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ABSTRACT: Abstract Clostridium perfringens is estimated to be the second most common bacterial cause of foodborne illness in the United States, causing one million illnesses each year. Local, state, and territorial health departments voluntarily report C. perfringens outbreaks to the U.S. Centers for Disease Control and Prevention through the Foodborne Disease Outbreak Surveillance System. Our analysis included outbreaks confirmed by laboratory evidence during 1998-2010. A food item was implicated if C. perfringens was isolated from food or based on epidemiologic evidence. Implicated foods were classified into one of 17 standard food commodities when possible. From 1998 to 2010, 289 confirmed outbreaks of C. perfringens illness were reported with 15,208 illnesses, 83 hospitalizations, and eight deaths. The number of outbreaks reported each year ranged from 16 to 31 with no apparent trend over time. The annual number of outbreak-associated illnesses ranged from 359 to 2,173, and the median outbreak size was 24 illnesses. Outbreaks occurred year round, with the largest number in November and December. Restaurants (43%) were the most common setting of food preparation. Other settings included catering facility (19%), private home (16%), prison or jail (11%), and other (10%). Among the 144 (50%) outbreaks attributed to a single food commodity, beef was the most common commodity (66 outbreaks, 46%), followed by poultry (43 outbreaks, 30%), and pork (23 outbreaks, 16%). Meat and poultry outbreaks accounted for 92% of outbreaks with an identified single food commodity. Outbreaks caused by C. perfringens occur regularly, are often large, and can cause substantial morbidity yet are preventable if contamination of raw meat and poultry products is prevented at the farm or slaughterhouse or, after contamination, if these products are properly handled and prepared, particularly in restaurants and catering facilities.
Foodborne Pathogens and Disease 02/2013; · 2.26 Impact Factor
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ABSTRACT: Although pasteurization eliminates pathogens and consumption of nonpasteurized dairy products is uncommon, dairy-associated disease outbreaks continue to occur. To determine the association of outbreaks caused by nonpasteurized dairy products with state laws regarding sale of these products, we reviewed dairy-associated outbreaks during 1993-2006. We found 121 outbreaks for which the product's pasteurization status was known; among these, 73 (60%) involved nonpasteurized products and resulted in 1,571 cases, 202 hospitalizations, and 2 deaths. A total of 55 (75%) outbreaks occurred in 21 states that permitted sale of nonpasteurized products; incidence of nonpasteurized product-associated outbreaks was higher in these states. Nonpasteurized products caused a disproportionate number (≈150× greater/unit of product consumed) of outbreaks and outbreak-associated illnesses and also disproportionately affected persons <20 years of age. States that restricted sale of nonpasteurized products had fewer outbreaks and illnesses; stronger restrictions and enforcement should be considered.
Emerging Infectious Diseases 03/2012; 18(3):385-91. · 6.79 Impact Factor
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ABSTRACT: Infection resulting from foodborne pathogens, including Escherichia coli O157:H7, is often associated with consumption of raw or undercooked ground beef. However, little is known about the frequency of ground beef consumption in the general population. The objective of this study was to describe patterns of self-reported ground beef and pink ground beef consumption using data from the 2006 through 2007 FoodNet Population Survey. From 1 July 2006 until 30 June 2007, residents of 10 FoodNet sites were contacted by telephone and asked about foods consumed within the previous week. The survey included questions regarding consumption of ground beef patties both inside and outside the home, the consumption of pink ground beef patties and other types of ground beef inside the home, and consumption of ground beef outside the home. Of 8,543 survey respondents, 75.3% reported consuming some type of ground beef in the home. Of respondents who ate ground beef patties in the home, 18.0% reported consuming pink ground beef. Consumption of ground beef was reported most frequently among men, persons with incomes from $40,000 to $75,000 per year, and persons with a high school or college education. Ground beef consumption was least often reported in adults ≥65 years of age. Men and persons with a graduate level education most commonly reported eating pink ground beef in the home. Reported consumption of ground beef and pink ground beef did not differ by season. Ground beef is a frequently consumed food item in the United States, and rates of consumption of pink ground beef have changed little since previous studies. The high rate of consumption of beef that has not been cooked sufficiently to kill pathogens makes pasteurization of ground beef an important consideration, especially for those individuals at high risk of complications from foodborne illnesses such as hemolytic uremic syndrome.
