Outbreak-Related Porcine Epidemic Diarrhea Virus Strains Similar to US Strains,South Korea, 2013

In late 2013, outbreaks of porcine epidemic diarrhea virus (PEDV) infection recurred in South Korea. Genetic and phylogenetic analyses showed that isolates from the outbreaks were most closely related to emergent US strains of PEDV. These US strain–like PEDV variants are prevalent in South Korea and responsible for recent outbreaks in the country.     

Etiology of gastroenteritis among Americans living in the Philippines.

Between December 1975 and June 1976, American military personnel with diarrhea who were seen at an outpatient clinic at Clark Air Force Base Hospital were investigated to determine the etiology of their disease. Enterotoxigenic Escherichia coli were detected in 16% (18/115), rotavirus in 4% (4/111), salmonellae in 3% (3/115), shigellae in 2% (2/115) and Giardia lamblia in 2% (3/152) of patients with diarrhea. Thus from only 27% of the subjects studied were identifiable potential pathogenic agents found. The incidence of gastroenteritis increased in May and June with the increase in rainfall; however, there was no increase in the proportion of diarrhea caused by any of these identifiable enteric pathogens. Americans experienced a seasonal increase of diarrhea similar to that affecting the Philippine population in Manila. Enterotoxigenic E. coli was the most common identifiable enteric pathogen among Americans with diarrhea at Clark Air Force Base in the Philippines during the study, though even in these cases, it may not have been the agent responsible for their illness.     

Lack of SARS transmission among healthcare workers, United States

Healthcare workers accounted for a large proportion of persons with severe acute respiratory syndrome (SARS) during the worldwide epidemic of early 2003. We conducted an investigation of healthcare workers exposed to laboratory-confirmed SARS patients in the United States to evaluate infection-control practices and possible SARS-associated coronavirus (SARS-CoV) transmission. We identified 110 healthcare workers with exposure within droplet range (i.e., 3 feet) to six SARS-CoV-positive patients. Forty-five healthcare workers had exposure without any mask use, 72 had exposure without eye protection, and 40 reported direct skin-to-skin contact. Potential droplet- and aerosol-generating procedures were infrequent: 5% of healthcare workers manipulated a patient's airway, and 4% administered aerosolized medication. Despite numerous unprotected exposures, there was no serologic evidence of healthcare-related SARS-CoV transmission. Lack of transmission in the United States may be related to the relative absence of high-risk procedures or patients, factors that may place healthcare workers at higher risk for infection.     

Surveillance of Rocky Mountain spotted fever, United States, 1981-1983

The increase in the incidence of RMSF observed in the 1970s appears to have plateaued at a median of 0.49 cases/100,000 for the 6-year period 1978-1983. In 1981-1983, for the first time, Oklahoma had the highest incidence of RMSF in the United States (4.10 cases/100,000/year); increased numbers of cases were also reported from two of the other three West South Central states-Texas and Arkansas. Texas, which reported 217 cases in the 3-year period, had an average incidence of 0.47 cases/100,000/year. This apparent regional increase in RMSF activity may reflect multiple factors, including increased recognition and reporting of cases and environmental factors that may be associated with a true increase in RMSF. Simultaneously, a decrease in the number of cases reported and in the incidence of RMSF have been observed in the South Atlantic states, although these states still account for most (51%) of the cases in the United States. The slight decrease in the case-fatality ratio observed over the last 9 years is unexplained. It may reflect increased awareness of RMSF and result in appropriate and timely treatment. The increasing number and percentage of cases that are laboratory confirmed suggest that the more sensitive and specific laboratory tests now required for serologic confirmation are being more widely used and are contributing to an increased accuracy of reporting of RMSF in this country.(ABSTRACT TRUNCATED AT 250 WORDS)     

Antibody to hemorrhagic fever with renal syndrome viruses (Hantaviruses) in the United States

