Hypersensitivity pneumonitis with Mycobacterium avium complex among spa workers.

BACKGROUND: The New Mexico Department of Health (NMDOH) investigated the cause of two cases of hypersensitivity pneumonitis (HP) in spa maintenance workers with laboratory confirmed Mycobacterium avium complex (MAC). The investigation occurred in tandem with worker protection and swimming pool regulatory investigations by the New Mexico Environment Department at the spa where the workers were employed. OBJECTIVES: The investigation was conducted in order to identify unreported cases, exposure source(s), and to prevent further worker exposure. METHODS: NMDOH surveyed 57 spa employees about symptoms and exposures, categorized jobs according to self-reported exposure to water, and computed odds ratios for symptom reporting by exposure category. Environmental isolates from spa water and filter swabs were cultured and compared to patient isolates by the Environmental and Applied Microbiology Team, Centers for Disease Control and Prevention (CDC). RESULTS: Workers with the highest exposure reported more HP-like symptoms (OR = 9.6), as did intermediate exposure workers (OR = 6.5), compared to workers with no aerosolized water exposure. Two of 13 environmental isolates were closely related to one of the patient isolates. CONCLUSIONS: Workers were likely exposed during spray cleaning of cartridge filters in a poorly ventilated work space. Recommendations include inhibiting organism growth in spa systems, assuring the use of respiratory protection, and adequately ventilating work spaces where filters and equipment are cleaned.

Does outpatient laboratory testing represent influenza burden and distribution in a rural state?

BACKGROUND: Laboratory testing results are often used to monitor influenza illness in populations, but results may not be representative of illness burden and distribution, especially in populations that are geographically, socioeconomically, and racially/ethnically diverse. OBJECTIVES: Descriptive epidemiology and chi-square analyses using demographic, geographic, and medical condition prevalence comparisons were employed to assess whether a group of individuals with outpatient laboratory-confirmed influenza illness during September-November 2009 represented the burden and distribution of influenza illness in New Mexico (NM). PATIENTS/METHODS: The outpatient group was identified via random selection from those with positive influenza tests at NM laboratories. Comparison groups included those with laboratory-confirmed H1N1-related influenza hospitalization and death identified via prospective active statewide surveillance, those with self-reported influenza-like illness (ILI) identified through random digit dialing, and the NM population. RESULTS: This analysis included 334 individuals with outpatient laboratory-confirmed influenza, 888 individuals with laboratory-confirmed H1N1-related hospitalization, 39 individuals with laboratory-confirmed H1N1-related death, 334 individuals with ILI, and NM population data (N = 2,036,112). The outpatient laboratory-confirmed group had a different distribution of demographic and geographic factors, as well as prevalence of certain medical conditions as compared to the groups of laboratory-confirmed H1N1-related hospitalization and death, the ILI group, and the NM population. CONCLUSIONS: The outpatient laboratory-confirmed group may reflect provider testing practices and potentially healthcare-seeking behavior and access to care, rather than influenza burden and distribution in NM during the H1N1 pandemic.

Persistent neuropsychological impairment associated with West Nile virus infection.

West Nile virus infection can result in prolonged subjective complaints of cognitive and functional decline even in the absence of a neuroinvasive form of infection. Persistent cognitive and functional complaints could be a result of general somatic symptoms, emotional distress, or residual central nervous system damage or dysfunction. Most studies of cognition in postacute West Nile virus infection rely on self-report. This descriptive study aimed to document cognitive deficits in a sample of the 2003 infected population reported in New Mexico. Patients with clinically defined neuroinvasive disease or who were impaired on brief mental status screening were seen for comprehensive neuropsychological assessment. We found that one year after symptom onset, more than half of the sample had objectively measurable neuropsychological impairment in at least two cognitive domains. Impairment was not related to subjective complaints of physical or emotional distress, or premorbid intellectual abilities. Persistent cognitive impairment in West Nile virus infection may be due to prolonged or permanent damage to the central nervous system.

Enhancement of influenza surveillance with aggregate rapid influenza test results: New Mexico, 2003-2007.

