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Firestone MJ, Thorell L, Kollmann L, Fess L, Ciessau G, Strain AK, Danila R, Lynfield R, Holzbauer S. Surveillance for Unexplained Deaths of Possible Infectious Etiologies During the COVID-19 Pandemic-Minnesota, 2020-2021. Public Health Rep 2024; 139:325-332. [PMID: 38205808 PMCID: PMC11037231 DOI: 10.1177/00333549231218283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES Surveillance systems for unexplained deaths that might have an infectious etiology are rare. We examined the Minnesota Department of Health Unexplained Deaths and Critical Illnesses of Possible Infectious Etiology and Medical Examiner Infectious Deaths (UNEX/MED-X) surveillance system,-a system that expanded postmortem surveillance for infectious diseases during the COVID-19 pandemic by leveraging standard (medical examiner [ME]) and expanded (mortuary) surveillance to identify COVID-19-related deaths. METHODS MEs, coroners, or morticians collected postmortem swabs from decedents with an infectious prodrome or with SARS-CoV-2 exposure before death but with no known recent infectious disease testing. The Minnesota Department of Health Public Health Laboratory used nucleic acid amplification, viral culture, and standard algorithms to test specimens collected postmortem for SARS-CoV-2, influenza virus, and other infectious pathogens. We reviewed UNEX/MED-X data from March 2, 2020, through December 31, 2021, and characterized decedents by location of swab collection (ie, ME or mortuary). RESULTS From March 2, 2020, through December 31, 2021, the UNEX/MED-X surveillance system received samples from 182 decedents from mortuaries and 955 decedents from MEs. Mortuary decedents were older than ME decedents (median age, 78 vs 46 y). Seventy-three mortuary decedents (40.1%) and 197 ME decedents (20.6%) had SARS-CoV-2 detections. The UNEX/MED-X system identified 212 COVID-19-related deaths, representing 2.0% of total COVID-19-related deaths in Minnesota. Eighty-nine decedents (42.0%) were from racial and ethnic minority populations, representing 6.1% more COVID-19-related deaths among people from racial and ethnic minority populations than would have been detected without this surveillance system. PRACTICE IMPLICATIONS Expanded and standard UNEX/MED-X surveillance builds capacity and flexibility for responding to emerging public health threats. Similar programs should be considered elsewhere as resources allow.
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Affiliation(s)
- Melanie J. Firestone
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Minnesota Department of Health, St Paul, MN, USA
- Now with School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Lydia Fess
- Minnesota Department of Health, St Paul, MN, USA
| | | | | | | | | | - Stacy Holzbauer
- Minnesota Department of Health, St Paul, MN, USA
- Career Epidemiology Field Officer Program, Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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2
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Schenk KE, Cornille K, Cater J, Vieira AR, Holzbauer S, Bye M, Scheftel J. Outbreak of anthrax in livestock with human occupational exposures - Minnesota, 2023. J Agromedicine 2024:1-4. [PMID: 38263576 DOI: 10.1080/1059924x.2024.2306835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
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.
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Affiliation(s)
- Kelly Elizabeth Schenk
- Council for State and Territorial Epidemiologists Applied Epidemiology Fellowship, Minnesota Department of Health, St. Paul, MN, USA
- Minnesota Department of Health, Zoonotic Diseases Unit, St. Paul, MN, USA
| | - K Cornille
- Minnesota Board of Animal Health, St. Paul, MN, USA
| | - J Cater
- Minnesota Board of Animal Health, St. Paul, MN, USA
| | - A R Vieira
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - S Holzbauer
- Minnesota Department of Health, Zoonotic Diseases Unit, St. Paul, MN, USA
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M Bye
- Minnesota Department of Health, Zoonotic Diseases Unit, St. Paul, MN, USA
| | - J Scheftel
- Minnesota Department of Health, Zoonotic Diseases Unit, St. Paul, MN, USA
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3
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Thielen BK, Holzbauer S, Templen B, Schafer IJ, Artus A, Galloway R, Ireland M, Femrite T, Schleiss MR. Case Report: Locally Acquired Leptospirosis in a Minnesota Boy and His Dog. Am J Trop Med Hyg 2024; 110:123-126. [PMID: 37983913 DOI: 10.4269/ajtmh.23-0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/18/2023] [Indexed: 11/22/2023] Open
Abstract
Leptospirosis affects numerous animal species, including domestic dogs, but documented transmission to humans is rare. Here, we describe epidemiologically linked cases in a 12-year-old Minnesota boy and his pet dog. While human leptospirosis is often thought of as a disease of tropical locations, this case report describes a rare documented example of local transmission in the northern United States, a region historically not perceived to be at high risk of Leptospira species transmission to humans. This case highlights an unusual presentation, with facial nerve palsy, underappreciated epidemiological risks, and diagnostic challenges of this reemerging infection.
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Affiliation(s)
- Beth K Thielen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Stacy Holzbauer
- Minnesota Department of Health, St. Paul, Minnesota
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Ilana J Schafer
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aileen Artus
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Renee Galloway
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Mark R Schleiss
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
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4
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Kniss K, Sumner KM, Tastad KJ, Lewis NM, Jansen L, Julian D, Reh M, Carlson E, Williams R, Koirala S, Buss B, Donahue M, Palm J, Kollmann L, Holzbauer S, Levine MZ, Davis T, Barnes JR, Flannery B, Brammer L, Fry A. Risk for Infection in Humans after Exposure to Birds Infected with Highly Pathogenic Avian Influenza A(H5N1) Virus, United States, 2022. Emerg Infect Dis 2023; 29:1215-1219. [PMID: 37095080 DOI: 10.3201/eid2906.230103] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
During February 7─September 3, 2022, a total of 39 states experienced outbreaks of highly pathogenic avian influenza A(H5N1) virus in birds from commercial poultry farms and backyard flocks. Among persons exposed to infected birds, highly pathogenic avian influenza A(H5) viral RNA was detected in 1 respiratory specimen from 1 person.
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5
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Firestone MJ, Holzbauer S, Conelea C, Danila R, Smith K, Bitsko RH, Klammer SM, Gingerich S, Lynfield R. Rapid onset of functional tic-like behaviors among adolescent girls-Minnesota, September-November 2021. Front Neurol 2023; 13:1063261. [PMID: 36742058 PMCID: PMC9892901 DOI: 10.3389/fneur.2022.1063261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/22/2022] [Indexed: 01/20/2023] Open
Abstract
Background On October 15, 2021, the Minnesota Department of Health began investigating a school cluster of students experiencing tic-like behaviors thought to be related to recent COVID-19. The objective of this report is to describe the investigation, key findings, and public health recommendations. Methods Affected students and proxies were interviewed with a standardized questionnaire including validated depression and anxiety screens. Results Eight students had tic-like behaviors lasting >24 h after initial report with onset during September 26-October 30, 2021. All eight students were females aged 15-17 years. All students either had a history of depression or anxiety or scored as having more than minimal anxiety or depression on validated screens. Four students previously had confirmed COVID-19: the interval between prior COVID-19 and tic symptom onset varied from more than a year prior to tic symptom onset to at the time of tic symptom onset. Conclusion The onset of tic-like behaviors at one school in Minnesota appeared to be related more to underlying mental health conditions than recent COVID-19. These findings highlight the need to better understand functional tic-like behaviors and adolescent mental health.
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Affiliation(s)
- Melanie J. Firestone
- Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States,Minnesota Department of Health, St. Paul, MN, United States,*Correspondence: Melanie J. Firestone ✉
| | - Stacy Holzbauer
- Minnesota Department of Health, St. Paul, MN, United States,Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Christine Conelea
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Richard Danila
- Minnesota Department of Health, St. Paul, MN, United States
| | - Kirk Smith
- Minnesota Department of Health, St. Paul, MN, United States
| | - Rebecca H. Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | | | | | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, MN, United States
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6
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Wiens T, Taylor J, Cole C, Saravia S, Peterson J, Lunda M, Margetta J, D’Heilly P, Holzbauer S, Lynfield R. Lessons Learned From the E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) Outbreak Response, Minnesota, 2019-2020. Public Health Rep 2022; 137:1053-1060. [PMID: 34694926 PMCID: PMC9574319 DOI: 10.1177/00333549211051394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Electronic cigarette (e-cigarette), or vaping, product use-associated lung injury (EVALI) is a novel noncommunicable disease with an unknown cause. The objective of this analysis was to describe the Minnesota Department of Health's (MDH's) outbreak response to EVALI, including challenges, successes, and lessons learned. METHODS MDH began investigating EVALI cases in August 2019 and quickly coordinated an agencywide response. This response included activating the incident command system; organizing multidisciplinary teams to perform the epidemiologic investigation; laboratory testing of e-cigarette, or vaping, products (EVPs) and clinical specimens; and collaborating with partners to gather information and develop recommendations. RESULTS MDH faced numerous investigational challenges during the outbreak response of EVALI, including the need to gather information on unregulated and illicit substances and their use and collecting information from minors and critically ill people. MDH laboratorians faced methodologic challenges in characterizing EVPs. Despite these challenges, MDH epidemiologists successfully collaborated with the MDH public health laboratory, law enforcement, partners with clinical and toxicology expertise, and local and national public health partners. PRACTICE IMPLICATIONS Lessons learned included ensuring the state public health agency has legal authority to conduct noncommunicable disease outbreak investigations and the necessity of cultivating and using internal and external partnerships, specifically with laboratories that can analyze clinical specimens and unknown substances. The lessons learned may be useful to public health agencies responding to similar public health emergencies. To improve preparedness for the next outbreak of EVALI or other noncommunicable diseases, we recommend building and maintaining partnerships with internal and external partners.
