Outbreaks of acute gastroenteritis transmitted by person-to-person contact -- United States, 2009-2010

Problem/Condition: Approximately 179 million cases of acute gastroenteritis (AGE) occur in the United States each year, and outbreaks of AGE are a substantial public health problem. Although CDC has conducted national surveillance for waterborne and foodborne AGE outbreaks since 1971 and 1973, respectively, no national surveillance existed for AGE outbreaks resulting primarily from person-to-person transmission before implementation of the National Outbreak Reporting System (NORS) in 2009. Reporting Period: 2009-2010. Description of System: NORS is a national surveillance system launched in 2009 to support the reporting of all waterborne outbreaks and enteric disease outbreaks from foodborne, person-to-person, animal contact, environmental, and unknown modes of transmission. State and local public health agencies in the 50 U.S. states, the District of Columbia, five U.S. territories, and three Freely Associated States report these outbreaks to CDC via NORS using a standardized online data entry system. Data are collected on general outbreak characteristics (e.g., dates, number of illnesses, and locations), demographic characteristics of cases (e.g., age and sex), symptoms, case outcomes, and laboratory testing information and results. Only outbreaks reported in NORS with a primary mode of transmission of person-to-person contact are included in this report. Results: During 2009-2010, a total of 2,259 person-to-person AGE outbreaks were reported in NORS from 42 states and the District of Columbia. These outbreaks resulted in 81,491 reported illnesses, 1,339 hospitalizations, and 136 deaths. No etiology was reported in approximately 40% (n = 840) of outbreaks. Of the remaining 1,419 outbreaks with a reported etiology, 1,270 (89%) were either suspected or confirmed to be caused solely by norovirus. Other reported etiologies included Shigella (n = 86), Salmonella (n = 16), Shiga toxin-producing Escherichia coli (STEC) (n = 11), and rotavirus (n = 10). Most (82%) of the 1,723 outbreaks caused by norovirus or an unknown etiology occurred during the winter months, and outbreaks caused by Shigella or another suspected or confirmed etiology most often occurred during the spring or summer months (62%, N = 53 and 60%, N = 38, respectively). A setting was reported for 1,187 (53%) of total outbreaks. Among these reported settings, nursing homes and other long-term-care facilities were most common (80%), followed by childcare centers (6%), hospitals (5%), and schools (5%). Interpretation: NORS provides the first national data on AGE outbreaks spread primarily through person-to-person transmission and describes the frequency of this mode of transmission. Norovirus is the most commonly reported cause of these outbreaks and, on the basis of epidemiologic characteristics, likely accounts for a substantial portion of the reported outbreaks of unknown etiology. In the United States, sporadic and outbreak-associated norovirus causes an estimated 800 deaths and 70,000 hospitalizations annually, which could increase by an additional 50% during epidemic years. During 2009-2010, norovirus outbreaks accounted for the majority of deaths and health-care visits in person-to-person AGE outbreaks reported to NORS. Public Health Action: Prevention and control of person-to-person AGE outbreaks depend primarily on appropriate hand hygiene and isolation of ill persons. NORS surveillance data can help identify the etiologic agents, settings, and populations most often involved in AGE outbreaks resulting primarily from person-to-person transmission and guide development of targeted interventions to avert these outbreaks or mitigate the spread of infection. Surveillance for person-to-person AGE outbreaks via NORS also might be important in clarifying the epidemiology and role of certain pathogens (e.g., STEC) that have been traditionally considered foodborne but can also be transmitted person-to-person. As ongoing improvements and enhancements to NORS are introduced, participation in NORS has the potential to increase, allowing for improved estimation of epidemic person-to-person AGE and its relative importance among other modes of transmission.Mary E. Wikswo, Aron J. Hall, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC ."December 14, 2012."Also available via the World Wide Web as an Acrobat .pdf file (919.1 KB, 16 p.).Includes bibliographical references (p. 11-12)

