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1.
MMWR Morb Mortal Wkly Rep ; 69(1): 14-19, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31917783

RESUMO

On August 1, 2018, the Democratic Republic of the Congo (DRC) declared its 10th Ebola virus disease (Ebola) outbreak in an area with a high volume of cross-border population movement to and from neighboring countries. The World Health Organization (WHO) designated Rwanda, South Sudan, and Uganda as the highest priority countries for Ebola preparedness because of the high risk for cross-border spread from DRC (1). Countries might base their disease case definitions on global standards; however, historical context and perceived risk often affect why countries modify and adapt definitions over time, moving toward or away from regional harmonization. Discordance in case definitions among countries might reduce the effectiveness of cross-border initiatives during outbreaks with high risk for regional spread. CDC worked with the ministries of health (MOHs) in DRC, Rwanda, South Sudan, and Uganda to collect MOH-approved Ebola case definitions used during the first 6 months of the outbreak to assess concordance (i.e., commonality in category case definitions) among countries. Changes in MOH-approved Ebola case definitions were analyzed, referencing the WHO standard case definition, and concordance among the four countries for Ebola case categories (i.e., community alert, suspected, probable, confirmed, and case contact) was assessed at three dates (2). The number of country-level revisions ranged from two to four, with all countries revising Ebola definitions by February 2019 after a December 2018 peak in incidence in DRC. Case definition complexity increased over time; all countries included more criteria per category than the WHO standard definition did, except for the "case contact" and "confirmed" categories. Low case definition concordance and lack of awareness of regional differences by national-level health officials could reduce effectiveness of cross-border communication and collaboration. Working toward regional harmonization or considering systematic approaches to addressing country-level differences might increase efficiency in cross-border information sharing.


Assuntos
Surtos de Doenças , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/epidemiologia , Vigilância em Saúde Pública/métodos , República Democrática do Congo/epidemiologia , Humanos , Ruanda/epidemiologia , Sudão do Sul/epidemiologia , Fatores de Tempo , Uganda/epidemiologia
2.
J Infect Dis ; 2019 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-31758182

RESUMO

BACKGROUND: The relationships between socioeconomic status (SES) and domestically-acquired salmonellosis and leading Salmonella serotypes are poorly understood. METHODS: We analyzed surveillance data from laboratory-confirmed cases of salmonellosis from 2010-2016 for all 10 Foodborne Disease Active Surveillance Network (FoodNet) sites, having a catchment population of 47.9 million. Case-residential data were geocoded, linked to census tract poverty (CTP) level, then categorized into four CTP-level groups. After excluding those reporting international travel before illness onset, age-specific and age-adjusted salmonellosis incidence rates were calculated for each CTP level, overall and for each of the 10 leading serotypes. RESULTS: Of 52,821 (>96%) geocodable Salmonella infections, 48,111 (91.1%) were domestically-acquired. Higher age-adjusted incidence occurred with higher CTP level (p<0.001, relative risk (RR) for highest (>20%) compared to lowest (<5%) CTP group = 1.37). Children <5 years had the highest RR (2.07). While this relationship was consistent by race/ethnicity and by serotype, it was not present in five FoodNet sites or among those 18-49 years. CONCLUSION: Children and older adults living in higher CTP have had a higher incidence of domestically-acquired salmonellosis. There is a need to understand SES differences for risk factors for domestically-acquired salmonellosis by age group and FoodNet site to help focus prevention efforts.

4.
MMWR Morb Mortal Wkly Rep ; 68(16): 369-373, 2019 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-31022166

RESUMO

Foodborne diseases represent a major health problem in the United States. The Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program monitors cases of laboratory-diagnosed infection caused by eight pathogens transmitted commonly through food in 10 U.S. sites.* This report summarizes preliminary 2018 data and changes since 2015. During 2018, FoodNet identified 25,606 infections, 5,893 hospitalizations, and 120 deaths. The incidence of most infections is increasing, including those caused by Campylobacter and Salmonella, which might be partially attributable to the increased use of culture-independent diagnostic tests (CIDTs). The incidence of Cyclospora infections increased markedly compared with 2015-2017, in part related to large outbreaks associated with produce (1). More targeted prevention measures are needed on produce farms, food animal farms, and in meat and poultry processing establishments to make food safer and decrease human illness.


