Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-30 (of 33 Records) |
Query Trace: Cieslak PR[original query] |
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Assessing the impact of the 2020 Council of State and Territorial Epidemiologists case definition for pertussis on reported pertussis cases
Rubis AB , Cole M , Tondella ML , Pawloski LC , Youngkin E , Firmender P , Aden V , Cruz V , Stanislawski E , Wester R , Cieslak PR , Acosta AM , Skoff TH . Clin Infect Dis 2024 BACKGROUND: In 2020, the Council of State and Territorial Epidemiologists (CSTE) pertussis case definition was modified; the main change was classifying PCR-positive cases as confirmed, regardless of cough duration. Pertussis data reported through Enhanced Pertussis Surveillance (EPS) in seven sites and the National Notifiable Diseases Surveillance System (NNDSS) were used to evaluate the impact of the new case definition. METHODS: We compared the number of EPS cases with cough onset in 2020 to the number that would have been reported based on the prior (2014) CSTE case definition. To assess the impact of the change nationally, the proportion of EPS cases newly reportable under the 2020 CSTE case definition was applied to 2020 NNDSS data to estimate how many additional cases were captured nationally. RESULTS: Among 442 confirmed and probable cases reported to EPS states in 2020, 42 (9.5%) were newly reportable according to the 2020 case definition. Applying this proportion to the 6,124 confirmed and probable cases reported nationally in 2020, we estimated that the new definition added 582 cases. Had the case definition not changed, reported cases in 2020 would have decreased by 70% from 2019; the observed decrease was 67%. CONCLUSIONS: Despite a substantial decrease in reported pertussis cases in the setting of COVID-19, our data show that the 2020 pertussis case definition change resulted in additional case reporting compared with the previous case definition, providing greater opportunities for public health interventions such as prophylaxis of close contacts. |
Surveillance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis During the COVID-19 Pandemic - United States, 2019-2021
Williams SL , Smith DJ , Benedict K , Ahlers JR , Austin C , Birn R , Carter AM , Christophe NN , Cibulskas K , Cieslak PR , Gibbons-Burgener SN , Gosciminski M , Ireland MJ , Lazenby KV , Loftus T , Lunquest K , Mathewson AA , Nguyen AD , Oltean HN , Osborn B , Petro EM , Power DJ , Reik RR , Schlosser L , Sedivy J , Smelser CB , Chiller T , Toda M . MMWR Morb Mortal Wkly Rep 2024 73 (11) 239-244 Coccidioidomycosis, histoplasmosis, and blastomycosis are lower respiratory tract fungal infections whose signs and symptoms can resemble those of other respiratory illnesses, including pneumonia caused by bacterial or viral etiologies; this overlap in clinical presentation might lead to missed or delayed diagnoses. The causative fungi live in the environment, often in soil or plant matter. To describe the epidemiologic characteristics of cases of coccidioidomycosis, histoplasmosis, and blastomycosis during the COVID-19 pandemic, CDC analyzed case surveillance data for 2019-2021. During this period, a total of 59,655 coccidioidomycosis cases, 3,595 histoplasmosis cases, and 719 blastomycosis cases were reported to CDC. In 2020, fewer cases of each disease occurred in spring compared with other seasons, and most cases occurred in fall; national seasonality is not typically observed, and cases were seasonally distributed more evenly in 2019 and 2021. Fewer cases coinciding with the start of the COVID-19 pandemic, along with an unusually high blastomycosis case fatality rate in 2021 (17% compared with more typical rates of 8%-10%), suggest that the pandemic might have affected patients' health care-seeking behavior, public health reporting practices, or clinical management of these diseases. Increased awareness and education are needed to encourage health care providers to consider fungal diseases and to identify pneumonia of fungal etiology. Standardized diagnostic guidance and informational resources for fungal testing could be incorporated into broader respiratory disease awareness and preparedness efforts to improve early diagnosis of coccidioidomycosis, histoplasmosis, and blastomycosis. |
Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on immunization practices
Rupprecht CE , Briggs D , Brown CM , Franka R , Katz SL , Kerr HD , Lett SM , Levis R , Meltzer MI , Schaffner W , Cieslak PR . MMWR Recomm Rep 2010 59 1-9 This report summarizes new recommendation and updates previous recommendations of the Advisory Committee on Immunization Practices (ACIP) for postexposure prophylaxis (PEP) to prevent human rabies (CDC. Human rabies prevention---United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR 2008;57[No. RR-3]). Previously, ACIP recommended a 5-dose rabies vaccination regimen with human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV). These new recommendations reduce the number of vaccine doses to four. The reduction in doses recommended for PEP was based in part on evidence from rabies virus pathogenesis data, experimental animal work, clinical studies, and epidemiologic surveillance. These studies indicated that 4 vaccine doses in combination with rabies immune globulin (RIG) elicited adequate immune responses and that a fifth dose of vaccine did not contribute to more favorable outcomes. For persons previously unvaccinated with rabies vaccine, the reduced regimen of 4 1-mL doses of HDCV or PCECV should be administered intramuscularly. The first dose of the 4-dose course should be administered as soon as possible after exposure (day 0). Additional doses then should be administered on days 3, 7, and 14 after the first vaccination. ACIP recommendations for the use of RIG remain unchanged. For persons who previously received a complete vaccination series (pre- or postexposure prophylaxis) with a cell-culture vaccine or who previously had a documented adequate rabies virus-neutralizing antibody titer following vaccination with noncell-culture vaccine, the recommendation for a 2-dose PEP vaccination series has not changed. Similarly, the number of doses recommended for persons with altered immunocompetence has not changed; for such persons, PEP should continue to comprise a 5-dose vaccination regimen with 1 dose of RIG. Recommendations for pre-exposure prophylaxis also remain unchanged, with 3 doses of vaccine administered on days 0, 7, and 21 or 28. Prompt rabies PEP combining wound care, infiltration of RIG into and around the wound, and multiple doses of rabies cell-culture vaccine continue to be highly effective in preventing human rabies. |
