Sarah Santana

Centro Universitário Barão de Mauá

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Mare Schumacher

Arizona Department of Health Services

Ken Komatsu

Tokyo University of Agriculture and Technology

Aaron T. Fleischauer

Centers for Disease Control and Prevention

Mitchell I. Wolfe

Centers for Disease Control and Prevention

Lori Hutwagner

Centers for Disease Control and Prevention

Tracee A. Treadwell

Centers for Disease Control and Prevention

Joanne Cono

Office of Science

Benjamin J. Silk

Centers for Disease Control and Prevention

Ruth L. Berkelman

Emory University

Victorio Vaz

Arizona Department of Health Services

Cooperative Institutions

Centers for Disease Control and Prevention

National Center for Infectious Diseases

California Health and Human Services Agency

ARUP Laboratories (United States)

Rogers (United States)

Universidade Federal do Ceará

Maricopa County Department of Public Health

Columbia University

Arizona Department of Health Services

Emory University

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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 (2013)

Kristen Pogreba-Brown Kyle Mckeown Sarah Santana Alisa Diggs Jennifer Stewart

Abstract Objective To develop an onsite syndromic surveillance system for the early detection of public health emergencies and outbreaks at large public events. Methods As the third largest public health jurisdiction in the United States, Maricopa County Department of Public Health has worked with academic and first-response partners to create an event-targeted syndromic surveillance (EVENTSS) system. This system complements long-standing traditional emergency department-based surveillance and provides public health agencies with rapid reporting of possible clusters of illness. Results At 6 high profile events, 164 patient reports were collected. Gastrointestinal and neurological syndromes were most commonly reported, followed by multisyndromic reports. Neurological symptoms were significantly increased during hot weather events. The interview rate was 2 to 7 interviews per 50 000 people per hour, depending on the ambient temperature. Discussion Study data allowed an estimation of baseline values of illness occurring at large public events. As more data are collected, prediction models can be built to determine threshold levels for public health response. Conclusions EVENTSS was conducted largely by volunteer public health graduate students, increasing the response capacity for the health department. Onsite epidemiology staff could make informed decisions and take actions quickly in the event of a public health emergency. ( Disaster Med Public Health Preparedness . 2013;0:1–8)

Public health surveillance

Preparedness

Health department

10.1017/dmp.2013.83

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Citations (4)

Human Immunodeficiency Virus in Cuba: The Public Health Response of a Third World Country

Routledge eBooks (2020)

Sarah Santana Lily Faas Karen Wald

Cuba's response to the epidemic of human immunodeficiency virus (HIV) infection merits attention for many reasons. The Cuban program and the Cuban HIV epidemic must be studied within the socioeconomic, political, cultural, and ethical context of Cuban society. Cuba is quite different from other socialist countries in culture and history, and from other Latin American countries in its political, ideological, and economic systems. A revolution overthrew dictator Fulgencio Batista in 1959. In 1961 the government officially declared Cuba a socialist state. The population is well organized in each community. The Cuban Ministry of Public Health (MINSAP) provided access to sanatoria, patients, physicians, and other health professionals working with HIV antibody-positive individuals, as well as epidemiologic and surveillance data on HIV infection. A better measure is the incidence rate of seropositivity. HIV infection in Cuba is largely a male heterosexual disease.

10.4324/9781315232638-15

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Some Thoughts on Vital Statistics and Health Status in Cuba

Routledge eBooks (2019)

Sarah Santana

Several published works have evaluated the quality of Cuban health and vital statistics and have arrived at varying levels of confidence or mistrust in them. Because health status is so important ideologically and politically, both domestically and internationally, the quality and interpretation of its statistical measures become essential issues to understand. Cuban vital statistics have been evaluated for completeness by foreign and Cuban investigators. The reliability and consistency of the birth and death information have been indirectly confirmed through various means. The progressive continuum from morbidity to mortality without medical intervention does not always hold true once treatment intervenes, lowering mortality risks without necessarily affecting morbidity. Morbidity from acute diarrheal and respiratory infections in Cuba is reported as the number of physician visits caused by that particular diagnosis. Measles has riot been an important cause of death in Cuba, since acute malnutrition is not present.