Assuntos
Surtos de Doenças , Microbiologia de Alimentos/estatística & dados numéricos , Parasitologia de Alimentos/estatística & dados numéricos , Doenças Transmitidas por Alimentos/epidemiologia , Vigilância em Saúde Pública , Testes Diagnósticos de Rotina/estatística & dados numéricos , Humanos , Incidência , Estados Unidos/epidemiologia
5.
Foodborne Pathog Dis ; 15(11): 726-733, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30192164

RESUMO

Chicken liver has been implicated in several reported U.S. illness outbreaks, probably caused by inadequate cooking and pathogen contamination. To identify commonalities among these outbreaks that could represent targets for prevention, we describe chicken liver-associated U.S. outbreaks during 2000-2016 reported to the Food Safety and Inspection Service, to the Centers for Disease Control and Prevention, and in published literature. We identified 28 outbreaks (23 [82.1%] were campylobacteriosis only, 3 [10.7%] were salmonellosis only, and 2 [7.1%] were caused by both pathogens), with 18 (64.3%) occurring during 2014-2016. Common outbreak features included blended chicken liver dishes (e.g., pâté; 24 [85.7%]), inadequate cooking (26 [92.8%]), and preparation in foodservice settings (e.g., sit-down restaurants; 25 [89.3%]). The increasing frequency of reported outbreaks highlights chicken liver as an important food safety problem. Public health partners should collaborate on prevention measures, including education on proper foodservice preparation of blended chicken liver dishes.


Assuntos
Infecções por Campylobacter/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Doenças Transmitidas por Alimentos/epidemiologia , Fígado/microbiologia , Carne/microbiologia , Intoxicação Alimentar por Salmonella/epidemiologia , Animais , Galinhas/microbiologia , Culinária , Contaminação de Alimentos , Doenças Transmitidas por Alimentos/etiologia , Humanos , Restaurantes , Estados Unidos/epidemiologia
6.
MMWR Morb Mortal Wkly Rep ; 67(37): 1032-1035, 2018 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-30235182

RESUMO

Campylobacter causes an estimated 1.3 million diarrheal illnesses in the United States annually (1). In August 2017, the Florida Department of Health notified CDC of six Campylobacter jejuni infections linked to company A, a national pet store chain based in Ohio. CDC examined whole-genome sequencing (WGS) data and identified six isolates from company A puppies in Florida that were highly related to an isolate from a company A customer in Ohio. This information prompted a multistate investigation by local and state health and agriculture departments and CDC to identify the outbreak source and prevent additional illness. Health officials from six states visited pet stores to collect puppy fecal samples, antibiotic records, and traceback information. Nationally, 118 persons, including 29 pet store employees, in 18 states were identified with illness onset during January 5, 2016-February 4, 2018. In total, six pet store companies were linked to the outbreak. Outbreak isolates were resistant by antibiotic susceptibility testing to all antibiotics commonly used to treat Campylobacter infections, including macrolides and quinolones. Store record reviews revealed that among 149 investigated puppies, 142 (95%) received one or more courses of antibiotics, raising concern that antibiotic use might have led to development of resistance. Public health authorities issued infection prevention recommendations to affected pet stores and recommendations for testing puppies to veterinarians. This outbreak demonstrates that puppies can be a source of multidrug-resistant Campylobacter infections in humans, warranting a closer look at antimicrobial use in the commercial dog industry.


Assuntos
Infecções por Campylobacter/epidemiologia , Campylobacter jejuni/efeitos dos fármacos , Surtos de Doenças , Cães/microbiologia , Farmacorresistência Bacteriana Múltipla , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Infecções por Campylobacter/tratamento farmacológico , Infecções por Campylobacter/prevenção & controle , Campylobacter jejuni/isolamento & purificação , Criança , Pré-Escolar , Busca de Comunicante , Surtos de Doenças/prevenção & controle , Fezes/microbiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem , Zoonoses
7.
Int J Epidemiol ; 47(5): 1613-1622, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-29562259

