Last data update: Nov 04, 2024. (Total: 48056 publications since 2009)
Records 1-12 (of 12 Records) |
Query Trace: Marder EP[original query] |
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The 2018-2019 FoodNet Population Survey: A tool to estimate risks and behaviors associated with enteric infections
Devine CJ , Molinari NA , Shah HJ , Blackstock AJ , Geissler A , Marder EP , Payne DC . Am J Epidemiol 2024 The FoodNet Population Survey is a periodic survey of randomly selected residents in 10 US sites on exposures and behaviors that may be associated with acute diarrheal infections and the health care sought for those infections. This survey is used to estimate the true disease burden of enteric illness in the United States and to estimate rates of exposure to potential sources of illness. Unlike previous FoodNet Population Surveys, this cycle used multiple sampling frames and administration modes, including cell phone and web-based questionnaires, that allowed for additional question topics and a larger sample size. It also oversampled children to increase representation of this population. Analytic modeling adjusted for mode effects when estimating the prevalence estimates of exposures and behaviors. This report describes the design, methodology, challenges, and descriptive results from the 2018-19 FoodNet Population Survey. |
Risk factors for non-O157 shiga toxin-producing Escherichia coli infections, United States
Marder EP , Cui Z , Bruce BB , Richardson LC , Boyle MM , Cieslak PR , Comstock N , Lathrop S , Garman K , McGuire S , Olson D , Vugia DJ , Wilson S , Griffin PM , Medus C . Emerg Infect Dis 2023 29 (6) 1183-1190 Shiga toxin-producing Escherichia coli (STEC) causes acute diarrheal illness. To determine risk factors for non-O157 STEC infection, we enrolled 939 patients and 2,464 healthy controls in a case-control study conducted in 10 US sites. The highest population-attributable fractions for domestically acquired infections were for eating lettuce (39%), tomatoes (21%), or at a fast-food restaurant (23%). Exposures with 10%-19% population attributable fractions included eating at a table service restaurant, eating watermelon, eating chicken, pork, beef, or iceberg lettuce prepared in a restaurant, eating exotic fruit, taking acid-reducing medication, and living or working on or visiting a farm. Significant exposures with high individual-level risk (odds ratio >10) among those >1 year of age who did not travel internationally were all from farm animal environments. To markedly decrease the number of STEC-related illnesses, prevention measures should focus on decreasing contamination of produce and improving the safety of foods prepared in restaurants. |
Nearest-neighbors matching for case-control study analyses: better risk factor identification from a study of sporadic campylobacteriosis in the United States
Cui Z , Marder EP , Click ES , Hoekstra RM , Bruce BB . Epidemiology 2022 33 (5) 633-641 BACKGROUND: Case-control studies are commonly used to explore factors associated with enteric bacterial diseases. Control of confounding is challenging due to the large number of exposures of interest and the low frequencies of many of them. METHODS: We evaluated nearest-neighbors matching in a case-control study (originally 1:1 matched, published in 2004) of sporadic Campylobacter infections that included information on 433 exposures in 2,632 subjects during 1998-1999. We performed multiple imputation of missing data (m=100) and calculated Gower distances between cases and controls using all possible confounders for each exposure in each dataset. We matched each case with ≤20 controls within a data-determined distance. We calculated odds ratios and population attributable fractions (PAFs). RESULTS: Examination of pairwise correlation between exposures found very strong associations for 1,046 pairs of exposures. More than 100 exposures were associated with campylobacteriosis, including nearly all risk factors identified using the previously published approach that included only 16 exposures and some less studied, rare exposures such as consumption of chicken liver and raw clams. Consumption of chicken and non-poultry meat had the highest PAFs (62% and 59%, respectively). CONCLUSIONS: Nearest-neighbors matching appears to provide an improved ability to examine rare exposures and better control for numerous highly associated confounders. |
Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020.
