Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-30 (of 50 Records) |
Query Trace: Tauxe R[original query] |
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Power law for estimating underdetection of foodborne disease outbreaks, United States
Ford L , Self JL , Wong KK , Hoekstra RM , Tauxe RV , Rose EB , Bruce BB . Emerg Infect Dis 2023 30 (2) 337-340 We fit a power law distribution to US foodborne disease outbreaks to assess underdetection and underreporting. We predicted that 788 fewer than expected small outbreaks were identified annually during 1998-2017 and 365 fewer during 2018-2019, after whole-genome sequencing was implemented. Power law can help assess effectiveness of public health interventions. |
Preliminary incidence and trends of infections caused by pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2022
Delahoy MJ , Shah HJ , Weller DL , Ray LC , Smith K , McGuire S , Trevejo RT , Scallan Walter E , Wymore K , Rissman T , McMillian M , Lathrop S , LaClair B , Boyle MM , Harris S , Zablotsky-Kufel J , Houck K , Devine CJ , Lau CE , Tauxe RV , Bruce BB , Griffin PM , Payne DC . MMWR Morb Mortal Wkly Rep 2023 72 (26) 701-706 Each year, infections from major foodborne pathogens are responsible for an estimated 9.4 million illnesses, 56,000 hospitalizations, and 1,350 deaths in the United States (1). To evaluate progress toward prevention of enteric infections in the United States, the Foodborne Diseases Active Surveillance Network (FoodNet) conducts surveillance for laboratory-diagnosed infections caused by eight pathogens transmitted commonly through food at 10 U.S. sites. During 2020-2021, FoodNet detected decreases in many infections that were due to behavioral modifications, public health interventions, and changes in health care-seeking and testing practices during the COVID-19 pandemic. This report presents preliminary estimates of pathogen-specific annual incidences during 2022, compared with average annual incidences during 2016-2018, the reference period for the U.S. Department of Health and Human Services' Healthy People 2030 targets (2). Many pandemic interventions ended by 2022, resulting in a resumption of outbreaks, international travel, and other factors leading to enteric infections. During 2022, annual incidences of illnesses caused by the pathogens Campylobacter, Salmonella, Shigella, and Listeria were similar to average annual incidences during 2016-2018; however, incidences of Shiga toxin-producing Escherichia coli (STEC), Yersinia, Vibrio, and Cyclospora illnesses were higher. Increasing culture-independent diagnostic test (CIDT) usage likely contributed to increased detection by identifying infections that would have remained undetected before widespread CIDT usage. Reducing pathogen contamination during poultry slaughter and processing of leafy greens requires collaboration among food growers and processors, retail stores, restaurants, and regulators. |
Preliminary Incidence and Trends of Infections Caused by Pathogens Transmitted Commonly Through Food - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2016-2021.
Collins JP , Shah HJ , Weller DL , Ray LC , Smith K , McGuire S , Trevejo RT , Jervis RH , Vugia DJ , Rissman T , Garman KN , Lathrop S , LaClair B , Boyle MM , Harris S , Kufel JZ , Tauxe RV , Bruce BB , Rose EB , Griffin PM , Payne DC . MMWR Morb Mortal Wkly Rep 2022 71 (40) 1260-1264 To evaluate progress toward prevention of enteric infections in the United States, the Foodborne Diseases Active Surveillance Network (FoodNet) conducts active population-based surveillance for laboratory-diagnosed infections caused by Campylobacter, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC), Shigella, Vibrio, and Yersinia at 10 U.S. sites. This report summarizes preliminary 2021 data and describes changes in annual incidence compared with the average annual incidence for 2016-2018, the reference period for the U.S. Department of Health and Human Services' (HHS) Healthy People 2030 goals for some pathogens (1). During 2021, the incidence of infections caused by Salmonella decreased, incidence of infections caused by Cyclospora, Yersinia, and Vibrio increased, and incidence of infections caused by other pathogens did not change. As in 2020, behavioral modifications and public health interventions implemented to control the COVID-19 pandemic might have decreased transmission of enteric infections (2). Other factors (e.g., increased use of telemedicine and continued increase in use of culture-independent diagnostic tests [CIDTs]) might have altered their detection or reporting (2). Much work remains to achieve HHS Healthy People 2030 goals, particularly for Salmonella infections, which are frequently attributed to poultry products and produce, and Campylobacter infections, which are frequently attributed to chicken products (3). |
The Use of Whole-Genome Sequencing by the Federal Interagency Collaboration for Genomics for Food and Feed Safety in the United States.
