Last data update: Oct 07, 2024. (Total: 47845 publications since 2009)
Records 1-27 (of 27 Records) |
Query Trace: Buss B[original query] |
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Campylobacteriosis outbreak linked to municipal water, Nebraska, USA, 2021(1)
Jansen L , Birn R , Koirala S , Oppegard S , Loeck B , Hamik J , Wyckoff E , Spindola D , Dempsey S , Bartling A , Roundtree A , Kahler A , Lane C , Hogan N , Strockbine N , McKeel H , Yoder J , Mattioli M , Donahue M , Buss B . Emerg Infect Dis 2024 30 (10) 1998-2005 In September 2021, eight campylobacteriosis cases were identified in a town in Nebraska, USA. We assessed potential exposures for a case-control analysis. We conducted whole-genome sequencing on Campylobacter isolates from patients' stool specimens. We collected large-volume dead-end ultrafiltration water samples for Campylobacter and microbial source tracking testing at the Centers for Disease Control and Prevention. We identified 64 cases in 2 waves of illnesses. Untreated municipal tap water consumption was strongly associated with illness (wave 1 odds ratio 15.36; wave 2 odds ratio 16.11). Whole-genome sequencing of 12 isolates identified 2 distinct Campylobacter jejuni subtypes (1 subtype/wave). The town began water chlorination, after which water testing detected coliforms. One dead-end ultrafiltration sample yielded nonculturable Campylobacter and avian-specific fecal rRNA genomic material. Our investigation implicated contaminated, untreated, municipal water as the source. Results of microbial source tracking supported mitigation with continued water chlorination. No further campylobacteriosis cases attributable to water were reported. |
Sporotrichosis cluster in domestic cats and veterinary technician, Kansas, USA, 2022
Hennessee I , Barber E , Petro E , Lindemann S , Buss B , Santos A , Gade L , Lockhart SR , Sexton DJ , Chiller T , Toda M . Emerg Infect Dis 2024 30 (5) 1053-1055 We describe a feline sporotrichosis cluster and zoonotic transmission between one of the affected cats and a technician at a veterinary clinic in Kansas, USA. Increased awareness of sporotrichosis and the potential for zoonotic transmission could help veterinary professionals manage feline cases and take precautions to prevent human acquisition. |
Detection of SARS-CoV-2 neutralizing antibodies in retropharyngeal lymph node exudates of white-tailed deer (odocoileus virginianus) from Nebraska, USA
Poonsuk K , Loy D , Birn R , Buss B , Donahue M , Nordeen T , Sinclair K , Meduna L , Brodersen B , Loy JD . J Wildl Dis 2023 59 (4) 702-708 Disease surveillance testing for emerging zoonotic pathogens in wildlife is a key component in understanding the epidemiology of these agents and potential risk to human populations. Recent emergence of SARS-CoV-2 in humans, and subsequent detection of this virus in wildlife, highlights the need for developing new One Health surveillance strategies. We used lymph node exudate, a sample type that is routinely collected in hunter-harvested white-tailed deer (WTD, Odocoileus virginianus) for surveillance of chronic wasting disease, to assess anti-SARS-CoV-2 neutralizing antibodies. A total of 132 pairs of retropharyngeal lymph nodes collected from Nebraska WTD harvested in Nebraska, US, in 2019 (pre-SARS-CoV-2 pandemic) and 2021 (post-SARS-CoV-2 pandemic) were tested for SARS-CoV-2 with reverse transcription PCR. Thereafter, exudates obtained from these same lymph nodes were tested for SARS-CoV-2 neutralizing antibodies using a surrogate virus neutralization test. Neutralizing antibodies were detected in the exudates with high diagnostic specificity (100% at proposed cutoff of 40% inhibition). Application of this testing approach to samples collected for use in other disease surveillance activities may provide additional epidemiological data on SARS-CoV-2 exposure, and there is further potential to apply this sample type to detection of other pathogens of interest. |
Risk for infection in humans after exposure to birds infected with highly pathogenic avian influenza A(H5N1) virus, United States, 2022
Kniss K , Sumner KM , Tastad KJ , Lewis NM , Jansen L , Julian D , Reh M , Carlson E , Williams R , Koirala S , Buss B , Donahue M , Palm J , Kollmann L , Holzbauer S , Levine MZ , Davis T , Barnes JR , Flannery B , Brammer L , Fry A . Emerg Infect Dis 2023 29 (6) 1215-1219 During February 7─September 3, 2022, a total of 39 US states experienced outbreaks of highly pathogenic avian influenza A(H5N1) virus in birds from commercial poultry farms and backyard flocks. Among persons exposed to infected birds, highly pathogenic avian influenza A(H5) viral RNA was detected in 1 respiratory specimen from 1 person. |
Public health surveillance and reporting for human toxoplasmosis - Six states, 2021
McCall J , Rothfeldt L , Giesbrecht K , Hunt A , Bauck L , Scheftel J , Birn R , Buss B , Schroeder B , Haupt TE , Klos R , Straily A . MMWR Morb Mortal Wkly Rep 2022 71 (28) 889-893 Toxoplasmosis is caused by infection with the zoonotic parasite Toxoplasma gondii. Although disease tends to be mild (e.g., self-limiting influenza-like symptoms) or asymptomatic in immunocompetent persons, toxoplasmosis is more severe in immunocompromised persons, who can develop potentially fatal encephalopathy (1). In addition, primary infections acquired during pregnancy might result in a range of adverse outcomes, including fetal ocular infection, cranial and neurologic deformities, stillbirth, and miscarriage (1,2). An estimated 11% of the U.S. population aged ≥6 years are seropositive for toxoplasmosis, based on analysis of sera collected through the National Health and Nutrition Examination Survey during 2011-2014 (3). Toxoplasmosis