Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-8 (of 8 Records) |
Query Trace: Firestone MJ[original query] |
---|
Surveillance for unexplained deaths of possible infectious etiologies during the COVID-19 pandemic-Minnesota, 2020-2021
Firestone MJ , Thorell L , Kollmann L , Fess L , Ciessau G , Strain AK , Danila R , Lynfield R , Holzbauer S . Public Health Rep 2024 333549231218283 OBJECTIVES: Surveillance systems for unexplained deaths that might have an infectious etiology are rare. We examined the Minnesota Department of Health Unexplained Deaths and Critical Illnesses of Possible Infectious Etiology and Medical Examiner Infectious Deaths (UNEX/MED-X) surveillance system,-a system that expanded postmortem surveillance for infectious diseases during the COVID-19 pandemic by leveraging standard (medical examiner [ME]) and expanded (mortuary) surveillance to identify COVID-19-related deaths. METHODS: MEs, coroners, or morticians collected postmortem swabs from decedents with an infectious prodrome or with SARS-CoV-2 exposure before death but with no known recent infectious disease testing. The Minnesota Department of Health Public Health Laboratory used nucleic acid amplification, viral culture, and standard algorithms to test specimens collected postmortem for SARS-CoV-2, influenza virus, and other infectious pathogens. We reviewed UNEX/MED-X data from March 2, 2020, through December 31, 2021, and characterized decedents by location of swab collection (ie, ME or mortuary). RESULTS: From March 2, 2020, through December 31, 2021, the UNEX/MED-X surveillance system received samples from 182 decedents from mortuaries and 955 decedents from MEs. Mortuary decedents were older than ME decedents (median age, 78 vs 46 y). Seventy-three mortuary decedents (40.1%) and 197 ME decedents (20.6%) had SARS-CoV-2 detections. The UNEX/MED-X system identified 212 COVID-19-related deaths, representing 2.0% of total COVID-19-related deaths in Minnesota. Eighty-nine decedents (42.0%) were from racial and ethnic minority populations, representing 6.1% more COVID-19-related deaths among people from racial and ethnic minority populations than would have been detected without this surveillance system. PRACTICE IMPLICATIONS: Expanded and standard UNEX/MED-X surveillance builds capacity and flexibility for responding to emerging public health threats. Similar programs should be considered elsewhere as resources allow. |
Fatal Human Rabies Infection with Suspected Host-mediated Failure of Post-Exposure Prophylaxis Following a Recognized Zoonotic Exposure-Minnesota, 2021.
Holzbauer SM , Schrodt CA , Prabhu RM , Asch-Kendrick RJ , Ireland M , Klumb C , Firestone MJ , Liu G , Harry K , Ritter JM , Levine MZ , Orciari LA , Wilkins K , Yager P , Gigante CM , Ellison JA , Zhao H , Niezgoda M , Li Y , Levis R , Scott D , Satheshkumar PS , Petersen BW , Rao AK , Bell WR , Bjerk SM , Forrest S , Gao W , Dasheiff R , Russell K , Pappas M , Kiefer J , Bickler W , Wiseman A , Jurantee J , Reichard RR , Smith KE , Lynfield R , Scheftel J , Wallace RM , Bonwitt J . Clin Infect Dis 2023 77 (8) 1201-1208 BACKGROUND: No rabies post-exposure prophylaxis (PEP) failure has been documented in humans in the United States using modern cell-culture vaccines. In January 2021, an 84-year-old male died from rabies six months after being bitten by a rabid bat despite receiving timely rabies post-exposure prophylaxis (PEP). We investigated the cause of breakthrough infection. METHODS: We reviewed medical records, laboratory results, and autopsy findings, and performed whole genome sequencing (WGS) to compare patient and bat virus sequences. Storage, administration, and integrity of PEP biologics administered to the patient were assessed; samples from leftover rabies immunoglobulin were evaluated for potency. We conducted risk assessments for persons potentially exposed to the bat and for close contacts of the patient. RESULTS: Rabies virus antibodies present in serum and cerebrospinal fluid were non-neutralizing. Antemortem blood testing revealed the patient had unrecognized monoclonal gammopathy of unknown significance. Autopsy findings showed rabies meningoencephalitis and metastatic prostatic adenocarcinoma. Rabies virus sequences from the patient and the offending bat were identical by WGS. No deviations were identified in potency, quality control, administration, or storage of administered PEP. Of 332 persons assessed for potential rabies exposure to the case patient, three (0.9%) warranted PEP. CONCLUSION: This is the first reported failure of rabies PEP in the Western Hemisphere using a cell culture vaccine. Host-mediated primary vaccine failure attributed to previously unrecognized impaired immunity is the most likely explanation for this breakthrough infection. Clinicians should consider measuring rabies neutralizing antibody titers after completion of PEP if there is any suspicion for immunocompromise. |
Rapid onset of functional tic-like behaviors among adolescent girls-Minnesota, September-November 2021
