Canine Infections with Onchocerca lupi Nematodes,United States, 2011–2014

Infections with Onchocerca lupi nematodes are diagnosed sporadically in the United States. We report 8 cases of canine onchocercosis in Minnesota, New Mexico, Colorado, and Florida. Identification of 1 cytochrome c oxidase subunit 1 gene haplotype identical to 1 of 5 from Europe suggests recent introduction of this nematode into the United States.     

Mycoplasma pneumoniae and Chlamydia spp. Infection in Community-Acquired Pneumonia,Germany, 2011–2012

Mycoplasma pneumoniae and Chlamydia spp., which are associated with community-acquired pneumonia (CAP), are difficult to propagate, and can cause clinically indistinguishable disease patterns. During 2011–2012, we used molecular methods to test adult patients in Germany with confirmed CAP for infection with these 2 pathogens. Overall, 12.3% (96/783) of samples were positive for M. pneumoniae and 3.9% (31/794) were positive for Chlamydia spp.; C. psittaci (2.1%) was detected more frequently than C. pneumoniae (1.4%). M. pneumoniae P1 type 1 predominated, and levels of macrolide resistance were low (3.1%). Quarterly rates of M. pneumoniae–positive samples ranged from 1.5% to 27.3%, showing a strong epidemic peak for these infections, but of Chlamydia spp. detection was consistent throughout the year. M. pneumoniae–positive patients were younger and more frequently female, had fewer co-occurring conditions, and experienced milder disease than did patients who tested negative. Clinicians should be aware of the epidemiology of these pathogens in CAP.     

Endoparasites of Rodents and Their Zoonotic Importance in Germi,Dashte–Mogan,Ardabil Province,Iran

Background

In order to verify the infectivity of rodents with endoparasites in Germi (Dashte-Mogan, Ardabil Province) the current study was undertaken.

Methods

Using live traps, 177 rodents were trapped during 2005–2007. In field laboratory, all rodents were bled prior to autopsy, frozen at −20°C, and shipped to the School of Public Health, Tehran University of Medical Sciences, Iran. In parasitological laboratory, every rodent was dissected and its different organs were examined for the presence of any parasite. Blood thick and thin smears as well as impression smears of liver and spleen were stained with Geimsa and examined microscopically.

Results

Two species of rodents were trapped; Meriones persicus (90.4%) and Microtus socialis (9.6%). The species of parasites found in M. persicus and their prevalences were as follows: Hymenolepis diminuta (38.8%), Hymenolepis nana (2.5%), Trichuris sp.(40.6), Mesocestoides larva (=tetrathyridium) (3.1%), Capillaria hepatica (6.9%), Moniliformis moniliformis (11.3%), Syphacia obvelata (2.5%), Taenia endothoracicus larva (0.6%), Physaloptera sp. (0.6%), Dentostomella translucida (0.6%), Heligmosomum mixtum (0.6%), Strobilocercus fasciolaris (0.6%),and Aspiculuris tetraptera (0.6%). The species of parasites found in M. socialis and their prevalences were as follows: H. diminuta (17.6%), Trichuris sp. (5.9%), Mesocestoides larva (5.9%), S. obvelata (11.8%), S. syphacia (11.8%), H. mixtum (17.6%), and Aspiculuris tetraptera (11.8%). There were no statistical differences between male and female for infectivity with parasites in either M. persicus or M. socialis. No blood or tissue protozoan parasite was found in any of the rodents examined.

Conclusion

Among different species identified, some had zoonotic importance. Therefore, the potential health hazard of these species needs to be considered to prevent infectivity of humans.     

