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DeMaria, Alfred

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DeMaria

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DeMaria, Alfred

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2001 - 20063

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Author's Publications: search.filters.isAuthorOfPublication.9609a8d6-e7a3-49bf-8e18-4b0edba830ba

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    Using Automated Medical Records for Rapid Identification of Illness Syndromes (Syndromic Surveillance): The Example of Lower Respiratory Infection
    (BioMed Central, 2001) Lazarus, Ross; Kleinman, Kenneth Paul; Dashevsky, Inna; DeMaria, Alfred; Platt, Richard
    Background: Gaps in disease surveillance capacity, particularly for emerging infections and bioterrorist attack, highlight a need for efficient, real time identification of diseases. Methods: We studied automated records from 1996 through 1999 of approximately 250,000 health plan members in greater Boston. Results: We identified 152,435 lower respiratory infection illness visits, comprising 106,670 episodes during 1,143,208 person-years. Three diagnoses, cough (ICD9CM 786.2), pneumonia not otherwise specified (ICD9CM 486) and acute bronchitis (ICD9CM 466.0) accounted for 91% of these visits, with expected age and sex distributions. Variation of weekly occurrences corresponded closely to national pneumonia and influenza mortality data. There was substantial variation in geographic location of the cases. Conclusion: This information complements existing surveillance programs by assessing the large majority of episodes of illness for which no etiologic agents are identified. Additional advantages include: a) sensitivity, uniformity and efficiency, since detection of events does not depend on clinicians' to actively report diagnoses, b) timeliness, the data are available within a day of the clinical event; and c) ease of integration into automated surveillance systems. These features facilitate early detection of conditions of public health importance, including regularly occurring events like seasonal respiratory illness, as well as unusual occurrences, such as a bioterrorist attack that first manifests as respiratory symptoms. These methods should also be applicable to other infectious and non-infectious conditions. Knowledge of disease patterns in real time may also help clinicians to manage patients, and assist health plan administrators in allocating resources efficiently.
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    Use of Automated Ambulatory-Care Encounter Records for Detection of Acute Illness Clusters, Including Potential Bioterrorism Events
    (Centers for Disease Control and Prevention, 2002) Lazarus, Ross; Kleinman, Kenneth Paul; Dashevsky, Inna; Adams, Courtney; Kludt, Patricia; DeMaria, Alfred; Platt, Richard
    The advent of domestic bioterrorism has emphasized the need for enhanced detection of clusters of acute illness. We describe a monitoring system operational in eastern Massachusetts, based on diagnoses obtained from electronic records of ambulatory-care encounters. Within 24 hours, ambulatory and telephone encounters recording patients with diagnoses of interest are identified and merged into major syndrome groups. Counts of new episodes of illness, rates calculated from health insurance records, and estimates of the probability of observing at least this number of new episodes are reported for syndrome surveillance. Census tracts with unusually large counts are identified by comparing observed with expected syndrome frequencies. During 1996–1999, weekly counts of new cases of lower respiratory syndrome were highly correlated with weekly hospital admissions. This system complements emergency room- and hospital-based surveillance by adding the capacity to rapidly identify clusters of illness, including potential bioterrorism events.
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    Transmission of Lymphocytic Choriomeningitis Virus by Organ Transplantation
    (New England Journal of Medicine (NEJM/MMS), 2006) Fischer, Staci A.; Graham, Mary Beth; Kuehnert, Matthew J.; Kotton, Camille; Srinivasan, Arjun; Marty, Francisco; Comer, James A.; Guarner, Jeannette; Paddock, Christopher D.; Demeo, Dawn; Shieh, Wun-Ju; Erickson, Bobbie R.; Bandy, Utpala; DeMaria, Alfred; Davis, Jeffrey P.; Delmonico, Francis; Pavlin, Boris; Likos, Anna; Vincent, Martin J.; Sealy, Tara K.; Goldsmith, Cynthia S.; Jernigan, Daniel B.; Rollin, Pierre E.; Packard, Michelle M.; Patel, Mitesh; Rowland, Courtney; Helfand, Rita F.; Nichol, Stuart T.; Fishman, Jay; Ksiazek, Thomas; Zaki, Sherif R.
    Background In December 2003 and April 2005, signs and symptoms suggestive of infection devel- oped in two groups of recipients of solid-organ transplants. Each cluster was inves- tigated because diagnostic evaluations were unrevealing, and in each a common do- nor was recognized. Methods We examined clinical specimens from the two donors and eight recipients, using viral culture, electron microscopy, serologic testing, molecular analysis, and histo- pathological examination with immunohistochemical staining to identify a cause. Epidemiologic investigations, including interviews, environmental assessments, and medical-record reviews, were performed to characterize clinical courses and to determine the cause of the illnesses. Results Laboratory testing revealed lymphocytic choriomeningitis virus (LCMV) in all the recipients, with a single, unique strain of LCMV identified in each cluster. In both investigations, LCMV could not be detected in the organ donor. In the 2005 cluster, the donor had had contact in her home with a pet hamster infected with an LCMV strain identical to that detected in the organ recipients; no source of LCMV infection was found in the 2003 cluster. The transplant recipients had abdominal pain, altered mental status, thrombocytopenia, elevated aminotransferase levels, coagulopathy, graft dysfunction, and either fever or leukocytosis within three weeks after transplan- tation. Diarrhea, peri-incisional rash, renal failure, and seizures were variably present. Seven of the eight recipients died, 9 to 76 days after transplantation. One recipient, who received ribavirin and reduced levels of immunosuppressive therapy, survived. Conclusions We document two clusters of LCMV infection transmitted through organ trans- plantation.