Last data update: Jun 17, 2024. (Total: 47034 publications since 2009)
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Detecting national human enteric disease outbreaks linked to animal contact in the United States of America.
Nichols M , Stevenson L , Koski L , Basler C , Wise M , Whitlock L , Francois Watkins L , Friedman CR , Chen J , Tagg K , Joseph L , Caidi H , Patel K , Tolar B , Hise K , Classon A , Ceric O , Reimschuessel R , Williams IT . Rev Sci Tech 2020 39 (2) 471-480 Enteric pathogens, such as non-typhoidal Salmonella, Campylobacter and Escherichia coli, can reside in the intestinal tract of many animals, including livestock, companion animals, small mammals and reptiles. Often, these animals can appear healthy; nonetheless, humans can become infected after direct or indirect contact, resulting in a substantial illness burden. An estimated 14% of the 3.2 million illnesses that occur in the United States of America (USA) each year from such enteric pathogens are attributable to animal contact. Surveillance for enteric pathogens in the USA includes the compilation and interpretation of both laboratory and epidemiologic data. However, the authors feel that a collaborative, multisectoral and transdisciplinary - or One Health - approach is needed for data collection and analysis, at every level. In addition, they suggest that the future of enteric illness surveillance lies in the development of improved technologies for pathogen detection and characterisation, such as genomic sequencing and metagenomics. In particular, using whole-genome sequencing to compare genetic sequences of enteric pathogens from humans, food, animals and the environment, can help to predict antimicrobial resistance among these pathogens, determine their genetic relatedness and identify outbreaks linked to a common source. In this paper, the authors describe three recent, multi-state human enteric illness outbreaks linked to animal contact in the USA and discuss how integrated disease surveillance was essential to outbreak detection and response. Additional datasharing between public health and animal health laboratories and epidemiologists at the local, national, regional and international level may help to improve surveillance for emerging animal and human health threats and lead to new opportunities for prevention. |
A multiple-serotype outbreak of Salmonella infections linked to kratom, United States, 2017-2018
Schwensohn C , Nsubuga J , Cronquist L , Jose G , Mastel L , McCullough L , Smith L , Powell M , Booth H , Allen K , Classon A , Gieraltowski L . Foodborne Pathog Dis 2022 19 (9) 648-653 In early 2018, we investigated a large national multiple-serotype Salmonella outbreak linked to contaminated kratom, a raw minimally processed botanical substance. Kratom is a plant consumed for its stimulant effects and as an opioid substitute. A case was defined as a laboratory-confirmed Salmonella infection with one of the outbreak strains (serotypes I 4,[5],12:b:-, Heidelberg, Javiana, Okatie, Weltevreden, or Thompson) with illnesses onset during January 11, 2017-May 8, 2018. State and local officials collected detailed information on product consumption and sources. Suspected products were tested for Salmonella and traceback was conducted to determine product distribution chains and suppliers. We identified 199 cases from 41 states; 54 patients were hospitalized. Early interviews indicated kratom was an exposure of interest. Seventy-six (74%) of 103 people interviewed reported consuming kratom in pills, powders, or teas. Multiple serotypes of Salmonella were detected in samples of kratom collected from the homes of the patients and from retail locations. Several companies issued recalls of kratom products due to Salmonella contamination. To the authors' knowledge, this investigation is the first to establish kratom as a vehicle for Salmonella infection. Our findings underscore the serious safety concerns regarding minimally processed botanical substances intended for oral consumption and the challenges in investigating outbreaks linked to novel outbreak vehicles. |
New product, old problem(s): multistate outbreak of Salmonella Paratyphi B variant L(+) tartrate(+) infections linked to raw sprouted nut butters, October 2015
Heiman Marshall KE , Booth H , Harrang J , Lamba K , Folley A , Ching-Lee M , Hannapel E , Greene V , Classon A , Whitlock L , Shade L , Viazis S , Nguyen T , Neil KP . Epidemiol Infect 2018 147 1-6 A cluster of Salmonella Paratyphi B variant L(+) tartrate(+) infections with indistinguishable pulsed-field gel electrophoresis patterns was detected in October 2015. Interviews initially identified nut butters, kale, kombucha, chia seeds and nutrition bars as common exposures. Epidemiologic, environmental and traceback investigations were conducted. Thirteen ill people infected with the outbreak strain were identified in 10 states with illness onset during 18 July-22 November 2015. Eight of 10 (80%) ill people reported eating Brand A raw sprouted nut butters. Brand A conducted a voluntary recall. Raw sprouted nut butters are a novel outbreak vehicle, though contaminated raw nuts, nut butters and sprouted seeds have all caused outbreaks previously. Firms producing raw sprouted products, including nut butters, should consider a kill step to reduce the risk of contamination. People at greater risk for foodborne illness may wish to consider avoiding raw products containing raw sprouted ingredients. |
Salmonella enterica Serotype Javiana Infections Linked to a Seafood Restaurant in Maricopa County, Arizona, 2016.
