Cholera outbreak --- Haiti, October 2010

An outbreak of cholera is ongoing in Haiti. On October 21, 2010, toxigenic Vibrio cholerae O1, serotype Ogawa, biotype El Tor was identified by the National Laboratory of Public Health of the Ministry of Public Health and Population in Haiti. Identification of the isolate was confirmed by CDC. Antimicrobial susceptibility testing of selected V. cholerae O1 isolates conducted at the National Laboratory of Public Health and at CDC demonstrated susceptibility to tetracycline (susceptibility to this drug predicts doxycycline susceptibility), ciprofloxacin, and kanamycin; and resistance to trimethoprim-sulfamethoxazole, furazolidone, nalidixic acid, sulfisoxazole, and streptomycin.     

Update: cholera outbreak --- Haiti, 2010

On October 19, 2010, the Haitian Ministry of Public Health and Population (MSPP) was notified of unusually high numbers of patients from Artibonite and Centre departments who had acute watery diarrhea and dehydration, in some cases leading to death. Within 4 days, the National Public Health Laboratory (LNSP) in Haiti isolated Vibrio cholerae serogroup O1, serotype Ogawa, from stool specimens obtained from patients in the affected areas by an investigation team from MSPP and CDC Haiti. This report describes the investigation of the initial cases, the ongoing outbreak of cholera in Haiti, and initial control measures. Since the initial identification of cholera, the outbreak has expanded to include cases in seven of Haiti's 10 departments and the capital city of Port-au-Prince. As of November 13, MSPP had reported 16,111 persons hospitalized with acute watery diarrhea and 992 cholera deaths, 620 of which occurred among hospitalized patients. Prevention and control measures implemented by MSPP with assistance from governmental and nongovernmental partners include 1) providing better access to treated drinking water; 2) providing education on improvement of sanitation, hygiene, and food preparation practices; 3) advising ill persons to begin using oral rehydration solution immediately and seek health care at the onset of watery diarrhea; 4) enhancing cholera treatment capacity at existing health-care institutions; and 5) establishing cholera treatment centers.     

Update on cholera --- Haiti, Dominican Republic, and Florida, 2010

On October 21, 2010, a cholera outbreak was confirmed by the Haitian National Public Health Laboratory. By November 19, the outbreak had reached every department of the country, and by December 17, a total of 121,518 cases of cholera, resulting in 63,711 hospitalizations and 2,591 deaths, had been reported. By November 16, additional cases of cholera had been confirmed in the neighboring Dominican Republic and in Florida. Several confirmed cases in the Dominican Republic and all confirmed U.S. cases were among travelers from Haiti. This report describes cases of cholera identified in the Dominican Republic and United States and provides recommendations to physicians regarding management of travel-related cases. Travelers who develop watery diarrhea within 5 days after returning from cholera-affected areas should seek health care and report their travel histories. Clinicians should enquire about recent travel when evaluating patients with diarrhea. When cholera is suspected, rehydration should be initiated immediately, a stool specimen should be collected for culture of Vibrio cholerae, and public health authorities should be notified.     

Nonfatal self-inflicted injuries treated in hospital emergency departments--United States, 2000

CDC, in collaboration with the Consumer Product Safety Commission (CPSC), expanded CPSC's National Electronic Injury Surveillance System (NEISS) in July 2000 to include all types and external causes of nonfatal injuries treated in U.S. hospital emergency departments (EDs). This ongoing surveillance system, called NEISS All Injury Program (NEISS-AIP), provides data to calculate national estimates for nonfatal injuries treated in EDs during 2000. This report provides national, annualized, weighted estimates of nonfatal self-inflicted injuries treated in U.S. hospital EDs. Overall, self-inflicted injury rates were highest among adolescents and young adults, particularly females. Most (90%) self-inflicted injuries were the result of poisoning or being cut/pierced with a sharp instrument, and 60% were probable suicide attempts. NEISS-AIP data increase understanding of self-inflicted injuries and can serve as a basis for monitoring trends, facilitating additional research, and evaluating intervention approaches.     

