59Th Annual Epidemic Intelligence Service (EIS) Conference Program Book

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Annual EIS Conference EIS Conference Annual A P R i L i R P A -9 1 , 3 2 0 1 0 2 C R O W N E P L A Z A H O T E L – A T L A N T A P E R i m E T E R A T R A v i N i A E P I D E M I C I N T E L L I G E N C E S E R V I C E

59 35482_ConferenceCover.indd 1 59th 59th ANNUAL EPIDEMIC INTELLIGENCE SERVICE (EIS) CONFERENCE • APRIL 19–23, 2010

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES www.cdc.gov Centers for Disease Control and Prevention CS210413-A 35482_CoverLayout.indd 1 59th ANNUAL EIS CONFERENCE 2 3 4 6 7 20 21 22 23 24 25 27 33 35 153 ......

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Color Key Name Tags Key Tags Name Color Blue–EIS Alumni EIS Officers Green–Current Red–Incoming EIS Officers Participants Black–Conference Staff Purple–Conference EIS AlumniBlue Dot–Field Orange Dot–Recruiters Pink Dot–Media ......

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Save the Date! Save the Date! Contents Preface Program Committees General Information Schedule 2010 EIS Conference Presenting EIS Officers Incoming EIS Class of 2010 Awards Members Committee Award 2010 Presented at the 2009 Conference Awards 1972–2009 Alexander D. Langmuir Lectures, Manuscripts, 1966–2009 Alexander D. Langmuir Prize Conference Evaluations Instructions for Completing Online Abstracts Index of Presenters Annual

th 60 Conference Atlanta, Georgia April 11–15, 2011 2011 April 11–15, Epidemic Intelligence Service (EIS) Epidemic Intelligence Service Centers for Disease Control and Prevention APRIL 2011 2011 APRIL the Date! Save

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Annual Epidemic Intelligence Service (EIS) Conference. We are delighted Annual Intelligence We Service Epidemic Conference. (EIS) th hop in the Emergency Operations Center (EOC) and coordinated deployment of EIS of deployment and coordinated (EOC) Center in Operations Emergency the hop ills. Fifty-five (64%) of the new officers are women, and 13 (15%) are citizens of other of (15%) are citizens 13 women, and are officers new the of ills. (64%) Fifty-five demiology to public health and prevention by EIS officers. We welcome you toyou an welcome We EIS by officers. healthdemiology and public prevention to erence week last year, I ran into a colleague who told me that she was going to have to leave leave to was have that going a colleague she to me ran I last week into year, told who erence nd year we used an online application system, and it was even more productive than last productive used year more system, was an we nd and even it online application se check your program carefully. Special lunchtime sessions start on Tuesday with program carefully.se your check start Special sessions Tuesday on lunchtime Dear Friends of EIS: Dear Friends 59 the to Welcome Preface exciting week — an opportunity to learn, to meet old and new friends, and to welcome the the — an week exciting opportunity and friends, new old welcome learn, and to to meet to forwardyou. incoming tolook seeing officers. I Douglas Hamilton, MD, PhD Intelligence Service Epidemic Director, (proposed) Sciences Applied of Division Program (proposed) Office Development Professional and Scientific Education year because we had a record number of applications. For the last decade, we have averaged 280 averaged last the decade, have For we applications. of number year because hadrecord a we each 412. year; this applications received year we completed of broad interests array a with women red men tags 86 and of This a select year’s are group and sk new of a EIS author the Wednesday, “Influenza:On A Historyof Response.” Chronology and will Mark history, Pendergrast, discuss his research in Outbreaks:Medical the The “Inside Elite Student “Graduate presentation, Intelligence Service.” Epidemic the Thursday’s of Detectives Epidemiologic the Supporting for A Resource ResponseEpidemiology Programs (GSERPs): Public the HealthCapacity of Infrastructure,” Friday’s Finally, will many. to interest be of magnitude will earthquake session lunchtime 7.0 the in to Haiti. focus response CDC the on applications opportunity many hear you the current to about provides Conference The 2010 epi of officers from there. EISOs played an important role in CDC’s response, duringand the role in CDC’s first there.important an played from EISOs officers pace the has Fortunately, H1N1. on person-hours in >9,500 put EISOs (74%) 3 weeks, 119 >35,000 put in have 184officers of lastweek but as the substantially, off in December, dropped response. H1N1 on hours This incoming the EISOs,As to was always, a special extend Class the the 2010. we of welcome seco followingthe of Costa countries: willfrom each officer France,Rica, one have We nations. and Mexico, Haiti, Nigeria; Korea, Iraq, and South two Kenya, Japan, each Canada from and race and ethnicity supplied have who India. residents U.S. permanent citizens or Among 76 the scientists, PhD-level racial and ethnic minority represent Thirty groups. (35%) data, 30 (35%) are in new the dentists nurses, and 2 (2%) veterinarians, 3 (3%) 9 (10%) physicians, 42 (49%) class the of members veterinarians the and 3 of class. physicians the also PhDs. of Ten One hold assignments in health state departments. prematch accepted have mornings; and Wednesday Again Tuesday on oral will sessions this we year, concurrent hold plea that you are able to attend our annual our which highlights attend to conference, are able that you activities professional the poster 31 and EISprogramof scientific 95 officers. The presentations includes oral this year this experience In will your week addition, Night, presentations. International by be enriched been activities that and EIS other have the Run, skit, Prediction the special presentations, award longstanding conference. the at traditions pandemic. In of middlethe H1N1 overridingthis year The been of the theme EIS hasprobably conf early deal had because to she with two children with down a novel in San had come who Diego strain at time influenza. the of thinking,remember I cases about prettytwo seems excited “She onlynow! if I I what knew know then Wow, flu!” the of became rapidly focus the EIS response weeks, of Programwe Flu first the activities. 2–3 For s set up

, left to to right,, left Vincius Antao, Nicole Flowers, Eddie Sheryl Weiss, Lyss, , left to to right,, left Emad Yanni, Priti Patel, Matt Breiding, Thomas Clark,

ances and Disease Registry Alexa Oster, Cindy Hinton Ann Schmitz, GeoffreyCalvert FRONt ROW BACk ROW SCIENtIFIC PROGRAM COMMIttEE SCIENtIFIC PROGRAM Immunization for and Respiratory Center Diseases National thomas Clark, Chair, EmergingPriti Patel, Chair for Infectious and Zoonotic Elect, Disease* Center National Toxic for Health/Agency Environmental for Center Antao, National Vinicius Subst and Control Injury for Prevention Center Matt Breiding, National Safety Occupational for Institute Geoffrey Calvert, National and Health and Health Promotion Disease Chronic for Prevention Center Nicole Flowers, National Birth Disabilities on Defects Center and Developmental Cindy Hinton, National Health for Statistics Center Susan Lukacs, National Program Office* Development Professional and , Scientific Education Sheryl Lyss Viral STD, Hepatitis, and TB HIV/AIDS, for Prevention Center Alexa Oster, National Emerging for Infectious and Zoonotic Disease* Center Ann Schmitz, National Immunization for and Respiratory Center Diseases, National Jacqueline tate Program Office* Development Professional , Scientific Educational Eddie Weiss Emerging for Infectious and Zoonotic Disease* Center , National Yanni Emad Committees Program 2010 EIS CONFERENCE

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Jones, Jean Michaels knoll, William Catherine R. Piper, Sheila Porter, Rickman, Jill (contractor) (contractor) tracey tucker,

Scientific Education and Professional Development Program Office* Development Professional and Scientific Education

cial position of the Centerscial Disease of for the position Control and Prevention. fore, the EIS content, internal Program the isfore, responsible not the for consistency, or editorial ices, Management the Analysis and Services Office,the editorial and support and staff of all CDC administrative units participating in the 2010 EIS Conference. CDC administrative 2010 participating in units the publication in this edited were andAbstracts officially respectivethe cleared by national centers. There quality material. of this of trade names publication this is identification Use for throughout only and does imply not endorsement U.S. by the Service Health U.S. Public or the Department of and HumanHealth Services. andnot do necessarily represent The the author(s) findingsthis of conclusions those report and in are offithe Creative ServicesCreative (contractor) Jacobs, Virginia name*Proposed under CDC reorganization The Program EIS valuableacknowledgesgratefully the of cooperation Creative and assistance Serv Science OfficeScience Smith, C. kay Office of Communication PROGRAM PRODUCtION Development Program Office Scientific Education and Professional EIS Program Rachel Avchen, LAtEBREAkER SESSION COMMIttEE LAtEBREAkER Ann Schmitz, Chair, Emerging for Infectious and Zoonotic Disease* Center National Disease Chronic for Prevention Center Nicole Flowers, National , Eddie Weiss Emerging for Infectious and Zoonotic Diseases* Center , National Yanni Emad Dott, Mary Edwards, Ronald Green, kathryn (contractor) Hamilton, Douglas H. korwaski Jeter,

lable to access the Internet for e-mail for or access to Internet the lable ndees, please turn phones off ringerson Smoking is not permitted con in the Smoking of is any not hallways sessions, meeting rooms. or ference and allAs a courtesy presenters meeting to atte Use sessions. and pagers during conference meet cellular the isof to restricted phones the areas and public outside foyers ing room meeting rooms. Lactation Room EIS the visit Please table, next information use the to need area if registration the to you and schedule key A sign-up room. lactation will Monday–Friday, be available table the at a.m.–5:00 p.m. 7:30 Speaker Ready-Room Located in Dogwood the Room, this need who is presenters available for room maketo changes their presentations. to software, PowerPoint with Threecomputers drives, and printer a CD-ROM rewritable will be available 8:00 a.m.–6:00 p.m. Monday–Thursday. Exhibit Hall 8:00 a.m.–5:00p.m., in Monday–Thursday, Suites. Dunwoody the areathe outside Environmental Considerations Message Center Message Center Located A, Room in Maplewood the the willMessage Board System handle internal needs during thiscommunication year’s large-screen the check Please conference. Messages message for notification. monitors can be on accessed using number by code the name badge.your are also in Message the Center Computers avai forms. evaluation education continuing the per minutes 10 use to limitPlease computer an attendees allow conference to session other opportunity use these to services as well.

Information Information

uates into leadership positions at CDC at positions leadership uates into stigations at CDC. at stigations es and are assist available to if you s during the conference. Your name Your s during conference. the

inve alumni, health public and other engage to inprofessionals scientific the topics. epidemiologic exchange current of andand health. local state of departments grad

need additional information or misplace additional or need information badge.your To highlight epidemiologic of breadth the  To Registration and Information registration conference the at available are Staff on Suites Dunwoody the outside desk located on and Check-in hotel. mainthe of the floor Monday–Friday, available are registration site a.m.–5:00 p.m. 7:30 badge all at conference wearPlease your time access to messages code badge your includes Center. in Communications the staffwearing Conference are purple badg Overall Conference Goals a forum EIS for officers, provide  To Purpose Statement Purpose Statement primary The purpose of EIS the a forum EIS for provide is to Conference (oral presentations to scientific officers give increase recent their knowledge of poster), or and significance the investigations public to health, andmaintain and increase their skills in determining appropriateness the methods, presenting epidemiologic of and results clearly, and interpreting conclusions appropriate developing and recommendations. EIS of recruitment for a venue provide  To General General

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IV Infections Associated with ......

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AMERICA’S MOSt WANtED MOSt WANtED AMERICA’S HOW I MEt YOUR MOtHER HOW I MEt

Denise Koo and Stephen B. Thacker Ursula Bauer A: AND CALL tO ORDER tO AND CALL

e Weight of War: The Psychological Impact of Displacement Due to Due Armed PsychologicalDisplacement of The Impact War: of e Weight xtensive Tuberculosis Outbreak Associated Outbreak with an Assisted Living Facility Tuberculosis xtensive valuation of Influenza A (H1N1) 2009 Monovalent Vaccines Safety 2009Monovalent Influenza(H1N1) of A valuation otluck Dinner Outbreak of Salmonella of Dinner Outbreak otluck Contamination from Bearded from Reptiles Dragon Contamination — Minnesota, 2009. Sara Lowther LUNCH October 1–December 4, 2009. Zheteyeva Yenlik 1–December October Th ConflictJaffna — District, Sri Lanka, Farah Husain2009. Remarks: HHS Secretary Kathleen Sebelius BREAk SESSION B: MODERAtOR: MODERAtORS: MODERAtORS: Can Quiet Kill? Pedestrian and Bicyclist Fatalities Caused by E with Adults Illnessfor Mental — Florida, 2008–2009. Joseph Cavanaugh P E States, United — System Reporting Event VaccineAdverse Through the SESSION Opening Session States, 2004–2008. — United Vehicles Amy Freeland Motor Hybrid REGIStRAtION DESk OPENS REGIStRAtION WELCOME Reproductive Health Reproductive Descent — Massachusetts,Descent 1998–2006. Danielle Barradas 2009. Andreea May–June Creanga City, York — New in Pregnant Women Sickle Cell Disease and Pregnancy Outcomes Among Women of African of Sickle Cell Disease and Pregnancy Among Women Outcomes Pregnancy Differences in Demographic DiagnosesAfter Outcomes with DisabilitiesBreast and Cervical — Screening Cancer Among Women States, 2008.United Brunella Frammartino Virus Infection Severity 2009 of Influenza(H1N1) Pandemic A of Neural Tube Defects — Texas, 1999–2005. Sharyn 1999–2005. Defects — Texas, Parks Neuralof Tube Stephen B. Thacker, Surveillance, for Deputy Director and Laboratory Epidemiology, Services, CDC

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MONDAY, APRIL 19, 2010 APRIL MONDAY, Schedule EIS Conference 2010

Ravinia Ballroom , United States, 1998-2008. Lee States, 1998-2008. Hampton, United FRIENDS — Meet the authors in the Ravinia Ballroom.

tHE DEADLIESt CAtCH tHE DEADLIESt CAtCH Kenneth Castro ......

Streptococcus pneumoniae SESSION C: MODERAtOR: POStER SESSION 1: POStER SESSION POStER SESSION POStER Diagnostic Tests in AfricanDiagnostic Refugee Tests — 2007–2008. Camps David Townes Epidemiology of Malaria of Epidemiology Rapid of Diagnostics with Introduction the Tuberculosis Argentina, 2009. Elissa Meites Healthcare Utilization on for Rotavirus Vaccine Impact Pentavalent of States, 2007–2008. — United Diarrhea in Children Aged Years <5 Jennifer Cortes Impact Changing of PenicillinVaccine of Effects Definitions Resistanceon Against Influenza-Like a New of IllnessEvaluation Surveillance System Among Alaska 2009. James Persons, Keck Native Health InfluenzaNational Messaging 2009 of H1N1 Impressions Travelers’ Campaign. Emily Jentes States, — United Events and Adverse Incidence Neonatal Male Circumcision 1979–2006. Charbel El Bcheraoui Critical Care Capacity During Influenza — Pandemic 2009 the H1N1 Smoking During Pregnancy and Maternal Other Characteristics as Risk Infants — West Among Full-Term Singleton Low Birth for Weight Factors Virginia, 2005–2006. Rachel Radcliffe Treatment the for Artemether-Lumefantrine to An Adherence of Assessment Malaria Malawi, — Phalombe, Uncomplicated of 2009. Kimberly Mace Mortality Active of SurveillanceEvaluation Following Hurricane Ike — — Nigeria, Hospitals Mortality Hospital-Based in Territory Federal Capital 2005-2008. Nykiconia Preacely Impact of Rotavirus Vaccine on Diarrhea-Associated Hospitalizations Among Hospitalizations Diarrhea-Associated on Impact Rotavirus of Vaccine States, 2004–2009. Age of — United Years CatherineChildren <5 Yen Surveillance Marshall the of — Republic Tuberculosis Islands, of Evaluation 2004–2008. Bisrat Abraham Risk Community for — Chivi Mortality District, Factors Cholera from Zimbabwe. Diane Morof Survey in Methods with Telephone Internet-Based of Comparison 2009.Investigating — Oregon, John Oh Outbreak a Norovirus 2008.Texas, Ekta Choudhary All posters presented during the conference will on be display Monday, 9:00 a.m. through Friday, 12:00 p.m. Thefollowing authors willbe present discussto his/ her p.m. study on Monday, 12:30–1:30 Relationship Between tuberculosis Relationship Mycobacterium Lineage and States, 2004–2008. — United Extrapulmonary Eleanor Tuberculosis Click Infection Among Immigration Facility Tuberculosis Screening Latent for Employees — Illinois,Employees 2009. Marie de Perio

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Roodly Archer

10 tHINGS I HAtE 10 tHINGS I HAtE Jonathan Mermin Lyn Finelli ......

EIS CONFERENCE SOCIAL CONCURRENt SESSION E1: MODERAtOR: BREAk SESSION D: MODERAtOR: Human ImmunodeficiencyVirus Influenza Genotypic Clustering of Tuberculosis Cases Among the Tuberculosis of Genotypic Clustering States, 2004–2008. — United Foreign-Born Philip Ricks in Outbreak a Homeless Case-Finding DuringOnsite Tuberculosis a — Georgia,Shelter 2008–2009. Krista Powell Zanzibar, 2007. DitaZanzibar, Broz 2007. Evaluation of a Screening Tool To Assess Peripheral Neuropathy Among Neuropathy Assess Peripheral To Screening a of Tool Evaluation in Settings. Resource-Limited Persons HIV-Infected A. Danielle Iuliano HIV of Correlates — Unguja, Infection Drug Among Users Injection Monitor To Surveillance Modified System Tuberculosis a of Evaluation Services Quality the in of a Provided Evaluation HIV of Care and Treatment Clinic — Tanzania, 2006–2008.Tuberculosis Surbhi Modi Dakota, 2007–2008. Jennifer Cope Pennsylvania, 2009. W. Widespread of in Context the Tuberculosis Increase in HIV-Associated — Kazakhstan,Drug-Resistant Tuberculosis 2003–2008. Matthew Willis — Zambia,Increased HIV 2008. Testing Simon Agolory Household Transmission of 2009 Pandemic Influenza A (H1N1) a After 2009 of Influenza(H1N1) Pandemic A Transmission Household 2009. April–May City, in Outbreak York New School-Based North — Workers PracticesHealthcare Vaccination Among Influenza Knowledge, During Attitudes, and Practices Among Dismissal School Parents Virus — 2009Because of Circulation Influenza(H1N1) of Pandemic A DeathsUnited Children — Among 2009 Influenza(H1N1) Pandemic A States, 2009. Chad Cox InfluenzaSurveillance Health — Using Department Emergency Records by 2009.Nebraska, Parvathy September Pillai Pneumococcal DiseaseInvasive Associated 2009 with Pandemic Influenza Area, Metro 2009. October George Nelson — Denver A (H1N1) Anne Marie France

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Ravinia Ballroom Dunwoody Suites Suites Dunwoody Dunwoody Suites Suites Dunwoody OF FIVE PARtY PARtY BURN NOtICE tHE FALL GUY tHE FALL ......

Gastroenteritis Outbreak at a Wedding a Wedding at Outbreak Gastroenteritis Paul Cieslak Grant Baldwin Kevin Fenton ......

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ethicillin-Susceptible aureus Staphylococcus Infections After ultiple-Serotype Salmonella ultiple-Serotype ave Self-Reported and Observed Seatbelt Use in the United States States in and Observed United the Use Self-Reported Seatbelt ave sefulness Influenza-Like Site Illness Sentinel of Surveillance — ftermath of the DC Metrorail Crash: Type of Injuries and Evaluation of TypeEvaluation of Injuries and Crash:Metrorail of ftermathDC the ariations in Positive Predictive Values for Rapid Influenza Tests for Tests2009 for Rapid Influenza for Values Predictive ariations in Positive entinel Roulette: Utility Individualentinel of Surveillance Hospital for urveillance and Prevention of Occupational Injury Occupational urveillance of Deaths — Wyoming, and Prevention MODERAtOR: MODERAtOR: LUNCH CONCURRENt SESSION F2: BREAk CONCURRENt SESSION F1: MODERAtOR: CONCURRENt SESSION E2: SESSION CONCURRENt MODERAtOR: A DC, Response Emergency — Washington 2009. Nagesh Borse Postevent DeathsUtah, — Overdose 2008–2009. Opioid WilliamPrescription Lanier H Aybaniz IbrahimovaConverged? S Paul Anderson2003-2007. Measuring Pneumococcal Conjugate Vaccine Impact in Young Children — Impact in Young MeasuringVaccine Pneumococcal Conjugate States, 1998–2006. Lee HamptonMultiple 2009. — Connecticut, JessicaReception Kattan M M Intra-Articular a Primary at Injections Care Clinic — Georgia, 2009. Roodly ArcherW. U 2003–2009.Wyoming, Aimee Geissler S V — Arizona, 2009. Steven Baty Influenza(H1N1) Pandemic A Sexually Diseases Transmitted Hot Topics Topics Hot Health Insurance, Health Care Utilization, and Chlamydia and Gonorrhea States, 1999–2008.Infection Elizabeth Among Females — United Torrone years Among Females Ages Coverage 9–59 Human Papillomavirus Vaccine Examination States, Health Survey — National and Nutrition — United 2007–2008. La’Shan Taylor Neisseria Alaska, of Outbreak gonorrhoeae Infection — Southwestern 2008–2009. Gardner Tracie Injury Cofactors for Cervical Intraepithelial Neoplasia in Women Referred to Referred to Cervical for Cofactors in Women Intraepithelial Neoplasia — Atlanta, Michigan,Colposcopy Georgia and Detroit, 2000–2004. Julia Gargano

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Owen Devine Lyn Finelli

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Bloodstream Infections — a Multi-Center Prospective Survival Prospective Bloodstream Infections — a Multi-Center Effect

MODERAtOR: MODERAtOR: BREAk PREDICtION RUN CONCURRENt SESSION H1: SPEAkERS: SPEAkERS: SESSION G: MODERAtOR: SPECIAL SESSION: SPECIAL MODERAtOR: POStERS ON DISPLA All posters presented during the conference will on be display in the Ravinia Ballroom Monday, 9:00 a.m.,through Friday, 12:00 p.m. A History Response of and Chronology Peavy Award Finalists Peavy Award School-Age Children School-Age Cancer Survival — United States, 1980–1997. Crystal SurvivalCancer States, 1980–1997. — United Candida Analysis. Loretta Chang Novel Metric for Risk-Adjustment of Hip Replacement Surgical Replacement Site Hip of Risk-Adjustment for Metric Novel Healthcare at Healthcare Facilities Safety — National Infection Frequency 2006–2009.Network, Matthew Wise UnderstandingSignificance Cease: Persistent the of Won’t Yeast That The Children Following Evidence-Based Treatment Guidelines — United States, Guidelines — United Treatment Children Following Evidence-Based and 2003–2006.1999–2002 Brian Kit 2008–2009. Sherry Burrer TB/HIV of Integration of Surveillance Evaluation Tuberculosis into Children Eleanor for — Ethiopia, 2007–2009. Click Treatment Does "Food the Insecurity Exist — Obesity Paradox" in U.S. Children? Among Asthma Asthmatic Use Changes Medication in Preventative Overweight and ObesityNew AmongHampshire, Third-Graders — Family Associated Support withAmong DecreasedUse Alcohol Perceived 2008. — Iowa, MaryYouth Fournier RacialSpectrum Autism of Disparities in Community Identification Atlanta, — Metropolitan Time Over 2000–2006.Disorders Jarquin Vanessa ExaminationHealth National Survey, Nutrition 2001–2006. The and Molly Lamb

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21, 2010 APRIL WEDNESDAY,

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COUGAR t Typhimurium Infections Associated with Typhimurium ......

Creanga Creanga

Nancy Messonnier James Buehler

Tracee A. Treadwell Tracee ......

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cute Versus Paired Serology Paired Encephalitis La Surveillance. for Crosse Versus cute easons Increasing the for Hispanic Infant Mortality Rate — Florida, o Test or Not To Test: Influenza-Like Versus IllnessCase Test: Definition To Not or o Test mergency Department Visits for Suspected Medication-Related Suspected Medication-Related for Visits Department mergency valuation of Three School Absenteeism Influenza Three Surveillance of Absenteeism School valuation Indicators: CONCURRENt SESSION I2: MODERAtOR: CONCURRENt SESSION I1: MODERAtOR: BREAk CONCURRENt SESSION H2: CONCURRENt MODERAtOR: Presentation of the Iain C. Hardy Award Iain the of C. Award Hardy Presentation Rendi Murphree Nancy Colorado. Williams Region), Metropolitan (Denver Tri-County ElissaAngioedema States, 2007. Meites — United A E — Lessons with Enabled 2009 the Influenza(H1N1) Pandemic A E T Pilot in a 2009 for Influenza(H1N1) Pandemic A Antigen Testing 2009. May–June City, Respiratory Virus Surveillance York New — System Al-SamarraiTeeb R 2004–2007. Erin Sauber-Schatz Zoonoses Nicaragua, 1991–2006. Andreea Nicaragua, 1991–2006. Among AsiansIncidence — California, 2005–2008. Erin Murray Surveillance Age, Period and Cohort Effects on Contraceptive Practices — Honduras and — Honduras Practices EffectsAge, and Cohort Contraceptive Period on Identify Areas SpatialUsing Analysis Increased Tuberculosis of Active To It’s Not Easy Human Salmonella Not of Outbreak A Multistate Being Green: It’s Diseases and Preventable Vaccines — Connecticut, Epidemiology Varicella on Vaccination Impact 2-Dose of 2005–2008. Jessica Kattan Dirty Chicks: Human Salmonella in Delay Rabies Prophylaxis Postexposure Associated with Factors Patient Rico, — Puerto Initiation 2008–2009. Kis Robertson Hantavirus of PulmonaryEvaluation Clinical Syndrome Findings and Case States, United 2003–2009.Definition — Barbara Knust States, Infections Associated — United Frogs with Aquatic Typhimurium 2009. Shauna Mettee Exposure Agricultural Poultry Baby from to and Mail-Order Stores Feed States, 2009. Anagha — United LoharikarHatcheries

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— Meet the authors in the Ravinia Ballroom.

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SESSION: Mark Pendergrast POStER SESSION 2: LUNCH SPECIAL SPEAkER: POStER SESSION Inside the Outbreak: The Elite Medical Detectives of the Epidemic Outbreak:Medical the Inside The Elite Epidemic of the Detectives Intelligence Service Impact of Rotavirus Vaccination on Rotavirus-Coded on — Hospitalizations Impact Rotavirus of Vaccination 2000–2008.Colorado, Christa Hale Projected Impact and Cost-Effectiveness of a National Rotavirus Vaccination Vaccination National Rotavirusof a Impact andCost-Effectiveness Projected Program — India. Douglas Esposito Administration of BetweenComparison Time Seasonal Attenuated Live Flu Vaccine Stop DuringHawaii’s Trivalent Influenza Vaccine and Influenza Campaign School at — Hawaii, 2009. Meera Sreenivasan Hepatitis B Virus InfectionHepatitis — Pinellas Florida, 2007–2008. County, Roxanne Williams 2009. PritishArthroscopy — Texas, Tosh Outbreak A Persistent Always in Vegas! Stay Doesn’t inWhat Vegas Happens Legionnaires’ Disease — Nevada, 2001–2008. Travel-Associated of Benjamin Silk Hiding Pandemic — Analysis Within Pandemic the What’s Non-2009 of FatalStates, United Cases 2009. Dianna — Blau Influenza(H1N1) A Associated Hemorrhage with 2009 InfluenzaRespiratory Tract Pandemic States, 2009. Infection Erin — United Kennedy A (H1N1) Salmonella of Outbreak Multistate Documented First States, 2009. CarrieUnited Nielsen Virus Viral 2009 Shedding of Duration Influenza(H1N1) Pandemic A During 2009. an Elementary — Pennsylvania, Outbreak School May–June Achuyt Bhattarai Outbreak of Salmonellosis of Outbreak Associated with 2009. Pulled — Memphis, Pork Rendi Murphree with Diagnosis a New Chronic of Persons of Referral and Treatment goodii Surgical Mycobacterium of Outbreak Infections — Midwest Site Pseudomonas of Outbreak aeruginosa Surgical Infections Following Site Campers Among 2009 Oseltamivir-Resistant Influenza(H1N1) Pandemic A — North Carolina,Receiving 2009. Chemoprophylaxis Natalie Dailey — Arizona, Hantavirus Pulmonary Patients Pediatric in Five Syndrome All posters presented during the conference will on be display Monday, 9:00 a.m., through Friday, 12:00 p.m. Thefollowing authors willbe present discuss to p.m. his/ her study on Wednesday, 12:30–1:30 Viruses Oseltamivir Resistance Among 2009 Influenza(H1N1) Pandemic A States, 2009. Samuel— United Graitcer Region, Parvathy 2007–2009. Pillai and California, Washington, Colorado, 2009. Barbara Knust

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DIRtY JOBS DIRtY Stephen B. Thacker

Christine Branche

Pat Remington Pat

cement of Distinguished Friend of EIS Award n Community Health Rankings in — Epidemiology Action ific Education and Professional Development Program Office* Development Professional ificand Education ...... Announcement of Langmuir Prize Winner Annou MODERAtOR: MODERAtOR: SPEAkER: tOPIC: BREAk SESSION k: EIS the by AlumniCosponsored Association and Scient SESSION J: MODERAtOR: ALExANDER D. LANGMUIR MEMORIAL LECtURE ALExANDER D. LANGMUIR MEMORIAL Distribution of Laboratory-Confirmed of 2009Distribution Pandemic Influenza A 2009. April–July — Wisconsin, Cases Among Healthcare Workers (H1N1) Jevon McFadden Fatalities and Food Drug Reported the to Donor Product and Blood Blood States, 1984–2008.Administration United Sanjaya — Dhakal Border, Findings with Neurologic Malawi-Mozambique — Fever Typhoid 2009. Emily C. Lutterloh Viral Shedding of 2009 Pandemic Influenza A (H1N1) Virus Among Viral Shedding 2009 of Influenza(H1N1) Pandemic A Care — Patient from Exclusion for and Implications Healthcare Workers Seattle,2009. Meagan Kay Washington, Occupational HealthOccupational 1979–2006. Muazzam Nasrullah VesselU.S. Aboard a Navy 2009 of Outbreak Influenza(H1N1) Pandemic A — San 2009. Diego, Christina Khaokham Influenza Vaccination Among Nursing Assistants WorkingU.S. in NursingNursing Vaccination AssistantsAmong Influenza MatthewHomes. Groenewold — Virginia, Cluster Mantle Cell of 2009. Lymphoma Investigation States, — United Silicosis Mortality with Respiratory Tuberculosis Occupational of Contribution Potential It? With Do Got To Work What’s Meeting 2008 Activity Physical Recommended ActivityPhysical Towards Myduc States, Ta 2007. Guidelines — United Drift Pesticide from Illnesses Pesticide Acute Associated with Off-Target Agricultural States, 1998–2006. Soo-Jeong Lee — United Applications Thomas Bender

3:15 1:35 1:55 2:15 2:35 2:55 P29. P30. P31. P28. 3:45 1:30 4:00 *Proposed name*Proposed under CDC reorganization

th 59 ANNUAL EIS CONFERENCE: Program Schedule 14 59th ANNUAL EIS CONFERENCE: Program Schedule 15

Oakwood Room O157 — Germany, — Germany, O157

...... The Center for Global Health (CGH)/ Division of Public Division (CGH)/ HealthGlobal for The Center ASSOCIAtION MEEtING ASSOCIAtION

icipants in international programs in applied field epidemiology similar thatto of EIS. Some of the programs are sponsored by or partnered with CDC, and some are independent. All conference attendees are invited to these sessions. Health Systems and Workforce Development and the Training Programs and Training the in Development and Workforce Health Systems Network andEpidemiology Public Health Interventions (TEPHINET). The posters and presentationsfeatured during InternationalNight are from part COSPONSORED BY: COSPONSORED EIS ALUMNI ALUMNI EIS NIGHt INtERNAtIONAL The Danger of Pirated Piped Water Connections: Post-Cyclonic Cholera Cholera Post-Cyclonic Connections: Water Piped DangerThe Pirated of Bengal, — SundarbanOutbreak India Area 2009. West of Rama Bhunia INtERNAtIONAL NIGHt POStER SESSION INtERNAtIONAL 2009. Stine Nielsen Gastrointestinal of Outbreak DiseaseFoodborne — Atyrau, Kazakhstan, July 2009. Manar A. Kasimzhanova Associated Outbreak withLeptospirosis Bathing Irrigation in a Polluted Canal — El Salado,Galván, 2009. Dominican Baoruco, November Republic, Ronald E. Skewes-Ramm Risk Ebola Virus Reston of (REBOV) Factors Infection Among Abattoir AfterItsDiscovery PigsPhilippines, in — 2009. Rolando CruzWorkers V. Epidemic of Chilblains of Epidemic in Rural Peoples Boarding Schools — Southwestern China, of Republic 2009. Bike Zhang 2009 InfluenzaH1N1 in Outbreak A two Novel of and Control Investigation Boarding Schools, Angthong — Thailand, Province August 2009. Sanisa Santayakorn Risk Child for Sexual Factors Abuse — Harare, Zimbabwe, 2009. MashumbaNgoni W. Syndrome SeekingDesperately Uremic Hemolytic Diarrhea: of Outbreak Escherichia coli EmergingCaused by Sorbitol-Fermenting East Region, Rabies of Outbreak — Upper Ghana, 2009. Cross-Border Paul N. Polkuu Protective EffectHandwashingof Protective HygienicHabits GoodAgainstand ConfirmedProvince, Fujian China, Influenza — Mingbin2009. Liu Dental Caries and Oral Health Knowledge Children and among Practice in Districts — Kenya. and MathiraWest West Nairobi Gladwell K. Gathecha

Posters from the Field fromProgram willbe on displaythe Posters EpidemiologyTraining the in Dunwoodylobby Suites. outside the

P9. P4. P5. P6. P7. P8. P3. P1. P2. P11. I I I I I I I I I P10. 6:00 5:30 I I

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Ravinia Ballroom Dunwoody Suites Suites Dunwoody Dunwoody Suites Suites Dunwoody

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Mandal Mandal

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Thomas Frieden ......

CSI AtLANtA AtLANtA CSI INtERNAtIONAL FIELD EPIDEMIOLOGY FIELD EPIDEMIOLOGY INtERNAtIONAL Patricia Simone and Paul Kelly Mitchell L. Cohen Strain Plague of — Illinois, 2009. Andrew Medina-Marino ustained Multi-State Outbreak of Hepatitis A Associated with Hepatitis Semi-Dried of Outbreak ustained Multi-State eterminants of Nondisclosure of HIV Status among Women Attending HIVof eterminants Nondisclosure Status of Women among holera Outbreak: The Importance of Hand Washing — Bashuri,with Soap Outbreak: Hand The of Importance holera everity and Factors Associated with Road Traffic Injuries in Patients — Patients Injuries Associated in everity and with Factors Road Traffic higellosis Outbreak in an Elementary School — Sichuan Province, People’s higellosis in Outbreak an People’s Province, Elementary — Sichuan School mpact of Trained Social Entrepreneurs on Access to Health Products in Health Accessto Products on Social Entrepreneurs Trained of mpact SESSION M: MODERAtOR: MODERAtORS: MODERAtORS: OPENING REMARkS: SESSION L: SESSION Reception follow to D Programme — Makonde Child to Transmission Mother of Prevention the District, Zimbabwe. Pride Mucheto S A S — Australia, 2009. EllenTomatoes J. Donnan Presentation of William H. Award Foege I — Nyanza 2007–2009. Rural Kenya, Province, Impoverished Populations Minal Patel S 2009. Ke Han China, of 7–16, Republic June C 2009. State, Nigeria, Saheed September Jigawa O. Gidado Thika Hospital,District2009. Kenya, Eric M. Osoro Mackel Award Finalists Translating Science into Practice Around the World Around World the Practice into Science Translating Night International Fatal Case of Laboratory-Acquired Infection with Y Fatal an Case Laboratory-Acquired Attenuated of Infections Escherichia O157:H7 of coli outbreak Multi-State Cookie Monster: PrepackagedAssociated of Raw Cookie with Consumption Dough — Mucormycosis Outbreak Associated Outbreak Linens with — Louisiana, Hospital Mucormycosis 2009. Jonathan Duffy — Key Outbreak West, Dengue Fever Autochthonous of Investigation Florida, 2009. Christopher Gregory PertussisSuspectedof a — Outbreak PerfectInvestigation Storm: The pestis States, 2009. KarenUnited Neil Colorado, Summer 2009. Sema Colorado,

8:15 7:55 8:35 8:55 9:35 9:55 8:35 8:55 9:15 9:15 7:35 8:30 9:35 7:30 tHURSDAY, APRIL 22, 2010 APRIL tHURSDAY,

th 59 ANNUAL EIS CONFERENCE: Program Schedule 16 59th ANNUAL EIS CONFERENCE: Program Schedule 17

Ravinia Ballroom Ravinia Ballroom Dunwoody Suites Suites Dunwoody

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GENERAL HOSPItAL HOSPItAL GENERAL tHE tICk tHE tICk Randolph Daley Denise Cardo

Paul Mead Laura Bettencourt, Erin Koers, Shauna Mettee

GRADUAtE StUDENt EPIDEMIOLOGY RESPONSE PROGRAMS StUDENt EPIDEMIOLOGY GRADUAtE (GSERPS): SPEAkERS: SESSION O: IllnessHealthcare-Associated MODERAtOR: SPECIAL SESSION: SPECIAL Capacity Epidemiologic the Supporting for A Resource Public the Healthof Infrastructure MODERAtOR: MODERAtOR: MODERAtOR: LUNCH BREAk BREAk N: SESSION Diseases Vectorborne POStERS ON DISPLAY POStERS ON DISPLAY in the display be on will conference the during presented posters All 12:00 p.m. Friday, 9:00 a.m. through Ravinia Monday, Ballroom, Staphylococcus aureusStaphylococcus Infections Associated a Pain at with Injections Epidural Virginia,Clinic 2009. — West Rachel Radcliffe Epidemiology of Babesiosis — New Jersey, 2006–2009. Jersey, Babesiosis — New of Epidemiology Andria Apostolou Management of a Vancomycin-Resistant Enterococci Outbreak in Outbreak a Neonatal Enterococci a Vancomycin-Resistant of Management — Indiana, Care Unit 2009.Intensive Matthew Ritchey 2009 Oseltamivir-Resistant Influenza(H1N1) of Pandemic A Cluster Acute Hepatitis B Virus Infections Hepatitis Acute in Skilled a Psychiatric Facility Nursing — Los Angeles, California, 2008. Matthew Wise C Virus Hemodialysis Infections Hepatitis of an Outbreak at Outpatient Facility — Maryland, 2009. Agam Rao — Patients Among Immunosuppressed Ward Infections a Hospital on North Carolina, 2009. Natalie Dailey Evaluation of Health Facility Versus Household Surveys Measuring for Household Health of Facility Evaluation Versus Malaria — Tanzania,2002, Burden 2004, 2006. Kimberly Mace Rocky Among of Fever Mountain Spotted Practices Regarding Treatment 2009. Kristina — Tennessee, McElroy Healthcare Providers Encephalitis La in Virus Place: Crosse Face a New Old Infection — Missouri, 2009. Yi-Chun Lo

2:35 2:55 1:35 1:55 2:15 1:30 11:15 11:35 10:35 10:55 12:30 12:00 10:15 10:30

Ravinia Ballroom Ravinia Ballroom Ravinia Ballroom Ravinia Ballroom pneumoniae

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...... AWARDS ......

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tHIRD ROCk FROM tHE SUN COLD CASE COLD CASE Douglas Hamilton Mike McGeehin Matt Moore

PRESENtAtION OF PRESENtAtION MODERAtOR: BREAk SESSION q: MODERAtOR: MODERAtOR: MODERAtOR: BREAk BREAk P: SESSION Outstanding Poster Presentation Award James H. Steele Veterinary Public Health Award Paul C. Shnitker International Health Award J. Virgil Peavy Memorial Award EIS SAtIRICAL REVUE EIS SAtIRICAL Donald C. Mackel Memorial Award Are Formaldehyde Levels in Portable and Traditional Classrooms a Cause for a Cause for Classrooms and Levels Traditional in Portable Are Formaldehyde Georgia,Concern? 2009. Isabela Ribeiro Lead in Burmese U.S.-Bound Refugee Poisoning Children — Thailand-Burma Refugee2009. Mitchell Tarissa Border Camps, May–June Illness Pesticide-Related — Bangladesh, Acute of Outbreak April 2009. Ellen Yard Environmental HealthEnvironmental Community PublicHealth for Needs Response Emergency Assessment Following Earthquake the — American and Tsunami Samoa, 2009. Ekta Choudhary Respiratory Illness During an Outbreak at a Child and Adolescent Residential Treatment Center Center During Treatment Residential an a Child at Outbreak and Adolescent 2009. Mexico, — New Megin Nichols Does Group A Streptococcal Strain Disease? A Streptococcal Severity the Predict Invasive of Does Group Benjamin Silk — Pennsylvania, Measles Outbreak 2009. March–April Hospital-Associated George Han with Adults of Asthma and Epidemiology Outcomes Hospitalized 2009 for California, — 2009. Eva Mortensen Influenza(H1N1) Pandemic A and Risk Mycoplasma for Factors Transmission of Modes

• • • • • 8:55 9:15 9:35 8:35 3:35 3:55 4:15 4:35 8:30 3:15 3:30 8:30 10:15 10:00 FRIDAY, APRIL 23, 2010 APRIL FRIDAY,

th 59 ANNUAL EIS CONFERENCE: Program Schedule 18 59th ANNUAL EIS CONFERENCE: Program Schedule 19 Ravinia Ballroom Ravinia Ballroom Ravinia Ballroom Dunwoody Suites Suites Dunwoody ......

ADJOURNMENt

AND

tHE HAItI RESPONSE tHE HAItI RESPONSE ......

LAtE-BREAkING REPORtS LAtE-BREAkING tHE CLOSER Thomas Frieden, Ann Schmitz Mehran Massoudi

Michael J. Beach

......

