Last data update: Nov 04, 2024. (Total: 48056 publications since 2009)
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Outbreak of anthrax in livestock with human occupational exposures - Minnesota, 2023
Schenk KE , Cornille K , Cater J , Vieira AR , Holzbauer S , Bye M , Scheftel J . J Agromedicine 2024 1-4 In July 2023, the Minnesota Department of Health (MDH) was notified of possible occupational exposures to anthrax during an outbreak in animals. In consultation with the Centers for Disease Control and Prevention, MDH epidemiologists created a questionnaire that assessed exposure risks and helped determine individual illness monitoring and antibiotic post-exposure prophylaxis needs. This investigation and the resources developed for it could be useful in future scenarios where there are occupational exposures to naturally occurring anthrax. |
The potential distribution of Bacillus anthracis suitability across Uganda using INLA.
Ndolo VA , Redding D , Deka MA , Salzer JS , Vieira AR , Onyuth H , Ocaido M , Tweyongyere R , Azuba R , Monje F , Ario AR , Kabwama S , Kisaakye E , Bulage L , Kwesiga B , Ntono V , Harris J , Wood JLN , Conlan AJK . Sci Rep 2022 12 (1) 19967 To reduce the veterinary, public health, environmental, and economic burden associated with anthrax outbreaks, it is vital to identify the spatial distribution of areas suitable for Bacillus anthracis, the causative agent of the disease. Bayesian approaches have previously been applied to estimate uncertainty around detected areas of B. anthracis suitability. However, conventional simulation-based techniques are often computationally demanding. To solve this computational problem, we use Integrated Nested Laplace Approximation (INLA) which can adjust for spatially structured random effects, to predict the suitability of B. anthracis across Uganda. We apply a Generalized Additive Model (GAM) within the INLA Bayesian framework to quantify the relationships between B. anthracis occurrence and the environment. We consolidate a national database of wildlife, livestock, and human anthrax case records across Uganda built across multiple sectors bridging human and animal partners using a One Health approach. The INLA framework successfully identified known areas of species suitability in Uganda, as well as suggested unknown hotspots across Northern, Eastern, and Central Uganda, which have not been previously identified by other niche models. The major risk factors for B. anthracis suitability were proximity to water bodies (0-0.3 km), increasing soil calcium (between 10 and 25 cmolc/kg), and elevation of 140-190 m. The sensitivity of the final model against the withheld evaluation dataset was 90% (181 out of 202 = 89.6%; rounded up to 90%). The prediction maps generated using this model can guide future anthrax prevention and surveillance plans by the relevant stakeholders in Uganda. |
What is anthrax
Bower WA , Hendricks KA , Vieira AR , Traxler RM , Weiner Z , Lynfield R , Hoffmaster A . Pathogens 2022 11 (6) Anthrax has been feared for its high mortality in animals and humans for centuries. The etiologic agent is considered a potentially devastating bioweapon, and since 1876-when Robert Koch demonstrated that Bacillus anthracis caused anthrax-it has been considered the sole cause of the disease. Anthrax is, however, a toxin-mediated disease. The toxins edema toxin and lethal toxin are formed from protein components encoded for by the pXO1 virulence plasmid present in pathogenic B. anthracis strains. However, other members of the Bacillus cereus group, to which B. anthracis belongs, have recently been shown to harbor the pXO1 plasmid and produce anthrax toxins. Infection with these Bacillus cereus group organisms produces a disease clinically similar to anthrax. This suggests that anthrax should be defined by the exotoxins encoded for by the pXO1 plasmid rather than the bacterial species it has historically been associated with, and that the definition of anthrax should be expanded to include disease caused by any member of the B. cereus group containing the toxin-producing pXO1 plasmid or anthrax toxin genes specifically. |
Modeling the ecological niche of naturally occurring anthrax at global and circumpolar extents using an ensemble modeling framework
