Last data update: Jun 03, 2024. (Total: 46935 publications since 2009)
Records 1-30 (of 48 Records) |
Query Trace: Jones TF [original query] |
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Implications of measles inclusion by commercial syndromic polymerase chain reaction panels - United States, May 2022-April 2023
Thomas CM , Hartley A , Schmitz A , Reid HD , Sullivan S , Huebner E , Robinson M , Mathis A , Fill MA , Levinson KJ , Jones TF , Schaffner W , Newhouse CN , Dunn JR . MMWR Morb Mortal Wkly Rep 2024 73 (12) 260-264 Syndromic polymerase chain reaction (PCR) panels are used to test for pathogens that can cause rash illnesses, including measles. Rash illnesses have infectious and noninfectious causes, and approximately 5% of persons experience a rash 7-10 days after receipt of a measles, mumps, and rubella (MMR) vaccine. MMR vaccine includes live attenuated measles virus, which is detectable by PCR tests. No evidence exists of person-to-person transmission of measles vaccine virus, and illness does not typically result among immunocompetent persons. During September 2022-January 2023, the Tennessee Department of Health received two reports of measles detected by syndromic PCR panels. Both reports involved children (aged 1 and 6 years) without known risk factors for measles, who were evaluated for rash that occurred 11-13 days after routine MMR vaccination. After public health responses in Tennessee determined that both PCR panels had detected measles vaccine virus, six state health departments collaborated to assess the frequency and characteristics of persons receiving a positive measles PCR panel test result in the United States. Information was retrospectively collected from a commercial laboratory testing for measles in syndromic multiplex PCR panels. During May 2022-April 2023, among 1,548 syndromic PCR panels, 17 (1.1%) returned positive test results for measles virus. Among 14 persons who received a positive test result and for whom vaccination and case investigation information were available, all had received MMR vaccine a median of 12 days before specimen collection, and none had known risk factors for acquiring measles. All positive PCR results were attributed to detection of measles vaccine virus. Increased awareness among health care providers about potential measles detection by PCR after vaccination is needed. Any detection of measles virus by syndromic PCR testing should be immediately reported to public health agencies, which can use measles vaccination history and assessment of risk factors to determine the appropriate public health response. If a person recently received MMR vaccine and has no risk factors for acquiring measles, additional public health response is likely unnecessary. |
Lessons learned from implementation of Mpox surveillance during an outbreak response in Tennessee, 2022
Thomas CM , Shaffner J , Johnson R , Wiedeman C , Fill MA , Jones TF , Schaffner W , Dunn JR . Public Health Rep 2024 333549231223710 OBJECTIVES: Mpox surveillance was integral during the 2022 outbreak response. We evaluated implementation of mpox surveillance in Tennessee during an outbreak response and made recommendations for surveillance during emerging infectious disease outbreaks. METHODS: To understand surveillance implementation, system processes, and areas for improvement, we conducted 8 semistructured focus groups and 7 interviews with 36 health care, laboratory, and health department representatives during September 9-20, 2022. We categorized and analyzed session transcription and notes. We analyzed completeness and timeliness of surveillance data, including 349 orthopoxvirus-positive laboratory reports from commercial, public health, and health system laboratories during July 1-August 31, 2022. RESULTS: Participants described an evolving system and noted that existing informatics platforms inefficiently supported iterations of reporting requirements. Clear communication, standardization of terminology, and shared, adaptable, and user-friendly informatics platforms were prioritized for future emerging infectious disease surveillance systems. Laboratory-reported epidemiologic information was often incomplete; only 55% (191 of 349) of reports included patient address and telephone number. The median time from symptom onset to specimen collection was 5 days (IQR, 3-6 d), from specimen collection to laboratory reporting was 3 days (IQR, 1-4 d), from laboratory reporting to patient interview was 1 day (IQR, 1-3 d), and from symptom onset to patient interview was 9 days (IQR, 7-12 d). CONCLUSIONS: Future emerging infectious disease responses would benefit from standardized surveillance approaches that facilitate rapid implementation. Closer collaboration among informatics, laboratory, and clinical partners across jurisdictions and agencies in determining system priorities and designing workflow processes could improve flexibility of the surveillance platform and completeness and timeliness of laboratory reporting. Improved timeliness will facilitate public health response and intervention, thereby mitigating morbidity. |
Early and increased influenza activity among children - Tennessee, 2022-23 influenza season
Thomas CM , White EB , Kojima N , Fill MA , Hanna S , Jones TF , Newhouse CN , Orejuela K , Roth E , Winders S , Chandler DR , Grijalva CG , Schaffner W , Schmitz JE , DaSilva J , Kirby MK , Mellis AM , Rolfes MA , Sumner KM , Flannery B , Talbot HK , Dunn JR . MMWR Morb Mortal Wkly Rep 2023 72 (3) 49-54 Influenza seasons typically begin in October and peak between December and February (1); however, the 2022-23 influenza season in Tennessee began in late September and was characterized by high pediatric hospitalization rates during November. This report describes a field investigation conducted in Tennessee during November 2022, following reports of increasing influenza hospitalizations. Data from surveillance networks, patient surveys, and whole genome sequencing of influenza virus specimens were analyzed to assess influenza activity and secondary illness risk. Influenza activity increased earlier than usual among all age groups, and rates of influenza-associated hospitalization among children were high in November, reaching 12.6 per 100,000 in children aged <5 years, comparable to peak levels typically seen in high-severity seasons. Circulating influenza viruses were genetically similar to vaccine components. Among persons who received testing for influenza at outpatient clinics, children were twice as likely to receive a positive influenza test result as were adults. Among household contacts exposed to someone with influenza, children were more than twice as likely to become ill compared with adults. As the influenza season continues, it is important for all persons, especially those at higher risk for severe disease, to protect themselves from influenza. To prevent influenza and severe influenza complications, all persons aged ≥6 months should get vaccinated, avoid contact with ill persons, and take influenza antivirals if recommended and prescribed. |
Disparities in COVID-19 Mortality Rates: Implications for Rural Health Policy and Preparedness.