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Affiliation(s)
- Terra Wiens
- Minnesota Department of Health, St. Paul, MN, USA
- Now with Washington State Department of Health, Seattle, WA, USA
| | - Joanne Taylor
- Minnesota Department of Health, St. Paul, MN, USA
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cory Cole
- Minnesota Department of Health, St. Paul, MN, USA
- Council of State and Territorial Epidemiologists, Atlanta, GA, USA
| | | | | | - Mark Lunda
- Minnesota Department of Health, St. Paul, MN, USA
| | | | | | - Stacy Holzbauer
- Minnesota Department of Health, St. Paul, MN, USA
- Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Varela K, Brown JA, Lipton B, Dunn J, Stanek D, Behravesh CB, Chapman H, Conger TH, Vanover T, Edling T, Holzbauer S, Lennox AM, Lindquist S, Loerzel S, Mehlenbacher S, Mitchell M, Murphy M, Olsen CW, Yager CM. A Review of Zoonotic Disease Threats to Pet Owners: A Compendium of Measures to Prevent Zoonotic Diseases Associated with Non-Traditional Pets: Rodents and Other Small Mammals, Reptiles, Amphibians, Backyard Poultry, and Other Selected Animals. Vector Borne Zoonotic Dis 2022; 22:303-360. [PMID: 35724316 PMCID: PMC9248330 DOI: 10.1089/vbz.2022.0022] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Kate Varela
- One Health Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer A. Brown
- National Association of State Public Health Veterinarians
- Indiana Department of Health
| | - Beth Lipton
- National Association of State Public Health Veterinarians
- Seattle & King County Public Health
| | - John Dunn
- National Association of State Public Health Veterinarians
- Tennessee Department of Health
| | - Danielle Stanek
- National Association of State Public Health Veterinarians
- Florida Department of Health
| | | | - Helena Chapman
- Division of Infectious Diseases and Global Medicine, University of Florida College of Medicine
- American Association for the Advancement of Science at NASA Applied Sciences
| | - Terry H. Conger
- U.S. Department of Agriculture Animal (USDA) and Plant Health Inspection Service (APHIS) Veterinary Services
| | | | | | - Stacy Holzbauer
- Minnesota Department of Health
- CDC Preparedness and Response Career Epidemiology Field Officer Program
| | | | | | | | | | - Mark Mitchell
- Louisiana State University School of Veterinary Medicine, Veterinary Clinical Sciences
| | - Michael Murphy
- Food and Drug Administration Center for Veterinary Medicine
| | - Christopher W. Olsen
- AVMA Council on Public Health
- Department of Pathobiological Sciences, University of Wisconsin-Madison School of Veterinary Medicine
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8
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Pecora N, Holzbauer S, Wang X, Gu Y, Taffner S, Hatwar T, Hardy D, Dziejman M, D’Heilly P, Pung K, Guh A, Qiu X, Gill S, Dumyati G. Genomic Analysis of Clostridioides difficile in 2 Regions of the United States Reveals a Diversity of Strains and Limited Transmission. J Infect Dis 2022; 225:121-129. [PMID: 34107037 PMCID: PMC8655013 DOI: 10.1093/infdis/jiab294] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/07/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The distribution of Clostridioides difficile strains and transmission dynamics in the United States are not well defined. Whole-genome sequencing across 2 Centers for Disease Control and Prevention Emerging Infections Program C. difficile infection (CDI) surveillance regions (Minnesota and New York) was performed to identify predominant multilocus sequence types (MLSTs) in community-associated (CA) and healthcare-associated (HCA) disease and assess transmission. METHODS Whole-genome sequencing was performed on C. difficile isolates from patients with CDI over 3 months between 2016 and 2017. Patients were residents of the catchment area without a positive C. difficile test in the preceding 8 weeks. CDI cases were epidemiologically classified as HCA or CA. RESULTS Of 422 isolates, 212 (50.2%) were HCA and 203 (48.1%) were CA. Predominant MLSTs were sequence type (ST) 42 (9.3%), ST8 (7.8%), and ST2 (8.1%). MLSTs associated with HCA-CDI included ST1 (76%), ST53 (83.3%), and ST43 (80.0%), while those associated with CA-CDI included ST3 (76.9%) and ST41 (77.8%). ST1 was more frequent in New York than in Minnesota (10.8% vs 3.1%). Thirty-three pairs were closely related genomically, 14 of which had potential patient-to-patient transmission supported by record review. CONCLUSIONS The genomic epidemiology of C. difficile across 2 regions of the United States indicates the presence of a diverse strain profile and limited direct transmission.
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Affiliation(s)
- Nicole Pecora
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, New York, USA
| | - Stacy Holzbauer
- Minnesota EIP, Minnesota Department of Health, St Paul, Minnesota, USA,,Career Epidemiology Field Officer Program, Division of State and Local Readiness, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Xiong Wang
- Public Health Laboratory, Minnesota Department of Health, St Paul, Minnesota, USA
| | - Yu Gu
- Dept of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Samantha Taffner
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, New York, USA
| | - Trupti Hatwar
- Center for Community Health and Prevention, University of Rochester, Rochester, New York, USA
| | - Dwight Hardy
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, New York, USA,,Department of Microbiology and Immunology, University of Rochester, Rochester, New York, USA
| | - Michelle Dziejman
- Department of Microbiology and Immunology, University of Rochester, Rochester, New York, USA
| | - Paige D’Heilly
- Minnesota EIP, Minnesota Department of Health, St Paul, Minnesota, USA
| | - Kelly Pung
- Public Health Laboratory, Minnesota Department of Health, St Paul, Minnesota, USA
| | - Alice Guh
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Xing Qiu
- Dept of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Steven Gill
- Department of Microbiology and Immunology, University of Rochester, Rochester, New York, USA,,Genomics Research Center, University of Rochester, Rochester, New York, USA
| | - Ghinwa Dumyati
- Center for Community Health and Prevention, University of Rochester, Rochester, New York, USA,,Department of Medicine, Infectious Diseases Division, University of Rochester Medical Center, Rochester, New York, USA
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Firestone MJ, Lorentz AJ, Meyer S, Wang X, Como-Sabetti K, Vetter S, Smith K, Holzbauer S, Beaudoin A, Garfin J, Ehresmann K, Danila R, Lynfield R. First Identified Cases of SARS-CoV-2 Variant P.1 in the United States - Minnesota, January 2021. MMWR Morb Mortal Wkly Rep 2021; 70:346-347. [PMID: 33705367 PMCID: PMC7951823 DOI: 10.15585/mmwr.mm7010e1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Knust B, Brown S, de St Maurice A, Whitmer S, Koske SE, Ervin E, Patel K, Graziano J, Morales-Betoulle ME, House J, Cannon D, Kerins J, Holzbauer S, Austin C, Gibbons-Burgener S, Colton L, Dunn J, Zufan S, Choi MJ, Davis WR, Chiang CF, Manning CR, Roesch L, Shoemaker T, Purpura L, McQuiston J, Peterson D, Radcliffe R, Garvey A, Christel E, Morgan L, Scheftel J, Kazmierczak J, Klena JD, Nichol ST, Rollin PE. Seoul Virus Infection and Spread in United States Home-Based Ratteries: Rat and Human Testing Results From a Multistate Outbreak Investigation. J Infect Dis 2021; 222:1311-1319. [PMID: 32484879 DOI: 10.1093/infdis/jiaa307] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/31/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND During 2017, a multistate outbreak investigation occurred after the confirmation of Seoul virus (SEOV) infections in people and pet rats. A total of 147 humans and 897 rats were tested. METHODS In addition to immunoglobulin (Ig)G and IgM serology and traditional reverse-transcription polymerase chain reaction (RT-PCR), novel quantitative RT-PCR primers/probe were developed, and whole genome sequencing was performed. RESULTS Seventeen people had SEOV IgM, indicating recent infection; 7 reported symptoms and 3 were hospitalized. All patients recovered. Thirty-one facilities in 11 US states had SEOV infection, and among those with ≥10 rats tested, rat IgG prevalence ranged 2%-70% and SEOV RT-PCR positivity ranged 0%-70%. Human laboratory-confirmed cases were significantly associated with rat IgG positivity and RT-PCR positivity (P = .03 and P = .006, respectively). Genomic sequencing identified >99.5% homology between SEOV sequences in this outbreak, and these were >99% identical to SEOV associated with previous pet rat infections in England, the Netherlands, and France. Frequent trade of rats between home-based ratteries contributed to transmission of SEOV between facilities. CONCLUSIONS Pet rat owners, breeders, and the healthcare and public health community should be aware and take steps to prevent SEOV transmission in pet rats and to humans. Biosecurity measures and diagnostic testing can prevent further infections.
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Affiliation(s)
- Barbara Knust
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shelley Brown
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Shannon Whitmer
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah E Koske
- Wisconsin Department of Health Services, Madison, Wisconsin, USA
| | - Elizabeth Ervin
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ketan Patel
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James Graziano
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jennifer House
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Deborah Cannon
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janna Kerins
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Chicago Department of Public Health, Chicago, Illinois, USA
| | | | - Connie Austin
- Illinois Department of Public Health, Springfield, Illinois, USA
| | | | - Leah Colton
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - John Dunn
- Tennessee Department of Health, Nashville, Tennessee, USA
| | - Sara Zufan
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary Joung Choi
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William R Davis
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cheng-Feng Chiang
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Craig R Manning
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Linda Roesch
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Trevor Shoemaker
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lawrence Purpura
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer McQuiston
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Rachel Radcliffe
- South Carolina Department of Health and Environmental Control, Columbia, South Carolina, USA
| | - Ann Garvey
- South Carolina Department of Health and Environmental Control, Columbia, South Carolina, USA
| | | | - Laura Morgan
- Manitowoc County Health Department, Manitowoc, Wisconsin, USA
| | - Joni Scheftel
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | | | - John D Klena
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stuart T Nichol
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pierre E Rollin
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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11
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Firestone MJ, Lorentz AJ, Wang X, Como-Sabetti K, Vetter S, Smith K, Holzbauer S, Meyer S, Ehresmann K, Danila R, Lynfield R. First Identified Cases of SARS-CoV-2 Variant B.1.1.7 in Minnesota - December 2020-January 2021. MMWR Morb Mortal Wkly Rep 2021; 70:278-279. [PMID: 33630825 PMCID: PMC8344980 DOI: 10.15585/mmwr.mm7008e1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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12
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Cole C, Wiens T, Taylor J, Danila R, D'Heilly P, Margetta J, Bye M, Mumm E, Schwerzler L, Makhtal R, Holzbauer S, Lynfield R. Vaping, lung injury, and mental health Minnesota 2018-2019. Minn Med 2021; 104:41-43. [PMID: 34413546 PMCID: PMC8372828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This report describes and contextualizes the high prevalence of mental health conditions (MHC) among Minnesota 2019 EVALI patients by examining the prevalence of MHC and associations between MHC and e-cigarette or vaping product (EVP) use in Minnesota population surveys. Investigators reviewed medical records for 140 EVALI patients to determine history of MHC. History of MHC and EVP use in the general population was estimated using self-reported measures and screening tools from two population-based surveys, the 2019 Minnesota Student Survey (MSS) and the 2018 Minnesota Behavioral Risk Factor Surveillance Survey (MN-BRFSS). Some 64.3% of EVALI patients had an MHC. In both Minnesota population surveys, MHCs were common among people who used EVP. The odds of MHC among youth aged <18 were higher among those who reported current EVP use compared with those did not report EVP use. Similarly, the odds of depression were higher among adults who reported current EVP use compared with those who did not. Clinicians treating patients with EVALI should consider evaluating the need for, and providing indicated referrals to, post-discharge mental health services for their patients.
