Louisa Castrodale

Guidelines for animal-assisted interventions in health care facilities.

Many hospitals and long-term care facilities in North America currently permit animals to visit with their patients; however, the development of relevant infection control and prevention policies has lagged, due in large part to the lack of scientific evidence regarding risks of patient infection associated with animal interaction. This report provides standard guidelines for animal-assisted interventions in health care facilities, taking into account the available evidence.

Outbreak of multidrug-resistant Salmonella typhimurium associated with ground beef served at a school potluck

An outbreak of gastroenteritis occurred among at least 47 persons attending a school potluck. Illness was associated with consumption of ground beef (estimated odds ratio, 16.3; 95% confidence interval, 2.2 to 338.3). Salmonella Typhimurium isolated from infected individuals and the implicated ground beef revealed identical pulsed-field gel electrophoresis patterns and was multidrug resistant. The implicated ground beef was improperly handled during the cooking process and stored above the U.S. Food and Drug Administration cooling temperature standard for >15 h before being served. This outbreak demonstrates the limitations of food safety regulations in settings where foods are prepared in the home environment for communal potlucks, bake sales, or other such gatherings held at schools, churches, or other institutions. Public health authorities should encourage school and other institutional administrators to develop policies that require dissemination of safe food preparation guidelines to prospective food handlers when such events are scheduled.

2009 Pandemic Influenza A H1N1 in Alaska: Temporal and Geographic Characteristics of Spread and Increased Risk of Hospitalization among Alaska Native and Asian/Pacific Islander People

Alaska Native people have suffered disproportionately from previous influenza pandemics. We evaluated 3 separate syndromic data sources to determine temporal and geographic patterns of spread of 2009 pandemic influenza A H1N1 (pH1N1) in Alaska, and reviewed records from persons hospitalized with pH1N1 disease in 3 areas in Alaska to characterize clinical and epidemiologic features of disease in Alaskans. A wave of pH1N1 disease swept through Alaska beginning in most areas in August or early September. In rural regions, where Alaska Native people comprise a substantial proportion of the population, disease occurred earlier than in other regions. Alaska Native people and Asian/Pacific Islanders (A/PI) were 2-4 times more likely to be hospitalized than whites. Alaska Native people and other minorities remain at high risk for early and substantial morbidity from pandemic influenza episodes. These findings should be integrated into plans for distribution and use of vaccine and antiviral agents.

Endemic Foodborne Botulism among Alaska Native Persons—Alaska, 1947–2007

BACKGROUND Foodborne botulism resulting from consumption of uncooked aquatic game foods has been an endemic hazard among Alaska Native populations for centuries. Our review was conducted to help target botulism prevention and response activities. METHODS Records of Alaska botulism investigations for the period 1947-2007 were reviewed. We used the Centers for Disease Control and Prevention case definitions for foodborne botulism and linear regression to evaluate incidence trends and χ(2) or Fishers Exact tests to evaluate categorical data. RESULTS A total of 317 patients (61% of whom were female) and 159 outbreaks were reported. Overall mean annual incidence was 6.9 cases per 100,000 Alaska Native persons; mean incidence was lower in 2000 (5.7 cases per 100,000 Alaska Native persons) than in any period since 1965-1969 (0.8 cases per 100,000 Alaska Native persons). Age-specific incidence was highest (26.6 cases per 100,000 Alaska Native persons) among persons aged ≥60 years. The overall case-fatality rate was 8.2%, and the case-fatality rate was ≤4.0% since 1980. Misdiagnosis was associated with a higher case-fatality rate and delayed antitoxin administration. CONCLUSIONS Foodborne botulism remains a public health problem in Alaska. Incidence might be decreasing, but it remains >800 times the overall US rate (0.0068 cases per 100,000 persons). Prevention messages should highlight the additional risk to female individuals and older persons. Early diagnosis is critical for timely access to antitoxin and supportive care.

Impact of a statewide childhood vaccine program in controlling hepatitis A virus infections in Alaska

Historically, Alaska experienced cyclic hepatitis A virus (HAV) epidemics, and the HAV rate among Alaska Native people was significantly higher than among other racial/ethnic groups. We evaluated the impact of universal childhood vaccination, initiated in 1996, on HAV epidemiology in Alaska by analyzing HAV cases reported to the State of Alaska. HAV incidence in all age groups declined 98.6% from 60.0/100,000 in 1972-1995 to 0.9/100,000 in 2002-2007. The largest decrease (99.9%) was in Alaska Native people, whose incidence (0.3) in 2002-2007 was lower than the overall U.S. 2007 rate (1.0). Among age groups, the decrease (99.8%) among children aged 0-14 years was the largest. Routine childhood vaccination has nearly eliminated HAV infection in Alaska.

