfires with structure/peat sources compared to natural sources for all cardiovascular ED visits (RR structure/peat: 1.08, 95 % CI: 1.03, 1.12; RR natural: 1.03, 95 % CI: 1.00, 1.05) and dysrhythmia ED visits (RR structure/peat: 1.10, 95 % CI: 1.04, 1.09; RR natural: 1.02, 95 % CI: 0.98, 1.06). When exploring pooled estimates of risk for cardiovascular health, we find higher estimates and narrower CIs for structure/peat sources compared to natural wildfires with largely null estimates and wider CIs. Future detailed and consistent information about wildfire fuel types will help to inform better wildfire response.
• Boyd, K., Condrey, K., Rosa Hernandez, A., Austhof, E., Lin, L., Dehnbostel, J., Hoffmann, S., Flaxel, C., Wang, Z., & Pogreba-Brown, K. (2025). Ocular Toxoplasmosis Infection Leading to Uveitis or Chorioretinal Lesions: A Systematic Review. Foodborne pathogens and disease.
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  () infections affect approximately 30% of the population worldwide. This systematic review of ocular sequelae from toxoplasmosis explores in greater depth the outcomes found in our previous scoping review. Uveitis and ocular lesions can be acute or recurrent following infection and result in long-term and often irreversible effects. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and used the Cochrane risk-of-bias tool to evaluate articles for inclusion. Data extraction included the frequency and proportion of participants who developed uveitis or chorioretinal lesions, the type, anatomical locations affected, and disease burden. Utilizing an inclusion criterion that included a physical examination combined with laboratory confirmation, 63 articles from 27 countries spanning a publication period from 2000 to 2023 were included. Most reported outcomes in these articles included uveitis ( = 61), chorioretinal lesions ( = 42), or both ( = 40). Meta analysis results indicate that the proportion of ocular toxoplasmosis (OT) cases resulting in lesions was lower than uveitis, with the highest estimates reported in Asia. Uniform diagnostic methodology was only found in articles describing congenital case populations arising from toxoplasmosis monitoring programs. Consistent use of nomenclature, consistent diagnostic testing, and standardized reporting of patient demographics by researchers would greatly aid in understanding the burden of disease experienced.
• Brown, K. P., Austhof, E., McFadden, C. M., Scranton, C., Sun, X., Vujkovic-Cviji, I., Rodriguez, D., Falk, L., Heslin, K. M., Arani, G., Obergh, V., Bessey, K., & Cooper, K. (2025). Determining the incidence, risk factors and biological drivers of irritable bowel syndrome (IBS) as part of the constellation of postacute sequelae of SARS-CoV-2 infection (PASC) outcomes in the Arizona CoVHORT-GI: a longitudinal cohort study. BMJ Open, 15(Issue 1). doi:10.1136/bmjopen-2024-095093
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  Introduction Postacute sequelae of SARS-CoV-2 infection (PASC) are extensive. Also known as long COVID, primary outcomes reported are neurologic, cardiac and respiratory in nature. However, several studies have also reported an increase in gastrointestinal (GI) symptoms and syndromes following COVID-19. This study of PASC will include extensive analyses of GI symptoms, determine if people with pre-existing irritable bowel syndrome (IBS) are at higher risk of developing PASC generally or PASC-GI, and which biomarkers are impacted and to what degree. This R01 study is being funded by the National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK135483-01) from 2023 to 2028. Methods and analyses This study combines a longitudinal epidemiologic cohort study and in-depth, novel biologic analyses. In collaboration with a preexisting study, the Arizona CoVID-19 Cohort (CoVHORT)GI will recruit participants based on the history of COVID infection(s), new or ongoing GI symptoms 3–6 months postinfection, and pre-existing or incident IBS diagnosis to represent five study groups for comparison and analyses. A subset (n=1000) of those recruited will submit both stool and blood samples. Both samples will undergo a novel method to quantitate humoral and mucosal immune responses to host-derived faecal communities in conjunction with magnetic bead-based separation and high-depth shotgun microbial sequencing. Stool samples will also undergo traditional microbiome analyses (diversity and abundance) and faecal calprotectin assays. Additional serum analyses will aim to determine if a proteomics-based signature exists that differentiates a unique biomarker compositional signature discriminating PASC-GI versus no PASC. All laboratory data will be linked with in-depth epidemiologic data on demographics, symptoms and chronic conditions.
• Li, Y., Ernst, K. C., Pogreba-Brown, K., Austhof, E., Heslin, K., Shilen, A., & Ram, S. (2025). An analytical evaluation of contact tracing systems using real-world individual-level data. International Journal of Medical Informatics, 203(Issue). doi:10.1016/j.ijmedinf.2025.106020
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  Background: Contact tracing plays an important role in controlling contagious diseases. During the COVID-19 pandemic, new contact tracing systems with automation have been developed and adopted. Nevertheless, due to the privacy-protecting nature of automated contact tracing apps, evaluation based on real-world individual-level data has been scarce. Semi-automated contact tracing and the concurrent adoption of multiple contact tracing systems, though widely adopted, have also not received proper attention. Objective: The objective of this study was to compare and evaluate concurrently adopted automated, manual, and semi-automated contact tracing systems using real-world individual-level data. Methods: We collected and synthesized individual-level data from September 2020 to February 2021 at a university in the United States. We empirically analyzed and contrasted the case coverage, contact completeness, timeliness, and precision of different contact tracing systems. Privacy protection and contacts’ actions were also investigated. Results: During our study time, 2415 individuals tested positive for COVID-19 on campus. Automated, semi-automated, and manual contact tracing systems had low overlap in case coverage (15%) and contact completeness (11% overlap in contacts that eventually became infected). Manual contact tracing achieved the highest case coverage (51% exclusive coverage) and contact identification precision (41% of identified contacts tested positive). Semi-automated and automated contact tracing was superior in timeliness, achieving a median of 1-day and 0-day test-to-report delay, respectively, much lower than the median of 6-day test-to-report delay in manual contact tracing. Of notified individuals, 93% took action to reduce COVID-19 transmission, and no one guessed/confirmed the case's identity merely through contact tracing notifications. Conclusion: Automated, semi-automated, and manual contact tracing each have their superiorities and weaknesses. None of the systems is superior in all aspects. Concurrent adoption of automated, semi-automated, and manual contact tracing systems is desirable because they complement each other.
• Armstrong, A., Hoffman, S., Austhof, E. C., McFadden, C. M., Boyd, K., Kenzie, S., & Pogreba Brown, K. M. (2024). Exposing vibriosis: a scoping review of the literature regarding sequelae of non-cholera Vibrio infection. Archives Clin Inf Dis, 19(3), e138679.