Guidelines for viral hepatitis surveillance and case management

"Surveillance for viral hepatitis is needed to direct and evaluate prevention and control activities. CDC recommends that all states and territories conduct surveillance for acute viral hepatitis, including hepatitis A, B, C, and non-ABC hepatitis. In addition, states and territories should consider establishing computerized databases of persons who test positive for hepatitis B surface antigen (HBsAg) or antibody to hepatitis C virus (anti-HCV) to facilitate the notification, counseling and management of persons with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections. The purpose of this document is to 1) provide guidance to clinicians, state and local health departments, and other health agencies regarding case ascertainment, reporting, investigation, and follow-up of persons with acute viral hepatitis; and 2) provide a framework for the development of systems for identifying and following up persons who may have chronic HBV or HCV infections. These guidelines describe the essential elements and best practices for conducting surveillance for viral hepatitis, and were developed based on consultation with representatives from state and local health departments who met in Atlanta in January 1999." - p. 1Summary -- Background -- Hepatitis A -- Hepatitis B -- Hepatitis C -- Non-ABC hepatitis -- -- General Surveillance Guidelines -- Case ascertainment -- Case reporting -- Databases of persons chronically infected with HBV or HCV -- Monitoring the quality of surveillance data -- Data analysis and dissemination -- -- Disease-Specific Surveillance Guidelines -- Acute hepatitis A -- Acute hepatitis B -- Perinatal HBV infection -- Chronic HBV infection -- Acute hepatitis C -- Hepatitis C virus infection, (past or present) -- -- Other Surveillance Methods -- Serologic surveys -- Chronic liver disease surveillance"January 2005."System requirements: Adobe Acrobat Reader.Mode of access: Internet from the CDC web site. Address as of 10/23/2008: http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/CDCpneumo%5Fguidelines.pdfIncludes bibliographical references (p. [43]-[45]).Centers for Disease Control and Prevention. Guidelines for Viral Hepatitis Surveillance and Case Management. Atlanta, GA 200

Viral and Bacterial Diseases in Broiler Chicken Farms at the Area of Banyumas District

. Efforts to control viral and bacterial diseases in poultry broiler should always be done by various efforts. Maintenance of strict management, implementation and administration of vaccines and bio security program are some efforts that are often done by farmers in order to eliminate viral and bacterial diseases. The purpose of this study was to determine the type of pathogenic viruses and bacteria that often infect broiler chickens and how to make efforts to control the broiler chicken farms in the subdistricts of Kedungbanteng and Baturraden, district of Banyumas. The research method was survey on broiler chicken farmers in the areas of Baturraden and Kedungbanteng of Banyumas district. Gradual cluster sampling was used in this study. 11 broiler chicken farms with various breeds were involved. The current study found that types of bacterial disease that infected broiler chicken farms in the subdistricts of Kedungbanteng and Baturraden were Chronic Respiratory Disease (CRD) and Colibacilosis, whereas viral diseases that infected were the Infectious Bursal Disease (IBD/Gumboro) and New Castle Disease (ND), although the prevalence rate was low. The efforts to control the main virus diseases, IBD and ND, succeeded in pressing the two diseases sould be implemented

Endogenous Viral Etiology of Prion Diseases

Transmissible spongiform encephalopathies (TSEs), or prion diseases, are a group of incurable neurodegenerative disorders, including Kuru and Creutzfeldt-Jakob disease in humans, “mad cow” disease in cattle, and scrapie in sheep. This paper presents structural, genetic, and evolutionary evidence supporting an endogenous TSE virus model that integrates the three major traditional views on the nature of TSE pathogens, the conventional virus view, the prion hypothesis, and the virino concept, into a novel conceptual and evolutionary framework. According to this model, the TSE pathogens are symbiotic endogenous viruses that inadvertently produce transmissible viral particles that lack the viral genome and are composed primarily of the viral prion protein (PrP). Production of defective viral particles that contain a partial genome or lack the viral genome entirely is a relatively common event in the life cycle of many viruses. Similar to the normal viral particles, which contain a genome, these defective viral particles can be transmitted to new host cells. Obviously, in the absence of viral genome, these protein-only viral particles cannot establish a productive infection. However, if these viral particles enter a host cell that carries the parental or a related virus and induce the production of similar protein-only particles, then they would appear as self-replicating, protein-only infectious pathogens if mistakenly taken out from the context of the viral life cycle. This misconception, which is rooted into the current dogma of viruses as viral particles, led to the development of the prion theory. The endogenous TSE virus model is consistent with the TSE data and offers solutions to many enigmatic features associated with TSE, including the function of PrP that, despite more than two decades of TSE research conducted primarily within the framework of the prion hypothesis, is still not known. According to the TSE endogenous virus model, PrP is the protein of an endogenous virus that has co-evolved with their vertebrate hosts by providing a protective function against pathogenic viruses. The evidence for the endogenous TSE virus model and for the antiviral protective function of PrP is strong, and they are fully open to additional experimental testing. The endogenous virus model opens the TSE research field to new interpretations and directions, both in basic research and in associated biomedical and public health fields, and could lead to development of new diagnostic and therapeutic approaches