Notes from the field: transplant-transmitted hepatitis B virus --- United States, 2010

On March 29, 2011, CDC was notified about a possible transplant-associated hepatitis B virus (HBV) infection in a liver transplant recipient with no known risk factors for HBV infection. An investigation was begun to learn if other recipients of organs or tissues from the donor had been infected with HBV and to investigate potential sources of the donor's infection.     

Nonfatal physical assault-related injuries treated in hospital emergency departments--United States, 2000

CDC, in collaboration with the Consumer Product Safety Commission (CPSC), expanded CPSC's National Electronic Injury Surveillance System (NEISS) in July 2000 to include all types and external causes of nonfatal injuries treated in U.S. hospital emergency departments (EDs). This ongoing surveillance system, called NEISS All Injury Program (NEISS-AIP), can be used to calculate national, annualized, weighted estimates for nonfatal injuries treated in U.S. hospital EDs. This report summarizes NEISS-AIP data, which indicate that approximately 1.6 million persons were treated in U.S. EDs during 2000 for nonfatal physical (i.e., nonsexual) assault-related injuries. Such injuries occurred disproportionately among males, adolescents, and young adults, particularly among black males; most of these injuries were contusions or lacerations, few of which resulted in hospital admission. NEISS-AIP data can increase understanding of physical assault-related injuries and serve as a basis for monitoring trends, facilitating additional research, and evaluating intervention approaches.     

Nonfatal dog bite-related injuries treated in hospital emergency departments--United States, 2001

In 1994, the most recent year for which published data are available, an estimated 4.7 million dog bites occurred in the United States, and approximately 799,700 persons required medical care. Of an estimated 333,700 patients treated for dog bites in emergency departments (EDs) in 1994, approximately 6,000 (1.8%) were hospitalized. To estimate the number of nonfatal dog bite-related injuries treated in U.S. hospital EDs, CDC analyzed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). This report summarizes the results of the analysis, which indicate that in 2001, an estimated 368,245 persons were treated in U.S. hospital EDs for nonfatal dog bite-related injuries. Injury rates were highest among children aged 5-9 years. To reduce the number of dog bite-related injuries, adults and children should be educated about bite prevention, and persons with canine pets should practice responsible pet ownership.     

National estimates of nonfatal injuries treated in hospital emergency departments--United States, 2000

On July 1, 2000, the Consumer Product Safety Commission's (CPSC) National Electronic Injury Surveillance System (NEISS) was expanded to collect data on all types and external causes of nonfatal injuries and poisonings treated in U.S. hospital emergency departments (EDs). This augmented system, called NEISS All Injury Program (NEISS-AIP), is a collaborative effort between CDC's National Center for Injury Prevention and Control and CPSC. This report presents annualized national estimates using NEISS-AIP data obtained during July 1-September 30, 2000, which indicate that approximately 31,000,000 persons were treated for nonfatal injuries in EDs in 2000. Although most of the injuries were unintentional, an estimated 1,973,000 were violence-related. Data from NEISS-AIP can be used for monitoring temporal trends in nonfatal injuries by mechanism and intent of injury.     

Nonfatal occupational injuries and illnesses treated in hospital emergency departments--United States, 1998

The National Electronic Injury Surveillance System (NEISS) includes data about nonfatal occupational injuries and illnesses treated in U.S. hospital emergency departments (EDs). This report summarizes 1998 injury and illness estimates based on NEISS, which indicate that the magnitude and patterns of nonfatal occupational injuries and illnesses were comparable to estimates reported for 1996 (1). Younger workers continue to have the highest rates of work-related injuries and illnesses; therefore, interventions should address the health and safety needs of young workers, most of whom lack substantial experience in the work place.     

Notes from the field: Vibrio mimicus infection from consuming crayfish --- Spokane, Washington, June 2010

On June 24, 2010, the Spokane (Washington) Regional Health District (SRHD) was notified of two hospitalized patients under intensive care with severe dehydration whose stool specimens yielded Vibrio mimicus. CDC was asked to assist with the environmental and epidemiologic investigation. Investigators learned that both persons had consumed crayfish on June 20, 2010. The previous day, live crayfish obtained from an online seafood company had been boiled and served warm at a party. The chef reported that the boiled crayfish were served out of a cooler that had contained live crayfish, and the cooler had not been cleaned before being used to serve the cooked crayfish. After the party, the remaining crayfish were refrigerated overnight in different containers and served cold as leftovers the following evening on June 20.     