• Austhof, E., Austhof, E., Brown, H., Brown, H., White, A., White, A., Jervis, R., Jervis, R., Weiss, J., Weiss, J., Davis, S., Davis, S., Shrum Davis, S., Shrum Davis, S., Moore, D., Moore, D., Pogreba-Brown, K., & Pogreba-Brown, K. (2024). Association between Precipitation Events, Drought, and Animal Operations with Campylobacter Infections in the Southwest United States, 2009–2021. Environmental Health Perspectives, 132(9). doi:10.1289/EHP14693
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  BACKGROUND: Weather variability is associated with enteric infections in people through a complex interaction of human, animal, and environmental factors. Although Campylobacter infections have been previously associated with precipitation and temperature, the association between precipitation and drought on campylobacteriosis has not been studied. OBJECTIVE: Using data from Arizona, Colorado, New Mexico, and counties in Utah, this ecological study aimed to assess the association between precipitation and the incidence of campylobacteriosis by county from 2009 to 2021 and to determine how this association is modified by prior drought level and animal operations. METHODS: We merged 38,782 cases of campylobacteriosis reported in 127 counties with total precipitation (in inches), temperature (in average degrees Fahrenheit), Palmer Drought Severity Index (PDSI, category), and animal census data (presence, density per square mile) by week from 2009 to 2021. Negative binomial generalized estimating equations adjusted for temperature with a 3-wk lag were used to explore the association between precipitation on campylobacteriosis with resulting incidence rate ratios (IRRs). Stratified analyses explored the association with precipitation following antecedent drought, presence of farm operations, and animal density. RESULTS: A 1-in (25:4 mm) increase in precipitation was associated with a 3% increase in campylobacteriosis reported 3 wks later (IRR = 1.03; 95% CI: 1.02, 1.04) after adjusting for average temperature and PDSI. Compared with normal conditions, there were significantly more cases when precipitation followed antecedent extremely wet (IRR = 1.15; 95% CI: 1.04, 1.26), very wet (IRR = 1.09; 95% CI: 1.01, 1.18), moderately wet (IRR = 1.06; 95% CI: 1.01, 1.12), moderate drought (IRR = 1.11; 95% CI: 1.07, 1.16), and severe drought (IRR = 1.06; 95% CI: 1.02, 1.11) conditions, whereas there were significantly fewer cases (IRR = 0.89; 95% CI: 0.85, 0.94) for antecedent extreme drought. Compared to counties with no animal opera-tions, counties with animal operations had significantly more cases following precipitation for every PDSI category except extreme drought. Counties with a higher density of beef cattle, goats for meat, chicken broilers, and chicken layers had significantly higher rates of campylobacteriosis following precipitation than those with no such operations, whereas those with dairy cattle and goats for milk, did not. DISCUSSION: In this majority arid and semiarid environment, precipitation following prior wet conditions and moderate and severe drought were significantly associated with increased rates of campylobacteriosis, and only in prior extreme drought did rates decrease. Where the precipitation fell made a difference; after precipitation, counties with farm operations had significantly more cases compared to counties without farm operations. Further work should assess individual-level risk factors within environmental exposure pathways for Campylobacter. https://doi.org/10.1289/EHP14693.
• Austhof, E., Pogreba-Brown, K., White, A., Jervis, R., Weiss, J., Davis, S., Moore, D., & Brown, H. (2024). Association between precipitation events, drought, and animal operations with Salmonella infections in the Southwest US, 2009–2021. One Health, 19. doi:10.1016/j.onehlt.2024.100941
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  Background: Temperature and precipitation have previously been associated with Salmonella infections. The association between salmonellosis and precipitation might be explained by antecedent drought conditions; however, few studies have explored this effect. Methods: Using an ecological study design with public health surveillance, meteorological (total precipitation [inches], temperature [average °F], Palmer Drought Severity Index [PDSI, category]), and livestock data we explored the association between precipitation and Salmonella infections reported in 127/141 counties from 2009 to 2021 in the Southwest, US and determined how this association was modified by antecedent drought. To explore the acute effect of precipitation on Salmonella infections we used negative binomial generalized estimating equations adjusted for temperature with a 2-week lag resulting in Incidence Rate Ratios (IRR). Stratified analyses were used to explore the effect of antecedent drought and type of animal density on this association. Results: A one inch increase in precipitation was associated with a 2 % increase in Salmonella infections reported two weeks later (IRR: 1.02, 95 % CI: 1.00, 1.04) after adjusting for average temperature and PDSI. Precipitation following moderate (IRR: 1.22, 95 % CI: 1.17, 1.28) and severe drought (IRR: 1.16, 95 % CI: 1.10, 1.22) was associated with a significant increase in cases, whereas in the most extreme drought conditions, cases were significantly decreased (IRR: 0.89, 95 % CI: 0.85, 0.94). Overall, more precipitation (above a 30-year normal, the 95th and 99th percentiles) were associated with greater increases in cases, with the highest increase following moderate and severe drought. Counties with a higher density of chicken and beef cattle were significantly associated with increased cases regardless of drought status, whereas dairy cattle, and cattle including calves had mixed results. Discussion: Our study suggests precipitation following prior dry conditions is associated with an increase in salmonellosis in the Southwest, US. Public health is likely to see an increase in salmonellosis with extreme precipitation events, especially in counties with a high density of chicken and beef cattle.
• Austhof, E., Warner, S., Helfrich, K., Pogreba-Brown, K., Brown, H. E., Klimentidis, Y. C., Scallan Walter, E., Jervis, R. H., & White, A. E. (2024). Exploring the association of weather variability on Campylobacter - A systematic review. Environmental research, 252(Pt 1), 118796.
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  Previous work has found climate change-induced weather variability is suspected to increase the transmission of enteric pathogens, including Campylobacter, a leading cause of bacterial gastroenteritis. While the relationship between extreme weather events and diarrheal diseases has been documented, the specific impact on Campylobacter infections remains underexplored.
• Watkins, L., Brown, H. E., Keith, L., Austhof, E., Lin, H., Chambers, S. N., Tabor, J., Gettel, A., & Guardaro, M. (2024). A Co-Produced Workflow for Addressing Inequities in Cooling Center Access. Community Science, 3(Issue 4). doi:10.1029/2023csj000038
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  Increasing extreme heat poses challenges to metropolitan areas, such as those areas already experiencing extreme heat in Arizona. Using the US Centers for Disease Control and Prevention (CDC)'s Building Resilience Against Climate Effects (BRACE) Framework, state and local health departments have looked to expand cooling center networks as one option to build heat resilience. We present a method to pick new locations for cooling centers based on demand and current coverage. Using two locations in Arizona, we highlight differences in workflows and how the resulting information can be incorporated into separate but parallel efforts to reduce heat impacts. We used the Network Analyst Location-Allocation tool in ArcGIS Pro to maximize coverage of cooling centers in each area, so that additional cooling centers are selected to reflect local needs. The input data and parameters of the workflow were co-produced with input from two county health departments and a cooling center working group to better address the unique challenges related to cooling center access. To facilitate the application of this approach to other regions seeking to address heat health inequities, we provide a detailed protocol and a discussion of alternative selections.
• Barraza, L. F., Austhof, E. C., Khan, S., Kelley, C. P., Shilen, A., Ernst, K. C., Pogreba Brown, K. M., Cordova, F. M., Jacobs, E., & Hall-Lipsy, E. A. (2023). Differences in Perceptions of Individual and Government-Level COVID-19 Prevention Measures Based on Vaccine Willingness. J Health Care L & Policy, 26(87).
