Cindy R Friedman

Centers for Disease Control and Prevention, Atlanta, Michigan, United States

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Publications (18)138.03 Total impact

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    ABSTRACT: Background Strategies to prevent gastric cancer by decreasing Helicobacter pylori infections in high-prevalence, low-income countries could include a population-based “screen and treat” eradication program.Methods We tested residents of two rural villages for H. pylori infection using urea breath test (UBT), treated infected persons using directly observed therapy (DOT), retested for cure, and retested after 1 year later for H. pylori infection.FindingsWe tested 1,065 (92%) of 1153 residents from two villages in rural Bolivia. Baseline H. pylori prevalence was 80% (95% confidence interval [CI]: 78–84). Age-specific cure rates were similar (≥92%) after DOT. Among those cured, 12% (95% CI: 8–15) had recurrent infection. Age-specific annual H. pylori recurrence rates for combined villages were 20% (95% CI: 10–29) in persons <5 years, 20% (95% CI: 10–29) in 5–9 years, 8% (95% CI: 1–15) in 10–14 years, and 8% (95% CI: 4–12) in persons ≥15 years. Compared with the referent population, those ≥15 years, recurrent infections were significantly more likely in children <5 years (odds ratios [OR] 2.7, 95% CI: 1.2–5.8) and 5–9 years (OR 2.7, 95% CI: 1.4–5.1).InterpretationChildren <10 years had high H. pylori recurrence rates following a population-based screen and treat program; this H. pylori eradication strategy may not be feasible in high-prevalence, low-income settings.
    Helicobacter 05/2014; 19(5). DOI:10.1111/hel.12137 · 2.99 Impact Factor
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    ABSTRACT: A 1998 investigation of an outbreak of Salmonella serotype Typhimurium infections among children tasting unpasteurized milk during tours of a dairy farm demonstrated a distribution of unusually long incubation periods (median, 8 days; interquartile range [IQR], 6-14 days). Bacterial isolates were highly acid tolerant and contained genes associated with protection against destructive phagocytic reactive oxygen intermediates. We hypothesize that exposure to low-dose oral inoculum of a pathogen with these properties could have contributed to cases of non-typhoidal salmonellosis with the longest incubation period reported to the Centers for Disease Control and Prevention (CDC).
    Foodborne Pathogens and Disease 03/2012; 9(3):245-8. DOI:10.1089/fpd.2011.0992 · 2.09 Impact Factor
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    ABSTRACT: The mail-related dispersal of Bacillus anthracis spores in the Washington, D.C., area during October 2001 resulted in 5 confirmed cases of inhalational anthrax. We identified an additional 144 ill persons who were potentially exposed to aerosolized spores and whose symptoms were compatible with early inhalational anthrax but whose clinical course and nonserologic laboratory evaluation revealed no evidence for B. anthracis infection. We hypothesized that early antibiotic use could have decreased the sensitivity of diagnostic tests or that bioterrorism-related inhalational anthrax may include mild disease. Eligible patients included those with illness compatible with early inhalational anthrax who had potential exposure to B. anthracis. Patient serum samples were tested for immunoglobulin G (IgG) antibody against B. anthracis protective antigen (PA) using a sensitive enzyme-linked immunosorbant assay (sensitivity, 97.6%). Of the 144 eligible patients, 66 (46%) had convalescent-phase serum samples available for testing; 29 (44%) worked in an area considered to pose a high risk of exposure to B. anthracis spores. Of the 37 patients who worked in areas that did not meet the definition of high-risk exposure, 23 (62%) worked in United States postal or other government facilities in which exposure was plausible but not documented. None of the 66 patients with convalescent-phase serum samples showed evidence of an anti-PA IgG serologic response to B. anthracis. These data suggest that a mild form of inhalational anthrax did not occur and that surveillance for moderate or severe illness was adequate to identify all inhalational anthrax cases resulting from the Washington, D.C., bioterrorism-related anthrax exposures.
