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Harvey K.,National Center for Emerging and Zoonotic Infectious Disease
Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002)

In 2012, the number of international tourist arrivals worldwide was projected to reach a new high of 1 billion arrivals, a 48% increase from 674 million arrivals in 2000. International travel also is increasing among U.S. residents. In 2009, U.S. residents made approximately 61 million trips outside the country, a 5% increase from 1999. Travel-related morbidity can occur during or after travel. Worldwide, 8% of travelers from industrialized to developing countries report becoming ill enough to seek health care during or after travel. Travelers have contributed to the global spread of infectious diseases, including novel and emerging pathogens. Therefore, surveillance of travel-related morbidity is an essential component of global public health surveillance and will be of greater importance as international travel increases worldwide. September 1997-December 2011. GeoSentinel is a clinic-based global surveillance system that tracks infectious diseases and other adverse health outcomes in returned travelers, foreign visitors, and immigrants. GeoSentinel comprises 54 travel/tropical medicine clinics worldwide that electronically submit demographic, travel, and clinical diagnosis data for all patients evaluated for an illness or other health condition that is presumed to be related to international travel. Clinical information is collected by physicians with expertise or experience in travel/tropical medicine. Data collected at all sites are entered electronically into a database, which is housed at and maintained by CDC. The GeoSentinel network membership program comprises 235 additional clinics in 40 countries on six continents. Although these network members do not report surveillance data systematically, they can report unusual or concerning diagnoses in travelers and might be asked to perform enhanced surveillance in response to specific health events or concerns. During September 1997-December 2011, data were collected on 141,789 patients with confirmed or probable travel-related diagnoses. Of these, 23,006 (16%) patients were evaluated in the United States, 10,032 (44%) of whom were evaluated after returning from travel outside of the United States (i.e., after-travel patients). Of the 10,032 after-travel patients, 4,977 (50%) were female, 4,856 (48%) were male, and 199 (2%) did not report sex; the median age was 34 years. Most were evaluated in outpatient settings (84%), were born in the United States (76%), and reported current U.S. residence (99%). The most common reasons for travel were tourism (38%), missionary/volunteer/research/aid work (24%), visiting friends and relatives (17%), and business (15%). The most common regions of exposure were Sub-Saharan Africa (23%), Central America (15%), and South America (12%). Fewer than half (44%) reported having had a pretravel visit with a health-care provider. Of the 13,059 diagnoses among the 10,032 after-travel patients, the most common diagnoses were acute unspecified diarrhea (8%), acute bacterial diarrhea (5%), postinfectious irritable bowel syndrome (5%), giardiasis (3%), and chronic unknown diarrhea (3%). The most common diagnostic groupings were acute diarrhea (22%), nondiarrheal gastrointestinal (15%), febrile/systemic illness (14%), and dermatologic (12%). Among 1,802 patients with febrile/systemic illness diagnoses, the most common diagnosis was Plasmodium falciparum malaria (19%). The rapid communication component of the GeoSentinel network has allowed prompt responses to important health events affecting travelers; during 2010 and 2011, the notification capability of the GeoSentinel network was used in the identification and public health response to East African trypanosomiasis in Eastern Zambia and North Central Zimbabwe, P. vivax malaria in Greece, and muscular sarcocystosis on Tioman Island, Malaysia. The GeoSentinel Global Surveillance System is the largest repository of provider-based data on travel-related illness. Among ill travelers evaluated in U.S. GeoSentinel sites after returning from international travel, gastrointestinal diagnoses were most frequent, suggesting that U.S. travelers might be exposed to unsafe food and water while traveling internationally. The most common febrile/systemic diagnosis was P. falciparum malaria, suggesting that some U.S. travelers to malarial areas are not receiving or using proper malaria chemoprophylaxis or mosquito-bite avoidance measures. The finding that fewer than half of all patients reported having made a pretravel visit with a health-care provider indicates that a substantial portion of U.S. travelers might not be following CDC travelers' health recommendations for international travel. GeoSentinel surveillance data have helped researchers define an evidence base for travel medicine that has informed travelers' health guidelines and the medical evaluation of ill international travelers. These data suggest that persons traveling internationally from the United States to developing countries remain at risk for illness. Health-care providers should help prepare travelers properly for safe travel and provide destination-specific medical evaluation of returning ill travelers. Training for health-care providers should focus on preventing and treating a variety of travel-related conditions, particularly traveler's diarrhea and malaria. Source

