1
|
Gharpure R, Friedman CR, Fialkowski V, Collins JP, Strysko J, Marsh ZA, Chen JC, Meservey EH, Adediran AA, Schroeder MN, Wadhwa A, Fullerton KE, Francois Watkins L. Azithromycin and Ciprofloxacin Treatment Outcomes During an Outbreak of Multidrug-Resistant Shigella sonnei Infections in a Retirement Community-Vermont, 2018. Clin Infect Dis 2022; 74:455-460. [PMID: 33993224 PMCID: PMC8963682 DOI: 10.1093/cid/ciab450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In 2018, the Centers for Disease Control and Prevention and the Vermont Department of Health investigated an outbreak of multidrug-resistant Shigella sonnei infections in a retirement community that offered a continuum of care from independent living through skilled nursing care. The investigation identified 24 culture-confirmed cases. Isolates were resistant to trimethoprim-sulfamethoxazole, ampicillin, and ceftriaxone, and had decreased susceptibility to azithromycin and ciprofloxacin. METHODS To evaluate clinical and microbiologic response, we reviewed inpatient and outpatient medical records for treatment outcomes among the 24 patients with culture-confirmed S. sonnei infection. We defined clinical failure as diarrhea (≥3 loose stools per day) for ≥1 day after treatment finished, and microbiologic failure as a stool culture that yielded S. sonnei after treatment finished. We used broth microdilution to perform antimicrobial susceptibility testing, and whole genome sequencing to identify resistance mechanisms. RESULTS Isolates contained macrolide resistance genes mph(A) and erm(B) and had azithromycin minimum inhibitory concentrations above the Clinical and Laboratory Standards Institute epidemiological cutoff value of ≤16 µg/mL. Among 24 patients with culture-confirmed Shigella infection, 4 were treated with azithromycin; all had clinical treatment failure and 2 also had microbiologic treatment failure. Isolates were susceptible to ciprofloxacin but contained a gyrA mutation; 2 patients failed treatment with ciprofloxacin. CONCLUSIONS These azithromycin treatment failures demonstrate the importance of clinical breakpoints to aid clinicians in identifying alternative treatment options for resistant strains. Additionally, these treatment failures highlight a need for comprehensive susceptibility testing and systematic outcome studies, particularly given the emergence of multidrug-resistant Shigella among an expanding range of patient populations.
Collapse
Affiliation(s)
- Radhika Gharpure
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cindy R. Friedman
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jennifer P. Collins
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan Strysko
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zachary A. Marsh
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessica C. Chen
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Azizat A. Adediran
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Morgan N. Schroeder
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ashutosh Wadhwa
- Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;,Laboratory Leadership Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathleen E. Fullerton
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Louise Francois Watkins
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
2
|
Collier SA, Deng L, Adam EA, Benedict KM, Beshearse EM, Blackstock AJ, Bruce BB, Derado G, Edens C, Fullerton KE, Gargano JW, Geissler AL, Hall AJ, Havelaar AH, Hill VR, Hoekstra RM, Reddy SC, Scallan E, Stokes EK, Yoder JS, Beach MJ. Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States. Emerg Infect Dis 2021; 27:140-149. [PMID: 33350905 PMCID: PMC7774540 DOI: 10.3201/eid2701.190676] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Provision of safe drinking water in the United States is a great public health achievement. However, new waterborne disease challenges have emerged (e.g., aging infrastructure, chlorine-tolerant and biofilm-related pathogens, increased recreational water use). Comprehensive estimates of the health burden for all water exposure routes (ingestion, contact, inhalation) and sources (drinking, recreational, environmental) are needed. We estimated total illnesses, emergency department (ED) visits, hospitalizations, deaths, and direct healthcare costs for 17 waterborne infectious diseases. About 7.15 million waterborne illnesses occur annually (95% credible interval [CrI] 3.88 million–12.0 million), results in 601,000 ED visits (95% CrI 364,000–866,000), 118,000 hospitalizations (95% CrI 86,800–150,000), and 6,630 deaths (95% CrI 4,520–8,870) and incurring US $3.33 billion (95% CrI 1.37 billion–8.77 billion) in direct healthcare costs. Otitis externa and norovirus infection were the most common illnesses. Most hospitalizations and deaths were caused by biofilm-associated pathogens (nontuberculous mycobacteria, Pseudomonas, Legionella), costing US $2.39 billion annually.
Collapse
|
3
|
Coffey CM, Collier SA, Gleason ME, Yoder JS, Kirk MD, Richardson AM, Fullerton KE, Benedict KM. Evolving Epidemiology of Reported Giardiasis Cases in the United States, 1995-2016. Clin Infect Dis 2021; 72:764-770. [PMID: 32047932 DOI: 10.1093/cid/ciaa128] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/07/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Giardiasis is the most common intestinal parasitic disease of humans identified in the United States (US) and an important waterborne disease. In the United States, giardiasis has been variably reportable since 1992 and was made a nationally notifiable disease in 2002. Our objective was to describe the epidemiology of US giardiasis cases from 1995 through 2016 using National Notifiable Diseases Surveillance System data. METHODS Negative binomial regression models were used to compare incidence rates by age group (0-4, 5-9, 10-19, 20-29, 30-39, 40-49, 50-64, and ≥ 65 years) during 3 time periods (1995-2001, 2002-2010, and 2011-2016). RESULTS During 1995-2016, the average number of reported cases was 19 781 per year (range, 14 623-27 778 cases). The annual incidence of reported giardiasis in the United States decreased across all age groups. This decrease differs by age group and sex and may reflect either changes in surveillance methods (eg, changes to case definitions or reporting practices) or changes in exposure. Incidence rates in males and older age groups did not decrease to the same extent as rates in females and children. CONCLUSIONS Trends suggest that differences in exposures by sex and age group are important to the epidemiology of giardiasis. Further investigation into the risk factors of populations with higher rates of giardiasis will support prevention and control efforts.
Collapse
Affiliation(s)
- Cushla M Coffey
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Sarah A Collier
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michelle E Gleason
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan S Yoder
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Martyn D Kirk
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Alice M Richardson
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Kathleen E Fullerton
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katharine M Benedict
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
4
|
Gold JAW, DeCuir J, Coyle JP, Duca LM, Adjemian J, Anderson KN, Baack BN, Bhattarai A, Dee D, Durant TM, Ewetola R, Finlayson T, Roush SW, Yin S, Jackson BR, Fullerton KE. COVID-19 Case Surveillance: Trends in Person-Level Case Data Completeness, United States, April 5-September 30, 2020. Public Health Rep 2021; 136:466-474. [PMID: 33789540 DOI: 10.1177/00333549211006973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To obtain timely and detailed data on COVID-19 cases in the United States, the Centers for Disease Control and Prevention (CDC) uses 2 data sources: (1) aggregate counts for daily situational awareness and (2) person-level data for each case (case surveillance). The objective of this study was to describe the sensitivity of case ascertainment and the completeness of person-level data received by CDC through national COVID-19 case surveillance. METHODS We compared case and death counts from case surveillance data with aggregate counts received by CDC during April 5-September 30, 2020. We analyzed case surveillance data to describe geographic and temporal trends in data completeness for selected variables, including demographic characteristics, underlying medical conditions, and outcomes. RESULTS As of November 18, 2020, national COVID-19 case surveillance data received by CDC during April 5-September 30, 2020, included 4 990 629 cases and 141 935 deaths, representing 72.7% of the volume of cases (n = 6 863 251) and 71.8% of the volume of deaths (n = 197 756) in aggregate counts. Nationally, completeness in case surveillance records was highest for age (99.9%) and sex (98.8%). Data on race/ethnicity were complete for 56.9% of cases; completeness varied by region. Data completeness for each underlying medical condition assessed was <25% and generally declined during the study period. About half of case records had complete data on hospitalization and death status. CONCLUSIONS Incompleteness in national COVID-19 case surveillance data might limit their usefulness. Streamlining and automating surveillance processes would decrease reporting burdens on jurisdictions and likely improve completeness of national COVID-19 case surveillance data.
