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

• 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.
• Catalfamo, C. J., Jacobs, E. T., Falk, L. P., Lauro, P., Ernst, K. C., Farland, L. V., Heslin, K. M., Pogreba-Brown, K., & Garcia-Filion, P. C. (2025). Concordance between self-reported SARS-CoV-2 positivity and laboratory-confirmed positivity. PLOS ONE, 20(Issue 10). doi:10.1371/journal.pone.0334102
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  As the use and availability of at-home antigen tests for SARS-CoV-2 infection have increased, the number of individuals with SARS-CoV-2 infections that are reported to state COVID-19 surveillance systems have decreased. Self-reported infection dates are critical to accurately track incidence and outbreaks of COVID-19 and for continued research on illness progression; however, the reliability of self-reported infection dates is unknown to date. To assess accuracy of self-reported test dates, we utilized self-reported SARS-CoV-2 testing data from the Arizona CoVHORT Study (CoVHORT) and laboratory-confirmed testing data collected by the Arizona Department of Health Services (ADHS) and calculated the difference in days between dates to examine their percent agreement. We used logistic regression to assess if any participant characteristics were associated with self-reporting a test date >7 days different than the laboratory confirmed date. A total of 1,900 CoVHORT participants aged 18 years or older were included in our analyses. Most participants (82.5%) reported a test date within 7 days of the laboratory confirmed date of their illness. Increasing age and number of weeks between testing positive and self-reporting the test date were both significantly associated with a difference of 7 days or greater between dates. There was an 84% increase (OR=1.84, 95% CI = 1.11–3.06) in likelihood of inaccurately self-reporting their SARS-CoV-2 test date for participants aged 55 years and older and a 2% increase (OR=1.02, 95% CI = 1.02–1.03) for each elapsed week following their SARS-CoV-2 test. We observed an 82% percent agreement (dates within 7 days of each other) between self-reported and laboratory confirmed test dates, suggesting that self-reported SARS-CoV-2 test dates are sufficient for identifying and tracking Long COVID or Post-COVID Conditions when a laboratory-confirmed test
• Dixon, B. E., Allen, K. S., Simmons, N., Brinkley, J., Andrews, J. G., Dzomba, B. J., Feiler, M. O., Jones, R. M., Ortiz, M. R., Sharma, V., Dalton, A. F., Pratt, C., Grannis, S. J., Saydah, S. H., & , T. P. (2025). Incidence of long COVID among U.S. children and adults during the omicron era - Tracking Post-COVID Conditions (Track-PCC) network, 2022-2023. Journal of infection and public health, 18(11), 102935.
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  Long COVID, or Post-COVID Conditions (PCC), refers to new and persisting sequelae occurring in the months following an acute SARS-CoV-2 infection. Although previous studies have reported estimates of PCC incidence, few have examined trends during the Omicron variant period or have included geographically distinct regions for the same time periods.
• Feldman, C. H., Santacroce, L., Bassett, I. V., Thaweethai, T., Alicic, R., Atchley-Challenner, R., Chung, A., Goldberg, M. P., Horowitz, C. R., Jacobson, K. B., Daniel Kelly, J., Knight, S., Lutrick, K., Mudumbi, P., Parthasarathy, S., Prendergast, H., Quintana, Y., Sharareh, N., Shellito, J., , Sherif, Z. A., et al. (2025). Social Determinants of Health and Risk for Long COVID in the: U.S. RECOVER-Adult Cohort. Annals of Internal Medicine, 178(Issue 9). doi:10.7326/annals-24-01971
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  Background: Social determinants of health (SDoH) contribute to disparities in SARS-CoV-2 infection, but their associations with long COVID are unknown. Objective: To determine associations between SDoH at the time of SARS-CoV-2 infection and risk for long COVID. Design: Prospective observational cohort study. Setting: 33 states plus Washington, DC, and Puerto Rico. Participants: Adults (aged =18 years) enrolled in RECOVER-Adult (Researching COVID to Enhance Recovery) between October 2021 and November 2023 who were within 30 days of SARS-CoV-2 infection; completed baseline SDoH, comorbidity, and pregnancy questionnaires; and were followed prospectively. Measurements: Social risk factors from SDoH baseline questionnaires, ZIP code poverty and household crowding measures, and a weighted score of 11 or higher on the Long COVID Research Index 6 months after infection. Results: Among 3787 participants, 418 (11%) developed long COVID. After adjustment for demographic characteristics, pregnancy, disability, comorbidities, SARS-CoV-2 severity, and vaccinations, financial hardship (adjusted marginal risk ratio [ARR], 2.36 [95% CI, 1.97 to 2.91]), food insecurity (ARR, 2.36 [CI, 1.83 to 2.98]), less than a college education (ARR, 1.60 [CI, 1.30 to 1.97]), experiences of medical discrimination (ARR, 2.37 [CI, 1.94 to 2.83]), skipped medical care due to cost (ARR, 2.87 [CI, 2.22 to 3.70]), and lack of social support (ARR, 1.79 [CI, 1.50 to 2.17]) were associated with increased risk for long COVID. Living in ZIP codes with the highest (vs. lowest) household crowding was also associated with greater risk (ARR, 1.36 [CI, 1.05 to 1.71]). Limitation: Selection bias may influence observed associations and generalizability. Conclusion: Participants with social risk factors at the time of SARS-CoV-2 infection had greater risk for subsequent long COVID than those without. Future studies should determine whether social risk factor interventions mitigate long-term effects of SARS-CoV-2 infection.