Grome HN , Raman R , Katz BD , Fill MM , Jones TF , Schaffner W , Dunn J . J Public Health Manag Pract 2022 28 (5) 478-485 CONTEXT: It is well established that rural communities face geographic and socioeconomic challenges linked to higher rates of health disparities across the United States, though the coronavirus disease 2019 (COVID-19) impact on rural communities is less certain. OBJECTIVE: To understand the COVID-19 pandemic's impact on rural communities in Tennessee, investigate differences in rural-urban mortality rates after controlling for confounding variables, and inform state pandemic response policy. DESIGN: A cross-sectional analysis of cumulative COVID-19 morality rates. SETTING/PARTICIPANTS: Tennessee county-level COVID-19 mortality data from March 1, 2020, to January 31, 2021, were matched with county-level sociodemographic and health data from public datasets: Agency for Healthcare Research and Quality Social Determinants of Health, PLACES: Local Data for Better Health County Data, and the US Census Bureau. County status was defined using the 2013 National Center for Health Statistics Urban-Rural Classification. MAIN OUTCOME MEASURES: A negative binomial regression model estimated adjusted incidence rate ratio and 95% confidence intervals (CI) for rural compared with urban mortality. Unadjusted rate ratios and rate differences for COVID-19 mortality in rural versus urban counties were compared with those for influenza and pneumonia and all-cause mortality over the past 5 years. RESULTS: During the study period, 9650 COVID-19 deaths occurred across 42 urban and 53 rural counties. Controlling for county-level sociodemographic characteristics, health care access, and comorbidities, incidence rate ratio was 1.13 (95% CI, 1.00-1.28, P < .05) for rural as compared with urban deaths. Unadjusted COVID-19 mortality risk difference between rural and urban counties was greater (61.85, 95% CI, 54.31-69.31) than 5-year influenza and pneumonia rural-urban risk difference (12.57, 95% CI, 11.16-13.00) during 2015-2019. CONCLUSIONS: COVID-19 mortality rates were greater for populations living in Tennessee's rural as compared with urban counties during the study period. This differential impact must be considered in public health decision making to mitigate COVID-19. |
SARS-CoV-2 Outbreak among Malayan Tigers and Humans, Tennessee, USA, 2020.
Grome HN , Meyer B , Read E , Buchanan M , Cushing A , Sawatzki K , Levinson KJ , Thomas LS , Perry Z , Uehara A , Tao Y , Queen K , Tong S , Ghai R , Fill MM , Jones TF , Schaffner W , Dunn J . Emerg Infect Dis 2022 28 (4) 833-836 We report an outbreak of severe acute respiratory syndrome coronavirus 2 involving 3 Malayan tigers (Panthera tigris jacksoni) at a zoo in Tennessee, USA. Investigation identified naturally occurring tiger-to-tiger transmission; genetic sequence change occurred with viral passage. We provide epidemiologic, environmental, and genomic sequencing data for animal and human infections. |
Fatal Multisystem Inflammatory Syndrome in Adult after SARS-CoV-2 Natural Infection and COVID-19 Vaccination.
Grome HN , Threlkeld M , Threlkeld S , Newman C , Martines RB , Reagan-Steiner S , Whitt MA , Gomes-Solecki M , Nair N , Fill MM , Jones TF , Schaffner W , Dunn J . Emerg Infect Dis 2021 27 (11) 2914-2918 We describe a fatal case of multisystem inflammatory syndrome in an adult with onset 22 days after a second dose of mRNA coronavirus disease vaccine. Serologic and clinical findings indicated severe acute respiratory syndrome coronavirus 2 infection occurred before vaccination. The immunopathology of this syndrome, regardless of vaccination status, remains poorly understood. |
Nosocomial hepatitis A outbreak among healthcare workers and patients in a community hospital during an ongoing statewide outbreak.
