Estimated number of symptomatic Lyme borreliosis cases in Germany in 2021 after adjusting for under-ascertainment.

BACKGROUND: Although nine of 16 federal states in Germany conduct public health surveillance for Lyme borreliosis (LB), the extent of under-ascertainment is unknown. OBJECTIVE: As a model for European countries that conduct LB surveillance, we sought to estimate the population-based incidence of symptomatic LB after adjusting for under-ascertainment. METHODS: Estimating seroprevalence-derived under-ascertainment relies on data from seroprevalence studies, public health surveillance, and published literature. The number of symptomatic LB cases in states that conduct LB surveillance was estimated from studies reporting the seroprevalence of antibodies against Borrelia burgdorferi sensu lato, the proportion of LB cases that are asymptomatic, and the duration of antibody detection. The number of estimated incident symptomatic LB cases was compared with the number of surveillance-reported LB cases to derive under-ascertainment multipliers. The multipliers were applied to the number of 2021 surveillance-reported LB cases to estimate the population-based incidence of symptomatic LB in Germany. RESULTS: Adjusting for seroprevalence-based under-ascertainment multipliers, the estimated number of symptomatic LB cases in states that conducted surveillance was 129,870 (408 per 100,000 population) in 2021. As there were 11,051 surveillance-reported cases in 2021 in these states, these data indicate there were 12 symptomatic LB cases for every surveillance-reported LB case. CONCLUSIONS: We demonstrate that symptomatic LB is underdetected in Germany and that this seroprevalence-based approach can be applied elsewhere in Europe where requisite data are available. Nationwide expansion of LB surveillance would further elucidate the true LB disease burden in Germany and could support targeted disease prevention efforts to address the high LB disease burden.

Added value of a household-level study during an outbreak investigation of Salmonella serotype Saintpaul infections, New Mexico 2008.

In 2008, nationwide investigations of a Salmonella serotype Saintpaul outbreak led first to consumer warnings for Roma and red round tomatoes, then later for jalapeño and serrano peppers. In New Mexico, where there were a large number of cases but no restaurant-based clusters, the NM Department of Health and the Indian Health Service participated with CDC in individual-level and household-level case-control studies of infections in New Mexico and the Navajo Nation. No food item was associated in the individual-level study. In the household-level study, households with an ill member were more likely to have had jalapeño peppers present during the exposure period and to have reported ever having serrano peppers in the household. This report illustrates the complexity of this investigation, the limitations of traditional individual-level case-control studies when vehicles of infection are ingredients or commonly eaten with other foods, and the added value of a household-level study.

Respiratory symptoms and the case definition of gastroenteritis: an international analysis of the potential impact on burden estimates.

Estimates of the burden of foodborne disease rely on attributing a proportion of syndromic gastroenteritis to foodborne transmission. Persons with syndromic diarrhoea/vomiting can also present with concurrent respiratory symptoms that could be due to respiratory infections, gastrointestinal infections, or both. This distinction is important when estimating the foodborne disease burden but has rarely been considered. Using data from population surveys from Australia, Canada and the USA we describe the effect of excluding persons with respiratory and associated symptoms from the case definition of gastroenteritis. Excluding persons first with respiratory symptoms, or second with respiratory symptoms plus fever and headache, resulted in a decrease in the weighted estimates of acute gastroenteritis of about 10-50% depending on the exclusion criteria. This has the potential to have a very significant impact on estimates of the burden of foodborne infections using syndromic case definitions of acute gastroenteritis.

Occurrence and characterization of Salmonella enterica subspecies enterica serovar 9,12:l,v:- strains from Bulgaria, Denmark, and the United States.