Zoonotic Mycobacterium bovis–induced Tuberculosis in Humans

We aimed to estimate the global occurrence of zoonotic tuberculosis (TB) caused by Mycobacterium bovis or M. caprae infections in humans by performing a multilingual, systematic review and analysis of relevant scientific literature of the last 2 decades. Although information from many parts of the world was not available, data from 61 countries suggested a low global disease incidence. In regions outside Africa included in this study, overall median proportions of zoonotic TB of ≤1.4% in connection with overall TB incidence rates ≤71/100,000 population/year suggested low incidence rates. For countries of Africa included in the study, we multiplied the observed median proportion of zoonotic TB cases of 2.8% with the continental average overall TB incidence rate of 264/100,000 population/year, which resulted in a crude estimate of 7 zoonotic TB cases/100,000 population/year. These generally low incidence rates notwithstanding, available data indicated substantial consequences of this disease for some population groups and settings.     

Severe Influenza-associated Respiratory Infection in High HIV Prevalence Setting,South Africa, 2009–2011

Data on influenza epidemiology in HIV-infected persons are limited, particularly for sub-Saharan Africa, where HIV infection is widespread. We tested respiratory and blood samples from patients with acute lower respiratory tract infections hospitalized in South Africa during 2009–2011 for viral and pneumococcal infections. Influenza was identified in 9% (1,056/11,925) of patients enrolled; among influenza case-patients, 358 (44%) of the 819 who were tested were infected with HIV. Influenza-associated acute lower respiratory tract infection incidence was 4–8 times greater for HIV-infected (186–228/100,000) than for HIV-uninfected persons (26–54/100,000). Furthermore, multivariable analysis showed HIV-infected patients were more likely to have pneumococcal co-infection; to be infected with influenza type B compared with type A; to be hospitalized for 2–7 days or >7 days; and to die from their illness. These findings indicate that HIV-infected persons are at greater risk for severe illnesses related to influenza and thus should be prioritized for influenza vaccination.     

Efficiency and productivity assessment of public hospitals in Greece during the crisis period 2009–2012

Background

This study is an initial effort to examine the dynamics of efficiency and productivity in Greek public hospitals during the first phase of the crisis 2009–2012. Data were collected by the Ministry of Health after several quality controls ensuring comparability and validity of hospital inputs and outputs. Productivity is estimated using the Malmquist Indicator, decomposing the estimated values into efficiency and technological change.

Methods

Hospital efficiency and productivity growth are calculated by bootstrapping the non-parametric Malmquist analysis. The advantage of this method is the estimation efficiency and productivity through the corresponding confidence intervals. Additionally, a Random-effects Tobit model is explored to investigate the impact of contextual factors on the magnitude of efficiency.

Results

Findings reveal substantial variations in hospital productivity over the period from 2009 to 2012. The economic crisis of 2009 had a negative impact in productivity. The average Malmquist Productivity Indicator (MPI) score is 0.72 with unity signifying stable production. Approximately 91% of the hospitals score lower than unity. Substantial increase is observed between 2010 and 2011, as indicated by the average MPI score which fluctuates to 1.52. Moreover, technology change scored more than unity in more than 75% of hospitals. The last period (2011–2012) has shown stabilization in the expansionary process of productivity. The main factors contributing to overall productivity gains are increases in occupancy rates, type and size of the hospital.

Conclusions

This paper attempts to offer insights in efficiency and productivity growth for public hospitals in Greece. The results suggest that the average hospital experienced substantial productivity growth between 2009 and 2012 as indicated by variations in MPI. Almost all of the productivity increase was due to technology change which could be explained by the concurrent managerial and financing healthcare reforms. Hospitals operating under decreasing returns to scale could achieve higher efficiency rates by reducing their capacity. However, certain social objectives should also be considered. Emphasis perhaps should be placed in utilizing and advancing managerial and organizational reforms, so that the benefits of technological improvements will have a continuing positive impact in the future.

     

Schmallenberg Virus Infection among Red Deer,France, 2010–2012

Schmallenberg virus infection is emerging in European domestic and wild ruminants. We investigated the serologic status of 9 red deer populations to describe virus spread from September 2010 through March 2012 among wildlife in France. Deer in 7 populations exhibited seropositivity, with an average seroprevalence of 20%.     