Collapse
Affiliation(s)
- Jeremy A W Gold
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,1242 Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer DeCuir
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,1242 Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.,US Public Health Service, Rockville, MD, USA
| | - Jayme P Coyle
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lindsey M Duca
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,1242 Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Adjemian
- US Public Health Service, Rockville, MD, USA.,144823 Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kayla N Anderson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brittney N Baack
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Achuyt Bhattarai
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Deborah Dee
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,US Public Health Service, Rockville, MD, USA
| | - Tonji M Durant
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Raimi Ewetola
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Teresa Finlayson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sandra W Roush
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shaoman Yin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brendan R Jackson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,US Public Health Service, Rockville, MD, USA
| | - Kathleen E Fullerton
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
5
|
Beshearse E, Bruce BB, Nane GF, Cooke RM, Aspinall W, Hald T, Crim SM, Griffin PM, Fullerton KE, Collier SA, Benedict KM, Beach MJ, Hall AJ, Havelaar AH. Attribution of Illnesses Transmitted by Food and Water to Comprehensive Transmission Pathways Using Structured Expert Judgment, United States. Emerg Infect Dis 2021; 27:182-195. [PMID: 33350907 PMCID: PMC7774530 DOI: 10.3201/eid2701.200316] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Illnesses transmitted by food and water cause a major disease burden in the United States despite advancements in food safety, water treatment, and sanitation. We report estimates from a structured expert judgment study using 48 experts who applied Cooke's classical model of the proportion of disease attributable to 5 major transmission pathways (foodborne, waterborne, person-to-person, animal contact, and environmental) and 6 subpathways (food handler-related, under foodborne; recreational, drinking, and nonrecreational/nondrinking, under waterborne; and presumed person-to-person-associated and presumed animal contact-associated, under environmental). Estimates for 33 pathogens were elicited, including bacteria such as Salmonella enterica, Campylobacter spp., Legionella spp., and Pseudomonas spp.; protozoa such as Acanthamoeba spp., Cyclospora cayetanensis, and Naegleria fowleri; and viruses such as norovirus, rotavirus, and hepatitis A virus. The results highlight the importance of multiple pathways in the transmission of the included pathogens and can be used to guide prioritization of public health interventions.
Collapse
|
6
|
Stokes EK, Zambrano LD, Anderson KN, Marder EP, Raz KM, El Burai Felix S, Tie Y, Fullerton KE. Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:759-765. [PMID: 32555134 PMCID: PMC7302472 DOI: 10.15585/mmwr.mm6924e2] [Citation(s) in RCA: 919] [Impact Index Per Article: 229.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
7
|
|
8
|
Gharpure R, Francois Watkins L, Francois Watkins L, Fialkowski V, Collins JP, Strysko J, Marsh ZA, Tagg KA, Meservey EH, Adediran A, Schroeder MN, Wadhwa A, Fullerton KE, Friedman CR, Friedman CR. 1603. Observation of Treatment Outcomes During an Outbreak of Multidrug-Resistant Shigella sonnei Infections in a Retirement Community—Vermont, 2018. Open Forum Infect Dis 2019. [PMCID: PMC6809760 DOI: 10.1093/ofid/ofz360.1467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background In 2018, CDC and the Vermont Department of Health investigated an outbreak of multidrug-resistant Shigella sonnei infections in a retirement community. Most Shigella infections are self-limited, but antibiotics are indicated for severe illness and sometimes to limit transmission. The Clinical and Laboratory Standards Institute has not yet established breakpoints for azithromycin, so laboratories cannot report resistance. Although breakpoints exist for ciprofloxacin, isolates with one fluoroquinolone resistance mechanism typically have minimum inhibitory concentrations within the susceptible range (≤ 0.25 µg/mL). Methods We reviewed charts for treatment outcomes of outbreak patients to evaluate clinical and microbiologic response. We defined clinical failure as ≥ 3 loose stools per day for ≥ 1 day after completion of antibiotics and microbiologic failure as a positive stool culture after completion of antibiotics. We used broth microdilution to perform antimicrobial susceptibility testing, and whole-genome sequencing to identify resistance mechanisms. Results Among the 24 patients with culture-confirmed Shigella infection, 4 were hospitalized and 2 died. All isolates were multidrug-resistant (Table 1) and harbored mechanisms for resistance to ampicillin, ceftriaxone, trimethoprim-sulfamethoxazole, azithromycin, and ciprofloxacin. Fifteen patients received one course of ciprofloxacin, 5 received multiple courses of antibiotics, and 4 received no antibiotics. Overall, 6 patients had treatment failure (Table 2); all 4 patients who received azithromycin had subsequent clinical failure and 2 also had microbiologic failure. Two patients had failure after ciprofloxacin (1 clinical, 1 microbiologic). Conclusion This outbreak of highly resistant shigellosis highlights the importance of comprehensive susceptibility testing and systematic outcome studies. Evidence of treatment failure after azithromycin suggests that an appropriate clinical breakpoint is needed to inform clinical decision-making. Ciprofloxacin treatment failures were observed in patients with a susceptible strain harboring a resistance mechanism, warranting further investigation. ![]()
![]()
Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
| | - Louise Francois Watkins
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Louise Francois Watkins
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Zachary A Marsh
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kaitlin A Tagg
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Azizat Adediran
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Ashutosh Wadhwa
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen E Fullerton
- Waterbore Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | | | | |
Collapse
|
9
|
Strysko J, Fialkowski V, Marsh Z, Wadhwa A, Collins J, Gharpure R, Kelso P, Friedman CR, Fullerton KE. Notes from the Field: Outbreak of Multidrug-Resistant Shigella sonnei Infections in a Retirement Community - Vermont, October-November 2018. MMWR Morb Mortal Wkly Rep 2019; 68:405-406. [PMID: 31048673 PMCID: PMC6541310 DOI: 10.15585/mmwr.mm6817a5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
|
10
|
Benedict KM, Collier SA, Marder EP, Hlavsa MC, Fullerton KE, Yoder JS. Case-case analyses of cryptosporidiosis and giardiasis using routine national surveillance data in the United States - 2005-2015. Epidemiol Infect 2019; 147:e178. [PMID: 31063098 PMCID: PMC6518830 DOI: 10.1017/s0950268819000645] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Understanding endemic infectious disease risk factors through traditional epidemiological tools is challenging. Population-based case-control studies are costly and time-consuming. A case-case analyses using surveillance data addresses these limitations by using resources more efficiently. We conducted a case-case analyses using routine surveillance data reported by 16 U.S. states (2005-2015), wherein reported cases of salmonellosis were used as a comparison group to identify exposure associations with reported cases of cryptosporidiosis and giardiasis. Odds ratios adjusted for age and reporting state (aOR) and 95% confidence intervals (95% CI) were calculated. A total of 10 704 cryptosporidiosis cases, 17 544 giardiasis cases, and 106 351 salmonellosis cases were included in this analyses. When compared with cases of salmonellosis, exposure to treated recreational water (aOR 4.7, 95% CI 4.3-5.0) and livestock (aOR: 3.2; 95% CI: 2.9-3.5) were significantly associated with cryptosporidiosis and exposure to untreated drinking (aOR 4.1, 95% CI 3.6-4.7) and recreational water (aOR 4.1, 95% CI 3.7-4.5) were associated with giardiasis. Our analyses shows that routine surveillance data with standardised exposure information can be used to identify associations of interest for cryptosporidiosis and giardiasis.