RESUMO

Background: Culture-independent diagnostic tests (CIDTs) are increasingly used to diagnose Campylobacter infection in the Foodborne Diseases Active Surveillance Network (FoodNet). Because CIDTs have different performance characteristics compared with culture, which has been used historically and is still used to diagnose campylobacteriosis, adjustment of cases diagnosed by CIDT is needed to compare with culture-confirmed cases for monitoring incidence trends. Methods: We identified the necessary parameters for CIDT adjustment using culture as the gold standard, and derived formulas to calculate positive predictive values (PPVs). We conducted a literature review and meta-analysis to examine the variability in CIDT performance and Campylobacter prevalence applicable to FoodNet sites. We then developed a Monte Carlo method to estimate test-type and site-specific PPVs with their associated uncertainties. Results: The uncertainty in our estimated PPVs was largely derived from uncertainty about the specificity of CIDTs and low prevalence of Campylobacter in tested samples. Stable CIDT-adjusted incidences of Campylobacter cases from 2012 to 2015 were observed compared with a decline in culture-confirmed incidence. Conclusions: We highlight the lack of data on the total numbers of tested samples as one of main limitations for CIDT adjustment. Our results demonstrate the importance of adjusting CIDTs for understanding trends in Campylobacter incidence in FoodNet.


Assuntos
Infecções por Campylobacter/epidemiologia , Campylobacter/isolamento & purificação , Testes Diagnósticos de Rotina , Doenças Transmitidas por Alimentos/epidemiologia , Modelos Estatísticos , Microbiologia de Alimentos , Previsões , Humanos , Vigilância da População/métodos , Valor Preditivo dos Testes , Estados Unidos/epidemiologia
8.
MMWR Morb Mortal Wkly Rep ; 67(11): 324-328, 2018 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-29565841

RESUMO

Despite ongoing food safety measures in the United States, foodborne illness continues to be a substantial health burden. The 10 U.S. sites of the Foodborne Diseases Active Surveillance Network (FoodNet)* monitor cases of laboratory-diagnosed infections caused by nine pathogens transmitted commonly through food. This report summarizes preliminary 2017 data and describes changes in incidence since 2006. In 2017, FoodNet reported 24,484 infections, 5,677 hospitalizations, and 122 deaths. Compared with 2014-2016, the 2017 incidence of infections with Campylobacter, Listeria, non-O157 Shiga toxin-producing Escherichia coli (STEC), Yersinia, Vibrio, and Cyclospora increased. The increased incidences of pathogens for which testing was previously limited might have resulted from the increased use and sensitivity of culture-independent diagnostic tests (CIDTs), which can improve incidence estimates (1). Compared with 2006-2008, the 2017 incidence of infections with Salmonella serotypes Typhimurium and Heidelberg decreased, and the incidence of serotypes Javiana, Infantis, and Thompson increased. New regulatory requirements that include enhanced testing of poultry products for Salmonella† might have contributed to the decreases. The incidence of STEC O157 infections during 2017 also decreased compared with 2006-2008, which parallels reductions in isolations from ground beef.§ The declines in two Salmonella serotypes and STEC O157 infections provide supportive evidence that targeted control measures are effective. The marked increases in infections caused by some Salmonella serotypes provide an opportunity to investigate food and nonfood sources of infection and to design specific interventions.


Assuntos
Microbiologia de Alimentos , Parasitologia de Alimentos , Doenças Transmitidas por Alimentos/epidemiologia , Vigilância da População , Doenças Transmitidas por Alimentos/microbiologia , Doenças Transmitidas por Alimentos/parasitologia , Humanos , Incidência , Estados Unidos/epidemiologia
9.
Clin Infect Dis ; 65(10): 1624-1631, 2017 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-29020144