Increase in Adverse Reactions Associated with Use of Synthetic Cannabinoids — Anchorage, Alaska, 2015–2016

In July 2015, personnel in the Alaska Division of Public Healths Section of Epidemiology became aware of an increase in the number of patients being treated in Anchorage hospital emergency departments for adverse reactions associated with use of synthetic cannabinoids (SCs). SCs are a chemically diverse class of designer drugs that bind to the same cannabinoid receptors as tetrahydrocannabinol, the main psychoactive component of cannabis. A public health investigation was initiated to describe clinical outcomes, characterize the outbreak, and identify SC chemicals circulating in Anchorage. During July 15, 2015-March 15, 2016, a total of 1,351 ambulance transports to Anchorage emergency departments for adverse SC reactions were identified. A review of charts obtained from two Anchorage hospitals determined that among 167 emergency department visits for adverse SC reactions during July 15-September 30, 2015, 11 (6.6%) involved a patient who required endotracheal intubation, 17 (10.2%) involved a patient who was admitted to the intensive care unit, and 66 (39.5%) involved a patient classified as being homeless. Testing of 25 product and paraphernalia samples collected from patients at one hospital identified 11 different SC chemicals. Educational outreach campaigns focused on the considerable health risks of using SCs need to complement judicial and law enforcement actions to reduce SC use.

Novel Orthopoxvirus Infection in an Alaska Resident

Summary A resident of interior Alaska, was diagnosed with an Orthopoxvirus infection. Phylogenetic analysis revealed it is a novel, previously undescribed Orthopoxvirus species. Phylogenetically, the virus is sister to recognized Old World orthopoxviruses, rather than North American Orthopoxvirus species.

A Case-Study of Implementation of Improved Strategies for Prevention of Laboratory-acquired Brucellosis

Background In 2012, the Alaska Section of Epidemiology investigated personnel potentially exposed to a Brucella suis isolate as it transited through three laboratories. Methods We summarize the first implementation of the United States Centers for Disease Control and Prevention 2013 revised recommendations for monitoring such exposures: (1) risk classification; (2) antimicrobial postexposure prophylaxis; (3) serologic monitoring; and (4) symptom surveillance. Results Over 30 people were assessed for exposure and subsequently monitored for development of illness. No cases of laboratory-associated brucellosis occurred. Changes were made to gaps in laboratory biosafety practices that had been identified in the investigation. Conclusion Achieving full compliance for the precise schedule of serologic monitoring was challenging and resource intensive for the laboratory performing testing. More refined exposure assessments could inform decision making for follow-up to maximize likelihood of detecting persons at risk while not overtaxing resources.

Outbreak of Invasive Infections From Subtype emm26.3 Group A Streptococcus Among Homeless Adults—Anchorage, Alaska, 2016–2017

Background In 2016, we detected an outbreak of group A Streptococcus (GAS) invasive infections among the estimated 1000 persons experiencing homelessness (PEH) in Anchorage, Alaska. We characterized the outbreak and implemented a mass antibiotic intervention at homeless service facilities. Methods We identified cases through the Alaska GAS laboratory-based surveillance system. We conducted emm typing, antimicrobial susceptibility testing, and whole-genome sequencing on all invasive isolates and compared medical record data of patients infected with emm26.3 and other emm types. In February 2017, we offered PEH at 6 facilities in Anchorage a single dose of 1 g of azithromycin. We collected oropharyngeal and nonintact skin swabs on a subset of participants concurrent with the intervention and 4 weeks afterward. Results From July 2016 through April 2017, we detected 42 invasive emm26.3 cases in Anchorage, 35 of which were in PEH. The emm26.3 isolates differed on average by only 2 single-nucleotide polymorphisms. Compared to other emm types, infection with emm26.3 was associated with cellulitis (odds ratio [OR], 2.5; P = .04) and necrotizing fasciitis (OR, 4.4; P = .02). We dispensed antibiotics to 391 PEH. Colonization with emm26.3 decreased from 4% of 277 at baseline to 1% of 287 at follow-up (P = .05). Invasive GAS incidence decreased from 1.5 cases per 1000 PEH/week in the 6 weeks prior to the intervention to 0.2 cases per 1000 PEH/week in the 6 weeks after (P = .01). Conclusions In an invasive GAS outbreak in PEH in Anchorage, mass antibiotic administration was temporally associated with reduced invasive disease cases and colonization prevalence.

Work-related injuries in the Alaska logging industry, 1991-2014

BACKGROUND Although loggers in Alaska are at high risk for occupational injury, no comprehensive review of such injuries has been performed since the mid-1990s. We investigated work-related injuries in the Alaska logging industry during 1991-2014. METHODS Using data from the Alaska Trauma Registry and the Alaska Occupational Injury Surveillance System, we described fatal and nonfatal injuries by factors including worker sex and age, timing and geographic location of injuries, and four injury characteristics. Annual injury rates and associated 5-year simple moving averages were calculated. RESULTS We identified an increase in the 5-year simple moving averages of fatal injury rates beginning around 2005. While injury characteristics were largely consistent between the first 14 and most recent 10 years of the investigation, the size of logging companies declined significantly between these periods. CONCLUSIONS Factors associated with declines in the size of Alaska logging companies might have contributed to the observed increase in fatal injury rates.