CLOSING REMARkS SESSION S: MODERAtOR: MODERAtORS: MODERAtORS: LUNCH SESSION: SPECIAL Efforts — the and Ground on the Cities Two of A Tale in Atlanta MODERAtOR: SPEAkERS: SESSION R: SESSION Food- and Waterborne Diseases in the and Waterborne Food- SettingInternational Roc Magloire, Susan Cookson, Isabela Ribeiro,Jeanette Rainey, Robin Nandy, Sara Vagi Stephen B. Thacker, Surveillance, for Director Deputy Epidemiology and Laboratory Services, CDC Excess 2009. Mortality — Cameroon, During Cholera Epidemic Emily Cartwright in Diarrheal Disease Water MortalityTrends Household of and Use Kisumu Health Surveillance and Demographic (KHDSS)Treatment, System Kashmira— Nyanza 2003–2007. Kenya, Province, Date Evaluation of Pot-Chlorination of Wells During a Cholera Outbreak — Outbreak During a Cholera Wells of Pot-Chlorination of Evaluation Bissau, 2008. Guinea-Bissau, Elizabeth Cavallaro Aflatoxin of Rapid Assessment Food — Commodities in Contamination Bangladesh, 2009. Monika Roy in Living with HIV/AIDS Practices in People Treatment Changing Water Ethiopia, 2008-2009. Programs — Gonder, DiarrheaResponse Prevention to Ethel Taylor 10:30–11:45 a.m. See supplement presenters for and abstracts. 10:30–11:45

2:35 2:55 1:35 1:55 2:15 1:30 3:15 12:00 12:30 10:30

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e Perio e Perio l-Samarrai tH (NIOSH) n Baty Paul Anderson Anderson Paul Marie d Roodly Archer W. Steve Matthew Groenewold Matthew Groenewold Lee Soo-Jeong Muazzam Nasrullah AND SCIENtIFIC EDUCAtION DEVELOPMENt PROFESSIONAL PROGRAM OFFICE (SEPDPO)* A Teeb Andria A Thomas Bender Sherry Burrer Jennifer Cope Natalie Dailey Mary Fournier Anne Marie France Gardner Tracie Aimee Geissler Christa Hale George Han KattanJessica Meagan Kay Christina Khaokham William Lanier Lo Yi-Chun Sara Lowther Emily Lutterloh McFadden Jevon Andrew Medina-Marino Mortensen Eva Rendi Murphree Erin Murray Megin Nichols Carrie Nielsen Oh John Sharyn Parks Parvathy Pillai Rachel Radcliffe Matthew Ritchey Erin Sauber-Schatz Sreenivasan Meera Ta Myduc Nancy Williams HEALtH CENtER FOR GLOBAL (CGH) Preacely Nykiconia NAtIONAL INStItUtE FOR NAtIONAL AND SAFEtY OCCUPAtIONAL HEAL

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essa Jarquin in Kit israt Abrahamisrat Molly L StAtIStICS (NCHS) StAtIStICS Bra ENVIRONMENtAL HEALtH/ ENVIRONMENtAL FOR t AGENCY AND tB StD, HEPAtItIS, VIRAL PREVENtION (NCHHStP) B A Simon Broz Dita Cavanaugh Joseph Eleanor Click Charbel El Bcheraoui Danielle Iuliano Surbhi Modi Krista Powell Philip Ricks La’Shan Taylor Elizabeth Torrone Roxanne Williams Matthew Willis CENtER FOR HEALtH NAtIONAL SUBStANCES AND DISEASE SUBStANCES Brunella Frammartino Erin Koers Crystal Tyler CENtER FOR NAtIONAL Farah Husain Diane Morof Isabela Ribeiro Ellen Yard Sara Vagi CENtER FOR HIV/AIDS, NAtIONAL CHRONIC DISEASE PREVENtION CHRONIC DISEASE PROMOtION AND HEALtH (NCCDPHP) Dani REGIStRY(NCEH/AtSDR) Ekta Choudhary Amy Fre Andre NAtIONAL CENtER FOR NAtIONAL DEFECtS AND DEVELOPMENtAL AND DEVELOPMENtAL DEFECtS DISABILItIES (NCBDDD) Van EIS OFFICERS BY AGENCY OR CDC ORGANIzAtIONAL UNIt OR CDC ORGANIzAtIONAL AGENCY BY EIS OFFICERS AND DRUG FOOD (FDA) ADMIMIStRAtION DhakalSanjaya CENtER ON BIRtH NAtIONAL Officers EIS Presenting *Proposed name*Proposed under CDC reorganization

th 59 ANNUAL EIS CONFERENCE 20 th

59 ANNUAL EIS CONFERENCE 21 rian, PhD(c), MPH MPH rian, PhD(c), Ko, Jean, PhD(c) Jean,Ko, PhD(c) BSN, MPH, MS Amy, Kolwaite, Candice,Kwan, MD Stacie,Lawson, DVM, MPH, MS Lehman,Mark, DVM, MPH, MS Longenberg, Allison, PhD(c) Mahamud, Abdirahman, MD Maxted, MS Angela, DVM, PhD(c), Mbaeyi, Chukwuma, BDS, MPH Adamma,Mba-Jonas, MD, MPH DVM, McCollum, Jeffrey, MPH(c) MA McDaniel, Dawn, PhD(c), MS AlyshaMeyers, , PhD(c), Meza, MD, MPH Francisco, MD, MSc Minniear, Timothy, Robyn, MD, MPH Neblett, Katherine, BSN, MPH O'Connor, Erika,Odom, MS PhD, Ekwutosi, MD, MPH Okoroh, Oramasionwu, Gloria, MD, MPH DVM, PhD Amy, Peterson, MSPH PhD(c), Kimberly, Porter, Jill,Ray, BSN, MPH Rodgers, PhD Loren, Janell,Routh, MD, MHS Samuels, Aaron, MD, MHS Cyrus,Shahpar, MD, MPH, MBA PhD(c) Sharp, Tyler, MSNSong, Minkyoung, PhD(c), MPH Steinhardt, Laura, PhD(c), Aaron,Storms, MD Swaminathan, Mahesh, MD Danielle, DVM,Tack, MPVM MPH Sara, PhD(c), Tartof, PhD(c) Christopher, Taylor, DVM, Tegwin, MPH Taylor, MD, MPH Andrew, Terranella, Mathieu, MD, MPH Tourdjman, Jenna, DVM, MPH Webeck, Woodhall, Dana, MD Kim, MD, MPH Lindsay, King, B Agarwal, Aarti, MD Azofeifa, Alejandro, DDS, MPH, MSc MD Ijeoma, Azonobi, Brian,Baker, MD MSc, MPH Kamil,Barbour, PhD(c), Michael, MD Bartholomew, MD, MPH Beau De Rochars, Valery, Bennett, Sarah, MD, MPH Adam,Bjork, PhD MHS PhD(c), Heather, Bradley, Meghan,Brett, MD MPH Allison,Brown, PhD(c), Bunga, Sudhir, MD, MBBS MPH(c) Buttke, Danielle, DVM, PhD(c), Cardemil, Cristina, MD, MPH Grace, MD, MPH Chen, Chitnis, Amit, MD, MPH Christensen, Bryan, PhD MPH PhD(c), Heather, Clayton, King,Coleman Sallyann, MD, MSc ScM Cunningham, ScD(c), Timothy, MPH Davila, PhD(c), Evelyn, MPH Demissie, Zewditu, PhD(c), Desai, Rishi, MD, MPH MD, MPH Fairlie, Tarayn, Farag, MBBCh, Noha, PhD MPH PhD(c), Nancy, Fleischer, Katherine,Fleming-Dutra, MD MA MPH(c), Gaines, Joanna, PhD(c), Garg, Shikha, MD, MPH(c) Gerhart, Melissa, MD, MPH MSc Gill, Simerpal, PhD(c), Goodman, Alyson, MD, MPH MD, MPH Prabhu, Gounder, Gupta, Neil, MD Hollis, Natasha, PhD(c) MPH PhD(c), Naomi, Hudson, Ibraheem, Mam, MBBCh, MPH(c) Ishida, Kanako, MA PhD, Asha, MA PhD, Ivey, MDJackson, Brendan, Lara,Jacobson, MD Sarah,Kemble, MD Incoming EIS Class of 2010 Class of EIS Incoming

AWARD AWARD

l or poster presentation that best presentation poster l or , sponsored by the Schnitker the by family, , sponsored exemplifies the effective and innovative exemplifies effectiveandthe innovative statistics and epidemiologic of application study. methods in or an investigation recognizesfor EIS a current his/ officer ora her recognizes or EISalumnus a current officer has who made a significantcontribu year) (1 health. public international to tion Paul C.Paul M.D., Schnitker, died in crash a plane serve was to He en route in in Nigeria 1969. to as health response officerthe in a public famine health problems public and other inresulting Biafra the from Civil War has who Nigeria. died is only the person He while serving as an EIS officer. Paul The HealthC. Schnitker International Award JAMES H. StEELE VEtERINARY PUBLIC HEALtH VeterinaryHealth James Public The Steele H. CDC veterinarians, by sponsored Award, recognizes or EISalumnus a current officer has who made outstanding 5 years) (within veterinaryof in field the public contributions in health through outstanding contributions of prevention or control, investigation, the diseases animal-relatedzoonotic hu other or man health problems. OUtStANDING POStER OUtStANDING PRESENtAtION Award Presentation The OutstandingPoster EIS the Program by Scientific is presented the for EIS Committee a current officer to content, that bestposter exemplifies scientific including originality, design study and analysis; health impact; public and effectiveness. presentation SCHNItkER C. PAUL HEALtH INtERNAtIONAL

AWARD AWARD

J. VIRGIL PEAVY MEMORIAL PEAVY J. VIRGIL Virgil J. The Award, PeavyMemorial EIS the by Alumnisponsored Association, IAIN C. HARDY by The IainAward,sponsored Hardy C. Immunization for and Center National the Respiratory Diseases, recognizes a current who (within years) orEIS 5 alumnus officer the to has made an outstanding contribution diseases. vaccine-preventable of control DONALD C. MACkEL MEMORIAL Award, Donald The Memorial C. Mackel EIS the by Alumnisponsored Association, recognizesfor EIS a current his/ officer that best presentation poster oral or her of a application exemplifies effective the and laboratory epidemiological combined study. or an to investigation approach DIStINGUISHED FRIEND AWARD OF tHE EIS Award, Distinguished The of EIS Friend EIS the by Alumnisponsored Association, recognizes an individual contributions for health, the to welfare, EIS of and happiness program.theand officers EIS The The D. Langmuir Alexander Prize, EIS the by Alumniestablished in 1966 Association, recognizes EIS a current officer excellence for year) alumnus (1 recent or an in or epidemiological a written report study. or investigation S. BRACHMAN PHILIP Philip The Award,sponsored Brachman S. graduating the by class EIS of officers, recognizes in teaching excellence EIS to epidemiology officers. Awards PRIzE D. LANGMUIR ALExANDER AWARD MANUSCRIPt

th 59 ANNUAL EIS CONFERENCE 22 th

59 ANNUAL EIS CONFERENCE 23 AWARD AWARD

AWARD AWARD

andzel (EIS ’00) AWARD AWARD

William Schaffner’66)(EIS Schultz (EIS ’63) Myron JAMES H. StEELE VEtERINARY PUBLIC HEALtH Jennifer McQuiston, Chair (EIS ’98) Casey Barton (EIS ’06) Behravesh Hugh Mainzer (EIS ’92) Marano Nina Rubin (EIS ’90) Carol (EIS ’02) Jennifer Wright J. VIRGIL PEAVY MEMORIAL MEMORIAL PEAVY J. VIRGIL Owen Devine, Chair Matthew (EIS ’05) J. Breiding (EIS ’06) Hinton F. Cynthia Susan Lukacs (EIS ’01) Satten Glen Elizabeth Zell POStER OUtStANDING PRESENtAtION GeoffreyCalvert, Chair (EIS ’87) Julie Hentz (EIS ‘06) Tate Jacqueline SCHNItkER INtERNAtIONAL C. PAUL HEALtH Douglas Hamilton, Chair (EIS ’91) Ezra Barzilay (EIS ’04) Conrad (EIS ’65) J. Lyle Thomas H

AWARD AWARD

DONALD C. MACkEL MEMORIAL C.Vinicius Antao, Chair (EIS ’03) Suzanne Kalb J. Lammie Patrick (EIS ’99) Sheryl Lyss Alexandra (EIS ’07) Oster MANUSCRIPt AWARD AWARD MANUSCRIPt DIStINGUISHED FRIEND AWARD OF tHE EIS Philip Brachman, Chair (EIS ’54) CastroKenneth (EIS ’83) Marion Kainer (EIS ’00) Alexandre (EIS ’02) Oliveria Macedo de Mohle-Boetani Janet (EIS ’90) IAIN C. HARDY Chair (EIS ’89) Swerdlow, David Beth Bell (EIS ’92) ModlinJohn (EIS ’73) William Schaffner’66) (EIS Melinda Wharton (EIS ’86) ALExANDER D. LANGMUIR PRIzE D. LANGMUIR ALExANDER Philip Brachman, Chair (EIS ’54) Castro Kenneth (EIS ’83) Marion Kainer (EIS ’00) Alexandre (EIS ’02) Oliveria Macedo de Mohle-Boetani (EISJanet ’90) S. BRACHMAN PHILIP (EIS Emily ’08) Jentes Erin (EIS ’08) Kennedy Members Committee Award 2010

AWARD AWARD

Type b (Hib) Vaccine Shortage the on Vaccine b (Hib) Type AWARD AWARD

influenzae

AWARD AWARD

Presented Presented AWARD AWARD

rtz, P. Patel for the Texas Dialysis Investigation Team Dialysis Team Investigation Texas rtz, the for Patel P. Incidence of Hib of DiseaseIncidence in Children years States, <5 Age of — United 2008 L.Michael Clark, Jackson, C. N. Rose, Messonnier Coronado, F. T. Rinn Song IAIN C. HARDY Amanda Cohn, Rosalyn O’Loughlin PUBLIC HEALtH JAMES H. StEELE VEtERINARY Casey Barton Stacy Behravesh, Holzbauer Predicting the Effectsof Haemophilus S. BRACHMAN PHILIP C. Kay Magri Julie Smith, DIStINGUISHED FRIEND OF tHE EIS Arjun Srinivasan HEALtH C. SCHNItkER INtERNAtIONAL PAUL Cardiac and DeathsEvents in a Dialysis Facility Associated with a Healthcare — Provider 2008Texas, C. K.Melissa Schaefer, M. Lucero, Sochaski, R. Kleiman, J. Su, M. Arduino, A. Kallen, M. Schwa POStER PRESENtAtION OUtStANDING 2 — National Health and Nutritional Herpes Examination of Type Seroprevalence Simplex Surveys, States, United 2005–2006 E.Sara Xu, Forhan, F. M. Sternberg, S. Gottlieb, S. Berman, L. Markowitz MEMORIAL PEAVY J. VIRGIL ALExANDER D. LANGMUIR PRIzE MANUSCRIPt AWARD AWARD PRIzE MANUSCRIPt ALExANDER D. LANGMUIR Investigation Immune-Mediated of Epidemiologic Polyradiculoneuropathy Among e9782. Exposed Brain. ONE Porcine (3): 5 PLOS to Abattoir Workers Stacy A. M. Holzbauer, S. C. J. J. Sejvar, DeVries, Lees, J. Adjemian, J. H. McQuiston, C. Medus, C. Lexau, J. R.Harris, S.E. Recuenco, E. D. Belay, Howell, J. F. B. Buss, M. Hornig, J. D. Gibbins, S. E. Brueck, K. E. R. Smith, I. N. Lipkin, Danila, D.H. Lachance, W. J. B.P. Dyck, R. Lynfield MEMORIAL DONALD C. MACkEL Awards Awards Conference 2009 EIS at the

th 59 ANNUAL EIS CONFERENCE 24

Alexander D. Langmuir Lectures, 59 th 1972–2009 ANNUAL

1972 Prevention of Rheumatic Heart 1982 The Epidemiology of Coronary Heart

Disease — Fact or Fancy. Disease: Public Health Implications. EIS CONFERENCE Charles H. Rammelkamp Henry W. Blackburn, Jr.

1973 Cytomegaloviral Disease in Man: 1983 Sexually Transmitted Diseases — An Ever Developing Problem. Past, Present and Future. Thomas H. Weller King K. Holmes

1974 Hepatitis B Revisited (By the 1984 Poliomyelitis Immunization — Non-Parenteral Route). Past and Future. Robert W. McCollum Jonas E. Salk

1975 Origin, Spread, and Disappearance of 1985 An Epidemiologist’s View of Kuru: Implications of the Epidemic Postmenopausal Estrogen Use, or Behavior of a Disease in New Guin What to Tell Your Mother. eans for the Epidemiologic Study of Elizabeth Barrett-Connor Transmissible Virus Dementias. D. Carleton Gajdusek 1986 Hepatitis B Virus and Hepatocellular Carcinoma: Epidemiologic 1976 The Future of Epidemiology Considerations. in the Hospital. Robert Palmer Beasley Paul F. Wehrle 1987 Environmental Hazards and the 1977 The Historical Evolution of Public Health. Epidemiology. Geoffrey Rose Abraham Lilienfeld 1988 Lymphotropic Retroviruses in 1978 The Biology of Cancer: Immunosuppression. An Epidemiological Perspective. Myron E. (Max) Essex Sir Richard Doll 1989 Aspirin in the Secondary and Primary 1979 The Epidemiology of Antibiotic Prevention of Cardiovascular Disease. Resistance. Charles H. Hennekens Theodore C. Eickoff 1990 Epidemiology and Global Health. 1980 Health and Population Growth. William H. Foege Thomas McKeown 1991 Public Health Action in a New 1981 The Pathogenesis of Dengue: Domain: The Epidemiology and Molecular Epidemiology in Prevention of Violence. Infectious Disease. Garen J. Wintemute Scott B. Halstead

5 9 th

ANNUAL 1992 Helicobacter pylori, Gastritis, Peptic 2001 Halfway Through a Century Ulcer Disease, and Gastric Cancer. of Excellence.

Martin J. Blasér J. Donald Millar

EIS CONFERENCE 1993 Diet and Health: How Firm 2002 Public Health Response to Is Our Footing? Terrorism: Rising to the Challenge. Walter C. Willett Marcelle Layton

1994 Alexander D. Langmuir: 2003 Alex Langmuir’s Somewhat Quiet A Tribute to the Man. Legacy: Epidemiology, Sexual Health, Philip S. Brachman and and Personal Choices. William H. Foege Willard (Ward) Cates, Jr.

1995 Epidemiology and the Elucidation 2004 HIV, Epidemiology, and the CDC. of Lyme Disease. James W. Curran Allen C. Steere 2005 Killin’ Time: Alcohol and Injury. 1996 50 Years of Epidemiology at CDC. Alexander C. Wagenaar Jeffrey P. Koplan 2006 Measuring Malaria. 1997 Public Health, Population-Based Brian Greenwood Medicine, and Managed Care. Diana B. Petitti 2007 Implications of Tuberculosis Control on Evidence-Based Public 1998 Pandemic Influenza: Again? Health Practice. Robert Couch Thomas Frieden

1999 The Evolution of Chemical 2008 Physical Activity and Public Health: Epidemiology. Does the Environment Matter? Philip J. Landrigan Ross C. Brownson

2000 Does Chlamydia pneumoniae Cause 2009 Epidemiology, Public Health, and Atherosclerotic Cardiovascular Public Policy. Disease? Evaluating the Role of Infec Jim Marks tious Agents in Chronic Diseases. Walter E. Stamm

59 th

Alexander D. Langmuir Prize Manuscripts, ANNUAL

1966–2009 EIS CONFERENCE 1966 Complications of Smallpox 1972 Salmonella Septicemia from Platelet Vaccination: I. National Survey in the Transfusions: Study of an Outbreak United States, 1963. N Engl J Med Traced to a Hematogenous Carrier of 1967;276:125–32. Salmonella cholerae-suis. Ann Intern J.M. Neff, J.M. Lane, J.H. Pert, R. Med 1973;78:633–41. Moore, J.D. Millar, D.A. Henderson F.S. Rhame, R.K. Root, J.D. MacLowry, T.A. Dadisman, 1967 An Outbreak of Neuromyasthe J.V. Bennett nia in a Kentucky Factory — The Possible Role of a Brief Exposure to 1973 Outbreak of Typhoid Fever in Trini Organic Mercury. Am J Epidemiol dad in 1971 Traced to a Commercial 1967;86:756–64. Ice Cream Product. Am J Epidemiol G. Miller, R. Chamberlin, 1974;100:150–7. W.M. McCormack A. Taylor Jr., A. Santiago, A. Gonzales-Cortes, E.J. Gangarosa 1968 Salmonellosis from Chicken Prepared in Commercial Rotisseries: Report 1974 Oyster-Associated Hepatitis: Fail of an Outbreak. Am J Epidemiol ure of Shellfish Certification Pro 1969;90:429–37. grams to Prevent Outbreaks. JAMA S.B. Werner, J. Allard, E.A. Ager 1975;233:1065–8. B.L. Portnoy, P.A. Mackowiak, 1969 Outbreak of Tick-Borne Relapsing C.T. Caraway, J.A. Walker, Fever in Spokane County, Washing T.W. McKinley, C.A. Klein Jr. ton. JAMA 1969;210:1045–50. R.S. Thompson, W. Burgdorfer, 1975 Staphylococcal Food Poisoning R. Russell, B.J. Francis Aboard a Commercial Aircraft. Lancet 1975;2:595–9. 1970 Tularemia Epidemic: Vermont, 1968 M.S. Eisenberg, K. Gaarslev, — Forty-Seven Cases Linked to W. Brown, M. Horwitz, D. Hill Contact with Muskrats. N Engl J Med 1969;280:1253–60. 1976 Nursery Outbreak of Peritonitis L.S. Young, D.S. Bicknell, with Pneumoperitoneum Probably B.G. Archer, et al. Caused by Thermometer-Induced Rectal Perforation. Am J Epidemiol 1971 Tomato Juice-Associated Gastro 1976;104:632–44. enteritis, Washington and Oregon, M.A. Horwitz, J.V. Bennett 1969. Am J Epidemiol 1972; 96:219–26. 1977 Epidemic Yersinia entercolitica W.H. Barker Jr., V. Runte Infection due to Contaminated Chocolate Milk. N Engl J Med 1978;298:76–9. 27 R.E. Black, R.J. Jackson, T. Tsai, et al.

59 1978 Measles Vaccine Efficacy in Children 1983 Epidemic Listeriosis C — Evidence th

ANNUAL Previously Vaccinated at 12 Months for Transmission by Food. N Engl J of Age. Pediatrics 1978;62:955–60. Med 1983;308:203–6. J.S. Marks, T.J. Halpin, W.F. Schlech III, P.M. Lavigne, W.A. Orenstein R.A. Bortolussi, et al. EIS CONFERENCE 1979 An Outbreak of Legionnaires’ Dis 1984 Unexplained Deaths in a Children’s ease Associated with a Contaminated Hospital: An Epidemiologic Air-Conditioning Cooling Tower. Assessment. N Engl J Med N Engl J Med 1980;302:365–70. 1985;313:211–6. T.J. Dondero, Jr., R.C. Rendtorff, J.W. Buehler, L.F. Smith, G.F. Mallison, et al. E.M. Wallace, C.W. Heath, and R. Kusiak, J.L. Herndon Risk of Vascular Disease in and Medication Errors with Inhalant Women: Smoking, Oral Epinephrine Mimicking an Epidemic Contraceptives, Noncontraceptive of Neonatal Sepsis. N Engl J Med Estrogens, and Other Factors. JAMA 1984;310:166–70. 1979;242:1150–4. S.L. Solomon, E.M. Wallace, D.B. Petitti, J.Wingerd, J. Pellegrin, E.L. Ford-Jones, et al. et al. 1985 The Use and Efficacy of 1980 Injuries from the Wichita Falls Child-Restraint Devices: The Tornado: Implications for Prevention. Tennessee Experience, 1982 and 1983. Science 1980;207:734–8. JAMA 1984;252:2571–5. R.I. Glass, R.B. Craven, M.D. Decker, M.J. Dewey, D.J. Bregman, et al. R.H. Hutcheson Jr., W.S. Schaffner

1981 Respiratory Irritation due to Carpet 1986 The Role of Parvovirus B19 in Shampoo: Two Outbreaks. Environ Aplastic Crisis and Erythema Int 1982;8:337–41. Infectiosum (Fifth Disease). J Infect K. Kreiss, M.G. Gonzalez, Dis 1986;154:383–93. K.L. Conright, A.R. Scheere T.L. Chorba, P. Coccia, and R.C. Holman, et al. Toxic-Shock Syndrome in Menstruating Women: 1987 Oral Contraceptives and Cervical Association with Tampon Use and Cancer Risk in Costa Rica: Detection Staphylococcus aureus and Clinical Bias or Causal Association? JAMA Features in 52 Cases. N Engl J Med 1988;259:59–64. 1980;303:1436–42. K.L. Irwin, L. Rosero-Bixby, K.N. Shands, G.P. Schmid, M.W. Oberle, et al. B.B. Dan, et al.

1982 Risk Factors for Heatstroke: A Case-Control Study. JAMA 1982;247:3332–6. E.M. Kilbourne, K. Choi, T.S. Jones, S.B. Thacker 28 th

59 ANNUAL EIS CONFERENCE 29

J.C. Mohle-Boetani, A. Schuchat, B.D. Plikaytis, J.D. Smith, BroomeC.V. the of Study and Retrospective Impact Lead-Based of Hazard Blood Children's on Remediation Lead Levels in St. Louis, Missouri. 1994;139:1016–26. Am J Epidemiol C. Staes, Matte, T. C.B. Copley, D. Flanders, S. Binder W.R. Mac Kenzie, N.J. Hoxie, M.E. Proctor, et al. of Outbreak A Multistate Escherichia 0157:H7-Associated coli Diarrhea and Hemolytic Bloody Hamburgers: from Syndrome Uremic Washington JAMAExperience. The 1994;272:1349–53. B.P. Bell, M. Goldoft,P.M. Griffin, et al. Comparison of Prevention Prevention of Comparison B Neonatal Group Strategies for Infection: A Streptococcal Analysis. Economic Population-Based JAMA 1993;270:1442–8. inA Massive Outbreak Milwaukee Crytosporidiumof Infection through the Transmitted N Engl J Med Supply. Public Water 1994;331:161–7.

1995 1993 1994 An Investigation of the Cause of the the Cause the of An of Investigation Eosinophilia-Myalgia Syndrome Associated Use. with Tryptophan N Engl 1990;323:357–65. J Med E.A. Belongia, Hedberg, C.W. G.J. Gleich, et al. An Multidrug-Resistant of Outbreak Hospitalized among Tuberculosis with Acquired the Patients Syndrome. Immunodeficiency N Engl 1992;326:1514–21. J Med B.R. Edlin, J.I. Tokars, M.H. Grieco, et al. An Outbreak of Surgical Wound An Surgical of Outbreak Wound A Group to Infections due Carried Scalp. the on Streptococcus N Engl 1990;323:968–72. J Med Mastro,T.D. T.A. Farley, J.A. Elliott, et al. Group A Meningococcal CarriageGroup Returning Saudi from in Travelers Arabia. JAMA 1988;260:2686–9. P.S. Moore, L.H. Harrison, E.E. Ajello, BroomeTelzak,, C.V. G.W. Plasmodium of and Transmission vivax Malaria in San County, Diego Med California, Am J Trop 1986. 1990;42:3–9. Hyg Maldonado,Y.A. B.L. Nahlen, R.R. Roberta, et al. A Day-Care-Based Case-Control Case-Control A Day-Care-Based Efficacy of Haemophilus Study Vaccine. Polysaccharideinfluenzae B JAMA 1988;260:1413–8. L.H. Harrison, C. Broome, Hightower, et al.A.W.

1991 1992 1990 1989 1988

J.T. Brooks, S.J.T. Rowe, Shillam, P. D. Heltzel, S. Hunter, L. Slutsker, R. Hoekstra,S. Luby LA Grohskopf, VR Roth, Feikin, DR MJ Arduino, LA Carson, JI Tokars, SC Holt, Jensen, BJ RE Hoffman, WR Jarvis M. Iwamoto, D.B. Jernigan, A. Guasch, M.J. Trepka, C.G. Blackmore, Hellinger, W.C. S.M. Pham, S. Zaki, R.S. Lanciotti, S.E. Lance-Parker, C.A. DiazGranados, A.G. Winquist, C.A. Perlino S. Wiersma, K.L. Hillyer, J.L. Goodman, A.A. Marfin, M.E. Chamberland, L.R. Petersen, Nile the West Virus in Transplant Recipients Investigation Team Risk Bacterial of Meningitis in Children with Cochlear Implants. N Engl J Med. 2003; 349:435–445. J. Reefhuis, M.A.Honein, C.G. Whitney, S. Chamany, E.A. Mann, K.R. Biernath, K. Broder, S.Manning, S. Avashia, M. Victor, Costa, P. O. Devine, A. Graham, C. Boyle Typhimurium Infections Salmonella Typhimurium Chlorine-Pretreated By Transmitted Seeds. AmSprout J Epidemiol Clover Dec2001 1;154:1020–8. Serratia liquefaciens Bloodstream Infections Contamination from Epoetinof Alfa a Hemodialysis at N Engl J Med.May 2001 Center. 17;344(20):1491–7. Virus Nile from West of Transmission Transplant Four an to Organ Donor N EnglRecipients. J Med. 2003; 348:2196–2203.

2004 2001 2002 2003

Infections Associated with Legalized Suicide Physician-Assisted Year’s First C — The in Oregon Experience. N Engl J Med 1999;340:577–583. A.E. Chin, K. Hedberg, G.K. Higginson, Fleming D.W. Infantile Pyloric Hypertrophic AfterPertussisStenosis Prophylaxis with Erythromycin: A Case Review Study. and Cohort Lancet 1999;354:2101–5. M.A. Honein, L.J. Paulozzi, I.M. Himelright, B. Lee, J.D. Cragan, L. Patterson, A. Correa, S. Hall, J. D. Erickson Epidemic MeningococcalEpidemic Disease and A Risk Study Smoke: Factor Tobacco Pediatr inNorthwest. Pacific the Infect Dis J 1997;16:979–83. M.A. Fisher, K. Hedberg, Cardosi,P. et al. AfterSuicide Natural Disasters. N Engl 1998;338:373–8. J Med E.G. Krug, M. Kresnow, J.P. Peddicord, et al. enteriditis Cream. Ice Schwan’s of Consumption 334:1281–6. N Engl 1996; J Med Hennessy, Hedberg, C.W. T.W. L. Slutsker, et al. Passenger and to Passenger Mycobacterium of Transmission tuberculosis Aboard Commercial Travel. AircraftTransoceanic During N Engl 1996;334:993–8. J Med T.A. Kenyon, S.E. Valway, Ihle, I.M. Onorato.W.W. Salmonella Salmonella of Outbreak A Multistate

1999 2000 1997 1998 1996

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J. Logan, H.A. Hill, A.E.Crosby, D.L. Karch, J.D. Barnes, K.M. Lubell Stacy M. Holzbauer, A. S. DeVries, J. J. Sejvar, et al. Characteristics of Perpetrators in Characteristics Perpetrators of Homicide-Followed-by-Suicide Death Violent National Incidents: States, US — 17 Reporting System 2003–2005. Am 2008 J Epidemiol. 1056–64. (9): 168 1; Nov Investigation Epidemiologic Immune-Mediated of Among Polyradiculoneuropathy Exposed to Abattoir Workers Brain. PLoS ONE.Porcine 5(3): e9782.

2008 2009

Methaphetamine Use is Use Methaphetamine Associated with Independently Risky Sexual and Behaviors Pregnancy. Adolescent JSch Health. 2008 Dec; R. Lowry Case-Control Study of an of Acute Study Case-Control Aflatoxicosis 2004. Kenya, Outbreak, 2005; HealthEnviron Perspect 1779–1783. Dec 113: E. Azziz-Baumgartner, Lindblade,K.Y. K. Gieseker, et al., Aflatoxin and the Investigative Group 641–8. (12): 78 L.B. Zapata, S.D Hillis, P.M. Marchbanks, K.M. Curtis, Changes Pneumococcalin Invasive Disease Among Adults HIV-Infected Living Childhood in of Era the Pneumococcal Immunization. Ann .2006 Med Intern Jan 3;144(1):1–9 B.L. Flannery, Heffernan, R.T. L.H. Harrison, et al.

2007 2006 2005 th 59 ANNUAL EIS CONFERENCE 32 th

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59 ANNUAL EIS CONFERENCECONFERENCE: MONDAY 35

=.01), P

=.74). P Ravinia Ballroom, 8:30–10:15 a.m. Ravinia Ballroom, The proportion of pedestrian fatalities proportion than The SEVs, is higher for HEVs Hybrid-electric vehicles (HEV) have environmental benefits, including environmental (HEV) vehicles have Hybrid-electric

......

environment design, motor vehicle, traffic crash, injury prevention, traffic vehicle, crash, design,injuryprevention, motor environment

Most Wanted America’s We used data from all 496,142 person-files recorded in the National Highway National Highway in the usedrecorded data all from person-files 496,142 We Denise Koo, Stephen Thacker Amy L. Freeland, A. Wendel, A. Dannenberg

There were 479,597 vehicles involved in 207,041 traffic-related fatalities traffic-related between in 207,041 vehicles involved 479,597 were There

fatality risk Transportation Safety Administration’s Fatality Safety Analysis Administration’s betweenTransportation Reporting 2004 System and 2008. years,across pooled and pedestrian, Data were bicyclist, and variables crash-specificwere analyzed. Insurance used National decoding manuals by Crime Bureau identify to HEVs We were which Nissan™ HEVs, and Motors™ General for numbers, except identification vehicle fatalities associated with both standard engine non-motorist compared We ambiguously. coded using analyses. Chi-squared and HEVs (SEV) vehicles yet HEVs caused very few of the overall non-motorist deaths. HEV Few fatalities caused very overall occur the few of non-motorist when HEVs yet examine research should fatal are quiet. injury Future population-based and non-fatal HEVs data,variables, and HEVfactors vehicle-specific crash- environmental distribution, market and explain help that risk may variations. Opening Session Session Opening CoNClUsioNs: CoNClUsioNs: KeyWorDs: resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: 2010 CoNfereNCe absTraCTs CoNfereNCe 2010 19 APRIL MONDAY, sessioN a: MODERAtORS: 8:35 — Fatalities Caused by Hybrid Motor Vehicles Can quiet kill? Pedestrian and Bicyclist United States, 2004–2008 Abstracts Abstracts 2004 and 2008. Of involved vehicles, <0.1% (n=300) were HEV. Of total fatalities, HEV. 25,252 were 2004 (n=300) and 2008. <0.1% vehicles, Of involved in fatal bicyclists. crashes, involved Of vehicles were pedestrians were (1.8%) and 3,798 (12.2%) ( SEVs of in pedestrian fatality involved 11.9% to were crashes compared HEVs of 16.7% ( SEVs for in bicyclist 2.1% fatalities to involved compared were and 2.4% HEVs of bicyclist six the of pedestrian HEV-related and none 54 the of HEV-related (13.0%) Only seven are quietest. HEVs fatalities miles when hour occurred per speeds at <35 decreased noise and reduced emissions of local air pollutants, which may provide public health local public of air emissions and provide pollutants,decreased reduced which noise may suggestsanecdotal evidence However, pedestriansthat benefits. bicyclistsdiffi have and may culty resulting hearing in HEVs, increased quiet risk injury of and death.

IV is

infections and 400 deaths occur Approximately 1.4 million 1.4 Approximately Salmonella The convergence of diagnostic delays, numerous of infectious numerous cases,diagnosticdelays, and convergence The

Despite often residing often congregatein settings Despite inabilityrelative a and to tuberculosis, epidemiology, mental illness, mental tuberculosis, epidemiology, homes group

Sara Lowther, C. Medus, J. Scheftel,F. Leano, Jawahir,S. K. Smith A case was defined as TB disease diagnosedJanuary 1, 2008–July9, 2009, Joseph S. Cavanaugh, K. Powell, C. Benjamin, A. Hilliard, K. Davis,

Fifteen facility residents and three nonresidents composed the outbreak.The the composed Fifteen facility nonresidents three and residents non-adherence to TB treatment resulted in intense transmission and deaths that could have and transmission in resulted deaths intense that TB have could to treatment non-adherence may adherence TB Active screening and treatment measures ensure to been prevented. diminish deaths in challenging and transmission prevent like populations this one. caused by either the outbreak strain (PCR00160) or an unavailable/pending genotype, an or unavailable/pending in a strain (PCR00160) outbreak the caused either by or and medical reviewed interviewed patients associated records person with facility. the We identify and to staff Facility contacts. standard their proxies residents underwent TB includingevaluation, tuberculin a infection. skin latent detect to test 9:15 Associated with Contamination from Potluck Dinner Outbreak of Salmonella IV Infections Bearded Dragon Reptiles — Minnesota, 2009 aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: 8:55 Adults with for Living Facility Assisted with an Associated Outbreak tuberculosis Extensive — Florida, 2008–2009 Mental Illness index patient was contagious for 8 months before diagnosis. Ten of the 18 patients did not did not patients 18 the of diagnosis. before 8 months Ten was for contagious index patient extensive healththrough identified and instead department’s symptoms the report were illness. regarding Sixteen mental investigation had index patient. the severe contact Eight required five involuntary ultimately adherence: with TBhad substantial treatment problems died. Of evaluated, 87 patients contacts (83%) 72 cure. ensure to Two commitment inpatient TBhad infection latent — that was general the U.S. that 20-fold of a percentage population. O. Renwick, K. Mitruka communicate symptoms, persons with severe and persistent mental illness, mental and persistent with constitute severe persons symptoms, who communicate 2.6% adult the U.S. categorized of are vulnerable rarely population, infectious as to more assisted living disease. a 91-bed at was reported In outbreak 2009, May a tuberculosis (TB) facility of cause the determine and mentally to extent investigated for ill adults in Florida. We outbreak. the annually States. During in 1–4, United the December 2009, Salmonella three of case-isolates IVidentified were with 6,7:z4,z24:- patterns indistinguishable electrophoresis gel pulsed-field through Minnesota Health surveillance. of laboratory-based Department Salmonella

th 59 ANNUAL EIS CONFERENCE: MONDAY 36 th

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=0.02). =0.02). risk from IV was isolated, , disease reptiles, disease foodborne outbreak, This foodborne outbreak likely resulted from environmental contamina Thisenvironmental resulted outbreak likely foodborne from In April Health of 2009, and Human Department the Services declared

Salmonella

Between October 1–December 4, all reviewed 2009, we Between 1–December October VAERS reports Potluck attendees were interviewed about illness, interviewed about were attendees and for foodsPotluck they prepared Yenlik A.Yenlik Zheteyeva, K. Broder, A. Guh, M. McNeil, M. Nguyen, A. Calugar, Sixty-six of 73 dinner consumers were interviewed; 16 cases were identified; 12 identified; casesSixty-six interviewed; were 16 dinner were 73 of consumers

ere two pet bearded dragons were kept. two kept. pet beardedere dragons were after H1N1 vaccinations daily. Reports were coded as serious based on the Code of Federalcoded based of on vaccinations as Code serious daily. were the Reports afterH1N1 of proportions compare calculated to (PRR) Regulations. reporting ratio proportional We reports medicalreviewed and We seasonal and afterH1N1 reports serious influenza vaccines. deaths, of GBSrecords and anaphylaxis verify to diagnosis. physician consumed at the event, and pet ownership. Cases were defined as fever and diarrhea (≥3 loose (≥3 defined Cases as fever were and anddiarrhea pet ownership. event, the at consumed confirmedor laboratory Salmonella after experienced foodconsumption instools 24-hours) house preparer’s taken a food were from samples environmental weeks after event, the Two IV. wh tion from bearded dragons. from tion Reptiles consump pose public a community food for threat when Salmonella on is needed with reptiles. Education in households is prepared tion reptiles in terms of environmental contamination of food preparation surfaces. food preparation of contamination in environmental reptiles of terms meTHoDs: meTHoDs: 9:35 Vaccine the Vaccines Safety Through A (H1N1) 2009 Monovalent Evaluation of Influenza United States, October 1–December 4, 2009 Adverse Event Reporting System — aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: meTHoDs: meTHoDs: resUlTs: primarily associated with reptiles. None of the three patients had reptile contact, but allprimarily but contact, had reptile had three the patients associated of with reptiles. None warranting thus dinner, same the potluck furtherattended investigation. reported illness but did not meet the definition. The median incubation period was 19 (range: 19 median illness definition.period The the reported meet was incubation did not but health- visited patients days. Five 3–26) illness of Median hours. 1–11) duration was 3 (range: was owner, asymptomatic reptiles’ the by gravy, prepared of Only consumption care providers. exact unexposed; P 6.1; risk ratio: exposed 1/15 versus associated with illness (15/37 samples, including reptiles’ the environmental 12/36 from Salmonellae recovered were terrarium sink and kitchen drains.PFGE subtype of Salmonella outbreak The bag vacuum cleaner only from contents. but J. Gidudu, D.Martin, A. J. Su, Rao, K. Haber, Tosh, P. S. Walton, P. Hocevar, J.Bell, D. Esposito, E. Meites, J. Duffy,Vellozzi C.

a pandemic influenza emergency. By October 2009, widespread US vaccination vaccination with US Influenza 2009,By October widespread influenzaa pandemic emergency. began with million 63.3 vaccines) doses by distributed (H1N1 Vaccines Monovalent A (H1N1) million ensuring people, safety vaccine >100 of 3, vaccination 2009. potential December With Adverse enhanced safety through Vaccine the monitoring implemented We priority. was a top rare, unusual or adverse of patterns new, detect promptly to (VAERS) Reporting System Event including anaphylaxisevents, and Guillian-Barré (GBS). Syndrome

The psychological consequences of conflict armed psychological The consequences in Sri Lankawere During the first two months of the H1N1 vaccination program, VAERSprogram, vaccination DuringH1N1 of first the the months two

Each year, nearly 2.6 million people worldwide are displaced from their their from displaced are 2.6 nearly Eachworldwide million year, people

vaccine safety, H1N1, influenza vaccine, Vaccine Adverse Event Event VaccineAdverse influenzavaccine, safety,vaccine H1N1,

From July-September 2009, we conducted a two-stage survey cluster conducted 2009, we among July-September From Farah Husain, M. Anderson, B. Lopes-Cardozo, K. Becknell, C. Blanton, Overall, 31.8%, 31.0%, and 7.5% of respondents reported symptoms of anxiety, of symptoms reported respondents of 7.5% and 31.0%, Overall,31.8%, VAERS received 4,981 reports after H1N1 vaccination and 5,099 and seasonalafter vaccination H1N1 after reports 4,981 received VAERS

Reporting System Reporting System 1,448 persons aged 15 years or older in Jaffna District. We assessed depression and We anxietyassessed in Jaffnadepression older yearsDistrict. or 1,448 aged persons 15 (PTSD) and disorder posttraumatic stress Checklist-25 using Hopkins the symptoms Symptom measure association between the displacement Questionnaire.using To Harvard the Trauma risk including for factors used other model a logistic we regression and psychiatric morbidity, as such psychiatric sex, morbidity age, marital as covariates. and income status, education, more severe in displaced. displaced than severe not persons Relief inrecognize effortsmust people more the data revealed no significant safety problems. We observed similar proportions of serious reportsobserved We similar of serious significantdata revealed no proportions safety problems. vaccine seasonaland after H1N1 influenza vaccine, well-established which has a safety record. resUlTs: CoNClUsioNs: meTHoDs: meTHoDs: 9:55 Armed Conflict — The Psychological Impact of Displacement Due to of War: The Weight Jaffna District, Sri Lanka, 2009 aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: resUlTs: depression, and PTSD, respectively. Compared to persons never displaced, recently displaced displaced recently displaced, never persons to Compared respectively. PTSD, and depression, anxiety of likely symptoms report to more were living camp) in a displacement (currently persons (40.0%, depression of symptoms [CI]=2.3-4.7), interval confidence 95% AOR=3.3, (48.5%, CI=1.4-6.2). 95% 2.9, AOR= PTSD of and (13.0%, symptoms CI=1.2-3.3), 95% AOR=2.0, likely PTSD report to more were in community) displaced (resettled persons Long-term displaced. than never persons CI=1.1-3.5) 95% AOR=2.0, (11.3%, symptoms influenza vaccination. We observed no significant difference in proportion of serious adverse adverse serious of proportion significantin no observed We difference vaccination. influenza vaccination seasonal with influenza compared [5.8%]) (291/4,981 vaccination H1N1 after events vac death afterH1N1 reports 19 the For 0.75-1.04). 95%CI (PRR=0.87, [6.6%]) (336/5,099 and unknown trauma (1), infectious (7), cardiac causes (7), death were: of cinations, reported the death, of Reports serious). (22 reports 53 anaphylaxis and serious) (8 GBS 9 identified We (4). doses distributed). vaccine million per H1N1 <1 GBS and anaphylaxis (each rare were D. Araki, E. Vithana, J. Ratto, N. Schaad, R. Chandrasekera homes due to armed to conflict. due homes Whileoverall morbidity psychiatricconflict-affected of in patterns been well little documented, psychological the is impact known have of about populations this understand assessed association, we of within level the displacement this To forced group. Sri Lanka, northern from >25 a population among psychiatric morbidity affected a region by armedyears of conflict.

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Ravinia Ballroom, 10:45 a.m.–12:15 p.m. Ravinia Ballroom,

......

Population-based linked data systemsPopulation-based are useful assessing for risks for

Sickle cell disease (SCD) is a severe hematologic condition whose potential potential whose condition hematologic is a severe Sickle cell disease (SCD) mental health,mental armed conflict,Sri Lanka, displacement, PTSD, sickle cell disease; perinatal mortality; birth; infant, premature birth low

How I Met Your Mother Your How I Met Ursula Bauer We used linked Massachusetts certificates, We birth/death fetal(FD) death Danielle Barradas,T. Barfield, W. S. Manning, M. Kotelchuck,

We estimated that 116,076 deliveries occurred among 84,561 African occurred deliveries 84,561 among descendant estimated that 116,076 We

weight; Cesareanweight; delivery depression, anxietydepression, Reproductive Health Health Reproductive certificates, and hospital discharge data to identify in-state resident deliveries during 1998–certificates,during deliveries hospital dischargeand resident identifyto data in-state used analyses then logistic2006. regression estimate association to the between and SCD We birth (LBW, low weight weeks gestational age [GA]), (<37 risk FD and for risk preterm for sex), for percentile <10th BW (SGA, small-for-gestational-age g), <2500 birth [BW] weight and cesarean sex and for GA), percentile growth (IUGR, <5th restriction BW intrauterine adequacy sex; for care; plurality; and adjusted prenatal Results of delivery. infant’s were maternal insurance parity, age, status, education, and smoking status during pregnancy. women in Massachusettswomen in during this 1998–2006. was prevalence SCD 0.6%. group was SCD interval confidence 95% [AOR]=2.2, odds ratio associated with risk FDpositively (adjusted for (AOR=1.7, and LBW deliveries CI=1.2–1.8) 95% (AOR=1.5; preterm and for [CI]=1.2–4.2) was SCD associated also with risk SGA positively for and cesarean delivery CI=1.1–2.6). 95% with risk IUGR. not for but adverse health outcomes among women with specific medical conditions such as SCD. Women Women with specific such medicalSCD. as women among conditions health outcomes adverse identify care to and modify risk seek preconception with and factors should receive SCD counseling pregnancy outcomes. regarding SCD-related adverse potential CoNClUsioNs: CoNClUsioNs: KeyWorDs: resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: KeyWorDs: 19 APRIL MONDAY, sessioN b: MODERAtOR: 10:50 — Descent African of Women Among Outcomes Pregnancy and Disease Cell Sickle Massachusetts, 1998–2006 importance of mental health interventions for all for affected healthimportance mental people by interventions conflict, of butarmed focus particular those living on camps. in displacement attention C. Shapiro-Mendoza complications among pregnant women, including vascular women, pregnant among uterus effectsplacenta, to the and complications increase risks and fetus. woman the a large, data to from we sample, Using population-based of Africanwomen among assessedancestryoutcomes differencespregnancy-related between SCD. with and SCD those without

=.07). =.07).

=.007) and SB =.001), but more more but =.001), =.001). =.04) and terminations (aPR=0.26; P and (aPR=0.26; =.04) terminations =.02). Compared with non-Hispanic whites, Hispanic women whites, Hispanic with women non-Hispanic Compared =.02). =.03) and SB fetal deaths than white women (aPR=0.31; P and SB fetal (aPR=0.31; deaths than women =.03) white Neural tube affect defects (NTDs) 1 in 2,000birthsStates United in the Demographic differencesDemographic in NTD existpregnancy a outcomes and are

Breast and cervical screening are best the early available methods for neuraltube defects, surveillance congenital abnormalities, pregnancy outcome,

Using 1999–2005 Texas Birth Defects Registry Texas 1999–2005 Using data, a hospital-based, Sharyn E. Parks, M. Canfield Brunella Frammartino, J. Miller, B. Armour, E. Courtney

=.009) and more live births for SB (aPR=1.39; P births live SB (aPR=1.39; for and more =.009) Data were available for 1,868 NTDs (anencephaly=689; SB=957; 1,868 available for NTDsData SB=957; were (anencephaly=689;

active surveillance system, we calculated crude and adjusted prevalence ratios (aPRs) for for surveillanceactive (aPRs) calculated system, we ratios prevalence crude and adjusted fetal of and termination, birth live death,pregnancy NTD elective of outcomes subtypes Models regression. Poisson using encephalocele) and [SB], bifida spina anencephaly, (i.e., age, education. and maternal stratified race/ethnicity, for adjusted were and potential source of bias. Supplementing hospital-based NTD data will hospital-based data with outpatient bias. of Supplementing source potential NTD-affected for ascertainment outcomes of pregnanciesenhanceimprove and capacityto NTDs. andstudy monitor aUTHors: aUTHors: baCKgroUND: 11:30 11:30 with Disabilities—United States, 2008 Among Women Breast and Cervical Cancer Screening CoNClUsioNs: CoNClUsioNs: KeyWorDs: resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: 11:10 11:10 Defects of Neural tube After Diagnoses Pregnancy Outcomes Differences in Demographic 1999–2005 — texas, annually and cause severe, life-long complications among surviving among annually complications and life-long cause infants. severe, Because NTDs often all not termination, elective casesresult in are in fetal captured typical outpatient death or hospital- based surveillance. Thisbiasesof studies NTD-affectedof prevalence risk factors and pregnancies. examinedbias.to of differencesassess pregnancy demographic sources in outcomes We encephalocele=222), resulting in 1,211 live births, live resulting 236 fetal in 1,211 deaths, and 405 elective encephalocele=222), fewer experienced ≥30 years, women aged 25–29 withterminations. women Compared P fetalanencephaly deaths (aPR=0.55; cancer detection. However, approximately 26 million a disability, approximately and have these U.S. women However, cancer detection. cancer screening services a disability. of rates Under without than lower women have women standing that factors influence underutilization screeningof cancer services with women among health these care women. for identifydisabilities improve issues key to help may SB fetal deaths (aPR=2.59; P SB fetal deaths (aPR=2.59; births live all across more experienced NTDs. anencephaly fewer experienced Black women P (aPR=0.50; terminations with high less than beyond high women school, with education with women Compared P fetal (aPR=1.83; deaths anencephaly more experienced for education school P (aPR=2.68;

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This study identified demographic and socioeconomic factors which factors can Thisdemographic and socioeconomic identified study

Information on the impact of 2009 H1N1 influenza infection on pregnant pregnant on infection influenza 2009 H1N1 of impact the on Information disparities, women with cervicaldisparities, disability, cancer, breast screening women cancer,

We abstracted medical record data a case-series abstracted hospitalized from medical of pregnant record We Using data from 258,806 female respondents to the 2008 the to 258,806 data from Using Behavioral Riskfemale respondents

Andreea A. Creanga, Johnson, S. T. Graitcer, L. Hartman, Al-Samarrai, T.

