Human Salmonellosis Outbreak Linked to Salmonella Typhimurium Epidemic in Wild Songbirds, United States, 2020-2021.

Salmonella infection causes epidemic death in wild songbirds, with potential to spread to humans. In February 2021, public health officials in Oregon and Washington, USA, isolated a strain of Salmonella enterica serovar Typhimurium from humans and a wild songbird. Investigation by public health partners ultimately identified 30 illnesses in 12 states linked to an epidemic of Salmonella Typhimurium in songbirds. We report a multistate outbreak of human salmonellosis associated with songbirds, resulting from direct handling of sick and dead birds or indirect contact with contaminated birdfeeders. Companion animals might have contributed to the spread of Salmonella between songbirds and patients; the outbreak strain was detected in 1 ill dog, and a cat became ill after contact with a wild bird. This outbreak highlights a One Health issue where actions like regular cleaning of birdfeeders might reduce the health risk to wildlife, companion animals, and humans.

MSG07: An International Cohort Study Comparing Epidemiology and Outcomes of Patients With Cryptococcus neoformans or Cryptococcus gattii Infections.

BACKGROUND: Cryptococcosis due to Cryptococcus neoformans and Cryptococcus gattii varies with geographic region, populations affected, disease manifestations, and severity of infection, which impact treatment. METHODS: We developed a retrospective cohort of patients diagnosed with culture-proven cryptococcosis during 1995-2013 from 5 centers in North America and Australia. We compared underlying diseases, clinical manifestations, treatment, and outcomes in patients with C. gattii or C. neoformans infection. RESULTS: A total of 709 patients (452 C. neoformans; 257 C. gattii) were identified. Mean age was 50.2 years; 61.4% were male; and 52.3% were white. Time to diagnosis was prolonged in C. gattii patients compared with C. neoformans (mean, 52.2 vs 36.0 days; P < .003), and there was a higher proportion of C. gattii patients without underlying disease (40.5% vs 10.2%; P < .0001). Overall, 59% had central nervous system (CNS) infection, with lung (42.5%) and blood (24.5%) being common sites. Pulmonary infection was more common in patients with C. gattii than in those with C. neoformans (60.7% vs 32.1%; P < .0001). CNS or blood infections were more common in C. neoformans-infected patients (P ≤ .0001 for both). Treatment of CNS disease with induction therapy of amphotericin B and flucytosine occurred in 76.4% of patients. Crude 12-month mortality was higher in patients with C. neoformans (28.4% vs 20.2%; odds ratio, 1.56 [95% confidence interval, 1.08-2.26]). CONCLUSIONS: This study emphasizes differences in species-specific epidemiology and outcomes of patients with cryptococcosis, including underlying diseases, site of infection, and mortality. Species identification in patients with cryptococcosis is necessary to discern epidemiologic patterns, guide treatment regimens, and predict clinical progression and outcomes.

Humoral and Mucosal Immune Responses to Human Norovirus in the Elderly.

BACKGROUND: Most information on mucosal and systemic immune response to norovirus infection is derived from human challenge studies, birth cohort studies, or vaccine trials in healthy adults. However, few data are available on immune responses to norovirus in the elderly. METHODS: To study the mucosal and systemic immune response against norovirus, 43 long-term care facilities were enrolled prospectively in 2010-2014. Baseline saliva samples from 17 facilities, cases and controls up to day 84 from 10 outbreaks, as well as acute and convalescent sera were collected. RESULTS: Norovirus-specific immunoglobulin A (IgA) levels in baseline saliva samples were low and increased in both symptomatic patients and asymptomatic shedders at day 5 after onset during outbreaks. Receiver operating characteristics analysis correctly assigned prior norovirus infection in 23 (92%) of 25 participants. Cases and asymptomatic shedders showed seroconversion for IgG (80%), IgA (78%), and blockade antibodies (87%). Salivary IgA levels strongly correlated with increased convalescent serum IgA titers and blockade antibodies. CONCLUSIONS: Salivary IgA levels strongly correlated with serum IgA titers and blockade antibodies and remained elevated 3 months after a norovirus outbreak. A single salivary sample collected on day 14 could be used to identify recent infection in a suspected outbreak or to monitor population salivary IgA.

