Outbreaks of enteric infections caused by multiple pathogens associated with calves at a farm day camp.

BACKGROUND: Transmission of enteric pathogens at venues where the public contacts farm animals is a growing problem, particularly among children. In 2000 and again in 2001, enteric illness outbreaks caused by multiple pathogens occurred at a farm day camp for children in Minnesota. METHODS: Camp attendees were interviewed about illness history and potential exposures each year. Stool samples from children and calves at the camp were tested for enteric pathogens. RESULTS: Eighty-four illnesses were documented among camp attendees in the 2 outbreaks; laboratory-confirmed infections included Cryptosporidium parvum (17 cases), Escherichia coli O157:H7 (4), non-O157 Shiga toxin-producing E. coli (STEC) (7) and Salmonella enterica serotype Typhimurium and Campylobacter jejuni (1 each). Kindergarten-fourth grade children provided 1-on-1 care for a bottle-fed calf. Sixty of 83 calves tested carried at least 1 pathogen, including Giardia spp. (26 calves), C. parvum (25), non-O157 STEC (17), Campylobacter spp. (11), 3 serotypes of Salmonella enterica (10) and E. coli O157:H7 (2). Risk factors among children included caring for an ill calf and getting visible manure on their hands. Always washing hands with soap after touching a calf and washing hands before going home were protective. Prevention measures implemented in 2000 failed to prevent the second outbreak. CONCLUSIONS: Calves were the reservoir of multiple enteric pathogens for children at a farm day camp. Health care providers should consider numerous zoonotic pathogens in patients presenting with gastroenteritis after contact with cattle. Public health officials should help venue operators prospectively implement published guidelines to prevent zoonotic disease transmission.

Highly resistant Salmonella Newport-MDRAmpC transmitted through the domestic US food supply: a FoodNet case-control study of sporadic Salmonella Newport infections, 2002-2003.

BACKGROUND: A new multidrug-resistant (MDR) strain of Salmonella serotype Newport, Newport-MDRAmpC, has recently emerged. We sought to identify the medical, behavioral, and dietary risk factors for laboratory-confirmed Salmonella Newport infection, including that with Newport-MDRAmpC. METHODS: A 12-month population-based case-control study was conducted during 2002-2003 in 8 sites of the Foodborne Diseases Active Surveillance Network (FoodNet), with 215 case patients with Salmonella Newport infection and 1154 healthy community control subjects. RESULTS: Case patients with Newport-MDRAmpC infection were more likely than control subjects to have taken an antimicrobial agent to which Newport-MDRAmpC is resistant during the 28 days before the onset of diarrheal illness (odds ratio [OR], 5.0 [95% confidence interval {CI}, 1.6-16]). Case patients with Newport-MDRAmpC infection were also more likely to have eaten uncooked ground beef (OR, 7.8 [95% CI, 1.4-44]) or runny scrambled eggs or omelets prepared in the home (OR, 4.9 [95% CI, 1.3-19]) during the 5 days before the onset of illness. International travel was not a risk factor for Newport-MDRAmpC infection but was a strong risk factor for pansusceptible Salmonella Newport infection (OR, 7.1 [95% CI, 2.0-24]). Case patients with pansusceptible infection were also more likely to have a frog or lizard in their household (OR, 2.9 [95% CI, 1.1-7.7]). CONCLUSIONS: Newport-MDRAmpC infection is acquired through the US food supply, most likely from bovine and, perhaps, poultry sources, particularly among persons already taking antimicrobial agents.

Web-based investigation of multistate salmonellosis outbreak.

We investigated a large outbreak of Salmonella enterica serotype Javiana among attendees of the 2002 U.S. Transplant Games, including 1,500 organ transplant recipients. Web-based survey methods identified pre-diced tomatoes as the source of this outbreak, which highlights the utility of such investigative tools to cope with the changing epidemiology of foodborne diseases.

Risk factors for sporadic cryptosporidiosis among immunocompetent persons in the United States from 1999 to 2001.

Many studies have evaluated the role of Cryptosporidium spp. in outbreaks of enteric illness, but few studies have evaluated sporadic cryptosporidiosis in the United States. To assess the risk factors for sporadic cryptosporidiosis among immunocompetent persons, a matched case-control study was conducted in seven sites of the Foodborne Diseases Active Surveillance Network (FoodNet) involving 282 persons with laboratory-identified cryptosporidiosis and 490 age-matched and geographically matched controls. Risk factors included international travel (odds ratio [OR] = 7.7; 95% confidence interval [95% CI] = 2.7 to 22.0), contact with cattle (OR = 3.5; 95% CI = 1.8 to 6.8), contact with persons >2 to 11 years of age with diarrhea (OR = 3.0; 95% CI = 1.5 to 6.2), and freshwater swimming (OR = 1.9; 95% CI = 1.049 to 3.5). Eating raw vegetables was protective (OR = 0.5; 95% CI = 0.3 to 0.7). This study underscores the need for ongoing public health education to prevent cryptosporidiosis, particularly among travelers, animal handlers, child caregivers, and swimmers, and the need for further assessment of the role of raw vegetables in cryptosporidiosis.