RESUMEN
The Emerging Infections Program (EIP) is a collaboration between the Centers for Disease Control and Prevention and 10 state health departments working with academic partners to conduct active population-based surveillance and special studies for several emerging infectious disease issues determined to need special attention. The Centers for Disease Control and Prevention funds the 10 EIP sites through cooperative agreements. Our objective was to highlight 1) what being an EIP site has meant for participating health departments and associated academic centers, including accomplishments and challenges, and 2) the synergy between the state and federal levels that has resulted from the collaborative relationship. Sharing these experiences should provide constructive insight to other public health programs and other countries contemplating a collaborative federal-local approach to collective public health challenges.
Asunto(s)
Control de Enfermedades Transmisibles/organización & administración , Enfermedades Transmisibles Emergentes/prevención & control , Vigilancia en Salud Pública , Gobierno Estatal , Enfermedades Transmisibles Emergentes/epidemiología , Humanos , Relaciones Interinstitucionales , Estados Unidos/epidemiologíaRESUMEN
One objective of the Emerging Infections Program (EIP) of the US Centers for Disease Control and Prevention is to provide training opportunities in infectious disease epidemiology. To determine the extent of training performed since the program's inception in 1995, we reviewed training efforts at the 10 EIP sites. By 2015, all sites hosted trainees (most were graduate public health students and physicians) who worked on a variety of infectious disease surveillance and epidemiologic projects. Trainee projects at all sites were used for graduate student theses or practicums. Numerous projects resulted in conference presentations and publications in peer-reviewed journals. Local public health and health care partners have also benefitted from EIP presentations and training. Consideration should be given to standardizing and documenting EIP training and to sharing useful training initiatives with other state and local health departments and academic institutions.
Asunto(s)
Enfermedades Transmisibles Emergentes/epidemiología , Educación , Vigilancia en Salud Pública , Centers for Disease Control and Prevention, U.S. , Enfermedades Transmisibles Emergentes/prevención & control , Humanos , Estados Unidos/epidemiologíaRESUMEN
Tracking of infectious diseases is a public health core function essential to disease prevention and control. Each state mandates reporting of certain infectious diseases to public health authorities. These laws vary by state, and the variation could affect the ability to collect critical information. The 2009 H1N1 influenza pandemic served as a case study to examine the legal authority in the 50 states; Washington, DC; and New York City for mandatory infectious disease reporting, particularly for influenza and new or emerging infectious diseases. Our study showed reporting laws to be generally present and functioning well; nevertheless, jurisdictions should be mindful of their mandated parameters and review the robustness of their laws before they face a new or emerging disease outbreak.
RESUMEN
Meningococcal disease outbreaks recently have occurred in several U.S. cities among men who are HIV-infected and who have had sex with other men. This article describes the first similar case of meningococcal meningitis serogroup C in Minnesota, which was confirmed this summer. It also offers vaccination guidance for physicians who care for patients who may be at high risk for the disease.
Asunto(s)
Brotes de Enfermedades , Homosexualidad Masculina , Meningitis Meningocócica/prevención & control , Meningitis Meningocócica/transmisión , Infecciones Oportunistas Relacionadas con el SIDA/prevención & control , Infecciones Oportunistas Relacionadas con el SIDA/transmisión , Humanos , Masculino , Vacunas Meningococicas/administración & dosificación , Minnesota , Factores de RiesgoRESUMEN
Between 1 November 2013 and 31 March 2014, concurrent shigellosis and cryptosporidiosis outbreaks occurred among men who have sex with men in the Minneapolis-St. Paul area, 75% of whom were HIV-infected. Current HIV/AIDS strategy emphasizing treatment as prevention may effectively decrease HIV transmission, but raises concerns about other diseases if safer sex messages are de-emphasized.
