Increase in adult Clostridium difficile-related hospitalizations and case-fatality rate, United States, 2000-2005

Virulence of and deaths from Clostridium difficile-associated disease (CDAD) are on the rise in the United States. The incidence of adult CDAD hospitalizations doubled from 5.5 cases per 10,000 population in 2000 to 11.2 in 2005, and the CDAD-related age-adjusted case-fatality rate rose from 1.2% in 2000 to 2.2% in 2004.     

Sequelae of Foodborne Illness Caused by 5 Pathogens,Australia, Circa 2010

In Australia circa 2010, 4.1 million (90% credible interval [CrI] 2.3–6.4 million) episodes of foodborne gastroenteritis occurred, many of which might have resulted in sequelae. We estimated the number of illnesses, hospitalizations, and deaths from Guillain-Barré syndrome, hemolytic uremic syndrome, irritable bowel syndrome, and reactive arthritis that were associated with contaminated food in Australia. Data from published studies, hospital records, and mortality reports were combined with multipliers to adjust for different transmission routes. We used Monte Carlo simulation to estimate median estimates and 90% CrIs. In Australia, circa 2010, we estimated that 35,840 (90% CrI 25,000–54,000) illnesses, 1,080 (90% CrI 700–1,600) hospitalizations, and 10 (90% CrI 5–14) deaths occurred from foodborne gastroenteritis–associated sequelae. Campylobacter spp. infection was responsible for 80% of incident cases. Reducing the incidence of campylobacteriosis and other foodborne diseases would minimize the health effects of sequelae.     

Epidemic cholera among refugees in Malawi,Africa: treatment and transmission.

Between 23 August and 15 December 1990 an epidemic of cholera affected Mozambican refugees in Malawi causing 1931 cases (attack rate = 2.4%); 86% of patients had arrived in Malawi < 3 months before illness onset. There were 68 deaths (case-fatality rate = 3.5%); most deaths (63%) occurred within 24 h of hospital admission which may have indicated delayed presentation to health facilities and inadequate early rehydration. Mortality was higher in children < 4 years old and febrile deaths may have been associated with prolonged i.v. use. Significant risk factors for illness (P < 0.05) in two case-control studies included drinking river water (odds ratio [OR] = 3.0); placing hands into stored household drinking water (OR = 6.0); and among those without adequate firewood to reheat food, eating leftover cooked peas (OR = 8.0). Toxigenic V. cholerae O1, serotype Inaba, was isolated from patients and stored household water. The rapidity with which newly arrived refugees became infected precluded effective use of a cholera vaccine to prevent cases unless vaccination had occurred immediately upon camp arrival. Improved access to treatment and care of paediatric patients, and increased use of oral rehydration therapy, could decrease mortality. Preventing future cholera outbreaks in Africa will depend on interrupting both waterborne and foodborne transmission of this pathogen.     

Hospitalizations involving gastroenteritis in the United States, 1985: the special burden of the disease among the elderly.

While diarrheal disease is a well-recognized problem in children, its impact in the elderly has not been adequately assessed. Among the 4.06 million hospitalizations in 1985 in the McDonnell-Douglas Health Information System database, 98,185 hospitalizations, including 1,130 deaths, had gastroenteritis recorded as a discharge diagnosis. The authors analyzed the 87,181 hospitalizations and 514 deaths for which gastroenteritis was one of the top three diagnoses. Gastroenteritis was among the top three diagnoses in 9% of all hospitalizations of children 1-4 years of age, compared with 1.5% of hospitalizations throughout adulthood (greater than or equal to 20 years). Only 0.05% of hospitalizations involving gastroenteritis were fatal for children younger than 5 years, compared with 3% in individuals 80 years or older. While children aged less than 5 years and adults aged 60 years or more each comprised one-fourth of hospitalizations involving gastroenteritis, the older group represented 85% of diarrheal deaths. Age was the most important risk factor for death subsequent to a hospitalization involving gastroenteritis (odds ratio = 52.6, 95% confidence interval 37.0-76.9 for age greater than or equal to 70 years vs. less than 5 years). Gastroenteritis is a large, underemphasized public health problem among the elderly, among whom its case-fatality ratio is higher than in children.     

Foodborne infections in France

To quantify the impact of foodborne diseases on health, and set priorities for data collection, prevention and control of these diseases, we compiled and analyzed information from surveillance systems and other sources on the morbidity and mortality due to foodborne infectious diseases in mainland France in the last decade of the 20th century. Illness due to 13 bacteria, two viruses, and eight parasites were studied. The number of foodborne infections, hospitalizations, and deaths were estimated from multiple data sources. For each agent, several estimates were derived from the different sources. Estimates were ranked according to their plausibility, based on an assessment of the validity of the data source, and are presented as a "plausible interval" consisting of a low and high estimate. We estimate that these pathogens caused 10,200-17,800 hospitalizations per year. Salmonella is the most frequent cause (5,700-10,200 cases), followed by Campylobacter (2,600-3,500 cases) and Listeria (304 cases). Toxoplasmosis accounts for the majority of hospitalizations (426 cases) attributable to the studied parasitic infections. The number of deaths related to foodborne infection was estimated between 228 and 691. Bacterial pathogens account for the majority (191 to 652) of deaths of which 92 to 535 are attributable to salmonellosis, ranking as the first cause of death, and 78 to listeriosis, the second cause. Salmonella, Campylobacter, and Listeria are the main causes of severe foodborne illness in France. For several pathogens, data are insufficient to derive exact estimates of the disease burden. Nevertheless, it has been possible to derive plausible estimates for the majority, and to rank them according to their impact on public health.     

West Nile fever outbreak, Israel, 2000: epidemiologic aspects

From August 1 to October 31, 2000, 417 cases of West Nile (WN) fever were serologically confirmed throughout Israel; 326 (78%) were hospitalized patients. Cases were distributed throughout the country; the highest incidence was in central Israel, the most populated part. Men and women were equally affected, and their mean age was 54+/-23.8 years (range 6 months to 95 years). Incidence per 1,000 population increased from 0.01 in the 1st decade of life to 0.87 in the 9th decade. There were 35 deaths (case-fatality rate 8.4%), all in patients >50 years of age. Age-specific case-fatality rate increased with age. Central nervous system involvement occurred in 170 (73%) of 233 hospitalized patients. The countrywide spread, number of hospitalizations, severity of the disease, and high death rate contrast with previously reported outbreaks in Israel.     

2002 - 2016年家庭内食源性疾病暴发事件分析

目的 分析2002 - 2016年我国文献报道家庭内食源性疾病暴发事件的特征,为有关部门制定家庭内食源性疾病防控对策提供参考。方法 收集2002 - 2016年有关我国食源性疾病暴发事件文献,采用自制调查表摘录相关信息,利用EpiData3.1对摘录信息进行录入,Excel2010进行数据整理,SPSS17.0进行数据分析。结果 2002 - 2016年我国文献报道571起家庭内食源性疾病暴发事件,累计发病人数7 430例,住院4 910例,死亡345例。主要的原因食品为肉类及其制品,占总起数的18.39%。化学污染物引起的暴发事件最多,占总起数的42.67%。死亡事件的主要致病因素是椰毒假单胞菌（占13.91%）和肉毒梭菌及其毒素（占12.17%）、毒蕈（占11.01%）。结论 应加强对亚硝酸盐、有机磷农药、沙门菌、毒蘑菇等主要致病因素引发的家庭内食源性疾病暴发事件的防控力度,以减少发病人数和死亡事件的发生。     

Estimating foodborne gastroenteritis, Australia

We estimated for Australia the number of cases, hospitalizations, and deaths due to foodborne gastroenteritis in a typical year, circa 2000. The total amount of infectious gastroenteritis was measured by using a national telephone survey. The foodborne proportion was estimated from Australian data on each of 16 pathogens. To account for uncertainty, we used simulation techniques to calculate 95% credibility intervals (CrI). The estimate of incidence of gastroenteritis in Australia is 17.2 million (95% confidence interval 14.5-19.9 million) cases per year. We estimate that 32% (95% CrI 24%-40%) are foodborne, which equals 0.3 (95% CrI 0.2-0.4) episodes per person, or 5.4 million (95% CrI 4.0-6.9 million) cases annually in Australia. Norovirus, enteropathogenic Escherichia coli, Campylobacter spp., and Salmonella spp. cause the most illnesses. In addition, foodborne gastroenteritis causes approximately 15,000 (95% CrI 11,000-18,000) hospitalizations and 80 (95% CrI 40-120) deaths annually. This study highlights global public health concerns about foodborne diseases and the need for standardized methods, including assessment of uncertainty, for international comparison.     

Impact of the 1996-1997 supplementary measles vaccination campaigns in South Africa

BACKGROUND: In South Africa, as part of an effort to eliminate indigenous measles by 2002, vaccination campaigns were conducted in 1996-1997 targeting all children aged 9 months to 14 years; coverage was estimated at 85%. The impact of the campaigns on measles disease burden was evaluated in 1999. METHODS: We analysed routine measles surveillance data and undertook a retrospective review of hospital registers in two of South Africa's nine provinces. RESULTS: In Mpumalanga in the pre-campaign years (1992-1996), 4,498 measles cases and 6 deaths were reported; 182 cases and no deaths were reported in 1997-1998. Hospital registers showed 1,647 measles hospitalizations and 11 deaths in the pre-campaign period, and 60 hospitalizations and no deaths after the campaign (1997-April 1999). In Western Cape in pre-campaign years (1992-1997), 5,164 measles cases and 19 deaths were reported; 132 cases and no deaths were reported in 1998. Hospital registers showed 736 measles hospitalizations and 23 deaths in the pre-campaign period, and 29 measles hospitalizations and no deaths post-campaign (1998-July 1999). CONCLUSIONS: Study findings indicate that reported measles cases, measles-related hospitalizations and deaths were considerably reduced in both provinces after the campaign compared with the pre-campaign period. Longer observation is needed to evaluate the long-term impact of the campaigns.     

Foodborne Illness,Australia, Circa 2000 and Circa 2010

Foodborne disease is a major public health problem worldwide. To examine changes in foodborne illness in Australia, we estimated the incidence, hospitalizations, and deaths attributed to contaminated food circa 2010 and recalculated estimates from circa 2000. Approximately 25% of gastroenteritis cases were caused by contaminated food; to account for uncertainty we used simulation techniques to estimate 90% credible intervals. We estimate that circa 2010, 4.1 million foodborne gastroenteritis cases occurred, and circa 2000, 4.3 million cases occurred. Circa 2010, contaminated food was estimated to be responsible for 30,840 gastroenteritis-associated hospitalizations, 76 associated deaths, and 5,140 nongastrointestinal illnesses. Cases of salmonellosis and campylobacteriosis increased from 2000 to 2010 and were the leading causes of gastroenteritis-associated hospitalizations; Listeria monocytogenes and nontyphoidal Salmonella spp. infections were the leading causes of death. Although the overall incidence of foodborne illnesses declined over time in Australia, cases of foodborne gastroenteritis are still common.Keywords: foodborne illness, foodborne disease, gastroenteritis, epidemiology, estimate, incidence, hospitalization, death, norovirus, salmonella, campylobacter, toxin, bacteria, parasites, viruses, AustraliaFoodborne illness is a major public health problem and a common cause of illness and death worldwide. Outbreaks linked to contaminated food can affect the public’s trust and financially harm implicated businesses and associated food industries. Estimates of the effects of foodborne illnesses and individual pathogens provide evidence for policy interventions and food safety regulation. In addition, estimates of changes in the incidence of foodborne illnesses and hospitalizations over time provide information on the effectiveness of changes to food safety standards and regulation.Many agents can cause foodborne illness; some of these agents are transmitted to humans by other routes as well as by food. Most foodborne illnesses manifest as gastroenteritis, but other presentations, such as meningitis and hepatitis may also result from infection, and sequelae may occur weeks after the acute infection.Many countries have estimated the incidence of foodborne diseases (1–5). In Australia in 2000, foodborne incidence, hospitalizations, and deaths were estimated to cost 1.25 billion Australian dollars annually (6,7). However, since 2000, surveillance has substantially improved, data availability has increased, and methods have been refined. To inform current public health decisions and policies in Australia, we used new methods and datasets to estimate the incidence of infectious gastroenteritis and associated hospitalizations and deaths in Australia circa 2010. We then applied these refined methods to circa 2000 data so that estimates from the 2 periods could be directly compared.     