Risk factors for non-O157 shiga toxin-producing Escherichia coli infections, United States
Marder EP , Cui Z , Bruce BB , Richardson LC , Boyle MM , Cieslak PR , Comstock N , Lathrop S , Garman K , McGuire S , Olson D , Vugia DJ , Wilson S , Griffin PM , Medus C . Emerg Infect Dis 2023 29 (6) 1183-1190 Shiga toxin-producing Escherichia coli (STEC) causes acute diarrheal illness. To determine risk factors for non-O157 STEC infection, we enrolled 939 patients and 2,464 healthy controls in a case-control study conducted in 10 US sites. The highest population-attributable fractions for domestically acquired infections were for eating lettuce (39%), tomatoes (21%), or at a fast-food restaurant (23%). Exposures with 10%-19% population attributable fractions included eating at a table service restaurant, eating watermelon, eating chicken, pork, beef, or iceberg lettuce prepared in a restaurant, eating exotic fruit, taking acid-reducing medication, and living or working on or visiting a farm. Significant exposures with high individual-level risk (odds ratio >10) among those >1 year of age who did not travel internationally were all from farm animal environments. To markedly decrease the number of STEC-related illnesses, prevention measures should focus on decreasing contamination of produce and improving the safety of foods prepared in restaurants. |
Case report: Persistent shedding of a live vaccine-derived rubella virus in a young man with severe combined immunodeficiency and cutaneous granuloma.
Bonner KE , Sukerman E , Liko J , Lanzieri TM , Sutton M , DeBess E , Leesman C , Icenogle J , Hao L , Chen MH , Faisthalab R , Leman RF , Cieslak PR , DeRavin SS , Perelygina L . Front Immunol 2022 13 1075351 A young man with X-linked severe combined immunodeficiency developed a persistent vaccine-derived rubella virus (VDRV) infection, with the emergence of cutaneous granulomas more than fifteen years after receipt of two doses of measles-mumps-rubella (MMR) vaccine. Following nasopharyngeal swab (NP) collection, VDRV was detected by real-time polymerase chain reaction (RT-qPCR) and sequencing, and live, replication-competent VDRV was isolated in cell culture. To assess duration and intensity of viral shedding, sequential respiratory samples, one cerebrospinal fluid sample, and two urine samples were collected over 15 months, and VDRV RNA was detected in all samples by RT-qPCR. Live VDRV was cultured from nine of the eleven respiratory specimens and from one urine specimen. To our knowledge, this was the first reported instance of VDRV cultured from respiratory specimens or from urine. To assess potential transmission to close contacts, NP specimens and sera were collected from all household contacts, all of whom were immunocompetent and previously vaccinated with MMR. VDRV RNA was not detected in any NP swabs from the contacts, nor did serologic investigations suggest VDRV transmission to any contacts. This report highlights the need to understand the prevalence and duration of VDRV shedding in granuloma patients and to estimate the risk of VDRV transmission to immune and non-immune contacts. |
Decreased Incidence of Infections Caused by Pathogens Transmitted Commonly Through Food During the COVID-19 Pandemic - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2017-2020.
Ray LC , Collins JP , Griffin PM , Shah HJ , Boyle MM , Cieslak PR , Dunn J , Lathrop S , McGuire S , Rissman T , Scallan Walter EJ , Smith K , Tobin-D'Angelo M , Wymore K , Kufel JZ , Wolpert BJ , Tauxe R , Payne DC . MMWR Morb Mortal Wkly Rep 2021 70 (38) 1332-1336 Foodborne illnesses are a substantial and largely preventable public health problem; before 2020 the incidence of most infections transmitted commonly through food had not declined for many years. To evaluate progress toward prevention of foodborne illnesses in the United States, the Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program monitors the incidence of laboratory-diagnosed infections caused by eight pathogens transmitted commonly through food reported by 10 U.S. sites.* FoodNet is a collaboration among CDC, 10 state health departments, the U.S. Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration. This report summarizes preliminary 2020 data and describes changes in incidence with those during 2017-2019. During 2020, observed incidences of infections caused by enteric pathogens decreased 26% compared with 2017-2019; infections associated with international travel decreased markedly. The extent to which these reductions reflect actual decreases in illness or decreases in case detection is unknown. On March 13, 2020, the United States declared a national emergency in response to the COVID-19 pandemic. After the declaration, state and local officials implemented stay-at-home orders, restaurant closures, school and child care center closures, and other public health interventions to slow the spread of SARS-CoV-2, the virus that causes COVID-19 (1). Federal travel restrictions were declared (1). These widespread interventions as well as other changes to daily life and hygiene behaviors, including increased handwashing, have likely changed exposures to foodborne pathogens. Other factors, such as changes in health care delivery, health care-seeking behaviors, and laboratory testing practices, might have decreased the detection of enteric infections. As the pandemic continues, surveillance of illness combined with data from other sources might help to elucidate the factors that led to the large changes in 2020; this understanding could lead to improved strategies to prevent illness. To reduce the incidence of these infections concerted efforts are needed, from farm to processing plant to restaurants and homes. Consumers can reduce their risk of foodborne illness by following safe food-handling and preparation recommendations. |
COVID-19 Case Investigation and Contact Tracing in the US, 2020.