Asunto(s)
Criptosporidiosis/epidemiología , Disentería Bacilar/epidemiología , Infecciones por VIH/complicaciones , Homosexualidad Masculina , Adulto , Anciano , Brotes de Enfermedades , Humanos , Masculino , Persona de Mediana Edad , Minnesota/epidemiologíaRESUMEN
Broadly protective coronavirus vaccines are an important tool for protecting against future SARS-CoV-2 variants and could play a critical role in mitigating the impact of future outbreaks or pandemics caused by novel coronaviruses. The Coronavirus Vaccines Research and Development (R&D) Roadmap (CVR) is aimed at promoting the development of such vaccines. The CVR, funded by the Bill & Melinda Gates Foundation and The Rockefeller Foundation, was generated through a collaborative and iterative process, which was led by the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota and involved 50 international subject matter experts and recognized leaders in the field. This report summarizes the major issues and areas of research outlined in the CVR and identifies high-priority milestones. The CVR covers a 6-year timeframe and is organized into five topic areas: virology, immunology, vaccinology, animal and human infection models, and policy and finance. Included in each topic area are key barriers, gaps, strategic goals, milestones, and additional R&D priorities. The roadmap includes 20 goals and 86 R&D milestones, 26 of which are ranked as high priority. By identifying key issues, and milestones for addressing them, the CVR provides a framework to guide funding and research campaigns that promote the development of broadly protective coronavirus vaccines.
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COVID-19 , Vacunas , Animales , Humanos , SARS-CoV-2 , COVID-19/prevención & control , Vacunas contra la COVID-19 , Pandemias/prevención & control , InvestigaciónRESUMEN
Detection of clusters of Legionnaires' disease, a leading waterborne cause of pneumonia, is challenging. Clusters vary in size and scope, are associated with a diverse range of aerosol-producing devices, including exposures such as whirlpool spas and hotel water systems typically associated with travel, and can occur without an easily identified exposure source. Recently, jurisdictions have begun to use SaTScan spatio-temporal analysis software prospectively as part of routine cluster surveillance. We used data collected by the Active Bacterial Core surveillance platform to assess the ability of SaTScan to detect Legionnaires' disease clusters. We found that SaTScan analysis using traditional surveillance data and geocoded residential addresses was unable to detect many common Legionnaires' disease cluster types, such as those associated with travel or a prolonged time between cases. Additionally, signals from an analysis designed to simulate a real-time search for clusters did not align with clusters identified by traditional surveillance methods or a retrospective SaTScan analysis. A geospatial analysis platform better tailored to the unique characteristics of Legionnaires' disease epidemiology would improve cluster detection and decrease time to public health action.
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Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/epidemiología , Neumonía/enzimología , Vigilancia de la Población , Análisis por Conglomerados , Brotes de Enfermedades , Humanos , Legionella pneumophila/patogenicidad , Enfermedad de los Legionarios/microbiología , Neumonía/microbiología , Neumonía/prevención & control , Estudios Prospectivos , Estudios Retrospectivos , Programas Informáticos , Microbiología del AguaRESUMEN
Nursing home residents are at high risk for invasive group A streptococcal (GAS) disease, and clusters of cases in nursing homes are common.To characterize the epidemiologic features of invasive GAS disease in nursing homes, we conducted active, statewide, population- and laboratory-based surveillance in Minnesota from April 1995 through 2006. Of 1,858 invasive GAS disease cases, 134 (7%) occurred in nursing home residents; 34 of these cases were identified as part of 13 clusters. Recognizing cases of GAS disease in nursing homes posed challenges. Measures to ensure identification of case-patients as residents of specific nursing homes need to be included in standard guidelines for the prevention and control of invasive GAS disease in this setting.
