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1.
MMWR Morb Mortal Wkly Rep ; 71(4): 132-138, 2022 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-35085223

RESUMO

Previous reports of COVID-19 case, hospitalization, and death rates by vaccination status† indicate that vaccine protection against infection, as well as serious COVID-19 illness for some groups, declined with the emergence of the B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, and waning of vaccine-induced immunity (1-4). During August-November 2021, CDC recommended§ additional primary COVID-19 vaccine doses among immunocompromised persons and booster doses among persons aged ≥18 years (5). The SARS-CoV-2 B.1.1.529 (Omicron) variant emerged in the United States during December 2021 (6) and by December 25 accounted for 72% of sequenced lineages (7). To assess the impact of full vaccination with additional and booster doses (booster doses),¶ case and death rates and incidence rate ratios (IRRs) were estimated among unvaccinated and fully vaccinated adults by receipt of booster doses during pre-Delta (April-May 2021), Delta emergence (June 2021), Delta predominance (July-November 2021), and Omicron emergence (December 2021) periods in the United States. During 2021, averaged weekly, age-standardized case IRRs among unvaccinated persons compared with fully vaccinated persons decreased from 13.9 pre-Delta to 8.7 as Delta emerged, and to 5.1 during the period of Delta predominance. During October-November, unvaccinated persons had 13.9 and 53.2 times the risks for infection and COVID-19-associated death, respectively, compared with fully vaccinated persons who received booster doses, and 4.0 and 12.7 times the risks compared with fully vaccinated persons without booster doses. When the Omicron variant emerged during December 2021, case IRRs decreased to 4.9 for fully vaccinated persons with booster doses and 2.8 for those without booster doses, relative to October-November 2021. The highest impact of booster doses against infection and death compared with full vaccination without booster doses was recorded among persons aged 50-64 and ≥65 years. Eligible persons should stay up to date with COVID-19 vaccinations.


Assuntos
Vacinas contra COVID-19/imunologia , COVID-19/epidemiologia , COVID-19/mortalidade , COVID-19/prevenção & controle , Imunização Secundária , SARS-CoV-2/imunologia , Eficácia de Vacinas , Adulto , Idoso , Humanos , Incidência , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
2.
MMWR Morb Mortal Wkly Rep ; 67(5): 146-148, 2018 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-29420460

RESUMO

In August 2016, a local public health agency (LPHA) notified the Colorado Department of Public Health and Environment (CDPHE) of two culture-confirmed cases of Campylobacter infection among persons who consumed raw (unpasteurized) milk from the same herdshare dairy. In Colorado, the sale of raw milk is illegal; however, herdshare programs, in which a member can purchase a share of a herd of cows or goats, are legal and are not regulated by state or local authorities. In coordination with LPHAs, CDPHE conducted an outbreak investigation that identified 12 confirmed and five probable cases of Campylobacter jejuni infection. Pulsed-field gel electrophoresis (PFGE) patterns for the 10 cases with available isolates were identical using the enzyme Sma. In addition, two milk samples (one from the dairy and one obtained from an ill shareholder) also tested positive for the outbreak strain. Five C. jejuni isolates sent to CDC for antimicrobial susceptibility testing were resistant to ciprofloxacin, tetracycline, and nalidixic acid (1). Although shareholders were notified of the outbreak and cautioned against drinking the milk on multiple occasions, milk distribution was not discontinued. Although its distribution is legal through herdshare programs, drinking raw milk is inherently risky (2). The role of public health in implementing control measures associated with a product that is known to be unsafe remains undefined.


Assuntos
Infecções por Campylobacter/epidemiologia , Campylobacter jejuni/efeitos dos fármacos , Surtos de Doenças , Fluoroquinolonas/farmacologia , Microbiologia de Alimentos , Doenças Transmitidas por Alimentos/epidemiologia , Leite/microbiologia , Adolescente , Adulto , Idoso , Animais , Infecções por Campylobacter/tratamento farmacológico , Criança , Colorado/epidemiologia , Farmacorresistência Bacteriana , Feminino , Doenças Transmitidas por Alimentos/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Alimentos Crus , Adulto Jovem
3.
Clin Infect Dis ; 66(suppl_1): S92-S94, 2017 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-29293930

RESUMO

From 1976 to 2016, neurotoxigenic Clostridium baratii type F caused 18 (<0.5%) reported US infant botulism cases. Six cases occurred during 2012-2013; no common source was identified. Type F infant botulism mostly occurs in very young infants and typically presents more rapidly and severely than illness caused by types A and B botulinum neurotoxin.


