Pertussis outbreak in an Amish Community: Kent County, Delaware, 2018.

The Amish lead a very simplistic lifestyle free of modern conveniences. They have unique perceptions and beliefs regarding health and illness and generally do not adhere to conventional preventive measures such as immunizations, which can result in un- or under-immunized populations. Populations with low vaccination coverage are at greater risk of outbreaks compared to vaccinated populations as a result of low herd immunity. Over the past two decades, the Delaware Division of Public Health (DPH) has recorded three distinct outbreaks of pertussis in Delaware's Amish community. The third, and most recent, outbreak was detected in May 2018. DPH conducted an outbreak investigation in the Amish community to identify cases, estimate the burden of disease in the community, and implement control measures including vaccination, treatment, and post-exposure prophylaxis. Through the conduct of active surveillance activities, DPH interviewed 134 families and identified 181 confirmed and probable cases of pertussis. The majority of pertussis cases (77%) occurred among children ≤10 years of age, of which 87% were unvaccinated. DPH engaged the Amish community in meetings, distributed educational materials, and provided medication and vaccines in the community to encourage prevention and implement control measures. DPH officially closed the outbreak investigation on December 20, 2018 following three full incubation periods (63 days) without any new pertussis cases identified in the community.

Knowledge and preventive behaviors towards tick-borne diseases in Delaware.

Delaware is among the top 10 states in the United States with the highest incidence for Lyme disease. The Delaware Division of Public Health (DPH) therefore has been working diligently to prevent and control tick-borne diseases through a variety of interventions including awareness campaigns and educational programs. To assess if tick-borne disease related information is reaching Delawareans through these programs, DPH in collaboration with Delaware State University administered an anonymous survey to 1755 participants in all three of Delaware counties during May 2017. The questionnaire assessed individuals' general knowledge about tick-borne diseases and performance of selected tick-borne disease prevention methods Overall, participants' knowledge of tick-borne diseases was poor; only 38.4% of respondents stated that ticks were problematic in Delaware and only 12.7% of respondents "strongly agreed" that Lyme disease is a problem in Delaware. A little over half of the respondents (51.6%) indicated having seen advertisements/infomercials/flyers for protection from ticks or the disease agents spread by ticks; the most common places for viewing these advertisements were doctor's offices and through social media. The reported frequency of performing preventive behaviors was variable and disparities were observed by age, race, gender and county of residence. Existing public health communication efforts on tick-borne diseases in Delaware do not appear to be having the desired effect. This study provides important baseline information to rethink communication channels for education and more effectively guide future tick-borne disease awareness campaigns.

Vancomycin-Resistant Staphylococcus aureus - Delaware, 2015.

Vancomycin-resistant Staphylococcus aureus (VRSA) is a rare, multidrug-resistant bacterium of public health concern that emerged in the United States in 2002. VRSA (S. aureus with vancomycin minimum inhibitory concentration [MIC] ≥16 µg/mL) arises when vancomycin resistance genes (e.g., the vanA operon, which codes for enzymes that result in modification or elimination of the vancomycin binding site) from vancomycin-resistant enterococci (VRE) are transferred to S. aureus (1). To date, all VRSA strains have arisen from methicillin-resistant S. aureus (MRSA). The fourteenth VRSA isolate (VRSA 14) identified in the United States was reported to CDC in February 2015.

Report of the 13th vancomycin-resistant Staphylococcus aureus isolate from the United States.

Vancomycin-resistant Staphylococcus aureus (VRSA), an important multidrug-resistant organism of public health concern, has been infrequently identified in the United States since 2002. All previous VRSA isolates belonged to clonal complex 5, a lineage associated primarily with health care. This report describes the most recent (13th) U.S. VRSA isolate, the first to be community associated.

H1N1 2009 influenza virus infection during pregnancy in the USA.

BACKGROUND: Pandemic H1N1 2009 influenza virus has been identified as the cause of a widespread outbreak of febrile respiratory infection in the USA and worldwide. We summarised cases of infection with pandemic H1N1 virus in pregnant women identified in the USA during the first month of the present outbreak, and deaths associated with this virus during the first 2 months of the outbreak. METHODS: After initial reports of infection in pregnant women, the US Centers for Disease Control and Prevention (CDC) began systematically collecting additional information about cases and deaths in pregnant women in the USA with pandemic H1N1 virus infection as part of enhanced surveillance. A confirmed case was defined as an acute respiratory illness with laboratory-confirmed pandemic H1N1 virus infection by real-time reverse-transcriptase PCR or viral culture; a probable case was defined as a person with an acute febrile respiratory illness who was positive for influenza A, but negative for H1 and H3. We used population estimates derived from the 2007 census data to calculate rates of admission to hospital and illness. FINDINGS: From April 15 to May 18, 2009, 34 confirmed or probable cases of pandemic H1N1 in pregnant women were reported to CDC from 13 states. 11 (32%) women were admitted to hospital. The estimated rate of admission for pandemic H1N1 influenza virus infection in pregnant women during the first month of the outbreak was higher than it was in the general population (0.32 per 100 000 pregnant women, 95% CI 0.13-0.52 vs 0.076 per 100 000 population at risk, 95% CI 0.07-0.09). Between April 15 and June 16, 2009, six deaths in pregnant women were reported to the CDC; all were in women who had developed pneumonia and subsequent acute respiratory distress syndrome requiring mechanical ventilation. INTERPRETATION: Pregnant women might be at increased risk for complications from pandemic H1N1 virus infection. These data lend support to the present recommendation to promptly treat pregnant women with H1N1 influenza virus infection with anti-influenza drugs. FUNDING: US CDC.