Deka MA , Vieira AR , Bower WA . Transbound Emerg Dis 2022 69 (5) e2563-e2577 Bacillus anthracis, the causative agent of anthrax, is a spore-forming bacterium that primarily affects herbivorous livestock, wildlife, and humans exposed to direct contact with infected animal carcasses or products. To date, there are a limited number of studies that have delineated the potential global distribution of anthrax, despite the importance of the disease from both an economic and public health standpoint. This study compiled occurrence data (n = 874) of confirmed human and animal cases from 1954 to 2021 in 94 countries. Using an ensemble ecological niche model (ENM) framework, we developed updated maps of the global predicted environmental suitability of anthrax to measure relative risk at multiple scales of analysis, including a model for circumpolar regions. Additionally, we produced maps quantifying the disease transmission risk associated with anthrax to cattle, sheep, and goat populations. Environmental suitability for B. anthracis globally is concentered throughout Eurasia, sub-Saharan Africa, the Americas, Southeast Asia, Australia, and Oceania. Suitable environments for B. anthracis at the circumpolar extent extend above the Arctic Circle into portions of Russia, Canada, Iceland, Alaska, and northern Scandinavia. Environmental factors driving B. anthracis suitability globally include vegetation (EVI), land surface temperature (LST), soil characteristics, primary climate conditions, and topography. While, at the circumpolar scale, suitability is influenced by soil factors, topography, and the derived climate characteristics. The greatest risk to livestock is concentrated within the Indian Subcontinent, eastern Australia, Anatolia, the Caucasus region, Central Asia, the Balkans, Spain, Uruguay, eastern China, United States, Canada, and East Africa. This study expands on previous work that predicted the potential environmental niche of anthrax by providing enhanced knowledge on the potential spatial distribution of anthrax risk in the Southern Hemisphere, sub-Saharan Africa, Asia, and circumpolar regions of the Northern Hemisphere. We conclude that these updated maps will provide pertinent information to guide disease control programs, inform policymakers, and raise awareness at the global level to lessen morbidity and mortality among animals and humans located in environmentally suitable areas. This article is protected by copyright. All rights reserved. |
A generalizable one health framework for the control of zoonotic diseases.
Ghai RR , Wallace RM , Kile JC , Shoemaker TR , Vieira AR , Negron ME , Shadomy SV , Sinclair JR , Goryoka GW , Salyer SJ , Barton Behravesh C . Sci Rep 2022 12 (1) 8588 Effectively preventing and controlling zoonotic diseases requires a One Health approach that involves collaboration across sectors responsible for human health, animal health (both domestic and wildlife), and the environment, as well as other partners. Here we describe the Generalizable One Health Framework (GOHF), a five-step framework that provides structure for using a One Health approach in zoonotic disease programs being implemented at the local, sub-national, national, regional, or international level. Part of the framework is a toolkit that compiles existing resources and presents them following a stepwise schematic, allowing users to identify relevant resources as they are required. Coupled with recommendations for implementing a One Health approach for zoonotic disease prevention and control in technical domains including laboratory, surveillance, preparedness and response, this framework can mobilize One Health and thereby enhance and guide capacity building to combat zoonotic disease threats at the human-animal-environment interface. |
Viability evaluation of freeze dried and suspension anthrax spore vaccine formulations stored at different temperatures
Abayneh T , Getachew B , Gelaye E , Traxler R , Vieira AR . Vaccine 2021 39 (42) 6245-6249 Anthrax is endemic in Ethiopia with sporadic outbreaks despite the regular vaccination of domestic livestock. This has raised concerns on the effectiveness of the vaccination strategy which may be associated with breaches in the vaccine cold chain maintenance. This study was aimed at demonstrating the tolerance of anthrax vaccine to cold chain breaches through evaluation of viable spore counts expressed as colony forming units per mL (CFU/mL) of freeze-dried and suspension anthrax vaccines stored at 5 °C, 20 °C and 37 °C for up to 6 months. Both vaccine formulations maintained above the recommended minimum required titre (2 × 10(6) culturable spores per dose for cattle, buffaloes and horses, and not <1 × 10(6) for sheep and goats) for up to 6 months at 5 °C storage. In storage at 20 °C, the viability of freeze-dried anthrax vaccine maintained the minimum required titre up to 6 months while up to 90 days in case of the suspension formulation. Both types of vaccine formulations maintained the minimum titre per dose for up to 30 days at 37 °C