• Brown, H. E., Austhof, E. C., Luz, P. M., & Ferguson, D. B. (2023). Economics, health, or environment: What motivates individual climate action?. PLOS Clim, 2(8), e0000177.
• Brown, H. E., Austhof, E., Luz, P. M., & Ferguson, D. B. (2023). Economics, health, or environment: What motivates individual climate action?. PLOS Climate, 2(Issue 8). doi:10.1371/journal.pclm.0000177
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  Climate change is a major threat to human health, however the role of health in climate change communication is understudied. The goal of this study was to understand how to support individuals’ adoption of climate related mitigation and adaptation activities. We hypothesized the primary motivation for engaging in pro-environmental activities would be unequally distributed across health, economics, or environment motivations. We also hypothesized respondents who felt greater susceptibility and those with higher perceived self-efficacy would adopt more pro-environmental behaviors. In 2020, we conducted a cross-sectional study using Amazon’s MTurk platform. Among the respondents, the most commonly reported activity was alternatives to private vehicles (30% already engaging), while more than two thirds of respondents reported wanting to install solar panels (70.1%) and converting to a high efficiency vehicle (63.2%). Depending on the action, respondents’ reported motivation varied. Economics was common to those who used public transportation and who installed solar paneling; purchasing a high efficiency vehicle was split between environment and economic reasons. Health was the primary motivation for converting to a plant-based diet. The perceived immediacy of climate change impacts was associated with adoption of pro-climate activities as were beliefs around human capacity to mitigate climate change. Despite the growing literature supporting health as a motivation for climate action, economic motivation was more commonly selected among the activities we evaluated. These results could aid the development of more efficient evidence-based communication strategies that would reach various audiences in society.
• Chambers, S., Brown, H., Keith, L., & Austhof, E. (2023). Development of a geographic human heat balance equation to support public health analyses: An Arizona urban sun corridor application. Remote Sensing Applications: Society and Environment, 32. doi:10.1016/j.rsase.2023.101009
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  Land surface temperature (LST) estimates often serve as urban heat islands maps and to infer human thermal comfort. Parallel to this, physiological heat balance calculations have been well documented to measure changes in body core temperature and measure risk of heat-related illness. However, there is a need for an improved spatially explicit method to assess human thermal comfort. Using spatial climate data measuring temperature, airflow, and humidity, we developed a geographic body heat storage (BHS) model based on heat exchange and evaporative heat loss from the human body. As proof of concept, we used heat-related illness emergency department visits in two Arizona metropolitan areas to demonstrate that BHS can improve LST's shortcomings, with its increased explanatory power of and linear fit to emergency records. The BHS model can support decision making for public health outcomes as heat risk increases with climate change and urban overheating to more closely approximate the human heat experience. BHS allows can be implemented in different climate regions and with investigations of additional physiological and community variables to better describe risk of heat-related illness.
• Jacobs, E., Catalfamo, C., Colombo, P., Khan, S., Austhof, E., Cordova-Marks, F., Ernst, K., Farland, L., & Pogreba-Brown, K. (2023). Pre-existing conditions associated with post-acute sequelae of COVID-19. Journal of Autoimmunity, 135. doi:10.1016/j.jaut.2022.102991
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  Post-acute sequelae of COVID-19 (PASC) are conditions that occur or remain at least 28 days after SARS-CoV-2 infection. While some risk factors for PASC have been identified, little is known about pre-existing conditions that render one susceptible to developing PASC. Data from participants (n = 1224) in a longitudinal COVID-19 cohort study in Arizona were used to investigate comorbid conditions associated with PASC. After adjustment of the models for age, BMI, gender, race, and smoking, the following pre-existing conditions were statistically significantly associated with the development of PASC: asthma (OR = 1.54; 95% CI = 1.10–2.15); chronic constipation (OR = 4.29; 95% CI = 1.15–16.00); reflux (OR = 1.54; 95% CI = 1.01–2.34); rheumatoid arthritis (OR = 3.69; 95%CI = 1.15–11.82); seasonal allergies (OR = 1.56; 95% CI = 1.22–1.98); and depression/anxiety (OR = 1.72; 95% CI = 1.17–2.52). When grouping conditions together, statistically significant associations with PASC were observed for respiratory (OR = 1.47; 95% CI = 1.06–2.14); gastrointestinal (OR = 1.62; 95% CI = 1.16–2.26), and autoimmune conditions (OR = 4.38; 95% CI = 1.59–12.06). After adjustment for severity of acute SARS-CoV-2 infection and depression/anxiety, seasonal allergies (OR = 1.48; 95% CI 1.15–1.91) and autoimmune disease (OR = 3.78; 95% CI - 1.31-10.91) remained significantly associated with risk for PASC. These findings indicate that numerous pre-existing conditions may be associated with an increased risk for the development of PASC. Patients with these conditions should consider taking extra steps to avoid infection.
• Anderson, E., Ernst, K., Garcia, D., Lopez, E., Pogreba Brown, K., Austhof, E., Carr McCuin, D., Hayden, M., & Koss, M. (2022). Knowledge of Sexual Transmission of Zika Virus Among Women Who Are Pregnant or Intend to Become Pregnant, Arizona, 2017. Public Health Reports, 137(3). doi:10.1177/00333549211006986
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  Objectives: Levels of knowledge about the sexual transmission of Zika virus are consistently low in populations at risk of a mosquito-borne outbreak, including among women of childbearing age and women who are pregnant or intend to become pregnant. We investigated the effectiveness of sources of public health messaging about sexual transmission to women who are pregnant or intend to become pregnant in Arizona. Methods: In 2017, we conducted an Arizona-statewide survey 15 months after the initial release of US guidelines on sexual transmission of Zika virus. We used Poisson regression, adjusting for demographic factors, to estimate the likelihood among women who were pregnant or intended to become pregnant of knowing that Zika virus is sexually transmitted relative to other women of childbearing age. We used multinomial logistic regression models to explore associations with most used health information sources, either in person (eg, medical providers) or online (eg, Facebook), categorized by extent of dependability. Results: Women who were pregnant or intended to become pregnant had similarly poor knowledge of the sexual transmission of Zika virus as compared with other women of childbearing age (adjusted prevalence ratio = 1.14 [95% CI, 0.83-1.55]). Only about one-third of all respondents reported knowledge of sexual transmission. Reliance on high- vs low-dependability information sources, whether in person or online, did not predict the extent of Zika virus knowledge among women who were pregnant or intended to become pregnant. Conclusion: As late as the second year of local Zika virus transmission in the United States, in 2017, women in Arizona were not receiving sufficient information about sexual transmission, even though it was available. To prepare for possible future outbreaks, research should explore which aspects of Zika information campaigns were ineffective or inefficient.