is not a nationally notifiable disease in the United States, and currently no national public health surveillance data are available; however, it is reportable in eight states. To better understand how surveillance data are collected and used, reviews of state-level toxoplasmosis surveillance were conducted during June-July 2021 using semistructured interviews with health officials in six states (Arkansas, Kentucky, Minnesota, Nebraska, Pennsylvania, and Wisconsin) where toxoplasmosis is currently reportable. Why or when toxoplasmosis became reportable could not be determined, and many of the states had limited capacity to respond to reported cases. Case definitions varied considerably in terms of clinical description, laboratory criteria, and case classification (i.e., confirmed, probable, or suspect), limiting disease estimates and comparisons among states. Implementation of a standardized case definition would help ensure that cases are counted consistently, enabling better use of surveillance data to characterize disease. Identifying newly acquired cases is challenging because most acute cases among immunocompetent persons (including pregnant women) are asymptomatic, disease among immunocompromised persons is likely reactivation of latent disease, and congenital infections might not manifest until later in life. |
Origins of high latitude introductions of Aedes aegypti to Nebraska and Utah during 2019.
Gloria-Soria A , Faraji A , Hamik J , White G , Amsberry S , Donahue M , Buss B , Pless E , Cosme LV , Powell JR . Infect Genet Evol 2022 103 105333 Aedes aegypti (L.), the yellow fever mosquito, is also an important vector of dengue and Zika viruses, and an invasive species in North America. Aedes aegypti inhabits tropical and sub-tropical areas of the world and in North America, is primarily distributed throughout the southern US states and Mexico. The northern range of Ae. aegypti is limited by cold winter months and establishment in these areas has been mostly unsuccessful. However, frequent introductions of Ae. aegypti to temperate, non-endemic areas during the warmer months can lead to seasonal activity and disease outbreaks. Two Ae. aegypti incursions were reported in the late summer of 2019 into York, Nebraska and Moab, Utah. These states had no history of established populations of this mosquito and no evidence of previous seasonal activity. We genotyped a subset of individuals from each location at 12 microsatellite loci and ~ 14,000 single nucleotide polymorphic markers to determine their genetic affinities to other populations worldwide and investigate their potential source of introduction. Our results support a single origin for each of the introductions from different sources. Aedes aegypti from Utah likely derived from Tucson, Arizona, or a nearby location. Nebraska specimen results were not as conclusive, but point to an origin from southcentral or southeastern US. In addition to an effective, efficient, and sustainable control of invasive mosquitoes, such as Ae. aegypti, identifying the potential routes of introduction will be key to prevent future incursions and assess their potential health threat based on the ability of the source population to transmit a particular virus and its insecticide resistance profile, which may complicate vector control. |
Investigation of a SARS-CoV-2 B.1.1.529 (Omicron) Variant Cluster - Nebraska, November-December 2021.
Jansen L , Tegomoh B , Lange K , Showalter K , Figliomeni J , Abdalhamid B , Iwen PC , Fauver J , Buss B , Donahue M . MMWR Morb Mortal Wkly Rep 2021 70 (5152) 1782-1784 The B.1.1.529 (Omicron) variant of SARS-CoV-2 (the virus that causes COVID-19) was first detected in specimens collected on November 11, 2021, in Botswana and on November 14 in South Africa;* the first confirmed case of Omicron in the United States was identified in California on December 1, 2021 (1). On November 29, the Nebraska Department of Health and Human Services was notified of six probable cases(†) of COVID-19 in one household, including one case in a man aged 48 years (the index patient) who had recently returned from Nigeria. Given the patient's travel history, Omicron infection was suspected. Specimens from all six persons in the household tested positive for SARS-CoV-2 by reverse transcription-polymerase chain reaction (RT-PCR) testing on December 1, and the following day genomic sequencing by the Nebraska Public Health Laboratory identified an identical Omicron genotype from each specimen (Figure). Phylogenetic analysis was conducted to determine if this cluster represented an independent introduction of Omicron into the United States, and a detailed epidemiologic investigation was conducted. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.(§). |
Aedes aegypti Identified in York, Nebraska, Through Routine Arboviral Surveillance-August-October 2019
Donahue MA , Hamik J , Phinney S , Schneider R , McDougall L , Koirala S , Buss B . J Am Mosq Control Assoc 2021 37 (2) 106-108 On August 27, 2019, Aedes aegypti mosquitoes were identified in a neighborhood located in York, NE, through routine arboviral surveillance. Expanded surveillance using traps and morphologic identification revealed 118 adult Ae. aegypti throughout the adjacent neighborhood, including identification from larval sampling. Our findings describe the first recorded Ae. aegypti introduction in Nebraska and provide evidence of a breeding mosquito population, which suggests suitable habitat and the risk of potential establishment, raising concerns about prevention of arboviral diseases in Nebraska. |
Notes from the Field: Characteristics of Meat Processing Facility Workers with Confirmed SARS-CoV-2 Infection - Nebraska, April-May 2020.
