Kristen M Pogreba Brown

Interests

Teaching

Outbreak Investigations, Field Methods, Food Safety, One Health

Research

Outbreak investigation methodology, Chronic Effects of Campylobacter and Salmonella, Antibiotic resistance transmission from environment and food to clinical cases

Courses

Scholarly Contributions

Journals/Publications

• Pogreba Brown, K. M., Barrett, E., & Fowel, N. (2017). Predominate Risk Factors for Campylobacter Cases in Arizona by Ethnicity– Explaining the Higher Rates of Campylobacter among Hispanics in Arizona.. Foodborne Pathogens and Disease.
• Barrett, E., Barnes, S., & Pogreba Brown, K. M. (2017). An Experiential Learning Exercise in Food-Borne Outbreak Investigations: Bridging Education and Experience. Pedagogy in Health Promotion, 4(1). doi:http://journals.sagepub.com/doi/10.1177/2373379917700440
• Pogreba-Brown, K., Weiss, J., Briggs, G., Taylor, A., Schumacher, M., England, B., & Harris, R. B. (2017). Student outbreak response teams: lessons learned from a decade of collaboration. Public health, 149, 60-64.
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  Student response teams within colleges of public health effectively address important concerns for two stakeholders. For universities, students learn the fundamentals of field epidemiology and provide popular training and networking opportunities. For health departments, students serve as surge capacity as trained workforce available during outbreak investigations and potentially for routine tasks.
• Ayala, A., Berisha, V., Goodin, K., Pogreba-Brown, K., Levy, C., McKinney, B., Koski, L., & Imholte, S. (2016). Public Health Surveillance Strategies for Mass Gatherings: Super Bowl XLIX and Related Events, Maricopa County, Arizona, 2015. Health security, 14(3), 173-84.
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  Super Bowl XLIX took place on February 1, 2015, in Glendale, Arizona. In preparation for this event and associated activities, the Maricopa County Department of Public Health (MCDPH) developed methods for enhanced surveillance, situational awareness, and early detection of public health emergencies. Surveillance strategies implemented from January 22 to February 6, 2015, included enhanced surveillance alerts; animal disease surveillance; review of NFL clinic visits; syndromic surveillance for emergency room visits, urgent care facilities, and hotels; real-time onsite syndromic surveillance; all-hazards mortality surveillance; emergency medical services surveillance, review of poison control center reports; media surveillance; and aberration detection algorithms for notifiable diseases. Surveillance results included increased influenzalike illness activity reported from urgent care centers and a few influenza cases reported in the NFL clinic. A cyanide single event exposure was investigated and determined not to be a public health threat. Real-time field syndromic surveillance documented minor injuries at all events and sporadic cases of gastrointestinal and neurological (mostly headaches) disease. Animal surveillance reports included a cat suspected of carrying plague and tularemia and an investigation of highly pathogenic avian influenza in a backyard chicken flock. Laboratory results in both instances were negative. Aberration detection and syndromic surveillance detected an increase in measles reports associated with a Disneyland exposure, and syndromic surveillance was used successfully during this investigation. Coordinated enhanced epidemiologic surveillance during Super Bowl XLIX increased the response capacity and preparedness of MCDPH to make informed decisions and take public health actions in a timely manner during these mass gathering events.
• Benjamin, P., & Pogreba Brown, K. M. (2016). Beware of More than the Yellow Snow: A Norovirus Outbreak at a Ski Resort in Arizona.. Epidemiology: Open Access, 6(244). doi:10.4172/2161-1165.1000244
• Pogreba-Brown, K., Baker, A., Ernst, K., Stewart, J., Harris, R. B., & Weiss, J. (2016). Assessing risk factors of sporadic Campylobacter infection: a case-control study in Arizona. Epidemiology and infection, 144(4), 829-39.
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  Case-control studies of sporadic Campylobacter infections have predominately been conducted in non-Hispanic populations. In Arizona, rates of campylobacteriosis have been historically higher than the national average, with particularly high rates in Hispanics. In 2010, health departments and a state university collaborated to conduct a statewide case-control study to determine whether risk factors differ in an ethnically diverse region of the United States. Statistically significant risk factors in the final multivariate model were: eating cantaloupe [odds ratio (OR) 7·64], handling raw poultry (OR 4·88) and eating queso fresco (OR 7·11). In addition, compared to non-Hispanic/non-travellers, the highest risk group were Hispanic/non-travellers (OR 7·27), and Hispanic/travellers (OR 5·87, not significant). Results of this study suggest Hispanics have higher odds of disease, probably due to differential exposures. In addition to common risk factors, consumption of cantaloupe was identified as a significant risk factor. These results will inform public health officials of the varying risk factors for Campylobacter in this region.
• Lamparelli, C. C., Pogreba-Brown, K., Verhougstraete, M., Sato, M. I., de Castro Bruni, A., Wade, T. J., & Eisenberg, J. N. (2015). Are fecal indicator bacteria appropriate measures of recreational water risks in the tropics: A cohort study of beach goers in Brazil?. Water Research, 87, 59-68.