RESUMO

Background: Campylobacteriosis, a leading cause of foodborne illness in the United States, was not nationally notifiable until 2015. Data describing national patterns and trends are limited. We describe the epidemiology of Campylobacter infections in the United States during 2004-2012. Methods: We summarized laboratory-confirmed campylobacteriosis data from the Nationally Notifiable Disease Surveillance System, National Outbreak Reporting System, National Antimicrobial Resistance Monitoring System, and Foodborne Diseases Active Surveillance Network. Results: During 2004-2012, 303520 culture-confirmed campylobacteriosis cases were reported. Average annual incidence rate (IR) was 11.4 cases/100000 persons, with substantial variation by state (range, 3.1-47.6 cases/100000 persons). IRs among patients aged 0-4 years were more than double overall IRs. IRs were highest among males in all age groups. IRs in western states and rural counties were higher (16.2/100000 and 14.2/100000, respectively) than southern states and metropolitan counties (6.8/100000 and 11.0/100000, respectively). Annual IRs increased 21% from 10.5/100000 during 2004-2006 to 12.7/100000 during 2010-2012, with the greatest increases among persons aged >60 years (40%) and in southern states (32%). The annual median number of Campylobacter outbreaks increased from 28 in 2004-2006 to 56 in 2010-2012; in total, 347 were reported. Antimicrobial susceptibility testing of isolates from 4793 domestic and 1070 travel-associated infections revealed that, comparing 2004-2009 to 2010-2012, ciprofloxacin resistance increased among domestic infections (12.8% vs 16.1%). Conclusions: During 2004-2012, incidence of campylobacteriosis, outbreaks, and clinically significant antimicrobial resistance increased. Marked demographic and geographic differences exist. Our findings underscore the importance of national surveillance and understanding of risk factors to guide and target control measures.


Assuntos
Antibacterianos/farmacologia , Infecções por Campylobacter , Campylobacter/efeitos dos fármacos , Surtos de Doenças/estatística & dados numéricos , Farmacorresistência Bacteriana , Vigilância em Saúde Pública , Adolescente , Adulto , Infecções por Campylobacter/epidemiologia , Infecções por Campylobacter/microbiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
10.
MMWR Morb Mortal Wkly Rep ; 66(15): 397-403, 2017 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-28426643

RESUMO

Foodborne diseases represent a substantial public health concern in the United States. CDC's Foodborne Diseases Active Surveillance Network (FoodNet) monitors cases reported from 10 U.S. sites* of laboratory-diagnosed infections caused by nine enteric pathogens commonly transmitted through food. This report describes preliminary surveillance data for 2016 on the nine pathogens and changes in incidences compared with 2013-2015. In 2016, FoodNet identified 24,029 infections, 5,512 hospitalizations, and 98 deaths caused by these pathogens. The use of culture-independent diagnostic tests (CIDTs) by clinical laboratories to detect enteric pathogens has been steadily increasing since FoodNet began surveying clinical laboratories in 2010 (1). CIDTs complicate the interpretation of FoodNet surveillance data because pathogen detection could be affected by changes in health care provider behaviors or laboratory testing practices (2). Health care providers might be more likely to order CIDTs because these tests are quicker and easier to use than traditional culture methods, a circumstance that could increase pathogen detection (3). Similarly, pathogen detection could also be increasing as clinical laboratories adopt DNA-based syndromic panels, which include pathogens not often included in routine stool culture (4,5). In addition, CIDTs do not yield isolates, which public health officials rely on to distinguish pathogen subtypes, determine antimicrobial resistance, monitor trends, and detect outbreaks. To obtain isolates for infections identified by CIDTs, laboratories must perform reflex culture†; if clinical laboratories do not, the burden of culturing falls to state public health laboratories, which might not be able to absorb that burden as the adoption of these tests increases (2). Strategies are needed to preserve access to bacterial isolates for further characterization and to determine the effect of changing trends in testing practices on surveillance.


Assuntos
Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/estatística & dados numéricos , Microbiologia de Alimentos , Parasitologia de Alimentos , Doenças Transmitidas por Alimentos/diagnóstico , Doenças Transmitidas por Alimentos/epidemiologia , Vigilância da População , Técnicas de Cultura/estatística & dados numéricos , Humanos , Incidência , Estados Unidos/epidemiologia
11.
Clin Infect Dis ; 66(suppl_1): S82-S84, 2017 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-29293929

RESUMO

We describe a botulism outbreak involving 4 Middle Eastern men complicated by delayed diagnosis, ambiguous epidemiologic links among patients, and illness onset dates inconsistent with a point-source exposure. Homemade turshi, a fermented vegetable dish, was the likely cause. Patients ate turshi at 2 locations on different days over 1 month.