Journal of food protection 02/2012; 75(2):341-6. · 1.94 Impact Factor
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Katherine A O'Connor,
Emily Cartwright,
Anagha Loharikar,
Janell Routh,
Joanna Gaines,
Marie-Délivrance Bernadette Fouché,
Reginald Jean-Louis,
Tracy Ayers,
Dawn Johnson,
Jordan W Tappero,
Thierry H Roels,
W Roodly Archer,
Georges A Dahourou,
Eric Mintz,
Robert Quick, Barbara E Mahon
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ABSTRACT: During the early weeks of the cholera outbreak that began in Haiti in October 2010, we conducted a case-control study to identify risk factors. Drinking treated water was strongly protective against illness. Our results highlight the effectiveness of safe water in cholera control.
Emerging Infectious Diseases 11/2011; 17(11):2136-8. · 6.79 Impact Factor
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Anna E Newton,
Katherine E Heiman,
Ann Schmitz,
Tom Torok,
Andria Apostolou,
Heather Hanson,
Prabhu Gounder,
Susan Bohm,
Katie Kurkjian,
Michele Parsons,
Deborah Talkington,
Steven Stroika,
Lawrence C Madoff,
Franny Elson,
David Sweat,
Venessa Cantu,
Okey Akwari, Barbara E Mahon,
Eric D Mintz
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ABSTRACT: Cholera is rare in the United States (annual average 6 cases). Since epidemic cholera began in Hispaniola in 2010, a total of 23 cholera cases caused by toxigenic Vibrio cholerae O1 have been confirmed in the United States. Twenty-two case-patients reported travel to Hispaniola and 1 reported consumption of seafood from Haiti.
Emerging Infectious Diseases 10/2011; 17(10):2166-8. · 6.79 Impact Factor
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Journal of Perinatal Medicine 08/2011; 39(6):749-50. · 1.70 Impact Factor
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ABSTRACT: Riding in a shopping cart next to raw meat or poultry is a risk factor for Salmonella and Campylobacter infections in infants. To describe the frequency of, and factors associated with, this behavior, we surveyed parents of children aged younger than 3 years in Foodborne Disease Active Surveillance Network sites. We defined exposure as answering yes to one of a series of questions asking if packages of raw meat or poultry were near a child in a shopping cart, or if a child was in the cart basket at the same time as was raw meat or poultry. Among 1,273 respondents, 767 (60%) reported that their children visited a grocery store in the past week and rode in shopping carts. Among these children, 103 (13%) were exposed to raw products. Children who rode in the baskets were more likely to be exposed than were those who rode only in the seats (odds ratio [OR], 17.8; 95% confidence interval [CI], 11.0 to 28.9). In a multivariate model, riding in the basket (OR, 15.5; 95% CI, 9.2 to 26.1), income less than $55,000 (OR, 1.8; 95% CI, 1.0 to 3.1), and Hispanic ethnicity (OR, 2.3; 95% CI, 1.2 to 4.5) were associated with exposure. Our study shows that children can be exposed to raw meat and poultry products while riding in shopping carts. Parents should separate children from raw products and place children in the seats rather than in the baskets of the cart. Retailer use of leak-proof packaging, customer placement of product in a plastic bag and on the rack underneath the cart, use of hand sanitizers and wipes, and consumer education may also be helpful.
Journal of food protection 06/2010; 73(6):1097-100. · 1.94 Impact Factor
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ABSTRACT: Seafood is part of a healthful diet, but seafood consumption is not risk-free. Seafood is responsible for an important proportion of food-borne illnesses and outbreaks in the United States. Seafood-associated infections are caused by a variety of bacteria, viruses, and parasites; this diverse group of pathogens results in a wide variety of clinical syndromes, each with its own epidemiology. Some seafood commodities are inherently more risky than others, owing to many factors, including the nature of the environment from which they come, their mode of feeding, the season during which they are harvested, and how they are prepared and served. Prevention of seafood-associated infections requires an understanding not only of the etiologic agents and seafood commodities associated with illness but also of the mechanisms of contamination that are amenable to control. Defining these problem areas, which relies on surveillance of seafood-associated infections through outbreak and case reporting, can lead to targeted research and help to guide control efforts. Coordinated efforts are necessary to further reduce the risk of seafood-associated illnesses. Continued surveillance will be important to assess the effectiveness of current and future prevention strategies.