• 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. 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.
• Mitchell, C. L., Ramirez, V., Santos, E., Noumeh, D., VerSchave, S., Escheman, H., Goetz, N., Figueroa, M., Wagner, K., Singletary, M., Kohler, L. N., Ellingson, K. D., Wagner, J., Pogreba-Brown, K., & Cullen, T. A. (2025). Integrating Human–Animal Care Through a Public Health–Driven One Health Clinic Model in Pima County, Arizona, October 2023–February 2024. Public Health Reports. doi:10.1177/00333549251367579
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  One Health clinics integrate human, animal, and environmental health to provide interdisciplinary health care and community resources to people experiencing homelessness (PEH). Five mobile, public health–led One Health clinics were newly implemented in Pima County, Arizona, during October 2023–February 2024. Clinic locations included parks, libraries, and homeless shelters to reduce transportation-related barriers and integrate public health, veterinary, and housing services. Originally designed for PEH and their pets, Pima County One Health clinics were open to everyone in neighborhoods where clinics were hosted to promote community engagement with clinics and strengthen relationships with public health. We evaluated the performance of these clinics by describing service patterns, client perceptions, and lessons learned to support development of clinics by other jurisdictions. During clinic visits, basic demographic information was collected for people and pets, along with data on housing status, environmental and resource concerns, use of clinic services, and perceptions of clinics. The first 5 monthly mobile community clinics served 108 clients and 93 pets; 44% of clients were unhoused or unstably housed, 36% of clients were housed, and housing status was unknown for 20% of clients. Clinics facilitated partnership among service providers and with housed and unhoused community members. Clinics supported vaccine uptake among people and their pets and identified 3 cases of sexually transmitted infections that might otherwise have remained undetected. By implementing a One Health Clinic framework, our local health department helped address gaps in human and veterinary health care services. Other public health agencies might consider implementing similar models to enhance public health engagement with local communities.
• Pogreba Brown, K., 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(1), e095093.
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  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.
• , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , , ., et al. (2024). Measurement of circulating viral antigens post-SARS-CoV-2 infection in a multicohort study. Clinical Microbiology and Infection, 30(12). doi:10.1016/j.cmi.2024.09.001
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  Objectives: To determine the proportion of individuals with detectable antigen in plasma or serum after SARS-CoV-2 infection and the association of antigen detection with postacute sequelae of COVID-19 (PASC) symptoms. Methods: Plasma and serum samples were collected from adults participating in four independent studies at different time points, ranging from several days up to 14 months post-SARS-CoV-2 infection. The primary outcome measure was to quantify SARS-CoV-2 antigens, including the S1 subunit of spike, full-length spike, and nucleocapsid, in participant samples. The presence of 34 commonly reported PASC symptoms during the postacute period was determined from participant surveys or chart reviews of electronic health records. Results: Of the 1569 samples analysed from 706 individuals infected with SARS-CoV-2, 21% (95% CI, 18–24%) were positive for either S1, spike, or nucleocapsid. Spike was predominantly detected, and the highest proportion of samples was spike positive (20%; 95% CI, 18–22%) between 4 and 7 months postinfection. In total, 578 participants (82%) reported at least one of the 34 PASC symptoms included in our analysis ≥1 month postinfection. Cardiopulmonary, musculoskeletal, and neurologic symptoms had the highest reported prevalence in over half of all participants, and among those participants, 43% (95% CI, 40–45%) on average were antigen-positive. Among the participants who reported no ongoing symptoms (128, 18%), antigen was detected in 28 participants (21%). The presence of antigen was associated with the presence of one or more PASC symptoms, adjusting for sex, age, time postinfection, and cohort (OR, 1.8; 95% CI, 1.4–2.2). Discussion: The findings of this multicohort study indicate that SARS-CoV-2 antigens can be detected in the blood of a substantial proportion of individuals up to 14 months after infection. While approximately one in five asymptomatic individuals was antigen-positive, roughly half of all individuals reporting ongoing cardiopulmonary, musculoskeletal, and neurologic symptoms were antigen-positive.
• Austhof, E., Brown, H. E., White, A. E., Jervis, R. H., Weiss, J., Shrum Davis, S., Moore, D., & Pogreba-Brown, K. (2024). Association between Precipitation Events, Drought, and Animal Operations with Infections in the Southwest United States, 2009-2021. Environmental health perspectives, 132(9), 97010.
