1
|
Benedict KM, Collier SA, Marder EP, Hlavsa MC, Fullerton KE, Yoder JS. Case-case analyses of cryptosporidiosis and giardiasis using routine national surveillance data in the United States - 2005-2015. Epidemiol Infect 2019; 147:e178. [PMID: 31063098 PMCID: PMC6518830 DOI: 10.1017/s0950268819000645] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Understanding endemic infectious disease risk factors through traditional epidemiological tools is challenging. Population-based case-control studies are costly and time-consuming. A case-case analyses using surveillance data addresses these limitations by using resources more efficiently. We conducted a case-case analyses using routine surveillance data reported by 16 U.S. states (2005-2015), wherein reported cases of salmonellosis were used as a comparison group to identify exposure associations with reported cases of cryptosporidiosis and giardiasis. Odds ratios adjusted for age and reporting state (aOR) and 95% confidence intervals (95% CI) were calculated. A total of 10 704 cryptosporidiosis cases, 17 544 giardiasis cases, and 106 351 salmonellosis cases were included in this analyses. When compared with cases of salmonellosis, exposure to treated recreational water (aOR 4.7, 95% CI 4.3-5.0) and livestock (aOR: 3.2; 95% CI: 2.9-3.5) were significantly associated with cryptosporidiosis and exposure to untreated drinking (aOR 4.1, 95% CI 3.6-4.7) and recreational water (aOR 4.1, 95% CI 3.7-4.5) were associated with giardiasis. Our analyses shows that routine surveillance data with standardised exposure information can be used to identify associations of interest for cryptosporidiosis and giardiasis.
Collapse
Affiliation(s)
- K M Benedict
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases,National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention,Atlanta, GA,USA
| | - S A Collier
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases,National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention,Atlanta, GA,USA
| | - E P Marder
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases,National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention,Atlanta, GA,USA
| | - M C Hlavsa
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases,National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention,Atlanta, GA,USA
| | - K E Fullerton
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases,National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention,Atlanta, GA,USA
| | - J S Yoder
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases,National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention,Atlanta, GA,USA
| |
Collapse
|
2
|
Reses HE, Gargano JW, Liang JL, Cronquist A, Smith K, Collier SA, Roy SL, Vanden Eng J, Bogard A, Lee B, Hlavsa MC, Rosenberg ES, Fullerton KE, Beach MJ, Yoder JS. Risk factors for sporadic Giardia infection in the USA: a case-control study in Colorado and Minnesota. Epidemiol Infect 2018; 146:1071-1078. [PMID: 29739483 PMCID: PMC9134275 DOI: 10.1017/s0950268818001073] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/16/2018] [Accepted: 04/04/2018] [Indexed: 01/12/2023] Open
Abstract
Giardia duodenalis is the most common intestinal parasite of humans in the USA, but the risk factors for sporadic (non-outbreak) giardiasis are not well described. The Centers for Disease Control and Prevention and the Colorado and Minnesota public health departments conducted a case-control study to assess risk factors for sporadic giardiasis in the USA. Cases (N = 199) were patients with non-outbreak-associated laboratory-confirmed Giardia infection in Colorado and Minnesota, and controls (N = 381) were matched by age and site. Identified risk factors included international travel (aOR = 13.9; 95% CI 4.9-39.8), drinking water from a river, lake, stream, or spring (aOR = 6.5; 95% CI 2.0-20.6), swimming in a natural body of water (aOR = 3.3; 95% CI 1.5-7.0), male-male sexual behaviour (aOR = 45.7; 95% CI 5.8-362.0), having contact with children in diapers (aOR = 1.6; 95% CI 1.01-2.6), taking antibiotics (aOR = 2.5; 95% CI 1.2-5.0) and having a chronic gastrointestinal condition (aOR = 1.8; 95% CI 1.1-3.0). Eating raw produce was inversely associated with infection (aOR = 0.2; 95% CI 0.1-0.7). Our results highlight the diversity of risk factors for sporadic giardiasis and the importance of non-international-travel-associated risk factors, particularly those involving person-to-person transmission. Prevention measures should focus on reducing risks associated with diaper handling, sexual contact, swimming in untreated water, and drinking untreated water.