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Affiliation(s)
- Cory Cole
- Cory Cole, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Terra Wiens, MPH, is an epidemiologist, MDH. Joanne Taylor, PhD, is with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, CDC, and MDH. Richard Danila, PhD, is epidemiology program manager, MDH. Paige D'Heilly, MPH, is an epidemiologist, MDH. Jamie Margetta, MPH, is health economics and outcomes researcher, Medtronic. Maria Bye, MPH, is healthcare worker monitoring interview team lead, MDH. Erica Mumm, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Lauren Schwerzler, MPH, RDN, is an epidemiologist, MDH. Roon Makhtal is data abstractor, MDH. Stacy Holzbauer, DVM, MPH, is epidemiology field officer, MDH and Center for Preparedness and Response, CDC. Ruth Lynfield, MD, is state epidemiologist, MDH
| | - Terra Wiens
- Cory Cole, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Terra Wiens, MPH, is an epidemiologist, MDH. Joanne Taylor, PhD, is with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, CDC, and MDH. Richard Danila, PhD, is epidemiology program manager, MDH. Paige D'Heilly, MPH, is an epidemiologist, MDH. Jamie Margetta, MPH, is health economics and outcomes researcher, Medtronic. Maria Bye, MPH, is healthcare worker monitoring interview team lead, MDH. Erica Mumm, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Lauren Schwerzler, MPH, RDN, is an epidemiologist, MDH. Roon Makhtal is data abstractor, MDH. Stacy Holzbauer, DVM, MPH, is epidemiology field officer, MDH and Center for Preparedness and Response, CDC. Ruth Lynfield, MD, is state epidemiologist, MDH
| | - Joanne Taylor
- Cory Cole, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Terra Wiens, MPH, is an epidemiologist, MDH. Joanne Taylor, PhD, is with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, CDC, and MDH. Richard Danila, PhD, is epidemiology program manager, MDH. Paige D'Heilly, MPH, is an epidemiologist, MDH. Jamie Margetta, MPH, is health economics and outcomes researcher, Medtronic. Maria Bye, MPH, is healthcare worker monitoring interview team lead, MDH. Erica Mumm, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Lauren Schwerzler, MPH, RDN, is an epidemiologist, MDH. Roon Makhtal is data abstractor, MDH. Stacy Holzbauer, DVM, MPH, is epidemiology field officer, MDH and Center for Preparedness and Response, CDC. Ruth Lynfield, MD, is state epidemiologist, MDH
| | - Richard Danila
- Cory Cole, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Terra Wiens, MPH, is an epidemiologist, MDH. Joanne Taylor, PhD, is with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, CDC, and MDH. Richard Danila, PhD, is epidemiology program manager, MDH. Paige D'Heilly, MPH, is an epidemiologist, MDH. Jamie Margetta, MPH, is health economics and outcomes researcher, Medtronic. Maria Bye, MPH, is healthcare worker monitoring interview team lead, MDH. Erica Mumm, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Lauren Schwerzler, MPH, RDN, is an epidemiologist, MDH. Roon Makhtal is data abstractor, MDH. Stacy Holzbauer, DVM, MPH, is epidemiology field officer, MDH and Center for Preparedness and Response, CDC. Ruth Lynfield, MD, is state epidemiologist, MDH
| | - Paige D'Heilly
- Cory Cole, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Terra Wiens, MPH, is an epidemiologist, MDH. Joanne Taylor, PhD, is with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, CDC, and MDH. Richard Danila, PhD, is epidemiology program manager, MDH. Paige D'Heilly, MPH, is an epidemiologist, MDH. Jamie Margetta, MPH, is health economics and outcomes researcher, Medtronic. Maria Bye, MPH, is healthcare worker monitoring interview team lead, MDH. Erica Mumm, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Lauren Schwerzler, MPH, RDN, is an epidemiologist, MDH. Roon Makhtal is data abstractor, MDH. Stacy Holzbauer, DVM, MPH, is epidemiology field officer, MDH and Center for Preparedness and Response, CDC. Ruth Lynfield, MD, is state epidemiologist, MDH
| | - Jamie Margetta
- Cory Cole, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Terra Wiens, MPH, is an epidemiologist, MDH. Joanne Taylor, PhD, is with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, CDC, and MDH. Richard Danila, PhD, is epidemiology program manager, MDH. Paige D'Heilly, MPH, is an epidemiologist, MDH. Jamie Margetta, MPH, is health economics and outcomes researcher, Medtronic. Maria Bye, MPH, is healthcare worker monitoring interview team lead, MDH. Erica Mumm, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Lauren Schwerzler, MPH, RDN, is an epidemiologist, MDH. Roon Makhtal is data abstractor, MDH. Stacy Holzbauer, DVM, MPH, is epidemiology field officer, MDH and Center for Preparedness and Response, CDC. Ruth Lynfield, MD, is state epidemiologist, MDH
| | - Maria Bye
- Cory Cole, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Terra Wiens, MPH, is an epidemiologist, MDH. Joanne Taylor, PhD, is with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, CDC, and MDH. Richard Danila, PhD, is epidemiology program manager, MDH. Paige D'Heilly, MPH, is an epidemiologist, MDH. Jamie Margetta, MPH, is health economics and outcomes researcher, Medtronic. Maria Bye, MPH, is healthcare worker monitoring interview team lead, MDH. Erica Mumm, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Lauren Schwerzler, MPH, RDN, is an epidemiologist, MDH. Roon Makhtal is data abstractor, MDH. Stacy Holzbauer, DVM, MPH, is epidemiology field officer, MDH and Center for Preparedness and Response, CDC. Ruth Lynfield, MD, is state epidemiologist, MDH
| | - Erica Mumm
- Cory Cole, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Terra Wiens, MPH, is an epidemiologist, MDH. Joanne Taylor, PhD, is with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, CDC, and MDH. Richard Danila, PhD, is epidemiology program manager, MDH. Paige D'Heilly, MPH, is an epidemiologist, MDH. Jamie Margetta, MPH, is health economics and outcomes researcher, Medtronic. Maria Bye, MPH, is healthcare worker monitoring interview team lead, MDH. Erica Mumm, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Lauren Schwerzler, MPH, RDN, is an epidemiologist, MDH. Roon Makhtal is data abstractor, MDH. Stacy Holzbauer, DVM, MPH, is epidemiology field officer, MDH and Center for Preparedness and Response, CDC. Ruth Lynfield, MD, is state epidemiologist, MDH
| | - Lauren Schwerzler
- Cory Cole, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Terra Wiens, MPH, is an epidemiologist, MDH. Joanne Taylor, PhD, is with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, CDC, and MDH. Richard Danila, PhD, is epidemiology program manager, MDH. Paige D'Heilly, MPH, is an epidemiologist, MDH. Jamie Margetta, MPH, is health economics and outcomes researcher, Medtronic. Maria Bye, MPH, is healthcare worker monitoring interview team lead, MDH. Erica Mumm, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Lauren Schwerzler, MPH, RDN, is an epidemiologist, MDH. Roon Makhtal is data abstractor, MDH. Stacy Holzbauer, DVM, MPH, is epidemiology field officer, MDH and Center for Preparedness and Response, CDC. Ruth Lynfield, MD, is state epidemiologist, MDH
| | - Roon Makhtal
- Cory Cole, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Terra Wiens, MPH, is an epidemiologist, MDH. Joanne Taylor, PhD, is with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, CDC, and MDH. Richard Danila, PhD, is epidemiology program manager, MDH. Paige D'Heilly, MPH, is an epidemiologist, MDH. Jamie Margetta, MPH, is health economics and outcomes researcher, Medtronic. Maria Bye, MPH, is healthcare worker monitoring interview team lead, MDH. Erica Mumm, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Lauren Schwerzler, MPH, RDN, is an epidemiologist, MDH. Roon Makhtal is data abstractor, MDH. Stacy Holzbauer, DVM, MPH, is epidemiology field officer, MDH and Center for Preparedness and Response, CDC. Ruth Lynfield, MD, is state epidemiologist, MDH
| | - Stacy Holzbauer
- Cory Cole, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Terra Wiens, MPH, is an epidemiologist, MDH. Joanne Taylor, PhD, is with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, CDC, and MDH. Richard Danila, PhD, is epidemiology program manager, MDH. Paige D'Heilly, MPH, is an epidemiologist, MDH. Jamie Margetta, MPH, is health economics and outcomes researcher, Medtronic. Maria Bye, MPH, is healthcare worker monitoring interview team lead, MDH. Erica Mumm, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Lauren Schwerzler, MPH, RDN, is an epidemiologist, MDH. Roon Makhtal is data abstractor, MDH. Stacy Holzbauer, DVM, MPH, is epidemiology field officer, MDH and Center for Preparedness and Response, CDC. Ruth Lynfield, MD, is state epidemiologist, MDH
| | - Ruth Lynfield
- Cory Cole, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Terra Wiens, MPH, is an epidemiologist, MDH. Joanne Taylor, PhD, is with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, CDC, and MDH. Richard Danila, PhD, is epidemiology program manager, MDH. Paige D'Heilly, MPH, is an epidemiologist, MDH. Jamie Margetta, MPH, is health economics and outcomes researcher, Medtronic. Maria Bye, MPH, is healthcare worker monitoring interview team lead, MDH. Erica Mumm, MPH, is applied epidemiology fellow, MDH, through the Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta. Lauren Schwerzler, MPH, RDN, is an epidemiologist, MDH. Roon Makhtal is data abstractor, MDH. Stacy Holzbauer, DVM, MPH, is epidemiology field officer, MDH and Center for Preparedness and Response, CDC. Ruth Lynfield, MD, is state epidemiologist, MDH