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Hogares para Ancianos/estadística & datos numéricos , Casas de Salud/estadística & datos numéricos , Infecciones Estreptocócicas/epidemiología , Streptococcus pyogenes/aislamiento & purificación , Anciano , Análisis por Conglomerados , Humanos , Persona de Mediana Edad , Minnesota , Vigilancia de la Población/métodos , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/prevención & control , Streptococcus pyogenes/clasificación , Streptococcus pyogenes/genéticaRESUMEN
From 1998 through 2006, four outbreaks of salmonellosis associated with raw, frozen, microwaveable, breaded, prebrowned, stuffed chicken products were identified in Minnesota. In 1998, 33 Salmonella Typhimurium cases were associated with a single brand of Chicken Kiev. In 2005, four Salmonella Heidelberg cases were associated with a different brand and variety (Chicken Broccoli and Cheese). From 2005 to 2006, 27 Salmonella Enteritidis cases were associated with multiple varieties of product, predominately of the same brand involved in the 1998 outbreak. In 2006, three Salmonella Typhimurium cases were associated with the same brand of product involved in the 2005 Salmonella Heidelberg outbreak. The outbreak serotype and pulsed-field gel electrophoresis subtype of Salmonella were isolated from product in each outbreak. In these outbreaks, most individuals affected thought that the product was precooked due to its breaded and prebrowned nature, most used a microwave oven, most did not follow package cooking instructions, and none took the internal temperature of the cooked product. Similar to previous salmonellosis outbreaks associated with raw, breaded chicken nuggets or strips in Canada and Australia, inadequate labeling, consumer responses to labeling, and microwave cooking were the key factors in the occurrence of these outbreaks. Modification of labels, verification of cooking instructions by the manufacturer, and notifications to alert the public that these products contain raw poultry, implemented because of the first two outbreaks, did not prevent the other outbreaks. Microwave cooking is not recommended as a preparation method for these types of products, unless they are precooked or irradiated prior to sale.
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Culinaria/métodos , Contaminación de Alimentos/análisis , Alimentos Congelados/microbiología , Productos Avícolas/microbiología , Intoxicación Alimentaria por Salmonella/epidemiología , Salmonella/aislamiento & purificación , Animales , Pollos , Seguridad de Productos para el Consumidor , Brotes de Enfermedades , Contaminación de Alimentos/prevención & control , Etiquetado de Alimentos , Microbiología de Alimentos , Humanos , Microondas , Minnesota/epidemiología , Factores de Riesgo , Salmonella typhimurium/aislamiento & purificaciónRESUMEN
Infection preventionists at Minnesota hospitals were surveyed to determine whether they had Legionella water management plans. Of 137 hospitals, 84 (61%) responded. Among them, 27% hospitals had a water management plan, 21% regularly sampled for Legionella, and 51% had knowledge of ASHRAE Legionella prevention standards. Significant changes are needed to protect patients from nosocomial infection. Infect Control Hosp Epidemiol 2018;39:336-338.
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Infección Hospitalaria/prevención & control , Monitoreo del Ambiente , Control de Infecciones , Enfermedad de los Legionarios/prevención & control , Microbiología del Agua , Infección Hospitalaria/microbiología , Monitoreo del Ambiente/normas , Hospitales , Humanos , Control de Infecciones/métodos , Control de Infecciones/normas , Legionella , Legionelosis/prevención & control , Minnesota , Encuestas y Cuestionarios , Microbiología del Agua/normas , Abastecimiento de AguaRESUMEN
From the Field is a semi-regular column that explores what it means to be a local health professional on the front lines of an emergency. Typically, National Association of County and City Health Officials (NACCHO) members share their stories of preparing for and responding to disasters, epidemics, and other major health issues. This month's column features a submission from a state health department that describes their experience in investigating white powder incidents. Through exploring the analysis of the challenges faced and the solutions developed, readers can learn how these public health champions keep their communities safe even in extreme situations. Readers may submit topics of interest to the column's editor, Meghan McGinty, PhD, MPH, MBA, at mmcginty@naccho.org.
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Armas Biológicas/estadística & datos numéricos , Sustancias Peligrosas/análisis , Armas Biológicas/legislación & jurisprudencia , Decepción , Humanos , Aplicación de la Ley/métodos , Minnesota , Polvos/análisis , Administración en Salud Pública/métodosRESUMEN
Minnesota residents who submitted a bat to the Minnesota Department of Health for rabies testing in 2003 were surveyed by telephone regarding the circumstances of the bat encounter and their knowledge of bats and rabies. Of 442 bats submitted for testing, 12 (3%) tested positive for rabies, and 410 (93%) tested negative; 17 (4%) bats were unsuitable for testing, and three (1%) had equivocal results. A case-control study found that rabid bats were more likely than non-rabid bats to be found in September, found outside, found in a wooded area, unable to fly, acting ill, or acting aggressively. Rabid bats were not more likely than non-rabid bats to be found during the day or to have bitten someone. While most persons submitting bats for rabies testing were aware that bats can carry rabies, few knew they should submit the bat for testing until they sought the advice of an animal control officer, veterinarian, or healthcare provider.