Collapse
Affiliation(s)
- K M Benedict
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases,National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention,Atlanta, GA,USA
| | - S A Collier
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases,National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention,Atlanta, GA,USA
| | - E P Marder
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases,National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention,Atlanta, GA,USA
| | - M C Hlavsa
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases,National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention,Atlanta, GA,USA
| | - K E Fullerton
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases,National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention,Atlanta, GA,USA
| | - J S Yoder
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases,National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention,Atlanta, GA,USA
| |
Collapse
|
11
|
Graciaa DS, Cope JR, Roberts VA, Cikesh BL, Kahler AM, Vigar M, Hilborn ED, Wade TJ, Backer LC, Montgomery SP, Evan Secor W, Hill VR, Beach MJ, Fullerton KE, Yoder JS, Hlavsa MC. Outbreaks Associated with Untreated Recreational Water - United States, 2000-2014. Am J Transplant 2018. [DOI: 10.1111/ajt.15002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Daniel S. Graciaa
- Department of Family and Preventive Medicine; Emory University School of Medicine; Atlanta GA USA
| | - Jennifer R. Cope
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Virginia A. Roberts
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Bryanna L. Cikesh
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
- Oak Ridge Institute for Science and Education; Oak Ridge TN USA
| | - Amy M. Kahler
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Marissa Vigar
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | | | | | - Lorraine C. Backer
- Division of Environmental Hazards and Health Effects; National Center for Environmental Health, CDC; Atlanta GA USA
| | - Susan P. Montgomery
- Division of Parasitic Diseases and Malaria; Center for Global Health; CDC; Atlanta GA USA
| | - W. Evan Secor
- Division of Parasitic Diseases and Malaria; Center for Global Health; CDC; Atlanta GA USA
| | - Vincent R. Hill
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Michael J. Beach
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Kathleen E. Fullerton
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Jonathan S. Yoder
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Michele C. Hlavsa
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| |
Collapse
|
12
|
Hlavsa MC, Cikesh BL, Roberts VA, Kahler AM, Vigar M, Hilborn ED, Wade TJ, Roellig DM, Murphy JL, Xiao L, Yates KM, Kunz JM, Arduino MJ, Reddy SC, Fullerton KE, Cooley LA, Beach MJ, Hill VR, Yoder JS. Outbreaks associated with treated recreational water - United States, 2000-2014. Am J Transplant 2018. [DOI: 10.1111/ajt.14956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michele C. Hlavsa
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Bryanna L. Cikesh
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
- Oak Ridge Institute for Science and Education; Oak Ridge TN USA
| | - Virginia A. Roberts
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Amy M. Kahler
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Marissa Vigar
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
- Oak Ridge Institute for Science and Education; Oak Ridge TN USA
| | | | | | - Dawn M. Roellig
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Jennifer L. Murphy
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Lihua Xiao
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Kirsten M. Yates
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Jasen M. Kunz
- Division of Emergency and Environmental Health Services; National Center for Environmental Health; CDC; Atlanta GA USA
| | - Matthew J. Arduino
- Division of Healthcare Quality Promotion; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Sujan C. Reddy
- Division of Healthcare Quality Promotion; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Kathleen E. Fullerton
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Laura A. Cooley
- Division of Bacterial Diseases; National Center for Immunization and Respiratory Diseases; CDC; Atlanta GA USA
| | - Michael J. Beach
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Vincent R. Hill
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Jonathan S. Yoder
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| |
Collapse
|
13
|
Graciaa DS, Cope JR, Roberts VA, Cikesh BL, Kahler AM, Vigar M, Hilborn ED, Wade TJ, Backer LC, Montgomery SP, Secor WE, Hill VR, Beach MJ, Fullerton KE, Yoder JS, Hlavsa MC. Outbreaks Associated with Untreated Recreational Water - United States, 2000-2014. MMWR Morb Mortal Wkly Rep 2018; 67:701-706. [PMID: 29953425 PMCID: PMC6023190 DOI: 10.15585/mmwr.mm6725a1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Outbreaks associated with untreated recreational water can be caused by pathogens, toxins, or chemicals in fresh water (e.g., lakes, rivers) or marine water (e.g., ocean). During 2000-2014, public health officials from 35 states and Guam voluntarily reported 140 untreated recreational water-associated outbreaks to CDC. These outbreaks resulted in at least 4,958 cases of disease and two deaths. Among the 95 outbreaks with a confirmed infectious etiology, enteric pathogens caused 80 (84%); 21 (22%) were caused by norovirus, 19 (20%) by Escherichia coli, 14 (15%) by Shigella, and 12 (13%) by Cryptosporidium. Investigations of these 95 outbreaks identified 3,125 cases; 2,704 (87%) were caused by enteric pathogens, including 1,459 (47%) by norovirus, 362 (12%) by Shigella, 314 (10%) by Cryptosporidium, and 155 (5%) by E. coli. Avian schistosomes were identified as the cause in 345 (11%) of the 3,125 cases. The two deaths were in persons affected by a single outbreak (two cases) caused by Naegleria fowleri. Public parks (50 [36%]) and beaches (45 [32%]) were the leading settings associated with the 140 outbreaks. Overall, the majority of outbreaks started during June-August (113 [81%]); 65 (58%) started in July. Swimmers and parents of young swimmers can take steps to minimize the risk for exposure to pathogens, toxins, and chemicals in untreated recreational water by heeding posted advisories closing the beach to swimming; not swimming in discolored, smelly, foamy, or scummy water; not swimming while sick with diarrhea; and limiting water entering the nose when swimming in warm freshwater.
Collapse
|
14
|
Hlavsa MC, Cikesh BL, Roberts VA, Kahler AM, Vigar M, Hilborn ED, Wade TJ, Roellig DM, Murphy JL, Xiao L, Yates KM, Kunz JM, Arduino MJ, Reddy SC, Fullerton KE, Cooley LA, Beach MJ, Hill VR, Yoder JS. Outbreaks Associated with Treated Recreational Water - United States, 2000-2014. MMWR Morb Mortal Wkly Rep 2018; 67:547-551. [PMID: 29771872 PMCID: PMC6048947 DOI: 10.15585/mmwr.mm6719a3] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Outbreaks associated with exposure to treated recreational water can be caused by pathogens or chemicals in venues such as pools, hot tubs/spas, and interactive water play venues (i.e., water playgrounds). During 2000-2014, public health officials from 46 states and Puerto Rico reported 493 outbreaks associated with treated recreational water. These outbreaks resulted in at least 27,219 cases and eight deaths. Among the 363 outbreaks with a confirmed infectious etiology, 212 (58%) were caused by Cryptosporidium (which causes predominantly gastrointestinal illness), 57 (16%) by Legionella (which causes Legionnaires' disease, a severe pneumonia, and Pontiac fever, a milder illness with flu-like symptoms), and 47 (13%) by Pseudomonas (which causes folliculitis ["hot tub rash"] and otitis externa ["swimmers' ear"]). Investigations of the 363 outbreaks identified 24,453 cases; 21,766 (89%) were caused by Cryptosporidium, 920 (4%) by Pseudomonas, and 624 (3%) by Legionella. At least six of the eight reported deaths occurred in persons affected by outbreaks caused by Legionella. Hotels were the leading setting, associated with 157 (32%) of the 493 outbreaks. Overall, the outbreaks had a bimodal temporal distribution: 275 (56%) outbreaks started during June-August and 46 (9%) in March. Assessment of trends in the annual counts of outbreaks caused by Cryptosporidium, Legionella, or Pseudomonas indicate mixed progress in preventing transmission. Pathogens able to evade chlorine inactivation have become leading outbreak etiologies. The consequent outbreak and case counts and mortality underscore the utility of CDC's Model Aquatic Health Code (https://www.cdc.gov/mahc) to prevent outbreaks associated with treated recreational water.
Collapse
|
15
|
McClung RP, Roth DM, Vigar M, Roberts VA, Kahler AM, Cooley LA, Hilborn ED, Wade TJ, Fullerton KE, Yoder JS, Hill VR. Waterborne disease outbreaks associated with environmental and undetermined exposures to water - United States, 2013-2014. Am J Transplant 2018; 18:262-267. [PMID: 29267998 DOI: 10.1111/ajt.14607] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- R Paul McClung
- Epidemic Intelligence Service, CDC, Atlanta, GA, USA.,Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - David M Roth
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Marissa Vigar
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Virginia A Roberts
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Amy M Kahler
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Laura A Cooley
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | | | - Timothy J Wade
- U.S. Environmental Protection Agency, Washington, DC, USA
| | - Kathleen E Fullerton
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Jonathan S Yoder
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Vincent R Hill
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| |
Collapse
|
16
|
Benedict KM, Reses H, Vigar M, Roth DM, Roberts VA, Mattioli M, Cooley LA, Hilborn ED, Wade TJ, Fullerton KE, Yoder JS, Hill VR. Surveillance for Waterborne Disease Outbreaks Associated with Drinking Water - United States, 2013-2014. MMWR Morb Mortal Wkly Rep 2017; 66:1216-1221. [PMID: 29121003 PMCID: PMC5679581 DOI: 10.15585/mmwr.mm6644a3] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
17
|
McClung RP, Roth DM, Vigar M, Roberts VA, Kahler AM, Cooley LA, Hilborn ED, Wade TJ, Fullerton KE, Yoder JS, Hill VR. Waterborne Disease Outbreaks Associated With Environmental and Undetermined Exposures to Water - United States, 2013-2014. MMWR Morb Mortal Wkly Rep 2017; 66:1222-1225. [PMID: 29120997 PMCID: PMC5679586 DOI: 10.15585/mmwr.mm6644a4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
18
|
Adam EA, Collier SA, Fullerton KE, Gargano JW, Beach MJ. Prevalence and direct costs of emergency department visits and hospitalizations for selected diseases that can be transmitted by water, United States. J Water Health 2017; 15:673-683. [PMID: 29040071 DOI: 10.2166/wh.2017.083] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
National emergency department (ED) visit prevalence and costs for selected diseases that can be transmitted by water were estimated using large healthcare databases (acute otitis externa, campylobacteriosis, cryptosporidiosis, Escherichia coli infection, free-living ameba infection, giardiasis, hepatitis A virus (HAV) infection, Legionnaires' disease, nontuberculous mycobacterial (NTM) infection, Pseudomonas-related pneumonia or septicemia, salmonellosis, shigellosis, and vibriosis or cholera). An estimated 477,000 annual ED visits (95% CI: 459,000-494,000) were documented, with 21% (n = 101,000, 95% CI: 97,000-105,000) resulting in immediate hospital admission. The remaining 376,000 annual treat-and-release ED visits (95% CI: 361,000-390,000) resulted in $194 million in annual direct costs. Most treat-and-release ED visits (97%) and costs ($178 million/year) were associated with acute otitis externa. HAV ($5.5 million), NTM ($2.3 million), and salmonellosis ($2.2 million) were associated with next highest total costs. Cryptosporidiosis ($2,035), campylobacteriosis ($1,783), and NTM ($1,709) had the highest mean costs per treat-and-release ED visit. Overall, the annual hospitalization and treat-and-release ED visit costs associated with the selected diseases totaled $3.8 billion. As most of these diseases are not solely transmitted by water, an attribution process is needed as a next step to determine the proportion of these visits and costs attributable to waterborne transmission.