Assuntos
Botulismo/diagnóstico , Botulismo/epidemiologia , Diagnóstico Tardio , Surtos de Doenças , Emigrantes e Imigrantes , Adulto , Botulismo/etiologia , Características Culturais , Humanos , Masculino , Texas/epidemiologia , Adulto Jovem
12.
Vector Borne Zoonotic Dis ; 16(3): 191-8, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26855300

RESUMO

Serum samples from 295 employees of Great Smoky Mountains National Park (GRSM), Rocky Mountain National Park (ROMO), and Grand Teton National Park with adjacent Bridger-Teton National Forest (GRTE-BTNF) were subjected to serological analysis for mosquito-borne bunyaviruses. The sera were analyzed for neutralizing antibodies against six orthobunyaviruses: La Crosse virus (LACV), Jamestown Canyon virus (JCV), snowshoe hare virus (SSHV), California encephalitis virus, and Trivittatus virus (TVTV) belonging to the California serogroup and Cache Valley virus (CVV) belonging to the Bunyamwera serogroup. Sera were also tested for immunoglobulin (Ig) G antibodies against LACV and JCV by enzyme-linked immunosorbent assay (ELISA). The proportion of employees with neutralizing antibodies to any California serogroup bunyavirus was similar in all three sites, with the prevalence ranging from 28% to 36%. The study demonstrated a seroprevalence of 3% to CVV across the three parks. However, proportions of persons with antibodies to specific viruses differed between parks. Participants residing in the eastern regions had a higher seroprevalence to LACV, with 24% (18/75) GRSM employees being seropositive. In contrast, SSHV seroprevalence was limited to employees from the western sites, with 1.7% (1/60) ROMO and 3.8% (6/160) GRTE-BTNF employees being positive. Seroprevalence to JCV was noted in employees from all sites at rates of 6.7% in GRSM, 21.7% in ROMO, and 15.6% in GRTE-BTNF. One employee each from ROMO (1.7%) and GRTE-BTNF (1.9%) were positive for TVTV. This study also has illustrated the greater sensitivity and specificity of plaque reduction neutralization test compared to IgG ELISA in conducting serosurveys for LACV and JCV.


Assuntos
Anticorpos Antivirais/sangue , Infecções por Bunyaviridae/epidemiologia , Culicidae/virologia , Insetos Vetores/virologia , Orthobunyavirus/imunologia , Animais , Infecções por Bunyaviridae/virologia , Colorado/epidemiologia , Reações Cruzadas , Ensaio de Imunoadsorção Enzimática , Florestas , Empregados do Governo , Imunoglobulina G/sangue , Testes de Neutralização , North Carolina/epidemiologia , Orthobunyavirus/isolamento & purificação , Parques Recreativos , Sensibilidade e Especificidade , Estudos Soroepidemiológicos , Tennessee/epidemiologia , Wyoming/epidemiologia
13.
MMWR Morb Mortal Wkly Rep ; 64(14): 399, 2015 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-25879900

RESUMO

On January 8, 2014, the Ohio Department of Health notified the Oregon Public Health Division (OPHD) of campylobacteriosis in two Ohio residents recently returned from Oregon. The travelers reported consuming chicken liver pâté* at an Oregon restaurant. On January 10, OPHD received additional reports of campylobacteriosis in two persons who had consumed chicken liver pâté at another Oregon restaurant. Campylobacter jejuni was isolated in cultures of fecal specimens from three patients. OPHD investigated to determine the sources of the illnesses and to institute preventive measures.


Assuntos
Infecções por Campylobacter/epidemiologia , Campylobacter jejuni/isolamento & purificação , Surtos de Doenças , Microbiologia de Alimentos , Doenças Transmitidas por Alimentos/epidemiologia , Carne/microbiologia , Animais , Infecções por Campylobacter/microbiologia , Galinhas , Culinária , Fezes/microbiologia , Doenças Transmitidas por Alimentos/microbiologia , Humanos , Fígado , Ohio/epidemiologia , Oregon/epidemiologia , Restaurantes
14.
Clin Infect Dis ; 60(11): 1659-66, 2015 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-25697742