Lash RR , Moonan PK , Byers BL , Bonacci RA , Bonner KE , Donahue M , Donovan CV , Grome HN , Janssen JM , Magleby R , McLaughlin HP , Miller JS , Pratt CQ , Steinberg J , Varela K , Anschuetz GL , Cieslak PR , Fialkowski V , Fleischauer AT , Goddard C , Johnson SJ , Morris M , Moses J , Newman A , Prinzing L , Sulka AC , Va P , Willis M , Oeltmann JE . JAMA Netw Open 2021 4 (6) e2115850 IMPORTANCE: Contact tracing is a multistep process to limit SARS-CoV-2 transmission. Gaps in the process result in missed opportunities to prevent COVID-19. OBJECTIVE: To quantify proportions of cases and their contacts reached by public health authorities and the amount of time needed to reach them and to compare the risk of a positive COVID-19 test result between contacts and the general public during 4-week assessment periods. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study took place at 13 health departments and 1 Indian Health Service Unit in 11 states and 1 tribal nation. Participants included all individuals with laboratory-confirmed COVID-19 and their named contacts. Local COVID-19 surveillance data were used to determine the numbers of persons reported to have laboratory-confirmed COVID-19 who were interviewed and named contacts between June and October 2020. MAIN OUTCOMES AND MEASURES: For contacts, the numbers who were identified, notified of their exposure, and agreed to monitoring were calculated. The median time from index case specimen collection to contact notification was calculated, as were numbers of named contacts subsequently notified of their exposure and monitored. The prevalence of a positive SARS-CoV-2 test among named and tested contacts was compared with that jurisdiction's general population during the same 4 weeks. RESULTS: The total number of cases reported was 74 185. Of these, 43 931 (59%) were interviewed, and 24 705 (33%) named any contacts. Among the 74 839 named contacts, 53 314 (71%) were notified of their exposure, and 34 345 (46%) agreed to monitoring. A mean of 0.7 contacts were reached by telephone by public health authorities, and only 0.5 contacts per case were monitored. In general, health departments reporting large case counts during the assessment (≥5000) conducted smaller proportions of case interviews and contact notifications. In 9 locations, the median time from specimen collection to contact notification was 6 days or less. In 6 of 8 locations with population comparison data, positive test prevalence was higher among named contacts than the general population. CONCLUSIONS AND RELEVANCE: In this cross-sectional study of US local COVID-19 surveillance data, testing named contacts was a high-yield activity for case finding. However, this assessment suggests that contact tracing had suboptimal impact on SARS-CoV-2 transmission, largely because 2 of 3 cases were either not reached for interview or named no contacts when interviewed. These findings are relevant to decisions regarding the allocation of public health resources among the various prevention strategies and for the prioritization of case investigations and contact tracing efforts. |
Preliminary incidence and trends of infections with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2016-2019
Tack DM , Ray L , Griffin PM , Cieslak PR , Dunn J , Rissman T , Jervis R , Lathrop S , Muse A , Duwell M , Smith K , Tobin-D'Angelo M , Vugia DJ , Zablotsky Kufel J , Wolpert BJ , Tauxe R , Payne DC . MMWR Morb Mortal Wkly Rep 2020 69 (17) 509-514 To evaluate progress toward prevention of enteric illnesses, the Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program monitors the incidence of laboratory-diagnosed infections caused by eight pathogens transmitted commonly through food at 10 U.S. sites.* This report summarizes preliminary 2019 data and describes changes in incidence compared with that during 2016-2018. The incidence of enteric infections caused by these eight pathogens reported by FoodNet sites in 2019 continued to increase or remained unchanged, indicating progress in controlling major foodborne pathogens in the United States has stalled. Campylobacter and Salmonella caused the largest proportion of illnesses; trends in incidence varied by Salmonella serotype. Widespread adoption of whole genome sequencing (WGS) of bacteria has improved the ability to identify outbreaks, emerging strains, and sources of pathogens. To maximize the potential of WGS to link illnesses to particular sources, testing of isolates by clinical and public health laboratories is needed. Reductions in Salmonella serotype Typhimurium suggest that targeted interventions (e.g., vaccinating chickens and other food animals) might decrease human infections. Reducing contamination during food production, processing, and preparation will require more widespread implementation of known prevention measures and of new strategies that target particular pathogens and serotypes. |
Humoral and mucosal immune responses to human norovirus in the elderly
Costantini VP , Cooper EM , Hardaker HL , Lee LE , DeBess EE , Cieslak PR , Hall AJ , Vinje J . J Infect Dis 2020 221 (11) 1864-1874 BACKGROUND: Most information on mucosal and systemic immune response to norovirus infection is derived from human challenge studies, birth cohort studies, or vaccine trials in healthy adults. However, few data are available on immune responses to norovirus in the elderly. MATERIALS: To study the mucosal and systemic immune response against norovirus, 43 long-term care facilities (LTCFs) were enrolled prospectively in 2010-2014. Baseline saliva samples were collected from 17 facilities and from cases and controls up to day 84 from 10 outbreaks as well as acute and convalescent sera. RESULTS: Norovirus-specific IgA levels in baseline saliva samples were low and increased in both symptomatic patients and asymptomatic shedders at day 5 after onset. ROC analysis correctly assigned prior norovirus infection in 23 (92%) of 25 participants. Cases and asymptomatic shedders showed seroconversion for IgG (80%), IgA (78%) and blockade antibodies (87%). Salivary IgA levels strongly correlated with increased convalescent serum IgA titers and blockade antibodies. CONCLUSIONS: Salivary IgA levels strongly correlated with serum IgA titers and blockade antibodies and remained elevated 3 months after a norovirus outbreak. A single salivary sample collected on day 14 could be used to identify recent infection in a suspected outbreak or to monitor population salivary IgA. |