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  Weather variability is associated with enteric infections in people through a complex interaction of human, animal, and environmental factors. Although infections have been previously associated with precipitation and temperature, the association between precipitation and drought on campylobacteriosis has not been studied.
• Austhof, E., Pogreba-Brown, K., White, A. E., Jervis, R. H., Weiss, J., Davis, S. S., Moore, D., & Brown, H. E. (2024). Association between precipitation events, drought, and animal operations with infections in the Southwest US, 2009-2021. One health (Amsterdam, Netherlands), 19, 100941.
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  Temperature and precipitation have previously been associated with infections. The association between salmonellosis and precipitation might be explained by antecedent drought conditions; however, few studies have explored this effect.
• 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.
• Jones, R. M., Andrews, J. G., Dalton, A. F., Dixon, B. E., Dzomba, B. J., Fernando, S. I., Pogreba-Brown, K. M., Ortiz, M. R., Sharma, V., Simmons, N., Saydah, S. H., & , T. P. (2024). Tracking the burden, distribution, and impact of Post-COVID conditions in diverse populations for children, adolescents, and adults (Track PCC): passive and active surveillance protocols. BMC public health, 24(1), 2345.
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  Track PCC includes five geographic surveillance sites to conduct standardized population-based surveillance to estimate and track Post-COVID Conditions (PCC) by age, sex, race/ethnicity, geographic area, severity of initial infection, and risk factors among persons with evidence of SARS-CoV-2 infection (based on the Council of State and Territorial Epidemiologist [CSTE] case definitions for confirmed cases or laboratory-confirmed evidence of infection).
• Pogreba Brown, K. M., Kenzie, S., Boyd, K., McFadden, C. M., Austhof, E. C., Hoffman, S., & Armstrong, A. (2024). Exposing vibriosis: a scoping review of the literature regarding sequelae of non-cholera Vibrio infection. Archives Clin Inf Dis, 19(3), e138679.
• Barraza, L. F., Kahn, S., Shilen, A., Austhof, E., Cordova, F. M., Ernst, K. C., Heslin, K., Kelly, C., Pogreba Brown, K. M., Jacobs, E. T., & Hall-Lipsy, E. A. (2023). Differences in Perceptions of Individual and Government-Level COVID-19 Prevention Measures Based on Vaccine Willingness.. Journal of Heath Care Law & Policy.
• Farland, L. V., Khan, S. M., Shilen, A., Heslin, K. M., Ishimwe, P., Allen, A. M., Herbst-Kralovetz, M. M., Mahnert, N. D., Pogreba-Brown, K., Ernst, K. C., & Jacobs, E. T. (2023). COVID-19 vaccination and changes in the menstrual cycle among vaccinated persons. Fertility and Sterility, 119(Issue 3). doi:10.1016/j.fertnstert.2022.12.023
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  Objective: To describe the characteristics of people who experience changes to their menstrual cycle after COVID-19 vaccination. Design: Longitudinal study. Patient(s): We recruited a volunteer sample with and without a history of SARS-CoV-2 infection who enrolled in the Arizona COVID-19 Cohort (CoVHORT) study and participated in a reproductive sub-cohort who were pre-menopausal, not pregnant, and had received a COVID-19 vaccine in 2021 (n = 545). Exposure(s): Demographic and reproductive characteristics were collected via self-reports. Main Outcome Measure(s): Information on self-reported changes in the menstrual cycle after COVID-19 vaccination was collected from May 2021 to December 2021. We looked at demographic and reproductive characteristics as predictors of menstrual cycle change. Result(s): The majority of our vaccinated sample received the Pfizer-BioNTech vaccine (58%), and were 26-35 years old (51%), non-Hispanic (84%), and White (88%). Approximately 25% of vaccinated participants reported a change in their menstrual cycle after vaccination; the majority reported changes after their second dose (56%) as compared with their first (18%) and third (14%) doses. The most commonly reported changes were irregular menstruation (43%), increased premenstrual symptoms (34%), increased menstrual pain or cramps (30%), and abnormally heavy or prolonged bleeding (31%). High self-reported perceived stress levels compared with low perceived stress (OR, 2.22; 95% CI 1.12-4.37) and greater body mass index (OR, 1.04; 95% CI 1.00-1.07) were associated with greater odds of experiencing the menstrual cycle changes after the vaccination. Participants having a history of SARS-CoV-2 infection were less likely to report changes in their menstrual cycle after vaccination compared with the participants with no history of SARS-CoV-2 infection (OR, 0.58; 95% CI 0.32-1.04). Conclusion(s): Among vaccinated participants, approximately 25% of them reported predominantly temporary changes in the menstrual cycle, however, we are unable to determine whether these changes are due to normal cycle variability. The COVID-19 vaccines are safe and effective for everyone, including pregnant people and people trying to conceive; hence, these findings should not discourage vaccination.
