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1.
AIDS Behav ; 28(3): 786-798, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37792231

RESUMEN

Stigma toward same-sex behaviors may be a structural driver of HIV epidemics among men who have sex with men (MSM) in Eastern Europe and has been linked to adverse HIV-outcomes elsewhere. We explored associations between sexual behavior stigma with HIV risk behaviors, testing, treatment, and infection. From November 2017 to February 2018, MSM across 27 Ukrainian cities were recruited to cross-sectional surveys using respondent driven sampling. Eligible participants were cisgender males aged ≥ 14 years residing in participating cities that reported ≥ 1 sexual contact with another man in the prior 6 months. Participants self-reported experience of stigma (ever) and various HIV-outcomes and were tested for HIV antibodies. Regression models were used to explore associations between three sexual behavior stigma variables with demographic and HIV-related variables. Of 5812 recruited cisgender MSM, 5544 (95.4%) were included. 1663 (30.0%) MSM reported having experienced stigma due to being MSM from family and friends, 698 (12.6%) reported anticipated healthcare stigma, and 1805 (32.6%) reported general public/social stigma due to being MSM (enacted). All forms of stigma were associated with heightened HIV risk behaviors; those experiencing stigma (vs not) had more anal sex partners in the prior month and were less likely to have used condoms during their last anal intercourse. Stigma was not associated with HIV infection, testing, or treatment variables. A sizeable proportion of Ukrainian MSM reported ever experiencing stigma due to being MSM. MSM that had experienced stigma had higher odds of HIV sexual risk behaviors. Further study using longitudinal designs is required to determine causality.


Asunto(s)
Infecciones por VIH , VIH-1 , Minorías Sexuales y de Género , Masculino , Humanos , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Homosexualidad Masculina , Estigma Social , Ucrania/epidemiología , Estudios Transversales , Conducta Sexual , Asunción de Riesgos , Parejas Sexuales
3.
PLoS One ; 18(10): e0290661, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37883454

RESUMEN

Achievement of viral load suppression among people living with HIV is one of the most important goals for effective HIV epidemic response. In Ukraine, people who inject drugs (PWID) experience the largest HIV burden. At the same time, this group disproportionally missed out in HIV treatment services. We performed a secondary data analysis of the national-wide cross-sectional bio-behavioral surveillance survey among PWID to assess the population-level prevalence of detectable HIV viremia and identify key characteristics that explain the outcome. Overall, 11.4% of PWID or 52.6% of HIV-positive PWID had a viral load level that exceeded the 1,000 copies/mL threshold. In the group of HIV-positive PWID, the detectable viremia was attributed to younger age, monthly income greater than minimum wage, lower education level, and non-usage of antiretroviral therapy (ART) and opioid agonistic therapy. Compared with HIV-negative PWID, the HIV-positive group with detectable viremia was more likely to be female, represented the middle age group (35-49 years old), had low education and monthly income levels, used opioid drugs, practiced risky injection behavior, and had previous incarceration history. Implementing the HIV case identification and ART linkage interventions focused on the most vulnerable PWID sub-groups might help closing the gaps in ART service coverage and increasing the proportion of HIV-positive PWID with viral load suppression.


Asunto(s)
Consumidores de Drogas , Infecciones por VIH , Abuso de Sustancias por Vía Intravenosa , Persona de Mediana Edad , Humanos , Femenino , Adulto , Masculino , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/epidemiología , Abuso de Sustancias por Vía Intravenosa/tratamiento farmacológico , Analgésicos Opioides/uso terapéutico , Ucrania/epidemiología , Prevalencia , Estudios Transversales , Viremia/tratamiento farmacológico , Viremia/epidemiología , Viremia/complicaciones , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología
4.
Emerg Infect Dis ; 28(13): S197-S202, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-36502392

RESUMEN

Annually, ≈30,000 Hasidic and Orthodox Jews travel to Uman, Ukraine, during the Jewish New Year to pray at the burial place of the founder of the Breslov Hasidic movement. Many pilgrims come from the northeastern United States. The global health implications of this event were seen in 2019 when measles outbreaks in the United States and Israel were linked to the pilgrimage. The 2020 pilgrimage was cancelled as part of the COVID-19 travel restrictions imposed by the government of Ukraine. To prepare for the 2021 event, the National Public Health Institute, the Public Health Center of Ukraine, organized mitigation measures for pilgrims arriving in Uman, and the CDC COVID-19 International Task Force assisted with mitigation measures for pilgrims coming from the United States. We describe efforts to support COVID-19 mitigation measures before, during, and after this mass gathering and lessons learned for future mass gatherings during pandemics.