Knust B.M.,University of Minnesota | Knust B.M.,National Center for Emerging and Zoonotic Infectious Disease | Wolf P.C.,U.S. Department of Agriculture | Wells S.J.,University of Minnesota
American Journal of Veterinary Research

Objective-To characterize the risk of interactions that may lead to the transmission of Mycobacterium bovis between cattle and white-tailed deer (Odocoileus virginianus) on farms in northern Minnesota. Sample-53 cattle farms in northwestern Minnesota adjacent to an area where bovine tuberculosis-infected cattle and deer were detected. Procedures-A semiquantitative deer-cattle interaction assessment tool was used for the 53 cattle herds. Farm risk scores were analyzed on the basis of deer damage to stored feed. Results-27 (51%) farms reported deer damage to stored cattle feeds within the year previous to the farm visit. A strong association was found between increases in the percentage of land that could serve as deer cover and deer damage to stored feeds on a farm. The total risk score was significantly associated with the probability of a farm having deer damage. By use of a logistic regression model, the total risk score and proportion of nonagricultural land around a farm could be used to predict the likelihood of deer damage to stored feeds. Conclusions and Clinical Relevance-Management practices on many farms in northwestern Minnesota allowed potential deer-cattle interactions. The on-farm risk assessment tool served as a valuable tool for prioritizing the biosecurity risks for farms. Continued development of biosecurity is needed to prevent potential transmission of bovine tuberculosis between deer and cattle, especially on farms that have a higher risk of deer damage. Source

Erin Staples J.,National Center for Emerging and Zoonotic Infectious Diseases | Gershman M.,National Center for Emerging and Zoonotic Infectious Disease | Fischer M.,National Center for Emerging and Zoonotic Infectious Diseases
Morbidity and Mortality Weekly Report

This report updates CDC's recommendations for using yellow fever (YF) vaccine (CDC. Yellow fever vaccine: recommendations of the Advisory Committee on Immunizations Practices: MMWR 2002;51[No. RR-17]). Since the previous YF vaccine recommendations were published in 2002, new or additional information has become available on the epidemiology of YF, safety profile of the vaccine, and health regulations related to the vaccine. This report summarizes the current epidemiology of YF, describes immunogenicity and safety data for the YF vaccine, and provides recommendations for the use of YF vaccine among travelers and laboratory workers. YF is a vectorborne disease resulting from the transmission of yellow fever virus (YFV) to a human from the bite of an infected mosquito. It is endemic to sub-Saharan Africa and tropical South America and is estimated to cause 200,000 cases of clinical disease and 30,000 deaths annually. Infection in humans is capable of producing hemorrhagic fever and is fatal in 20%-50% of persons with severe disease. Because no treatment exists for YF disease, prevention is critical to lower disease risk and mortality. A traveler's risk for acquiring YFV is determined by multiple factors, including immunization status, location of travel, season, duration of exposure, occupational and recreational activities while traveling, and local rate of virus transmission at the time of travel. All travelers to countries in which YF is endemic should be advised of the risks for contracting the disease and available methods to prevent it, including use of personal protective measures and receipt of vaccine. Administration of YF vaccine is recommended for persons aged ≥9 months who are traveling to or living in areas of South America and Africa in which a risk exists for YFV transmission. Because serious adverse events can occur following YF vaccine administration, health-care providers should vaccinate only persons who are at risk for exposure to YFV or who require proof of vaccination for country entry. To minimize the risk for serious adverse events, health-care providers should observe the contraindications, consider the precautions to vaccination before administering vaccine, and issue a medical waiver if indicated. Source