• Austhof, E., & Brown, H. (2022). Global Warming’s Six MTurks: A Secondary Analysis of a US-Based Online Crowdsourcing Market. International Journal of Environmental Research and Public Health, 19(14). doi:10.3390/ijerph19148320
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  Using a global warming audience segmentation tool (Six Americas Super Short Survey (SASSY)) as a case study, we consider how public health can use consumer panels and online crowdsourcing markets (OCMs) in research. Through a secondary analysis, we aim to understand how consumer panels and OCMs are similar to or different from each other on demographics and global warming beliefs through SASSY, and how they compare to US Census estimates. With this information, researchers will understand public opinion of global warming in their sample, which is useful for many climate change initiatives. Neither the consumer panel (Ipsos) or OCM sample (MTurk) matched US estimates of population demographics. Both panels achieved similar SASSY segments, showing that even with diverse sampling frames, SASSY is a useful tool for understanding global warming sentiment. Compared to Ipsos, MTurk was younger (more Millennials and Generation X), had higher educational attainment, and lower income. Both panels were majority White, but Ipsos was more diverse than the unweighted MTurk. Ipsos had more respondents from the South whereas MTurk had more respondents from the West. Across the MTurk SASSY segment, there were no significant differences for the majority of demographic characteristics except for age; younger generations were more Alarmed or Concerned, and older generations were more Doubtful and Dismissive. Researchers interested in understanding their sample’s opinions of global warming should use SASSY and consider oversampling in key demographic variables if they intend to achieve a nationally representative and diverse sample.
• Austhof, E., Bell, M., Riddle, M., Catalfamo, C., McFadden, C., Cooper, K., Scallan Walter, E., Jacobs, E., & Pogreba-Brown, K. (2022). Persisting gastrointestinal symptoms and post-infectious irritable bowel syndrome following SARS-CoV-2 infection: Results from the Arizona CoVHORT. Epidemiology and Infection, 150. doi:10.1017/S0950268822001200
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  In this study, we aimed to examine the association between gastrointestinal (GI) symptom presence during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the prevalence of GI symptoms and the development of post-infectious irritable bowel syndrome (PI-IBS). We used data from a prospective cohort and logistic regression to examine the association between GI symptom status during confirmed SARS-CoV-2 infection and prevalence of persistent GI symptoms at ≥45 days. We also report the incidence of PI-IBS following SARS-CoV-2 infection. Of the 1475 participants in this study, 33.8% (n = 499) had GI symptoms during acute infection. Cases with acute GI symptoms had an odds of persisting GI symptoms 4 times higher than cases without acute GI symptoms (odds ratio (OR) 4.29, 95% confidence interval (CI) 2.45-7.53); symptoms lasted on average 8 months following infection. Of those with persisting GI symptoms, 67% sought care for their symptoms and incident PI-IBS occurred in 3.0% (n = 15) of participants. Those with acute GI symptoms after SARS-CoV-2 infection are likely to have similar persistent symptoms 45 days and greater. These data indicate that attention to a potential increase in related healthcare needs is warranted.
• Khan, S., Farland, L., Catalfamo, C., Austhof, E., Bell, M., Chen, Z., Cordova-Marks, F., Ernst, K., Garcia-Filion, P., Heslin, K., Hoskinson, J., Jehn, M., Joseph, E., Kelley, C., Klimentidis, Y., Russo Carroll, S., Kohler, L., Pogreba-Brown, K., & Jacobs, E. (2022). Elucidating symptoms of COVID-19 illness in the Arizona CoVHORT: A longitudinal cohort study. BMJ Open, 12(1). doi:10.1136/bmjopen-2021-053403
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  Objective To elucidate the symptoms of laboratory-confirmed COVID-19 cases as compared with laboratory-confirmed negative individuals and to the untested general population among all participants who reported symptoms within a large prospective cohort study. Setting and design This work was conducted within the framework of the Arizona CoVHORT, a longitudinal prospective cohort study conducted among Arizona residents. Participants Eligible participants were any individual living in Arizona and were recruited from across Arizona via COVID-19 case investigations, participation in testing studies and a postcard mailing effort. Primary and secondary outcome measures The primary outcome measure was a comparison of the type and frequency of symptoms between COVID-19-positive cases, tested but negative individuals and the general untested population who reported experiencing symptoms consistent with COVID-19. Results Of the 1335 laboratory-confirmed COVID-19 cases, 180 (13.5%) reported having no symptoms. Of those that did report symptoms, the most commonly reported were fatigue (82.2%), headache (74.6%), aches, pains or sore muscles (66.3%), loss of taste or smell (62.8) and cough (61.9%). In adjusted logistic regression models, COVID-19-positive participants were more likely than negative participants to experience loss of taste and smell (OR 12.1; 95% CI 9.6 to 15.2), bone or nerve pain (OR 3.0; 95% CI 2.2 to 4.1), headache (OR 2.6; 95% CI 2.2 to 3.2), nausea (OR 2.4; 95% CI 1.9 to 3.1) or diarrhoea (OR 2.1; 95% CI 1.7 to 2.6). Fatigue (82.9) and headache (74.9) had the highest sensitivities among symptoms, while loss of taste or smell (87.2) and bone or nerve pain (92.9) had the high specificities among significant symptoms associated with COVID-19. Conclusion When comparing confirmed COVID-19 cases with either confirmed negative or untested participants, the pattern of symptoms that discriminates SARS-CoV-2 infection from those arising from other potential circulating pathogens may differ from general reports of symptoms among cases alone.
• Pogreba-Brown, K., Boyd, K., Schaefer, K., Austhof, E., Armstrong, A., Owusu-Dommey, A., Villa-Zapata, L., Arora, M., Mcclelland, J., & Hoffman, S. (2022). Complications Associated with Foodborne Listeriosis: A Scoping Review. Foodborne Pathogens and Disease, 19(11). doi:10.1089/fpd.2022.0012
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  Listeria monocytogenes is a relatively rare but highly pathogenic bacterium that can cause foodborne infections. In the United States there are ∼1600 cases per year, 94% of which result in hospitalizations and 20% in deaths. Per-case burden is high because the disease also causes serious complications, including sepsis, encephalitis, meningitis, miscarriage, and stillbirth. The disease burden of L. monocytogenes is underestimated because some of these acute complications can also result in long-term outcomes. In this article, we conducted a scoping review of L. monocytogenes complications and longer term outcomes from articles published between 2000 and 2018. Search terms were developed for four major databases (PubMed, Scopus, Web of Science, and Embase) as well as gray literature and hand searches of review articles. We follow standard scoping review methodology and assessment. Out of 10,618 unique articles originally identified, 115 articles were included, representing 49 unique outcomes. The majority of studies were cohort designs (n = 67) and conducted in the United States or Europe (n = 98). Four major outcome groupings were death, neurological disorders, sepsis, and congenital infection. This study identifies substantial research on the common acute complications of L. monocytogenes and few long-term consequences of L. monocytogenes. We identify the need for additional studies to determine the longer term impacts of these acute complications.