In 2006, Salmonella enterica serovar I 9,12:l,v:- emerged in Bulgaria. The aim of this study was to characterize Salmonella serovar I 9,12:l,v:- isolates from Bulgaria, Denmark, and the United States. We compared isolates of Salmonella I 9,12:l,v:- and diphasic serovars with similar antigenic formulas by pulsed-field gel electrophoresis (PFGE) and antimicrobial susceptibility. The phase 2 flagellin gene (fljB) was also sequenced for selected isolates. By PFGE, the Salmonella I 9,12:l,v:- isolates from Bulgaria were indistinguishable from the isolate from the United States and distinct from isolates from Denmark; furthermore, several Salmonella I 9,12:l,v:- were indistinguishable from an isolate of Salmonella serovar Goettingen. Sequence analysis showed 100% sequence identity with known H:e,n,z15 sequences of Salmonella Goettingen, which has the antigenic formula I 9,12:l,v:e,n,z15. The study indicated that Salmonella I 9,12:l,v:- is a monophasic variant of Salmonella Goettingen and is present in different countries and on different continents.

Higher rate of culture-confirmed Campylobacter infections in Australia than in the USA: is this due to differences in healthcare-seeking behaviour or stool culture frequency?

Laboratory-based surveillance by OzFoodNet in Australia and FoodNet in the USA indicated that the incidence of Campylobacter infections in 2001 in Australia was about nine times higher than in the USA. We assessed whether this disparity could be explained by differences in the frequency of stool culturing. Using data from population surveys of diarrhoea and symptom profiles for Campylobacter from case-control studies, indices of healthcare behaviour taking into account the severity of Campylobacter infections were calculated. These suggest that culture-confirmed Campylobacter infections underestimate the incidence of community cases by similar ratios in the two countries. The incidence of Campylobacter infections in Australia was about 12 times higher than in the USA after consideration of healthcare system differences.

Implementation of an audio computer-assisted self-interview (ACASI) system in a general medicine clinic: patient response burden.

BACKGROUND: Routine implementation of instruments to capture patient-reported outcomes could guide clinical practice and facilitate health services research. Audio interviews facilitate self-interviews across literacy levels. OBJECTIVES: To evaluate time burden for patients, and factors associated with response times for an audio computer-assisted self interview (ACASI) system integrated into the clinical workflow. METHODS: We developed an ACASI system, integrated with a research data warehouse. Instruments for symptom burden, self-reported health, depression screening, tobacco use, and patient satisfaction were administered through touch-screen monitors in the general medicine clinic at the Cook County Health & Hospitals System during April 8, 2011-July 27, 2012. We performed a cross-sectional study to evaluate the mean time burden per item and for each module of instruments; we evaluated factors associated with longer response latency. RESULTS: Among 1,670 interviews, the mean per-question response time was 18.4 [SD, 6.1] seconds. By multivariable analysis, age was most strongly associated with prolonged response time and increased per decade compared to < 50 years as follows (additional seconds per question; 95% CI): 50-59 years (1.4; 0.7 to 2.1 seconds); 60-69 (3.4; 2.6 to 4.1); 70-79 (5.1; 4.0 to 6.1); and 80-89 (5.5; 4.1 to 7.0). Response times also were longer for Spanish language (3.9; 2.9 to 4.9); no home computer use (3.3; 2.8 to 3.9); and, low mental self-reported health (0.6; 0.0 to 1.1). However, most interviews were completed within 10 minutes. CONCLUSIONS: An ACASI software system can be included in a patient visit and adds minimal time burden. The burden was greatest for older patients, interviews in Spanish, and for those with less computer exposure. A patient's self-reported health had minimal impact on response times.

Use of stool collection kits delivered to patients can improve confirmation of etiology in foodborne disease outbreaks.

BACKGROUND: In 68% of foodborne disease outbreaks, no etiologic pathogen is identified. In two-thirds of outbreaks with no identified etiology, no stool specimens are submitted for testing. METHODS: From April 2001 to March 2003, we pilot-tested use of prepackaged, self-contained stool specimen collection kits in 3 states, delivered to and from patients by courier or mail, to improve rates of specimen collection in the outbreak setting. Specimens were tested for bacterial and viral pathogens at health department laboratories, and results were correlated with epidemiological investigation data. RESULTS: Specimens were returned by > or =1 person in 52 (96%) of 54 outbreaks in which kits were deployed; in total, 263 (76%) of 347 persons who received kits returned specimens. Resolution of symptoms was the most commonly cited reason for nonsubmission of kits. An etiology was confirmed in 37 (71%) of 52 outbreaks with specimens returned; 28 (76%) were attributable to norovirus, and 9 (24%) were attributed to bacterial pathogens. Stool kits were well received and cost an average of approximately 43 dollars per specimen returned. CONCLUSIONS: In two-thirds of foodborne disease outbreaks in which delivered stool collection kits were successfully deployed, an etiologic organism was identified. Delivery of kits to and from patients to improve rates of stool collection in outbreaks in which specimens might otherwise not be submitted could substantially reduce the number of outbreaks with an unknown etiology.