Stevens EL , Carleton HA , Beal J , Tillman GE , Lindsey RL , Lauer AC , Pightling A , Jarvis KG , Ottesen A , Ramachandran P , Hintz L , Katz LS , Folster JP , Whichard JM , Trees E , Timme RE , McDermott P , Wolpert B , Bazaco M , Zhao S , Lindley S , Bruce BB , Griffin PM , Brown E , Allard M , Tallent S , Irvin K , Hoffmann M , Wise M , Tauxe R , Gerner-Smidt P , Simmons M , Kissler B , Defibaugh-Chavez S , Klimke W , Agarwala R , Lindsay J , Cook K , Austerman SR , Goldman D , McGarry S , Hale KR , Dessai U , Musser SM , Braden C . J Food Prot 2022 85 (5) 755-772 ![]() ![]() This multi-agency report developed under the Interagency Collaboration for Genomics for Food and Feed Safety (Gen-FS) provides an overview of the use of and transition to Whole-Genome Sequencing (WGS) technology to detect and characterize pathogens transmitted commonly by food and identify their sources. We describe foodborne pathogen analysis, investigation, and harmonization efforts among federal agencies, including the National Institutes of Health (NIH); the Department of Health and Human Services' Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA); and the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS), Agricultural Research Service (ARS), and Animal and Plant Health Inspection Service (APHIS). We describe single nucleotide polymorphism (SNP), core-genome (cg) and whole-genome multi-locus sequence typing (wgMLST) data analysis methods as used in CDC's PulseNet and FDA's GenomeTrakr networks, underscoring the complementary nature of the results for linking genetically related foodborne pathogens during outbreak investigations while allowing flexibility to meet the specific needs of Gen-FS agency partners. We highlight how we apply WGS to pathogen characterization (virulence and antimicrobial resistance profiles), source attribution efforts, and increasing transparency by making the sequences and other data publicly available through the National Center for Biotechnology Information (NCBI). Finally, we highlight the impact of current trends in the use of culture-independent diagnostics tests (CIDT) for human diagnostic testing on analytical approaches related to food safety. Lastly, we highlight what is next for WGS in food safety. |
Risk for Newly Diagnosed Diabetes >30 Days After SARS-CoV-2 Infection Among Persons Aged <18 Years - United States, March 1, 2020-June 28, 2021.
Barrett CE , Koyama AK , Alvarez P , Chow W , Lundeen EA , Perrine CG , Pavkov ME , Rolka DB , Wiltz JL , Bull-Otterson L , Gray S , Boehmer TK , Gundlapalli AV , Siegel DA , Kompaniyets L , Goodman AB , Mahon BE , Tauxe RV , Remley K , Saydah S . MMWR Morb Mortal Wkly Rep 2022 71 (2) 59-65 The COVID-19 pandemic has disproportionately affected people with diabetes, who are at increased risk of severe COVID-19.* Increases in the number of type 1 diabetes diagnoses (1,2) and increased frequency and severity of diabetic ketoacidosis (DKA) at the time of diabetes diagnosis (3) have been reported in European pediatric populations during the COVID-19 pandemic. In adults, diabetes might be a long-term consequence of SARS-CoV-2 infection (4-7). To evaluate the risk for any new diabetes diagnosis (type 1, type 2, or other diabetes) >30 days(†) after acute infection with SARS-CoV-2 (the virus that causes COVID-19), CDC estimated diabetes incidence among patients aged <18 years (patients) with diagnosed COVID-19 from retrospective cohorts constructed using IQVIA health care claims data from March 1, 2020, through February 26, 2021, and compared it with incidence among patients matched by age and sex 1) who did not receive a COVID-19 diagnosis during the pandemic, or 2) who received a prepandemic non-COVID-19 acute respiratory infection (ARI) diagnosis. Analyses were replicated using a second data source (HealthVerity; March 1, 2020-June 28, 2021) that included patients who had any health care encounter possibly related to COVID-19. Among these patients, diabetes incidence was significantly higher among those with COVID-19 than among those 1) without COVID-19 in both databases (IQVIA: hazard ratio [HR] = 2.66, 95% CI = 1.98-3.56; HealthVerity: HR = 1.31, 95% CI = 1.20-1.44) and 2) with non-COVID-19 ARI in the prepandemic period (IQVIA, HR = 2.16, 95% CI = 1.64-2.86). The observed increased risk for diabetes among persons aged <18 years who had COVID-19 highlights the importance of COVID-19 prevention strategies, including vaccination, for all eligible persons in this age group,(§) in addition to chronic disease prevention and management. The mechanism of how SARS-CoV-2 might lead to incident diabetes is likely complex and could differ by type 1 and type 2 diabetes. Monitoring for long-term consequences, including signs of new diabetes, following SARS-CoV-2 infection is important in this age group. |
Decreased Incidence of Infections Caused by Pathogens Transmitted Commonly Through Food During the COVID-19 Pandemic - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2017-2020.
