PROBLEM/CONDITION: An estimated 450,000 enteric illnesses, 5,000 hospitalizations, and 76 deaths associated with animal contact occur each year in the United States. Enteric illnesses are diseases that affect the stomach or intestines and cause symptoms, such as diarrhea, nausea, or vomiting, and are typically transmitted from animals to humans through the fecal-oral route. Humans might encounter animal feces or bodily fluids through contact with the animal itself, the animal's environment, or the animal's food or water. Although outbreak-associated illnesses account for a small subset of all enteric illnesses linked to animal contact, data obtained from outbreak surveillance offer insights into the underlying epidemiologic factors contributing to illnesses, including the pathogens, animals, pathogen-animal category pairs, and settings of outbreaks associated with animal contact. PERIOD COVERED: 2009-2021. DESCRIPTION OF SYSTEM: The Animal Contact Outbreak Surveillance System (ACOSS) was launched in 2009 in conjunction with the National Outbreak Reporting System (NORS), a web-based platform that includes reports of foodborne and waterborne outbreaks as well as enteric disease outbreaks transmitted by contact with environmental sources, infected persons or animals, or unknown modes. ACOSS encompasses animal contact outbreaks that are reported to CDC through NORS. Local, state, and territorial health departments voluntarily report animal contact outbreaks, which are defined as two or more enteric illnesses associated with a common animal source. Outbreaks can involve single or multiple states; CDC staff typically report multistate outbreaks on behalf of state and territorial health departments. ACOSS defines an animal source as an animal (including domestic and wild animals); an animal's feces or bodily fluids (except milk and other fluids consumed as food, which are defined as foodborne sources); an animal's fur, hair, feathers, scales, or skin; an animal's food; or an animal's environment, which includes places in which it lives and roams. RESULTS: During 2009-2021, a total of 557 animal contact outbreaks of enteric disease were reported in the United States through ACOSS, accounting for 14,377 illnesses, 2,656 hospitalizations, and 22 deaths. Exposures were reported in all 50 states, Washington, DC, and Puerto Rico. During the period there were 393 single-state outbreaks and 164 multistate outbreaks. Although multistate outbreaks comprised 29% of all outbreaks reported through ACOSS, they accounted for 80% of illnesses, 88% of hospitalizations, and 82% of deaths. Among 474 outbreaks with a confirmed single etiology, Salmonella was the most common cause of outbreaks (248 outbreaks [52%]); these outbreaks accounted for the most outbreak-associated illnesses (11,822 [85%]), hospitalizations (2,393 [91%]), and deaths (17 [77%]). Cryptosporidium (108 outbreaks [23%]) was the second leading cause of confirmed, single etiology outbreaks, followed by Escherichia coli (63 [13%]) and Campylobacter (52 [11%]). The most common exposure locations among outbreaks with a single location reported were private home (168 [40%]) and farm or dairy (89 [21%]). Among 467 outbreaks for which an animal source could be attributed to a single animal category, ruminants (171 [37%]) were the most implicated animal category (with 75% of ruminant outbreaks attributed to cattle), followed by poultry (155 [33%]) and turtles (39 [12%]). Poultry were associated with the most outbreak-associated illnesses (9,095 [66% of illnesses resulting from outbreaks attributed to a single animal category]), hospitalizations (1,804 [70%]), and deaths (15 [83%]). Most outbreaks (130 [84% of all poultry outbreaks]) attributed to poultry had private home reported as at least one of the exposure locations (i.e., backyard poultry) and were responsible for nearly all poultry-associated illnesses (8,897 [98%]). The most common confirmed pathogen-animal pair was Salmonella and poultry (132 outbreaks), followed by Cryptosporidium and ruminants (88), and Salmonella and turtles (37). Salmonella and poultry accounted for the highest number of outbreak-associated illnesses (8,965), hospitalizations (1,790), and deaths (15). INTERPRETATION: Animal contact outbreaks of enteric disease reported through ACOSS provide insights into the animals and etiologies causing outbreak-associated enteric illnesses as well as other outbreak characteristics, such as settings in which outbreaks occur. These findings can guide public health actions, developed in collaboration with specific populations (e.g., backyard poultry owners) and including interventions tailored to settings, such as private homes and farms or dairies, that are more commonly associated with animal contact outbreaks. The high proportion of outbreaks occurring in private homes identifies a potential gap in proper hygiene and enteric disease prevention knowledge among animal owners, including owners of backyard poultry, which might be considered by owners to be pets rather than livestock. Settings and populations linked to ruminants, poultry, and turtles (particularly cattle, backyard poultry, and small turtles, respectively) are important targets for public health interventions because of the high number of outbreaks and outbreak-associated illnesses associated with these animal sources. Furthermore, the disproportionate impact of multistate outbreaks reiterates the importance of a collaborative national response but also might reflect limited resources to investigate or report animal contact outbreaks at state and local levels. PUBLIC HEALTH ACTION: Public health partners should continue to report animal contact outbreaks through ACOSS to inform evidence-based interventions tailored to specific animals, pathogens, populations, and settings. Strengthening the capacity of local, state, and territorial health departments to investigate and report animal contact outbreaks is critical to improving surveillance of animal contact outbreaks. Close collaboration between state, local, and Federal public health and agricultural partners nationwide is also key in investigating and responding to multistate outbreaks. An integrated One Health approach that leverages the expertise of animal, environmental, and public health partners can facilitate successful public health interventions aimed at preventing animal contact outbreaks.