Collapse
Affiliation(s)
- E A Adam
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - S A Collier
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - K E Fullerton
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - J W Gargano
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - M J Beach
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| |
Collapse
|
19
|
Geissler AL, Bustos Carrillo F, Swanson K, Patrick ME, Fullerton KE, Bennett C, Barrett K, Mahon BE. Increasing Campylobacter Infections, Outbreaks, and Antimicrobial Resistance in the United States, 2004–2012. Clin Infect Dis 2017; 65:1624-1631. [DOI: 10.1093/cid/cix624] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/17/2017] [Indexed: 11/14/2022] Open
|
20
|
Gargano JW, Adam EA, Collier SA, Fullerton KE, Feinman SJ, Beach MJ. Mortality from selected diseases that can be transmitted by water - United States, 2003-2009. J Water Health 2017; 15:438-450. [PMID: 28598348 DOI: 10.2166/wh.2017.301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Diseases spread by water are caused by fecal-oral, contact, inhalation, or other routes, resulting in illnesses affecting multiple body systems. We selected 13 pathogens or syndromes implicated in waterborne disease outbreaks or other well-documented waterborne transmission (acute otitis externa, Campylobacter, Cryptosporidium, Escherichia coli (E. coli), free-living ameba, Giardia, Hepatitis A virus, Legionella (Legionnaires' disease), nontuberculous mycobacteria (NTM), Pseudomonas-related pneumonia or septicemia, Salmonella, Shigella, and Vibrio). We documented annual numbers of deaths in the United States associated with these infections using a combination of death certificate data, nationally representative hospital discharge data, and disease-specific surveillance systems (2003-2009). We documented 6,939 annual total deaths associated with the 13 infections; of these, 493 (7%) were caused by seven pathogens transmitted by the fecal-oral route. A total of 6,301 deaths (91%) were associated with infections from Pseudomonas, NTM, and Legionella, environmental pathogens that grow in water system biofilms. Biofilm-associated pathogens can cause illness following inhalation of aerosols or contact with contaminated water. These findings suggest that most mortality from these 13 selected infections in the United States does not result from classical fecal-oral transmission but rather from other transmission routes.
Collapse
Affiliation(s)
- J W Gargano
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - E A Adam
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - S A Collier
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - K E Fullerton
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - S J Feinman
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail: ; Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - M J Beach
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| |
Collapse
|
21
|
Hlavsa MC, Roellig DM, Seabolt MH, Kahler AM, Murphy JL, McKitt TK, Geeter EF, Dawsey R, Davidson SL, Kim TN, Tucker TH, Iverson SA, Garrett B, Fowle N, Collins J, Epperson G, Zusy S, Weiss JR, Komatsu K, Rodriguez E, Patterson JG, Sunenshine R, Taylor B, Cibulskas K, Denny L, Omura K, Tsorin B, Fullerton KE, Xiao L. Using Molecular Characterization to Support Investigations of Aquatic Facility-Associated Outbreaks of Cryptosporidiosis - Alabama, Arizona, and Ohio, 2016. MMWR Morb Mortal Wkly Rep 2017; 66:493-497. [PMID: 28520707 PMCID: PMC5657643 DOI: 10.15585/mmwr.mm6619a2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
22
|
Dewey-Mattia D, Roberts VA, Vieira A, Fullerton KE. Foodborne (1973-2013) and Waterborne (1971-2013) Disease Outbreaks - United States. MMWR Morb Mortal Wkly Rep 2016; 63:79-84. [PMID: 27736832 DOI: 10.15585/mmwr.mm6355a8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
CDC collects data on foodborne and waterborne disease outbreaks reported by all U.S. states and territories through the Foodborne Disease Outbreak Surveillance System (FDOSS) (http://www.cdc.gov/foodsafety/fdoss/surveillance/index.html) and the Waterborne Disease and Outbreak Surveillance System (WBDOSS) http://www.cdc.gov/healthywater/surveillance), respectively. These two systems are the primary source of national data describing the number of reported outbreaks; outbreak-associated illnesses, hospitalizations, and deaths; etiologic agents; water source or implicated foods; settings of exposure; and other factors associated with recognized foodborne and waterborne disease outbreaks in the United States.
Collapse
Affiliation(s)
- Daniel Dewey-Mattia
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Virginia A Roberts
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Antonio Vieira
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Kathleen E Fullerton
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| |
Collapse
|
23
|
Hlavsa MC, Gerth TR, Collier SA, Dunbar EL, Rao G, Epperson G, Bramlett B, Ludwig DF, Gomez D, Stansbury MM, Miller F, Warren J, Nichol J, Bowman H, Huynh BA, Loewe KM, Vincent B, Tarrier AL, Shay T, Wright R, Brown AC, Kunz JM, Fullerton KE, Cope JR, Beach MJ. Immediate Closures and Violations Identified During Routine Inspections of Public Aquatic Facilities - Network for Aquatic Facility Inspection Surveillance, Five States, 2013. MMWR Surveill Summ 2016; 65:1-26. [PMID: 27199095 DOI: 10.15585/mmwr.ss6505a1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PROBLEM/CONDITION Aquatic facility-associated illness and injury in the United States include disease outbreaks of infectious or chemical etiology, drowning, and pool chemical-associated health events (e.g., respiratory distress or burns). These conditions affect persons of all ages, particularly young children, and can lead to disability or even death. A total of 650 aquatic facility-associated outbreaks have been reported to CDC for 1978-2012. During 1999-2010, drownings resulted in approximately 4,000 deaths each year in the United States. Drowning is the leading cause of injury deaths in children aged 1-4 years, and approximately half of fatal drownings in this age group occur in swimming pools. During 2003-2012, pool chemical-associated health events resulted in an estimated 3,000-5,000 visits to U.S. emergency departments each year, and approximately half of the patients were aged <18 years. In August 2014, CDC released the Model Aquatic Health Code (MAHC), national guidance that can be adopted voluntarily by state and local jurisdictions to minimize the risk for illness and injury at public aquatic facilities. REPORTING PERIOD COVERED 2013. DESCRIPTION OF SYSTEM The Network for Aquatic Facility Inspection Surveillance (NAFIS) was established by CDC in 2013. NAFIS receives aquatic facility inspection data collected by environmental health practitioners when assessing the operation and maintenance of public aquatic facilities. This report presents inspection data that were reported by 16 public health agencies in five states (Arizona, California, Florida, New York, and Texas) and focuses on 15 MAHC elements deemed critical to minimizing the risk for illness and injury associated with aquatic facilities (e.g., disinfection to prevent transmission of infectious pathogens, safety equipment to rescue distressed bathers, and pool chemical safety). Although these data (the first and most recent that are available) are not nationally representative, 15.7% of the estimated 309,000 U.S. public aquatic venues are located in the 16 reporting jurisdictions. RESULTS During 2013, environmental health practitioners in the 16 reporting NAFIS jurisdictions conducted 84,187 routine inspections of 48,632 public aquatic venues. Of the 84,187 routine inspection records for individual aquatic venues, 78.5% (66,098) included data on immediate closure; 12.3% (8,118) of routine inspections resulted in immediate closure because of at least one identified violation that represented a serious threat to public health. Disinfectant concentration violations were identified during 11.9% (7,662/64,580) of routine inspections, representing risk for aquatic facility-associated outbreaks of infectious etiology. Safety equipment violations were identified during 12.7% (7,845/61,648) of routine inspections, representing risk for drowning. Pool chemical safety violations were identified during 4.6% (471/10,264) of routine inspections, representing risk for pool chemical-associated health events. INTERPRETATION Routine inspections frequently resulted in immediate closure and identified violations of inspection items corresponding to 15 MAHC elements critical to protecting public health, highlighting the need to improve operation and maintenance of U.S. public aquatic facilities. These findings also underscore the public health function that code enforcement, conducted by environmental health practitioners, has in preventing illness and injury at public aquatic facilities. PUBLIC HEALTH ACTION Findings from the routine analyses of aquatic facility inspection data can inform program planning, implementation, and evaluation. At the state and local level, these inspection data can be used to identify aquatic facilities and venues in need of more frequent inspections and to select topics to cover in training for aquatic facility operators. At the national level, these data can be used to evaluate whether the adoption of MAHC elements minimizes the risk for aquatic facility-associated illness and injury. These findings also can be used to prioritize revisions or updates to the MAHC. To optimize the collection and analysis of aquatic facility inspection data and thus application of findings, environmental health practitioners and epidemiologists need to collaborate extensively to identify public aquatic facility code elements deemed critical to protecting public health and determine the best way to assess and document compliance during inspections.