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Guh A, Korhonen LC, Winston LG, Martin B, Johnston H, Brousseau G, Basiliere E, Olson DM, Fridkin S, Wilson LE, Perlmutter R, Holzbauer S, Bye M, Phipps EC, Flores K, Dumyati G, Nelson D, Hatwar T, Ocampo V, Kainer M, McDonald C. 780. How Much Does Prior Hospitalization Contribute to Readmission with Community-onset Clostridioides difficile Infection? Open Forum Infect Dis 2020. [PMCID: PMC7777850 DOI: 10.1093/ofid/ofaa439.970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Interventions to reduce community-onset (CO) Clostridioides difficile Infection (CDI) are not usually hospital-based due to the perception that they are often acquired outside the hospital. We determined the proportion of admitted CO CDI that might be associated with previous hospitalization. Methods The CDC’s Emerging Infections Program conducts population-based CDI surveillance in 10 US sites. We defined an incident case as a C. difficile-positive stool collected in 2017 from a person aged ≥ 1 year admitted to a hospital with no positive tests in the prior 8 weeks. Cases were defined as CO if stool was collected within 3 days of hospitalization. CO cases were classified into four categories: long-term care facility (LTCF)-onset if patient was admitted from an LTCF; long-term acute care hospital (LTACH)-onset if patient was admitted from an LTACH; CO-healthcare-facility associated (CO-HCFA) if patient was admitted from a private residence but had a prior healthcare-facility admission in the past 12 weeks; or community-associated (CA) if there was no admission to a healthcare facility in the prior 12 weeks. We excluded hospitals with < 10 cases among admitted catchment-area residents. Results Of 4724 cases in 86 hospitals, 2984 (63.2%) were CO (median per hospital: 65.8%; interquartile range [IQR]: 58.3%-70.7%). Among the CO cases, 1424 (47.7%) were CA (median per hospital: 48.1%; IQR: 40.3%-57.7%), 1201 (40.3%) were CO-HCFA (median per hospital: 41.0%; IQR: 32.9%-47.8%), 350 (11.7%) were LTCF-onset (median per hospital: 10.0%; IQR: 0.6%-14.4%), and 9 (0.3%) were LTACH-onset. Of 1201 CO-HCFA cases, 1174 (97.8%) had a prior hospitalization; among these, 978 (83.3%) (median per hospital: 83.3%; IQR: 69.2%-90.6%), which consists of 32.8% of all hospitalized CO cases, had been discharged from the same hospital (Figure), and 84.4% of the 978 cases (median per hospital: 88.2%: IQR: 76.5%-100.0%) had received antibiotics sometime in the prior 12 weeks. Figure. Frequency of Cases Discharged in the 12 Weeks Prior to Readmission with Clostridioides difficile Infection (N=1138*) ![]()
Conclusion A third of hospitalized CO CDI had been recently discharged from the same hospital, and most had received antibiotics during or soon after the last admission. Hospital-based and post-discharge antibiotic stewardship interventions could help reduce subsequent CDI hospitalizations. Disclosures Ghinwa Dumyati, MD, Roche Diagnostics (Consultant)
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Affiliation(s)
- Alice Guh
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, Colorado
| | | | | | | | | | - Lucy E Wilson
- University of Maryland Baltimore County, Baltimore, MD
| | | | | | - Maria Bye
- Minnesota Department of Health, St. Paul, Minnesota
| | | | | | - Ghinwa Dumyati
- New York Rochester Emerging Infections Program at the University of Rochester Medical Center, Rochester, NY
| | - Deborah Nelson
- New York Emerging Infections Program and University of Rochester Medical Center, Rochester, New York
| | - Trupti Hatwar
- New York Emerging Infections Program and University of Rochester Medical Center, Rochester, New York
| | | | - Marion Kainer
- Tennessee Department of Health, Nashville, Tennessee
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Reagan-Steiner S, Gary J, Matkovic E, Ritter JM, Shieh WJ, Martines RB, Werner AK, Lynfield R, Holzbauer S, Bullock H, Denison AM, Bhatnagar J, Bollweg BC, Patel M, Evans ME, King BA, Rose DA, Baldwin GT, Jones CM, Krishnasamy V, Briss PA, Weissman DN, Meaney-Delman D, Zaki SR, Jatlaoui T, Koumans E, Kiernan E, Petersen E, Karwowski MP, Valentin-Blasini L, Blount BC, Cummings KJ, Ghinai I, Feder K, Wells EV, Turabelidze G, Byers P, Tanz LJ, Navarette KA, Ramadugu K, Dewart C, Miller J, Squires K, Marsden L, Fields CA. Pathological findings in suspected cases of e-cigarette, or vaping, product use-associated lung injury (EVALI): a case series. The Lancet Respiratory Medicine 2020; 8:1219-1232. [DOI: 10.1016/s2213-2600(20)30321-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022]
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15
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Firestone MJ, Wienkes H, Garfin J, Wang X, Vilen K, Smith KE, Holzbauer S, Plumb M, Pung K, Medus C, Yao JD, Binnicker MJ, Nelson AC, Yohe S, Como-Sabetti K, Ehresmann K, Lynfield R, Danila R. COVID-19 Outbreak Associated with a 10-Day Motorcycle Rally in a Neighboring State - Minnesota, August-September 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1771-1776. [PMID: 33237891 PMCID: PMC8022865 DOI: 10.15585/mmwr.mm6947e1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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16
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Fell A, Beaudoin A, D’Heilly P, Mumm E, Cole C, Tourdot L, Ruhland A, Klumb C, Rounds J, Bailey B, Liverseed G, Peterson M, Mahoehney J, Ireland M, Bye M, Setty S, Leeds M, Taylor J, Holzbauer S. SARS-CoV-2 Exposure and Infection Among Health Care Personnel - Minnesota, March 6-July 11, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1605-1610. [PMID: 33119557 PMCID: PMC7641003 DOI: 10.15585/mmwr.mm6943a5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Taylor J, Carter RJ, Lehnertz N, Kazazian L, Sullivan M, Wang X, Garfin J, Diekman S, Plumb M, Bennet ME, Hale, T, Vallabhaneni S, Namugenyi S, Carpenter D, Turner-Harper D, Booth M, Coursey EJ, Martin K, McMahon M, Beaudoin A, Lifson A, Holzbauer S, Reddy SC, Jernigan JA, Lynfield R. Serial Testing for SARS-CoV-2 and Virus Whole Genome Sequencing Inform Infection Risk at Two Skilled Nursing Facilities with COVID-19 Outbreaks - Minnesota, April-June 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1288-1295. [PMID: 32966272 PMCID: PMC7498172 DOI: 10.15585/mmwr.mm6937a3] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bixler D, Miller AD, Mattison CP, Taylor B, Komatsu K, Peterson Pompa X, Moon S, Karmarkar E, Liu CY, Openshaw JJ, Plotzker RE, Rosen HE, Alden N, Kawasaki B, Siniscalchi A, Leapley A, Drenzek C, Tobin-D'Angelo M, Kauerauf J, Reid H, Hawkins E, White K, Ahmed F, Hand J, Richardson G, Sokol T, Eckel S, Collins J, Holzbauer S, Kollmann L, Larson L, Schiffman E, Kittle TS, Hertin K, Kraushaar V, Raman D, LeGarde V, Kinsinger L, Peek-Bullock M, Lifshitz J, Ojo M, Arciuolo RJ, Davidson A, Huynh M, Lash MK, Latash J, Lee EH, Li L, McGibbon E, McIntosh-Beckles N, Pouchet R, Ramachandran JS, Reilly KH, Dufort E, Pulver W, Zamcheck A, Wilson E, de Fijter S, Naqvi O, Nalluswami K, Waller K, Bell LJ, Burch AK, Radcliffe R, Fiscus MD, Lewis A, Kolsin J, Pont S, Salinas A, Sanders K, Barbeau B, Althomsons S, Atti S, Brown JS, Chang A, Clarke KR, Datta SD, Iskander J, Leitgeb B, Pindyck T, Priyamvada L, Reagan-Steiner S, Scott NA, Viens LJ, Zhong J, Koumans EH. SARS-CoV-2-Associated Deaths Among Persons Aged <21 Years - United States, February 12-July 31, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1324-1329. [PMID: 32941417 DOI: 10.15585/mmwr.mm6937e4] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Since February 12, 2020, approximately 6.5 million cases of SARS-CoV-2 infection, the cause of coronavirus disease 2019 (COVID-19), and 190,000 SARS-CoV-2-associated deaths have been reported in the United States (1,2). Symptoms associated with SARS-CoV-2 infection are milder in children compared with adults (3). Persons aged <21 years constitute 26% of the U.S. population (4), and this report describes characteristics of U.S. persons in that population who died in association with SARS-CoV-2 infection, as reported by public health jurisdictions. Among 121 SARS-CoV-2-associated deaths reported to CDC among persons aged <21 years in the United States during February 12-July 31, 2020, 63% occurred in males, 10% of decedents were aged <1 year, 20% were aged 1-9 years, 70% were aged 10-20 years, 45% were Hispanic persons, 29% were non-Hispanic Black (Black) persons, and 4% were non-Hispanic American Indian or Alaska Native (AI/AN) persons. Among these 121 decedents, 91 (75%) had an underlying medical condition,* 79 (65%) died after admission to a hospital, and 39 (32%) died at home or in the emergency department (ED).† These data show that nearly three quarters of SARS-CoV-2-associated deaths among infants, children, adolescents, and young adults have occurred in persons aged 10-20 years, with a disproportionate percentage among young adults aged 18-20 years and among Hispanics, Blacks, AI/ANs, and persons with underlying medical conditions. Careful monitoring of SARS-CoV-2 infections, deaths, and other severe outcomes among persons aged <21 years remains particularly important as schools reopen in the United States. Ongoing evaluation of effectiveness of prevention and control strategies will also be important to inform public health guidance for schools and parents and other caregivers.
