Presence of animal feeding operations and community socioeconomic factors impact salmonellosis incidence rates: An ecological analysis using data from the Foodborne Diseases Active Surveillance Network (FoodNet), 2004-2010.

Nontyphoidal Salmonella spp. are a leading cause of foodborne illness. Risk factors for salmonellosis include the consumption of contaminated chicken, eggs, pork and beef. Agricultural, environmental and socioeconomic factors also have been associated with rates of Salmonella infection. However, to our knowledge, these factors have not been modeled together at the community-level to improve our understanding of whether rates of salmonellosis are variable across communities defined by differing factors. To address this knowledge gap, we obtained data on culture-confirmed Salmonella Typhimurium, S. Enteritidis, S. Newport and S. Javiana cases (2004-2010; n=14,297) from the Foodborne Diseases Active Surveillance Network (FoodNet), and socioeconomic, environmental and agricultural data from the 2010 Census of Population and Housing, the 2011 American Community Survey, and the 2007 U.S. Census of Agriculture. We linked data by zip code and derived incidence rate ratios using negative binomial regressions. Multiple community-level factors were associated with salmonellosis rates; however, our findings varied by state. For example, in Georgia (Incidence Rate Ratio (IRR)=1.01; 95% Confidence Interval (CI)=1.005-1.015) Maryland (IRR=1.01; 95% CI=1.003-1.015) and Tennessee (IRR=1.01; 95% CI=1.002-1.012), zip codes characterized by greater rurality had higher rates of S. Newport infections. The presence of broiler chicken operations, dairy operations and cattle operations in a zip code also was associated with significantly higher rates of infection with at least one serotype in states that are leading producers of these animal products. For instance, in Georgia and Tennessee, rates of S. Enteritidis infection were 48% (IRR=1.48; 95% CI=1.12-1.95) and 46% (IRR=1.46; 95% CI=1.17-1.81) higher in zip codes with broiler chicken operations compared to those without these operations. In Maryland, New Mexico and Tennessee, higher poverty levels in zip codes were associated with higher rates of infection with one or more Salmonella serotypes. In Georgia and Tennessee, zip codes with higher percentages of the population composed of African Americans had significantly higher rates of infection with one or more Salmonella serotypes. In summary, our findings show that community-level agricultural, environmental and socioeconomic factors may be important with regard to rates of infection with Salmonella Typhimurium, Enteritidis, Newport and Javiana.

Recreational swimmers' exposure to Vibrio vulnificus and Vibrio parahaemolyticus in the Chesapeake Bay, Maryland, USA.

Vibrio vulnificus and Vibrio parahaemolyticus are ubiquitous in the marine-estuarine environment, but the magnitude of human non-ingestion exposure to these waterborne pathogens is largely unknown. We evaluated the magnitude of dermal exposure to V. vulnificus and V. parahaemolyticus among swimmers recreating in Vibrio-populated waters by conducting swim studies at four swimming locations in the Chesapeake Bay in 2009 and 2011. Volunteers (n=31) swam for set time periods, and surface water (n=25) and handwash (n=250) samples were collected. Samples were analyzed for Vibrio concentrations using quantitative PCR. Linear and logistic regressions were used to evaluate factors associated with recreational exposures. Mean surface water V. vulnificus and V. parahaemolyticus concentrations were 1128CFUmL(-1) (95% confidence interval (CI): 665.6, 1591.4) and 18CFUmL(-1) (95% CI: 9.8, 26.1), respectively, across all sampling locations. Mean Vibrio concentrations in handwash samples (V. vulnificus, 180CFUcm(-2) (95% CI: 136.6, 222.5); V. parahaemolyticus, 3CFUcm(-2) (95% CI: 2.4, 3.7)) were significantly associated with Vibrio concentrations in surface water (V. vulnificus, p<0.01; V. parahaemolyticus, p<0.01), but not with salinity or temperature (V. vulnificus, p=0.52, p=0.17; V. parahaemolyticus, p=0.82, p=0.06). Handwashing reduced V. vulnificus and V. parahaemolyticus on subjects' hands by approximately one log (93.9%, 89.4%, respectively). It can be concluded that when Chesapeake Bay surface waters are characterized by elevated concentrations of Vibrio, swimmers and individuals working in those waters could experience significant dermal exposures to V. vulnificus and V. parahaemolyticus, increasing their risk of infection.

Climate change, extreme events and increased risk of salmonellosis in Maryland, USA: Evidence for coastal vulnerability.