Donahue M , Sreenivasan N , Stover D , Rajasingham A , Watson J , Bealle A , Ritchison N , Safranek T , Waltenburg MA , Buss B , Reefhuis J . MMWR Morb Mortal Wkly Rep 2020 69 (31) 1020-1022 Coronavirus disease 2019 (COVID-19) has been reported nationwide among meat processing facility workers (1). In late April 2020, through flyers and text messages, workers at a Nebraska meat processing facility were invited by the facility, in partnership with the Nebraska Department of Health and Human Services, to be tested for current SARS-CoV-2, the virus that causes COVID-19, at their worksite, free of charge. Specimens were analyzed using reverse transcription–polymerase chain reaction (RT-PCR) by a contracting laboratory. This investigation was determined by CDC to be public health surveillance.* Among 1,216 Nebraska-resident meat processing facility workers tested, 375 (31%) had positive results. During May 8–25, case investigators attempted to interview the 349 workers who had positive test results and available phone numbers; five refused, 99 were not reached after five attempts, and four did not report symptom status, leaving 241 (69%) of the attempted interviews for analysis. |
Multistate mumps outbreak originating from asymptomatic transmission at a nebraska wedding - six states, August-October 2019
Donahue M , Hendrickson B , Julian D , Hill N , Rother J , Koirala S , Clayton JL , Safranek T , Buss B . MMWR Morb Mortal Wkly Rep 2020 69 (22) 666-669 In August 2019, 30 attendees at a Nebraska wedding developed mumps after being exposed to one asymptomatic index patient who was fully vaccinated according to Advisory Committee on Immunization Practices (ACIP) recommendations (1), resulting in a multistate outbreak. A public health investigation and response revealed epidemiologic links that extended from the index patient through secondary, tertiary, and quaternary patients and culminated in a measles-mumps-rubella (MMR) booster vaccination campaign in the local community where approximately half of the patients resided. |
COVID-19 Among Workers in Meat and Poultry Processing Facilities - 19 States, April 2020.
Dyal JW , Grant MP , Broadwater K , Bjork A , Waltenburg MA , Gibbins JD , Hale C , Silver M , Fischer M , Steinberg J , Basler CA , Jacobs JR , Kennedy ED , Tomasi S , Trout D , Hornsby-Myers J , Oussayef NL , Delaney LJ , Patel K , Shetty V , Kline KE , Schroeder B , Herlihy RK , House J , Jervis R , Clayton JL , Ortbahn D , Austin C , Berl E , Moore Z , Buss BF , Stover D , Westergaard R , Pray I , DeBolt M , Person A , Gabel J , Kittle TS , Hendren P , Rhea C , Holsinger C , Dunn J , Turabelidze G , Ahmed FS , deFijter S , Pedati CS , Rattay K , Smith EE , Luna-Pinto C , Cooley LA , Saydah S , Preacely ND , Maddox RA , Lundeen E , Goodwin B , Karpathy SE , Griffing S , Jenkins MM , Lowry G , Schwarz RD , Yoder J , Peacock G , Walke HT , Rose DA , Honein MA . MMWR Morb Mortal Wkly Rep 2020 69 (18) Congregate work and residential locations are at increased risk for infectious disease transmission including respiratory illness outbreaks. SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is primarily spread person to person through respiratory droplets. Nationwide, the meat and poultry processing industry, an essential component of the U.S. food infrastructure, employs approximately 500,000 persons, many of whom work in proximity to other workers (1). Because of reports of initial cases of COVID-19, in some meat processing facilities, states were asked to provide aggregated data concerning the number of meat and poultry processing facilities affected by COVID-19 and the number of workers with COVID-19 in these facilities, including COVID-19-related deaths. Qualitative data gathered by CDC during on-site and remote assessments were analyzed and summarized. During April 9-27, aggregate data on COVID-19 cases among 115 meat or poultry processing facilities in 19 states were reported to CDC. Among these facilities, COVID-19 was diagnosed in 4,913 (approximately 3%) workers, and 20 COVID-19-related deaths were reported. Facility barriers to effective prevention and control of COVID-19 included difficulty distancing workers at least 6 feet (2 meters) from one another (2) and in implementing COVID-19-specific disinfection guidelines.* Among workers, socioeconomic challenges might contribute to working while feeling ill, particularly if there are management practices such as bonuses that incentivize attendance. Methods to decrease transmission within the facility include worker symptom screening programs, policies to discourage working while experiencing symptoms compatible with COVID-19, and social distancing by workers. Source control measures (e.g., the use of cloth face covers) as well as increased disinfection of high-touch surfaces are also important means of preventing SARS-CoV-2 exposure. Mitigation efforts to reduce transmission in the community should also be considered. Many of these measures might also reduce asymptomatic and presymptomatic transmission (3). Implementation of these public health strategies will help protect workers from COVID-19 in this industry and assist in preserving the critical meat and poultry production infrastructure (4). |