Origins and consequences of antimicrobial-resistant nontyphoidal Salmonella: implications for the use of fluoroquinolones in food animals.

Human Salmonella infections are common; most infections are self-limiting, however severe disease may occur. Antimicrobial agents, while not essential for the treatment of Salmonella gastroenteritis, are essential for the treatment of thousands of patients each year with invasive infections. Fluoroquinolones and third-generation cephalosporins are the drugs-of-choice for invasive Salmonella infections in humans; alternative antimicrobial choices are limited by increasing antimicrobial resistance, limited efficacy, and less desirable pharmacodynamic properties. Antimicrobial-resistant Salmonella results from the use of antimicrobial agents in food animals, and these antimicrobial resistant Salmonella are subsequently transmitted to humans, usually through the food supply. The antimicrobial resistance patterns of isolates collected from persons with Salmonella infections show more resistance to antimicrobial agents used in agriculture than to antimicrobial agents used for the treatment of Salmonella infections in humans. Because of the adverse health consequences in humans and animals associated with the increasing prevalence of antimicrobial-resistant Salmonella, there is an urgent need to emphasize non-antimicrobial infection control strategies, such as improved sanitation and hygiene, to develop guidelines for the prudent usage of antimicrobial agents, and establishment of adequate public health safeguards to minimize the development and dissemination of antimicrobial resistance and dissemination of Salmonella resistant to these agents.

Scientific approach to the 1-h cycling world record: a case study.

The purpose of this study was to describe the physiological and aerodynamic characteristics and the preparation for a successful attempt to break the 1-h cycling world record. An elite professional road cyclist (30 yr, 188 cm, 81 kg) performed an incremental laboratory test to assess maximal power output (W(max)) and power output (W(OBLA)), estimated speed (V(OBLA)), and heart rate (HR(OBLA)) at the onset of blood lactate accumulation (OBLA). He also completed an incremental velodrome (cycling track) test (VT1), during which V(OBLAVT1) and HR(OBLAVT1) were measured and W(OBLAVT1) was estimated. W(max) was 572 W, W(OBLA) 505 W, V(OBLA) 52.88 km/h, and HR(OBLA) 183 beats/min. V(OBLAVT1), HR(OBLAVT1), and W(OBLAVT1) were 52.7 km/h, 180 beats/min, and 500.6 W, respectively. Drag coefficient and shape coefficient, measured in a wind tunnel, were 0. 244 and 0.65 m(2), respectively. The cyclist set a world record of 53,040 m, with an estimated average power output of 509.5 W. Based on direct laboratory data of the power vs. oxygen uptake relationship for this cyclist, this is slightly higher than the 497. 25 W corresponding to his oxygen uptake at OBLA (5.65 l/min). In conclusion, 1) the 1-h cycling world record is the result of the interaction between physiological and aerodynamic characteristics; and 2) performance in this event can be predicted using mathematical models that integrate the principal performance-determining variables.

A multi-state survey of consumer food-handling and food-consumption practices.