BACKGROUND: Salmonella is a leading cause of acute gastroenteritis worldwide. Patterns of salmonellosis have been linked to weather events. However, there is a dearth of data regarding the association between extreme events and risk of salmonellosis, and how this risk may disproportionately impact coastal communities. METHODS: We obtained Salmonella case data from the Maryland Foodborne Diseases Active Surveillance Network (2002-2012), and weather data from the National Climatic Data Center (1960-2012). We developed exposure metrics related to extreme temperature and precipitation events using a 30 year baseline (1960-1989) and linked them with county-level salmonellosis data. Data were analyzed using negative binomial Generalized Estimating Equations. RESULTS: We observed a 4.1% increase in salmonellosis risk associated with a 1 unit increase in extreme temperature events (incidence rate ratio (IRR):1.041; 95% confidence interval (CI):1.013-1.069). This increase in risk was more pronounced in coastal versus non-coastal areas (5.1% vs 1.5%). Likewise, we observed a 5.6% increase in salmonellosis risk (IRR:1.056; CI:1.035-1.078) associated with a 1 unit increase in extreme precipitation events, with the impact disproportionately felt in coastal areas (7.1% vs 3.6%). CONCLUSIONS: To our knowledge, this is the first empirical evidence showing that extreme temperature/precipitation events-that are expected to be more frequent and intense in coming decades-are disproportionately impacting coastal communities with regard to salmonellosis. Adaptation strategies need to account for this differential burden, particularly in light of ever increasing coastal populations.

Impact of Hurricane Irene on Vibrio vulnificus and Vibrio parahaemolyticus concentrations in surface water, sediment, and cultured oysters in the Chesapeake Bay, MD, USA.

To determine if a storm event (i.e., high winds, large volumes of precipitation) could alter concentrations of Vibrio vulnificus and V. parahaemolyticus in aquacultured oysters (Crassostrea virginica) and associated surface water and sediment, this study followed a sampling timeline before and after Hurricane Irene impacted the Chesapeake Bay estuary in late August 2011. Aquacultured oysters were sampled from two levels in the water column: surface (0.3 m) and near-bottom (just above the sediment). Concentrations of each Vibrio spp. and associated virulence genes were measured in oysters with a combination of real-time PCR and most probable number (MPN) enrichment methods, and in sediment and surface water with real-time PCR. While concentration shifts of each Vibrio species were apparent post-storm, statistical tests indicated no significant change in concentration for either Vibrio species by location (surface or near bottom oysters) or date sampled (oyster tissue, surface water, and sediment concentrations). V. vulnificus in oyster tissue was correlated with total suspended solids (r = 0.41, P = 0.04), and V. vulnificus in sediment was correlated with secchi depth (r = -0.93, P <0.01), salinity (r = -0.46, P = 0.02), tidal height (r = -0.45, P = 0.03), and surface water V. vulnificus (r = 0.98, P <0.01). V. parahaemolyticus in oyster tissue did not correlate with environmental measurements, but V. parahaemolyticus in sediment and surface water correlated with several measurements including secchi depth [r = -0.48, P = 0.02 (sediment); r = -0.97, P <0.01 (surface water)] and tidal height [r = -0.96, P <0.01 (sediment), r = -0.59, P <0.01 (surface water)]. The concentrations of Vibrio spp. were higher in oysters relative to other studies (average V. vulnificus 4 × 10(5) MPN g(-1), V. parahaemolyticus 1 × 10(5) MPN g(-1)), and virulence-associated genes were detected in most oyster samples. This study provides a first estimate of storm-related Vibrio density changes in oyster tissues, sediment, and surface water at an aquaculture facility in the Chesapeake Bay.

Antimicrobial susceptibility of Vibrio vulnificus and Vibrio parahaemolyticus recovered from recreational and commercial areas of Chesapeake Bay and Maryland Coastal Bays.

Vibrio vulnificus and V. parahaemolyticus in the estuarine-marine environment are of human health significance and may be increasing in pathogenicity and abundance. Vibrio illness originating from dermal contact with Vibrio laden waters or through ingestion of seafood originating from such waters can cause deleterious health effects, particularly if the strains involved are resistant to clinically important antibiotics. The purpose of this study was to evaluate antimicrobial susceptibility among these pathogens. Surface-water samples were collected from three sites of recreational and commercial importance from July to September 2009. Samples were plated onto species-specific media and resulting V. vulnificus and V. parahaemolyticus strains were confirmed using polymerase chain reaction assays and tested for antimicrobial susceptibility using the Sensititre® microbroth dilution system. Descriptive statistics, Friedman two-way Analysis of Variance (ANOVA) and Kruskal-Wallis one-way ANOVA were used to analyze the data. Vibrio vulnificus (n = 120) and V. parahaemolyticus (n = 77) were isolated from all sampling sites. Most isolates were susceptible to antibiotics recommended for treating Vibrio infections, although the majority of isolates expressed intermediate resistance to chloramphenicol (78% of V. vulnificus, 96% of V. parahaemolyticus). Vibrio parahaemolyticus also demonstrated resistance to penicillin (68%). Sampling location or month did not significantly impact V. parahaemolyticus resistance patterns, but V. vulnificus isolates from St. Martin's River had lower overall intermediate resistance than that of the other two sampling sites during the month of July (p = 0.0166). Antibiotics recommended to treat adult Vibrio infections were effective in suppressing bacterial growth, while some antibiotics recommended for pediatric treatment were not effective against some of the recovered isolates. To our knowledge, these are the first antimicrobial susceptibility data of V. vulnificus and V. parahaemolyticus recovered from the Chesapeake Bay. These data can serve as a baseline against which future studies can be compared to evaluate whether susceptibilities change over time.