Among women with disabilities, having aged denied a Among ≥40 women (N=66,632) 18%

services women (N=62) with laboratory-confirmedinfluenza June 2009betweenMay 1 30, and H1N1 (N=62) women characteris compare exact, tests to trend and Cuzick’s Chi-square, Fisher’s conducted 2009. We influenza 2009 care or with(resultingadmission severe illness in H1N1 intensive women tics of illness. with moderate characteristics with corresponding women among death) Factor Surveillance Factor calculated questionnaire, women we of System age-adjusted the prevalence with mammogram in in last test the last the two Pap three years disability years or by status. “Disability” We used SAS/ was defined as activity any specialof or use limitations equipment. assess to SUDAAN logistic multivariable regression disability conduct to status and other variables associated with these use cancer screening of tests. be used for targeted interventions. A next step would be to identifybe to specific would nextA step barriers beused targeted for interventions. and increase withaccess cancer screening services disabilities to in women as Healthy the for proposed objectives. 2010 People meTHoDs: meTHoDs: 11:50 11:50 Women — Pregnant Virus Infection in A (H1N1) Severity of 2009 Pandemic Influenza 2009 May–June City, York New aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: resUlTs: meTHoDs: meTHoDs: recent mammogram, and 20% aged ≥18 (N=73,685) denied a recent Pap test. After Pap adjusting a recent denied mammogram, (N=73,685) recent and 20% aged ≥18 with disabilities less likely variables, than women were and socioeconomic demographic for Confidence Interval 95% had a mammogram Ratio have to [OR]=0.90, (Odds without women CI=0.75–0.84). cancer 95% of (OR=0.80, Underutilization test a Pap or [CI]=0.85–0.95) with disabilitiesscreeningwomen among was associated being with race, married, white not not having medical not insurance,having and lack a healthcare social provider, of and emotional support. A. Schwarz, S. Chu, J. Sackoff,Jamieson, D. Fine,A. C. Shapiro-Mendoza, Uyeki,T. Jones, L. S. Balter, C. Bish, L. Finelli, M. Honein women is limited. Whereas pregnant women account for only about 1% of the U.S. the of population, 1% only about for is limited. account women Whereas women pregnant to attributable U.S.deaths of 6% for accounted have they that indicated surveillance reports early hospitalization influenza H1N1 the 2009 estimated study This infection. influenza 2009H1N1 New in women pregnant illness influenza among 2009 H1N1 of severity examinedthe and rate City. York

0.002 for

= P Ravinia Ballroom, 12:30–1:30 p.m......

0.004). illness Severe who occurred in women only of 3.3% = P Friends 0.03). Five (83.3%) of the infants whose mothers had severe illness had infants severe the of mothers whose were (83.3%) Five 0.03). = P Our findings highlight illness severe for potential the 2009among H1N1 Rotavirus is leading the diarrheal severe cause of illness young among

influenza pregnancyinfection, A virus, H1N1,

We examined Association discharge National the hospital by dataWe provided

Catherine J. Wenk, J. Harris J. Tate, Yen, II, Parashar U.

Among 62 pediatric hospitals, a median of 16,826 (range 15,536–17,100) pediatricAmong 62 15,536–17,100) hospitals, a median 16,826 of (range The rate of 2009 H1N1 hospitalization among pregnant women was 55.3 per was women pregnant hospitalization among of 2009 rate H1N1 The

Meet the Authors of Posters 1–15 Authors Meet the received oseltamivir within 2 days of symptom-onset, compared with 21.4% and 44.4% oseltamivir with 21.4% received those within of compared symptom-onset, 2 days of 3–4 ( respectively started days after who treatment days andsymptom-onset, ≥5 of Children’s Hospitals and Related Institutions and compared all-cause and compared and Related Hospitals Institutions diarrhea Children’s of rotavirus seasons (2003–2006) pre-vaccine post-vaccine of to trends hospitalization rotavirus defined seasons years. children among We <5 seasons (2007–2009) introduction Virus Respiratoryusing and laboratory National the testing Enteric to results reported rotavirus antigen-positive were tests reported of Surveillance Seasons began System. >10% once tests decreased positive of proportion the weeks. Seasons least once at 3 consecutive for ended 10%. below children worldwide. Prior to implementation of routine rotavirus vaccination of United States States United rotavirus of vaccination routine of implementation to Prior children worldwide. infants in(U.S.) 2006, rotavirus caused 55,000–70,000 gastroenteritis annually hospitalizations examined in diarrhea-associated age. trends years children of among at hospitalizations <5 We U.S. pediatric 2003–2009 from hospitals assess to rotavirus the impact the of program. vaccine influenza-infected pregnant women and for adverse outcomes among their infants,among outcomes suggest and adverse for and women influenza-infectedpregnant similar regulationRGMof early oseltamivirprevent Such SSI benefit the help might treatment. outbreaks. resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: KeyWorDs: 19 APRIL MONDAY, sessioNPosTer 1: 1 PosTer Among Children <5 Hospitalizations on Diarrhea-Associated Impact of Rotavirus Vaccine States, 2004–2009 Age — United of Years CoNClUsioNs: CoNClUsioNs: resUlTs: diarrhea-associated occurred hospitalizations each rotavirus season years children among <5 during 2003–2006. this to Compared median, diarrhea-associated decreased hospitalizations admitted to neonatal intensive care or died, compared with only 2 (12.5%) of those whose those whose of with died, care only or 2 (12.5%) admitted compared neonatal intensive to illness had moderate mothers ( trend). 100,000 population. Eight infected women (12.9%) had severe illness, had severe 100,000 and died. two them of Eight (12.9%) population. infected women during delivered illness with moderate and (29.6%) 16 illness with severe Six women (75.0%) ( their hospitalization

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< .001). Discussions with Discussions TB surveillance< .001).

Large reductions in occurredLarge diarrhea-associated have rates hospitalization reductions Although >50% of TB of cases Although in >50% RMI unreported during 2004–2008, were

The Republic of the Marshall Islands (RMI) has the highest tuberculosis (TB) (TB) tuberculosis highest the has (RMI) Islands Marshall the of Republic The tuberculosis, Marshall Islands, surveillance, population disease notification rotavirus, diarrhea, gastroenteritis, rotavirus vaccines

We reviewed data from CDC’s National Tuberculosis Surveillance System Tuberculosis National data CDC’s reviewed from We Bisrat K. Abraham, A. Forbes, J. Jones, R. Bukbuk, M. Hauma, L. Armstrong

During 2004–2008, we identified 782 TB cases in RMI, of which 384 were re were 384 which of in cases RMI, TB 782 identified 2004–2008, we During

(NTSS) to identify(NTSS) to all cases RMI from reported during 2004–2008. In RMI, examined we TB books, log registration admission medical hospital and discharge records, death records, records, cases of determined proportion the unreported cases. document to We and laboratory records and a sensitivity analysis. performed reported analysis Chi-square sensitiv was used compare to ity during two periods. TB surveillance interviewed assess to were their knowledge of personnel reporting requirements. reporting has markedly improved in recent years. Further in trainingreporting has recent markedly TB of improved surveillance personnel optimize to is needed TB reporting in RMI. reporting will Improved a better give stakeholders understanding TB in the of RMI burden allocate them accordingly. and help thus resources and continue nationally following introduction of rotavirus of in vaccine nationally year U.S. the the following Given introduction and continue in in rates variation 2007–2008 hospitalization to-year surveillance and 2008–2009, continued diarrheal impact vaccine on disease monitor is to required burden. CoNClUsioNs: KeyWorDs: resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: CoNClUsioNs: CoNClUsioNs: KeyWorDs: PosTer 2 Islands, 2004–2008 Surveillance — Republic of the Marshall Evaluation of tuberculosis by 53% (n=7,901) in 2007–2008 and by 30% (n=11,713) in 2008–2009.reduc The greatest in 2007–2008 30% and by (n=11,713) (n=7,901) 53% by occurred reduc tions in Major 2007–2008, particularly children among years (50–54%). ≤2 In 2008–2009, these years also(49-51%). tions occurred children vaccine-ineligible among >2 decreased in magnitude,reductions especially years (11-26%). childrenamong >2 staff revealedreportingrequirements. of lackof knowledge ported to the NTSS (sensitivity: 49.1%). Reporting improved in 2007–2008 (sensitivity: 74.4%), 74.4%), (sensitivity: 2007–2008 in improved Reporting 49.1%). (sensitivity: NTSS the to ported with as 2004–2006 compared 30.0%; P (sensitivity: out health screening to the United States, where TB in RMI natives has been identified. The RMI The identified. been has natives RMI in TB where States, United the to screening health out began reporting TB surveillance CDC in data to 2004, underreporting has been suspected. but We RMI’s anperformed of evaluation TB surveillance system. incidence of all the U.S.-affiliated Pacific Islands, and case rates are substantially higher than those in those than higher substantially are rates case and Islands, Pacific U.S.-affiliated the all of incidence vs. 4.2/100,000 RMI of in Citizens (192/100,000 States 2008). with United the can travel freely

A failure to receive care at home or visit a CTC was a CTC associated visit or with care home at A failure receive to Internet-based questionnaires during outbreak investigations conserve investigations during questionnaires outbreak Internet-based A cholera outbreak occurred in Zimbabwe, from August 2008–July 2009 2008–July August from Zimbabwe, in occurred outbreak cholera A cholera, community mortality, cholera, risk factors, Zimbabwe The case-control study was conducted in September 2009 in September was study conducted Chivi in District. case-control The

Diane Morof, S. Cookson, S. Laver, D. Chirundu, S. Desai, John Y. Oh, J. Bancroft,John Y. M. Cunningham,W. Keene, Lyss,S. P. Cieslak,

We enrolled 55 cases and 110 controls with and age an 36, 37 average of controls cases and 110 55 enrolled We

A case was defined as anyone ≥5 years of age with ≥3 episodes of sudden onset wateryonset yearsof sudden diarrheaof ≥5 episodes age≥3 A case with was defined as anyone 2008–Julysurviving 1, October from 28, a health 2009 of facility. Two died outside who case age, per selected by onset, and and matched residence. were symptom patients cholera demographics, illness health on information captured A questionnaire and severity, duration mortality associated with Factors cholera-related seeking awareness. and cholera behaviors, exactwaslogistictests. regression Conditional Fisher’s or using identified chi-squared were performed. mortality. Community cholera education is needed to reinforce the importance of prompt importance the prompt of reinforce to is needed education mortality. Community cholera and referral CTCs. to rehydration PosTer 4 PosTer Survey Methods in Investigating a Norovirus Comparison of Internet-Based with telephone Outbreak — Oregon, 2009 aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: PosTer 3 PosTer zimbabwe — Chivi District, Mortality from Cholera for Community Risk Factors respectively. The odds of death were higher among males (adjusted odd ratio [AOR] =5.0, 95% =5.0, 95% [AOR] ratio odd (adjusted highermales were death of The odds among respectively. Receiving CI=1.0-1.5). 95% sizes (AOR=1.2, with and larger persons household CI=1.6-16.1) (CTC) center treatment CI=0.06-0.71) and a visiting cholera 95% (AOR=0.21, home fluidsat had borderline income of Having source any CI=0.02-0.22) protective. 95% were (AOR=0.06, was information associated Receiving with cholera CI=0.05-1.13). 95% (AOR=0.24, protection in 28% house of present salts care and were visiting a CTC.receiving home Oral rehydration associated mortality. with not reduced but holds, K. Hedberg Mathenge,P. D. Shambare, L. Charimari, S.Midzi, C. Blanton, Handzel T. resources otherwise needed for telephone interviews.basis on of the response Differential otherwise resources telephone for needed survey or mightexposures, method bias results, outcomes highlighting importance the of resulting in >100,000 cases and >4,000 deaths. Approximately 60% of reported deaths occurred occurred deaths reported of 60% Approximately >4,000 deaths. and cases >100,000 in resulting to district affected one in conducted was study case-control A facilities. health of outside deaths. community cholera-related for factors risk determine

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Argentina, 2009

=0.44). Fewer Internet-based than telephone surveys than had >90% telephone =0.44). Internet-based Fewer Internet-based and telephone surveys revealed similar and telephone and response Internet-based

During the 2009 influenza A (H1N1) pandemic in the Southern pandemic in Southern the During 2009 the (H1N1) influenza A gastroenteritis, norovirus, travel, Internet, questionnaires questionnaires Internet, norovirus,gastroenteritis, travel,

We reviewed daily reviewed critical available administrative hospital care on We records E-mail addresses and telephone numbers were available for all available for were numbers 1,288 E-mail Oregon addresses and telephone

Elissa M. Meites, D. Farias, L. Raffo, Carlino,O. McDonald,L.

Norovirus (GII) infection was confirmed among 5/6 persons tested. persons In the infection5/6 was confirmed (GII) Norovirus among

<0.0001). Attack rates (18%) were identical in both identical surveys. were Illness was unassociated with age, Attack (18%) rates <0.0001). ventilator beds, comparing data from the 3-month peak pandemic period (6/1–8/31/2009) peak beds, (6/1–8/31/2009) period comparing 3-month data the pandemic ventilator from in period 2008 and same the 3-month (3/1–5/31/2009), period 3-month with previous the was Overflow calculatedavailable demand exceeded when as bed-days (6/1–8/31/2008). limits.resource cyclists. Cohorts were randomly selected to participate in identically formatted Internet-based in participate cyclists. Internet-based selected to identically randomly formatted were Cohorts surveys. loose Illnessstools in telephone live 24 or (≥3 was definedor vomiting diarrhea as norovirus collected for 2009. were Specimens 11–22, with during onset September hours) was defined as Survey survey. the to answeringwhich testing completion last prior the question illnessasked whether had developed. attack rates, suggesting differentialbased response surveysno upon illness. Internet-based might facilitate be designed must carefully and data entry collection but maximize to completion. questionnaire meTHoDs: meTHoDs: KeyWorDs: PosTer 5 H1N1 Influenza Pandemic — Critical Care Capacity During the 2009 aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: meTHoDs: meTHoDs: resUlTs: validating Internet-based survey among validating outbreak methods. 2009, In a gastroenteritis September Internet-based surveys Internet-based participants in compare us a weeklong cycling to enabled in tour Oregon surveys. with telephone Internet-based survey, 153/201 (76%) initiated the survey, 137/153 (90%) confirmed ride (90%) initiated 137/153 survey, the (76%) 153/201 survey, Internet-based (84%) 76/91 survey, telephone the For survey. the completed (94%) and 129/137 participation, completed (100%) confirmed72/72 participation, and ride (95%) initiated 72/76 survey, the Internet-based [71%] surveys collected within were 2 days (92/129 completed Most survey. the P telephone; [65%] 47/72 versus telephone, [94%] 68/72 versus Internet-based [58%] answered (73/126 questions food-item of P survey. foods and or in accessibility, practices consumed either sex, hand-hygiene M. Widdowson Hemisphere, Argentina reported the most H1N1-related deaths from severe respiratory disease respiratory deaths severe from H1N1-related Argentina most the reported Hemisphere, Aires, largest the (500+ Buenos hospital national from where were Most through 8/31/2009. assess to critical is located. were Our care this capacity at objectives andbeds) preparedness peak. during pandemic hospital 2009 the H1N1

Smoking during pregnancy demonstrated the strongest association withSmoking during strongest the pregnancy demonstrated Without advanced assessment of critical of care advanced demand, assessment and to methods Without Low birth weight (LBW) is a major determinant of neonatalmortality determinant of Lowbirth is major a (LBW) andweight

Argentina, disease outbreaks, hospitals, influenza A virus

Secondary analysis cross-sectional 2005–2006 of WV birth certificate wasdata

Rachel A. Radcliffe, Cadwell,B. L. Zapata

Beginning influenzaNorth severe in of reports to in 4/26/2009, response on Of 31,450 births, 959 (3%) were LBW. Among all median mothers, age LBW. was 26 years; were births, (3%) 959 Of 31,450

morbidity. Although prematurity contributes to LBW, fetal growth can cause restriction LBW LBW, to Although prematurity contributes morbidity. infants. term among Certain factors,fetal including to maternal growth smoking, contribute Virginia (WV), Inrestriction. West during maternal smoking 2005–2006. was 26.6%–27.2% examined smoking during pregnancyWe maternal and characteristics other as risk for factors LBW interm WV. 97% were white. Smoking 1–10 (AOR: 2.3; 95% CI, 2.0–2.7), 11–20 (AOR: 2.7; 95% CI, 2.2– 95% 2.7; (AOR: 2.3; CI, 2.0–2.7), 95% (AOR: 11–20 white. Smoking97% 1–10 were 4.3; CI, 3.0–6.4) associated 95% cigarettes with (AOR: day per independently and >20 were 3.4), (AOR: having a high education school CI, 1.1–1.5), Being 95% 1.3; unmarried (AOR: LBW. term and residing in highest the poverty CI, 1.3–1.9), 1.6; 95% less (AOR: or CI, 1.1–1.6) 95% 1.3; associated also with LBW. term were independently CI, 1.1–1.7) 95% 1.3; (AOR: counties term LBW and exhibited a dose-response effect as the number of cigarettes smoked per day per day effectof cigarettesnumber smoked LBW and term as exhibitedthe a dose-response perinatal WV by health. cessation improve might help mothers increased. Tobacco redistribute or acquire new resources in a timely fashion, the needs of patients with severe with severe in a timely fashion, acquire patients resources needs new the or of redistribute diseaserespiratory during period a pandemic. can capacity a prolonged exceed for resUlTs: CoNClUsioNs: meTHoDs: meTHoDs: KeyWorDs: PosTer 6 Maternal Characteristics as Risk Factors for Low Smoking During Pregnancy and Other 2005–2006 Virginia, Infants — West Among Singleton Full-term Birth Weight aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: resUlTs: America, the hospital implemented a pandemic plan, adding 33 ventilator beds. plan, a pandemic During adding ventilator 33 the America, implemented hospital the bed-days) 3033 versus increasedpeak (3837 27% demand by period, pandemic ventilator the to compared bed-days) 3306 versus (3837 and three 16% months, prior the to compared patients increased Demand in year. adult most critical ventilated care wards,prior where 1606 versus (1617 and increased only 1% bed-days), 1427 versus (2220 increased 56% by critical Hospital in three months. pediatric prior the critical to care wards,bed-days) compared addition the for not it were duringcare exceeded capacity pandemic. was the However, never 166 bed-days wardsin adult occurred bedsand for would have in April, ventilator of overflow three in bed-days pediatric wards. completed. Live, infants singleton, term weighingcompleted. <4,000 grams residing in WV, mothers to born analysis. for included LBW years, was blackaged were defined or and <2,500 white 18–45 as for associations CIs) (95% intervals confidence and 95% grams. (AORs) odds ratios Adjusted between maternal characteristics estimated with logistic and multilevel LBW were regression.

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Two-thirds of patients in Phalombe District, Malawi were completely District,in Phalombe Malawi completely patients of were Two-thirds Hurricane Ike landed as third date the in destructive hurricane to most Malaria Plasmodium to substantial causes falciparum due infection

malaria, antimalarials, Malawi, adherence, medication drug resistance infant, birthlow weight, smoking, birth, term use cessation tobacco

Adults and children with uncomplicated malaria were recruited at three health health three at recruited were malaria uncomplicated with children and Adults Ekta Choudhary, R. Noe, C. Martin, Bayleygen, T. D. Zane Kimberly E. Mace, D. Mwandama, J. Jafali, M. Luka, S. Kachur, S. Filler,

We recruited 427 patients, completed in-home interviews on 414 (97%) patients patients (97%) interviews 414 on in-home completed recruited 427 patients, We

centers. To assess adherence, we conducted visual pill counts and in-home interviews regarding regarding interviews in-home and counts pill visual conducted we adherence, assess centers. To was received administrationdefined AL.adherence aftermedication hours 72 patients Complete as taking correctly all six AL doses of as assessed recall of pill number by and patient of count pills of doses, number dose, per and timing the each of dose. adherent to a six-dose AL regimen for the treatment of uncomplicated malaria. uncomplicated of AL Interventions a six-dose to regimen treatment the for adherent clinical potentially could AL improve to that adherence further treatment increase complete antimalarial of spread or drug andcure might rates mitigate development resistance. the KeyWorDs: 8 PosTer 2008 Active Mortality Surveillance Following Hurricane Ike — texas, Evaluation of aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: meTHoDs: resUlTs: PosTer 7 of treatment Artemether-Lumefantrine for the Adherence to Assessment of An — Phalombe, Malawi, 2009 Uncomplicated Malaria aUTHors: baCKgroUND: KeyWorDs: and included 368 (86%) patients with complete data on pill data and on dose-recall in count the with complete patients 368 (86%) and included adherent. completely were data,analysis. 238 (65%) with complete Among 368 patients failing included Main regimencorrect or to non-adherence take classificationsthe entire of the pills of also reasons number and dose taking per explored times. incorrect at We medication the adherence. of and in predictors adherence errors for D. Mathanga, J. Skarbinski the United States. Ike, a Category 2 hurricane, struck Texas, on September 13, 2008. The Texas States. 2008. Ike, 13, United September the a Category on 2 hurricane, The struck Texas, Mortality Hurricane-Related Health State Services of SurveillanceDepartment implemented and characterize deaths.(HRMS) HRMS enumerate system hurricane-related to used estab morbidity and mortalitymalariaof morbidity is a inpatients and effective treatment Malawi. Prompt increasing first-line the to to resistance parasite due malaria In of 2007, control. cornerstone malaria, uncomplicated for with Malawi sulphadoxine single-dosetreatment replaced treatment (AL). pyrimethamine regimen artemether-lumefantrine of with three-day a six-dose, treatment AL regimen, complicated assessed we more the patient to adherence about concerns Given malaria uncomplicated of District, in Phalombe Malawi. AL to treatment adherence the for

HRMS successfullydeaths. hurricane-related HRMS identified data

Cause-specificmortality mortal in trends monitor to data are important hurricane, mortality active surveillance, surveillance evaluation,

Deaths reported in 15 secondary and tertiaryDeaths in reported 15 occurring hospitals FCT from We conducted interviews and analyzed with stakeholders conducted surveillance the We

Nykiconia D. Preacely, O. Biya, S. Gidado, H. Ayanleke, M. Kida,

From September 8, 2008, September 2008, 13, From October to medical examiners and (MEs)

disaster-related mortality disaster-related January 1, 2005- December 31, 2008 were identified by a retrospective review of hospital records. records. hospital reviewof retrospective by a 2008 January identified 2005- 1, were 31, December the to addition in study the in included were tertiary and hospitals secondary FCT All public sociodemographics, two included largest hospitals. Data extracted private records the from assigned Physicians information. cause-of-death underlying and residence of area geographic deaths.International reported Revision codes for Classification of Disease, Tenth database. We retrospectively reviewed Texas Vital Statistics (VS) data for the same the data time for period Vital Statistics (VS) Texas reviewed retrospectively database. We as surveillance active the identify to deaths HRMS by captured and additional Hurricane deaths.Ike-related were used for situational awareness, media reporting, awareness, used situational for and missingwere inquires. persons HRMS is necessary mortality collecting for detailed data capture because VS and does not representative deaths.identify to hurricane-related sufficient information HRMSfindings help enhance will future reduce to plans and and response identify healthpreparedness interventions public case improving definitions and mortality. recommend In we addition, hurricane-related training data reporters. meTHoDs: meTHoDs: KeyWorDs: 9 PosTer 2005–2008 Hospitals — Nigeria, territory Hospital-Based Mortality in Federal Capital aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: meTHoDs: meTHoDs: resUlTs: lished caseto to categorize definitions related deaths possibly as and indirectly, directly, of thiswashurricane. study to objective evaluate The HRMS, the firstthe on system based mortalityCDC’s surveillance guidelines. Justices of the Peace (JPs) in 44 Peace the of Justices deathsreported affected dailycounties one-page, using a standardized mortalitydeaths. reviewhurricane-related of form.VS A HRMS 74 identified a 10% reviewed hurricane. the to We data possibly-related revealed only 4 deaths that were All HRMS of sample complete. random MEs that and forms were 98% found and JPs participated in system, classifying the although found some deaths using by HRMS case definitions difficult. M. Akhimien, A. Abubakar, I. Kurmi ity over time. Nigeria requires civil registration of births and deaths, however, there is evidence is evidence time. there requires civil Nigeria ity births over of registration and deaths, however, documenta reliable provide Medical indicating are often underreported. records these events causes the deaths of of occurringtion in hospitals. Thisdescribes study allmortality causesof (FCT). in hospitals Territory at Federal Capital the reported

th 59 ANNUAL EIS CONFERENCE: MONDAY 48 th

59 ANNUAL EIS CONFERENCE: MONDAY 49

Routine vaccination of US infants with pentavalent rotavirus infants vaccine US of with vaccination pentavalent Routine Many of the leading the Many of causes mortality of identified in thispre study are

hospital, mortality, hospital, surveillance, Territory Federal Capital We evaluated RV5 coverage and diarrhea-associated impact on coverage healthcare evaluated RV5 We

Jennifer E. Cortes, A. Curns, M. Cortese, J. Tate, M. Patel, Zhou, F.

A total 4,623 of deathswere: causes occurred of death five intop hospitals. the The On December 31, 2007, ≥1 dose RV5 coverage was 18% among children among <5, was 18% coverage RV5 dose ≥1 2007, 31, December On

utilization and medical rates expenditures 2008 during with 2007–June July July compared 2006 years insured children using databases. US MarketScan® <5 privately among 2001–June during calculated 2008 January–June reductions vaccinated rate children among for <2 We children unvaccinated assessversus to childrenvaccine directof for unvaccinated and benefits estimate to indirect rates benefits. prevaccine versus HIV 951 (21%), road traffic accidents 422 (9%), malaria 264 (6%), septicemia 206 (5%), and and hyper (5%), septicemia 206 malaria(6%), (9%), traffic road 264 422 accidents (21%), HIV 951 median The age at Mortality males among 2724 (59%). occurred frequently most (4%). 194 tension those less than age. among year of deaths one of were 888 (20%) death 0-100); was 30 years (range: ventable. Infant mortalityventable. in hospitals. FCT Although is a large health these problem public of allFCTdeaths, findings quantifybe to usedmay representative they not mortality are in that occursmortality inother hospitals. FCT with These combined data surveillance data can FCT. the inform for to health policy evidence strategies public and on interventions provide meTHoDs: meTHoDs: resUlTs: PosTer 10 10 PosTer Healthcare Utilization for Diarrhea in Children on Impact of Pentavalent Rotavirus Vaccine — United States, 2007–2008 Years Aged <5 aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: resUlTs: 63% in children <1, 23% for 1 year olds, for and negligible 23% in in 2–4 children <1, 63% with year olds. Compared diarrhea for 2001–2006, 2007–2008 hospi 10,000 per rates 31 children to declined 52 from for 158 to 185 38%–43%), from 40%,[CI], interval confidence reduction, talizations 95% (rate visits (reduc outpatient for 1348 and 1245 from to CI, 13%–16%), 14%, ED visits (reduction, similar Declines 8%,tion, were 7%–8%). CI with age across unvaccinated Compared groups. diarrhea fewer hospitalizations, (CI 36% 25%–50%) children, vaccinated children had (CI 39% visits. 2008 outpatient hospitaliza fewer 7%–14%) (CI ED29%–43%) fewer visits, and 11% in 2007– less than rates. Nationally, prevaccine 33% children unvaccinated for rates were tion hospitalizations, 44,112 baseline, of 2008 prevaccine the estimated we a reduction compared visits, and $200 nearly million outpatient in medical annually costs 56,236 ED visits, 217,915 children among <5. ParasharU. (RV5) began in 2006. (RV5) assess impact, vaccine examined we healthcare utilization diarrhea To for and afterbefore vaccine introduction.

, pneumococcal infections, drug microbial

PCV7’s introduction triggered a major decline in penicillin nonsusceptible inpenicillindecline nonsusceptible major triggereda PCV7’sintroduction Following RV5 introduction, diarrhea-associated healthcare utilization introduction, in Following RV5 (pneumococcus) causes 43,000Streptococcus pneumoniae (pneumococcus) U.S. invasive

Streptococcus pneumoniae gastroenteritis, rotavirus,gastroenteritis, vaccine, disease burden

IPD cases were defined by isolation of pneumococcus from a normally a pneumococcus of sterilefrom definedIPDby casesisolation were

Lee M. Hampton, M. Schaffner, Farley, W. A. Thomas, A. Reingold,

During ABCs 1998-2008, cases5,707 years identified IPD <5 children among

site in children <5 years old residing in any of eight Active Bacterial residing in in eight Active years children old of any surveillancesite <5 Core (ABCs) susceptibility. serotypedareas antibiotic and for tested were during Pneumococci 1998-2008. using penicillin the rate in IPD rates average compared 2008 1998-99 the nonsusceptible to We >0.06(MIC definitions ug/ml, and older also cases) in ug/ml non-meningitis >2 (MIC new used all for meningitis cases both definitions). under IPD among children <5 years childrenIPD old, regardless among definitions the <5 used. of PCV7’s disparate effects definitionshow changing different under illustrate case definitions can affect vaccine measured effects. US childrenUS decreased in vaccinated and children.unvaccinated KeyWorDs: resUlTs: CoNClUsioNs: meTHoDs: meTHoDs: KeyWorDs: 11 PosTer Against Vaccine Effects on Definitions of Penicillin Resistance Impact of Changing , United States, 1998–2008 Streptococcus pneumoniae aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: old. Using the old and new definitions, 35.3% and 14.6% of these cases, respectively, were were 14.6% of cases, these 35.3% respectively, and and definitions, new old the Using old. caused penicillin by (cases strains. per The penicillin nonsusceptible rate IPD nonsusceptible to 8.0by average) (1998-1999 35.6 from 100,000 definitions usingdropped old the population) definitions, new penicillinthe retrospectively-applied the Using -72,-82). 95%CI: 2008 (-78%, Rates penicillin of -71). -47, CI: 95% declined 5.2 IPD 13.0 to rate from (-61%, nonsusceptible 82.8% IPD for caused serotypes by which all accounted of in 93.7% PCV7, or nonsusceptible to 0.8 dropped respectively, and definitions, new old the under IPD in 1998-99 nonsusceptible respectively. and definitions, new old the under and zero L. Harrison, R. Lynfield, N. Bennett, Petit,S. B. Beall,Jorgensen, J. MooreM. pneumococcal disease (IPD) cases annually. Antibiotic nonsusceptible IPD is more difficult IPD is more casespneumococcal disease nonsusceptible annually. Antibiotic (IPD) (PCV7)vaccine evaluated effects the of a pediatric pneumococcal conjugate We treat. to in 2000introduced using penicillin new susceptibility in 2008. definitions adopted resistance, heptavalent pneumococcal conjugate vaccine vaccine pneumococcal conjugate resistance, heptavalent

th 59 ANNUAL EIS CONFERENCE: MONDAY 50 th

59 ANNUAL EIS CONFERENCE: MONDAY 51

IIAS has high sensitivity and specificityidentifying for ILI visits in AN Influenza disproportionately affectsInfluenza disproportionately persons (AN); Alaska2009Native

During the spring 2009 H1N1 influenza (H1N1) outbreak, outbreak, initial ill During(H1N1) influenza spring the 2009 H1N1 influenza, Native Americans, surveillance, Alaska

We reviewed ambulatory patient visits in September 2009 visits in ambulatory reviewed urban September and one at one patient We

Emily S. Jentes, A. Whatley, K. Holton, G. Brunette

James W. Keck, James M. W. Bruce, S. Kitka, J. Cheek, Cullen, T. L. Layne, J. Redd, Of 2,375 patient visits reviewed, 111 (4.7%) met the ILI the met case definition. IIAS (4.7%) visits reviewed, 111 Of 2,375 patient

nesses were associated with travel from Mexico, and later with travel to and from the United United the and from to with and Mexico, travel later from associated withnesses were travel transmission, commu a national H1N1 of and prevention the travel healthy promote States. To campaignnications disseminating by was planned targethealth to effective travelers messages in fall the Before campaign 2009 (airports, etc.). sought launch, we H1N1 centers transportation health messages. proposed the of impressions determine travelers’ to rural Alaska using ILINet the hospital (tem Health System for definition an Tribal ILI visit measured sensitivity the and specificityof We cough). throat or sore and either ≥100°F perature IIAS ILI detect to by chart visitsreview identified and assessed timelinessthe of IIASmea by suring an from health ILI system. delay the information electronic the data entry to visit into receiving care rural at and urban hospitals. Modifying IIAS the ILI algorithm detection to 100%. specificitynearly to increasedIIAS system’s fever the documented visits without exclude can fill a gap in influenza surveillanceproviding on by accurate ILIinformation activity in AN. aUTHors: aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: PosTer 13 Impressions of 2009 H1N1 Influenza National Health Messaging Campaign Travelers’ meTHoDs: meTHoDs: resUlTs: aUTHors: baCKgroUND: PosTer 12 Alaska Native Among System Illness Surveillance of a New Influenza-Like Evaluation 2009 Persons, urban and rural ILI98.2%of and specificities surveillance 95.2% of and 97.9% had sensitivities Eliminating IIAS respectively. 33 the and 96.1%, false that lacked a documented positives increased ≥100°F overall the IIAS temperature to 99.3%. IIAS specificity 97.8% detectedfrom ILI of urban the >90% days of visits and within 46 rural the days of 11 encounter. hospital HennessyT. pandemic influenza A (H1N1) related hospitalization rates among hospitalizationrates related among AN were 4.5 in Anchorage (H1N1) influenzapandemic A times higher than in Caucasians. influenza-like National illness (ILI) little reportingprovides evaluated ability the this Indian the data on of vulnerable Health We population. Service In (IIAS), surveillance newSystem electronic a ILIAwareness monitor to in system, fluenza AN.

=7.4),

x =7.3; HA =7.3; x =7.8; HA, =7.8; x =7.1; F, F, =7.1; x =7.6; F, F, =7.6; x =5.7), and likeable (D, and likeable (D, =5.7),

x <.05. =7.3; HA =7.3; x

=7.2; F, F, =7.2; x Although travelers reported that HA would motivate change and was clear, clear, was and change motivate would HA that reported travelers Although Three that Africanadult trialsshowed randomized recently controlled

travel, communication, influenza subtype, A communication, virus, travel, H1N1 advertisements

NHDS provides representative national estimates national health of care utilization from representative NHDS provides Five campaign posters (B-F) focusing on CDC travel recommendations recommendations campaign focusing CDC travel on (B-F) Five posters

Charbel E. El Bcheraoui, K. Kretsinger, R. Chen

Of 54,786,525 newborn males, 33,306,056 (60.8%) underwent circumcision withmales, newborn circumcision Of underwent 54,786,525 33,306,056 (60.8%)

Surveys were completed by 901 travelers (51% female). Preliminary female). data showed (51% travelers 901 by Surveys completed were

=6.6) with HA. compared

x a stratified random sample of nonfederal hospitals. Using weighted analysis for 1979–2006 data, data, 1979–2006 for analysis weighted Using hospitals. nonfederal of sample random stratified a in sutures) and wounds AEs(e.g., of rates and MC neonatal of incidence the calculated we codes Diseases Classificationof International (ICD-9) using by relevant circumcised neonates penis). of laceration of suture (e.g., procedures 14 and penis) of edema (e.g., diagnoses 18 for for H1N1 were proposed and compared with the spring CDC Health Alert (HA). Travelers with spring CDC Health the and Alert Travelers compared proposed (HA). were H1N1 for online surveys firm anonymous completed recruitment and throughenrolled a professional regarding under while 1-10(high)], viewing [scaled posters. the Surveys questions included change. analyzed behavior for Data were standability, appeal, motivation clarity, and reported significant and were if P t-test Student’s by D and F were considered more understandable, appealing, and likeable. CDC adapted concepts from from concepts adapted CDC likeable. and appealing, understandable, more considered were F and D usethese three as to posters This campaign study highlights cornerstones. that travelers including health messages travel is essential, especially developing when with these messages when compete resultsneeddirection. These inthe centers. transportation also advertisements underscore and products consumer guidance campaign effective for audiences target with messages check to meTHoDs: meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: 14 PosTer Adverse Events — United States, 1979–2006 and Neonatal Male Circumcision Incidence resUlTs: meTHoDs: meTHoDs: relatively stable MC rates during rates survey the MC stable period. AEsrelatively Among of circumcised rates neonates, person-years. 0.10/100,000 were penile of and rates procedures person-years, 0.07/100,000 were However, D and F rated significantly more understandable (D, (D, significantly D and F rated understandable more However, that HA significantly rated higher change. for than clarity for posters B-F motivation and visually appealing (D, male circumcision (MC) conferred approximately 50% protection against 50% protection HIV approximately conferred acquisition. (MC) male circumcision inCDC is preparing guidelines United the HIV for adult and neonatal MC on prevention during be 57.5% to incidence neonatal MC database showed States. A large nonrepresentative ranging (AEs) events adverse of rates reported studies have cohort 1993-2006, and published 0.2 and AEsfrom the 2.0%. incidence to MC develop data to on are needed Representative Hospital evaluated National the forthcoming guidelines their impact. We and monitor Discharge Survey as (NHDS) surveillance national a potential this meet system to need.

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59 ANNUAL EIS CONFERENCE: MONDAY 53

During their first year of introduction, the use and impact of RDTs varied During use of the and impact their firstyearof RDTs introduction, Compared to published studies, published NHDS to similarCompared found but incidence MC In Africa approximately 1.1 million refugees are under the protection of the the of protection the under millionare refugees 1.1 InAfrica approximately

malaria, refugee, health system, information malaria diagnostic test rapid circumcision, adverse effects, newborn, United States, effects,United adverse HIVnewborn,circumcision,

UNHCR records healthUNHCR including indicators, malaria records diagnostics a paper on

David C. A. Townes, Blanton, C. Haskew, S. Kachur, H. Williams

In their first year of introduction, over 105,000 of performed.rate The were over In their firstyearof RDTs introduction,

form at camp level and electronically camp at level form country at Malaria level. or by confirmation is microcopy MalariaRDT. diagnostics Chad, data from Ethiopia, Sudan,Kenya, Tanzania, and Uganda analyzed were and Microsoft 9.2 OfficeExcel with2003. SAS version (2007-2008) widely. The observed countries The aredue,integra differencesamong in likely widely. part, toinconsistent existing into guidelines RDTs of tion diagnostic use of for tests in suspected malaria and dispar in trainingities These results staff of of indicate on ause the willingnessRDTs. to to useRDTs existing guidelines diagnostics. and trainingsupplement However, in their these integration for settings is necessary. much lower rates of AEs. The lower AE rates may be due to the fact that ICD-9 codes are not not are codes ICD-9 that fact the to due be may rates AE lower AEs. The of rates lower much Specific discharge. hospital AEs after ascertain to failure or MC AEs capture to enough specific AEs. neonatal MC of rates codes and longitudinal better monitor data to are needed KeyWorDs: resUlTs: CoNClUsioNs: baCKgroUND: baCKgroUND: meTHoDs: KeyWorDs: 15 PosTer in of Rapid Diagnostic tests Diagnostics with the Introduction Epidemiology of Malaria — 2007–2008 African Refugee Camps aUTHors: CoNClUsioNs: CoNClUsioNs: testing malaria(median for six increased of 464%, in the countries five range with 20-2200%), The percent increase, the of majority the (57%). and for decreased accounting in Kenya RDTs age confirmed of malaria 19%,(medianrange cases increased Chad,in Kenya Ethiopia and and was unchanged in Uganda. (14%) and Tanzania decreased in Sudan (5%) 10-28%), United Nations High Refugees, for Commissioner Nations with livingUnited majority the in malaria-endemic in Introduced areas. microscopy. clinicallydiagnosedby malaria been hasor Historically, rapid, portable, a offer (RDTs) tests diagnostic 2008, in Africancamps malaria refugee rapid changes in describe We malaria to diagnostics. addition effective cost potentially and use easyto malaria of testing andyear confirmation in followingthe RDTs. the introduction

) has

M. tuberculosis Ravinia Ballroom 1:30–3:00 p.m. 1:30–3:00 Ravinia Ballroom spoligotype-defined lineage from

<.001). In a comparison of East of In Asian a comparison lineage <.001). M. tuberculosis lineage is associated with EPTB. In settings populations or Genotyping tuberculosis Mycobacterium ( of

tuberculosis, genotype, States, tuberculosis Mycobacterium United

All culture-confirmednational to casesreported the States of United TB in the the Deadliest Catch the Deadliest

Eleanor S. Click, Moonan, P. C. Winston, L. Cowan, J. Oeltmann

Kenneth Castro ......

Of 70,560 reports of TB cases, 32,000 (45.4%) included data on lineage. TB data on of Of reports 70,560 included cases, Of 32,000 (45.4%)

M. tuberculosis lineage and EPTB.

revealed four major lineages not It is known revealed major four withworldwide. differential distribution different (e.g.,lineages whether ofpulmonary sites are associatedinfection with different vs. differences such may increase clinical Understanding extrapulmonary tuberculosis [EPTB]). EPTB, of specific the use the of consideration diagnosticsrequiredto tests diagnose EPTB, association the with investigated EPTB. patients to We treatment appropriate of and provision between in which EPTB-associatedof recognition genotypic lineages effortsto areimprove common, EPTB diagnosis adequate be ensure important to may and treatment. KeyWorDs: resUlTs: CoNClUsioNs: meTHoDs: meTHoDs: MODERAtOR: MODERAtOR: 1:35 Mycobacterium tuberculosis Lineage and Extrapulmonary Relationship Between United States, 2004–2008 — tuberculosis aUTHors: baCKgroUND: MONDAY, APRIL 19 19 APRIL MONDAY, sessioN C: these, 23,844 (74.5%) were pulmonary only, and 8,156 (25.5%) were EPTB. were to According (25.5%) pulmonary and 8,156 were only, these, 23,844 (74.5%) preliminary EPTB of results, percentages the cases differedby lineage: East Asian=996/4,302 Euro (31.4%); Indo-Oceanic=1,530/4,873 East-African Indian=602/1,366 (44.1%); (22.5%); P (chi-square (23.6%) American=5,058/21,459 lineages,and other odds the EPTB of odds ratio increased East-African Indian for (adjusted CI=1.3–1.6) (AOR=1.4, Indo-Oceanic [CI]=1.3–1.7), interval confidence 95% [AOR]=1.4, =1.1–1.3). CI and Euro-American (AOR=1.2, tuberculosis 2004-2008 each four lineages, the of cases For of included. with percentage the EPTB were was calculated. Controlling known be factors associated to with EPTB age, birth, of region (sex, HIV between assess lineage used to logistic we regression relationship the and EPTB.status, and race), surveillance determined M. systemtuberculosis with routinely

th 59 ANNUAL EIS CONFERENCE: MONDAY 54 th

59 ANNUAL EIS CONFERENCE: MONDAY 55

=0.03). =0.03). =0.006), of having lived outside P P

<0.001). Agreement between TST and QFT-GIT results was 94%. between TST Agreement and QFT-GIT <0.001). , immigration Most immigration employees have face-to-face contact with detainees, contact face-to-face have immigrationMost employees In the United States, the percentage of reported tuberculosis (TB) cases tuberculosis (TB) reported in of States, percentage the In United the One-third of the world’s population has latent tuberculosis infection has population latent world’s the of One-third

latent tuberculosis infection, tuberculinlatent Gold, skin test, QuantiFERON-TB

We administered regarding questionnaires and medical demographics,work We

Philip M. Ricks, K. Cain, S. Kammerer, Moonan P. Marie Niemeier, de Perio, T. M. Groenewold

Seventy-two (60%) of 120 employees participated; 67 (93%) employees reported reported employees (93%) participated; 67 employees 120 of (60%) Seventy-two

=0.003), and being a detention removal assistant ( removal and=0.003), being a detention P

Mycobacterium tuberculosisMycobacterium history, and TBhistory, risk tuberculin factors. underwent Participants skin (TST) test placement assay; QFT-GIT (QFT-GIT) in-Tube Gold QuantiFERON-TB the for collection and blood rates completion compared We and visit hasrequires higher only one specificity than TST. TST screening through completing bivariate for and each determined predictors for method analyses. placing them at risk for exposure to TB. Employees had low return rates for TST returnfor readingplacing rates risk at exposure had TB. them low for to and Employees advantages the performing of Our demonstrates one the evaluation TST placement. second TB for screening in this group. occupational QFT-GIT visit 2:15 Among the Foreign-Born — United States, Cases Genotypic Clustering of tuberculosis 2004–2008 aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: 1:55 — Facility Employees Among Immigration Infection for Latent tuberculosis Screening Illinois, 2009 face-to-face contact with detainees. Fifty-four employees underwent both QFT-GIT TSTand QFT-GIT both underwent with detainees. contact employees face-to-face Fifty-four and tested TST positive employees (6%) Three negative. results All were placement. QFT-GIT a TST year in previous the have did not employees likely falsewere (92%) Forty-seven positives. Return for TST rates placement. second underwent testing;and 2-step required only 23 (49%) was higher for QFT-GIT rate completion 74%. The 76% and reading TSTfirst second were and vs. 39%,than P TST (100% age ( older TST screening included completing for Predictors the U.S.the ( foreign-born persons doubled, from 29% in 1993 to 58% in 58% 2008. to in 29% from 1993 Small, doubled, persons geographicallyforeign-born limited the to transmission, but suggestedstudies these recent cases have to of that most not are due, (LTBI). Foreign-born persons account for most active tuberculosis (TB) cases tuberculosis active (TB) in most U.S. the for account TB persons Foreign-born (LTBI). LTBI. for screening in and treating employees immigration routinely facilitiescontrol involves two at immigration facilities two employees among and compared prevalence assessed LTBI We screening methods.

genotype in a given

TB among foreign-born persons, compared with U.S.-born is persons, compared persons, TB foreign-born among transmission among homeless Controlling tuberculosis homeless Mycobacterium transmission among

tuberculosis, foreign-born, genotyping,tuberculosis, foreign-born, length residence of

We drew blood to test for TB infection (using interferon gamma interferon release assay TB for test to drew infection blood (using We A bivariate analysisA bivariate was using performed all data on with TB reported patients

Krista M. Powell, B. Yarn, R. Brown, R. Hardy, R. Sales, S. Bamrah

Among 26,711 patients with genotyped isolates, 15,444 (58%) were foreign-born. foreign-born. were with genotyped patients isolates, 15,444 (58%) Among 26,711

We screened 311 shelter clients and staff.and clients shelter IGRA311 participants Of with 286 results,screened We [IGRA]) and HIV infection. Physicians referred persons with TB symptoms or positive IGRA and HIV with TB persons positive or referred symptoms infection.[IGRA]) Physicians A furtherevaluation. or collection, digital sputum off-site onsite results for radiography, chest genotype M. tuberculosis culture a positive with outbreak-associated the (1) case was defined as clinical genotyping) for TB a specimen and disease (2) anor established social (without link to a culture-confirmed case in a Georgiaresident. an genotyped TB isolate National the by Genotyping Service, 2005–2008. defined a case We as with Mycobacterium a unique a TB activated LTBI patient of tuberculosis county. more likely due to the activation of LTBI. TB control strategies among foreign-born persons persons strategies foreign-born among TB LTBI. control of activation the likely to due more within arrival 2 years LTBI of of in focus strengthening and treatment should on detection the States. United the meTHoDs: meTHoDs: resUlTs: Onsite Case-Finding During a tuberculosis Outbreak in a Homeless Shelter — Georgia, Outbreak in a Homeless Onsite Case-Finding During a tuberculosis 2008–2009 aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: 2:35 meTHoDs: meTHoDs: resUlTs: activation of latent TB infection (LTBI) acquired before U.S. acquired before arrival. TB infection latent (LTBI) of controlling Strategies for activation differ transmission: the strategies addressing recent for LTBI from of activation TB to due We LTBI;requires transmission. requires finding latter interrupting the former treating and TB of of activation the cases to percentage determine the to used due data a national source and describe characteristics the these cases. of LTBI 117 (41%) tested positive. Of 301 participants with HIV test results, 17 (6%) tested positive. Of positive. tested participants with HIV Of 301 (6%) positive. tested results, test 17 (41%) 117 The activation of LTBI was more common among foreign-born than among U.S.-born than foreign-born among among common LTBIwas more of The activation Among [CI]=1.78–1.97). interval confidence 95% [OR]=1.88, odds ratio vs. 55%, (70% persons aged persons diagnosed 15–44 commonly arrival, at foreign-born was <2 more activated LTBI CI=1.42–1.74). years>5 years after(OR=1.57, after arrival,arrival with compared persons remainspersons challenging; high HIV can intensify prevalence transmission, and homeless with diagnosed name. identify by newly persons be to unable contacts may tuberculosis (TB) During March 2008–May cases 2009, 13 genotypically of diagnosed TB identical were among only social whose in persons link Georgia.homeless shelter was Because a common use of TB of cases treatment is necessary M. conducted tuberculosis transmission, interrupt we to June 2009. case-finding in shelter onsite at the

th 59 ANNUAL EIS CONFERENCE: MONDAY 56 th

59 ANNUAL EIS CONFERENCE: MONDAY 57

Ravinia Ballroom 3:15–5:20 p.m.

