Elizabeth T Russo

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

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Publications (10)77.38 Total impact

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    ABSTRACT: An outbreak of Salmonella enterica serotype Agona infections associated with nationwide distribution of cereal from Company X was identified in April 2008. This outbreak was detected using PulseNet, the national molecular subtyping network for foodborne disease surveillance, which coincided with Company X's voluntary recall of unsweetened puffed rice and wheat cereals after routine product sampling yielded Salmonella Agona. A case patient was defined as being infected with the outbreak strain of Salmonella Agona, with illness onset from 1 January through 1 July 2008. Case patients were interviewed using a standard questionnaire, and the proportion of ill persons who reported eating Company X puffed rice cereal was compared with Company X's market share data using binomial testing. The Minnesota Department of Agriculture inspected the cereal production facility and collected both product and environmental swab samples. Routine surveillance identified 33 case patients in 17 states. Of 32 patients interviewed, 24 (83%) reported eating Company X puffed rice cereal. Company X puffed rice cereal represented 0.063% of the total ready-to-eat dry cereal market share in the United States at the time of the investigation. Binomial testing suggested that the proportion of exposed case patients would not likely occur by chance (P < 0.0001). Of 17 cereal samples collected from case patient homes for laboratory testing, 2 (12%) yielded Salmonella Agona indistinguishable from the outbreak strain. Twelve environmental swabs and nine product samples from the cereal plant yielded the outbreak strain of Salmonella Agona. Company X cereal was implicated in a similar outbreak of Salmonella Agona infection in 1998 with the same outbreak strain linked to the same production facility. We hypothesize that a recent construction project at this facility created an open wall near the cereal production area allowing reintroduction of Salmonella Agona into the product, highlighting the resilience of Salmonella in dry food production environments.
    Journal of food protection 02/2013; 76(2):227-30. · 1.83 Impact Factor
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    ABSTRACT: A clinic-based program to integrate antenatal services with distribution of hygiene kits including safe water storage containers, water treatment solution (brand name WaterGuard), soap, and hygiene education, was implemented in Malawi in 2007 and evaluated in 2010. We surveyed 389 participants at baseline in 2007, and found and surveyed 232 (60%) participants to assess water treatment, test stored drinking water for residual chlorine (an objective measure of treatment), and observe handwashing technique at follow-up in 2010. Program participants were more likely to know correct water treatment procedures (67% versus 36%; P < 0.0001), treat drinking water with WaterGuard (24% versus.2%; P < 0.0001), purchase and use WaterGuard (21% versus 1%; P < 0.001), and demonstrate correct handwashing technique (50% versus 21%; P < 0.001) at the three-year follow-up survey than at baseline. This antenatal-clinic-based program may have contributed to sustained water treatment and proper handwashing technique among program participants.
    The American journal of tropical medicine and hygiene 12/2012; · 2.53 Impact Factor
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    ABSTRACT: Access to safe drinking water and improved hygiene are essential for preventing diarrheal diseases. To integrate hygiene improvement with antenatal care, free hygiene kits (water storage containers, water treatment solution, soap) and educational messages were distributed to pregnant women at antenatal clinics in Malawi. We assessed water treatment and hygiene practices of 275 non-pregnant friends and relatives of the hygiene kit recipients at baseline and follow-up nine months later to measure program impact on non-participants in the same communities. At follow-up, friends and relatives who did not receive kits or education were more likely than at baseline to purchase and use water treatment solution (25% versus 1%; P < 0.0001) and demonstrate correct handwashing practices (60% versus 18%; P < 0.0001). This antenatal clinic-based program resulted in improved water treatment and hygiene behaviors among non-pregnant friends and relatives living in the same communities as hygiene kit recipients, suggesting that program benefits extended beyond direct beneficiaries.
    The American journal of tropical medicine and hygiene 05/2012; 86(5):860-5. · 2.53 Impact Factor
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    ABSTRACT: Hygiene interventions reduce child mortality from diarrhea. Vaccination visits provide a platform for delivery of other health services but may overburden nurses. We compared 2 strategies to integrate hygiene interventions with vaccinations in Kenya's Homa Bay district, 1 using community workers to support nurses and 1 using nurses. Homa Bay was divided into 2 geographical areas, each with 9 clinics. Each area was randomly assigned to either the nurse or community-assisted strategy. At infant vaccination visits hygiene kits were distributed by the nurse or community member. Surveys pre- and post-intervention, measured hygiene indicators and vaccination coverage. Interviews and focus groups assessed acceptability. Between April 2009 and March 2010, 39 158 hygiene kits were distributed. Both nurse and community-assisted strategies were well-accepted. Hygiene indicators improved similarly in nurse and community sites. However, residual chlorine in water changed in neither group. Vaccination coverage increased in urban areas. In rural areas coverage either remained unchanged or increased with 1 exception (13% third dose poliovirus vaccine decrease). Distribution of hygiene products and education during vaccination visits was found to be feasible using both delivery strategies. Additional studies should consider assessing the use of community members to support integrated service delivery.
