Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
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Query Trace: Holst M[original query] |
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Foodborne illness outbreaks at retail food establishments - National Environmental Assessment Reporting System, 25 state and local health departments, 2017-2019
Moritz ED , Ebrahim-Zadeh SD , Wittry B , Holst MM , Daise B , Zern A , Taylor T , Kramer A , Brown LG . MMWR Surveill Summ 2023 72 (6) 1-11 PROBLEM/CONDITION: Each year, state and local public health departments report hundreds of foodborne illness outbreaks associated with retail food establishments (e.g., restaurants or caterers) to CDC. Typically, investigations involve epidemiology, laboratory, and environmental health components. Health departments voluntarily report epidemiologic and laboratory data from their foodborne illness outbreak investigations to CDC through the National Outbreak Reporting System (NORS); however, minimal environmental health data from outbreak investigations are reported to NORS. This report summarizes environmental health data collected during outbreak investigations and reported to the National Environmental Assessment Reporting System (NEARS). PERIOD COVERED: 2017-2019. DESCRIPTION OF SYSTEM: In 2014, CDC launched NEARS to complement NORS surveillance and to use these data to enhance prevention efforts. State and local health departments voluntarily enter data from their foodborne illness outbreak investigations of retail food establishments into NEARS. These data include characteristics of foodborne illness outbreaks (e.g., etiologic agent and factors contributing to the outbreak), characteristics of establishments with outbreaks (e.g., number of meals served daily), and food safety policies in these establishments (e.g., ill worker policy requirements). NEARS is the only available data source that collects environmental characteristics of retail establishments with foodborne illness outbreaks. RESULTS: During 2017-2019, a total of 800 foodborne illness outbreaks associated with 875 retail food establishments were reported to NEARS by 25 state and local health departments. Among outbreaks with a confirmed or suspected agent (555 of 800 [69.4%]), the most common pathogens were norovirus and Salmonella, accounting for 47.0% and 18.6% of outbreaks, respectively. Contributing factors were identified in 62.5% of outbreaks. Approximately 40% of outbreaks with identified contributing factors had at least one reported factor associated with food contamination by an ill or infectious food worker. Investigators conducted an interview with an establishment manager in 679 (84.9%) outbreaks. Of the 725 managers interviewed, most (91.7%) said their establishment had a policy requiring food workers to notify their manager when they were ill, and 66.0% also said these policies were written. Only 23.0% said their policy listed all five illness symptoms workers needed to notify managers about (i.e., vomiting, diarrhea, jaundice, sore throat with fever, and lesion with pus). Most (85.5%) said that their establishment had a policy restricting or excluding ill workers from working, and 62.4% said these policies were written. Only 17.8% said their policy listed all five illness symptoms that would require restriction or exclusion from work. Only 16.1% of establishments with outbreaks had policies addressing all four components relating to ill or infectious workers (i.e., policy requires workers to notify a manager when they are ill, policy specifies all five illness symptoms workers need to notify managers about, policy restricts or excludes ill workers from working, and policy specifies all five illness symptoms requiring restriction or exclusion from work). INTERPRETATION: Norovirus was the most commonly identified cause of outbreaks reported to NEARS, and contamination of food by ill or infectious food workers contributed to approximately 40% of outbreaks with identified contributing factors. These findings are consistent with findings from other national outbreak data sets and highlight the role of ill workers in foodborne illness outbreaks. Although a majority of managers reported their establishment had an ill worker policy, often these policies were missing components intended to reduce foodborne illness risk. Contamination of food by ill or infectious food workers is an important cause of outbreaks; therefore, the content and enforcement of existing policies might need to be re-examined and refined. PUBLIC HEALTH ACTION: Retail food establishments can reduce viral foodborne illness outbreaks by protecting food from contamination through proper hand hygiene and excluding ill or infectious workers from working. Development and implementation of policies that prevent contamination of food by workers are important to foodborne outbreak reduction. NEARS data can help identify gaps in food safety policies and practices, particularly those concerning ill workers. Future analyses of stratified data linking specific outbreak agents and foods with outbreak contributing factors can help guide the development of effective prevention approaches by describing how establishments' characteristics and food safety policies and practices relate to foodborne illness outbreaks. |
