A 15 Year Evaluation of West Nile Virus in Wisconsin: Effects on Wildlife and Human Health

West Nile virus (WNV) is the most important and widespread mosquito-borne virus in the United States (U.S.). WNV has the ability to spread rapidly and effectively, infecting more than 320 bird and mammalian species. An examination of environmental conditions and the health of keystone species may help predict the susceptibility of various habitats to WNV and reveal key risk factors, annual trends, and vulnerable regions. Since 2002, WNV outbreaks in Wisconsin varied by species, place, and time, significantly affected by unique climatic, environmental, and geographical factors. During a 15 year period, WNV was detected in 71 of 72 counties, resulting in 239 human and 1397 wildlife cases. Controlling for population and sampling efforts in Wisconsin, rates of WNV are highest in the western and northwestern rural regions of the state. WNV incidence rates were highest in counties with low human population densities, predominantly wetland, and at elevations greater than 1000 feet. Resources for surveillance, prevention, and detection of WNV were lowest in rural counties, likely resulting in underestimation of cases. Overall, increasing mean temperature and decreasing precipitation showed positive influence on WNV transmission in Wisconsin. This study incorporates the first statewide assessment of WNV in Wisconsin

Serological Typing of Pseudomonas aeruginosa: Use of Commerical Antisera and Live Antigens

A practical slide agglutination test, with commercial antisera (Difco) and live antigens (antigens of live bacteria) taken directly from 24-h antimicrobial susceptibility plates, has been established for serotyping Pseudomonas aeruginosa. Until recently, the lack of both a standard antigenic scheme and a source of commercial antisera has made serological typing of this organism impractical. A simplified procedure with 17 unabsorbed antisera and live antigens prepared from materials readily available in most clinical microbiology laboratories makes epidemiological typing of this organism possible in hospital laboratories. The distribution of each serotype examined in this study was determined by using 425 consecutive patient isolates from six different hospitals. The distribution of O antigen groups (live antigen) was as follows: O1, 11.5%; O2, 1.6%; O3, 3.8%; O4, 7.8%; O5, 4.2% O6, 27.1%; O7,8, 5.9%; O9, 6.8%; O10, 2.4%; O11, 8.2%; O12 through O17, each less than 1%. Ten and six-tenths percent of the above agglutinated in two antisera, 3.3% agglutinated in more than two antisera, and 5.2% did not agglutinate in any antisera. A comparison of live and heated antigens shows that 93.2% were typable with the live antigen, and 94.5% were typable with the heated antigen. When both antigens were used, we typed 96.3% of 725 isolates. The reproductibility and specificity of the serological procedure were examined. We recommend using the live antigen for routine serological typing in clinical microbiology laboratories for “in house” epidemiology and reserving the heated antigen for reference and research typing (and for those few cases where results cannot be obtained using the live antigen). The application of serotyping in the study of outbreaks of P. aeruginosa is also presented

Newborn screening for severe combined immunodeficiency in 11 screening programs in the United States.

ImportanceNewborn screening for severe combined immunodeficiency (SCID) using assays to detect T-cell receptor excision circles (TRECs) began in Wisconsin in 2008, and SCID was added to the national recommended uniform panel for newborn screened disorders in 2010. Currently 23 states, the District of Columbia, and the Navajo Nation conduct population-wide newborn screening for SCID. The incidence of SCID is estimated at 1 in 100,000 births.ObjectivesTo present data from a spectrum of SCID newborn screening programs, establish population-based incidence for SCID and other conditions with T-cell lymphopenia, and document early institution of effective treatments.DesignEpidemiological and retrospective observational study.SettingRepresentatives in states conducting SCID newborn screening were invited to submit their SCID screening algorithms, test performance data, and deidentified clinical and laboratory information regarding infants screened and cases with nonnormal results. Infants born from the start of each participating program from January 2008 through the most recent evaluable date prior to July 2013 were included. Representatives from 10 states plus the Navajo Area Indian Health Service contributed data from 3,030,083 newborns screened with a TREC test.Main outcomes and measuresInfants with SCID and other diagnoses of T-cell lymphopenia were classified. Incidence and, where possible, etiologies were determined. Interventions and survival were tracked.ResultsScreening detected 52 cases of typical SCID, leaky SCID, and Omenn syndrome, affecting 1 in 58,000 infants (95% CI, 1/46,000-1/80,000). Survival of SCID-affected infants through their diagnosis and immune reconstitution was 87% (45/52), 92% (45/49) for infants who received transplantation, enzyme replacement, and/or gene therapy. Additional interventions for SCID and non-SCID T-cell lymphopenia included immunoglobulin infusions, preventive antibiotics, and avoidance of live vaccines. Variations in definitions and follow-up practices influenced the rates of detection of non-SCID T-cell lymphopenia.Conclusions and relevanceNewborn screening in 11 programs in the United States identified SCID in 1 in 58,000 infants, with high survival. The usefulness of detection of non-SCID T-cell lymphopenias by the same screening remains to be determined