storage. Generally, both vaccine formulations showed similar trends in titre fall in all of the three storage temperatures (5 °C, 20 °C and 37 °C) as observed in the almost linearly overlapping 95% confidence intervals (CI) up to day 90 at 5 °C and 20 °C storages while up to day 30 at 37 °C storage. However, a significant (P < 0.05) drop in titre was observed after day 90 for storages at 5 °C and 20 °C, and after day 30 for 37 °C storage as observed in the non overlapping 95% CI from the average titres of previous time points. This study showed that if temperature excursion occurs above the recommended temperature range (4-8 °C) during storage or transport, the vaccine should remain effective and can still be used in vaccination programs. |
Potential distributions of Bacillus anthracis and Bacillus cereus biovar anthracis causing anthrax in Africa
Romero-Alvarez D , Peterson AT , Salzer JS , Pittiglio C , Shadomy S , Traxler R , Vieira AR , Bower WA , Walke H , Campbell LP . PLoS Negl Trop Dis 2020 14 (3) e0008131 BACKGROUND: Bacillus cereus biovar anthracis (Bcbva) is an emergent bacterium closely related to Bacillus anthracis, the etiological agent of anthrax. The latter has a worldwide distribution and usually causes infectious disease in mammals associated with savanna ecosystems. Bcbva was identified in humid tropical forests of Cote d'Ivoire in 2001. Here, we characterize the potential geographic distributions of Bcbva in West Africa and B. anthracis in sub-Saharan Africa using an ecological niche modeling approach. METHODOLOGY/PRINCIPAL FINDINGS: Georeferenced occurrence data for B. anthracis and Bcbva were obtained from public data repositories and the scientific literature. Combinations of temperature, humidity, vegetation greenness, and soils values served as environmental variables in model calibrations. To predict the potential distribution of suitable environments for each pathogen across the study region, parameter values derived from the median of 10 replicates of the best-performing model for each pathogen were used. We found suitable environments predicted for B. anthracis across areas of confirmed and suspected anthrax activity in sub-Saharan Africa, including an east-west corridor from Ethiopia to Sierra Leone in the Sahel region and multiple areas in eastern, central, and southern Africa. The study area for Bcbva was restricted to West and Central Africa to reflect areas that have likely been accessible to Bcbva by dispersal. Model predicted values indicated potential suitable environments within humid forested environments. Background similarity tests in geographic space indicated statistical support to reject the null hypothesis of similarity when comparing environments associated with B. anthracis to those of Bcbva and when comparing humidity values and soils values individually. We failed to reject the null hypothesis of similarity when comparing environments associated with Bcbva to those of B. anthracis, suggesting that additional investigation is needed to provide a more robust characterization of the Bcbva niche. CONCLUSIONS/SIGNIFICANCE: This study represents the first time that the environmental and geographic distribution of Bcbva has been mapped. We document likely differences in ecological niche-and consequently in geographic distribution-between Bcbva and typical B. anthracis, and areas of possible co-occurrence between the two. We provide information crucial to guiding and improving monitoring efforts focused on these pathogens. |
Anthrax epizootic in wildlife, Bwabwata National Park, Namibia, 2017
Cossaboom CM , Khaiseb S , Haufiku B , Katjiuanjo P , Kannyinga A , Mbai K , Shuro T , Hausiku J , Likando A , Shikesho R , Nyarko K , Miller LA , Agolory S , Vieira AR , Salzer JS , Bower WA , Campbell L , Kolton CB , Marston C , Gary J , Bollweg BC , Zaki SR , Hoffmaster A , Walke H . Emerg Infect Dis 2019 25 (5) 947-950 In late September 2017, Bwabwata National Park in Namibia experienced a sudden die-off of hippopotamuses and Cape buffalo. A multiorganizational response was initiated, involving several ministries within Namibia and the US Centers for Disease Control and Prevention. Rapid interventions resulted in zero human or livestock cases associated with this epizootic. |
Prevention and control of youth camp-associated acute gastroenteritis outbreaks