Collapse
Affiliation(s)
- H. E. Reses
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J. W. Gargano
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J. L. Liang
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - A. Cronquist
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - K. Smith
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - S. A. Collier
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - S. L. Roy
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J. Vanden Eng
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - A. Bogard
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - B. Lee
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - M. C. Hlavsa
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - E. S. Rosenberg
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, SUNY, Rensselaer, New York, USA
| | - K. E. Fullerton
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - M. J. Beach
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J. S. Yoder
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
3
|
Adam EA, Collier SA, Fullerton KE, Gargano JW, Beach MJ. Prevalence and direct costs of emergency department visits and hospitalizations for selected diseases that can be transmitted by water, United States. J Water Health 2017; 15:673-683. [PMID: 29040071 DOI: 10.2166/wh.2017.083] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
National emergency department (ED) visit prevalence and costs for selected diseases that can be transmitted by water were estimated using large healthcare databases (acute otitis externa, campylobacteriosis, cryptosporidiosis, Escherichia coli infection, free-living ameba infection, giardiasis, hepatitis A virus (HAV) infection, Legionnaires' disease, nontuberculous mycobacterial (NTM) infection, Pseudomonas-related pneumonia or septicemia, salmonellosis, shigellosis, and vibriosis or cholera). An estimated 477,000 annual ED visits (95% CI: 459,000-494,000) were documented, with 21% (n = 101,000, 95% CI: 97,000-105,000) resulting in immediate hospital admission. The remaining 376,000 annual treat-and-release ED visits (95% CI: 361,000-390,000) resulted in $194 million in annual direct costs. Most treat-and-release ED visits (97%) and costs ($178 million/year) were associated with acute otitis externa. HAV ($5.5 million), NTM ($2.3 million), and salmonellosis ($2.2 million) were associated with next highest total costs. Cryptosporidiosis ($2,035), campylobacteriosis ($1,783), and NTM ($1,709) had the highest mean costs per treat-and-release ED visit. Overall, the annual hospitalization and treat-and-release ED visit costs associated with the selected diseases totaled $3.8 billion. As most of these diseases are not solely transmitted by water, an attribution process is needed as a next step to determine the proportion of these visits and costs attributable to waterborne transmission.
Collapse
Affiliation(s)
- E A Adam
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - S A Collier
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - K E Fullerton
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - J W Gargano
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - M J Beach
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| |
Collapse
|
4
|
Gargano JW, Adam EA, Collier SA, Fullerton KE, Feinman SJ, Beach MJ. Mortality from selected diseases that can be transmitted by water - United States, 2003-2009. J Water Health 2017; 15:438-450. [PMID: 28598348 DOI: 10.2166/wh.2017.301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Diseases spread by water are caused by fecal-oral, contact, inhalation, or other routes, resulting in illnesses affecting multiple body systems. We selected 13 pathogens or syndromes implicated in waterborne disease outbreaks or other well-documented waterborne transmission (acute otitis externa, Campylobacter, Cryptosporidium, Escherichia coli (E. coli), free-living ameba, Giardia, Hepatitis A virus, Legionella (Legionnaires' disease), nontuberculous mycobacteria (NTM), Pseudomonas-related pneumonia or septicemia, Salmonella, Shigella, and Vibrio). We documented annual numbers of deaths in the United States associated with these infections using a combination of death certificate data, nationally representative hospital discharge data, and disease-specific surveillance systems (2003-2009). We documented 6,939 annual total deaths associated with the 13 infections; of these, 493 (7%) were caused by seven pathogens transmitted by the fecal-oral route. A total of 6,301 deaths (91%) were associated with infections from Pseudomonas, NTM, and Legionella, environmental pathogens that grow in water system biofilms. Biofilm-associated pathogens can cause illness following inhalation of aerosols or contact with contaminated water. These findings suggest that most mortality from these 13 selected infections in the United States does not result from classical fecal-oral transmission but rather from other transmission routes.
Collapse
Affiliation(s)
- J W Gargano
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - E A Adam
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - S A Collier
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - K E Fullerton
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - S J Feinman
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail: ; Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - M J Beach
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| |
Collapse
|
5
|
Marcus R, Varma JK, Medus C, Boothe EJ, Anderson BJ, Crume T, Fullerton KE, Moore MR, White PL, Lyszkowicz E, Voetsch AC, Angulo FJ. Re-assessment of risk factors for sporadic Salmonella serotype Enteritidis infections: a case-control study in five FoodNet Sites, 2002-2003. Epidemiol Infect 2007; 135:84-92. [PMID: 16756692 PMCID: PMC2870546 DOI: 10.1017/s0950268806006558] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2006] [Indexed: 11/07/2022] Open
Abstract
Active surveillance for laboratory-confirmed Salmonella serotype Enteritidis (SE) infection revealed a decline in incidence in the 1990s, followed by an increase starting in 2000. We sought to determine if the fluctuation in SE incidence could be explained by changes in foodborne sources of infection. We conducted a population-based case-control study of sporadic SE infection in five of the Foodborne Diseases Active Surveillance Network (FoodNet) sites during a 12-month period in 2002-2003. A total of 218 cases and 742 controls were enrolled. Sixty-seven (31%) of the 218 case-patients and six (1%) of the 742 controls reported travel outside the United States during the 5 days before the case's illness onset (OR 53, 95% CI 23-125). Eighty-one percent of cases with SE phage type 4 travelled internationally. Among persons who did not travel internationally, eating chicken prepared outside the home and undercooked eggs inside the home were associated with SE infections. Contact with birds and reptiles was also associated with SE infections. This study supports the findings of previous case-control studies and identifies risk factors associated with specific phage types and molecular subtypes.