• Hall-Lipsy, E. A., Jacobs, E. T., Pogreba Brown, K. M., Cordova, F. M., Ernst, K. C., Shilen, A., Kelley, C., Khan, S. M., Austhof, E., Barraza, L. F., Hall-Lipsy, E. A., Jacobs, E. T., Pogreba Brown, K. M., Cordova, F. M., Ernst, K. C., Shilen, A., Kelley, C., Khan, S. M., Austhof, E., & Barraza, L. F. (2023). Differences in Perceptions of Individual and Government-Level COVID-19 Prevention Measures Based on Vaccine Willingness. Journal of Health Care Law & Policy, 26(1), 87-104.
• Hall-Lipsy, E. A., Jacobs, E., Cordova, F. M., Pogreba Brown, K. M., Ernst, K. C., Shilen, A., Kelley, C. P., Khan, S., Austhof, E. C., & Barraza, L. F. (2023). Differences in Perceptions of Individual and Government-Level COVID-19 Prevention Measures Based on Vaccine Willingness. J Health Care L & Policy, 26(87).
• Horwitz, L. I., Thaweethai, T., Brosnahan, S. B., Cicek, M. S., Fitzgerald, M. L., Goldman, J. D., Hess, R., Hodder, S. L., Jacoby, V. L., Jordan, M. R., Krishnan, J. A., Laiyemo, A. O., Metz, T. D., Nichols, L., Patzer, R. E., Sekar, A., Singer, N. G., Stiles, L. E., Taylor, B. S., , Ahmed, S., et al. (2023). Researching COVID to Enhance Recovery (RECOVER) adult study protocol: Rationale, objectives, and design. PloS one, 18(6), e0286297. doi:10.1371/journal. pone.0286297
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  SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis.
• Jacobs, E. T., Catalfamo, C. J., Colombo, P. M., Khan, S. M., Austhof, E., Cordova-Marks, F., Ernst, K. C., Farland, L. V., & Pogreba-Brown, K. (2023). Pre-existing conditions associated with post-acute sequelae of COVID-19. Journal of autoimmunity, 135, 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.
• Jacobs, E. T., Cordova-Marks, F. M., Farland, L. V., Ernst, K. C., Andrews, J. G., Vu, S., Heslin, K. M., Catalfamo, C., Chen, Z., & Pogreba-Brown, K. (2023). Understanding low COVID-19 booster uptake among US adults. Vaccine, 41(42), 6221-6226.
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  Vaccinations against SARS-CoV-2 have consistently been shown to reduce the risk of severe COVID-19 disease. However, uptake of boosters has stalled in the United States at less than 20% of the eligible population. The objective of this study was to assess the reasons for not having obtained a bivalent booster within an existing COVID-19 cohort.
• Thaweethai, T., Jolley, S. E., Karlson, E. W., Levitan, E. B., Levy, B., McComsey, G. A., McCorkell, L., Nadkarni, G. N., Parthasarathy, S., Singh, U., Walker, T. A., Selvaggi, C. A., Shinnick, D. J., Schulte, C. C., Atchley-Challenner, R., Alba, G. A., Alicic, R., Altman, N., Anglin, K., , Argueta, U., et al. (2023). Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection. JAMA, 329(22), 1934-1946.
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  SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals.
• Trejo, M. J., Batai, K., Chen, Y., Brezina, S., Chow, H. S., Ellis, N., Lance, P., Hsu, C. H., Pogreba-Brown, K., Bishop, M., Gsur, A., & Jacobs, E. T. (2022). Genome-Wide Association Study of Metachronous Colorectal Adenoma Risk among Participants in the Selenium Trial. Nutrition and cancer, 75(1), 143-153.
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  Genetic variants related to colorectal adenoma may help identify those who are at highest risk of colorectal cancer development or illuminate potential chemopreventive strategies. The purpose of this genome-wide association study was to identify genetic variants that are associated with risk of developing a metachronous colorectal adenoma among 1,215 study participants of European descent from the Selenium Trial. Associations of variants were assessed with logistic regression analyses and validated in an independent case-control study population of 1,491 participants from the Colorectal Cancer Study of Austria (CORSA). No statistically significant genome-wide associations between any variant and metachronous adenoma were identified after correction for multiple comparisons. However, an intron variant of gene, rs61901554, showed a suggestive association ( = 1.10 × 10) and was associated with advanced adenomas in CORSA ( = 0.04). Two intronic variants, rs12728998 and rs6699944 in were also observed to have suggestive associations with metachronous lesions ( = 2.00 × 10) in the Selenium Trial and were associated with advanced adenoma in CORSA ( = 0.03). Our results provide new areas of investigation for the genetic basis of the development of metachronous colorectal adenoma and support a role for involvement in the Wnt/β-catenin pathway leading to colorectal neoplasia.Trial Registration number: NCT00078897 (ClinicalTrials.gov).
• 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., Bell, M. L., Riddle, M. S., 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, e136.
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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% ( = 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% ( = 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.