Outbreak of Panton-Valentine Leukocidin–Associated Methicillin-Susceptible Staphylococcus aureus Infection in a Rugby Team,France, 2010–2011

Staphylococcus aureus strains that produce Panton-Valentine leukocidin are known to cause community infections. We describe an outbreak of skin abscesses caused by Panton-Valentine leukocidin–producing methicillin-susceptible S. aureus (clonal complex 121) in a professional rugby team in France during July 2010–February 2011. Eight team members were carriers; 7 had skin abscesses.     

Kyasanur Forest Disease,India, 2011–2012

To determine the cause of the recent upsurge in Kyasanur Forest disease, we investigated the outbreak that occurred during December 2011–March 2012 in India. Male patients >14 years of age were most commonly affected. Although vaccination is the key strategy for preventing disease, vaccine for boosters was unavailable during 2011, which might be a reason for the increased cases.     

Trends in food availability in Portugal in 1966–2003

BACKGROUND: Dietary intake has changed considerably in South European countries, but whether those changes were similar between countries is currently unknown. AIM OF THE STUDY: To assess the trends in food availability in Portugal and four other Mediterranean countries from 1966 to 2003. METHODS: Food and Agricultural Organization food balance sheets from Portugal, France, Italy, Greece and Spain. Trends were assessed by linear regression. RESULTS: The per capita availability of calories has increased in Portugal, France, Greece, Italy and Spain in the past 40 years. Portugal presented the most rapid growth with an annual increase of 28.5 +/- 2.2 kcal (slope +/- standard error), or +1000 kcal overall. In animal products, Portugal had an annual increase of 20.7 +/- 0.9 kcal, much higher than the other four countries. Conversely, the availabilities of vegetable and fruit only showed a slight growth of 1.0 +/- 0.1 kcal/year and 2.5 +/- 0.4 kcal/year, respectively, thus increasing the ration of animal to vegetable products. Olive oil availability increased in all countries with the notable exception of Portugal, where a significant decrease was noted. Wine supply decreased in all five countries; in contrast, beer supply started to take up more alcohol share. Percentage of total calories from fat increased from nearly 25% to almost 35% in Portugal during the study period, mainly at the expenses of calories from carbohydrates, whereas the share of protein showed just a slight increase. Furthermore, fat and protein were increasingly provided by animal products. CONCLUSIONS: Portugal is gradually moving away from the traditional Mediterranean diet to a more Westernized diet as well as France, Greece, Italy and Spain. Noticeably, the trends of diet transition were observed relatively faster in Portugal than in the other four Mediterranean countries.     

Measles incidence and reporting trends in Germany, 2007–2011

Objective

We aimed to quantify progress towards measles elimination in Germany from 2007 to 2011 and to estimate any potential underreporting over this period.

Methods

We determined the annual incidence of notified cases of measles – for each year – in northern, western, eastern and southern Germany and across the whole country. We then used measles-related health insurance claims to estimate the corresponding incidence.

Findings

In each year between 2007 and 2011, there were 6.9–19.6 (mean: 10.8) notified cases of measles per million population. Incidence decreased with age and showed geographical variation, with highest mean incidence – 20.3 cases per million – in southern Germany. Over the study period, incidence decreased by 10% (incidence rate ratio, IRR: 0.90; 95% confidence interval, CI: 0.85–0.95) per year in western Germany but increased by 77% (IRR: 1.77; 95% CI: 1.62–1.93) per year in eastern Germany. Although the estimated incidence of measles based on insurance claims showed similar trends, these estimates were 2.0- to 4.8-fold higher than the incidence of notified cases. Comparisons between the data sets indicated that the underreporting increased with age and was generally less in years when measles incidence was high than in low-incidence years.

Conclusion

Germany is still far from achieving measles elimination. There is substantial regional variation in measles epidemiology and, therefore, a need for region-specific interventions. Our analysis indicates underreporting in the routine surveillance system between 2007 and 2011, especially among adults.     

