Kristen M Pogreba Brown

Interests

Research

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

Teaching

Outbreak Investigations, Field Methods, Food Safety, One Health

Courses

Scholarly Contributions

Journals/Publications

• Habila, M. A., Valencia, D. Y., Khan, S. M., Heslin, K. M., Hoskinson, J., Ernst, K. C., Pogreba-Brown, K., Jacobs, E. T., Cordova-Marks, F. M., & Warholak, T. (2022). A Rasch analysis assessing the reliability and validity of the Arizona CoVHORT COVID-19 vaccine questionnaire. SSM - population health, 17, 101040.
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  Despite the widespread availability of COVID-19 vaccines in the United States, many that have chosen not to be vaccinated have done so because of vaccine hesitancy. This highlights the need for tools that accurately capture the knowledge, attitudes, and beliefs towards COVID-19 vaccines, and provide steps toward improving vaccine acceptance.
• Khan, S. M., Farland, L. V., Catalfamo, C. J., Austhof, E., Bell, M. L., Chen, Z., Cordova-Marks, F., Ernst, K. C., Garcia-Filion, P., Heslin, K. M., Hoskinson, J., Jehn, M. L., Joseph, E. C., Kelley, C. P., Klimentidis, Y., Russo Carroll, S., Kohler, L. N., Pogreba-Brown, K., & Jacobs, E. T. (2022). Elucidating symptoms of COVID-19 illness in the Arizona CoVHORT: a longitudinal cohort study. BMJ open, 12(1), e053403.
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  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.
• 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.
• Anderson, E. J., Ernst, K., Garcia, D. O., Lopez, E., Pogreba Brown, K., Austhof, E., Carr McCuin, D., Hayden, M. H., & Koss, M. P. (2021). Knowledge of Sexual Transmission of Zika Virus Among Women Who Are Pregnant or Intend to Become Pregnant, Arizona, 2017. Public health reports (Washington, D.C. : 1974), 333549211006986.
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  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.
• Bell, M. L., Catalfamo, C. J., Farland, L. V., Ernst, K. C., Jacobs, E. T., Klimentidis, Y. C., Jehn, M., & Pogreba-Brown, K. (2021). Post-acute sequelae of COVID-19 in a non-hospitalized cohort: Results from the Arizona CoVHORT. PloS one, 16(8), e0254347.
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  Clinical presentation, outcomes, and duration of COVID-19 has ranged dramatically. While some individuals recover quickly, others suffer from persistent symptoms, collectively known as long COVID, or post-acute sequelae of SARS-CoV-2 (PASC). Most PASC research has focused on hospitalized COVID-19 patients with moderate to severe disease. We used data from a diverse population-based cohort of Arizonans to estimate prevalence of PASC, defined as experiencing at least one symptom 30 days or longer, and prevalence of individual symptoms. There were 303 non-hospitalized individuals with a positive lab-confirmed COVID-19 test who were followed for a median of 61 days (range 30-250). COVID-19 positive participants were mostly female (70%), non-Hispanic white (68%), and on average 44 years old. Prevalence of PASC at 30 days post-infection was 68.7% (95% confidence interval: 63.4, 73.9). The most common symptoms were fatigue (37.5%), shortness-of-breath (37.5%), brain fog (30.8%), and stress/anxiety (30.8%). The median number of symptoms was 3 (range 1-20). Amongst 157 participants with longer follow-up (≥60 days), PASC prevalence was 77.1%.
• Betancourt, W. Q., Schmitz, B. W., Innes, G. K., Prasek, S. M., Pogreba Brown, K. M., Stark, E. R., Foster, A. R., Sprissler, R. S., Harris, D. T., Sherchan, S. P., Gerba, C. P., & Pepper, I. L. (2021). COVID-19 containment on a college campus via wastewater-based epidemiology, targeted clinical testing and an intervention. The Science of the total environment, 779, 146408.
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  Wastewater-based epidemiology has potential as an early-warning tool for determining the presence of COVID-19 in a community. The University of Arizona (UArizona) utilized WBE paired with clinical testing as a surveillance tool to monitor the UArizona community for SARS-CoV-2 in near real-time, as students re-entered campus in the fall. Positive detection of virus RNA in wastewater lead to selected clinical testing, identification, and isolation of three infected individuals (one symptomatic and two asymptomatic) that averted potential disease transmission. This case study demonstrated the value of WBE as a tool to efficiently utilize resources for COVID-19 prevention and response. Thus, WBE coupled with targeted clinical