Asunto(s)
COVID-19 , Estados Unidos , Humanos , COVID-19/epidemiología , COVID-19/prevención & control , Reuniones Masivas , Pandemias/prevención & control , Viaje , Brotes de Enfermedades
6.
Health Secur ; 16(S1): S18-S24, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30480497

RESUMEN

The Staged Development Tool (SDT) was created to help national public health institutes (NPHIs) assess their current capacity and develop roadmaps for achieving a higher level of functioning. This article discusses the current use of the SDT by national public health institutes to establish baseline capacity and inform strategic planning and its proposed use in a 3-step sequence for measuring the impact of capacity-building interventions over time. The article also includes descriptions of how national public health institutes have been using the SDT to assess their baseline capacity in management issues and core public health functions. The first use of the SDT by a national public health institute provides essential baseline information on their capacities and levels of functioning and plans for addressing gaps. By repeating the SDT after time for the plans to be implemented, the SDT can be used to evaluate changes in capacity and the effectiveness of the interventions made. Because the SDT is built to be complementary to existing assessments and public health strengthening tools and guidelines, implementing the SDT provides concrete, complementary information that can help countries achieve global health security goals and address current and future threats to public health.


Asunto(s)
Academias e Institutos , Creación de Capacidad , Técnicas de Planificación , Administración en Salud Pública , Planificación Estratégica , Creación de Capacidad/normas , Salud Global , Humanos , Agencias Internacionales/organización & administración , Medidas de Seguridad , Planificación Estratégica/normas
7.
Am J Trop Med Hyg ; 97(4_Suppl): 12-20, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-29064361

RESUMEN

Haiti's health system has faced many challenges over the years, with competing health priorities in the context of chronic financial and human resource limitations. As a result, the existing notifiable disease surveillance system was unable to provide the most basic epidemiologic data for public health decision-making and action. In the wake of the January 2010 earthquake, the Haitian Ministry of Public Health and Population collaborated with the U.S. Centers for Disease Control and Prevention, the Pan American Health Organization, and other local and international partners to implement a functional national surveillance system. More than 7 years later, it is important to take the opportunity to reflect on progress made on surveillance and response in Haiti, including disease detection, reporting, outbreak investigation, and response. The national epidemiologic surveillance network that started with 51 sites in 2010 has been expanded to 357 sites as of December 2015. Disease outbreaks identified via the surveillance system, or other surveillance approaches, are investigated by epidemiologists trained by the Ministry of Health's Field Epidemiology Training Program. Other related surveillance modules have been developed on the same model and electronic platform, allowing the country to document the impact of interventions, track progress, and monitor health problems. Sustainability remains the greatest challenge since most of the funding for surveillance come from external sources.


Asunto(s)
Desastres , Notificación de Enfermedades/métodos , Brotes de Enfermedades , Terremotos , Monitoreo Epidemiológico , Cooperación Internacional , Salud Pública , Centers for Disease Control and Prevention, U.S. , Haití/epidemiología , Prioridades en Salud , Humanos , Estados Unidos
8.
MMWR Morb Mortal Wkly Rep ; 66(29): 781-793, 2017 Jul 28.
Artículo en Inglés | MEDLINE | ID: mdl-28749921