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Conducta Animal , Quirópteros/virología , Vectores de Enfermedades , Conocimientos, Actitudes y Práctica en Salud , Rabia/transmisión , Animales , Estudios de Casos y Controles , Humanos , Minnesota/epidemiología , Vigilancia de la Población , Rabia/epidemiología , Estaciones del Año , Encuestas y CuestionariosRESUMEN
Steaks have not been recognized as an important vehicle of Escherichia coli O157:H7 infection. During 11 to 27 June 2003, the Minnesota Department of Health (MDH) identified four O157 infection cases with the same pulsed-field gel electrophoresis (PFGE) subtype. All four case patients consumed brand A vacuum packed frozen steaks sold by door-to-door vendors. The steaks were blade tenderized and injected with marinade (i.e., nonintact). Information from single case patients in Michigan and Kansas identified through PulseNet confirmed the outbreak. The MDH issued a press release on 27 June to warn consumers, prompting a nationwide recall of 739,000 lb (335,506 kg) of frozen beef products. The outbreak resulted in six culture-confirmed cases (including one with hemolytic uremic syndrome) and two probable cases in Minnesota and single confirmed cases in four other states. The outbreak PFGE subtype of O157 was isolated from unopened brand A bacon-wrapped fillets from five affected Minnesota households. A fillet from one affected household was partially cooked in the laboratory, and the same O157 subtype was isolated from the uncooked interior. The tenderizing and injection processes likely transferred O157 from the surface to the interior of the steaks. These processing methods create new challenges for prevention of O157 infection. Food regulatory officials should reevaluate safety issues presented by nonintact steak products, such as microbiologic hazards of processing methods, possible labeling to distinguish intact from nonintact steaks, and education of the public and commercial food establishments on the increased risk associated with undercooked nonintact steaks. Information on single cases of O157 infection in individual states identified through PulseNet can be critical in solving multistate outbreaks in a timely manner.
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Infecciones por Escherichia coli/epidemiología , Escherichia coli O157/crecimiento & desarrollo , Contaminación de Alimentos , Microbiología de Alimentos , Carne/microbiología , Brotes de Enfermedades , Manipulación de Alimentos/métodos , Síndrome Hemolítico-Urémico/epidemiología , Síndrome Hemolítico-Urémico/microbiología , Humanos , Minnesota/epidemiologíaRESUMEN
CONTEXT: Methicillin-resistant Staphylococcus aureus (MRSA) has traditionally been considered a health care-associated pathogen in patients with established risk factors. However, MRSA has emerged in patients without established risk factors (community-associated MRSA). OBJECTIVE: To characterize epidemiological and microbiological characteristics of community-associated MRSA cases compared with health care-associated MRSA cases. DESIGN, SETTING, AND PATIENTS: Prospective cohort study of patients with MRSA infection identified at 12 Minnesota laboratory facilities from January 1 through December 31, 2000, comparing community-associated (median age, 23 years) with health care-associated (median age, 68 years) MRSA cases. MAIN OUTCOME MEASURES: Clinical infections associated with either community-associated or health care-associated MRSA, microbiological characteristics of the MRSA isolates including susceptibility testing, pulsed-field gel electrophoresis, and staphylococcal exotoxin gene testing. RESULTS: Of 1100 MRSA infections, 131 (12%) were community-associated and 937 (85%) were health care-associated; 32 (3%) could not be classified due to lack of information. Skin and soft tissue infections were more common among community-associated cases (75%) than among health care-associated cases (37%) (odds ratio [OR], 4.25; 95% confidence interval [CI], 2.97-5.90). Although community-associated MRSA isolates were more likely to be susceptible to 4 antimicrobial classes (adjusted OR, 2.44; 95% CI, 1.35-3.86), most community-associated infections were initially treated with antimicrobials to which the isolate was nonsusceptible. Community-associated isolates were also more likely to belong to 1 of 2 pulsed-field gel electrophoresis clonal groups in both univariate and multivariate analysis. Community-associated isolates typically possessed different exotoxin gene profiles (eg, Panton Valentine leukocidin genes) compared with health care-associated isolates. CONCLUSIONS: Community-associated and health care-associated MRSA cases differ demographically and clinically, and their respective isolates are microbiologically distinct. This suggests that most community-associated MRSA strains did not originate in health care settings, and that their microbiological features may have contributed to their emergence in the community. Clinicians should be aware that therapy with beta-lactam antimicrobials can no longer be relied on as the sole empiric therapy for severely ill outpatients whose infections may be staphylococcal in origin.