Onsite, location-based active case-finding active was location-based Onsite, a successful to alternative Characterizing the epidemiology of 2009 pandemic influenza A (H1N1) Characterizing 2009 of epidemiology the (H1N1) influenza pandemic A

tuberculosis, disease HIV persons, outbreaks, homeless

10 things I Hate About Flu 10 things I Hate Since September 1, 2009, a portion of the EMR for every patient visiting HCF EMR the visiting of 2009, HCF a portion every 1, for patient September Since Parvathy Pillai, B. Safranek Buss, T.

Lyn Finelli

During September 3–28, 2009, a total of 417 of 2,469 of During 3–28, ED unique 2009, September EMRs a total 417 of were

......

A’s ED and has health classified state the been transferred department to by as non-ILI ILIor A’s throat”, “sore plus using following the “fever”, three ED(1) EMR-based ILI case definitions: historyof fever, (2) text; SAS® by detected as of chief-complaint processing “flu,” or “cough”, yes/ by as chief noted complaint, of throat, independent sore cough or history either plus of influenza performance of asked ED by during nurses questions triageno and (3) assessment; laboratory testing, regardless result. Classification of as ILIby these three case definitions was reviewentire of the standard influenzaphysician basis on for of the with a reference compared ED definedinfluenza health ortest, laboratory record, as positive discharge diagnosis of without cough sore plus throat or influenza, or or fever influenzaantiviralprescription, noninfluenzadefinitive diagnosis. traditional name-based contact investigation methods in this investigation traditional in name-based large contact a challenging outbreak Becausepopulation. HIV increases TB are disproportionately persons risk,and homeless healthinfected officials public integrateshould with HIV, HIV testing during TB case-finding early during outbreak be considered methods should Location-based shelters. homeless at congregate settings. involving investigations resUlTs: meTHoDs: sessioN D: MODERAtOR: 3:20 Influenza SurveillanceUsingby Emergency Department HealthRecords — Nebraska, September 2009 aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: 19 APRIL MONDAY, 134 participants referred for further off-site evaluation, 6 (2%) participants, including two with (2%) 6 furtherevaluation, for 134 participants referred off-site HIV TB a diagnosis disease infection, outbreak-associated received of and initiated treatment. Influenza randomly selected and physician-reviewed. Sensitivity and specificity, respectively, were 75.2% were respectively, Sensitivity and specificity, and selected randomly physician-reviewed. case 56.2% definition; chief-complaint–based and for 90.2% andtriage-assessment– 89.2% for case laboratory-testing–based definition. for and 97.6% based9.5% case definition, and virus is a public health priority, and emergency department (ED) electronic medical records medical electronic records (ED) department virus and emergency health is priority, a public evaluated three performance of case for definitions data. of source are We (EMRs) a ready influenza-like illness(ILI) based on ED EMRs healthcareNebraska A). facilityone at (HCF

Approximately 17-62% of IPD cases in Denver during IPD cases 2009 of October in Denver 17-62% Approximately Performance of the three the ED of EMR-basedPerformance ILI casevaried. definitions (pneumococcus) was a frequent was a frequent Death Streptococcus pneumoniae from (pneumococcus)

pneumococcus, invasive pneumococcal disease,pneumococcus, invasive influenza, IPD, pneumococcal influenza,healthhealthhuman; public public surveillance informatics;

IPD cases were defined as isolation of pneumococcus from normally pneumococcus of sterilefrom defined IPDsites. cases as were isolation

George E. Nelson, S. Mandal, N.Williams, D.Aragon, B. Beall,

During October 2009, 58 cases of IPD were identified (2004-2008During identified 2009, cases October 58 IPD were October of

polysaccharide vaccine, vaccination PPV23, Confirmed casesof influenza-associated test during IPD theirinfluenza anyhad positive illness; We abstracted cases possible had influenza-like illness throat). (ILI:coughsore or plus fever all on medical records IPD cases ascertained evaluate preceding to ILI and disease We severity. serotyped interviews. using were the and Pneumococci provider use throughPPV23 patient Quellung reaction. were associated with pandemic H1N1 infection, and missed with associated vaccination opportunities for with H1N1 were pandemic PPV23 use. effortsto needed improve Greater are common. were PPV23 Chief-complaint–based case definition produced the most favorable balance of sensitivity and most favorable the caseproduced definition Chief-complaint–based specificity. CoNClUsioNs: CoNClUsioNs: KeyWorDs: resUlTs: baCKgroUND: baCKgroUND: meTHoDs: KeyWorDs: 3:40 (H1N1) — A with Pandemic 2009 Influenza Associated Disease Invasive Pneumococcal Area, October 2009 Denver Metro aUTHors: CoNClUsioNs: CoNClUsioNs: average, n=18). Of these, 54 (93%) were hospitalized and seven (12%) were fatal. were Of 48 cases hospitalized (12%) and seven were Of these, 54 (93%) n=18). average, >17% influenza haddocumented suggestinginfection, that (21%) influenza, for 10 tested influenza-associated. IPD cases of 53 cases were IPD Of sufficient with clinical (10/58) preceding ILI. reported Of 38 cases adults among aged 18-64 (62%) years, 29 33 information, and 5 (26%) those records, had available of vaccination (66%) indications, 19 had PPV23 (76%) caused serotypes by were 75% Among cases PPV23. had with received available (n=47), isolates in PPV23. included D. Swerdlow, M. Moore, K. Gershman complication of influenzaduring of pneumococcal past polysaccharidepandemics. The complication 23-valent certain for high-risk is recommended adults 18-64 years During old. (PPV23) vaccine October hospitalizations and invasive [pH1N1] 2009, increases in 2009 pandemic influenzaA(H1N1) the investigated We residents. observed Denver among were pneumococcal disease (IPD) identify and to missed opportunities for pH1N1 of increase in role the determine IPD to vaccination. PPV23

th 59 ANNUAL EIS CONFERENCE: MONDAY 58 th

59 ANNUAL EIS CONFERENCE: MONDAY 59

Having household discussions regardingHaving household influenza reducing transmission, Vaccination of healthcare workers (HCWs) for influenza for has been (HCWs) healthcare workers of Vaccination In April infection 2009, of with an 2009 outbreak influenza pandemic A

2009 pandemic influenza A (H1N1) virus; household transmission; secondary transmission; virus; household 2009(H1N1) influenza pandemic A

We surveyed households of School A students who reported influenza-like reported who A students School of surveyed households We

Jennifer R. Cope, S. Pickard, B. Cadwell, E. Weiss Anne Marie France, M. Jackson, S. Schrag, M. Lynch, C. Zimmerman,

ILI was reported by 79/702 household contacts (11.3% AR). On multivariate AR). On (11.3% contacts household ILI 79/702 was by reported

attack antiviral rates; prophylaxis illness A secondary 2009). (ILI) 22–30, during (April case peak the outbreak of school the of contact household throat in a coughsore or ILIeither fever and was defined as self-reported (AR)multivariateAttack bivariate rates and and analyseswith after onset student’s. the index associated factors and individual-level with secondary ILI household- calculatedof were by using 9.1.3. SAS® version time spent in proximity ill close to time spent and persons, taking antiviral second can prophylaxis reduce occur should immediately because transmission speed, of ary intervention attack however, rates; onset. symptom afterpatient index 4:20 Workers — North Dakota, 2007–2008 Among Healthcare Vaccination Practices Influenza aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: 4:00 Out a School-Based After A (H1N1) Pandemic Influenza of 2009 Transmission Household 2009 April–May City, York break in New analysis, older age was protective; for eachanalysis, for increasing age, age year of was older protective; risk ILI for 5% by was reduced Providing care the index for 0.92–0.98). [CI], interval confidence 95% 0.95; [RR]: ratio (risk with watching television increased (RR: risk parents CI, among 1.24–16.89); patient 95% 4.98; Both antiviral increased risk siblings among indexthe patient (RR: 2.23; CI, 1.17–3.78). 95% discussion regarding and havingprophylaxis had influenzarisk a household for reduced ILI (RR: CI, 0.12–0.82; 0.32; 95% of and RR: Fifty percent 0.60; respectively). CI, 0.35–0.99, 95% cases occurred days after ≤3 illness onset patient. in the index M. Biggerstaff, J. Hadler associated with fewer deaths among hospitalized and nursing home patients and reduced and reduced associated with patients deaths hospitalized fewer among and home nursing Advisory the by Immunization Committee on recommendations Despite absenteeism. We examined influenza influenza year. eachvaccination receive U.S. of Practices, HCWs <50% and associated factors with coverage North Dakota uptake among vaccine HCWs. vaccination (H1N1) virus (pH1N1) was investigated in a New York City (NYC) high school (School A). A). high (School (NYC) City school was in investigated York a New virus (pH1N1) (H1N1) opportunity an presented tocharacterize NYC into pH1N1 of This introduction firstknown transmission dynamics virus. the of household

<.0001). Among 696 HCWs, Among HCWs, 696 <.0001). P

North Dakota HCWs received influenza vaccination more commonly commonly more influenza vaccination received North Dakota HCWs School dismissalSchool has been used limit to 2009 of transmission pandemic

influenza,humanshealth vaccination, personnel,

We conducted telephone interviews of School A students’ caregivers. We used caregivers. We interviews A students’ School of telephone conducted We We analyzed data from the North Dakota Behavioral Risk Factor Surveillance Risk Factor Behavioral Dakota North the analyzedfrom data We

W. Roodly Archer,W. C. Drenzek, Gift, T. Meltzer,M. Nygren,B.

Of 363 households, 214 (59%) were successfully were Among contacted. respondents, (59%) 214 households, Of 363 Sixty-one percent of North Dakota HCWs had received an influenza hadvaccination received North Dakota HCWs of Sixty-one percent

chi-square testing to compare education level and KAP level transmission among education testingchi-square compare regarding to pH1N1 experiencingcaregivers ILI. with experiencing ILI those not compared in We their household, 1,or on May after throat 2009. coughsore or with (≥100oF) defined fever ILI as self-reported System (2007–2008), a random-digit–dialed survey representative of adults aged ≥18 years in years ≥18 aged adults of surveyrepresentative random-digit–dialed a (2007–2008), System most healthcarework who that answered defined respondents as were North Dakota. HCWs logistic multiple conducted we SAS®, Using often. most do they work the described accurately weighted were Data uptake. vaccination influenza with associated factors determine to regression sampling. complex for account to than non-HCWs, but 39% of HCWs did not receive vaccination. Improved understanding of Improved vaccination. receive did not HCWs of 39% but than non-HCWs, better to is uptake vaccine needed lower have obese HCWs or and nonoverweight smokers why in North Dakota. HCWs among tailor interventions vaccination meTHoDs: meTHoDs: resUlTs: knowledge, Attitudes, and Practices Among Parents During School Dismissal Because of Among Parents During School and Practices Attitudes, knowledge, Virus — Pennsylvania, 2009 A (H1N1) Circulation of 2009 Pandemic Influenza aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: 4:40 resUlTs: meTHoDs: meTHoDs: 89% believed children could catch pH1N1 by coming within by an 6 feet of ill89% believed children pH1N1 catch 84% could from person, in the prior 12 months, compared with 40% of non-HCWs ( with 40% compared non-HCWs months, of 12 in prior the odds of receiving influenza vaccination were significantly lower among smokers, compared with compared smokers, significantly among were odds receivinglower influenza of vaccination 0.26–[CI], interval confidence 95% 0.45; [AOR]: odds ratio (adjusted nonsmokers current ≥25), obese mass (body or overweight index [BMI] 0.77) and higher were those who among factors Model CI, 1.18–2.73). 95% 1.79; (AOR: <25) (BMI not were with those who compared sex, nonsignificant were healthage, that were income, insurance coverage, diabetes, physical andactivity, binge drinking. A. Bhattarai, R. Fagan, S. Sodha, S. Ostroff,T. Marchbanks, D. Swerdlow, A. McWhorter, and Edelson, P. for the Pennsylvania Working Group H1N1 influenza A (H1N1) virus (pH1N1) among students and staff. However, evidence of effective evidence staff. However, and students among virus(pH1N1) (H1N1) influenza A investigated is scant. We contacts out-of-school dismissal school of ness children’s reducing on knowledge, children attitudes, of (KAP) and practices attending parents a semirural among dismissal school to during a pH1N1-outbreak–associated A) (School school K–4 elementary contacts. out-of-school children’s reducing on effectiveness determine its

th 59 ANNUAL EIS CONFERENCE: MONDAY 60 th

59 ANNUAL EIS CONFERENCE: MONDAY 61

<.01), and nonasthma pulmonary disease <.01), P <.01), developmental delay ( delay developmental <.01), P The majority of pediatric deaths from pH1N1 were among children were among with of pediatric pH1N1 majority deathsThe from Although knowledge of how pH1N1 is transmitted was high, Although pH1N1 without how knowledge of

The 2009 pandemic influenza A (H1N1) virus emerged in the United United virusemergedthe in The 2009(H1N1) pandemic influenza A 2009 pandemic influenza A (H1N1), pH1N1, pediatric,mortality, pH1N1, 2009(H1N1), influenza pandemic A 2009 pandemic influenza A (H1N1) virus,social 2009distancing,(H1N1) influenza pandemic A community

Laboratory-confirmed pH1N1-associated deaths occurringduring Laboratory-confirmed AprilpH1N1-associated

Chad M. Cox, L. Blanton, R. Dhara, L. Brammer, L. Finelli During April 15–December 5, 2009, During 224 pediatric April deaths associated 15–December with pH1N1

<.01). P mitigation, school school mitigation, chronic diseasechronic 15–December 5, 2009, were compared with laboratory-confirmed, compared seasonal 5, 2009, were influenza-associat 15–December ed deaths occurring 2009. 30, health completed State departments 2007–April 14, September pediatric compared each deaths for death.questionnaires were Seasonal and pH1N1-associated evaluate using differences to test by proportions. a chi-square between underlying chronic disease and were more likely diseaseunderlying be associated chronic to more with or neurological disorders and were pulmonary disease, with seasonal compared influenzadeaths last the for seasons.two All chil and seasonal influenzavaccinations. pH1N1 receive to are recommended ageddren months ≥6 antiviralsFurthermore, be used should early and aggressively children among with conditions associated with illness. increased risk severe for caregivers’ keeping childrencaregivers’ keeping congregating, from dismissal school effective cannot ensure alone social distancing. During dismissals, school encourage efforts healthshould educational public children for decrease likelihood the to contacts influenza of caregivers limit to out-of-school viruses transmission. KeyWorDs: CoNClUsioNs: CoNClUsioNs: meTHoDs: meTHoDs: resUlTs: 5:00 2009 States, United — Children Among Deaths (H1N1) A Influenza Pandemic 2009 aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: contact with germs on school surfaces, with participating school germs from on incontact a social and 85% gathering; 52% this asduring serious. Thirty-six outbreak remain of home childrenperceived at not did percent dismissal, school children with had other home interacted and at 64% students of week-long the and KAPlevel education differ did not Respondent sports shopping, events). (e.g., elsewhere or significantlynot. caregivers who experiencingdid among those from ILI household in their virus infections were reported. Of 206 deaths with a reported medical history, 138 (67%) had virus reported. Of 206 infections were deaths (67%) medical with a reported 138 history, neurological were disreported conditions common most underlying The medical conditions. and nonasthma pulmonary Compared disease (30%). (45%) delay developmental (49%), order an withto have likelyunderlying seasonalmore pediatricdeaths were influenza deaths, pH1N1 ( neurological disorder ( States inStates April 2009 impact children. among 2003–04 the with Since a disproportionate influenza surveillance season,CDC hasconducted laboratory-confirmed, for influenza-associ and types frequency the among compared underlying conditions of pediatricated deaths. We determine to prevention if additional children died seasonal from who pH1N1influenza versus strategies are needed.

Ravinia Ballroom, 8:30–10:15 a.m. 8:30–10:15 Ravinia Ballroom,

Blood Blood

true true

1: 1: ......

essioN e HIV in TB among Kazakhstan patients prevalence is increasing — a trend Kazakhstan cases/100,000). has (126 high incidence tuberculosis (TB)

.001). Compared with patients who had TB alone (n=102,368), those with had TB who (n=102,368), alone with patients Compared .001).

tuberculosis, HIV, Kazakhstantuberculosis, HIV,

The The Kazakhstan Electronic TB Registry(ETR)containson data TB cases

Matthew Willis, A. Tursynbaeva, I. Aitmagambetova, K. Cain, Holtz T.

Jonathan Mermin

HIV with TB persons among in increased 0.9% prevalence 2005 in from 1.4% to

Human Immunodeficiency Virus Human Immunodeficiency reported in the public sector (90% of cases). Using ETR Using available data years for (2005–2008), cases). of (90% sector in public reported the 2003–2008, HIV TB among For the patients. prevalence computed compared we we with TB characteristics anddemographic patients those with alone of HIV-associated TB of particular concern in the context of widespread MDR TB. Containment of the epidemic of of particular MDRof TB. widespread epidemic the of of in context the Containment concern HIV-associated TB efforts, requires urgent in high-risk a focusincluding on HIVprevention drug impact the of of andregions evaluation epidemic. the use on KeyWorDs: resUlTs: CoNClUsioNs: meTHoDs: meTHoDs: MODERAtOR: MODERAtOR: 8:35 Drug-Resistant Widespread in the Context of tuberculosis Increase in HIV-Associated kazakhstan, 2003–2008 — tuberculosis aUTHors: baCKgroUND: tUESDAY, APRIL 20 APRIL tUESDAY, s CoNCUrreNT 2008 (chi-square P< 2008 (chi-square confidence 95% [OR]=1.4; ratio male commonly (odds more were HIV-associated TB (n=1011) and living in an CI=2.8–3.7), urban area aged years (OR=3.2; 25–45 interval [CI]=1.3–1.6), popula country’s the of containing regions 13% regions, 2 (urban Of 16 1.8–2.3). CI (OR=2.0; 48% all of reported HIV-associated TB route. cases. transit tion), a heroin Both on are located At 18%, the percentage of newly diagnosed newly of TB percentage the 18%, At cases TB (MDR) that are multidrug-resistant highest. HIVis world’s in the increasing. among Kazakhstan HIV but prevalence (0.3%) is low TB, of increases incidence including MDR TB; HIV and MDR TB each increase risk the of death, especially Thus, combined. increased challengesHIV-associated when compounds TB in examined and characteristics prevalence the of MDR TBa country We where is common. HIV-associated TB in Kazakhstan.

th 59 ANNUAL EIS CONFERENCE: tUESDAY 62 th

59 ANNUAL EIS CONFERENCE: tUESDAY 63

<.001). <.001). Our screening tool detected clinically relevant neuropathy. Higher neu Our clinically detected screening tool neuropathy. relevant Although the role of drugAlthough of HIV in transmission of the injection role the is widely Peripheral neuropathy (PN) is a common complication of HIV of infection complication is a common (PN) neuropathy Peripheral

peripheral neuropathy, Kenya, human Kenya, immunodeficiency virus, neuropathy, peripheral

We developed a clinical developed capturing PN tool for signs screen to and symptoms We

Dita Broz, A. Kim, E. Kim, A. Holman, A. Khatib, A. Othman, M. Mussa, A. Danielle Iuliano, Odawo, P. Muange, P. C. Mwangi, Mwaura,P.

We screened 3,858 patients for PN (median assessment time, assessment 4 minutes; (median PN for 3,858 patients screened We

developing country developing among HIV-infected patients attending four clinics in Nairobi, Kenya. We assessed symp attending 32 four clinics patients We HIV-infected among in Kenya. Nairobi, (pain, tingling,toms numbness, and weakness in each signs arm, and 12 (loss leg, foot, and toe) the at medialvibration and monofilament] [by points sole at five touch fine to sensation of and, for and signs), symptoms of (sum score a neuropathy produce malleoli to tuning [by fork]) thosewith assessed PN, functional daily of impairment and severe). activities moderate, (mild, these this by captured and and PN correlated severity tool of determined prevalence the We measures Rank with functional using impairment Wilcoxon the Sum test. ropathy scores were linearly associated were with scores greater functional impairment. Thisropathy brief simple, and address settings PN. be could used resource-limited and in detect monitor to other screener Correlates of HIV Infection Among Injection Drug Users — Unguja, zanzibar, 2007 Among Injection Drug Users — Unguja, zanzibar, Correlates of HIV Infection aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: 9:15 resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: 8:55 HIV-Infected Among Neuropathy Assess Peripheral to of a Screening tool Evaluation Settings Resource-Limited Persons in cost<$0.20/assessment). At least one PN sign or symptom was found in 863 (22.4%) patients: patients: (22.4%) was in sign found 863 symptom PN or least At one cost<$0.20/assessment). both signs and symp (17.0%), signs and only; 147 (12.4%), 107 only; symptoms 609 (70.6%), (asymptom of differed by impairment score functionalextent median The toms. neuropathy P 20.5; severe, 4; 11; moderate, atic/mild, L. Johnston, A. Kangolle, M. Dahoma M. Ackers, A. Njoroge, J. Brooks recognized, data in sub-Saharan Africa are limited. In among Zanzibar, HIV is 0.5% prevalence drug is that injection use concern will a major fuelmales and females; among 0.7% however, increased are at risk HIV of drug through Injection users (IDUs) unsafe epidemic. the injec and sexualtion and can practices transmit HIV a probability Using general the population. to and a consequence of antiretroviral therapy. If PN is recognized early, permanent disability If is recognized PN permanent antiretroviral early, can of therapy. and a consequence settingsPN resource-limited of wellin epidemiology hasbeen not The character be prevented. ized standardized because simple used. widely examinations are not PN for

HIV seroprevalence among IDUs in Unguja is high. High-risk drug injection injection drug High-risk high. is Unguja in IDUs among seroprevalence HIV In Zambia, 55%-80% of tuberculosis (TB) patients are coinfected with HIV. HIV. with coinfected are patients (TB) tuberculosis of 55%-80% Zambia, In

sub-Saharan Africa, HIV, respondent-driven sampling,sub-Saharan drug injection use, Africa, respondent-driven HIV,

We selected 53 TB clinics in the Northern (n=14), Eastern (n=14) and Western and Western Eastern (n=14) TB clinics selected 53 (n=14), in Northern the We During August–September 2007, IDUs were recruited by using recruited by respondent- were During IDUs August–September 2007,

Simon G. Agolory, M. Desai, R. Shiraishi, N. Kapata, C. Kaayunga,

Of 499 IDUs, 96.8% were male, median age was 31 years (range: 15–66 years), Of 96.8% 499 IDUs, male, years), 15–66 median were years (range: age was 31

Revised registers and treatment cards were used during 2008 in 46 (87%) of 53 clin usedRevised during cards 53 were 2008 of registers and treatment in 46 (87%)

HCV (n=25) provinces of Zambia to represent different levels of care, levels provincial different vs. including district, Zambia represent of to provinces (n=25) urban vs. cards rural, treatment the Data from large sector. vs. vs. small private and government for compared and were during treated TB 2008 completeness for reviewed patients were 767 of with data the in registers. statistic) kappa the (by agreement driven sampling (RDS), a probability-based, peer-recruitment sampling method. Participants driven sampling a probability-based, peer-recruitment (RDS), HIV for tested C virus and behavioral a questionnaires were and hepatitis (HCV), completed were logistic regression estimates and multiple unsafe for practices. Proportion marker injection RDS for adjusted design. and sexual practices will probably continue the spread of HIV of and sexual and spread the in IDUs community. among the will practices continue probably in Zanzibar programs IDUs for HIV are greatly needed. prevention Comprehensive meTHoDs: meTHoDs: resUlTs: Evaluation of a Tuberculosis Surveillance System Modified To Monitor Increased HIV Surveillance System Modified Evaluation of a Tuberculosis — zambia, 2008 testing aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: 9:35 meTHoDs: meTHoDs: resUlTs: sampling survey firstthe — to be used in sub-Saharan with IDUs Africawe — assessed HIV and HIV riskseroprevalence in factors Unguja, Zanzibar. and 34.6% had ≤7 years of education. HIV seroprevalence was 16.3% (95% confidence interval confidence (95% and 34.6% was HIV 16.3% education. had years ≤7 of seroprevalence for age After adjustment (CI=20.2–31.9). was 25.7% and seroprevalence HCV [CI]=11.6–21.8), odds (adjusted level and sex, HIV education associated with infection lower was independently HCV CI=1.3–4.8), (AOR=2.5, used condoms having never CI=1.1–4.4), [AOR]=2.2, ratio sexually of and symptoms CI=1.6–6.2), transmitted infections in past the infection (AOR=3.1, CI=1.1–4.2). (AOR=2.1, 6 months A. Mwinga, N. Mwananyambe, A. Nakashima ics. Data from registers indicated that 32 (70%) of 46 of clinics for TB of had ≥80% tested patients ics. registers (70%) Data from indicated that 32 Early HIV diagnosis and treatment significantly decrease morbidity and mortality among TB among mortality and morbidity decrease significantly treatment and HIVdiagnosis Early to effort an2006, inin HIVtesting; increasing been have 2004, TBclinics Since patients. HIV revised cards testing,monitor and TB introduced treatment Zambian the government registers. Accurate surveillance is essential assess to increase the in evaluated HIV the testing. We increased of HIVaccuracy testing. registers and of implementation the

th 59 ANNUAL EIS CONFERENCE: tUESDAY 64 th

59 ANNUAL EIS CONFERENCE: tUESDAY 65

Provision of HIV of servicesProvision within TB the clinic in resulted early enroll HIV available testing TB in is most now clinics. the to According Early HIV is important for care during treatment tuberculosis (TB)

tuberculosis, HIV, TB/HIVtuberculosis, HIV, Zambia coinfection, tuberculosis, HIV, opportunistic infection,tuberculosis, antiretroviral HIV, therapy

We reviewed records of patients registered for TB treatment during 2006-June TB July registered for treatment patients of records reviewed We

Surbhi Modi, A. Date, S. Nandi, M. Patel, M. Nyamkara, G. Arthur,

Forty-five percent (1363 of 3029) of HIV-infected TB patients sought sought HIVof HIV-infected patients TB care; of 3029) (1363 percent Forty-five

2008 who were HIV-infected and who agreed to be enrolled in the pilot program. We extracted agreed and who 2008 HIV-infected be in program. enrolled to pilot the We were who in HIV enrollment data on and clinical district care, from ART TB provision, registers, outcomes medical charts. and paper electronic records, ment in HIV care and early initiation of appropriate ART regimens. in HIV Expansion HIVment of appropriate care of and early initiation services for HIV-infected patients. TB TBto clinicsoutcomes offers opportunityan to improve monitoring data on the revised the data TB on tools, most monitoring HIV clinics for patients are testing of ≥80% data are missing. determine why infection. to is needed Interventions, Further investigation assuch additional training address to be instituted the supervision, and should closer to led missing that data.deficiencies CoNClUsioNs: CoNClUsioNs: KeyWorDs: meTHoDs: meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: 9:55 Services Provided in a tuberculosis and treatment Evaluation of the quality of HIV Care 2006–2008 Clinic — tanzania, HIV. For HIV cards and For registers was between results, test substantialHIV. treatment agreement the HIV interval=0.66–0.74). testing confidence missing resultswere However, 95% (kappa=0.70, patients. 767 of (23%) cards and 180 registers for treatment from 60% (821 of 1363) enrolled in the TB clinic’s pilot program. We located medical records for for medical located records program. in enrolled pilot TB the We clinic’s 1363) of 60% (821 median The patients. time HIV thesefrom 821 of diagnosisenrollment in to HIV (82%) 675 cotrimoxazole received range: 0–6)care was 0 (interquartile 642 patients, days. (96%) Of 675 againstprophylaxis medically opportunistic infections. patients eligible ART Of 470 the for these and received of 98% ART, received Tanzanian guidelines,according to (84%) 395 regimens.median35 The days and was enrollment to after time appropriate initiation ART was to determinedbe days afterpatient a ART-eligible. 15 Z. Mkomwa, J. Vertefeuille and S. Egwaga reducing morbidity and mortality among HIV-infected TB patients, yet many patients do not not do and mortality morbidity patients reducing many TB yet HIV-infected among patients, HIV needed receive services. of are only HIV-infected; In 32% TB of Tanzania, 47% patients during (ART) In antiretroviral TB 2006, therapy treatment. receive these patients Tanzania HIV program provide initiated services to a pilot in evaluated a TB this clinic. pilot We program assess to qualitythe HIV of care provided.

Dunwoody Suites, 8:30–10:15 a.m. Suites, 8:30–10:15 Dunwoody Party of Five Party of Five 2:

essioN e Clinical genetically indistinguishable, were isolates indicating a common Georgia Division of Public Health was notified of five patients who PublicGeorgia Healthpatients of was Division of notifiedfive

intra-articular vial, clinic multidose injection, infection control,

Clinic activity, injection logs, and medical records were reviewed for case for reviewed Clinic logs, and were medical injection activity, records

W. Roodly Archer,W. M. Schaefer, K. Arnold, A. Srinivasan, J. Noble-Wang,

Paul Cieslak

Five consecutive cases occurred among 15 patients who had received injections. injections. had received who patients cases occurred consecutive 15 among Five

......

Hot topics finding, assessed.were practices IC A caseand was defined redness, as warmth, and painthe at Clinic at A during injection a methylprednisolone had received who in a patient site injection 2008–February 1, December syringes pathogen and for tested prepared were 12, 2009. MDVs typing and genetic contamination, clinical was on performed gel pulsed-field by isolates (PFGE). electrophoresis source of joint infections. Despite lack of MSSA growth, injected medication from MDVs lack infections. MSSA of growth, MDVs from joint Despite of medication injected source increase likelihood errors IC source. extrinsic MDVs. a possible of of contamination represents using vials, single-dose and hand cor hygiene, include medication Recommendations consistent cleaningrect and disinfection methods. CoNClUsioNs: CoNClUsioNs: KeyWorDs: resUlTs: baCKgroUND: baCKgroUND: meTHoDs: MODERAtOR: MODERAtOR: 8:35 aUTHors: tUESDAY, APRIL 20 APRIL tUESDAY, s CoNCUrreNT Four patients (80%) were female (median age = 71 years). All hospitalization required patients years). age female = 71 (median were (80%) patients Four had culture-confirmed Four methicillin- treatment. antibiotic intravenous and prolonged with indistinguishable aureus Staphylococcus (MSSA) susceptible patterns. MSSA PFGE was at Clinic IC errors revealed A, investigation environmental The tested identified in MDVs. not cleaningincluding inadequate and hand mishandling incorrect hygiene, and disinfec MDVs, of medical of equipment. tion J. Perz, M. Arduino, G. Fosheim, B. Jensen, S. McAllister, H. Davidson, A. Reeves, C. Drenzek Infections After Intra-Articular Injections at a After Intra-Articular Injections Staphylococcus aureus Infections Methicillin-Susceptible — Georgia, 2009 Primary Care Clinic experienced joint infections after intra-articular (IA) corticosteroid injections at Clinicat infections after A joint experienced injections intra-articular(IA)corticosteroid inflammatory techniques for are therapeutic during injections joint 1 week. IA corticosteroid injections). Reported infections IA from conditions. are (<1/15,000 rare injections and multidose extrinsic practices of contamination (IC) lapses in infection-control However, to been associated outbreak the investigated with have similar outbreaks. We vials (MDVs) additional cases. identify extent, and source, prevent determine its its

th 59 ANNUAL EIS CONFERENCE: tUESDAY 66 th

59 ANNUAL EIS CONFERENCE: tUESDAY 67

yoming, 2003–2009 yoming, 2003–2009

Streptococcus pneumoniae causes >800,000 annual deaths in children Earlyhealth influenza public activity timely paramount for is detection ILI most by caseapplied and inaccurately was definition inconsistently

Wyoming, sentinel surveillance, sentinel Wyoming, influenza, ILI, influenza-like illness

Lee M. Hampton, M. Schaffner, Farley, W. A. Thomas, A. Reingold, Aimee L. Geissler, R. McClinton, Houten, Murphy C. T. Van

: Quality ILI sentinel of surveillance was assessed reviewing by all charts patient Among 2,659 reviewed charts, percentage of patients with ILIAmong charts, reviewed 2,659 patients of was 8%, percentage compared

Cohen sentinels, resulting in low sensitivity for ILI with resultingsentinels, sensitivity for laboratory-based in When compared low detection. reporting, ILI surveillance tracked influenza activity inconsistently limitedprovided added and influenza surveillance Wyoming’s to value system. Sentinel Roulette: Utility of Individual Hospital Surveillance for Measuring Pneumococcal Sentinel Roulette: Utility of Individual Hospital Surveillance for Measuring Children — Multiple States, 1998–2006 Young Impact in Conjugate Vaccine aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: 9:15 resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs 8:55 — W Surveillance Influenza-Like Illness of Sentinel Site Usefulness from three representative sentinels that reported consistently during 5 peak the consistently that the weeks reported of sentinels threefrom representative 2008–09meeting CDC (fever ILIpatients of case influenzadefinition season.Proportion pa of proportion with reported the was compared throat) sore cough,≥100.0°F and/or plus assess with ILI. accuracytients ILI of To case-definition use, a surveywas to alldistributed 23 ILIsentinel evaluate timeliness, reported with laboratory-confirmed compared we To sentinels. cases during each six of influenza seasons, 2003–2009. with 4% ILI reported by sentinels (sensitivity: 66%). Survey results indicated only 4/18 re Survey results indicated only 4/18 66%). with ILI (sensitivity: 4% sentinels by reported used correctly ILI the sponding sentinels case laboratory-con with definition. compared When 2–6)[CI], in interval confidence firmed cases,(95% ILIreportingsentinel haddelay a 4-week 4–6); (95%CI, season of conclusion prediction predicting season and premature a 4-week onset failedit influenza detect to activityduring 2006–07the season. L. Harrison, R. Lynfield, N. Bennett, Petit,S. B. Beall,Jorgensen, J. E. Zell, S. Schrag, A. <5 years old globally and is prevented by 7-valent pneumococcal conjugate vaccine (PCV7). vaccine pneumococcal conjugate 7-valent by globally years old <5 and is prevented in inva reduction In U.S., the based -76,-80) population surveillance (95%CI: a 78% found interventions. The Wyoming influenza surveillance The interventions. mandatory system components, has two allreporting of laboratory-confirmed cases clinic reporting of sentinel and influenza-like illness laboratory-confirmed In of data,(ILI). absence the states use ILIsentinel surveillancedeter to We quality,evaluated accuracy, geographicspread. mineand influenza onset,seasonconclusion, and ILI timeliness sentinel of surveillance detecting for influenza.

, pneumococcal infections, surveillance, sentinel Rapid influenza diagnostic tests (RIDTs) used are for influenzaRapidscreening, influenza diagnostic (RIDTs) tests IPD surveillance data individual large from reporting relatively hospitals

Streptococcus pneumoniae

To determine the positive predictive value (PPV) of RIDTs compared with compared RIDTs of (PPV) value predictive positive determine the To IPD cases were defined as pneumococcus isolated from normally definedIPD cases pneumococcus isolated sterilefrom as in were sites

Steven A. Baty, A. D’Souza, R. Sunenshine, L. Erhart

During identified 4,664 we 1998-2006, total caseseightIPD the among ABCs

the standard real-time reverse transcription-polymerase chain reaction assay (rRT-PCR), chain assay (rRT-PCR), reaction transcription-polymerase standardthe reverse real-time ADHS surveyed Arizona RIDT seven collected Information included laboratories. brand/ training performing swab personnel number, and type, test, of specimen location, test lot time testing, to collection from storage, and viral sample transport medium. Because only positive available and assuming resultsRIDTs were equal disease during April–September, prevalence results. was calculatedPPV based rRT-PCR-positive on children <5 years old residing in any of eight, population-based Active Bacterial Active residing in eight, surveil yearschildren old of any population-based Core <5 change calculated in cases areas percent the individual at duringlance We (ABCs) 1998-2006. baseline and 2006, pre-vaccine maximum year the of between declinehospitals 1998-1999 the in eight areas’ the aggregate IPD incidence. numbers of cases may be appropriate for evaluating for impact vaccine in use children, the of cases but of be appropriate numbers may IPD surveillance data smaller from carries hospitals a substantial risk an assessment of incorrect impact. vaccine of meTHoDs: meTHoDs: 9:35 Tests for 2009 Pandemic Influenza for Rapid in Positive Predictive Values Variations Arizona, 2009 A (H1N1) — Influenza aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: meTHoDs: meTHoDs: resUlTs: sive pneumococcal disease (IPD) rates after PCV7 introduction in 2000. The World Health after rates pneumococcal disease World PCV7 sive in 2000. (IPD) introduction The surveillance that cannot that performOrganization countries population-based recommends use individual surveillance assessed hospital PCV7 individual whether monitor impact. to We surveillancehospital accurately could characterize this impact. areas. 217 hospitals in hospitals eight ABCs the areas. IPD case areas least at one during reported 217 1998-2006, change in hospital’s each The percent 1-536). cases (range: hospital 21 with per of an average and 2006 ranged a 100% decline from a 100% in to IPD cases between baseline (1998-1999) showed change, no and 22 (10%) showed decline,a (23%) 49 showed hospitals (67%) crease;146 cases during had 1998–2006 cases >100 or their area’s of an increase. reporting >20% Hospitals declines 97%. to 22% of clinical decision-making, and influenza surveillance. August,In reported increased hospital a RIDTfalse-positive Arizona the results to Health of Because Services Department (ADHS). the 2009 for influenza pandemic (pH1N1), A RIDT reported (40%–70%) of sensitivities low raised report specificity the further about hospital’s clinical concerns and utility of RIDTs. heptavalent pneumococcal conjugate vaccine vaccine pneumococcal conjugate heptavalent

th 59 ANNUAL EIS CONFERENCE: tUESDAY 68 th

59 ANNUAL EIS CONFERENCE: tUESDAY 69

Salmonella Salmonella Typhimurium (var. 5-); 5-); (var. Typhimurium hwarzengrund and S.Typhimurium Sc commonly causes illness, commonly foodborne of outbreaks . Schwarzengrund; two S. yielded

Wide PPV variability combined with documented low sensitivity among sensitivity among variability low PPV with documented Wide combined Although Salmonella

2009 pandemic influenza A (H1N1), positive predictive value, rapid influenzavalue, rapid predictive positive 2009(H1N1), influenza pandemic A

A case-control study was conducted. Case-patients were defined attendees as were Case-patients was study conducted. A case-control

Jessica A. Kattan, Rabatsky-Ehr, T. J. Krasnitski, Q. Phan, J. Brockmeyer,

Results available. 600 Median from were RIDTs four of specimens using one Of ~150 attendees, nine case-patients and 16 control subjects were identified. were subjects control and 16 nine attendees, case-patients Of ~150

.01]). The The facilitiessimilarnumbersreported used lot and testing practices except .01]). infection with multiple serotypes 2009, infection reported. In are with uncommonly September multiple P<

.01). Typhimurium (var. 5-). All S. 5-). Schwarzengrund (var. and S. Typhimurium P< isolates, respectively, had indistinguishable PFGE patterns. Food-worker bare-handed contact contact bare-handed had indistinguishableisolates, patterns. respectively, Food-worker PFGE surfaces food was contact observed. with of ready-to-eat samples and spices Environmental Salmonella. for negative tested one yielded both. All four asymptomatic food workers were tested; one specimen yielded both yielded specimen tested; both. one yielded Allone were food workers four asymptomatic S. diagnostic test. who experienced diarrhea (>3 stools/day) within no Because 5 days after reception. guest listthe stools/day) diarrhea experienced who (>3 not did who subjects control illattendees; for information contact provided groom the existed, asking recruited by identify to diarrhea were experience case-patients and additional case-patients gel pulsed-field and pathogens, bacterial enteric for tested were samples Stool attendees. other catering the facility of An investigation was done. environmental was (PFGE) electrophoresis conducted. RIDTs for pH1N1 diagnosis their specificity about increases clinical concerns and pH1N1 for RIDTs epide and RIDT investigate to a need Results utility. miologic Laboratory Lot from A demonstrate X. resUlTs: meTHoDs: meTHoDs: KeyWorDs: 9:55 Reception — Multiple-Serotype Salmonella Gastroenteritis Outbreak at a Wedding Connecticut, 2009 aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: resUlTs: Seven (88%) of eight case-patients and one (8%) of 13 control subjects reported potato salad potato reported subjects control 13 of (8%) and one eight case-patients of (88%) Seven six Of case-patients ratio=84.0; interval=4.5–1,564). confidence (odds 95% consumption tested, S specimens yielded two stool timing testing. of Laboratory A used Lot X and testing performed within collection; of 1 hour excluding Lot lots, X,Laboratory and testing B used performed multiple within 24 hours. 91% Laboratory A switched RIDTto 33% a significant brands and noted PPV increase from ( pH1N1 PPV was 79% (range: 62%–91%). A significant A identified PPV was in difference 62%–91%). was 79% (range: PPV pH1N1 between two the largest facilities, which used same the and RIDT A, 33% (Laboratories brand B, 92%, [ L. Bushnell, C. Applewhite, M. Mandour, L. Mank, M. Cartter Salmonella Public Health of was of laboratory-confirmedDepartment notified Connecticut the infection in a wedding reception attendee; other attendees were reportedly ill. We investigated investigated reportedly ill. were attendees other We attendee; infection in a wedding reception measures. characterizeto illnesses the control and implement

-positive food worker. food worker. -positive Ravinia Ballroom, 10:45 a.m.–12:15 p.m. Ravinia Ballroom,

Burn Notice 1: ......

, disease studies, Connecticut case-control outbreak, essioN f If validated age, sample, in smoking, an independent education ethnicity, Epidemiologic and laboratory data suggestEpidemiologic Salmonella of an outbreak Over 2 million women are referred to colposcopy annually colposcopy to afterOver 2 million are referred women

Salmonella

We collected information on demographics, health behaviors, and reproductive reproductive and behaviors, health demographics, on information collected We Julia Gargano, R. Nisenbaum, D. Lee, M. Ruffin, M.Steinau, I. Horowitz,

Kevin Fenton

A total of 1052 (63.4%) women had HR-HPV, and of these, 133 (12.6%) had CIN3+. CIN3+. had (12.6%) 133 these, of and HR-HPV, had women (63.4%) 1052 of total A

Sexually transmitted Diseases Sexually transmitted history on 1658 women (12% Hispanic, 12% white, and 74% black) enrolled from urban public public urban from enrolled black) 74% and white, 12% Hispanic, (12% women 1658 on history or (no CIN0–CIN1 as disease cervical classified pathologists Study clinics. colposcopy hospital CIN2, indeterminate based or histology CIN3+ on and clinicallow-grade), findings. HPV cervical of using PCR consensus used and multiple typing conducted detection cells. were We CIN0–CIN2) HR-HPV among (versus CIN3+ for identify to cofactors logistic regression women. positive and HPV-16 may have clinical have may utilityunnecessaryreduce to risk for stratification colposcopy and HPV-16 referrals. infection with multiple serotypes saladinfectionpotato occurred with multiple attendees; among was likely the source instruction regarding measures included mechanism contamination Control is the unclear. but Salmonella the of food-handling and exclusion practices resUlTs: CoNClUsioNs: meTHoDs: Cofactors for Cervical Intraepithelial Neoplasia in Women Referred to Colposcopy — Referred Neoplasia in Women Cofactors for Cervical Intraepithelial 2000–2004 Atlanta, Georgia and Detroit, Michigan, aUTHors: baCKgroUND: KeyWorDs: 20 APRIL tUESDAY, s CoNCUrreNT MODERAtOR: 10:50 CoNClUsioNs: CoNClUsioNs: 1.2–2.9), smoking (AOR 1.8, 95% CI 1.2–2.8), Hispanic ethnicity (AOR 1.9, 95% CI 1.1–3.5), [CI] interval confidence 1.1–3.5), 95% CI 1.9, 95% [AOR] odds ratio wasCIN3+ associated with age1.9, (adjusted ≥30 (AOR ethnicity Hispanic 1.2–2.8), CI 95% 1.8, CI 6.2,95% (AOR smoking (AOR 1.2–2.9), HPV-16 and 1.1–2.8), CI 95% 1.8, (AOR factor education risk one secondary least at Having incomplete (c-statistic=0.77). discrimination moderate had model The negative 94.8% and value 4.1–9.5). predictive positive 18.6% specificity, 31.2% sensitivity, 90.3% in resulted CIN3+. for value predictive L. Flowers, G. Tadros, Birdsong, T. E. Unger abnormal cervicalabnormal cervical disease screening, cancer (i.e. few have but that requires treatment Identifying variables associated with [CIN3+]). grade worse neoplasia intraepithelial 3 or reduce to risk stratification toward step disease is one referral population in colposcopy the unnecessary aimed expenses identify to and potentially harmful colposcopy We overtreatment. high for risk positive a human papillomavirus women among CIN3+ (HR-HPV), for cofactors necessary cervical cause of cancer.

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59 ANNUAL EIS CONFERENCE: tUESDAY 71

With few exceptions, we found no association between health no found insurance we few exceptions, With Chlamydia (CT) and gonorrhea (GC) are the most frequently reported reported frequently are most the (GC) and gonorrhea Chlamydia (CT)

sexually transmitted diseases, health insurance, health services/utilization, cervical cervical neoplasia, intraepithelial uterine papillomavirus neoplasms,

We analyzed nationally representative data for females aged 14–39 years (1999– years (1999– analyzed females data for aged 14–39 nationallyWe representative

Elizabeth A. S. Torrone, Datta

Among 9,003 females surveyed, prevalence estimates were: CT=2.2% (95% Con (95% Among females9,003 CT=2.2% surveyed, estimates were: prevalence

infections, cancer of early detection NHANES 2008 National Health and Nutrition Examination Survey). Respondents reported insurance reported Examination2008 Respondents Health Survey). and National Nutrition and type,coverage gaps in usual coverage, health for place care, and health care visits during test acid infectionamplification wasnucleic definedurine as a positive CT/GC last months. 12 GC. CT or result for survey for Adjusting design, calculated we associations bivariate stratified ageby and race/ethnicity. or health care utilization, and CT/GC. This may result from ineffective screening practices or Thisresultscreening healthineffective may or care from utilization, and CT/GC. blacks high-risk using sexual emergency confounding patients’ by Young behaviors. usual for departments care had alarminglyfrom and benefit could prevalence high CT/GC targeted screening and prevention. KeyWorDs: CoNClUsioNs: CoNClUsioNs: meTHoDs: meTHoDs: resUlTs: 11:10 11:10 Among and Gonorrhea Infection Health Care Utilization, and Chlamydia Health Insurance, States, 1999–2008 Females — United aUTHors: baCKgroUND: KeyWorDs: fidence Interval [CI] =1.8-2.7); GC=0.3% (CI=0.2-0.6); CT/GC=2.4% (CI=2.0-2.9). Health (CI=2.0-2.9). (CI=0.2-0.6); GC=0.3%=1.8-2.7); CT/GC=2.4% [CI] Intervalfidence usual of insurance Place type, care was coverage, associated with not CT/GC. and gaps were was highest prevalence among blacks aged non-Hispanic 14–25; for associated with CT/GC blacks usual whose care departments non-Hispanic was of place emergency prevalence, CT/GC Health associated care was visit with not lower (26.0% [CI=12.8–45.8]). CI=1.6–4.3; blacks visit=8.0%, no aged (visit=2.7%, non-Hispanic among 26–39 except CI=4.7–13.2). diseases in the United States (1.5 million cases in 2008). To prevent CT- and GC- associated CT- prevent million cases in To 2008). diseases (1.5 States in United the infertility, annual recommends CDC CT sexually screening for females active aged years, <26 and targeted CT and GC all screening for associations investigated females high-risk. at We between health health insurance or care utilization and coverage CT and GC infection.