• Farland, L. V., Khan, S. M., Shilen, A., Heslin, K. M., Ishimwe, P., Allen, A. M., Herbst-Kralovetz, M. M., Mahnert, N. D., Pogreba-Brown, K., Ernst, K. C., & Jacobs, E. T. (2022). COVID-19 vaccination and changes in the menstrual cycle among vaccinated persons. Fertility and sterility.
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  To describe the characteristics of people who experience changes to their menstrual cycle after COVID-19 vaccination.
• Garcia, P. C., Barraza, L. F., Peace-Tuskey, K., Jehn, M., Cordova, F. M., Pogreba Brown, K. M., Carr, D. L., Dykinga, M., Dawodu, O., Mantina, N. M., & Nuno, V. L. (2022). Consequences of COVID-19 on adolescents in Arizona: A longitudinal study protocol. . Frontiers in Public Health.
• 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.
• Klotz, S. A., Miller, M. L., Pogreba-Brown, K. M., Komatsu, K. K., Morehouse, L. M., Dudley, S. W., & Shirazi, F. M. (2022). E-Health for COVID-19 Epidemic: The Arizona Poison and Drug Information Center Experience. Telemedicine and e-Health, 28(Issue 5). doi:10.1089/tmj.2021.0287
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  Background: 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. Methodology: 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. Results: 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). Conclusion: In conclusion, the APDIC, rapidly expanded to address urgent public health information needs surrounding COVID-19 while still accomplishing its founding mission.
• Leybas Nuño, V., Mantina, N. M., Dawodu, O., Dykinga, M., Carr, D. L., Pogreba-Brown, K., Cordova-Marks, F., Jehn, M., Peace-Tuskey, K., Barraza, L., & Garcia-Filion, P. (2022). Consequences of COVID-19 on adolescents in Arizona: A longitudinal study protocol. Frontiers in public health, 10, 945089.
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  The long-term impact of COVID-19 is unknown. We developed a 5-year prospective cohort study designed to generate actionable community-informed research about the consequences of COVID-19 on adolescents ages 12-17 years in Arizona.
• 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.
• 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.
• Austhof, E., Battaglia, S., Boyd, K., Brown, K. P., Hernandez, A. M., Heslin, K. M., Mcfadden, C., Sharma, J., & Shilen, A. (2021). Training and Incorporating Students in SARS-CoV-2 Case Investigations and Contact Tracing.. Public health reports (Washington, D.C. : 1974), 136(2), 154-160. doi:10.1177/0033354920974664
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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..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..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..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.
• 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.
• 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.
• Donzella, S. M., Kohler, L. N., Crane, T. E., Jacobs, E. T., Ernst, K. C., Bell, M. L., Catalfamo, C. J., Begay, R., Pogreba-Brown, K., & Farland, L. V. (2022). COVID-19 Infection, the COVID-19 Pandemic, and Changes in Sleep. Frontiers in public health, 9, 795320.
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  The objective of this study was to investigate the differences in sleep patterns among individuals with and without laboratory-confirmed SARS-CoV-2 infection. Laboratory-confirmed SARS-CoV-2 test results and self-reported measures recalling sleep habits prior to and during the pandemic were collected from May 2020 to March 2021 among 1,848 individuals in The Arizona CoVHORT Study. We used linear and logistic regression to model the association between test status, presentation of symptoms, and time since test result with sleep duration and trouble sleeping, respectively. Mixed models were used to investigate change in sleep duration prior to the pandemic compared to during the pandemic. Overall, 16.2% of the sample were SARS-CoV-2 positive, 64.3% were SARS-CoV-2 negative, and 19.5% were untested for SARS-CoV-2. Independent of SARS-CoV-2 infection status, all participants slept longer during the pandemic compared to pre-pandemic (Δ SARS-CoV-2 positive: 77.7 min, 95% CI 67.9, 87.5; Δ SARS-CoV-2 negative: 13.4 min, 95% CI 8.4, 18.3). However, SARS-CoV-2 positive participants slept 60.9 min longer (95% CI 49.1, 72.8) than SARS-CoV-2 negative participants in multivariable-adjusted models and had greater odds of trouble sleeping three or more times per week since the start of the pandemic (OR: 1.34 95% CI 1.02, 1.77) This greater odds of trouble sleeping persisted for participants who reported sleep habits > 30 days after their positive SARS-CoV-2 (OR: 2.11 95% CI 1.47, 3.03). Sleep patterns among non-hospitalized individuals with COVID-19 were altered following infection, regardless of the presentation of symptoms and time since infection.
• 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.