Assuntos
Botulismo/epidemiologia , Clostridium botulinum tipo F , Doenças Raras/epidemiologia , Doenças Raras/microbiologia , Feminino , Humanos , Recém-Nascido , Masculino , Estados Unidos/epidemiologia
4.
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
5.
Am J Ind Med ; 60(2): 208-214, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28079280

RESUMO

BACKGROUND: After cryptosporidiosis was reported in three workers caring for preweaned calves at an academic research laboratory, we sought to identify cases, determine risk factors, and implement control measures. METHODS: A cryptosporidiosis case was defined as diarrhea duration ≥72 hr, abdominal cramps, or vomiting in an animal research laboratory worker during July 14-July 31. A confirmed case had laboratory evidence of Cryptosporidium infection. Staff were interviewed regarding illness, potential exposures, training, and personal protective equipment (PPE) standard operating procedures (SOPs). RESULTS: The cryptosporidiosis attack rate (AR) was 74% (20/27); five were laboratory-confirmed. Median job training was 2 hr including respiratory-fit testing. No SOPs existed for doffing PPE. AR for workers who removed their gloves first was 84% (16/19) compared with 20% (1/5) for workers who removed gloves last (risk ratio = 4.2; P < 0.02). CONCLUSIONS: This outbreak highlights the importance of adequate training, enforced proper PPE procedures, and promoting a culture of safety. Am. J. Ind. Med. 60:208-214, 2017. © 2017 Wiley Periodicals, Inc.


Assuntos
Criptosporidiose/diagnóstico , Pessoal de Laboratório , Doenças Profissionais/diagnóstico , Exposição Ocupacional/efeitos adversos , Pesquisadores , Adulto , Animais , Colorado , Surtos de Doenças , Feminino , Humanos , Laboratórios , Masculino , Pessoa de Meia-Idade , Saúde Ocupacional , Universidades , Adulto Jovem
6.
N Engl J Med ; 369(10): 944-53, 2013 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-24004121

RESUMO

BACKGROUND: Although new pathogen-vehicle combinations are increasingly being identified in produce-related disease outbreaks, fresh produce is a rarely recognized vehicle for listeriosis. We investigated a nationwide listeriosis outbreak that occurred in the United States during 2011. METHODS: We defined an outbreak-related case as a laboratory-confirmed infection with any of five outbreak-related subtypes of Listeria monocytogenes isolated during the period from August 1 through October 31, 2011. Multistate epidemiologic, trace-back, and environmental investigations were conducted, and outbreak-related cases were compared with sporadic cases reported previously to the Listeria Initiative, an enhanced surveillance system that routinely collects detailed information about U.S. cases of listeriosis. RESULTS: We identified 147 outbreak-related cases in 28 states. The majority of patients (127 of 147, 86%) were 60 years of age or older. Seven infections among pregnant women and newborns and one related miscarriage were reported. Of 145 patients for whom information about hospitalization was available, 143 (99%) were hospitalized. Thirty-three of the 147 patients (22%) died. Patients with outbreak-related illness were significantly more likely to have eaten cantaloupe than were patients 60 years of age or older with sporadic illness (odds ratio, 8.5; 95% confidence interval, 1.3 to ∞). Cantaloupe and environmental samples collected during the investigation yielded isolates matching all five outbreak-related subtypes, confirming that whole cantaloupe produced by a single Colorado farm was the outbreak source. Unsanitary conditions identified in the processing facility operated by the farm probably resulted in contamination of cantaloupes with L. monocytogenes. CONCLUSIONS: Raw produce, including cantaloupe, can serve as a vehicle for listeriosis. This outbreak highlights the importance of preventing produce contamination within farm and processing environments.