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Infecciones Comunitarias Adquiridas/epidemiología , Infección Hospitalaria/epidemiología , Resistencia a la Meticilina , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/efectos de los fármacos , Adulto , Anciano , Estudios de Cohortes , Infecciones Comunitarias Adquiridas/microbiología , Infección Hospitalaria/microbiología , Electroforesis en Gel de Campo Pulsado , Humanos , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Minnesota/epidemiología , Staphylococcus aureus/genéticaAsunto(s)
Medicina de Desastres/organización & administración , Brotes de Enfermedades/historia , Gripe Humana/historia , Población Urbana , Animales , Aves , Medicina de Desastres/historia , Historia del Siglo XX , Humanos , Subtipo H5N1 del Virus de la Influenza A/patogenicidad , Gripe Aviar/virología , Gripe Humana/epidemiología , Gripe Humana/mortalidad , Gripe Humana/prevención & control , Gripe Humana/virología , Minnesota/epidemiologíaRESUMEN
BACKGROUND: In October 2007, a cluster of patients experiencing a novel polyradiculoneuropathy was identified at a pork abattoir (Plant A). Patients worked in the primary carcass processing area (warm room); the majority processed severed heads (head-table). An investigation was initiated to determine risk factors for illness. METHODS AND RESULTS: Symptoms of the reported patients were unlike previously described occupational associated illnesses. A case-control study was conducted at Plant A. A case was defined as evidence of symptoms of peripheral neuropathy and compatible electrodiagnostic testing in a pork abattoir worker. Two control groups were used - randomly selected non-ill warm-room workers (n = 49), and all non-ill head-table workers (n = 56). Consenting cases and controls were interviewed and blood and throat swabs were collected. The 26 largest U.S. pork abattoirs were surveyed to identify additional cases. Fifteen cases were identified at Plant A; illness onsets occurred during May 2004-November 2007. Median age was 32 years (range, 21-55 years). Cases were more likely than warm-room controls to have ever worked at the head-table (adjusted odds ratio [AOR], 6.6; 95% confidence interval [CI], 1.6-26.7), removed brains or removed muscle from the backs of heads (AOR, 10.3; 95% CI, 1.5-68.5), and worked within 0-10 feet of the brain removal operation (AOR, 9.9; 95% CI, 1.2-80.0). Associations remained when comparing head-table cases and head-table controls. Workers removed brains by using compressed air that liquefied brain and generated aerosolized droplets, exposing themselves and nearby workers. Eight additional cases were identified in the only two other abattoirs using this technique. The three abattoirs that used this technique have stopped brain removal, and no new cases have been reported after 24 months of follow up. Cases compared to controls had higher median interferon-gamma (IFNgamma) levels (21.7 pg/ml; vs 14.8 pg/ml, P<0.001). DISCUSSION: This novel polyradiculoneuropathy was associated with removing porcine brains with compressed air. An autoimmune mechanism is supported by higher levels of IFNgamma in cases than in controls consistent with other immune mediated illnesses occurring in association with neural tissue exposure. Abattoirs should not use compressed air to remove brains and should avoid procedures that aerosolize CNS tissue. This outbreak highlights the potential for respiratory or mucosal exposure to cause an immune-mediated illness in an occupational setting.