Ectopic pregnancy in the United States, 1970-1986

In 1986, both the rate of hospitalizations due to ectopic pregnancy and the number of hospitalizations decreased from those reported in the previous year, although the decreases were not statistically significant. If this leveling off of previous yearly increases becomes a continuing trend, possible explanatory hypotheses include a leveling off of disease occurrence, and an increasing use of outpatient management. The case-fatality rate rose slightly in 1986, to 4.9 deaths per 10,000 ectopic pregnancies, although this rate still represents an 86% decline from the 35.5 deaths per 10,000 ectopic pregnancies reported in 1970. In 1986, ectopic pregnancy accounted for only 1.4% of all pregnancies but was associated with over 13% of maternal deaths. Compared with white women, women of black and other minority races had a 1.6 times greater risk of ectopic pregnancy. Ectopic pregnancy remains one of the leading causes of maternal death in the United States and continues to be an important public health problem.     

Foodborne illness acquired in the United States--unspecified agents

Each year, 31 major known pathogens acquired in the United States caused an estimated 9.4 million episodes of foodborne illness. Additional episodes of illness were caused by unspecified agents, including known agents with insufficient data to estimate agent-specific illness, known agents not yet recognized as causing foodborne illness, substances known to be in food but of unproven pathogenicity, and unknown agents. To estimate these additional illnesses, we used data from surveys, hospital records, and death certificates to estimate illnesses, hospitalizations, and deaths from acute gastroenteritis and subtracted illnesses caused by known gastroenteritis pathogens. If the proportions acquired by domestic foodborne transmission were similar to those for known gastroenteritis pathogens, then an estimated 38.4 million (90% credible interval [CrI] 19.8-61.2 million) episodes of domestically acquired foodborne illness were caused by unspecified agents, resulting in 71,878 hospitalizations (90% CrI 9,924-157,340) and 1,686 deaths (90% CrI 369-3,338).     

Global Burden of Invasive Nontyphoidal Salmonella Disease, 2010

Nontyphoidal Salmonella is a major cause of bloodstream infections worldwide, and HIV-infected persons and malaria-infected and malnourished children are at increased risk for the disease. We conducted a systematic literature review to obtain age group–specific, population-based invasive nontyphoidal Salmonella (iNTS) incidence data. Data were categorized by HIV and malaria prevalence and then extrapolated by using 2010 population data. The case-fatality ratio (CFR) was determined by expert opinion consensus. We estimated that 3.4 (range 2.1–6.5) million cases of iNTS disease occur annually (overall incidence 49 cases [range 30–94] per 100,000 population). Africa, where infants, young children, and young adults are most affected, had the highest incidence (227 cases [range 152–341] per 100,000 population) and number of cases (1.9 [range 1.3–2.9] million cases). An iNTS CFR of 20% yielded 681,316 (range 415,164–1,301,520) deaths annually. iNTS disease is a major cause of illness and death globally, particularly in Africa. Improved understanding of the epidemiology of iNTS is needed.     

Epidemiology of salmonellosis in California, 1990-1999: morbidity,mortality, and hospitalization costs

Salmonella is a common cause of bacterial foodborne illness in the United States. The epidemiology and costs of nontyphoidal salmonellosis in California from 1990 through 1999 are described using surveillance, hospitalization, and death data. Trends in Salmonella rates and factors associated with prolonged hospitalization were evaluated using Poisson and linear regression models, respectively. There were 56,660 reported cases, 11,102 hospitalizations, and 74 deaths attributed to Samonella. Reported case and hospital discharge rates have decreased since 1996. Among reported cases, infants had the highest rate (121 cases per 10(5) person-years), followed by children 1-4 years of age (40 cases per 10(5) person-years). The highest hospitalization rates were among the elderly and young children. Most deaths occurred among persons aged 65 or more years (59%). Among hospitalizations, gastroenteritis (61%) and septicemia (23%) were the most common Salmonella diagnoses. Salmonella pneumonia patients were the oldest (median age, 55 years) and Salmonella meningitis patients the youngest (median age, 0.3 years). These two diagnoses were the costliest, approaching 30,000 dollars (median) per hospitalization. Having an acquired immunodeficiency syndrome diagnosis or multiple Salmonella diagnoses was independently associated with prolonged hospitalization. The estimated 10-year hospitalization costs for Salmonella were $200 million. Salmonellosis is a costly disease that disproportionately affects the young and elderly.     

1995—2013年安顺市食源性疾病分析

目的分析近20年来安顺市食源性疾病发病规律以寻求降低食品风险的依据和食品安全措施。方法采用Excel2007和Epinfo软件对1995—2013年突发公共卫生事件报告管理信息系统中安顺食源性疾病报告事件作流行病学描述性和分析性研究。结果 1995—2013年共报告103起食源性疾病事件,发病3 587例,死亡61例。7、8月是高发季节。中毒原因以微生物为主,报告事件数为33起,占总事件数的32.04%（33/103）;中毒人数为1 419人,占总病例数的39.56%（1 419/3 587）。死亡原因以化学中毒尤其是鼠药中毒为主,占死亡病例的55.74%（34/61）;其次为不明原因死亡,占死亡病例的26.23%（16/61）。发病和死亡主要集中在农村人口中,中毒发病起数农村高于城市,中毒发病率城市高于农村（χ^2=153.077 8,P〈0.01）,但中毒病死率农村远高于城市（χ^2=28.177 8,P〈0.05）。结论安顺市食物中毒预防与控制重点在农村家庭与学校食堂,针对安顺市在高发季节对高发人群采取有效的干预措施可降低发病数和死亡数,以保障食品安全。     

Ectopic pregnancy surveillance, United States, 1970-1987

In 1987, both the rate of hospitalizations due to ectopic pregnancy and the number of women hospitalized increased from those reported in 1986. Although ectopic pregnancy represented 1.7% of all pregnancies in 1987, complications of this condition accounted for 12% of all maternal deaths in that year. The case-fatality rate was 3.4 deaths per 10,000 ectopic pregnancies, a decline of 30% from the rate of 4.9 deaths reported in 1986, and a 90% decline from the 35.5 deaths per 10,000 ectopic pregnancies reported in 1970. Although the racial gap decreased slightly in 1987, the risk of ectopic pregnancy remained 1.4 times higher for women of black and other minority races than for white women. The risk of death from this condition remained 1.8 times higher for women of black and other minority races.     

贵州省2011—2021年0~6岁儿童食源性疾病暴发事件分析

  目的  对2011—2021年贵州省0~6岁儿童的食源性疾病暴发事件监测结果进行描述和统计分析,为儿童的食源性疾病预防控制提供支撑依据。  方法  对监测系统中2011—2021年0~6岁儿童食源性疾病暴发事件数据进行流行病学特征分析,以发病率为因变量,以致病因素、居住地等因素为自变量,进行因素分析。  结果  2011—2021年0~6岁儿童的食源性疾病暴发事件共报告618起,占报告总体食源性疾病暴发事件的21.29%。发病1 169人,住院833人,死亡18人,病死率为1.54%;上报事件集中发生在夏秋季节,5月为报告高峰,共报告159起;报告事件数最多的地区为遵义、铜仁,分别报告169,98起;主要是农村家庭误食误用引起食源性疾病;毒蘑菇及其毒素、有毒植物及其毒素和不明原因是主要致病因素;发病率在不同年份、居住地、致病因素等因素间差异均有统计学意义(χ2值分别为3 444.44,577.82,1 935.15,P值均＜0.05)。  结论  0~6岁儿童的食源性疾病暴发事件在贵州省总体食源性疾病暴发事件中占比较大,病死率较高。要加强对儿童食源性疾病的防控,且农村家庭是重点防控宣教对象。     

