Murine Typhus in Austin, Texas, USA, 2008

Physicians should be alert for possible cases in this area

Outbreak of Marburg hemorrhagic fever among miners in Kamwenge and Ibanda Districts, Uganda, 2007

Marburg hemorrhagic fever was detected among 4 miners in Ibanda District, Uganda, from June through September, 2007. Infection was likely acquired through exposure to bats or bat secretions in a mine in Kamwenge District, Uganda, and possibly human-to-human transmission between some patients. We describe the epidemiologic investigation and the health education response

Epidemiologic investigation of immune-mediated polyradiculoneuropathy among abattoir workers exposed to porcine brain

Background In October 2007, a cluster of patients experiencing a novel polyradiculoneuropathy was identified at a pork abattoir (Plant A). Patients worked in the primary carcass processing area (warm room); the majority processed severed heads (head-table). An investigation was initiated to determine risk factors for illness. Methods and Results Symptoms of the reported patients were unlike previously described occupational associated illnesses. A case-control study was conducted at Plant A. A case was defined as evidence of symptoms of peripheral neuropathy and compatible electrodiagnostic testing in a pork abattoir worker. Two control groups were used - randomly selected non-ill warm-room workers (n = 49), and all non-ill head-table workers (n = 56). Consenting cases and controls were interviewed and blood and throat swabs were collected. The 26 largest U.S. pork abattoirs were surveyed to identify additional cases. Fifteen cases were identified at Plant A; illness onsets occurred during May 2004–November 2007. Median age was 32 years (range, 21–55 years). Cases were more likely than warm-room controls to have ever worked at the head-table (adjusted odds ratio [AOR], 6.6; 95% confidence interval [CI], 1.6–26.7), removed brains or removed muscle from the backs of heads (AOR, 10.3; 95% CI, 1.5–68.5), and worked within 0–10 feet of the brain removal operation (AOR, 9.9; 95% CI, 1.2–80.0). Associations remained when comparing head-table cases and head-table controls. Workers removed brains by using compressed air that liquefied brain and generated aerosolized droplets, exposing themselves and nearby workers. Eight additional cases were identified in the only two other abattoirs using this technique. The three abattoirs that used this technique have stopped brain removal, and no new cases have been reported after 24 months of follow up. Cases compared to controls had higher median interferon-gamma (IFNγ) levels (21.7 pg/ml; vs 14.8 pg/ml, P<0.001). Discussion This novel polyradiculoneuropathy was associated with removing porcine brains with compressed air. An autoimmune mechanism is supported by higher levels of IFNγ in cases than in controls consistent with other immune mediated illnesses occurring in association with neural tissue exposure. Abattoirs should not use compressed air to remove brains and should avoid procedures that aerosolize CNS tissue. This outbreak highlights the potential for respiratory or mucosal exposure to cause an immune-mediated illness in an occupational setting

Epidemiologic investigation of immune-mediated polyradiculoneuropathy among abattoir workers exposed to porcine brain

Background In October 2007, a cluster of patients experiencing a novel polyradiculoneuropathy was identified at a pork abattoir (Plant A). Patients worked in the primary carcass processing area (warm room); the majority processed severed heads (head-table). An investigation was initiated to determine risk factors for illness. Methods and Results Symptoms of the reported patients were unlike previously described occupational associated illnesses. A case-control study was conducted at Plant A. A case was defined as evidence of symptoms of peripheral neuropathy and compatible electrodiagnostic testing in a pork abattoir worker. Two control groups were used - randomly selected non-ill warm-room workers (n = 49), and all non-ill head-table workers (n = 56). Consenting cases and controls were interviewed and blood and throat swabs were collected. The 26 largest U.S. pork abattoirs were surveyed to identify additional cases. Fifteen cases were identified at Plant A; illness onsets occurred during May 2004–November 2007. Median age was 32 years (range, 21–55 years). Cases were more likely than warm-room controls to have ever worked at the head-table (adjusted odds ratio [AOR], 6.6; 95% confidence interval [CI], 1.6–26.7), removed brains or removed muscle from the backs of heads (AOR, 10.3; 95% CI, 1.5–68.5), and worked within 0–10 feet of the brain removal operation (AOR, 9.9; 95% CI, 1.2–80.0). Associations remained when comparing head-table cases and head-table controls. Workers removed brains by using compressed air that liquefied brain and generated aerosolized droplets, exposing themselves and nearby workers. Eight additional cases were identified in the only two other abattoirs using this technique. The three abattoirs that used this technique have stopped brain removal, and no new cases have been reported after 24 months of follow up. Cases compared to controls had higher median interferon-gamma (IFNγ) levels (21.7 pg/ml; vs 14.8 pg/ml, P<0.001). Discussion This novel polyradiculoneuropathy was associated with removing porcine brains with compressed air. An autoimmune mechanism is supported by higher levels of IFNγ in cases than in controls consistent with other immune mediated illnesses occurring in association with neural tissue exposure. Abattoirs should not use compressed air to remove brains and should avoid procedures that aerosolize CNS tissue. This outbreak highlights the potential for respiratory or mucosal exposure to cause an immune-mediated illness in an occupational setting

Relationships between Diet, Alcohol Preference, and Heart Disease and Type 2 Diabetes among Americans.