Assuntos
Cucumis melo/microbiologia , Surtos de Doenças , Doenças Transmitidas por Alimentos/epidemiologia , Listeria monocytogenes/isolamento & purificação , Listeriose/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Animais , Citrullus/microbiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Carne/microbiologia , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Sus scrofa , Estados Unidos/epidemiologia , Adulto Jovem
7.
MMWR Morb Mortal Wkly Rep ; 65(23): 606-7, 2016 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-27310090

RESUMO

On September 11, 2015, a single case of typhoid fever, caused by Salmonella Typhi infection, was reported to the Colorado Department of Public Health and Environment (CDPHE). Because the patient (patient A) had symptom onset September 2 and had traveled internationally for 4 days 60 days before symptom onset, the case initially was thought to be travel-associated* (1,2). On October 1, a second case of S. Typhi infection was reported in patient B, with symptom onset September 20. Patient B reported no international travel or contact with ill persons or known carriers. Patients A and B resided approximately 6 miles (10 kilometers) apart and had no discernible epidemiologic connection. Family members of patients A and B tested negative for S. Typhi. CDPHE and the Weld County Department of Public Health and Environment (WCDPHE) investigated to 1) determine whether these cases represented a larger outbreak, 2) identify common exposure sources, and 3) stop transmission. Investigators determined that the typhoid fever in both patients and in a third patient (patient C) was associated with eating in the same restaurant during a 5-day period.


Assuntos
Surtos de Doenças , Febre Tifoide/diagnóstico , Febre Tifoide/epidemiologia , Infecções Assintomáticas , Portador Sadio , Colorado/epidemiologia , Humanos , Restaurantes
8.
MMWR Morb Mortal Wkly Rep ; 65(14): 368-71, 2016 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-27077946

RESUMO

To evaluate progress toward prevention of enteric and foodborne illnesses in the United States, the Foodborne Diseases Active Surveillance Network (FoodNet) monitors the incidence of laboratory-confirmed infections caused by nine pathogens transmitted commonly through food in 10 U.S. sites. This report summarizes preliminary 2015 data and describes trends since 2012. In 2015, FoodNet reported 20,107 confirmed cases (defined as culture-confirmed bacterial infections and laboratory-confirmed parasitic infections), 4,531 hospitalizations, and 77 deaths. FoodNet also received reports of 3,112 positive culture-independent diagnostic tests (CIDTs) without culture-confirmation, a number that has markedly increased since 2012. Diagnostic testing practices for enteric pathogens are rapidly moving away from culture-based methods. The continued shift from culture-based methods to CIDTs that do not produce the isolates needed to distinguish between strains and subtypes affects the interpretation of public health surveillance data and ability to monitor progress toward prevention efforts. Expanded case definitions and strategies for obtaining bacterial isolates are crucial during this transition period.


Assuntos
Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/estatística & dados numéricos , Microbiologia 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
9.
Foodborne Pathog Dis ; 13(10): 527-534, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27526280

RESUMO

BACKGROUND: Foodborne illness is a continuing public health problem in the United States. Although outbreak-associated illnesses represent a fraction of all foodborne illnesses, foodborne outbreak investigations provide critical information on the pathogens, foods, and food-pathogen pairs causing illness. Therefore, identification of a food source in an outbreak investigation is key to impacting food safety. OBJECTIVE: The objective of this study was to systematically identify outbreak-associated case demographic and outbreak characteristics that are predictive of food sources using Shiga toxin-producing Escherichia coli (STEC) outbreaks reported to Centers for Disease Control and Prevention (CDC) from 1998 to 2014 with a single ingredient identified. MATERIALS AND METHODS: Differences between STEC food sources by all candidate predictors were assessed univariately. Multinomial logistic regression was used to build a prediction model, which was internally validated using a split-sample approach. RESULTS: There were 206 single-ingredient STEC outbreaks reported to CDC, including 125 (61%) beef outbreaks, 30 (14%) dairy outbreaks, and 51 (25%) vegetable outbreaks. The model differentiated food sources, with an overall sensitivity of 80% in the derivation set and 61% in the validation set. CONCLUSIONS: This study demonstrates the feasibility for a tool for public health professionals to rule out food sources during hypothesis generation in foodborne outbreak investigation and to improve efficiency while complementing existing methods.