Identification of Source of Brucella suis Infection in Human by Using Whole-Genome Sequencing, United States and Tonga.

Brucella suis infection was diagnosed in a man from Tonga, Polynesia, who had butchered swine in Oregon, USA. Although the US commercial swine herd is designated brucellosis-free, exposure history suggested infection from commercial pigs. We used whole-genome sequencing to determine that the man was infected in Tonga, averting a field investigation.

Travel-associated antimicrobial drug-resistant nontyphoidal Salmonellae, 2004-2009.

To evaluate trends in and risk factors for acquisition of antimicrobial-drug resistant nontyphoidal Salmonella infections, we searched Oregon surveillance data for 2004-2009 for all culture-confirmed cases of salmonellosis. We defined clinically important resistance (CIR) as decreased susceptibility to ampicillin, ceftriaxone, ciprofloxacin, gentamicin, or trimethoprim/sulfamethoxazole. Of 2,153 cases, 2,127 (99%) nontyphoidal Salmonella isolates were obtained from a specific source (e.g., feces, urine, blood, or other normally sterile tissue) and had been tested for drug susceptibility. Among these, 347 (16%) isolates had CIR. The odds of acquiring CIR infection significantly increased each year. Hospitalization was more likely for patients with than without CIR infections. Among patients with isolates that had been tested, we analyzed data from 1,813 (84%) who were interviewed. Travel to eastern or Southeast Asia was associated with increased CIR. Isolates associated with outbreaks were less likely to have CIR. Future surveillance activities should evaluate resistance with respect to international travel.

Correlation of genotype and in vitro susceptibilities of Cryptococcus gattii strains from the Pacific Northwest of the United States.

Cryptococcus gattii emerged in North America in 1999 as a human and veterinary pathogen on Vancouver Island, British Columbia. The emergent subtype, VGIIa, and the closely related subtype VGIIb can now be found in the United States in Washington, Oregon, and California. We performed multilocus sequence typing and antifungal susceptibility testing on 43 isolates of C. gattii from human patients in Oregon, Washington, California, and Idaho. In contrast to Vancouver Island, VGIIa was the most frequent but not the predominant subtype in the northwest United States. Antifungal susceptibility testing showed statistically significant differences in MICs between the subtypes. This is the first study to apply antifungal susceptibility testing to C. gattii isolates from the Pacific Northwest and the first to make direct comparisons between subtypes.

Natural cases of 2009 pandemic H1N1 Influenza A virus in pet ferrets.

Respiratory swab samples were collected from 5 pet ferrets (Mustela putorius furo) exhibiting influenza-like illness. The ferrets represented 3 households in 2 states. In each case, the owners reported influenza-like illness in themselves or family members prior to the onset of a similar illness in the ferrets. Real-time reverse transcription polymerase chain reaction assays designed for the detection of the 2009 H1N1 Influenza A virus were conducted in the state animal health laboratories. The assays included detection of the matrix gene of Influenza A virus and neuraminidase gene specific for 2009 H1N1 virus. Samples were positive for both screening assays. The samples were confirmed positive by the National Veterinary Services Laboratories. The history of illness in family members prior to illness in the ferrets suggests that Influenza A virus was transmitted from humans to the ferrets.

Food handler assessment in Oregon.

This survey reports on the knowledge and practices of 407 food handlers (FHs) working at 67 randomly selected restaurants in Washington and Marion counties in Oregon. During April-September 2000, a 28-question survey distilled from a longer survey obtained from the Oregon Food Handler Certification Program was administered in writing. FHs present at the time of visit were surveyed regarding their knowledge of food safety and prevention of foodborne illness. The average score on the FH survey was 68%. Of the 407 participants, 84% were line staff and 16% were managers, 56% were women and 44% men, 68% were English-speaking Whites, 19% were Spanish-speaking Hispanics, 9% were Asian, and 42% had some college education. Managers scored 74%, while line staff scored 67%. Women scored 69%, and men scored 66%. Non-Hispanic Whites scored 72%, and Spanish-speaking Hispanics scored 54%. FH staff who reported some college education scored 73%, and those who did not report any college education scored 64%. Those with a food handlers card (FHC) scored 69%, while those without an FHC scored 63%. The results demonstrate a lack of food-safety knowledge among FHs that may result in the transmission of foodborne pathogens to the public during food preparation. Survey scores emphasize the need for educational programs to improve workers' knowledge of foodborne diseases and their transmission. The scores also illustrate the need for Spanish language education in food safety in these two counties.

