Elevated incidence of infant botulism in a 17-county area of the Mid-Atlantic region in the United States, 2000-2019, including association with soil types.

We sought to identify counties in the northeastern United States where the incidence of infant botulism (IB) is elevated compared to the nationwide incidence and to assess associations with soil type at the case residence. IB cases were identified through the distribution of the orphan drug Human Botulism Immune Globulin Intravenous for treatment of IB by state and national surveillance systems and were subsequently confirmed by laboratory testing. IB incidence by county was calculated as the number of IB cases divided by the number of live births in the county from 2000 to 2019. Cases were spatially mapped and assigned to soil types using the US Department of Agriculture's online soils database. Possible association with soil type was evaluated with the Chi-squared test. We identified a rectangular area consisting of 17 contiguous counties in Delaware, Maryland, New Jersey, New York, and Pennsylvania, approximately 80 km by 250 km, in which the 20-year incidence of IB was nearly seven times greater than that of the remaining counties in those five states. Within this area, case residences were strongly associated with certain soil types (P ≤ 0.003). From 2000 to 2019, IB occurred with disproportionate incidence in a rectangular area encompassing the lower Delaware and Raritan River Valley and parts of five adjacent states. Further investigation of the soils in counties from this area could assess whether C. botulinum is more prevalent in certain soil types and whether isolation of C. botulinum is more common in counties with higher IB incidence. IMPORTANCE: Infant botulism occurs more frequently in 17 counties within and adjacent to the Delaware and Raritan River watersheds. This study should alert physicians and pediatricians in the area to the higher likelihood of encountering cases of this otherwise rare disease that manifests with constipation, poor feeding, loss of head control, weak suck/cry, generalized weakness, and descending bilateral paralysis.

Zika-Associated Birth Defects Reported in Pregnancies with Laboratory Evidence of Confirmed or Possible Zika Virus Infection - U.S. Zika Pregnancy and Infant Registry, December 1, 2015-March 31, 2018.

Zika virus infection during pregnancy can cause serious birth defects of the brain and eyes, including intracranial calcifications, cerebral or cortical atrophy, chorioretinal abnormalities, and optic nerve abnormalities (1,2). The frequency of these Zika-associated brain and eye defects, based on data from the U.S. Zika Pregnancy and Infant Registry (USZPIR), has been previously reported in aggregate (3,4). This report describes the frequency of individual Zika-associated brain and eye defects among infants from pregnancies with laboratory evidence of confirmed or possible Zika virus infection. Among 6,799 live-born infants in USZPIR born during December 1, 2015-March 31, 2018, 4.6% had any Zika-associated birth defect; in a subgroup of pregnancies with a positive nucleic acid amplification test (NAAT) for Zika virus infection, the percentage was 6.1% of live-born infants. The brain and eye defects most frequently reported included microcephaly, corpus callosum abnormalities, intracranial calcification, abnormal cortical gyral patterns, ventriculomegaly, cerebral or cortical atrophy, chorioretinal abnormalities, and optic nerve abnormalities. Among infants with any Zika-associated birth defect, one third had more than one defect reported. Certain brain and eye defects in an infant might prompt suspicion of prenatal Zika virus infection. These findings can help target surveillance efforts to the most common brain and eye defects associated with Zika virus infection during pregnancy should a Zika virus outbreak reemerge, and might provide a signal to the reemergence of Zika virus, particularly in geographic regions without ongoing comprehensive Zika virus surveillance.

Guiding questions for appraising epidemiologic literature.

OBJECTIVE: Scientific findings need to be summarized for the better understanding of the community and for the development of the respective preventive actions that they espouse, suggest, or imply. The news media play a critical role in communicating health information to the public. Among chronic diseases, cancer receives a great deal of attention from the media, possibly because of its position as a leading cause of death. While the news media are vital to the dissemination of health information, one of the main information sources comes from epidemiological studies. Thus, it is important that health professionals interpret the results of these studies in order to efficiently communicate the results in a thorough and comprehensible manner. This special article aims to guide health professionals through the process of reading and interpreting the most relevant components of epidemiological literature. METHODS: Guiding questions were prepared based on the main components of the aforementioned literature. RESULTS: An abstract that was chosen from the available literature was used for the responses to the proposed guiding questions. CONCLUSION: We expect that reading the proposed questions will improve the communication and dissemination of epidemiological findings, thereby contributing to the understanding of the health problems of our community. Also, we expect the readers to visit the recommended web sites presented at the end of this document for more complete definitions of the epidemiological terms found herein.