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  Regulating recreational water exposure to pathogens within the tropics is a major public health and economic concern. Although numerous epidemiological studies estimating the risk to recreational marine water exposure have been conducted since the 1950s, few studies have been done in the tropics. Furthermore, many have suggested that the use of fecal indicator bacteria for monitoring recreational water quality in temperate regions is not appropriate in the tropics. We analyzed a large cohort study of five beaches in Sao Paulo, Brazil, conducted during consecutive weekends in the summer of 1999 that estimated risk to water, sand, and food exposures. Enterococci and Escherichia coli concentrations were measured each day of the study. Elevated risks were estimated for both swimming (OR = 1.36 95% CI: 1.05-1.58) and sand contact (OR = 1.29 95% CI 1.05-1.58). A 1 log increase in enterococci concentration was associated with an 11% increase in risk (OR = 1.11 95% CI: 1.04-1.19). For E. coli a 1-log increase in concentration was associated with 19% increase in risk (OR = 1.19 95% CI: 1.14-1.28). Most countries with beaches in the tropics are lower or middle income countries (LMIC) and rely on tourism as a major source of income. We present data that suggests fecal indicator bacteria such as enterococci are an appropriate indicator of risk in tropical urban settings where contamination is coming from predominantly human sources. Additional studies in tropical settings could help inform and refine guidelines for safe use of recreational waters.
• Pogreba Brown, K. M., Ernst, K. C., Woodson, L., & Harris, R. (2015). Determining Risk Factors of a Non-Point Source Outbreak of Campylobacter Cases Using Case-Case and Case-Control Studies.. Epidemiology Open Access.
• Pogreba Brown, K. M., Ernst, K. C., & Harris, R. B. (2014). Case-case methods for studying enteric diseases: A review and approach for standardization.. OA Epidemiology, 18(2), 1-9.
• Pogreba-Brown, K., McKeown, K., Santana, S., Diggs, A., Stewart, J., & Harris, R. B. (2013). Public health in the field and the emergency operations center: methods for implementing real-time onsite syndromic surveillance at large public events. Disaster medicine and public health preparedness, 7(5).
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  To develop an onsite syndromic surveillance system for the early detection of public health emergencies and outbreaks at large public events.
• Yasmin, S., Pogreba-Brown, K., Stewart, J., & Sunenshine, R. (2013). Use of an Online Survey During an Outbreak of Clostridium perfringens in a Retirement Community-Arizona, 2012. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE, 20(2), 205-209.
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  Context: An outbreak of gastrointestinal (GI) illness among retirement community residents was reported to the Maricopa County Department of Public Health. Online surveys can be useful for rapid investigation of disease outbreaks, especially when local health departments lack time and resources to perform telephone interviews. Online survey utility among older populations, which may lack computer access or literacy, has not been defined. Objective: To investigate and implement prevention measures for a GI outbreak and assess the utility of an online survey among retirement community residents. Design: A retrospective cohort investigation was conducted using an online survey distributed through the retirement community e-mail listserv; a follow-up telephone survey was conducted to assess computer literacy and Internet access. A case was defined as any GI illness occurring among residents during March 1-14, 2012. Setting: A barbecue in a retirement community of 3000 residents. Participants: Retirement community residents. Intervention: Residents were directed to discard leftover food and seek health care for symptoms. A telephone survey was conducted to assess the utility of online surveys in this population. Main Outcome Measures: Computer literacy and Internet access of retirement community residents. Results: Of 1000 residents on the listserv, 370 (37%) completed the online survey (mean age, 69.7 years; 60.6% women); 66 residents (17.8%) reported a GI illness after the barbecue, 63 (95.5%) reported diarrhea, and 5 (7.6%) reported vomiting. Leftover beef from an attendee's refrigerator grew Clostridium perfringens. Of 552 residents contacted by telephone, 113 completed the telephone survey (mean age, 71.3 years; 63.3% women), 101 (89.4%) reported the ability to send e-mail, 82 (81.2%) checked e-mail daily, and 28 (27.7%) checked e-mail on a handheld device. The attack rate was 17.8% for online versus 2.7% for telephone respondents (P < .001). Conclusions: This outbreak demonstrated the utility of an online survey to rapidly collect information and implement prevention measures among an older demographic.
• Yasmin, S., Pogreba-Brown, K., Stewart, J., & Sunenshine, R. (2013). Use of an Online Survey During an Outbreak of Clostridium perfringens in a Retirement Community-Arizona, 2012. Journal of public health management and practice : JPHMP.
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  CONTEXT:: An outbreak of gastrointestinal (GI) illness among retirement community residents was reported to the Maricopa County Department of Public Health. Online surveys can be useful for rapid investigation of disease outbreaks, especially when local health departments lack time and resources to perform telephone interviews. Online survey utility among older populations, which may lack computer access or literacy, has not been defined. OBJECTIVE:: To investigate and implement prevention measures for a GI outbreak and assess the utility of an online survey among retirement community residents. DESIGN:: A retrospective cohort investigation was conducted using an online survey distributed through the retirement community e-mail listserv; a follow-up telephone survey was conducted to assess computer literacy and Internet access. A case was