Venkat H , Matthews J , Lumadao P , Caballero B , Collins J , Fowle N , Kellis M , Tewell M , White S , Hassan R , Classon A , Joung Y , Komatsu K , Weiss J , Zusy S , Sunenshine R . J Food Prot 2018 81 (8) 1283-1292 On 10 August 2016, the Maricopa County Department of Public Health identified culture-confirmed Salmonella enterica serotype Javiana isolates from two persons who reported eating at a seafood restaurant; seven additional cases were reported by 15 August. We investigated to identify a source and prevent further illness. We interviewed persons with laboratory-reported Salmonella Javiana infection. Pulsed-field gel electrophoresis (PFGE) and whole genome sequencing of isolates were performed. A case was defined as diarrheal illness in a person during July to September 2016; confirmed cases had Salmonella Javiana isolate yielding outbreak-related PFGE patterns; probable cases had diarrheal illness and an epidemiologic link to a confirmed case. Case finding was performed (passive surveillance and identification of ill meal companions). A case-control study assessed risk factors for Salmonella Javiana infection among restaurant diners; control subjects were chosen among meal companions. No restaurant workers reported illness. Foods were reportedly cooked according to the Food Code. Food and environmental samples were collected and cultured; Salmonella Javiana with an indistinguishable PFGE pattern was isolated from portioned repackaged raw shrimp, halibut, and a freezer door handle. We identified 50 Salmonella Javiana cases (40 confirmed and 10 probable); illness onset range was from 22 July to 17 September 2016. Isolates from 40 patients had highly related PFGE patterns. Thirty-three (73%) of 45 patients interviewed reported eating at the restaurant. Among 21 case patients and 31 control subjects, unfried cooked shrimp was associated with illness (odds ratio, 6.7; 95% confidence interval, 1.8 to 24.9; P = 0.004). Among restaurant diners, laboratory and case-control evidence indicated shrimp as the possible outbreak source; poor thermal inactivation of Salmonella on shrimp is theorized as a possible cause. Cross-contamination might have prolonged this outbreak; however, the source was not identified and highlights limitations that can arise during these types of investigations. |
Notes from the Field: Investigation of an Outbreak of Salmonella Paratyphi B Variant L(+) tartrate + (Java) Associated with Ball Python Exposure - United States, 2017.
Krishnasamy V , Stevenson L , Koski L , Kellis M , Schroeder B , Sundararajan M , Ladd-Wilson S , Sampsel A , Mannell M , Classon A , Wagner D , Hise K , Carleton H , Trees E , Schlater L , Lantz K , Nichols M . MMWR Morb Mortal Wkly Rep 2018 67 (19) 562-563 In July 2017, PulseNet, the national molecular subtyping network for foodborne disease surveillance, identified a cluster of five Salmonella Paratyphi B variant L(+) tartrate + (Java) clinical isolates that were indistinguishable by pulsed-field gel electrophoresis (PFGE). Initial questionnaires administered by state and local health department investigators indicated animal exposure as a possible source of infection, with all five patients reporting snake exposure. An outbreak investigation was initiated to identify the source of infection. |
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