Stokes EK , Zambrano LD , Anderson KN , Marder EP , Raz KM , El Burai Felix S , Tie Y , Fullerton KE . MMWR Morb Mortal Wkly Rep 2020 69 (24) 759-765 The coronavirus disease 2019 (COVID-19) pandemic resulted in 5,817,385 reported cases and 362,705 deaths worldwide through May, 30, 2020,(dagger) including 1,761,503 aggregated reported cases and 103,700 deaths in the United States.( section sign) Previous analyses during February-early April 2020 indicated that age >/=65 years and underlying health conditions were associated with a higher risk for severe outcomes, which were less common among children aged <18 years (1-3). This report describes demographic characteristics, underlying health conditions, symptoms, and outcomes among 1,320,488 laboratory-confirmed COVID-19 cases individually reported to CDC during January 22-May 30, 2020. Cumulative incidence, 403.6 cases per 100,000 persons,( paragraph sign) was similar among males (401.1) and females (406.0) and highest among persons aged >/=80 years (902.0). Among 599,636 (45%) cases with known information, 33% of persons were Hispanic or Latino of any race (Hispanic), 22% were non-Hispanic black (black), and 1.3% were non-Hispanic American Indian or Alaska Native (AI/AN). Among 287,320 (22%) cases with sufficient data on underlying health conditions, the most common were cardiovascular disease (32%), diabetes (30%), and chronic lung disease (18%). Overall, 184,673 (14%) patients were hospitalized, 29,837 (2%) were admitted to an intensive care unit (ICU), and 71,116 (5%) died. Hospitalizations were six times higher among patients with a reported underlying condition (45.4%) than those without reported underlying conditions (7.6%). Deaths were 12 times higher among patients with reported underlying conditions (19.5%) compared with those without reported underlying conditions (1.6%). The COVID-19 pandemic continues to be severe, particularly in certain population groups. These preliminary findings underscore the need to build on current efforts to collect and analyze case data, especially among those with underlying health conditions. These data are used to monitor trends in COVID-19 illness, identify and respond to localized incidence increase, and inform policies and practices designed to reduce transmission in the United States. |
Case-case analyses of cryptosporidiosis and giardiasis using routine national surveillance data in the United States - 2005-2015
Benedict KM , Collier SA , Marder EP , Hlavsa MC , Fullerton KE , Yoder JS . Epidemiol Infect 2019 147 e178 Understanding endemic infectious disease risk factors through traditional epidemiological tools is challenging. Population-based case-control studies are costly and time-consuming. A case-case analyses using surveillance data addresses these limitations by using resources more efficiently. We conducted a case-case analyses using routine surveillance data reported by 16 U.S. states (2005-2015), wherein reported cases of salmonellosis were used as a comparison group to identify exposure associations with reported cases of cryptosporidiosis and giardiasis. Odds ratios adjusted for age and reporting state (aOR) and 95% confidence intervals (95% CI) were calculated. A total of 10 704 cryptosporidiosis cases, 17 544 giardiasis cases, and 106 351 salmonellosis cases were included in this analyses. When compared with cases of salmonellosis, exposure to treated recreational water (aOR 4.7, 95% CI 4.3-5.0) and livestock (aOR: 3.2; 95% CI: 2.9-3.5) were significantly associated with cryptosporidiosis and exposure to untreated drinking (aOR 4.1, 95% CI 3.6-4.7) and recreational water (aOR 4.1, 95% CI 3.7-4.5) were associated with giardiasis. Our analyses shows that routine surveillance data with standardised exposure information can be used to identify associations of interest for cryptosporidiosis and giardiasis. |