Hantaviruses similar to those which cause hemorrhagic fever with renal syndrome have been isolated from rodents in the United States. Serologic evidence suggests that these viruses infect humans. Clinical disease has not, however, been associated with infection in the United States. To expand knowledge of the distribution of Hantaviruses in the United States and attempt to identify a clinical syndrome associated with infection, a serologic survey was undertaken of US Forestry Service personnel and US Geological Survey personnel in Mississippi, Virginia, and Alaska. In addition, sera from persons with unidentified illnesses were collected from state public health laboratories in Washington state and Virginia. One of 85 sera (1.2%) from Forestry Service personnel in Mississippi and one of 79 sera (1.3%) from Forestry Service personnel in Virginia, and nine of 360 sera (2.5%) from Forestry Service and Geological Service personnel in Alaska were tested by immunofluorescent assay and were found to have antibody to Hantaan, Tchoupitoulas, or Prospect Hill viruses, ranging in titer from 1:32 to 1:512. Those persons questioned revealed no renal disease, hemorrhagic phenomenon, or unidentified febrile illnesses. Sera from two persons in Virginia, collected at the time of an illness, had antibody titers of 1:32 and 1:64, respectively, to Prospect Hill virus. An etiologic role for Prospect Hill virus could not be confirmed. Current information would suggest that Hantaviruses do not present a public health problem in the United States.     

The prevalence and correlates of alcohol use disorders in the United States and Korea—a cross-national comparative study

The purpose of this study was to compare the prevalence rates of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition 12-month diagnoses of alcohol use disorders between the United States and South Korea using two large nationally representative surveys. Cross-tabulations were used to derive weighted prevalences of alcohol abuse and dependence, and odds ratio derived from linear logistic regression analyses were used to determine the relationships between alcohol abuse and dependence across sociodemographic characteristics of the general population samples. The prevalence of 12-month alcohol abuse was greater in the United States (5.3%) than Korea (2.0%), whereas the rate of alcohol dependence was greater in Korea (5.1%) compared with the United States (4.4%). The odds of abuse were significantly greater among men, and in the youngest age groups in both countries. There was increased odds of 12-month dependence among men, and those who were employed or never married in each country. Further, the rates of abuse and dependence in the United States and of abuse in Korea decreased as a function of age, a result that did not generalize to dependence among Koreans. The implications of the results of this study are discussed in terms of national differences between the United States and Korea as the result of gender roles and drinking patterns, and the need to understand the potential influence of the cultural applicability and specificity of psychiatric assessment interviews across countries.     

2014年上海市宝山区腹泻病监测结果分析

目的 了解上海市宝山区腹泻病流行特征和病原谱分布,为制定防控措施提供科学依据.方法 在监测点肠道门诊对腹泻病病例进行监测,按一定的抽样间隔进行调查,并采集粪便标本,进行细菌培养和病毒检测.对检测阳性的细菌菌株进行抗生素耐药实验.结果 2014年两家监测点医院共监测到腹泻病2486例,腹泻病发病呈明显季节性.380例病例的粪便标本开展病原学检测,179例病例标本病原检出阳性,检出率为47.11%; 检出细菌5种,病毒4种; 细菌检出率为14.74%(56/380),主要为致泻性大肠杆菌(32例,占57.14%) ,沙门氏菌(10例,占17.86%)和副溶血型弧菌(10例,占17.86%); 病毒检出率为37.11%(141/380),主要为诺如病毒(98例,占69.50%),轮状病毒(20例,占14.18%).夏季以细菌感染为主,冬春季以病毒感染为主.4种细菌对抗生素都有不同程度耐药.结论 宝山区腹泻病病原谱较为广泛,季节高峰较为明显,应该在不同季节根据不同病原流行情况开展针对性防控措施.     