RESUMEN

CDC has updated the interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure in response to 1) declining prevalence of Zika virus disease in the World Health Organization's Region of the Americas (Americas) and 2) emerging evidence indicating prolonged detection of Zika virus immunoglobulin M (IgM) antibodies. Zika virus cases were first reported in the Americas during 2015-2016; however, the incidence of Zika virus disease has since declined. As the prevalence of Zika virus disease declines, the likelihood of false-positive test results increases. In addition, emerging epidemiologic and laboratory data indicate that, as is the case with other flaviviruses, Zika virus IgM antibodies can persist beyond 12 weeks after infection. Therefore, IgM test results cannot always reliably distinguish between an infection that occurred during the current pregnancy and one that occurred before the current pregnancy, particularly for women with possible Zika virus exposure before the current pregnancy. These limitations should be considered when counseling pregnant women about the risks and benefits of testing for Zika virus infection during pregnancy. This updated guidance emphasizes a shared decision-making model for testing and screening pregnant women, one in which patients and providers work together to make decisions about testing and care plans based on patient preferences and values, clinical judgment, and a balanced assessment of risks and expected outcomes.


Asunto(s)
Personal de Salud , Guías de Práctica Clínica como Asunto , Complicaciones Infecciosas del Embarazo/prevención & control , Infección por el Virus Zika/prevención & control , Centers for Disease Control and Prevention, U.S. , Femenino , Humanos , Embarazo , Estados Unidos
9.
Foodborne Pathog Dis ; 11(5): 335-41, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24617446

RESUMEN

BACKGROUND: Nontyphoidal Salmonella causes an estimated 1.2 million infections, 23,000 hospitalizations, and 450 deaths annually in the United States. Most illnesses are self-limited; however, treatment with antimicrobial agents can be life-saving for invasive infections. METHODS: The Foodborne Diseases Active Surveillance Network and the National Antimicrobial Resistance Monitoring System collaborated on a prospective cohort study of patients with nontyphoidal Salmonella bloodstream and gastrointestinal infections to determine differences in the clinical outcomes of resistant compared with pansusceptible infections. Interviews were conducted within 85 days of specimen collection date. RESULTS: Of 875 nontyphoidal Salmonella isolates, 705 (81%) were pansusceptible, 165 (19%) were resistant to at least 1 agent, and 5 (0.6%) had only intermediate resistance. The most common pattern, found in 51 (31%) of resistant isolates, was resistance to at least ampicillin, chloramphenicol, streptomycin, sulfisoxazole, and tetracycline (ACSSuT); 88% of isolates with this pattern were serotype Typhimurium or Newport. Fourteen (52%) of the 27 ceftriaxone-resistant isolates were also ACSSuT resistant. Adjusted for age and serotype, bloodstream infection was significantly more common among patients infected with strains resistant to only two, only three, or only five antimicrobial classes, to ACSSuT with or without other agents, to ACSSuT only, or to nalidixic acid with or without other agents than among patients with pansusceptible isolates. Adjusted for age, serotype, and bloodstream infection, hospitalization was significantly more common among patients infected with strains resistant to only three agents or to ceftriaxone (all ceftriaxone-resistant isolates were resistant to other agents) than among patients with pansusceptible isolates. CONCLUSION: This study extends evidence that patients with antimicrobial-resistant nontyphoidal Salmonella infections have more severe outcomes. Prevention efforts are needed to reduce unnecessary antimicrobial use in patient care settings and in food animals to help prevent the emergence of resistance and infections with resistant nontyphoidal Salmonella.


Asunto(s)
Ceftriaxona/farmacología , Farmacorresistencia Bacteriana Múltiple , Ácido Nalidíxico/farmacología , Intoxicación Alimentaria por Salmonella/epidemiología , Adolescente , Adulto , Ampicilina/farmacología , Antibacterianos/farmacología , Niño , Preescolar , Cloranfenicol/farmacología , Femenino , Contaminación de Alimentos/análisis , Microbiología de Alimentos , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Prospectivos , Salmonella/efectos de los fármacos , Salmonella/aislamiento & purificación , Intoxicación Alimentaria por Salmonella/tratamiento farmacológico , Estreptomicina/farmacología , Sulfisoxazol/farmacología , Tetraciclina/farmacología , Resultado del Tratamiento , Adulto Joven
10.
11.
Am J Epidemiol ; 178(8): 1319-26, 2013 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-24008913