Collapse
Affiliation(s)
- Michele C Hlavsa
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infections Diseases, CDC
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Johnson RO, Cope JR, Moskowitz M, Kahler A, Hill V, Behrendt K, Molina L, Fullerton KE, Beach MJ. Notes from the Field: Primary Amebic Meningoencephalitis Associated with Exposure to Swimming Pool Water Supplied by an Overland Pipe — Inyo County, California, 2015. MMWR Morb Mortal Wkly Rep 2016; 65:424. [DOI: 10.15585/mmwr.mm6516a4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
25
|
Goodman AB, Meites E, Anstey EH, Fullerton KE, Jayatilleke A, Ruben W, Koumans E, Oster AM, Karwowski MP, Dziuban E, Kirkcaldy RD, Glover M, Lowe L, Peacock G, Mahon B, Griese SE. Clinical Inquiries Received by CDC Regarding Suspected Ebola Virus Disease in Children--United States, July 9, 2014-January 4, 2015. MMWR Morb Mortal Wkly Rep 2015; 64:1006-10. [PMID: 26390343 DOI: 10.15585/mmwr.mm6436a3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The 2014–2015 Ebola virus disease (Ebola) epidemic is the largest in history and represents the first time Ebola has been diagnosed in the United States. On July 9, 2014, CDC activated its Emergency Operations Center and established an Ebola clinical consultation service to assist U.S. state and local public health officials and health care providers with the evaluation of suspected cases. CDC reviewed all 89 inquiries received by the consultation service during July 9, 2014– January 4, 2015, about children (persons aged ≤18 years). Most (56 [63%]) children had no identifiable epidemiologic risk factors for Ebola; among the 33 (37%) who did have an epidemiologic risk factor, in every case this was travel from an Ebola-affected country. Thirty-two of these children met criteria for a person under investigation (PUI) because of clinical signs or symptoms. Fifteen PUIs had blood samples tested for Ebola virus RNA by reverse transcription–polymerase chain reaction; all tested negative. Febrile children who have recently traveled from an Ebola-affected country can be expected to have other common diagnoses, such as malaria and influenza, and in the absence of epidemiologic risk factors for Ebola, the likelihood of Ebola is extremely low. Delaying evaluation and treatment for these other more common illnesses might lead to poorer clinical outcomes. Additionally, many health care providers expressed concerns about whether and how parents should be allowed in the isolation room. While maintaining an appropriate level of vigilance for Ebola, public health officials and health care providers should ensure that pediatric PUIs receive timely triage, diagnosis, and treatment of other more common illnesses, and care reflecting best practices in supporting children’s psychosocial needs.
Collapse
|
26
|
Beer KD, Gargano JW, Roberts VA, Reses HE, Hill VR, Garrison LE, Kutty PK, Hilborn ED, Wade TJ, Fullerton KE, Yoder JS. Outbreaks Associated With Environmental and Undetermined Water Exposures — United States, 2011–2012. MMWR Morb Mortal Wkly Rep 2015; 64:849-51. [PMID: 26270060 PMCID: PMC4584590 DOI: 10.15585/mmwr.mm6431a3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Karlyn D. Beer
- Epidemic Intelligence Service, CDC
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
- Corresponding author: Karlyn Beer, , 404-718-1151
| | - Julia W. Gargano
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Virginia A. Roberts
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Hannah E. Reses
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Vincent R. Hill
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Laurel E. Garrison
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Preeta K. Kutty
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | | | | | - Kathleen E. Fullerton
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jonathan S. Yoder
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| |
Collapse
|
27
|
Beer KD, Gargano JW, Roberts VA, Hill VR, Garrison LE, Kutty PK, Hilborn ED, Wade TJ, Fullerton KE, Yoder JS. Surveillance for Waterborne Disease Outbreaks Associated with Drinking Water — United States, 2011–2012. MMWR Morb Mortal Wkly Rep 2015; 64:842-8. [PMID: 26270059 PMCID: PMC4584589 DOI: 10.15585/mmwr.mm6431a2] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Karlyn D. Beer
- Epidemic Intelligence Service, CDC
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
- Corresponding author: Karlyn Beer, , 404-718-1151
| | - Julia W. Gargano
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Virginia A. Roberts
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Vincent R. Hill
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Laurel E. Garrison
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Preeta K. Kutty
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | | | | | - Kathleen E. Fullerton
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jonathan S. Yoder
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| |
Collapse
|
28
|
Karwowski MP, Meites E, Fullerton KE, Ströher U, Lowe L, Rayfield M, Blau DM, Knust B, Gindler J, Van Beneden C, Bialek SR, Mead P, Oster AM. Clinical inquiries regarding Ebola virus disease received by CDC--United States, July 9-November 15, 2014. MMWR Morb Mortal Wkly Rep 2014; 63:1175-9. [PMID: 25503923 PMCID: PMC4584543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Since early 2014, there have been more than 6,000 reported deaths from Ebola virus disease (Ebola), mostly in Guinea, Liberia, and Sierra Leone. On July 9, 2014, CDC activated its Emergency Operations Center for the Ebola outbreak response and formalized the consultation service it had been providing to assist state and local public health officials and health care providers evaluate persons in the United States thought to be at risk for Ebola. During July 9-November 15, CDC responded to clinical inquiries from public health officials and health care providers from 49 states and the District of Columbia regarding 650 persons thought to be at risk. Among these, 118 (18%) had initial signs or symptoms consistent with Ebola and epidemiologic risk factors placing them at risk for infection, thereby meeting the definition of persons under investigation (PUIs). Testing was not always performed for PUIs because alternative diagnoses were made or symptoms resolved. In total, 61 (9%) persons were tested for Ebola virus, and four, all of whom met PUI criteria, had laboratory-confirmed Ebola. Overall, 490 (75%) inquiries concerned persons who had neither traveled to an Ebola-affected country nor had contact with an Ebola patient. Appropriate medical evaluation and treatment for other conditions were noted in some instances to have been delayed while a person was undergoing evaluation for Ebola. Evaluating and managing persons who might have Ebola is one component of the overall approach to domestic surveillance, the goal of which is to rapidly identify and isolate Ebola patients so that they receive appropriate medical care and secondary transmission is prevented. Health care providers should remain vigilant and consult their local and state health departments and CDC when assessing ill travelers from Ebola-affected countries. Most of these persons do not have Ebola; prompt diagnostic assessments, laboratory testing, and provision of appropriate care for other conditions are essential for appropriate patient care and reflect hospital preparedness.
Collapse
Affiliation(s)
- Mateusz P. Karwowski
- Epidemic Intelligence Service, CDC
- Epidemiology/Laboratory Task Force, 2014 Ebola Response Team, CDC
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC
| | - Elissa Meites
- Epidemiology/Laboratory Task Force, 2014 Ebola Response Team, CDC
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Kathleen E. Fullerton
- Epidemiology/Laboratory Task Force, 2014 Ebola Response Team, CDC
- Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, CDC
| | - Ute Ströher
- Epidemiology/Laboratory Task Force, 2014 Ebola Response Team, CDC
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Luis Lowe
- Epidemiology/Laboratory Task Force, 2014 Ebola Response Team, CDC
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Mark Rayfield
- Epidemiology/Laboratory Task Force, 2014 Ebola Response Team, CDC
- Division of Global Disease Detection and Emergency Response, Center for Global Health, CDC
| | - Dianna M. Blau
- Epidemiology/Laboratory Task Force, 2014 Ebola Response Team, CDC
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Barbara Knust
- Epidemiology/Laboratory Task Force, 2014 Ebola Response Team, CDC
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jacqueline Gindler
- Epidemiology/Laboratory Task Force, 2014 Ebola Response Team, CDC
- Global Immunization Division, Center for Global Health, CDC
| | - Chris Van Beneden
- Epidemiology/Laboratory Task Force, 2014 Ebola Response Team, CDC
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Stephanie R. Bialek
- Epidemiology/Laboratory Task Force, 2014 Ebola Response Team, CDC
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Paul Mead
- Epidemiology/Laboratory Task Force, 2014 Ebola Response Team, CDC
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Alexandra M. Oster
- Epidemiology/Laboratory Task Force, 2014 Ebola Response Team, CDC
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
| |
Collapse
|
29
|
Fullerton KE, Scallan E, Kirk MD, Mahon BE, Angulo FJ, de Valk H, van Pelt W, Gauci C, Hauri AM, Majowicz S, O'Brien SJ. Case-control studies of sporadic enteric infections: a review and discussion of studies conducted internationally from 1990 to 2009. Foodborne Pathog Dis 2014; 9:281-92. [PMID: 22443481 DOI: 10.1089/fpd.2011.1065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Epidemiologists have used case-control studies to investigate enteric disease outbreaks for many decades. Increasingly, case-control studies are also used to investigate risk factors for sporadic (not outbreak-associated) disease. While the same basic approach is used, there are important differences between outbreak and sporadic disease settings that need to be considered in the design and implementation of the case-control study for sporadic disease. Through the International Collaboration on Enteric Disease "Burden of Illness" Studies (the International Collaboration), we reviewed 79 case-control studies of sporadic enteric infections caused by nine pathogens that were conducted in 22 countries and published from 1990 through to 2009. We highlight important methodological and study design issues (including case definition, control selection, and exposure assessment) and discuss how approaches to the study of sporadic enteric disease have changed over the last 20 years (e.g., making use of more sensitive case definitions, databases of controls, and computer-assisted interviewing). As our understanding of sporadic enteric infections grows, methods and topics for case-control studies are expected to continue to evolve; for example, advances in understanding of the role of immunity can be used to improve control selection, the apparent protective effects of certain foods can be further explored, and case-control studies can be used to provide population-based measures of the burden of disease.
Collapse
Affiliation(s)
- Kathleen E Fullerton
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Fullerton KE, Mahon BE. Case-control studies of sporadic enteric infections complement information from outbreak investigations. Foodborne Pathog Dis 2012; 10:97-8. [PMID: 23210922 DOI: 10.1089/fpd.2012.1412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
31
|
Donnan EJ, Fielding JE, Gregory JE, Lalor K, Rowe S, Goldsmith P, Antoniou M, Fullerton KE, Knope K, Copland JG, Bowden DS, Tracy SL, Hogg GG, Tan A, Adamopoulos J, Gaston J, Vally H. A multistate outbreak of hepatitis A associated with semidried tomatoes in Australia, 2009. Clin Infect Dis 2012; 54:775-81. [PMID: 22238166 DOI: 10.1093/cid/cir949] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A large outbreak of hepatitis A affected individuals in several Australian states in 2009, resulting in a 2-fold increase in cases reported to state health departments compared with 2008. Two peaks of infection occurred (April-May and September-November), with surveillance data suggesting locally acquired infections from a widely distributed food product. METHODS Two case-control studies were completed. Intensive product trace-back and food sampling was undertaken. Genotyping was conducted on virus isolates from patient serum and food samples. Control measures included prophylaxis for close contacts, public health warnings, an order by the chief health officer under the Victorian Food Act 1984, and trade-level recalls on implicated batches of semidried tomatoes. RESULTS A multijurisdictional case-control study in April-May found an association between illness and consumption of semidried tomatoes (odds ratio [OR], 3.0; 95% CI 1.4-6.7). A second case-control study conducted in Victoria in October-November also implicated semidried tomatoes as being associated with illness (OR, 10.3; 95% CI, 4.7-22.7). Hepatitis A RNA was detected in 22 samples of semidried tomatoes. Hepatitis A virus genotype IB was identified in 144 of 153 (94%) patients tested from 2009, and partial sequence analysis showed complete identity with an isolate found in a sample of semidried tomatoes. CONCLUSIONS The results of both case-control studies and food testing implicated the novel vehicle of semidried tomatoes as the cause of this hepatitis A outbreak. The outbreak was extensive and sustained despite public health interventions, the design and implementation of which were complicated by limitations in food testing capability and complex supply chains.
Collapse
Affiliation(s)
- Ellen J Donnan
- Victorian Government Department of Health, ational Centre for Epidemiology and Population Health, College of Medicine and Biological Sciences, The Australian National University, Melbourne, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Barton Behravesh C, Jones TF, Vugia DJ, Long C, Marcus R, Smith K, Thomas S, Zansky S, Fullerton KE, Henao OL, Scallan E. Deaths Associated With Bacterial Pathogens Transmitted Commonly Through Food: Foodborne Diseases Active Surveillance Network (FoodNet), 1996–2005. J Infect Dis 2011; 204:263-7. [DOI: 10.1093/infdis/jir263] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Casey Barton Behravesh
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases
- Epidemic Intelligence Service Program Office for Scientific Education and Professional Development, Division of Applied Sciences, Centers for Disease Control and Prevention
| | | | - Duc J. Vugia
- California Department of Public Health Infectious Diseases Branch, Richmond
| | - Cherie Long
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases
| | - Ruthanne Marcus
- Connecticut Emerging Infections Program, New Haven and Hartford
| | - Kirk Smith
- Minnesota Department of Health, Minneapolis
| | - Stephanie Thomas
- Georgia Emerging Infections Program, Division of Public Health, Atlanta
| | - Shelley Zansky
- New York Emerging Infections Program, New York State Department of Health, Albany
| | - Kathleen E. Fullerton
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases
| | - Olga L. Henao
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases
| | - Elaine Scallan
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases
| | | |
Collapse
|
33
|
Kirk MD, Fullerton KE, Hall GV, Gregory J, Stafford R, Veitch MG, Becker N. Surveillance for outbreaks of gastroenteritis in long-term care facilities, Australia, 2002-2008. Clin Infect Dis 2011; 51:907-14. [PMID: 20825308 DOI: 10.1086/656406] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Each year in Australia, health departments investigate hundreds of gastroenteritis outbreaks. Long-term care facilities (LTCFs) for elderly persons are a common setting for these outbreaks and can result in potentially serious outcomes. METHODS We established surveillance for gastroenteritis outbreaks in 2001, and analyzed data on outbreaks occurring from 1 July 2002 through 30 June 2008 to estimate the incidence in Australian LTCFs and residents. We summarized outbreaks by mode of transmission and etiological agent. We used negative binomial regression to examine variation in the number of fecal specimens collected in outbreaks-a marker of investigation intensity. RESULTS During surveillance, 3257 (52%) of 6295 outbreaks of gastroenteritis and foodborne disease in Australia were reported in LTCFs. These outbreaks affected 84,769 people, with 1577 people hospitalized and 209 deaths. There were 0.19 (95% confidence interval, 0.14-0.26) residents affected per 1000 bed days and 16.8 (95% confidence interval, 12.4-22.7) outbreaks per 100 LTCFs annually. LTCF outbreaks were most commonly transmitted from person to person. Only 43 (1.3% ) of 3257 outbreaks were foodborne, although 47 (6.4%) of 733 residents were hospitalized and 20 (2.7%) of 733 died. Norovirus was responsible for 1136 (35%) of all 3257 outbreaks. Higher numbers of fecal specimens per outbreak were collected in 4 Australian States, in later years of surveillance, and where the etiology was identified. CONCLUSIONS Norovirus outbreaks spread from person to person are common in LTCFs, although clinicians should be alert for foodborne outbreaks with more serious consequences. There is a need to identify effective infection control measures to assist facilities in managing outbreaks of gastroenteritis.
Collapse
Affiliation(s)
- Martyn D Kirk
- Australian Government Department of Health and Ageing, National Centre for Epidemiology and Population Health, The Australian National University, OzFoodNet, Canberra, Australia.
| | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
The objective of this study was to examine the frequency of Campylobacter outbreaks in Australia and determine common transmission routes and vehicles. Summary and unit data on Campylobacter outbreaks that occurred between January 2001 and December 2006 were systematically collected and analyzed. Data from Campylobacter mandatory notifications for the same period were used for comparison. During the study period there were 33 Campylobacter outbreaks reported, affecting 457 persons. Of these, 147 (32%) had laboratory-confirmed infections, constituting 0.1% of notified Campylobacter cases. Campylobacter outbreaks most commonly occurred during the Australian Spring (September to November; n = 14, 45%), when notifications generally peaked. Transmission was predominantly foodborne or suspected foodborne (n = 27, 82%), commercial settings (n = 15, 55%) being most commonly involved. There were eight foodborne outbreaks (30%) attributed to food prepared or eaten at institutions; four (15%) at aged care facilities and three (11%) at school camps. A vehicle or suspected vehicle was determined for 16 (59%) foodborne outbreaks; poultry (chicken or duck) was associated with 11 (41%) of these, unpasteurized milk and salad were associated with two outbreaks each. Three potential waterborne outbreaks were detected, and one was due to person-to-person transmission. Campylobacter outbreaks were more commonly detected during this study period compared to a previous 6-year period (n = 9) when prospective recording of information was not undertaken. However, outbreak cases continue to constitute a very small proportion of notifications. Improved recognition through subtyping is required to enhance outbreak detection and investigation so as to aid policy formulation for prevention of infection. In addition to detection of chicken as a common source of outbreaks, these data highlight the importance of directing policy at commercial premises, aged care facilities, and school camps to reduce Campylobacter disease burden.
Collapse
Affiliation(s)
- Leanne E Unicomb
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
| | | | | | | |
Collapse
|
35
|
Fullerton KE, Ingram LA, Jones TF, Anderson BJ, McCarthy PV, Hurd S, Shiferaw B, Vugia D, Haubert N, Hayes T, Wedel S, Scallan E, Henao O, Angulo FJ. Sporadic campylobacter infection in infants: a population-based surveillance case-control study. Pediatr Infect Dis J 2007; 26:19-24. [PMID: 17195700 DOI: 10.1097/01.inf.0000247137.43495.34] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Campylobacter is an important cause of foodborne illness in infants (younger than 1 year of age), but little is known about the sources of infection in this age group. METHODS Eight sites in the Foodborne Diseases Active Surveillance Network (FoodNet) participated in a 24-month population-based case-control study conducted in 2002-2004. Cases were infants with laboratory-confirmed Campylobacter infection ascertained through active laboratory surveillance, and controls were infants in the community. RESULTS We enrolled 123 cases and 928 controls. Infants 0-6 months of age with Campylobacter infection were less likely to be breast-fed than controls [odds ratio (OR); 0.2; 95% confidence interval (CI), 0.1-0.6]. Risk factors for infants 0-6 months of age included drinking well water (OR 4.4; CI, 1.4-14) and riding in a shopping cart next to meat or poultry (OR 4.0; CI, 1.2-13.0). Risk factors for infants 7-11 months of age included visiting or living on a farm (OR 6.2; CI, 2.2-17), having a pet with diarrhea in the home (OR 7.6; CI, 2.1-28) and eating fruits and vegetables prepared in the home (OR 2.5, CI 1.2-4.9). Campylobacter infection was associated with travel outside the United States at all ages (OR 19.3; CI, 4.5-82.1). CONCLUSIONS Several unique protective and risk factors were identified among infants, and these risk factors vary by age, suggesting that prevention measures be targeted accordingly. Breast-feeding was protective for the youngest infants and should continue to be encouraged.
Collapse
|
36
|
Marcus R, Varma JK, Medus C, Boothe EJ, Anderson BJ, Crume T, Fullerton KE, Moore MR, White PL, Lyszkowicz E, Voetsch AC, Angulo FJ. Re-assessment of risk factors for sporadic Salmonella serotype Enteritidis infections: a case-control study in five FoodNet Sites, 2002-2003. Epidemiol Infect 2007; 135:84-92. [PMID: 16756692 PMCID: PMC2870546 DOI: 10.1017/s0950268806006558] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2006] [Indexed: 11/07/2022] Open
Abstract
Active surveillance for laboratory-confirmed Salmonella serotype Enteritidis (SE) infection revealed a decline in incidence in the 1990s, followed by an increase starting in 2000. We sought to determine if the fluctuation in SE incidence could be explained by changes in foodborne sources of infection. We conducted a population-based case-control study of sporadic SE infection in five of the Foodborne Diseases Active Surveillance Network (FoodNet) sites during a 12-month period in 2002-2003. A total of 218 cases and 742 controls were enrolled. Sixty-seven (31%) of the 218 case-patients and six (1%) of the 742 controls reported travel outside the United States during the 5 days before the case's illness onset (OR 53, 95% CI 23-125). Eighty-one percent of cases with SE phage type 4 travelled internationally. Among persons who did not travel internationally, eating chicken prepared outside the home and undercooked eggs inside the home were associated with SE infections. Contact with birds and reptiles was also associated with SE infections. This study supports the findings of previous case-control studies and identifies risk factors associated with specific phage types and molecular subtypes.
Collapse
Affiliation(s)
- R Marcus
- Connecticut Emerging Infections Program, New Haven, CT 06510, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Dayan GH, Iskander J, Glasser J, English-Bullard R, Fullerton KE, Chen R. Tracking vaccine lot lifecycles using reports to the vaccine adverse event reporting system (VAERS). Pharmacoepidemiol Drug Saf 2006; 14:671-6. [PMID: 15662715 DOI: 10.1002/pds.1070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE There is currently no systematically available information available on how rapidly a specific lot of vaccine is used once distributed. We used data from reports to the Vaccine Adverse Event Reporting System (VAERS) to develop a proxy means of surveillance for the lifecycle of selected vaccine lots. METHODS A convenience sample, consisting of selected lots of: diphtheria, tetanus, and acellular pertussis (DTaP), Haemophilus influenzae type b (Hib), Hepatitis B, and varicella vaccines, was selected for lifecycle analysis. Assuming that circulation of a vaccine lot is proportional to vaccine-specific adverse event (AE) reporting for that vaccine type, we constructed Gamma distributed usage models and compared them with lot-specific VAERS reports to estimate the actual lifecycle of lots in the system. RESULTS Evidence of lot circulation was detected within 1-2 months, and a peak was observed 3-4 months after the vaccine release date for most of the study vaccines. Ninety percent of the vaccine doses in each lot were estimated to be used within 5-9 months of distribution. The length of time a vaccine lot was in use ranged from 5 to 17 months from earliest vaccination date. CONCLUSIONS Our modeled and inferred administration of the selected lots of different vaccines were concordant. This method may be useful for spatial and temporal tracking of vaccine lot utilization.
Collapse
Affiliation(s)
- Gustavo H Dayan
- Epidemiology and Surveillance Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | | | | | |
Collapse
|
38
|
Jones TF, Ingram LA, Fullerton KE, Marcus R, Anderson BJ, McCarthy PV, Vugia D, Shiferaw B, Haubert N, Wedel S, Angulo FJ. A case-control study of the epidemiology of sporadic Salmonella infection in infants. Pediatrics 2006; 118:2380-7. [PMID: 17142522 DOI: 10.1542/peds.2006-1218] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Rates of Salmonella infection are highest in infants, but little is known about potential sources of infection in this high-risk population. We performed a case-control study to identify dietary and environmental risk factors for sporadic salmonellosis among infants. PATIENTS AND METHODS In 2002-2004, the Foodborne Diseases Active Surveillance Network conducted a population-based, case-control study of sporadic salmonellosis among infants <1 year of age in 8 states. Cases were identified via active laboratory-based surveillance. Healthy controls were frequency matched by age and identified through birth registries or published birth announcements. We assessed diet and environmental exposures in the 5 days before illness onset or interview. Data were analyzed by using logistic regression adjusting for age. RESULTS The study enrolled 442 subjects and 928 controls. Compared with healthy controls, infants with Salmonella infection were less likely to have been breastfed and more likely to have had exposure to reptiles, to have ridden in a shopping cart next to meat or poultry, or to have consumed concentrated liquid infant formula during the 5-day exposure period. Travel outside the United States was associated with illness in infants 3 to 6 and >6 months of age. Attending day care with a child with diarrhea was associated with salmonellosis in infants >6 months of age. CONCLUSIONS We identified a number of modifiable protective and risk factors for salmonellosis in infants. Attention should be directed at developing effective preventive measures for this high-risk population.
Collapse
Affiliation(s)
- Timothy F Jones
- Communicable and Environmental Disease Services, Tennessee Department of Health, 4th Floor, Cordell Hull Building, 425 5th Ave N, Nashville, TN 37247, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Varma JK, Marcus R, Stenzel SA, Hanna SS, Gettner S, Anderson BJ, Hayes T, Shiferaw B, Crume TL, Joyce K, Fullerton KE, Voetsch AC, Angulo FJ. Highly resistant Salmonella Newport-MDRAmpC transmitted through the domestic US food supply: a FoodNet case-control study of sporadic Salmonella Newport infections, 2002-2003. J Infect Dis 2006; 194:222-30. [PMID: 16779729 DOI: 10.1086/505084] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2006] [Accepted: 02/24/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND A new multidrug-resistant (MDR) strain of Salmonella serotype Newport, Newport-MDRAmpC, has recently emerged. We sought to identify the medical, behavioral, and dietary risk factors for laboratory-confirmed Salmonella Newport infection, including that with Newport-MDRAmpC. METHODS A 12-month population-based case-control study was conducted during 2002-2003 in 8 sites of the Foodborne Diseases Active Surveillance Network (FoodNet), with 215 case patients with Salmonella Newport infection and 1154 healthy community control subjects. RESULTS Case patients with Newport-MDRAmpC infection were more likely than control subjects to have taken an antimicrobial agent to which Newport-MDRAmpC is resistant during the 28 days before the onset of diarrheal illness (odds ratio [OR], 5.0 [95% confidence interval {CI}, 1.6-16]). Case patients with Newport-MDRAmpC infection were also more likely to have eaten uncooked ground beef (OR, 7.8 [95% CI, 1.4-44]) or runny scrambled eggs or omelets prepared in the home (OR, 4.9 [95% CI, 1.3-19]) during the 5 days before the onset of illness. International travel was not a risk factor for Newport-MDRAmpC infection but was a strong risk factor for pansusceptible Salmonella Newport infection (OR, 7.1 [95% CI, 2.0-24]). Case patients with pansusceptible infection were also more likely to have a frog or lizard in their household (OR, 2.9 [95% CI, 1.1-7.7]). CONCLUSIONS Newport-MDRAmpC infection is acquired through the US food supply, most likely from bovine and, perhaps, poultry sources, particularly among persons already taking antimicrobial agents.