Assuntos
Surtos de Doenças/história , Infecções por Escherichia coli/microbiologia , Contaminação de Alimentos , Doenças Transmitidas por Alimentos/microbiologia , Gastroenterite/microbiologia , Modelos Biológicos , Escherichia coli Shiga Toxigênica/crescimento & desenvolvimento , Animais , Centers for Disease Control and Prevention, U.S. , Laticínios/efeitos adversos , Laticínios/microbiologia , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/história , Escherichia coli O157/crescimento & desenvolvimento , Feminino , Doenças Transmitidas por Alimentos/epidemiologia , Doenças Transmitidas por Alimentos/história , Gastroenterite/epidemiologia , Gastroenterite/história , História do Século XX , História do Século XXI , Humanos , Masculino , Carne/efeitos adversos , Carne/microbiologia , Folhas de Planta/efeitos adversos , Folhas de Planta/microbiologia , Sistema de Registros , Estações do Ano , Estados Unidos/epidemiologia , Verduras/efeitos adversos , Verduras/microbiologia
10.
Emerg Infect Dis ; 21(9): 1582-8, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26291736

RESUMO

The Centers for Disease Control and Prevention Emerging Infections Program (EIP) network conducts population-based surveillance for pathogens of public health importance. Central to obtaining estimates of disease burden and tracking microbiological characteristics of these infections is accurate laboratory detection of pathogens. The use of culture-independent diagnostic tests (CIDTs) in clinical settings presents both opportunities and challenges to EIP surveillance. Because CIDTs offer better sensitivity than culture and are relatively easy to perform, their use could potentially improve estimates of disease burden. However, changes in clinical testing practices, use of tests with different sensitivities and specificities, and changes to case definitions make it challenging to monitor trends. Isolates are still needed for performing strain typing, antimicrobial resistance testing, and identifying other molecular characteristics of organisms. In this article, we outline current and future EIP activities to address issues associated with adoption of CIDTs, which may apply to other public health surveillance.


Assuntos
Controle de Doenças Transmissíveis/métodos , Doenças Transmissíveis Emergentes/diagnóstico , Testes Diagnósticos de Rotina/tendências , Técnicas Bacteriológicas , Centers for Disease Control and Prevention, U.S. , Doenças Transmissíveis Emergentes/epidemiologia , Técnicas de Cultura , Previsões , Humanos , Vigilância em Saúde Pública , Estados Unidos/epidemiologia
11.
N Engl J Med ; 366(22): 2065-73, 2012 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-22646629

RESUMO

BACKGROUND: Outbreaks of human salmonella infections are increasingly associated with contact with live poultry, but effective control measures are elusive. In 2005, a cluster of human salmonella Montevideo infections with a rare pattern on pulsed-field gel electrophoresis (the outbreak strain) was identified by PulseNet, a national subtyping network. METHODS: In cooperation with public health and animal health agencies, we conducted multistate investigations involving patient interviews, trace-back investigations, and environmental testing at a mail-order hatchery linked to the outbreak in order to identify the source of infections and prevent additional illnesses. A case was defined as an infection with the outbreak strain between 2004 and 2011. RESULTS: From 2004 through 2011, we identified 316 cases in 43 states. The median age of the patient was 4 years. Interviews were completed with 156 patients (or their caretakers) (49%), and 36 of these patients (23%) were hospitalized. Among the 145 patients for whom information was available, 80 (55%) had bloody diarrhea. Information on contact with live young poultry was available for 159 patients, and 122 of these patients (77%) reported having such contact. A mail-order hatchery in the western United States was identified in 81% of the trace-back investigations, and the outbreak strain was isolated from samples collected at the hatchery. After interventions at the hatchery, the number of human infections declined, but transmission continued. CONCLUSIONS: We identified a prolonged multistate outbreak of salmonellosis, predominantly affecting young children and associated with contact with live young poultry from a mail-order hatchery. Interventions performed at the hatchery reduced, but did not eliminate, associated human infections, demonstrating the difficulty of eliminating salmonella transmission from live poultry.