Ray LC , Collins JP , Griffin PM , Shah HJ , Boyle MM , Cieslak PR , Dunn J , Lathrop S , McGuire S , Rissman T , Scallan Walter EJ , Smith K , Tobin-D'Angelo M , Wymore K , Kufel JZ , Wolpert BJ , Tauxe R , Payne DC . MMWR Morb Mortal Wkly Rep 2021 70 (38) 1332-1336 Foodborne illnesses are a substantial and largely preventable public health problem; before 2020 the incidence of most infections transmitted commonly through food had not declined for many years. To evaluate progress toward prevention of foodborne illnesses in the United States, the Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program monitors the incidence of laboratory-diagnosed infections caused by eight pathogens transmitted commonly through food reported by 10 U.S. sites.* FoodNet is a collaboration among CDC, 10 state health departments, the U.S. Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration. This report summarizes preliminary 2020 data and describes changes in incidence with those during 2017-2019. During 2020, observed incidences of infections caused by enteric pathogens decreased 26% compared with 2017-2019; infections associated with international travel decreased markedly. The extent to which these reductions reflect actual decreases in illness or decreases in case detection is unknown. On March 13, 2020, the United States declared a national emergency in response to the COVID-19 pandemic. After the declaration, state and local officials implemented stay-at-home orders, restaurant closures, school and child care center closures, and other public health interventions to slow the spread of SARS-CoV-2, the virus that causes COVID-19 (1). Federal travel restrictions were declared (1). These widespread interventions as well as other changes to daily life and hygiene behaviors, including increased handwashing, have likely changed exposures to foodborne pathogens. Other factors, such as changes in health care delivery, health care-seeking behaviors, and laboratory testing practices, might have decreased the detection of enteric infections. As the pandemic continues, surveillance of illness combined with data from other sources might help to elucidate the factors that led to the large changes in 2020; this understanding could lead to improved strategies to prevent illness. To reduce the incidence of these infections concerted efforts are needed, from farm to processing plant to restaurants and homes. Consumers can reduce their risk of foodborne illness by following safe food-handling and preparation recommendations. |
Antimicrobial Resistance Creates Threat to Chimpanzee Health and Conservation in the Wild.
Parsons MB , Travis DA , Lonsdorf EV , Lipende I , Elchoufi D , Gilagiza B , Collins A , Kamenya S , Tauxe RV , Gillespie TR . Pathogens 2021 10 (4) ![]() Infectious disease is recognized as the greatest threat to the endangered chimpanzees made famous by the groundbreaking work of Dr. Jane Goodall at Gombe National Park (GNP), Tanzania. The permeable boundary of this small protected area allows for regular wildlife-human and wildlife-domestic animal overlap, which may facilitate cross-species transmission of pathogens and antimicrobial resistance. Few studies have examined the prevalence of antimicrobial resistance in wild ape populations. We used molecular techniques to investigate the presence of genes conferring resistance to sulfonamides (often used to treat diarrheal illness in human settings in this region) and tetracycline (used in the past-though much less so now) in fecal specimens from humans, domestic animals, chimpanzees, and baboons in and around GNP. We also tested stream water used by these groups. Sulfonamide resistance was common in humans (74%), non-human primates (43%), and domestic animals (17%). Tetracycline resistance was less common in all groups: humans (14%), non-human primates (3%), and domestic animals (6%). Sul resistance genes were detected from 4/22 (18%) of streams sampled. Differences in sul gene frequencies did not vary by location in humans nor in chimpanzees. |
Hypothesis Generation during Foodborne Illness Outbreak Investigations
White AE , Smith KE , Booth H , Medus C , Tauxe RV , Gieraltowski L , Walter ES . Am J Epidemiol 2021 190 (10) 2188-2197 Hypothesis generation is a critical, but challenging, step in a foodborne outbreak investigation. The pathogens that contaminate food have many diverse reservoirs, resulting in seemingly limitless potential vehicles. Identifying a vehicle is particularly challenging for clusters detected through national pathogen-specific surveillance, as cases can be geographically dispersed and lack an obvious epidemiological link. Moreover, state and local health departments may have limited resources to dedicate to cluster and outbreak investigations. These challenges underscore the importance of hypothesis generation during an outbreak investigation. In this review, we present a framework for hypothesis generation focusing on three primary sources of information, typically used in combination: (1) known sources of the pathogen causing illness; (2) person, place, and time characteristics of cases associated with the outbreak (descriptive data); and (3) case exposure assessment. Hypothesis generation can narrow the list of potential food vehicles and focus subsequent epidemiologic, laboratory, environmental, and traceback efforts, ensuring that time and resources are used more efficiently and increasing the likelihood of rapidly and conclusively implicating the contaminated food vehicle. |
