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Risks and Realities: Community-Acquired Diseases in New York and New Jersey

Risks and Realities
Reported by
Marilynn Larkin

Posted May 25, 2007


Many people think of emerging infectious diseases as a problem of the developing world. However, on February 8, 2007, the Emerging Infectious Disease Discussion Group turned its focus inward, looking not at outbreaks occurring elsewhere, but rather in the neighborhoods surrounding the Academy.

Topics included an investigation into why the prevalence of both hepatitis B and hepatitis C infection, as well as HIV, are significantly greater in Newark, New Jersey compared with New York City; the prevalence and severity of meningococcal disease and how public health officials coped with an outbreak in Brooklyn; and the rise of methicillin-resistant Staphylococcus aureus (MRSA) in the community.

Use the tabs above to find a meeting report and multimedia from this event.

Web Sites

CDC—Meningococcal Disease
Information provided by the Division of Bacterial and Mycotic Diseases at the Centers for Disease Control and Prevention.

The Centers for Disease Control and Prevention (CDC) monitors and prevents disease outbreaks, implements disease prevention strategies, and maintains national health statistics. CDC also guards against international disease transmission, with personnel stationed in more than 25 foreign countries. It has web pages on both healthcare-associated MRSA and community-associated MRSA.

CDC—Viral Hepatitis B
This Web site has a wealth of material about viral hepatitis, including a series of fact sheets that address viral hepatitis, particularly hepatitis B and C—two important blood-borne infections that have a major impact on injection drug users (IDUs).

Meningococcal Disease Fact Sheet
An educational Web site from the Acute and Communicable Disease Prevention Program of the Oregon Department of Human Services, Health Services cluster.

Meningococcal Education
An Australian Web site with information about recognizing and preventing meningococcal disease.
A central resource for the Neisseria research community. Includes links to pages on diagnosis and management for clinicians and clinical microbiologists, surveillance and public health control, vaccines, and more.

World Health Organization—Hepatitis
This page provides links to fact sheets on hepatitis B and C, vaccine research, and immunization surveillance, assessment, and monitoring for hepatitis B, and more.

World Health Organization—Meningococcal Disease
Information provided by the Epidemic and Pandemic Response unit at the World Health Organization.

World Health Organization—MRSA
The World Health Organization (WHO) is the United Nations specialized agency for health and tracks emerging infections worldwide. It has information about the worldwide spread of MRSA.


Friedman SR, Curtis R, Neaigus A, et al. 1999. Social Networks, Drug Injectors' Lives, and HIV/AIDS. Kluwer Academic/Plenum Publishers, New York.

National Research Council (U.S.) Panel on needle exchange and bleach distribution programs. 1994. Proceedings—Workshop on Needle Exchange and Bleach Distribution Programs. National Academy Press, Washington, D.C.


Persisting Hepatitis B and Hepatitis C Infection Among Injecting and Non-injecting Drug Users: The Behavioral, Network, and Structural Risks

Des Jarlais DC, Arasteh K, Perlis T, et al. 2007. Convergence of HIV seroprevalence among injecting and non-injecting drug users in New York City. AIDS 21: 231-235.

Des Jarlais DC, Diaz T, Perlis T, et al. 2003. Variability in the incidence of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infection among young injecting drug users in New York City. Am. J. Epidemiol. 157: 467-471. FULL TEXT

Des Jarlais DC, Perlis T, Arasteh K, et al. 2005. HIV incidence among injection drug users in New York City, 1990 to 2002: use of serologic test algorithm to assess expansion of HIV prevention services. Am. J. Public Health 95: 1439-1444.

Des Jarlais DC, Perlis T, Arasteh K, et al. 2005. Reductions in hepatitis C virus and HIV infections among injecting drug users in New York City, 1990-2001. AIDS 19 Suppl 3:S20-S25.

Frajzyngier VM, Neaigus A, Gyarmathy VA, et al. 2007. Gender differences in injection risk behaviors at the first injection episode. Epub ahead of print. Drug Alcohol Depend.

Gyarmathy VA, Neaigus A, Miller M, et al. 2002. Risk Correlates of Prevalent HIV, Hepatitis B Virus, and Hepatitis C Virus Infections among noninjecting heroin users. J. Acquir. Immune Defic. Syndr. 30: 448-456.

Neaigus A, Gyarmathy VA, Miller M, et al. 2007. Injecting and sexual risk correlates of HBV and HCV seroprevalence among new drug injectors. Drug Alcohol Depend. Feb 6; [Epub ahead of print]

Neaigus A, Gyarmathy VA, Zhao M, et al. 2007. Sexual and other noninjection risks for HBV and HCV seroconversions among noninjecting heroin users. J. Infect. Dis. 195: 1052-1061.

Ompad DC, Galea S, Wu Y, et al. 2004. Acceptance and completion of hepatitis B vaccination among drug users in New York City. Commun. Dis. Public Health 7: 294-300.