Kambhampati AK , Marsh ZA , Hlavsa MC , Roberts VA , Vieira AR , Yoder JS , Hall AJ . J Pediatric Infect Dis Soc 2018 8 (5) 392-399 Background: Approximately 14 million children attend more than 14000 US camps every year. Shared accommodations and activities can facilitate acute gastroenteritis (AGE) outbreaks. Methods: We analyzed data from the National Outbreak Reporting System on US youth camp-associated AGE outbreaks that occurred between 2009 and 2016. We also conducted a systematic literature search of youth camp-associated AGE outbreaks that have occurred around the world and a gray literature search for existing recommendations on outbreak prevention and control at camps worldwide. Results: Thirty-nine US jurisdictions reported a total of 229 youth camp-associated AGE outbreaks to the National Outbreak Reporting System. Of the 226 outbreaks included in our analyses, 120 (53%) were reported to have resulted from person-to-person transmission, 42 (19%) from an unknown transmission mode, 38 (17%) from foodborne transmission, 19 (8%) from waterborne transmission, 5 (2%) from animal contact, and 2 (<1%) from environmental contamination. Among 170 (75%) outbreaks with a single suspected or confirmed etiology, norovirus (107 [63%] outbreaks), Salmonella spp (16 [9%]), and Shiga-toxin producing Escherichia coli (12 [7%]) were implicated most frequently. We identified 43 additional youth camp-associated AGE outbreaks in the literature that occurred in various countries between 1938 and 2014. Control measures identified through the literature search included camp closure, separation of ill campers, environmental disinfection, and education on food preparation and hand hygiene. Conclusions: Youth camp-associated AGE outbreaks are caused by numerous pathogens every year. These outbreaks are facilitated by factors that include improper food preparation, inadequate cleaning and disinfection, shared accommodations, and contact with animals. Health education focused on proper hygiene and preventing disease transmission could help control or prevent these outbreaks. |
Enhancing surveillance and diagnostics in anthrax-endemic countries
Vieira AR , Salzer JS , Traxler RM , Hendricks KA , Kadzik ME , Marston CK , Kolton CB , Stoddard RA , Hoffmaster AR , Bower WA , Walke HT . Emerg Infect Dis 2017 23 (13) S147-53 Naturally occurring anthrax disproportionately affects the health and economic welfare of poor, rural communities in anthrax-endemic countries. However, many of these countries have limited anthrax prevention and control programs. Effective prevention of anthrax outbreaks among humans is accomplished through routine livestock vaccination programs and prompt response to animal outbreaks. The Centers for Disease Control and Prevention uses a 2-phase framework when providing technical assistance to partners in anthrax-endemic countries. The first phase assesses and identifies areas for improvement in existing human and animal surveillance, laboratory diagnostics, and outbreak response. The second phase provides steps to implement improvements to these areas. We describe examples of implementing this framework in anthrax-endemic countries. These activities are at varying stages of completion; however, the public health impact of these initiatives has been encouraging. The anthrax framework can be extended to other zoonotic diseases to build on these efforts, improve human and animal health, and enhance global health security. |
Outbreaks attributed to pork in the United States, 1998-2015
Self JL , Luna-Gierke RE , Fothergill A , Holt KG , Vieira AR . Epidemiol Infect 2017 145 (14) 1-11 Each year in the United States, an estimated 525 000 infections, 2900 hospitalizations, and 82 deaths are attributed to consumption of pork. We analyzed the epidemiology of outbreaks attributed to pork in the United States reported to the Centers for Disease Control and Prevention (CDC) 1998-2015. During that period, 288 outbreaks were attributed to pork, resulting in 6372 illnesses, 443 hospitalizations, and four deaths. The frequency of outbreaks attributed to pork decreased by 37% during this period, consistent with a decline in total foodborne outbreaks. However, outbreaks attributed to pork increased by 73% in 2015 (19 outbreaks) compared with the previous 3 years (average of 11 outbreaks per year), without a similar increase in total foodborne outbreaks. Most (>99%) of these outbreaks occurred among people exposed in the same state. The most frequent etiology shifted from Staphylococcus aureus toxin during 1998-2001 (19%) to Salmonella during 2012-2015 (46%). Outbreaks associated with ham decreased from eight outbreaks per year during 1998-2001, to one per year during 2012-2015 (P < 0.01). Additional efforts are necessary to reduce outbreaks and sporadic illnesses associated with pork products. |
Association between wetland presence and incidence of Salmonella enterica serotype Javiana infections in selected US sites, 2005-2011
