Influenza-associated Hospitalizations and Deaths,Costa Rica, 2009–2012

Data needed to guide influenza vaccine policies are lacking in tropical countries. We multiplied the number of severe acute respiratory infections by the proportion testing positive for influenza. There were ≈6,699 influenza hospitalizations and 803 deaths in Costa Rica during 2009–2012, supporting continuation of a national influenza vaccine program.     

Association of Melioidosis Incidence with Rainfall and Humidity,Singapore, 2003–2012

Soil has been considered the natural reservoir for the bacterium Burkholderia pseudomallei, which causes melioidosis. We examined 550 melioidosis cases that occurred during a 10-year period in the highly urbanized city of Singapore, where soil exposure is rare, and found that rainfall and humidity levels were associated with disease incidence.     

Case-based Surveillance of Influenza Hospitalizations during 2004�C2008, Colorado, USA

Colorado became the first state to make laboratory-confirmed influenza-associated hospitalizations a case-based reportable condition in 2004. We summarized surveillance for influenza hospitalizations in Colorado during the first 4 recorded influenza seasons (2004–2008). We highlight the similarities and differences among influenza seasons; no 2 seasons were entirely the same. The 2005–06 influenza season had 2 distinct waves of activity (types A and B), the 2006–07 season was substantially later and milder, and 2007–08 had substantially greater influenza B activity. The case-based surveillance for influenza hospitalizations provides information regarding the time course of seasonal influenza activity, reported case numbers and population-based rates by age group and influenza virus type, and a measure of relative severity. Influenza hospitalization surveillance provides more information about seasonal influenza activity than any other surveillance measure (e.g., surveillance for influenza-like illness) currently in widespread use among states. More states should consider implementing case-based surveillance for influenza hospitalizations.     

Respiratory Illness Hospitalizations Among Pregnant Women During Influenza Season, 1998–2008

To examine health care burden, pregnancy outcomes and impact of high risk medical conditions among pregnancy hospitalizations during influenza season. Length of stay, hospitalization charges, and delivery complications were compared between hospitalizations with and without respiratory illness and compared by presence of high risk medical conditions. Length of stay and hospital charges were significantly increased among respiratory illness hospitalizations versus non-respiratory hospitalizations. Among respiratory illness hospitalization, the odds of intrauterine fetal demise were increased (adjusted odds ratio (aOR) 2.50, 95 % confidence interval (CI) 1.97–3.18). Among live births, there were higher odds of preterm delivery (aOR 3.82, 95 % CI 3.53–4.14), cesarean delivery (aOR 3.47, 95 % CI 3.22–3.74), and fetal distress (aOR 2.33, 95 % CI 2.15–2.52). The presence of high risk medical conditions did not impact pregnancy outcomes. Among pregnant women hospitalized during influenza season, those with respiratory illness were more likely than those without respiratory illness to have poor perinatal outcomes, regardless of the presence of high risk conditions. Efforts to minimize influenza morbidity, including universal vaccination and early antiviral therapy should be promoted among all pregnant women.     

Chronic Liver Disease-Associated Hospitalizations Among Adults with Diabetes,National Inpatient Sample, 2001–2012

Objective

Many people with diabetes have a variety of diabetes-related complications. Among the variety of conditions associated with diabetes, however, liver diseases are less well recognized. As such, we aimed to describe chronic liver disease (CLD)-associated hospitalization rates among U.S. adults with diabetes from 2001–2012.

Methods

We used a nationally representative database of hospitalizations, the National Inpatient Sample, to determine CLD-associated hospitalization rates among U.S. adults aged ≥18 years with and without diabetes, from 2001–2012. Hospitalizations listing an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for CLD on the discharge record were selected for analysis and were further classified by diabetes status based on concurrent presence of a diabetes ICD-9-CM code. We calculated average annual age-adjusted hospitalization rates and 95% confidence intervals (CIs), and conducted a test for trend.