• Riddle, M. S., Zapata, L. V., Bazaco, M. C., Porter, C. K., Kuecken, M., Batz, M. B., Mcclelland, D. J., Schaefer, K., Armstrong, A., Armstrong, A., Austhof, E., & Pogreba-brown, K. (2020). Chronic Gastrointestinal and Joint-Related Sequelae Associated with Common Foodborne Illnesses: A Scoping Review.. Foodborne pathogens and disease, 17(2), 67-86. doi:10.1089/fpd.2019.2692
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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 (Campylobacter, Salmonella, Escherichia coli, Listeria, Shigella, Cryptosporidium, Cyclospora, Giardia, Yersinia, 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 Salmonella (n = 104) and Campylobacter (n = 99); E. coli (n = 55), Shigella (n = 49), Yersinia (n = 49), and Listeria (n = 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, Giardia (n = 26) and Cryptosporidium (n = 18) had the most articles, and no results were found for Cyclospora. The most commonly reported GI outcomes were irritable bowel syndrome (IBS; n = 119) and inflammatory bowel disease (n = 29), and ReA (n = 122) or "joint pain" (n = 19) for joint-related sequelae. Salmonella and Campylobacter were most often associated with a variety of outcomes, with ReA (n = 34 and n = 27) and IBS (n = 17 and n = 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.
• 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.
• Goodin, K., Kumar, R. S., Berisha, V., Levy, C., Prasai, S., Pogreba-brown, K., & Smith, W. C. (2018). Surveillance for Mass Gatherings: NCAA Final Four 2017 in Maricopa County, Arizona. Online Journal of Public Health Informatics, 10(1). doi:10.5210/ojphi.v10i1.8965
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  Objective: To describe and present results for the enhanced epidemiologic surveillance system established during the 2017 National Collegiate Athletic Association Division I Men’s College Basketball Championship (Final Four) events. Introduction: Final Four-associated events culminated in four days of intense activity from March 31st through April 3rd, and added an estimated 400,000 visitors to Maricopa County's 4.2 million residents. Methods: Preparation included: refinements in enhanced surveillance for previous events (including Super Bowl XLII); a rehearsal on information sharing for team leads; just in time training for field team members; a tabletop exercise on 2/22; and solicitation of lessons learned from jurisdictions recently hosting the Final Four. Enhanced surveillance began on 3/24 and continued through 4/10 (one week before the first major event until one week after the championship game) with intensified surveillance from 3/31-4/3. Subject matter experts for each enhanced surveillance component functioned as team leads. A surveillance coordinator was assigned to review data and prepare reports. Team members were sent a plan of the day detailing daily surveillance activities. An enhanced surveillance (SURV) alert requesting an increased index of suspicion for events of public health significance was sent to pre-established lists of healthcare providers. Urgent care clinics within five miles of venues were asked to report influenza-like, gastrointestinal, rash, and neurological illness visits daily. Emergency department records in the National Syndromic Surveillance Program, Electronic Surveillance System for Early Notification of Community-Bases Epidemics (ESSENCE) were monitored daily for influenza-like illness, gastrointestinal illness, injury, records of interest, heat-related illness and event-specific terms. Mumps and meningitis were added after outbreak reports were received from home jurisdictions of Final Four teams. Death certificate data, Office of the Medical Examiner line lists and preliminary reports of death were reviewed daily for reportable diseases or circumstances of public health significance. Communicable disease data was reviewed daily for notifiable disease cases of concern, aberration detection as compared to the previous four years, outbreak review, and Influenza-like-illness. Field teams of staff and volunteers were deployed to three days of Music Fest, four days of Fan Fest, and three Final Four games. Attendees presenting to first aid stations were requested to complete an electronic questionnaire capturing illness and injury syndromes. These were submitted and epidemiologically assessed in near-real-time. Syndrome-specific data were geo-located on venue maps during events to identify spatial clustering. Patient Presentation Rates (PPR) and Transport to Hospital Rates (TTHR) per 10,000 attendees were calculated. To enhance animal health system surveillance, veterinarians and agencies that work with animals were notified to increase the index of suspicion for unusual animal disease, keep alert for outbreaks with zoonotic potential, and update 24/7 emergency contact lists. Health-related media reports, Final-Four-specific reports, health-aggregated Twitter reports, and breaking news alert subscriptions were monitored. Poison Control Center (PCC) reports were assessed by conducting regular queries of the National Poison Data System (NPDS). Reports from the 24/7 Disease Reporting Line were monitored. A one page enhanced surveillance report was developed for daily distribution to inter-disciplinary partners; a more detailed report was distributed to health and medical partners. Physicians overseeing the health/medical care of teams were included in information sharing. Public health intelligence information was exchanged with epidemiologists from home jurisdictions of Final Four teams. Results: 301 field questionnaires were completed, including 146 from Final Four games, 127 from the Music Fest, and 28 from the Fan Fest. Final Four games experienced a PPR of 9.5, and a TTHR of 0.52. Music Fest results were a PPR of 9.4, and a TTHR of 0.15. For the Fan Fest, there was a PPR of 5.5, and a TTHR of 0. PCC data review resulted in investigation of four cases for potential ricin exposure. These reports were determined to be exposure to castor beans and the castor bean plant ( Ricinus communis ) only. One report indicating potential phosgene occupational exposure to an air conditioning system worker was reviewed, and judged unlikely to cause noted symptoms. Outbreak information from home jurisdictions of Final Four teams resulted in increased index of suspicion for mumps, additional surveillance and mentions in media surveillance reports. Review of communicable disease, mortality, and ESSENSE data resulted only in routine investigations. Conclusions: Surveillance information from disparate surveillance systems was synthesized into reports which enhanced health and medical situational awareness and information sharing; interdisciplinary partners highlighted the utility of the one-page report. Enhanced surveillance allowed the rapid identification and characterization of potential threats, and provided an evidence base for public health decisions. Establishment of field teams allowed for near-real-time tracking of patient presentations and transports and rapid identification and characterization of syndromes of concern and potential threats. Public health intelligence information exchange with home jurisdictions of Final Four teams resulted in targeted surveillance for mumps and meningitis.