Prevalence and Treatment of Latent Tuberculosis Infection Among Newly Arrived Refugees in San Diego County,January 2010–October 2012

Objectives. We determined the prevalence and treatment rates of latent tuberculosis infection (LTBI) in newly arrived refugees in San Diego County, California, and assessed demographic and clinical characteristics associated with these outcomes.Methods. We analyzed data from LTBI screening results of 4280 refugees resettled in San Diego County between January 2010 and October 2012. Using multivariate logistic regression, we calculated the associations between demographic and clinical risk factors and the outcomes of LTBI diagnosis and LTBI treatment initiation.Results. The prevalence of LTBI was highest among refugees from sub-Saharan Africa (43%) and was associated with current smoking and having a clinical comorbidity that increases the risk for active tuberculosis. Although refugees from sub-Saharan Africa had the highest prevalence of infection, they were significantly less likely to initiate treatment than refugees from the Middle East. Refugees with postsecondary education were significantly more likely to initiate LTBI treatment.Conclusions. Public health strategies are needed to increase treatment rates among high-risk refugees with LTBI. Particular attention is required among refugees from sub-Saharan Africa and those with less education.Tuberculosis (TB) in the United States is primarily a disease of foreign-born people. In 2011, approximately 62% of all incident TB cases within the United States occurred among foreign-born individuals, a proportion that has been increasing steadily since 2001.1–3 Within the first few years after arrival in the United States, immigrants and refugees from countries in which TB is highly endemic have been found to develop active TB at rates more similar to incidence rates in their home countries than those of the United States, which has been documented to be largely because of reactivation of latent TB infection (LTBI) acquired abroad.4–8 Among foreign-born people in the United States, the risk for active TB is particularly elevated for immigrants and refugees from sub-Saharan Africa and Southeast Asia.2,3 A recent study found that the TB case rate among Africans in the United States was 3 times higher than that among other foreign-born people and 27 times higher than that among US-born people, a finding attributed to the large burden of LTBI in this population.9Refugees resettling in the United States have typically originated from regions with high rates of active TB, including Southeast Asia and sub-Saharan Africa. In addition, previous studies have documented that refugees have higher rates of TB after resettlement in the United States than other foreign-born people.10,11 Although active TB disease among refugees is usually diagnosed and treated before departure for the United States,12 the treatment of LTBI before arrival in the United States is not mandated. To prevent the reactivation of LTBI after arrival to the United States, the Centers for Disease Control and Prevention currently recommends screening for and treating LTBI among all recently arrived refugees.8,13Despite the Centers for Disease Control and Prevention’s recommendation, there has been only limited assessment of the prevalence, epidemiology, and treatment rates of LTBI among newly arrived refugees in the United States. Previous studies of LTBI among refugees in the United States14–17 were primarily conducted during the previous decade and do not reflect changes in the demographics of more recent refugee arrivals. Additionally, few reported LTBI treatment completion rates. The majority of these studies were also conducted before the introduction of interferon γ release assays, TB screening tests that provide a more accurate diagnosis of LTBI because of their higher specificity than the tuberculin skin test.18,19Between 2010 and 2012, California received almost 10% of the 187 966 refugees settled in the United States, making it one of the largest resettlement regions in the country.20–22 San Diego County, in Southern California, is a leading refugee resettlement site, and it also has one of the highest rates of active TB in the country, with an incidence rate of 8.4 cases per 100 000 people in 2011.23,24 Assessment of LTBI prevalence and treatment among recently arrived refugees is needed to effectively address the control of TB, because untreated, reactivated LTBI in this population may be an important contributor to TB incidence in the United States.8 This information is critical for public health departments that provide care for refugee populations, not only to ensure the health of individual refugees, but also to prioritize efforts to reduce the disproportionately high rate of active TB among foreign-born people in the United States. In this study, we investigated LTBI prevalence by birth region and clinical risk factors, and identified demographic and clinical factors associated with LTBI treatment initiation and completion among newly arrived refugees diagnosed with LTBI in San Diego County from January 1, 2010, through October 1, 2012.     