Results

For 2001–2012, the total age-adjusted CLD-associated hospitalization rate among adults with diabetes (1,680.9 per 100,000 population; 95% CI 1,577.2, 1,784.6) was approximately four times the rate of adults without diabetes (424.2 per 100,000 population; 95% CI 413.4, 435.1). Total age-adjusted hospitalization rates of adults with and without diabetes increased 59% and 48%, respectively, from 2001–2002 to 2011–2012 (p<0.001). Hepatitis C- and chronic hepatitis and cirrhosis-associated hospitalizations comprised the largest proportion of total CLD-associated hospitalizations among adults with and without diabetes.

Conclusion

Providers should be aware of the potential existence of CLD among adults with diabetes and counsel patients on preventive methods to avoid progressive liver damage.Approximately 11% of U.S. adults, or 25.6 million people, have diabetes mellitus. Diagnosed diabetes accounts for 73% of all cases of diabetes.¹ The number of Americans diagnosed with diabetes has more than tripled over the years, from approximately 6 million in 1980 to 21 million in 2011.² Type 2 diabetes, usually beginning with insulin resistance, comprises 90% to 95% of diagnosed diabetes cases among adults.¹ Insulin resistance and type 2 diabetes are associated with chronic liver disease (CLD), which has also increased in prevalence among U.S. adults, from 12% during 1988–1994 to 15% during 2005–2008.³ The spectrum of CLD associated with diabetes includes nonalcoholic fatty liver disease, cirrhosis, hepatocellular carcinoma, and viral hepatitis.^3–15Despite the increasing prevalence of both type 2 diabetes and CLD and the wide spectrum of CLD associated with diabetes, few studies have explored CLD-associated hospitalizations among adults with diabetes. We used hospital discharge data from the 2001–2012 National Inpatient Sample (NIS) to estimate CLD-associated hospitalizations among adults aged ≥18 years with and without diabetes.¹⁶     

Leptospirosis-Associated Hospitalizations,United States, 1998–2009

A small percentage of persons with leptospirosis, a reemerging zoonosis, experience severe complications that require hospitalization. The number of leptospirosis cases in the United States is unknown. Thus, to estimate the hospitalization rate for this disease, we analyzed US hospital discharge records for 1998–2009 for the total US population by using the Nationwide Inpatient Sample. During that time, the average annual rate of leptospirosis-associated hospitalizations was 0.6 hospitalizations/1,000,000 population. Leptospirosis-associated hospitalization rates were higher for persons >20 years of age and for male patients. For leptospirosis-associated hospitalizations, the average age of patients at admission was lower, the average length of stay for patients was longer, and hospital charges were higher than those for nonleptospirosis infectious disease–associated hospitalizations. Educating clinicians on the signs and symptoms of leptospirosis may result in earlier diagnosis and treatment and, thereby, reduced disease severity and hospitalization costs.     

Hospitalizations and Deaths Associated with Clostridium difficile Infection, Finland, 1996�C2004

To determine whether the rate of Clostridium difficile–associated disease (CDAD) and CDAD-related deaths were increasing in Finland, we analyzed registry data from 1996 through 2004. We determined the number of hospital discharges that had a diagnosis code specific for CDAD from the International Classification of Diseases, 10th revision: “enterocolitis due to Clostridium difficile” (A04.7) and “pseudomembranous enterocolitis associated with antimicrobial therapy” (K52.8), listed as any diagnosis in the National Hospital Discharge Registry. CDAD-related deaths were identified from death certificates. Those discharged with a CDAD diagnosis doubled from 810 (16/100,000 population) in 1996 to 1,787 (34/100,000) in 2004. The increase was most prominent for patients >64 years of age but concerned only those discharged with diagnosis code A04.7. The number of those discharged with diagnosis code K52.8 remained stable. The age-standardized mortality rate associated with CDAD increased from 9/million in 1998 to 17/million in 2004; the increase was limited to persons >64 years of age.     