Prevalence of Escherichia coli O157:H7 in range beef calves at weaning

This study was designed to determine the prevalence of Escherichia coli O157:H7 infection of beef calves at weaning, prior to arrival at the feedlot or mixing with cattle from other sources. Fifteen range cow-calf herds, which weaned calves in October and November, were sampled in Kansas, Missouri, Montana, Nebraska and South Dakota. Faecal culture for E. coli O157:H7 was performed and anti-O157 serum antibody titres were determined by blocking ELISA. Thirteen of the 15 herds (87%) were found to have at least one positive isolation of E. coli O157:H7 in faecal samples. Within positive herds, prevalence ranged from 1.7-20.0%, with an average of 7.4+/-6.2% S.D. of individual animals shedding E. coli O157:H7 in faeces. All herds had high prevalence of anti-O157 antibodies, ranging 63-100% of individuals within herds seropositive. This study indicates that E. coli O157:H7 infection before weaning, prior to entry into feedlots, is widespread. Furthermore, serologic evidence suggests that most calves (83%) and all herds (100%) have been exposed to E. coli O157.     

Acute diarrheal infections in infants I. Bacterial and viral causes

This first article of a 2-part series examined the epidemiology, therapy, and prospects for immunoprophylaxis of diarrheal infections in infants. 3 main strains of Escherichia coli can be identifiied with the etiology of infantile diarrhea: enterotoxigenic E. coli, invasive E. coli, and enteropathogenic E. coli. Viral agents may also be the etiological agents. Specific pathogens can be identified in 55-85% of cases of infantile diarrhea today; in the 1960s, only 25-34% of cases could be identified by specific etiology. Rotavirus, the usual viral etiological agent, and shigella, salmonella, campylobacter, and yersinia occur less commonly in summer diarrhea syndrome than does E. coli. Possible mechanisms of infection for each specific pathogen are discussed. For example, enterotoxigenic E. coli infection is thought to proceed by a mechanism similar to that of cholera, where a toxin is released by the organism and attaches to intestinal epithelial cells. Then, part of the toxin molecule migrates to the inner plasma membrane where, by stimulating the adenylate cyclase-cyclic adenosine monophosphate system, it evokes active fluid and electrolyte transport and blockade of sodium and chloride reabsorption, resulting in copius diarrhea. Studies showing the existence of antibody to rotavirus in exposed populations indicate that immunoprophylaxis is conceivable.     

Viral agents of gastroenteritis. Public health importance and outbreak management

Each year, infectious gastroenteritis causes greater than 210,000 children in the United States to be hospitalized and 4-10 million children to die worldwide. Since the mid-1970s, knowledge has increased dramatically concerning the viral agents that are responsible for much of this public health burden. Rotavirus, the most common cause of diarrhea among children, infects virtually every child in the United States by the age of 4 years and causes potentially lethal dehydration in 0.75% of children less than 2 years of age. Other recently identified pathogens include the enteric adenoviruses, calicivirus, astrovirus, and the Norwalk family of agents. Conclusive diagnosis of these viruses requires electron microscopic examination of stool specimens, a laboratory technique that is available only at a few large centers, including CDC. Stool samples from an outbreak that are submitted to CDC for detection of viral pathology should be collected in bulk from 10 ill persons during their first 48 hours of illness, while feces are still liquid, and should be stored at 4 C (not frozen). Acute- and convalescent-phase serum samples should be collected from the same persons, plus from an equal number of controls, during the first week of illness and 3 weeks thereafter. Control measures for outbreaks of viral gastroenteritis should focus on the removal of an ongoing common source of infection (e.g., an ill food handler or the contamination of a water supply) and on the interruption of person-to-person transmission that can perpetuate an outbreak in a population after the common source has been removed. Because improvements in environmental hygiene may not be accompanied by reductions of endemic diarrhea caused by viruses, immunization may play an important role in future control; vaccine trials for rotavirus are in progress. In anticipation of vaccine development and use, CDC recently began national surveillance for the viral agents of gastroenteritis. Health-care facilities involved in the detection of rotavirus or the other viral agents of diarrhea can participate.     

Baylisascaris procyonis in the metropolitan Atlanta area

Baylisascaris procyonis, the raccoon roundworm responsible for fatal larva migrans in humans, has long been thought to be absent from many regions in the southeastern United States. During spring 2002, 11 (22%) of 50 raccoons trapped in DeKalb County, Georgia, had B. procyonis infection. The increasing number of cases highlight this emerging zoonotic infection.     