Brennan J , Mullins H , Tobey K , Jones C , Kainer MA , Fiscus M , May S , Dunn JR , Schaffner W , Jones TF . Infect Control Hosp Epidemiol 2020 42 (2) 1-3 OBJECTIVE: The Tennessee Department of Health (TDH) investigated a hepatitis A virus (HAV) outbreak to identify risk factors for infection and make prevention recommendations. DESIGN: Case series. SETTING: Community hospital. PARTICIPANTS: Healthcare workers (HCWs) or patients with laboratory-confirmed acute HAV infection during October 1, 2018-January 10, 2019. METHODS: HCWs with suspected or confirmed hepatitis A infections were interviewed to assess their exposures and activities. Patient medical records and hospital administrative records were reviewed to identify common exposures. We conducted a site investigation to assess knowledge of infection control practices among HCWs. Serum specimens from ill persons were tested for HAV RNA by polymerase chain reaction (PCR) and genotyped. RESULTS: We identified 6 HCWs and 2 patients with laboratory-confirmed HAV infection. All cases likely resulted from exposure to a homeless patient with a history of recreational substance use and undiagnosed HAV infection. Breaches in hand hygiene and use of standard precautions were identified. HAV RNA was detected in 7 serum specimens and all belonged to an identical strain of HAV genotype 1b. CONCLUSIONS: A hepatitis A outbreak among hospital patients and HCWs resulted from exposure to a single patient with undiagnosed HAV infection. Breakdowns in infection control practices contributed to the outbreak. The likelihood of nosocomial transmission can be reduced with proper hand hygiene, standard precautions, and routine disinfection. During community outbreaks, medical providers can better prevent ongoing transmission by including hepatitis A in the differential diagnosis among patients with a history of recreational substance use and homelessness. |
Injection drug use-associated candidemia: Incidence, clinical features, and outcomes, east Tennessee, 2014-2018
Rossow JA , Gharpure R , Brennan J , Relan P , Williams SR , Vallabhaneni S , Jackson BR , Graber CR , Hillis SR , Schaffner W , Dunn JR , Jones TF . J Infect Dis 2020 222 S442-s450 BACKGROUND: Injection drug use (IDU) is an established but uncommon risk factor for candidemia. Surveillance for candidemia is conducted in East Tennessee, an area heavily impacted by the opioid crisis and IDU. We evaluated IDU-associated candidemia to characterize the epidemiology and estimate the burden. METHODS: We assessed the proportion of candidemia cases related to IDU during January 1, 2014-September 30, 2018, estimated candidemia incidence in the overall population and among persons who inject drugs (PWID), and reviewed medical records to compare clinical features and outcomes among IDU-associated and non-IDU candidemia cases. RESULTS: The proportion of IDU-associated candidemia cases in East Tennessee increased from 6.1% in 2014 to 14.5% in 2018. Overall candidemia incidence in East Tennessee was 13.5/100 000, and incidence among PWID was 402-1895/100 000. Injection drug use-associated cases were younger (median age, 34.5 vs 60 years) and more frequently had endocarditis (39% vs 3%). All-cause 30-day mortality was 8% among IDU-associated cases versus 25% among non-IDU cases. CONCLUSIONS: A growing proportion of candidemia in East Tennessee is associated with IDU, posing an additional burden from the opioid crisis. The lower mortality among IDU-associated cases likely reflects in part the younger demographic; however, Candida endocarditis seen among approximately 40% underscores the seriousness of the infection and need for prevention. |
Surveillance, epidemiology, and estimated burden of neonatal abstinence syndrome, Tennessee, 2013-2016
Brennan J , Wiedeman C , Dunn JR , Schaffner W , Jones TF . Public Health Rep 2019 134 (5) 537-541 OBJECTIVES: Between 2003 and 2013, the rate of neonatal abstinence syndrome (NAS)-a postnatal drug withdrawal syndrome-in Tennessee increased approximately 10-fold. NAS surveillance is relatively new, and underestimation associated with surveillance has not been described. We compared data from the Tennessee NAS public health surveillance system (TNSS) with a second source of NAS data, hospital discharge data system (HDDS), and estimated the true number of infants with NAS using capture-recapture methods. METHODS: We obtained NAS data on cases of NAS among Tennessee infants from TNSS and HDDS from January 1, 2013, through December 31, 2016. We matched cases of NAS identified in TNSS to cases identified in HDDS. We estimated the true number of infants with NAS by using the Lincoln-Peterson estimator capture-recapture methodology. RESULTS: During the study period, 4070 infants with NAS were reported to TNSS, and 5321 infants with NAS were identified in HDDS; 2757 were in both data sets. Using capture-recapture methods, the total estimated number of infants with NAS during the study period was 7855 (annual mean = 1972; estimated range = 1531-2427), which was 93% more than in TNSS and 48% more than in HDDS. Drugs used for the medication-assisted treatment of substance use disorder were the most commonly reported substances associated with NAS (n = 2389, 59%). CONCLUSIONS: TNSS underestimated the total burden of NAS based on the capture-recapture estimate. Case-based public health surveillance is important for monitoring the burden of and risk factors for NAS and helping guide public health interventions. |
Notes from the field: Acute hepatitis A virus infection among previously vaccinated persons with HIV infection - Tennessee, 2018