Prevalence of Baylisascaris procyonis in raccoons (Procyon lotor) in Portland, Oregon, USA.

We investigated the prevalence of Baylisascaris procyonis in raccoons living in the metropolitan area of Portland, Oregon, USA, in order to assess the potential public health risk involved in the transmission of B. procyonis to humans and companion animals. Sixty-nine euthanized raccoons were collected from Portland wildlife-control agencies. Infection with B. procyonis was determined through the harvesting of adult worms from raccoon intestines during necropsy and by fecal analysis using modified double-centrifugation technique with a sugar-flotation solution. Fifty-eight percent of sampled raccoons were found to be infected with B. procyonis. Juveniles represented a greater percentage (64%) of raccoons captured by wildlife-control agents and were found to have the highest prevalence (70%) and heavier adult worm burdens (mean=35 worms). No gender bias was evident. This is one of the few studies of Baylisascaris prevalence in the Pacific Northwest, and it demonstrates that there is a high prevalence of B. procyonis in raccoons inhabiting the Portland area. This factor should be considered in raccoon relocation and management. The data also suggest that juvenile raccoons are the major potential source of B. procyonis contamination in the Portland community and may merit special attention to minimize their interaction with humans.

Canine and human factors related to dog bite injuries.

OBJECTIVE: To identify physical traits of biting dogs and characteristics of injured persons and dog owners associated with bite situations for use in public health prevention activities. DESIGN: Retrospective cohort study. STUDY POPULATION: Licensed dog and dog bite report data from June 30, 2002, to July 1, 2003, that were obtained from Animal Control Services of Multnomah County, Oregon. PROCEDURES: To determine the canine and human factors associated with dog bite injuries, the number of bites, dog and injured person characteristics, and the overall canine population were evaluated. Dog owner characteristics at the block group level were defined by use of geographic information system software through 2000 census information based on place of residence. RESULTS: During the study period, 636 dog bites were reported to Animal Control Services, and 47,526 dogs were licensed in Multnomah County. Risk factors associated with biting dogs included breed (terrier, working, herding, and nonsporting breeds), being a sexually intact male, and purebred status. Male children aged 5 to 9 years had the highest rate of injury (178 bites/100,000 children). Biting dogs were more likely than nonbiting dogs to live in neighborhoods where the residents' median incomes were less than the county median income value ($41,278). CONCLUSIONS AND CLINICAL RELEVANCE: Dog bites continue to be a source of preventable injury. Prevention programs should target owners of sexually intact male and purebred dogs and owners who live in lower income neighborhoods.

Characterization of leptospirosis among dogs in Oregon, 2007-2011.

OBJECTIVE: To characterize the demographics, exposure risks, and outcomes for dogs with leptospirosis in Oregon between 2007 and 2011 and to identify geographic and temporal distributions of known cases of canine leptospirosis within the state during this period. DESIGN: Retrospective descriptive epidemiological study. ANIMALS: 72 dogs. PROCEDURES: Reports of laboratory tests for leptospirosis and zoonosis reporting forms voluntarily submitted by veterinarians to the Oregon Health Authority were evaluated to identify dogs with leptospirosis during the study period; data were also collected by examination of medical records or by telephone surveys with veterinarians from reporting facilities. RESULTS: 72 confirmed cases of leptospirosis were identified; surveys were completed for 65 cases. Seasonal and spatial distributions coincided with rainfall patterns for the state, with most cases diagnosed in the spring and in the western part of the state. Common exposure risks included contact with water in the environment (14/65) and contact with wildlife (14); 33 dogs had no history of known exposure risks. Among dogs with other conditions at the time of diagnosis (26/64), dermatitis, otitis, or both were the most commonly reported findings (9/26). Of 65 dogs, 44 recovered, 12 died or were euthanized because of leptospirosis, and 9 were lost to follow-up. CONCLUSIONS AND CLINICAL RELEVANCE: Distribution of canine leptospirosis cases in Oregon fit the rainfall theory pattern. Dermatologic conditions were present in 9 of 64 (14%) dogs that had a diagnosis of leptospirosis; however, further investigation is needed to determine whether such conditions predispose dogs to the disease.

