Matthew L. Cartter

The Changing Epidemiology of Meningococcal Disease in the United States, 1992–1996

New meningococcal vaccines are undergoing clinical trials, and changes in the epidemiologic features of meningococcal disease will affect their use. Active laboratory-based, population-based US surveillance for meningococcal disease during 1992-1996 was used to project that 2400 cases of meningococcal disease occurred annually. Incidence was highest in infants; however, 32% of cases occurred in persons >/=30 years of age. Serogroup C caused 35% of cases; serogroup B, 32%; and serogroup Y, 26%. Increasing age (relative risk [RR], 1.01 per year), having an isolate obtained from blood (RR, 4.5), and serogroup C (RR, 1.6) were associated with increased case fatality. Among serogroup B isolates, the most commonly expressed serosubtype was P1.15; 68% of isolates expressed 1 of the 6 most common serosubtypes. Compared with cases occurring in previous years, recent cases are more likely to be caused by serogroup Y and to occur among older age groups. Ongoing surveillance is necessary to determine the stability of serogroup and serosubtype distribution.

Underreporting of lyme disease by connecticut physicians, 1992

To determine the magnitude of underreporting of Lyme disease, a random sample of Connecticut physicians was surveyed in 1993. The magnitude of underreporting was assessed by comparing physician estimates of Lyme disease diagnoses with reports of Lyme disease sent by physicians to the Connecticut Lyme disease surveillance system. Complete questionnaires were returned by 59 percent (412/698) of those surveyed. Of the 224 respondents who indicated that they had made a diagnosis of Lyme disease in 1992, only 56 (25 percent) reported a case of Lyme disease that year. Survey results suggested that, at best, only 16 percent of Lyme disease cases were reported in 1992. Physician underreporting of Lyme disease underestimates the public health impact of Lyme disease.

Knowledge, Attitudes, and Behaviors Regarding Lyme Disease Prevention Among Connecticut Residents, 1999–2004

Lyme disease, caused by the tick-transmitted bacterium Borrelia burgdorferi, is the most common vector-borne disease in the United States. We surveyed residents of three Connecticut health districts to evaluate the impact of intensive community-wide education programs on knowledge, attitudes, and behaviors to prevent Lyme disease. Overall, 84% of respondents reported that they knew a lot or some about Lyme disease, and 56% felt that they were very or somewhat likely to get Lyme disease in the coming year. During 2002-2004, the percentage of respondents who reported always performing tick checks increased by 7% and the percentage of respondents who reported always using repellents increased by 5%, whereas the percentage of respondents who reported avoiding wooded areas and tucking pants into socks decreased. Overall, 99% of respondents used personal protective behaviors to prevent Lyme disease. In comparison, 65% of respondents reported using environmental tick controls, and increased use of environmental tick controls was observed in only one health district. The majority of respondents were unwilling to spend more than

The Emergence of Another Tickborne Infection in the 12-Town Area around Lyme, Connecticut: Human Granulocytic Ehrlichiosis

100 on tick control. These results provide guidance for the development of effective Lyme disease prevention programs by identifying measures most likely to be adopted by residents of Lyme disease endemic communities.

Outbreak of Escherichia coli O157 Associated with Raw Milk, Connecticut, 2008

Human granulocytic ehrlichiosis (HGE) is an emerging tickborne infection, increasingly recognized in areas in which Lyme disease is endemic, but there are few data on the incidence of HGE. Prospective population-based surveillance was conducted in the 12-town area around Lyme, Connecticut, by means of both active and passive methods, from April through November of 1997, 1998, and 1999. Five hundred thirty-seven residents presenting to their primary care provider with an acute febrile illness suggestive of HGE were identified. Of these, 137 (26%) had laboratory evidence (by indirect fluorescent antibody staining or polymerase chain reaction) of HGE; 89 were confirmed cases, and 48 were probable cases. The incidence of confirmed HGE was 31 cases/100,000 in 1997, 51 cases/100,000 in 1998, and 24 cases/100,000 in 1999. A subset of sera was tested by use of immunoblot assays, and results were in agreement with indirect fluorescent antibody methods for 86% of samples analyzed. Thus, HGE is an important cause of morbidity and is now the second most common tickborne infection in southeastern Connecticut.

Trends in Invasive Infection with Methicillin-Resistant Staphylococcus aureus, Connecticut, USA, 2001–2010

BACKGROUNDnIn Connecticut, despite hazards of raw milk consumption, attempts to ban raw milk sales have been unsuccessful. In July 2008, 2 children experienced Escherichia coli O157-associated hemolytic uremic syndrome (HUS) after consuming raw milk purchased at a retail market and a farm (farm X). We investigated to determine the outbreak source and control measures.nnnMETHODSnConfirmed cases were HUS diagnosis or E. coli O157:NM infections with isolates matching outbreak strains among patients during June to July 2008. Probable cases were diarrheal illness among farm X customers during the same period. We conducted case-control studies to determine the source of E. coli O157 exposure and assess for dose-response relation between illness and frequency of raw milk consumption. Farm X dairy practices were evaluated; stool specimens of humans and animals were cultured for E. coli O157. Staff time and laboratory and medical costs were calculated.nnnRESULTSnWe identified 14 cases (7 confirmed). Five (36%) case patients required hospitalization; 3 (21%) experienced HUS. No deaths were reported. Raw milk consumption was associated with illness (P = .008); a dose-response relation was demonstrated (P = .01). Dairy practices reflected industry standards. E. coli O157:NM outbreak strains were isolated from stool specimens of 6 case patients and 1 milking cow. The total estimated outbreak cost was

Effect of Surveillance Method on Reported Characteristics of Lyme Disease, Connecticut, 1996–2007

413,402.nnnCONCLUSIONSnFarm Xs raw milk was the outbreak source despite no violations of current raw milk regulatory standards. This outbreak resulted in substantial costs and proposed legislation to prohibit nonfarm retail sale, strengthen advisory labels, and increase raw milk testing for pathogens.

Investigation of Escherichia coli Harboring the mcr-1 Resistance Gene — Connecticut, 2016

Decreases in health care–related isolates accounted for all reductions in MRSA during 2007–2010.

A 2009 Varicella Outbreak in a Connecticut Residential Facility for Adults with Intellectual Disability

The epidemiology of Lyme disease varies by surveillance method.

Training in Infectious Disease Epidemiology through the Emerging Infections Program Sites.

The mcr-1 gene confers resistance to the polymyxins, including the antibiotic colistin, a medication of last resort for multidrug-resistant infections. The mcr-1 gene was first reported in 2015 in food, animal, and patient isolates from China (1) and is notable for being the first plasmid-mediated colistin resistance mechanism to be identified. Plasmids can be transferred between bacteria, potentially spreading the resistance gene to other bacterial species. Since its discovery, the mcr-1 gene has been reported from Africa, Asia, Europe, South America, and North America (2,3), including the United States, where it has been identified in Escherichia coli isolated from three patients and from two intestinal samples from pigs (2,4-6). In July 2016, the Pathogen Detection System at the National Center for Biotechnology Information (Bethesda, Maryland) identified mcr-1 in the whole genome sequence of an E. coli isolate from a Connecticut patient (7); this is the fourth isolate from a U.S. patient to contain the mcr-1 gene.