    Clinical Infectious Diseases 11/2005; 41(7):991-7. DOI:10.1086/432937 · 9.42 Impact Factor
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    ABSTRACT: Fresh produce is an important part of a healthy diet. During the last three decades, the number of outbreaks caused by foodborne pathogens associated with fresh produce consumption reported to the Centers for Disease Control and Prevention has increased. To identify trends, we analyzed data for 1973 through 1997 from the Foodborne Outbreak Surveillance System. We defined a produce-associated outbreak as the occurrence of two or more cases of the same illness in which epidemiologic investigation implicated the same uncooked fruit, vegetable, salad, or juice. A total of 190 produce-associated outbreaks were reported, associated with 16,058 illnesses, 598 hospitalizations, and eight deaths. Produce-associated outbreaks accounted for an increasing proportion of all reported foodborne outbreaks with a known food item, rising from 0.7% in the 1970s to 6% in the 1990s. Among produce-associated outbreaks, the food items most frequently implicated included salad, lettuce, juice, melon, sprouts, and berries. Among 103 (54%) produce-associated outbreaks with a known pathogen, 62 (60%) were caused by bacterial pathogens, of which 30 (48%) were caused by Salmonella. During the study period, Cyclospora and Escherichia coli O157:H7 were newly recognized as causes of foodborne illness. Foodborne outbreaks associated with fresh produce in the United States have increased in absolute numbers and as a proportion of all reported foodborne outbreaks. Fruit and vegetables are major components of a healthy diet, but eating fresh uncooked produce is not risk free. Further efforts are needed to better understand the complex interactions between microbes and produce and the mechanisms by which contamination occurs from farm to table.
    Journal of food protection 11/2004; 67(10):2342-53. · 1.80 Impact Factor
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    ABSTRACT: We summarize antimicrobial resistance surveillance data in human and chicken isolates of Campylobacter. Isolates were from a sentinel county study from 1989 through 1990 and from nine state health departments participating in National Antimicrobial Resistance Monitoring System for enteric bacteria (NARMS) from 1997 through 2001. None of the 297 C. jejuni or C. coli isolates tested from 1989 through 1990 was ciprofloxacin-resistant. From 1997 through 2001, a total of 1,553 human Campylobacter isolates were characterized: 1,471 (95%) were C. jejuni, 63 (4%) were C. coli, and 19 (1%) were other Campylobacter species. The prevalence of ciprofloxacin-resistant Campylobacter was 13% (28 of 217) in 1997 and 19% (75 of 384) in 2001; erythromycin resistance was 2% (4 of 217) in 1997 and 2% (8 of 384) in 2001. Ciprofloxacin-resistant Campylobacter was isolated from 10% of 180 chicken products purchased from grocery stores in three states in 1999. Ciprofloxacin resistance has emerged among Campylobacter since 1990 and has increased in prevalence since 1997.
    Emerging infectious diseases 07/2004; 10(6):1102-9. DOI:10.3201/eid1006.030635 · 7.33 Impact Factor
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    ABSTRACT: Helicobacter pylori is the primary cause of peptic ulcer disease and an etiologic agent in the development of gastric cancer. H. pylori infection is curable with regimens of multiple antimicrobial agents, and antimicrobial resistance is a leading cause of treatment failure. The Helicobacter pylori Antimicrobial Resistance Monitoring Program (HARP) is a prospective, multicenter U.S. network that tracks national incidence rates of H. pylori antimicrobial resistance. Of 347 clinical H. pylori isolates collected from December 1998 through 2002, 101 (29.1%) were resistant to one antimicrobial agent, and 17 (5%) were resistant to two or more antimicrobial agents. Eighty-seven (25.1%) isolates were resistant to metronidazole, 45 (12.9%) to clarithromycin, and 3 (0.9%) to amoxicillin. On multivariate analysis, black race was the only significant risk factor (p < 0.01, hazard ratio 2.04) for infection with a resistant H. pylori strain. Formulating pretreatment screening strategies or providing alternative therapeutic regimens for high-risk populations may be important for future clinical practice.