Successive norovirus outbreaks at an event center - Nebraska, October-November, 2017
Free RJ , Buss BF , Koirala S , Ulses M , Carlson A , Loeck B , Safranek T . MMWR Morb Mortal Wkly Rep 2019 68 (28) 627-630 In October 2017, the Nebraska Department of Health and Human Services (NDHHS) was notified by a local health department of a gastrointestinal illness outbreak among attendees of a wedding reception at facility A, an event center. Shortly thereafter, state and local public health officials began receiving reports of similar gastrointestinal illness among attendees of subsequent facility A events. An investigation was initiated to identify cases, establish the cause, assess possible transmission routes, and provide control recommendations. Overall, 159 cases consistent with norovirus infection (three confirmed and 156 probable) were identified among employees of facility A and attendees of nine facility A events during October 27-November 18, 2017. The investigation revealed a public vomiting episode at the facility on October 27 and at least one employee involved with preparing and serving food who returned to work <24 hours after symptom resolution, suggesting that a combination of contaminated environmental surfaces and infected food handlers likely sustained the outbreak. Recommendations regarding sanitation and excluding ill employees were communicated to facility A management. However, facility A performed minimal environmental cleaning and did not exclude ill employees. Consequently, transmission continued. To prevent persistent norovirus outbreaks in similar settings, public health officials should ensure that involved facilities implement a comprehensive prevention strategy as early as possible that includes extensive sanitation and strict exclusion of ill food handlers for at least 48 hours after symptom resolution (1). |
Campylobacteriosis outbreak associated with contaminated municipal water supply - Nebraska, 2017
Pedati C , Koirala S , Safranek T , Buss BF , Carlson AV . MMWR Morb Mortal Wkly Rep 2019 68 (7) 169-173 In March 2017, the Nebraska Department of Health and Human Services (NDHHS) and the Southwest Nebraska Public Health Department were notified of an apparent cluster of Campylobacter jejuni infections in city A and initiated an investigation. Overall, 39 cases were investigated, including six confirmed and 33 probable. Untreated, unboiled city A tap water (i.e., well water) was the only exposure significantly associated with illness (odds ratio [OR] = 7.84; 95% confidence interval [CI] = 1.69-36.36). City A is served by four untreated wells and an interconnected distribution system. Onsite investigations identified that a center pivot irrigation system intended to pump livestock wastewater from a nearby concentrated animal feeding operation onto adjacent farmland had malfunctioned, allowing excessive runoff to collect in a road ditch near two wells that supplied water to the city. These wells were promptly removed from service, after which no subsequent cases occurred. This coordinated response rapidly identified an important risk to city A's municipal water supply and provided the evidence needed to decommission the affected wells, with plans to build a new well to safely serve this community. |
REDCap for biocontainment worker symptom monitoring
O'Keefe AL , Buss BF , Koirala S , Gleason MX , Mudgapalli A , Schwedhelm S . Health Secur 2019 17 (1) 3-10 The Ebola epidemic of 2014 demonstrated that outbreaks of high-consequence infectious diseases, even in remote parts of the world, can affect communities anywhere in the developed world and that every healthcare facility must be prepared to identify, isolate, and provide care for infected patients. The Nebraska Biocontainment Unit (NBU), located at Nebraska Medicine in Omaha, Nebraska, cared for 3 American citizens exposed in West Africa and confirmed with Ebola virus disease (EVD). Symptom monitoring of healthcare workers caring for these patients was implemented, which included twice daily contact to document the absence or presence of signs of fever or illness. This article describes the symptom monitoring experience of the NBU and local and state public health agencies. Based on lessons learned from that experience, we sought a more efficient solution to meet the needs of both the healthcare facility and public health authorities. REDCap, an open-source application used commonly by academic health centers, was used to develop an inexpensive symptom monitoring application that could reduce the burden of managing these activities, thus freeing up valuable time. Our pilot activities demonstrated that this novel use of REDCap holds promise for minimizing costs and resource demands associated with symptom monitoring while offering a more user-friendly experience for people being monitored and the officials managing the response. |
Potentially serious drug interactions resulting from the pretravel health encounter