=0.001). Among =0.001). P =0.04). Within first the years few afterlicensure,varied vaccineHPV initiation (GC), a common cause of pelvic inflammatory cause of a common Neisseria gonorrhoeae (GC), Human papillomavirus cervical of cause 70% (HPV) types and 18 16

human papillomavirus, NHANES HPV Vaccine,

In 2007–2008, 2,775 females aged 9–59 responded to a question on HPV vaccine vaccine HPV on question a to responded 9–59 aged females 2,775 2007–2008, In

Tracie J. Gardner,Tracie D. Cecere, S. Jones, D. Keebler, M. Boyette, La’Shan D. Taylor, M.La’Shan Sternberg, D. Taylor, S. Hariri, E.Dunne, L. Markowitz

Vaccine initiation varied significantly by age: 9–10 years, 4.4%; 11–13 years, years, varied 11–13 significantly initiation 4.4%; by age: Vaccine 9–10

receipt in the National Health and Nutrition Examination Survey. Bivariate associations stratified stratified associations Bivariate Survey. Examination Nutrition and Health National the in receipt characteristics survey select demographic for by and adjusted calculated. design were by age group and was highest in the 14-18 year-old catch-up group. The lack of difference by The lackof difference group. catch-up year-old age andby was group highest in 14-18 the reflects the years probably race, and poverty insurance level, type females among aged 11–18 VFC the 12 impact of or 11 program. Efforts vaccinate to agesof recommended girls at the be increased.years should aUTHors: aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: 11:50 Alaska, 2008–2009 Outbreak of Neisseria gonorrhoeae Infections— Southwestern meTHoDs: meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: 11:30 11:30 years — National Ages 9–59 Females Among Coverage Vaccine Human Papillomavirus Survey — Nutrition Examination Health and States, 2007–2008 United 15.6%; 14–18 years, 21.6%; 19–26 years, 10.5%; and 27–59 years, 2.0% ( and 27–59 years, 10.5%; 19–26 years, 21.6%; 14–18 15.6%; females ages 11–26 who initiated vaccine, 37.2% received all received three doses. Race initiated vaccine, who 37.2% and poverty level females ages 11–26 Typeof insurancenot affect did affect vaccine did not vaccine in ageinitiation any category. insurance with private females aged more 19–26 but females among agedinitiation 11–18, vs. 4.0% insurance; had public who P initiated (16.3% vaccine Hernandez,T. J. McLaughlin disease, 700,000 causes approximately infections annually States. In a Region-A, in United the tripled GC the infection approximately largely rate Alaska (AN) community (86.2%), Native conducted during 2007–2008. cases/100,000 We 373 respectively) versus population, (118 recommend and interventions, confirm to outbreak, treatment anevaluate the investigation measures. control cancers; typescancers; cause 90% genital of 6 and warts. 11 In2006, against a vaccine these HPV four types was is females recommended licensed three-dose years. for vaccination aged Routine 9-26 through is vaccination uninsured available age for 26. and and catch-up Vaccine agesat 11–12 Children for (VFC) program. We through Vaccines the underinsured females aged 9-18 examining by sample. evaluated HPV coverage vaccine data a nationally from representative

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59 ANNUAL EIS CONFERENCE: tUESDAY 73

Dunwoody Suites, 10:45 a.m.–12:15 p.m. Dunwoody Suites, 10:45 a.m.–12:15 ; disease chlamydia outbreaks; dual coinfection; treat the Fall Guy 2: 2:

essioN f This is outbreak GC affectingequal ANswithapproximately sex and an

Between 2002 than $8 and more 2008, spent federal the government

Neisseria gonorrhoeae

Medical charts for 64 of 76 patients from 11 hospitals and death records for 9 for and death hospitals records 11 Medical from charts patients 64 for 76 of A case was defined residingas laboratory-confirmed GC patient infection in a

Nagesh N. Borse, M. Ballesteros, S. Basavaraju, J. Enders, J. Gilchrist,

Grant Baldwin

We identified 206 identified GC casesduring study period, We the aged from 6–69years

......

ment; Alaska ment; Native Injury of 9 deaths from the coroner’s report were abstracted using a CDC mass were casualty report surveillance 9 deaths coroner’s the of from in Region-A during Januaryin re Region-A 2008–September 1, were 5, 2009. patients for Medical records and regional health the two center public healthcare facilities: Hospital-A Region-A’s viewed at calculated were clinical for and Frequencies information. Subanalyses risk behavior (Facility-B). exhibited who patients symptomatic among conducted were dual determine use of to treatment GC risk (GCRF). factors age distribution. Intervention efforts should include improving empiric dual treatment rates rates dual empiric treatment improving efforts should include age Intervention distribution. with GCRF persons females with symptomatic GCRF symptomatic for and Facility-B at for at both facilities; GC- partner on services increasing Region-A and education providing rates; specifically targetingprevention, ANs. baCKgroUND: meTHoDs: tUESDAY, APRIL 20 APRIL tUESDAY, s CoNCUrreNT MODERAtOR: 10:50 of Injuries and Evaluation of Postevent Aftermath of the DC Metrorail Crash: type DC, 2009 Emergency Response — Washington aUTHors: CoNClUsioNs: CoNClUsioNs: KeyWorDs: resUlTs: meTHoDs: meTHoDs: (median: 29 years). Cases were 52% male; 99% AN; 74% had received partner services and 21% partner services male; had received 99% and AN; 52% 21% Cases 74% were years). 29 (median: reported who patients symptomatic Of 113 coinfected with Chlamydiawere trachomatis (CT). GCRF testing, time the of at multi GC On and CT dual empiric 64% treatment. had received with GCRF patients likely was to symptomatic variate more of analysis, dual treatment empiric 95% = 12.1; (OR patients Facility-A and to CI, 2–149) 95% = 17.2; males to (OR be provided CI, 3.2–45). R. Hunt, A. Ibrahimova,E. Sullivent, M. Wald billion on hospital and public health preparedness mostly focused on bioterrorism and focused mostly health bioterrorism billion and preparedness public on hospital on massattention. little received casualty sudden have influenza.pandemic events However, 22, June on pm 2009, two 4:58 At train Metrorail collided resulting in deadliest the in incident historythe this of system. transit This injuries study characterizedand crash-related of patterns medical emergency response. evaluated postevent the

0.0001). Substance abuse history Substance was 0.0001). P< Most prescription-opioid-overdose decedents in Utah had decedents a history of prescription-opioid-overdose Most Crash-related injuries varied by type and severity. Distribution of patients patients of varied typeinjuries by Distribution and severity. Crash-related Deaths from prescription opioids in Utah increased by >500% during in Utah increased >500% by opioids Deaths prescription from

injuries, mass casualty medical emergency service, event, DC Washington

During 2008–August October identified were decedents 2009, drug overdose

William A. Lanier, E. Johnson, R. Rolfs

All pulmonary deaths 9 was to occurred Death crash the due at site. contusion Of 155 prescription opioid overdose decedents, 82 (53%) were female. Median were female 82 (53%) decedents, overdose opioid prescription Of 155

by using medical examiner records. Next-of-kin were asked about decedent characteristics that decedent asked about were usingby medical examiner Next-of-kin records. intent-undetermined or focused unintentional on death. the to We contributed might have an illicit not but drug, opioid, was as implicated a prescription a cause. deaths Data on where history substance abuse, assessed. illness, of mental were abuse Substance and prescriptions history wascocaine, defined heroin, using as hallucinogens, ever methamphetamine, or or ever illness Mental receiving substance abuse treatment. history was defined as having a chronic illness,mental a nondrug– for hospitalization or diagnosis illness mental of a provider, by psychiatric reason. related substance abuse or mental illness. mental substance abuse or duringprescribedpain majority used The medication their from the site was not based trauma distance was severity on or not A unified hospital. the site the to from incident is region warranted. capital nation’s the command system for resUlTs: CoNClUsioNs: meTHoDs: meTHoDs: KeyWorDs: 11:10 — Utah, 2008–2009 Prescription Opioid Overdose Deaths aUTHors: baCKgroUND: resUlTs: CoNClUsioNs: instrument and EpiInfo™. Semi-structured interviews were conducted at 10 of 11 hospitals with hospitals 11 of 10 at instrumentand EpiInfo™. Semi-structured conducted interviews were and disasterstaff. department emergency preparedness reported in 7 deaths. Of 64 injured patients, 10% were critical, 76% urgent and 14% minor. minor. and 14% urgent critical, in76% were reported 7 deaths. 10% Of 64 patients, injured hospitals The injurymechanismcommon most wasThe (60%). collision a with object fixed miles from 1-12 located and were betweenthat assisted 1 and patients 27 in received this event critical for patients 105–176) (range: average arrival The 140 crashthe site. was time minutes Jurisdictions hadmass different patients. casualty urgent for 35–405) and 200 (range: minutes and policies plans.response This a lackof resulted patients, of in an unsystematic distribution and hospitals. responders emergency among and communication poor coordination, 1999-2007. Knowledge is limited regarding these that factors Under fatal lead to 1999-2007. overdoses. efforts. can guidestanding opioids prevention characteristics those dying of prescription from age (46 years) was ( higher than years) age years) median (46 male age (32 reported for 93 (60%) decedents, prior heroin use for 31 (20%), and mental illness and mental history 89 for (20%), 31 use for heroin prior decedents, (60%) 93 for reported reportedly had used pain during Overall, their own prescribed their medication (80%) 124 (57%). pain with during prescribed of their medication last decedents last Use for year year. was common 79%). illness and mental (n=70; 71%), use (n=22; heroin 81%), history substance abuse (n=75; of

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59 ANNUAL EIS CONFERENCE: tUESDAY 75

Findings suggest that, as use time, has seatbelt increased measures over Preventing motor-vehicle crashes is a major public health challenge public is crashes a major in the motor-vehicle Preventing motor-vehicle crashes, BRFSS, survey seatbelts, self-report, motor-vehicle overdose; analgesics, opioid; prescription drugs; disorders; analgesics, mental prescription overdose; opioid;

Self-reported seatbelt use from the 2008 use the from seatbelt Behavioral RiskSelf-reported Surveillance Factor

Aybaniz Ibrahimova, R. Shults, L. Beck

National self-reported seatbelt use while was seatbelt 85%, observed useme was 83%. The self-reported National

dian state ratio of self-reported to observed use was 0.97, indicating that self-reported seatbelt seatbelt indicating that self-reported observed to use was 0.97, dian self-reported of ratio state than observed least at use halfuse lower for was somewhat jurisdictions. the of Linear regression with each use observed for jurisdiction seatbelt revealed a moderate comparing self-reported the association (r2=0.514). substance-related disorders disorders substance-related System (BRFSS) (n=406,552) was compared with 2008 was compared use observed collected seatbelt by (n=406,552) (BRFSS) System Safety Traffic Highway Administration National the by and published andstates territories observedto use seatbelt of self-reported was by madecomparison using ratios The (n=147,000). use and linearseatbelt modeling. regression of self-reported and observed use have converged and any bias in self-reported use due to social to use due and bias any in self-reported converged and observed use have self-reported of desirability has declined.complement The rather, surveillance but, two duplicate not do systems characteristics socio-demographic on BRFSS information and healtheach risk other. provides observational seatbelts, whereas surveys of than use other seatbelt nonuse differentiate behaviors type vehicle by patterns Further and analyses seating position. reveal differences may conver in age by andgence drivers and sex passengers. of KeyWorDs: CoNClUsioNs: meTHoDs: meTHoDs: resUlTs: KeyWorDs: 11:30 States Converged? and Observed Seatbelt Use in the United Have Self-Reported aUTHors: baCKgroUND: last year. Providers should use caution when prescribing opioids to patients with history patients of to opioids prescribing when use caution should last Providers year. illness. mental substance abuse or United States. In 2008, motor-vehicle crashes in the United States resulted in more than in resulted States 37,000 more crashes in United the States. In 2008,United motor-vehicle deaths and 5 million injuries and meansreduce effective to injuries. are most Seatbelts the use Americans among seatbelt deaths inhas a crash. been 10%–40% self-reported Historically, higher than use, use observed has seatbelt seatbelt and been validity the self-reported of questioned. persistently Wyoming officials could target prevention efforts on the Transportation, the on efforts officialscouldprevention Wyoming target

Four out of five years during 2003-2007, Wyoming reported the reported highthe Wyoming yearsduring five of 2003-2007, out Four Wyoming, surveillance,Wyoming, crashes fatalities, vehicle occupational motor

CDC gathered fatalityCDC gathered surveillance 2003-2007 data for Wyoming’s from

Paul J. Anderson, G. Conway, J. Lincoln

From 2003-2007 Wyoming recorded 210 workplace deaths. By industry, most most deaths. industry, By workplace 210 2003-2007 recorded From Wyoming

est worker fatality rate in the United States. Wyoming’s average annual worker fatality annual average worker of rate fatality States. Wyoming’s est worker inUnited rate the was almost 4 times fatality annual for the 15.3/100,000 U.S. 3.9/100,000 average worker of rate thisfor officials the CDC same contacted period. Wyoming guidance in prevention targeting efforts. Departments of Employment, Transportation, and Occupational Safety and Occupational and Health. Transportation, CDC Employment, of Departments crash vehicle fatalities matchingby death a motor confirmedcertificate occupational with a Transportation. of Wyoming Department crash file the from Oil and Gas, and Construction industries and on motor vehicle crash deathsOil and vehicle deaths and Gas, from motor and industries and on Construction Good suggests evidence with and objects equipment. thatcontact legislation, increased enforce health and messaging public ment, all use, increase seatbelt decrease driver speeds, and decrease crashes. Industrymortality vehicle partners also could motor technology from adopt that with machinery contact close from oil rigs on in workers and sites heavy construction removes Wyoming. CoNClUsioNs: CoNClUsioNs: KeyWorDs: resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: 11:50 11:50 2003–2007 Injury Deaths — Wyoming, of Occupational and Prevention Surveillance deaths occurred in Transportation (49) Oil and Gas Extraction (40), Construction (28) and (28) Construction Oil and Gas Extraction (40), (49) deaths occurred in Transportation deaths, while (49%) type, crashes caused 103 vehicle event By highway motor Agriculture (20). deaths falls, from (13%) 12 with and objects equipment, deaths contact from resulted (14%) 35 deaths exposure harmful from to substances. Speeding caused 30% (13%) MVC and 12 of cases use in of deaths, seatbelts rollover 58% did not reviewed. and Single-vehicle decedents MVC deaths. worker victim the 26% of for was andcrashes where ejected accounted unbelted

th 59 ANNUAL EIS CONFERENCE: tUESDAY 76 th

59 ANNUAL EIS CONFERENCE: tUESDAY 77

Ravinia Ballroom, 1:45–4:00 p.m. 1:45–4:00 Ravinia Ballroom, 0.05 In all all years, years). NHB children P<

......

NHB less likely children be diagnosed to were with milder ASDs, Research indicates non-Hispanic black (NHB) children black beResearch (NHB) less may indicates non-Hispanic

.05 in 2002, 2004, 2006) diagnoses PDD and less likely have to either of P< autism spectrum disorder, surveillance, spectrumautism disorder, racial disparities

Rugrats Participants were 1,273 8-year-old children identified as an surveillance ASD identified children 8-year-old 1,273 were Participants

: Richard Olney Vanessa G. Jarquin,Vanessa L. Wiggins, L. Schieve, Naarden K. Van Braun ASD prevalence was consistently lower among NHB among than lower NHW among wasASD consistently prevalence children

0.05 2002, ( 2006) disorder Asperger’s or

case in 2000-2006 records using abstracted health behavioral information from and education ASD mutually into grouped criteria. exclusive Children were with DSM-IV-TR consistent communityclassifications by basednoted on diagnosticspecificity placements educational and spectrum the on milder disorders disorder, including autistic in their records professionals [PDD-NOS]), otherwise specified disorder-not developmental pervasive and disorder (Asperger’s ASD eligibility,ASD an educational enough ASD and those without but diagnosis/eligibility, as an ASD racialsurveillance between inclusion case. warrant Differences to noted behaviors assessedand ethnic were using tests. groups chi-square such as PDD-NOS and Asperger’s disorder. This disorder. disparity to the and Asperger’s in diagnoses assuch contribute PDD-NOS may ASDs of in NHB prevalence children.lower the Undiagnosed NHB receive children not may necessary services. intervention KeyWorDs: resUlTs: CoNClUsioNs: meTHoDs: meTHoDs: MODERAtOR: MODERAtOR: 1:50 Time — Over Autism Spectrum Disorders in Community Identification of Racial Disparities Atlanta, 2000–2006 Metropolitan aUTHor: baCKgroUND: tUESDAY, APRIL 20 APRIL tUESDAY, sessioN g overall. However, NHB children were more likely NHB than more diagnosis children NHWoverall. documented were of However, have to ( disorder autistic ( NOS significantly were likelymore than NHWco-occurring childrento have intellectual disability, severity. for a proxy likely (NHW) white than spectrum an non-Hispanic children autism (ASD) have to disorder hypothesized that NHBdiagnosis. children We with milder particularly ASDs were under- communityidentified in settings. NHB children with undiagnosed mildof forms be may ASD services with NHW compared intervention less likely children. receive to School-Aged Children School-Aged

percentile of the CDC growth CDC the of percentile th ) ≥ age- and sex-specific 95 ) ≥ age- and sex-specific 2 Food insecurityFood increase appears to risk the obesity in of Mexican young Asthma and mortality morbidity in childhood appro by can be reduced In the U.S., over 10% of 2–5 year olds and almost 20% of 6–11 year olds year and olds almost 2–5 of 20% 6–11 In of 10% U.S., the over

food insecurity, obesity, young children, National Health and Nutrition children, young Healthfood insecurity, and National Nutrition obesity,

Measured weight and height and information on food insecurity on and information andMeasured height weight were

Brian K. Kit, C. Ogden Molly M. Lamb, C. Ogden

Logistic regression adjusted for age, foodLogistic insecurity for adjusted sex showed regression and poverty level

Examination Survey available from 5,579 participants in the National Health and Nutrition Examination participants Health Survey in and National the Nutrition available 5,579 from (NHANES, years. The NHANES age 2001–2006) 2–11 interviewindividual-contains five food insecuritylevel children, insecurity for Food a caregiver. answered by questions was defined as questions.Obesity an five of these was one definedaffirmative at to as least answer (kg) (m) / height a BMI (weight American childhood children designed reduce in to U.S. obesity the in Mexican Interventions American children strategies address to a child’s might food insecurity. consider 2:30 Asthmatic Children Following Among Asthma Medication Use Changes in Preventative Guidelines — United States, 1999–2002 and 2003–2006 Evidence-Based treatment aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: meTHoDs: meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: 2:10 Health and the National in U.S. Children? Paradox" Exist "Food Insecurity-Obesity Does the 2001–2006 Examination Survey, Nutrition was associated with obesity in Mexican Ratio Americans = 1.86. Confidence Interval (Odds 95% non-Hispanic or whites non-Hispanic for found were associations significant No 1.08–3.20). sex. either for or blacks, charts. Multiple logistic regression was conducted to investigate the association the between investigate to charts. was logistic conducted regression Multiple food non-Hispanic insecurityindividual-level for Separate analyses conducted and obesity. were blacks,whites, and non-Hispanic Mexican Americans, and both sexes. priate use of preventative asthma medications (PAM). To improve health outcomes of asthmatic of health outcomes improve To asthma (PAM). medications preventative use of priate released revised Program (NAEPP) children, Asthma and National Prevention the Education guidelinestreatment in 2002.of PAM thisdescribeto study is objective changes The use fol in lowing guidelines. the are obese. Childhood associated with and obesity household inversely has been both positively / resources). food insecurity money lack household (limited to of access food adequate due to access food may to data, however, studies only examined far thus Most have household-level differWe examined between foodindividuals insecurityindividual-level withinhousehold. a association withfor obesity in U.S. children.

th 59 ANNUAL EIS CONFERENCE: tUESDAY 78 meTHoDs: Data from 1,822 asthmatic children aged 1-19 years in the cross-sectional 1999 59 th

2002 and 2003-2006 National Health and Nutrition Examination Surveys were analyzed. ANNUAL Asthma was defined by self-report. The primary outcome, PAM use, was defined using the 1997 and 2002 NAEPP definitions Classes of PAM in the NAEPP guidelines include: inhaled cor ticosteroids, long acting beta agonists, leukotriene receptor antagonists, mast cell stabilizers, and methylxanthines. Data for prescription medications was collected during an in-home interview. EIS CONFERENCE: tUESDAY Multiple logistic regression was conducted to assess the odds of PAM use based on survey years, controlling for race/ethnicity, age, head of household education, and health insurance. resUlTs: Among asthmatic children, 21.1% (SE=2.0) in 1999-2002 and 30% (SE=2.9) in 2003-2006 were prescribed PAM. In 2003-2006, after the release of NAEPP, children and ado lescents had an increased adjusted odds of PAM use compared to those in 1999-2002 (AOR= 1.55, 95%CI 1.08-2.21) after adjusting for covariates. Non-Hispanic black (NHB) children, when compared to Non-Hispanic white (NHW) children, had a lower adjusted odds of PAM (AOR=0.62, 95%CI 0.46-0.82). Uninsured children had a lower adjusted odds of PAM use compared to insured children (AOR=0.5, 95%CI 0.26-0.94).

CoNClUsioNs: There was an increase in PAM use among asthmatic children following evidence-based treatment guidelines. Public health interventions should be geared towards addressing disparities in PAM use among NHBs and the uninsured population.

KeyWorDs: pediatrics, asthma, quality of health care, healthcare disparities

2:50 Overweight and Obesity Among third-Graders — New Hampshire, 2008–2009 aUTHors: Sherry L. Burrer, L. Anderson, R. Flynn, N. Martin baCKgroUND: The prevalence of obesity among U.S. children aged 6–11 years more than doubled from 1980 to 2006; obese children are at greater risk for chronic diseases. We examined obesity and overweight prevalence of New Hampshire (NH) third-graders to establish a baseline, identify correlates, and target interventions. meTHoDs: The cross-sectional survey used systematic sampling and was stratified by county and percentage of students participating in the free and reduced lunch program (FRL). During the 2008–09 school year, 3,086/4,725 (65%) third-graders participated at the 81 sampled public schools. Height and weight were measured by trained staff who used identical equipment; sex, birth date, and measurement date were recorded. We documented obesity and overweight status by calculating age- and sex-specific body mass index (BMI) values and by using the BMI-for-age percentile growth chart cutoffs, which define obesity as BMI ≥95th percentile and overweight as ≥85th–<95th percentile. Prevalence estimates were weighted to represent all NH third-graders and to reflect selection probability and nonresponse. resUlTs: On preliminary analysis, 18% (95% confidence interval [CI], 16.1%–19.9%) of NH third-graders were obese, and 15.4% (95% CI, 14.1%–16.7%) were overweight. Obesity prevalence was significantly higher among males (20.8%) than females (14.6%) P( = .02) and 79

<.0001). Obesity prevalence by by Obesity prevalence <.0001). P

During 2008–09 the Healthy the exceeded obesity prevalence year, school Adolescent alcohol use has alcohol been linked and injuries unintentional Adolescent to Increased perception of family support by a student has a protective has family of a protective a student by Increased support perception

New Hampshire, obesity, overweight, body mass Hampshire,New index,obesity, third-graders adolescent, alcohol consumption, risk factors consumption, alcohol adolescent,

We analyzed 2008 data from the Iowa Youth Survey, a census survey of public public surveyof census a Survey, Youth Iowa the analyzed 2008from data We

Mary E. Fournier, Quinlisk, P. A. Garvey, J. Goddard, S. Lyss

In 2008, a total of 97,741 sixth-, eighth-, and eleventh-grade students students and sixth-, eleventh-grade eighth-, In 2008, a total 97,741 of

2010 goal 5%. Obesity of was sex, by unevenly distributed FRL 2010 and county. category,

and private schools. We assessed use drinks and binge alcohol any drinking occasion) schools. We one and private on (≥5 to responses of basis the on dichotomized was support Family days. 30 previous withinthe life. in student’s the adult family of involvement level regarding members’ questions perceived associationagainst community-based programs or use. that teach families alcohol School- to use. mitigate alcohol might guide help adolescents and support People be should addressed by targeted inequities Identified interventions. CoNClUsioNs: KeyWorDs: resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: county ranged from 13.6% to 23.9%.county ranged to 13.6% from CoNClUsioNs: KeyWorDs: 3:10 — Youth Among Alcohol Use with Decreased Associated Perceived Family Support Iowa, 2008 among children in schools with >50% of students participating in FRL (27.3%), compared with compared participating in students FRL of childrenamong in with (27.3%), schools >50% ( participating (16.3%) students of those in with schools <25% participated in the survey. Overall, 62% (n = 60,999) of students reported perceived high levels perceived reported students of = 60,999) participated in Overall, survey. the (n 62% reported 13,592) = (n use, alcohol any and 14% reported = 18,543) (n familyof 19% support; binge drinking. those with of Among eighth graders, 11% use was by alcohol any reported high ratio family family low perceived (odds support those with and 26% of perceived support 0.35–0.40).Binge drinking[CI], of interval5% confidence by was reported 95% 0.37; [OR]: family low support those with of perceived highthose with family perceived and 15% support in same the direction, Associations although for were CI, 0.29–0.35). weaker, 0.32; 95% (OR: sixth graders. and eleventh violence, including deaths from homicides, suicides, and motor-vehicle collisions. Whether per suicides, including deaths and homicides, motor-vehicle violence, from well-understood. not use is influences family of alcohol receive level that youths ceived support a high support of level perceived who youths Iowa use in-school among alcohol compared We their familiesfrom less support. perceived with their who peers

th 59 ANNUAL EIS CONFERENCE: tUESDAY 80 th

59 ANNUAL EIS CONFERENCE: tUESDAY 81

Integrating HIV of recording TB results test into registers to led Tuberculosis (TB) is a leading (TB) death children cause among of with HIV. Tuberculosis child, surveillance population tuberculosis, HIV, From the 11 medium and large TB clinics in three regions, we extracted data data extracted we regions, three in clinics TB large and medium 11 the From Eleanor S. Click, B. Feleke, R. Gadisa, Fantu, T. D. Assefa, Z. Melaku,

In preintegration registers, HIV In preintegration clinic results test by ranged 0%–82% from

consistently complete data and accurate assurance ensure surveillance HIV of complete testing. of consistently To HIV children among with TB in Ethiopia, HMIS the TB/HIV report should data separately children.for CoNClUsioNs: KeyWorDs: meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: 3:30 Children — for treatment into tuberculosis tB/HIV Surveillance of Integration of Evaluation 2007–2009 Ethiopia, complete (median 48%, interquartile range [IQR] 24, 71); integrated registers were 86%–100% 86%–100% integrated registers were 24, 71); 48%, (median interquartile range [IQR] complete children Of 383 with results test in postintegration the 93, 100). 96%, IQR (median complete All HIV. for six positive tested staff interviewedmembers registers, range 26 (7%; 0%–33%) said that integrated the register facilitated HIV of recording that HMIS the data but will not children on data separately andreport adults. E. Pevzner, H. Menzies, J. Oeltmann, K. Cain Among children with TB disease, HIV early of diagnosis can and treatment decrease mortality. TB and HIVUnfortunately, care are well generally integrated, not and HIV data on infection in children with TB disease (TB/HIV) are lacking. In 2008, integrated HIV Ethiopia testing integrated evaluated current the impact the of registers. TB We its variables into treatment HIV documented register on testing and assessed planned the health management how impact system pediatric would (HMIS) information TB/HIV surveillance data. for children (aged <15 years) diagnosed with years) TB 2009. 2007–September We during September <15 childrenfor (aged children of HIV with registers percentages documented results test compared in preintegration also We and HIV TB for treatment testing) registers and (combined). postintegration (separate interviewed staff hospital about TB/HIV the HMIS. about and integration

0.01), 0.01), P< Ravinia Ballroom, 8:30–10:15 a.m. 8:30–10:15 Ravinia Ballroom,

Freqs and Geeks Freqs and

......

essioN H1: essioN H1: A novel model-based metric improved SSI risk-adjustment relative to to relative SSI risk-adjustment improved metric model-based A novel Over 3,000 occur surgical annually infections (SSI) site replacement hip

risk adjustment, logistic models, surgicalrisk adjustment, infection, population wound

We used data on fourteen patient, procedure, and facility procedure, used fourteen data patient, on candidate variables We Matthew E. Mu, Wise, J. Edwards, Horan, Y. M. T. Jhung, S. Fridkin,

Owen Devine

The final model incorporated seven new variables including replacement revision revision replacement including variables new seven incorporated model final The

ward Finalists

surveillance Peavy A Peavy for hip replacements reported to NHSN for 2006-2008 (n=131,948) to construct a logistic construct to NHSN to 2006-2008 reported for replacements hip for (n=131,948) final the performance contrasted model’s We expected for model SSI frequency. regression We characteristicwith operating NHSN the curves index using receiver the area under (AUC). calculated SIRs comparing observed and expected SSIs facilities for reporting replacements hip NHSNto in 2009. established methods. SIRs and will will in NHSNprovide effective 2010 be implemented healthcare facilities with figure a single,should This to evaluate risk-adjusted SSI frequency. SSI and increase program could of acceptance assessment surgeons’ facilitate SSI prevention surveillance data. CoNClUsioNs: KeyWorDs: resUlTs: meTHoDs: MODERAtOR: MODERAtOR: 8:35 Site Infection Frequency at of Hip Replacement Surgical Novel Metric for Risk-Adjustment 2006–2009 — National Healthcare Safety Network, Healthcare Facilities aUTHors: baCKgroUND: WEDNESDAY, APRIL 21 APRIL WEDNESDAY, s CoNCUrreNT (OR=1.46, 95% CI=1.27-1.68), partial replacement (1.35, 1.18-1.45), and trauma-associated trauma-associated and 1.18-1.45), (1.35, replacement partial CI=1.27-1.68), 95% (OR=1.46, as well and illness as two duration NHSN index variables (procedure 1.13-1.58), (1.34, procedure thisfor was model AUC 7% higher than established the for The risk ( index severity). Berrios-Torres S. Berrios-Torres in the United States, resulting in potentially severe complications. Risk-adjustment, employed employed Risk-adjustment, States, resulting in complications. in potentially United the severe in SSI surveillance comparability ensure facilities, across to in performed is currently the Healthcare SafetyNational of (NHSN) stratification Network usingindex three-variable a statistical determine whether modeling- to sought characteristics. and procedure We patient usingbased all collected standardized NHSN (SIR) ratios variables routinely could incidence SSI risk-adjustment. established replacement hip improve indicating improved SSI prediction. In 2009, model-based SIRs for 36 (5.3%) of 679 facilities 679 of In SIRs SSI 2009, prediction. model-based indicating 36 (5.3%) for improved observed of SSI times than number the indicated these predicted; more three spanned or a range facility types and sizes.

th 59 ANNUAL EIS CONFERENCE: WEDNESDAY 82 th

59 ANNUAL EIS CONFERENCE: WEDNESDAY 83

≥ two days after the incident infection. Patients lost lost Patients ≥ twoinfection. days after the incident spp. are the third most common cause of nosocomial cause bloodstream of are third the common most spp.

Candida This of analysis,PC,outcomes finds evaluate tothe indepen the an first Ovarian cancer causes more U.S. deaths than any other gynecologic gynecologic other any than deaths U.S. more causes cancer Ovarian

candidemia, epidemiology, Brazil, candidemia, mortality epidemiology, We systematically obtained hemocultures on days 0, 3, 5, 7, 14 and 21 on all on and 21 14 systematically obtained 0, days hemocultures 3, on 5, 7, We Crystal P. Tyler, M.Crystal Whiteman, Tyler, P. L. Zapata, S. Hillis, K. Curtis, J. McDonald, Loretta S. Chang, M. Nucci, A.Colombo, B. Chiller, Le, T. B. Park

Of 266 detected candidemia cases, 76 (29%) were persistent. Case-patient median Case-patient persistent. were Of 266 candidemia detected cases, (29%) 76 despite treatment, are not known. We performed a prospective, longitudinal, a prospective, performed known. We are not treatment, despite

infection. Outcomes of persistent candidemia (PC), in which hemocultures remain positive in which hemocultures remain positive candidemia (PC), persistent of infection. Outcomes Candidafor assess to study on survival. effect the of PC multi-center incident candidemia casesBrazilian incident five at definedWe duringhospitals April 2005–June 2007. PC as growing a hemoculture Candida PC status We be could ascertained) censored. 3 (before day deaths or before were follow-up to survival, The plotted cohort. and hazard functions combined the probability for density, between clinical relationship bivariate variables and survival via Kaplan- the compared were method. survivorship The common by statusfourPC to wasfitted Meier plotted function and Weibull,lognormal, and gamma. exponential, goodness-of-fit: for parametric distributions modeling the multivariable for of analyses risk bivariate from factors considered Potential were survivorship function via distribution. exponential the dent association with mortality. Further studies to determine preventable factors associated factors association with mortality. Furtherdent studies determine preventable to with PC are warranted. Effect of Body Mass Index and Weight Change on Epithelial Ovarian Cancer Survival — Change on Epithelial Ovarian Effect of Body Mass Index and Weight United States, 1980–1997 aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: 9:15 resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: 8:55 Bloodstream Persistent Candida Significance of Understanding the Cease: Won’t Yeast That Analysis Survival Prospective Multi-Center a — Infections age was 63.5 (range, 18-94 years) and 128 (48%) were male; 161 (62%) died. Median time to (62%) male; 161 were and 128 (48%) years) 18-94 (range, age was 63.5 CI 95% (AHR that PC 1.7, showed 0-96) model multivariable days. (range, death The was 23.5 and illness severity of 1.2-2.5), (1.8, 65 age over use (3.6, 1.3-14.6), history antibiotic of 1.4-2.2), significantly were associated death. with 1.9-3.8), (2.7, Wingo, MarchbanksP. P. trial with ovarian survival cancer cancers, relationship its is less clear. malignancy, approximately 14,900 in 2009. Although body mass index (BMI) has been associated associated been has (BMI) index mass body Although 2009. in 14,900 approximately malignancy, with survival with hormonally mediated malignancies women among as such and breast endome

-value for trend = 0.40). Similarly, neither age 18 BMI nor weight gain weight BMI nor age 18 Similarly, neither = 0.40). trend for -value p Although BMI is associated with likelihood surviving of cancers, we some Despite broad availability of other modern contraceptive methods, female availability broad contraceptive modern Despite other of

ovarian neoplasm, cancer, survival, ovarian cancer, neoplasm, body mass index, BMI We pooled data from four rounds of nationally-representative cross-sectional nationally-representative of rounds data four pooled from We We conducted a cohort analysis of the relationship between BMI and survival survival and BMI between relationship the of analysis cohort a conducted We Andreea A. Creanga, C. Shapiro-Mendoza, D. Williams, Stupp P.

During a mean follow-up of 9.7 years, 170 women died ovarian from cancer. women years, 170 9.7 of During a mean follow-up

reproductive health surveys conducted in Honduras and Nicaragua from 1991 through 2006 and health Nicaragua in surveys Honduras 1991 from conducted reproductive n=27,214; (Honduras: women reproductive-aged of and birth-cohorts synthetic constructed and specified separate approach a hierarchical adopted multi-level We Nicaragua: n=30,125). method, modern contraceptive cross-classifiedany logit ofpractice for models random-effects methods (pills, injectables, IUDs, condoms, surgical and female sterilization. sterilization) We estimated fixed effectsfor treatingage,cohorts by effects these for and periods two and random household education, residence, women’s for adjusted were models factors; variables as level-two survey design.wealth complex and for among 425 participants in the Cancer and Steroid Hormone (CASH) study, a population-based a population-based study, (CASH) cancer Hormone participants in 425 among and Cancer Steroid the ovarian epithelial whom in years 20–54 aged women included Cases study. case-control linkage data though ascertained was status vital Participants’ 1980–1982. during diagnosed was with Surveillance, the hazards and Results Epidemiology End proportional Cox system. Using association the between for survival estimatedmodels, we hazard (HRs) ratios and participants’ BMI quartiles at based their “usual” on both age self-reported at and weight adult 18, weight adult. to 18 age from change weight and diagnosis, found no evidence of its association with its ovarian of evidence cancer survival. no found meTHoDs: Age, Period and Cohort Effects on Contraceptive Practices — Honduras and Nicaragua, Age, Period and Cohort Effects on Contraceptive 1991–2006 aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: 9:35 resUlTs: meTHoDs: were associated withwere ovarian cancer survival. After adjusting for tumor characteristics, reproductive factors, and the presence of other other of presence Afterfactors, the and characteristics, tumor for adjusting reproductive association between adult no BMI and found ovarian we cancer survival. conditions, chronic the adult BMI quartile in lowest the with (<20.7), risk death women Compared among for third and fourth (22.6-24.7), quartiles (≥24.8) (20.8-22.5), inHRs second the women for CI, (95% 0.87and CI, 0.74-1.86) (95% 1.17 0.77-1.93), [CI], intervalconfidence 1.22 (95% were ( respectively 0.53-1.42), sterilization emerged as the most widely practiced method in Honduras and Nicaragua; in sterilization method Honduras as practiced widely most emerged the over sterilized, in are currently these countries women a 30% third increase reproductive-aged of one determine if this increase changes and corresponding in To con 1991. in since both countries effects, age, to cohort are due or period practices this traceptive analysis disentangles three the types effects. of

th 59 ANNUAL EIS CONFERENCE: WEDNESDAY 84 th

59 ANNUAL EIS CONFERENCE: WEDNESDAY 85

.05). Multiple comparisons were were comparisons Multiple .05). P< 0.001). Period effects Period affected of the use 0.001). P< The low percentage of U.S.-bornof highAsiansrelatively percentage low genotypic and The Cohort effects have independently contributed to the to the increase in use the contributed effectsindependently Cohort have Tuberculosis incidence among U.S.-born Asians among incidence in California increased Tuberculosis contraception, cohort, Honduras, Nicaragua Honduras, cohort, contraception, We identified active casesactive tuberculosis identified during 2005–2008 We Asiansamong Erin L. Murray, M. Cilnis, J. Westenhouse, S. Kanowitz, Shaw, T.

Six spatial clusters were identified during identified study period with Sixthe tuberculosis were spatial clusters After accounting for age and period effects, use of any contraceptive method method Aftervaried for age accounting effects,period contraceptive and any of use

from the California Tuberculosis Case Registry, country birth California the of from which includes and U.S. zip Tuberculosis code. used calculate intracensal Census yearly to Bureau estimates Asians were of code zip by used identify to spatial were clusters repetitions Carlo and Monte model A Poisson incidence. with significantly higher than expected ( annual incidence in for analysis. the accounted was Genotypic in diversity of defined a cluster distinctratio as the genotypes genotyped to cases. Asians among Statewide genotypic diversity all for was counties sumof definedof the distinctratio as genotypesthe to countyby all genotyped cases. diversity within tuberculosisdiversity infections among suggest latent spatial the of clusters reactivation disease was predominant the persons U.S.-born although source, foreign-born presence the transmission.these of Confirmation findingsrecent reflects efforts and probably to persons of all contraceptive methods, and all increase the disproportionallyof to in so female sterilization contraceptive counseling in both Strategiespractice and as countries. mass-media such targeted contraceptive contraception. non-surgical use modern of campaigns increase women’s may resUlTs: CoNClUsioNs: meTHoDs: 9:55 Among Incidence Active tuberculosis Areas of Increased Identify to Analysis Using Spatial Asians — California, 2005–2008 aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: resUlTs: incidence rangingincidence 1.6–4.6 from times statewide the Asian during rate 2005–2008. the of Four U.S.-born Asian included cases,clusters 0.7%–4.7% comprising all of cases within their spatial Among five clusters. the with genotype clusters respective data, genotypic diversity ranged California with 0.65–0.93, for from 0.65 compared Asians. all modern methods considered together more so than birth-cohort membership (Honduras: (Honduras: than so membership birth-cohort more together all methods considered modern coefsc=0.276 vs. coefbc=0.187; Nicaragua: coefsc=0.432 vs. coefbc=0.203; all p-values<0.05). of femaleso sterilization,practice than more influenced the positively birth-cohort Conversely, effects.period by birth-cohort membership in both countries ( in both countries membership birth-cohort by J. Flood, J. Watt from 2.8from 3.3 to cases/100,000 during population 2005–2008, disease about raising concerns studied areas with high Asians among transmission. We tuberculosis incidence and examined transmission. possibilitythe recent of

Dunwoody Suites, 8:30–10:15 a.m. Dunwoody Suites, Big Brother essioN H2: essioN H2: This characterizedsystem circulatingrespiratory viruses demonstrated and

Influenza causes ~36,000 Influenza causes deaths annually In York 2004,nationwide. New

tuberculosis, spatial analysis,Asians, genotype EHR alerts were added to encourage clinicians to perform respiratory virus virus respiratory perform to clinicians encourage to added were alerts EHR Teeb Al-Samarrai,Teeb N. Soulakis, M. Plagianos, C. Greene, L. Thorpe,

James Buehler

......

Of 5,775 clinical encounters, 445 (8.3%) were ILI were cases. Overall, Of clinical 5,775 results test 445 (8.3%) 108 encounters,

or diagnoses were entered. Alert triggers included but were not restricted to ILI. Specimens were were diagnosticSpecimens testingILI. nasopharyngeal by symptoms to influenza-compatible when collection specimen restricted not were but included triggers Alert entered. were diagnoses or polymerase all MassTag later, specimens underwent initially using AntigenTest; tested a commercial and specificities Sensitivities viruses, respiratory 12 for including pH1N1. chain (mtPCR) reaction calculatedwere mtPCR with as gold detecting pH1N1 for ILIof case definition and AntigenTest 30,standard, 2009 using May–June results. that the ILI case definition is more sensitive than antigen testing for pH1N1. We recommend recommend We that ILIthan the pH1N1. testing sensitive for antigen casemore definition is specimens and send that this virus respiratory surveillance AntigenTest the system discontinue virus respiratory directly for mtPCR for identification. CoNClUsioNs: meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: KeyWorDs: 21 APRIL WEDNESDAY, s CoNCUrreNT MODERAtOR: 8:35 Testing for Antigen Versus Illness Case Definition Influenza-Like Test: Not To or Test To — New Virus Surveillance System A (H1N1) in a Pilot Respiratory 2009 Pandemic Influenza May–June 2009 City, York increase diagnosis and treatment of latent tuberculosis infections within latent increase are of diagnosis these clusters and treatment recommended. were available; of these, 76 (70%) had an mtPCR-identified respiratory virus, commonly most had an mtPCR-identified (70%) these, available; of 76 were 29% (sensitivity, positive AntigenTest 20 were with pH1N1, patients Of 69 (91%). pH1N1 [95%CI: 70% (sensitivity were ILI48 cases 84–98]); [95%CI: 94% specificity, 18-41]; [95%CI: 29-49]). [95%CI: 39% specificity, 57-80]; Surveillance E. Begier, J. Lurio, Briese, T. I. Lipkin, Wu W. City (NYC) began (NYC) syndromicCity surveillance influenza-like for illness(ILI) using ambulatory pilot a long-planned In 2009, May NYC implemented (EHR). health records electronic surveillance characterize system to in viruses respiratory with cough) ≥99.9°F causing ILI (fever communitythe linking by EHR data with diagnostic testing in nine community health centers. assessed sensitivity and specificity of We the ILI casesyndromic ofdefinition and influenza virus(pH1N1) during influenza pandemic the A(H1N1) A/B antigen testing (AntigenTest) peak in period spring 2009.

th 59 ANNUAL EIS CONFERENCE: WEDNESDAY 86 th

59 ANNUAL EIS CONFERENCE: WEDNESDAY 87

.001) to 2005 to .001) 01); nontraditional HIMR nontraditional 5.4 increased to (Chi- 20% 4.5 from 01); .0 Differences Differences in revisedHispanicreportingon death certificates accounted Since 1996, Florida’s infant mortality (IMR) rate has during Florida’s been stable; 1996, Since .001). .001). infant mortality, Hispanic, Florida, vital records syndromic surveillance, influenza, health records, electronic 2009 pandemic We included live births among Florida residents using 2004–2007 births live residents included Florida among linked We Erin K. Sauber-Schatz, Sappenfield, W. Hernandez,L. K. Freeman,

From 2004 From 2007 to 1,000 per births, live traditional HIMR from increased 55% =.03). From 2004 From 2005, to traditional HIMR=.03). births; live increased 1.8/1,000 by non

influenza A (H1N1), influenza-like illness, MassTag PCR PCR influenza-like illness, MassTag (H1N1), influenza A birth and infant deathbirth certificates.collectedon not certificates;is Infant race/ethnicity HIMRtherefore, is traditionally calculated with infant Hispanic classificationdeath from certificates,maternal but Hispanic classificationbirthfrom certificates. Using linked data, we classified Hispanicethnicity birthsof infantand decedents live based maternalon ethnicity birthfrom certificates calculated and HIMRs,nontraditional death of certificate independent ethnicity reporting. Hispanic was defined Mexican,as Puerto Rican,Cuban, Central/South Hispanic.American, other/unknown or for the majority of traditional HIMR of majority the for increase, indicating IMR increase was primarily artifac tual. HIMR, nontraditional Using IMR still increased 20% during 2004–2007. Assessment ethnicityof birth on and death certificates criticalis to understanding of infantmortality.Use HIMRs,nontraditional Hispanic of classification, source which utilizebe should a consistent considered. KeyWorDs: CoNClUsioNs: meTHoDs: resUlTs: 8:55 — Florida, 2004–2007 Hispanic Infant Mortality Rate Reasons for the Increasing aUTHors: baCKgroUND: KeyWorDs: to 6.2 (Chi-square P< 4.0 6.2 to (Chi-square square P traditional HIMR increased 0.8/1,000 by births. live births This live 1.0/1,000 of difference traditional the HIMR of increase.revised 55% for The accounts death certificate notchange did maternal and infant Hispanic ethnicity 2004 from agreement P< (kappa=0.76, P< (kappa=0.78, Barfield,W. D. Bensyl 2004–2007, Florida’s Hispanic IMR 2004–2007, In (HIMR) 2005, Florida’s increased implemented 55%. Florida a revised deathdetailed certificate We assessed more race/Hispanic with ethnicity assessment. HIMR the whether increase was real artifactual. or

In the absence of paired serology, single positive results appear reliable for for results appear reliable single paired positive In of serology, absence the The emergence of 2009 pandemic influenza A (H1N1) virus, which of 2009 (H1N1) emergence pandemic The influenza A La Crosse virus La Crosse is primary the (LACV) arboviral cause of encephalitis La Crosse virus, La Crosse surveillance encephalitis, serology, Data regarding patients with suspected La Crosse encephalitis were reported reported with Data regarding suspected encephalitis were La Crosse patients Nancy J. Williams,Ghosh, R. T. Vogt Rendi Murphree, J. Dunn, Schaffner,JonesT. W.