    Emerging infectious diseases 06/2004; 10(6):1088-94. DOI:10.3201/eid1006.030744 · 7.33 Impact Factor
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    ABSTRACT: Campylobacter is a common cause of gastroenteritis in the United States. We conducted a population-based case-control study to determine risk factors for sporadic Campylobacter infection. During a 12-month study, we enrolled 1316 patients with culture-confirmed Campylobacter infections from 7 states, collecting demographic, clinical, and exposure data using a standardized questionnaire. We interviewed 1 matched control subject for each case patient. Thirteen percent of patients had traveled abroad. In multivariate analysis of persons who had not traveled, the largest population attributable fraction (PAF) of 24% was related to consumption of chicken prepared at a restaurant. The PAF for consumption of nonpoultry meat that was prepared at a restaurant was also large (21%); smaller proportions of illness were associated with other food and nonfood exposures. Efforts to reduce contamination of poultry with Campylobacter should benefit public health. Restaurants should improve food-handling practices, ensure adequate cooking of meat and poultry, and consider purchasing poultry that has been treated to reduce Campylobacter contamination.
    Clinical Infectious Diseases 05/2004; 38 Suppl 3(s3):S285-96. DOI:10.1086/381598 · 9.42 Impact Factor
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    ABSTRACT: Few US clinical laboratories screen stool specimens for Shiga toxin-producing Escherichia coli (STEC) other than E. coli O157. An outbreak of STEC O111:H8 infections indistinguishable from E. coli O157:H7 at a youth camp highlights the need to improve non-O157 STEC surveillance. Interviews of 521 (80%) of 650 attendees revealed 55 (11%) were ill; 2 developed hemolytic-uremic syndrome. Illness was associated with consuming salad during the camp's first lunch meal (hazard ratio [HR], 4.68; P<.01), consuming ice provided in barrels on the camp's final day (HR, 3.41; P<.01), eating cob corn (HR, 3.22; P<.01), and eating a dinner roll (HR, 2.82; P<.01). Cultures of 2 of 11 stools yielded E. coli O111:H8. Results of serologic testing and additional stool cultures demonstrated no evidence of infection with other bacterial pathogens, including E. coli O157, and supported infection with E. coli O111. Clinical laboratories should routinely screen suspect specimens for non-O157 STEC and should serotype and report Shiga-positive isolates.
    Clinical Infectious Diseases 01/2004; 38(2):190-8. DOI:10.1086/380634 · 9.42 Impact Factor
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    ABSTRACT: High seroprevalence rates for Helicobacter pylori are reported in developing countries, yet few seroincidence studies exist that determine age of initial acquisition and risk factors for H. pylori seroconversion. Two H. pylori serosurveys were conducted in August 1996 and November 1997. Of 188 children aged 21 months to 6 years who were seronegative in the first survey, 44 (23%) had seroconverted at follow-up, yielding an 18% annual seroincidence. The largest increase in seroincidence occurred between children aged 2 years (10%) and children aged 3 years (32%). Use of a lidded, narrow-mouthed water vessel was protective against seroconversion (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.1-0.8), and the presence of another H. pylori-seropositive sibling in the household was a risk factor for seroconversion (OR, 3.1; 95% CI, 1.3-8.7). Although not a randomized intervention trial, this study suggests that the use of a narrow-mouthed water vessel may prevent the transmission of H. pylori in households in developing countries.
    Clinical Infectious Diseases 12/2002; 35(9):1059-65. DOI:10.1086/342910 · 9.42 Impact Factor
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    ABSTRACT: The biological attacks with powders containing Bacillus anthracis sent through the mail during September and October 2001 led to unprecedented public health and law enforcement investigations, which involved thousands of investigators from federal, state, and local agencies. Following recognition of the first cases of anthrax in Florida in early October 2001, investigators from the Centers for Disease Control and Prevention (CDC) and the Federal Bureau of Investigation (FBI) were mobilized to assist investigators from state and local public health and law enforcement agencies. Although public health and criminal investigations have been conducted in concert in the past, the response to the anthrax attacks required close collaboration because of the immediate and ongoing threat to public safety. We describe the collaborations between CDC and FBI during the investigation of the 2001 anthrax attacks and highlight the challenges and successes of public health and law enforcement collaborations in general.