Preliminary incidence and trends of infections with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2015-2018
Tack DM , Marder EP , Griffin PM , Cieslak PR , Dunn J , Hurd S , Scallan E , Lathrop S , Muse A , Ryan P , Smith K , Tobin-D'Angelo M , Vugia DJ , Holt KG , Wolpert BJ , Tauxe R , Geissler AL . MMWR Morb Mortal Wkly Rep 2019 68 (16) 369-373 Foodborne diseases represent a major health problem in the United States. The Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program monitors cases of laboratory-diagnosed infection caused by eight pathogens transmitted commonly through food in 10 U.S. sites.* This report summarizes preliminary 2018 data and changes since 2015. During 2018, FoodNet identified 25,606 infections, 5,893 hospitalizations, and 120 deaths. The incidence of most infections is increasing, including those caused by Campylobacter and Salmonella, which might be partially attributable to the increased use of culture-independent diagnostic tests (CIDTs). The incidence of Cyclospora infections increased markedly compared with 2015-2017, in part related to large outbreaks associated with produce (1). More targeted prevention measures are needed on produce farms, food animal farms, and in meat and poultry processing establishments to make food safer and decrease human illness. |
Preliminary incidence and trends of infections with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2006-2017
Marder EP , Griffin PM , Cieslak PR , Dunn J , Hurd S , Jervis R , Lathrop S , Muse A , Ryan P , Smith K , Tobin-D'Angelo M , Vugia DJ , Holt KG , Wolpert BJ , Tauxe R , Geissler AL . MMWR Morb Mortal Wkly Rep 2018 67 (11) 324-328 Despite ongoing food safety measures in the United States, foodborne illness continues to be a substantial health burden. The 10 U.S. sites of the Foodborne Diseases Active Surveillance Network (FoodNet)* monitor cases of laboratory-diagnosed infections caused by nine pathogens transmitted commonly through food. This report summarizes preliminary 2017 data and describes changes in incidence since 2006. In 2017, FoodNet reported 24,484 infections, 5,677 hospitalizations, and 122 deaths. Compared with 2014-2016, the 2017 incidence of infections with Campylobacter, Listeria, non-O157 Shiga toxin-producing Escherichia coli (STEC), Yersinia, Vibrio, and Cyclospora increased. The increased incidences of pathogens for which testing was previously limited might have resulted from the increased use and sensitivity of culture-independent diagnostic tests (CIDTs), which can improve incidence estimates (1). Compared with 2006-2008, the 2017 incidence of infections with Salmonella serotypes Typhimurium and Heidelberg decreased, and the incidence of serotypes Javiana, Infantis, and Thompson increased. New regulatory requirements that include enhanced testing of poultry products for Salmonella(dagger) might have contributed to the decreases. The incidence of STEC O157 infections during 2017 also decreased compared with 2006-2008, which parallels reductions in isolations from ground beef.( section sign) The declines in two Salmonella serotypes and STEC O157 infections provide supportive evidence that targeted control measures are effective. The marked increases in infections caused by some Salmonella serotypes provide an opportunity to investigate food and nonfood sources of infection and to design specific interventions. |
Incidence and Trends of Infections with Pathogens Transmitted Commonly Through Food and the Effect of Increasing Use of Culture-Independent Diagnostic Tests on Surveillance - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2013-2016.