Brennan J , Moore K , Sizemore L , Mathieson SA , Wester C , Dunn JR , Schaffner W , Jones TF . MMWR Morb Mortal Wkly Rep 2019 68 (14) 328-329 Complete immunization against hepatitis A requires 2 doses of a monovalent vaccine or 3 doses of a combined hepatitis A and hepatitis B vaccine; approximately 90% of vaccinated persons achieve protective antibody levels after a single dose of either product (1). However, persons living with human immunodeficiency virus (HIV) infection might not develop the same level of immunity after hepatitis A virus (HAV) vaccination as do immunocompetent persons (2,3). Compared with immunocompetent persons, seroconversion rates among persons with HIV infection are lower and are further affected by CD4 count and HIV viral load at the time of the first dose of vaccine (3). In addition, time to seroconversion is longer (3), and duration of protection wanes earlier (4) among persons with HIV infection. During an outbreak, evaluating predictors of a better vaccine response (CD4 count and HIV viral load at the time of first vaccination) is generally not feasible. Routine assessment of immune response after vaccination is not recommended for persons in general, nor for those with HIV infection (1); therefore, providers use a documented history of HAV vaccination to guide decisions regarding administration of HAV postexposure prophylaxis (PEP). However, compared with vaccination among the general population, a previous hepatitis A vaccination in persons with HIV infection after a high-risk exposure (e.g., household member or sexual contact) might not reliably protect against illness. The Tennessee Department of Health (TDH) sought to determine the frequency at which persons with HIV infection who were previously vaccinated for hepatitis A developed HAV infection during an HAV outbreak. |
Notes from the field: Multiple modes of transmission during a Thanksgiving day norovirus outbreak - Tennessee, 2017
Brennan J , Cavallo SJ , Garman K , Lewis K , Irving DJ , Moore C , Thomas L , Hill J , Villegas R , Norman JF , Dunn JR , Schaffner W , Jones TF . MMWR Morb Mortal Wkly Rep 2018 67 (46) 1300-1301 On November 28, 2017, the manager of restaurant A in Tennessee reported receiving 18 complaints from patrons with gastrointestinal illness who had dined there on Thanksgiving Day, November 23, 2017. Tennessee Department of Health officials conducted an investigation to confirm the outbreak, assess exposures, and recommend measures to prevent continued spread. | | On November 23, one patron vomited in a private dining room, and an employee immediately used disinfectant spray labeled as effective against norovirus* to clean the vomitus. After handwashing, the employee served family-style platters of food and cut pecan pie. For the November 23 Thanksgiving Day, restaurant A served 676 patrons a limited menu from 11 a.m. to 8 p.m. The manager provided contact information, seating times, and seating locations for 114 patrons with reservations. All patrons with contact information were telephoned, and a questionnaire was used to assess illness and exposures for anyone living in the household who ate at restaurant A on November 23. Stool specimens were requested from ill patrons. Among the 676 patrons, 137 (20%) were enrolled in a case-control study. |
Educational disabilities among children born with neonatal abstinence syndrome
Fill MA , Miller AM , Wilkinson RH , Warren MD , Dunn JR , Schaffner W , Jones TF . Pediatrics 2018 142 (3) BACKGROUND: Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome that can occur after intrauterine opioid exposure. Adverse neurobehavioral outcomes have been documented in infants with NAS; however, educational outcomes have not been thoroughly examined. We analyzed Tennessee data to understand the need for special educational services among infants who are born with NAS. METHODS: By using Tennessee Medicaid and birth certificate data, infants who were born in Tennessee between 2008 and 2011 with a history of NAS were matched (1:3) to infants who were born during the same period without a history of NAS. Groups were matched on the basis of sex, race and/or ethnicity, age, birth region of residence, and Medicaid enrollment status. Data were linked to Tennessee Department of Education special education data during early childhood (3-8 years of age). Conditional multivariable logistic regression was used to assess associations between NAS and selected special education outcomes. RESULTS: A total of 1815 children with a history of NAS and 5441 children without NAS were assessed. Children with NAS were significantly more likely to be referred for a disability evaluation (351 of 1815 [19.3%] vs 745 of 5441 [13.7%]; P < .0001), to meet criteria for a disability (284 of 1815 [15.6%] vs 634 of 5441 [11.7%]; P < .0001), and to require classroom therapies or services (278 of 1815 [15.3%] vs 620 of 5441 [11.4%]; P < .0001). These findings were sustained in a multivariable analysis, with multiple models controlling for maternal tobacco use, maternal education status, birth weight, gestational age, and/or NICU admission. CONCLUSIONS: Results of this novel analysis linking health and education data revealed that children with a history of NAS were significantly more likely to have a subsequent educational disability. |
Epidemiology and risk factors for hepatitis C virus infection in a high-prevalence population
Fill MA , Sizemore LA , Rickles M , Cooper KC , Buecker CM , Mullins HL , Hofmeister MG , Abara WE , Foster MA , Asher AK , Schaffner W , Dunn JR , Jones TF , Wester C . Epidemiol Infect 2018 146 (4) 1-7 To understand increasing rates of hepatitis C virus (HCV) infection in Tennessee, we conducted testing, risk factor analysis and a nested case-control study among persons who use drugs. During June-October 2016, HCV testing with risk factor assessment was conducted in sexually transmitted disease clinics, family planning clinics and an addiction treatment facility in eastern Tennessee; data were analysed by using multivariable logistic regression. A nested case-control study was conducted to assess drug-using risks and behaviours among persons who reported intranasal or injection drug use (IDU). Of 4753 persons tested, 397 (8.4%) were HCV-antibody positive. HCV infection was significantly associated with a history of both intranasal and IDU (adjusted odds ratio (aOR) 35.4, 95% confidence interval (CI) 24.1-51.9), IDU alone (aOR 52.7, CI 25.3-109.9), intranasal drug use alone (aOR 2.6, CI 1.8-3.9) and incarceration (aOR 2.7, CI 2.0-3.8). By 4 October 2016, 574 persons with a reported history of drug use; 63 (11%) were interviewed further. Of 31 persons who used both intranasal and injection drugs, 26 (84%) reported previous intranasal drug use, occurring 1-18 years (median 5.5 years) before their first IDU. Our findings provide evidence that reported IDU, intranasal drug use and incarceration are independent indicators of risk for past or present HCV infection in the study population. |
Genetic Susceptibility to Hemolytic-Uremic Syndrome after Shiga Toxin-Producing Escherichia Coli (STEC) Infection: a Centers for Disease Control and Prevention (CDC) FoodNet Study.