Neuraminidase inhibitors for treatment of influenza A and B infections

Influenza epidemics are responsible for an average of approximately 20,000 deaths per year in the United States. The main method for preventing influenza and its severe complications is influenza vaccination. Influenza-specific antiviral drugs are an important adjunct to vaccine but are not a substitute for vaccine. In the United States, four antiviral agents are approved for preventing or treating influenza: amantadine, rimantadine, zanamivir, and oseltamivir. Amantadine was approved for prophylaxis of influenza A(H2N2) infection in the United States in 1966 and was approved for prophylaxis and treatment of influenza A infection in 1976; rimantadine was approved for treatment and prophylaxis of influenza A infection in 1993 [corrected]. This report provides information on two neuraminidase inhibitors, zanamivir and oseltamivir, which were approved in 1999. Neuraminidase inhibitors are a new class of antiviral drugs that inhibit influenza A and B viruses. Zanamivir is approved for treatment of uncomplicated acute illness caused by influenza virus in persons aged > or =12 years who have been symptomatic for no more than 2 days. Oseltamivir is approved for treatment of uncomplicated illness caused by influenza infection in adults aged > or =18 years who have been symptomatic for no more than 2 days. Neither zanamivir nor oseltamivir is approved for influenza prophylaxis. This report and the Advisory Committee on Immunization Practices (ACIP) 1999 recommendations on influenza prevention and control (MMWR 1999;48[No.RR-4]:1-28) can be accessed at the website for the Influenza Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, CDC, at or at the MMWR website at .December 17, 1999.The following CDC staff members prepared this report: Andrea G. Winquist, Keiji Fukuda, Carolyn B. Bridges, Nancy J. Cox, Division of Viral and Rickettsial Diseases, National Center for Infectious Disease.Includes bibliographical references (p. 7-9)

Modeling viral infectious diseases and development of antiviral therapies using human induced pluripotent stem cell-derived systems

The recent biotechnology breakthrough of cell reprogramming and generation of induced pluripotent stem cells (iPSCs), which has revolutionized the approaches to study the mechanisms of human diseases and to test new drugs, can be exploited to generate patient-specific models for the investigation of host-pathogen interactions and to develop new antimicrobial and antiviral therapies. Applications of iPSC technology to the study of viral infections in humans have included in vitro modeling of viral infections of neural, liver, and cardiac cells; modeling of human genetic susceptibility to severe viral infectious diseases, such as encephalitis and severe influenza; genetic engineering and genome editing of patient-specific iPSC-derived cells to confer antiviral resistance

The interplay between viral-derived miRNAs and host immunity during infection

MicroRNAs are short non-coding RNAs that play a crucial role in the regulation of gene expression during cellular processes. The host-encoded miRNAs are known to modulate the antiviral defense during viral infection. In the last decade, multiple DNA and RNA viruses have been shown to produce miRNAs known as viral miRNAs (v-miRNAs) so as to evade the host immune response. In this review, we highlight the origin and biogenesis of viral miRNAs during the viral lifecycle. We also explore the role of viral miRNAs in immune evasion and hence in maintaining chronic infection and disease. Finally, we offer insights into the underexplored role of viral miRNAs as potential targets for developing therapeutics for treating complex viral diseases

Viral-induced neurodegenerative disease.

Viral etiology has been postulated in a variety of neurological diseases in humans, including multiple sclerosis. Several experimental animal models of viral-induced neurodegenerative disease provide insight into potential host- and pathogen-dependent mechanisms involved in the disease process. Two such mouse models are the Theiler's murine encephalomyelitis virus (TMEV) infection and mouse hepatitis virus (MHV) infection