Randall S. Nelson

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

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

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.

West Nile virus serosurvey and assessment of personal prevention efforts in an area with intense epizootic activity: Connecticut, 2000.

BACKGROUND In 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. METHODS Confirmed 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. RESULTS We 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. CONCLUSIONS Farm 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.

Expansion of zoonotic babesiosis and reported human cases, Connecticut, 2001-2010.

Abstract: West Nile virus (WNV) can cause large outbreaks of febrile illness and severe neurologic disease. This study estimates the seroprevalence of WNV infection and assesses risk perception and practices regarding potential exposures to mosquitoes of persons in an area with intense epizootics in 1999 and 2000. A serosurvey of persons aged ≥12 years was conducted in southwestern Connecticut during October 10‐15, 2000, using household‐based stratified cluster sampling. Participants completed a questionnaire regarding concern for and personal measures taken with respect to WNV and provided a blood sample for WNV testing. Seven hundred thirty persons from 645 households participated. No person tested positive for WNV (95% CI: 0‐0.5%). Overall, 44% of persons used mosquito repellent, 56% practiced ≥ two personal precautions to avoid mosquitoes, and 61% of households did ≥ two mosquito‐ source reduction activities. In multivariate analyses, using mosquito repellent was associated with age <50 years, using English as the primary language in the home, being worried about WNV, being a little worried about pesticides, and finding mosquitoes frequently in the home (P <0.05). Females (OR = 2.0; CI = 1.2‐2.9) and persons very worried about WNV (OR = 3.8; CI = 2.2‐6.5) were more likely to practice ≥ two personal precautions. Taking ≥ two mosquito source reductions was associated with persons with English as the primary language (OR = 2.0; CI = 1.1‐3.5) and finding a dead bird on the property (OR = 1.8; CI = 1.1‐2.8).

West Nile virus surveillance in Connecticut in 2000: an intense epizootic without high risk for severe human disease.

The epidemiology of Lyme disease varies by surveillance method.

Three Sudden Cardiac Deaths Associated with Lyme Carditis — United States, November 2012–July 2013

ABSTRACT To document the expansion of human babesiosis in Connecticut, we analyzed reservoir host sera for seroreactivity to Babesia microti Franca and reviewed Connecticut human surveillance case data collected during 2001–2010. Sera from white-footed mice, Peromyscus leucopus Rafinesque, from 10 towns in 5 counties, collected at 4–7-yr periods between 2001 and 2010, were tested for total immunoglobulins. The prevalence of B. microti-positive mice was compared with confirmed and probable human case reports tabulated by the Connecticut Department of Public Health. The highest babesiosis and rodent seroprevalence rates were in New London County, where this protozoan disease was first documented in the state. However, human cases and reservoir host infection increased significantly from 2001–2005 to 2005–2010 and in other parts of the state. Clinicians should be aware that the disease is not confined to long-established endemic areas of the state.