Huang JY , Patrick ME , Manners J , Sapkota AR , Scherzinger KJ , Tobin-D'Angelo M , Henao OL , Cole DJ , Vieira AR . Epidemiol Infect 2017 145 (14) 1-7 Salmonella causes an estimated 1.2 million illnesses annually in the USA. Salmonella enterica serotype Javiana (serotype Javiana) is the fourth most common serotype isolated from humans, with the majority of illnesses occurring in southeastern states. The percentage of wetland cover by wetland type and the average incidence rates of serotype Javiana infection in selected counties of the Foodborne Disease Active Surveillance Network (FoodNet) were examined. This analysis explored the relationship between wetland environments and incidence in order to assess whether regional differences in environmental habitats may be associated with observed variations in incidence. Findings suggest that environmental habitats may support reservoirs or contribute to the persistence of serotype Javiana, and may frequently contribute to the transmission of infection compared with other Salmonella serotypes. |
Foodborne disease outbreaks in correctional institutions - United States, 1998-2014
Marlow MA , Luna-Gierke RE , Griffin PM , Vieira AR . Am J Public Health 2017 107 (7) e1-e7 OBJECTIVES: To present the first update on the epidemiology of US foodborne correctional institution outbreaks in 20 years. METHODS: We analyzed data from the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System to describe correctional institution outbreaks from 1998 to 2014 and compare them with other foodborne outbreaks. RESULTS: Two hundred foodborne outbreaks in correctional institutions were reported, resulting in 20 625 illnesses, 204 hospitalizations, and 5 deaths. Median number of outbreak-associated illnesses per 100 000 population per year was 45 (range = 11-141) compared with 7 (range = 4-10) for other outbreaks. These outbreaks accounted for 6% (20 625 of 358 330) of outbreak-associated foodborne illnesses. Thirty-seven states reported at least 1 outbreak in a correctional institution. Clostridium perfringens (28%; 36 of 128) was the most frequently reported single etiology. The most frequently reported contributing factor was food remaining at room temperature (37%; 28 of 76). CONCLUSIONS: Incarcerated persons suffer a disproportionate number of outbreak-associated foodborne illnesses. Better food safety oversight and regulation in correctional food services could decrease outbreaks. Public Health Implications. Public health officials, correctional officials, and food suppliers can work together for food safety. Clearer jurisdiction over regulation of correctional food services is needed. (Am J Public Health. Published online ahead of print May 18, 2017: e1-e7. doi:10.2105/AJPH.2017.303816). |
Attribution of Salmonella enterica serotype Hadar infections using antimicrobial resistance data from two points in the food supply system
Vieira AR , Grass J , Fedorka-Cray PJ , Plumblee JR , Tate H , Cole DJ . Epidemiol Infect 2016 144 (9) 1-8 A challenge to the development of foodborne illness prevention measures is determining the sources of enteric illness. Microbial subtyping source-attribution models attribute illnesses to various sources, requiring data characterizing bacterial isolate subtypes collected from human and food sources. We evaluated the use of antimicrobial resistance data on isolates of Salmonella enterica serotype Hadar, collected from ill humans, food animals, and from retail meats, in two microbial subtyping attribution models. We also compared model results when either antimicrobial resistance or pulsed-field gel electrophoresis (PFGE) patterns were used to subtype isolates. Depending on the subtyping model used, 68-96% of the human infections were attributed to meat and poultry food products. All models yielded similar outcomes, with 86% [95% confidence interval (CI) 80-91] to 91% (95% CI 88-96) of the attributable infections attributed to turkey, and 6% (95% CI 2-10) to 14% (95% CI 8-20) to chicken. Few illnesses (<3%) were attributed to cattle or swine. Results were similar whether the isolates were obtained from food animals during processing or from retail meat products. Our results support the view that microbial subtyping models are a flexible and robust approach for attributing Salmonella Hadar. |
Vital signs: multistate foodborne outbreaks - United States, 2010-2014
