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Grohskopf L.A.,National Center for Immunization and Respiratory Diseases | Shay D.K.,National Center for Immunization and Respiratory Diseases | Shimabukuro T.T.,National Center for Emerging and Zoonotic Diseases | Sokolow L.Z.,National Center for Immunization and Respiratory Diseases | And 4 more authors.
MMWR Recommendations and Reports | Year: 2013

This report updates the 2012 recommendations by CDC's Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccines for the prevention and control of seasonal influenza (CDC. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2012;61:613-8). Routine annual influenza vaccination is recommended for all persons aged ≥6 months. For the 2013-14 influenza season, it is expected that trivalent live attenuated influenza vaccine (LAIV3) will be replaced by a quadrivalent LAIV formulation (LAIV4). Inactivated influenza vaccines (IIVs) will be available in both trivalent (IIV3) and quadrivalent (IIV4) formulations. Vaccine virus strains included in the 2013-14 U.S. trivalent influenza vaccines will be an A/California/7/2009 (H1N1)-like virus, an H3N2 virus antigenically like the cell-propagated prototype virus A/Victoria/361/2011, and a B/Massachusetts/2/2012-like virus. Quadrivalent vaccines will include an additional influenza B virus strain, a B/Brisbane/60/2008-like virus, intended to ensure that both influenza B virus antigenic lineages (Victoria and Yamagata) are included in the vaccine. This report describes recently approved vaccines, including LAIV4, IIV4, trivalent cell culture-based inactivated influenza vaccine (ccIIV3), and trivalent recombinant influenza vaccine (RIV3). No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one product is otherwise appropriate. This information is intended for vaccination providers, immunization program personnel, and public health personnel. These recommendations and other information are available at CDC's influenza website (http://www.cdc.gov/flu); any updates also will be found at this website. Vaccination and health-care providers should check the CDC influenza website periodically for additional information.


Damon I.K.,National Center for Emerging and Zoonotic Diseases
Vaccine | Year: 2011

Monkeypox, a vesiculo-pustular rash illness, was initially discovered to cause human infection in 1970 through the World Health Organization (WHO)-sponsored efforts of the Commission to Certify Smallpox Eradication in Western Africa and the Congo Basin. The virus had been discovered to cause a nonhuman primate rash illness in 1958, and was thus named monkeypox. The causative agents of monkeypox and smallpox diseases both are species of Orthopoxvirus. Orthopoxvirus monkeypox, when it infects humans as an epizootic, produces a similar clinical picture to that of ordinary human smallpox. Since 1970, extensive epidemiology, virology, ecology and public health research has enabled better characterization of monkeypox virus and the associated human disease. This work reviews the progress in this body of research, and reviews studies of this "newly" emerging zoonotic disease. © 2011.


Jacob J.T.,Emory University | Klein G.E.,Johns Hopkins University | Laxminarayan R.,Center for Disease Dynamics | Kallen A.J.,National Center for Emerging and Zoonotic Diseases | And 13 more authors.
Morbidity and Mortality Weekly Report | Year: 2013

Background: Enterobacteriaceae are a family of bacteria that commonly cause infections in health-care settings as well as in the community. Among Enterobacteriaceae, resistance to broad-spectrum carbapenem antimicrobials has been uncommon. Over the past decade, however, carbapenem-resistant Enterobacteriaceae (CRE) have been recognized in health-care settings as a cause of difficult-to-treat infections associated with high mortality. Methods: The percentage of acute-care hospitals reporting at least one CRE from health-care-associated infections (HAIs) in 2012 was estimated using data submitted to the National Healthcare Safety Network (NHSN) in 2012. The proportion of Enterobacteriaceae infections that were CRE was calculated using two surveillance systems: 1) the National Nosocomial Infection Surveillance system (NNIS) and NHSN (for 2001 and 2011, respectively) and 2) the Surveillance Network-USA (TSN) (for 2001 and 2010). Characteristics of CRE culture-positive episodes were determined using data collected as part of a population-based CRE surveillance project conducted by the Emerging Infections Program (EIP) in three states. Results: In 2012, 4.6% of acute-care hospitals reported at least one CRE HAI (short-stay hospitals, 3.9%; long-term acute-care hospitals, 17.8%). The proportion of Enterobacteriaceae that were CRE increased from 1.2% in 2001 to 4.2% in 2011 in NNIS/NHSN and from 0% in 2001 to 1.4% in 2010 in TSN; most of the increase was observed in Klebsiella species (from 1.6% to 10.4% in NNIS/NHSN). In the EIP surveillance, 92% of CRE episodes occurred in patients with substantial health-care exposures. Conclusions: Carbapenem resistance among common Enterobacteriaceae has increased over the past decade; most CRE are associated with health-care exposures. Implications for Public Health: Interventions exist that could slow the dissemination of CRE. Health departments are well positioned to play a leading role in prevention efforts by assisting with surveillance, situational awareness, and coordinating prevention efforts.