Susceptibility to antimicrobial agents of enteroaggregative Escherichia coli strains isolated from children with diarrhea

Enteroaggregative Escherichia coli (EAEC) are responsible for infant's persistent secretory diarrhea, traveler's diarrhea and outbreaks. Since isolated all over the world EAEC strains show a low to high level of resistance to antimicrobial agents, the aim of the study was to determine antimicrobial susceptibility and beta-lactamases extended spectrum (ESBL) production in vitro among 55 enteroaggregative E. coli strains isolated from children with diarrhea. Among the 17 antimicrobial agents tested, most of them showed good in vitro activity against EAEC isolates examined, apart from ampicylin and piperacylin (about 30% resistant EAEC strains). Three of 55 examined EAEC isolates were ESBL--producing strains. Because of the presence of ESBL--producing as well as resistant to antimicrobial agents EAEC isolates among enteroaggregative E. coli strains examined, treatment with antibiotics should be undertaken according to antibiogram.     

Seasonal and racial incidence of infantile gastroenteritis in South Africa

The etiology of summer diarrhea, which formerly caused extensive mortality in children living in industrialized countries, was never discovered. This condition no longer occurs in developed countries, having been replaced by winter diarrhea, which is associated with a low mortality. Summer epidemics of diarrhea still take place in black South African infants, whereas, in white South African children, the pattern of diarrhea is similar to that seen in children in industrialized countries today. In 1977-1980, the author studied the records of patients less than two years of age admitted for treatment of dehydrating diarrhea to two teaching hospitals in Johannesburg, the Johannesburg General and Baragwanath Hospitals, which serve the needs of white and black patients, respectively. The incidence of severe diarrhea (i.e., diarrhea necessitating hospitalization) showed highly significant seasonality (p less than 0.001) and distinctive patterns by race. Dehydrating diarrhea in black children was strongly associated with warm weather, while diarrhea in white children occurred more regularly throughout the year, with a peak incidence in late fall. Laboratory studies have shown that bacteria, in particular "classical" enteropathogenic Escherichia coli, are the leading cause of diarrhea in black South African children, and that diarrhea in white children is largely attributable to rotaviruses. The association of enteropathogenic E. coli with diarrhea in black children suggests that these bacteria were responsible for earlier outbreaks of summer diarrhea. The finding that the etiology of diarrhea varies according to socioeconomic class has important implications for diarrhea control programs.     

Changing Relationship between Unemployment and Mortality in South Korea

Over the period from 1989 to 2012, total mortality in South Korea shifted from being weakly procyclical or unrelated to the economy to strongly countercyclical in the early 2000s. Cancers played a significant role in changing the direction of the effects of unemployment on mortality. The overall pattern of the effects of macroeconomic conditions on mortality in South Korea roughly follows the corresponding changes observed in the United States. We have provided evidence that the sudden change in the relationship between economic conditions and mortality was driven by diseases with higher and rapidly rising treatment costs. Copyright © 2016 John Wiley & Sons, Ltd.     

Trends in encephalitis-associated deaths in the United States

The United States national mortality statistics and HIV/AIDS surveillance data were analysed to determine trends in encephalitis-associated deaths and to assess the impact of HIV infection on those deaths during 1979-1998, a period when ICD-9 codes were used for coding deaths in the United States. A total of 25125 encephalitis deaths were reported; 4779 of them (19%) had concurrent HIV infection. Overall encephalitis death rates remained stable, but they increased for groups where HIV infection was common and declined or remained unchanged for others. For persons without HIV infection, the rates declined in all demographic groups. Encephalitis deaths in HIV-infected persons followed general trends for HIV deaths in the United States. The rates in the HIV-infected population were several hundred- to thousand-fold higher than in the HIV-uninfected population. HIV infection was largely responsible for the lack of overall decline in the considerable mortality associated with encephalitis in the United States during 1979-1998.     

