Low pathogenic avian influenza A (H7N2) virus infection in immunocompromised adult, New York, USA, 2003.

In 2003, infection with low pathogenic avian influenza A (H7N2) virus was identified in an immunocompromised man with fever and community-acquired pneumonia in New York, USA. The patient recovered. Although the source of the virus was not identified, this case indicates the usefulness of virus culture for detecting novel influenza A viruses.

Multistate outbreak of Listeriosis linked to turkey deli meat and subsequent changes in US regulatory policy.

BACKGROUND: Listeriosis, a life-threatening foodborne illness caused by Listeria monocytogenes, affects approximately 2500 Americans annually. Between July and October 2002, an uncommon strain of L. monocytogenes caused an outbreak of listeriosis in 9 states. METHODS: We conducted case finding, a case-control study, and traceback and microbiological investigations to determine the extent and source of the outbreak and to propose control measures. Case patients were infected with the outbreak strain of L. monocytogenes between July and November 2002 in 9 states, and control patients were infected with different L. monocytogenes strains. Outcome measures included food exposure associated with outbreak strain infection and source of the implicated food. RESULTS: Fifty-four case patients were identified; 8 died, and 3 pregnant women had fetal deaths. The case-control study included 38 case patients and 53 control patients. Case patients consumed turkey deli meat much more frequently than did control patients (P = .008, by Wilcoxon rank-sum test). In the 4 weeks before illness, 55% of case patients had eaten deli turkey breast more than 1-2 times, compared with 28% of control patients (odds ratio, 4.5; 95% confidence interval, 1.3-17.1). Investigation of turkey deli meat eaten by case patients led to several turkey processing plants. The outbreak strain was found in the environment of 1 processing plant and in turkey products from a second. Together, the processing plants recalled > 30 million pounds of products. Following the outbreak, the US Department of Agriculture's Food Safety and Inspection Service issued new regulations outlining a L. monocytogenes control and testing program for ready-to-eat meat and poultry processing plants. CONCLUSIONS: Turkey deli meat was the source of a large multistate outbreak of listeriosis. Investigation of this outbreak helped guide policy changes designed to prevent future L. monocytogenes contamination of ready-to-eat meat and poultry products.

Cultural competence of baccalaureate nursing faculty: are we up to the task?

Reported low levels of cultural competence among baccalaureate nursing students, as well as professional nurses, have raised questions about nursing faculty's readiness to prepare culturally competent graduates. This study examined cultural competence among faculty of baccalaureate nursing programs in Louisiana. Using a five-point Likert-type scale, the respondents were asked to express their level of agreement with statements addressing the components of cultural competence. The data analysis revealed the respondents' rating of their cultural awareness (4.14), desire (3.67) knowledge (3.65), skills (3.65), and encounters (3.56). Overall cultural competence was rated as 3.73. When the overall cultural competence index was regressed on the index of each subscale, the cultural knowledge index and the cultural encounter index significantly explained 87% of the variance in the model. These findings suggest that faculty should be encouraged to attend continuing education programs on cultural competence to improve their knowledge in this area. This continuing education, coupled with more local and/or international cross-cultural encounters should significantly improve the overall cultural competence of the respondents.

Lyme disease trends--Dutchess County, New York, 1992-2000.

BACKGROUND: Lyme disease is a vector-borne infectious disease, accounting for more than 95% of all reported vector-borne illness in the United States. From 1992 2000, Dutchess County reported more cases of Lyme disease than any other county in the United States, consistently ranking among the top ten in incidence rates. We analyzed 1992-2000 Dutchess County Lyme disease surveillance data to characterize Lyme disease trends, identify high-risk populations, and examine the frequency of the characteristic lesion, erythema migrans. METHODS: A Lyme disease case was defined as a person with physician-diagnosed erythema migrans or at least one late manifestation of the disease, with laboratory confirmation. A surveillance database of cases reported in Dutchess County from 1992-2000 was obtained from the New York State Department of Health. Annual incidence rates by age, gender, race, ethnicity, and ZIP codes, and frequency of erythema migrans were calculated. RESULTS: From 1992 through 2000, a total of 9,548 cases of Lyme disease were reported by Dutchess County to the New York State Department of Health, for a crude mean annual incidence rate of 400 cases per 100,000 persons per year. The incidence rate peaked at 683/100,000 in 1996, and then declined from 1998 to 2000. A bimodal age distribution was seen, with the initial peak among children aged 5-9 years (617/100,000) and the second peak among adults aged 60-64 years (627/100,000). A male preponderance was clearly seen between the ages of 5-19 years, and beyond the age of 60 years. Highest incidence rates were reported in central Dutchess County. Onset of illness occurred most frequently in June, July, and August. Ninety-four percent of cases occurred among the predominantly white population, which had the highest incidence rate (431/100,000) among the races. Incidence rate for non-Hispanics was more than double that for Hispanics. Eighty-one percent of reported cases had erythema migrans. CONCLUSIONS: While some prevention programs could be broadly targeted to the entire Dutchess County population, other interventions might be most effective if they focused on the high-risk population groups and areas defined in this report. The high proportion of cases with erythema migrans suggests that early diagnosis and treatment should be effective in reducing late-stage complications of Lyme disease in Dutchess County. Surveillance data for other endemic counties and states can be similarly analyzed to enhance and monitor local prevention programs.

Transmission of hepatitis B virus associated with assisted monitoring of blood glucose at an assisted living facility in New York State.

BACKGROUND: Hepatitis B virus (HBV) transmission has been reported after patient-to-patient blood exposure during assisted monitoring of blood glucose (AMBG). Three assisted-living facility (ALF) residents who underwent AMBG developed acute HBV infection (HBVI) within 10 days. We investigated HBV transmission and implemented preventive measures. METHODS: A retrospective cohort study was conducted. Infection control practices were assessed. HBVI screening was conducted for all staff and epidemiologically linked residents. Viral DNA sequences were compared for a subset of isolates. RESULTS: Lancing devices and glucometers were shared among residents without proper sanitization. Serologic testing of all 34 residents with diabetes and 12 epidemiologically linked residents present during the exposure period detected 6 residents with diabetes with current HBVI and 4 residents with diabetes and 1 epidemiologically linked resident with previous HBVI. A cohort study of 32 individuals with diabetes identified AMBG as a significant risk factor for HBVI (relative risk, 6.7; 95% confidence interval, 1.7-26.3). Viral DNA sequences for 5 AMBG-exposed residents' isolates were identical, suggesting a common source. CONCLUSIONS: AMBG was significantly associated with HBVI in ALF residents with diabetes. Despite clear preventive recommendations, bloodborne pathogen transmission continues to occur in the setting of AMBG. Strengthening direct care provider, infection preventionist, and health department partnerships with ALFs is crucial to ensure safe AMBG practices and prevent HBV transmission.

Salmonella Typhimurium outbreak associated with veterinary clinic.

A Salmonella enterica serovar Typhimurium outbreak was associated with a veterinary clinic. Confirmed cases were in one cat, two veterinary technicians, four persons associated with clinic patients, and a nurse not linked to the clinic. This outbreak emphasizes the importance of strong public health ties to the animal health community.