    The Journal of Infectious Diseases 03/2012; 205 Suppl 1:S65-76. · 5.85 Impact Factor
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    ABSTRACT: Integration of immunizations with hygiene interventions may improve use of both interventions. We interviewed 1361 intervention and 1139 comparison caregivers about hygiene practices and vaccination history, distributed water treatment and hygiene kits to caregivers during infant vaccination sessions in intervention clinics for 12 months, and conducted a followup survey of 2361 intervention and 1033 comparison caregivers. We observed significant increases in reported household water treatment (30% vs 44%, P < .0001) and correct handwashing technique (25% vs 51%, P < .0001) in intervention households and no changes in comparison households. Immunization coverage improved in both intervention and comparison infants (57% vs 66%, P = .04; 37% vs 53%, P < .0001, respectively). Hygiene kit distribution during routine immunizations positively impacted household water treatment and hygiene without a negative impact on vaccination coverage. Further study is needed to assess hygiene incentives, implement alternative water quality indicators, and evaluate the impact of this intervention in other settings.
    The Journal of Infectious Diseases 03/2012; 205 Suppl 1:S56-64. · 5.85 Impact Factor
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    ABSTRACT: Raw produce is an increasingly recognized vehicle for salmonellosis. We investigated a nationwide outbreak that occurred in the United States in 2008. We defined a case as diarrhea in a person with laboratory-confirmed infection with the outbreak strain of Salmonella enterica serotype Saintpaul. Epidemiologic, traceback, and environmental studies were conducted. Among the 1500 case subjects, 21% were hospitalized, and 2 died. In three case-control studies of cases not linked to restaurant clusters, illness was significantly associated with eating raw tomatoes (matched odds ratio, 5.6; 95% confidence interval [CI], 1.6 to 30.3); eating at a Mexican-style restaurant (matched odds ratio, 4.6; 95% CI, 2.1 to ∞) and eating pico de gallo salsa (matched odds ratio, 4.0; 95% CI, 1.5 to 17.8), corn tortillas (matched odds ratio, 2.3; 95% CI, 1.2 to 5.0), or salsa (matched odds ratio, 2.1; 95% CI, 1.1 to 3.9); and having a raw jalapeño pepper in the household (matched odds ratio, 2.9; 95% CI, 1.2 to 7.6). In nine analyses of clusters associated with restaurants or events, jalapeño peppers were implicated in all three clusters with implicated ingredients, and jalapeño or serrano peppers were an ingredient in an implicated item in the other three clusters. Raw tomatoes were an ingredient in an implicated item in three clusters. The outbreak strain was identified in jalapeño peppers collected in Texas and in agricultural water and serrano peppers on a Mexican farm. Tomato tracebacks did not converge on a source. Although an epidemiologic association with raw tomatoes was identified early in this investigation, subsequent epidemiologic and microbiologic evidence implicated jalapeño and serrano peppers. This outbreak highlights the importance of preventing raw-produce contamination.
    New England Journal of Medicine 02/2011; 364(10):918-27. · 54.42 Impact Factor
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    ABSTRACT: Access to safe drinking water and improved hygiene are important for reducing morbidity and mortality from diarrhea. We surveyed 330 pregnant women who participated in an antenatal clinic-based intervention in Malawi that promoted water treatment and hygiene through distribution of water storage containers, sodium hypochlorite water treatment solution, soap, and educational messages. Program participants were more likely to know correct water treatment procedures (62% versus 27%, P < 0.0001), chlorinate drinking water (61% versus 1%, P < 0.0001), demonstrate correct handwashing practices (68% versus 22%, P < 0.0001), and purchase water treatment solution after free distribution (32% versus 1%, P < 0.0001). Among participants, 72% had at least three antenatal visits, 76% delivered in a health facility, and 54% had a postnatal check. This antenatal-clinic-based program is an effective new strategy for promoting water treatment and hygiene behaviors among pregnant women. Participants had high use of antenatal, delivery, and postnatal services, which could improve maternal and child health.