OBJECTIVES: Electronic case reporting (eCR), a cornerstone of the Centers for Disease Control and Prevention's (CDC's) Data Modernization Initiative, automates bidirectional information sharing between electronic health records and public health agencies for reportable conditions. eCR grew rapidly in response to the COVID-19 pandemic. CDC and the Florida Department of Health (FDOH) collaborated to compare the completeness and timeliness of eCR with that of traditional reporting methods for COVID-19-related patient encounters at 4 health care organizations in Florida in December 2020. METHODS: Electronic initial case reports (eICRs) were matched to corresponding (ie, for same patient encounter) electronic laboratory reports (ELRs) or manually transmitted documents. We extracted and compared selected data from each report type across matched reports for completeness and timeliness. RESULTS: Most (>98%) eICRs provided earlier notification of COVID-19 to the local public health department than corresponding ELRs or manually transmitted documents. Additionally, eICRs provided more data on race and ethnicity (>90%) than ELRs (71%) or manually transmitted documents (<5%). CONCLUSIONS: Advancing implementation of eCR nationwide may provide more complete and timely case data than ELR or manually transmitted documents to guide public health action.

Food irradiation can reduce foodborne illnesses but is rarely used in the United States. We determined whether outbreaks related to Campylobacter, Salmonella, Escherichia coli, and Listeria monocytogenes were linked to irradiation-eligible foods. Of 482 outbreaks, 155 (32.2%) were linked to an irradiation-eligible food, none of which were known to be irradiated.

Not ready-to-eat (NRTE) breaded, stuffed chicken products (e.g., chicken stuffed with broccoli and cheese) typically have a crispy, browned exterior that can make them appear cooked. These products have been repeatedly linked to U.S. salmonellosis outbreaks, despite changes to packaging initiated in 2006 to identify the products as raw and warn against preparing them in a microwave oven (microwave) (1-4). On April 28, 2023, the U.S. Department of Agriculture proposed to declare Salmonella an adulterant* at levels of one colony forming unit per gram or higher in these products (5). Salmonella outbreaks associated with NRTE breaded, stuffed chicken products during 1998-2022 were summarized using reports in CDC's Foodborne Disease Outbreak Surveillance System (FDOSS), outbreak questionnaires, web postings, and data from the Minnesota Department of Health (MDH)(†) and the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS). Eleven outbreaks were identified in FDOSS. Among cultured samples from products obtained from patients' homes and from retail stores during 10 outbreaks, a median of 57% of cultures per outbreak yielded Salmonella. The NRTE breaded, stuffed chicken products were produced in at least three establishments.(§) In the seven most recent outbreaks, 0%-75% of ill respondents reported cooking the product in a microwave and reported that they thought the product was sold fully cooked or did not know whether it was sold raw or fully cooked. Outbreaks associated with these products have occurred despite changes to product labels that better inform consumers that the products are raw and provide instructions on safe preparation, indicating that consumer-targeted interventions are not sufficient. Additional Salmonella controls at the manufacturer level to reduce contamination in ingredients might reduce illnesses attributable to NRTE breaded, stuffed chicken products.