defined as any GI illness occurring among residents during March 1-14, 2012. SETTING:: A barbecue in a retirement community of 3000 residents. PARTICIPANTS:: Retirement community residents. INTERVENTION:: Residents were directed to discard leftover food and seek health care for symptoms. A telephone survey was conducted to assess the utility of online surveys in this population. MAIN OUTCOME MEASURES:: Computer literacy and Internet access of retirement community residents. RESULTS:: Of 1000 residents on the listserv, 370 (37%) completed the online survey (mean age, 69.7 years; 60.6% women); 66 residents (17.8%) reported a GI illness after the barbecue, 63 (95.5%) reported diarrhea, and 5 (7.6%) reported vomiting. Leftover beef from an attendee's refrigerator grew Clostridium perfringens. Of 552 residents contacted by telephone, 113 completed the telephone survey (mean age, 71.3 years; 63.3% women), 101 (89.4%) reported the ability to send e-mail, 82 (81.2%) checked e-mail daily, and 28 (27.7%) checked e-mail on a handheld device. The attack rate was 17.8% for online versus 2.7% for telephone respondents (P < .001). CONCLUSIONS:: This outbreak demonstrated the utility of an online survey to rapidly collect information and implement prevention measures among an older demographic.
• Pogreba-Brown, K., Ernst, K., & Harris, R. (2012). Teaching epidemiology concepts experientially: a "real" foodborne outbreak in the classroom. Public health reports (Washington, D.C. : 1974), 127(5).
• Ernst, K. C., Pogreba-Brown, K., Rasmussen, L., & Erhart, L. M. (2011). The effect of policy changes on hepatitis A vaccine uptake in Arizona children, 1995-2008. Public health reports (Washington, D.C. : 1974), 126 Suppl 2.
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  In 1995, the first hepatitis A vaccines became available for use. At that time, Arizona had the highest hepatitis A incidence of all 50 states. During that same time period, the Arizona State Immunization Information System (ASIIS) was created to collect information on all immunizations given in the state. Four state-level hepatitis A vaccination policies were enacted according to Centers for Disease Control and Prevention recommendations and local initiatives from 1996 to 2005. Our primary objective was to assess the impact of these policies on vaccine uptake in children.
• Pogreba-Brown, K., Harris, R. B., Stewart, J., Anderson, S., Erhart, L. M., & England, B. (2010). Outbreak investigation partnerships: utilizing a student response team in public health responses. Public health reports (Washington, D.C. : 1974), 125(6).
• Barber, B. J., Donnerstein, R. L., Secomb, T. W., Pogreba-Brown, K., Steelman, R., Ellenby, M. S., Shen, I., & Ungerleider, R. M. (2007). The dicrotic pulse: a common, non-ominous finding after the Ross operation. Pediatric cardiology, 28(4).
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  We noted a dicrotic pulse in several patients following a Ross operation. Although the etiology of this unique arterial waveform is not completely understood, it has been reported as a sign of low cardiac output and a poor prognosis. We reviewed preoperative echocardiograms and postoperative radial arterial pressure tracings in 33 patients who underwent a Ross procedure between 2000 and 2004. We found a dicrotic pulse to occur commonly (20/33; 61%) following a Ross operation. Moderate to severe preoperative aortic insufficiency was present in 19/20 patients (95%) in whom a dicrotic pulse was noted and in only 3/13 (23%) who did not exhibit a postoperative dicrotic pulse (p<0.001). A dicrotic pulse was not associated with an increased use of vasoactive infusions or longer hospitalization following the Ross operation. The dicrotic pulse should be recognized as a common postoperative finding in Ross patients that does not herald a delayed postoperative convalescence. The mechanism for a dicrotic pulse in these patients is speculative but may result from changes in vascular compliance secondary to chronic aortic insufficiency.
• Klewer, S. E., Yatskievych, T., Pogreba, K., Stevens, M. V., Antin, P. B., & Camenisch, T. D. (2006). Has2 expression in heart forming regions is independent of BMP signaling. Gene expression patterns : GEP, 6(5).
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  Heart septation and valve malformations constitute the most common birth defects. These cardiac structures arise from the endocardial cushions through dynamic interactions between cells and the extracellular matrix (cardiac jelly). Targeted deletion of the hyaluronan synthase-2 (Has2) gene in mice results in an absence of cardiac jelly and endocardial cushions, a loss of vascular integrity, and embryonic death at E9.5. Despite the requirements for Has2 and its synthetic product hyaluronan (HA) in the developing cardiovascular system, little is known about the normal expression pattern of Has2 or the factors regulating Has2 gene transcription during development. Bmp signaling is an important regulator of cardiac myogenesis, and is also important for endocardial cushion formation. The current study defines the embryonic expression pattern of Has2 and explores the regulation of Has2 gene expression by Bmp signaling. In situ hybridization studies demonstrate dynamic Has2 expression patterns during myocardial cell development and cardiac tube formation, formation of the cardiac endocardial cushions, and cushion invasion by valve primordial cells. Despite overlapping regional expression of Bmp2 in the late gastrula anterior lateral endoderm and Has2 in the adjacent cardiogenic mesoderm, application of noggin-expressing CHO cells beneath the endoderm failed to perturb normal Has2 expression. Thus, in contrast to many genes expressed in the heart forming region, regulation of Has2 in the cardiogenic mesoderm is independent of Bmp signaling.