• 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., Barnes, S., & Barrett, E. C. (2018). An Experiential Learning Exercise in food-borne illness outbreak investigations: bridging education and experience. Pedagogy in Health Promotion, 4(1), 43-51.
• 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.
• Smith, W. E., Scranton, R., Kretschmer, M., Zabel, K., & Pogreba-brown, K. (2018). Field Team Syndromic Surveillance for Mass Gatherings: NCAA Final Four 2017. Online Journal of Public Health Informatics, 10(1). doi:10.5210/ojphi.v10i1.8900
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  Objective To describe and present results of field-based near-real time syndromic surveillance conducted at first aid stations during the 2017 National Collegiate Athletic Association Division I Men’s College Basketball Championship (Final Four) events, and the use of field team data to improve situational awareness for Mass Gathering events. Introduction Final Four-associated events culminated in four days of intense activity from 3/31/17-4/3/17, which attracted an estimated 400,000 visitors to Maricopa County (population 4.2 million). Field teams of staff and volunteers were deployed to three days of Music Fest, four days of Fan Fest, and three Final Four games (Games) as part of an enhanced epidemiologic surveillance system. Methods Attendees presenting to first aid stations were requested to complete an electronic questionnaire which captured illness and injury syndromes (after needed care was given). Emergency Medical Services technicians and nurses (EMS) conducted patient care. These were submitted and epidemiologically assessed in near-real-time to rapidly identify threats. Syndrome-specific data were mapped during events to identify spatial clustering. Field Teams were provided with case contact log sheets, suspicious substance investigation and exposure registry forms to allow rapid investigation of significant public health events. Patient Presentation Rates (PPR) and Transport to Hospital Rates (TTHR) were calculated per 10,000 attendees. Patients presenting per hour of event and transports per hour of event were calculated. Field reports were included in daily reports to inter-disciplinary partners, and shared during regular Multi-Agency Coordination Center briefings. Results 301 field questionnaires were completed, including 146 from Final Four games (Games), 127 from the Music Fest, and 28 from the Fan Fest (see Figure). Among the 153,780 attendees of the three Games, there were 146 cases who presented to one of five first aid stations (over 12 hours). There were 27 illness cases who sought care (18.5% of Games cases), among whom 21 (78%) were assessed by EMS. Illness cases not assessed by EMS (n=6) included mostly allergy symptoms/medication needs. There were 50 injury cases who sought care (34.2% of Games cases), among whom 10 (20%) were assessed by EMS. Sixty (41.1%) persons presented seeking a pain reliever, and 9 (6.2%) presented seeking an antacid. Games experienced a PPR of 9.5, and a TTHR of 0.52. Patients presented at 12.2 per hour on average and there were eight transports to medical facilities (0.66 per hour). There were 127 cases among an estimated 135,000 Music Fest attendees who presented to one of two first aid stations (and at times 2 roving teams) over 3 days (22.5 hours) from 3/31 to 4/2. Illnesses accounted for 29 cases (22.8% of Music Fest cases) and 28 of 29 were assessed by EMS. There were 68 injury cases who sought care (53.5% of Music Fest cases), among whom 22 (32.4%) were assessed by EMS. Twenty-seven persons (21.3%) presented seeking a pain reliever and 2 (1.6%) sought an antacid. Music Fest results included a PPR of 9.4, and a TTHR of 0.15. There were 5.6 patients presenting per hour on average, and there were two transports to the hospital (0.09 per hour). At the Fan Fest there were 28 cases among an estimated 50,803 attendees presenting to the first aid station (or roving teams) from 3/31-4/3 (over 37 hours). Most cases sought care for an injury (n=22, 78.6% of cases). Four persons sought care for an illness (14.3%), all with relatively minor complaints. For the Fan Fest, there was a PPR of 5.5, and a TTHR of 0 (there were no transports to the hospital). There were 0.76 patient presentations per hour on average. No geographic clustering or public health threats requiring investigation were identified at any of the three sites. Interdisciplinary partners requested additional field data during the response. Conclusions Injuries were more common than illnesses at all three sites. Visits requiring pain relievers only were more common at Games (41.1%) than at Music Fest (21.3%) or Fan Fest (3.6%). A greater percentage of visits requiring EMS assessment were seen at the Fan Fest (78.6%) than at the Music Fest (40.2%) or the Games (21.2%). The PPRs per 10,000 attendees were highest at the Games (9.5) and Music Fest (9.4), compared to the Fan Fest (5.5). The TTHR per 10,000 attendees was highest at the Games (0.52), compared to the Music Fest (0.15) and Fan Fest (0.0). The Music Fest field team reported greater effectiveness at fixed first aid stations compared to traveling with roving EMS teams. Field reports enhanced health and medical situational awareness and information sharing as evidenced by requests from interdisciplinary partners for additional field data.