During 1997–2009, a total of 108 cases and 258 noncases were reported. Sensitiv were noncases cases a total 108 and of 258 During 1997–2009,

to the Tennessee Department of Health during 1997–2009. Patients with a four-fold rise in with a four-fold Patients Health of during Department 1997–2009. Tennessee the to in paired classified titers antibody LACV serum were samples as cases; lackingthose a four-fold these data noncases. as Using rise standard, the were calculated specificity, we and sensitivity, diagnosis. for a single of values titer antibody acute predictive diagnosing surveillance encephalitis for La Crosse purposes. serology surveil acute for Using lance will increase case sustainability ascertainment and promote and statewide expansion of system.the aUTHors: aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: 9:35 Absenteeism Influenza Surveillance Indicators: Lessons Evaluation of Three School Tri-County (Denver Metropolitan A (H1N1) — the 2009 Pandemic Influenza Enabled With Region), Colorado resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: 9:15 Surveillance La Crosse Encephalitis Serology for Paired Acute Versus ity of a single acute antibody titer was 75%, specificity 98%, positive predictive value95%, specificity waspredictive and ity a single 75%, of 98%, titer antibody acute positive 90%. value predictive negative Among cases, median interval and acute onset between symptom was single a Sensitivity 70% of titer antibody acute serum 0–20 days). was draw 4 days (range: regard casesdata among with1997–2009, onset. days after serum During drawnsymptom <4 also were titer convalescent no but titer antibody with acute a singleing positive patients 37 (age, reported. Their characteristicssex,race, hospitalizationrate, geographicand distribution) differdidconfirmed not from cases. disproportionately affects school-aged children, prompted Tri-CountyHealth Department affects children, school-aged disproportionately prompted an influenza-like-illness develop to (ILI) surveillance and basedabsenteeism on system school outbreaks. of identification enable timely health to office visits among North Americanamong children.of 1997serologically AfterconfirmedLACV cluster a infec surveillance active priorities, with Faced in competing easttions Tennessee, was implemented. if determine to surveillance sought the we system can be maintained using by data regarding titer. withantibody suspected encephalitis and La a single Crosse patients LACV-specific acute

th 59 ANNUAL EIS CONFERENCE: WEDNESDAY 88 th

59 ANNUAL EIS CONFERENCE: WEDNESDAY 89

Three of our active school surveillanceour school Threeof active peaked indicators weeksprior two Angioedema is an allergic characterized swelling reaction rapid by of

2009 pandemic influenza A (H1N1), primary schools, secondary schools, 2009(H1N1), influenza pandemic A We identified emergency department (ED) visits for suspected medication- suspected for visits (ED) department emergency identified We We performed active surveillance of all-cause school absenteeism, ILI-specific surveillanceabsenteeism, all-causeactive of school performed We Elissa Meites, Johnson, N. Shehab, D. V. Budnitz

Overall, of 226 outbreaks detected August 31–November 21, all-cause 21, August31–November detected 226outbreaks Overall,of

surveillance, influenza related angioedema between January 1–December 31, 2007, from a nationally representative a nationally from representative 2007, angioedemarelated 31, between January 1–December U.S.63 hospitals.of stratified probabilityCasesclinically for visits sample included document allergy medication to ed angioedema attributed edema assigned or treating the clinician. by We and calculated selection, probability of case based weights inverse the national sample on design. sample complex for accounting (CIs) intervals confidence estimates and 95% lance of all-cause absenteeism at an additional 163 schools. We tracked outbreaks, defined as ≥2 defined as outbreaks, tracked We schools. 163 an additional at all-cause absenteeism of lance all-cause following the of was absenteeism, observed: ≥10% ≥1 days where school consecutive compared ourWe different ≥2% or ILI-specific ILI-specific health visits. office absenteeism, ≥5% types surveillance of of and with another counts with detected one outbreaks of and numbers hospitalizedlaboratory-confirmed withininfluenza(all counties.cases our ages) three school absenteeism, and ILI-specific school health office visits at 216 schools, 216 and passive and ILI-specifichealthsurveil absenteeism, at officeschool school visits to hospitalizations; schools might be viable alternatives to outpatient sentinel providers for for providers sentinel might outpatient schools hospitalizations; to be alternatives to viable ILI surveillancecommunity-level surveillance Passive activity. no was is ineffective.There produced our a school nationally definitions for ILIoutbreak definition three and accepted definition. a better develop to is needed results; work inconsistent meTHoDs: 9:55 Angioedema — United for Suspected Medication-Related Emergency Department Visits States, 2007 aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: resUlTs: meTHoDs: absenteeism, ILI-specifichealth absenteeism, and office visit absenteeism, surveillance found 88%, 24%, definedby outbreaks the of all-cause (35%) 69 for and 0%, accounted 8 schools respectively; surveillance Active outbreaks. the of (<1%) only two surveillance identified Passive absenteeism. and and daily (36) all-cause of rates (7.3%) outbreaks/week school of indicated that number the Laboratory-confirmed 39. Week influenza (2.0%) each peakedduringILI-specific absenteeism surveillance preliminary since are Results 41. Week during peaked cases/week hospitalized continues. deep layers of the skin or mucous membranes that can be membranes life-threatening affecting skin the of when mucous or layers deep the oropharynx. carry medications of Hundreds warning labels angioedema, for population- but describe clinical to the sought of based epidemiology are scarce. these data reactions We on angioedema and identify associated commonly medications. medication-related

Typhimurium in a Pennsylvania Typhimurium Ravinia Ballroom, 10:30 a.m.–12:00 p.m. serotype Typhimurium infections in August serotype Typhimurium 2009. Cougar town Cougar town

1: 1:

typhimurium Infections Associated with Exposure to Baby Associated with Exposure Infections Salmonella typhimurium essioN i Since 1990, >25 outbreaks of human of salmonellosis outbreaks linked with contact to >25 1990, Since ED visits for medication-related angioedema and often are common ED medication-related visits for

adverse drug adverse reporting systems, reaction angioedema, drug hypersensitivity, We conducted a case-control study to examine between to illness study relationship the a case-control conducted We Anagha R. Loharikar, E. Cavallaro, C. Schwensohn, S. Vawter,

Tracee A. Treadwell Tracee

We identified 41 cases; the median age was 8.5 (range <1-70) and 31% (9/29) were were (9/29) 31% and <1-70) 41 cases;(rangemedian identified the agewas 8.5 We Nationally, there were an estimated 58,625 ED visits (CI=48,227–69,023) for for an ED estimated visits (CI=48,227–69,023) 58,625 were there Nationally, ......

emergency treatment treatment emergency zoonoses and contact with A case poultry. baby and contact was defined as Salmonella 2009, yielding with 10, between 1 and October onset May an indis isolate resident York New or tinguishable from the outbreak strain by molecular subtyping and multiple-locus variable-number tinguishable strain molecular variable-number outbreak by the from subtyping and multiple-locus investigations age- and analysis. geographically-matched. were tandem repeat Traceback Controls completed. were sampling environmental and require emergent interventions. Awareness of these serious allergic these serious of is recommended, reactions Awareness interventions. emergent require especially starting when medications. new meTHoDs: meTHoDs: resUlTs: Poultry from Agricultural Feed Stores and Mail-Order Hatcheries — United States, 2009 Agricultural Poultry from aUTHors: baCKgroUND: KeyWorDs: 21 APRIL WEDNESDAY, s CoNCUrreNT MODERAtOR: 10:35 Dirty Chicks: Human CoNClUsioNs: resUlTs: hospitalized. Twenty-nine cases and 26 controls were enrolled. Live baby poultry enrolled. baby was Live were cases contact and 26 controls hospitalized. Twenty-nine odds ra (matched controls of (1/26) 4% to compared case-patients of (19/26) 73% by reported 95% (mOR=14, chicksContact with 2.6-710.5). [CI]= interval confidence 95% [mOR]=17, tio suspected medication-related angioedema in 2007, based on a sample of 982 cases, 982 angioedema of based a sample in on including 2007, suspected medication-related and CI=61%–68%) (65%; angioedema.women by with documented 166 visits were Most antihista steroids, (e.g., oropharyngeal ED treatment involved swelling CI=55%–64%). (60%; 80% for required and visits, 9% of (CI=73%–87% and were hospitalization mines, intubation) CI=29%–39%) (35%; implicated frequently most were Antibiotics respectively. and 4%–14%), (43%; implicated in these visits overall; frequently renin-angiotensin most antagonists were angioedema. with subset only the among documented visits of least At 73% CI=27%–59%) medication a new of dose started one and to 39% medications, recently to attributed were and 34%–43%, (CI=67%–79% respectively). Hyytia-Trees, P. Lafon, P. E. J. Kincaid Hyytia-Trees, Adams, B. Le, A. Rhorer, K. Warren, M. Deasy III, M. Moll, C. Sandt, R. Gilhousen, E. Villamil, C. Barton Behravesh live poultry from mail-order hatcheries have been reported. Distribution of birds through birds of been reported. Distribution have poultrylive hatcheries mail-order from agricultural occurs hatcheries with mail-order minimal by or feed stores regulatory oversight. Salmonella of an investigated outbreak We

th 59 ANNUAL EIS CONFERENCE: WEDNESDAY 90 th

59 ANNUAL EIS CONFERENCE: WEDNESDAY 91

, baby poultry, agricultural poultry, , baby hatcheries, mail-order feed stores, Young live poultry live remain human an of salmonellosis, important source Young Patient delay in PEP initiation is an important problem in Rico. Puerto is an in initiation important PEP delay problem Patient Timely initiation of rabies postexposure prophylaxis (PEP) composed of of composed postexposure (PEP) prophylaxis rabies of initiation Timely Salmonella rabies, postexposure prophylaxis, delay, initiation initiation postexposure rabies, prophylaxis, delay,

Study cohort consisted of patients who were recommended for PEP by the the by PEP for recommended were who patients of consisted cohort Study Kis Robertson, B. Rivera-García, R. Serrano, A. Oquendo, J. Blanton,

By August 31, 2009, 347 patients had initiated rabies PEP within PEP had initiated 2009, rabies period. study the 347 patients August By 31, Typhimurium from a duck flock; PFGE is flock;pending. a duck from Typhimurium

children PRDH and received rabies immune globulin between vaccine rabies PRDH rabies of and dose received and least at one was 2008 obtained health 1, 2009. from each Data for patient September and August 31, and multivariate Cox Univariate interview. and through telephone records department analysisregression was used examine between to demographics, exposure relationship the characteristics, variables with and other interval the time between recommendation of PEP delay). patient as (defined initiation and PEP Increasing the number of medicalIncreasing of number the facilities administer rabies to authorized and promoting PEP animal treat who strategies im victims to physicians among bite are recommended awareness timeliness. PEP prove particularly children. among hatchery mail-order outbreaks The industry hasnumerous caused human of salmonellosis, particularly via agricultural and poses feed stores, an challenge ongoing health community. public the to KeyWorDs: CoNClUsioNs: meTHoDs: resUlTs: Factors Associated with Patient Delay in Rabies Postexposure Prophylaxis Initiation — Associated Factors Puerto Rico, 2008–2009 aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: 10:55 CI 2.1-592), ducklings (mOR=8, 95% CI 1.1-355), and visiting Feed Store Chain X (mOR=5, Chain (mOR=5, X and visiting Store Feed 1.1-355), CI 95% ducklings (mOR=8, 2.1-592), CI significantly were associated with Chainpoultryillness. 1.1-46.9) received CI X Store Feed95% egg sampling Environmental sources. Hatchery yielded multiple A,from by which is supplied Salmonella Median patient delay was 15 days (range: 0-140), with 23% of patients initiating greater PEP patients with of 23% 0-140), days (range: was 15 delay Median patient than 30Exposureto days after recommendation. animals other thanwas mongoose indepen while 0.10-0.32), CI 95% 0.18, [HR] (hazard ratio delays associated patient withdently longer (HR delay less was days or associated patient with 10 shorter recommendation time-to-PEP 1.43-2.55). CI 95% 1.71, J. Rullán, C. Rupprecht rabies immune globulin and multiple doses of rabies vaccine is critical to preventing disease is vaccine critical immune preventing in globulin rabies to rabies doses of and multiple animals. exposedpersons rabid to in Rico Puerto investigation and CDC Puerto the by A prior days were > 10 initiation Rico revealed Health that days-to-PEP of (PRDH) Department we barriers timely PEP, potential to observed elucidate in victims many animal of To bites. PEP delay in initiation. assessed associated factors with patient-specific

causes approximately 1.4 million 1.4 causes infections, approximately 15,000 hospital Salmonella Thrombocytopeniawas of be a HPS should highly and indicator sensitive

Hantavirus is Pulmonary a nationally notifiable disease, (HPS) Syndrome hantavirus pulmonary syndrome,epidemiology, sensitivity and specificity,

Among patients with samples submitted to the CDC for hantavirus CDC for the to with submitted testing samples Among patients Shauna L. Mettee, L. Capewell, C. Barton-Behravesh, J. Hall, M. Poulson, Barbara Knust, A. MacNeil, Rollin P.

Of 157 suspected HPS patients tested, 101 were serologically negative and 56 were were 56 and negative serologically were 101 tested, HPSpatients suspected 157 Of

disease notification between 2003-2009, we compared clinicalbetween compared 2003-2009, we characteristics and between those with positive of valuesclinical predictive negative and positive specificity, results. test negative Sensitivity, white elevated thrombocytopenia,findings,hematocrit, of fever, elevated presence including suggestive distress respiratory acute syndrome, of and treatment cell X-ray chest blood count, calculated. oxygen were with supplemental included in surveillanceincluded suspect for definitions HPS. Clinicians HPS in febrileconsider should with signs respiratory and thrombocytopenia. presenting patients 11:35 11:35 Multistate Outbreak of Human Salmonella typhimurium A Not Easy Being Green: It’s Frogs — United States, 2009 Aquatic Associated with Infections aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: 11:15 11:15 — and Case Definition Clinical Findings Syndrome of Hantavirus Pulmonary Evaluation 2003–2009 United States, laboratory confirmed. The clinical finding most sensitive for HPS was thrombocytopenia (95%), (95%), thrombocytopenia for HPS was The confirmed. clinical sensitive most laboratory finding of thrombocytopeniawith combination The (83%). specific was most while hematocrit elevated clinical positive other cases finding leastat one was most moderately positive and detected the The 55%). Value= Predictive 95%, Positive results test (Sensitivity= positive of predictive all of but presence six clinical(90%), findings test of a positive had value highestthe predictive all met patients 6 criteria. only positive 42% of S. Cosgrove, L. Fawcett, K. Lujan, M. Adams-Cameron, K. Torres, Winpisinger, P. A. Kimura, Hudecek, P. J. Yaeger, N. Garrett, B. E. Le, G. Ewald, Hyytia-Trees., L. Hausman, I. Williams, S. Sodha izations, and 400 deaths annually States. Reptiles and in amphibians United the are known and more than 500 cases have been identified in the United States since its in thansince States description first United 500and more cases beenin identified the have HPS is an illness respiratory acute 1993. with a case 36%. mortality Progres approximately of and death shock are often to swift.sion other diseases, resemble can Clinical presentation which diagnosis, cloud may and management, evaluating reporting. By clinical findings patients in identify HPS. to characteristics of HPS,suspected for attempt predictive we

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59 ANNUAL EIS CONFERENCE: WEDNESDAY 93

Typhimurium infections Typhimurium , pulsed-field gel electrophoresis, electrophoresis, gel , pulsed-field Dunwoody Suites, 10:30 a.m.–12:00 p.m. infections associated with turtle contact strains than strain other outbreak and the

......

Epidemiologic and laboratory evidence from this investigation identified ADFs ADFs identified investigation this from evidence laboratory and Epidemiologic Before vaccine licensure in 1995, varicella in licensure vaccine infection 1995, Before in resulted >10,000 amphibians, frog, Ranidae, Salmonella We conducted a matched case-control study. Cases were defined Cases Salmonella as were study. case-control a matched conducted We Jessica A. Kattan, H. Bohnwagner, L. Sosa, J. Hadler

Nancy Messonnier

We identified 85 cases from 31 states; 34% (16/47) were hospitalized none were and (16/47) states; 31 34% 85 cases identified from We carriers. While Salmonella of outbreaks

Typhimurium infection in a person whose isolates matched the outbreak strain gel pulsed-field outbreak the matched isolates infection whose in a person Typhimurium analysis tandem repeat patterns. Controls variable-number and multiple-locus electrophoresis infection with Salmonella with recent persons were obtained patients’ from were samples Environmental age by residence. andmatched county of samples. tracebacks positive on with subsequent homes other reptiles should be expanded to include risk for salmonellosis from frogs and other amphibians. amphibians. other and frogs from salmonellosis for risk regarding this of as risk illness Public outbreak. education source the for associated with turtles and include to expanded be should reptiles other aUTHors: aUTHors: baCKgroUND: KeyWorDs: 21 APRIL WEDNESDAY, Concurrent Session I2: Just Shoot Me and Preventable Diseases Vaccines MODERAtOR: 10:35 Epidemiology — Connecticut, 2005–2008 on Varicella Impact of 2-Dose Vaccination CoNClUsioNs: meTHoDs: resUlTs: Salmonella outbreak associatedreported. no been identified, with haspreviously amphibians have been During Salmonella of Fall outbreak multistate a investigated 2009, we predominantly among children. among predominantly died. Median age was four years (range = <1-54 years); 79% were <10 years. Among 19 cases years. Among 19 <10 79% were years); died. Median age = <1-54 was four years (range illness controls, was significantlyand 31 cases3% vs (63% associated exposureto with frogs CI=4.0-infinity).who knew the frog type, mOR=24.4, 6 case-patients Among controls, allwere exposed a single to frog species, aquatic African the samples Environmental Dwarf (ADF). Frog matching isolates yielded aquariums outbreak the from homes containing ADFs in 4 patients’ Environmental breeder. a common to converged ADF’s of investigations strain. Traceback facility strain. outbreak the yielded breeder’s the from samples hospitalizations and deathshospitalizations 100 annually States. In varicella Connecticut, in United the has indicating during remained stable that 2001–2005, the Incidence 2001. since been reportable childhood program. with had been reached 1-dose the vaccination In 2006,limits control of routine of Advisorythe implementation Immunization Committee on Practices recommended initial varicella impact on assessed this children. for 2-dose recommendation’s vaccination We inepidemiology Connecticut. animals, humans, child, infant

Varicella incidence has declined rapidly in Connecticut coincident with with coincident Connecticut in rapidly declined has incidence Varicella Of the world’s estimated 527,000 annual estimated rotavirus 527,000 deaths in children Of world’s the varicella, vaccination, epidemiology, Connecticut Connecticut varicella, epidemiology, vaccination, Published and unpublished data and national statistics were used estimate to the data and Published statistics were national and unpublished Connecticut varicella Connecticut surveillancedaycares, is passive. Healthcare providers, Douglas H. Esposito, Parashar, U. G. Kang J. Tate,

Annually in India, rotavirus diarrhea causes an estimated 122,000–153,000 Varicella incidence decreased from 48.7 cases/100,000 persons in 2005 to 24.5 24.5 to 2005 in persons cases/100,000 48.7 from decreased incidence Varicella

annual visits and rotavirus their associated of deaths, number hospitalizations, and outpatient age years children of among costs in <5 India. Impact a rotavirus program of on vaccination dollars US expressed in per disability-adjusted and cost-effectiveness, these healthlife- events calculated. were year (DALY), and schools are required to report varicella report areand to required schools required. cases; not laboratory confirmation is tabulated using by 2005–2008 were and frequencies rates varicellaIncidence Connecticut surveillance data. implementation of routine 2-dose varicella vaccination for children. However, 2-dose vaccine 2-dose varicella children. for routine vaccination However, of implementation among increased paradoxically has cases of number the and disease, experiencing are fullrecipients the determine to needed is surveillance Continued adults. and adolescents, older infants, and risk trends for factors children for monitor and to 2-dose the impact recommendation of groups. age older among incidence increasing possibly meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: 10:55 of a National Rotavirus Vaccination Projected Impact and Cost-Effectiveness Program — India resUlTs: meTHoDs: deaths, 457,000–884,000 hospitalizations, visits in and years 2 million children <5 outpatient million age.of annually India $41–72 spends in medical rotavirus treat diarrhea. to costs Based programrotavirus would and a efficacy, availablevaccination estimateson coverage vaccine of $20.6 visits and save outpatient deaths, 43,963 293,086 hospitalizations, and 328,156 prevent persons aged 1–4 years (29%), 5–9 years (66%), and 10–14 years (48%). Despite this decrease, decrease, this Despite cases/100,000 in 2008. persons During(48%). this varicella of period, number the casesyears decreased among 10–14 and (66%), years 5–9 (29%), years 1–4 aged persons cases. of of casesnumber The increased (83%) majority the for years accounted children aged 1–14 In 2008, cases of 63% years (82%). and >20 years (9%), 15–19 year (36%), aged persons among <1 unvac among and 23% 2-dose among recipients, 14% recipients, vaccine occurred 1-dose among cinated persons. under 5, more than 25% occur in than India. 5, 25% more 2009 global the under for With use WHO recommendation policy help makers rotavirus inof vaccines, India. immunization be introduced soon may To assess rotavirus in of India, value vaccination the rotavirus determined national the we disease rotavirusof a vaccination and estimated impact the and burden cost-effectiveness and economic program.

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59 ANNUAL EIS CONFERENCE: WEDNESDAY 95

= .01). Two (1%) stu (1%) Two = .01). P LAIV time savings offered easebetter and of administration. LAIV A national rotavirus program A national in vaccination India will substantial prevent School-aged children account for 25%–43% of infections 25%–43% of children School-aged during for account influenza, vaccination, live-attenuated influenza, influenza vaccine,inactivated vaccination, trivalent live-attenuated

rotavirus, India disease cost-effectiveness, burden, We conducted a prospective study in during study schools three 2009 the public a prospective conducted We Meera V. Sreenivasan,Meera V. M. C. Wong, Giles, R. H. Toiya, Okumura,

Of 657 students, 213 (32%) received LAIV (mean: 75 seconds; 95% confidence confidence LAIV 95% seconds; received 75 (mean: (32%) 213 students, Of 657 = .0001). Therefore, 192 childrenin a clinic,vaccinatedwould be Therefore, 4-hour with LAIV= .0001). influenzavaccine, clinic school campaign. We videotaped all vaccination encounters and calculated all videotaped campaign. encounters administration vaccination time by We started Time arrival after on and ended review. vaccinatedbeingvideotape station a vaccine at reviewed and verifiedidentification vaccinator the and departing additionally, station; the calculated mean times administer to We contraindications. LAIV and TIV all to and students t-test and We usedstudent’s size. for first the group in to three the students clinics30 control to establish to chi-square significance. should improve ability to vaccinate healthy children rapidly, but excludes children with excludes but ability children healthy vaccinate to rapidly, improve should influenza clinicsvaccination valuable modeling assets School-located are for contraindications. clinics.mass-vaccination rotavirus morbidity and mortality and, at the GAVI price, would be cost-saving to the Indian the to rotavirus and mortality morbidity be cost-saving price, would and, GAVI the at Public health officialsgovernment. can use implementa for locally-derivedthis todata advocate this of very tion effective cost intervention. CoNClUsioNs: KeyWorDs: meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: 11:15 Attenuated Influenza Between Seasonal Live Administration Time Comparison of Stop Flu at School Campaign — Vaccine During Hawaii’s Influenza and Trivalent Vaccine Hawaii, 2009 million in medical annually. costs Global the At Alliance and Immunization Vaccines for million but $0.20 of price dose, $17.3 per a rotavirus cost program would vaccination (GAVI) will million $3.3 Indian the $2.44 save averted. or government DALY per interval [CI], 73–78 seconds) and 444 (68%) received TIV (mean: 86 seconds; 95% CI, 83–90 TIV 95% 86 seconds; received and 444 (mean: seconds) (68%) 73–78 interval [CI], P seconds; 75–82CI, (95% children was Mean first78 the withseconds time for TIV. students 30 167 or TIV for LAIV for CI, ( 82–97 seconds) seconds) (95% and seconds 89 dents receiving LAIV and 25 (6%) receiving TIV receiving LAIVdents assistance required an from additional adult. (6%) and 25 D. Vassalotti, C. Chu, L. Mendez, H. He, S. Park typical influenzaK–8th seasons.HealthHawaiigraders of vaccinates The Department against We evaluated time betweencampaign. at differences School influenzaFlu itsStop through administering intranasal(LAIV) influenzavaccine live-attenuated trivalent and injectable inactivated influenzavaccine(TIV) to mass-vaccination planningguide school-located for clinics.

Ravinia Ballroom, 12:30–1:30 p.m......

Perfect Strangers Postvaccine period was period in Postvaccine associated 60% with an reduction approximate Early treatment with neuraminidase Early treatment inhibitors, oseltamivir and zanami Rotavirus gastrointestinal acute causes severe illness children among aged rotavirus, rotavirus infections, rotavirus vaccines Rotavirus gastrointestinal acute causes severe illness children among aged <5 Samuel B. Graitcer, S. Doshi, L. Gubareva, Deyde, M. V. Okomo-Adhiambo, Christa R. Hale, K. Gershman, M. Cortese

For the 2007–08 season, 141 rotavirus-coded 2007–08 the occurred hospitalizations For among season, 141

vir, reduces morbidity and mortality morbidity influenza. reduces vir, severe from with contraindications of Because years and was responsible for 55,000–70,000 for years and was annually States responsible in hospitalizations United the rotavirus wasbefore vaccine infants licensed for in February assessed 2006. vaccination We children. Colorado impact young among the rotavirus-codedthe children among rates hospitalization years. agedreduction The <5 greatest was infants among also aged were observed to 4–6 children among old too reductions months; monitoring as be vaccinated. The 2007–08 months. Continued by 3 was onsetseason delayed additional birth are vaccinated will cohorts increase impact. understanding vaccination of PosTer 16 Viruses — A (H1N1) Among 2009 Pandemic Influenza Oseltamivir Resistance United States, 2009 aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: 21 APRIL WEDNESDAY, sessioNPosTer 2: resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: 11:35 11:35 — Colorado, Hospitalizations Rotavirus-Coded on Rotavirus Vaccination Impact of 2000–2008 children aged <5 years, compared with a mean of 308 hospitalizations/season during 2000–children with 308 years, a mean aged of compared hospitalizations/season <5 confi RR was period 0.42 postvaccine2006 prevaccine for versus (95% 248–382). (range, Children aged 4–6 RR had lowest the 0.35–0.52). CI, (0.26; months 95% intervaldence [CI], RR age other for RR0.12–0.54); was 0.29–1.62); children 0.68 for aged months (CI, 36–59 differoverall did not groups the from RR. During 2000–2006the seasons,rotavirus-coded beganhospitalizations increasing in during December; 2007–08, this increase began in March. Z. Moore, N. Dailey, K. Lofy, S. Penfield, J. Louie, S. Marshall, Pan,C. K. St. George, M. Uyeki, Jhung, A. T. Klimov, A. Fry Meet the Authors of Posters 16–30 Meet the <5 years and was responsible for 55,000–70,000 for years and was annually States responsible <5 in hospitalizations United the rotavirus wasbefore vaccine infants licensed for in February assessed 2006. vaccination We children. Colorado impact young among

th 59 ANNUAL EIS CONFERENCE: WEDNESDAY 96 th

59 ANNUAL EIS CONFERENCE: WEDNESDAY 97

is a leading bacterial cause of illness, foodborne causing ap Salmonella Infections with oseltamivir-resistant pH1N1 were rare and rare occurred most were pH1N1 Infections with oseltamivir-resistant

antiviral resistance, oseltamivir resistance, 2009(H1N1), influenzaA We conducted a cohort study among reunion attendees and an environmental and an attendees environmental reunion among study a cohort conducted We We tested a sample of pH1N1 virus isolates identified by U.S. virusby identified isolates pH1N1 of WHO a sample tested We Rendi Murphree, J. Dunn, A. Otuka, O. Schaffner, Sawyer,JonesT. W.

Thirty (0.8%) of 3,903 pH1N1 viruses tested were oseltamivir-resistant, none none viruses oseltamivir-resistant, were tested ThirtypH1N1 of 3,903 (0.8%)

proximately 1.4 million cases annually. The Tennessee Department of Healthof was millionnotified Tennessee 1.4 Department proximately cases annually. The twoof family hospitalized with members and salmonellosis, renal leading rhabdomyolysis to of a familyfailure attendees after10 among Julyand gastroenteritis eating at on Restaurant A identify to risk illness investigated for factors We Restaurant by same A the day. catered reunion transmission.and strategies interrupt to pandemic influenza,pandemic immunosuppressed health assessment of Restaurant A. Attendees were identified by the reunion coordinator, host host coordinator, reunion by the identified Restauranthealth of A. assessment were Attendees collaborating laboratories duringcollaborating 2009 laboratories with neuraminidase assay zanamivir inhibition for clinical of a sample tested and for oseltamivir with specimens pyrosequencing resistance. We a neuraminidase associated with oseltamivir mutation H275Y, standardized resistance. Using with oseltamivir-resistant patients from information case collected forms, epidemiologic we infection. pH1N1 often among patients with immunosuppression or prior exposureto oseltamivir.prior Hygienic or with immunosuppression patients often among during oseltamivirresistant-viruses risk the transmission of of usemeasures reduce are to important, especially Ongoing surveillance patients. immunosuppressed among identify to virusescommunity resistant of transmission is critical. aUTHors: aUTHors: baCKgroUND: meTHoDs: KeyWorDs: PosTers 17 Associated with Pulled Pork — Memphis, 2009 Outbreak of Salmonellosis CoNClUsioNs: meTHoDs: resUlTs: zanamivir, oseltamivir widespread for significantly would resistance options limit treatment describeWe findings infections.U.S.from surveil [pH1N1] influenzapandemic A(H1N1) and highlight pH1N1 antiviral-resistant lance potentially factors for associated with oseltami vir resistance. of 1552 isolates were zanamivir-resistant. Among 28 with epidemiologic information, nine information, Among zanamivir-resistant. 28 with epidemiologic were isolates 1552 of fatalities. four received were oseltamivir collection, specimen Of to 22 that received prior with oseltamivir patients with other had contact Four treatment. and18 chemoprophylaxis (82%) known had oseltamivir no exposure. Twenty-three infections. Two pH1N1 resistant condition immunosuppressive infection had a severe pH1N1 with oseltamivir-resistant patients with leukemia or (78%) including taking 18 medication, were or immunosuppressive infection was 39 pH1N1 Median withlymphoma. oseltamivir-resistant age patients among oseltamivir median the on duration treatment, patients Among 18 the years). 1-67 years (range was days specimen oseltamivir ten of initiation from oseltamivir-resistant until of collection days). 1-30 (range

pli

; im

=.33). Of 135 persons with persons Of 135 =.33). P Heidelberg was isolated from five patient speci patient five was from isolated Heidelberg

, meat, restaurants , meat, restaurants =.004), those >40 and for years than age years of those <40 for

We identified an outbreak of salmonellosis outbreak identified an associated consumption with We Chronic hepatitis B virus hepatitis infection Chronic (HBV) affects 1.25 million U.S. =.09). Of 133 persons with insurance persons and referral data, Of 133 similar=.09). percentages Salmonella

Through enhancedan surveillanceprogram Pinellas healthin County, Roxanne E. Williams, J. Groeger, M. Denniston, D. Cui, M. Klevens

Of 233 persons with chronic HBV infection, 157 had referral data information on with HBV infection, chronic persons 157 Of 233 Respondents (n = 87) lived in 12 states. Of these, 45 (52%) met the case definition; definition; case the met (52%) 45 these, Of states. 12 in lived 87) = (n Respondents

ars and >40 years (60.3% vs. 61.4%). However, treatment was more common for males for than common was more treatment However, ars and vs. >40 61.4%). years (60.3% department personnel collected data on persons reported during reported collected 2007–2008 persons data on as personnel havingdepartment received were care and to receiving treatment referred a diagnosis HBV infection. chronic of Percentages probability significantlevel). at .05 the determined (chi-square of pulled pork. Restaurant closure, employee education, and 6 months of increased monitoring increased of monitoring and 6 months education, pulledof pork. Restaurant closure, employee additional illness. prevent to implemented were resUlTs: baCKgroUND: meTHoDs: KeyWorDs: PosTer 18 Diagnosis of Chronic Hepatitis B Virus of Persons with a New Referral and treatment Florida, 2007–2008 Infection — Pinellas County, aUTHors: resUlTs: CoNClUsioNs: hotel, and other attendees. A case attendees. A and other washotel, defined as duringvomiting diarrhea lastingor ≥2 days culture-confirmed or salmonellosisreunion. eating at in a person 15, the 10–July July available, 96 (61.2%) of whom were referred to care; 153 had data on treatment available, 20 had treatment data on care; 153 to referred were whom of available, 96 (61.2%) with 94 an persons of clinician Forty-two identified were treatment. received whom of (13.1%) primary mainly by (8). referred gastroenterologists treatment, by care clinicians; received 14 and those aged vs. 60.6%) <40 similar were males referred for and females (61.3% Percentages ye P vs. 8.1%; females (14.0% P vs. 9.5%; (16.5% ( referred were persons and insured (60.2%) uninsuredof (68.9%) mens; the molecular the mens; subtype a 2007 from isolates matched associated with outbreak Restaurant Salmonella A. for food, from negative tested Samples surfaces, employees and restaurant 96% reported diarrhea; 47% reported vomiting. Median incubation time was 27 hours (range: diarrhea; Median time (range: vomiting. reported was hours reported 96% 27 incubation 47% patients Twenty-six days). 1–10 diarrheaof median was 4 days (range: duration hours); 0.5–118 42 by consumed was Pulled pork hospitalized. were (9%) four treatment; medical sought (58%) and statistically was only the food item associated with 2.32;illness ratio: (93%) (risk patients Salmonella interval, confidence 1.59–3.37). 95% cated pork was unavailable pork cated testing. for residents and causes 2,000–4,000residents and morbidity deaths annually. Although HBV-related mortality after little can referral is known and be therapies, treatment about mitigated new by as reported having HBV examined persons chronic of diagnosis. referral and treatment We infection.

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. goodiiof surgical-site cause identified Mycobacterium is a recently We report the largest the this report known demonstrating M. goodii outbreak, We Fewer than two-thirds of HBV-infected persons were referred for for referred were persons than Fewer two-thirds HBV-infected of

chronic hepatitis B, referral and consultation/standards, health B, services referral and hepatitis consultation/standards, chronic

mycobacterium, atypical, mycobacterium, surgical infection, outbreaks wound A case was defined as an M. goodii SSI occurring weeks within in a person 16 Parvathy Pillai, M. Williams, H. O’Connell, B. Brown-Elliott, S. McNulty,

SSI isolates demonstrated indistinguishable M. goodii SSI The seven demonstrated isolates types. PFGE =.004). SSI attack rate: 0.32%). Body-surfacecultures A and HCW water- from M. goodii SSI attack 0.32%). rate: accessibility, qualityaccessibility, health of care, primary health care, humans of surgery performed at HCF X during the investigation period (11/01/2007–08/20/2009). surgery (11/01/2007–08/20/2009). period of X during investigation the HCF at performed X staff HCF Chartinterviews, body-surface review, and environmental per culturesand were typing. (PFGE) electrophoresis gel pulsed-field M. underwent goodii isolates formed. Recovered organism’s potential to cause outbreaks. The only causecommonality outbreaks. to The potential identifiedamong cases wasorganism’s an clearanesthesiologist. mechanism No transmission was of Ongoing identified. surveillanceat X is warranted.HCF treatment, and few received treatment. Barriers linking to treatment. and few received diagnosedtreatment, newly care and to persons be identified addressed.and to need receiving treatment CoNClUsioNs: KeyWorDs: resUlTs: baCKgroUND: baCKgroUND: meTHoDs: CoNClUsioNs: KeyWorDs: 19 PosTer — Midwest Region, 2007–2009 Surgical Site Infections Outbreak of Mycobacterium goodii aUTHors: insurance and treatment data, a much smaller percentage of uninsured received treatment (2.1% (2.1% uninsureddata, treatment of smallerinsurance a much percentage received and treatment P vs. 20.5%; Surgeries occurred during November 2007–April 2009. Five cases (71%) involved surgical involved cases 2007–April 2009.Surgeries (71%) occurred Five during November implants,device.materials, each a different No suture involving surgicalpacks, sources, water occurred in the (29%) procedures all among common cases. were sources Two ventilation or same surgical occurred five suite; in surgicaldifferent fourseparate surgicalacross suites all of a portion for was present A) (HCW only one theaters. Of 44 (HCWs), healthcare workers A,cases’ HCW procedures. an personal changes or anesthesiologist, no reported in professional 2,215 for preceding During outbreak. the period,habits A was HCW present investigation the surgeries ( M. for goodii negative were residence cultures A’s HCW source from M. McGlasson, L. Mann, R. R. Vasireddy, Wallace Jr., B. Buss infections (SSIs) but is rarely implicated in implicated is outbreaks. rarely In health 2009, state July but a Midwestern infections (SSIs) M. was goodii of SSIsseven notified department occurring healthcare facility one X) at (HCF source. identify to outbreak the investigated M. goodii SSIs. previous with no We

, disease outbreaks, surgical infection, wound These SSIs were most likely related to surgical most related likely These were SSIs contamination instrument Arthroscopy minimally is a common, surgical invasive procedure a during instrument reprocessing. Retained tissue in inflow/outflow cannulae a during Retained instrument reprocessing. tissue in inflow/outflow vironmental and performed, cultures surgical and select were equipment arthroscopy, Pseudomonas arthroscopy, Laboratory records were reviewed for case for reviewed finding.was study were Laboratory A case-control records Pritish J. Duffy, K. Tosh, Heseltine,G. M. Disbot, M. Boom, A. Srinivasan,

. En The case-control study did not identify significantnot study did any case-control The aeruginosa risk P. factors. P. aeruginosP.

equipment contamination contamination equipment isolates underwent PFGE testing. reviewed, PFGE Surgical underwent isolates were practices instrument reprocessing assess to and surgical inspected post-reprocessing with were a video scope instrument lumens cleanliness. conducted. A case was defined as a patient who underwent knee or shoulder at arthroscopy shoulder or A case knee who underwent was conducted. defined patient as a SSI with organ/space developed and period subsequently X duringHospital outbreak the aeruginosaP. with and/or shaver handpieces could have allowed survive bacteria to have could handpieces sterilization. remained shaver Tissue and/or cleaning manufacturer’s the instructions. to adherence The FDA despite handpieces in shaver arthroscopic shaver for and validated protocols manufacturers reprocessing are developing handpieces. KeyWorDs: CoNClUsioNs: meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: PosTer 20 20 PosTer — Arthroscopy Site Infections Following aeruginosa Surgical of Pseudomonas Outbreak 2009 texas, grew from 62 of 388 environmental samples. One isolate from the gross decontamination sink gross the from decontamination isolate samples. One 388 environmental of grew 62 from indistinguishablepattern had isolates. a PFGE Review instrument of case-patient the from being reprocessed was not arthroscopic equipment revealed that practices some reprocessing arthroscopic inflow/ instructions. reprocessed Inspection of manufacturer’s the according to processed cannulaewere revealedoutflow retained handpieces tissue. shaver Arthroscopic also instructions but had retained manufacturer’s the tissue inaccording to their suction cannulae. further No cases occurredwere after changesprotocols reprocessing in instrument implemented. C. Gould, S. Berrios-Torres (>600,000 performed annually in the United States). Seven post-arthroscopy organ/space organ/space post-arthroscopy Seven (>600,000 annually performed States). in United the caused Pseudomonas by aeruginosasurgical indistinguishable infections of (SSIs) site pulsed patterns X Hospital occurredbetween Aprilat 22,(PFGE) 2009 and electrophoresis gel field 2009. 7, May

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The close proximity cabinof mates, The close the the interval between illnessonset, Widespread oseltamivir resistance is of international concern, because it because oseltamivir it concern, international Widespread is resistance of

antiviral drug resistance, pandemic influenza A (H1N1) virus, H1N1 subtype, virus,H1N1 antiviral drug resistance,(H1N1) influenza pandemic A We reviewed camp records and interviewed cabin the regarding camp mates reviewed records symptom We Natalie J.M. Dailey, A. Fleischauer, M. Garrison, L. Weldon, L. J-M. Wolf,

Both previously healthy female cabin mates, aged 14 years, had received oseltamivir oseltamivir received had years, 14 aged mates, cabin female healthy previously Both

oseltamivir, chemoprevention oseltamivir, chemoprevention onset and antiviralonset use. was medication Neuraminidase used pyrosequencing to gene (NA) was and used other sequencing detect to H275Y, oseltamivir the detect mutation, resistance in nasopharyngeal mutations 2009 two the specimens from campers. H1N1 Pyrosequencing surveillance NC routine was on performed specimens. and the presence of identical NA mutations strongly supports person-to-person transmission person-to-person supports strongly mutations NA identical of and presence the virus. camp the was 2009 transmission beyond of evidence oseltamivir-resistant No H1N1 of virusesH1N1 2009 of oseltamivir-resistant transmission and emergence identified.The highlights in otherwise chemoprophylaxis use individuals healthy of importance the avoiding of in community. the KeyWorDs: CoNClUsioNs: meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: PosTer 21 21 PosTer Campers Receiving Among A (H1N1) Pandemic Influenza 2009 Oseltamivir-Resistant Carolina, 2009 — North Chemoprophylaxis chemoprophylaxis before symptom onset which occurred on July 8 for one and 11 for the other. other. the for and 11 one which occurred 8 for onset July on symptom before chemoprophylaxis H1N1 2009 in described previously not mutation NA second a I223V, and mutation H275Y The pyrosequencing novel a detection, After campers. both from specimens in detected were viruses, statewide surveil was in detected 59 mutation NA Neither I223V. for test to assay was developed 2009. 29–August lance 14, collected specimens June from Maillard, Z. Moore, M. Davies, Deyde, Sheu, L. T. V. Gubareva, A. Fry is one of only two antiviral medications for treatment of 2009 pandemic influenza A (H1N1) 2009 of only two of (H1N1) influenza antiviral pandemic is treatment one A for medications Of all viruses 2009 been oseltamivir-susceptible. have tested, H1N1 >99% H1N1]. [2009 virus 2009 infectionOseltamivir-resistant was H1N1 confirmed were in who cabin mates two in program during North 2009 of part ancampwide a chemoprophylaxis outbreak of H1N1 2009 determine if oseltamivir-resistant to of transmission investigated We Carolina (NC). had occurred. H1N1

. In the United States, ~25% of LD of is travel-asso States, ~25% . In United the HPS should be considered in with children unexplained presenting beHPS considered should Legionnaires’ disease (LD) is a serious form of pneumonia caused Legionnaires’ by pneumonia of form disease is a serious (LD) Hantavirus infectious pulmonary is disease a reportable (HPS) syndrome hantavirus pulmonary virus, syndrome, Sin distress, Nombre respiratory Medical records and environmental assessments were reviewed for the pediatric the for reviewed were assessments and Medical environmental records Benjamin J. Silk, N. Kozak, M. Bergtholdt, E. Brown, M. Tha, Hulbert,J. M. Barbara Knust, A. MacNeil, Rollin, P. J. Mills, C. Levy, E. Lawaczek,

Three of five children were under 10 years of 10 age.under were Threeof hadchildren five patients All illnessfor pediatrics cases of HPS reported to the CDC. Patient history, clinical history, cases CDC. the to HPS findings, of reported Patient were and diseaseoutcomes compiled. acute respiratory distress, respiratory acute exposure especially Children is noted. with HPS rodent if recent measures for care. Preventive disease, supportive severe have intensive require and may areas, inand play housing and children should control hantavirus rodent infection include efforts Educational with children, rodents. and parents aimed contact at be advised avoid to and precautions recognize infestation to and takeincluding signs how the proper rodent of are recommended. reinfestation prevent PosTer 23 23 PosTer Persistent Outbreak of A Always Stay in Vegas! Doesn’t What Happens in Vegas Disease — Nevada, 2001–2008 Legionnaires’ travel-Associated aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: PosTer 22 22 PosTer Arizona, Colorado, Patients — in Five Pediatric Pulmonary Syndrome Hantavirus 2009 and California, Washington, 2-6 Thrombocytopenia, symptoms. respiratory acute of days preceding onset elevated WBC and radiographscount, with pulmonary infiltratesobserved were in allwhile patients, elevated was in seen three children.hematocrit case One was fatal, and three surviving required patients mechanical during hospitalization. All had ventilation in a rodents the historyof patients five home. Moore, B. Fields, L. Hicks Ray, N.W. Marsden-Haug, C. Fritz, C. Watson ciated. 2008, In September two facility guests LD among reported cases a hotel of were in Las inhaling containing aerosols Legionella water with 20-40 high case fatality. cases Typically, occur annually States. Pediatric in United the than fewer HPS 7% of casescases contributing overall. are uncommon, Cases age the under of are exceptionally rare. During10 2009, children summer the diagnosedwere of five with HPS in Arizona, examine November to California, May these from We and Washington. Colorado, unusual HPS highlight occurrences of to clinical findings and meanslikely of transmission.

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was isolated from 15 (68%) of 22 of (68%) 15 was from isolated , pneumonia, persistence, travel travel persistence, , pneumonia, Long-term colonization of a potable water system led to recurrent LD recurrent to system led water a potable of colonization Long-term Despite many advances many inmedicine, Despite infectious the diseases represent Legionella

Autopsy specimens were submitted to the Infectious the to Diseases submitted specimens were Pathology Branch Autopsy (confirmed) or or Legionellaof LD defineddetection by caseslaboratory (confirmed) were Dianna M. Blau, A. Denison, C. Drew, C. Shieh, Paddock, W-J.