Sbaih N , Buss B , Goyal D , Rao SR , Benefield R , Walker AT , Esposito DH , Ryan ET , LaRocque RC , Leung DT . Open Forum Infect Dis 2018 5 (11) ofy266 Travelers seen for pretravel health encounters are frequently prescribed new travel-related medications, which may interact with their previously prescribed medications. In a cohort of 76 324 travelers seen at 23 US clinics, we found that 2650 (3.5%) travelers were prescribed travel-related medications with potential for serious drug interactions. |
The use of a shared services model for mycobacteriology testing: Lessons learned
Stafford C , Atkinson-Dunn R , Buss SN , Dalton T , Gibson D , Johnston S , King E , Grace Lin SY , Mitchell KK , Murtaugh WA , Sease H , Southern TR , Tans-Kersten JL , Travanty EA , Triplett LR , Wroblewski K , Starks AM . Public Health Rep 2017 133 (1) 33354917743498 OBJECTIVES: Public health laboratories (PHLs) provide essential services in the diagnosis and surveillance of diseases of public health concern, such as tuberculosis. Maintaining access to high-quality laboratory testing is critical to continued disease detection and decline of tuberculosis cases in the United States. We investigated the practical experience of sharing tuberculosis testing services between PHLs through the Shared Services Project. METHODS: The Shared Services Project was a 9-month-long project funded through the Association of Public Health Laboratories and the Centers for Disease Control and Prevention during 2012-2013 as a one-time funding opportunity to consortiums of PHLs that proposed collaborative approaches to sharing tuberculosis laboratory services. Submitting PHLs maintained testing while simultaneously sending specimens to reference laboratories to compare turnaround times. RESULTS: During the 9-month project period, 107 Mycobacterium tuberculosis complex submissions for growth-based drug susceptibility testing and molecular detection of drug resistance testing occurred among the 3 consortiums. The median transit time for all submissions was 1.0 day. Overall, median drug susceptibility testing turnaround time (date of receipt in submitting laboratory to result) for parallel testing performed in house by submitting laboratories was 31.0 days; it was 43.0 days for reference laboratories. The median turnaround time for molecular detection of drug resistance results was 1.0 day (mean = 2.8; range, 0-14) from specimen receipt at the reference laboratories. CONCLUSIONS: The shared services model holds promise for specialized tuberculosis testing. Sharing of services requires a balance among quality, timeliness, efficiency, communication, and fiscal costs. |
Occupational animal exposure among persons with campylobacteriosis and cryptosporidiosis - Nebraska, 2005-2015
Su CP , Stover DT , Buss BF , Carlson AV , Luckhaupt SE . MMWR Morb Mortal Wkly Rep 2017 66 (36) 955-958 Campylobacter and Cryptosporidium are two common causes of gastroenteritis in the United States. National incidence rates measured for these pathogens in 2015 were 17.7 and 3.0 per 100,000 population, respectively; Nebraska was among the states with the highest incidence for both campylobacteriosis (26.6) and cryptosporidiosis (≥6.01) (1). Although campylobacteriosis and cryptosporidiosis are primarily transmitted via consumption of contaminated food or water, they can also be acquired through contact with live animals or animal products, including through occupational exposure (2). This exposure route is of particular interest in Nebraska, where animal agriculture and associated industries are an important part of the state's economy. To estimate the percentage of disease that might be related to occupational animal exposure in Nebraska, the Nebraska Department of Health and Human Services (NDHHS) and CDC reviewed deidentified investigation reports from 2005 to 2015 of cases of campylobacteriosis and cryptosporidiosis among Nebraska residents aged ≥14 years. Case investigation notes were searched for evidence of occupational animal exposures, which were classified into discrete categories based on industry, animal/meat, and specific work activity/exposure. Occupational animal exposure was identified in 16.6% of 3,352 campylobacteriosis and 8.7% of 1,070 cryptosporidiosis cases, among which animal production (e.g., farming or ranching) was the most commonly mentioned industry type (68.2% and 78.5%, respectively), followed by employment in animal slaughter and processing facilities (16.3% and 5.4%, respectively). Among animal/meat occupational exposures, cattle/beef was most commonly mentioned, with exposure to feedlots (concentrated animal feeding operations in which animals are fed on stored feeds) reported in 29.9% of campylobacteriosis and 7.9% of cryptosporidiosis cases. Close contact with animals and manure in feedlots and other farm settings might place workers in these areas at increased risk for infection. It is important to educate workers with occupational animal exposure about the symptoms of enteric diseases and prevention measures. Targeting prevention strategies to high-risk workplaces and activities could help reduce disease. |
Possible Airborne Person-to-Person Transmission of Mycobacterium bovis - Nebraska 2014-2015.