Crowe SJ , Mahon BE , Vieira AR , Gould LH . MMWR Morb Mortal Wkly Rep 2015 64 (43) 1221-5 INTRODUCTION: Millions of U.S. residents become ill from foodborne pathogens each year. Most foodborne outbreaks occur among small groups of persons in a localized area. However, because many foods are distributed widely and rapidly, and because detection methods have improved, outbreaks that occur in multiple states and that even span the entire country are being recognized with increasing frequency. METHODS: This report analyzes data from CDC's Foodborne Disease Outbreak Surveillance System to describe multistate foodborne outbreaks that occurred in the United States during 2010-2014. RESULTS: During this 5-year period, 120 multistate foodborne disease outbreaks (with identified pathogen and food or common setting) were reported to CDC. These multistate outbreaks accounted for 3% (120 of 4,163) of all reported foodborne outbreaks, but were responsible for 11% (7,929 of 71,747) of illnesses, 34% (1,460 of 4,247) of hospitalizations, and 56% (66 of 118) of deaths associated with foodborne outbreaks. Salmonella (63 outbreaks), Shiga toxin-producing E. coli (34), and Listeria monocytogenes (12) were the leading pathogens. Fruits (17), vegetable row crops (15), beef (13), sprouts (10), and seeded vegetables (nine) were the most commonly implicated foods. Traceback investigations to identify the food origin were conducted for 87 outbreaks, of which 55 led to a product recall. Imported foods were linked to 18 multistate outbreaks. CONCLUSIONS: Multistate foodborne disease outbreaks account for a disproportionate number of outbreak-associated illnesses, hospitalizations, and deaths relative to their occurrence. Working together, food industries and public health departments and agencies can develop and implement more effective ways to identify and to trace contaminated foods linked to multistate outbreaks. Lessons learned during outbreak investigations can help improve food safety practices and regulations, and might prevent future outbreaks. |
Use of random forest to estimate population attributable fractions from a case-control study of Salmonella enterica serotype Enteritidis infections
Gu W , Vieira AR , Hoekstra RM , Griffin PM , Cole D . Epidemiol Infect 2015 143 (13) 1-9 To design effective food safety programmes we need to estimate how many sporadic foodborne illnesses are caused by specific food sources based on case-control studies. Logistic regression has substantive limitations for analysing structured questionnaire data with numerous exposures and missing values. We adapted random forest to analyse data of a case-control study of Salmonella enterica serotype Enteritidis illness for source attribution. For estimation of summary population attributable fractions (PAFs) of exposures grouped into transmission routes, we devised a counterfactual estimator to predict reductions in illness associated with removing grouped exposures. For the purpose of comparison, we fitted the data using logistic regression models with stepwise forward and backward variable selection. Our results show that the forward and backward variable selection of logistic regression models were not consistent for parameter estimation, with different significant exposures identified. By contrast, the random forest model produced estimated PAFs of grouped exposures consistent in rank order with results obtained from outbreak data, with egg-related exposures having the highest estimated PAF (22.1%, 95% confidence interval 8.5-31.8). Random forest might be structurally more coherent and efficient than logistic regression models for attributing Salmonella illnesses to sources involving many causal pathways. |
Typhoid fever acquired in the United States, 1999-2010: epidemiology, microbiology, and use of a space-time scan statistic for outbreak detection
Imanishi M , Newton AE , Vieira AR , Gonzalez-Aviles G , Kendall Scott ME , Manikonda K , Maxwell TN , Halpin JL , Freeman MM , Medalla F , Ayers TL , Derado G , Mahon BE , Mintz ED . Epidemiol Infect 2014 143 (11) 1-12 Although rare, typhoid fever cases acquired in the United States continue to be reported. Detection and investigation of outbreaks in these domestically acquired cases offer opportunities to identify chronic carriers. We searched surveillance and laboratory databases for domestically acquired typhoid fever cases, used a space-time scan statistic to identify clusters, and classified clusters as outbreaks or non-outbreaks. From 1999 to 2010, domestically acquired cases accounted for 18% of 3373 reported typhoid fever cases; their isolates were less often multidrug-resistant (2% vs. 15%) compared to isolates from travel-associated cases. We identified 28 outbreaks and two possible outbreaks within 45 space-time clusters of 2 domestically acquired cases, including three outbreaks involving 2 molecular subtypes. The approach detected seven of the ten outbreaks published in the literature or reported to CDC. Although this approach did not definitively identify any previously unrecognized outbreaks, it showed the potential to detect outbreaks of typhoid fever that may escape detection by routine analysis of surveillance data. Sixteen outbreaks had been linked to a carrier. Every case of typhoid fever acquired in a non-endemic country warrants thorough investigation. Space-time scan statistics, together with shoe-leather epidemiology and molecular subtyping, may improve outbreak detection. |