Clinical microbiology reviews 04/2010; 23(2):399-411. · 14.69 Impact Factor
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ABSTRACT: To examine the association between febrile seizures and cognitive performance in early adulthood.
This is a population-based study using data linked from health-care databases and conscript records of Danish men born from 1977 to 1983. The association between febrile seizures and cognitive function, measured with the Boerge Prien validated group intelligence test, was examined overall and by age of seizure, adjusted for potential confounders. The analysis was restricted to men without a known history of epilepsy (n = 18 276).
Of the 18 276 eligible conscripts, 507 (2.8%) had a record of hospitalization with febrile seizures. Compared with conscripts with no such record, the adjusted prevalence ratio for having a Boerge Prien score in the bottom quartile was 1.08 (95% CI, 0.94-1.25). The adjusted prevalence ratios were 1.38 (95% CI, 1.07-1.79) for febrile seizures with an onset age of 3 months to <1 year, 0.98 (95% CI, 0.80-1.18) for febrile seizures with an onset age of 1 to 2 years, and 1.14 (95% CI, 0.79-1.66) for an onset age of 3 to 5 years.
Overall, there was little association between febrile seizures and cognitive function.
The Journal of pediatrics 06/2009; 155(3):404-9. · 4.02 Impact Factor
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ABSTRACT: Because classic pneumococcal serotyping methods cannot distinguish between serotypes 6A and 6C, the effects of pneumococcal vaccines against serotype 6C are unknown. Pneumococcal vaccines contain serotype 6B but not serotypes 6A and 6C.
We used a phagocytic killing assay to estimate the immunogenicity of the 7-valent conjugate vaccine (PCV7) in children and the 23-valent polysaccharide vaccine (PPV23) in adults against serotypes 6A and 6C. We evaluated trends in invasive pneumococcal disease (IPD) caused by serotypes 6A and 6C in the United States, using active surveillance.
Serum specimens from PCV7-immunized children had median opsonization indices of 150 and < 20 for serotypes 6A and 6C, respectively. Similarly, only 52% of adults (25 of 48) vaccinated with PPV23 showed opsonic indices of > 20 against serotype 6C. During 1999--2006, the incidence of serotype 6A IPD decreased by 91% (from 4.9 to 0.46 cases per 100,000 persons; P < .05) among individuals aged < 5 years and by 58% (from 0.86 to 0.36 cases per 100,000 persons; P < .05) among those aged > or = 5 years. Although the incidence of 6C IPD showed no consistent trend (range, 0-0.6 cases per 100,000 persons) among individuals aged < 5 years, it increased from 0.25 to 0.62 cases per 100,000 persons (P < .05) among those aged > or = 5 years.
PCV7 introduction has led to reductions in serotype 6A IPD but not serotype 6C IPD in the United States.
The Journal of Infectious Diseases 12/2008; 198(12):1818-22. · 6.41 Impact Factor
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ABSTRACT: To prevent congenital syphilis, the Centers for Disease Control and Prevention and professional organizations recommend universal prenatal syphilis screening. State-level or larger-scale evaluations of adherence to these guidelines have relied on administrative data. We measured prenatal syphilis screening rates in Indiana women with prenatal Medicaid coverage and also used electronic medical records to examine the completeness of syphilis screening claims in Medicaid administrative data.
In statewide Indiana Medicaid claims data, diagnosis and procedure codes were used to identify women who delivered an infant between October 1, 1998, and September 30, 2002. Claims for prenatal (that is, during the 40 weeks before and including the delivery date) syphilis screens, including the "obstetric panel" of tests, and for prenatal visits were extracted. A subset of the study population received prenatal care in a large public hospital and its affiliated clinics served by an electronic medical records system. For these women, claims data were compared with laboratory reports.
Among 74,188 women with one delivery in Medicaid claims data, 60% had at least 1 prenatal syphilis screening claim, and 15% had 2 or more. Women with continuous Medicaid enrollment during pregnancy or with at least one prenatal visit claim had higher rates. Among the 3960 women for whom Medicaid claims and laboratory data were available, 49.8% had at least one prenatal syphilis screen in Medicaid claims, but 99.3% had at least one laboratory report of a syphilis screen.
Measurements made using Medicaid administrative data appear to substantially underestimate true prenatal syphilis screening rates.