Although excessive alcohol consumption is a recognized cause of morbidity and mortality, many studies have linked moderate alcohol consumption to improved cardiovascular health and a lower risk of Type 2 Diabetes (T2D). Self-reported alcohol and diet data used to generate these results suffer from measurement error due to recall bias. We estimate the effects of diet, alcohol, and lifestyle choices on the prevalence and incidence of cardiovascular disease and T2D among U.S. adults using a nationally representative cohort of households with scanner data representing their food-at-home, alcohol, and tobacco purchases from 2007-2010, and self-reported health surveys for the same study participants from 2010-2012. Multivariate regression models were used to identify significant associations among purchase data and lifestyle/demographic factors with disease prevalence in 2010, and with incidence of new disease from 2011-2012. After controlling for important confounders, respondents who purchased moderate levels of wine were 25% less likely than non-drinkers to report heart disease in 2010. However, no alcohol-related expenditure variables significantly affected the likelihood of reporting incident heart disease from 2011-2012. In contrast, many types of alcohol-related purchases were associated with a lower prevalence of T2D, and respondents who purchased the greatest volumes of wine or beer--but not liquor--were less likely to report being diagnosed with T2D in 2011-2012 than non-drinkers

Variable Means for the 2010 MedProfiler Survey Population Households, Stratified by Alcohol Type Preference^a.

<p>Notes: Unless otherwise indicated, all values in the table represent percentages. The "All Participants" total is slightly smaller than the sum of the population sizes for each alcohol type category, since a handful of included respondents were classified in multiple categories because spending on multiple alcohol types was equivalent. Healthshare and USDAscore are aggregate average dietary index scores, based on a household’s scanned purchases from 2007–2010.</p><p>^aAlcohol type preference was defined as the type of alcohol on which the participant's household spent the most from 2007–2010. “Non-drinkers” recorded no alcohol purchases in the sample.</p><p>^bHeart disease includes respondents who reported "heart problems" as well as heart attacks. The significance of the results in the table is unchanged when only "heart problems” are considered.</p><p>^cDrinker levels are classified in thirds, increasing with the household's average per-capita alcohol expenditures.</p><p>*** <i>P</i><0.01</p><p>** <i>P</i><0.05</p><p>* <i>P</i><0.1</p><p>Variable Means for the 2010 MedProfiler Survey Population Households, Stratified by Alcohol Type Preference<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124351#t001fn002" target="_blank">^a</a>.</p

Association between Sociodemographic, Health, and Lifestyle Factors with the Prevalence and Incidence of Heart Disease⁺, 2010–2012.

<p>⁺Heart disease includes respondents who reported "heart problems" as well as heart attacks. The significance of the results in the table is unchanged when only "heart problems" is considered.</p><p>^{^}The results in this table use Healthshare to represent diet score (virtually identical results are estimated with USDAscore).</p><p>OR = unadjusted Odds Ratio; aOR = adjusted Odds Ratio; C.I. = 95% confidence interval. Standard errors used to estimate confidence intervals are robust to clustering at the household level. Race, region, and marital status were controlled for in the multivariate analyses but are not presented in the table to conserve space. Levels of significance are represented as</p><p>*** <i>P</i><0.01,</p><p>** <i>P</i><0.05,</p><p>* <i>P</i><0.1.</p><p>Association between Sociodemographic, Health, and Lifestyle Factors with the Prevalence and Incidence of Heart Disease<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124351#t002fn001" target="_blank">⁺</a>, 2010–2012.</p

Association between Sociodemographic, Health, and Lifestyle Factors with the Prevalence and Incidence of Type 2 Diabetes, 2010–2012.

<p>^{^}The results in this table use Healthshare to represent diet score. Virtually identical results are estimated when USDAscore is used.</p><p>OR = unadjusted Odds Ratio; aOR = adjusted Odds Ratio; C.I. = 95% confidence interval. Standard errors used to estimate confidence intervals are robust to clustering at the household level. Race, region, and marital status were controlled for in the multivariate analyses but are not presented in the table to conserve space. Levels of significance are represented as</p><p>*** <i>P</i><0.01,</p><p>** <i>P</i><0.05,</p><p>* <i>P</i><0.1.</p><p>Association between Sociodemographic, Health, and Lifestyle Factors with the Prevalence and Incidence of Type 2 Diabetes, 2010–2012.</p

Anaplasma phagocytophilum Infection in Small Mammal Hosts of Ixodes Ticks, Western United States

A total of 2,121 small mammals in California were assessed for Anaplasma phagocytophilum from 2006 through 2008. Odds ratios were >1 for 4 sciurids species and dusky-footed woodrats. High seroprevalence was observed in northern sites. Ten tick species were identified. Heavily infested rodent species included meadow voles, woodrats, deer mice, and redwood chipmunks