Physician attitudes regarding school-located vaccination clinics.

BACKGROUND: School-located vaccination clinics offer an opportunity to target children for vaccination programs during communicable disease outbreaks. However, children in the United States are primarily vaccinated in the pediatrician's or family physician's office, and the concept of school-located vaccinations may be unfamiliar to some parents and guardians. Physician support could contribute to effective implementation of school-located vaccination clinics during outbreak situations. The primary objective of the study was to assess physician opinion of using school-located vaccination clinics to administer both outbreak-specific and routine vaccines. METHODS: A statewide mail and Internet survey was administered to 275 pediatricians and 275 family physicians in Oregon during July and August 2010. RESULTS: Ninety-one percent of physicians supported the use of school-located vaccination clinics as immunization delivery sites during outbreak situations. Sixty percent of physicians supported using school-located vaccination clinics to administer routine vaccinations. Only 57% of physicians had knowledge of school-located vaccination clinic availability to their patients. CONCLUSIONS: Pediatricians and family physicians expressed strong support of school vaccination clinics as sites for immunization delivery during outbreak situations but significantly less support for administering routine vaccinations. Increasing physician awareness of school-located vaccination clinic availability and establishing partnerships between physician practices and school vaccination clinics may improve access to immunizations for school-aged children and adolescents, particularly during large-scale communicable disease outbreaks.

Epidemiologic cutoff values for triazole drugs in Cryptococcus gattii: correlation of molecular type and in vitro susceptibility.

Cryptococcus gattii causes infection in tropical and subtropical regions worldwide but has garnered increased attention since its 1999 emergence in North America. C. gattii can be divided into 4 molecular types that may represent cryptic species. Recent evidence has shown that azole antifungal MIC values differ among these molecular types. We tested a large collection of C. gattii isolates for susceptibility to 4 azole drugs. We found that isolates of molecular type VGII have the highest geometric mean (GM) fluconazole MIC values (8.6 µg/mL), while isolates of molecular type VGI have the lowest (1.7 µg/mL). For fluconazole, itraconazole, and voriconazole GM MIC values, VGI < VGIII < VGIV < VGII. The GM MIC values for posaconazole were similarly represented across molecular types, with the exception that VGII < VGIII and VGIV. We used the MIC values to establish preliminary epidemiologic cutoff values for each azole and molecular type of C. gattii.

Retrospective case series of suspected intentional paraquat poisonings: diagnostic findings and risk factors for death.

We investigated a cluster of canine poisonings around the 4th of July weekend in 2003 in dogs that visited a local park. Medical records review and personal interviews were performed on 17 suspect cases; 14 dogs met the case definition criteria. The 13/14 dogs were allowed off-leash at some point during their visit to the park; 7 owners noted their dog had either eaten something at the park or vomited up meat-like material within 1 h after their walk. Eleven of the 14 dogs died or were euthanized. Urine samples from 4 dogs were positive for trace amounts of paraquat and 1 vomitus sample tested positive. Tachypnea was a significant risk factor for death of the dogs. Oral or gastrointestinal ulcers were significantly correlated with recovery.

Time-space clustering of human brucellosis, California, 1973-1992.

Infection with Brucella spp. continues to pose a human health risk in California despite great strides in eradicating the disease from domestic animals. Clustering of human cases in time and space has important public health implications for understanding risk factors and sources of infection. Temporal-spatial clustering of human brucellosis in California for the 20-year period 1973-1992 was evaluated by the Ederer-Myers-Mantel, Moran's I, and population-adjusted Moran's I procedures. Cases were clustered in concentrated agricultural regions in the first 5-year interval (1973-1977). Time-space clustering of human brucellosis cases in California late in the 20-year study period may reflect the distribution of Hispanic populations. Public health programs in California should focus on educating Hispanic populations about the risk of consuming dairy products, such as soft cheeses, made from unpasteurized milk.