Characteristics associated with successful foodborne outbreak investigations involving United States retail food establishments (2014-2016)
Holst MM , Kramer A , Hoover ER , Dewey-Mattia D , Mack J , Hawkins T , Brown LG . Epidemiol Infect 2023 151 1-21 This study examined relationships between foodborne outbreak investigation characteristics, | such as the epidemiological methods used, and the success of the investigation, as determined by | whether the investigation identified an outbreak agent (i.e., pathogen), food item, and contributing | factor. This study used data from the Centers for Disease Control and Prevention’s (CDC) National | Outbreak Reporting System (NORS) and National Environmental Assessment Reporting System (NEARS) | to identify outbreak investigation characteristics associated with outbreak investigation success. We | identified investigation characteristics that increase the probability of successful outbreak | investigations: a rigorous epidemiology investigation method; a thorough environmental assessment, as | measured by number of visits to complete the assessment; and the collection of clinical samples. This | research highlights the importance of a comprehensive outbreak investigation, which includes | epidemiology, environmental health, and laboratory personnel working together to solve the outbreak. |
Rapid implementation of high-frequency wastewater surveillance of SARS-CoV-2
Holst MM , Person J , Jennings W , Welsh RM , Focazio MJ , Bradley PM , Schill WB , Kirby AE , Marsh ZA . ACS ES T Water 2022 2 (11) 2201-2210 There have been over 507 million cases of COVID-19, the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulting in 6 million deaths globally. Wastewater surveillance has emerged as a valuable tool in understanding SARS-CoV-2 burden in communities. The National Wastewater Surveillance System (NWSS) partnered with the United States Geological Survey (USGS) to implement a high-frequency sampling program. This report describes basic surveillance and sampling statistics as well as a comparison of SARS-CoV-2 trends between high-frequency sampling 3-5 times per week, referred to as USGS samples, and routine sampling 1-2 times per week, referred to as NWSS samples. USGS samples provided a more nuanced impression of the changes in wastewater trends, which could be important in emergency response situations. Despite the rapid implementation time frame, USGS samples had similar data quality and testing turnaround times as NWSS samples. Ensuring there is a reliable sample collection and testing plan before an emergency arises will aid in the rapid implementation of a high-frequency sampling approach. High-frequency sampling requires a constant flow of information and supplies throughout sample collection, testing, analysis, and data sharing. High-frequency sampling may be a useful approach for increased resolution of disease trends in emergency response. © 2022 American Chemical Society. All rights reserved. |
Operational Antecedents Associated with Clostridium perfringens Outbreaks in Retail Food Establishments, United States, 2015-2018
Wittry BC , Holst MM , Anderberg J , Hedeen N . Foodborne Pathog Dis 2022 19 (3) 209-216 Clostridium perfringens is a common foodborne pathogen, frequently associated with improper cooking, and cooling or reheating of animal products. The U.S. Food and Drug Administration Food Code outlines proper food preparation practices to prevent foodborne outbreaks; however, retail food establishments continue to have C. perfringens outbreaks. We qualitatively analyzed responses to two open-ended questions from the National Environmental Assessment Reporting System (NEARS) to understand patterns of unique circumstances in the retail food establishment that precede a C. perfringens outbreak. We identified three environmental antecedents, with three subcategories, to create nine operational antecedents to help explain why a C. perfringens outbreak occurred. Those antecedents included factors related to (1) people (a lack of adherence to food safety procedures, a lack of food safety culture, and no active managerial control), (2) processes (increased demand, a process change during food preparation, and new operations), and (3) equipment (not enough equipment, malfunctioning cold-holding equipment, and holding equipment not used as intended). We recommend that food establishments support food safety training and certification programs and adhere to a food safety management plan to reduce errors made by people and processes. Retail food establishments should conduct routine maintenance on equipment and use only properly working equipment for temperature control. They also should train workers on the purpose, use, and functionality of the equipment. |
An analysis of shiftwork and self-reported depressive symptoms in a police cohort from Buffalo, New York
