Time-Space Clustering of Human Brucellosis, California, 1973–1992 1

Infection with Brucella spp. continues to pose a human health risk in California despite great strides in eradicating the disease from domestic animals. Clustering of human cases in time and space has important public health implications for understanding risk factors and sources of infection. Temporal-spatial clustering of human brucellosis in California for the 20-year period 1973–1992 was evaluated by the Ederer-Myers-Mantel, Moran’s I, and population-adjusted Moran’s I procedures. Cases were clustered in concentrated agricultural regions in the first 5-year interval (1973–1977). Time-space clustering of human brucellosis cases in California late in the 20-year study period may reflect the distribution of Hispanic populations. Public health programs in California should focus on educating Hispanic populations about the risk of consuming dairy products, such as soft cheeses, made from unpasteurized milk

Pathology and Viral Antigen Distribution of Lethal Pneumonia in Domestic Cats Due to Pandemic (H1N1) 2009 Influenza A Virus

A novel swine-origin H1N1 influenza A virus has been identified as the cause of the 2009 influenza pandemic in humans. Since then, infections with the pandemic (H1N1) 2009 influenza virus have been documented in a number of animal species. The first known cases of lethal respiratory disease associated with pandemic (H1N1) 2009 influenza virus infection in house pets occurred in domestic cats in Oregon. A 10-year-old, neutered male and an 8-year-old, spayed female domestic short hair cat died shortly after developing severe respiratory disease. Grossly, lung lobes of both cats were diffusely firm and incompletely collapsed. Histologically, moderate to severe, necrotizing to pyonecrotizing bronchointerstitial pneumonia was accompanied by serofibrinous exudation and hyaline membranes in the alveolar spaces. Influenza A virus was isolated from nasal secretions of the male and from lung homogenate of the female cat. Both isolates were confirmed as pandemic (H1N1) 2009 influenza virus by real-time reverse transcriptase PCR (rRT-PCR). Using immunohistochemistry, influenza A viral antigen was demonstrated in bronchiolar epithelial cells, pneumocytes and alveolar macrophages in pneumonic areas. The most likely sources of infection were people in the household with influenza-like illness or confirmed pandemic (H1N1) 2009 influenza. The two cases reported here provide, to the best of the authors’ knowledge, the first description of the pathology and viral antigen distribution of lethal respiratory disease in domestic cats after natural pandemic (H1N1) 2009 influenza virus infection, probably transmitted from humans.This is an author's peer-reviewed final manuscript, as accepted by the publisher. The article is published by Sage Publications on behalf of the American College of Veterinary Pathologists, European College of Veterinary Pathologists, and the Japanese College of Veterinary. The published article can be found at: http://vet.sagepub.com/.Keywords: influenza, pneumonia, pandemic, pH1N1, lung, immunohistochemistry, ca

Rapid, Active Surveillance for Medically Attended Acute Gastroenteritis and Norovirus Infection in a Managed Care Environment

Background/Aims: Norovirus is the leading cause of acute gastroenteritis in the United States and is the leading cause of medically attended acute gastroenteritis (MAAGE) among children younger than five years of age. Our primary goal is to describe the community incidence of MAAGE and the proportion of MAAGE encounters due to norovirus within the membership population of Kaiser Permanente Northwest (KPNW). Our secondary goal is to describe transmission of norovirus within households. Methods: We are conducting a 12-month active surveillance project in which we identify all KPNW members with MAAGE-associated health care encounters through daily electronic abstraction of the electronic health record system. We are recruiting a sample of this population daily, along with their symptomatic household members, to complete a recruitment survey and collect a stool sample for norovirus testing. Results: During the four months of our surveillance period, we identified 6,156 members presenting for MAAGE (annualized incidence of 413/100,000). We attempted to reach 1,782 (30%) potential participants, 525 (29%) of whom were ineligible. Of those remaining, 708 (56%) refused and 549 (44%) agreed to participate. Of those agreeing to participate, 453 (83%) provided a sample from which we obtained viral testing results. Among samples tested, we identified 52 (11%) positive for norovirus. Norovirus positivity was highest among those 0–4 years of age (20%) and lowest among those 65 years or older (6%). Thus far, we have recruited 48 household members, 8 (15%) of whom tested positive for norovirus; 7 (88%) had the same laboratory results as their MAAGE-associated household member. Discussion: Our observed incidence of MAAGE and proportion of MAAGE encounters due to norovirus infection in the KPNW member population over the first four months of our surveillance period are consistent with results obtained from other studies using varying methodologies and reinforce the high burden of MAAGE and norovirus infection within the community. Our results further support the high transmission of norovirus infection within households. Importantly, our project –– with 44% agreeing to participate and 83% collecting and returning a stool sample –– demonstrates a model for conducting other community-based studies of acute infectious diseases within a managed care system

Travel-associated Antimicrobial Drug–Resistant Nontyphoidal Salmonellae, 2004–2009

To evaluate trends in and risk factors for acquisition of antimicrobial-drug resistant nontyphoidal Salmonella infections, we searched Oregon surveillance data for 2004–2009 for all culture-confirmed cases of salmonellosis. We defined clinically important resistance (CIR) as decreased susceptibility to ampicillin, ceftriaxone, ciprofloxacin, gentamicin, or trimethoprim/sulfamethoxazole. Of 2,153 cases, 2,127 (99%) nontyphoidal Salmonella isolates were obtained from a specific source (e.g., feces, urine, blood, or other normally sterile tissue) and had been tested for drug susceptibility. Among these, 347 (16%) isolates had CIR. The odds of acquiring CIR infection significantly increased each year. Hospitalization was more likely for patients with than without CIR infections. Among patients with isolates that had been tested, we analyzed data from 1,813 (84%) who were interviewed. Travel to eastern or Southeast Asia was associated with increased CIR. Isolates associated with outbreaks were less likely to have CIR. Future surveillance activities should evaluate resistance with respect to international travel