OBJECTIVES: We sought to determine whether monitoring rapid influenza laboratory tests improved the influenza-like illness surveillance already in place in New Mexico. METHODS: For the past 3 influenza seasons, the New Mexico Department of Health examined influenza-like illness visits and positive rapid influenza test results. RESULTS: The proportion of positive rapid influenza test results started to rise earlier than did the percentage of clinical visits because of influenza-like illness in each of the past 3 influenza seasons: 5 weeks earlier during the 2004-2005 season; 3 weeks earlier in 2005-2006; and 2 weeks earlier in 2006-2007. In addition, rapid influenza tests showed a spike in influenza B activity late in the 2005-2006 season that influenza-like illness syndrome surveillance did not. CONCLUSIONS: Laboratory-based rapid influenza test surveillance required relatively few resources to implement and offered a sensitive mechanism to detect the onset of influenza activity while allowing for the distinction of influenza types.

Outbreak of cystoscopy related infections with Pseudomonas aeruginosa: New Mexico, 2007.

PURPOSE: Personnel at the New Mexico Department of Health investigated a Pseudomonas aeruginosa outbreak potentially associated with outpatient cystoscopy performed by a urologist during January 1 to April 22, 2007. MATERIALS AND METHODS: We compared infection rates with baseline rates, reviewed infection control procedures and performed environmental sampling at the urologist office. We also performed a case-control study. Cases had blood or urine cultures positive for P. aeruginosa during January 1 to April 22, 2007. Controls had blood or urine cultures ordered through the same laboratory. Clinical and environmental isolates were typed by pulsed field gel electrophoresis. RESULTS: A total of 23 case-patients were identified, including 17 with urinary tract infections alone, 2 with bacteremia alone and 4 with urinary tract infections plus bacteremia. Seven case-patients experienced P. aeruginosa infection after cystoscopy was performed by this urologist. On multivariate analysis cystoscopy done by this urologist was the strongest risk factor for positive P. aeruginosa culture (OR 46.5, 95% confidence limits 3.1, 705). Recent hospitalization, having a urinary catheter and age 75 years or older were also independently associated with case status. Multiple breaches in cystoscope reprocessing procedures were identified. The urologist cystoscope was culture positive for P. aeruginosa. All 4 available clinical isolates from patients in whom cystoscopy was done by this urologist had pulsed field gel electrophoresis patterns identical to those of specimens from the cystoscope. The implementation of proper reprocessing methods terminated the outbreak. CONCLUSIONS: Our investigation implicated a contaminated cystoscope as the likely source of these infections. Health care personnel who disinfect cystoscopes should follow manufacturer recommendations and guidelines on reprocessing flexible endoscopes. The development of cystoscope specific guidelines might promote increased compliance with correct reprocessing procedures.

Unauthorized border crossings and migrant deaths: Arizona, New Mexico, and El Paso, Texas, 2002-2003.

OBJECTIVES: We examined the major causes of and risk factors for death among migrants who died while making unauthorized border crossings into the United States from Mexico. METHODS: Decedents were included in the study if (1) their remains were found between January 1, 2002, and December 31, 2003, in any US county along the 650-mi (1040-km) section of the US-Mexican border from Yuma, Ariz, to El Paso, Tex; (2) their immigration status was unauthorized; and (3) they were believed to have died during transit from Mexico to the United States. Characteristics of the decedents and causes of and risk factors for their deaths were examined. RESULTS: Among the 409 decedents meeting our inclusion criteria, environmental heat exposure (n=250; 61.1%) was the leading cause of death, followed by vehicle crashes (n=33; 8.1%) and drownings (n=24; 5.9%). Male decedents (n= 298; 72.8%) outnumbered female decedents (n = 105; 25.6%) nearly 3 to 1. More than half of the decedents were known to be Mexican nationals (n=235; 57.5%) and were aged 20 to 39 years (n=213; 52.0%); the nationality of 148 (36.2%) decedents was undetermined. CONCLUSIONS: Deaths among migrants making unauthorized crossings of the US-Mexican border are due to causes that are largely preventable. Prevention strategies should target young Mexican men, and focus on preventing them from conceiving plans to cross the border, discouraging them from using dangerous routes as crossing points, and providing search-and-rescue teams to locate lost or injured migrant crossers.

Assessment of urinary metals following exposure to a large vegetative fire, New Mexico, 2000.