Five confirmed and 2 probable cases were identified in confirmedcases overall,were 16 confirmed 2008; probable 2 and Five (IDPB) for evaluation of suspected of influenza1, 2009. evaluation for April29–December infection from (IDPB) in this included series, confirmatory hadCase-patients influenzaprior no done resultstestingor in IDPB. rRT-PCR by 2009and for had tissues negative tested (H1N1) influenza pandemic A and clinicalDemographic infectious tissues collected for of if data available. were Evaluation special examination histopathology, the histochemical included of etiologies stains, and molecular and immunohistochemical assays. radiographic diagnosis of pneumonia (probable) among travelers who stayed overnight at the the at overnight stayed who travelers among radiographic diagnosis (probable) pneumonia of casesnotifying identified facilityby August (since 1, period. during We their incubation guests We LD surveillance2008) querying and travel-associated by CDC’s database (2001–present). system, swimming water potable the from samples and collected samplingreviewed 70 records fountain,pools, L. and cooling whirlpool spa, decorative towers. pneumophila were isolates typing. sequence-based using DNA compared transmission among facilitytransmission among guests. Health officials recognizeshould importancethe of occurred. have outbreaks ensuring Legionella permanent where in hotels eradication meTHoDs: PosTer 24 24 PosTer A (H1N1) Influenza Analysis of Non-2009 Pandemic the Pandemic — Hiding Within What’s Fatal Cases — United States, 2009 aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: meTHoDs: resUlTs: Vegas, Nevada where an LD outbreak occurred in 2001. The Southern NevadaHealth an occurredDistrict LD The Southern in Nevada outbreak where 2001. Vegas, transmission. and interrupt identify to and source the investigated CDC and 19 probable cases occurred (2001–2008). Among the 35 cases, stay Among of 35 the median the duration cases occurred (2001–2008). probable and 19 years) age (median=69 older was 7 days and two common: known risk LD for factors were fatal. cases No were In 2008, Legionella and smoking (75%). indistinguishable guest collected four six from samples these were isolates rooms; of a from collected water from and (2001–2002) historical isolates environmental clinical (2001) isolate and guest facility. the at heaters rooms S. Zaki and Influenza IDPB Working Group second most common cause of death worldwide. Evaluation of autopsy specimens often specimens often autopsy of Evaluation death cause worldwide. of common most second an diagnosis etiologic anprovides of infection that was otherwise undiagnosed. During the pandemic, undiagnosed tissue specimens from current fatal illnesses respiratory submitted were and testing. evaluation pathologic for

Evaluation of autopsy tissues from patients with a suspect infectious tissues patients from autopsy of Evaluation Lower respiratory tract hemorrhage (LRTH) is rarely seen in associa in seen rarely is (LRTH) hemorrhage tract respiratory Lower autopsy, fatal, infectious pathology, diseases, autopsy, respiratory We defined cases clinical, with radiographicor patients as evidence We laboratory, Erin D. Kennedy, M. Roy, J. Norris, D. Blau, Urdaneta, V. K. Waller,

Median age of case-patients (n=9) was 24 years (range: 4–57 years), and six (67%) and six (67%) years), 4–57 was 24 years (range: Median (n=9) age case-patients of Tissues from 322 case-patients were submitted for evaluation of suspected 2009 of evaluation for submitted were case-patients 322 from Tissues

tion with seasonal influenza infections but can be a complication of severe or fatal illness. CDC CDC illness. fatal or severe of complication a be can but infections influenza seasonal with tion LRTH several of associated and has reports intraalveolar withreceived hemorrhage 2009 H1N1, define its help To with fatal patients infection. 2009multiple H1N1 of beenin identified tissue and clinicalepidemiology features, LRTH case- describe first the we 2009H1N1-associated Pennsylvania. in investigation an during identified patients of LRTHof and laboratory confirmed influenzaA andinfection beginning October 2009 asked abstractedall data, cases including, report health CDC. to state to departments We patient demographics, medical and clinical history, medical records. course, patient from process can provide an clinical diagnosis etiologic canprocess available routine provide that from was not testing. The clinical infectiousdiagnosis some of diseases,may go conditions, notifiable including duringundetected influenza current the pandemic. resUlTs: meTHoDs: KeyWorDs: 25 PosTer A (H1N1) Associated with 2009 Pandemic Influenza Hemorrhage Respiratory Tract Infection — United States, 2009 aUTHors: baCKgroUND: CoNClUsioNs: resUlTs: were male. LRTH began a median of five days (range: 0–12 days) followingof onset influenza male. days) LRTHwere (range: began a median0–12 days five of oseltamivir Allsymptoms. initiated a median three received (range: of days treatment, patients medicalno had underlying (78%) followingonset.patients influenza Seven symptom days) 1–9 mechani invasive required All failure: respiratory experienced conditions. three (33%) patients All oxygenation. extracorporeal required membrane patients and sixcal (67%) ventilation their influenza to died due patients distress respiratory acute syndrome. Eight (89%) developed infection. between Median illness duration failure and respiratory onset was three days (range: 0–9 days). H1N1 infection and 160 (50%) were found to be negative. Of these, 87 (54%) were male and were be Of negative. these, to found 87 (54%) were (50%) infection and 160 H1N1 median medianthe The illnessfrom duration age onset was 30 years, 81years. range to 8 days of with available days. medical death was to Of case-patients the 5 days, records, 45 range 1 to of An diagnosis etiologic underlying condition. had least 100 at was one of made in 26% 80 (80%) infections, and fungal (2) viral (19) including bacterial these case-patients, of (20), (41/160) health importance. public of were most Dato, J. Lo, Lando, S.V. W. Y. Coffin, Shieh, S. Zaki, A. Cohen, S. Ostroff, A.Fry, L. Finelli, M. Jhung

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. carrau . carrau of infections. Conduct = .03). A single source or type A single or source melon of = .03). enterica serotype Carrau serotype; isolated is enterica a rarely during . carrau isolates were reported in the United States. In March, in United reported the . carrau were isolates , salmonellosis, illness, foodborne disease multistate outbreak Salmonella This is the first documented outbreak of S Thisoutbreak is documented the first LRTH is a life-threatening complication of 2009 H1N1 influenza 2009 of LRTH is a life-threatening H1N1 complication

Salmonella influenza,respiratory hemorrhage,distress acute fatal syndrome, outcome,

We conducted a multistate matched case-control study; random digit-dialing random study; case-control matched a multistate conducted We Carrie Nielsen, F. A. Langer, J. Pringle, R. Heffernan, Monson,T. R. Klos,

Fifty-two cases from 18 states were identified; 84%occurred females,were states among 18 Fifty-two and cases from GX01.0019 by pulsed-field gel electrophoresis in a U.S. resident during1. U.S.February in a 1–May resident electrophoresis gel pulsed-field by GX01.0019 1968–2008, only 235 human S 1968–2008, only 235 also cases were states reported. in WDPH, CDC, other residents; infections Wisconsin among partners thisand investigated other suspected outbreak. foodborne the Wisconsin Division of Public Health (WDPH) received reports of multiple S multiple of reports Public Health received of (WDPH) Division Wisconsin the H1N1 virus H1N1 was used to recruit age-, geographic-, and sex-matched control subjects. A case was defined control as and sex-matched was used recruit age-, geographic-, to S. that was carrau indistinguishable body any infection site from isolated PulseNet from strain JR health and public regulatory by conducted agencies. suspected were food of vehicles Tracebacks the matched case-control study required numerous calls per control subject. Although melon Although calls subject. melon numerous required study control per case-control matched the was significantlyconsumption nor study associated with epidemiologic illness, the neither distinguishtraceback to was able the for illnesses; specific the melon typeresponsible new arestrategies needed. solving outbreaks for such infection that can occur individuals. in young otherwise healthy, Clinicaldecline can be abrupt. LRTH and identify describeFurther to risk is 2009 study needed for factors H1N1-associated strategies. and treatment prevention appropriate KeyWorDs: resUlTs: CoNClUsioNs: baCKgroUND: baCKgroUND: meTHoDs: KeyWorDs: 26 PosTer — United States, 2009 Multistate Outbreak of Salmonella Carrau Infections First Documented aUTHors: CoNClUsioNs: ages ranged from 11 months to 93 years (median: 51 years). Four patients were hospitalized were patients Four years). 51 years 93 (median: to months ages ranged 11 from calls/ 2,000 died.and one (52 Approximately subjects control calls recruit 45 to required were or honeydew, (cantaloupe, melon of criteria. Consumption inclusion the met only 14 match); 13% versus case-patients of in (14/19) or fruit alone salad 74% was by reported watermelon) 8.0; odds ratio: P (matched subjects control of (6/45) identified. was not M. Rauch, J. Ball, M. Hoekstra, J. Archer, M. Sotir, J. Davis

pH1N1 virus was detected by rRT-PCR from patients up to 13 days after days 13 to up patients from rRT-PCR virusby wasdetected pH1N1 Because infected healthcare workers (HCWs) can spread disease can spread to Because (HCWs) infected healthcare workers Shedding duration of pandemic H1N1 influenza A (pH1N1) viruswas influenza(pH1N1) A H1N1 pandemic of Shedding duration H1N1, shedding, influenza, H1N1, outbreak transmission, Elementary school students or household contacts with influenza-like contacts illness household or Elementary students school Meagan K. Kay, D. Zerr, J. Englund, Kwan-Gett, T. J. Duchin Achuyt Bhattarai, J. Villanueva, R. Palekar, R. Sessions, Fagan, W.

Twenty-six persons positive by rRT-PCR for pH1N1 virus were included in virus the included were pH1N1 for rRT-PCR by positive persons Twenty-six

(ILI) within Nasopharyngeal onset eligible interview inclusion. 7 days of for were specimens tested tests. were Specimens collected every until non-positive 48were hours two consecutive virus of presence for transcriptase reverse polymerase chain real-time by (rRT-PCR) reaction virus. and viral pH1N1 viable of genome culture presence for onset of fever and viable viruses were detected by virus culture for up to 7 days after fever onset, after fever days 7 to virus up by culturefor detected viruses viable and were fever of onset critical obtained Data including provides this those casesfrom study resolution. after fever health officials public for information determining in studiesmeasures. Future control influenza between virus be undertaken andshould relationship determine the transmissibility to detection following inform persons to ILI. for exclusionary criteria in order PosTer 28 PosTer Workers and Among Healthcare Virus A (H1N1) Shedding of 2009 Pandemic Influenza Viral 2009 Implications for Exclusion from Patient Care — Seattle, Washington, aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: PosTer 27 27 PosTer School During an Elementary Virus A (H1N1) of Pandemic Influenza Shedding Duration Viral May–June 2009 — Pennsylvania, Outbreak analysis. The median duration of positive rRT-PCR was 6 days (range 1-13) after fever onset. after fever 1-13) (range was 6 days rRT-PCR analysis.of positive median The duration persons. positive of rRT-PCR 26 (73%) virus19 wascellby pH1N1 isolated The culture from of twenty-six (46%) Twelve 1-7). (range of wasmedian culture-positivity The 5 days duration viruses 0-5) a median for 2 days (range of pH1N1 viable shed to in continued study the persons following resolution. fever J. Winter, L. Berman, R. Marchbanks, Archer, T. R. Leap, B. Nygren, M.Moll, X. Xu, A. Fry, A. Fiore, S. Ostroff, D. Swerdlow patients, CDC recommends that infected HCWs not work until after 24 hours work defervescence not that infected CDC recommends HCWs patients, medicines. infection respiratory caused 2009 An of by outbreak using fever-reducing without attending medicaloccurred a residents among virus(pH1N1) (H1N1) influenzapandemic A unknown will guidance but return ill may developing when be important for when patients elementary school onset after evaluated sheddingamong fever duration We work. or school to virus in Pennsylvania during outbreak during contacts pH1N1 and their household students 2009. May–June,

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HCWs with influenza infection might test positive by culture or rRT-PCR rRT-PCR or culture by positive test might infection influenza with HCWs Healthcare workers (HCWs) are at high are at risk exposure 2009 for to (HCWs) Healthcare workers influenza, virusshedding, polymerase chainhealthcareworker reaction, We queried the Wisconsin Electronic Disease Electronic Wisconsin the Surveillance queried patients for System We Jevon D. McFadden, E. Suarthana, A. Laney, E. Storey, K. Kreiss,

On September 27, residents who attended the retreat and experienced respiratory and respiratory experienced retreat the attended who residents 27, September On Of 32 residents at the retreat, 19 (59%) experienced respiratory symptoms; 17 17 symptoms; respiratory experienced (59%) 19 retreat, the at residents Of 32

aged ≥16 years with confirmed pH1N1 during April–July 2009. We applied the Standard the applied We during April–July 2009. years with confirmedpH1N1 aged ≥16 one into placement for identifiableHCWs as Classificationpatients to Occupational system We housekeeping). (e.g., HCWs other or paraprofessionals, three professionals, of categories: setting: work by ambulatorycharacterized healthcare settings, HCWs hospitals, and nursing/ care facilities.residential longer than 24 hours after defervescence. Until more is known about the association of viral is thanthe association about more known afterUntil longer 24 hours defervescence. CDC guidelines follow should culture for or and infectiousness, HCWs rRT-PCR by detection returning when work. etiquette, as and to such respiratory hand hygiene precautions, meTHoDs: Distribution of Laboratory-Confirmed 2009 Pandemic Influenza A (H1N1) Cases Among Cases A (H1N1) 2009 Pandemic Influenza Distribution of Laboratory-Confirmed April–July 2009 — Wisconsin, Healthcare Workers aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: PosTer 29 meTHoD: resUlTs: residency retreat in Seattle, Washington during September 21–25, 2009. We examined as the 2009. We in Seattle,21–25, during retreat September Washington residency practitioners between inform viral to sociation infectionfever control of shedding and presence in healthcare settings. symptoms during or following the retreat provided nasal swabs for pH1N1 testing by real-time testing real-time by nasal during provided swabs following pH1N1 symptoms or for retreat the with 30, residents September On polymerase chain (rRT-PCR). transcription reaction reverse daily and symptoms measurements temperature record to requested results test were positive provided onset. Six 2 weeks, symptom times time the residents of duringsince subsequent the and culture assess to viral shedding. nasal both rRT-PCR by tested wash which specimens were tested positive for pH1N1 (attack rate, 17/32=53%). Seven (41%) infected residents measured infected residents (41%) Seven rate, 17/32=53%). (attack pH1N1 for positive tested residents 12 of Eleven fever. had subjective others 5 (29%) while symptomatic; >100.5ºF a fever positive tested serial nasal provided fever with subjective wash measured 8 (73%) specimens; or after hours defervescence. culture by also >24 positive tested and 6 (55%) rRT-PCR by H. Anderson pandemic influenza A (H1N1) [pH1N1]. Because occupational data is often inconsistently Because data occupational inconsistently is often [pH1N1]. (H1N1) influenzapandemic A collected and evaluated through health surveillance public systems, knowledge remains limited in influenza environment illness. and work Wisconsin occupation regarding of role the surveillance pH1N1 efforts, into affording cases of HCWs among follow-up active incorporated illness opportunitya unique of describe category distribution to the healthcare professional by and setting.

HCWs in all healthcare settings were represented among pH1N1 cases; in pH1N1 among all healthcare settings HCWs represented were Public confidence in blood donation safetydonation is blood essentialin thisfor Public confidence crucial

healthcare worker, healthcare setting, 2009 pandemic influenza A (H1N1), healthcare setting, 2009 healthcare worker, (H1N1), influenza pandemic A Regulations require reports “When a complication of blood collection/transfu blood Regulations of “When reports require a complication Sanjaya Dhakal, L. Holness, S. Cannon, R. Wise

FDA received 112 reports of donor deaths (mean age 47 years, 69% male, male, 69% years, 47 age (mean deaths donor of reports 112 received FDA Work status information was available for 744 (38%) of 1,941 laboratory-con 1,941 of status (38%) was information 744 available for Work

Wisconsin sion is confirmed to be fatal …” and “If a donor has a fatal reaction which, in any way, may be may has a is…” fatal confirmed“If to which, be donor reaction and fatal a way, sion in any and autopsy, fatality reviewed (1984–2008), reports We ….” associated with plasmapheresis screening characterize data to statistics, through examine to donor deceased descriptive donors reporting system limitations, identify and improvements. to potential the case-ratio of health paraprofessionals to professionals mirrors the ratio of these categories of mirrors ratio the professionals to health of paraprofessionals case-ratio the missing of data, occupational Becausein large the and workforces. national state of proportion cannot assess infection.we settings or which categories HCW greatest are at risk pH1N1 for in surveillance state-based influenza of Improvements illness to neededbetter understand are strategies. prevention effective create to environment and work occupation of role the resUlTs: meTHoDs: KeyWorDs: 30PosTer Reported to the Food and Drug Blood and Blood Product Donor Fatalities Administration — United States, 1984–2008 aUTHors: baCKgroUND: CoNClUsioNs: resUlTs: 58% Caucasian, average BMI 29.8 kg/m2, 83% repeat donors, and 56.3% plasma donors). and 56.3% plasma donors). kg/m2, donors, Caucasian, BMI repeat 29.8 58% average 83% obituaries, spouses, donors’ including sources, various from deaths of learned Reporters reaction transfusion hemolytic acute an donation: to due was death One friends. and hospitals, circuit closed current to prior 1987, in cells red donor’s another of receipt erroneous after discussion with a firmreportingof numberslarge Follow-up technology. plasmapheresis deaths verifiedvariable reportsthat stemmed interpretations increased donor from plasmapheresis sharply. fell subsequently numbers requirements; submission of firmed pH1N1 cases. Of 489 employed patients, 156 (32%) worked in the healthcare sector. healthcare in sector. the worked (32%) 156 patients, cases. Of employed firmed489 pH1N1 further were characterized category: 54%, professional by health (71%) Among these, 110 workplace on Information 34%, HCWs. and other paraprofessionals; 13%, health professionals; 27%, ambulatory healthcare; 46%, HCWs: and hospitals; settings was (60%) 93 available for care. 27%, nursing/residential biological product supply but could be jeopardized by reported donor deaths. to Methods be could donor jeopardized reported by but supply biological product Food the reporting to include and their collection assure safety components and blood blood of Recent and 640.73). CFR 606.170(b) dies (21 a donor when and Drug Administration (FDA) this study. death prompted reports increases in plasmapheresis

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serovar serovar serovar Typhi is the agent of typhoid fever, which often typhoid fever, of is agent the Salmonella enterica Typhi serovar The The manifestations unusualneurologic certainof in thispatients typhoid Reported deaths after donations are extremely rare and with one exception rareexception one Reported and deaths with extremely are afterdonations

blood donors, donor selection, public health surveillance, public selection, donor plasmapheresis donors, blood typhoid fever, serologic tests, neurologic manifestations, tests, neurologic serologic antibacterial typhoid fever, drug

Ill persons were identified Illthrough identified Malawi were persons MinistryHealthof surveillance.We Emily C. Lutterloh, A. Likaka, J. Sejvar, J. Naiene, E. Mintz, R. Manda,

We identified 229 suspect, 35 probable, and 37 confirmed cases from 18confirmed37 and probable, villages.cases35 from suspect, 229 identified We resistance resistance gathered demographic and clinical information on ill persons for March–November by inter and by clinical demographic gathered ill on information March–November for persons from complaint and least examination, had at one fever Suspect andview, patients chart review. IgM rapid test for typhoid antibody had a positive fever and a listpatients findings; of probable blood from isolated (TUBEX® Typhi serovar Salmonella had fever and confirmed TF); patients susceptibilitytesting. antibiotic Isolates underwent stool. or outbreak initiallyoutbreak posed a diagnostic challenge. Rapid typhoid testing antibody in field the diagnosis. the support susceptibilityhelped testing Culture confirmation is with antibiotic in water improvements measures include control Recommended guideimportant to treatment. quality, and sanitation, hygiene. in this series could not be attributed to the donation itself. To reduce ambiguity reduce in surveil the itself. To donation the in to this be attributed not series could lancespecify casecould revisions definition, reportingdeaths of withinspecific a interval after learn deaths. of consistently more to along with procedures donations, CoNClUsioNs: KeyWorDs: resUlTs: baCKgroUND: baCKgroUND: meTHoDs: KeyWorDs: 31 PosTer 2009 Border, with Neurologic Findings — Malawi-Mozambique Fever typhoid aUTHors: CoNClUsioNs: Median age was 21 years (range: 1–81 years); 56% were female. Forty-two patients had neuro female. patients Forty-two were 56% years); Median 1–81 age years (range: was 21 15 had logic signs includingof ataxia, (87%) hyperreflexia,13 Of these clonus. patients, 42 and six cultures of blood Salmonella yielded typhoid tests, and four (67%) rapid positive confirmed 37 the cases from susceptibility isolates demonstrated testing 21 Antibiotic of Typhi. ampicillin, chloramphenicol, to resistant that and all trimethoprim-sulfamethoxazole; were 21 also nalidixicthree to were resistant acid. M. Humphrys, A. Phiri, R. Lungu, J. Kaphiyo, D. Talkington, K. Joyce, L. Stockman, B. Nygren, K. Schilling, B. Tippett Barr, A. Demby, L. Capewell, S. Lowther, D. Townes, Redwood,K. Date, Y. J. Schier, G.Armstrong, S. Monroe presents with fever and with abdominal fever presents pain and is fecal-oral transmitted the Annually, by anroute. millionestimated 16 cases and 600,000 an investigated outbreak deaths We occur worldwide. unexplainedof febrile illnesses findings, with neurologic in vilto determinedbe fever, typhoid border. lages along Malawi-Mozambique the

Ravinia Ballroom, 1:30–3:35 p.m. 1:30–3:35 Ravinia Ballroom,

Vaccination coverage among nursing assistants was lower than assistants nursing among among was coverage lower Vaccination ......

Current estimates seasonal place Current coverage among influenzaall vaccination nursing assistants, nursing working influenza conditions vaccination, We analyzed data 2,873 from We assistants nursing and calculated population- Dirty Jobs Dirty Jobs Matthew Groenwold, S. Baron Christine Branche Overall, influenza vaccination coverage among nursing assistants was 37.1%. Overall,nursing assistantswas among 37.1%. coverage influenza vaccination

weighted point estimates of vaccination coverage and their design-adjusted 95% confidence confidence and 95% their design-adjusted coverage estimates vaccination point of weighted wasintervals used regression and characteristics. occupational selected demographic by Poisson and their (ACRs) ratios (prevalence) calculate coverage to vaccination multivariable-adjusted intervals. confidence 95% design-adjusted health care personnel generally. Our findings generally. health care personnel characteristicsthat institutional be may that nursing well workingof as conditions, assistants’ reflective as individual characteristics, were increase to vaccina interventions associated status with suggest vaccination that employer-level as potentially important assistants adjuncts nursing among be considered should coverage tion individual interventions. to and community-level KeyWorDs: CoNClUsioNs: CoNClUsioNs: meTHoDs: meTHoDs: resUlTs: MODERAtOR: 1:35 Working in U.S. Nursing Homes Assistants Among Nursing Vaccination Influenza aUTHors: baCKgroUND: WEDNESDAY, APRIL 21 APRIL WEDNESDAY, sessioN J: Nursing assistants age 45 and over were significantly vaccinated were to likelybe more assistantsthanNursing and over agethose 45 significantly blacks were less Non-Hispanic likely CI=1.07–1.41). 95% age 16–44 (ACR=1.23, CI=0.70–0.97). Self-perceived 95% (ACR=0.82, whites be vaccinated thanto non-Hispanic facility working a for-profit at CI=0.71–1.00), 95% (ACR=0.85, their work lack for respect of median of andthan fewer number being sample offered the CI=0.72–0.95) 95% (ACR=0.83, were all negatively associated with CI=0.67–0.90) 95% (ACR=0.77, benefits job nonwage status.vaccination Occupational Health Occupational US health care personnel at 44.4%, well below the Healthy People 2010 goal 60%. of 44.4%, at health 2010 Nursing US care personnel People Healthy the well below assistants, in with particular, highest the those at illness in contact close risk severe work of or identify occupa and demographic coverage and To vaccination estimate influenza.death from status assistants, nursing among vaccination of analyzed we tional correlates nationally repre cross-sectional 2004 the data from sentative, Assistant Nursing National Survey.

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Despite patients’ similar employment histories, common exposures histories, of common similar patients’ employment Despite Silicosis is a preventable occupational lung disease lung occupational and a known Silicosis risk is for a preventable Mantle cell lymphoma (MCL), a cancer with unknown etiology, constitutes constitutes unknownetiology, with cancer a (MCL), lymphoma cell Mantle lymphoma, mantle cell; neoplasms, epidemiology; cluster analysis; cell; mantle cluster epidemiology; neoplasms, lymphoma, VDH coordinated with local oncologists to identify residents of the Central the of VDH with coordinated identify local to residents oncologists For surveillance For silicosis- of TB Cen deaths, National used 1979–2006 the we Muazzam Nasrullah, J. Mazurek, K. J. Wood, Bang, K. Kreiss ThomasJohn Bender;Woolard, C. M. Williams, Gateley,K. C. Halbert Five patients diagnosed with MCL were identified by localby no oncologists diagnosed identified with patients were with MCL Five

occupational exposure,occupational effects; adverse uranium ter for Health Statistics mortality data for decedents aged ≥25 years. We calculated Health for proportion Statistics mortalityter years. aged We ≥25 decedents data for Virginia a pathologically-confirmed Health had District received during who MCL diagnosisof 2004-2009.Virginia The reviewed. Cancer Registry Detailedwas subsequently inter (VCR) telephone by Virginia or for in-person residents conducted were views using a standard template and e-mail nonresidents. for concern were not identified during identified detailed not defy raremay of cancers interviews. were causalClusters concern explanation. 2:15 — United States, 1979–2006 Silicosis Mortality with Respiratory tuberculosis aUTHors: baCKgroUND: meTHoDs: CoNClUsioNs: KeyWorDs: meTHoDs: meTHoDs: resUlTs: aUTHors: baCKgroUND: 1:55 2009 — Virginia, Cluster Lymphoma of Mantle Cell Investigation additional patients identified by VCR. During 1997–2008, there were 415 casesto reported 415 VCR.were 1997–2008, by Duringthere identified additional patients cases expected of reliable health numbers by district. statewide, provide few too to AllVCR five males, white aged were 58–66patients diagnosis, in years time at settings of office worked who diagnosisbuildings. inoccurredduringdate different onlyyearshe had 2 the patient’s One lived in Virginia. All minimal reported patients exposure chemicals, to ionizing radiation, other known carcinogens, suspected causes or lymphoma. of tuberculosis (TB). Tuberculin-positive persons with silicosis have a 30 with times silicosis persons higher have risk de of Tuberculin-positive tuberculosis (TB). tuberculin regard to without status. test population TB active a control to asveloping compared 6% of non-Hodgkin lymphoma (NHL) cases, (NHL) and 3,500 cases non-Hodgkin lymphoma MCL of new occur6% in United the InJune 1992–2004. during 8% mortalityby and 6% by increased U.S.incidence annually. States 2009, Virginia the MCL Health of of (VDH) Department was cluster of a potential notified Ionizing company. uranium-processing a of employees former or current four least at among rarity Because shared employment, lymphoma. of not isradiation known cause leukemia to but and geographic and temporal clustering, condition, the VDHof identify to affected investigated exposures concern. and of common patients

<0.01 time-related trend) from from trend) time-related <0.01 P =0.02) and blacks among than all of races combined other In the United States, 20061979 Inno United the with first marked the year since Regular physical activity (PA) helps maintain Regular and helps weight healthy activity physical (PA) <0.01). Silicosis- TB deaths declined 94.3% ( <0.01). silicosis, comortality industry, tuberculosis, occupation, Myduc L. L. Ta, Bensley, J. VanEenwyk Data are from 2007 Data are from Behavioral Risk Surveillance a Factor (BRFSS), System Complete non-OPA and OPA data were available for 386,397 respondents from from 386,397 available for data were respondents and OPA non-OPA Complete Of 7,505 deaths with silicosis, 311 (4.1%) had concurrent TB; 248 (79.9%) TB; 248 had concurrent (79.9%) (4.1%) deaths with silicosis, 311 Of 7,505 06. Ohio (n=35; 11.3%), Pennsylvania (n=33; 10.6%), and Michigan (n=24; 7.7%) accounted accounted 7.7%) and Michigan (n=24; 10.6%), Pennsylvania (n=33; 11.3%), 06. (n=35; Ohio state-based random digit-dialed telephone survey U.S. the of digit-dialed civilian, random state-based telephone non-institutionalized activity of and as frequency duration. product the was computed Non-OPA adult population. did not who respondents considered we and frequency duration; BRFSS collect OPA does not mostly potentially guidelines to meet guidelines involved meet if their work through non-OPA walking All heavy labor. or sampling physical design. analyses complex the for accounted silicosis- TB deaths. comortality substantial The decline prevention silicosis-TB reflectslikely in measures both diseases. for and control resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: CoNClUsioNs: KeyWorDs: 2:35 Activity Contribution of Occupational Physical It? Potential Do With Got to Work What’s Activity Guidelines — United States, 2007 Meeting 2008 Recommended Physical towards resUlTs: ate mortality ratios (PMRs) using available information on the decedents’ industry and decedents’ using the available on mortality information ate (PMRs) ratios 26 1985–1999. from for states reported occupation across the United States. Overall, 64.3% (95% confidence interval [CI]=64.0%–64.7%) States. Overall, interval confidence United the across met 64.3% (95% engaged in work An (95%CI=6.3%–6.7%) guidelines additional 6.5% through non-OPA. activities requiring walking mostly was heavy guidelines or and labor meet could if OPA was highest The potential increase meetingin OPA considered. considering guidelineswhen (8.0% vs. 3.5%; P vs.(8.0% 3.5%; were ≥65 years; 306 (98.4%) were males, and 221 (71.1%) were whites. The proportion of proportion whites. The were males, (71.1%) were and 221 years; 306 (98.4%) ≥65 were silicosis-TB deaths was significantly25–44 silicosis ageddecedents among greater than those P vs. years 4.1%; (8.0% aged ≥45 reduces the likelihood the are basedreduces on diseases. experiencing chronic of PA of reports National meeting ≥150 the toward counts (OPA) PA occupational yet (non-OPA) PA nonoccupational in 2008 the Activity recommended Physical Guidelines PA moderate-intensity of minutes/week influence potential determine the to examined in Americans. patterns for PA demographic We meeting these guidelines. on OPA of per year during 1979–1983 to 1.2 year per to during 2002–2006, cases reported with year per during no in 1979–1983 21.0 20 all of deaths. 29.6% such for The highest industry-specific for andPMRs occupation-specific associated deaths with miscellaneous were the silicosis-TB nonmetallic mineral and stone and crushing the and grinding machine 33.8–139.8) CI operators 95% industry (73.7; products 57.2–293.5). CI 95% (142.3; occupation

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The trainingThe for better needapplica findingsthe for support of pesticide Consideration of occupational activities walking occupational mostly which require of Consideration or Pesticides are used widely in agriculture Pesticides and off-target drift of agricultural pesticides, poisoning, surveillance, drift, agriculture physical activity, guidelines, activity, physical health surveillance, public behavioral risk factor Data were obtained from the Sentinel Event Notification System for Occupa for System Notification Event obtained Sentinel the from Datawere Soo-Jeong Lee, L. Mehler, B. Diebolt-Brown, J. Prado, G. Calvert During states.11 were Of 1998–2006,these,47% 2,945 identified in cases were

surveillance tional Risks-Pesticides Program Regulation. and California the Pesticide of Cases Department acute illnessdeveloped defined pesticide who off-target drift as were persons from exposure arising identify to performed agricultural from were logistic regressions Multiple applications. cases). (≥5 large to drift contributing factors incidents heavy labor potentially increases the proportion of Americans meeting PA recommendations recommendations Americans of heavy potentially meeting labor PA increases proportion the OPA and time intervals. ≥10-minute of Collection activityfor intensity if work is sufficient at and recommendations meeting PA to contributions quantify better to canintensity help OPA PA. programs improve for to identify subgroups demographic tors, stringent enforcement of existing of regulations, enforcement stringent andtors, enhanced regulatory protect effortsto especially public, the agricultural and children. Special workers focus be directed should at and minimizingpreventing off-target driftsoil from fumigations. CoNClUsioNs: CoNClUsioNs: KeyWorDs: resUlTs: aUTHors: baCKgroUND: meTHoDs: CoNClUsioNs: KeyWorDs: 2:55 Agricultural Pesticide Drift from Associated with Off-target Acute Pesticide Illnesses Applications — United States, 1998–2006 for Hispanics (10.9%; 95%CI=10.1%–11.8%), males (7.7%; 95%CI=7.4%–8.1%) and non-high and non-high 95%CI=7.4%–8.1%) males (7.7%; 95%CI=10.1%–11.8%), Hispanicsfor (10.9%; 95%CI=10.7%–12.7%). graduatesschool (11.7%; exposed at work, 53% were male, 58% were 15– 44 severity years low old, and experienced 15– 92% male, were 58% were exposed 53% work, at illness.was rate (114.3/1,000,000 agriculhighest The agriculturalincidence among workers cases/1,000,000 1.6 nonoccupational to compared in general the popula persons tural workers) nonoccupational among had (1.9/1,000,000) highest the incidence years) Childrention. (<15 95% (AOR=14.08, cases. The largerisk for soildriftapplications for was greatest incidents class pesticide the and were soil applications, of 2.12–93.66).CI Fumigants used in 91% were all of cases. associated factors Common with drift (45%) largest the for proportion responsible fumigant measures prevent escape, to and applicator improper cases windy weather, included carelessness. pesticides haspesticides raised Better understandingpesticide substantial drift-related concern. of public efforts. and guide education to isThis needed poisoning regulatory, incidents enforcement, off-target poisoningdrift from pesticide acute of from estimated study incidence the agricul tural and identified associated risk applications, factors.

Despite control measures, ARs control Despite this among military high. were population During 29–August 3, June 2009, a U.S. Navy an experienced vessel

disease influenza, outbreak; human epidemiology; military 2009 personnel; We retrospectively surveyed a random sample of the crew from the outbreak outbreak the from crew the of surveyed sample a random retrospectively We Christina B. Khaokham, M. Selent, Loustalot, F. S. Mettee, D. Harrrington, Among 456 enlisted personnel, 25 (5.5%) experienced ILI and 89 (19.5%) ARI, (19.5%) ILI89 and experienced (5.5%) 25 personnel, enlisted 456 Among

shbein, S. Waterman pandemic influenza A (H1N1) virus, H1N1 subtype virus, classificationH1N1 (H1N1) influenzapandemic A time 2009, during period and and medical reviewed infection- September–October records measures. Influenza-like control illness(ILI) was defined withcough sore throat fever or as illness respiratory Acute (ARI) was defined >100ºF. throat without coughsore or as using tests. chi-square Bivariate analyses conducted fever. were documented This outbreak demonstrates how easilyhow influenzasettingspread Thisdemonstrates in a shipboard can potential outbreak and ill of antiviral and empiric impact. quar persons, isolation treatment In to addition workplace working confined andantine into antiviral embarkation exposed before of prophylaxis persons and vaccine. living of in outbreaks absence the 2009 settings, shipboard H1N1 might prevent CoNClUsioNs: CoNClUsioNs: KeyWorDs: meTHoDs: meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: 3:15 Vessel Navy Aboard a U.S. A (H1N1) Influenza of 2009 Pandemic Outbreak 2009 — San Diego, (overall attack rate, 25%). Persons ill Persons with ILI and ARI attack rate, 25%). had a median(overall 19–47) age 23 (range, of years. ARs differ did not significantly by or well sex.with age Compared persons, persons ill ill greater exposure other reported to in sleeping, persons working, meeting, and dining areas (all 4 days). (average: duty timelost (n=114) of Thirty-sevenill persons percent P≤.01). Chi-square E. Hoke, Blair, P. D. Faix, B. Alvarez, N. Almond, K. McMullen, B. Cadwell, Uyeki, D. T. Fi outbreak of 2009 pandemic influenza A (H1N1) peaking 124 were of July; week cases the first 2009 of outbreak (H1N1) influenzapandemic A Militarycrew. populations confirmedby polymerase chain reaction the among 2,319-person ill seek were medical to members crew care, been reluctant hypothesized and we thathave more characterize estimate to attack an (ARs), rates investigation conducted during We outbreak. the illness, andassess risk factors.

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Lobby outside Dunwoody Suites, 6:00–7:30 p.m. Lobby outside Dunwoody

......

Although hand-washing is recommended to prevent influenza,protec the prevent Although to hand-washing is recommended Hand-washing and good hygienic habits are protective against are protective and Hand-washing good influenza habits hygienic

......

human influenza, handwashing, study, case-control transmission,matched We enrolled 100 laboratory-confirmed 100 enrolled seasonalthe from influenzapatients We Mingbin Liu, L. Zhang,J. Ou, R. Hong, H. Ma, B. Zhu, R. Fontaine, G. Zeng Compared with the lowest hand washing level (0-3), odds ratios (ORs) progres (ORs) ratios odds (0-3), level washing hand lowest the with Compared

hing basin (OR=0.14, 95% CI: 0.030-0.61), and having received influenza vaccine (OR=0.13, (OR=0.13, vaccine influenza received having and 0.030-0.61), CI: 95% (OR=0.14, hingbasin

logistic regression logistic regression surveillance individually persons, recruited 100 we system as to cases. matched controls For cases through age, digit by random dialing. and interviewed residence in both each persons We handwashing their about pairmatched case withintelephone of by week confirmation one created We rubbing eyes with (picking nose, mouth, hand). touching habits and hygienic poor lack the of hand washing of frequency represent to and another relative the represent to score analyzed logistic regression using conditional these as We habits. hygienic a dose-response poor habits. estimate change to the models in with odds improved ratio and should be promoted as preventive measures during influenza epidemics. as preventive be promoted and should CoNClUsioNs: KeyWorDs: resUlTs: meTHoDs: INtERNAtIONAL NIGHt INtERNAtIONAL POStER SESSION 1 PosTer iNTerNaTioNal Against Confirmed and Good Hygienic Habits Hand Washing Protective Effect of Province, China, 2009 Influenza, Fujian aUTHors: baCKgroUND: WEDNESDAY, APRIL 21 APRIL WEDNESDAY, NIGHt INtERNAtIONAL sively decreased from 0.28 (95% CI: 0.074-1.1) to 0.020 (95% CI: 0.0043-0.11) as 0.0043-0.11) CI: hand wash 0.020 to (95% 0.074-1.1) CI: decreased 0.28 from sively (95% 0-2, of score habit hygienic a with residents with Compared >7. to 4 from improved level ing ashygienic 0.0010-0.092) CI: (95% 0.010 0.0070-0.69)to CI: (95% 0.071 from ORsdecreased washing hand model, regression logistic conditional multivariable Ina improved. scores habit 95% (OR=0.43, habits hygienic 0.23-0.70 CI: 95% (OR=0.40, hand unit washing per of score), hand sanitizer having or soap hand the next to score), habit hygienic unit per of 0.27-0.71 CI: was 95% CI: 0.018-0.99) were protective. protective. were 0.018-0.99) CI: 95% tive effect of hand washing has not been empirically documented. We conducted a commu a conducted We effect handwashingof tive empirically hasbeen not documented. importance community of exposures estimate relative to the study to nity-based case-control hygienic measures. effects of influenza protective the and

=0.0004) was The prevalence of dental of caries prevalence is higher The in urbanthe area than in the rural The health authorities of Gosaba block in Sundarban area of West of block SundarbanGosaba in health The of authorities area Dental caries infectious is a chronic disease that causes demineralization dental caries, dental children, knowledge, practice Rama Bhunia, S. Ghosh =0.0003). Drinking 2.8 sodas three six to times P (OR a week We defined a casewatery of acute as occurrence diarrhoea We severe with We conducted a cross-sectional study among children among a cross-sectional study aged years attending 12 conducted We Gladwell K. Gathecha, A. Mahokha, Wanjala, P. J. Omolo

P The prevalence of dental caries in 12 year old children in both Nairobi West and dental of cariesyear childrenold 12 prevalence in Nairobi The in both dehydration admitted in age any health Gosaba of between of care block dehydration facilities in a resident public primary schools in Nairobi West and Mathira West districts. We used multistage districts. and Mathira We primary West public West in schools Nairobi children.sampling An 639 select the to interviewer administered was questionnaire used. Oral screening was methods. using performed Dental caries WHO was recommended measured using Decayed, the Missing, (DMFT) index. Filled Teeth area. The school health policy should be used to promote oral health by provision of oralhealthof oralhealth provision by area.health school promote The policy be to should used instructions harmful and on educating dietary practices. the Danger of Pirated Piped Water Connections: Post-Cyclonic Cholera Outbreak — the Danger of Pirated Piped Water Bengal, India 2009 Area of West Sundarban aUTHors: baCKgroUND: meTHoDs: CoNClUsioNs: KeyWorDs: 3 PosTer iNTerNaTioNal meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: iNTerNaTioNal PosTer 2 PosTer iNTerNaTioNal and West Children in Nairobi Among Practice knowledge and and Oral Health Dental Caries kenya Districts, Mathira West Mathira West was found to be 31.5% and mean DMFT 0.58.The urban region represented by represented urbanregion and mean DMFT 0.58.The be 31.5% was to found Mathira West a had significantly(27%) West higher cariesthanprevalence Mathira (37.5%) West Nairobi rural ( region be significantly to found havingassociated a dental caries.with factors included Protective with brush tertiary to mother instructions how on and secondary having or received education teeth. Bengal, India, increase in watery sudden acute after diarrhoea reported patients Aila cyclone. measures. control and identify propose to agent, the source outbreak the investigated We of dental hard tissues. In Kenya approximately 50% of children aged 13-15 year have dental dental year have children 50% of aged tissues. hard dental 13-15 approximately of In Kenya caries.oraldental of caries The pain impact includes which may affect speech,eating, sleeping,swallowing self causes and breathing appearance can it altered the low lead to andesteem undermine social acceptance. was A study undertaken association the determine to between caries dental and oral health children among knowledge and practice West in Nairobi districts.and Mathira West

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<0.001). 4.6% of 4356 students in with schools students 4.6% 4356 of <0.001). P Contaminated piped water was the probable cause of the cholera out cholera the cause of was probable the water Contaminated piped Chilblains is a cold-induced inflammatory Chilblainsvery is that skin rarely a cold-induced condition El Tor Ogawa, outbreaks, India El cholerae Tor Vibrio cholera, A chilblains case was definederythematous,of onset as purplishor plaques Bike Zhang, X. Liu, L. Zhang, H. Ma, B. Zhu

2.8% in located had schools chilblains. 8770 students 5892 students of of 4.1% We identified 1,076 probable case-patients and 14 deaths (attack rate: deaths44/10,000). 14 and case-patients probable 1,076 identified We <0.01). In the case-control study, 61% of case-students and 47% of control-students control-students of and 47% case-students of 61% study, In case-control the <0.01). P nodules on the hands or feet of the students in rural the students the hands the feet of on nodules or boarding February from schools to 12 geographical, meteorological, compared and in living nine the conditions March 5, 2009. We measures to seat location, compare to study a case-control conducted we school, schools. In one warm, activitykeep physical exposures chilblains 93 and other of randomly 279 to case-students selected, unaffectedcontrol-students. resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: CoNClUsioNs: KeyWorDs: 4 PosTer iNTerNaTioNal Schools — Southwestern People’s Epidemic of Chilblains in Rural Boarding Republic of China, 2009 resUlTs: 3rd week of May 2009 and 4th week of August 2009. We searched for probable cholera patients patients cholera 2009 May probable of for searched week and August 4th3rd of week 2009. We conducted time, by We andin place described person. health outbreak the care facilities. We We assessed identify environment. the to risk study the factors. We casea matched control for sources water different from specimens collected and rectal water swabs case-patients from laboratory examination. in higher altitude, windy areas had chilblains, in 0.2% to schools 2878 of students compared areas altitude, ( protected inlocated lower broken windows had chilblains, 4234 of in 0.9% withbroken schools to intact students compared windows ( control-students of and 56% case-students of 78% CI=1.1-2.9). 95% nearsat windows (OR=1.8, 60% and 30% case-students control- of of CI=1.3-4.0). 95% (OR=2.8, gloves wore seldom CI=2.1-6.0). daily of hours (OR=3.6, sedentary >8 position reported students EL Tor Ogawa was isolated from two of five stool specimens. The outbreak specimens. The stool two was five Ogawa from isolated of EL cholerae Tor Vibrio started 2009 May 4th of on week with two peaks and lasted and June 4th till 2nd of on week interval confidence 95% 16, August 2009. [MOR]: Drinking odds ratio (Matched water piped house at and water chlorine treated 58%) fraction [PAF]: attributable population 4.9-51, [CI]: 0.06, (MOR: 0.02-0.20) CI: hold associated 95% with illness. were the The villagers broke easy drinking for near pipelines their house specimens and access. stored water water Piped faecal for positive contamination. were water appears as outbreaks. We investigated an epidemic of chilblains of an investigated epidemic during March 2009appears as outbreaks. We in nine rural China identify boarding to risk in schools factors.Southwestern break. We recommended repairing of the water pipelines and villagers. pipelines educating repairing water the of recommended Repairingbreak. We the pipelines, villagers the educating regarding and at chlorination danger connections pirated of outbreak. the controlled household

Laboratory-confirmed influenza A H1N1 outbreaks Laboratory-confirmedH1N1 2009 occurred influenza A intwo This chilblainsresulted increased duringexposurefrom epidemic a In Thailand,H1N1outbreak school in A 2009 novel influenza the first novel influenza A (H1N1), boarding school, dormitory, mask use,boardingdormitory, Thailand school, (H1N1), influenza A novel chilblains, rural epidemics, schools communities, Active surveillance Active was in initiated in two and boarding B) (A schools Sanisa Santayakorn Sitthi, Wongphruksasoog, , W. V. S. Al-sihak, Of 1115 students in School A, 382 cases (11 confirmed and 371 suspected) suspected) confirmed371 and in A, School students 382 cases (11 Of 1115 Angthong. A suspected case was a student/teacher who developed 2 of the following the 2 of 4 developed Angthong. who A suspected case was a student/teacher throat between and 27 August July and sore cough, rhinorrhea 6, 2009. fever, A symptoms: confirmed casewasH1N1 2009 pandemic a suspectedinfluenza casevirustested positive in in was study conducted cohort technique.retrospective A nasopharyngeal swabs RT-PCR by A.School boarding schools. Influenza transmission between schools linkedthe sharingto dormitories. mask of use sharing glasses, and no water of including promotion and rapid Health education transmissions in both schools. reduced to cases new of contributed isolation prolonged cold and windy weather and poor preparation. Provision of warmer classrooms warmer and of Provision and and preparation. poor windy weather cold prolonged of awareness increasing activity physical dormitories, student’s time and improving student’s be implemented. should protection cold CoNClUsioNs: KeyWorDs: resUlTs: baCKgroUND: meTHoDs: KeyWorDs: 5 PosTer iNTerNaTioNal Two Boarding 2009 Outbreak in A H1N1 of Novel Influenza Investigation and Control August 2009 Angthong Province, thailand, Schools — aUTHors: CoNClUsioNs: developed symptoms (attack rate 34.3%). The attack rate was 9.2% (32/349) confirmed 2 with (32/349) 9.2%attack was The rate 34.3%). rate (attack symptoms developed cases and fatal in B.median severe 11 School reported. cases The No were agesof cases were in A and B, School respectively. years) years (Range: and 12-19 14 years) years (Range: 6-19 18%-63%. attack in 2 schools Dormitory-specific samein rangedlived Students rates the from regularly influenza for factors infection included Protective mask dormitories. (RR=0.33, use and glass using personal water (RR=0.72,95%CI=0.21-0.50) 95%CI=0.63-0.82). N. Prajaksub, B. Ardkam, C. Daraphong, Ayood, Silaporn, P. P. C. Pittayawonganon was reported in mid-June 2009was in in reported mid-June Bangkok. August On 4, 2009, local the Surveillance and in a boardingstudents 120sick of school, Angthong notified a cluster Rapid Response Team identify An wasProvince. to risk carried with and factors objectives investigation out measures. and control prevention implement

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O157 — Germany, 2009 Escherichia coli O157 — Germany, Having one parent, large household size and not attending school were were attending size school and not large parent, household Having one O157 (STEC O157) primarily causes O157) (STEC E. O157 Shiga coli toxin-producing Between 1997 and Between 2002, 1997 family clinics support treating survivors of child sexual Harare abuse, case, pregnancy, control, Stine Nielsen, A. Fruth, C. Frank, A. Spode, R. Prager, A. Graff , A 1:1 case-control study was carried out with 115 cases and 115 controls between controls cases and 115 was study carried with 115 case-control out A 1:1 Ngoni W. Mashumba;Ngoni W. S. Midzi, J. Maradzika, N. Ndlovu

Nine cases were male; 106 were female. The majority (87.8%) experienced experienced (87.8%) female. majority The were male; cases 106 Nine were rpetrators were male and ninety-nine (86.1%) were known child. to were Among had cases, 71.3% male and ninety-nine (86.1%) were rpetrators 20/06/2009 and 12/08/2009 at Harare Hospital. Cases and controls were frequency matched matched frequency were Harare at Cases Hospital. and 12/08/2009 and20/06/2009 controls age, asfor a sex presenting and neighbourhood. A case was child any years and below, aged 16 a history without presenting wassurvivor child any years CSA. and below, of aged A control 16 CSA.of significant risk factors.resulted Abuse in behavioural psychological changes,and genital state. on the cost of burden significantinfections CSA creates and pregnancy. preventable and aUTHors: aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: 7 PosTer iNTerNaTioNal Caused by Emerg Desperately Seeking Diarrhea: Outbreak of Hemolytic Uremic Syndrome ing Sorbitol-Fermenting resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: iNTerNaTioNal PosTer 6 PosTer iNTerNaTioNal zimbabwe, 2009 Abuse — Harare, for Child Sexual Risk Factors penetrative sexual abuse; 47% of abuse occurred within child’s home. Most CSA (71.3%) sexual abuse occurredpenetrative of abuse; within 47% CSA (71.3%) Most child’s home. or occurred physical noticing in high through someone discovered suburbs. density Cases were Risk caregiver single (AOR included: factors parent behavioural changes in child the (57.4%). = CI = 95% 2.98; size(AOR greater than five and household - 14.81), = 4.89; = 1.62 CI 95% (87%) Most = 0.02 = 0.09; CI was - 0.37) protective. 95% (AOR Attending school 1.46 - 6.03). pe sexually hadcontracted pregnant,anogenital transmitted had findings, 6.1% become 11.3% exhibited behavioural/psychological trauma and 51.3% infections, had genital/physical 10.4% change. child. per managing Costs of estimated US$109 at CSA were M. Lüttgehetmann , D. Müller-Wiefel , D. Werber pediatric diarrheal infected of individuals illness; life-threatening hemolytic develop ~10% has emerged (sf) variant STEC of O157 sorbitol-fermenting A rare (HUS). syndrome uremic littlein diarrheal Europe, causing with HUS outbreaks apparently background. July On HUS caused 23-26, by residing 2009, boys in four young developed Hamburg a suburb child sexual abuse (CSA) in Zimbabwe saw approximately 38 cases of CSA a month nationally. nationally. 38 cases CSA a month of child approximately in saw Zimbabwe sexual abuse (CSA) evaluated Harare clinic We is managingcurrently alone cases 100 monthly. over of an average risk associated factors with CSA.