Notes from the field: respiratory diphtheria-like illness caused by toxigenic Corynebacterium ulcerans --- Idaho, 2010

On September 12, 2010, the Idaho Department of Health and Welfare was notified of a case of respiratory diphtheria-like illness in an Idaho man aged 80 years whose pharyngeal specimens yielded Corynebacterium ulcerans. Although C. ulcerans is zoonotic, the patient reported no animal contact or consumption of an unpasteurized dairy product. His vaccination history was unknown. Respiratory diphtheria-like illness from C. ulcerans is uncommon but has been reported in industrialized countries where respiratory diphtheria is rare. The last case of diphtheria-like illness caused by C. ulcerans in the United States was reported in 2005.     

Nonfatal occupational injuries and illnesses among older workers --- United States, 2009

Older workers (defined as those aged ≥ 55 years) represented 19% of the U.S. workforce in 2009* and are the nation's fastest growing segment of the working population (1). To identify occupational safety issues affecting older workers, an analysis of data from the Bureau of Labor Statistics (BLS) Survey of Occupational Injuries and Illnesses (SOII) was conducted by CDC, BLS, and several state partners. This report summarizes the results of that analysis, which indicated that, based on employer reports, an estimated 210,830 nonfatal occupational injuries and illnesses among older workers in 2009 resulted in lost workdays. Although older workers had similar or lower rates for all injuries and illnesses combined compared with younger workers, the length of absence from work increased steadily with age and was highest for older workers (medians of 11 and 12 days for workers aged 55-64 years and ≥ 65 years, respectively). Older workers had higher rates of falls on the same level, fractures, and hip injuries compared with younger workers and workers of all ages. Public health and research agencies should conduct research to better understand the overall burden of occupational injuries and illnesses on older workers, aging-associated risks, and effective prevention strategies. Employers and others should take steps to address specific risks for older workers such as falls (e.g., by ensuring floor surfaces are clean, dry, well-lit, and free from tripping hazardS.)     

Work-related eye injuries treated in hospital emergency departments in the US

BACKGROUND: Eye injuries account for 3.3% of all occupational injuries resulting in lost workdays in private industry in the United States. Work-related eye injuries among individuals 15 years of age and older treated in hospital emergency departments (EDs) in the United States in 1999 were investigated in this study. METHODS: Work-related eye injuries treated in hospital EDs in the US were identified from the Work-Related Injury Statistics Query System (Work-RISQS). National estimates of the numbers and rates per 10,000 full-time worker equivalents (FTE) of work-related eye injuries were determined by gender and age. The characteristics of these injuries were described, including the injury event, the main source of injury, injury diagnosis, and the disposition of the injured patient. RESULTS: In 1999, there were approximately 280,000 (95% confidence interval (CIs) +/- 66,400) work-related eye injuries treated in hospital EDs, with individuals 20-34 years of age at highest risk for work-related eye injury. Foreign-bodies in the eye and chemical burns were among the most common types of work-related eye injuries. CONCLUSIONS: The findings of this study underscore the need for use of appropriate eye protection and implementation, and enforcement of eye protection policies in the workplace to prevent work-related eye injuries.     

口腔医院护工锐器伤现况调查

摘要:目的　了解口腔医院护工锐器伤的发生情况,为制定口腔医院护工锐器伤规范化防护措施提供理论依据。方法　采用卫生部设计的《医务人员锐器伤筛查表》,对某院55名护工人员对过去1个月中锐器损伤的发生情况进行问卷调查。结果　护工锐器伤发生率为21.8%（12/55）,发生密度为 0.47次/（人.月）;年限≤1年的护工锐器伤发生率最高,为61.1%;接受过培训的护工锐器损伤发生率（18.5%）明显低于未培训的护士（39.3%）。结论　口腔医院护工是锐器伤发生的高危人群,通过针对性预防和干预,可有效地降低锐器伤发生率。     

Nonfatal occupational injuries and illnesses among workers treated in hospital emergency departments--United States, 2003