Meningococcal Disease in NYC

Bilukha OO, Rosenstein N. 2005. Prevention and control of meningococcal disease: recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm. Rep. 54: 1-21. FULL TEXT

Brooks R, Woods CW, Benjamin DK, Rosenstein NE. 2006. Increased case-fatality rate associated with outbreaks of Neisseria meningitidis infection, compared with sporadic meningococcal disease, in the United States, 1994-2002. Clin. Inf. Dis. 43: 49-54.

Centers for Disease Control and Prevention. 2000. Serogroup W-135 meningococcal disease among travelers returning from Saudi Arabia-United States, 2000. MMWR 49: 345-346. FULL TEXT

Coen PG, Tully J, Stuart JM, et al. 2006. Is it exposure to cigarette smoke or to smokers which increases the risk of meningococcal disease in teenagers? Int. J. Epidemiol. 35: 330-336.

De Waal EJ, Van Der Laan, Van Loveren H. 1998. Effects of prolonged exposure to morphine and methadone on in vivo parameters of immune function in rats. Toxicology 129: 201-210.

Diaz S, Specter S, Coffey RG. 1993. Suppression of lymphocyte adenosine 3':5'-cyclic monophosphate (cAMP) by delta-9-tetrahydrocannabinol. Int. J. Immunopharmacol. 15: 523-532.

Dolan-Livengood JM., Miller YK, Martin LE, et al. 2003. Genetic basis for nongroupable Neisseria meningitidis. J. Inf. Dis. 187: 1616-1628. FULL TEXT

Finn R, Groves C, Coe M, et al. 2001. Cluster of serogroup C meningococcal disease associated with attendance at a party. South Med. J. 94: 1192-1194.

Imrey PB, Jackson LA, Ludwinski PH, et al. 1996. Outbreak of serogroup C meningococcal disease associated with campus bar patronage. Am. J. Epi. 143: 624-630. (PDF, 744 KB) FULL TEXT

Krause G, Blackmore G, Wiersma S, et al. 2001. Marijuana use and social networks in a community outbreak of meningococcal disease. South Med. J. 94: 482-484.

LeVier DG, Brown RD, Musgrove DL, et al. 1995. The effect of methadone on the immune status of B6C3F1 mice. Fundam. Appl. Toxicol. 24: 275-284.

Moura AS, Pablos-Mendez A, Layton M, Weiss D. 2003. Epidemiology of meningococcal disease, New York City, 1989-2000. Emerg. Inf. Dis. 9: 355-361. FULL TEXT

Orr HJ, Gray SJ, Macdonald M, Stuart JM. 2003. Saliva and meningococcal transmission. Emerging Inf. Dis. 9: 1314-1315. FULL TEXT

Perper JA, Van Thiel DH. 1992. Respiratory complications of cocaine use. Rec. Dev. Alcohol 10: 363-377.

Popovic T, Schmink S, Rosenstein NA, et al. 2001. Evaluation of pulsed-field gel electrophoresis in epidemiological investigations of meningococcal disease outbreaks caused by Neisseria meningitidis serogroup C. J. Clin. Microbiol. 39: 75-85. FULL TEXT

Rosenstein NE, Perkins BA, Stephens DS, et al. 1999. The changing epidemiology of meningococcal disease in the United States, 1992-1996. J. Infect. Dis. 180: 1894-1901. FULL TEXT

Trotter CL, Gay NJ, Edmunds WJ. 2006. The natural history of meningococcal carriage. Epidemiol. Infect. 134: 556-566.

Weber MV, Claus H, Maiden MC, et al. 2006. Genetic mechanisms for loss of encapsulation in polysialyltransferase-gene-positive meningococci isolated from healthy carriers. Int. J. Med. Micro. 296: 475-484.

Yazdankhah SP, Caugant DA. 2004. Neisseria meningitidis: and overview of the carriage state. J. Med. Micro. 53: 821-832. FULL TEXT

MRSA in the Community: The New York and New Jersey Experience

Charlebois ED, Perdreau-Remington F, Kreiswirth B, et al. 2004. Origins of community strains of methicillin-resistant Staphylococcus aureus. Clin. Infect. Dis. 39: 47-54. FULL TEXT

Fey PD, Said-Salim B, Rupp ME, et al. 2003. Comparative molecular analysis of community- or hospital-acquired methicillin-resistant Staphylococcus aureus. Antimicrob. Agents Chemother. 47: 196-203. FULL TEXT

Kazakova SV, Hageman JC, Matava M, et al. 2005. A clone of methicillin-resistant Staphylococcus aureus among professional football players. N. Engl. J. Med. 352: 468-475.

Koreen L, Ramaswamy SV, Graviss EA, et al. 2004. spa typing method for discriminating among Staphylococcus aureus isolates: implications for use of a single marker to detect genetic micro- and macrovariation. J. Clin. Microbiol. 42: 792-799. FULL TEXT

Said-Salim B, Mathema B, Kreiswirth BN. 2003. Community-acquired methicillin-resistant Staphylococcus aureus: an emerging pathogen. Infect. Control Hosp. Epidemiol. 24: 451-455.

