San Joaquin County Public Health Services

Abstract Agronomic cropping systems in many regions face growing economic and management challenges as well as new regulations designed to address negative environmental and social externalities. At the same time, public support for agricultural education and extension is decreasing. Hence, new approaches are necessary to understand the most pressing on‐farm issues and help prioritize critical needs. With a diversity of agronomic crops and new regulations for water and nitrogen, California is an important case study for other regions. The objective of this study was to identify major grower and industry concerns, management challenges, and motivations in making management decisions. In 2020, 483 growers, consultants, and allied industry of agronomic crop production responded to an online survey. The crops most widely grown by respondents included rice (Oryza sativa L.), alfalfa (Medicago sativa L.), wheat (Triticum aestivum L.), and corn (Zea mays L.). Four out of the five top concerns were related to water. Weed control and irrigation/water management were primary management challenges, though differences occurred by crop and region. The highest priorities considered in grower management decision‐making were water, profitability, and land stewardship. Crop rotation benefits were a primary reason for growing agronomic crops, with profitability and tradition ranking closely behind. This study highlights opportunities to guide research and extension efforts based on critical needs identified by growers and industry, while also informing larger policy and institutional decisions regarding new programs and funding to address key issues in agronomic crop production.

Botulism is a rare and potentially fatal paralytic disease caused by botulinum neurotoxin (BoNT). In April 2017, 4 California residents from 2 adjacent counties were hospitalized with suspected foodborne botulism, precipitating an investigation by state and local public health departments in California. We interviewed suspected botulism patients and their families, inspected the suspect establishment, and collected suspect food. We tested patient sera, stool, and gastric aspirates using mouse bioassay for BoNT and/or culture for Clostridium botulinum. We tested suspect food and environmental samples for BoNT and confirmed presumptive positives using direct mouse bioassay and culture. We performed whole-genome sequencing on food and clinical isolates. From April 2017 through May 2017, 10 patients in the Sacramento area were hospitalized with laboratory-confirmed botulism; 7 required mechanical ventilation, and 1 died. Of 9 patients with information, all had visited Gas Station X before illness onset, where 8 reported consuming a commercial cheese sauce. BoNT/A and/or BoNT/A-producing C. botulinum were detected from each patient and from leftover cheese sauce. Clostridium botulinum isolates from 4 patients were closely related to cheese sauce isolates by whole-genome high-quality single-nucleotide polymorphism analysis. No other botulism cases associated with this cheese sauce were reported elsewhere in the United States. This large foodborne botulism outbreak in California was caused by consumption of commercial cheese sauce dispensed at a gas station market. The epidemiologic and laboratory evidence confirmed the cheese sauce as the outbreak source. The cheese sauce was likely locally contaminated, although the mechanism is unclear.

This paper presents a unique comparison of single and multi-layer interface shear strength tests for a recently constructed landfill liner system. The comparison includes peak and large displacement combination strength envelopes from single- and multi-layer interface direct shear tests for the same geomembrane (GM)/ drainage geocomposite (GC), geosynthetic clay liner (GCL)/geomembrane, and soil/GCL interfaces. This comparison shows excellent agreement between strength envelopes and critical interfaces derived from single- and multi-layer interface tests for the materials tested. Based on this comparison, it is recommended that multi-layer interface tests be used for composite liner system design and if there is an anomaly with the multi-layer interface test results, single interface tests can be conducted to verify the weakest interface and to clarify the test results. Alternatively, the liner system can be designed using single interface tests and multi-layer interface tests can be used to verify the combination strength envelope derived from the single interface tests as was done in this case.