    Emerging infectious diseases 11/2002; 8(10):1152-6. DOI:10.3201/eid0810.020400 · 7.33 Impact Factor
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    ABSTRACT: Background: Infection with H. pylori can cause duodenal ulcers and gastric adenocarcinoma. The definitive mode of transmission is unknown. To confirm previous research showing that using a narrow-mouth water vessel and water disinfectant prevented infection in children, we are determining whether special vessel use can prevent H. pylori re-infection in a treated population. Methods: We tested residents of 2 villages for H. pylori using urea breath tests (UBT). Special vessels and water disinfectant were distributed to one village and their use is monitored monthly; the other village received no intervention. Twice daily directly observed therapy (DOT) for the recommended 10 days with lansoprazole, clarithromycin and amoxicillin was offered to persons testing positive. UBTs were repeated at 2 months; H. pylori-positive persons were retreated. Village re-infection rates will be determined by UBT and compared after 1 year. Results: We tested 1,065 (97%) of 1,093 residents of 2 villages; 849(81%) were positive and village prevalence rates were similar. Prevalence ranged from 12% in children = 14 years. 849 persons with positive tests, 699 (82%) received treatment. Of these, 552 (79%) had follow-up UB Ts, 484 (87%) of which were negative. Eradication rates were 94% with 20 treatment doses, 94% with 15-19 doses and 85% with 10-14 doses. Vessel use rates ranged from 87%-100%. Conclusions: H. pylori treatment in this high-prevalence population was effective with 10 or more doses and DOT, suggesting that, for compliant patients, recommended treatment duration could be shortened to 7 days, thereby reducing costs and improving compliance. Use of the vessel remains high after 6 months; H. pylori re-infection rates will be determined in June 2001.
  • Gastroenterology 04/2000; 118(4). DOI:10.1016/S0016-5085(00)84928-8 · 13.93 Impact Factor
  • B D Gold · M Kennedy · J Stockwell · C R Friedman
    Journal of Pediatric Gastroenterology and Nutrition 10/1999; 29(4):491. DOI:10.1097/00005176-199910000-00036 · 2.87 Impact Factor
  • C R Friedman · M K Glynn · R Quick · B Khanna · N Iihoshi · C Revollo · B D Gold
    Journal of Pediatric Gastroenterology and Nutrition 09/1998; 27(4):477. DOI:10.1097/00005176-199810000-00078 · 2.87 Impact Factor
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    ABSTRACT: In January 1996, an outbreak of diarrhea caused by Salmonella Enteritidis occurred in children attending a Komodo dragon exhibit at a metropolitan zoo. We sought to determine the extent of the outbreak and mode of transmission. A case-control study was conducted. Controls were randomly selected from zoo membership lists and matched to patients by age group and date of exhibit visit. Of 65 patients identified, 39 had confirmed and 26 had suspected cases. The median age was 7 years (range, 3 months to 48 years); 55% were enrolled in the case-control study. No patients and two (4%) controls reported touching a dragon; however, 83% of patients but only 52% of controls touched the wooden barrier that surrounded the dragon pen (odds ratio = 4.0, 95% CI 1.2 to 13.9). Washing hands at the zoo after visiting the dragons was highly protective (OR = 0.14, 95% CI 0.03 to 0.7). Cultures from the patients, one dragon, and the exhibit barriers yielded Salmonella Enteritidis, phage type 8. On the basis of an attack rate of 4.3% among exhibit attendees under 13 years old on whom data were collected, we estimate that 315 additional cases of salmonellosis occurred among visitors in this age group. This large outbreak demonstrates the importance of environmental contamination in the transmission of Salmonella from reptiles, and the protective value of hand washing. Recommendations regarding reptile exhibits and reptilian pets should emphasize this indirect route.
    Journal of Pediatrics 06/1998; 132(5):802-7. DOI:10.1016/S0022-3476(98)70307-5 · 3.74 Impact Factor
  • Journal of Pediatric Gastroenterology and Nutrition 10/1997; 25(4). DOI:10.1097/00005176-199710000-00115 · 2.87 Impact Factor
  • The Lancet 07/1996; 347(9016):1705-6. DOI:10.1016/S0140-6736(96)91542-1 · 45.22 Impact Factor
  • C. R. Friedman · J. Neimann · H. C. Wegener · R. V. Tauxe