Notes from the field: Multistate outbreak of Salmonella agbeni associated with consumption of raw cake mix - five states, 2018
Ladd-Wilson SG , Morey K , Koske SE , Burkhalter B , Bottichio L , Brandenburg J , Fontana J , Tenney K , Kutumbaka KK , Samadpour M , Kreil K , Cieslak PR . MMWR Morb Mortal Wkly Rep 2019 68 (34) 751-752 In August 2018, two Oregon patients with diagnosed Salmonella infection were interviewed using a standard enteric illness questionnaire; both patients reported having eaten raw cake mix. Standardized interview questionnaire data collected from 207 Oregon patients with salmonellosis in 2017 indicated a 5% rate of consumption of raw “cake mix or cornbread mix” (Oregon Health Authority, unpublished data, 2017). The binomial probability that both 2018 patients were exposed to raw cake mix by chance was determined to be 0.003, prompting the Oregon Health Authority (OHA) to collect and test the contents of 43 boxes of unopened cake mix of various brands from six retail locations. OHA sent samples to the Institute for Environmental Health Laboratories in Lake Forest Park, Washington, for pathogen testing. Salmonella Agbeni was isolated from an unopened box of white cake mix from manufacturer A, and whole genome sequencing (WGS) data describing the isolate were uploaded to the U.S. National Library of Medicine’s National Center for Biotechnology Information (NCBI) website (https://www.ncbi.nlm.nih.gov/pathogensexternal icon). OHA used the NCBI database to compare sequence data with the cake mix isolate (PNUSAS056022) and then consulted CDC’s System for Enteric Disease Response, Investigation, and Coordination (SEDRIC), a web-based, outbreak investigation tool designed for collaborative, multistate investigations of enteric disease outbreaks.* On October 19, OHA determined that clinical isolates from four patients from Maryland, Ohio, and Wisconsin, with specimen isolation dates ranging from June to September 2018, were genetically related to the Salmonella Agbeni isolate from the unopened box of white cake mix, within four single nucleotide polymorphisms (SNPs). |
Outbreak of nontuberculous mycobacteria joint prosthesis infections, Oregon, USA, 2010-2016
Buser GL , Laidler MR , Cassidy PM , Moulton-Meissner H , Beldavs ZG , Cieslak PR . Emerg Infect Dis 2019 25 (5) 849-855 We investigated a cluster of Mycobacterium fortuitum and M. goodii prosthetic joint surgical site infections occurring during 2010-2014. Cases were defined as culture-positive nontuberculous mycobacteria surgical site infections that had occurred within 1 year of joint replacement surgery performed on or after October 1, 2010. We identified 9 cases by case finding, chart review, interviews, surgical observations, matched case-control study, pulsed-field gel electrophoresis of isolates, and environmental investigation; 6 cases were diagnosed >90 days after surgery. Cases were associated with a surgical instrument vendor representative being in the operating room during surgery; other potential sources were ruled out. A tenth case occurred during 2016. This cluster of infections associated with a vendor reinforces that all personnel entering the operating suite should follow infection control guidelines; samples for mycobacterial culture should be collected early; and postoperative surveillance for <90 days can miss surgical site infections caused by slow-growing organisms requiring specialized cultures, like mycobacteria. |
Preliminary incidence and trends of infections with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2015-2018
Tack DM , Marder EP , Griffin PM , Cieslak PR , Dunn J , Hurd S , Scallan E , Lathrop S , Muse A , Ryan P , Smith K , Tobin-D'Angelo M , Vugia DJ , Holt KG , Wolpert BJ , Tauxe R , Geissler AL . MMWR Morb Mortal Wkly Rep 2019 68 (16) 369-373 Foodborne diseases represent a major health problem in the United States. The Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program monitors cases of laboratory-diagnosed infection caused by eight pathogens transmitted commonly through food in 10 U.S. sites.* This report summarizes preliminary 2018 data and changes since 2015. During 2018, FoodNet identified 25,606 infections, 5,893 hospitalizations, and 120 deaths. The incidence of most infections is increasing, including those caused by Campylobacter and Salmonella, which might be partially attributable to the increased use of culture-independent diagnostic tests (CIDTs). The incidence of Cyclospora infections increased markedly compared with 2015-2017, in part related to large outbreaks associated with produce (1). More targeted prevention measures are needed on produce farms, food animal farms, and in meat and poultry processing establishments to make food safer and decrease human illness. |
Characteristics of intracranial group a streptococcal infections in US children, 1997-2014
Link-Gelles R , Toews KA , Schaffner W , Edwards KM , Wright C , Beall B , Barnes B , Jewell B , Harrison LH , Kirley PD , Lorentzson L , Aragon D , Petit S , Bareta J , Spina NL , Cieslak PR , Van Beneden C . J Pediatric Infect Dis Soc 2018 9 (1) 30-35 Background: Few data on intracranial group A Streptococcus (GAS) infection in children are available. Here, we describe the demographic, clinical, and diagnostic characteristics of 91 children with intracranial GAS infection. Methods: Cases of intracranial GAS infection in persons </=18 years of age reported between 1997 and 2014 were identified by the Centers for Disease Control and Prevention's population- and laboratory-based Active Bacterial Core surveillance (ABCs) system. Medical charts were abstracted using a active, standardized case report form. All available isolates were emm typed. US census data were used to calculate rates. Results: ABCs identified 2596 children with invasive GAS infection over an 18-year period; 91 (3.5%) had an intracranial infection. Intracranial infections were most frequent during the winter months and among children aged <1 year. The average annual incidence was 0.07 cases per 100000 children. For 83 patients for whom information for further classification was available, the principal clinical presentations included meningitis (35 [42%]), intracranial infection after otitis media, mastoiditis, or sinusitis (34 [41%]), and ventriculoperitoneal shunt infection (14 [17%]). Seven (8%) of these infections progressed to streptococcal toxic shock syndrome. The overall case fatality rate was 15%. GAS emm types 1 (31% of available isolates) and 12 (13% of available isolates) were most common. Conclusions: Pediatric intracranial (GAS) infections are uncommon but often severe. Risk factors for intracranial GAS infection include the presence of a ventriculoperitoneal shunt and contiguous infections in the middle ear or sinuses. |