• Schaefer, K., Austhof, E., Boyd, K., Armstrong, A., Hoffman, S., & Pogreba-Brown, K. (2022). Septicemia Due to Infection: A Systematic Review and Meta-Analysis. Foodborne pathogens and disease, 19(2), 104-114.
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  Listeriosis is a rare bacterial infection associated with foodborne illness that can result in septicemia, a serious acute outcome. Sepsis is responsible for one in three deaths during hospitalization. The objective of this study was to conduct a systematic review and meta-analysis to estimate the proportion of infections resulting in septicemia. PubMed, Embase, Scopus, and Web of Science were searched from January 1, 2000, to April 1, 2018, for epidemiological studies that assessed studies focusing on infections with the outcome of septicemia. Articles in English, Spanish, and Portuguese using case-control, cohort, or outbreak studies reporting measures of association between and septicemia were included. Bias and heterogeneity were assessed using univariate meta-regression for region, sample size, study design, and report method. Nineteen articles were eligible for inclusion post-screening, the majority of which were conducted in Europe ( = 15); utilized a retrospective cohort design ( = 16); and collected data via routine or laboratory surveillance methods ( = 10). Prevalence of sepsis ranged from 4.2% to 100% among study populations of 6 to 1374 individuals. Overall, the proportion of listeriosis cases that developed sepsis was 46% (95% confidence interval [CI] 31.0-61.0%); for neonatal cases, 21.3% (95% CI 11.0-31.6%); and for maternal and neonatal cases, 18.8% (95% CI 10.7-26.8%). The heterogeneity was high for overall and group meta-analyses, but it could not be explained by the subanalyses for the overall proportion, whereas for neonatal, and neonatal and maternal cases combined, China had a significantly lower proportion than Europe and the United States. Septicemia following infection is a severe acute complication with 31-61% rate found overall; however, greater delineation of demographic data is needed to determine important risk factors. Future research should aim to address the gaps in knowledge in the long-term outcomes of sepsis from infection, and whether these outcomes differ from those due to other infections.
• Austhof, E., & Brown, H. (2021). Flexibility and partnerships perceived as supportive of dual hazard response: COVID-19 and heat related illness, Summer 2020. Journal of Climate Change and Health, 4. doi:10.1016/j.joclim.2021.100068
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  Objectives: To understand how health departments implemented the response to the dual hazards of Heat Related Illness (HRI) and COVID-19 in Summer 2020. Methods: We interviewed five health jurisdictions with a Building Resilience Against Climate Effects (BRACE) Framework HRI project to understand impacts to organizational roles and preparedness activities, capacity to respond to the heat season, challenges experienced with resources and personnel, and how partners influenced their capacity to respond to dual hazards. Results: Health jurisdictions working in both heat preparedness and on the COVID-19 response highlighted three components as integral to maintaining public health capacity throughout the pandemic: 1) adapting to changing roles and responsibilities, 2) building and strengthening inter-organizational partnerships, and 3) maintaining flexibility through cross-training as themes to maintain the public health capacity throughout the pandemic. Conclusions: With impacts of the changing climate, including resultant extreme events with subsequent public health impacts, simultaneous responses are likely to arise again in the future. Developing cross-training programs, fostering flexibility and adaptability within the workforce, and building and sustaining external partnerships can support health departments anticipating the need to respond to simultaneous public health hazards in the future.
• Austhof, E., Boyd, K., Schaefer, K., McFadden, C., Owusu-Dommey, A., Hoffman, S., Villa-Zapata, L., McClelland, D. J., & Pogreba-Brown, K. (2021). Scoping Review of Postinfectious Sequelae. Foodborne pathogens and disease, 18(10), 687-701.
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  Previous economic estimates of infection with and chronic sequelae following infection lack sufficient data to establish the true burden of disease and its chronic sequelae. This scoping review aims to fill this gap by updating existing literature regarding the development of postinfectious sequelae following infection. Literature published between January 1, 2000, and November 6, 2018, in PubMed, EMBASE, and Scopus was searched for a wide range of postinfectious sequelae and economic estimate terms. This scoping review includes summaries from the 108 articles covering 5 main groupings of outcomes (categories are not exclusive) including vision disorders ( = 58), psychological and mental health disorders ( = 27), neurological disorders ( = 17), fetal death and infection ( = 15), and hearing loss ( = 6), as well as a description of other outcomes reported. While the majority of the included studies assessed the incidence of these outcomes postinfection, very few followed participants long-term. These prospective studies are needed to understand the true burden of postinfectious sequelae over the life course, particularly because congenital infection with can lead to severe outcomes for newborns. This scoping review can be used as an important resource for other researchers wishing to conduct future systematic reviews and meta-analyses, as well as for policy makers interested in developing guidance for public and health care partners.
• Catalfamo, C., Heslin, K., Shilen, A., Khan, S., Hunsaker, J., Austhof, E., Barraza, L., Cordova-Marks, F., Farland, L., Garcia-Filion, P., Hoskinson, J., Jehn, M., Kohler, L., Lutrick, K., Harris, R., Chen, Z., Klimentidis, Y., Bell, M., Ernst, K., , Jacobs, E., et al. (2021). Design of the Arizona CoVHORT: A Population-Based COVID-19 Cohort. Frontiers in Public Health, 9. doi:10.3389/fpubh.2021.620060
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  This study is a prospective, population-based cohort of individuals with a history of SARS-CoV-2 infection and those without past infection through multiple recruitment sources. The main study goal is to track health status over time, within the diverse populations of Arizona and to identify the long-term consequences of COVID-19 on health and well-being. A total of 2,881 study participants (16.2% with a confirmed SARS-CoV-2 infection) have been enrolled as of December 22, 2020, with a target enrollment of 10,000 participants and a planned follow-up of at least 2 years. This manuscript describes a scalable study design that utilizes a wide range of recruitment sources, leveraging electronic data collection to capture and link longitudinal participant data on the current and emerging issues associated with the COVID-19 pandemic. The cohort is built within a collaborative infrastructure that includes new and established partnerships with multiple stakeholders, including the state's public universities, local health departments, tribes, and tribal organizations. Challenges remain for ensuring recruitment of diverse participants and participant retention, although the electronic data management system and timing of participant contact can help to mitigate these problems.
• Keith, L., Iroz-Elardo, N., Austof, E., Sami, I., & Arora, M. (2021). Extreme heat at outdoor COVID-19 vaccination sites. The journal of climate change and health, 4, 100043.