INTRODUCTION: In the United States, foodborne infections cause an estimated 6.5-33 million illnesses a year. Also included in the burden of foodborne illnesses are sequelae such as hemolytic uremic syndrome, Guillain-Barré syndrome, and reactive arthritis. Surveillance for risky food-handling and food-consumption practices can be used to identify high-risk populations, develop educational efforts, and evaluate progress toward risk reduction. DESIGN: In 1995 and 1996, Behavioral Risk Factor Surveillance System interviews of 19,356 adults in eight states (1995: Colorado, Florida, Missouri, New York, and Tennessee; 1996: Indiana, New Jersey, and South Dakota) included questions related to food-handling and/or food-consumption practices. Risky food-handling and food-consumption practices were not uncommon. Overall, 19% of respondents did not adequately wash hands or cutting boards after contact with raw meat or chicken. During the previous year, 20% ate pink hamburgers, 50% ate undercooked eggs, 8% ate raw oysters, and 1% drank raw milk. Men were more likely to report risky practices than women. The prevalence of most risky behaviors increased with increasing socioeconomic status. CONCLUSION: Targeted education efforts may reduce the frequency of these behaviors. Periodic surveillance can be used to assess effectiveness. In addition to consumer education, prevention efforts are needed throughout the food chain including on the farm, in processing, distribution, and at retail.

Exercise intensity during competition time trials in professional road cycling.

PURPOSE: To estimate, upon competition heart rate (HR), exercise intensity during time trials (TT) in professional road cycling. METHODS: Eighteen world-class cyclists completed an incremental laboratory cycling test to assess maximal power output (Wmax), maximal HR (HRmax), onset of blood lactate accumulation (OBLA), lactate threshold (LT), and a HR-power output relationship. An OBLA(ZONE) (HR(OBLA) +/- 3 beats x min(-1)) and a LT(ZONE) (HR(LT) +/- 3 beats x min(-1)) were described. HR was monitored during 12 prologue (<10 km, PTT), 18 short (<40 km, STT), 19 long (>40 km, LTT), eight uphill (UTT), and seven team (TTT) time trials. A HR-power output relationship was computed to estimate each cyclist's power output during TT racing from competition HR. Competition training impulse (TRIMP) values were estimated from HR and race duration. RESULTS: %HRmax were 89+/-3%, 85+/-5%, 80+/-5%, 78+/-3%, and 82+/-2% in PTT, STT, LTT, UTT, and TTT, respectively. The amount of TRIMP were, respectively, 21+/-3, 77+/-23, 122+/-27, 129+/-14, and 146+/-6. Competition HR values relative to HR(OBLA) and HR(LT) were, respectively, 100+/-3%, 114+/-8% in PTT, 95+/-7%, 108+/-9% in STT, 89+/-5%, 103+/-8% in LTT, 87+/-2%, 101+/-5% in UTT, and 91+/-4%, 105+/-11% in TTT. CONCLUSIONS: %HRmax, TRIMP and time distribution around HR(OBLA) and HR(LT) reflected the physiological demands of different TT categories. HR(OBLA) and HR(LT) were accurate intensity markers in events lasting, respectively, < or =30 (PTT and STT) and > or =30 min (LTT, UTT, TTT).

Exercise intensity and load during mass-start stage races in professional road cycling.

PURPOSE: To evaluate exercise intensity and load during mass-start stages in professional road cycling, using competition heart rate (HR) recordings. METHODS: Seventeen world-class cyclists performed an incremental laboratory test during which maximal power output (Wmax), maximal HR (HRmax), onset of blood lactate accumulation (OBLA), lactate threshold (LT), and a HR-power output relationship were assessed. An OBLAZONE (HROBLA +/- 3 beats.min-1) and an LTZONE (HRLT +/- 3 beats.min-1) were described. HR was monitored during 125 flat (< 13 km uphill, < 800-m altitude change; FLAT), 99 semi-mountainous (13-35 km uphill, 800- to 2000-m altitude change; SEMO), and 86 high-mountain (> 35 km uphill, > 2000-m altitude change; HIMO) stages. Each cyclist's competition power output was estimated from competition HR and individual HR-power output relationships. Competition training impulse (TRIMP) values and time spent at "easy," "moderate," and "hard" zones were estimated from HR and race duration. RESULTS: Average %HRmax were 61 +/- 5%, 58 +/- 6%, and 51 +/- 7% in HIMO, SEMO, and FLAT stages, respectively, and estimated average power outputs were 246 +/- 44, 234 +/- 43, and 192 +/- 45 W. Competition HR values relative to HROBLA and HRLT were, respectively, 69 +/- 6, 79 +/- 9% in HIMO; 65 +/- 7, 74 +/- 11% in SEMO; and 57 +/- 8, 65 +/- 10% in FLAT stages. The amount of TRIMP in HIMO, SEMO, and FLAT stages were, respectively, 215 +/- 38, 172 +/- 31, and 156 +/- 31. Percentage time spent in the "moderate" and "hard" zones was highest in HIMO (22 +/- 14, 5 +/- 6%) followed by SEMO (15 +/- 13, 5 +/- 5%) and FLAT (9 +/- 7, 2 +/- 2%) stages. CONCLUSIONS: %HRmax, time distribution around HROBLA and HRLT, TRIMP, and load zones reflected the physiological demands of different mass-start cycling stage categories. The knowledge of these demands could be useful for planning precompetition training strategies.