Extrapulmonary nontuberculous mycobacterial disease surveillance - Oregon, 2014-2016
Shih DC , Cassidy PM , Perkins KM , Crist MB , Cieslak PR , Leman RL . MMWR Morb Mortal Wkly Rep 2018 67 (31) 854-857 Nontuberculous mycobacteria (NTM), ubiquitous in soil and water, usually infect immunocompromised persons. However, even healthy persons are susceptible to infection through percutaneous inoculation. Although 77% of NTM diseases manifest as primarily pulmonary illnesses (1), NTM also infect skin, bones, joints, the lymphatic system, and soft tissue. NTM infections can have incubation periods that exceed 5 years (2), often require prolonged treatment, and can lead to sepsis and death. Extrapulmonary NTM outbreaks have been reported in association with contaminated surgical gentian violet (3), nail salon pedicures (4), and tattoos received at tattoo parlors (5), although few surveillance data have been available for estimating the public health burden of NTM.* On January 1, 2014, the Oregon Health Authority designated extrapulmonary NTM disease a reportable condition. To characterize extrapulmonary NTM infection, estimate resources required for surveillance, and assess the usefulness of surveillance in outbreak detection and investigation, 2014-2016 extrapulmonary NTM surveillance data were reviewed, and interviews with stakeholders were conducted. During 2014-2016, 134 extrapulmonary NTM cases (11 per 1 million persons per year) were reported in Oregon. The age distribution was bimodal, with highest incidence among persons aged <10 years (20 per 1 million persons per year) and persons aged 60-69 years (18 per 1 million persons per year). The most frequently reported predisposing factors (occurring within 14-70 days of symptom onset) were soil exposure (41/98; 42%), immunocompromised condition (42/124; 34%), and surgery (32/120; 27%). Overall, 43 (33%) patients were hospitalized, 18 (15%) developed sepsis, and one (0.7%) died. Surveillance detected or helped to control two outbreaks at low cost. Jurisdictions interested in implementing extrapulmonary NTM surveillance can use the Council of State and Territorial Epidemiologists (CSTE) standardized case definition (6) for extrapulmonary NTM reporting or investigative guidelines maintained by the Oregon Health Authority (7). |
Preliminary incidence and trends of infections with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2006-2017
Marder EP , Griffin PM , Cieslak PR , Dunn J , Hurd S , Jervis R , Lathrop S , Muse A , Ryan P , Smith K , Tobin-D'Angelo M , Vugia DJ , Holt KG , Wolpert BJ , Tauxe R , Geissler AL . MMWR Morb Mortal Wkly Rep 2018 67 (11) 324-328 Despite ongoing food safety measures in the United States, foodborne illness continues to be a substantial health burden. The 10 U.S. sites of the Foodborne Diseases Active Surveillance Network (FoodNet)* monitor cases of laboratory-diagnosed infections caused by nine pathogens transmitted commonly through food. This report summarizes preliminary 2017 data and describes changes in incidence since 2006. In 2017, FoodNet reported 24,484 infections, 5,677 hospitalizations, and 122 deaths. Compared with 2014-2016, the 2017 incidence of infections with Campylobacter, Listeria, non-O157 Shiga toxin-producing Escherichia coli (STEC), Yersinia, Vibrio, and Cyclospora increased. The increased incidences of pathogens for which testing was previously limited might have resulted from the increased use and sensitivity of culture-independent diagnostic tests (CIDTs), which can improve incidence estimates (1). Compared with 2006-2008, the 2017 incidence of infections with Salmonella serotypes Typhimurium and Heidelberg decreased, and the incidence of serotypes Javiana, Infantis, and Thompson increased. New regulatory requirements that include enhanced testing of poultry products for Salmonella(dagger) might have contributed to the decreases. The incidence of STEC O157 infections during 2017 also decreased compared with 2006-2008, which parallels reductions in isolations from ground beef.( section sign) The declines in two Salmonella serotypes and STEC O157 infections provide supportive evidence that targeted control measures are effective. The marked increases in infections caused by some Salmonella serotypes provide an opportunity to investigate food and nonfood sources of infection and to design specific interventions. |
High hand contamination rates during norovirus outbreaks in long-term care facilities
Park GW , Williamson KJ , DeBess E , Cieslak PR , Gregoricus N , De Nardo E , Fricker C , Costantini V , Vinje J . Infect Control Hosp Epidemiol 2018 39 (2) 1-3 We examined norovirus contamination on hands of ill patients during 12 norovirus outbreaks in 12 long-term care facilities (LTCFs). The higher frequency and norovirus titers on hands of residents compared to hands of heathcare workers highlights the importance of adhering to appropriate hand hygiene practices during norovirus outbreaks in LTCFs. Infect Control Hosp Epidemiol 2018;1-3. |
Impact of the US maternal tetanus, diphtheria, and acellular pertussis vaccination program on preventing pertussis in infants <2 months of age: A case-control evaluation