CDC's National Institute for Occupational Safety and Health (NIOSH) collects data on nonfatal occupational injuries and illnesses through the National Electronic Injury Surveillance System (NEISS), an emergency department (ED)-based surveillance system. This report summarizes data for 2003. The overall number and rate of occupational injuries and illnesses did not change substantially during the 5-year period since data were last reported in 1998. In 2003, age-, sex-, and diagnosis-related patterns of injury and illness among workers treated in EDs (ED-treated injuries/illnesses) were similar to those reported in 1998. To achieve substantial decreases in these injuries and illnesses, prevention efforts must focus on effective, targeted workplace-safety interventions for diverse occupations.     

Occupational hand injuries treated at a tertiary care facility in western Turkey

The study was designed to investigate characteristics of work-related hand injuries (WRHI) referred to a University hospital emergency department (ED) in an industrialized region as well as to supply data for preventive strategies. All patients with WRHI referred to the University-based ED in the two-year period were investigated. Sociodemographic and injury-related clinical information were analyzed. Out of 746 patients who were admitted to the ED due to occupational injuries within the two-year study period, 244 (32.7%) with isolated wrist, hand and finger injuries were included in the study. Male patients constituted the majority 87.2% (n=213) and 57.0% (n=139) of the patients were between 25 and 34 yr of age. WRHI recorded in industries involving metal and machinery constituted 41.4% (n=101) of all injuries. The sites of injuries were not significantly affected by differences in age, social security status and sectors. The most common types of injury were lacerations, punctures, and abrasions (40.2%, n=98). There was a statistically insignificant rise in amputation injuries with increasing age. Incidences, etiologies and characteristics of WRHI should be highlighted and preventive strategies based on these facts be implemented due to higher level of suffering and more serious consequences attributed to this specific injury.     

Notes from the field: malaria imported from West Africa by flight crews --- Florida and Pennsylvania, 2010

On September 15, 2010, CDC notified the Florida and Pennsylvania departments of health of four Plasmodium falciparum--associated malaria cases among employees of a single commercial airline. All four employees had traveled to Accra, Ghana, during August 25-September 2, 2010, two of whom were on the same flight. Their duration of stay in Accra ranged from 48 to 80 hours. All had stayed at the same hotel and spent time outdoors near the swimming pool, in restaurants without air conditioning, and in other locations during the evening and night.     

Notes from the field: emergence of Shigella flexneri 2a resistant to ceftriaxone and ciprofloxacin --- South Carolina, October 2010

On October 20, 2010, the South Carolina Department of Health and Environmental Control and CDC began investigating a cluster of three diarrheal illnesses caused by multidrug-resistant Shigella flexneri 2a. The index case occurred in a girl aged 2 years who experienced the onset of diarrhea on September 25 and was hospitalized the next day because of a seizure and fever. On September 30, her brother, aged 6 years, was hospitalized with vomiting, bloody diarrhea, and hyponatremia. Three days later, her father was hospitalized with vomiting, bloody diarrhea, and hyponatremia.     

Notes from the field: hantavirus pulmonary syndrome --- Maine, April 2011

On April 25, 2011, the Maine Center for Disease Control and Prevention was notified of a suspected case of hantavirus pulmonary syndrome (HPS) in a man aged 70 years with no recent out-of-state travel. The Maine resident went to a community hospital in early April with a 5-day history of fatigue, decreased appetite, weakness, chills, myalgias, and progressive shortness of breath. On examination, he was hypoxic and tachypneic. The patient was admitted with laboratory evidence of acute renal insufficiency, leukocytosis and thrombocytopenia, and appearance of diffuse bilateral infiltrates on chest radiograph. Two days later, he was transferred to a tertiary-care facility for management of respiratory failure with hypoxemia and worsening renal insufficiency. The next day, he was intubated and mechanically ventilated. Serum specimens demonstrated high titers of hantavirus reactive immunoglobulin M (1:6,400) and immunoglobulin G (1:1,600) antibodies. Hantavirus RNA was detected in the patient's blood. The patient was discharged to a skilled nursing facility 1 month after admission and is recovering with extensive rehabilitation.