Holst MM , Wirth MD , Allison P , Burch JB , Andrew ME , Fekedulegn D , Hussey J , Charles LE , Violanti JM . Chronobiol Int 2021 38 (6) 1-9 Shiftwork has been associated with elevated depressive symptoms; police officers frequently work shifts and may experience depressive symptoms. This study assessed the association between depressive symptoms and shiftwork in a police cohort from Buffalo, New York, USA using a repeated cross-sectional design with data collected in 2004-2009 (n = 428) and 2010-2014 (n = 261). Electronic payroll records were used to quantitatively classify officers on the day, evening, or night shift based on the shift they spent most of their working hours. Two self-reported depressive symptomology measures were used as outcomes - the Center for Epidemiological Studies - Depression (CES-D) scale and the Beck Depression Inventory (BDI). Repeated measures linear and logistic regression analyses were used to estimate least squares means or odds, respectively, of depressive symptom questionnaire scores by shiftwork category. Those working the evening/night shift had higher odds for depressive symptoms according to the BDI (based on a cut-point score of 14) than those working the day shift (OR = 4.60, 95% CI = 1.15-18.39). Similar results were observed for the evening shift group. No differences in mean CES-D or BDI scores were observed between groups for short-term shiftwork, long-term shiftwork, or shift changes. After stratifying by stress, as measured by the Perceived Stress Scale (PSS), total Impact of Events (IES), and the Spielberger Police Stress Survey (SPSS), mean values for depressive symptoms were higher in the high-stress categories regardless of shiftwork status. Further research should include biomarkers for depression, a longitudinal study design with a larger cohort, and joint effects of shiftwork and stress on depressive symptoms. |
Observed potential cross-contamination in retail delicatessens
Holst M , Brown LG , Viveiros B , Faw B , Hedeen N , McKelvey W , Nicholas D , Ripley D , Hammons S . J Food Prot 2021 84 (6) 1055-1059 Listeria monocytogenes (L. monocytogenes) is a persistent public health concern in the United States and is the third leading cause of death from foodborne illness. Cross-contamination of L. monocytogenes is common in delis (between contaminated and uncontaminated equipment, food and hands) and likely plays a role in the associated with retail deli meats. In 2012, EHS-Net conducted a study to describe deli characteristics related to cross-contamination with L. monocytogenes. The study included 298 retail delis in six state and local health departments' jurisdictions and assessed how well deli practices complied with the Food and Drug Administration (FDA) Food Code provisions. Among delis observed using wet wiping cloths for cleaning, 23.6% did not store the cloths in a sanitizing solution between uses. Observed potential cross-contamination of raw meats and ready-to-eat foods during preparation (e.g., same knife used on raw meats and ready-to-eat foods, without cleaning in between) was present in 9.4% of delis. In 24.6% of delis with a cold storage unit, raw meats were not stored separately from ready-to-eat products in containers, bins, or trays. A proper food safety management plan can reduce gaps in cross-contamination and include the adoption of procedures to minimize food safety risks, training with instructions and in-person demonstrations and certifying staff on those procedures, and monitoring to ensure procedures are followed. |
Retail deli characteristics associated with sanitizing solution concentrations
Holst M , Brown LG , Hoover ER , Julian E , Faw BV , Hedeen N , McKelvey W , Nicholas D , Ripley D , McKelvey W . J Food Prot 2020 83 (10) 1667-1672 Listeria monocytogenes (L. mono) is commonly found in retail deli environments. Proper types and concentrations of sanitizers must be used to eliminate this pathogen from surfaces and reduce the consumer's risk for infection. In 2012, the CDC's Environmental Health Specialists Network completed a study on practices in retail delis that can help prevent cross-contamination and growth of L. mono. This report focuses on the sanitizing solution used by delis, given its importance to cleaning and reducing pathogen contamination in retail food environments. In this study, we identified deli, manager, and worker characteristics associated with use of improper concentrations of sanitizing solution used to wipe down food contact surfaces. Results indicate that 22.8% of sanitizing solutions used for wiping food contact surfaces were at improper concentrations. Independent delis were more likely to use improper concentrations of sanitizing solution, as were delis that sold fewer chubs (plastic tubes of meat) per week. Counter-intuitively, improper sanitizing solution concentration was associated with required food safety training for managers; additional analyses suggest that this relationship is significant for independent, but not chain, delis. It is important to emphasize cleaning and sanitizing education and focus food safety efforts on independent and smaller delis. |
Shift work and biomarkers of subclinical cardiovascular disease: The BCOPS Study