Collapse
Affiliation(s)
- Jay K Varma
- Epidemic Intelligence Service, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Baggs J, Chen RT, Damon IK, Rotz L, Allen C, Fullerton KE, Casey C, Nordenberg D, Mootrey G. Safety profile of smallpox vaccine: insights from the laboratory worker smallpox vaccination program. Clin Infect Dis 2005; 40:1133-40. [PMID: 15791513 DOI: 10.1086/428731] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2004] [Accepted: 12/03/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The frequency of mild-to-moderate adverse events following smallpox vaccination was not well documented or reported during the pre-eradication era. This report describes the frequency of such symptoms among 936 adult smallpox vaccinees with and without a history of prior smallpox vaccination. METHODS Diary cards were distributed to 1006 laboratory workers and members of the Centers for Disease Control and Prevention (CDC) smallpox response team who received smallpox vaccination under an investigational new drug protocol during 2001-2002. Vaccinees were requested to complete the diary card daily and return it to the CDC 28 days after vaccination. The proportion of vaccinees reporting symptoms was determined and compared among subgroups. RESULTS Ninety-three percent of the diary cards were returned. The most common symptom reported was "itching at vaccination site." Primary vaccines reported statistically higher proportions of the following 11 symptoms: joint pain (25% vs. 11%; P=.0011), muscle pain (46% vs. 19%; P<.0001), fatigue (43% vs. 29%; P=.0161), swelling at vaccination site (58% vs. 33%; P<.0001), itching on the body (31% vs. 17%; P=.0048), abdominal pain (11% vs. 2%; P=.0012), swollen or tender lymph nodes (71% vs. 33%; P<.0001), pain at injection site (48% vs. 30%; P=.0018), headache (40% vs. 25%; P=.0088), backache (17% vs. 7%; P=.0090), and fever (temperature, >or=100 degrees F [37.7 degrees C]; 20% vs. 9%; P=.0047). CONCLUSIONS This analysis suggests that previously unvaccinated persons aged <30 years experienced more symptoms than did previously vaccinated persons. The findings of increased proportions with joint pain, abdominal pain, backache, and difficulty breathing were unexpected. As with recently described cardiac adverse events, these symptoms are suggestive of systemic involvement and warrant further study.
Collapse
Affiliation(s)
- James Baggs
- Centers for Disease Control and Prevention, National Immunization Program, Epidemiology and Surveillance Division, Immunization Safety Branch, 1600 Clifton Rd., Mailstop E61, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Hoe NP, Fullerton KE, Liu M, Peters JE, Gackstetter GD, Adams GJ, Musser JM. Molecular genetic analysis of 675 group A streptococcus isolates collected in a carrier study at Lackland Air Force Base, San Antonio, Texas. J Infect Dis 2003; 188:818-27. [PMID: 12964112 DOI: 10.1086/377644] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2003] [Accepted: 04/11/2003] [Indexed: 11/03/2022] Open
Abstract
Contemporary molecular genetic analysis methods have not been used to study large samples of carriage isolates of group A Streptococcus. To determine the emm types causing asymptomatic carriage and pharyngitis in a closed population, we analyzed 675 isolates recovered from a population-based surveillance study of 10,634 recruits at Lackland Air Force Base, Texas, during 4 months in 1993-1994. Strains with emm1 and emm6 alleles accounted for only 22% of the isolates recovered from asymptomatic recruits at entrance to training. However, these 2 emm types caused 69% of the pharyngitis cases identified during training and represented 51% of the isolates recovered from the throat on exit from training. Sequence analysis of the hypervariable sic gene documented that distinct emm1 subclones disseminated in specific training groups called flights. The preferential increase in the prevalence of emm1 and emm6 isolates during the 6-week training period indicates an enhanced ability of these strains to disseminate and cause disease in this population.
Collapse
Affiliation(s)
- Nancy P Hoe
- Laboratory of Human Bacterial Pathogenesis, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
| | | | | | | | | | | | | |
Collapse
|
42
|
Fullerton KE, Reef SE. Commentary: Ongoing debate over the safety of the different mumps vaccine strains impacts mumps disease control. Int J Epidemiol 2002; 31:983-4. [PMID: 12435772 DOI: 10.1093/ije/31.5.983] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K E Fullerton
- National Immunization Program, Centers for Disease Control and Prevention, 1600 Clifton Rd NE MS E-61, Atlanta, GA 30333, USA
| | | |
Collapse
|
43
|
Manges AR, Johnson JR, Foxman B, O'Bryan TT, Fullerton KE, Riley LW. Widespread distribution of urinary tract infections caused by a multidrug-resistant Escherichia coli clonal group. N Engl J Med 2001; 345:1007-13. [PMID: 11586952 DOI: 10.1056/nejmoa011265] [Citation(s) in RCA: 333] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The management of urinary tract infections is complicated by the increasing prevalence of antibiotic-resistant strains of Escherichia coli. We studied the clonal composition of E. coli isolates that were resistant to trimethoprim-sulfamethoxazole from women with community-acquired urinary tract infections. METHODS Prospectively collected E. coli isolates from women with urinary tract infections in a university community in California were evaluated for antibiotic susceptibility, O:H serotype, DNA fingerprinting, pulsed-field gel electrophoretic pattern, and virulence factors. The prevalence and characteristics of an antibiotic-resistant clone were evaluated in this group of isolates and in those from comparison cohorts in Michigan and Minnesota. RESULTS Fifty-five of the 255 E. coli isolates (22 percent) from the California cohort were resistant to trimethoprim-sulfamethoxazole as well as other antibiotics. There was a common pattern of DNA fingerprinting, suggesting that the isolates belonged to the same clonal group (clonal group A), in 28 of 55 isolates with trimethoprim-sulfamethoxazole resistance (51 percent) and in 2 of 50 randomly selected isolates that were susceptible to trimethoprim-sulfamethoxazole (4 percent, P<0.001). In addition, 11 of 29 resistant isolates (38 percent) from the Michigan cohort and 7 of 18 (39 percent) from the Minnesota cohort belonged to clonal group A. Most of the clonal group A isolates were serotype O11:H(nt) or O77:H(nt), with similar patterns of virulence factors, antibiotic susceptibility, and electrophoretic features. CONCLUSIONS In three geographically diverse communities, a single clonal group accounted for nearly half of community-acquired urinary tract infections in women that were caused by E. coli strains with resistance to trimethoprim-sulfamethoxazole. The widespread distribution and high prevalence of E. coli clonal group A has major public health implications.
Collapse
Affiliation(s)
- A R Manges
- Division of Epidemiology and Public Health Biology, School of Public Health, University of California at Berkeley, 94720, USA
| | | | | | | | | | | |
Collapse
|
44
|
Chen JL, Fullerton KE, Flynn NM. Necrotizing fasciitis associated with injection drug use. Clin Infect Dis 2001; 33:6-15. [PMID: 11389488 DOI: 10.1086/320874] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2000] [Revised: 11/02/2000] [Indexed: 11/03/2022] Open
Abstract
We studied cases of necrotizing fasciitis among injection drug users (IDUs) and non-IDUs who presented at the University of California Davis Medical Center from 1984 through 1999. Of 107 patients, 59 (55%) were IDUs and 48 (45%) non-IDUs. Among IDUs, 32 (54%) recently injected at the site of infection, and 17 patients (29%) presented with an abscess. Among non-IDUs, 17 (35%) reported a recent insect bite and 9 (19%) reported a wound or abrasion at the site of infection. Overall, seventy cases (65%) had > or = 3 debridements, and 31 patients (29%) had > 5% of their total body surface area debrided. Of all patients with necrotizing fasciitis, 16 (15%) did not survive. Among the 59 IDUs, 6 (10%) did not survive, while among non-IDUs, 10 (21%) did not survive. Our results indicate the need for a high index of suspicion for necrotizing fasciitis among patients presenting with cellulitis, a recent insect bite, wound, or recent injection drug use. Preventive interventions for necrotizing fasciitis among IDUs should include street-based education and treatment for abscesses and cellulitis.
Collapse
Affiliation(s)
- J L Chen
- Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, USA.
| | | | | |
Collapse
|
45
|
|