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  Extreme heat is an increasing climate risk due to climate change and the urban heat island (UHI) effect and can jeopardize points of dispensing (PODs) for COVID-19 vaccination distribution and broader public health emergency preparedness (PHEP) response operations. These PODs were often located on large parking lot sites with high heat severity and did not take heat mitigation or management strategies into account for unacclimated workers and volunteers. To investigate the personal heat exposure of workers, volunteers, and clients at three PODs in Tucson, Arizona, we collected ambient air temperatures, wet bulb globe temperatures (WBGT), surface temperatures, and thermal images. We also made qualitative observations and compared data against daily meteorological records. Ambient air temperatures at all three PODs exceeded the meteorological recorded high. WBGT on average were 8°F (4.4 °C) higher in full sun locations than shaded locations such as tents. Evaporative cooling decreased ambient air temperatures by 2°F (1.2 °C) when placed one per tent, but decreased ambient air temperatures by 7°F (3.9 °C) when placed en masse in a larger tent. Vehicle surface temperatures exceeded recommended safe limits of 140°F (60 °C) at all three sites, with a maximum temperature recorded at 170.9°F (77.2 °C). Public health professionals should consider heat resilience, including heat mitigation and management measures, in POD and PHEP response operations to reduce exposure. This includes considering the UHI effect in the siting of PODs, applying heat mitigation strategies in the design of PODs such as the adaptive use of solar panels for shading, and improving heat safety guidance for workers and volunteers.
• Keith, L., Iroz-Elardo, N., Austof, E., Sami, I., & Arora, M. (2021). Response to correspondence on "Extreme heat at outdoor COVID-19 vaccination sites". The journal of climate change and health, 4, 100073.
• Pogreba Brown, K., Austhof, E., McFadden, C., Boyd, K., Sharma, J., Battaglia, S., Shilen, A., Heslin, K., & Rosa Hernández, A. (2021). Training and Incorporating Students in SARS-CoV-2 Case Investigations and Contact Tracing. Public Health Reports, 136(2). doi:10.1177/0033354920974664
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  Objectives: In June 2020, Arizona had the fastest-growing number of cases of coronavirus disease 2019 (COVID-19) worldwide. As part of the growing public health response, the University of Arizona Student Aid for Field Epidemiology Response (SAFER) team was able to modify and increase case investigation efforts to assist local health departments. We outline the recommended logistical and management steps to include students in a public health response of this scope. Methods: From April 1 through September 1, 2020, the SAFER team identified key components of a successful student team response: volunteer training, management that allows more senior students to manage newer students, adoption of case-management software, and use of an online survey platform for students to conduct interviews consistently and allow for data quality control and management. Results: From April 1 through September 1, 2020, SAFER worked with 3 local health departments to complete 1910 COVID-19 case investigations through a virtual call center. A total of 233 volunteers and 46 hourly student workers and staff members were involved. As of September 2020, students were completing >150 interviews per week, including contact-tracing efforts. Practice Implications: Developing relationships between applied public health and academic programs can relieve the burden of low-risk, high-volume case investigations at local and state health departments. Furthermore, by establishing a virtual call center, health sciences faculty and students can volunteer remotely during a pandemic with no additional risk of infection.
• Pogreba-Brown, K., Austhof, E., Tang, X., Trejo, M. J., Owusu-Dommey, A., Boyd, K., Armstrong, A., Schaefer, K., Bazaco, M. C., Batz, M., Riddle, M., & Porter, C. (2021). Enteric Pathogens and Reactive Arthritis: Systematic Review and Meta-Analyses of Pathogen-Associated Reactive Arthritis. Foodborne pathogens and disease, 18(9), 627-639.
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  The objective of this systematic review and meta-analysis was to estimate the proportion of postinfectious reactive arthritis (ReA) after bacterial enteric infection from one of four selected pathogens. We collected studies from PubMed, Web of Science, and Embase, which assessed the proportion of postinfectious ReA published from January 1, 2000 to April 1, 2018. Papers were screened independently by title, abstract, and full text; papers in English, Spanish, and Portuguese utilizing a case-control (CC) or cohort study design, with a laboratory confirmed or probable acute bacterial enteric infection and subsequent ReA, were included. The proportion of ReA cases was pooled between and across pathogens. Factors that can induce study heterogeneity were explored using univariate meta-regression, including region, sample size, study design, and ReA case ascertainment. Twenty-four articles were included in the final review. The estimated percentage of cases across studies describing -associated ReA ( = 11) was 1.71 (95% confidence interval [CI] 0.49-5.84%); ( = 17) was 3.9 (95% CI 1.6-9.1%); ( = 6) was 1.0 (95% CI 0.2-4.9%); and ( = 7) was 3.4 (95% CI 0.8-13.7%). Combining all four pathogens, the estimated percentage of cases that developed ReA was 2.6 (95% CI 1.5-4.7%). Due to high heterogeneity reflected by high values, results should be interpreted with caution. However, the pooled proportion developing ReA from studies with sample sizes ()  1000 (6% vs. 0.3%), retrospective cohort studies were lower (1.1%) compared with CC or prospective cohorts (6.8% and 5.9%, respectively), and those where ReA cases are identified through medical record review were lower (0.3%) than those identified by a specialist (3.9%) or self-report (12%). The estimated percentage of people who developed ReA after infection with , , , or is relatively low (2.6). In the United States, this estimate would result in 84,480 new cases of ReA annually.
• Austhof, E., Berisha, V., McMahan, B., Owen, G., Keith, L., Roach, M., & Brown, H. (2020). Participation and engagement of public health stakeholders in climate and health adaptation. Atmosphere, 11(3). doi:10.3390/atmos11030265
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  Stakeholder participation at the intersection of climate and health is essential to assess and plan for the human health impacts of current and projected climate-sensitive hazards. Using the Maricopa County Department of Public Health (MCDPH) Coalition on Climate Change and Public Health workgroup and the Climate Assessment for the Southwest (CLIMAS) program as examples, this paper describes the important role of scientist-public health stakeholder collaboratives in addressing the public health impacts of climate-sensitive hazards. Using the MCDPH and CLIMAS stakeholder groups, stakeholder connections were mapped to show relationships between the organization types and connections between scientists and public health stakeholders. Stakeholders, defined as meeting attendees, were primarily individuals from academic institutions (n = 175), government agencies (n = 114), non-profits (n = 90), and health departments (n = 85). Engaging public health stakeholders in transdisciplinary regional climate initiatives and addressing gaps in their networks helped these programs to develop more collaborative projects over time.
• Austhof, E., Schaefer, K., Faulkner, J., Bach, L., Riddle, M., & Pogreba-Brown, K. (2020). Knowledge and practices of primary care physicians or general practitioners treating post-infectious Irritable Bowel Syndrome. BMC Gastroenterology, 20(1). doi:10.1186/s12876-020-01305-z
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  Background: Post-infectious Irritable Bowel Syndrome (PI-IBS) is a functional bowel disorder which has significant impacts to a patient's quality of life. No IBS-specific biomarker or treatment regimen for PI-IBS currently exists, therefore understanding practice patterns and variance is of interest. Methods: This online survey of primary care physicians and general practitioners in the USA aimed to understand the knowledge and treatment of PI-IBS within the physician's current practice. Summary statistics are provided with a commentary on implications for practices and treatment of PI-IBS. Results: Most physician survey respondents (n = 50) were aware of PI-IBS, but less than half discussed this condition as a possible outcome in their patients with a recent gastrointestinal infection. Most physicians indicated that they would treat the patients themselves with a focus on managing IBS through different treatment modalities based on severity. Treatment for PI-IBS followed IBS recommendations, but most physicians also prescribed a probiotic for therapy. Physicians estimated that 4 out of 10 patients who develop PI-IBS will have life-long symptoms and described significant impacts to their patient's quality of life. Additionally, physicians estimated a significant financial burden for PI-IBS patients, ranging from $100-1000 (USD) over the course of their illness. Most physicians agreed that they would use a risk score to predict the probability of their patients developing PI-IBS, if available. Conclusions: While this survey is limited due to sample size, physician knowledge and treatment of PI-IBS was consistent across respondents. Overall, the physicians identified significant impacts to patient's quality of life due to PI-IBS.