Collapse
Affiliation(s)
- R Marcus
- Connecticut Emerging Infections Program, New Haven, CT 06510, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Fullerton KE, Reef SE. Commentary: Ongoing debate over the safety of the different mumps vaccine strains impacts mumps disease control. Int J Epidemiol 2002; 31:983-4. [PMID: 12435772 DOI: 10.1093/ije/31.5.983] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K E Fullerton
- National Immunization Program, Centers for Disease Control and Prevention, 1600 Clifton Rd NE MS E-61, Atlanta, GA 30333, USA
| | | |
Collapse
|
7
|
Manges AR, Johnson JR, Foxman B, O'Bryan TT, Fullerton KE, Riley LW. Widespread distribution of urinary tract infections caused by a multidrug-resistant Escherichia coli clonal group. N Engl J Med 2001; 345:1007-13. [PMID: 11586952 DOI: 10.1056/nejmoa011265] [Citation(s) in RCA: 333] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The management of urinary tract infections is complicated by the increasing prevalence of antibiotic-resistant strains of Escherichia coli. We studied the clonal composition of E. coli isolates that were resistant to trimethoprim-sulfamethoxazole from women with community-acquired urinary tract infections. METHODS Prospectively collected E. coli isolates from women with urinary tract infections in a university community in California were evaluated for antibiotic susceptibility, O:H serotype, DNA fingerprinting, pulsed-field gel electrophoretic pattern, and virulence factors. The prevalence and characteristics of an antibiotic-resistant clone were evaluated in this group of isolates and in those from comparison cohorts in Michigan and Minnesota. RESULTS Fifty-five of the 255 E. coli isolates (22 percent) from the California cohort were resistant to trimethoprim-sulfamethoxazole as well as other antibiotics. There was a common pattern of DNA fingerprinting, suggesting that the isolates belonged to the same clonal group (clonal group A), in 28 of 55 isolates with trimethoprim-sulfamethoxazole resistance (51 percent) and in 2 of 50 randomly selected isolates that were susceptible to trimethoprim-sulfamethoxazole (4 percent, P<0.001). In addition, 11 of 29 resistant isolates (38 percent) from the Michigan cohort and 7 of 18 (39 percent) from the Minnesota cohort belonged to clonal group A. Most of the clonal group A isolates were serotype O11:H(nt) or O77:H(nt), with similar patterns of virulence factors, antibiotic susceptibility, and electrophoretic features. CONCLUSIONS In three geographically diverse communities, a single clonal group accounted for nearly half of community-acquired urinary tract infections in women that were caused by E. coli strains with resistance to trimethoprim-sulfamethoxazole. The widespread distribution and high prevalence of E. coli clonal group A has major public health implications.
Collapse
Affiliation(s)
- A R Manges
- Division of Epidemiology and Public Health Biology, School of Public Health, University of California at Berkeley, 94720, USA
| | | | | | | | | | | |
Collapse
|
8
|
Chen JL, Fullerton KE, Flynn NM. Necrotizing fasciitis associated with injection drug use. Clin Infect Dis 2001; 33:6-15. [PMID: 11389488 DOI: 10.1086/320874] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2000] [Revised: 11/02/2000] [Indexed: 11/03/2022] Open
Abstract
We studied cases of necrotizing fasciitis among injection drug users (IDUs) and non-IDUs who presented at the University of California Davis Medical Center from 1984 through 1999. Of 107 patients, 59 (55%) were IDUs and 48 (45%) non-IDUs. Among IDUs, 32 (54%) recently injected at the site of infection, and 17 patients (29%) presented with an abscess. Among non-IDUs, 17 (35%) reported a recent insect bite and 9 (19%) reported a wound or abrasion at the site of infection. Overall, seventy cases (65%) had > or = 3 debridements, and 31 patients (29%) had > 5% of their total body surface area debrided. Of all patients with necrotizing fasciitis, 16 (15%) did not survive. Among the 59 IDUs, 6 (10%) did not survive, while among non-IDUs, 10 (21%) did not survive. Our results indicate the need for a high index of suspicion for necrotizing fasciitis among patients presenting with cellulitis, a recent insect bite, wound, or recent injection drug use. Preventive interventions for necrotizing fasciitis among IDUs should include street-based education and treatment for abscesses and cellulitis.
Collapse
Affiliation(s)
- J L Chen
- Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, USA.
| | | | | |
Collapse
|
9
|
|