INTRODUCTION: In May 2000, a vegetative fire burned 47,000 acres in northern New Mexico, including 7500 acres of land administered by the Los Alamos National Laboratory. We evaluated potential human exposures from the fire. METHODS: We surveyed two populations (firefighters and the general population) in four cities for urine heavy metal concentrations. Reference concentrations were based on the Third National Health and Nutrition Examination Survey (NHANES III). Multivariate linear regression assessed the association of urinary metal concentrations with smoke exposure. We also performed isotopic analysis of uranium and cesium on a subset of specimens. RESULTS: A total of 92 firefighters and 135 nonfirefighters participated. In both populations, urinary nickel, cesium, chromium, and uranium concentrations were greater than expected compared with NHANES III reference values. No values required immediate medical follow-up. Regression analysis demonstrated that for National Guard members, arsenic and cadmium levels were significantly related to smoke exposure, and for firefighters, cesium and arsenic levels were significantly related to exposure; however, only for cesium in National Guard members was this association in the positive direction. Isotopic analysis demonstrated that the cesium and uranium were naturally occurring. CONCLUSIONS: Some people had spot urine metal concentrations above nationally derived reference values, and values for some metals were associated with smoke exposure. These associations had little public health or clinical importance. Studies of exposures resulting from vegetative fires are difficult, and careful consideration should be given to the technical and communication processes at the outset of a fire exposure investigation. Recommendations for future investigations include testing as soon as possible during or after a fire, and early clinical consultation with a medical toxicologist.

Methodological issues in the surveillance of poisoning, illicit drug overdose, and heroin overdose deaths in new Mexico.

New Mexico leads the nation in poisoning mortality, which has increased during the 1990s in New Mexico and the United States. Most of this increase has been due to unintentional deaths from illicit drug overdoses. Medical examiner and/or vital statistics data have been used to track poisoning deaths. In this study, the authors linked medical examiner and vital statistics records on underlying cause of death, coded using the International Classification of Diseases, Ninth Revision, to assess the extent to which these data sources agreed with respect to poisoning deaths. The authors used multiple-cause files, which are files with several causes listed for each death, to further assess poisoning deaths involving more than one drug. Using vital statistics or medical examiner records, 94.7% of poisoning deaths were captured by each source alone. For unintentional illicit drug and heroin overdose deaths, each data source alone captured smaller percentages of deaths. Deaths coded as E858.8 (unintentional poisoning due to other drugs) require linkage with medical examiner or multiple-cause records, because this code identifies a significant percentage of illicit drug overdose deaths but obscures the specific drug(s) involved. Surveillance of poisoning death should include the use of medical examiner records and underlying- and multiple-cause vital statistics records.

Results from the fielding of the Bio-surveillance Analysis, Feedback, Evaluation and Response (B-SAFER) system in Albuquerque, New Mexico.

Public health authorities need a surveillance system that is sensitive enough to detect a disease outbreak early to enable a proper response. In order to meet this challenge we have deployed a pilot component-based system in Albuquerque, NM as part of the National Biodefense Initiative (BDI). B-SAFER gathers routinely collected data from healthcare institutions to monitor disease events in the community. We describe initial results from the deployment of the system for the past 6 months

U.S. medical students' rotations in epidemiology and public health at state and local health departments.

Elective rotations in health departments expose medical students to public health practice and career opportunities in applied epidemiology and preventive medicine. State and county epidemiologists and health officers can serve as excellent role models for medical students. In 2000-2001, the authors identified such electives by consulting medical schools' Web sites and by contacting state epidemiologists, teachers of preventive medicine, and medical school associate deans. The authors found that electives were offered in nine state and five local health departments; these are described in detail. Those electives usually focused on infectious diseases, involved students in outbreak investigations when possible, lasted four or more weeks, were open to other students and medical residents, and were overseen by a health department preceptor with a medical school faculty appointment and a commitment to train students. Some electives included more didactic components, encouraged the student to publish a manuscript, or were coordinated by a preventive medicine residency director. The authors observe that health departments can benefit from training enthusiastic medical students via such electives; these students bring fresh ideas to the departments. Medical school catalogs, Web sites, and word of mouth are important means for promoting these electives. Ideally, in the future every medical school will offer a state or local health department elective so that all medical students will become aware of epidemiology and public health career options. The electives reported in this article can help guide additional medical schools and health departments as they initiate such rotations.