Perry F. Smith

Detection, Isolation, and Molecular Subtyping of Escherichia coli O157:H7 and Campylobacter jejuni Associated with a Large Waterborne Outbreak

ABSTRACT The largest reported outbreak of waterborne Escherichia coli O157:H7 in the United States occurred in upstate New York following a county fair in August 1999. Culture methods were used to isolate E. coli O157:H7 from specimens from 128 of 775 patients with suspected infections. Campylobacter jejuni was also isolated from stools of 44 persons who developed diarrheal illness after attending this fair. There was one case of a confirmed coinfection with E. coli O157:H7 and C. jejuni. Molecular detection of stx1 and stx2 Shiga toxin genes, immunomagnetic separation (IMS), and selective culture enrichment were utilized to detect and isolate E. coli O157:H7 from an unchlorinated well and its distribution points, a dry well, and a nearby septic tank. PCR for stx1 and stx2 was shown to provide a useful screen for toxin-producing E. coli O157:H7, and IMS subculture improved recovery. Pulsed-field gel electrophoresis (PFGE) was used to compare patient and environmental E. coli O157:H7 isolates. Among patient isolates, 117 of 128 (91.5%) were type 1 or 1a (three or fewer bands different). Among the water distribution system isolates, 13 of 19 (68%) were type 1 or 1a. Additionally, PFGE of C. jejuni isolates revealed that 29 of 35 (83%) had indistinguishable PFGE patterns. The PFGE results implicated the water distribution system as the main source of the E. coli O157:H7 outbreak. This investigation demonstrates the potential for outbreaks involving more than one pathogen and the importance of analyzing isolates from multiple patients and environmental samples to develop a better understanding of bacterial transmission during an outbreak.

Issues Associated with and Recommendations for Using PCR To Detect Outbreaks of Pertussis

ABSTRACT Two outbreaks of respiratory tract illness associated with prolonged cough occurring in 1998 and 1999 in New York State were investigated. A PCR test for Bordetella pertussis was primarily used by a private laboratory to confirm 680 pertussis cases. Several clinical specimens had positive culture results for B. pertussis during both outbreaks, which confirmed that B. pertussis was circulating during the outbreaks. However, testing by the New York State Department of Health reference laboratory suggested that some of the PCR results may have been falsely positive. In addition, features of the outbreak that suggested that B. pertussis may not have been the primary agent of infection included a low attack rate among incompletely vaccinated children and a significant amount of illness among patients testing PCR negative for B. pertussis. These investigations highlight the importance of appropriate clinical laboratory quality assurance programs, of the limitations of the PCR test, and of interpreting laboratory results in context of clinical disease.

A comparison of alcohol sales data with survey data on self-reported alcohol use in 21 states

We used data from 21 states that participated in the 1985 Behavioral Risk Factor Surveillance System to compare state-specific per capita self-reported alcohol consumption and the prevalence of three drinking behaviors with state-specific per capita sales. The correlation coefficient for per capita sales and per capita self-reported consumption for the 21 states was 0.81. Per capita sales were also significantly correlated with the prevalence of self-reported heavier drinking, binge drinking, and drinking and driving; the corresponding correlation coefficients were 0.74, 0.59, and 0.51. These findings suggest that states with higher per capita sales of alcohol also have higher rates of self-reported consumption and drinking patterns suggestive of high-risk behavior.

Occupational Risk of Lyme Disease in Endemic Areas of New York State

Although Lyme disease (LD) is the most common tick-borne disease in the United States, little is known about the frequency of and risk factors for infection with Borrelia burgdorferi in occupational groups. In 1986, we recruited primarily outdoor workers from six employee groups in southeastern New York where LD is endemic. Of 414 participants who completed questionnaires and had blood samples tested for antibodies against B. burgdorferi by ELISA and Western immunoblot, 27 (6.5%) were seropositive, but only 14 of the 27 reported previous symptoms of LD. Persons who spent more than 30 hours per week outdoors during leisure were 2.5 times more likely to be seropositive than those who did not (p = .02). Those with a history of outdoor employment were twice as likely to be seropositive as those without such a history, although this finding was not statistically significant (p = .70). However, the seroprevalence rate for the employees was 5.9 times higher than the rate for a comparison group of anonymous blood donors from the same region of New York (p less than .001). These results suggest that there was a relatively high rate of seropositivity for the employee groups and that infection was frequently asymptomatic and associated with outdoor exposure.