Gargano J.W.,Epidemic Intelligence Service | Gargano J.W.,National Center for Emerging and Zoonotic Diseases | Freeland A.L.,Epidemic Intelligence Service | Freeland A.L.,National Center for Environmental Health | And 7 more authors.
Epidemiology and Infection | Year: 2015

The drinking water infrastructure in the United States is ageing; extreme weather events place additional stress on water systems that can lead to interruptions in the delivery of safe drinking water. We investigated the association between household exposures to water service problems and acute gastrointestinal illness (AGI) and acute respiratory illness (ARI) in Alabama communities that experienced a freeze-related community-wide water emergency. Following the water emergency, investigators conducted a household survey. Logistic regression models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for self-reported AGI and ARI by water exposures. AGI was higher in households that lost water service for ≥7 days (aPR 2·4, 95% CI 1·1-5·2) and experienced low water pressure for ≥7 days (aPR 3·6, 95% CI 1·4-9·0) compared to households that experienced normal service and pressure; prevalence of AGI increased with increasing duration of water service interruptions. Investments in the ageing drinking water infrastructure are needed to prevent future low-pressure events and to maintain uninterrupted access to the fundamental public health protection provided by safe water supplies. Households and communities need to increase their awareness of and preparedness for water emergencies to mitigate adverse health impacts. © Cambridge University Press 2015.


Hall A.J.,National Center for Immunization and Respiratory Diseases | Wikswo M.E.,National Center for Immunization and Respiratory Diseases | Pringle K.,CDC | Gould L.H.,National Center for Emerging and Zoonotic Diseases | Parashar U.D.,National Center for Immunization and Respiratory Diseases
Morbidity and Mortality Weekly Report | Year: 2014

Introduction: Norovirus is the leading cause of acute gastroenteritis and foodborne disease in the United States, causing an estimated one in 15 U.S. residents to become ill each year as well as 56,000-71,000 hospitalizations and 570-800 deaths, predominantly among young children and the elderly. Whereas noroviruses often spread through person-to-person contact, foodborne transmission can cause widespread exposures and presents important prevention opportunities. Methods: CDC analyzed 2009-2012 data on suspected and confirmed norovirus outbreaks reported by state, local, and territorial health departments through the National Outbreak Reporting System (NORS) to characterize the epidemiology of foodborne norovirus outbreaks. Results: During 2009-2012, a total of 1,008 foodborne norovirus outbreaks were reported to NORS, constituting 48% of all foodborne outbreaks with a single known cause. Outbreaks were reported by 43 states and occurred year round. Restaurants were the most common setting (64%) of food preparation reported in outbreaks. Of 520 outbreaks with factors contributing to contamination reported, food workers were implicated as the source in 70%. Of 324 outbreaks with an implicated food, most resulted from food contaminated during preparation (92%) and food consumed raw (75%). Specific food categories were implicated in only 67 outbreaks; the most frequently named were vegetable row crops (e.g., leafy vegetables) (30%), fruits (21%), and mollusks (19%). Conclusions: Noroviruses are the leading cause of reported foodborne disease outbreaks and most often associated with contamination of food in restaurants during preparation by infected food workers. Implications for Public Health Practice: Improved adherence to appropriate hand hygiene, excluding ill staff members from working until ≥48 hours after symptom resolution, and supervision by certified kitchen managers are all recommended to reduce the incidence of foodborne norovirus disease. © 2014 Massachusetts Medical Society. All rights reserved.

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