Canine heartworm is one of the most serious infections primarily affecting domestic dogs but will also infect cats and wild canids. To evaluate the potential of mosquitoes as vectors of dog heartworm, Dirofilaria immitis (Leidy) in San Joaquin County, CA, we collected mosquitoes in 2011 and analyzed for infection with heartworm by using polymerase chain reaction. Of 3,000 mosquito pools (total number of specimens = 36,554), D. immitis DNA was detected in 97 pools of seven species, and the overall minimum infection rate (MIR) for all mosquito species was 2.69: Culex pipiens L. (n = 40; MIR = 3.66), Culex tarsalis Coquillett (n = 25; MIR = 1.89), Culiseta incidens (Thomson) (n = 11; MIR = 2.81), Aedes vexans (Meigen) (n = 7; MIR = 2.18), Aedes melanimon Dyar (n = 5; MIR = 4.64), Culex erythrothorax Dyar (n = 5; MIR = 3.96), and Culiseta inornata (Williston) (n = 4; MIR = 2.65). Cx. pipiens and Cx. tarsalis had the highest number of D. immitis infections and collectively accounted for 67% of all positive pools. Ae. melanimon, Ae. vexans, and Cx. erythrothorax were found to be infected with D. immitis only in rural and agriculture areas, whereas infections in other species were identified in rural and agriculture areas, and urban and residential settings. The majority of positive pools were identified from June through November and peaked during August through October. This is the first report of D. immitis infection in Ae. melanimon, Cx. erythrothorax, Cx. tarsalis, Cs. incidens, and Cs. inornata. The frequent detection of D. immitis in field-collected Cx. pipiens and Cx. tarsalis in concert with their seasonal abundance and widespread distribution suggest a central role for these species in dog heartworm transmission. Other species, including Ae. vexans, Ae. melanimon, Cs. incidens, Cs. inornata, and Cx. erythrothorax, may play a secondary role in transmission.

ObjectiveThis presentation describes how syndromic surveillance information was combined with fire emission information and spatio-temporal fire occurrence data to evaluate, model and forecast climate change impacts on future fire scenarios.IntroductionSyndromic surveillance information can be a useful for the early recognition of outbreaks, acute public health events and in response to natural disasters. Inhalation of particulate matter from wildland fire smoke has been linked to various acute respiratory and cardiovascular health effects. Historically, wildfire disasters occur across Southern California on a recurring basis. During 2003 and 2007, wildfires ravaged San Diego County and resulted in historic levels of population evacuation, significant impact on air quality and loss of lives and infrastructure. In 2011, the National Institutes of Health-National Institute of Environmental Health Sciences awarded Michigan Tech Research Institute a grant to address the impact of fire emissions on human health, within the context of a changing climate. San Diego County Public Health Services assisted on this project through assessment of population health impacts and provisioning of syndromic surveillance data for advanced modeling.MethodsVarious historical data sets were used during this study. These included: emergency department syndromic surveillance from 17 hospitals, as well as air quality and particulate matter, meteorological, wildland burn fuel, and atmospheric dispersion data. The study area was San Diego County. These data were linked temporally and spatially to create statistical models based on selected modeling approaches including generalized additive modeling. Future fire frequency was modeled for the entire region to determine the impacts of climate change on future fire and health outcomes. Modeling based upon previous fire occurrence was used to develop models for future fire indexes, risk of ignition, potential burning, and fire weather.ResultsSeveral models were developed to produce expected respiratory health impacts under future climate conditions for the San Diego County region. Model results showed that at peak fire particulate concentrations, the odds of a person seeking emergency care increased by approximately 50% compared to non-fire conditions. Also developed was a model to forecast future fire occurrence based on regional climate model predictions. This forecast covering the next the next three decades reveals that San Diego County will experience approximately two extreme fire seasons each decade by 2040.ConclusionsSyndromic surveillance data are useful during disasters for situational awareness. These data may also provide value for post-disaster analytic work and predictive modeling for future disasters. This study demonstrates utility of syndromic data for collaborative work resulting in better understanding of environmental interactions on human health. We do know that wildfire occurs with some degree of historic regularity and these results may be useful for preparedness planning. We also know the conditions which must be present for medium to high wildland fire impact upon the population. This study further supports the notion that agencies should be able to strategically deploy resources and messaging immediately preceding the fire period with the goal of reducing human health risk factors and encouraging changes in community behaviors before, during and after a fire. Future fire model shows San Diego County will experience approximately two extreme fire seasons each decade by 2040. This project also promoted collaboration between public health and environmental health entities to better understand determinants of health during a disaster. In addition to developing a better understanding of the consequences of climate change on fire-induced respiratory illness, the project funding has provided support for San Diego County to improve their syndromic surveillance capacity and infrastructure.