RESUMO

BACKGROUND: Rocky Mountain spotted fever (RMSF) is a disease that now causes significant morbidity and mortality on several American Indian reservations in Arizona. Although the disease is treatable, reported RMSF case fatality rates from this region are high (7%) compared to the rest of the nation (<1%), suggesting a need to identify clinical points for intervention. METHODS: The first 205 cases from this region were reviewed and fatal RMSF cases were compared to nonfatal cases to determine clinical risk factors for fatal outcome. RESULTS: Doxycycline was initiated significantly later in fatal cases (median, day 7) than nonfatal cases (median, day 3), although both groups of case patients presented for care early (median, day 2). Multiple factors increased the risk of doxycycline delay and fatal outcome, such as early symptoms of nausea and diarrhea, history of alcoholism or chronic lung disease, and abnormal laboratory results such as elevated liver aminotransferases. Rash, history of tick bite, thrombocytopenia, and hyponatremia were often absent at initial presentation. CONCLUSIONS: Earlier treatment with doxycycline can decrease morbidity and mortality from RMSF in this region. Recognition of risk factors associated with doxycycline delay and fatal outcome, such as early gastrointestinal symptoms and a history of alcoholism or chronic lung disease, may be useful in guiding early treatment decisions. Healthcare providers should have a low threshold for initiating doxycycline whenever treating febrile or potentially septic patients from tribal lands in Arizona, even if an alternative diagnosis seems more likely and classic findings of RMSF are absent.


Assuntos
Doenças Endêmicas , Febre Maculosa das Montanhas Rochosas/epidemiologia , Febre Maculosa das Montanhas Rochosas/patologia , Animais , Feminino , Humanos , Masculino
15.
Clin Infect Dis ; 60(11): 1650-8, 2015 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-25697743

RESUMO

BACKGROUND: Rocky Mountain spotted fever (RMSF) has emerged as a significant cause of morbidity and mortality since 2002 on tribal lands in Arizona. The explosive nature of this outbreak and the recognition of an unexpected tick vector, Rhipicephalus sanguineus, prompted an investigation to characterize RMSF in this unique setting and compare RMSF cases to similar illnesses. METHODS: We compared medical records of 205 patients with RMSF and 175 with non-RMSF illnesses that prompted RMSF testing during 2002-2011 from 2 Indian reservations in Arizona. RESULTS: RMSF cases in Arizona occurred year-round and peaked later (July-September) than RMSF cases reported from other US regions. Cases were younger (median age, 11 years) and reported fever and rash less frequently, compared to cases from other US regions. Fever was present in 81% of cases but not significantly different from that in patients with non-RMSF illnesses. Classic laboratory abnormalities such as low sodium and platelet counts had small and subtle differences between cases and patients with non-RMSF illnesses. Imaging studies reflected the variability and complexity of the illness but proved unhelpful in clarifying the early diagnosis. CONCLUSIONS: RMSF epidemiology in this region appears different than RMSF elsewhere in the United States. No specific pattern of signs, symptoms, or laboratory findings occurred with enough frequency to consistently differentiate RMSF from other illnesses. Due to the nonspecific and variable nature of RMSF presentations, clinicians in this region should aggressively treat febrile illnesses and sepsis with doxycycline for suspected RMSF.


Assuntos
Doenças Endêmicas , Febre Maculosa das Montanhas Rochosas/epidemiologia , Febre Maculosa das Montanhas Rochosas/patologia , Adolescente , Adulto , Idoso , Animais , Antibacterianos/uso terapêutico , Arizona/epidemiologia , Criança , Pré-Escolar , Diagnóstico Diferencial , Testes Diagnósticos de Rotina , Doxiciclina/uso terapêutico , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Febre Maculosa das Montanhas Rochosas/diagnóstico , Febre Maculosa das Montanhas Rochosas/tratamento farmacológico , Adulto Jovem
16.
MMWR Morb Mortal Wkly Rep ; 64(3): 58-60, 2015 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-25632952

RESUMO

Tickborne relapsing fever (TBRF) is a zoonosis caused by spirochetes of the genus Borrelia and transmitted to humans by ticks of the genus Ornithodoros. TBRF is endemic in the western United States, predominately in mountainous regions. Clinical illness is characterized by recurrent bouts of fever, headache, and malaise. Although TBRF is usually a mild illness, severe sequelae and death can occur. This report summarizes the epidemiology of 504 TBRF cases reported from 12 western states during 1990-2011. Cases occurred most commonly among males and among persons aged 10‒14 and 40‒44 years. Most reported infections occurred among nonresident visitors to areas where TBRF is endemic. Clinicians and public health practitioners need to be familiar with current epidemiology and features of TBRF to adequately diagnose and treat patients and recognize that any TBRF case might indicate an ongoing source of potential exposure that needs to be investigated and eliminated.