Marder EP , Cieslak PR , Cronquist AB , Dunn J , Lathrop S , Rabatsky-Ehr T , Ryan P , Smith K , Tobin-D'Angelo M , Vugia DJ , Zansky S , Holt KG , Wolpert BJ , Lynch M , Tauxe R , Geissler AL . MMWR Morb Mortal Wkly Rep 2017 66 (15) 397-403 Foodborne diseases represent a substantial public health concern in the United States. CDC's Foodborne Diseases Active Surveillance Network (FoodNet) monitors cases reported from 10 U.S. sites* of laboratory-diagnosed infections caused by nine enteric pathogens commonly transmitted through food. This report describes preliminary surveillance data for 2016 on the nine pathogens and changes in incidences compared with 2013-2015. In 2016, FoodNet identified 24,029 infections, 5,512 hospitalizations, and 98 deaths caused by these pathogens. The use of culture-independent diagnostic tests (CIDTs) by clinical laboratories to detect enteric pathogens has been steadily increasing since FoodNet began surveying clinical laboratories in 2010 (1). CIDTs complicate the interpretation of FoodNet surveillance data because pathogen detection could be affected by changes in health care provider behaviors or laboratory testing practices (2). Health care providers might be more likely to order CIDTs because these tests are quicker and easier to use than traditional culture methods, a circumstance that could increase pathogen detection (3). Similarly, pathogen detection could also be increasing as clinical laboratories adopt DNA-based syndromic panels, which include pathogens not often included in routine stool culture (4,5). In addition, CIDTs do not yield isolates, which public health officials rely on to distinguish pathogen subtypes, determine antimicrobial resistance, monitor trends, and detect outbreaks. To obtain isolates for infections identified by CIDTs, laboratories must perform reflex culturedagger; if clinical laboratories do not, the burden of culturing falls to state public health laboratories, which might not be able to absorb that burden as the adoption of these tests increases (2). Strategies are needed to preserve access to bacterial isolates for further characterization and to determine the effect of changing trends in testing practices on surveillance. |
Two Listeria monocytogenes pseudo-outbreaks caused by contaminated laboratory culture media
Matanock A , Katz LS , Jackson KA , Kucerova Z , Conrad AR , Glover WA , Nguyen V , Mohr MC , Marsden-Haug N , Thompson D , Dunn JR , Stroika S , Melius B , Tarr C , Dietrich SE , Kao AS , Kornstein L , Li Z , Maroufi A , Marder EP , Meyer R , Perez-Osorio AC , Reddy V , Reporter R , Carleton H , Tweeten S , Waechter H , Yee LM , Wise ME , Davis K , Jackson B . J Clin Microbiol 2015 54 (3) 768-70 Listeriosis is a serious foodborne infection that disproportionately affects elderly adults, pregnant women, newborns, and immunocompromised individuals. Diagnosis is made by culturing Listeria monocytogenes from sterile body fluids or products of conception. This report describes investigations of two listeriosis pseudo-outbreaks caused by contaminated laboratory media made from sheep blood. |
Preliminary incidence and trends of infection with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2006-2014
Crim SM , Griffin PM , Tauxe R , Marder EP , Gilliss D , Cronquist AB , Cartter M , Tobin-D'Angelo M , Blythe D , Smith K , Lathrop S , Zansky S , Cieslak PR , Dunn J , Holt KG , Wolpert B , Henao OL . MMWR Morb Mortal Wkly Rep 2015 64 (18) 495-9 Foodborne illnesses represent a substantial, yet largely preventable, health burden in the United States. In 10 U.S. geographic areas, the Foodborne Diseases Active Surveillance Network* (FoodNet) monitors the incidence of laboratory-confirmed infections caused by nine pathogens transmitted commonly through food. This report summarizes preliminary 2014 data and describes changes in incidence compared with 2006-2008 and 2011-2013. In 2014, FoodNet reported 19,542 infections, 4,445 hospitalizations, and 71 deaths. The incidence of Shiga toxin-producing Escherichia coli (STEC) O157 and Salmonella enterica serotype Typhimurium infections declined in 2014 compared with 2006-2008, and the incidence of infection with Campylobacter, Vibrio, and Salmonella serotypes Infantis and Javiana was higher. Compared with 2011-2013, the incidence of STEC O157 and Salmonella Typhimurium infections was lower, and the incidence of STEC non-O157 and Salmonella serotype Infantis infections was higher in 2014. Despite ongoing food safety efforts, the incidence of many infections remains high, indicating that further prevention measures are needed to make food safer and achieve national health objectives. |