Firestone MJ , Holzbauer S , Conelea C , Danila R , Smith K , Bitsko RH , Klammer SM , Gingerich S , Lynfield R . Front Neurol 2022 13 1063261 BACKGROUND: On October 15, 2021, the Minnesota Department of Health began investigating a school cluster of students experiencing tic-like behaviors thought to be related to recent COVID-19. The objective of this report is to describe the investigation, key findings, and public health recommendations. METHODS: Affected students and proxies were interviewed with a standardized questionnaire including validated depression and anxiety screens. RESULTS: Eight students had tic-like behaviors lasting >24 h after initial report with onset during September 26-October 30, 2021. All eight students were females aged 15-17 years. All students either had a history of depression or anxiety or scored as having more than minimal anxiety or depression on validated screens. Four students previously had confirmed COVID-19: the interval between prior COVID-19 and tic symptom onset varied from more than a year prior to tic symptom onset to at the time of tic symptom onset. CONCLUSION: The onset of tic-like behaviors at one school in Minnesota appeared to be related more to underlying mental health conditions than recent COVID-19. These findings highlight the need to better understand functional tic-like behaviors and adolescent mental health. |
Use of Serial Testing to Interrupt a SARS-CoV-2 Outbreak on a Hospital Medical Floor - Minnesota, October-December 2020.
Prabhu RM , Firestone MJ , Bergman KL , Beaudoin AL , Hale T , Lorentz AJ , Garfin J , Wang X , Holzbauer SM . Infect Control Hosp Epidemiol 2023 44 (3) 427-432 OBJECTIVE: Describe a severe acute respiratory coronavirus virus 2 (SARS-CoV-2) hospital outbreak and the role of serial testing of patients and healthcare personnel (HCP) in interrupting SARS-CoV-2 transmission. DESIGN: Outbreak investigation. SETTING: Medical floor of a tertiary-care center in Minnesota. METHODS: Serial testing for SARS-CoV-2 and whole-genome sequencing (WGS) of positive specimens from HCP and patients were used. An outbreak-associated case was defined as a positive SARS-CoV-2 molecular test in an HCP who worked on the floor prior to testing positive or in a patient who was hospitalized on the medical floor bewteen October 27 and December 1, 2020. WGS was used to determine potential routes of transmission. RESULTS: The outbreak was detected after a patient hospitalized for 12 days tested positive for SARS-CoV-2. Serial testing of patients and HCP was conducted in response. Overall, 247 HCP and 41 patients participated in serial SARS-CoV-2 testing; 52 HCP (21%) and 19 hospitalized patients (46%) tested positive. One additional HCP tested positive outside serial testing. The WGS of specimens from 27 (51%) HCP and 15 (79%) patients identified 3 distinct transmission clusters. WGS and epidemiologic evidence suggested intrafacility transmission. The proportions of asymptomatic and presymptomatic patients who tested positive (63%) and HCP who worked during their infectious period (75%) highlight the need for serial testing of asymptomatic patients and HCP during outbreaks. CONCLUSIONS: Coupled with preventive measures such as personal protective equipment use and physical distancing, serial testing of HCP and patients could help detect and prevent transmission within healthcare facilities during outbreaks and when nosocomial transmission is suspected. |
Foodborne outbreak rates associated with restaurant inspection grading and posting at the point of service: Evaluation using national foodborne outbreak surveillance data
Kim TN , Wildey L , Gleason B , Bleser J , Firestone MJ , Bare G , Bliss J , Dewey-Mattia D , Stueven H , Brown L , Dyjack D , Hedberg CW . J Food Prot 2022 85 (7) 1000-1007 A previously conducted national survey of restaurant inspection programs associated the practice of disclosing inspection results to consumers at the restaurant point-of-service (POS) with fewer foodborne outbreaks. We used data from the national Foodborne Disease Outbreak Surveillance System (FDOSS) to assess the reproducibility of the survey results. Programs that participated in the survey accounted for approximately 23% of the single state, foodborne illness outbreaks in restaurant settings reported to FDOSS during 2016 - 2018. Agencies that disclosed inspection results at the POS reported fewer outbreaks (mean = 0.29 outbreaks per 1,000 establishments) than those that disclosed results online (0.7) or not at all (1.0). Having any grading method for inspections was associated with fewer reported outbreaks than having no grading method. Agencies that used letter grades had the lowest numbers of outbreaks per 1,000 establishments. There was a positive association (correlation coefficient, r= 0.54) between the mean number of foodborne illness complaints per 1,000 establishments, per the survey, and the mean number of restaurant outbreaks reported to FDOSS (R2= 0.29). This association was stronger for bacterial toxin-mediated outbreaks (R2= 0.35) than for norovirus (R2= 0.10) or Salmonella (R2= 0.01) outbreaks. Our cross-sectional study findings are consistent with previous observations that linked the practice of posting graded inspection results at the POS with reduced occurrence of foodborne illnesses and outbreaks associated with restaurants. Support for foodborne illness surveillance programs and food regulatory activities at local health agencies is foundational for food safety systems coordinated at state and federal levels. |
First Identified Cases of SARS-CoV-2 Variant P.1 in the United States - Minnesota, January 2021.