Buss BF , Keyser-Metobo A , Rother J , Holtz L , Gall K , Jereb J , Murphy CN , Iwen PC , Robbe-Austerman S , Holcomb MA , Infield P . MMWR Morb Mortal Wkly Rep 2016 65 (8) 197-201 Mycobacterium bovis, one of several mycobacteria of the M. tuberculosis complex, is a global zoonotic pathogen that primarily infects cattle. Humans become infected by consuming unpasteurized dairy products from infected cows; possible person-to-person airborne transmission has also been reported. In April 2014, a man in Nebraska who was born in Mexico was determined to have extensive pulmonary tuberculosis (TB) caused by M. bovis after experiencing approximately 3 months of cough and fever. Four months later, a U.S.-born Hispanic girl from a nearby town who had been ill for 4-5 months was also determined to have pulmonary TB caused by M. bovis. The only social connection between the two patients was attendance at the same church, and no common dietary exposure was identified. Both patients had pulmonary cavities on radiography and acid-fast bacilli (AFB) on sputum-smear microscopy, indicators of being contagious. Whole-genome sequencing results of the isolates were nearly indistinguishable. Initial examination of 181 contacts determined that 39 (22%) had latent infection: 10 (42%) of 24 who had close exposure to either patient, 28 (28%) of 100 who were exposed to one or both patients in church, and one (2%) of 57 exposed to the second patient at a school. Latent infection was diagnosed in six contacts on follow-up examination, 2 months after an initial negative test result, for an overall latent infection rate of 25%. No infected contacts recalled consuming unpasteurized dairy products, and none had active TB disease at the initial or secondary examination. Persons who have M. bovis TB should be asked about consumption of unpasteurized dairy products (2), and contact investigations should follow the same guidance as for M. tuberculosis TB. |
Notes from the field: Increase in human cases of tularemia - Colorado, Nebraska, South Dakota, and Wyoming, January-September 2015
Pedati C , House J , Hancock-Allen J , Colton L , Bryan K , Ortbahn D , Kightlinger L , Kugeler K , Petersen J , Mead P , Safranek T , Buss B . MMWR Morb Mortal Wkly Rep 2015 64 (47) 1317-8 Tularemia is a rare, often serious disease caused by a gram-negative coccobacillus, Francisella tularensis, which infects humans and animals in the Northern Hemisphere. Approximately 125 cases have been reported annually in the United States during the last two decades (2). As of September 30, a total of 100 tularemia cases were reported in 2015 among residents of Colorado (n = 43), Nebraska (n = 21), South Dakota (n = 20), and Wyoming (n = 16). This represents a substantial increase in the annual mean number of four (975% increase), seven (200%), seven (186%) and two (70%) cases, respectively, reported in each state during 2004-2014. |
Regional investigation of a cyclosporiasis outbreak linked to imported romaine lettuce - Nebraska and Iowa, June-August 2013
Buss BF , Joshi MV , O'Keefe AL , Allensworth CD , Garvey A , Obbink K , Mandernach S , Safranek TJ . Epidemiol Infect 2015 144 (9) 1-11 A regional, multistate investigation into a June-August 2013 cyclosporiasis outbreak was conducted in Nebraska, Iowa, and neighbouring states. Cases were confirmed on the basis of laboratory and clinical findings. Of 227 cases in Iowa (n = 140) and Nebraska (n = 87) residents, 162 (71%) reported dining at chain A/B restaurants - 96% reported house salad consumption. A case-control study identified chain A/B house salad as the most likely vehicle. Traceback was conducted to ascertain production lot codes of bagged salad mix (iceberg and romaine lettuce, red cabbage, and carrots) served as house salad in implicated restaurants. A single production lot code of salad mix supplied by both a common producer and distributor was linked to the majority of confirmed cases in persons reporting regional chain A/B exposure. The salad mix linked to illnesses contained imported romaine lettuce from two separate single-grower fields-of-origin and 1 additional field from another grower. |
Multistate product traceforward investigation to link imported romaine lettuce to a US cyclosporiasis outbreak - Nebraska, Texas, and Florida, June-August 2013
Buss BF , Joshi MV , Dement JL , Cantu V , Safranek TJ . Epidemiol Infect 2015 144 (13) 1-10 During June-August 2013, 25 US states reported 631 cyclosporiasis cases including Nebraska and Iowa where a regional investigation implicated common-source imported salad mix served in two chain restaurants. At least two common-origin growing fields were likely sources of contaminated romaine lettuce. Using producer- and distributor-provided data, we conducted a grower-specific traceforward investigation to reveal exposures of ill US residents elsewhere who reported symptom onset during 11 June-1 July 2013, the time period established in the Nebraska and Iowa investigation. Romaine lettuce shipped on 2-6 June from one of these Mexico-origin growing fields likely caused cyclosporiasis in 78 persons reporting illness onsets from 11 June to 1 July in Nebraska, Texas, and Florida. Nationwide, 97% (314/324) of persons confirmed with cyclosporiasis with symptom onset from 11 June to 1 July 2013 resided in 11 central and eastern US states receiving approximately two-thirds of romaine lettuce from this field. This grower's production practices should be investigated to determine potential sources of contamination and to develop recommendations to prevent future illnesses. |
Surveillance of physician-diagnosed skin and soft tissue infections consistent with methicillin-resistant Staphylococcus aureus (MRSA) among Nebraska high school athletes, 2008-2012
Buss BF , Connolly S . J Sch Nurs 2014 30 (1) 42-8 Though historically confined to hospital settings, methicillin-resistant Staphylococcus aureus (MRSA) has received increasing attention in the wider community, particularly among athletes. A 2007-2008 investigation in Nebraska concluded that MRSA skin infections were an emerging problem among the state's student athletes. Statewide surveillance was subsequently conducted during 4 school years (2008-2012) to estimate incidence of skin and soft tissue infections (SSTI) consistent with MRSA among student athletes. High school athletic officials completed Internet-based surveys following winter and fall sport seasons. Over 3 school years, incidence estimates per 10,000 athletes decreased substantially from 20.9 (2008-2009) to 11.3 (2010-2011) among football players and from 60.8 (2008-2009) to 28.1 (2010-2011) among wrestlers. Following the 2011-2012 sport seasons, however, incidence estimates increased to 16.6 per 10,000 football players and 43.3 per 10,000 wrestlers. School nurses should support school officials to prioritize prevention and control efforts for SSTI, including MRSA. |
A cluster of dengue cases in American missionaries returning from Haiti, 2010
Sharp TM , Pillai P , Hunsperger E , Santiago GA , Anderson T , Vap T , Collinson J , Buss BF , Safranek TJ , Sotir MJ , Jentes ES , Munoz-Jordan JL , Arguello DF . Am J Trop Med Hyg 2012 86 (1) 16-22 Dengue is an acute febrile illness caused by four mosquito-borne dengue viruses (DENV-1 to -4) that are endemic throughout the tropics. After returning from a 1-week missionary trip to Haiti in October of 2010, 5 of 28 (18%) travelers were hospitalized for dengue-like illness. All travelers were invited to submit serum specimens and complete questionnaires on pre-travel preparations, mosquito avoidance practices, and activities during travel. DENV infection was confirmed in seven (25%) travelers, including all travelers that were hospitalized. Viral sequencing revealed closest homology to a 2007 DENV-1 isolate from the Dominican Republic. Although most (88%) travelers had a pre-travel healthcare visit, only one-quarter knew that dengue is a risk in Haiti, and one-quarter regularly used insect repellent. This report confirms recent DENV transmission in Haiti. Travelers to DENV-endemic areas should receive dengue education during pre-travel health consultations, follow mosquito avoidance recommendations, and seek medical care for febrile illness during or after travel. |
Statewide applied epidemiology workforce capacity and competency assessment - Nebraska, 2008
Buss BF , Safranek TJ , Foley BP . J Public Health Manag Pract 2011 17 (2) 110-21 This study suggests increasing the number of epidemiologists and identifying strategies to retain well-qualified epidemiologists in the public health workforce in Nebraska. | Since adopted in 1994 by the American Public Health Association, the Ten Essential Services of Public Health have served as the national standard to guide the overall mission of public health in the United States to promote physical and mental health and prevent disease, injury, and disability.1 To provide these services effectively, an appropriately educated and well-trained workforce is required. However, within all levels of government, public health workers often have little or no formal public health training.2 Accordingly, to ensure workforce preparedness, foster leadership, and ultimately strengthen delivery of essential services, governmental public health agencies should assess workforce competence and identify strategies to enhance worker knowledge and skill in the core public health competencies appropriate to their jobs.2 |
Epidemiologic investigation of immune-mediated polyradiculoneuropathy among abattoir workers exposed to porcine brain
Holzbauer SM , DeVries AS , Sejvar JJ , Lees CH , Adjemian J , McQuiston JH , Medus C , Lexau CA , Harris JR , Recuenco SE , Belay ED , Howell JF , Buss BF , Hornig M , Gibbins JD , Brueck SE , Smith KE , Danila RN , Lipkin WI , Lachance DH , Dyck PJ , Lynfield R . PLoS One 2010 5 (3) e9782 BACKGROUND: In October 2007, a cluster of patients experiencing a novel polyradiculoneuropathy was identified at a pork abattoir (Plant A). Patients worked in the primary carcass processing area (warm room); the majority processed severed heads (head-table). An investigation was initiated to determine risk factors for illness. METHODS AND RESULTS: Symptoms of the reported patients were unlike previously described occupational associated illnesses. A case-control study was conducted at Plant A. A case was defined as evidence of symptoms of peripheral neuropathy and compatible electrodiagnostic testing in a pork abattoir worker. Two control groups were used - randomly selected non-ill warm-room workers (n = 49), and all non-ill head-table workers (n = 56). Consenting cases and controls were interviewed and blood and throat swabs were collected. The 26 largest U.S. pork abattoirs were surveyed to identify additional cases. Fifteen cases were identified at Plant A; illness onsets occurred during May 