Kallianpur AR , Bradford Y , Mody RK , Garman KN , Comstock N , Lathrop SL , Lyons C , Saupe A , Wymore K , Canter JA , Olson LM , Palmer A , Jones TF . J Infect Dis 2017 217 (6) 1000-1010 Background: Post-diarrheal hemolytic-uremic syndrome (D+HUS) following Shiga toxin-producing Escherichia coli (STEC) infection is a serious condition lacking specific treatment. Host immune dysregulation and genetic susceptibility to complement hyperactivation are implicated in non-STEC-related HUS. However, genetic susceptibility to D+HUS remains largely uncharacterized. Methods: Patients with culture-confirmed STEC diarrhea, identified through the CDC FoodNet surveillance system (2007-2012), were serotyped and classified by laboratory and/or clinical criteria as suspected, probable, or confirmed D+HUS, or as controls and genotyped at 200 loci linked to non-diarrheal HUS or similar pathologies. Genetic associations with D+HUS were explored by multivariable regression, adjusting for known risk factors. Results: Of 641 enrollees with STEC O157:H7, 80 had suspected D+HUS (41 probable and 32 confirmed D+HUS). Twelve genes related to cytokine signaling, complement pathways, platelet function, pathogen recognition, iron transport, and endothelial function were associated with D+HUS in multivariable-adjusted analyses (p≤0.05). Of 12 significant SNPs, 5 were associated with all levels of D+HUS (intergenic SNP rs10874639, TFRC rs3804141, EDN1 rs5370, GP1BA rs121908064, and B2M rs16966334), and 7 SNPs (6 non-complement-related) were associated with confirmed D+HUS (all p<0.05). Conclusions: Polymorphisms in many non-complement-related genes may contribute to D+HUS susceptibility. These results require replication, but they suggest novel therapeutic targets in D+HUS. |
Notes from the field: Multiple cases of Seoul virus infection in a household with infected pet rats - Tennessee, December 2016-April 2017
Fill MA , Mullins H , May AS , Henderson H , Brown SM , Chiang CF , Patel NR , Klena JD , de St Maurice A , Knust B , Nichol ST , Dunn JR , Schaffner W , Jones TF . MMWR Morb Mortal Wkly Rep 2017 66 (40) 1081-1082 In late December 2016, a female aged 18 years in Tennessee (patient A) developed fever, chills, anorexia, nausea, and hematuria. Approximately 1 week later, she was evaluated by her local physician and received a diagnosis of an unspecified viral illness. Laboratory testing at that time was notable only for an elevated creatinine level (1.27 mg/dL; normal = 0.60–1.10 mg/dL). She recovered from her illness without treatment or complications. | In January 2017, an outbreak of Seoul virus infection was identified among rat breeders and owners in Wisconsin and Illinois. CDC assisted Illinois and Wisconsin health officials in performing tracing of potentially infected or exposed rats, and in late January 2017, the Tennessee Department of Health was notified that pet rats owned by patient A were linked to confirmed Seoul virus–infected rats. On February 14, 2017, a follow-up specimen of patient A’s blood tested positive for Seoul virus immunoglobulin M and immunoglobulin G by enzyme-linked immunosorbent assay; she declined testing of her rats, although they were presumed to be positive in light of the patient’s confirmed infection. Consistent with CDC guidance, the Tennessee Department of Health recommended euthanizing the rats; however, patient A refused. In collaboration with the Tennessee Department of Agriculture, an order of quarantine was issued to patient A, prohibiting movement of the rodents from her home. In addition, she and her family received extensive education about risk reduction techniques, including avoiding contact with rodent urine, droppings, saliva, and nesting materials. |
Evaluation of a spotted fever group Rickettsia public health surveillance system in Tennessee
Fill MA , Moncayo AC , Bloch KC , Dunn JR , Schaffner W , Jones TF . Am J Trop Med Hyg 2017 97 (3) 789-794 Spotted fever group (SFG) rickettsioses are endemic in Tennessee, with approximately 2,500 cases reported during 2000-2012. Because of this substantial burden of disease, we performed a three-part evaluation of Tennessee's routine surveillance for SFG rickettsioses cases and deaths to assess the system's effectiveness. Tennessee Department of Health (TDH) SFG rickettsioses surveillance records were matched to three patient series: 1) patients with positive serologic specimens from a commercial reference laboratory during 2010-2011, 2) tertiary medical center patients with positive serologic tests during 2007-2013, and 3) patients identified from death certificates issued during 1995-2014 with SFG rickettsiosis-related causes of death. Chart reviews were performed and patients were classified according to the Council of State and Territorial Epidemiologists' case definition. Of 254 SFG Rickettsia-positive serologic specimens from the reference laboratory, 129 (51%) met the case definition for confirmed or probable cases of rickettsial disease after chart review. The sensitivity of the TDH surveillance system to detect cases was 45%. Of the 98 confirmed or probable cases identified from the medical center, the sensitivity of the TDH surveillance system to detect cases was 34%. Of 27 patients identified by death certificates, 12 (44%) were classified as confirmed or probable cases; four (33%) were reported to TDH, but none were correctly identified as deceased. Cases of SFG rickettsioses were underreported and fatalities not correctly identified. Efforts are needed to improve SFG rickettsiosis surveillance in Tennessee. |
Cryptosporidiosis outbreak associated with a single hotel