Epidemic cholera in Guinea-Bissau: the challenge of preventing deaths in rural West Africa.

OBJECTIVES: An epidemiologic investigation was conducted to identify factors associated with cholera mortality in a rural African setting and interventions likely to prevent deaths in future epidemics. METHODS: The authors reviewed surveillance data from rural Biombo, Guinea-Bissau, interviewed family members of persons who died of cholera, and conducted a case-control study in the catchment area of a health center with a high case:fatality ratio (CFR). RESULTS: Forty-three deaths occurred among the 1169 persons who reported to health centers with cholera during the epidemic (CFR = 3.7%). Delayed rehydration and over-hydration probably contributed to 10 of these deaths. An additional 19 cholera deaths occurred outside health centers. In the case-control study, persons with cholera who died were 5.4 times (95% CI = 1.0-53.4) more likely to be in poor health or intoxicated at illness onset than persons with cholera who survived. Fatal cases were 6.0 times (95% CI = 1.1-60.8) more likely to not attend the health center than survivors. CONCLUSIONS: The low overall CFR in Biombo, compared to CFRs reported during other epidemics in sub-Saharan Africa, suggests that medical care provided at rudimentary rural health centers prevented numerous deaths. Additional deaths may be prevented by strengthening the infrastructure of health services in the rural areas and by enhanced public education regarding the need for persons with cholera to promptly seek medical care.

Foodborne disease in our global village: a multinational investigation of an outbreak of Salmonella serotype Enteritidis phage type 4 infection in Puerto Vallarta, Mexico.

OBJECTIVES: In late 1996, a multinational investigation was launched following an outbreak of diarrheal illness that caused the disruption of an international scientific conference at a first-class hotel in Puerto Vallarta, Mexico. METHODS: A questionnaire was mailed to all American and to selected international attendees. Additional copies of the questionnaire were provided for any family members who may have attended the conference. A case was defined as an illness with three or more loose stools during a 24-h period in a conference attendee or accompanying family member, with illness lasting 2 or more days and onset between 6 and 9 November 1996. RESULTS: Questionnaires were returned by 81% (232/288) of American attendees, 47% (18/38) of selected international attendees, and 25 family members; 30% (83/275) of respondents met the case definition. Ill persons resided in at least seven countries. Salmonella serotype Enteritidis phage type 4 was isolated from stool specimens from patients residing in Canada, the UK, and the USA. Attending a hotel banquet on 6 November was associated with illness; 42% (82/194) of banquet attendees became ill versus 3% (1/37) of non-attendees (relative risk (RR)515.6, 95% confidence interval (CI)52.3-108.9). The only banquet food item associated with illness was chili rellenos; 53% (58/109) of persons who ate chili rellenos were ill versus 22% (12/55) of those who did not (RR52.4, 95% CI51.4-4.1). Chili rellenos ingredients included shelled eggs and cheese; Salmonella was isolated from the leftover cheese but the isolate was not serotyped. CONCLUSIONS: Salmonella may be a cause of traveler's diarrhea and can result in outbreaks even among travelers who follow routine precautions (i.e. staying in a first-class hotel and eating hot foods). International collaboration in investigating similar outbreaks, including sharing subtyping results, will be necessary for long-term prevention. Global Salm-Surv, an international network of Salmonella reference laboratories coordinated by the World Health Organization, may facilitate such collaboration.

