Investigation of Salmonella Enteritidis Outbreak Associated with Truffle Oil - District of Columbia, 2015.

On September 8, 2015, the District of Columbia Department of Health (DCDOH) received a call from a person who reported experiencing gastrointestinal illness after eating at a District of Columbia (DC) restaurant with multiple locations throughout the United States (restaurant A). Later the same day, a local emergency department notified DCDOH to report four persons with gastrointestinal illness, all of whom had eaten at restaurant A during August 30-September 5. Two patients had laboratory-confirmed Salmonella group D by stool culture. On the evening of September 9, a local newspaper article highlighted a possible outbreak associated with restaurant A. Investigation of the outbreak by DCDOH identified 159 patrons who were residents of 11 states and DC with gastrointestinal illness after eating at restaurant A during July 1-September 10. A case-control study was conducted, which suggested truffle oil-containing food items as a possible source of Salmonella enterica serotype Enteritidis infection. Although several violations were noted during the restaurant inspections, the environmental, laboratory, and traceback investigations did not confirm the contamination source. Because of concern about the outbreak, the restaurant's license was suspended during September 10-15. The collaboration and cooperation of the public, media, health care providers, and local, state, and federal public health officials facilitated recognition of this outbreak involving a pathogen commonly implicated in foodborne illness.

Zika Virus Infection Among U.S. Pregnant Travelers - August 2015-February 2016.

After reports of microcephaly and other adverse pregnancy outcomes in infants of mothers infected with Zika virus during pregnancy, CDC issued a travel alert on January 15, 2016, advising pregnant women to consider postponing travel to areas with active transmission of Zika virus. On January 19, CDC released interim guidelines for U.S. health care providers caring for pregnant women with travel to an affected area, and an update was released on February 5. As of February 17, CDC had received reports of nine pregnant travelers with laboratory-confirmed Zika virus disease; 10 additional reports of Zika virus disease among pregnant women are currently under investigation. No Zika virus-related hospitalizations or deaths among pregnant women were reported. Pregnancy outcomes among the nine confirmed cases included two early pregnancy losses, two elective terminations, and three live births (two apparently healthy infants and one infant with severe microcephaly); two pregnancies (approximately 18 weeks' and 34 weeks' gestation) are continuing without known complications. Confirmed cases of Zika virus infection were reported among women who had traveled to one or more of the following nine areas with ongoing local transmission of Zika virus: American Samoa, Brazil, El Salvador, Guatemala, Haiti, Honduras, Mexico, Puerto Rico, and Samoa. This report summarizes findings from the nine women with confirmed Zika virus infection during pregnancy, including case reports for four women with various clinical outcomes. U.S. health care providers caring for pregnant women with possible Zika virus exposure during pregnancy should follow CDC guidelines for patient evaluation and management. Zika virus disease is a nationally notifiable condition. CDC has developed a voluntary registry to collect information about U.S. pregnant women with confirmed Zika virus infection and their infants. Information about the registry is in preparation and will be available on the CDC website.

An overview from the 2019 Swine Fever Exercise for Agriculture Response in Iowa.

Iowa leads the United States in pork production, housing approximately one-third of the country's swine population. This puts Iowa at great economic risk if an outbreak of African swine fever, a disease that limits international trade opportunities, were to occur anywhere in the United States. To hone emergency response plans to combat an outbreak, the Iowa Department of Agriculture and Land Stewardship in September 2019 participated in a 4-day exercise with representatives from the other 13 top pork-producing states. This exercise involved a mock foreign animal disease response and helped to concisely summarize what pork producers could expect should a foreign animal disease be detected in Iowa.

Enhanced One Health Surveillance during the 58th Presidential Inauguration-District of Columbia, January 2017.

OBJECTIVE: In January 2017, Washington, DC, hosted the 58th United States presidential inauguration. The DC Department of Health leveraged multiple health surveillance approaches, including syndromic surveillance (human and animal) and medical aid station-based patient tracking, to detect disease and injury associated with this mass gathering. METHODS: Patient data were collected from a regional syndromic surveillance system, medical aid stations, and an internet-based emergency department reporting system. Animal health data were collected from DC veterinary facilities. RESULTS: Of 174 703 chief complaints from human syndromic data, there were 6 inauguration-related alerts. Inauguration attendees who visited aid stations (n = 162) and emergency departments (n = 180) most commonly reported feeling faint/dizzy (n = 29; 17.9%) and pain/cramps (n = 34;18.9%). In animals, of 533 clinical signs reported, most were gastrointestinal (n = 237; 44.5%) and occurred in canines (n = 374; 70.2%). Ten animals that presented dead on arrival were investigated; no significant threats were identified. CONCLUSION: Use of multiple surveillance systems allowed for near-real-time detection and monitoring of disease and injury syndromes in humans and domestic animals potentially associated with inaugural events and in local health care systems.

Assessing rabies knowledge gaps in human and animal healthcare professionals practicing in Washington, DC-A one health approach.

Once a person is exposed to the rabies virus, it is universally fatal unless postexposure prophylaxis (PEP) is administered promptly. In the United States, determining whether PEP recommeded is often a collaborative effort where health departments work with both animal and human healthcare professionals to enact animal quarantines (or rabies testing), recommending PEP when appropriate. A failure in the knowledge base of either profession can result in incorrect PEP recommendations and an increased risk of adverse outcomes. To assess rabies knowledge in licensed physicians and veterinarians practicing in Washington, DC, we conducted a survey from December 2, 2016, to January 2, 2017, assessing their knowledge of the clinical signs, epidemiology and the primary vectors of rabies. These responses were compared between the two groups. Physician-specific or veterinary-specific questions regarding the correct PEP schedule and administration site or animal quarantine recommendations, respectively, were also included. Nine hundred and fifty-two physicians and 125 veterinarians responded. Veterinarians were more likely to select the correct vectors and clinical signs in animals than physicians. Physicians more likely selected the correct transmission routes. Less than half of physicians identified the correct PEP schedule (39.4%) and administration site (49.0%). Half of veterinarians (50.0%) correctly identified quarantine length for wildlife-exposed vaccinated dogs compared to only 19.4% for unvaccinated dogs. Several knowledge gaps were identified amongst physicians and veterinarians. Due to the fatal nature of rabies, it is important that all healthcare providers have an understanding of current recommendations. Health departments can work to correct these gaps and serve as a bridge between human and animal healthcare professionals.