Gounder P.P.,National Center for Emerging and Zoonotic Infectious Disease | Bruce M.G.,National Center for Emerging and Zoonotic Infectious Disease | Bruden D.J.T.,National Center for Emerging and Zoonotic Infectious Disease | Rudolph K.,National Center for Emerging and Zoonotic Infectious Disease | And 2 more authors.
Pediatric Infectious Disease Journal

Background: We describe the relative impact of the heptavalent pneumococcal conjugate vaccine (PCV7, introduced 2001) and antibiotic use on colonization by antibiotic-resistant pneumococci in urban Alaskan children during 2000-2010. Methods: We obtained nasopharyngeal swab specimens from a convenience sample of children aged <5 years at clinics annually during 2000-2004 and 2008-2010. PCV7 status and antibiotic use <90 days before enrollment were determined by interview/medical records review. Pneumococci were characterized by serotype and susceptibility to penicillin (PCN). Isolates with full PCN resistance (PCN-R) or intermediate PCN resistance (PCN-I) were classified as PCN-NS. Results: We recruited 3496 children (median, 452 per year). During 2000-2010, a range of 18-29% per year of children used PCN/amoxicillin (P value for trend = 0.09); the proportion age-appropriately vaccinated with PCV7 increased (0-90%; P < 0.01). Among pneumococcal isolates, the PCV7-serotype proportion decreased (53-<1%; P < 0.01) and non-PCV7-serotype proportion increased (43-95%; P < 0.01). PCN-R pneumococcal colonization prevalence decreased (23-9%; P < 0.01) and PCN-I pneumococcal colonization prevalence increased (13-24%; P < 0.01); overall PCN-NS pneumococcal colonization prevalence was unchanged. PCN-NS among colonizing PCV7-type and non- PCV7-type pneumococci remained unchanged; a mean of 31% per year of PCV7-type and 10% per year of non-PCV7-type isolates were PCNR, and 10% per year of PCV7 and 20% per year of non-PCV7-type isolates were PCN-I. Conclusions: Overall, PCN-NS pneumococcal colonization remained unchanged during 2000-2010 because increased colonization by predominantly PCN-I non-PCV7 serotypes offset decreased colonization by predominantly PCN-R PCV7 serotypes. Proportion PCN-NS did not increase within colonizing pneumococcal serotype groups (PCV7 vs. non-PCV7) despite stable PCN use in our population. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source

Fitzpatrick J.L.,National Center for Emerging and Zoonotic Infectious Disease | Dyer J.L.,National Center for Emerging and Zoonotic Infectious Disease | Blanton J.D.,National Center for Emerging and Zoonotic Infectious Disease | Kuzmin I.V.,National Center for Emerging and Zoonotic Infectious Disease | And 2 more authors.
Journal of the American Veterinary Medical Association

Objective-To assess the epidemiology of rabies in rodents and lagomorphs and provide information that will enable public health officials to make recommendations regarding postexposure prophylaxis for humans after contact with these animals. Design-Cross-sectional epidemiological analysis. Sample-Rodents and lagomorphs submitted to state laboratories for rabies diagnosis from 1995 through 2010. Procedures-Positive samples were identified by use of direct fluorescent antibody testing, typed by sequencing of viral genes, and quantified via titration in mice or cell culture. Results-737 rabid rodents and lagomorphs were reported from 1995 through 2010, which represented a 62.3% increase, compared with the number of rabid rodents and lagomorphs reported from 1979 through 1994. The most commonly reported rodents or lagomorphs were groundhogs (Marmota monax). All animals submitted to the CDC for additional viral characterization were positive for the raccoon rabies virus variant. Infectious virus or viral RNA was detected in salivary glands or oral cavity tissues in 11 of 13 rabid rodents. Conclusions and Clinical Relevance-The increase in reported rabid rodents, compared with results of previous studies, appeared to be associated with spillover infections from the raccoon rabies epizootic during the first half of the study period. Analysis supported the assumption that rabies remained rare in rodents and lagomorphs. However, transmission of rabies virus via exposure to a rabid rodent or lagomorph may be possible. Given the rarity of rabies in these species, diagnostic testing and consideration of postexposure prophylaxis for humans with potential exposures should be considered on a case-by-case basis. Source

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