Socioeconomic Status and Foodborne Pathogens in Connecticut,USA, 2000–2011

Foodborne pathogens cause >9 million illnesses annually. Food safety efforts address the entire food chain, but an essential strategy for preventing foodborne disease is educating consumers and food preparers. To better understand the epidemiology of foodborne disease and to direct prevention efforts, we examined incidence of Salmonella infection, Shiga toxin–producing Escherichia coli infection, and hemolytic uremic syndrome by census tract–level socioeconomic status (SES) in the Connecticut Foodborne Diseases Active Surveillance Network site for 2000–2011. Addresses of case-patients were geocoded to census tracts and linked to census tract–level SES data. Higher census tract–level SES was associated with Shiga toxin–producing Escherichia coli, regardless of serotype; hemolytic uremic syndrome; salmonellosis in persons ≥5 years of age; and some Salmonella serotypes. A reverse association was found for salmonellosis in children <5 years of age and for 1 Salmonella serotype. These findings will inform education and prevention efforts as well as further research.     

Recommendations and offers for adult influenza vaccination, 2011–2012 season,United States

BackgroundProvider recommendations and offers for influenza vaccination improve adult influenza vaccination coverage. Analysis was performed to describe receipt of influenza vaccination recommendations and offers among adults who visited a healthcare provider (HCP) during the 2011–2012 influenza season and describe differences between those receiving and not receiving recommendations and offers for influenza vaccination. Associations between influenza vaccination and receipt of recommendations and offers were examined.MethodsRespondents to a random digit dial telephone survey who had visited a HCP since July 1, 2011 were asked if they had received a recommendation for influenza vaccination. Those receiving a recommendation were asked if they received an offer for vaccination. Participants were characterized by demographic and access to health care variables. Logistic regression was used to examine the relationships between participant characteristics and recommendation alone, between participant characteristics and recommendation and offer, and between influenza vaccination and recommendation and offer.ResultsOf those who reported visiting a HCP, 43.8% reported receiving a recommendation for influenza vaccination. Of those who reported receiving a recommendation, 76.6% reported receiving an offer for influenza vaccination. Persons with high-risk conditions and persons over 65 years were more likely to receive recommendations for influenza vaccination when compared to those without high-risk conditions and 18–49 year olds, respectively. Those reporting receipt of a recommendation and offer for influenza vaccination were 1.76 times more likely and those reporting receipt of a recommendation but no offer were 1.72 times more likely to report being vaccinated for influenza controlling for all patient characteristics.ConclusionsLess than half of respondents reported receipt of recommendations and offers of influenza vaccination during the 2011–2012 influenza season and disparities exist between groups. All healthcare providers seeing adults should recommend or offer influenza vaccination for all patients at every visit during the influenza season.     

Health Care–Associated Infection Outbreak Investigations in Outpatient Settings,Los Angeles County,California, USA, 2000?2012

Health care services are increasingly delivered in outpatient settings. However, infection control oversight in outpatient settings to ensure patient safety has not improved and literature quantifying reported health care–associated infection outbreaks in outpatient settings is scarce. The objective of this analysis was to characterize investigations of suspected and confirmed outbreaks in outpatient settings in Los Angeles County, California, USA, reported during 2000–2012, by using internal logs; publications; records; and correspondence of outbreak investigations by characteristics of the setting, number, and type of infection control breaches found during investigations, outcomes of cases, and public health responses. Twenty-eight investigations met the inclusion criteria. Investigations occurred frequently, in diverse settings, and required substantial public health resources. Most outpatient settings investigated had >1 infection control breach. Lapses in infection control were suspected to be the outbreak source for 16 of the reviewed investigations.     

Estimated Latent Tuberculosis Infection Prevalence and Tuberculosis Reactivation Rates Among Non-U.S.-Born Residents in the United States,from the 2011–2012 National Health and Nutrition Examination Survey

Journal of Immigrant and Minority Health - Increased testing and treatment of latent tuberculosis infection (LTBI) among US-residents who were born (or lived) in countries with high rates of TB can...