• Pogreba-Brown, K., Austhof, E., & Ellingson, K. (2020). Methodology minute: An overview of the case–case study design and its applications in infection prevention. American Journal of Infection Control, 48(3). doi:10.1016/j.ajic.2018.11.024
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  The case–case study design is a potentially useful tool for infection preventionists during outbreak or cluster investigations. This column clarifies terminology related to case–case, case–control, and case-case-control study designs. Examples of practical applications of the case–case study design include determining risk factors for health care–onset versus community-onset infections, or antibiotic-resistant versus antibiotic-susceptible infections.
• Pogreba-Brown, K., Austhof, E., Armstrong, A., Schaefer, K., Villa Zapata, L., McClelland, D. J., Batz, M. B., Kuecken, M., Riddle, M., Porter, C. K., & Bazaco, M. C. (2020). Chronic Gastrointestinal and Joint-Related Sequelae Associated with Common Foodborne Illnesses: A Scoping Review. Foodborne pathogens and disease, 17(2), 67-86.
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  To strengthen the burden estimates for chronic sequelae of foodborne illness, we conducted a scoping review of the current literature for common foodborne pathogens and their associated sequelae. We aim to describe the current literature and gaps in knowledge of chronic sequelae associated with common foodborne illnesses. A comprehensive search was conducted in PubMed, EMBASE, and Web of Science for peer-reviewed articles published January 1, 2000 to April 1, 2018. Articles available in English, of any epidemiological study design, for 10 common foodborne pathogens (, , , , , , , , , and norovirus) and their associated gastrointestinal (GI)- and joint-related sequelae were included. Of the 6348 titles screened for inclusion, 380 articles underwent full-text review; of those 380, 129 were included for data extraction. Of the bacterial pathogens included in the search terms, the most commonly reported were ( = 104) and ( = 99); ( = 55), ( = 49), ( = 49), and ( = 15) all had fewer results. Norovirus was the only virus included in our search, with 28 article that reported mostly GI-related sequelae and reactive arthritis (ReA) reported once. For parasitic diseases, ( = 26) and ( = 18) had the most articles, and no results were found for . The most commonly reported GI outcomes were irritable bowel syndrome (IBS;  = 119) and inflammatory bowel disease ( = 29), and ReA ( = 122) or "joint pain" ( = 19) for joint-related sequelae. and were most often associated with a variety of outcomes, with ReA ( = 34 and  = 27) and IBS ( = 17 and  = 20) reported most often. This scoping review shows there are still a relatively small number of studies being conducted to understand specific pathogen/outcome relationships. It also shows where important gaps in the impact of chronic sequelae from common foodborne illnesses still exist and where more focused research would best be implemented.
• Pogreba-Brown, K., Austhof, E., Okello, A., Weiss, J., Lira, R., & Ernst, K. (2020). Public perceptions of non-pharmaceutical interventions for influenza and mosquito-borne illnesses - a statewide survey in Arizona. Perspectives in public health, 140(4), 214-221.
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  We conducted a statewide online survey to understand public knowledge, attitudes, and practices (KAP) related to non-pharmaceutical interventions (NPIs) for mosquito-borne diseases and influenza in Arizona.
• Barrett, E. C., Barnes, S., & Pogreba Brown, K. M. (2018). An Experiential Learning Exercise in food-borne illness outbreak investigations: bridging education and experience. Pedagogy in Health Promotion, 4(1), 43-51.
• Barrett, E., Barnes, S., & Pogreba-Brown, K. (2018). An Experiential Learning Exercise in Food-Borne Illness Outbreak Investigations: Bridging Education and Experience. Pedagogy in Health Promotion, 4(1). doi:10.1177/2373379917700440
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  Conducting engaging experiential learning exercises is an exceptional strategy for teaching multidisciplinary teams of public health students. The objective of this article is to present an experiential student-driven exercise through a simulated food-borne outbreak. Through this process, students gain an understanding of the steps of an outbreak investigation, Incident Command Systems; identify and calculate appropriate measures of association; develop a questionnaire; and refine their communication techniques. This exercise is also unique in that it was codesigned by graduate teaching assistants who had previously taken the course. These targeted learning objectives created for students, and by students, allow for the development of peer-based training and also serve as a learning experience for student alumni. The authors provide all the needed teaching materials to provide an easy-to-follow guide for others to conduct similar exercises with their students.
• Barrett, E., Carr, D., Bell, M., & Pogreba-Brown, K. (2018). Post-infectious sequelae after Campylobacter enteric infection: A pilot study in Maricopa County, Arizona, USA. Pilot and Feasibility Studies, 4(1). doi:10.1186/s40814-018-0335-z
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  Background: Campylobacter is a leading cause of gastroenteritis across the globe caused by the ingestion of contaminated food, water, or contact with animals carrying Campylobacter bacteria. The resulting disease, campylobacteriosis, is usually self-limiting, but cases may develop post-infectious sequelae (PIS) such as gastrointestinal disorders, neurological disorders, and joint disorders. The objective of this study was to estimate a crude incidence rate for PIS among Campylobacter cases in Maricopa County, Arizona, USA and to determine the feasibility of conducting a larger scale study to understand chronic outcomes from campylobacteriosis and salmonellosis. Methods: The pilot study spanned from August 1, 2016, to August 31, 2017. During this time, cases of campylobacteriosis were reported to the Maricopa County Department of Public Health and interviewed by public health students at the University of Arizona. Initial interviews were conducted using a routine enteric surveillance questionnaire, and eligible cases were recruited and consented into the pilot study. Follow-up with a questionnaire occurred 4 to 6 weeks from the date of each case's initial interview. Data analysis was conducted using STATA SE 14 and included chi-squared tests to determine differences in demographics, symptoms, and exposures between those enrolled in the study and those eligible but not enrolled during the study period and feasibility metrics for the study including enrollment rates, response rates, time to interview, and reasons for non-enrollment. Crude rates with 95% confidence intervals were calculated to estimate PIS. Results: Of the routine surveillance cases, 102 (36%) enrolled into the pilot study. Of enrolled participants, 68.6% completed the follow-up questionnaire. Most enrolled participants were non-Hispanic White, male, and aged 60 + years. Over half (52.8%, 95% CI 41.1%, 64.5%) of cases experienced PIS approximately 4 to 6 weeks after acute onset of campylobacteriosis. Conclusions: Results from this pilot study indicate that a larger study is feasible. The larger study will identify the true incidence of PIS and improve the management of patient health among ethnically diverse populations.