Preliminary incidence and trends of infections with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2016-2019
Tack DM , Ray L , Griffin PM , Cieslak PR , Dunn J , Rissman T , Jervis R , Lathrop S , Muse A , Duwell M , Smith K , Tobin-D'Angelo M , Vugia DJ , Zablotsky Kufel J , Wolpert BJ , Tauxe R , Payne DC . MMWR Morb Mortal Wkly Rep 2020 69 (17) 509-514 To evaluate progress toward prevention of enteric illnesses, the Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program monitors the incidence of laboratory-diagnosed infections caused by eight pathogens transmitted commonly through food at 10 U.S. sites.* This report summarizes preliminary 2019 data and describes changes in incidence compared with that during 2016-2018. The incidence of enteric infections caused by these eight pathogens reported by FoodNet sites in 2019 continued to increase or remained unchanged, indicating progress in controlling major foodborne pathogens in the United States has stalled. Campylobacter and Salmonella caused the largest proportion of illnesses; trends in incidence varied by Salmonella serotype. Widespread adoption of whole genome sequencing (WGS) of bacteria has improved the ability to identify outbreaks, emerging strains, and sources of pathogens. To maximize the potential of WGS to link illnesses to particular sources, testing of isolates by clinical and public health laboratories is needed. Reductions in Salmonella serotype Typhimurium suggest that targeted interventions (e.g., vaccinating chickens and other food animals) might decrease human infections. Reducing contamination during food production, processing, and preparation will require more widespread implementation of known prevention measures and of new strategies that target particular pathogens and serotypes. |
From Outbreak Catastrophes to Clades of Concern: How Whole Genome Sequencing Can Change the Food Safety Landscape
Tauxe RV . Food Prot Trends 2019 36 (6) 482-485 Attending the IAFP conference has been an annual highlight for the past decade, and a time for learning and sharing for more and more of my colleagues at CDC. It is an honor and a pleasure to join you here now, and to honor the formative contributions of John H Silliker to the field of food safety. | | When I first came to CDC to start a two year fellowship in field epidemiology and joined the small excited group that just 6 months before had identified E. coli O157 as a human pathogen, there were many questions in the air. One of the most interesting and persistent was around the first efforts towards molecular epidemiology. How could the new laboratory tools of molecular subtyping help solve epidemiological problems? Back then we tried plasmid profiles and satisfied ourselves that they could sometimes help us solve outbreaks. When a staff position was offered at CDC, I was fortunate to be able to start a career working in that same group for what has become several exciting decades. |
Incubation periods of enteric illnesses in foodborne outbreaks, United States, 1998-2013
Chai SJ , Gu W , O'Connor KA , Richardson LC , Tauxe RV . Epidemiol Infect 2019 147 e285 Early in a foodborne disease outbreak investigation, illness incubation periods can help focus case interviews, case definitions, clinical and environmental evaluations and predict an aetiology. Data describing incubation periods are limited. We examined foodborne disease outbreaks from laboratory-confirmed, single aetiology, enteric bacterial and viral pathogens reported to United States foodborne disease outbreak surveillance from 1998-2013. We grouped pathogens by clinical presentation and analysed the reported median incubation period among all illnesses from the implicated pathogen for each outbreak as the outbreak incubation period. Outbreaks from preformed bacterial toxins (Staphylococcus aureus, Bacillus cereus and Clostridium perfringens) had the shortest outbreak incubation periods (4-10 h medians), distinct from that of Vibrio parahaemolyticus (17 h median). Norovirus, salmonella and shigella had longer but similar outbreak incubation periods (32-45 h medians); campylobacter and Shiga toxin-producing Escherichia coli had the longest among bacteria (62-87 h medians); hepatitis A had the longest overall (672 h median). Our results can help guide diagnostic and investigative strategies early in an outbreak investigation to suggest or rule out specific etiologies or, when the pathogen is known, the likely timeframe for exposure. They also point to possible differences in pathogenesis among pathogens causing broadly similar syndromes. |
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. |
Produce-associated foodborne disease outbreaks, USA, 1998-2013