Assuntos
Galinhas/microbiologia , Surtos de Doenças , Patos/microbiologia , Serviços Postais , Doenças das Aves Domésticas/transmissão , Infecções por Salmonella/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criação de Animais Domésticos , Animais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Infecções por Salmonella/transmissão , Estados Unidos/epidemiologia , Adulto Jovem
12.
MMWR Morb Mortal Wkly Rep ; 64(9): 252-7, 2015 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-25763878

RESUMO

The increased availability and rapid adoption of culture-independent diagnostic tests (CIDTs) is moving clinical detection of bacterial enteric infections away from culture-based methods. These new tests do not yield isolates that are currently needed for further tests to distinguish among strains or subtypes of Salmonella, Campylobacter, Shiga toxin-producing Escherichia coli, and other organisms. Public health surveillance relies on this detailed characterization of isolates to monitor trends and rapidly detect outbreaks; consequently, the increased use of CIDTs makes prevention and control of these infections more difficult. During 2012-2013, the Foodborne Diseases Active Surveillance Network (FoodNet*) identified a total of 38,666 culture-confirmed cases and positive CIDT reports of Campylobacter, Salmonella, Shigella, Shiga toxin-producing E. coli, Vibrio, and Yersinia. Among the 5,614 positive CIDT reports, 2,595 (46%) were not confirmed by culture. In addition, a 2014 survey of clinical laboratories serving the FoodNet surveillance area indicated that use of CIDTs by the laboratories varied by pathogen; only CIDT methods were used most often for detection of Campylobacter (10%) and STEC (19%). Maintaining surveillance of bacterial enteric infections in this period of transition will require enhanced surveillance methods and strategies for obtaining bacterial isolates.


Assuntos
Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/epidemiologia , Vigilância da População , Técnicas Bacteriológicas , Campylobacter/isolamento & purificação , Infecções por Campylobacter/diagnóstico , Infecções por Campylobacter/epidemiologia , Técnicas de Cultura/estatística & dados numéricos , Disenteria Bacilar/diagnóstico , Disenteria Bacilar/epidemiologia , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/epidemiologia , Doenças Transmitidas por Alimentos , Humanos , Incidência , Salmonella/isolamento & purificação , Infecções por Salmonella/diagnóstico , Infecções por Salmonella/epidemiologia , Escherichia coli Shiga Toxigênica/isolamento & purificação , Shigella/isolamento & purificação , Estados Unidos/epidemiologia , Vibrio/isolamento & purificação , Vibrioses/diagnóstico , Vibrioses/epidemiologia , Yersinia/isolamento & purificação , Yersiniose/diagnóstico , Yersiniose/epidemiologia
13.
MMWR Morb Mortal Wkly Rep ; 64(18): 495-9, 2015 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-25974634

RESUMO

Foodborne illnesses represent a substantial, yet largely preventable, health burden in the United States. In 10 U.S. geographic areas, the Foodborne Diseases Active Surveillance Network (FoodNet) monitors the incidence of laboratory-confirmed infections caused by nine pathogens transmitted commonly through food. This report summarizes preliminary 2014 data and describes changes in incidence compared with 2006-2008 and 2011-2013. In 2014, FoodNet reported 19,542 infections, 4,445 hospitalizations, and 71 deaths. The incidence of Shiga toxin-producing Escherichia coli (STEC) O157 and Salmonella enterica serotype Typhimurium infections declined in 2014 compared with 2006-2008, and the incidence of infection with Campylobacter, Vibrio, and Salmonella serotypes Infantis and Javiana was higher. Compared with 2011-2013, the incidence of STEC O157 and Salmonella Typhimurium infections was lower, and the incidence of STEC non-O157 and Salmonella serotype Infantis infections was higher in 2014. Despite ongoing food safety efforts, the incidence of many infections remains high, indicating that further prevention measures are needed to make food safer and achieve national health objectives.


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
14.
Emerg Infect Dis ; 20(9): 1520-3, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25148394

RESUMO

During 2003-2009, we identified 544 cases of Cronobacter spp. infection from 6 US states. The highest percentage of invasive infections occurred among children <5 years of age; urine isolates predominated among adults. Rates of invasive infections among infants approximate earlier estimates. Overall incidence of 0.66 cases/100,000 population was higher than anticipated.