Firestone MJ , Lorentz AJ , Meyer S , Wang X , Como-Sabetti K , Vetter S , Smith K , Holzbauer S , Beaudoin A , Garfin J , Ehresmann K , Danila R , Lynfield R . MMWR Morb Mortal Wkly Rep 2021 70 (10) 346-347 Since December 2020, the Minnesota Department of Health (MDH) Public Health Laboratory has been receiving 100 specimens per week (50 from each of two clinical partners) with low cycle threshold (Ct) values for routine surveillance for SARS-CoV-2, the virus that causes COVID-19. On January 25, 2021, MDH identified the SARS-CoV-2 variant P.1 in one specimen through this surveillance system using whole genome sequencing, representing the first identified case of this variant in the United States. The P.1 variant was first identified in travelers from Brazil during routine airport screening in Tokyo, Japan, in early January 2021 (1). This variant has been associated with increased transmissibility (2), and there are concerns that mutations in the spike protein receptor-binding domain might disrupt both vaccine-induced and natural immunity (3,4). As of February 28, 2021, a total of 10 P.1 cases had been identified in the United States, including the two cases described in this report, followed by one case each in Alaska, Florida, Maryland, and Oklahoma (5). |
First Identified Cases of SARS-CoV-2 Variant B.1.1.7 in Minnesota - December 2020-January 2021.
Firestone MJ , Lorentz AJ , Wang X , Como-Sabetti K , Vetter S , Smith K , Holzbauer S , Meyer S , Ehresmann K , Danila R , Lynfield R . MMWR Morb Mortal Wkly Rep 2021 70 (8) 278-279 On January 9, 2021, the Minnesota Department of Health (MDH) announced the identification of the SARS-CoV-2 variant of concern (VOC) B.1.1.7, also referred to as 20I/501Y.V1 and VOC 202012/01, in specimens from five persons; on January 25, MDH announced the identification of this variant in specimens from three additional persons. The B.1.1.7 variant, which is reported to be more transmissible than certain other SARS-CoV-2 lineages*(,)(†) (1), was first reported in the United Kingdom in December 2020 (1). As of February 14, 2021, a total of 1,173 COVID-19 cases of the B.1.1.7 variant had been identified in 39 U.S. states and the District of Columbia (2). Modeling data suggest that B.1.1.7 could become the predominant variant in the United States in March 2021 (3). |
COVID-19 Outbreak Associated with a 10-Day Motorcycle Rally in a Neighboring State - Minnesota, August-September 2020.
Firestone MJ , Wienkes H , Garfin J , Wang X , Vilen K , Smith KE , Holzbauer S , Plumb M , Pung K , Medus C , Yao JD , Binnicker MJ , Nelson AC , Yohe S , Como-Sabetti K , Ehresmann K , Lynfield R , Danila R . MMWR Morb Mortal Wkly Rep 2020 69 (47) 1771-1776 During August 7-16, 2020, a motorcycle rally was held in western South Dakota that attracted approximately 460,000 persons from across the United States to numerous indoor and outdoor events over a 10-day period. During August-September 2020, the Minnesota Department of Health (MDH) investigated a coronavirus disease 2019 (COVID-19) outbreak associated with the rally in Minnesota residents. Fifty-one primary event-associated cases were identified, and 35 secondary or tertiary cases occurred among household, social, and workplace contacts, for a total of 86 cases; four patients were hospitalized, and one died. Approximately one third (34%) of 87 counties in Minnesota had at least one primary, secondary, or tertiary case associated with this rally. Genomic sequencing supported the associations with the motorcycle rally. These findings support current recommendations for mask use, physical distancing, reducing the number of attendees at gatherings, isolation for patients with COVID-19, and quarantine for close contacts to slow the spread of SARS-CoV-2 (1). Furthermore, although these findings did not capture the impact of the motorcycle rally on residents of other states, they demonstrate the rationale for consistent mitigation measures across states. |
- Page last reviewed:Feb 1, 2024
- Page last updated:Apr 29, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure