Occupational Exposure to Dromedaries and Risk for MERS-CoV Infection,Qatar, 2013–2014

We determined the presence of neutralizing antibodies to Middle East respiratory syndrome coronavirus in persons in Qatar with and without dromedary contact. Antibodies were only detected in those with contact, suggesting dromedary exposure as a risk factor for infection. Findings also showed evidence for substantial underestimation of the infection in populations at risk in Qatar.     

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.     

Cat-Scratch Disease in the United States, 2005–2013

Cat-scratch disease (CSD) is mostly preventable. More information about the epidemiology and extent of CSD would help direct prevention efforts to those at highest risk. To gain such information, we reviewed the 2005–2013 MarketScan national health insurance claims databases and identified patients <65 years of age with an inpatient admission or outpatient visit that included a CSD code from the International Classification of Diseases, Ninth Revision, Clinical Modification. Incidence of CSD was highest among those who lived in the southern United States (6.4 cases/100,000 population) and among children 5–9 years of age (9.4 cases/100,000 population). Inpatients were significantly more likely than outpatients to be male and 50–64 years of age. We estimate that each year, 12,000 outpatients are given a CSD diagnosis and 500 inpatients are hospitalized for CSD. Prevention measures (e.g., flea control for cats) are particularly helpful in southern states and in households with children.     

USA300 Methicillin-Resistant Staphylococcus aureus,United States, 2000–2013

In the United States, methicillin-resistant Staphylococcus aureus (MRSA) with the USA300 pulsed-field gel electrophoresis type causes most community-associated MRSA infections and is an increasingly common cause of health care–associated MRSA infections. USA300 probably emerged during the early 1990s. To assess the spatiotemporal diffusion of USA300 MRSA and USA100 MRSA throughout the United States, we systematically reviewed 354 articles for data on 33,543 isolates, of which 8,092 were classified as USA300 and 2,595 as USA100. Using the biomedical literature as a proxy for USA300 prevalence among genotyped MRSA samples, we found that USA300 was isolated during 2000 in several states, including California, Texas, and midwestern states. The geographic mean center of USA300 MRSA then shifted eastward from 2000 to 2013. Analyzing genotyping studies enabled us to track the emergence of a new, successful MRSA type in space and time across the country.     

Tuberculosis Caused by Mycobacterium africanum,United States, 2004–2013

Mycobacterium africanum is endemic to West Africa and causes tuberculosis (TB). We reviewed reported cases of TB in the United States during 2004–2013 that had lineage assigned by genotype (spoligotype and mycobacterial interspersed repetitive unit variable number tandem repeats). M. africanum caused 315 (0.4%) of 73,290 TB cases with lineage assigned by genotype. TB caused by M. africanum was associated more with persons from West Africa (adjusted odds ratio [aOR] 253.8, 95% CI 59.9–1,076.1) and US-born black persons (aOR 5.7, 95% CI 1.2–25.9) than with US-born white persons. TB caused by M. africanum did not show differences in clinical characteristics when compared with TB caused by M. tuberculosis. Clustered cases defined as >2 cases in a county with identical 24-locus mycobacterial interspersed repetitive unit genotypes, were less likely for M. africanum (aOR 0.1, 95% CI 0.1–0.4), which suggests that M. africanum is not commonly transmitted in the United States.     

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.     

Indications for Testing Among Reported Cases of HCV Infection From Enhanced Hepatitis Surveillance Sites in the United States, 2004–2010