Assuntos
Cronobacter , Infecções por Bactérias Gram-Negativas/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Cronobacter/isolamento & purificação , Infecções por Bactérias Gram-Negativas/história , Infecções por Bactérias Gram-Negativas/prevenção & controle , História do Século XXI , Humanos , Incidência , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Vigilância da População , Estados Unidos , Adulto Jovem
15.
MMWR Morb Mortal Wkly Rep ; 63(15): 328-32, 2014 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-24739341

RESUMO

Foodborne disease continues to be an important problem in the United States. Most illnesses are preventable. To evaluate progress toward prevention, the Foodborne Diseases Active Surveillance Network (FoodNet) monitors the incidence of laboratory-confirmed infections caused by nine pathogens transmitted commonly through food in 10 U.S. sites, covering approximately 15% of the U.S. population. This report summarizes preliminary 2013 data and describes trends since 2006. In 2013, a total of 19,056 infections, 4,200 hospitalizations, and 80 deaths were reported. For most infections, incidence was well above national Healthy People 2020 incidence targets and highest among children aged <5 years. Compared with 2010-2012, the estimated incidence of infection in 2013 was lower for Salmonella, higher for Vibrio, and unchanged overall.† Since 2006-2008, the overall incidence has not changed significantly. More needs to be done. Reducing these infections requires actions targeted to sources and pathogens, such as continued use of Salmonella poultry performance standards and actions mandated by the Food Safety Modernization Act (FSMA). FoodNet provides federal and state public health and regulatory agencies as well as the food industry with important information needed to determine if regulations, guidelines, and safety practices applied across the farm-to-table continuum are working.


Assuntos
Microbiologia de Alimentos/estatística & dados numéricos , Parasitologia de Alimentos/estatística & dados numéricos , Doenças Transmitidas por Alimentos/epidemiologia , Vigilância da População , Doenças Transmitidas por Alimentos/microbiologia , Doenças Transmitidas por Alimentos/parasitologia , Doenças Transmitidas por Alimentos/prevenção & controle , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Estados Unidos/epidemiologia
16.
Foodborne Pathog Dis ; 10(5): 453-60, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23560425

RESUMO

BACKGROUND: Shiga toxin-producing Escherichia coli (STEC) are an important cause of diarrhea and the major cause of postdiarrheal hemolytic uremic syndrome. Non-O157 STEC infections are being recognized with greater frequency because of changing laboratory practices. METHODS: Foodborne Diseases Active Surveillance Network (FoodNet) site staff conducted active, population-based surveillance for laboratory-confirmed STEC infections. We assessed frequency and incidence of STEC infections by serogroup and examined and compared demographic factors, clinical characteristics, and frequency of international travel among patients. RESULTS: During 2000-2010, FoodNet sites reported 2006 cases of non-O157 STEC infection and 5688 cases of O157 STEC infections. The number of reported non-O157 STEC infections increased from an incidence of 0.12 per 100,000 population in 2000 to 0.95 per 100,000 in 2010; while the rate of O157 STEC infections decreased from 2.17 to 0.95 per 100,000. Among non-O157 STEC, six serogroups were most commonly reported: O26 (26%), O103 (22%), O111 (19%), O121 (6%), O45 (5%), and O145 (4%). Non-O157 STEC infections were more common among Hispanics, and infections were less severe than those caused by O157 STEC, but this varied by serogroup. Fewer non-O157 STEC infections were associated with outbreaks (7% versus 20% for O157), while more were associated with international travel (14% versus 3% for O157). CONCLUSIONS: Improved understanding of the epidemiologic features of non-O157 STEC infections can inform food safety and other prevention efforts. To detect both O157 and non-O157 STEC infections, clinical laboratories should routinely and simultaneously test all stool specimens submitted for diagnosis of acute community-acquired diarrhea for O157 STEC and for Shiga toxin and ensure that isolates are sent to a public health laboratory for serotyping and subtyping.


Assuntos
Infecções por Escherichia coli/epidemiologia , Escherichia coli O157/isolamento & purificação , Doenças Transmitidas por Alimentos/epidemiologia , Síndrome Hemolítico-Urêmica/epidemiologia , Vigilância da População , Escherichia coli Shiga Toxigênica/isolamento & purificação , Adolescente , Adulto , Criança , Demografia , Diarreia , Surtos de Doenças , Infecções por Escherichia coli/microbiologia , Feminino , Doenças Transmitidas por Alimentos/microbiologia , Síndrome Hemolítico-Urêmica/microbiologia , Humanos , Incidência , Masculino , Antígenos O/imunologia , Sorotipagem , Toxina Shiga/metabolismo , Escherichia coli Shiga Toxigênica/classificação , Viagem , Estados Unidos/epidemiologia , Adulto Jovem
17.
Clin Infect Dis ; 54 Suppl 5: S432-9, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22572666