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Wortham JM, Lee JT, Althomsons S, Latash J, Davidson A, Guerra K, Murray K, McGibbon E, Pichardo C, Toro B, Li L, Paladini M, Eddy ML, Reilly KH, McHugh L, Thomas D, Tsai S, Ojo M, Rolland S, Bhat M, Hutchinson K, Sabel J, Eckel S, Collins J, Donovan C, Cope A, Kawasaki B, McLafferty S, Alden N, Herlihy R, Barbeau B, Dunn AC, Clark C, Pontones P, McLafferty ML, Sidelinger DE, Krueger A, Kollmann L, Larson L, Holzbauer S, Lynfield R, Westergaard R, Crawford R, Zhao L, Bressler JM, Read JS, Dunn J, Lewis A, Richardson G, Hand J, Sokol T, Adkins SH, Leitgeb B, Pindyck T, Eure T, Wong K, Datta D, Appiah GD, Brown J, Traxler R, Koumans EH, Reagan-Steiner S. Characteristics of Persons Who Died with COVID-19 - United States, February 12-May 18, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:923-929. [PMID: 32673298 DOI: 10.15585/mmwr.mm6928e1] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
During January 1, 2020-May 18, 2020, approximately 1.3 million cases of coronavirus disease 2019 (COVID-19) and 83,000 COVID-19-associated deaths were reported in the United States (1). Understanding the demographic and clinical characteristics of decedents could inform medical and public health interventions focused on preventing COVID-19-associated mortality. This report describes decedents with laboratory-confirmed infection with SARS-CoV-2, the virus that causes COVID-19, using data from 1) the standardized CDC case-report form (case-based surveillance) (https://www.cdc.gov/coronavirus/2019-ncov/php/reporting-pui.html) and 2) supplementary data (supplemental surveillance), such as underlying medical conditions and location of death, obtained through collaboration between CDC and 16 public health jurisdictions (15 states and New York City).
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Taylor J, Wiens T, Peterson J, Saravia S, Lunda M, Hanson K, Wogen M, D’Heilly P, Margetta J, Bye M, Cole C, Mumm E, Schwerzler L, Makhtal R, Danila R, Lynfield R, Holzbauer S. Characteristics of E-cigarette, or Vaping, Products Used by Patients with Associated Lung Injury and Products Seized by Law Enforcement - Minnesota, 2018 and 2019. MMWR Morb Mortal Wkly Rep 2019; 68:1096-1100. [PMID: 31774740 PMCID: PMC6881051 DOI: 10.15585/mmwr.mm6847e1] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hatfield KM, Baggs J, Winston LG, Parker E, Johnston H, Brousseau G, Olson DM, Fridkin S, Wilson L, Perlmuter R, Holzbauer S, Phipps EC, Hancock EB, Dumyati G, Ocampo V, Kainer MA, Korhonen LC, Jernigan JA, McDonald LC, Guh A. 837. Prior Hospitalizations Among Cases of Community-Associated Clostridioides difficile Infection—10 US States, 2014–2015. Open Forum Infect Dis 2019. [PMCID: PMC6809087 DOI: 10.1093/ofid/ofz359.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Despite overall progress in preventing Clostridioides difficile Infection (CDI), community-associated (CA) infections have been steadily increasing. Although the incubation period of CDI is thought to be relatively short, gastrointestinal microbial disruption from remote healthcare exposures (e.g., inpatient antibiotic use) may be associated with CA-CDI. To assess this potential association, we linked CA-CDI infections identified through CDC’s Emerging Infections Program (EIP) to Medicare claims data to describe prior healthcare utilization. Methods We defined an EIP CA-CDI case as a positive C. difficile test collected in 2014–2015 from an outpatient or inpatient within 3 days of hospital admission, provided there was no positive test in the prior 8 weeks and no admission to a healthcare facility in the prior 12 weeks. We linked EIP CA-CDI cases aged ≥65 years to a Medicare beneficiary using unique combinations of birthdate, sex, and zip code. Cases were included if they maintained continuous fee-for-service coverage for 1 year prior to the event date. To calculate exposure odds ratios for previous hospitalizations, each case was matched to 5 control beneficiaries on age, sex, and county of residence. We used logistic regression to calculate adjusted matched odds ratios (amOR) that controlled for chronic conditions. Results We successfully linked 2,287/3,367 (68%) EIP CA-CDI cases. Of these, 1,236 cases met inclusion criteria; the median age was 77 years and 63% were female. We identified 69 (5.6%) cases with misclassification of prior healthcare exposures, most of whom (48, 70%) were hospitalized in the 12 weeks prior to their event. Among the 1,167 true CA-CDI cases, 33% were hospitalized in the prior 12 weeks to 1 year. The median number of weeks from prior hospitalization to CDI was 27 (IQR 18–38, Figure 1). Cases had a higher risk of hospitalization than matched controls in the prior 3–6 months (amOR: 2.33, 95% CI: 1.87, 2.90) and 6–12 months (amOR: 1.43 95% CI: 1.18, 1.74). Conclusion Remote hospitalization in the previous year was a significant risk factor for CA-CDI, especially in the 3–6 months prior to CA-CDI. Long-lasting prevention strategies implemented at hospital discharge and enhanced inpatient antibiotic stewardship may prevent CA-CDI among older adults. ![]()
Disclosures All Authors: No reported Disclosures.
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Affiliation(s)
- Kelly M Hatfield
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - James Baggs
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Erin Parker
- California Emerging Infections Program, Oakland, California
| | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Geoff Brousseau
- Colorado Department of Public Health and Environment, Denver, Colorado
| | | | - Scott Fridkin
- Emory University and Emory Healthcare, Atlanta, Georgia
| | - Lucy Wilson
- University of Maryland Baltimore County, Baltimore, Maryland
| | | | - Stacy Holzbauer
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Ghinwa Dumyati
- New York Rochester Emerging Infections Program at the University of Rochester Medical Center, Rochester, New York
| | | | | | | | - John A Jernigan
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Alice Guh
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Taylor J, Holzbauer S, Wanduragala D, Ivaskovic A, Spinosa R, Smith K, Corcoran J, Jensen A. Notes from the Field: Acute Intoxications from Consumption of Amanita muscaria Mushrooms - Minnesota, 2018. MMWR Morb Mortal Wkly Rep 2019; 68:483-484. [PMID: 31145720 PMCID: PMC6542478 DOI: 10.15585/mmwr.mm6821a4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hall V, Scheftel J, Holzbauer S, Smith K. Gastrointestinal illness among contract construction workers at a chicken processing facility-Minnesota, 2016. Am J Ind Med 2019; 62:175-179. [PMID: 30584658 DOI: 10.1002/ajim.22927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND After Campylobacter infection was reported in a contract construction worker (contractor) at a chicken processing facility, we described the illness and determined illness associations with workforce exposure. METHODS Case finding was conducted by reportable disease surveillance and contractor interviews. A case was defined as either diarrhea and fever, or diarrhea lasting ≥3 days during January-September, 2016. RESULTS Fourteen cases were identified among 74 contractors interviewed; four were laboratory-confirmed (two Campylobacter, two Salmonella). Cases were more likely to perform electrical work (odds ratio [OR] 10.4, P < 0.001), take breaks in unofficial areas (OR 6.4, P = 0.01), bring drinks into work areas (OR 4.2, P = 0.02), and have contact with poultry fluids (OR 6.4, P = 0.03). Only 23 (31%) contractors reported infectious disease prevention training. CONCLUSIONS This outbreak emphasizes the importance of training contractors for all potential hazards. Host employers and staffing agencies share responsibility for contractor safety.
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Affiliation(s)
- Victoria Hall
- Epidemic Intelligence Service; Division of Scientific Education and Professional Development; Centers for Disease Control and Prevention; Atlanta Georgia
- Infectious Disease Epidemiology; Prevention and Control Division; Minnesota Department of Health; Saint Paul Minnesota
| | - Joni Scheftel
- Infectious Disease Epidemiology; Prevention and Control Division; Minnesota Department of Health; Saint Paul Minnesota
| | - Stacy Holzbauer
- Infectious Disease Epidemiology; Prevention and Control Division; Minnesota Department of Health; Saint Paul Minnesota
- Career Epidemiology Field Officer Program; Centers for Disease Control and Prevention; Atlanta Georgia
| | - Kirk Smith
- Infectious Disease Epidemiology; Prevention and Control Division; Minnesota Department of Health; Saint Paul Minnesota
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Skrobarcek K, Mu Y, Ahern J, Beldavs Z, Brousseau G, Dumyati G, Farley MM, Holzbauer S, Kainer MA, Meek JI, Perlmutter R, Phipps EC, Winston LG, Guh AY. 482. Association between Socioeconomic Status Factors and Incidence of Community-Associated Clostridium difficile Infection Utilizing Factor Analysis—United States, 2014–2015. Open Forum Infect Dis 2018. [PMCID: PMC6253049 DOI: 10.1093/ofid/ofy210.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Traditionally a healthcare-associated infection, Clostridium difficile infection (CDI) is increasingly emerging in communities. Health disparities in CDI exist, but the social determinants of health that influence community-associated (CA) CDI are unknown. We used factor analysis and disparate data sources to identify area-based socioeconomic status (SES) factors associated with CA-CDI incidence. Methods CDC’s Emerging Infections Program conducts population-based CDI surveillance in 35 US counties. A CA-CDI case is defined as a positive C. difficile specimen collected as an outpatient or within 3 days of hospitalization in a person aged ≥1 year without a positive test in the prior 8 weeks or an overnight stay in a healthcare facility in the prior 12 weeks. 2014–2015 CA-CDI case addresses were geocoded to a 2010 census tract (CT) and incidence rates were calculated. CT-level SES variables were obtained from the 2011–2015 American Community Survey. The Health Resources and Services Administration provided medically underserved area (MUA) designations. Exploratory factor analysis transformed 15 highly correlated SES variables into threefactors using scree plot and Kaiser criteria: “Low Income,” “Foreign-born,” and “High Income.” To account for CT-level clustering, a negative binomial generalized linear mixed model was used to evaluate the associations of these factors and MUA with CA-CDI incidence, adjusting for age, sex, race and diagnostic test. Results Of 13,903 CA-CDI geocoded cases, 63% were female, 80% were white, and 36% were aged ≥65 years. Annual CA-CDI incidence was 63.4/100,000 persons. In multivariable analysis, “Low Income” (rate ratio [RR]: 1.09; 95% confidence interval [CI]: 1.05–1.13) and “High Income” (RR: 0.90; CI: 0.87–0.93) were significantly associated with CA-CDI incidence. Conclusion Factor analysis was instrumental in identifying key drivers of disparities among interrelated SES variables. Low-income areas were surprisingly associated with higher CA-CDI incidence, given that known CDI risk factors include increased access to healthcare. Understanding how SES factors might impact CA-CDI incidence can inform prevention strategies in low-income areas. Disclosures G. Dumyati, Seres: Scientific Advisor, Consulting fee.
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Affiliation(s)
- Kimberly Skrobarcek
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yi Mu
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Ahern
- University of California at Berkeley, Berkeley, California
| | | | - Geoff Brousseau
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Ghinwa Dumyati
- NY Emerging Infections Program, Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, New York
| | - Monica M Farley
- Department of Medicine, Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, Georgia
| | | | - Marion A Kainer
- Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Public Health, Nashville, Tennessee
| | - James I Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut
| | | | - Erin C Phipps
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, New Mexico
| | - Lisa G Winston
- Medicine, University of California, San Francisco and Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Alice Y Guh
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Hatfield KM, Baggs J, Winston LG, Parker E, Martin B, Meek JI, Olson D, Farley MM, Revis A, Holzbauer S, Bye M, Wilson L, Perlmutter R, Phipps EC, Pierce R, Ocampo VLS, Kainer MA, Smith M, McDonald LC, Jernigan JA, Guh A. 492. Long-Term Outcomes of Clostridium difficile Infection Among Medicare Beneficiaries. Open Forum Infect Dis 2018. [PMCID: PMC6253260 DOI: 10.1093/ofid/ofy210.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Clostridium difficile infection (CDI) is a common healthcare-associated infection, particularly among older adults. We used laboratory-confirmed CDI surveillance data from 8 states participating in the Centers for Disease Control and Prevention’s Emerging Infections Program linked to claims data for Centers for Medicare and Medicaid Services (CMS) beneficiaries to measure variation in 1-year outcomes associated with CDI. Methods A CDI case was defined as a positive C. difficile stool test in 2014 in a person without a positive test in the prior 8 weeks. Cases aged ≥65 years were linked to their CMS beneficiary ID using unique combinations of date of birth, sex, and zip code. Each case was matched to five control beneficiaries who did not link to any case and were residents of the same catchment area. Inclusion criteria were continuous fee-for-service Medicare for the entire study period (1 year before and after event date), and no hospitalization or skilled nursing facility stay with an ICD-9-CM code for CDI in the year prior to their match date. Multivariable logistic regression models were used to compare mortality and hospitalization for 1 year following the event date between beneficiaries with and without CDI, adjusting for age, sex, race, catchment area, chronic conditions, number of hospitalizations in the prior year, and hospitalization status at the time of and 7 days preceding the event date. Results Of 5,097 cases aged ≥65, 3,082 (60%) were linked to a CMS ID, and 1,832 (59%) met inclusion criteria. In crude analysis, 34% of beneficiaries with CDI died within 1 year, compared with 5% of beneficiaries without CDI. Beneficiaries with CDI were also more likely to be hospitalized in the subsequent year (54% vs. 17%). Beneficiaries with CDI had a higher adjusted odds of death (adjusted OR 3.01, 95% CI: 2.46, 3.69) and hospitalization within 1 year (adjusted OR 1.93, 95% CI: 1.65, 2.25) than those without CDI. Conclusion Older adults with CDI were three times more likely to die in the year following infection and nearly two times more likely to be hospitalized compared with those without CDI, revealing independent long-term risk of poor outcomes. This excess morbidity and mortality supports the need to develop novel CDI prevention strategies for this population. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Kelly M Hatfield
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James Baggs
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa G Winston
- Medicine, University of California, San Francisco and Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- California Emerging Infections Program, Oakland, California
| | - Erin Parker
- California Emerging Infections Program, Oakland, California
| | | | - James I Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut
| | - Danyel Olson
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut
| | - Monica M Farley
- Department of Medicine, Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta, Georgia
| | - Andrew Revis
- Georgia Emerging Infections Program, Atlanta, Georgia
| | - Stacy Holzbauer
- Minnesota Department of Health, Saint Paul, Minnesota
- Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maria Bye
- Minnesota Department of Health, Saint Paul, Minnesota
| | - Lucy Wilson
- Maryland Department of Health, Baltimore, Maryland
| | | | - Erin C Phipps
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, New Mexico
| | - Rebecca Pierce
- Acute and Communicable Disease Prevention, Oregon Health Authority, Portland, Oregon
| | - Valerie L S Ocampo
- Acute and Communicable Disease Prevention, Oregon Health Authority, Portland, Oregon
| | | | - Miranda Smith
- Tennessee Department of Health, Nashville, Tennessee
| | - L Clifford McDonald
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John A Jernigan
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alice Guh
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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26
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Wang X, Holzbauer S, Pung K, Bye M, Adamczyk M, Paulick AL, Vlachos N, Guh A, Laufer-Halpin AS, Karlsson MS, Boxrud D. 473. Molecular Typing of Clostridium difficile: Concordance Between PCR-Ribotyping and Multilocus Sequence Typing (MLST). Open Forum Infect Dis 2018. [PMCID: PMC6254467 DOI: 10.1093/ofid/ofy210.482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Clostridium difficile infection (CDI) incidence has increased dramatically in the past decade, making CDI one of the most common causes of infectious diarrhea and an urgent public health threat. Understanding the biological features and spread of C. difficile strains can help target control efforts. PCR-ribotyping, the current method of choice for C. difficile typing, remains subjective and challenging for interlaboratory comparisons. Multilocus sequence typing (MLST), based on the alleles of seven housekeeping genes, represents a more robust tool that would enhance interlaboratory reproducibility. However, a comprehensive translation system to ribotyping is a prerequisite. Here, we describe the concordance between MLST and PCR-ribotyping. Methods The Centers for Disease Control and Prevention’s (CDC) Emerging Infections Program (EIP) conducts CDI surveillance in 10 US sites. C. difficile isolates cultured from a subset of cases underwent capillary-based PCR-ribotyping at CDC. A representative sample, selected from the top 30 ribotypes (RTs), underwent whole genome sequencing (WGS) at Minnesota Department of Health. An additional subset of isolates, representing the top 10 RTs, underwent WGS at CDC. At both laboratories, the Illumina MiSeq platform was used to obtain 250 bp paired-end sequencing reads. MLST analyses were done using the pubMLST C. difficile scheme. Results A total of 479 C. difficile isolates, including at least 10 isolates for each RT, were analyzed by WGS. Among the 30 RTs represented, 35 different MLST sequence types (STs) were identified. Twenty-two of the RTs (including 027) were each associated with a single unique ST, while 8 RTs (020, 014, 015, 076, 046, 153–251, A27, and 075) presented more genetic diversity with single-locus or double-locus variants, resulting in multiple STs within one ribotype. There were two instances of two different RTs sharing the same ST. Conclusion Multilocus sequence typing and PCR-Ribotyping showed comparable discriminatory abilities. However, the ST is not always predictive of the RT and vice versa. This represents the first step toward a transition to using WGS for standard C. difficile typing. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Xiong Wang
- Minnesota Department of Health, Saint Paul, Minnesota
| | | | - Kelly Pung
- Minnesota Department of Health, Saint Paul, Minnesota
| | - Maria Bye
- Minnesota Department of Health, Saint Paul, Minnesota
| | - Michelle Adamczyk
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ashley Lyn Paulick
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicholas Vlachos
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alice Guh
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alison S Laufer-Halpin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maria S Karlsson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dave Boxrud
- Minnesota Department of Health, Saint Paul, Minnesota
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Balius P, Bye M, Smith K, Holzbauer S. 476. Comparison of Community-Associated Clostridium difficile Infections With Other Reportable Enteric Pathogens, Minnesota, 2016. Open Forum Infect Dis 2018. [PMCID: PMC6253868 DOI: 10.1093/ofid/ofy210.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
| | - Maria Bye
- Minnesota Department of Health, Saint Paul, Minnesota
| | - Kirk Smith
- Minnesota Department of Health, Saint Paul, Minnesota
| | - Stacy Holzbauer
- Minnesota Department of Health, Saint Paul, Minnesota
- Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
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Shaughnessy MK, Snider T, Sepulveda R, Boxrud D, Cebelinski E, Jawahir S, Holzbauer S, Johnston BD, Smith K, Bender JB, Thuras P, Diez-Gonzalez F, Johnson JR. Prevalence and Molecular Characteristics of Clostridium difficile in Retail Meats, Food-Producing and Companion Animals, and Humans in Minnesota. J Food Prot 2018; 81:1635-1642. [PMID: 30198756 DOI: 10.4315/0362-028x.jfp-18-104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Community-associated Clostridium difficile infection (CA-CDI) now accounts for approximately 50% of CDI cases in central Minnesota; animals and meat products are potential sources. From November 2011 to July 2013, we cultured retail meat products and fecal samples from food-producing and companion animals in central Minnesota for C. difficile by using standard methods. The resulting 51 C. difficile isolates, plus 30 archived local veterinary C. difficile isolates and 208 human CA-CDI case isolates from central Minnesota (from 2012) from the Minnesota Department of Health, were characterized molecularly, and source groups were compared using discriminant analysis. C. difficile was recovered from 0 (0%) of 342 retail meat samples and 51 (9%) of 559 animal fecal samples. Overall, the 81 animal source isolates and 208 human source isolates were highly diverse genetically. Molecular traits segregated extensively in relation to animal versus human origin. Discriminant analysis classified 95% of isolates correctly by source group; only five (2.5%) human source isolates were classified as animal source. These data do not support meat products or food-producing and companion animals as important sources of CA-CDI in the central Minnesota study region.
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Affiliation(s)
- Megan K Shaughnessy
- 1 University of Minnesota, Minneapolis, Minnesota 55455.,2 Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Minneapolis, Minnesota 55417 (ORCID: http://orcid.org/0000-0002-9588-5045 [J.R.J.])
| | - Tim Snider
- 2 Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Minneapolis, Minnesota 55417 (ORCID: http://orcid.org/0000-0002-9588-5045 [J.R.J.])
| | | | - David Boxrud
- 4 Minnesota Department of Health, 625 Robert Street North, St. Paul, Minnesota 55164-0975
| | - Elizabeth Cebelinski
- 4 Minnesota Department of Health, 625 Robert Street North, St. Paul, Minnesota 55164-0975
| | - Selina Jawahir
- 4 Minnesota Department of Health, 625 Robert Street North, St. Paul, Minnesota 55164-0975
| | - Stacy Holzbauer
- 4 Minnesota Department of Health, 625 Robert Street North, St. Paul, Minnesota 55164-0975.,5 Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329-4027, USA
| | - Brian D Johnston
- 1 University of Minnesota, Minneapolis, Minnesota 55455.,2 Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Minneapolis, Minnesota 55417 (ORCID: http://orcid.org/0000-0002-9588-5045 [J.R.J.])
| | - Kirk Smith
- 4 Minnesota Department of Health, 625 Robert Street North, St. Paul, Minnesota 55164-0975
| | - Jeff B Bender
- 3 University of Minnesota, St. Paul, Minnesota 55108
| | - Paul Thuras
- 1 University of Minnesota, Minneapolis, Minnesota 55455.,2 Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Minneapolis, Minnesota 55417 (ORCID: http://orcid.org/0000-0002-9588-5045 [J.R.J.])
| | | | - James R Johnson
- 1 University of Minnesota, Minneapolis, Minnesota 55455.,2 Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Minneapolis, Minnesota 55417 (ORCID: http://orcid.org/0000-0002-9588-5045 [J.R.J.])
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Choi MJ, Worku S, Knust B, Vang A, Lynfield R, Mount MR, Objio T, Brown S, Griffith J, Hulbert D, Lippold S, Ervin E, Ströher U, Holzbauer S, Slattery W, Washburn F, Harper J, Koeck M, Uher C, Rollin P, Nichol S, Else R, DeVries A. A Case of Lassa Fever Diagnosed at a Community Hospital-Minnesota 2014. Open Forum Infect Dis 2018; 5:ofy131. [PMID: 30035149 DOI: 10.1093/ofid/ofy131] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/09/2018] [Indexed: 11/13/2022] Open
Abstract
Background In April 2014, a 46-year-old returning traveler from Liberia was transported by emergency medical services to a community hospital in Minnesota with fever and altered mental status. Twenty-four hours later, he developed gingival bleeding. Blood samples tested positive for Lassa fever RNA by reverse transcriptase polymerase chain reaction. Methods Blood and urine samples were obtained from the patient and tested for evidence of Lassa fever virus infection. Hospital infection control personnel and health department personnel reviewed infection control practices with health care personnel. In addition to standard precautions, infection control measures were upgraded to include contact, droplet, and airborne precautions. State and federal public health officials conducted contract tracing activities among family contacts, health care personnel, and fellow airline travelers. Results The patient was discharged from the hospital after 14 days. However, his recovery was complicated by the development of near complete bilateral sensorineural hearing loss. Lassa virus RNA continued to be detected in his urine for several weeks after hospital discharge. State and federal public health authorities identified and monitored individuals who had contact with the patient while he was ill. No secondary cases of Lassa fever were identified among 75 contacts. Conclusions Given the nonspecific presentation of viral hemorrhagic fevers, isolation of ill travelers and consistent implementation of basic infection control measures are key to preventing secondary transmission. When consistently applied, these measures can prevent secondary transmission even if travel history information is not obtained, not immediately available, or the diagnosis of a viral hemorrhagic fever is delayed.
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Affiliation(s)
- Mary J Choi
- Minnesota Department of Health, St. Paul, Minnesota
| | | | | | - Arnold Vang
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Mark R Mount
- Mercy Hospital, Allina Health, Coon Rapids, Minnesota
| | - Tina Objio
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Susan Lippold
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Ute Ströher
- Viral Special Pathogens Branch, Atlanta, Georgia
| | | | | | - Faith Washburn
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jane Harper
- Minnesota Department of Health, St. Paul, Minnesota
| | | | - Carol Uher
- Mercy Hospital, Allina Health, Coon Rapids, Minnesota
| | | | | | - Ryan Else
- Mercy Hospital, Allina Health, Coon Rapids, Minnesota
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Bye M, Whitten T, Holzbauer S. Antibiotic Prescribing for Dental Procedures in Community-Associated Clostridium difficile cases, Minnesota, 2009–2015. Open Forum Infect Dis 2017. [PMCID: PMC5631193 DOI: 10.1093/ofid/ofx162.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Clostridium difficile infections (CDIs) are the leading cause of healthcare-associated diarrhea. Two of the most significant risk factors for CDI are antibiotic use and healthcare exposure. Dentists write approximately 10% of all outpatient prescriptions in the USA; however, limited data are available regarding dental prescribing’s impact on CDI. We described characteristics of community-associated (CA) CDI cases following antibiotics for dental procedures. Methods The Minnesota Department of Health (MDH) performs active population- and laboratory-based surveillance for CDI as part of the CDC’s Emerging Infections Program (EIP). A case was defined as a positive C. difficile toxin or molecular assay on a stool specimen from a person >1 years old without a positive test in the prior 8 weeks, living in one of the five EIP catchment counties. Cases were classified as CA if stool was collected ≤3 days of admission or as an outpatient, with no overnight stay in a healthcare facility in the past 12 weeks. Medical records were reviewed and interviews performed to assess CDI risk factors and potential exposures. Differences in antibiotic prescribing and documentation among CA CDI cases receiving dental procedures were explored. Results During 2009–2015, 2176 presumptive CA CDI cases were reported to MDH; 1626 (75%) were confirmed as CA and interviewed. In total, 926 (57%) were prescribed antibiotics and 136 (15%) for dental procedures. Cases prescribed antibiotics for dental procedures were significantly older (median age: 57 vs. 45 years, P < 0.001), more likely to be prescribed clindamycin (50% vs. 10%, P < 0.001), and less likely to be prescribed fluoroquinolones (6% vs. 19%, P < 0.001) and cephalosporins (7% vs. 30%, P < 0.001) than those prescribed antibiotics for other indications. Among cases who received antibiotics for a dental procedure, 31 (23%) reported antibiotics on interview which were also documented in the medical record and 46 (34%) reported antibiotics for any reason on interview without documentation in the medical record. Conclusion Dental antibiotic prescribing rates are likely underestimated. Stewardship programs should address dental prescribing and alert dentists to CDI subsequent to antibiotics prescribed for dental procedures. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Maria Bye
- Infectious Disease Epidemiology, Prevention, and Control Division, Minnesota Department of Health, St. Paul, Minnesota
| | - Tory Whitten
- Infectious Disease Epidemiology, Prevention, and Control Division, Minnesota Department of Health, St. Paul, Minnesota
| | - Stacy Holzbauer
- Minnesota Department of Health, St. Paul, Minnesota
- Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
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Skrobarcek K, Mu Y, Winston LG, Brousseau G, Lyons C, Farley M, Perlmutter R, Holzbauer S, Phipps EC, Dumyati G, Beldavs ZG, Kainer M, Guh A. Socioeconomic Status Factors Associated with Increased Incidence of Community-Associated Clostridium difficile Infection. Open Forum Infect Dis 2017. [PMCID: PMC5630861 DOI: 10.1093/ofid/ofx163.944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Traditionally a hospital-acquired pathogen, Clostridium difficile is increasingly recognized as an important cause of diarrhea in community settings. Health disparities in C. difficileinfection (CDI) have been reported, but little is known about the social determinants of health that influence community-associated (CA) CDI incidence. We sought to identify socioeconomic status (SES) factors associated with increased CA-CDI incidence. Methods Population-based CDI surveillance is conducted in 35 U.S. counties through the Centers for Disease Control and Prevention’s Emerging Infections Program. A CA-CDI case is defined as a positive C. difficile stool specimen collected as an outpatient or within three days of hospitalization in a person aged ≥ 1 year who did not have a positive test in the prior 8 weeks or an overnight stay in a healthcare facility in the prior 12 weeks. ArcGIS software was used to geocode 2014–2015 CA-CDI case addresses to a 2010 census tract (CT). Incidence rate was calculated using 2010 Census population denominators. CT-level SES factors were obtained from the 2011–2015 American Community Survey 5-year estimates and divided into deciles. To account for CT-level clustering effects, separate generalized linear mixed models with negative binomial distribution were used to evaluate the association between each SES factor and CA-CDI incidence, adjusted by age, sex and race. Results Of 9686 CA-CDI cases, 9417 (97%) had addresses geocoded to a CT; of these, 62% were female, 82% were white, and 35% were aged ≥65 years. Annual CA-CDI incidence was 42.9 per 100,000 persons. After adjusting for age, sex and race, CT-level SES factors significantly associated with increased CA-CDI incidence included living under the poverty level (rate ratio [RR] 1.12; 95% confidence interval [CI] 1.09–1.53), crowding in homes (RR 1.11; 95% CI 1.01–1.21), low education (RR 1.11; 95% CI 1.07–1.15), low income (RR 1.15; 95% CI 1.12–1.17), having public health insurance (RR 1.21; 95% CI 1.18–1.24), receiving public assistance income (RR 1.69; 95% CI 1.55–1.84), and unemployment (RR 1.14; 95% CI 1.07–1.22). Conclusion Areas with lower SES have modestly increased CA-CDI incidence. Understanding the mechanisms by which SES factors impact CA-CDI incidence could help guide prevention efforts in these higher-risk areas. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Kimberly Skrobarcek
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yi Mu
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa G Winston
- Medicine, University of California, San Francisco and Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Geoff Brousseau
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Carol Lyons