Skoff TH , Blain AE , Watt J , Scherzinger K , McMahon M , Zansky SM , Kudish K , Cieslak PR , Lewis M , Shang N , Martin SW . Clin Infect Dis 2017 65 (12) 1977-1983 Background: Infants aged <1 year are at highest risk for pertussis-related morbidity and mortality. In 2012, Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccine was recommended for women during each pregnancy to protect infants in the first months of life; data on effectiveness of this strategy are currently limited. Methods: We conducted a case-control evaluation among pertussis cases <2 months old with cough onset between 1 January 2011 and 31 December 2014 from 6 US Emerging Infection Program Network states. Controls were hospital-matched and selected by birth certificate. Mothers were interviewed to collect information on demographics, household characteristics, and healthcare providers. Provider-verified immunization history was obtained on mothers and infants. Mothers were considered vaccinated during pregnancy if Tdap was received ≥14 days before delivery; trimester was calculated using Tdap date, infant's date of birth, and gestational age. Odds ratios were calculated using multivariable conditional logistic regression; vaccine effectiveness (VE) was estimated as (1 - odds ratio) x 100%. Results: A total of 240 cases and 535 controls were included; 17 (7.1%) case mothers and 90 (16.8%) control mothers received Tdap during the third trimester of pregnancy. The multivariable VE estimate for Tdap administered during the third trimester of pregnancy was 77.7% (95% confidence interval [CI], 48.3%-90.4%); VE increased to 90.5% (95% CI, 65.2%-97.4%) against hospitalized cases. Conclusions: Vaccination during pregnancy is an effective way to protect infants during the early months of life. With a continuing resurgence in pertussis, efforts should focus on maximizing Tdap uptake among pregnant women. |
Incidence and Trends of Infections with Pathogens Transmitted Commonly Through Food and the Effect of Increasing Use of Culture-Independent Diagnostic Tests on Surveillance - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2013-2016.
Marder EP , Cieslak PR , Cronquist AB , Dunn J , Lathrop S , Rabatsky-Ehr T , Ryan P , Smith K , Tobin-D'Angelo M , Vugia DJ , Zansky S , Holt KG , Wolpert BJ , Lynch M , Tauxe R , Geissler AL . MMWR Morb Mortal Wkly Rep 2017 66 (15) 397-403 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 culturedagger; 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. |
Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005-2012
Nelson GE , Pondo T , Toews KA , Farley MM , Lindegren ML , Lynfield R , Aragon D , Zansky SM , Watt JP , Cieslak PR , Angeles K , Harrison LH , Petit S , Beall B , Van Beneden CA . Clin Infect Dis 2016 63 (4) 478-86 BACKGROUND: Invasive group A Streptococcus (GAS) infections cause significant morbidity and mortality. We report the epidemiology and trends of invasive GAS over 8 years of surveillance. METHODS: From January 2005 through December 2012, we collected data from the Centers for Disease Control and Prevention's Active Bacterial Core surveillance (ABCs), a population-based network of 10 geographically diverse U.S. sites (2012 population, 32.8 million). We defined invasive GAS as isolation of GAS from a normally sterile site or from a wound in a patient with necrotizing fasciitis (NF) or streptococcal toxic shock syndrome (STSS). Available isolates were emm typed. We calculated rates and made age- and race-adjusted national projections using census data. RESULTS: We identified 9557 cases (3.8 cases per 100,000 persons per year) with 1116 deaths (case-fatality ratio [CFR]: 11.7%). CFRs for septic shock, STSS and NF were 45%, 38%, and 29%, respectively. Annual incidence was highest among persons aged ≥65 years (9.4 per 100,000), persons aged <1 year (5.3), and blacks (4.7). National rates remained steady over 8 years of surveillance. Factors independently associated with death included increasing age, residence in a nursing home, recent surgery, septic shock, NF, meningitis, isolated bacteremia, pneumonia, emm type 1 or 3, and underlying chronic illness or immunosuppression. An estimated 10,649-13,434 cases of invasive GAS infections occur in the U.S. annually, resulting in 1,136-1,607 deaths. emm types in a 30-valent M-protein vaccine accounted for 91% of isolates. CONCLUSIONS: The burden of invasive GAS infection in the U.S. remains substantial. Vaccines under development could have a considerable public health impact. |
Infection with Pathogens Transmitted Commonly Through Food and the Effect of Increasing Use of Culture-Independent Diagnostic Tests on Surveillance - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2012-2015
Huang JY , Henao OL , Griffin PM , Vugia DJ , Cronquist AB , Hurd S , Tobin-D'Angelo M , Ryan P , Smith K , Lathrop S , Zansky S , Cieslak PR , Dunn J , Holt KG , Wolpert BJ , Patrick ME . MMWR Morb Mortal Wkly Rep 2016 65 (14) 368-71 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 (1). 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. |
Risk factors for pertussis among Hispanic infants - Metropolitan Portland, Oregon, 2010-2012
Levri KM , Reynolds L , Liko J , Dott M , Robinson BF , Cieslak PR . Pediatr Infect Dis J 2016 35 (5) 488-93 BACKGROUND: In 2012, Oregon observed its highest numbers of reported pertussis cases since 1953. The greatest morbidity occurred among infants <6 months of age, with higher rates among Hispanics than non-Hispanics. To explain this disparity, we analyzed pertussis surveillance data. METHODS: An analysis was conducted among infants <6 months of age in the Portland metropolitan area during 2010-2012. Characteristics examined were ethnicity (Hispanic or non-Hispanic), household size (>4 or ≤4 persons), pertussis vaccination status (up-to-date or not up-to-date for age), child care center attendance (yes or no), infant birth weight (<2,500 or ≥2,500 g), and maternal age (<20 or ≥20 years). RESULTS: Eighty-two infants <6 months of age with pertussis were identified. Twenty-eight case-infants (34%) were Hispanic, and 54 (66%) were non-Hispanic. By ethnicity, infants with pertussis were similar in illness confirmation method, sex, age, hospitalization status, vaccination status, child care center attendance, infant birth weight, and maternal age. Hispanic infants were more likely than non-Hispanic infants to live in households with >4 persons. Univariate analysis showed Hispanic infants had ~2.3 times the risk for pertussis, compared with non-Hispanic infants, and infants living in households >4 persons had ~2.4 times the risk for illness, compared with those in households with ≤4 persons; stratified risk ratios did not differ between Hispanic (2.4 [confidence interval {CI}: 1.0-5.7]) and non-Hispanic infants (2.0 [CI: 1.2-3.5]). CONCLUSIONS: A household size of >4 persons is a potential risk factor for pertussis; the magnitude of this risk is similar for Hispanic and non-Hispanic infants. |
Epidemiologic, Virologic, and Host Genetic Factors of Norovirus Outbreaks in Long-term Care Facilities.