Sex Transm Dis 05/2008; 35(4):387-92. · 2.87 Impact Factor
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ABSTRACT: Population-based electronic immunization registries create the possibility of using registry data to conduct vaccine effectiveness studies which could have methodological advantages over traditional observational studies. For study validity, the base population would have to be clearly defined and the immunization status of members of the population accurately recorded in the registry. We evaluated a city-wide immunization registry, focusing on its potential as a tool to study pertussis vaccine effectiveness, especially in adolescents.
We conducted two evaluations - one in sites that were active registry participants and one in sites that had implemented an electronic medical record with plans for future direct data transfer to the registry - of the ability to match patients' medical records to registry records and the accuracy of immunization records in the registry. For each site, records from current pediatric patients were chosen randomly. Data regarding pertussis-related immunizations, clinic usage, and demographic and identifying information were recorded; for 11-17-year-old subjects, information on MMR, hepatitis B, and varicella immunizations was also collected. Records were then matched, when possible, to registry records. For records with a registry match, immunization data were compared.
Among 350 subjects from sites that were current registry users, 307 (87.7%) matched a registry record. Discrepancies in pertussis-related data were common for up-to-date status (22.6%), number of immunizations (34.7%), dates (10.2%), and formulation (34.4%). Among 442 subjects from sites that planned direct electronic transfer of immunization data to the registry, 393 (88.9%) would have matched a registry record; discrepancies occurred frequently in number of immunizations (11.9%), formulation (29.1%), manufacturer (94.4%), and lot number (95.1%.) Inability to match and immunization discrepancies were both more common in subjects who were older at their first visit to the provider site. For 11-17-year-old subjects, discrepancies were also common for MMR, hepatitis B, and varicella vaccination data.
Provider records frequently could not be matched to registry records or had discrepancies in key immunization data. These issues were more common for older children and were present even with electronic data transfer. These results highlight general challenges that may face investigators wishing to use registry-based immunization data for vaccine effectiveness studies, especially in adolescents.
BMC Public Health 02/2008; 8:160. · 2.00 Impact Factor
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ABSTRACT: To determine the impact of state policies on vaccine coverage among adolescents with managed care insurance.
We used the 2003 Health Plan Employer Data and Information Set to determine state-specific hepatitis B and varicella vaccine coverage among children with managed care insurance who turned 13 years in 2002. Our outcomes of interest were receipt of hepatitis B and varicella vaccines by age 13. Utilizing weighted least-squares methods, multiple linear regression models were developed to evaluate the relationship between hepatitis B and varicella vaccine coverage and state policies, while controlling for state sociodemographic variables.
Across 28 states, adolescent hepatitis B vaccine coverage ranged from 35.3% to 80.5% (mean = 55.3%) and varicella vaccine coverage ranged from 22.9% to 7.6% (mean = 42.3%). In separate multiple regression models, after adjusting for potentially confounding sociodemographic variables, middle school mandates were significantly associated with hepatitis B vaccine coverage (p = .002) and varicella vaccine coverage (p = .024). Other policies, including universal purchase of vaccines and availability of philosophic exemptions, were not associated with vaccine coverage in this insured population.
In this population of insured adolescents, middle school vaccine mandates were the only state policy associated with improved hepatitis B and varicella vaccine coverage. Mandates are an effective method for promoting adolescent immunization.
Journal of Adolescent Health 06/2007; 40(5):405-11. · 3.33 Impact Factor
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ABSTRACT: The objective of this study was to examine the relation of factors that are present at birth to subsequent hospitalization for childhood pneumococcal disease.
We conducted a cohort study of all singletons born in 3 counties in western Denmark from 1980 through 2001, using population-based registries to obtain data on pregnancy- and birth-related variables and hospitalizations through age 12. We calculated incidence rates of pneumococcal disease hospitalization overall and within strata of study variables and used Poisson regression to estimate rate ratios for pneumococcal disease hospitalization while accounting for other birth characteristics.