Public health impact of reemergence of rabies, New York.

This report summarizes the spread of a raccoon rabies epizootic into New York in the 1990s, the species of animals affected, and human postexposure treatments (PET). A total of 57,008 specimens were submitted to the state laboratory from 1993 to 1998; 8,858 (16%) animals were confirmed rabid, with raccoons the most common species (75%). After exposure to 11,769 animals, 18,238 (45%) persons received PET, mostly because of contact with saliva or nervous tissue. We analyzed expenditure reports to estimate the cost of rabies prevention activities. An estimated

Effectiveness of Previous Mumps Vaccination During a Summer Camp Outbreak

13.9 million was spent in New York State to prevent rabies from 1993 to 1998. Traditional prevention methods such as vaccinating pets, avoiding wildlife, and verifying an animal’s rabies status must be continued to reduce costly PET. To reduce rabid animals, exposures, and costs, oral vaccination of wildlife should also be considered.

Hemolytic Uremic Syndrome Risk and Escherichia coli O157:H7

OBJECTIVES. Mumps is a vaccine-preventable disease that may cause outbreaks. In July 2005, an outbreak of mumps occurred during a childrens summer camp in upstate New York. An investigation was initiated to describe the cases and evaluate vaccine effectiveness. METHODS. A retrospective cohort study was conducted among 541 children from the United States and abroad who attended a 1- or 2-month overnight summer camp. Patients with mumps were interviewed; serologic analysis was conducted for 6 case patients. Vaccine effectiveness was calculated by retrospective review of immunization records for 507 attendees who were eligible for vaccination and had verified immunization history. RESULTS. Thirty-one camp attendees were identified as having mumps (attack rate: 5.7%); 5 (83%) of 6 patients tested had positivity for mumps immunoglobulin M. Of the 507 participants (including 29 patients) with available immunization history, 440 (including 16 [87%] patients) were 2-dose recipients of mumps vaccine (attack rate: 3.6%); 46 participants (including 4 [9%] patients) were 1-dose recipients (attack rate: 8.7%); and 21 (including 9 [4%] patients) were unvaccinated (attack rate: 42.9%). Vaccine effectiveness was 92% for 2 doses and 80% for 1 dose. CONCLUSIONS. Outbreaks of mumps in settings such as summer camps can occur despite high vaccination rates. Vaccine effectiveness for 2 mumps vaccinations was greater than vaccine effectiveness for 1 mumps vaccination. Therefore, recommendation of 2 mumps vaccinations for summer camp participants continues to be appropriate. Control of mumps disease relies on broad vaccination coupled with correct clinical diagnosis and strict control measures.

West Nile virus: a case study in how NY State Health Information infrastructure facilitates preparation and response to disease outbreaks.

We reviewed medical records of 238 hospitalized patients with Escherichia coli O157:H7 diarrhea to identify risk factors for progression to diarrhea-associated hemolytic uremic syndrome (HUS). Data indicated that young age, long duration of diarrhea, elevated leukocyte count, and proteinuria were associated with HUS.

Hemolytic Uremic Syndrome Incidence in New York

New Yorks (NY) Health Information Network (HIN) provided timely access to West Nile Virus (WNV) data during the initial outbreak in the late Summer 1999. In December 1999, NY developed a plan to deal with WNV in 2000 that required an integrated surveillance system for humans, birds, mammals, and mosquitoes. The HIN infrastructure allowed NY to deploy this system statewide in three months. Local health departments throughout NY used the system to report, track, and retrieve surveillance data as WNV spread throughout NY in 2000. The HIN infrastructure includes partnerships, training/support, technical capacity and architecture similar to NEDSS as proposed by the US CDC.

Policy Issues in Developing Information Systems for Public Health Surveillance of Communicable Diseases

A comparison of New York’s traditional communicable disease surveillance system for diarrhea-associated hemolytic uremic syndrome with hospital discharge data showed a sensitivity of 65%. Escherichia coli O157:H7 was found in 63% of samples cultured from hemolytic uremic syndrome patients, and samples were more likely to be positive when collected early in illness.