Serological antibody detection tests for tuberculosis may offer the potential to improve diagnosis. Recent meta-analyses have shown that commercially available tests have variable accuracies and a limited clinical role. We reviewed the immunodiagnostic potential of antigens evaluated in research laboratories (in-house) for the serodiagnosis of pulmonary tuberculosis and conducted a meta-analysis to evaluate the performance of comparable antigens. Selection criteria included the participation of at least 25 pulmonary tuberculosis patients and the use of purified antigens. Studies evaluating 38 kDa, MPT51, malate synthase, culture filtrate protein 10, TbF6, antigen 85B, alpha-crystallin, 2,3-diacyltrehalose, 2,3,6-triacyltrehalose, 2,3,6,6'-tetraacyltrehalose 2'-sulfate, cord factor, and TbF6 plus DPEP (multiple antigen) were included in the meta-analysis. The results demonstrated that (i) in sputum smear-positive patients, sensitivities significantly >or=50% were provided for recombinant malate synthase (73%; 95% confidence interval [CI], 58 to 85) and TbF6 plus DPEP (75%; 95% CI, 50 to 91); (ii) protein antigens achieved high specificities; (iii) among the lipid antigens, cord factor had the best overall performance (sensitivity, 69% [95% CI, 28 to 94]; specificity, 91% [95% CI, 78 to 97]); (iv) compared with the sensitivities achieved with single antigens (median sensitivity, 53%; range, 2% to 100%), multiple antigens yielded higher sensitivities (median sensitivity, 76%; range, 16% to 96%); (v) in human immunodeficiency virus (HIV)-infected patients who are sputum smear positive, antibodies to several single and multiple antigens were detected; and (vi) data on seroreactivity to antigens in sputum smear-negative or pediatric patients were insufficient. Potential candidate antigens for an antibody detection test for pulmonary tuberculosis in HIV-infected and -uninfected patients have been identified, although no antigen achieves sufficient sensitivity to replace sputum smear microscopy. Combinations of select antigens provide higher sensitivities than single antigens. The use of a case-control design with healthy controls for the majority of studies was a limitation of the review. Efforts are needed to improve the methodological quality of tuberculosis diagnostic studies.

The Gen-Probe APTIMA Combo 2 (AC2) assay is a second-generation transcription-mediated amplification assay for the detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). The goal of this study was to evaluate AC2 performance of endocervical (cx) swabs for the detection of CT and NG using either a specimen or an infected patient standard. In a multicenter clinical study, we compared AC2 with Abbott's ligase chain reaction (LCR) and Roche's polymerase chain reaction (PCR; Amplicor or COBAS) for CT, and we compared AC2 with Abbott's LCR and culture for NG. A total of 1569 females were enrolled in the study; we collected cx and first-catch urine (FCU) specimens. CT prevalence was 13.3% for cx specimens and 13.7% for FCU specimens. NG prevalence was 8.7% and 7.9% for cx and FCU specimens, respectively. When based only on cx specimens, AC2, LCR, and PCR sensitivities for CT were 99.4%, 95.6%, and 95.6%, respectively. However, cx sensitivity for CT was reduced to 92.1%, 86.6%, and 87.1% for each respective assay when based on both cx and FCU specimen results (infected patient standard). NG sensitivities for AC2, LCR, and culture based solely on cx specimen results were 99.2%, 96.1%, and 85.9%, respectively. Based on infected patient standard, the sensitivities of each respective assay were 98.5%, 93.9%, and 84.0%. The infected patient standard reduces the sensitivity of the endocervical evaluation because some infected patients are positive only with FCU. The reduction in sensitivity is greater when testing for CT. Specificities improved slightly, because some unique cx positives, initially classified as false-positive were confirmed by a positive FCU result. Sensitivity of AC2 was higher than LCR, PCR, and culture. Specificity was slightly lower, but discrepant analysis (using alternate TMA targets) of apparent AC2 false-positives showed that 75% to 80% were true-positives.