Among 338,504 eligible births, 1052 children were later hospitalized for pneumococcal disease. Pneumonia accounted for most hospitalizations (81.9%). The pneumococcal disease hospitalization rate was highest among 7- to 24-month-olds, followed by 0- to 6-month-olds and 25- to 60-month-olds. The highest rates, typically over 200 hospitalizations per 100,000 person-years, were in 0- to 6- and 7- to 24-month-old children who were born preterm or with low birth weight, a low 5-minute Apgar score, or birth defects. The hospitalization rate was lower for first-born children at 0 to 6 months but not at older ages. At older ages, hospitalization rates were not substantially different for children whose mothers smoked during pregnancy, but at 0 to 6 months, the rate was higher for children of multiparous nonsmokers than for others. Adjusted rate ratios were elevated across all age categories for several variables, including low birth weight, presence of birth defects, and low 5-minute Apgar. For several others, including preterm birth, maternal multiparity, age < or = 20 years, and non-Danish/European Union citizenship, adjusted rate ratios were elevated only for 0- to 6-month-olds.
This large cohort study of hospitalization for childhood pneumococcal disease clarifies the roles of some gestation and birth factors while raising new questions about how these factors work.
PEDIATRICS 04/2007; 119(4):e804-12. · 4.47 Impact Factor
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ABSTRACT: Among 200 adolescents presenting to an emergency department in a city with high vaccination coverage, 11 (6%) were seronegative to rubella or varicella. Seronegative adolescents were older and more likely to be immigrants. ED screening for under-immunized adolescents may have a low yield in settings with high vaccine coverage.
Journal of Adolescent Health 11/2006; 39(4):598-600. · 3.33 Impact Factor
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ABSTRACT: We estimated the effectiveness of abbreviated regimens of 7-valent pneumococcal conjugate vaccine (PCV7) based on serotyped cases of invasive pneumococcal disease (IPD) in children under 5 reported from 2001 to 2004 to two US surveillance programs. Vaccination regimens included in the analysis were 1 dose < 3 months old, 2 doses < 5 months old, 3 doses < 7 months old, full schedule (3 doses and a booster), 1 dose at 12-23 months, and 2 doses at 12-23 months. Vaccine effectiveness (VE) was calculated as (1-Mantel-Haenszel summary odds ratio in vaccinated children, as compared to unvaccinated children)x100% for each regimen, stratifying by year. Among 400 eligible cases, for vaccine-type IPD, VE was 90.5% for the full schedule, 76.6% for 3 doses < 7 months old, and 70.5% for 2 doses < 5 months old; 1 dose < 3 months provided no significant protection. No regimen provided significant protection against vaccine-related serotypes. Data for regimens begun at 12-23 months were inconclusive. These data support the use of the 2-dose and 3-dose infant PCV7 regimens when the full series cannot be delivered and detail the limitations of abbreviated dosing regimens.
Vaccine 04/2006; 24(14):2514-20. · 3.77 Impact Factor
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ABSTRACT: To investigate the occurrence of, and risk factors for, pelvic inflammatory disease (PID) occurring during the post-partum year.
Demographic and clinical data for women who delivered a term infant with 5-minute Apgar score > or = 8 from 1992 through 1999 at a large urban hospital were extracted from an electronic medical record system.
During the study period, 15 206 deliveries occurred among 12 549 women. PID was diagnosed during the post-partum year of 148 (1.0%) deliveries. In univariate analysis, young age, black race, and both pre-delivery history and post-partum diagnosis of chlamydial and gonococcal infection were associated with PID. In multivariate analysis, only young age and a positive test for gonorrhea before delivery or post-partum were independent predictors of PID.
Pelvic inflammatory disease was diagnosed during the post-partum year in 1% of women studied. Young maternal age was an important demographic risk factor. Further investigation of post-partum STD acquisition and progression to PID is needed to determine whether women are at increased risk following delivery.
Infectious Diseases in Obstetrics and Gynecology 01/2006; 13(4):191-6.
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ABSTRACT: Objective. To investigate the occurrence of, and risk factors for, pelvic inflammatory disease (PID) occurring during the post-partum year.
Infectious Diseases in Obstetrics & Gynecology. 01/2005;
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ABSTRACT: We used an electronic medical records system retrospectively to evaluate how frequently, in a public hospital and its clinics, combined gonorrhea/chlamydia tests were accompanied by a syphilis test before and during a syphilis outbreak. Among 70,330 gonorrhea/chlamydia tests (1996-2000), the proportion with a syphilis test increased from 13% (preoutbreak) to 50% (intervention period) for men and from 6% to 13% for nonpregnant women. The increased syphilis testing coincided with a multifaceted public health intervention.
American Journal of Public Health 08/2004; 94(7):1124-6. · 3.93 Impact Factor
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European Journal of Epidemiology 02/2004; 19(3):205-207. · 4.71 Impact Factor