Presentations

• Pogreba Brown, K. M. (2015, June). SAFER - Using Student Teams as an Avenue to Partnerships - Lessons Learned from 10 Years of Collaboration. CSTE Annual Conference. Boston, MA: Council of State and Territorial Epidemiologists.
• Pogreba Brown, K. M. (2015, March). Foodborne Diseases and Outbreaks. Desert Agriculture Conference. Yuma, AZ: University of Arizona Office of Extension.
• Pogreba Brown, K. M. (2015, November). State-wide Case Control Study of Campylobacterosis Risk Factors in Arizona. Campylobacter, Helicobacter and Related Organisms (CHRO) 2015 International Meeting. Rotorua, New Zealand.
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  This presentation was accepted, but I could not present in person due to medical reasons. Dr. Alexandra Armstrong gave my prepared presentation for me.

Poster Presentations

• Pogreba Brown, K. M., Foote, J. A., & Rodriguez, M. D. (2017, Summer). Descriptive Analysis of Opioid-related Events Presenting to Emergency Departments in Arizona, 2014. UROC-PREP 2017. The University of Arizona: UROC-PREP.
• Pogreba Brown, K. M. (2016, June 2016). Case-case methods for studying enteric diseases: A review and approach for standardization.. Council of State and Territorial Epidemiologists. Anchorage, AK: CSTE, CDC.
• Pogreba Brown, K. M. (2015, June). Assessing Risk Factors of Sporadic Campylobacter Infections: A State-wide Case-Control Study in Arizona. CSTE Annual Conference. Boston, MA: Council of State and Territorial Epidemiologists.
• Pogreba Brown, K. M., Ernst, K. C., & Harris, R. B. (2015, November). Determining Risk Factors of a Non-Point Source Outbreak of Campylobacter Cases Using Case-Case and Case-Control Studies. Campylobacter, Helicobbacter and Other Related Organisms International Conference. Rotorua, New Zealand.
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  This poster was accepted for the conference, but I was unable to attend due to medical reasons. Dr. Alexandra Armstrong, a colleague from CALS was able to present for me.
• Pogreba Brown, K. M. (2014, June). Methods for Implementing Real-Time Syndromic Surveillance at Large Public Events. Council for State and Territorial Epidemiologists Annual Conference. Boston.