Chad Smelser

Spinach-associated Escherichia coli O157:H7 Outbreak, Utah and New Mexico, 2006

In 2006, Utah and New Mexico health departments investigated a multistate cluster of Escherichia coli O157:H7. A case–control study of 22 case-patients found that consuming bagged spinach was significantly associated with illness (p<0.01). The outbreak strain was isolated from 3 bags of 1 brand of spinach. Nationally, 205 persons were ill with the outbreak strain.

Cryptococcus gattii Infections in Multiple States Outside the US Pacific Northwest

Clonal VGII subtypes (outbreak strains) of Cryptococcus gattii have caused an outbreak in the US Pacific Northwest since 2004. Outbreak-associated infections occur equally in male and female patients (median age 56 years) and usually cause pulmonary disease in persons with underlying medical conditions. Since 2009, a total of 25 C. gattii infections, 23 (92%) caused by non–outbreak strain C. gattii, have been reported from 8 non–Pacific Northwest states. Sixteen (64%) patients were previously healthy, and 21 (84%) were male; median age was 43 years (range 15–83 years). Ten patients who provided information reported no past-year travel to areas where C. gattii is known to be endemic. Nineteen (76%) patients had central nervous system infections; 6 (24%) died. C. gattii infection in persons without exposure to known disease-endemic areas suggests possible endemicity in the United States outside the outbreak-affected region; these infections appear to differ in clinical and demographic characteristics from outbreak-associated C. gattii. Clinicians outside the outbreak-affected areas should be aware of locally acquired C. gattii infection and its varied signs and symptoms.

Risk Factors for 2009 Pandemic Influenza A (H1N1)–Related Hospitalization and Death Among Racial/Ethnic Groups in New Mexico

OBJECTIVES We assessed risk factors for 2009 pandemic influenza A (H1N1)-related hospitalization, mechanical ventilation, and death among New Mexico residents. METHODS We calculated population rate ratios using Poisson regression to analyze risk factors for H1N1-related hospitalization. We performed a cross-sectional analysis of hospitalizations during September 14, 2009 through January 13, 2010, using logistic regression to assess risk factors for mechanical ventilation and death among those hospitalized. RESULTS During the study period, 926 laboratory-confirmed H1N1-related hospitalizations were identified. H1N1-related hospitalization was significantly higher among American Indians (risk ratio [RR] = 2.6; 95% confidence interval [CI] = 2.2, 3.2), Blacks (RR = 1.7; 95% CI = 1.2, 2.4), and Hispanics (RR = 1.8; 95% CI = 1.5, 2.0) than it was among non-Hispanic Whites, and also was higher among persons of younger age and lower household income. Mechanical ventilation was significantly associated with age 25 years and older, obesity, and lack of or delayed antiviral treatment. Death was significantly associated with male gender, cancer during the previous 12 months, and liver disorder. CONCLUSIONS This analysis supports recent national efforts to include American Indian/Alaska Native race as a group at high risk for complications of influenza with respect to vaccination and antiviral treatment recommendations.

Cluster of necrotizing enterocolitis in a neonatal intensive care unit: New Mexico, 2007

Background Although the cause of necrotizing enterocolitis (NEC) is unknown, infection control practices have been shown to play an important role in containing many outbreaks. We investigated the etiology of a cluster of NEC in a level 3 neonatal intensive care unit and monitored for new cases following the implementation of enhanced infection control measures. Methods Investigators performed a chart and laboratory review for neonates with a diagnosis of NEC during January 1, 2007, to February 13, 2007, to identify risk factors. Enhanced environmental cleaning, cohorting of infants and nurses, and increased attention to hand hygiene were instituted. Commercial feeding products in the unit were tested for bacterial contamination. Close monitoring for new cases continued for 2 months following the identification of the cluster. Results Eleven cases of NEC were identified during the study period. Patients had a median of 5 disease risk factors (range, 3-8). Four distinct pathogens were detected in blood or stool specimens from 4 different patients. One sample of human milk fortifier (HMF) tested contained a colony count of Bacillus cereus at the US Food and Drug Administrations upper microbiologic limit for contamination. Seven (65%) patients received HMF before symptom onset, and 9 (82%) patients received 1 or more types of liquid formula. Only 1 new case was identified during the period of close monitoring. Conclusion A microbiologic cause was not identified, and, although the cluster might have resolved spontaneously, enhanced infection control and changing batches of HMF might have played a role in controlling this outbreak.

Pandemic (H1N1) 2009–associated Deaths Detected by Unexplained Death and Medical Examiner Surveillance

During the pandemic (H1N1) 2009 outbreak, Minnesota, New Mexico, and Oregon used several surveillance methods to detect associated deaths. Surveillance using unexplained death and medical examiner data allowed for detection of 34 (18%) pandemic (H1N1) 2009–associated deaths that were not detected by hospital-based surveillance.

Enhancement of Influenza Surveillance With Aggregate Rapid Influenza Test Results: New Mexico, 2003-2007

OBJECTIVES We sought to determine whether monitoring rapid influenza laboratory tests improved the influenza-like illness surveillance already in place in New Mexico. METHODS For the past 3 influenza seasons, the New Mexico Department of Health examined influenza-like illness visits and positive rapid influenza test results. RESULTS The proportion of positive rapid influenza test results started to rise earlier than did the percentage of clinical visits because of influenza-like illness in each of the past 3 influenza seasons: 5 weeks earlier during the 2004-2005 season; 3 weeks earlier in 2005-2006; and 2 weeks earlier in 2006-2007. In addition, rapid influenza tests showed a spike in influenza B activity late in the 2005-2006 season that influenza-like illness syndrome surveillance did not. CONCLUSIONS Laboratory-based rapid influenza test surveillance required relatively few resources to implement and offered a sensitive mechanism to detect the onset of influenza activity while allowing for the distinction of influenza types.

Does outpatient laboratory testing represent influenza burden and distribution in a rural state

Laboratory testing results are often used to monitor influenza illness in populations, but results may not be representative of illness burden and distribution, especially in populations that are geographically, socioeconomically, and racially/ethnically diverse.