Saiman L, O'Keefe M, Graham PL 3rd, et al. 2003. Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women. Clin. Infect. Dis. 37: 1313-1319.

Shopsin B, Herring S, Kreiswirth BN. 2003. Hospital-acquired and community-derived: the future of MRSA? Clin. Infect. Dis. 37: 151-152.

Shopsin B, Mathema B, Alcabes P, et al. 2003. Prevalence of agr specificity groups among Staphylococcus aureus strains colonizing children and their guardians. J. Clin. Microbiol. 41: 456-459. FULL TEXT

Shopsin B, Zhao X, Kreiswirth B, et al. 2004. Are the new quinolones appropriate treatment for community-acquired methicillin-resistant Staphylococcus aureus? Int. J. Antimicrob. Agents 24: 32-34.

Saiman L, Cronquist A, Wu F, et al. 2003. An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect. Control Hosp. Epidemiol. 24: 317-321.


Alan Neaigus, PhD

National Development and Research Institutes
e-mail | web site | publications

Alan Neaigus is deputy director of the Institute for International Research on Youth at Risk and a principal investigator at National Development and Research Institutes in New York City. He is also on the faculty of the Department of Epidemiology at the Mailman School of Public Health at Columbia University. His research interests focus on the social epidemiology of illicit drug use and its relationship to infectious diseases and other health outcomes among racial/ethnic minority groups and vulnerable populations.

Over the past several years Neaigus has conducted research on HIV/AIDS and other blood-borne and sexually transmitted infections among injecting and non-injecting drug users in New York City and other locations, examining the relationship of drug users' social and risk networks to their risk of infection, as well as research on the factors associated with the initiation and resumption of injecting among non-injecting drug users. His current research includes studies on the neighborhood and network context of HIV risk among drug users and their sex partners in New York City and Newark, NJ, and on transitions to injecting and HIV and hepatitis B and C risk among Mexican-American heroin users in San Antonio, Texas.

In addition, Neaigus has conducted international research, including studies on the behavioral and network risks for HIV and sexually transmitted infections among drug injectors in Budapest, Hungary, and on the social context of injecting drug use and HIV risk in Marseilles, France. He has authored or coauthored numerous publications in peer-reviewed journals.

Don Weiss, MD, MPH

New York City Department of Health and Mental Hygiene

Don Weiss, a medical epidemiologist, is medical director of the New York City Department of Health and Mental Hygiene's Bureau of Communicable Disease, overseeing the syndromic surveillance unit. He received his medical degree from the University of Medicine and Dentistry of New Jersey, and completed a residency in pediatrics at the Albert Einstein College of Medicine/Montefiore Medical Center and a masters of public health in epidemiology from St. Louis University.

Before joining the New York City Department of Health in June 2000, he was with the St. Louis City Department of Health and taught epidemiology at St. Louis University School of Public Health.

Barry Kreiswirth, PhD

Public Health Research Institute
e-mail | web site | publications

Barry Kreiswirth joined the Public Health Research (PHRI) in 1978 as a graduate student in Richard Novick's laboratory to work on the molecular biology of Staphylococcus aureus. His doctoral thesis was on the cloning of this bacterium and the genetic characterization of its toxic shock syndrome (TSS) toxin-1. Kreiswirth remained in the Novick laboratory as a post-doctoral fellow and research assistant, continuing his investigation into the molecular epidemiology of methicillin-resistant S. aureus (MRSA).

Fourteen years later, in response the New York City outbreak, Kreiswirth became the director of PHRI's Tuberculosis Center. However, despite the extensive investment in tuberculosis research, the Center has not abandoned its interest in the molecular typing of MRSA and recently developed a rapid DNA-sequenced-based genotyping method enabling scientists to accurately sub-speciate strains of staphylococcus. This approach has been adapted to identify a variety of hospital-acquired pathogens and is now used to construct a nosocomial surveillance database in collaboration with the New Jersey Department of Health and Hospitals.

Marilynn Larkin

Marilynn Larkin is a medical editor, journalist, and videographer based in New York City. Her work has frequently appeared in, among others, The Lancet, The Lancet Infectious Diseases, and Reuters Health's professional newswire. She is currently head of publications for The Society for Biomolecular Screening.

Ms. Larkin has served as editor of clinical publications for neurologists, anesthesiologists, HIV providers, and long-term care professionals. She also developed physician/patient education videos and continuing medical education symposia for several medical communications companies.

Prior to her work for physician audiences, she covered health, nutrition, fitness, psychology, and travel for women's and general interest magazines. She is also author of five medical books for general readers, and of Reporting on Health Risk, a handbook for journalists.

In 2004, Ms. Larkin started her own fitness consulting company (, and developed a class, Posture-cize, that helps people improve their posture, increase productivity, and reduce injury.