Previous reports of COVID-19 case, hospitalization, and death rates by vaccination status() indicate that vaccine protection against infection, as well as serious COVID-19 illness for some groups, declined with the emergence of the B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, and waning of vaccine-induced immunity (1-4). During August-November 2021, CDC recommended() additional primary COVID-19 vaccine doses among immunocompromised persons and booster doses among persons aged 18 years (5). The SARS-CoV-2 B.1.1.529 (Omicron) variant emerged in the United States during December 2021 (6) and by December 25 accounted for 72% of sequenced lineages (7). To assess the impact of full vaccination with additional and booster doses (booster doses),() case and death rates and incidence rate ratios (IRRs) were estimated among unvaccinated and fully vaccinated adults by receipt of booster doses during pre-Delta (April-May 2021), Delta emergence (June 2021), Delta predominance (July-November 2021), and Omicron emergence (December 2021) periods in the United States. During 2021, averaged weekly, age-standardized case IRRs among unvaccinated persons compared with fully vaccinated persons decreased from 13.9 pre-Delta to 8.7 as Delta emerged, and to 5.1 during the period of Delta predominance. During October-November, unvaccinated persons had 13.9 and 53.2 times the risks for infection and COVID-19-associated death, respectively, compared with fully vaccinated persons who received booster doses, and 4.0 and 12.7 times the risks compared with fully vaccinated persons without booster doses. When the Omicron variant emerged during December 2021, case IRRs decreased to 4.9 for fully vaccinated persons with booster doses and 2.8 for those without booster doses, relative to October-November 2021. The highest impact of booster doses against infection and death compared with full vaccination without booster doses was recorded among persons aged 50-64 and 65 years. Eligible persons should stay up to date with COVID-19 vaccinations.

During the first 6 months of 2016, large outbreaks of Zika virus disease caused by local mosquito-borne transmission occurred in Puerto Rico and other U.S. territories, but local mosquito-borne transmission was not identified in the continental United States. As of July 22, 2016, the Florida Department of Health had identified 321 Zika virus disease cases among Florida residents and visitors, all occurring in either travelers from other countries or territories with ongoing Zika virus transmission or sexual contacts of recent travelers.* During standard case investigation of persons with compatible illness and laboratory evidence of recent Zika virus infection (i.e., a specimen positive by real-time reverse transcription-polymerase chain reaction [rRT-PCR], or positive Zika immunoglobulin M [IgM] with supporting dengue serology [negative for dengue IgM antibodies and positive for dengue IgG antibodies], or confirmation of Zika virus neutralizing antibodies by plaque reduction neutralization testing [PRNT]), four persons were identified in Broward and Miami-Dade counties whose infections were attributed to likely local mosquito-borne transmission. Two of these persons worked within 120 meters (131 yards) of each other but had no other epidemiologic connections, suggesting the possibility of a local community-based outbreak. Further epidemiologic and laboratory investigations of the worksites and surrounding neighborhood identified a total of 29 persons with laboratory evidence of recent Zika virus infection and likely exposure during late June to early August, most within an approximate 6-block area. In response to limited impact on the population of Aedes aegypti mosquito vectors from initial ground-based mosquito control efforts, aerial ultralow volume spraying with the organophosphate insecticide naled was applied over a 10 square-mile area beginning in early August and alternated with aerial larviciding with Bacillus thuringiensis subspecies israelensis (Bti), a group biologic control agent, in a central 2 square-mile area. No additional cases were identified after implementation of this mosquito control strategy. No increases in emergency department (ED) patient visits associated with aerial spraying were reported, including visits for asthma, reactive airway disease, wheezing, shortness of breath, nausea, vomiting, or diarrhea. Local and state health departments serving communities where Ae. aegypti, the primary vector of Zika virus, is found should continue to actively monitor for local transmission of the virus.