Bennett SD , Sodha SV , Ayers TL , Lynch MF , Gould LH , Tauxe RV . Epidemiol Infect 2018 146 (11) 1-10 The US Food Safety Modernization Act (FSMA) gives food safety regulators increased authority to require implementation of safety measures to reduce the contamination of produce. To evaluate the future impact of FSMA on food safety, a better understanding is needed regarding outbreaks attributed to the consumption of raw produce. Data reported to the US Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System during 1998-2013 were analysed. During 1998-2013, there were 972 raw produce outbreaks reported resulting in 34 674 outbreak-associated illnesses, 2315 hospitalisations, and 72 deaths. Overall, the total number of foodborne outbreaks reported decreased by 38% during the study period and the number of raw produce outbreaks decreased 19% during the same period; however, the percentage of outbreaks attributed to raw produce among outbreaks with a food reported increased from 8% during 1998-2001 to 16% during 2010-2013. Raw produce outbreaks were most commonly attributed to vegetable row crops (38% of outbreaks), fruits (35%) and seeded vegetables (11%). The most common aetiologic agents identified were norovirus (54% of outbreaks), Salmonella enterica (21%) and Shiga toxin-producing Escherichia coli (10%). Food-handling errors were reported in 39% of outbreaks. The proportion of all foodborne outbreaks attributable to raw produce has been increasing. Evaluation of safety measures to address the contamination on farms, during processing and food preparation, should take into account the trends occurring before FSMA implementation. |
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. |
CDC safety training course for Ebola virus disease healthcare workers
Narra R , Sobel J , Piper C , Gould D , Bhadelia N , Dott M , Fiore A , Fischer WA2nd , Frawley MJ , Griffin PM , Hamilton D , Mahon B , Pillai SK , Veltus EF , Tauxe R , Jhung M . Emerg Infect Dis 2017 23 (13) S217-24 Response to sudden epidemic infectious disease emergencies can demand intensive and specialized training, as demonstrated in 2014 when Ebola virus disease (EVD) rapidly spread throughout West Africa. The medical community quickly became overwhelmed because of limited staff, supplies, and Ebola treatment units (ETUs). Because a mechanism to rapidly increase trained healthcare workers was needed, the US Centers for Disease Control and Prevention developed and implemented an introductory EVD safety training course to prepare US healthcare workers to work in West Africa ETUs. The goal was to teach principles and practices of safely providing patient care and was delivered through lectures, small-group breakout sessions, and practical exercises. During September 2014-March 2015, a total of 570 participants were trained during 16 course sessions. This course quickly increased the number of clinicians who could provide care in West Africa ETUs, showing the feasibility of rapidly developing and implementing training in response to a public health emergency. |
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. |
Turtle-associated salmonellosis, United States, 2006-2014
Bosch S , Tauxe RV , Behravesh CB . Emerg Infect Dis 2016 22 (7) 1149-55 During 2006-2014, a total of 15 multistate outbreaks of turtle-associated salmonellosis in humans were reported in the United States. Exposure to small pet turtles has long been recognized as a source of human salmonellosis. The risk to public health has persisted and may be increasing. Turtles are a popular reptilian pet among children, and numerous risky behaviors for the zoonotic transmission of Salmonella bacteria to children have been reported in recent outbreaks. Despite a long-standing federal ban against the sale and distribution of turtles <4 in (<10.16 cm) long, these small reptiles can be readily acquired through multiple venues and continue to be the main source of turtle-associated salmonellosis in children. Enhanced efforts are needed to minimize the disease risk associated with small turtle exposure. Prevention will require novel partnerships and a comprehensive One Health approach involving human, animal, and environmental health. |
Multistate outbreak of listeriosis caused by imported cheese and evidence of cross-contamination of other cheeses, USA, 2012
Heiman KE , Garalde VB , Gronostaj M , Jackson KA , Beam S , Joseph L , Saupe A , Ricotta E , Waechter H , Wellman A , Adams-Cameron M , Ray G , Fields A , Chen Y , Datta A , Burall L , Sabol A , Kucerova Z , Trees E , Metz M , Leblanc P , Lance S , Griffin PM , Tauxe RV , Silk BJ . Epidemiol Infect 2015 144 (13) 1-11 Listeria monocytogenes is a foodborne pathogen that can cause bacteraemia, meningitis, and complications during pregnancy. In July 2012, molecular subtyping identified indistinguishable L. monocytogenes isolates from six patients and two samples of different cut and repackaged cheeses. A multistate outbreak investigation was initiated. Initial analyses identified an association between eating soft cheese and outbreak-related illness (odds ratio 17.3, 95% confidence interval 2.0-825.7) but no common brand. Cheese inventory data from locations where patients bought cheese and an additional location where repackaged cheese yielded the outbreak strain were compared to identify cheeses for microbiological sampling. Intact packages of imported ricotta salata yielded the outbreak strain. Fourteen jurisdictions reported 22 cases from March-October 2012, including four deaths and a fetal loss. Six patients ultimately reported eating ricotta salata; another reported eating cheese likely cut with equipment also used for contaminated ricotta salata, and nine more reported eating other cheeses that might also have been cross-contaminated. An FDA import alert and US and international recalls followed. Epidemiology-directed microbiological testing of suspect cheeses helped identify the outbreak source. Cross-contamination of cheese highlights the importance of using validated disinfectant protocols and routine cleaning and sanitizing after cutting each block or wheel. |
Ebola virus disease: what clinicians in the United States need to know