Costantini VP , Cooper EM , Hardaker HL , Lee LE , Bierhoff M , Biggs C , Cieslak PR , Hall AJ , Vinje J . Clin Infect Dis 2015 62 (1) 1-10 BACKGROUND: In the Unites States, long-term care facilities (LTCFs) are the most common setting for norovirus outbreaks. These outbreaks provide a unique opportunity to better characterize the viral and host characteristics of norovirus disease. METHODS: We enrolled 43 LTCFs prospectively to study the epidemiology, virology, and genetic host factors of naturally occurring norovirus outbreaks. Acute and convalescent stool, serum, and saliva samples from cases, exposed and nonexposed controls were collected. Norovirus infection was confirmed using quantitative polymerase chain reaction testing of stool samples or 4-fold increase in serum antibody titers. The presence of histo-blood group antigens (secretor, ABO, and Lewis type) was determined in saliva. RESULTS: Sixty-two cases, 34 exposed controls, and 18 nonexposed controls from 10 norovirus outbreaks were enrolled. Forty-six percent of acute, 27% of convalescent case, and 11% of control stool samples tested norovirus positive. Outbreak genotypes were GII.4 (Den Haag, n = 3; New Orleans, n = 4; and Sydney, n = 2) and GI.1 (n = 1). Viral load in GII.4 Sydney outbreaks was significantly higher than in outbreaks caused by other genotypes; cases and controls shed similar amounts of virus. Forty-seven percent of cases shed virus for ≥21 days. Symptomatic infections with GII.4 Den Haag and GII.4 New Orleans were detected among nonsecretor individuals. CONCLUSIONS: Almost half of all symptomatic individuals shed virus for at least 21 days. Viral load was highest in GII.4 viruses that most recently emerged; these viruses also infect the nonsecretor population. These findings will help to guide development of targeted prevention and control measures in the elderly. |
Tracking pertussis and evaluating control measures through enhanced pertussis surveillance, Emerging Infections Program, United States
Skoff TH , Baumbach J , Cieslak PR . Emerg Infect Dis 2015 21 (9) 1568-73 Despite high coverage with pertussis-containing vaccines, pertussis remains endemic to the United States. There have been increases in reported cases in recent years, punctuated by striking epidemics and shifting epidemiology, both of which raise questions about current policies regarding its prevention and control. Limited data on pertussis reported through the National Notifiable Disease Surveillance System have proved insufficient to answer these questions. To address shortcomings of national pertussis data, the Emerging Infections Program at the US Centers for Disease Control and Prevention launched Enhanced Pertussis Surveillance (EPS), which is characterized by systematic case ascertainment, augmented data collection, and collection of Bordetella pertussis isolates. Data collected through EPS have been instrumental in understanding the rapidly evolving epidemiology and molecular epidemiology of pertussis and have contributed essential information regarding pertussis vaccines. EPS also serves as a platform for conducting critical and timely evaluations of pertussis prevention and control strategies, including targeting of vaccinations and antimicrobial prophylaxis. |
Preliminary incidence and trends of infection with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2006-2014
Crim SM , Griffin PM , Tauxe R , Marder EP , Gilliss D , Cronquist AB , Cartter M , Tobin-D'Angelo M , Blythe D , Smith K , Lathrop S , Zansky S , Cieslak PR , Dunn J , Holt KG , Wolpert B , Henao OL . MMWR Morb Mortal Wkly Rep 2015 64 (18) 495-9 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. |
Notes from the field: campylobacteriosis outbreak associated with consuming undercooked chicken liver pate - Ohio and Oregon, December 2013-January 2014
Scott MK , Geissler A , Poissant T , DeBess E , Melius B , Eckmann K , Salehi E , Cieslak PR . MMWR Morb Mortal Wkly Rep 2015 64 (14) 399 On January 8, 2014, the Ohio Department of Health notified the Oregon Public Health Division (OPHD) of campylobacteriosis in two Ohio residents recently returned from Oregon. The travelers reported consuming chicken liver pate at an Oregon restaurant. On January 10, OPHD received additional reports of campylobacteriosis in two persons who had consumed chicken liver pate at another Oregon restaurant. Campylobacter jejuni was isolated in cultures of fecal specimens from three patients. OPHD investigated to determine the sources of the illnesses and to institute preventive measures. |
Isolation of Cryptococcus gattii from Oregon soil and tree bark, 2010-2011
