Investigation of Escherichia coli Harboring the mcr-1 Resistance Gene - Connecticut, 2016.

The mcr-1 gene confers resistance to the polymyxins, including the antibiotic colistin, a medication of last resort for multidrug-resistant infections. The mcr-1 gene was first reported in 2015 in food, animal, and patient isolates from China (1) and is notable for being the first plasmid-mediated colistin resistance mechanism to be identified. Plasmids can be transferred between bacteria, potentially spreading the resistance gene to other bacterial species. Since its discovery, the mcr-1 gene has been reported from Africa, Asia, Europe, South America, and North America (2,3), including the United States, where it has been identified in Escherichia coli isolated from three patients and from two intestinal samples from pigs (2,4-6). In July 2016, the Pathogen Detection System at the National Center for Biotechnology Information (Bethesda, Maryland) identified mcr-1 in the whole genome sequence of an E. coli isolate from a Connecticut patient (7); this is the fourth isolate from a U.S. patient to contain the mcr-1 gene.

Emerging Infections Program--State Health Department Perspective.

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.

Training in Infectious Disease Epidemiology through the Emerging Infections Program Sites.

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.

Impact of requiring influenza vaccination for children in licensed child care or preschool programs--Connecticut, 2012-13 influenza season.

Preschool-aged children are at increased risk for severe influenza-related illness and complications. Congregate child care settings facilitate influenza transmission among susceptible children. To protect against influenza transmission in these settings, in September 2010, Connecticut became the second U.S. state (after New Jersey) to implement regulations requiring that all children aged 6-59 months receive at least 1 dose of influenza vaccine each year to attend a licensed child care program. To evaluate the impact of this regulation on vaccination levels and influenza-associated hospitalizations during the 2012-13 influenza season, vaccination data from U.S. and Connecticut surveys and the Emerging Infections Program (EIP) were analyzed. After the regulation took effect, vaccination rates among Connecticut children aged 6-59 months increased from 67.8% during the 2009-10 influenza season to 84.1% during the 2012-13 season. During the 2012-13 influenza season, among all 11 EIP surveillance sites, Connecticut had the greatest percentage decrease (12%) in the influenza-associated hospitalization rate from 2007-08 among children aged ≤4 years. Additionally, the ratio of the influenza-associated hospitalization rates among children aged ≤4 years to the overall population rate (0.53) was lower than for any other EIP site. Requiring vaccination for child care admission might have helped to increase vaccination rates in Connecticut and reduced serious morbidity from influenza.

Effect of surveillance method on reported characteristics of Lyme disease, Connecticut, 1996-2007.

To determine the effect of changing public health surveillance methods on the reported epidemiology of Lyme disease, we analyzed Connecticut data for 1996-2007. Data were stratified by 4 surveillance methods and compared. A total of 87,174 reports were received that included 79,896 potential cases. Variations based on surveillance methods were seen. Cases reported through physician-based surveillance were significantly more likely to be classified as confirmed; such case-patients were significantly more likely to have symptoms of erythema migrans only and to have illness onset during summer months. Case-patients reported through laboratory-based surveillance were significantly more likely to have late manifestations only and to be older. Use of multiple surveillance methods provided a more complete clinical and demographic description of cases but lacked efficiency. When interpreting data, changes in surveillance method must be considered.

Trends in invasive infection with methicillin-resistant Staphylococcus aureus, Connecticut, USA, 2001-2010.

We examined trends in incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections in Connecticut, with emphasis on 2007-2010, after legislation required reporting of hospital infections. A case was defined as isolation of MRSA from normally sterile body sites, classified after medical record review as hospital onset (HO), community onset, health care-associated community onset (HACO), or community-associated (CA). Blood isolates collected during 2005-2010 were typed and categorized as community- or health care-related strains. During 2001-2010, a total of 8,758 cases were reported (58% HACO, 31% HO, and 11% CA), and MRSA incidence decreased (p<0.05) for HACO and HO, but increased for CA. Significant 3- to 4-year period trends were decreases in all MRSA (-18.8%), HACO (-12.8%), HO (-33.2%), and CA (-12.7%) infections during 2007-2010, and an increase in CA infections during 2004-2006. Decreases in health care-related isolates accounted for all reductions. Hospital infections reporting may have catalyzed the decreases.

Knowledge, attitudes, and behaviors regarding Lyme disease prevention among Connecticut residents, 1999-2004.

Lyme disease, caused by the tick-transmitted bacterium Borrelia burgdorferi, is the most common vector-borne disease in the United States. We surveyed residents of three Connecticut health districts to evaluate the impact of intensive community-wide education programs on knowledge, attitudes, and behaviors to prevent Lyme disease. Overall, 84% of respondents reported that they knew a lot or some about Lyme disease, and 56% felt that they were very or somewhat likely to get Lyme disease in the coming year. During 2002-2004, the percentage of respondents who reported always performing tick checks increased by 7% and the percentage of respondents who reported always using repellents increased by 5%, whereas the percentage of respondents who reported avoiding wooded areas and tucking pants into socks decreased. Overall, 99% of respondents used personal protective behaviors to prevent Lyme disease. In comparison, 65% of respondents reported using environmental tick controls, and increased use of environmental tick controls was observed in only one health district. The majority of respondents were unwilling to spend more than $100 on tick control. These results provide guidance for the development of effective Lyme disease prevention programs by identifying measures most likely to be adopted by residents of Lyme disease endemic communities.