Correlation of Genotype and In Vitro Susceptibilities of Cryptococcus gattii Strains from the Pacific Northwest of the United States▿

Cryptococcus gattii emerged in North America in 1999 as a human and veterinary pathogen on Vancouver Island, British Columbia. The emergent subtype, VGIIa, and the closely related subtype VGIIb can now be found in the United States in Washington, Oregon, and California. We performed multilocus sequence typing and antifungal susceptibility testing on 43 isolates of C. gattii from human patients in Oregon, Washington, California, and Idaho. In contrast to Vancouver Island, VGIIa was the most frequent but not the predominant subtype in the northwest United States. Antifungal susceptibility testing showed statistically significant differences in MICs between the subtypes. This is the first study to apply antifungal susceptibility testing to C. gattii isolates from the Pacific Northwest and the first to make direct comparisons between subtypes

Identification of Source of Brucella suis Infection in Human by Whole-Genome Sequencing, United States and Tonga

Brucella suis infection was diagnosed in a man from Tonga, Polynesia, who had butchered swine in Oregon, USA. Although the US commercial swine herd is designated brucellosis-free, exposure history suggested infection from commercial pigs. We used whole-genome sequencing to determine that the man was infected in Tonga, averting a field investigation

Incidence of Norovirus and Other Viral Pathogens That Cause Acute Gastroenteritis (AGE) among Kaiser Permanente Member Populations in the United States, 2012–2013

<div><p>Noroviruses and other viral pathogens are increasingly recognized as frequent causes of acute gastroenteritis (AGE). However, few laboratory-based data are available on the incidence of AGE caused by viral pathogens in the U.S. This study examined stool specimens submitted for routine clinical diagnostics from patients enrolled in Kaiser Permanente (KP) health plans in metro Portland, OR, and the Maryland, District of Columbia, and northern Virginia geographic areas to estimate the incidence of viral enteropathogens in these populations. Over a one-year study period, participating laboratories randomly selected stools submitted for routine clinical diagnostics for inclusion in the study along with accompanying demographic and clinical data. Selected stools were tested for norovirus, rotavirus, sapovirus, and astrovirus using standardized real-time RT-PCR protocols. Each KP site provided administrative data which were used in conjunction with previously published data on healthcare utilization to extrapolate pathogen detection rates into population-based incidence rates. A total of 1,099 specimens collected during August 2012 to September 2013 were included. Mean age of patients providing stool specimens was 46 years (range: 0–98 years). Noroviruses were the most common viral pathogen identified among patients with AGE (n = 63 specimens, 6% of specimens tested). In addition, 22 (2%) of specimens were positive for rotavirus; 19 (2%) were positive for sapovirus; and 7 (1%) were positive for astrovirus. Incidence of norovirus-associated outpatient visits was 5.6 per 1,000 person-years; incidence of norovirus disease in the community was estimated to be 69.5 per 1,000 person-years. Norovirus incidence was highest among children <5 years of age (outpatient incidence = 25.6 per 1,000 person-years; community incidence = 152.2 per 1,000 person-years), followed by older adults aged >65 years (outpatient incidence = 7.8 per 1,000 person-years; community incidence = 75.8 per 1,000 person-years). Outpatient incidence rates of rotavirus, sapovirus, and astrovirus were 2.0, 1.6, 0.6 per 1,000 person-years, respectively; community incidence rates for these viruses were 23.4, 22.5, and 8.5 per 1,000 person-years, respectively. This study provides the first age-group specific laboratory-based community and outpatient incidence rates for norovirus AGE in the U.S. Norovirus was the most frequently detected viral enteropathogen across the age spectrum with the highest rates of norovirus disease observed among young children and, to a lesser extent, the elderly. These data provide a better understanding of the norovirus disease burden in the United States, including variations within different age groups, which can help inform the development, targeting, and future impacts of interventions, including vaccines.</p></div

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A novel swine-origin H1N1 influenza A virus has been identified as the cause of the 2009 influenza pandemic in humans. Since then, infections with the pandemic (H1N1) 2009 influenza virus have been documented in a number of animal species. The first known cases of lethal respiratory disease associated with pandemic (H1N1) 2009 influenza virus infection in house pets occurred in domestic cats in Oregon. A 10-year-old, neutered male and an 8-year-old, spayed female domestic short hair cat died shortly after developing severe respiratory disease. Grossly, lung lobes of both cats were diffusely firm and incompletely collapsed. Histologically, moderate to severe, necrotizing to pyonecrotizing bronchointerstitial pneumonia was accompanied by serofibrinous exudation and hyaline membranes in the alveolar spaces. Influenza A virus was isolated from nasal secretions of the male and from lung homogenate of the female cat. Both isolates were confirmed as pandemic (H1N1) 2009 influenza virus by real-time reverse transcriptase PCR (rRT-PCR). Using immunohistochemistry, influenza A viral antigen was demonstrated in bronchiolar epithelial cells, pneumocytes and alveolar macrophages in pneumonic areas. The most likely sources of infection were people in the household with influenza-like illness or confirmed pandemic (H1N1) 2009 influenza. The two cases reported here provide, to the best of the authors’ knowledge, the first description of the pathology and viral antigen distribution of lethal respiratory disease in domestic cats after natural pandemic (H1N1) 2009 influenza virus infection, probably transmitted from humans