Assuntos
Borrelia/isolamento & purificação , Doenças Endêmicas , Ornithodoros , Febre Recorrente/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Febre Recorrente/diagnóstico , Estados Unidos/epidemiologia , Adulto Jovem
17.
Vector Borne Zoonotic Dis ; 14(9): 675-80, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25229706

RESUMO

BACKGROUND: Colorado tick fever (CTF) is an underreported tick-borne viral disease occurring in the western United States. CTF illness includes fever, headache, and severe myalgia lasting for weeks. Wyoming has one of the highest CTF incidence rates with approximately 30% of infected persons reporting tick exposure in a Wyoming National Park or Forest before symptom onset. We assessed CTF virus infections among humans and Dermacentor andersoni ticks in Grand Teton National Park (GRTE) and Bridger-Teton National Forest (BTNF). METHODS: In June of 2010, 526 eligible employees were approached to participate in a baseline and 3-month follow-up serosurvey and risk behavior survey. Seropositivity was defined as antibody titers against CTF virus ≥10, as measured by the plaque reduction neutralization test. Ticks were collected at 27 sites within GRTE/BTNF and tested by RT-PCR for the CTF virus. RESULTS: A total of 126 (24%) employees participated in the baseline and follow-up study visits. Three (2%) employees were seropositive for CTF virus infection at baseline. During the study, 47 (37%) participants found unattached ticks on themselves, and 12 (10%) found attached ticks; however, no participants seroconverted against CTF virus. Walking through sagebrush (p=0.04) and spending time at ≥7000 feet elevation (p<0.01) were significantly associated with tick exposure. Ninety-nine percent (174/176) of ticks were D. andersoni, and all were found at ≥7000 feet elevation in sagebrush areas; 37 (21%) ticks tested positive for CTF virus and were found at 10 (38%) of 26 sites sampled. CONCLUSIONS: Although no GRTE or BTNF employees were infected with CTF virus during the study period, high rates of infected ticks were identified in areas with sagebrush at ≥7000 feet. CTF education and personal protection measures against tick exposure should be targeted to visitors and employees traveling to the high-risk environs identified in this study.


Assuntos
Anticorpos Antivirais/sangue , Febre do Carrapato do Colorado/epidemiologia , Vírus da Febre do Carrapato do Colorado/imunologia , Dermacentor/virologia , Adulto , Idoso , Animais , Febre do Carrapato do Colorado/virologia , Vírus da Febre do Carrapato do Colorado/isolamento & purificação , Feminino , Seguimentos , Florestas , Humanos , Masculino , Pessoa de Meia-Idade , Wyoming/epidemiologia , Adulto Jovem
18.
J Sch Nurs ; 30(5): 332-9, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24407317

RESUMO

During 2010-2011, varicella vaccination was an added requirement for school entrance in Wyoming. Vaccination exemption rates were compared during the 2009-2010 and 2011-2012 school years, and impacts of implementing a new childhood vaccine requirement were evaluated. All public schools, grades K-12, were required to report vaccination status of enrolled children for the 2009-2010 and 2011-2012 school years to the Wyoming Department of Health. Exemption data were analyzed by exemption category, vaccine, county, grade, and rurality. The proportion of children exempt for ≥ 1 vaccine increased from 1.2% (1,035/87,398) during the 2009-2010 school year to 1.9% (1,678/89,476) during 2011-2012. In 2011, exemptions were lowest (1.5%) in urban areas and highest (2.6%) in the most rural areas, and varicella vaccine exemptions represented 67.1% (294/438) of single vaccination exemptions. Implementation of a new vaccination requirement for school admission led to an increased exemption rate across Wyoming.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Programas de Imunização/estatística & dados numéricos , População Rural/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Wyoming
19.
J Infect Dis ; 206 Suppl 1: S87-93, 2012 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-23169978