Health statistics

10.4324/9780429044021-6

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Citations (2)

The Validity of Chief Complaint and Discharge Diagnosis in Emergency Department–based Syndromic Surveillance

Academic Emergency Medicine (2004)

Aaron T. Fleischauer Benjamin J. Silk Mare Schumacher Ken Komatsu Sarah Santana

Objective: Emergency department (ED)–based syndromic surveillance systems are being used by public health departments to monitor for outbreaks of infectious diseases, including bioterrorism; however, few systems have been validated. The authors evaluated a “drop‐in” syndromic surveillance system by comparing syndrome categorization in the ED with chief complaints and ED discharge diagnoses from medical record review. Methods: A surveillance form was completed for each ED visit at 15 participating Arizona hospitals between October 27 and November 18, 2001. Each patient visit was assigned one of ten clinical syndromes or “none.” For six of 15 EDs, κ statistics were used to compare syndrome agreement between surveillance forms and syndrome categorization with chief complaint and ED discharge diagnosis from medical record review. Results: Overall, agreement between surveillance forms and ED discharge diagnoses (κ= 0.55; 95% confidence interval [CI] = 0.52 to 0.59) was significantly higher than between surveillance forms and chief complaints (κ= 0.48; 95% CI = 0.44 to 0.52). Agreement between chief complaints and ED discharge diagnoses was poor for respiratory tract infection with fever (κ= 0.33; 95% CI = 0.27 to 0.39). Furthermore, pediatric chief complaints showed lower agreement for respiratory tract infection with fever when compared with adults (κ= 0.34 [95% CI = 0.20 to 0.47] vs. κ= 0.44 [95% CI = 0.28 to 0.59], respectively). Conclusions: In general, this syndromic surveillance system classified patients into appropriate syndrome categories with fair to good agreement compared with chief complaints and discharge diagnoses. The present findings suggest that use of ED discharge diagnoses, in addition to or instead of chief complaints, may increase surveillance validity for both automated and drop‐in syndromic surveillance systems.

Medical record

Complaint

10.1197/j.aem.2004.07.013

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A study of postneonatal diarrheal mortality in Cuba 1969-1978: conceptual framework and methodology.

Sarah Santana G Solimano J. A. Gutiérrez-Muniz E Rios-Massabot Nigel Paneth

In most developing countries acute diarrheal disease (ADD) and respiratory infections continue to be the 2 major contributions to infant mortality. In Cuba however congenital anomalies and neonatal conditions now account for the largest proportion of infant deaths. Although a decrease in mortality has been well documented the objective of this study is to determine the contribution of specific medical and nonmedical interventions to the decline in postnatal diarrheal mortality in 9 provinces of Cuba over a 10-year period 1969 to 1978. Models are developed to explain the specific mechanisms responsible for the decrease in infant mortality due to diarrheal disease in Cuba. The study is conducted jointly by the Center for Population and Health the Gertrude H. Sergievsky Center and the Institute for Health Development of Havana and consists of 4 distinct but interrelated components: 1) The descriptive and historical analysis of antidiarrheal programs in Cuba provides a detailed picture of the implementation of antidiarrheal programs as well as important information concerning many of the independent variables included in the study. 2) An ecologic analysis of variation in postnatal diarrheal mortality rates which is both cross-sectional and over time establishes relationships with variables at the district and provincial levels. 3) An individual analysis uses the case-control method. 4) All infants dying of postnatal diarrhea during the 10-year period in the 9 provinces are compared to survivors. Clinical charts are reviewed in a sample of hospitals to ascertain secular and geographic patterns of morbidity clinical diagnosis and treatment modalities in both surviving and decreased infants.

Diarrheal diseases

Under-five

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The impact of the economic crisis and the US embargo on health in Cuba.

American Journal of Public Health (1997)

Richard Garfield Sarah Santana

OBJECTIVES: This paper examines the combined effects of a severe economic decline since 1989 and a tightening of the US embargo in 1992 on health and health care in Cuba. METHODS: Data from surveillance systems for nutrition, reportable diseases, and hospital diagnoses were reviewed. These sources were supplemented with utilization data from the national health system and interviews with health leaders. RESULTS: Changes in Cuba include declining nutritional levels, rising rates of infectious diseases and violent death, and a deteriorating public health infrastructure. But despite these threats, mortality levels for children and women remain low. Instead, much of the health impact of the economic decline of Cuba has fallen on adult men and the elderly. CONCLUSIONS: To be consistent with international humanitarian law, embargoes must not impede access to essential humanitarian goods. Yet this embargo has raised the cost of medical supplies and food Rationing, universal access to primary health services, a highly educated population, and preferential access to scarce goods for women and children help protect most Cubans from what otherwise might have been a health disaster.