DeBess E , Lockhart SR , Iqbal N , Cieslak PR . BMC Microbiol 2014 14 (1) 323 BACKGROUND: In Oregon, human and animal infections by C. gattii were first identified in 2004. Cryptococcus gattii is considered to be an emerging non-zoonotic infection affecting animals and humans in Oregon. We report a longitudinal environmental isolation of C. gattii after an Oregon dog was diagnosed with the disease in 2009. RESULTS: Cryptococcus gattii was isolated twice from the same location with a span of one year between isolation dates. Cryptococcus gattii molecular types VGIIa and VGI were isolated in 2010 from soil and tree bark near the home of a 9-month-old dog which three months previously had an infection caused by C. gattii genotype VGIIa. The environment featured heavy growth of Douglas Fir trees. In 2011, a second set of soil and tree bark samples was collected in the same area and C. gattii VGIIa was again identified from the environment, along with genotypes VGIIb and VGIIc. CONCLUSIONS: The use of animal surveillance data to identify environmental niches of C. gattii should be considered to expand the understanding of this emerging pathogen. Understanding the ecology and how the environment and other factors might modify the existing niches is important for assessing risk and for designing measures to protect human and animal health. |
Tickborne relapsing fever - United States, 1990-2011
Forrester JD , Kjemtrup AM , Fritz CL , Marsden-Haug N , Nichols JB , Tengelsen LA , Sowadsky R , DeBess E , Cieslak PR , Weiss J , Evert N , Ettestad P , Smelser C , Iralu J , Nett RJ , Mosher E , Baker JS , Houten CV , Thorp E , Geissler AL , Kugeler K , Mead P . MMWR Morb Mortal Wkly Rep 2015 64 (3) 58-60 Tickborne relapsing fever (TBRF) is a zoonosis caused by spirochetes of the genus Borrelia and transmitted to humans by ticks of the genus Ornithodoros. TBRF is endemic in the western United States, predominately in mountainous regions. Clinical illness is characterized by recurrent bouts of fever, headache, and malaise. Although TBRF is usually a mild illness, severe sequelae and death can occur. This report summarizes the epidemiology of 504 TBRF cases reported from 12 western states during 1990-2011. Cases occurred most commonly among males and among persons aged 1014 and 4044 years. Most reported infections occurred among nonresident visitors to areas where TBRF is endemic. Clinicians and public health practitioners need to be familiar with current epidemiology and features of TBRF to adequately diagnose and treat patients and recognize that any TBRF case might indicate an ongoing source of potential exposure that needs to be investigated and eliminated. |
Incidence and trends of infection with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2006-2013
Crim SM , Iwamoto M , Huang JY , Griffin PM , Gilliss D , Cronquist AB , Cartter M , Tobin-D'Angelo M , Blythe D , Smith K , Lathrop S , Zansky S , Cieslak PR , Dunn J , Holt KG , Lance S , Tauxe R , Henao OL . MMWR Morb Mortal Wkly Rep 2014 63 (15) 328-32 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.dagger 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. |
Statewide validation of hospital-reported central line-associated bloodstream infections: Oregon, 2009
Oh JY , Cunningham MC , Beldavs ZG , Tujo J , Moore SW , Thomas AR , Cieslak PR . Infect Control Hosp Epidemiol 2012 33 (5) 439-45 BACKGROUND: Mandatory reporting of healthcare-associated infections is common, but underreporting by hospitals limits meaningful interpretation. OBJECTIVE: To validate mandatory intensive care unit (ICU) central line-associated bloodstream infection (CLABSI) reporting by Oregon hospitals. DESIGN: Blinded comparison of ICU CLABSI determination by hospitals and health department-based external reviewers with group adjudication. SETTING: Forty-four Oregon hospitals required by state law to report ICU CLABSIs. PARTICIPANTS: Seventy-six patients with ICU CLABSIs and a systematic sample of 741 other patients with ICU-related bacteremia episodes. METHODS: External reviewers examined medical records and determined CLABSI status. All cases with CLABSI determinations discordant from hospital reporting were adjudicated through formal discussion with hospital staff, a process novel to validation of CLABSI reporting. RESULTS: Hospital representatives and external reviewers agreed on CLABSI status in 782 (96%) of 817 bacteremia episodes ([Formula: see text] [95% confidence interval (CI), 0.70-0.84]). Among the 27 episodes identified as CLABSIs by external reviewers but not reported by hospitals, the final status was CLABSI in 16 (59%). The measured sensitivities of hospital ICU CLABSI reporting were 72% (95% CI, 62%-81%) with adjudicated CLABSI determination as the reference standard and 60% (95% CI, 51%-69%) with external review alone as the reference standard ([Formula: see text]). Validation increased the statewide ICU CLABSI rate from 1.21 (95% CI, 0.95-1.51) to 1.54 (95% CI, 1.25-1.88) CLABSIs/1,000 central line-days; ICU CLABSI rates increased by more than 1.00 CLABSI/1,000 central line-days in 6 (14%) hospitals. CONCLUSIONS: Validating hospital CLABSI reporting improves accuracy of hospital-based CLABSI surveillance. Discussing discordant findings improves the quality of validation. |
Comparison of survey methods in norovirus outbreak investigation, Oregon, USA, 2009
Oh JY , Bancroft JE , Cunningham MC , Keene WE , Lyss SB , Cieslak PR , Hedberg K . Emerg Infect Dis 2010 16 (11) 1773-6 We compared data from an Internet-based survey and a telephone-based survey during a 2009 norovirus outbreak in Oregon. Survey initiation, timeliness of response, and attack rates were comparable, but participants were less likely to complete Internet questions. Internet-based surveys permit efficient data collection but should be designed to maximize complete responses. |
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