RESUMO

For decades, culture has been the mainstay of diagnostic testing for bacterial enteric pathogens. This paradigm is changing as clinical laboratories adopt culture-independent methods, such as antigen-based tests and nucleic acid-based assays. Public health surveillance for enteric infections addresses 4 interrelated but distinct objectives: case investigation for localized disease control; assessment of disease burden and trends to prioritize and assess impact of population-based control measures; outbreak detection; and microbiologic characterization to improve understanding of pathogens, their virulence mechanisms, and epidemiology. We summarize the challenges and opportunities that culture-independent tests present and suggest strategies, such as validation studies and development of culture-independent tests compatible with subtyping, that could be adopted to ensure that surveillance remains robust. Many of these approaches will require time and resources to implement, but they will be necessary to maintain a strong surveillance system. Public health practitioners must clearly explain the value of surveillance, especially how outbreak detection benefits the public, and collaborate with all stakeholders to develop solutions.


Assuntos
Técnicas de Cultura/métodos , Testes Diagnósticos de Rotina/métodos , Infecções por Enterobacteriaceae/diagnóstico , Enterobacteriaceae/isolamento & purificação , Técnicas Microbiológicas/métodos , Vigilância da População/métodos , Centers for Disease Control and Prevention, U.S. , Técnicas de Cultura/normas , Testes Diagnósticos de Rotina/tendências , Surtos de Doenças , Feminino , Microbiologia de Alimentos/métodos , Microbiologia de Alimentos/tendências , Humanos , Laboratórios/normas , Masculino , Técnicas Microbiológicas/tendências , Estados Unidos
18.
Clin Infect Dis ; 54 Suppl 5: S440-5, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22572667

RESUMO

BACKGROUND: Campylobacter is a leading cause of foodborne illness in the United States. Understanding laboratory practices is essential to interpreting incidence and trends in reported campylobacteriosis over time and provides a baseline for evaluating the increasing use of culture-independent diagnostic methods for Campylobacter infection. METHODS: The Foodborne Diseases Active Surveillance Network (FoodNet) conducts surveillance for laboratory-confirmed Campylobacter infections. In 2005, FoodNet conducted a survey of clinical laboratories to describe routine practices used for isolation and identification of Campylobacter. A profile was assigned to laboratories based on complete responses to key survey questions that could impact the recovery and isolation of Campylobacter from stool specimens. RESULTS: Of 411 laboratories testing on-site for Campylobacter, 97% used only culture methods. Among those responding to the individual questions, nearly all used transport medium (97%) and incubated at 42°C (94%); however, most deviated from existing guidelines in other areas: 68% held specimens in transport medium at room temperature before plating, 51% used Campy blood agar plate medium, 52% read plates at <72 hours of incubation, and 14% batched plates before placing them in a microaerobic environment. In all, there were 106 testing algorithms among 214 laboratories with a complete profile; only 16 laboratories were fully adherent to existing guidelines. CONCLUSIONS: Although most laboratories used culture-based methods, procedures differed widely and most did not adhere to existing guidelines, likely resulting in underdiagnosis. Given the availability of new culture-independent testing methods, these data highlight a clear need to develop best practice recommendations for Campylobacter infection diagnostic testing.


Assuntos
Infecções por Campylobacter/microbiologia , Campylobacter/isolamento & purificação , Doenças Transmitidas por Alimentos/microbiologia , Técnicas Bacteriológicas , Infecções por Campylobacter/diagnóstico , Infecções por Campylobacter/epidemiologia , Centers for Disease Control and Prevention, U.S. , Surtos de Doenças , Doenças Transmitidas por Alimentos/diagnóstico , Doenças Transmitidas por Alimentos/epidemiologia , Humanos , Incidência , Laboratórios , Vigilância da População , Estados Unidos/epidemiologia
19.
Clin Infect Dis ; 54 Suppl 5: S472-9, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22572672