Quinolone-resistant Salmonella enterica serotype Enteritidis infections associated with international travel
O'Donnell AT , Vieira AR , Huang JY , Whichard J , Cole D , Karp BE . Clin Infect Dis 2014 59 (9) e139-41 We found a strong association between nalidixic acid (NA)-resistant Salmonella serotype Enteritidis (SE) infections in the United States and recent international travel. |
Surveillance for foodborne disease outbreaks - United States, 1998-2008
Gould LH , Walsh KA , Vieira AR , Herman K , Williams IT , Hall AJ , Cole D . MMWR Surveill Summ 2013 62 (2) 1-34 PROBLEM/CONDITION: Foodborne diseases cause an estimated 48 million illnesses each year in the United States, including 9.4 million caused by known pathogens. Foodborne disease outbreak surveillance provides valuable insights into the agents and foods that cause illness and the settings in which transmission occurs. CDC maintains a surveillance program for collection and periodic reporting of data on the occurrence and causes of foodborne disease outbreaks in the United States. This surveillance system is the primary source of national data describing the numbers of illnesses, hospitalizations, and deaths; etiologic agents; implicated foods; contributing factors; and settings of food preparation and consumption associated with recognized foodborne disease outbreaks in the United States. REPORTING PERIOD: 1998-2008. DESCRIPTION OF THE SYSTEM: The Foodborne Disease Outbreak Surveillance System collects data on foodborne disease outbreaks, defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. Public health agencies in all 50 states, the District of Columbia, U.S. territories, and Freely Associated States have primary responsibility for identifying and investigating outbreaks and use a standard form to report outbreaks voluntarily to CDC. During 1998-2008, reporting was made through the electronic Foodborne Outbreak Reporting System (eFORS). RESULTS: During 1998-2008, CDC received reports of 13,405 foodborne disease outbreaks, which resulted in 273,120 reported cases of illness, 9,109 hospitalizations, and 200 deaths. Of the 7,998 outbreaks with a known etiology, 3,633 (45%) were caused by viruses, 3,613 (45%) were caused by bacteria, 685 (5%) were caused by chemical and toxic agents, and 67 (1%) were caused by parasites. Among the 7,724 (58%) outbreaks with an implicated food or contaminated ingredient reported, 3,264 (42%) could be assigned to one of 17 predefined commodity categories: fish, crustaceans, mollusks, dairy, eggs, beef, game, pork, poultry, grains/beans, oils/sugars, fruits/nuts, fungi, leafy vegetables, root vegetables, sprouts, and vegetables from a vine or stalk. The commodities implicated most commonly were poultry (18.9%; 95% confidence interval [CI] = 17.4-20.3) and fish (18.6%; CI = 17.2-20), followed by beef (11.9%; CI = 10.8-13.1). The pathogen-commodity pairs most commonly responsible for outbreaks were scombroid toxin/histamine and fish (317 outbreaks), ciguatoxin and fish (172 outbreaks), Salmonella and poultry (145 outbreaks), and norovirus and leafy vegetables (141 outbreaks). The pathogen-commodity pairs most commonly responsible for outbreak-related illnesses were norovirus and leafy vegetables (4,011 illnesses), Clostridium perfringens and poultry (3,452 illnesses), Salmonella and vine-stalk vegetables (3,216 illnesses), and Clostridium perfringens and beef (2,963 illnesses). Compared with the first 2 years of the study (1998-1999), the percentage of outbreaks associated with leafy vegetables and dairy increased substantially during 2006-2008, while the percentage of outbreaks associated with eggs decreased. INTERPRETATION: Outbreak reporting rates and implicated foods varied by state and year, respectively; analysis of surveillance data for this 11-year period provides important information regarding changes in sources of illness over time. A substantial percentage of foodborne disease outbreaks were associated with poultry, fish, and beef, whereas many outbreak-related illnesses were associated with poultry, leafy vegetables, beef, and fruits/nuts. The percentage of outbreaks associated with leafy