RESUMO

BACKGROUND: To assess the epidemiology and seasonality of influenza in Uganda, we established a sentinel surveillance system for influenza in 5 hospitals and 5 outpatient clinics in 4 geographically distinct regions, using standard case definitions for influenzalike illness (ILI) and severe acute respiratory illness (SARI). METHODS: Nasopharyngeal and oropharyngeal specimens were collected from April 2007 through September 2010 from patients with ILI and SARI aged ≥ 2 months, tested for influenza A and B with real-time reverse-transcription polymerase chain reaction, and subtyped for seasonal A/H1, A/H3, A/H5, and 2009 pandemic influenza A (pH1N1). RESULTS: Among the 2758 patients sampled, 2656 (96%) enrolled with ILI and 101 (4%) with SARI. Specimens from 359 (13.0%) were positive for influenza; 267 (74.4%) were influenza A, and 92 (25.6%) were influenza B. The median age of both patients with ILI and patients with SARI was 4 years (range, 2 months to 67 years); patients aged 5-14 years had the highest influenza-positive percentage (19.6%), and patients aged 0-4 years had the lowest percentage (9.1%). Influenza circulated throughout the year, but the percentage of influenza-positive specimens peaked during June-November, coinciding with the second rainy season. CONCLUSIONS: Continued and increased surveillance is needed to better understand the morbidity and mortality of influenza in Uganda.


Assuntos
Vírus da Influenza A/isolamento & purificação , Vírus da Influenza B/isolamento & purificação , Influenza Humana/epidemiologia , Influenza Humana/virologia , Adolescente , Adulto , Idoso , Instituições de Assistência Ambulatorial , Criança , Pré-Escolar , Feminino , Hospitais , Humanos , Lactente , Vírus da Influenza A/classificação , Masculino , Pessoa de Meia-Idade , Nasofaringe/virologia , Orofaringe/virologia , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Estações do Ano , Vigilância de Evento Sentinela , Uganda/epidemiologia , Adulto Jovem
20.
Infect Immun ; 79(9): 3596-606, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21768286

RESUMO

Listeria monocytogenes is a Gram-positive intracellular pathogen that is naturally resistant to lysozyme. Recently, it was shown that peptidoglycan modification by N-deacetylation or O-acetylation confers resistance to lysozyme in various Gram-positive bacteria, including L. monocytogenes. L. monocytogenes peptidoglycan is deacetylated by the action of N-acetylglucosamine deacetylase (Pgd) and acetylated by O-acetylmuramic acid transferase (Oat). We characterized Pgd(-), Oat(-), and double mutants to determine the specific role of L. monocytogenes peptidoglycan acetylation in conferring lysozyme sensitivity during infection of macrophages and mice. Pgd(-) and Pgd(-) Oat(-) double mutants were attenuated approximately 2 and 3.5 logs, respectively, in vivo. In bone-marrow derived macrophages, the mutants demonstrated intracellular growth defects and increased induction of cytokine transcriptional responses that emanated from a phagosome and the cytosol. Lysozyme-sensitive mutants underwent bacteriolysis in the macrophage cytosol, resulting in AIM2-dependent pyroptosis. Each of the in vitro phenotypes was rescued upon infection of LysM(-) macrophages. The addition of extracellular lysozyme to LysM(-) macrophages restored cytokine induction, host cell death, and L. monocytogenes growth inhibition. This surprising observation suggests that extracellular lysozyme can access the macrophage cytosol and act on intracellular lysozyme-sensitive bacteria.


Assuntos
Amidoidrolases/metabolismo , Imunidade Inata , Listeria monocytogenes/enzimologia , Listeria monocytogenes/imunologia , Muramidase/metabolismo , Transferases/metabolismo , Acetilação , Amidoidrolases/genética , Animais , Apoptose , Bacteriólise , Citocinas/biossíntese , Feminino , Listeria monocytogenes/genética , Listeria monocytogenes/crescimento & desenvolvimento , Macrófagos/imunologia , Macrófagos/metabolismo , Macrófagos/microbiologia , Camundongos , Camundongos Endogâmicos C57BL , Mutação , Peptidoglicano/imunologia , Peptidoglicano/metabolismo , Interferência de RNA , RNA Interferente Pequeno , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Transdução de Sinais , Transferases/genética
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