Multidrug-resistant Strains of Salmonella enterica Typhimurium, United States, 1997–19981

To evaluate multidrug-resistant strains of Salmonella enterica Typhimurium, including definitive type 104 (DT104) in the United States, we reviewed data from the National Antimicrobial Resistance Monitoring System (NARMS). In 1997–1998, 25% (703) of 2,767 serotyped Salmonella isolates received at NARMS were S. Typhimurium; antimicrobial susceptibility testing and phage typing were completed for 697. Fifty-eight percent (402) were resistant to >1 antimicrobial agent. Three multidrug-resistant (>5 drugs) strains accounted for 74% (296) of all resistant isolates. Ceftriaxone resistance was present in 3% (8), and nalidixic acid resistance in 1% (4), of these multidrug-resistant strains. By phage typing, 37% (259) of S. Typhimurium isolates were DT104, 30% (209) were of undefined type and 15% (103) were untypable. Fifty percent (202) of resistant (>1 drug) isolates were DT104. Multidrug-resistant S. Typhimurium isolates, particularly DT104, account for a substantial proportion of S. Typhimurium isolates; ceftriaxone resistance is exhibited by some of these strains

When it Rains it Pours: Real-time Situational Awareness for Two Weather Emergencies in Connecticut

During 2011 Connecticut was impacted by two major weather events. The Hospital Emergency Department Syndromic Surveillance System (HEDSS) was utilized to provide real-time situational awareness during the response and recovery phases of both storm events. Increased emergency department utilization for carbon monoxide exposure, asthma, and hypothermia were observed. HEDSS data were likely an underestimation of true disease/injury in the community following the storm events. HEDSS should continue to be used, in conjunction with other existing surveillance systems, for near real-time situational monitoring during public health emergencies

When it Rains it Pours: Real-time Situational Awareness for Two Weather Emergencies in Connecticut

OBJECTIVE: To characterize the utility of the Connecticut Hospital Emergency Department Syndromic Surveillance (HEDSS) system for real-time situational awareness during two weather-related emergencies. INTRODUCTION: On August 28, 2011 Tropical Storm Irene made landfall in Connecticut. On October 29, 2011 Connecticut was impacted by Winter Storm Alfred. Both of these storms included high winds and heavy precipitation which resulted in prolonged power outages, disruption of public drinking water systems, property damage, and widespread debris throughout the state. The HEDSS System was utilized to provide real-time situational awareness during the response and recovery phases of both storm events. METHODS: The HEDSS System receives electronic patient abstract data from 21 of 32 emergency departments on a daily basis. Free-text chief complaint data are characterized into syndrome categories. ED visits for carbon monoxide exposure (CO), gastrointestinal illness (GI), injury, hypothermia, motor vehicle accidents (MVA), and asthma syndromes were monitored throughout the response and recovery periods of both storm. Odds Ratios were calculated using the two weeks pre-and post-storm as reference dates. CO visits were further assessed for geographic and demographic trends to target public health messages. The HEDSS system was evaluated to make recommendations for event monitoring during future public health emergencies. RESULTS: Following both storms there was a high completeness of daily HEDSS reporting despite extensive power outages (96% post-tropical storm, 91% post-winter storm). Increased emergency department utilization for CO (OR: 26.20, 95% CI: 3.57–192.64) was observed post-tropical storm. Increased emergency department utilization for CO (OR: 14.61, 95% CI: 7.43–28.72), hypothermia (OR: 17.02, 95% CI: 3.01–359.30), and asthma (OR: 1.17, 95% CI: 1.05–1.30) were observed following the winter storm. Regional increases in ED utilization for injuries and MVA were observed following both storm events; no increase in GI was associated with either storm event. During the 2 weeks post-tropical storm 28 cases of CO exposure were reported through HEDSS and 5 cases through laboratory surveillance; during the winter storm 131 cases were reported through HEDSS and 162 through reportable disease surveillance. Of the 167 cases reported through laboratory surveillance, 111 (66%) were from hospitals that sent data to HEDSS hospitals and 94(56%) were able to be matched to a specific ED record; of these 22(20%) were characterized as visiting the ED for CO syndrome, 13(14%) had symptoms consistent with CO as their chief complaint, 11(12%) had smoke/gasoline inhalation exposures as their chief complaint and 2(2%) had unrelated chief complaints. During the post-storm period the HEDSS systems detected 137 potential CO exposures that were not reported through laboratory surveillance. CONCLUSIONS: Tropical Storm Irene and Winter Storm Alfred both had significant health impacts, particularly increased ED utilization for CO due to prolonged power outages. The HEDSS system is the only all-hazards surveillance system that was able to provide near-real time information during the storm response phase. In addition to the current CO syndrome definition, where the chief complaint must specifically mention the term CO, a broader definition should also be used in the future to better assess the magnitude of CO-related exposures. The broad definition should include symptomology and related exposures, such as smoke inhalation, to improve case detection. The HEDSS system should continue to be used in conjunction with reportable disease surveillance for situational monitoring during public health emergencies

An Integrated System for Enteric Disease Surveillance and Outbreak Detection

In Connecticut, foodborne disease surveillance and response is a collaborative effort requiring real-time data sharing between key stakeholders including: DPH Epidemiology, DPH Laboratory, DPH Food Protection Program, Yale EIP, and local health department staff. Since 2011 a centralized electronic surveillance system has been used for routine enteric disease surveillance, cluster detection and monitioring, information sharing among key stakeholders, and documentation

Hospitalizations and deaths due to Salmonella infections, FoodNet

Nontyphoidal Salmonella causes a higher proportion of food-related deaths annually than any other bacterial pathogen in the United States. We reviewed 4 years (1996-1999) of population-based active surveillance data on laboratory-confirmed Salmonella infections from the Emerging Infections Program's Foodborne Diseases Active Surveillance Network (FoodNet), to determine the rates of hospitalization and death associated with Salmonella infection. Overall, 22% of infected persons were hospitalized, with the highest rate (47%) among persons aged 160 years. Fifty-eight deaths occurred, for an estimated annual incidence of 0.08 deaths/100,000 population. These deaths accounted for 38% of all deaths reported through FoodNet from 1996 through 1999, and they occurred primarily among adults with serious underlying disease. Although Salmonella infection was seldom listed as a cause of death on hospital charts and death certificates, our chart review suggests that Salmonella infection contributed to these deaths. Each year in the United States, nontyphoidal Salmonella, which is one of the most common bacterial pathogens, accounts for ∼1.4 million foodborne infections and roughly one-quarter (26%) of the ∼323,000 hospitalizations for foodborne infection