RESUMEN

Shigellosis, a diarrheal disease, is endemic worldwide and is responsible for approximately 15,000 laboratory-confirmed cases in the United States every year. However, patients with shigellosis often do not seek medical care. To estimate the burden of shigellosis, we extended time-series susceptible-infected-recovered models to infer epidemiologic parameters from underreported case data. We applied the time-series susceptible-infected-recovered-based inference schemes to analyze the largest surveillance data set of Shigella sonnei in the United States from 1967 to 2007 with county-level resolution. The dynamics of shigellosis transmission show strong annual and multiyear cycles, as well as seasonality. By using the schemes, we inferred individual-level parameters of shigellosis infection, including seasonal transmissibilities and basic reproductive number (R0). In addition, this study provides quantitative estimates of the reporting rate, suggesting that the shigellosis burden in the United States may be more than 10 times the number of laboratory-confirmed cases. Although the estimated reporting rate is generally under 20%, and R0 is generally under 1.5, there is a strong negative correlation between estimates of the reporting rate and R0. Such negative correlations are likely to pose identifiability problems in underreported diseases. We discuss complementary approaches that might further disentangle the true reporting rate and R0.


Asunto(s)
Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Disentería Bacilar/epidemiología , Shigella , Niño , Preescolar , Disentería Bacilar/transmisión , Humanos , Lactante , Recién Nacido , Cadenas de Markov , Método de Montecarlo , Dinámicas no Lineales , Estados Unidos/epidemiología
12.
Foodborne Pathog Dis ; 10(4): 302-9, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23464603

RESUMEN

BACKGROUND: Salmonella is a major bacterial pathogen transmitted commonly through food. Increasing resistance to antimicrobial agents (e.g., ceftriaxone, ciprofloxacin) used to treat serious Salmonella infections threatens the utility of these agents. Infection with antimicrobial-resistant Salmonella has been associated with increased risk of severe infection, hospitalization, and death. We describe changes in antimicrobial resistance among nontyphoidal Salmonella in the United States from 1996 through 2009. METHODS: The Centers for Disease Control and Prevention's National Antimicrobial Resistance Monitoring System conducts surveillance of resistance among Salmonella isolated from humans. From 1996 through 2009, public health laboratories submitted isolates for antimicrobial susceptibility testing. We used interpretive criteria from the Clinical and Laboratory Standards Institute and defined isolates with ciprofloxacin resistance or intermediate susceptibility as nonsusceptible to ciprofloxacin. Using logistic regression, we modeled annual data to assess changes in antimicrobial resistance. RESULTS: From 1996 through 2009, the percentage of nontyphoidal Salmonella isolates resistant to ceftriaxone increased from 0.2% to 3.4% (odds ratio [OR]=20, 95% confidence interval [CI] 6.3-64), and the percentage with nonsusceptibility to ciprofloxacin increased from 0.4% to 2.4% (OR=8.3, 95% CI 3.3-21). The percentage of isolates that were multidrug resistant (resistant to ≥3 antimicrobial classes) decreased from 17% to 9.6% (OR=0.6, 95% CI 0.5-0.7), which was driven mainly by a decline among serotype Typhimurium. However, multidrug resistance increased from 5.9% in 1996 to a peak of 31% in 2001 among serotype Newport and increased from 12% in 1996 to 26% in 2009 (OR=2.6, 95% CI 1.1-6.2) among serotype Heidelberg. CONCLUSIONS: We describe an increase in resistance to ceftriaxone and nonsusceptibility to ciprofloxacin and an overall decline in multidrug resistance. Trends varied by serotype. Because of evidence that antimicrobial resistance among Salmonella is predominantly a consequence of antimicrobial use in food animals, efforts are needed to reduce unnecessary use, especially of critically important agents.