Measles--United States, 2005

Measles is a highly infectious, acute viral illness that can be complicated by severe pneumonia, diarrhea, and encephalitis and can result in death. In the prevaccine era, approximately 500,000 cases of measles occurred annually in the United States. During 2005, local and state health departments reported to CDC 66 confirmed cases of measles (incidence rate: less than one case per 1 million population), 34 of which were from a single outbreak in Indiana associated with infection in a traveler returning to the United States. This report describes the epidemiology of U.S. measles cases in 2005 and documents the absence of endemic measles and the continued risk for imported measles infections that can result in transmission within the United States. The findings underscore the need to maintain the highest possible measles vaccination coverage in the United States and to adhere to recommendations regarding measles vaccination.     

Psittacosis outbreak in employees of a turkey-processing plant

In June 1976, 28 employees of a Nebraska poultry processing plant had clinical onset of an illness compatible with psittacosis. The diagnosis was serologically confirmed in 22 patients by fourfold or greater changes in their complement fixation antibody titers, using a Chlamydia group antigen. Lack of serologic response in the remaining patients could not be readily explained by therapy differences, timing of serologic evaluation, or severity of clinical illness. The comparable attack rates in the various processing departments were consistent with an airborne infection. However, results of the investigation also suggested that workers having both frequent contact with turkey tissues and skin injuries were more likely to be infected than other processing workers. The cost of the outbreak for reimbursed medical costs, workmen's compensation, and lost wages was $19,000. A single turkey flock was implicated as the source of infection. This flock had been screened on a voluntary basis for evidence of infection prior to slaughter, using criteria developed by the United States Department of Agriculture. Although the preslaughter screening failed to detect psittacosis infection, two turkeys from the same flock which inadvertently had not been sent to slaught were subsequently found to be infected.     

国内外餐厨垃圾的生物处理及资源化技术进展

分析了美国、日本、韩国、中国的餐厨垃圾产生、处理现状,重点介绍了这些国家在餐厨垃圾生物处理方面的研究进展。蚯蚓堆肥、容器式堆肥成为目前美国、中国的研究及应用热点;韩国、日本则重点着手于非传统方式的餐厨垃圾资源化技术研究,如利用餐厨垃圾生产动物饲料,厌氧消化一生物气回收,浆状好氧降解法处理餐厨垃圾。简述了部分国家关于餐厨垃圾资源化利用方面所制定的相应法规,并提出了今后的工作及研究方向。     

Public health implications of cysticercosis acquired in the United States

Cysticercosis has emerged as a cause of severe neurologic disease in the United States that primarily affects immigrants from Latin America. Moreover, the relevance of cysticercosis as a public health problem has been highlighted by local transmission. We searched the biomedical literature for reports documenting cases of cysticercosis acquired in the United States. A total of 78 cases, principally neurocysticercosis, were reported from 12 states during 1954-2005. A confirmed or presumptive source of infection was identified among household members or close personal contacts of 16 (21%) case-patients. Several factors, including the severe, potentially fatal, nature of cysticercosis; its fecal-oral route of transmission; the considerable economic effect; the availability of a sensitive and specific serologic test for infection by adult Taenia solium tapeworms; and the demonstrated ability to find a probable source of infection among contacts, all provide a compelling rationale for implementation of public health control efforts.     

Zoonotic Leprosy in the Southeastern United States

Nine-banded armadillos (Dasypus novemcinctus) are naturally infected with Mycobacterium leprae and have been implicated in zoonotic transmission of leprosy. Early studies found this disease mainly in Texas and Louisiana, but armadillos in the southeastern United States appeared to be free of infection. We screened 645 armadillos from 8 locations in the southeastern United States not known to harbor enzootic leprosy for M. leprae DNA and antibodies. We found M. leprae–infected armadillos at each location, and 106 (16.4%) animals had serologic/PCR evidence of infection. Using single-nucleotide polymorphism variable number tandem repeat genotyping/genome sequencing, we detected M. leprae genotype 3I-2-v1 among 35 armadillos. Seven armadillos harbored a newly identified genotype (3I-2-v15). In comparison, 52 human patients from the same region were infected with 31 M. leprae types. However, 42.3% (22/52) of patients were infected with 1 of the 2 M. leprae genotype strains associated with armadillos. The geographic range and complexity of zoonotic leprosy is expanding.