2004-November 2007. Median age was 32 years (range, 21-55 years). Cases were more likely than warm-room controls to have ever worked at the head-table (adjusted odds ratio [AOR], 6.6; 95% confidence interval [CI], 1.6-26.7), removed brains or removed muscle from the backs of heads (AOR, 10.3; 95% CI, 1.5-68.5), and worked within 0-10 feet of the brain removal operation (AOR, 9.9; 95% CI, 1.2-80.0). Associations remained when comparing head-table cases and head-table controls. Workers removed brains by using compressed air that liquefied brain and generated aerosolized droplets, exposing themselves and nearby workers. Eight additional cases were identified in the only two other abattoirs using this technique. The three abattoirs that used this technique have stopped brain removal, and no new cases have been reported after 24 months of follow up. Cases compared to controls had higher median interferon-gamma (IFNgamma) levels (21.7 pg/ml; vs 14.8 pg/ml, P<0.001). DISCUSSION: This novel polyradiculoneuropathy was associated with removing porcine brains with compressed air. An autoimmune mechanism is supported by higher levels of IFNgamma in cases than in controls consistent with other immune mediated illnesses occurring in association with neural tissue exposure. Abattoirs should not use compressed air to remove brains and should avoid procedures that aerosolize CNS tissue. This outbreak highlights the potential for respiratory or mucosal exposure to cause an immune-mediated illness in an occupational setting. |
Virulence factors encoded by Legionella longbeachae identified on the basis of the genome sequence analysis of clinical isolate D-4968
Kozak NA , Buss M , Lucas CE , Frace M , Govil D , Travis T , Olsen-Rasmussen M , Benson RF , Fields BS . J Bacteriol 2009 192 (4) 1030-44 Legionella longbeachae causes most cases of legionellosis in Australia and may be under-reported worldwide due to the lack of L. longbeachae-specific diagnostic tests. L. longbeachae displays distinctive differences in intracellular trafficking, caspase-1 activation, and infection of mouse models compared to L. pneumophila, yet both species have an indistinguishable clinical presentation in humans. Unlike other legionellae, which inhabit fresh water systems, L. longbeachae is found predominantly in moist soil. In this study, we sequenced and annotated the genome of a L. longbeachae clinical isolate, D-4968, from Oregon, US, and compared it to the published genomes of L. pneumophila. The study revealed that the D-4968 genome is larger with a gene order that is different from L. pneumophila. Genes encoding structural components of type II, type IV Lvh, and type IV Icm/Dot secretion systems are conserved. In contrast, only 42/140 homologs of L. pneumophila Icm/Dot substrates have been found in the D-4968 genome. L. longbeachae encodes numerous proteins with eukaryotic motifs and eukaryotic-like proteins unique to this species, including 16 ankyrin repeat-containing proteins and a novel U-box protein. We predict that these proteins are secreted by the L. longbeachae Icm/Dot secretion system. In contrast to L. pneumophila, the L. longbeachae D-4968 genome does not carry flagellar biosynthesis genes, yet contains a chemotaxis operon. The lack of a flagellum explains the failure of L. longbeachae to activate caspase-1 and trigger pyroptosis in murine macrophages. These unique features of the L. longbeachae genome may reflect adaptation of this species to life in soil. |
Pediatric influenza-associated myositis - Nebraska, 2001-2007
Buss BF , Shinde VM , Safranek TJ , Uyeki TM . Influenza Other Respir Viruses 2009 3 (6) 277-285 OBJECTIVE: Influenza-associated myositis (IAM), characterized by severe lower-extremity myalgia and reluctance to walk, is a complication of influenza among children. We investigated IAM in Nebraska during six influenza seasons, 2001-2007. METHODS: During 2006-2007, we requested reports of severe influenza illness among persons aged < 18 years and investigated medical records to identify and confirm IAM cases defined as severe myalgia with elevated serum creatinine kinase level in a patient aged < 18 years, occurring within 7 days of laboratory confirmed influenza illness onset. Statewide hospital discharge data (HDD) were reviewed to identify retrospectively confirmed IAM cases during 2006-2007 and five previous seasons, by using surveillance data to define periods of influenza activity. Statewide IAM incidence was estimated for 2001-2002 through 2006-2007. RESULTS: During 2006-2007, a total of 13 IAM cases were confirmed by enhanced surveillance. Median age was 6 years (range, 4-11 years). Influenza diagnosis was established by viral isolation from six patients (one influenza A and five influenza B) and rapid diagnostic tests for seven. Twelve (92%) patients, including one who died, were hospitalized for a median of 3 days (range, 1-4 days). Review of HDD identified 12 retrospectively confirmed IAM cases during 2006-2007, including four not reported through enhanced surveillance, and only one during five previous seasons (2003-2004). The HDD-derived, retrospectively confirmed statewide IAM incidence estimates/1 00 000 population aged < 18 years were 2 center dot 693 and 0 center dot 225 during 2006-2007 and 2003-2004, respectively. CONCLUSION: An IAM epidemic occurred in Nebraska during the 2006-2007 influenza season. |
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