Asunto(s)
Ceftriaxona/farmacología , Ciprofloxacina/farmacología , Farmacorresistencia Bacteriana Múltiple , Salmonella/efectos de los fármacos , Adolescente , Adulto , Animales , Antibacterianos/farmacología , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Salmonella/aislamiento & purificación , Infecciones por Salmonella/epidemiología , Infecciones por Salmonella/microbiología , Estados Unidos/epidemiología , Adulto Joven
13.
N Engl J Med ; 368(7): 599-609, 2013 Feb 14.
Artículo en Inglés | MEDLINE | ID: mdl-23301694

RESUMEN

BACKGROUND: In October 2010, nearly 10 months after a devastating earthquake, Haiti was stricken by epidemic cholera. Within days after detection, the Ministry of Public Health and Population established a National Cholera Surveillance System (NCSS). METHODS: The NCSS used a modified World Health Organization case definition for cholera that included acute watery diarrhea, with or without vomiting, in persons of all ages residing in an area in which at least one case of Vibrio cholerae O1 infection had been confirmed by culture. RESULTS: Within 29 days after the first report, cases of V. cholerae O1 (serotype Ogawa, biotype El Tor) were confirmed in all 10 administrative departments (similar to states or provinces) in Haiti. Through October 20, 2012, the public health ministry reported 604,634 cases of infection, 329,697 hospitalizations, and 7436 deaths from cholera and isolated V. cholerae O1 from 1675 of 2703 stool specimens tested (62.0%). The cumulative attack rate was 5.1% at the end of the first year and 6.1% at the end of the second year. The cumulative case fatality rate consistently trended downward, reaching 1.2% at the close of year 2, with departmental cumulative rates ranging from 0.6% to 4.6% (median, 1.4%). Within 3 months after the start of the epidemic, the rolling 14-day case fatality rate was 1.0% and remained at or below this level with few, brief exceptions. Overall, the cholera epidemic in Haiti accounted for 57% of all cholera cases and 53% of all cholera deaths reported to the World Health Organization in 2010 and 58% of all cholera cases and 37% of all cholera deaths in 2011. CONCLUSIONS: A review of NCSS data shows that during the first 2 years of the cholera epidemic in Haiti, the cumulative attack rate was 6.1%, with cases reported in all 10 departments. Within 3 months after the first case was reported, there was a downward trend in mortality, with a 14-day case fatality rate of 1.0% or less in most areas.


Asunto(s)
Cólera/epidemiología , Epidemias , Vigilancia de la Población , Vibrio cholerae O1/aislamiento & purificación , Adulto , Distribución por Edad , Preescolar , Cólera/mortalidad , Bases de Datos Factuales , Diarrea/epidemiología , Diarrea/microbiología , Desastres , Terremotos , Heces/microbiología , Haití/epidemiología , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Mortalidad/tendencias , Serotipificación
14.
Clin Infect Dis ; 56(3): 376-82, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23097586

RESUMEN

BACKGROUND: On 7 and 11 July 2007, health officials in Texas and Indiana, respectively, reported 4 possible cases of type A foodborne botulism to the US Centers for Disease Control and Prevention. Foodborne botulism is a rare and sometimes fatal illness caused by consuming foods containing botulinum neurotoxin. METHODS: Investigators reviewed patients' medical charts and food histories. Clinical specimens and food samples were tested for botulinum toxin and neurotoxin-producing Clostridium species. Investigators conducted inspections of the cannery that produced the implicated product. RESULTS: Eight confirmed outbreak associated cases were identified from Indiana (n = 2), Texas (n = 3), and Ohio (n = 3). Botulinum toxin type A was identified in leftover chili sauce consumed by the Indiana patients and 1 of the Ohio patients. Cannery inspectors found violations of federal canned-food regulations that could have led to survival of Clostridium botulinum spores during sterilization. The company recalled 39 million cans of chili. Following the outbreak, the US Food and Drug Administration inspected other canneries with similar canning systems and issued warnings to the industry about the danger of C. botulinum and the importance of compliance with canned food manufacturing regulations. CONCLUSIONS: Commercially produced hot dog chili sauce caused these cases of type A botulism. This is the first US foodborne botulism outbreak involving a commercial cannery in >30 years. Sharing of epidemiologic and laboratory findings allowed for the rapid identification of implicated food items and swift removal of potentially deadly products from the market by US food regulatory authorities.