Holst MM , Wirth MD , Mnatsakanova A , Burch JB , Charles LE , Tinney-Zara C , Fekedulegn D , Andrew ME , Hartley TA , Violanti JM . J Occup Environ Med 2019 61 (5) 391-396 OBJECTIVE: To assess the association of shift work with biomarkers of subclinical cardiovascular disease and examine the moderating role of body mass index (BMI) in a police cohort METHODS: A cross-sectional analysis was conducted among officers who were categorized as working the day, evening, or night shift. Comparisons with inflammatory biomarkers were performed among shifts using analysis of variance/covariance and further stratified by BMI to assess potential effect modification. RESULTS: Associations were observed between day and night shift workers for leukocytes, tumor necrosis factor alpha and homocysteine. After BMI stratification, higher c-reactive protein (CRP) levels were observed among evening shift workers with a BMI >/= 30 kg/m. versus the day shift. CONCLUSIONS: Future studies examining prospective changes in these markers will allow for more comprehensive evaluation of their association with shift work. |
Early-onset group B streptococcal disease in the United States: potential for further reduction
Verani JR , Spina NL , Lynfield R , Schaffner W , Harrison LH , Holst A , Thomas S , Garcia JM , Scherzinger K , Aragon D , Petit S , Thompson J , Pasutti L , Carey R , McGee L , Weston E , Schrag SJ . Obstet Gynecol 2014 123 (4) 828-837 OBJECTIVE: To describe lapses in adherence to group B streptococcus (GBS) prevention guidelines among cases of early-onset GBS disease in term and preterm neonates and to estimate the potential for further reduction in disease burden under current prevention strategies. METHODS: We reviewed labor and delivery and prenatal records of mothers of neonates with early-onset GBS disease (aged younger than 7 days with GBS isolated from a normally sterile site) identified at population-based surveillance sites in 2008-2009. We interviewed prenatal care providers about GBS screening practices and obtained relevant laboratory records. We evaluated the data for errors in prenatal screening, laboratory methods, communication of results, and intrapartum antibiotic prophylaxis. Using published data on screening sensitivity and intrapartum prophylaxis effectiveness, we estimated the potential reduction in cases under optimal prevention implementation. RESULTS: Among 309 cases, 179 (57.9%) had one or more implementation errors. The most common error type in term and preterm case-patients was prenatal screening (80 of 222 [36.0%]) and intrapartum prophylaxis (46 of 85 [54.1%]), respectively. We estimated that under optimal implementation, cases of early-onset GBS disease could be reduced by 26-59% with the largest benefit from a single intervention coming from improved use of intrapartum prophylaxis (16% decrease). CONCLUSION: Further reduction of early-onset GBS disease burden is possible under current prevention strategies, particularly with improved implementation of antibiotic prophylaxis. However, even with perfect adherence to recommended practices, the decline in cases may be modest. Therefore, novel prevention approaches such as improved intrapartum assays and vaccines are also needed. |
Pneumococcal carriage and invasive disease in children before introduction of the 13-valent conjugate vaccine: comparison with the pre-7-valent conjugate vaccine era
Sharma D , Baughman W , Holst A , Thomas S , Jackson D , Carvalho MD , Beall B , Satola S , Jerris R , Jain S , Farley MM , Nuorti JP . Pediatr Infect Dis J 2012 32 (2) e45-53 BACKGROUND: Nasopharyngeal (NP) carriage and invasive pneumococcal disease (IPD) due to serotypes in the 7-valent pneumococcal conjugate vaccine (PCV7) declined dramatically after vaccine introduction, whereas non-PCV7 serotypes increased modestly. Characteristics of pneumococcal carriage and IPD among children in Atlanta were compared during two time periods: pre-PCV7 introduction and pre-PCV13 introduction. METHODS: NP swabs from 231 and 451 children aged 6 to 59 months receiving outpatient medical care were obtained in 1995 and 2009, respectively. A total of 202 and 47 IPD cases were identified in children < 5 years of age in 1995 and 2008-2009, respectively, through active, population-based surveillance in Atlanta. Isolates were serotyped, sequence typed (ST), and tested for antimicrobial susceptibility RESULTS: Forty percent (93/231) of children in 1995 and 31% (139/451) in 2009 were colonized with Streptococcus pneumoniae; 60% and 0.7% were PCV7 serotypes, respectively. In 1995, PCV7 serotypes accounted for 83% and 19A 5% of IPD compared with no PCV7 serotypes and 49% 19A among IPD in 2009 [P<0.001]. In 2009, PCV13 serotypes accounted for 22% of carriage (mostly 19A) and 60% of invasive isolates [P<0.001]. ST320 accounted for 66% and 52% of 19A carriage and IPD isolates in 2009, respectively; all ST320 isolates were multi-drug resistant. No ST320 NP or IPD isolates were identified pre-PCV7. CONCLUSIONS: Serotype distribution among NP and IPD isolates in Atlanta has shifted to non-PCV7 serotypes; 19A was the leading serotype for both. The multi-drug resistant ST320 strain was responsible for two-thirds of 19A carriage isolates and nearly half of IPD isolates. The predominance of serotype 19A in carriage and IPD among children in Atlanta highlights the potential direct and indirect benefits anticipated by implementation of PCV13 in the community. |
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