Evaluation of safe food-handling instructions on raw meat and poultry products.

Every year in the United States, millions of people become ill, thousands of people die, and substantial economic costs are incurred from foodborne diseases. As a measure to prevent foodborne diseases, since July 1994, the U.S. Department of Agriculture has required that safe food-handling labels be placed on retail packages of raw or partially cooked meat and poultry products. Through selected states' Behavioral Risk Factor Surveillance System (BRFSS) interviews, survey data were collected to determine the proportion of adults aware of the label and adults who reported changing their raw meat-handling practices because of the label. Fifty-one percent of the 14,262 respondents reported that they had seen the label. Of these, 79% remembered reading the label, and 37% of persons who reported that they had seen and read the label reported changing their raw meat preparation methods because of the label. Women were more likely than men to have read the label, as were persons who are at least 30 years of age compared to younger adults (P < 0.05). Both label awareness and risky food-handling behaviors increased with education and income, suggesting that safe food-handling labels have limited influence on consumer practices. Our results also suggest that the labels might be more effective in discouraging cross-contamination than in promoting thorough cooking practices. We suggest that the label is only one component among many food safety education programs that are needed to inform consumers about proper food-handling and preparation practices and to motivate persons who have risky food-handling and preparation behaviors to change these behaviors.

Complaints of foodborne illness in San Francisco, California, 1998.

Foodborne diseases are an important public problem affecting millions of Americans each year and resulting in substantial morbidity and mortality. Many foodborne infections occur in outbreak settings. Outbreaks are often detected by complaints from the public to health authorities. This report reviews complaints received by the San Francisco Department of Public Health involving suspected foodborne illness in 1998. Although such foodborne complaints are commonly received by health officials, we provide the first review of population-based data describing such complaints. We use a broad definition of a foodborne disease outbreak. We judged a complaint to be a "likely foodborne disease outbreak" if it involved more than one person and more than one family; no other common meals were shared recently by ill persons; diarrhea, vomiting, or both was reported; and the incubation period was more than one hour. In 1998, 326 complaints of foodborne illness, involving a total of 599 ill people, were received by the Communicable Disease Control Unit in San Francisco. The complaints involved from 1 to 36 ill persons, with 61% involving one ill person and 25% involving two ill persons. Of the 126 reports involving illness in more than one person, 77 (61%) were judged to be likely foodborne disease outbreaks. Three of these 77 outbreaks had been investigated prior to our review. This project confirms that more foodborne disease outbreaks occur than are reported to state and national outbreak surveillance systems. Our review of the San Francisco system highlights opportunities for gleaning valuable information from the foodborne disease complaint systems in place in most jurisdictions.

Prevalence of high-risk food consumption and food-handling practices among adults: a multistate survey, 1996 to 1997. The Foodnet Working Group.

Risk factors for foodborne diseases include consumption of high-risk foods and unsanitary food-handling practices; however, little is known about the prevalence of these risk factors in the general population. A survey was done in five FoodNet sites (California, Connecticut, Georgia, Minnesota, Oregon) to determine the prevalence of these risk factors in the population. A total of 7,493 adults were interviewed by telephone between 1 July 1996 and 30 June 1997. Results showed that 1.5% drank raw milk, 1.9% ate raw shellfish, 18% ate runny egg, 30% preferred pink hamburger, 93% said they almost always washed their cutting board after cutting raw chicken, and 93% said they almost always washed their hands after handling raw meat or poultry, during 5 days before interview. The results differed by state and demographic group. Consumption of raw shellfish (3.2%) and undercooked hamburger (43%) were more common in Connecticut than other states. Raw milk consumption was more common among people who lived on a farm (8.6%) compared with people who lived in a city or urban area (1.1%). Preference for undercooked hamburger was more common among men (35%), young adults (18 to 25 years, 33%), people with college education (38%), and among people with household income of more than $100,000/year (49%). African-Americans were less likely to prefer undercooked hamburger compared to other racial groups (10% versus 30%). Young adults compared to older adults were less likely to wash their hands after handling raw chicken (88% versus 95%), and men washed their hands less often than women (89% versus 97%). Although there were statistical differences between demographic groups, they are insufficient to warrant targeted educational programs.

Incidence of foodborne illnesses reported by the foodborne diseases active surveillance network (FoodNet)-1997. FoodNet Working Group.

In 1997, the Foodborne Diseases Active Surveillance Program (FoodNet) conducted active surveillance for culture-confirmed cases of Campylobacter, Escherichia coli O157, Listeria, Salmonella, Shigella, Vibrio, Yersinia, Cyclospora, and Cryptosporidium in five Emerging Infections Program sites. FoodNet is a collaborative effort of the Centers for Disease Control and Prevention's National Center for Infectious Diseases, the United States Department of Agriculture's Food Safety and Inspection Service, the Food and Drug Administration's Center for Food Safety and Applied Nutrition, and state health departments in California, Connecticut, Georgia, Minnesota, and Oregon. The population under active surveillance for foodborne infections was approximately 16.1 million persons or roughly 6% of the United States Population. Through weekly or monthly contact with all clinical laboratories in these sites, 8,576 total isolations were recorded: 2,205 cases of salmonellosis, 1,273 cases of shigellosis, 468 cases of cryptosporidiosis, 340 of E. coli O157:H7 infections, 139 of yersiniosis, 77 of listeriosis, 51 of Vibrio infections, and 49 of cyclosporiasis. Results from 1997 demonstrate that while there are regional and seasonal differences in reported incidence rates of certain bacterial and parasitic diseases, and that some pathogens showed a change in incidence from 1996, the overall incidence of illness caused by pathogens under surveillance was stable. More data over more years are needed to assess if observed variations in incidence reflect yearly fluctuations or true changes in the burden of foodborne illness.

Antimicrobial resistance in zoonotic enteric pathogens.

Antimicrobial resistance is a zoonotic health threat. As in humans, the use of antimicrobial agents in animals results in the emergence and spread of resistant bacteria. Resistant bacteria from animals may be passed to humans via the food chain or direct animal contact, and may result in resistant infections. Increasing prevalence of resistance to antimicrobial agents such as fluoroquinolones and third-generation cephalosporins, which are important for the treatment of infections caused by enteric pathogens, has significant public health implications. Controlling the spread of resistance requires the collaboration of several partners, including the farming, veterinary, medical, and public health communities.

Prevalence of fecal shedding of Salmonella organisms among captive green iguanas and potential public health implications.

OBJECTIVE: To determine prevalence of fecal shedding of Salmonella organisms among captive green iguanas (Iguana iguana). DESIGN: Cohort study. ANIMALS: 12 captive green iguanas. PROCEDURE: Iguanas were isolated in an environmental chamber, and fecal samples were collected weekly for 10 consecutive weeks. Samples were incubated aerobically in tetrathionate broth for 18 to 24 hours. Aliquots were then transferred to Hektoen and Salmonella-Shigella agar plates and incubated for an additional 18 to 24 hours. Isolated colonies were subcultured on nutrient agar slants, and Salmonella isolates were serogrouped and serotyped. RESULTS: All 12 iguanas were found to be shedding Salmonella organisms at least once during the study, and multiple serotypes were isolated from 7 of the 12. Salmonella organisms were isolated from 88 of 106 (83%) fecal samples; 21 samples contained multiple Salmonella serotypes. Overall, 11 Salmonella serotypes were identified. In 74 of 100 instances, when a particular Salmonella serotype was isolated from an individual iguana, the same serotype was also isolated from a subsequent fecal sample from that iguana. CLINICAL IMPLICATIONS: Results suggested that most iguanas have a stable mixture of Salmonella serotypes in their intestinal tracts and intermittently or continuously shed Salmonella organisms in their feces. Veterinarians should advise their clients on precautions for reducing the risk of acquiring these organisms from their pets. Public health officials trying to determine whether an iguana is the source of a specific Salmonella serotype that caused infection in human patients should submit at least 3 fecal samples collected from the iguana 1 week apart for bacterial culture.