Asunto(s)
Toxinas Botulínicas/aislamiento & purificación , Botulismo/epidemiología , Clostridium botulinum/aislamiento & purificación , Brotes de Enfermedades , Contaminación de Alimentos , Alimentos en Conserva/microbiología , Adolescente , Adulto , Botulismo/microbiología , Niño , Femenino , Microbiología de Alimentos , Conservación de Alimentos/métodos , Conservación de Alimentos/normas , Humanos , Indiana/epidemiología , Masculino , Persona de Mediana Edad , Ohio/epidemiología , Texas/epidemiología
15.
Clin Infect Dis ; 54 Suppl 5: S458-63, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22572670

RESUMEN

BACKGROUND: Treatment of shigellosis with appropriate antimicrobial agents shortens duration of illness and bacterial shedding, but resistance to commonly used agents is increasing. METHODS: We describe resistance patterns among Shigella isolates in the United States with use of linked data from the Foodborne Diseases Active Surveillance Network (FoodNet) and National Antimicrobial Resistance Monitoring System (NARMS). FoodNet sites send every 20th Shigella isolate to the NARMS laboratory for susceptibility testing. RESULTS: During 2000-2010, the NARMS laboratory tested 1376 Shigella isolates from FoodNet sites. Of 1118 isolates (81%) linked to FoodNet, 826 (74%) were resistant to ampicillin, 649 (58%) to streptomycin, 402 (36%) to trimethoprim-sulfamethoxazole (TMP-SMX), 355 (32%) to sulfamethoxazole-sulfisoxazole, 312 (28%) to tetracycline, 19 (2%) to nalidixic acid, and 6 (0.5%) to ciprofloxacin. The proportion of Shigella isolates with resistance to TMP-SMX was 40% among white persons, 58% among Hispanic persons, and 75% among persons with a history of international travel. Resistance to at least TMP-SMX and ampicillin was present in 25% of isolate, and 5% were resistant to ampicillin, TMP-SMX, and chloramphenicol. Overall, 5% of isolates showed multidrug resistance to ampicillin, chloramphenicol, streptomycin, sulfamethoxazole-sulfisoxazole, and tetracycline, including 49 Shigella flexneri (33%) and 3 Shigella sonnei (0.3%) isolates. Male individuals were more likely than female individuals to be infected with a multidrug-resistant strain (7% versus 3%; P < .01). CONCLUSIONS: Antimicrobial resistance differed by race, ethnicity, age, travel, and species. Resistance to commonly used antibiotics is high; therefore, it is important to look at the susceptibility pattern before starting treatment.


Asunto(s)
Antiinfecciosos/farmacología , Farmacorresistencia Bacteriana Múltiple , Disentería Bacilar/microbiología , Enfermedades Transmitidas por los Alimentos/microbiología , Shigella/efectos de los fármacos , Shigella/aislamiento & purificación , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Centers for Disease Control and Prevention, U.S. , Niño , Preescolar , Disentería Bacilar/etnología , Femenino , Enfermedades Transmitidas por los Alimentos/etnología , Hispánicos o Latinos , Humanos , Lactante , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Viaje , Estados Unidos , Población Blanca , Adulto Joven
16.
J Food Prot ; 75(4): 762-4, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22488068

RESUMEN

We report a cluster of severe diarrheal disease caused by Vibrio mimicus infection among four persons who had consumed leftover crayfish the day after a private crayfish boil. Gastrointestinal illness caused by Vibrio mimicus has not been reported previously in Washington State. Three cases were laboratory confirmed by stool culture; using PCR, isolates were found to have ctx genes that encode cholera toxin (CT). Two of the cases were hospitalized under intensive care with a cholera-like illness. The illnesses were most likely caused by cross-contamination of cooked crayfish with uncooked crayfish; however, V. mimicus was not isolated nor were CT genes detected by PCR in leftover samples of frozen crayfish. Clinicians should be aware that V. mimicus can produce CT and that V. mimicus infection can cause severe illness.