• 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. M. (2016). Public Health in the Field and the Emergency Operations Center: Methods for Implementing Real-Time Onsite Syndromic Surveillance at Large Public Events. Health Security, 4(3).
• 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. (2015). Assessing Risk Factors of Sporadic Campylobacter Infections: A State-Wide Case-Control Study in Arizona. Epidemiology and Infection, 144(4).
• 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.
• Yasmin, S., Pogreba-Brown, K., Stewart, J., & Sunenshine, R. (2014). 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). doi:10.1097/PHH.0b013e31829a2cf5
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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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.
• Yasmin, S., Pogreba-brown, K., Stewart, J., & Sunenshine, R. (2014). 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, 20(2), 205-9. doi:10.1097/phh.0b013e31829a2cf5
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  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..To investigate and implement prevention measures for a GI outbreak and assess the utility of an online survey among retirement community residents..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..A barbecue in a retirement community of 3000 residents..Retirement community residents..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..Computer literacy and Internet access of retirement community residents..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)..This outbreak demonstrated the utility of an online survey to rapidly collect information and implement prevention measures among an older demographic.
• 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).
• Azhar, M., Brown, K., Gard, C., Chen, H., Rajan, S., Elliott, D., Stevens, M., Camenisch, T., Conway, S., & Doetschman, T. (2011). Transforming growth factor Beta2 is required for valve remodeling during heart development. Developmental Dynamics, 240(9). doi:10.1002/dvdy.22702
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  Although the function of transforming growth factor beta2 (TGFβ2) in epithelial mesenchymal transition (EMT) is well studied, its role in valve remodeling remains to be fully explored. Here, we used histological, morphometric, immunohistochemical and molecular approaches and showed that significant dysregulation of major extracellular matrix (ECM) components contributed to valve remodeling defects in Tgfb2 -/- embryos. The data indicated that cushion mesenchymal cell differentiation was impaired in Tgfb2 -/- embryos. Hyaluronan and cartilage link protein-1 (CRTL1) were increased in hyperplastic valves of Tgfb2 -/- embryos, indicating increased expansion and diversification of cushion mesenchyme into the cartilage cell lineage during heart development. Finally, Western blot and immunohistochemistry analyses indicate that the activation of SMAD2/3 was decreased in Tgfb2 -/- embryos during valve remodeling. Collectively, the data indicate that TGFβ2 promotes valve remodeling and differentiation by inducing matrix organization and suppressing cushion mesenchyme differentiation into cartilage cell lineage during heart development. © 2011 Wiley-Liss, Inc.
• 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, 126(Issue 2). doi:10.1177/00333549111260s211
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  Objective. 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. Methods. Immunization records from ASIIS were used to calculate yearly coverage of children with at least one reported hepatitis A vaccination between 1995 and 2008. Proportions vaccinated were calculated by age group (12-23 months, 24-59 months, 5-9 years, 10-14 years, and 15-19 years) for three regions: Maricopa County; Apache and Navajo counties; and the remaining 12 Arizona counties, which were grouped as one to reflect different target groups for the four policies examined. We calculated percent changes from before and after each policy implementation. Results. Significantly different percent changes were detected among the three regions that related to the four policies implemented. Percent change in uptake was consistently higher in the regions that were targeted for that specific policy. Conclusions. Analysis of ASIIS data revealed a major effect of hepatitis A policy recommendations on vaccine uptake in Arizona. Targeting high-risk populations through vaccine recommendations and child care entry requirements was highly successful in achieving higher vaccination coverage. © 2011 Association of Schools of Public Health.
• 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.

Reviews

• Pogreba-Brown, K., Boyd, K., Schaefer, K., Austhof, E., Armstrong, A., Owusu-Dommey, A., Villa-Zapata, L., Arora, M., McClelland, J. D., & Hoffman, S. (2022. Complications Associated with Foodborne Listeriosis: A Scoping Review(pp 725-743).
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  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 is underestimated because some of these acute complications can also result in long-term outcomes. In this article, we conducted a scoping review of 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 ( = 67) and conducted in the United States or Europe ( = 98). Four major outcome groupings were death, neurological disorders, sepsis, and congenital infection. This study identifies substantial research on the common acute complications of and few long-term consequences of . We identify the need for additional studies to determine the longer term impacts of these acute complications.

Others

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