• Ernst, K., Barrett, E., Hoswell, E., & Hayden, M. (2018). Increasing women's engagement in vector control: A report from accelerate to equal project workshops. BMC Malaria Journal, 17(1), 326.
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  Workshops with academic, national and local government, and community stakeholders were held in Kenya (2017) and Indonesia (2018) to understand the role and perceptions of women in vector control and to identify strategies for accelerating involvement of women in sustained support for vector control interventions at multiple levels/sectors.
• Hayden, M., Barrett, E., Bernard, G., Toko, E., Agawo, M., Okello, A., Gunn, J., & Ernst, K. (2018). Barriers and opportunities to advancing women in leadership roles in vector control: Perspectives from a stakeholder survey. American Journal of Tropical Medicine and Hygiene, 98(5). doi:10.4269/ajtmh.17-0693
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  Increasing the active participation of professional women in vector control (VC) activities may help promote greater gender equity in the workplace and reduce the burden of vector-borne diseases. This stakeholder survey examined the current roles and perspective of professionals employed in the VC sector in Kenya, Indonesia, India, and other countries. The largest barriers that women face in pursuing leadership roles in the VC sector include lack of awareness of career opportunities, limitations based on cultural norms, and the belief that VC is men’s work. These barriers could be addressed through improving education and recruitment campaigns, as well as supporting higher education and mentoring programs. Females were almost six times more likely to be encouraged to pursue leadership positions in their organization compared with male respondents (odds ratio = 5.9, P > 0.03, 95% confidence interval: 1.19, 29.42). These findings suggest that once women are recruited into the VC workforce, they face minimal discrimination and have increased leadership opportunities.
• Pogreba-Brown, K., & Barrett, E. (2018). Campylobacter and Ethnicity - A Case-Case Analysis to Determine Differences in Disease Presentation and Risk Factors. Foodborne Pathogens and Disease, 15(5). doi:10.1089/fpd.2017.2337
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  Background: Rates of Campylobacter infection in Arizona have historically been higher than the national average, with the highest rates in Hispanic populations. The purpose of this retrospective case-case analysis was to determine how risk factors and disease presentation differ by ethnicity (Hispanic vs. Non-Hispanic) in cases of campylobacteriosis from 2012 to 2015 in Maricopa County, Arizona. Methods: Basic demographics and seasonality, including standardized morbidity ratios (SMRs), were analyzed to determine differences by ethnicity. To determine differences in risk factors, adjusted univariate and multivariable logistic regression was conducted. Results: There were significant differences by ethnicity by age (1-14 years and >60 years), location of residence (urban vs. suburban), and testing methodology. Most months in the seasonality analysis showed higher than expected values of Hispanic cases based on population distributions (SMR Range: 0.91-1.78, annual mean: 1.23). Differences in disease presentation showed that Hispanics (adjusted for age and location of residence) were more likely to experience vomiting (OR = 1.41) and fever (OR = 1.08), as well as seek care through an urgent care or emergency department (OR = 1.50), than non-Hispanic cases. Hispanics had a higher odds of reporting consumption of tomatoes (OR = 1.45), salsa (OR = 2.35), cilantro (OR = 2.21), queso fresco (OR = 8.53), and sprouts (OR = 1.94) than non-Hispanic cases. Multivariable analyses found queso fresco (aOR = 6.58), cilantro (aOR = 3.93), and animal products (aOR = 0.38) all to be significant by ethnicity. Conclusions: Hispanics had a higher likelihood of consuming high risk foods, while non-Hispanics were more likely to have environmental exposures linked to Campylobacter infection. Focused questionnaires can reveal differences and contribute to improving public health action/education for specific populations.
• Pogreba-Brown, K., O'Connor, P., Matthews, J., Barrett, E., & Bell, M. (2018). Case-case analysis of Campylobacter and Salmonella - Using surveillance data for outbreak investigations and monitoring routine risk factors. Epidemiology and Infection, 146(15). doi:10.1017/S0950268818002200
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  Utilising routine surveillance data, this study presents a method for generating a baseline comparison that can be used in future foodborne outbreak investigations following a case-case methodology. Salmonella and Campylobacter cases (2012-2015) from Maricopa County, AZ were compared to determine differences in risk factors, symptoms and demographics. For foods and other risk factors, adjusted odds ratios were developed using Campylobacter as the reference. Comparisons were also made for three major Salmonella subtypes, Typhimurium, Enteritidis and Poona as compared with Campylobacter. Salmonella cases were younger, while Campylobacter cases were more Hispanic and female. Campylobacter cases reported consuming peppers, sprouts, poultry, queso fresco, eggs and raw nuts more and reported contact with animal products, birds, visiting a farm or dairy, owning a pet, a sick pet, swimming in a river, lake or pond, or handling multiple raw meats more. Salmonella cases reported visiting a petting zoo and contact with a reptile more. There were significant variations by Salmonella subtype in both foods and exposures. We recommend departments conduct this analysis to generate a baseline comparison and a running average of relevant odds ratios allowing staff to focus on trace-back of contaminated food items earlier in the outbreak investigation process.
• Oren, E., Fiero, M., Barrett, E., Anderson, B., Gonzalez-Salazar, F., & Nuñez, M. (2016). Detection of latent tuberculosis infection among migrant farmworkers along the US-Mexico border. BMC Infectious Diseases, 16(1). doi:10.1186/s12879-016-1959-3
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  Background: Migrant farmworkers are among the highest-risk populations for latent TB infection (LTBI) in the United States with numerous barriers to healthcare access and increased vulnerability to infectious diseases. LTBI is usually diagnosed on the border using the tuberculin skin test (TST). QuantiFERON-TB Gold In-Tube (QFT-GIT) also measures immune response against specific Mycobacterium tuberculosis antigens. The objective of this study is to assess the comparability of TST and QFT-GIT to detect LTBI among migrant farmworkers on the border, as well as to examine the effects of various demographic and clinical factors on test positivity. Methods: Participants were recruited using mobile clinics on the San Luis US-Mexico border and tested with QFT-GIT and TST. Demographic profiles and clinical histories were collected. Kappa coefficients assessed agreement between TST and QFT-GIT using various assay cutoffs. Logistic regression examined factors associated with positive TST or QFT-GIT results. Results: Of 109 participants, 59 of 108 (55 %) were either TST (24/71, 34 %) or QFT-GIT (52/106, 50 %) positive. Concordance between TST and QFT-GIT was fair (71 % agreement, k = 0.38, 95 % CI: 0.15, 0.61). Factors associated with LTBI positivity included smoking (OR = 1.26, 95 % CI-1.01-1.58) and diabetes/high blood sugar (OR = 0.70, 95 % CI = 0.51-0.98). Discussion: Test concordance between the two tests was fair, with numerous discordant results observed. Greater proportion of positives detected using QFT-GIT may help avoid LTBI under-diagnosis. Assessment of LTBI status on the border provides evidence whether QFT-GIT should replace the TST in routine practice, as well as identifies risk factors for LTBI among migrant populations.