Asunto(s)
Astacoidea/microbiología , Contaminación de Alimentos/análisis , Manipulación de Alimentos/métodos , Mariscos/microbiología , Vibriosis/etiología , Vibrio mimicus , Adolescente , Animales , Diarrea/epidemiología , Diarrea/etiología , Diarrea/microbiología , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Vibriosis/epidemiología , Vibriosis/microbiología , Washingtón
17.
Clin Infect Dis ; 55(1): 61-6, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22423132

RESUMEN

BACKGROUND: Fifty-four outbreaks of domestically acquired typhoid fever were reported between 1960 and 1999. In 2010, the Southern Nevada Health District detected an outbreak of typhoid fever among persons who had not recently travelled abroad. METHODS: We conducted a case-control study to examine the relationship between illness and exposures. A case was defined as illness with the outbreak strain of Salmonella serotype Typhi, as determined by pulsed-field gel electrophoresis (PFGE), with onset during 2010. Controls were matched by neighborhood, age, and sex. Bivariate and multivariate statistical analyses were completed using logistic regression. Traceback investigation was completed. RESULTS: We identified 12 cases in 3 states with onset from 15 April 2010 to 4 September 2010. The median age of case patients was 18 years (range, 4-48 years), 8 (67%) were female, and 11 (92%) were Hispanic. Nine (82%) were hospitalized; none died. Consumption of frozen mamey pulp in a fruit shake was reported by 6 of 8 case patients (75%) and none of the 33 controls (matched odds ratio, 33.9; 95% confidence interval, 4.9). Traceback investigations implicated 2 brands of frozen mamey pulp from a single manufacturer in Guatemala, which was also implicated in a 1998-1999 outbreak of typhoid fever in Florida. CONCLUSIONS: Reporting of individual cases of typhoid fever and subtyping of isolates by PFGE resulted in rapid detection of an outbreak associated with a ready-to-eat frozen food imported from a typhoid-endemic region. Improvements in food manufacturing practices and monitoring will prevent additional outbreaks.


Asunto(s)
Frutas/microbiología , Mammea/inmunología , Salmonella typhi/aislamiento & purificación , Fiebre Tifoidea/epidemiología , Adolescente , Adulto , Bebidas/microbiología , California/epidemiología , Estudios de Casos y Controles , Niño , Preescolar , Trazado de Contacto , Brotes de Enfermedades , Femenino , Microbiología de Alimentos , Guatemala , Hispánicos o Latinos , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Nevada/epidemiología , Oregon/epidemiología , Factores de Riesgo , Salmonella typhi/clasificación , Salmonella typhi/genética , Encuestas y Cuestionarios , Fiebre Tifoidea/etnología , Fiebre Tifoidea/microbiología
18.
AIDS Care ; 23(3): 330-9, 2011 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21347896

RESUMEN

Diarrhea is a leading cause of morbidity and mortality in people living with HIV (PLHIV) in Africa. The impact of a point-of-use water chlorination and storage intervention on diarrheal-disease risk in a population of HIV-infected women in Lagos, Nigeria was evaluated. A baseline survey was performed, followed by six weeks of baseline diarrhea surveillance consisting of weekly home visits, distribution of free water chlorination products and safe storage containers to project participants, and continued weekly home-based diarrhea surveillance for 15 additional weeks. To confirm use of the water chlorination product, during each home visit, stored water was tested for residual chlorine. About 187 women were enrolled. At baseline, 80% of women had access to improved water supplies and 95% had access to sanitation facilities. Following distribution of the intervention, water stored in participants' households was observed to have residual chlorine during 50-80% of home visits, a sign of adherence to recommended water-treatment practices. Diarrhea rates in project participants were 36% lower in the post-intervention period than during the baseline period (p=0.04). Diarrhea rates were 46% lower in the post-intervention period than the baseline period among project participants who were confirmed to have residual chlorine in stored water during 85% or more of home visits (p=0.04); there was no significant difference in diarrhea rates between baseline and post-intervention periods in participants confirmed to have residual chlorine in stored water during less than 85% of home visits. The percent change in diarrhea rates between baseline and post-intervention surveillance periods was statistically significant among non-users of prophylactic antibiotics (-62%, p=0.02) and among persons who used neither prophylactic antibiotics nor antiretroviral treatment (-46%, p=0.04). Point-of-use water treatment was associated with a reduced risk of diarrhea in PLHIV. Regular water treatment was required to achieve health benefits.