testing was further conducted on 13 dorms during the course of the Fall semester (Table 3). In total, 91 wastewater samples resulted in positive detection of SARS-CoV-2 RNA that successfully provided an early-warning for at least a single new reported case of infection (positive clinical test) among the residents living in the dorm. Overall, WBE proved to be an accurate diagnostic for new cases of COVID-19 with an 82.0% positive predictive value and an 88.9% negative predictive value. Increases in positive wastewater samples and clinical tests were noted following holiday-related activities. However, shelter-in-place policies proved to be effective in reducing the number of daily reported positive wastewater and clinical tests. This case study provides evidence for WBE paired with clinical testing and public health interventions to effectively contain potential outbreaks of COVID-19 in defined communities.
• Catalfamo, C. J., Heslin, K. M., Shilen, A., Khan, S. M., Hunsaker, J. R., Austhof, E., Barraza, L., Cordova-Marks, F. M., Farland, L. V., Garcia-Filion, P., Hoskinson, J., Jehn, M., Kohler, L. N., Lutrick, K., Harris, R. B., Chen, Z., Klimentidis, Y. C., Bell, M. L., Ernst, K. C., , Jacobs, E. T., et al. (2021). Design of the Arizona CoVHORT: A Population-Based COVID-19 Cohort. Frontiers in public health, 9, 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.
• Klotz, S. A., Miller, M. L., Pogreba-Brown, K. M., Komatsu, K. K., Morehouse, L. M., Dudley, S. W., & Shirazi, F. M. (2021). e-Health for COVID-19 Epidemic: The Arizona Poison and Drug Information Center Experience. Telemedicine journal and e-health : the official journal of the American Telemedicine Association.
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  A significant challenge of the COVID-19 epidemic was the dissemination of accurate and timely information to the public, health care providers, and first responders. We describe the expansion of the Arizona Poison and Drug Information Center (APDIC) to fill such a need for residents of Arizona. The original mission of the APDIC was recognition and management of chemical exposure, poisoning, envenomation, and drug-related medical problems. In response to COVID-19, APDIC expanded its personnel and facilities to accommodate telephone calls and teleconsults regarding COVID-19. Thirteen different topics dealing with COVID-19 were addressed and tracked and included: testing information, isolation, prevention, personal protective equipment, travel, vaccines, therapies, antibody testing, contact tracing, exposure to the virus and what to do in businesses, at work or at school regarding isolation and quarantine. Responding to the public health needs, APDIC accepted >320,000 telephone calls and completed 48,346 teleconsults from March 3, 2020 to March 3, 2021. This represented a 15-fold increase in calls and twice the number of consults over 2019. Upon release of the vaccine, calls increased sharply with >7,000 calls in 1 day (February 7, 2021). In conclusion, the APDIC, rapidly expanded to address urgent public health information needs surrounding COVID-19 while still accomplishing its founding mission.
• Moore, T. C., Fong, J., Rosa Hernández, A. M., & Pogreba-Brown, K. (2021). CAFOs, novel influenza, and the need for One Health approaches. One health (Amsterdam, Netherlands), 13, 100246.
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  Concentrated animal feeding operations (CAFOs) present highly efficient means of meeting food demands. CAFOs create unique conditions that can affect the health and environment of animals and humans within and outside operations, leading to potential epidemiological concerns that scale with operational size. One such arena meriting further investigation is their possible contribution to novel influenzas. CAFOs present opportunities for cross-species transmission of influenza as demonstrated by reports of swine flu and avian influenza outbreaks. Conditions and pathways leading to novel influenza strains are complex and require varied prevention and intervention approaches. Current challenges for prevention of respiratory viruses entering or leaving swine and poultry CAFOs are multifaceted and include adherence of personal safety measures, lack of training and safety provisions for personnel, and incomplete standardized federal, state, and/or county regulation and enforcement coverage across agricultural systems. This report acknowledges that any proposed CAFO-associated influenza intervention should be cross-organizational, and no single intervention should be