- Yale School of Public Health, Connecticut Emerging Infections Program, New Haven, Connecticut
| | - Monica Farley
- Department of Medicine, Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, Georgia
| | | | | | - Erin C Phipps
- University of New Mexico, New Mexico Emerging Infections Program, Albuquerque, New Mexico
| | - Ghinwa Dumyati
- New York Emerging Infections Program at the University of Rochester Medical Center, Rochester, New York
| | | | - Marion Kainer
- Tennessee Department of Health, Nashville, Tennessee
| | - Alice Guh
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Sandmeier D, Whitten T, Karlsson MS, Holzbauer S. Prevalence of Clostridium difficile Ribotypes in Minnesota, 2012–2014. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Dominic Sandmeier
- Infectious Disease Epidemiology, Prevention, and Control Division, Minnesota Department of Health, St. Paul, Minnesota
| | - Tory Whitten
- Infectious Disease Epidemiology, Prevention, and Control Division, Minnesota Department of Health, St. Paul, Minnesota
| | - Maria S. Karlsson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stacy Holzbauer
- Infectious Disease Epidemiology, Prevention, and Control Division, Minnesota Department of Health, St. Paul, Minnesota
- Division of State and Local Readiness, Centers for Disease Control and Prevention, Atlanta, Georgia
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Talley P, Holzbauer S, Smith K, Pomputius W. Notes from the Field: Lymphocytic Choriomeningitis Virus Meningoencephalitis from a Household Rodent Infestation — Minnesota, 2015. MMWR Morb Mortal Wkly Rep 2016; 65:248-9. [DOI: 10.15585/mmwr.mm6509a4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Hocevar SN, Bulens SN, Farley M, Holzbauer S, Hancock EB, Dumyati G, Davis CM, Lyons C, Perlmutter R, Parker E, Reisenauer C, Ocampo VLS, Mu Y, Mcdonald LC. Risk Factors for Community-Associated Clostridium difficile Infection: A Case Control Study. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Whitten T, Holzbauer S. Depressive Disorders, Antidepressant Use, and Alcohol Dependency in Persons With Community-Associated Clostridium difficile Infection, Minnesota 2013–2014. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dantes R, Mu Y, Hicks LA, Cohen J, Bamberg W, Beldavs ZG, Dumyati G, Farley MM, Holzbauer S, Meek J, Phipps E, Wilson L, Winston LG, McDonald LC, Lessa FC. Association Between Outpatient Antibiotic Prescribing Practices and Community-Associated Clostridium difficile Infection. Open Forum Infect Dis 2015; 2:ofv113. [PMID: 26509182 PMCID: PMC4551478 DOI: 10.1093/ofid/ofv113] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 08/03/2015] [Indexed: 01/21/2023] Open
Abstract
A modest, 10% reduction in outpatient antibiotic prescribing among U.S. adults
could result in a substantial 17% reduction in Clostridium
difficile infections that originate in the community. Background. Antibiotic use predisposes patients to
Clostridium difficile infections (CDI), and approximately
32% of these infections are community-associated (CA) CDI. The
population-level impact of antibiotic use on adult CA-CDI rates is not well
described. Methods. We used 2011 active population- and
laboratory-based surveillance data from 9 US geographic locations to identify adult
CA-CDI cases, defined as C difficile-positive stool specimens (by
toxin or molecular assay) collected from outpatients or from patients ≤3 days
after hospital admission. All patients were surveillance area residents and aged
≥20 years with no positive test ≤8 weeks prior and no overnight stay in a
healthcare facility ≤12 weeks prior. Outpatient oral antibiotic prescriptions
dispensed in 2010 were obtained from the IMS Health Xponent database. Regression
models examined the association between outpatient antibiotic prescribing and adult
CA-CDI rates. Methods. Healthcare providers prescribed 5.2
million courses of antibiotics among adults in the surveillance population in 2010,
for an average of 0.73 per person. Across surveillance sites, antibiotic prescription
rates (0.50–0.88 prescriptions per capita) and unadjusted CA-CDI rates
(40.7–139.3 cases per 100 000 persons) varied. In regression modeling, reducing
antibiotic prescribing rates by 10% among persons ≥20 years old was
associated with a 17% (95% confidence interval,
6.0%–26.3%; P = .032) decrease in CA-CDI
rates after adjusting for age, gender, race, and type of diagnostic assay. Reductions
in prescribing penicillins and amoxicillin/clavulanic acid were associated with the
greatest decreases in CA-CDI rates. Conclusions and Relevance. Community-associated
CDI prevention should include reducing unnecessary outpatient antibiotic use. A
modest reduction of 10% in outpatient antibiotic prescribing can have a
disproportionate impact on reducing CA-CDI rates.
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Affiliation(s)
| | - Yi Mu
- Centers for Disease Control and Prevention , Atlanta
| | - Lauri A Hicks
- Centers for Disease Control and Prevention , Atlanta
| | - Jessica Cohen
- Centers for Disease Control and Prevention , Atlanta ; Atlanta Research and Education Foundation, Georgia
| | - Wendy Bamberg
- Colorado Department of Public Health and Environment, Denver
| | | | | | - Monica M Farley
- Emory University , Atlanta ; Atlanta Veterans Affairs Medical Center , Georgia
| | | | - James Meek
- Connecticut Emerging Infections Program , New Haven
| | | | - Lucy Wilson
- Maryland Emerging Infections Program Baltimore ; Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Lisa G Winston
- University of California , San Francisco ; San Francisco General Hospital , California
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See I, Mu Y, Cohen J, Beldavs ZG, Winston LG, Dumyati G, Holzbauer S, Dunn J, Farley MM, Lyons C, Johnston H, Phipps E, Perlmutter R, Anderson L, Gerding DN, Lessa FC. NAP1 strain type predicts outcomes from Clostridium difficile infection. Clin Infect Dis 2014; 58:1394-400. [PMID: 24604900 DOI: 10.1093/cid/ciu125] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Studies are conflicting regarding the importance of the fluoroquinolone-resistant North American pulsed-field gel electrophoresis type 1 (NAP1) strain in Clostridium difficile infection (CDI) outcome. We describe strain types causing CDI and evaluate their association with patient outcomes. METHODS CDI cases were identified from population-based surveillance. Multivariate regression models were used to evaluate the associations of strain type with severe disease (ileus, toxic megacolon, or pseudomembranous colitis within 5 days; or white blood cell count ≥15 000 cells/µL within 1 day of positive test), severe outcome (intensive care unit admission after positive test, colectomy for C. difficile infection, or death within 30 days of positive test), and death within 14 days of positive test. RESULTS Strain typing results were available for 2057 cases. Severe disease occurred in 363 (17.7%) cases, severe outcome in 100 (4.9%), and death within 14 days in 56 (2.7%). The most common strain types were NAP1 (28.4%), NAP4 (10.2%), and NAP11 (9.1%). In unadjusted analysis, NAP1 was associated with greater odds of severe disease than other strains. After controlling for patient risk factors, healthcare exposure, and antibiotic use, NAP1 was associated with severe disease (adjusted odds ratio [AOR], 1.74; 95% confidence interval [CI], 1.36-2.22), severe outcome (AOR, 1.66; 95% CI, 1.09-2.54), and death within 14 days (AOR, 2.12; 95% CI, 1.22-3.68). CONCLUSIONS NAP1 was the most prevalent strain and a predictor of severe disease, severe outcome, and death. Strategies to reduce NAP1 prevalence, such as antibiotic stewardship to reduce fluoroquinolone use, might reduce CDI morbidity.
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Affiliation(s)
- Isaac See
- Division of Healthcare Quality Promotion
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Adjemian JZ, Howell J, Holzbauer S, Harris J, Recuenco S, McQuiston J, Chester T, Lynfield R, Devries A, Belay E, Sejvar J. A clustering of immune-mediated polyradiculoneuropathy among swine abattoir workers exposed to aerosolized porcine brains, Indiana, United States. Int J Occup Environ Health 2009; 15:331-8. [PMID: 19886343 DOI: 10.1179/oeh.2009.15.4.331] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In November 2007 a novel neuropathy, immune-mediated polyradiculoneuropathy (IP), was identified among workers at a Minnesota swine abattoir where a unique compressed air technique was used to remove porcine brains. An epidemiologic investigation at another abattoir in Indiana that also uses this process was launched to evaluate workers self-reporting neurologic illness compatible with IP. A nested case-control study was performed to identify cases and risk factors. Six confirmed, one probable, and three possible IP cases were detected. IP cases were 28-52 years old, of Latino origin, and 62.5% female. Onset dates ranged from April 2005-December 2007; 60% were hospitalized. IP cases at this plant were similar in clinical presentation and exposure risks to those detected in Minnesota. Swine abattoirs using similar brain extraction methods should discontinue this process.
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Greene SK, Daly ER, Talbot EA, Demma LJ, Holzbauer S, Patel NJ, Hill TA, Walderhaug MO, Hoekstra RM, Lynch MF, Painter JA. Recurrent multistate outbreak of Salmonella Newport associated with tomatoes from contaminated fields, 2005. Epidemiol Infect 2008; 136:157-65. [PMID: 17475091 PMCID: PMC2870807 DOI: 10.1017/s095026880700859x] [Citation(s) in RCA: 241] [Impact Index Per Article: 15.1] [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: 03/28/2007] [Indexed: 11/07/2022] Open
Abstract
Salmonella Newport causes more than an estimated 100,000 infections annually in the United States. In 2002, tomatoes grown and packed on the eastern shore of Virginia contaminated with a pan-susceptible S. Newport strain caused illness in 510 patients in 26 states. In July-November 2005, the same strain caused illness in at least 72 patients in 16 states. We conducted a case-control study during the 2005 outbreak, enrolling 29 cases and 140 matched neighbourhood controls. Infection was associated with eating tomatoes (matched odds ratio 9.7, 95% confidence interval 3.3-34.9). Tomatoes were traced back to the eastern shore of Virginia, where the outbreak strain was isolated from pond water used to irrigate tomato fields. Two multistate outbreaks caused by one rare strain, and identification of that strain in irrigation ponds 2 years apart, suggest persistent contamination of tomato fields. Further efforts are needed to prevent produce contamination on farms and throughout the food supply chain.
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Affiliation(s)
- S K Greene
- Division of Foodborne, Bacterial, and Mycotic Diseases, National Center for Zoonotic, Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Affiliation(s)
- Stacy Holzbauer
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tom Chiller
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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