Fill MMA , Lloyd J , Chakraverty T , Sweat D , Manners J , Garman K , Hlavsa MC , Roellig DM , Dunn JR , Schaffner W , Jones TF . J Environ Health 2017 79 (9) 16-23 We investigated a gastrointestinal illness cluster among persons who attended a baseball tournament (>200 teams) during July 2015. We interviewed representatives of 19 teams; illness was reported among only the 9 (47%) teams that stayed at Hotel A (p<.01). We identified 55 primary cases. A case-control study demonstrated that pool exposure at Hotel A was significantly associated with illness (odds ratio: 7.3; 95% confidence interval: 3.6, 15.2). Eight out of nine (89%) stool specimens tested were positive for Cryptosporidium, with C. hominis IfA12 G1 subtype identified in two specimens. The environmental health assessment detected a low free available chlorine level, and pool water tested positive for E. coli and total coliforms. A possible diarrheal contamination event, substantial hotel pool use, and use of cyanuric acid might have contributed to this outbreak and magnitude. Aquatic facilities practicing proper operation and maintenance (e.g., following the Centers for Disease Control and Prevention's Model Aquatic Health Code) can protect the public's health. |
Water quality survey of splash pads after a waterborne salmonellosis outbreak - Tennessee, 2014
Clayton JL , Manners J , Miller S , Shepherd C , Dunn JR , Schaffner W , Jones TF . J Environ Health 2017 79 (10) 8-13 Waterborne outbreaks of salmonellosis are uncommon. The Tennessee Department of Health investigated a salmonellosis outbreak of 10 cases with the only common risk factor being exposure to a single splash pad. Risks included water splashed in the face at the splash pad and no free residual chlorine in the water system. We surveyed water quality and patron behaviors at splash pads statewide. Of the 29 splash pads participating in the water quality survey, 24 (83%) used a recirculating water system. Of the 24, 5 (21%) water samples were tested by polymerase chain reaction and found to be positive for E. coli, Giardia, norovirus, or Salmonella. Among 95 patrons observed, we identified common high-risk behaviors of sitting on the fountain or spray head and putting mouth to water. Water venue regulations and improved education of patrons are important to aid prevention efforts. |
Population survey of attitudes and beliefs regarding organic, genetically modified, and irradiated foods
Gwira Baumblatt JA , Carpenter LR , Wiedeman C , Dunn JR , Schaffner W , Jones TF . Nutr Health 2017 23 (1) 7-11 BACKGROUND: Sales of organic foods are increasing due to public demand, while genetically modified (GM) and irradiated foods are often viewed with suspicion. AIM: The aim of this research was to examine consumer attitudes toward organic, GM and irradiated foods to direct educational efforts regarding their consumption Methods: A telephone survey of 1838 residents in Tennessee, USA was conducted regarding organic, GM, and irradiated foods. RESULTS: Approximately half of respondents (50.4%) purchased organic food during the previous 6 months ('consumers'). The most common beliefs about organic foods by consumers were higher cost (92%), and fewer pesticides (89%). Consumers were more likely than non-consumers to believe organic food tasted better (prevalence ratio 3.6; 95% confidence interval 3.02-4.23). A minority of respondents were familiar with GM foods (33%) and irradiated foods (22%). CONCLUSION: Organic food consumption is common in Tennessee, but knowledge about GM and irradiated foods is less common. Consumer health education should emphasize the benefits of these food options, and the safety of GM and irradiated foods. |
Novel clinical and pathologic findings in a Heartland Virus-associated death
Fill MA , Compton ML , McDonald EC , Moncayo AC , Dunn JR , Schaffner W , Bhatnagar J , Zaki SR , Jones TF , Shieh WJ . Clin Infect Dis 2016 64 (4) 510-512 We describe an investigation into a Heartland Virus (HRTV)-associated death in Tennessee with novel clinical and pathologic findings. HRTV can cause rapidly fatal, widely disseminated infection with multisystem organ failure in patients without substantial comorbidities. We identified viral antigen in multiple organ tissues where it was not detected previously. |
Characteristics of clusters of Salmonella and Escherichia coli O157 detected by pulsed-field gel electrophoresis that predict identification of outbreaks
Jones TF , Sashti N , Ingram A , Phan Q , Booth H , Rounds J , Nicholson CS , Cosgrove S , Crocker K , Gould LH . Foodborne Pathog Dis 2016 13 (12) 674-678 INTRODUCTION: Molecular subtyping of pathogens is critical for foodborne disease outbreak detection and investigation. Many clusters initially identified by pulsed-field gel electrophoresis (PFGE) are not confirmed as point-source outbreaks. We evaluated characteristics of clusters that can help prioritize investigations to maximize effective use of limited resources. MATERIALS AND METHODS: A multiagency collaboration (FoodNet) collected data on Salmonella and Escherichia coli O157 clusters for 3 years. Cluster size, timing, extent, and nature of epidemiologic investigations were analyzed to determine associations with whether the cluster was identified as a confirmed outbreak. RESULTS: During the 3-year study period, 948 PFGE clusters were identified; 849 (90%) were Salmonella and 99 (10%) were E. coli O157. Of those, 192 (20%) were ultimately identified as outbreaks (154 [18%] of Salmonella and 38 [38%] of E. coli O157 clusters). Successful investigation was significantly associated with larger cluster size, more rapid submission of isolates (e.g., for Salmonella, 6 days for outbreaks vs. 8 days for nonoutbreaks) and PFGE result reporting to investigators (16 days vs. 29 days, respectively), and performance of analytic studies (completed in 33% of Salmonella outbreaks vs. 1% of nonoutbreaks) and environmental investigations (40% and 1%, respectively). Intervals between first and second cases in a cluster did not differ significantly between outbreaks and nonoutbreaks. CONCLUSIONS: Molecular subtyping of pathogens is a rapidly advancing technology, and successfully identifying outbreaks will vary by pathogen and methods used. Understanding criteria for successfully investigating outbreaks is critical for efficiently using limited resources. |