Fischer WA 2nd , Uyeki TM , Tauxe RV . Am J Infect Control 2015 43 (8) 788-93 In March 2014 the World Health Organization was notified of an outbreak of Ebola virus disease (EVD) in the forest region of Guinea. As of May 2015, the outbreak had become the most devastating EVD epidemic in history with more than 27,000 cases and more than 11,000 deaths. The introduction of EVD into noncontiguous countries, including the United States, from infected travelers highlights the importance of preparedness of all health care providers. Early identification and rapid isolation of patients suspected with EVD is critical to limiting the spread of Ebola virus. Additionally, enhanced understanding of EVD case definitions, clinical presentation, treatment procedures, and infection control strategies will improve the ability of health care workers to provide safe care for patients with EVD. |
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. |
2013 multistate outbreaks of Cyclospora cayetanensis infections associated with fresh produce: focus on the Texas investigations
Abanyie F , Harvey RR , Harris JR , Wiegand RE , Gaul L , Desvignes-Kendrick M , Irvin K , Williams I , Hall RL , Herwaldt B , Gray EB , Qvarnstrom Y , Wise ME , Cantu V , Cantey PT , Bosch S , da Silva AJ , Fields A , Bishop H , Wellman A , Beal J , Wilson N , Fiore AE , Tauxe R , Lance S , Slutsker L , Parise M . Epidemiol Infect 2015 143 (16) 1-8 The 2013 multistate outbreaks contributed to the largest annual number of reported US cases of cyclosporiasis since 1997. In this paper we focus on investigations in Texas. We defined an outbreak-associated case as laboratory-confirmed cyclosporiasis in a person with illness onset between 1 June and 31 August 2013, with no history of international travel in the previous 14 days. Epidemiological, environmental, and traceback investigations were conducted. Of the 631 cases reported in the multistate outbreaks, Texas reported the greatest number of cases, 270 (43%). More than 70 clusters were identified in Texas, four of which were further investigated. One restaurant-associated cluster of 25 case-patients was selected for a case-control study. Consumption of cilantro was most strongly associated with illness on meal date-matched analysis (matched odds ratio 19.8, 95% confidence interval 4.0-infinity). All case-patients in the other three clusters investigated also ate cilantro. Traceback investigations converged on three suppliers in Puebla, Mexico. Cilantro was the vehicle of infection in the four clusters investigated; the temporal association of these clusters with the large overall increase in cyclosporiasis cases in Texas suggests cilantro was the vehicle of infection for many other cases. However, the paucity of epidemiological and traceback information does not allow for a conclusive determination; moreover, molecular epidemiological tools for cyclosporiasis that could provide more definitive linkage between case clusters are needed. |
Cholera: fourth year of the epidemic in Haiti; sixth decade of the global pandemic
Tauxe RV . Pathog Glob Health 2014 108 (1) 1-2 The cholera epidemic in Haiti entered its fourth year on 21 October 2013. This unexpected catastrophe appeared in a rural area, spreading rapidly to all departments within a month, and 5% of the population was reported with cholera in the first year.1 It has persisted, with lower case counts reported each year (national data, accessed 30 July 2013 at: http://mspp.gouv.ht/site/index.php#). Rapid case reporting to public health surveillance provided a detailed picture, guided mobilization of resources to treat and prevent the illness, identified areas for more detailed investigation, and documented the decrease in case mortality that followed improved treatment. As part of that surveillance, microbiological studies showed the epidemic strain of Vibrio cholerae O1 belongs to a lineage of atypical El Tor stains that arose in the 1990s and is now the predominant strain circulating in Asia and Africa. |
Outbreaks caused by sprouts, United States, 1998-2010: lessons learned and solutions needed
Dechet AM , Herman KM , Chen Parker C , Taormina P , Johanson J , Tauxe RV , Mahon BE . Foodborne Pathog Dis 2014 11 (8) 635-44 After a series of outbreaks associated with sprouts in the mid-1990s, the U.S. Food and Drug Administration (FDA) published guidelines in 1999 for sprouts producers to reduce the risk of contamination. The recommendations included treating seeds with an antimicrobial agent such as calcium hypochlorite solution and testing spent irrigation water for pathogens. From 1998 through 2010, 33 outbreaks from seed and bean sprouts were documented in the United States, affecting 1330 reported persons. Twenty-eight outbreaks were caused by Salmonella, four by Shiga toxin-producing Escherichia coli, and one by Listeria. In 15 of the 18 outbreaks with information available, growers had not followed key FDA guidelines. In three outbreaks, however, the implicated sprouts were produced by firms that appeared to have implemented key FDA guidelines. Although seed chlorination, if consistently applied, reduces pathogen burden on sprouts, it does not eliminate the risk of human infection. Further seed and sprouts disinfection technologies, some recently developed, will be needed to enhance sprouts safety and reduce human disease. Improved seed production practices could also decrease pathogen burden but, because seeds are a globally distributed commodity, will require international cooperation. |
Campylobacter fetus subsp. testudinum subsp. nov., isolated from humans and reptiles.