expected to provide full resolution. Proposed interventions affect multiple components of the One Health triad, and include seasonal human influenza immunization, PPE regulation and adherence, alternative waste management, general biosecurity standardization and an industry best practices incentive program. Due to the complexity of this problem, multiple anticipated communication, enforcement, and logistical challenges may hinder the full implementation of proposed solutions. General and operation-specific (swine and poultry) biosecurity practices may mitigate some of the risks associated with influenza virus reassortment across species. Education and advocacy can help protect workers, communities, veterinarians and consumers from CAFO-associated influenza virus. To achieve this, there must be more complete communication between CAFOs, governing agencies, health services, animal services, researchers, and consumers to better explore the potential health outcomes associated with CAFOs.
• Pepper, I. L., Gerba, C. P., Sherchan, S. P., Harris, D. T., Sprissler, R. S., Foster, A. R., Stark, E. R., Pogreba Brown, K. M., Prasek, S. M., Innes, G. K., Schmitz, B. W., & Betancourt, W. Q. (2021). COVID-19 containment on a college campus via wastewater-based epidemiology, targeted clinical testing and an intervention. Science of the Total Environment.
• 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., 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), 159.
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  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.
• Ellingson, K. D., Pogreba-Brown, K., Gerba, C. P., & Elliott, S. P. (2020). Impact of a Novel Antimicrobial Surface Coating on Health Care-Associated Infections and Environmental Bioburden at 2 Urban Hospitals. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 71(8), 1807-1813.
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  Approximately 1 in 25 people admitted to a hospital in the United States will suffer a health care-associated infection (HAI). Environmental contamination of hospital surfaces contributes to HAI transmission. We investigated the impact of an antimicrobial surface coating on HAIs and environmental bioburdens at 2 urban hospitals.
• Owusu-Dommey, A., Pogreba-Brown, K., & Villa-Zapata, L. (2020). Seroprevalence of Toxoplasma gondii in the U.S.: Evidence from a representative cross-sectional survey. Parasitology international, 79, 102175.
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  The National Health and Nutrition Examination Survey (NHANES) evaluates the epidemiology in the U.S. population of certain infectious diseases, including Toxoplasma gondii (T. gondii), a protozoan parasite. This study aims to evaluate the seroprevalence of T. gondii -IgG antibodies using NHANES data to identify risk factors related to T. gondii. Using NHANES 2009-10, 2011-12, and 2013-14 cycles, univariate analyses and logistic regression models were conducted to determine the relationship between T. gondii seropositivity and various risk factors. Across the three cycles, 13.3% of participants tested positive for T. gondii-IgG seroprevalence, with a significant decrease in seroprevalence from the earlier to later cycles. 53.4% of individuals with positive serology were male. The probability of testing positive for T. gondii -IgG significantly increases between four and five times from the 18-29 age group to 70-79 age group. Seroprevalence also differed by ethnicity, with Latinos of any race having two times higher odds of testing positive for T. gondii compared to other ethnicities. Other sociodemographic factors were associated with lower odds of T. gondii seropositivity, including college education, higher household income, and health insurance. Most clinical conditions were not significantly associated with T. gondii, excluding depression, which was observed in 25% of patients positive for T. gondii-IgG. Further research on the influence of this parasite on infected individuals, including predispositions for risk-taking, is needed to better understand the relationship between Toxoplasma gondii, depression, and other mental illnesses.
• Pogreba Brown, K., Austhof, E., Rosa Hernández, A. M., McFadden, C., Boyd, K., Sharma, J., Battaglia, S., Shilen, A., & Heslin, K. M. (2020). Training and Incorporating Students in SARS-CoV-2 Case Investigations and Contact Tracing. Public health reports (Washington, D.C. : 1974), 33354920974664.
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  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.