Notes from the field: Measles outbreak of unknown source - Shelby County, Tennessee, April-May 2016
Fill MA , Sweat D , Morrow H , Haushalter A , Martin JC , Zerwekh T , Chakraverty T , Kmet J , Morris K , Moore K , Kainer M , Murphree R , Dunn JR , Schaffner W , Jones TF . MMWR Morb Mortal Wkly Rep 2016 65 (38) 1039-1040 On April 15, 2016, local public health officials in Shelby County, Tennessee, were notified of a positive measles immunoglobulin M (IgM) test for a male aged 18 months (patient A). On April 18, 2016, a second positive measles IgM test was reported for a man aged 50 years (patient B). Both patients had rash onset on April 9, 2016. The Shelby County Health Department initiated an investigation, and confirmatory testing for measles virus on oropharyngeal swabs by polymerase chain reaction (PCR) at CDC was positive for both patients. On April 21, 2016, public health officials were notified of a third suspected measles case in a female aged 7 months (patient C) who had developed a rash on April 14; PCR testing was positive. Genotyping conducted at CDC identified genotype B3 measles virus in all three cases. Genotype B3 is known to be circulating globally and has previously been associated with imported cases in the United States. |
Notes from the field: Intoxication and deaths associated with ingestion of a racing fuel and carbonated soft drink mixture - Tennessee, January 2016
Fill MA , Seger DL , Dunn JR , Schaffner W , Jones TF . MMWR Morb Mortal Wkly Rep 2016 65 (22) 585-586 In January 2016, the Tennessee Poison Center and Tennessee Department of Health learned of the deaths of two adolescents, and the nonfatal intoxication of two other adolescents, after ingestion of a mixture of racing fuel (approximately 100% methanol) and a carbonated soft drink. The Tennessee Department of Health reviewed medical records and police reports to learn more about the racing fuel source, assess ongoing risk, and guide prevention efforts. These are the first reported deaths in the United States associated with ingestion of this racing fuel mixture. |
An economic evaluation of PulseNet: A network for foodborne disease surveillance
Scharff RL , Besser J , Sharp DJ , Jones TF , Peter GS , Hedberg CW . Am J Prev Med 2016 50 S66-S73 The PulseNet surveillance system is a molecular subtyping network of public health and food regulatory agency laboratories designed to identify and facilitate investigation of foodborne illness outbreaks. This study estimates health and economic impacts associated with PulseNet. The staggered adoption of PulseNet across the states offers a natural experiment to evaluate its effectiveness, which is measured as reduction of reported illnesses due to improved information, enhanced industry accountability, and more-rapid recalls. Economic impacts attributable to PulseNet include medical costs and productivity losses averted due to reduced illness. Program costs are also reported. Better information and accountability from enhanced surveillance is associated with large reductions of reported illnesses. Data collected between 1994 and 2009 were assembled and analyzed between 2010 and 2015. Conservatively, accounting for underreporting and underdiagnosis, 266,522 illnesses from Salmonella, 9,489 illnesses from Escherichia coli (E. coli), and 56 illnesses due to Listeria monocytogenes are avoided annually. This reduces medical and productivity costs by $507 million. Additionally, direct effects from improved recalls reduce illnesses from E. coli by 2,819 and Salmonella by 16,994, leading to $37 million in costs averted. Annual costs to public health agencies are $7.3 million. The PulseNet system makes possible the identification of food safety risks by detecting widespread or non-focal outbreaks. This gives stakeholders information for informed decision making and provides a powerful incentive for industry. Furthermore, PulseNet enhances the focus of regulatory agencies and limits the impact of outbreaks. The health and economic benefits from PulseNet and the foodborne disease surveillance system are substantial. |
Enhancing Lyme disease surveillance by using administrative claims data, Tennessee, USA
Clayton JL , Jones SG , Dunn JR , Schaffner W , Jones TF . Emerg Infect Dis 2015 21 (9) 1632-4 Lyme disease is underreported in the United States. We used insurance administrative claims data to determine the value of such data in enhancing case ascertainment in Tennessee during January 2011-June 2013. Although we identified approximately 20% more cases of Lyme disease (5/year), the method was resource intensive and not sustainable in this low-incidence state. |
Foodborne Diseases Active Surveillance Network - 2 decades of achievements, 1996-2015
Henao OL , Jones TF , Vugia DJ , Griffin PM . Emerg Infect Dis 2015 21 (9) 1529-36 The Foodborne Diseases Active Surveillance Network (FoodNet) provides a foundation for food safety policy and illness prevention in the United States. FoodNet conducts active, population-based surveillance at 10 US sites for laboratory-confirmed infections of 9 bacterial and parasitic pathogens transmitted commonly through food and for hemolytic uremic syndrome. Through FoodNet, state and federal scientists collaborate to monitor trends in enteric illnesses, identify their sources, and implement special studies. FoodNet's major contributions include establishment of reliable, active population-based surveillance of enteric diseases; development and implementation of epidemiologic studies to determine risk and protective factors for sporadic enteric infections; population and laboratory surveys that describe the features of gastrointestinal illnesses, medical care-seeking behavior, frequency of eating various foods, and laboratory practices; and development of a surveillance and research platform that can be adapted to address emerging issues. The importance of FoodNet's ongoing contributions probably will grow as clinical, laboratory, and informatics technologies continue changing rapidly. |