Sporotrichosis-Associated Hospitalizations,United States, 2000–2013

To determine frequency and risk for sporotrichosis-associated hospitalizations, we analyzed the US 2000–2013 National (Nationwide) Inpatient Sample. An estimated 1,471 hospitalizations occurred (average annual rate 0.35/1 million persons). Hospitalizations were associated with HIV/AIDS, immune-mediated inflammatory diseases, and chronic obstructive pulmonary disease. Although rare, severe sporotrichosis should be considered for at-risk patients.Key words: sporotrichosis, epidemiology, mycoses, fungi, hospitalization, United States, USASporotrichosis is a fungal disease caused by the Sporothrix schenckii species complex (1). In the environment, S. schenckii is commonly associated with decaying plant matter, soil, and sphagnum moss (2). Infection usually occurs through cutaneous inoculation of the organism and typically is a disease of the skin, subcutaneous tissue, and lymph nodes. Less commonly, disseminated forms of disease can occur if infection spreads from primary to secondary body sites, and pulmonary disease can occur if conidia are inhaled (3). Extracutaneous sporotrichosis typically develops in persons with immunosuppression, chronic obstructive pulmonary disease (COPD), diabetes mellitus, or alcoholism (2). Infections are usually sporadic, but outbreaks have been associated with traumatic skin injury sustained during outdoor work or with zoonotic spread from infected animals (4,5). Considered rare in the United States, sporotrichosis is not a reportable disease, and most information about its epidemiology comes from outbreak investigations.To develop nationally representative estimates and to assess underlying conditions associated with sporotrichosis-associated hospitalizations, we analyzed data from the Healthcare Cost and Utilization Project (HCUP). This family of databases, sponsored by the Agency for Healthcare Research and Quality, comprises the largest collection of publicly available all-payer healthcare data in the United States.     

Levofloxacin-Resistant Haemophilus influenzae,Taiwan, 2004–2010

Levofloxacin resistance in Haemophilus influenzae has increased significantly in Taiwan, from 2.0% in 2004 to 24.3% in 2010 (p<0.001). Clinical and molecular investigations of 182 levofloxacin-resistant isolates revealed that the increase was mainly the result of the spread of several clones in the elderly population in different regions.     

Rates of Influenza-like Illness and Winter School Breaks,Chile, 2004–2010

To determine effects of school breaks on influenza virus transmission in the Southern Hemisphere, we analyzed 2004–2010 influenza-like–illness surveillance data from Chile. Winter breaks were significantly associated with a two-thirds temporary incidence reduction among schoolchildren, which supports use of school closure to temporarily reduce illness, especially among schoolchildren, in the Southern Hemisphere.     

Human Cutaneous Anthrax,Georgia 2010–2012

We assessed the occurrence of human cutaneous anthrax in Georgia during 2010–-2012 by examining demographic and spatial characteristics of reported cases. Reporting increased substantially, as did clustering of cases near urban centers. Control efforts, including education about anthrax and livestock vaccination, can be directed at areas of high risk.     

Gentrification and Preterm Birth in New York City, 2008–2010

Adverse birth outcomes have been linked to neighborhood level socioeconomic status. However, little work has examined the influence of social and economic change over time (i.e., gentrification) on health. This study aims to assess the association between gentrification and preterm birth (PTB) while examining the modifying effect of maternal race/ethnicity and educational attainment. New York City births, 2008–2010, (n = 126,165) were linked to a measure of gentrification at the community district level (n = 59). The gentrification measure was calculated using percent change in education level, poverty level, and median household income (MHI) between the 2005–2009 American Community Survey and the 1990 Census. PTB was defined as clinical gestational age less than 37 weeks. Generalized estimating equations were utilized to examine the association. Gentrification (i.e., increase in residents with a college education, increase in MHI, and decrease in residents living below the poverty line) was not associated with PTB. However, among Non-Hispanic Blacks, very high gentrification was adversely associated with PTB (AOR, 1.16; 95 % CI, 1.01–1.33) as compared to those who lived in a very low gentrified neighborhood. Among non-Hispanic Whites, living in a very high gentrified neighborhood was protective as compared to living in a very low gentrified neighborhood (AOR, 0.78; 95 % CI, 0.64–0.94). Although there is a need to develop a more nuanced measure of gentrification, these results indicate that changes in the economic character of a neighborhood may have a significant influence on birth outcomes.