• 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), 342-344.
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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.
• Verhougstraete, M. P., Pogreba-Brown, K., Reynolds, K. A., Lamparelli, C. C., Zanoli Sato, M. I., Wade, T. J., & Eisenberg, J. N. (2020). A critical analysis of recreational water guidelines developed from temperate climate data and applied to the tropics. Water research, 170, 115294.
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  Recreational water epidemiology studies are rare in settings with minimal wastewater treatment where risk may be highest, and in tropical settings where warmer temperature influences the ecology of fecal indicator bacteria commonly used to monitor recreational waters. One exception is a 1999 study conducted in São Paulo Brazil. We compared the risk and exposure characteristics of these data with those conducted in the United Kingdom (UK) in the early 1990s that are the basis of the World Health Organization's (WHO) guidelines on recreational water risks. We then developed adjusted risk difference models (excess gastrointestinal illness per swimming event) for children (
• Eisenburg, J., Wade, T., Zanoli Satof, M., Conde Lamparellie, C., Reynolds, K. A., Canales, R. A., Pogreba Brown, K. M., & Verhougstraete, M. (2019). Using Local Data in a Quantitative Microbial Risk Assessment in Sao Paulo, Brazil. Water Research. doi:https://doi.org/10.1016/j.watres.2019.115294
• Ellingson, K., Pogreba Brown, K. M., Gerba, C. P., & Elliott, S. P. (2019). Impact of a Novel Antimicrobial Surface Coating on Healthcare-Associated Infections and Environmental Bioburden at Two Urban Hospitals. Clinical Infectious Diseases. doi:https://doi.org/10.1093/cid/ciz1077
• Pogreba Brown, K. M., Ellingson, K., & Barrett, E. (2019). Overview of Case-Case Investigations for Hospital Acquired Infections. American Journal of Infection Control. doi:https://doi.org/10.1016/j.ajic.2018.11.024
• Pogreba Brown, K. M., Erika, B., Amanda, O., Joli, W., Rosa, L., & Ernst, K. C. (2019). Public Perceptions of Non-Pharmaceutical Interventions for Vectorborne and Respiratory Illnesses – A Statewide Survey in Arizona.. Epidemiology and Community Health. doi:https://journals.sagepub.com/doi/pdf/10.1177/1757913919886605
• Pogreba-Brown, K., Austhof, E., Armstrong, A., Schaefer, K., Zapata, L. V., McClelland, D. J., Batz, M. B., Kuecken, M., Riddle, M., Porter, C. K., & Bazaco, M. C. (2019). Chronic Gastrointestinal and Joint-Related Sequelae Associated with Common Foodborne Illnesses: A Scoping Review. FOODBORNE PATHOGENS AND DISEASE. doi:https://doi.org/10.1089/fpd.2019.2692
• Verhougstraete, M., Pogreba Brown, K. M., Canales, R. A., Reynolds, K. A., Conde Lamparellie, C., Zanoli Satof, M., Wade, T., & Eisenburg, J. (2019). Using Local Data in a Quantitative Microbial Risk Assessment in Sao Paulo, Brazil. Water Research. doi:https://doi.org/10.1016/j.watres.2019.115294
• Barrett, E., Carr, D., Bell, M. L., & Pogreba Brown, K. M. (2018). Pilot Study of Long-Term Sequelae following a Campylobacteriosis Infection. Submitted to Pilot and Feasibility Studies. Pilot and Feasibility Studies.
• Barrett, E., Carr, D., Bell, M. L., & Pogreba-Brown, K. (2018). Post-infectious sequelae after Campylobacter enteric infection: a pilot study in Maricopa County, Arizona, USA. Pilot and feasibility studies, 4, 142.
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  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.
• Pogreba Brown, K. M., & Barrett, E. (2018). Predominate Risk Factors for Campylobacter Cases in Arizona by Ethnicity– Explaining the Higher Rates of Campylobacter among Hispanics in Arizona.. Foodborne Pathogens and Disease.
• Pogreba Brown, K. M., O'Connor, P., Matthews, J., Barrett, E., & Bell, M. (2018). Case-Case Analysis of Campylobacter and Salmonella to determine differences in risk factors for use in outbreak investigations.. Epidemiology and Infection.
• 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), 277-284.
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  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.
• Pogreba-Brown, K., O'Connor, P., Matthews, J., Barrett, E., & Bell, M. L. (2018). Case-case analysis of Campylobacter and Salmonella - using surveillance data for outbreak investigations and monitoring routine risk factors. Epidemiology and infection, 146(15), 1916-1921.
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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.
• 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