10.2105/ajph.87.1.15

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Citations (189)

The Validity of Chief Complaint and Discharge Diagnosis in Emergency Department–based Syndromic Surveillance

Academic Emergency Medicine (2004)

Aaron T. Fleischauer Benjamin J. Silk Mare Schumacher Ken Komatsu Sarah Santana

Complaint

10.1111/j.1553-2712.2004.tb01909.x

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Citations (10)

Lessons learned from syndemic HIV research in an immigrant, latinx sexual and gender minority community

Discover Social Science and Health (2025)

Nicholas Metheny Dalton Scott Sarah Santana Rosa Pache

The HIV incidence rate in Miami-Dade County is among the highest in the United States, with Latinx sexual and gender minority (SGM) groups experiencing a disproportionate burden. Despite extensive efforts by both private and public sectors to curb transmission and improve pre-exposure prophylaxis (PrEP) uptake, Latinx SGM groups continue to have high rates of HIV and low PrEP uptake compared to SGM groups overall. Using data collected from a biobehavioral study of the socio-structural factors affecting HIV susceptibility and PrEP uptake among Latinx SGM subgroups in Miami-Dade County, this paper shares lessons learned and provides concrete recommendations for tailoring survey research and biospecimen collection among a largely immigrant, socioeconomically disadvantaged community that is especially vulnerable to HIV. By drawing inferences from study data and contextualizing these with community partners, we learned: (1) Large parts of the target community may be unfamiliar with the underlying constructs captured in important HIV-related measures; (2) Cash incentives may shift motivation from intrinsic to extrinsic and lead to poorer data quality; (3) Deviations in Spanish go beyond vocabulary used in different Latin American countries, and more formal Spanish may relay concepts in unfamiliar ways that are unapproachable; and (4) community members may be unfamiliar with survey data collection processes and the protections in place to ensure confidentiality. These lessons and associated recommendations may help improve recruitment, study design, analysis, and community engagement in future studies, building trust and ultimately reducing the burden of HIV in these communities.

Syndemic

10.1007/s44155-024-00145-6

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Article on HIV in Cuba criticized.

American Journal of Public Health (1992)

Sarah Santana

Article on HIV in Cuba criticized. S SantanaCopyRight https://doi.org/10.2105/AJPH.82.6.899-a Published Online: November 15, 2011

10.2105/ajph.82.6.899-a

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Evaluation of a Hepatitis A Immunization Program

The Pediatric Infectious Disease Journal (2005)

Hesha J. Duggirala Susan E. Hassig Sarah Santana J. B. RICE

Background: The purpose of this study was to evaluate the effectiveness of a hepatitis A vaccine requirement targeted at child-care center attendees 2–5 years of age in Maricopa County, AZ. A case-control study conducted before implementation in 1997 found that individuals with hepatitis A were 6 times more likely to have worked in or attended a child-care center than were matched controls, and 40% of hepatitis A cases were attributable to attending or working in a child-care center. Methods: A case-control study was conducted postimplementation in 1999. Cases were individuals reported to surveillance staff between August 1, 1999 and April 30, 2000. Cases were included if they met the Centers for Disease Control and Prevention hepatitis A surveillance case definition. Each case (n = 72) was matched to 2 controls (n = 144) based on age and neighborhood. Results: Cases were more likely to have had contact with a hepatitis A case [odds ratio (OR), 7.04; 95% confidence interval (CI), 1.96, 25.31] than were their matched controls in the unadjusted analysis. Individuals with direct contact with a child-care center (OR 0.221; CI 0.05, 0.99) were protected against disease. In the multivariate analysis, contact with a hepatitis A case (OR 5.63; CI 1.22, 25.91) was significantly associated with disease, and the protective effect of education (OR 0.19; CI 0.06, 0.60) remained significant. Conclusion: The results of this study suggest the vaccination requirement had some impact on the epidemiology of hepatitis A in Maricopa County. The risk associated with child-care centers seen in the 1997 study is no longer significantly associated with hepatitis A disease.

Hepatitis A vaccine

Disease Control

Hepatitis B

Hepatitis C

10.1097/01.inf.0000183760.75182.01

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Citations (10)