RESUMO

BACKGROUND: Contact with animals and their environment is an important, and often preventable, route of transmission for enteric pathogens. This study estimated the annual burden of illness attributable to animal contact for 7 groups of pathogens: Campylobacter species, Cryptosporidium species, Shiga toxin-producing Escherichia coli (STEC) O157, STEC non-O157, Listeria monocytogenes, nontyphoidal Salmonella species, and Yersinia enterocolitica. METHODS: By using data from the US Foodborne Diseases Active Surveillance Network and other sources, we estimated the proportion of illnesses attributable to animal contact for each pathogen and applied those proportions to the estimated annual number of illnesses, hospitalizations, and deaths among US residents. We established credible intervals (CrIs) for each estimate. RESULTS: We estimated that 14% of all illnesses caused by these 7 groups of pathogens were attributable to animal contact. This estimate translates to 445 213 (90% CrI, 234 197-774 839) illnesses annually for the 7 groups combined. Campylobacter species caused an estimated 187 481 illnesses annually (90% CrI, 66 259-372 359), followed by nontyphoidal Salmonella species (127 155; 90% CrI, 66 502-219 886) and Cryptosporidium species (113 344; 90% CrI, 22 570-299 243). Of an estimated 4933 hospitalizations (90% CrI, 2704-7914), the majority were attributable to nontyphoidal Salmonella (48%), Campylobacter (38%), and Cryptosporidium (8%) species. Nontyphoidal Salmonella (62%), Campylobacter (22%), and Cryptosporidium (9%) were also responsible for the majority of the estimated 76 deaths (90% CrI, 5-211). CONCLUSIONS: Animal contact is an important transmission route for multiple major enteric pathogens. Continued efforts are needed to prevent pathogen transmission from animals to humans, including increasing awareness and encouraging hand hygiene.


Assuntos
Animais Domésticos/microbiologia , Animais de Zoológico/microbiologia , Infecções por Enterobacteriaceae/transmissão , Infecções por Enterobacteriaceae/veterinária , Enterobacteriaceae/isolamento & purificação , Doenças Transmitidas por Alimentos/microbiologia , Gastroenteropatias/microbiologia , Animais , Centers for Disease Control and Prevention, U.S. , Reservatórios de Doenças , Doenças Transmitidas por Alimentos/epidemiologia , Gastroenteropatias/epidemiologia , Humanos , Higiene/educação , Higiene/normas , Estados Unidos/epidemiologia
20.
Clin Infect Dis ; 54 Suppl 5: S480-7, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22572673

RESUMO

BACKGROUND: Approximately 40% of US travelers to less developed countries experience diarrheal illness. Using data from the Foodborne Diseases Active Surveillance Network (FoodNet), we describe travel-associated enteric infections during 2004-2009, characterizing the patients, pathogens, and destinations involved. METHODS: FoodNet conducts active surveillance at 10 US sites for laboratory-confirmed infections with 9 pathogens transmitted commonly through food. Travel-associated infections are infections diagnosed in the United States but likely acquired abroad based on a pathogen-specific time window between return from international travel to diagnosis. We compare the demographic, clinical, and exposure-related characteristics of travelers with those of nontravelers and estimate the risk of travel-associated infections by destination, using US Department of Commerce data. RESULTS: Of 64,039 enteric infections reported to FoodNet with information about travel, 8270 (13%) were travel associated. The pathogens identified most commonly in travelers were Campylobacter (42%), nontyphoidal Salmonella (32%), and Shigella (13%). The most common travel destinations were Mexico, India, Peru, Dominican Republic, and Jamaica. Most travel-associated infections occurred in travelers returning from Latin America and the Caribbean (LAC). Risk was greatest after travel to Africa (75.9 cases per 100,000 population), followed by Asia (22.7 cases per 100,000), and LAC (20.0 cases per 100,000). CONCLUSIONS: The Latin America and Caribbean region accounts for most travel-associated enteric infections diagnosed in the United States, although travel to Africa carries the greatest risk. Although FoodNet surveillance does not cover enterotoxigenic Escherichia coli, a common travel-associated infection, this information about other key enteric pathogens can be used by travelers and clinicians in pre- and posttravel consultations.


Assuntos
Diarreia/epidemiologia , Infecções por Enterobacteriaceae/epidemiologia , Enterobacteriaceae/isolamento & purificação , Doenças Transmitidas por Alimentos/epidemiologia , Viagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Centers for Disease Control and Prevention, U.S. , Criança , Pré-Escolar , Diarreia/microbiologia , Infecções por Enterobacteriaceae/transmissão , Exposição Ambiental , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
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