• Ernst, K. C., Tamari, N., Li, Y., Pogreba Brown, K. M., Shilen, A., Orias, J., Elmer, C., Helming, B., Kaur, D., Beamer, P., & Ram, S. (2021). Deployment of the COVID-Watch exposure notification application in Arizona: acceptability, performance, and utility.. Council of State and Territorial Epidemiologists Virtual Conference.
• Mclain, J. E., Cooper, K. K., Verhougstraete, M., & Pogreba Brown, K. M. (2019, November). Breaking down scientific silos: using One Health to address the World’s wicked problems. TENWEST Impact Festival. Tucson, Arizona.
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  McLain, J.E. K. Cooper, K. Pogreba-Brown, and M. Verhougstraete. Breaking down scientific silos: using One Health to address the World’s wicked problems. Tucson, Arizona, October 14, 2019.
• Pogreba Brown, K. M. (2019, July). Chronic Sequelae and Common Foodborne Illnesses – A Scoping Review of the Literature. International Association of Food Protection. Louisville, KY.
• Pogreba Brown, K. M. (2019, September). Post-infectious sequelae after Campylobacter infection: a pilot study.. Campylobacter, Helicobacter and Related Organisms (CHRO). Belfast, Ireland.
• Pogreba Brown, K. M., Batz, M., Tauxe, R., Pascoe, B., & Taboada, E. (2018, July). The Conundrum of Campylobacter Source Attribution. International Association of Food Protection (IAFP) Annual Conference. Salt Lake City, UT: IAFP.
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  Panel Discussion
• 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. (2019, July). Chronic gastrointestinal and joint-related sequelae associated with common foodborne illnesses – a scoping review.. International Association of Food Protection.. Louiville, KY.
• Pogreba Brown, K. M. (2019, June). Post-infectious sequelae after Campylobacter enteric infection: a pilot study.. Council of State and Territorial Epidemiologists. Raleigh, NC.
• Pogreba Brown, K. M., & Austhof, E. (2019, Sept). Campylobacter and Ethnicity – A Case-Case Analysis to Determine Differences in Disease Presentation and Risk Factors.. Campylobacter, Helicobacter and Related Organisms (CHRO). Belfast, Ireland.
• Pogreba Brown, K. M., Austhof, E., Armstrong, A., Schaefer, K., Villa-Zapata, L., Owusu-Dommey, A., McClelland, J., Batz, M., Kuecken, M., Riddle, M., & Bazaco, M. (2019, September). A Scoping Review to Determine the Current Data on Campylobacter and Post-Infectious Sequelae. Campylobacter, Helicobacter and Related Organisms (CHRO). Belfast, Ireland: Campylobacter, Helicobacter and Related Organisms (CHRO).
• Villa, L., Armstrong, A., Austhof, E., Schaefer, K., & Pogreba-Brown, K. (2019, MAY). FOODBORNE ILLNESSES AND CHRONIC SEQUELAE: A REVIEW OF DISEASE BURDEN EVALUATIONS. VALUE IN HEALTH.
• Pogreba Brown, K. M., O'Conner, P., Matthews, J., Barrett, E., & Bell, M. L. (2018, June). Case-Case Analysis of Campylobacter and Salmonella – Using Surveillance Data for Outbreak Investigations and Monitoring Routine Risk Factors.. Council of State and Territorial Epidemiologists (CSTE) Annual Conference. West Palm Beach, FL: CSTE.
• 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.

Others

• Barraza, L. F., & Pogreba Brown, K. M. (2020, March). COVID-19: Your Questions About Quarantine and Isolation Answered.. BottomLineInc..