Fitzgerald C , Tu ZC , Patrick M , Stiles T , Lawson AJ , Santovenia M , Gilbert MJ , van Bergen M , Joyce K , Pruckler J , Stroika S , Duim B , Miller WG , Loparev VL , Sinnige JC , Fields PI , Tauxe RV , Blaser MJ , Wagenaar JA . Int J Syst Evol Microbiol 2014 64 2944-2948 ![]() A polyphasic study was undertaken to determine the taxonomic position of 13 Campylobacter fetus-like strains from humans (n=8) and reptiles (n=5). The results of matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) and genomic data from sap analysis, 16S rRNA and hsp60 sequence comparison, pulsed- field gel electrophoresis (PFGE), amplified fragment length polymorphism (AFLP) analysis, DNA-DNA hybridization and whole genome sequencing demonstrate that these strains are closely related to C. fetus but clearly differentiated from the present C. fetus subspecies. Therefore this unique cluster of 13 strains represents a novel subspecies within the species C. fetus, for which the name Campylobacter fetus subsp. testudinum subsp. nov. is proposed, with strain 03-427T (=ATCC BAA-2539T = LMG 27499T) as the type strain. Although this novel taxon cannot be differentiated from C. fetus subsp. fetus and C. fetus subsp. venerealis using conventional phenotypic tests, MALDI-TOF MS analysis revealed the presence of multiple phenotypic biomarkers which distinguish C. fetus subsp. testudinum from the present C. fetus subspecies. |
Campylobacter fetus infections in humans: exposure and disease
Wagenaar JA , van Bergen MA , Blaser MJ , Tauxe RV , Newell DG , van Putten JP . Clin Infect Dis 2014 58 (11) 1579-86 Campylobacter fetus can cause intestinal illness and, occasionally, severe systemic infections. Infections mainly affect persons at higher risk, including elderly and immunocompromised individuals and those with occupational exposure to infected animals. Outbreaks are infrequent but have provided insight into sources. Source attribution of sporadic cases through case-control interviews has not been reported. The reservoirs for C. fetus are mainly cattle and sheep. Products from these animals are suspected as sources for human infections. Campylobacter fetus is rarely isolated from food, albeit selective isolation methods used in food microbiology are not suited for its detection. We hypothesize that the general population is regularly exposed to C. fetus through foods of animal origin, cross-contaminated foodstuffs, and perhaps other, as yet unidentified, routes. Campylobacter fetus infection should be suspected particularly in patients with nonspecific febrile illness who are immunocompromised or who may have been occupationally exposed to ruminants. |
Multilocus sequence typing confirms wild birds as the source of a Campylobacter outbreak associated with the consumption of raw peas.
Kwan PS , Xavier C , Santovenia M , Pruckler J , Stroika S , Joyce K , Gardner T , Fields PI , McLaughlin J , Tauxe RV , Fitzgerald C . Appl Environ Microbiol 2014 80 (15) 4540-6 ![]() From August to September 2008, the Centers for Disease Control and Prevention (CDC) assisted the Alaska Division of Public Health with an outbreak investigation of campylobacteriosis occurring among the residents of Southcentral Alaska. During the investigation, pulsed-field gel electrophoresis (PFGE) of Campylobacter jejuni isolates from human, raw pea and wild bird fecal samples confirmed the epidemiologic link between illness and the consumption of raw peas contaminated by Sandhill cranes from 15 of 43 epidemiologically-linked human isolates. However, an association between the remaining epidemiologically-linked human infections and the pea and wild bird isolates was not established. To better understand the molecular epidemiology of the outbreak, C. jejuni isolates (n=130; 59 humans, 40 peas and 31 wild birds) were further characterized by multi-locus sequence typing (MLST). Here, we present the molecular evidence to demonstrate the association of many more human C. jejuni infections associated with the outbreak with raw peas and wild bird feces. Among all sequence types (STs) identified, 26 (67%) of 39 were novel and exclusive to the outbreak. Five clusters of overlapping STs (n=32 isolates; 17 humans, 2 peas and 13 wild birds) were identified. In particular, Cluster E (n=7 isolates, ST-5049) consisted of isolates from humans, peas and wild birds. Novel STs clustered closely with isolates typically associated with wild birds and the environment, but distinct from lineages commonly seen in human infections. Novel STs and alleles recovered from human outbreak isolates allowed additional infections caused by these rare genotypes to be attributed to the contaminated raw peas. |
Incidence and trends of infection with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2006-2013
Crim SM , Iwamoto M , Huang JY , Griffin PM , Gilliss D , Cronquist AB , Cartter M , Tobin-D'Angelo M , Blythe D , Smith K , Lathrop S , Zansky S , Cieslak PR , Dunn J , Holt KG , Lance S , Tauxe R , Henao OL . MMWR Morb Mortal Wkly Rep 2014 63 (15) 328-32 Foodborne disease continues to be an important problem in the United States. Most illnesses are preventable. To evaluate progress toward prevention, the Foodborne Diseases Active Surveillance Network (FoodNet) monitors the incidence of laboratory-confirmed infections caused by nine pathogens transmitted commonly through food in 10 U.S. sites, covering approximately 15% of the U.S. population. This report summarizes preliminary 2013 data and describes trends since 2006. In 2013, a total of 19,056 infections, 4,200 hospitalizations, and 80 deaths were reported. For most infections, incidence was well above national Healthy People 2020 incidence targets and highest among children aged <5 years. Compared with 2010-2012, the estimated incidence of infection in 2013 was lower for Salmonella, higher for Vibrio, and unchanged overall.dagger Since 2006-2008, the overall incidence has not changed significantly. More needs to be done. Reducing these infections requires actions targeted to sources and pathogens, such as continued use of Salmonella poultry performance standards and actions mandated by the Food Safety Modernization Act (FSMA). FoodNet provides federal and state public health and regulatory agencies as well as the food industry with important information needed to determine if regulations, guidelines, and safety practices applied across the farm-to-table continuum are working. |
