Coccidioidomycosis in a State Where It Is Not Known To Be Endemic - Missouri, 2004-2013.

During 1998‒2012, coccidioidomycosis cases increased nationally nearly eightfold. To describe the epidemiology of coccidioidomycosis in Missouri, a state without endemic coccidioidomycosis, coccidioidomycosis surveillance data during 2004-2013 at the Missouri Department of Health and Senior Services were retrospectively reviewed. The incidence of reported coccidioidomycosis increased from 0.05 per 100,000 population in 2004 to 0.28 per 100,000 in 2013, with cases distributed throughout all regions of Missouri. Persons aged >60 years were most affected. In cases in which patients had disease manifestations, the most common were pneumonia (37%) and influenza-like illness (31%). Nearly half (48%) of patients had traveled to an area where coccidioidomycosis is endemic, whereas approximately one-quarter (26%) of patients did not report such travel. Those with history of travel to endemic areas were significantly more likely to receive a diagnosis by positive culture or polymerase chain reaction (PCR) testing, compared with those without a history of travel to endemic areas, who were more likely to receive a diagnosis by serological tests. Additional studies will be required to ascertain whether truly endemic cases exist in Missouri.

Transmission risk factors and treatment of pediatric shigellosis during a large daycare center-associated outbreak of multidrug resistant Shigella sonnei: implications for the management of shigellosis outbreaks among children.

BACKGROUND: Shigellosis outbreaks in daycare centers result in substantial disease and economic burdens in the United States. The emergence of multidrug resistant Shigella strains raises questions regarding control of transmission within daycare centers and treatment for children. From May to October 2005, 639 Shigella sonnei cases were reported in northwest Missouri, mostly among persons exposed to daycare centers. METHODS: We conducted a case-control investigation among licensed daycare centers (LDCs) in northwest Missouri to determine transmission risk factors, tested isolates for antimicrobial resistance, and described treatment practices. Case LDCs had secondary attack rates of shigellosis>or=2% (range, 2%-25%) and control LDCsor=1 sink in every room (odds ratio [OR]: 0.1; 95% confidence interval [CI]: 0.02-0.5) or a diapering station in every room (OR: 0.1; 95% CI: 0.01-0.6) were less likely to be case-LDCs. Resistance to ampicillin and trimethoprim-sulfamethoxazole was found in 90% of the outbreak strains. Among 210 children treated with antimicrobial agents, azithromycin was used in 92 (44%) while a fluoroquinolone was used in 11 (5%) children. CONCLUSIONS: During a large daycare center-associated shigellosis outbreak, strains were highly resistant to ampicillin and trimethoprim-sulfamethoxazole. Children were frequently treated with azithromycin and occasionally fluoroquinolones. Appropriate handwashing and diapering infrastructure are necessary to minimize spread of shigellosis within daycare centers, and could reduce use of antimicrobial agents.

Case-control study of vaccination history in relation to pertussis risk during an outbreak among school students.

BACKGROUND: Between September and December 2003, an outbreak of pertussis occurred in Cass County, MO, mostly among adolescent school children. METHODS: We conducted a 1:2 matched case-control study among school children and used conditional logistic regression to evaluate risk factors for pertussis, including the total number of vaccine doses received, age at administration of each dose of vaccine and the type of vaccine (whole cell or acellular). RESULTS: Of all 127 pertussis cases reported in this outbreak, the majority were adolescents (10-19 years of age, 50%) and adults (20 years or older, 22%); only 10% were infants and children less than 5 years of age. Because the focus of our investigation was on school-aged children, we enrolled 237 students (79 cases and 158 controls) in our study. Students missing at least one dose of the vaccine had higher risk for pertussis than those who received all 5 doses (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.17-4.77). Early administration of the fifth dose of the vaccine at age 4 years was significantly associated with risk for pertussis compared with vaccination at age 5 years (adjusted OR, 2.45; 95% CI, 1.16-5.16). A short time interval (<36 months) between the fourth and fifth doses of the vaccine also tended to increase the risk for pertussis, although this association was not statistically significant. The type of vaccine was not a significant risk factor. CONCLUSION: Administering all 5 doses of pertussis vaccine and the fifth dose at age 5 years with at least 36 months between the fourth and fifth doses provided the best protection against pertussis among children and adolescents in this outbreak.