vegetables and dairy increased during the surveillance period, while the percentage associated with eggs decreased. PUBLIC HEALTH ACTIONS: Outbreak surveillance data highlight the etiologic agents, foods, and settings involved most often in foodborne disease outbreaks and can help to identify food commodities and preparation settings in which interventions might be most effective. Analysis of data collected over several years of surveillance provides a means to assess changes in the food commodities associated most frequently with outbreaks that might occur following improvements in food safety or changes in consumption patterns or food preparation practices. Prevention of foodborne disease depends on targeted interventions at appropriate points from food production to food preparation. Efforts to reduce foodborne illness should focus on the pathogens and food commodities causing the most outbreaks and outbreak-associated illnesses, including beef, poultry, fish, and produce. |
Binational outbreak of Guillain-Barre syndrome associated with Campylobacter jejuni infection, Mexico and USA, 2011
Jackson BR , Zegarra JA , Lopez-Gatell H , Sejvar J , Arzate F , Waterman S , Nunez AS , Lopez B , Weiss J , Cruz RQ , Murrieta DY , Luna-Gierke R , Heiman K , Vieira AR , Fitzgerald C , Kwan P , Zarate-Bermudez M , Talkington D , Hill VR , Mahon B . Epidemiol Infect 2013 142 (5) 1-11 SUMMARY: In June 2011, a cluster of suspected cases of Guillain-Barre syndrome (GBS), which can follow Campylobacter jejuni infection, was identified in San Luis Rio Colorado (SLRC), Sonora, Mexico and Yuma County, Arizona, USA. An outbreak investigation identified 26 patients (18 from Sonora, eight from Arizona) with onset of GBS 4 May-21 July 2011, exceeding the expected number of cases (n = 1-2). Twenty-one (81%) patients reported antecedent diarrhoea, and 61% of 18 patients tested were seropositive for C. jejuni IgM antibodies. In a case-control study matched on age group, sex, ethnicity, and neighbourhood of residence, all Arizona GBS patients travelled to SLRC during the exposure period vs. 45% of matched controls (matched odds ratio 8.1, 95% confidence interval 1.5-infinity). Exposure information and an environmental assessment suggested that GBS cases resulted from a large outbreak of C. jejuni infection from inadequately disinfected tap water in SLRC. Binational collaboration was essential in investigating this cross-border GBS outbreak, the first in mainland North America since 1976. |
WHO Global Salm-Surv external quality assurance system for serotyping of Salmonella isolates from 2000 to 2007
Hendriksen RS , Mikoleit M , Carlson VP , Karlsmose S , Vieira AR , Jensen AB , Seyfarth AM , DeLong SM , Weill FX , Wong DM , Angulo FJ , Wegener HC , Aarestrup FM . J Clin Microbiol 2009 47 (9) 2729-36 An international external quality assurance system (EQAS) for the serotyping of Salmonella species was initiated in 2000 by WHO Global Salm-Surv to enhance the capacity of national reference laboratories to obtain reliable data for surveillance purposes worldwide. Seven EQAS iterations were conducted between 2000 and 2007. In each iteration, participating laboratories submitted serotyping results for eight Salmonella isolates. A total of 249 laboratories in 96 countries participated in at least one EQAS iteration. A total of 756 reports were received from the participating laboratories during the seven EQAS iterations. Cumulatively, 76% of participating laboratories submitted data for all eight strains, and 82% of strains were correctly serotyped. In each iteration, 84% to 96% of the laboratories correctly serotyped the Salmonella enterica serovar Enteritidis isolate that was included as an internal quality control strain. Regional differences in performance were observed, with laboratories in Central Asia and the Middle East performing less well overall than those in other regions. Errors that resulted in incorrect serovar identification were typically caused by difficulties in the detection of the phase two flagellar antigen or in differentiation within antigen complexes; some of these errors are likely related to the quality of the antisera available. The results from the WHO Global Salm-Surv EQAS, the largest of its kind in the world, show that most laboratories worldwide are capable of correctly serotyping Salmonella species. However, this study also indicates a continuing need for improvement. Future training efforts should be aimed at enhancing the ability to detect the phase two flagellar antigen and at disseminating information on where to purchase high-quality antisera. |
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