    The American journal of tropical medicine and hygiene 12/2010; 83(6):1315-21. · 2.53 Impact Factor
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    ABSTRACT: An outbreak of Salmonella serotype Montevideo infections associated with multiple locations of restaurant chain A in Phoenix, AZ, was identified in July 2008. One infected individual reported eating at a chain A catered luncheon where others fell ill; we conducted a cohort study among attendees to identify the vehicle. Food and environmental samples collected at six chain A locations were cultured for Salmonella. Restaurant inspection results were compared among 18 chain A locations. Routine surveillance identified 58 Arizona residents infected with the outbreak strain. Three chain A locations, one of which catered the luncheon, were named by two or more case patients as a meal source in the week prior to illness onset. In the cohort study of luncheon attendees, 30 reported illness, 10 of which were later culture confirmed. Illness was reported by 30 (61%) of 49 attendees who ate chicken and by 0 of 7 who did not. The outbreak strain was isolated from two of these three locations from uncooked chicken in marinade, chopped cilantro, and a cutting board dedicated to cutting cooked chicken. Raw chicken, contaminated before arrival at the restaurant, was the apparent source of this outbreak. The three locations where two or more case patients ate had critical violations upon routine inspection, while 15 other locations received none. Poor hygiene likely led to cross-contamination of food and work areas. This outbreak supports the potential use of inspections in identifying restaurants at high risk of outbreaks and the need to reduce contamination of raw products at the source and prevent cross-contamination at the point of service.
    Journal of food protection 10/2010; 73(10):1858-63. · 1.83 Impact Factor
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    ABSTRACT: Background: Diarrhea, one of Malawi's leading causes of childhood mortality, can be mitigated by improving water quality and hygiene. We distributed free safe water storage containers, sodium hypochlorite water treatment (WaterGuard) solution, soap, and educational messages to pregnant women during antenatal clinic (ANC) visits; provided up to 3 free refills of WaterGuard and soap at subsequent ANC visits; and evaluated program impact. A national population-based survey in 2005 found lowest WaterGuard use rates among poorer, rural, less educated women. Methods: At baseline and 9 months after implementation we interviewed 389 women about water treatment practices, tested household stored drinking water for residual chlorine, and observed handwashing procedure. Results: Program participants were significantly more likely to know correct water treatment procedures (62% vs. 29%, p<0.0001), demonstrate correct handwashing practices (68% vs. 22%, p<0.0001), treat drinking water with WaterGuard (61% vs. 2%, p<0.0001), and (after free distribution ended) purchase and use WaterGuard (32% vs. 2%, p<0.0001) at follow-up than at baseline. WaterGuard treatment was more likely among rural (OR=2.5, 95% CI 1.1, 2.5), poor (OR=1.7, 95% CI 1.4, 2.2), and illiterate (OR=1.2, 95% CI 1.0, 1.5) women. WaterGuard purchase and use was more common among rural (OR=1.9, 95% CI 1.2, 3.0) and poor (OR=1.7, 95% CI 1.1, 2.5) women. Conclusions: Antenatal clinic product distribution and health promotion appeared to be an effective hygiene behavior strategy for reaching rural, poor, less educated women in Malawi. Evidence of product purchase following program exit suggests that program benefits may be sustained.
    137st APHA Annual Meeting and Exposition 2009; 11/2009
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    ABSTRACT: Background: In July 2008, the Maricopa County Dept. of Public Health identified an outbreak of Salmonella Montevideo infections associated with several Chain A restaurants in Phoenix. An investigation was initiated to identify the source of infections in order to prevent additional illnesses. Methods: Persons infected with S. Montevideo with the outbreak pulsed-field gel electrophoresis pattern from May to November 2008 were interviewed. Routine restaurant inspection data were reviewed. Food and environmental samples were cultured for Salmonella. A cohort of attendees of an event catered by one of the implicated Chain A restaurants was interviewed using an event-specific questionnaire. Results: Fifty-eight persons were confirmed to have been infected with the outbreak strain; 35 (64%) of 55 interviewed patients ate at one of three implicated Chain A restaurants. In the cohort study, 30 (61%) of the 49 persons who ate chicken were ill compared to none of the 7 who did not eat chicken (relative risk=∞). Inspection data revealed that the 3 implicated restaurants were more likely to have had critical violations that could lead directly to foodborne contamination than the 15 unaffected Chain A restaurants. Cultures of uncooked chicken in marinade, chopped cilantro, and a cutting board used to cut cooked chicken yielded the outbreak strain. Conclusion: Contamination of chicken before arrival at the restaurant was the most likely source of this prolonged outbreak. Poor restaurant hygiene practices likely led to cross contamination of chicken products, cilantro, and cutting board. This outbreak demonstrates the need to prevent contamination at the source and at the point of service.
    Infectious Diseases Society of America 2009 Annual Meeting; 10/2009