BackgroundLegionnaires’ disease, a severe pneumonia, is typically acquired through inhalation of aerosolized water containing Legionella bacteria. Legionella can grow in the complex water systems of buildings, including health care facilities. Effective water management programs could prevent the growth of Legionella in building water systems.MethodsUsing national surveillance data, Legionnaires’ disease cases were characterized from the 21 jurisdictions (20 U.S. states and one large metropolitan area) that reported exposure information for ≥90% of 2015 Legionella infections. An assessment of whether cases were health care–associated was completed; definite health care association was defined as hospitalization or long-term care facility residence for the entire 10 days preceding symptom onset, and possible association was defined as any exposure to a health care facility for a portion of the 10 days preceding symptom onset. All other Legionnaires’ disease cases were considered unrelated to health care.ResultsA total of 2,809 confirmed Legionnaires’ disease cases were reported from the 21 jurisdictions, including 85 (3%) definite and 468 (17%) possible health care–associated cases. Among the 21 jurisdictions, 16 (76%) reported 1–21 definite health care–associated cases per jurisdiction. Among definite health care–associated cases, the majority (75, 88%) occurred in persons aged ≥60 years, and exposures occurred at 72 facilities (15 hospitals and 57 long-term care facilities). The case fatality rate was 25% for definite and 10% for possible health care–associated Legionnaires’ disease.Conclusions and Implications for Public Health PracticeExposure to Legionella from health care facility water systems can result in Legionnaires’ disease. The high case fatality rate of health care–associated Legionnaires’ disease highlights the importance of case prevention and response activities, including implementation of effective water management programs and timely case identification.

Background Legionnaires’ disease, a severe pneumonia, is typically acquired through inhalation of aerosolized water containing Legionella bacteria. Legionella can grow in the complex water systems of buildings, including health care facilities. Effective water management programs could prevent the growth of Legionella in building water systems. Methods Using national surveillance data, Legionnaires’ disease cases were characterized from the 21 jurisdictions (20 U.S. states and one large metropolitan area) that reported exposure information for ≥90% of 2015 Legionella infections. An assessment of whether cases were health care–associated was completed; definite health care association was defined as hospitalization or long‐term care facility residence for the entire 10 days preceding symptom onset, and possible association was defined as any exposure to a health care facility for a portion of the 10 days preceding symptom onset. All other Legionnaires’ disease cases were considered unrelated to health care. Results A total of 2,809 confirmed Legionnaires’ disease cases were reported from the 21 jurisdictions, including 85 (3%) definite and 468 (17%) possible health care–associated cases. Among the 21 jurisdictions, 16 (76%) reported 1–21 definite health care–associated cases per jurisdiction. Among definite health care–associated cases, the majority (75, 88%) occurred in persons aged ≥60 years, and exposures occurred at 72 facilities (15 hospitals and 57 long‐term care facilities). The case fatality rate was 25% for definite and 10% for possible health care–associated Legionnaires’ disease. Conclusions and Implications for Public Health Practice Exposure to Legionella from health care facility water systems can result in Legionnaires’ disease. The high case fatality rate of health care–associated Legionnaires’ disease highlights the importance of case prevention and response activities, including implementation of effective water management programs and timely case identification.

Introduction: Public health investigations, including research, in refugee populations are necessary to inform evidence-based interventions and care. The unique challenges refugees face (displacement, limited political protections, economic hardship) can make them especially vulnerable to harm, burden, or undue influence. Acute survival needs, fear of stigma or persecution, and history of trauma may present challenges to ensuring meaningful informed consent and establishing trust. We examined the recently published literature to understand the application of ethics principles in investigations involving refugees. Methods: We conducted a preliminary review of refugee health literature (research and non-research data collections) published from 2015 through 2018 available in PubMed. Article inclusion criteria were: participants were refugees, topic was health-related, and methods used primary data collection. Information regarding type of investigation, methods, and reported ethics considerations was abstracted. Results: We examined 288 articles. Results indicated 33% of investigations were conducted before resettlement, during the displacement period (68% of these were in refugee camps). Common topics included mental health (48%) and healthcare access (8%). The majority (87%) of investigations obtained consent. Incentives were provided less frequently (23%). Most authors discussed the ways in which community stakeholders were engaged (91%), yet few noted whether refugee representatives had an opportunity to review investigational protocols (8%). Cultural considerations were generally limited to gender and religious norms, and 13% mentioned providing some form of post-investigation support.

Background: Early detection of neurodevelopmental abnormalities is important because of possibility of instituting early intervention program for that child. Trivandrum developmental screening test (TDSC) has sensitivity of 66.7% and specificity of 78.8%. This makes it a reasonably good test to screen children. Aims & Objective: To study the prevalence of developmental delay among children less than 2 years attending well baby clinic using TDSC and antecedents factors of developmental delay. Material and Methods: This cross sectional study was conducted on 200 patients visiting well baby clinic starting from age of 1 month till 2 years. Study was conducted for a period of 3 months from February 2013 to May 2013. Details pertaining to exact age, term or preterm status, maternal and paternal h/o was taken. Developmental screening was done using TDSC chart. Bell, pen, keys were used for assessment along with chart. Results were analyzed using SPSS 16.0. Results: Total of 200 patients was screened.181 children were found to be normal with 85.6%-94.2 % CI. In 19 children, delay was found with 5.8%-14.4 % CI. Preterm, IUGR, respiratory distress, sepsis, seizures in neonatal period showed significant p value for developmental delay. Microcephaly patients when screened for TDSC showed developmental delay with p value less than 0.05.All growth parameters (head, weight and length) when less than third centile showed significant association to developmental delay. The study also showed linear regression curve significant for awareness of developmental as maternal education improves. Conclusion: Developmental screening with TDSC showed developmental delay prevalence 9.5%. All children should be screened in well baby clinic for developmental delay. In India, sources have found prevalence of 1.5-2.5% of developmental delay in children less than 2 years of age. High incidence of our study can be due to study done at tertiary care centre. Preterm and IUGR were found to have developmental delay with significant p value. Various antecedents' factors responsible for early brain injury showed significant p value. Hence every child attending well baby clinic should be screened for developmental delay with effective screening method such as TDSC.