Timeliness of enteric disease surveillance in 6 US states.

We reviewed timeline information for a sample of Salmonella spp., Shigella spp., Campylobacter spp., and Escherichia coli O157:H7 cases and all confirmed foodborne outbreaks reported in 6 states during 2002. Increasing the timeliness of case follow-up, molecular subtyping, and linkage of results are critical to reducing delays in the investigation of foodborne outbreaks.

Common ground for the control of multidrug-resistant Salmonella in ground beef.

A strategy to combat multidrug-resistant (MDR) Salmonella in ground beef is urgently needed. A national multi-disciplinary meeting reviewed the epidemiology of MDR Salmonella infection and contamination in humans, animals, and retail meat. In spite of a recent overall decrease in human MDR Salmonella isolates, certain types, such as Salmonella enterica serotype Newport multidrug-resistant-AmpC strain and Salmonella enterica serotype Typhimurium definitive type (DT) 104, have persisted, and several recent large outbreaks of human infection have occurred. Key agencies that contribute to a safe ground beef supply were represented at the meeting and contributed to the discussion of possible control strategies from the farm to the table. Several of the control strategies suggested are unpopular to some, including restricting the use of antimicrobial agents in food animals, designation of multidrug-resistant Salmonella as an adulterant in ground beef, and improving the mechanisms for product trace-back investigations. Nevertheless, enhanced farm-based animal infection control, judicious veterinary and human antibiotic use, regulatory controls, and consumer practices will lead to important industry, veterinary, and public health outcomes.

Assessment of perinatal hepatitis B and rubella prevention in New Hampshire delivery hospitals.

OBJECTIVE: To evaluate current performance on recommended perinatal hepatitis B and rubella prevention practices in New Hampshire. METHODS: Data were extracted from 2021 paired mother-infant records for the year 2000 birth cohort in New Hampshire's 25 delivery hospitals. Assessment was done on the following: prenatal screening for hepatitis B and rubella, administration of the hepatitis B vaccine birth dose to all infants, administration of hepatitis B immune globulin to infants who were born to hepatitis B surface antigen-positive mothers, rubella immunity, and administration of in-hospital postpartum rubella vaccine to rubella nonimmune women. RESULTS: Prenatal screening rates for hepatitis B (98.8%) and rubella (99.4%) were high. Hepatitis B vaccine birth dose was administered to 76.2% of all infants. All infants who were born to hepatitis B surface antigen-positive mothers also received hepatitis B immune globulin. Multivariate logistic regression showed that the month of delivery and infant birth weight were independent predictors of hepatitis B vaccination. The proportion of infants who were vaccinated in January and February 2000 (48.5% and 67.5%, respectively) was less than any other months, whereas the proportion who were vaccinated in December 2000 (88.2%) was the highest. Women who were born between 1971 and 1975 had the highest rate of rubella nonimmunity (9.5%). In-hospital postpartum rubella vaccine administration was documented for 75.6% of nonimmune women. CONCLUSION: This study documents good compliance in New Hampshire's birthing hospitals with national guidelines for perinatal hepatitis B and rubella prevention and highlights potential areas for improvement.

Capacity of state and territorial health agencies to prevent foodborne illness.

The capacity of state and territorial health departments to investigate foodborne diseases was assessed by the Council of State and Territorial Epidemiologists from 2001 to 2002 with a self-administered, Web-based survey. Forty-eight health departments responded (47 states and 1 territory). The primary reason for not conducting more active case surveillance of enteric disease is lack of staff, while the primary reasons for not investigating foodborne disease outbreaks are limited staff and delayed notification of the outbreak. Sixty-four percent of respondents have the capacity to conduct analytic epidemiologic investigations. States receiving Emerging Infections Program (EIP) funding from the Centers for Disease Control and Prevention more often reported having a dedicated foodborne disease epidemiologist and the capability to perform analytic studies than non-EIP states. We conclude that by addressing shortages in the number of dedicated personnel and reducing delays in reporting, the capacity of state health departments to respond to foodborne disease can be improved.

Lyme disease knowledge, beliefs, and practices of New Hampshire primary care physicians.

BACKGROUND: Lyme disease is the most commonly reported vectorborne illness in the United States and is endemic in many counties in the Northeast, including counties in New Hampshire. Previous studies conducted elsewhere on Lyme disease have indicated substantial differences between physician practices and published consensus guidelines for diagnosis and treatment. METHODS: During 1999, we mailed a 21-item questionnaire to 600 randomly selected family practice physicians, internists, and pediatricians in New Hampshire. RESULTS: Respondents answered a median of 10 (76.9%) of 13 knowledge items correctly. Most physicians (73.6%) underestimated the incidence of erythema migrans among Lyme disease patients, and 41.2% would either test or offer treatment to an asymptomatic patient with deer-tick bite. When surveyed, most respondents (72.4%) planned to recommend Lyme disease vaccine to high-risk persons. Approximately one half (44.8%) reported giving empiric antibiotic treatment of Lyme disease solely because of patient concern. CONCLUSIONS: New Hampshire primary care physicians indicated good knowledge about Lyme disease. Lack of awareness about Lyme disease diagnostic criteria, however, could contribute to misdiagnosis through overreliance on laboratory testing. Lyme disease vaccine appeared to be well accepted by physicians, although the vaccine has since been withdrawn from the US market. Both inappropriate management of tick bite and empiric treatment of unsubstantiated Lyme disease diagnoses were common.