Multistate outbreak of Escherichia coli O157:H7 associated with bagged salad
Marder EP , Garman KN , Ingram LA , Dunn JR . Foodborne Pathog Dis 2014 11 (8) 593-5 Shiga toxin-producing Escherichia coli O157:H7 (STEC O157) is the most commonly identified serotype of STEC in the United States. An estimated 63,000 STEC O157 infections occur annually. Infection typically results in diarrhea, bloody stool, abdominal cramps, and, in some cases, hemolytic uremic syndrome. Recent outbreaks of STEC O157 have increasingly been associated with consumption of leafy greens such as lettuce and spinach. We investigated an outbreak of STEC O157 associated with the consumption of bagged salad with cases clustered in various institutional settings. A case-control study was conducted among cases from selected schools with controls matched by school and grade. Seventeen cases from three U.S. states were identified. The median age of cases was 23 years (range: 3-88) and 13 (76%) were female. Six cases were hospitalized and two died. Onset dates ranged from April 29 to May 12, 2012. The matched case-control analysis identified a single significant food service exposure: consumption of lettuce provided by a school cafeteria (median odds ratio=9.4, 95% confidence interval: 1.4-infinity, p=0.0469). The implicated bagged salad product was traced back to a single production facility. Implicated growing areas were scheduled for heightened inspection for the upcoming growing season. A combination of analytical epidemiologic studies among subclusters of cases, surveillance, and traceback implicated bagged salad in this outbreak investigation. |
Fungal infections associated with contaminated methylprednisolone in Tennessee
Kainer MA , Reagan DR , Nguyen DB , Wiese AD , Wise ME , Ward J , Park BJ , Kanago ML , Baumblatt J , Schaefer MK , Berger BE , Marder EP , Min JY , Dunn JR , Smith RM , Dreyzehner J , Jones TF . N Engl J Med 2012 367 (23) 2194-203 BACKGROUND: We investigated an outbreak of fungal infections of the central nervous system that occurred among patients who received epidural or paraspinal glucocorticoid injections of preservative-free methylprednisolone acetate prepared by a single compounding pharmacy. METHODS: Case patients were defined as patients with fungal meningitis, posterior circulation stroke, spinal osteomyelitis, or epidural abscess that developed after epidural or paraspinal glucocorticoid injections. Clinical and procedure data were abstracted. A cohort analysis was performed. RESULTS: The median age of the 66 case patients was 69 years (range, 23 to 91). The median time from the last epidural glucocorticoid injection to symptom onset was 18 days (range, 0 to 56). Patients presented with meningitis alone (73%), the cauda equina syndrome or focal infection (15%), or posterior circulation stroke with or without meningitis (12%). Symptoms and signs included headache (in 73% of the patients), new or worsening back pain (in 50%), neurologic symptoms (in 48%), nausea (in 39%), and stiff neck (in 29%). The median cerebrospinal fluid white-cell count on the first lumbar puncture among patients who presented with meningitis, with or without stroke or focal infection, was 648 per cubic millimeter (range, 6 to 10,140), with 78% granulocytes (range, 0 to 97); the protein level was 114 mg per deciliter (range, 29 to 440); and the glucose concentration was 44 mg per deciliter (range, 12 to 121) (2.5 mmol per liter [range, 0.7 to 6.7]). A total of 22 patients had laboratory confirmation of Exserohilum rostratum infection (21 patients) or Aspergillus fumigatus infection (1 patient). The risk of infection increased with exposure to lot 06292012@26, older vials, higher doses, multiple procedures, and translaminar approach to epidural glucocorticoid injection. Voriconazole was used to treat 61 patients (92%); 35 patients (53%) were also treated with liposomal amphotericin B. Eight patients (12%) died, seven of whom had stroke. CONCLUSIONS: We describe an outbreak of fungal meningitis after epidural or paraspinal glucocorticoid injection with methylprednisolone from a single compounding pharmacy. Rapid recognition of illness and prompt initiation of therapy are important to prevent complications. (Funded by the Tennessee Department of Health and the Centers for Disease Control and Prevention.). |
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