Objectives. Centers for Disease Control and Prevention has recommended a 1-time HCV test for persons born from 1945 through 1965 to supplement current risk-based screening. We examined indications for testing by birth cohort (before 1945, 1945–1965, and after 1965) among persons with past or current HCV.Methods. Cases had positive HCV laboratory markers reported by 4 surveillance sites (Colorado, Connecticut, Minnesota, and New York) to health departments from 2004 to 2010. Health department staff abstracted demographics and indications for testing from cases’ medical records and compiled this information into a surveillance database.Results. Of 110 223 cases of past or current HCV infection reported during 2004–2010, 74 578 (68%) were among persons born during 1945–1965. Testing indications were abstracted for 45 034 (41%) cases; of these, 29 544 (66%) identified at least 1 Centers for Disease Control and Prevention–recommended risk factor as a testing indication. Overall, 74% of reported cases were born from 1945 to 1965 or had an injection drug use history.Conclusions. These data support augmenting the current HCV risk-based screening recommendations by screening adults born from 1945 to 1965.In the United States, an estimated 3.2 million persons are chronically infected with HCV,1 and of these, 45% to 85% are unaware of their infection.2–5 Of those infected, most were born from January 1, 1945, through December 31, 1965.6 Previous Centers for Disease Control and Prevention (CDC) screening recommendations for hepatitis C were risk-based and included testing of injection drug users, hemodialysis recipients, those with persistently abnormal alanine aminotransferase levels, blood transfusion or organ transplant recipients before 1992, health care workers exposed to HCV, and children born to HCV-positive women.7 However, research has shown that physicians are often hesitant to elicit a risk history for hepatitis; when this is combined with underreporting of risk factors by patients, there is a lack of identification and underdiagnosis in the primary care setting.8–10 A recent study that used data from the National Health and Nutrition Examination Survey showed that less than 5% of patients who knew that they were HCV-positive had been tested because of physician-identified risk factors.11As the number of persons with complications and mortality related to hepatitis C continues to increase because of undiagnosed and untreated hepatitis C infection,12–14 CDC has recently recommended a birth cohort–based screening strategy.15 Using the Grading of Recommendations Assessment, Development, and Evaluation framework,16–24 CDC recently released a recommendation for 1-time testing for HCV for persons born during 1945–1965 without previous ascertainment of HCV risk.15 The framework’s approach defines a research question, conducts systematic reviews, determines the overall quality of evidence, and provides strength of the recommendations.16–24 Recent data suggest that, compared with risk-based screening strategies, routine 1-time HCV screening of persons in the 1945–1965 birth cohort is cost-effective and could prevent 120 000 deaths when combined with direct-acting antiviral treatments.25 Other economic models have also been utilized and support birth cohort screening of this age group.26,27 In this study, we describe indications for testing by birth cohort among reported HCV cases from 4 enhanced hepatitis surveillance jurisdictions.     

Shiga Toxin 1–Producing Shigella sonnei Infections,California, United States, 2014–2015

Shiga toxins (Stx) are primarily associated with Shiga toxin–producing Escherichia coli and Shigella dysenteriae serotype 1. Stx production by other shigellae is uncommon, but in 2014, Stx1-producing S. sonnei infections were detected in California. Surveillance was enhanced to test S. sonnei isolates for the presence and expression of stx genes, perform DNA subtyping, describe clinical and epidemiologic characteristics of case-patients, and investigate for sources of infection. During June 2014–April 2015, we identified 56 cases of Stx1-producing S. sonnei, in 2 clusters. All isolates encoded stx₁ and produced active Stx1. Multiple pulsed-field gel electrophoresis patterns were identified. Bloody diarrhea was reported by 71% of case-patients; none had hemolytic uremic syndrome. Some initial cases were epidemiologically linked to travel to Mexico, but subsequent infections were transmitted domestically. Continued surveillance of Stx1-producing S. sonnei in California is necessary to characterize its features and plan for reduction of its spread in the United States.     

Influenza vaccination coverage of Vaccine for Children (VFC)-entitled versus privately insured children,United States, 2011–2013

BackgroundThe Vaccines for Children (VFC) program provides vaccines at no cost to children who are Medicaid-eligible, uninsured, American Indian or Alaska Native (AI/AN), or underinsured and vaccinated at Federally Qualified Health Centers or Rural Health Clinics. The objective of this study was to compare influenza vaccination coverage of VFC-entitled to privately insured children in the United States, nationally, by state, and by selected socio-demographic variables.MethodsData from the National Immunization Survey-Flu (NIS-Flu) surveys were analyzed for the 2011–2012 and 2012–2013 influenza seasons for households with children 6 months–17 years. VFC-entitlement and private insurance status were defined based upon questions asked of the parent during the telephone interview. Influenza vaccination coverage estimates of children VFC-entitled versus privately insured were compared by t-tests, both nationally and within state, and within selected socio-demographic variables.ResultsFor both seasons studied, influenza coverage for VFC-entitled children did not significantly differ from coverage for privately insured children (2011–2012: 52.0% ± 1.9% versus 50.7% ± 1.2%; 2012–2013: 56.0% ± 1.6% versus 57.2% ± 1.2%). Among VFC-entitled children, uninsured children had lower coverage (2011–2012: 38.9% ± 4.7%; 2012–2013: 44.8% ± 3.5%) than Medicaid-eligible (2011–2012: 55.2% ± 2.1%; 2012–2013: 58.6% ± 1.9%) and AI/AN children (2011–2012: 54.4% ± 11.3%; 2012–2013: 54.6% ± 7.0%). Significant differences in vaccination coverage among VFC-entitled and privately insured children were observed within some subgroups of race/ethnicity, income, age, region, and living in a metropolitan statistical area principle city.ConclusionsAlthough finding few differences in influenza vaccination coverage among VFC-entitled versus privately insured children was encouraging, nearly half of all children were not vaccinated for influenza and coverage was particularly low among uninsured children. Additional public health interventions are needed to ensure that more children are vaccinated such as a strong recommendation from health care providers, utilization of immunization information systems, provider reminders, standing orders, and community-based interventions such as educational activities and expanded access to vaccination services.