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Encéfalo/patología , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/epidemiología , Exposición Profesional , Polirradiculoneuropatía/diagnóstico , Polirradiculoneuropatía/epidemiología , Mataderos , Adulto , Animales , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/etiología , Estudios de Casos y Controles , Aire Comprimido , Femenino , Humanos , Masculino , Persona de Mediana Edad , Minnesota , Polirradiculoneuropatía/etiología , PorcinosRESUMEN
In 2002, revised guidelines for preventing perinatal group B streptococcal disease were published. In 2002, all Minnesota providers surveyed reported using a prevention policy. Most screen vaginal and rectal specimens at 34-37 weeks of gestation. The use of screening-based methods has increased dramatically since 1998.
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Atención Perinatal/métodos , Pautas de la Práctica en Medicina , Atención Prenatal/estadística & datos numéricos , Infecciones Estreptocócicas/prevención & control , Streptococcus agalactiae/patogenicidad , Medicina Familiar y Comunitaria , Femenino , Humanos , Partería , Minnesota , Obstetricia , Embarazo , Infecciones Estreptocócicas/diagnóstico , Encuestas y CuestionariosRESUMEN
We compared characteristics of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) and CA-MRSA invasive disease identified in Minnesota from 2000 through 2003. A total of 586 patients with SSTIs and 65 patients with invasive disease were identified. Patients with invasive disease were more likely to be smokers (p = 0.03), and report a history of immunosuppressive therapy (p = 0.03), emphysema (p = 0.011), or injection drug use (p = 0.020) than were SSTI patients. Invasive disease isolates were less likely to be susceptible to ciprofloxacin (p = 0.002) and clindamycin (p = 0.001) and more likely to have healthcare-associated pulsed-field gel electrophoresis subtypes than SSTI isolates (p<0.001). Patients with invasive disease may have had healthcare exposures that put them at risk of acquiring healthcare-associated MRSA and which were not exclusion criteria in the CA-MRSA case definition. Continued surveillance of MRSA is needed to better characterize CA-MRSA infections.
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Infecciones Comunitarias Adquiridas/epidemiología , Resistencia a la Meticilina , Infecciones de los Tejidos Blandos/epidemiología , Infecciones Estafilocócicas/epidemiología , Infecciones Cutáneas Estafilocócicas/epidemiología , Staphylococcus aureus/efectos de los fármacos , Adulto , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/fisiopatología , Femenino , Humanos , Masculino , Minnesota/epidemiología , Factores de Riesgo , Infecciones de los Tejidos Blandos/microbiología , Infecciones de los Tejidos Blandos/fisiopatología , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/fisiopatología , Infecciones Cutáneas Estafilocócicas/microbiología , Infecciones Cutáneas Estafilocócicas/fisiopatología , Staphylococcus aureus/clasificación , Staphylococcus aureus/genética , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
BACKGROUND: In August 2000, the Minnesota Department of Health was notified of and investigated an outbreak of febrile respiratory illness among workers at a sugar-beet processing plant. METHODS: A case was defined as fever and respiratory symptoms occurring in a worker at the sugar-beet plant on or after 31 July 2000. Case patients were interviewed, medical and work records were reviewed, and clinical samples were obtained. The plant was inspected, and environmental samples were collected. RESULTS: Fourteen of 15 case patients performed high-pressure water cleaning in the confined space of an evaporator vessel. Symptoms included fever and chills (100%), chest tightness (93%), cough (80%), and shortness of breath (73%). In case patients, median temperature was 39.4 degrees C, median oxygen saturation was 93%, and median white blood cell count was 12x10(3) cells/ mu L. Four (29%) of 14 case patients showed evidence of Legionella pneumophila exposure, according to serologic testing. Water sources contained up to 10(5) cfu/mL of L. pneumophila and 22,200 endotoxin units/mL. CONCLUSIONS: Outbreak features were consistent with Pontiac fever. Respiratory symptoms, which are atypical for Pontiac fever, could be attributed to a high exposure dose of L. pneumophila from confined-space aerosolization or to endotoxin exposure. This outbreak demonstrates the potential occupational hazards for those performing high-pressure cleaning in confined spaces.