Surveillance for foodborne disease outbreaks--United States, 2008

Foodborne agents cause an estimated 48 million illnesses annually in the United States, including 9.4 million illnesses from known pathogens. CDC collects data on foodborne disease outbreaks submitted from all states and territories through the Foodborne Disease Outbreak Surveillance System. During 2008, the most recent year for which data are finalized, 1,034 foodborne disease outbreaks were reported, which resulted in 23,152 cases of illness, 1,276 hospitalizations, and 22 deaths. Among the 479 outbreaks with a laboratory-confirmed single etiologic agent reported, norovirus was the most common, accounting for 49% of outbreaks and 46% of illnesses. Salmonella was the second most common, accounting for 23% of outbreaks and 31% of illnesses. Among the 218 outbreaks attributed to a food vehicle with ingredients from only one of 17 defined food commodities, the top commodities to which outbreaks were attributed were poultry (15%), beef (14%), and finfish (14%), whereas the top commodities to which outbreak-related illnesses were attributed were fruits and nuts (24%), vine-stalk vegetables (23%), and beef (13%). Outbreak surveillance provides insights into the agents that cause foodborne illness, types of implicated foods, and settings where transmission occurs. Public health, regulatory, and food industry professionals can use this information to target prevention efforts against pathogens and foods that cause the most foodborne disease outbreaks.     

Community- and Healthcare-Associated Clostridium difficile Infections,Finland, 2008?2013

We evaluated incidence, case-fatality rate, and trends of community-associated (CA) and healthcare-associated (HA) Clostridium difficile infections (CDIs) in Finland during 2008–2013. CDIs were identified in the National Infectious Disease Register, deaths in the National Population Information System, hospitalizations to classify infections as CA or HA in the National Hospital Discharge Register, and genotypes in a reference laboratory. A total of 32,991 CDIs were identified: 10,643 (32.3%) were CA (32.9 cases/100,000 population) and 22,348 (67.7%) HA (69.1/100,000). Overall annual incidence decreased from 118.7/100,000 in 2008 to 92.1/100,000 in 2013, which was caused by reduction in HA-CDI rates (average annual decrease 8.1%; p<0.001). The 30-day case-fatality rate was lower for CA-CDIs than for HA-CDIs (3.2% vs. 13.3%; p<0.001). PCR ribotypes 027 and 001 were more common in HA-CDIs than in CA-CDIs. Although the HA-CDI incidence rate decreased, which was probably caused by increased awareness and improved infection control, the CA-CDI rate increased.     

Fatality rate in the epidemiology of meningococcal disease: study in the region of Campinas, SP, Brazil, 1993 to 1998

OBJECTIVE: To analyze the trends of the meningococcal disease cumulative incidence and case-fatality rate in the region of Campinas, Brazil, an area that encircles five cities and 1.2 million inhabitants, from 1993 to 1998. METHODS: A longitudinal retrospective study of all case records (375) obtained from the regional epidemiological surveillance system was carried out. A logistic regression analysis allowed identifying the risk factors related to fatal outcomes of meningococcal disease. RESULTS: The highest fatality rates (23.8%) were seen in the period of 1996 and 1997, coinciding with the incidence peaks of serogroup B Neisseria and a high percentage of septicemia cases. Also at the same period there was registered a poor etiological investigation of the cases. A seasonal pattern and the predomination of strains B:4:P1.15 and C:2b:P1.3 were observed. In the logistic regression analysis, the risk factors related to fatality were: septicemia with or without meningitis (adjusted odds ratio [OR(aj)] = 13.88 and 95% confidence interval [CI] = 4.68 - 42.13); age over 30 years (OR(aj) = 6.42; CI = 2.32 - 17.80); age under 1 year (OR(aj) = 2.95; CI = 1.55 - 5.63); and serogroup B (OR(aj) = 2.33; CI = 1.14 - 4.79). CONCLUSIONS: Septicemia, age and serogroup were predictive variables related to a fatal outcome. In 1996 and 1997, case-fatality rates were high, indicating the need to further assessment of the quality of the services delivered and their readiness to take preventive action. The lack of etiological identification in many cases precluded more accurate inferences about the epidemiological behavior of Neisseria meningitidis in the region.