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Metropolitan Government of Nashville-Davidson (balance), TN, United States

Nelson J.M.,Emory University | Griffin P.M.,Centers for Disease Control and Prevention | Jones T.F.,Communicable and Environmental Disease Services | Smith K.E.,Infectious Disease
Clinical Infectious Diseases | Year: 2011

Antimicrobial and antimotility agents are not recommended for the treatment of Shiga toxin-producing Escherichia coli O157 infection. In our study, many persons with Shiga toxin-producing E. coli O157 infection took antimicrobial (62%) and antimotility agents (32%); 43 (29%) of 146 reported commencing antimicrobial treatment after laboratory confirmation. Efforts are needed to promote practice guidelines. © 2011 The Author. Source

Humphries D.,The New School | Mosites E.,Communicable and Environmental Disease Services | Otchere J.,University of Ghana | Twum W.A.,Rural Health Training School | And 9 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2011

A cross-sectional pilot study of hookworm infection was carried out among 292 subjects from 62 households in Kintampo North, Ghana. The overall prevalence of hookworm infection was 45%, peaking in those 11-20 years old (58.5%). In children, risk factors for hookworm infection included coinfection with malaria and increased serum immunoglobulin G reactivity to hookworm secretory antigens. Risk factors for infection in adults included poor nutritional status, not using a latrine, not wearing shoes, and occupation (farming). Although albendazole therapy was associated with an overall egg reduction rate of 82%, 37 subjects (39%) remained infected. Among those who failed therapy, treatment was not associated with a significant reduction in egg excretion, and nearly one-third had higher counts on repeat examination. These data confirm a high prevalence of low-intensity hookworm infection in central Ghana and its association with poor nutritional status. The high rate of albendazole failure raises concern about emerging resistance. Copyright © 2011 by The American Society of Tropical Medicine and Hygiene. Source

Murphree R.,Centers for Disease Control and Prevention | Garman K.,Communicable and Environmental Disease Services | Phan Q.,Epidemiology and Emerging Infections Program | Everstine K.,Acute Disease Investigation and Control | And 2 more authors.
Clinical Infectious Diseases | Year: 2012

Background.A mean of ≥1000 foodborne disease outbreaks (FBDOs) causing ≥20000 illnesses are reported to the Centers for Disease Control and Prevention (CDC) annually. We evaluated characteristics of successful outbreak investigations (ie, those that identified an etiologic agent or food vehicle) in the Foodborne Diseases Active Surveillance Network (FoodNet).Methods.FBDOs were defined as the occurrence of ≥2 cases of a similar illness resulting from ingestion of a common food. FBDOs reported to CDC Foodborne Disease Outbreak Surveillance System during 2003-2008 with FoodNet supplemental data available were included in the analyses.Results.Data regarding 1200 FBDOs were available. An etiologic agent was confirmed in 715 (60%); a food vehicle was identified in 387 (32%). At least 4 fecal specimens were collected in 425 of 639 outbreaks (67%) with a confirmed etiologic agent and 48 of 232 (21%) without a confirmed etiologic agent (odds ratio [OR], 7.6; 95% confidence interval [CI], 5.3-10.9). A food vehicle was identified in 314 (47%) of 671 outbreaks investigated using a case-control or cohort study, compared with only 73 (14%) of 529 outbreaks investigated by using other methods (OR, 5.5; 95% CI, 4.1-7.3). At least 1 barrier affecting the success of the investigation was reported for 655 outbreaks, including too few patients (n = 172; 26%), too few stool specimens (n = 167; 25%), and too few control subjects (n = 152; 23%).Conclusions.Etiologic agent and vehicle are frequently undetermined in FBDOs. Greater emphasis on fecal specimen collection and overcoming barriers to pursuing analytic epidemiologic studies can improve ascertainment of these factors. © 2012 The Author. Source

Jones T.F.,Communicable and Environmental Disease Services | Rosenberg L.,Council of State and Territorial Epidemiologists | Kubota K.,Association of Public Health Laboratories | Ingram L.A.,Communicable and Environmental Disease Services
Foodborne Pathogens and Disease | Year: 2013

Over 1,100 foodborne disease outbreaks cause over 23,000 illnesses in the United States annually, but the rates of outbreaks reported and successful investigation vary dramatically among states. We used data from the Centers for Disease Control and Prevention's outbreak reporting database, Association of Public Health Laboratories' PulseNet laboratory subtyping network survey and Salmonella laboratory survey, national public health surveillance data, and national surveys to examine potential causes of this variability. The mean rate of reporting of Salmonella outbreaks was higher in states requiring submission of all isolates to the state public health laboratory, compared to those that do not (5.9 vs. 4.1 per 10 million population, p=0.0062). Rates of overall outbreak reporting or successful identification of an etiology or food vehicle did not correlate at the state level with population, rates of sporadic disease reporting, health department organizational structure, or self-reported laboratory or epidemiologic capacity. Foodborne disease outbreak surveillance systems are complex, and improving them will require a multi-faceted approach to identifying and overcoming barriers. © Mary Ann Liebert, Inc. Source

Green A.L.,Communicable and Environmental Disease Services | Carpenter L.R.,Communicable and Environmental Disease Services | Edmisson D.E.,Communicable and Environmental Disease Services | Lane C.D.,University of Tennessee | And 2 more authors.
Journal of the American Veterinary Medical Association | Year: 2010

Objective-To evaluate knowledge, attitudes, and management practices involving antimicrobial use among Tennessee beef producers. Design-Mail survey. Sample Population-A population-based, stratified random sample of 3,000 beef producers across the state. Procedures-Questionnaires were mailed to beef producers. Questions focused on producer practices related to education, biosecurity, veterinary use, and the purchase and use of antimicrobials. Operation types were categorized as either cow-calf only or multiple operation type (MOT). Associations between various factors and antimicrobial use were evaluated by use of multivariable logistic regression, with the outcome variable being any antimicrobial use (injectable or by mouth) in the past year. Results-Of 3,000 questionnaires mailed, 1,042 (34.7%) were returned. A significantly higher proportion of producers with MOTs reported giving antimicrobials by mouth or by injection than did producers with cow-calf only operations. In addition, higher proportions of producers with MOTs than producers with cow-calf only operations reported treating with macrolides, florfenicol, ceftiofur, and aminoglycosides. In the multivariable analysis, herd size > 50 cattle, participation in Beef Quality Assurance or master beef producer certification programs, quarantining of newly purchased animals, use of written instructions for treating disease, and observation of withdrawal times were associated with a higher likelihood of antimicrobial use. Conclusions and Clinical Relevance-Results suggested that producers who engaged in more progressive farming practices were also more likely to use antimicrobials. Incorporating training on judicious antimicrobial use into educational programs would likely increase awareness of best management practices regarding antimicrobial use. Source

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