Cholera in Africa: a closer look and a time for action
Mintz ED , Tauxe RV . J Infect Dis 2013 208 Suppl 1 S4-7 Timely, accurate, and representative data on disease occurrence are the foundation for effective, targeted prevention and control. In recent years, the achievements of disease-specific programs in Africa, including the President's Emergency Plan for AIDS Relief, the President's Malaria Initiative, and campaigns to eradicate Guinea worm and polio, have demonstrated the power of enhanced surveillance closely coupled with prevention and control measures. Broadly-based programs for strengthening public health capacity, such as the Integrated Diseases Surveillance and Response program [1], the Field Epidemiology and Laboratory Training Program [2], the African Field Epidemiology Network [3], and the EPIVAC Field Vaccinology Training Program [4], combined with new international health regulations adopted in 2005 and fully implemented in 2012 [5], have provided new resources and lent new impetus to improved surveillance, investigation, and reporting for many diseases, including cholera. |
Human pathogens on plants: designing a multidisciplinary strategy for research
Fletcher J , Leach JE , Eversole K , Tauxe R . Phytopathology 2013 103 (4) 306-15 Recent efforts to address concerns about microbial contamination of food plants and resulting foodborne illness have prompted new collaboration and interactions between the scientific communities of plant pathology and food safety. This article provides perspectives from scientists of both disciplines and presents selected research results and concepts that highlight existing and possible future synergisms for audiences of both disciplines. Plant pathology is a complex discipline that encompasses studies of the dissemination, colonization, and infection of plants by microbes such as bacteria, viruses, fungi, and oomycetes. Plant pathologists study plant diseases as well as host plant defense responses and disease management strategies with the goal of minimizing disease occurrences and impacts. Repeated outbreaks of human illness attributed to the contamination of fresh produce, nuts and seeds, and other plant-derived foods by human enteric pathogens such as Shiga toxin-producing Escherichia coli and Salmonella spp. have led some plant pathologists to broaden the application of their science in the past two decades, to address problems of human pathogens on plants (HPOPs). Food microbiology, which began with the study of microbes that spoil foods and those that are critical to produce food, now also focuses study on how foods become contaminated with pathogens and how this can be controlled or prevented. Thus, at the same time, public health researchers and food microbiologists have become more concerned about plant-microbe interactions before and after harvest. New collaborations are forming between members of the plant pathology and food safety communities, leading to enhanced research capacity and greater understanding of the issues for which research is needed. The two communities use somewhat different vocabularies and conceptual models. For example, traditional plant pathology concepts such as the disease triangle and the disease cycle can help to define cross-over issues that pertain also to HPOP research, and can suggest logical strategies for minimizing the risk of microbial contamination. Continued interactions and communication among these two disciplinary communities is essential and can be achieved by the creation of an interdisciplinary research coordination network. We hope that this article, an introduction to the multidisciplinary HPOP arena, will be useful to researchers in many related fields. |
Outbreak of Salmonella enterica serotype I 4,5,12:i:- infections: the challenges of hypothesis generation and microwave cooking
Mody RK , Meyer S , Trees E , White PL , Nguyen T , Sowadsky R , Henao OL , Lafon PC , Austin J , Azzam I , Griffin PM , Tauxe RV , Smith K , Williams IT . Epidemiol Infect 2013 142 (5) 1-11 We investigated an outbreak of 396 Salmonella enterica serotype I 4,5,12:i:- infections to determine the source. After 7 weeks of extensive hypothesis-generation interviews, no refined hypothesis was formed. Nevertheless, a case-control study was initiated. Subsequently, an iterative hypothesis-generation approach used by a single interviewing team identified brand A not-ready-to-eat frozen pot pies as a likely vehicle. The case-control study, modified to assess this new hypothesis, along with product testing indicated that the turkey variety of pot pies was responsible. Review of product labels identified inconsistent language regarding preparation, and the cooking instructions included undefined microwave wattage categories. Surveys found that most patients did not follow the product's cooking instructions and did not know their oven's wattage. The manufacturer voluntarily recalled pot pies and improved the product's cooking instructions. This investigation highlights the value of careful hypothesis-generation and the risks posed by frozen not-ready-to-eat microwavable foods. |
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