Asunto(s)
Diarrea/prevención & control , Infecciones por VIH/complicaciones , Purificación del Agua/métodos , Adolescente , Adulto , Diarrea/epidemiología , Diarrea/etiología , Femenino , Infecciones por VIH/epidemiología , Seropositividad para VIH/complicaciones , Humanos , Persona de Mediana Edad , Nigeria/epidemiología , Cooperación del Paciente , Factores de Riesgo , Saneamiento , Adulto Joven
19.
Antimicrob Agents Chemother ; 55(3): 1148-54, 2011 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21199924

RESUMEN

Nontyphoidal salmonellae (NTS) are important causes of community-acquired bloodstream infection. We describe patterns of antimicrobial resistance among invasive NTS in the United States. We compared bloodstream NTS isolates with those from stool submitted to the National Antimicrobial Resistance Monitoring System (NARMS) from 1996 to 2007. We describe antimicrobial resistance among invasive strains by serogroup and serotype. Of the 19,302 NTS isolates, 17,804 (92.2%) were from stool or blood. Of these, 1,050 (5.9%) were bloodstream isolates. The median ages (ranges) of patients with and without bacteremia were 36 (<1 to 97) years and 20 (<1 to 105) years, respectively (P < 0.001). Males (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.06 to 1.38) and those ≥65 years of age were at greater risk for invasive disease. Salmonella enterica serotypes Enteritidis, Typhimurium, and Heidelberg were the most common serotypes isolated from blood; S. enterica serotypes Dublin, Sandiego, and Schwarzengrund were associated with the greatest risk for bloodstream isolation. Of invasive isolates, 208 (19.8%) were resistant to ampicillin, 117 (11.1%) to chloramphenicol, and 26 (2.5%) to trimethoprim-sulfamethoxazole; 28 (2.7%) isolates were resistant to nalidixic acid and 26 (2.5%) to ceftriaxone. Antimicrobial resistance to traditional agents is common. However, the occurrence of nalidixic acid and ceftriaxone resistance among invasive NTS is cause for clinical and public health vigilance.


Asunto(s)
Salmonella enterica/efectos de los fármacos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ampicilina/uso terapéutico , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Ceftriaxona/uso terapéutico , Niño , Preescolar , Cloranfenicol/uso terapéutico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Femenino , Humanos , Lactante , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Ácido Nalidíxico/uso terapéutico , Infecciones por Salmonella/microbiología , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Estados Unidos , Adulto Joven
20.
Foodborne Pathog Dis ; 8(2): 329-32, 2011 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-20973731

RESUMEN

To increase understanding of community-acquired resistance, stool samples from 477 nonhospitalized persons in Maryland and Michigan, from 2004 to 2008, were screened for ceftriaxone resistance. Seven (1.5%) yielded ceftriaxone-resistant Escherichia coli; one isolate was resistant to all eight antimicrobial classes routinely tested: aminoglycosides, ß-lactam/ß-lactamase inhibitor combinations, cephems, penicillins, folate pathway inhibitors, phenicols, quinolones, and tetracyclines. The extensively resistant isolate was from a 50-year-old woman who denied antimicrobial use, hospitalization, or international travel within 6 months. Meat (beef, chicken, and pork) and eggs were consumed within 1 month before stool collection. Further studies are warranted to understand potential sources, including the food supply, of resistant E. coli.


Asunto(s)
Farmacorresistencia Bacteriana Múltiple , Escherichia coli/efectos de los fármacos , Escherichia coli/genética , Adulto , Animales , Ceftriaxona/farmacología , Farmacorresistencia Bacteriana Múltiple/genética , Escherichia coli/aislamiento & purificación , Heces/microbiología , Femenino , Genes Bacterianos , Genes MDR , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Plásmidos/genética , Plásmidos/aislamiento & purificación , Vigilancia de la Población , Encuestas y Cuestionarios , Estados Unidos
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