Postdiarrheal hemolytic uremic syndrome in United States children: clinical spectrum and predictors of in-hospital death
Mody RK , Gu W , Griffin PM , Jones TF , Rounds J , Shiferaw B , Tobin-D'Angelo M , Smith G , Spina N , Hurd S , Lathrop S , Palmer A , Boothe E , Luna-Gierke RE , Hoekstra RM . J Pediatr 2015 166 (4) 1022-9 OBJECTIVE: To assess the clinical spectrum of postdiarrheal hemolytic uremic syndrome (D+HUS) hospitalizations and sought predictors of in-hospital death to help identify children at risk of poor outcomes. STUDY DESIGN: We assessed clinical variables collected through population-based surveillance of D+HUS in children <18 years old hospitalized in 10 states during 1997-2012 as predictors of in-hospital death by using tree modeling. RESULTS: We identified 770 cases. Of children with information available, 56.5% (430 of 761) required dialysis, 92.6% (698 of 754) required a transfusion, and 2.9% (22 of 770) died; few had a persistent dialysis requirement (52 [7.3%] of 716) at discharge. The tree model partitioned children into 5 groups on the basis of 3 predictors (highest leukocyte count and lowest hematocrit value during the 7 days before to 3 days after the diagnosis of hemolytic uremic syndrome, and presence of respiratory tract infection [RTI] within 3 weeks before diagnosis). Patients with greater leukocyte or hematocrit values or a recent RTI had a greater probability of in-hospital death. The largest group identified (n = 533) had none of these factors and had the lowest odds of death. Many children with RTI had recent antibiotic treatment for nondiarrheal indications. CONCLUSION: Most children with D+HUS have good hospitalization outcomes. Our findings support previous reports of increased leukocyte count and hematocrit as predictors of death. Recent RTI could be an additional predictor, or a marker of other factors such as antibiotic exposure, that may warrant further study. |
An assessment of the human health impact of seven leading foodborne pathogens in the United States using disability adjusted life years
Scallan E , Hoekstra RM , Mahon BE , Jones TF , Griffin PM . Epidemiol Infect 2015 143 (13) 1-10 We explored the overall impact of foodborne disease caused by seven leading foodborne pathogens in the United States using the disability adjusted life year (DALY). We defined health states for each pathogen (acute illness and sequelae) and estimated the average annual incidence of each health state using data from public health surveillance and previously published estimates from studies in the United States, Canada and Europe. These pathogens caused about 112 000 DALYs annually due to foodborne illnesses acquired in the United States. Non-typhoidal Salmonella (32 900) and Toxoplasma (32 700) caused the most DALYs, followed by Campylobacter (22 500), norovirus (9900), Listeria monocytogenes (8800), Clostridium perfringens (4000), and Escherichia coli O157 (1200). These estimates can be used to prioritize food safety interventions. Future estimates of the burden of foodborne disease in DALYs would be improved by addressing important data gaps and by the development and validation of US-specific disability weights for foodborne diseases. |
Assessment of administrative claims data for public health reporting of Salmonella in Tennessee
Marder E , Garman K , Jones TF , Dunn J , Jones S . J Am Med Inform Assoc 2014 22 e34-8 In the USA, approximately 4% of the estimated 1 million Salmonella infections occurring annually are reported to public health. Administrative claims data from large health insurance companies capture disease-specific data which could potentially enhance public health surveillance. To determine the utility of medical claims data for public health reporting of Salmonella, we assessed medical claims data from BlueCross BlueShield of Tennessee (BCBST) members compared to Tennessee Department of Health (TDH) surveillance data. BCBST Salmonella cases diagnosed during 2007-2011 were matched to TDH Salmonella cases reported during the same time period. Matches and non-matches were validated using medical records. Of the 450 BCBST cases identified, 72% matched TDH cases. All culture-confirmed BCBST cases were reported to TDH. Non-matched BCBST cases included clinical diagnoses which were culture negative or not tested. Our findings indicate administrative claims data are not a viable mechanism for enhancing routine reporting of Salmonella infections. |
Notes from the field: heartland virus disease - United States, 2012-2013
Pastula DM , Turabelidze G , Yates KF , Jones TF , Lambert AJ , Panella AJ , Kosoy OI , Velez JO , Fisher M , Staples E . MMWR Morb Mortal Wkly Rep 2014 63 (12) 270-1 Heartland virus is a newly identified phlebovirus that was first isolated from two northwestern Missouri farmers hospitalized with fever, leukopenia, and thrombocytopenia in 2009. Based on the patients' clinical findings and their reported exposures, the virus was suspected to be transmitted by ticks. After this discovery, CDC worked with state and local partners to define the ecology and modes of transmission of Heartland virus, develop diagnostic assays, and identify additional cases to describe the epidemiology and clinical disease. From this work, it was learned that Heartland virus is found in the Lone Star tick (Amblyomma americanum). Six additional cases of Heartland virus disease were identified during 2012-2013; four of those patients were hospitalized, including one with comorbidities who died. |
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