In this local transmission was outbreak, linked simultaneous exposure to Rabies is virus usually causes outcome encephalitis and fatal. acute its It’s O157, Germany E. O157, Shiga coli toxin-producing

Data on exposure history and management of rabies were obtained using exposure a Data were on history rabies of and management We administered questionnaires and collected stool from household, day-care administered day-care household, from and questionnaires collected stool We Paul N. Polkuu, Iddrisah, F. G. Burimuah, Boateng, V. N.Yebuah, Dog-human population ratio was 40-106/1000. Of 11 cases of dog bites reported, cases bites dog of Of 11 was 40-106/1000. ratio population Dog-human We screened 242 persons’ stool and identified andnine identified cases: 242 stool one had HUS,had five persons’ screened We checklist. We interviewed stakeholders in interviewed both Ghana stakeholders checklist. and and Burkina-Faso, hospital reviewed We 2009. A clinical August for - November cases reported veterinary case dog-bites of of records was neurologicalpresenting with defineddominated rabies an of acute syndrome as a person hyperactivity of forms paralyticby or and death within coma syndromes towards progressing days afterdog followingthe in a suspected rabid from bitefirst a symptom, history of a 7-10 expressed asUER 2009. analyses data Univariate were during outbreak August of - November, and percentages. frequencies and playground contacts, sampled the environment, and conducted a case-control study. Cases study. a case-control and conducted environment, the sampled contacts, and playground infection O157 suburb of diagnosed the definedsf-STEC or residents with as were HUS recruited through day-care were between 23 - August July controls 2009. Age-matched 25, investigated were samples environmental Stool and and flyers. community-distributed centers O157. sf-STEC for to a playground and was a playground unlikelyto foodborne. Extensive case finding efforts ascertained just remains O157 infected childreservoirsf-STEC of The with diarrhea-only. O157 sf-STEC one Only timely HUS surveillance,elusive. and in detection can countries, in place not most enable similar to response thereby future outbreaks. meTHoDs: resUlTs: iNTerNaTioNal PosTer 8 PosTer iNTerNaTioNal Upper East Region, Ghana, 2009 Cross-Border Outbreak of Rabies — aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: meTHoDs: resUlTs: sf-STEC O157. Our investigation aimed to stop the outbreak, delineate its extent, and extent, delineate its outbreak, the aimed Our stop to investigation O157. sf-STEC review STEC surveillance. nine (82%) of the dogs had identifiable owners, but not vaccinated (100%). Nine casesrabies of (100%). vaccinated not but owners, dogs the had of identifiable nine (82%) only diarrhea, three were asymptomatic. The median age was four years (range 0-13 years) and years) only diarrhea,median The asymptomatic. (range three were agewasyears 0-13 four HUS was strongly HUS cases, 34 (four study boys. controls), In case-control the eight were 95%CI:2.6-+INF, (oddsratio=27, 16 associatedJuly with visitingon a specific playground meal was common identified. negative p-value<0.006); no tested samples Allenvironmental 12 diarrhea increase of in No was community noticed. incidence O157. sf-STEC for J. Akpabile, Anyorikeya, T. E. Afari, C. Ohuabunwo estimated to cause 55 000 deaths/year worldwide. A suspected outbreak of rabies was reported rabies of 000 A suspected outbreak estimated worldwide. cause 55 to deaths/year the investigated 2009. We 10, Region Ghana November, (UER), on in Bongo, Upper-East and magnitude source outbreak. the of

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. An On July 24, 2009, twenty-eight patients were admitted Atyrau 24, to July were On 2009, patients twenty-eight

The outbreak resulted from the contamination of food that was probably of food was probably that contamination resulted the outbreak from The An outbreak of clinically-confirmed An of outbreak rabies with high case fatality occurred

gastrointestinal illness, Kazakhstan outbreak, foodborne Rabies, outbreak, vaccination, cross-border outbreak, dog bite bite dog outbreak, Rabies, cross-border vaccination, outbreak, Manar A. Kasimzhanova, S. Baymenova, S Ajeilat All 186 workers residing at the hostel were enrolled in the study. A case-patient case-patient A study. the in enrolled were hostel the at residing workers All186 We identified 30 case-patients; all 30 identified case-patients; had diseaseonset within We period in an 8-hour

was defined as a worker with at least two episodes of vomiting or diarrhea on July 24. The menu menu July The 24. on or diarrhea vomiting of episodes least two at with worker a as defined was cafeteria. was was obtained hostel the interviewed from 22-24 learn July Each to for their worker and vomitus and signs, and Stool their symptoms history 22-24 July if for any. food consumption and was skin the swabbed for cafeteria collected case-patients of from workers specimens were Logistic wasbacteriological associations the used between study regression study. to food items disease. and in a highly susceptible cross-border population of the UER, Ghana. We recommended free UER, the of population recommended in a highly Ghana. cross-border We susceptible of dogs against of and control compulsory rabies, vaccination on community rabies, education high for vaccine risk communities. As anti-rabies a of free-roaming dogs and provision adequate campaign educational result, a joint health and mass by and veterinary vaccination staff against initiated. were rabies stored improperly before consumption. The cafeteria The was wasclosed until consumption. sanitation before improved. improperly stored food handling proper on practices. educated were Cafeteria workers CoNClUsioNs: CoNClUsioNs: KeyWorDs: resUlTs: Foodborne Outbreak of Gastrointestinal Disease — Atyrau, kazakhstan, July 2009 Disease — Foodborne Outbreak of Gastrointestinal aUTHors: iNTroDUCTioN: meTHoDs: CoNClUsioNs: KeyWorDs: 9 PosTer iNTerNaTioNal with 100% case fatality occurred in three districts. Males aged 20-49 most the years were vaccination affectedpre/post-exposure a peakwith receive not in October. Alldid case-patients herbalist. by treatment wound and hadimproper the evening of July 24. The epidemic 24.curve July eveningthe of epidemic outbreak. multivariate The suggested In source a point analysis, macaroni the with served 24 July meat was on associated strongly with illness (OR eating Twenty reported it. 30 the case-patients of (94%) 29 432.2); CI=6.7 to 53.8, 95% aureus Staphylococcus for positive were and three cafeteria workers case-patients cafeteria the of revealed that overall was investigation sanitation and poor environmental food always handling observed. not that proper were practices and storage Hospital in Western Kazakhstan in Western Hospital with signs gastrointestinal of illness; all a for worked study cohort a retrospective conducted hostels. We its of and lived in one company construction identify and 1 to 27 July disease the between prevent June transmission to and of modes source future outbreaks.

In July 2007, pig raisers in northern Philippines were alarmed raisers pig Philippines were in the by In northern 2007, July The outbreak was due to bathingto waspractices due outbreak canal,in the The whichcould be

On October 2, October On 2009 Health Baoruco from District epidemiologist the leptospirosis, ecology, outbreak outbreak ecology, leptospirosis,

1. Descriptive phase: we looked for the cases and geo-referencing them as them cases the well for and geo-referencing looked phase: we Descriptive 1. Rolando Cruz , J. Pabellon, V. E. Malbas, F. Tayag, C. Demetria, Ronald E. Skewes-Ramm, R. Pimentel, Medina, F. A. Castillo Five serovars of leptospirois were identified in 16 of 16 34-suspected identified in cases. were The leptospirois of serovars Five as animals the comparing risk 2. sources. study exposures. and water Case-control Case was defined clinicallaboratory with as person any MAT positive and diagnosisleptospirosis of Odds Confidence Ratio history with and no fever. 95% of residents 78 were result. Controls Intervals calculated. were contaminated by the animal the contaminated by faeces dragged rain the outbreak. the by to in weeks the prior to zero after reduced banning thethe to access canal,leptospirosis of living The incidence andhealth education. chemoprophylaxis aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: 11 PosTer iNTerNaTioNal After Its Abattoir Workers Among (REBOV) Infection Risk Factors of Reston Ebola Virus Discovery in Pigs — Philippines, 2009 resUlTs: aUTHors: baCKgroUND: meTHoDs: iNTerNaTioNal PosTer 10 10 PosTer iNTerNaTioNal El Salado, Irrigation Canal — in a Polluted with Bathing Associated Outbreak Leptospirosis 2009 Republic, November Dominican Galván, Baoruco, median age was 9.5 years, 75% were school age school males.human found in were same The serovars years,median 75% age was 9.5 in also goats,cases dogs and analyzed. were pigs present samples Thiscommunity lacksof an in bathed a channel used for (46%) and 36 controls cases (94%) system and 15 aqueduct to reported (22%) controls and 17 Eight cases (50%) 95%CI=1.6-98). irrigation (OR=12.5; apparently leptospirosis for negative were samples Water 95%CI=1.3-11.2). own goats (OR=3.9; because this weekspreviousthree was The notification. chlorinatedcanal afteroutbreak the was that contaminated with draggedwater rainwater hillsides many contaminates. J. Feliciano, J. Lopez notified a possible Leptospirosis outbreak in outbreak the rural community of notifiedLeptospirosis a possible El Salado-Galván- to an investigation reportingBaoruco, 24 cases, conducted including two deaths. We outbreak. the transmission of of and mode extent determine the unusual number of pig deaths.unusual pig of of Bureau The number Animal blood tissue pig and Industry(BAI) sent Ebola Virus Reston for (REBOV) positive RNA. 9 were where USCDC This to samples was producing animal. food first the time that Sixnon-primate humans was a in REBOV discovered butchers. were 49 of IgG for illness, with antibody be positive to no documented were 2(4%)

th 59 ANNUAL EIS CONFERENCE: WEDNESDAY 122 59th ANNUAL EIS CONFERENCE: WEDNESDAY 123

=.022), =.022),

=05) an d smoking while smoking and =05) Dunwoody Suites, 7:30-9:45 p.m......

=001), injury (OR=3.93, CI=1.2-13.69, P CI=1.2-13.69, injury (OR=3.93, =001),

=03) were risk factors. factors. risk were =03) Around the World Thomas Frieden A REBOV infection prevalence of 9% among slaughterhouse workers is workers A REBOV 9% slaughterhouse of among infection prevalence Children <5 years old in years rural old Children <5 villages Kenyan high have diarrhea and Reston Ebola Virus, ebolavirus, REBOV, abattoir, IgG antibody, multi-stage Ebola Virus, multi-stage IgG Reston abattoir, ebolavirus, antibody, REBOV, A cross-sectional study designA cross-sectional study was sampling. used with cluster multi-stage Patricia Simone and Paul Kelly Minal K. Patel, J. Harris, B. Nygren, Juliao, P. C. Ochieng, A. Obure,

A total of 460 abattoir workers participated in the study. Forty (9%) were posi were (9%) Forty study. the in participated workers 460 abattoir of total A yard slaughtering (OR=3.6, CI=1.64-8.1683, P CI=1.64-8.1683, slaughteringyard (OR=3.6, tive for REBOV IgG Antibody. Age range 18-56 years (median=36). Only 1 case was female. REBOV years for (median=36). tive IgG Age range Antibody. 18-56 with pigs sick and contact (93%), injuries (65%), inHistory blood eyes/mouth exposure pig of to which (PPE) equipment used personal protective workers (79%) was seen. Twenty-nine (11%) IgG of positive was limited boots. to History illness (38%) of was in in seen past the 15 6 months back that hadshowed Influenza-like-illness study (ILI).Case-control (23%) Nine respondents. CI=0.905-4.78, P (OR=2.14, in with blood eyes/mouth pig contact CI=1.0-4.72, P working (OR=2.25, cluster sampling,cluster health, public emerging disease Forty-six clusters were identified with10 respondents to complete a sample size of a sample 460. Blood complete to respondents identified with10 were Forty-six clusters was study done. REBOV for tested case-control A nested IgG were samples antibody. higher than the previously documented 4% and also 4% higher documented than higher among than previously the documented 6% the surveillance (Miranda, in As improved al). study 1996 the et farmmonkey a result of workers on agencies BAI the concerned by and other strategies in pigs being are currently implemented animal strategy and started a collaborative human on health emerging for have collaboration infectious disease all at health system. public the of levels 7:35 Access to Health Products in Impoverished Rural Social Entrepreneurs on Impact of trained Populations — Nyanza Province, kenya, 2007–2009 aUTHors: baCKgroUND: KeyWorDs: 21 APRIL WEDNESDAY, SESSION L: FIELD EPIDEMIOLOGY INtERNAtIONAL Science into Practice translating OPENING REMARkS: MODERAtORS: CoNClUsioNs: meTHoDs: meTHoDs: resUlTs: The study was done to determine the prevalence of prevalence determineslaughterhouse to infection the REBOV among was study done The measures infection this for of emerging assess preventive workers, risk and factors recommend disease. Were, P. Suchdev, P. Were, L.V. Ruth, R. Quick malnutrition rates, with poor access to preventive interventions. The Safe Water Water and AIDS Safe The interventions. rates, with access poor preventive malnutrition to organization is a Kenyan 2005 that since skills has taught entrepreneurial (SWAP) Project selling by income in health products generate then who members group HIVto self-help

from the stools or or stools the from <0.01) and Sprinkles <0.01) <0.01). Intervention households were more likely than more were households Intervention <0.01). P SWAP-trained entrepreneurs increased access to two proven health increased access two to proven entrepreneurs SWAP-trained In rural China, near constructed stagnant wells are frequently pools social marketing, Kenya, micronutrients, diarrhea prevention and control and control diarrhea social prevention marketing, micronutrients, Kenya, A probable case had onset of diarrhea (>3 times/day) plus >1 of the following the of >1 plus times/day) case diarrhea of had onset (>3 A probable We enrolled 1,104 households with children 6-35 months old from 30 from randomly old months with children 6-35 households 1,104 enrolled We <0.01) from SWAP-trained entrepreneurs. At second follow-up, 327 intervention intervention 327 follow-up, second At entrepreneurs. SWAP-trained from <0.01) Ke Han, He, F. H. Ma, B. Zhu, L. Zhang, R. Fontaine At baseline, SWAP-trained entrepreneurs had visited 3% of 572 intervention intervention 572 of had 3% visited entrepreneurs baseline, At SWAP-trained selected intervention villagesselected intervention villages and 30 comparison we In groups. 2007, SWAP with no bleach a baseline survey (WaterGuard conducted products evaluating two purchasing of SWAP exclusively work to trainedentrepreneurs Then, SWAP Sprinkles). and micronutrient solution villages. surveyin 30 product intervention of household In 2008, a follow-up conducted we villages. 30 comparison for trained In entrepreneurs 2009, SWAP we purchases; subsequently, survey. household follow-up a second performed symptoms: Fever (≥37.5 ⁰C), vomiting, abdominal the or of pain students ⁰C), or teachers among (≥37.5 Fever symptoms: 2009. A confirmed case 2-16, during school the June around and residents school elementary Shigella case cultureof serologicalgenus plus confirmation or was a probable consumption water, of exposures sources to compared we rectal swabs. study, In a case-control or 84 of and suspected probable well habits and food water hygienic items, untreated of by class. confirmed frequency-matched cases,controls, 71 and products in Kenyan villages. in Kenyan products meTHoDs: meTHoDs: KeyWorDs: 7:55 Republic of School — Sichuan Province, People’s Shigellosis Outbreak in an Elementary China, June 7–16, 2009 aUTHors: baCKgroUND: CoNClUsioNs: meTHoDs: resUlTs: their communities. We evaluated SWAP-trained entrepreneurs’ impact on villagers’ impact on access to entrepreneurs’ evaluated SWAP-trained their communities. We products. evidence-based households and 2% of 532 comparison households; 2% of intervention and 1% of comparison comparison of and 1% intervention of 2% households; comparison 532 of and 2% households Sprinkles unavailable for were entrepreneurs. from had purchased WaterGuard households intervention 514 had visited of 40% entrepreneurs SWAP-trained purchase. first At follow-up, ( and 9% 484 of households comparison vs. 2%, P (14% purchased WaterGuard have to households comparison vs. 6%, P (36% equally a SWAP- by were been visited likely have households to comparison former and 322 and purchased vs. 21%) (27% purchased WaterGuard vs. 41%), (47% trained entrepreneur Sprinkles vs. 33%). (39% thatby contaminatedsewage, are often recurring causingcommunicable diseasewaterborne a shigellosis in investigated an China in outbreak western school to elementary outbreaks. We transmission and infection, risk infection. of of for factors identify mode source the

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organism. , outbreaks, case-control study study , outbreaks, case-control This shigellosiswas drinking by outbreak caused untreated water from In Nigeria, cholera outbreaks are associated outbreaks In with Nigeria, high cholera and morbidity bacillary Shigella flexneri dysentery, of the 533 students and no teachers developed disease. cases of developed teachers (n=44) and no 52% students 533 the % of We conducted an unmatched case-control study. A case was defined study. an as unmatched case-control any conducted We Saheed O. Gidado, E. Awosanya, S. Haladu, H. Ayanleke, Nguku, P. =0.035, chi-squared test for trend). Consumption of various food items was not was not food various items of Consumption trend). =0.035, for test chi-squared Median age was 25 years for cases and 30 years for controls; 38/80 (47.5%) of of (47.5%) Median 38/80 cases age years for was and 25 30 controls; years for 18 P . resident of Bashuri of community two with years watery acute and above diarrhearesident with or Bashuri of as 2009; resident any andcontrol a September, 3rd from vomiting without recruited 80 watery acute communitydiarrhea two without and We years vomiting. and above used structured collect to questionnaire We caseshospital-based controls. and 80 neighborhood characteristics, demographic data on clinical and analyzed risk information factors. Data were samples open-well 14 collectedWe and analyzedsamples software.and withstool 10 Epi-Info agarusing thiosulfate-citrate-bile-sucrose culture to Vibrio 2b. We recommend that the use of Well A water be A water that Well use the of recommend Shigella by flexneri A polluted We 2b. Well in thisdiscontinued school. resUlTs: meTHoDs: 8:15 with Soap — Bashuri, Jigawa State, Hand Washing Cholera Outbreak: the Importance of Nigeria, September 2009 aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: resUlTs: cases and 60/80 (75%) of controls were males. Compared to the controls, cases were less likelycases were males. controls, the to were Compared controls of cases (75%) and 60/80 95% =0.27, (AAOR) odds ratio hands eating washed (age-adjusted with before soap have to washed hands less and soap to have likelywith interval: usingafterconfidence the 0.10-0.72) was in isolated 01 cholerae Vibrio interval: confidence (AAOR=0.34,0.15-0.75). toilet 95% growth yielded samples Vibrio of analyzed; samples open-well the stool of of none (60%) 6/10 cholerae and 17% (n=12) of controls had drunk untreated well water (OR=5.3, 95% CI=2.5-11); 47% 47% CI=2.5-11); 95% had drunk (OR=5.3, controls well of water untreated (n=12) and 17% A (OR=5.6, had drunk Well from controls water of untreated (n=10) cases of and 14% (n=39) Well water A of ratio increased untreated The odd with the amount 2.5-13). CI= 95% ( consumed significantly associated with disease risk.Well Rectalwater A of 6 cases 5 swabs from and Shigellayielded flexneri A was near a sewage located lagoon. Well 2b. K. Sabitu, I. Mamuda, H. Akpan mortality. Effective interventions to control these outbreaks require the identification of the of identification require outbreaks the these control to mortality. Effective interventions in outbreak 2009 and risk infection. a cholera for source factors investigated In we September, Bashuri identify to community State, risk the infection Nigeria in for factors and Jigawa measures. control institute

=0.03], =0.01] and needing spousal approval of HIV and needing of spousal approval =0.01] <0.001]. <0.001]. Unhygienic hand washingUnhygienic waskey practices identified as risk the factor Lack of psychosocial support and counseling for women and belief Lack that and psychosocial counseling of support women for nondisclosure, Zimbabwe, PMTCT Zimbabwe, PMTCT nondisclosure, cholera, case-control study, thiosulfate-citrate-bile-sucrose agar, Nigeria thiosulfate-citrate-bile-sucrose study, case-control cholera,

The 2007 United Nations General Assembly Report on HIV/AIDS in on General Report HIV/AIDS Nations Assembly The 2007 United Pride Nyamayaro, Mucheto, D. W. Jones A cross sectional A cross analytic six at health facilities was study conducted in We enrolled 334 women. Thirty four percent (114) did not not disclose their did HIV (114) Thirty women. 334 enrolled four percent We itive women were perception that disclosure would cause divorce [AOR=7.82, P [AOR=7.82, that disclosure cause divorce would perception were women itive Makonde district.Makonde PlannedTheory The of toBehaviour was adapted socio-culturalguide variables assessed. Antenatal HIV for tested and postnatal program in women PMTCT the interviewed. were participate to consented who disclosure causes divorce, abuse or is unimportant contributes to nondisclosure. Identifying nondisclosure. to is disclosure unimportant abuse or causes divorce, contributes with socialwomen challenges and strengthening can their psychosocial referral for support child disclosure HIV to of HIV. of transmission mother statusimprove and reduce for infection in this outbreak. We conducted an intensive health education with emphasis on on with emphasis health education an intensive conducted infectionfor in this We outbreak. importancethe hand washing of with soap. CoNClUsioNs: KeyWorDs: meTHoDs: resUlTs: KeyWorDs: 8:35 of Attending the Prevention Among Women of HIV Status Determinants of Nondisclosure zimbabwe Programme — Makonde District, Mother to Child transmission aUTHors: INtRODUCtION: CoNClUsioNs: CoNClUsioNs: Zimbabwe reported nondisclosure of HIV of nondisclosure status reported Zimbabwe as a challenge programme. in PMTCT the HIV for tested Chinhoyi at women Preliminary 21 among nondisclosure on investigations that only six had disclosed showed determinantsthe Hospital investigated their HIV status. We HIV of nondisclosure of status. testing [AOR= 0.11, P 0.11, testing [AOR= living with an extended family [AOR=10.3, P living with an family extended [AOR=10.3, status. Among HIV positive respondents, 43% (25) did not disclose their status. Women disclose did their status. not Women status. (25) 43% Among HIV respondents, positive caused divorce 1.17-2.90], CI 95% believed disclosure abusewho [OR=1.81, causedphysical two were 2.26, and was 1.33-3.87] unimportantCI 95% [OR= 1.25-3.22] CI 95% [OR=2.01, counsel HIV group times less likely received pre-test disclose to who their status. Respondents 2.4 disclose. likelying to were Receiving times not more ANC HIV least at twice and education CI 0.24-0.63)(95% and 0.54 [OR significantly were psychosocialreferralprotective for support HIV among determinants nondisclosure of Independent respectively. 0.06-0.41)] CI (95% 0.16 pos

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In this study, moderate or severe injury severe was or associated with moderate In vulnerable this study, In 2009 a large outbreak of hepatitis A of over ten months duration duration months ten In over 2009 A of hepatitis of a large outbreak Developing countries account for more than 85% of the world’s road road world’s the of than 85% more for account countries Developing road traffic crashes, severe moderate injury, Kenya Kenya injury, trafficmoderate road crashes, severe Ellen J Donnan, K. Lalor, J. Gregory, S. Rowe, Goldsmith, P. L. Tracy, We recruited all consecutive RTC victims recruited all August from attending RTC hospital the consecutive We Eric M. J. Oundo,Osoro, Z. J. Omolo Ng’ang’a, Of the 300 participants, 225(75%) were aged between 20-49 years and 216(72%) aged between were 20-49 years and 216(72%) Of 300 the participants, 225(75%) to November 2009. Epidemiologic and clinical 2009. Epidemiologic obtained through data November were interviewsto and medicalreview of charts. mild graded or based Injury as the Injuries were moderate on severe, injuryinjurymoderate 15, Severe wasan definedISS (ISS). from as Severity Score an ISS above and those with severe and or mild with injury Participants moderate an 9. ISS below of 9-15 injury. severe associated or determine factors to withmild moderate compared injury were road users, rainy weather and night time crashes. We recommend that policies and efforts that recommend and users, nightroad rainy weather time crashes. We vulnerable users and road mitigate risks the protect and associated night weather with adverse time driving and implemented. be developed aUTHors: aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: 9:15 — Associated with Semi-Dried tomatoes A Sustained Multi-State Outbreak of Hepatitis Australia, 2009 resUlTs: aUTHors: baCKgroUND: meTHoDs: 8:55 — Thika District Injuries in Patients Traffic with Road Associated Factors Severity and kenya, 2009 Hospital, were male. Vulnerable road users (pedestrians and two-wheel users) comprised 99(33%) of the the of 99(33%) comprised users (pedestrians road users) male. and two-wheel Vulnerable were the of (18%) had fractures.Fifty-six head had 115(38%) injurywhile (5%) participants. Fifteen 95%CI=1.02-3.92), users (OR=2.0, road Vulnerable injury. severe or participants had moderate and night time crashes (OR=2.0, 95%CI=1.33-6.51) (OR=2.9, crashes inroad rainy weather injury. risk sustaining for factors severe or were moderate 95%CI=1.10-3.92) G. Hogg, A. J. Fielding, Tan, H. Vally affected a severalAustralian representing fornotifications states. 550 2009, resultedThis in hospitalised, patients of 45% with approximately year, previous increase the on two-fold peaks infection of occurred (April- health. public Two to burden a considerable representing with surveillance data suggesting locally infections were and September-November) May acquired food distributed a widely and product. from fatalities and the economic cost of road traffic crashes (RTC) in Kenya is about 5% of the Gross the of 5% is about Kenya in (RTC) traffic road crashes of cost fatalities and economic the health road The occurrence traffic injuriesKenya of and impact in (GDP). Product Domestic determine factors to carried a cross-sectional study out We attention. much received has not associated injury with severe in victims traffic road crashes of attending Thikahospital. district

Ravinia Ballroom, 8:30–10:15 a.m. <0.001), particularly those purchased <0.001),

<0.001), but with consumption mostly at restaurants or cafés.or restaurants at mostly with consumption but <0.001), species. Infections and persons occur in immunocompromised ......

Both case-control studies and food testing implicated the novel vehicle of of vehicle studies and food Both testing novel the case-control implicated Mucormycosis is fungal an invasive infection Mucormycosis caused several by types of hepatitis A, outbreak, case-control studies, A, Australia case-control outbreak, hepatitis Two separate unmatched case control studies were conducted. Genotyping was conducted. studies were unmatched separate case control Two A case was defined as a hospital-onset illness consistent with mucormycosis A case was definedmucormycosis hospital-onset illness with as a consistent Jonathan Duffy, J. Harris, Newhouse,E. Balajee,A. Noble-Wang, J. Mitchell L. Cohen The first case control study found anbetweenstudy The association first control case illnessconsumption and

confirmed by culture or histopathology. Case-patient medical records were reviewed for reviewedclinical for were medical records Case-patient confirmedby cultureor histopathology. within collected from and locations and Cultures hospital. course the exposure were items to air and were surfaces A. Hospital at and environment the Fungal patients from isolated species methods. Repeat Sequence subtyped sequencing and DNA using identified using Inter-Simple conducted on patient serum and food samples. Intensive product traceback and food sampling serum product and food patient samples. Intensive on conducted health warnings, public measureswas included requir undertaken. health Control order a public ing sanitation or pasteurisation in semi-dried tomato production in Victoria, and a trade level level trade a and Victoria, in production tomato semi-dried in pasteurisation or sanitation ing immunoglobulinrecall imported semi-dried Prophylactic an of or batch tomatoes. on implicated contacts. close for provided was vaccine semi-dried tomatoes as the cause of this hepatitis A outbreak. The outbreak was outbreak and extensive as The semi-dried A outbreak. this cause the of tomatoes hepatitis which were of design the and health implementation interventions, public sustained despite chains limitations by in food with testing supply changing capabilitycomplicated and complex patterns. distribution baCKgroUND: meTHoDs: tHURSDAY, APRIL 22 APRIL tHURSDAY, Atlanta SESSION M: CSI Finalists Award Mackel MODERAtOR: 8:35 aUTHors: CoNClUsioNs: KeyWorDs: resUlTs: meTHoDs: meTHoDs: of semi-dried tomatoes (OR 3.62, P 1.59-8.26, CI 95% (OR semi-driedof tomatoes (OR chains. twofrom supermarket study also semi-dried The second tomatoes implicated 4.73-22.73, P CI 10.32, 95% A virus A RNA semi-dried Hepatitis of tomatoes. samples Hepatitis was in detected 11 tested, whichwas 142 patients indistinguishableof (94%) 134 was genotype identified in 1b genotype the from in found an food epidemiologically sample. implicated L. Sehulster, S. Gilbert, M. Howard, H. O'Connell, E. Stanley, C. Rao, Chiller T. Mucormycosis Outbreak Associated with Hospital Linens — Louisiana, 2009 Mucormycosis Outbreak molds, includingmolds, Rhizopus > 50% are fatal. We investigated an outbreak of mucormycosis among Hospital A patients to to A patients Hospital among mucormycosis of an investigated outbreak > 50% are fatal. We further infections.prevent

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. One . One

species from 26 (40%) of 65 swabs clean of linens and 65 of 26 from species (40%) Hospital linens likely acted as a vector exposing susceptible patients to to linens likelyHospital patients acted exposing as susceptible a vector Three cases of autochthonous dengue fever were identified in Key West, identified in Key were dengue fever Three casesautochthonous of might have contaminated linens at the off-site laundry contaminated linens off-site the might at facility have during or mycoses, mucormycosis, zygomycosis, cross infection, cross bedding zygomycosis, and linens mucormycosis, mycoses, Christopher J. Gregory, E. Radke, K. E. Weis, Sauber-Schatz, G. Gallagher, A stratified random sample of households withinhouseholds radius of of 1 the A stratified kilometer sample random Blood was collected from 240 persons in 175 households. Eight (3.3%) Eight (3.3%) households. was Blood collected 240 from in 175 persons Five patients developed cutaneous mucormycosis from August from 2008 2009; July to mucormycosis cutaneous developed patients Five . Rhizopus delivery to the hospital. Hospital linens should be laundered, shipped, and stored in a manner be shipped, linens laundered, anddelivery stored should Hospital hospital. the to that minimizes contaminants. exposure environmental to index cases was selected. At each household, residents were asked to provide blood samples samples blood asked provide to were index cases was residents selected. each At household, and medical histories. was anti-dengue IgM Blood for tested and travel and IgG antibodies. neutralizing (PRNT) test with tested to a plaque-reduction were samples Antibody-positive infectingdetermine the flavivirus serotype.participants For past in fever with 7 the days, (NS-1) and non-structural protein-1 dengue for tested virus were samples (DENV) RT-PCR by area DENV collected the and from for tested were RT-PCR. by Mosquitoes assay. Rhizopus resUlTs: meTHoDs: KeyWorDs: 8:55 Florida, 2009 Autochthonous Dengue Fever Outbreak — key West, Investigation of aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: resUlTs: participants who had not recently traveled had evidence of recent dengue infection IgM, by recent of had evidence traveled recently hadparticipants not who participants (37.9%) Ninety-one identified havingDENV-1. as 5 were NS1; or RT-PCR, IgG a indicating persons with were positive, past flavivirus (2.1%) infection. Of these, 5 dengue-like illnessdengue classified recent were in past the 3 months probable as having strain as same the Mexican for DENV-1 positive were infection Mosquitoes PRNT. by human cases. patient isolate was isolate subtyping available for and waspatient genotypically an a to from isolate related clean linen transport cart. all A replaced Hospital linens and disinfected areas. linen storage negative. taken three were weeks later Air and surface cultures (n=29) associated areas, and from 1 (4%) of 25 samples from non-linen-related items. Allitems. specimens non-linen-related from samples 25 of associated areas, 1 (4%) and from identified as Rhizopus were oryzae and4 patient) environmental testingavailable for (13 allwards identified.Cases cases died.with multiple previous different were occurredair on No cases. the to common only the items were handling and gowns) systems. linens (sheets Hospital culturesEnvironmental grew Rhizopus E. Hunsperger, K. Tomashek, B. Biggerstaff, L. Stark, J. Muñoz, C. Blackmore Florida after a 70–year absence. An outbreak investigation to determine the incidence of recent recent of determine to after the incidence 70–yearFlorida a absence. investigation outbreak An Florida the by was conducted pastdengue of infection infection in and Key prevalence the West Dengue Health Branch. of and CDC’s the Department

<0.01). Cultures and serology Bordetella for <0.01). <0.01), and an increase in the proportion of of and an increase in proportion the <0.01), <0.01), smaller pertussis detected of amounts DNA <0.01),

Our results suggest a multi-factorial “pseudo” pertussis Our Based results outbreak. suggest on “pseudo” a multi-factorial Approximately 5% of Key West residents tested positive for recent dengue recent for positive tested residents Key West of 5% Approximately Verifying pertussis is difficult outbreaks because clinical diagnosis is pertussis, polymerase reactions, chain outbreaks, false-positive reaction dengue, community disease outbreak, transmission, epidemiology We investigated a prolonged pertussis characterized outbreak atypical prolonged a by investigated We Sema Mandal, Cassiday, P. A. Faulkner, M. Griffith, Jackson, M. Tatti, K.

Between November 2008 and August 2009, 127 cases were reported, of which 91 91 which of reported, caseswere 127 2008 August2009, and November Between

oup, M. Tondella, A. Clark, Cohn, T. S. Martin cases confirmed only by PCR that persisted despite high vaccine coverage and routine control control casesroutine high and vaccinecoverage confirmeddespite only by PCR persisted that case ascertainment conducted using modifiedmeasures. CSTE We casedefinitions, and confirmatoryperformed pertussistesting(PCR, pathogen culture, and alternate serology) observed clinic clinics pertussis practices, sampled testing. environmental DNA, for We and laboratory qualityreviewed PCR false for evaluate potential the to indicators positives. these findings, changes recommended in clinicwere collection specimencleaning and protocols clinical epidemiologic, of and laboratory data should interpretation Cautious implemented. responses. inform outbreak infection, making in States 60 this years. United largest the in dengue continental the outbreak Aedes aegypti and ample Key travel populations, increasing West international With mosquito be risk at future may of dengue Florida outbreaks. and southern CoNClUsioNs: KeyWorDs: resUlTs: baCKgroUND: meTHoDs: KeyWorDs: 9:15 aUTHors: CoNClUsioNs: (mean PCR cycle threshold value: 33.7 to 40.8, to 33.7 value: threshold cycle P PCR (mean (72%) were PCR positive. In cases occurring after April (n=78; 61%), we observed a shift to fewer fewer shift to a observed we 61%), (n=78; InApril casesoccurringafter positive. PCR were (72%) P 53%; to classic pertussis (84% symptoms 36%; P results to all among positive PCR tests (6% pertussis were negative, but evidence of other common respiratory pathogens was detected. We was pathogens detected. respiratory We common other of evidence negative, but pertussis were collection of and which factors identified at resultedpoint likelythe contamination specimen in false clinic vac with pertussissubsequent true positives: contamination from cases DNA and/or handling; specimen cine; lapses in appropriate liquid use transport of media; and lack clini of criteria. cally interpretation PCR relevant L. Pawloski, D. M. Woods-Stout, Barnes, B. K. Wagner, Lujan, M. Bonkosky, M. Martin, K. O’Connell, A. Schmidtke, CDC Unexplained Respiratory Diseases Outbreak Working Gr the Perfect Storm: Investigation of a Suspected Pertussis Outbreak — Colorado, Investigation of a Suspected Pertussis the Perfect Storm: Summer 2009 challenging and laboratory testing is suboptimal. polymeraseuse chain of Exclusive reaction increases likelihood the (PCR) that false will unnecessary positives ineffective prompt or and response. interventions

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, the , the

=.15); 19/24 (79%) mice inoculated with unattenuated (79%) 19/24 =.15); P

. Histopathology and immunohistochemistry not indicate septicemic, Thisreported is laboratory-acquired the andfirst fatalityinfection caused a Yersinia pestis a Yersinia working with 2009, In KIM-D27, a researcher September plague, risk infections, factor laboratory-acquired hemochromatosis, We conducted an environmental assessment, interviewed assessment, an laboratory personnel, environmental conducted We Andrew Medina-Marino, M. Schriefer, S. Black, Mead, P. K. Weaver,

No deficiencies were identified in requiredidentified in laboratory Interviewsmaintenance.were deficiencies No

and reviewed autopsy and medical records. Laboratory investigation included histopathologic histopathologic and included medical Laboratoryand autopsy investigation reviewed records. and immunohistochemical testing, samples, analysis genetic profiling, plasmid autopsy DNA of characterizationand strain the polymerase chain the of from (PCR)-based isolated reaction deceased; in mice. virulence conducted studies were Y. pestis Y. attenuated by pneumonic plague, exposure.pneumonic Although mucocutaneous indicating or percutaneous mouse inoculation studies confirm that the infectingstrain hemochromatosis-induced was attenuated, con susceptibility host creating an to by environment contributed might have overload iron are being overload iron of assess Studies pathogenesis. to to contribution pathologic the ducive risk a new might represent mice. Hemochromatosis in hemochromatosis-mutant conducted defects. iron-acquisition infections by for factor with bacteria attenuated KeyWorDs: CoNClUsioNs: meTHoDs: meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: 9:35 pestis Strain of Yersinia Attenuated an Infection with of Laboratory-Acquired Fatal Case Illinois, 2009 Plague — with coworkers identified inconsistencies deceased’s biosafetyin the practices. identified inconsistencies Immunohis with coworkers pestis within alltochemistry vessels of blood alveolar revealed Y. airspaces. not organs but serum pre-mortem Markedlydeposits. elevated iron Histopathologyabnormal identified liver testing confirmedhereditary postmortem. Genetic identified hemochroma were levels iron disease. and analysis PCR tosis, an DNA Plasmid iron-overload the infecting identified strain 0/64 died versus Of mice inoculated withas KIM-D27 KIM-D27. strain, stock (3%) 2/64 inoculated with deceased’s the strain ( pestis died. Y. K. Metzger, B. King, S. Shieh, Gerber, S. W-J. Zaki, S. Cali, C. Conover, K. Soyemi, K. Ritger Y. pestis genes, septicemia. died acute Y. of iron-acquisition of deletion by strain attenuated infection, of strain source the investigated plague,cause of cultures. blood was from isolated We factors.virulence, host and contributing

, outbreak, food , outbreak, O157:H7 (O157:H7) causes approximately 73,000 causes approximately (O157:H7) Escherichia O157:H7 coli This is the first O157:H7 outbreak linked to PRCDandoutbreak highlights linked to the O157:H7 This is the first

Shiga-Toxigenic Escherichia coli Shiga-Toxigenic We defined a case as O157:H7 infection yielding an indistinguishisolate definedO157:H7 a case as We Karen Neil, P. G. Ewald, K. MacDonald, S. E. Stroika, Hyytia-Trees,

Seventy-seven case-patients with illness case-patients during onsets 8 were Seventy-seven March 16–July

57:H7 Investigation OutbreakNet,57:H7 Team, Enteric Diseases Laboratory Branch able from the outbreak strain by Pulsed-Field Gel Electrophoresis (PFGE) and Multi-Locus and Multi-Locus (PFGE) Gel Electrophoresis strain Pulsed-Field outbreak by the from able hypotheses using question developed We Repeat Analysis (MLVA). Tandem Variable-Number and using study age, a case-control gender, interviewsnaires and conducted and open-ended E. (STEC). Shiga coli for tested toxin-producing were products Food controls. state-matched importance of not eating raw food products that are intended for cooking before consumption. cooking consumption. for before that are intended food eating products raw importance not of ground beef as a source. exclude critical to information testing provided MLVA KeyWorDs: CoNClUsioNs: meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: 9:55 identified in 30 states: 66% were <19 years and 69% were female. Thirty-five patients were female.years were 69% and Thirty-five patients <19 were identified in states: 30 66% as an initial was considered beef HUS. consumption Ground developed hospitalized; 10 in March was identified. produced ground beefsample a PFGE-matched when hypothesis strain. testing outbreak the indicated match After this did not sample MLVA Subsequent exposures with female cases, young,considering that might predominately be consistent interviewscookie prepackaged X Brand had raw many consumed found opened-ended iterative was significantly eating X PRCD Brand associated study, Inwith a case-control dough (PRCD). odds ratio=45.6, matched 42 of controls, cases 47 none of versus illness, (81%) [38 PRCD. strainsBrand X of isolated from STECwere non-outbreak Three p-value<0.0001)]. 19. June X recalled on Company all products PRCD C. Medus, Lafon, P. G. Gómez, M. Humphrys, N. Comstock, M. Sotir and theE. coli O1 O157:H7 Infections Associated with Associated Infections coli O157:H7 outbreak of Escherichia Multistate Cookie Monster: 2009 — United States, Raw Cookie Dough of Prepackaged Consumption infections annually in the US. Very young children and the elderly are more likely to develop likelyinfections develop annually to are more children young and elderly the in US. the Very began investigating a multistate We illnesssevere (HUS). syndrome uremic and hemolytic infections in 2009. May O157:H7 of outbreak

th 59 ANNUAL EIS CONFERENCE: tHURSDAY 132 59th ANNUAL EIS CONFERENCE: tHURSDAY 133

=0.07). a.m. 10:30–11:55 Ravinia Ballroom, ......

Parasitemia prevalence was similar prevalence Parasitemia in both HFS and HHS, overall and Malaria causes approximately 250 million Malaria 250 illnesses causes approximately and 1 million deaths the tick the tick malaria, surveillance, parasitemia, health facilities, community surveys Eight facilities were selected for the HFS. Fever history and blood smears were Eight history HFS. the facilities selected for smears were Fever and blood were Kimberly E. Mace, J. Skarbinski, R Khatib, J. Gutman, B. Elling, A. Malila,

Paul Mead Prevalence of fever was higher fever in of subjects among HFS thanPrevalence in vs. HHS 12%, (60%

<0.0001). Parasitemia prevalence varied between HFS and HHS by approximately 5% over all over 5% varied between HFS and prevalence HHS approximately Parasitemia by <0.0001). obtained on all patients presenting for sick visits. HHS were conducted on a random sample of of sample a random on visits. conducted sick HHS for were allobtained on presenting patients in these health areas. facilities’ households catchment census-enumerated Surveyors recorded and fever self-reported of prevalence compared and smears. collected blood We history fever, of parasitemia between HFS and HHS. Evaluation of Health Facility Versus Household Surveys for Measuring Malaria Burden — Household Surveys for Measuring Facility Versus Evaluation of Health 2004, 2006 2002, tanzania, over time. These findings should be interpreted cautiously, but suggest that prevalence of certainbut suggest of prevalence that time. These cautiously, over findingsinterpreted should be malaria observed in indicators track HFS those observed closely in HHS. HFS might be a valid community of malaria evaluation the for data source burden. KeyWorDs: resUlTs: CoNClUsioNs: baCKgroUND: meTHoDs: MODERAtOR: MODERAtOR: 10:35 aUTHors: tHURSDAY, APRIL 22 APRIL tHURSDAY, N: SESSION P different and was yearsafter not (2002, vs. 29% 24%; 2004, 2006, vs. 26% vs. 15%), 21%; 10% P and year, parasitemia (age of knownadjusting confounders for A. Ngadjilo, L. Causer, H. Williams, M. Lynch, E. Kahigwa, Bloland, P. S. Abdulla, S. Kachur Vectorborne Diseases Vectorborne annually. Recent scale-up of malaria interventions in endemic countries has countries intensified malariathe in of endemic annually. scale-up Recent interventions and impact program assessment for management. and timely information reliable for need an estimating surveys for established method malaria (HHS), Household are resource burden, andyears. every performed health three five Ongoing to intensive facility surveys as(HFS) been validated not againstsessing have quality data but source, alternative care are a possible of malaria community the at In level. assessed Tanzania, we burden HFS data validity compar by data HFS andfrom HHS biennially performed generated ing 2002 from concurrently 2006. to

, is

-specific -specific

Rocky (RMSF), caused Rickettsia Mountain fever by spotted rickettsii Babesiosis is a zoonotic vectorborne infectioncaused Babesia by parasites. vectorborne Babesiosis is a zoonotic Babesiosis is an emerging disease in increase the NJ. in cases Given and

babesiosis, blood-transfusion, vectorborne vectorborne babesiosis, blood-transfusion,

Kristina M. McElroy, L. Carpenter, M. Lancaster, J. McQuiston, S. Ngo, T. We defined cases as clinically We illnesses of Babesiacompatible identification with Andria Apostolou, Sorhage, F. C. Robertson, C. Tan

Between 2006 and October 2009, a total of 291 confirmed (96%) and probable probable and (96%) Between confirmed 2006 2009, and October a total 291 of

ath, persons. Babesiosis cases especially and older resulting immunocompromised among in blood smear or by animal inoculation (confirmed), or by demonstration of Babesia demonstration by or animal by in smear or blood inoculation (confirmed), collected through (NJ) Disease Jersey Data were New Communicable the (probable). antibody Reporting and Surveillance System. increased recognition of transfusion-associated cases, we recommend development of laboratory of transfusion-associated development of increased cases, recognition recommend we education Public and physician products. Babesia-contaminated blood for screen methods to this diseases. tickborne regarding and other might babesiosis that prevent increase behaviors aUTHors: aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: 11:15 resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: 10:55 2006–2009 — New Jersey, of Babesiosis Epidemiology Practices Regarding treatment of Rocky Mountain Spotted Fever Among Healthcare of Rocky Mountain Spotted Fever Practices Regarding treatment 2009 Providers — tennessee, (4%) cases were identified in NJ residents, with a two-fold increase of cases in 2009 (126 cases), of cases increase in a identified (126 casescases), with residents, NJ two-fold in were 2009 (4%) cases Most central during had from with onset 2008 summer and cases). were compared (54 median patients, ageand coastal 1 month–96 was 66 regions. years (range: Among 291 the cases For with available non-Hispanic. were and 61% white were male; 71% 69% were years); 290 of had care been admitted unit; six an patients to (2%) intensive 273 of data, 28 (10%) died. data indicate that Provisional eight cases,patients fatal including one case, might have been linked transfusions. blood to Dahlgren, J. Dunn the most commonly fatal commonly most illnessthe tickborne of States. Doxycycline in is treatment the United the is associated with antibiotics children. non-tetracycline RMSF, for of for even Use choice practices healthcare understand provider to sought We outcome. increased risk severe of annual the is four times national the where incidence regarding RMSF in Tennessee, treatment are particularly million) per and outcomes severe. (16.6 average from receipt of contaminated blood products are increasingly all products for being contaminated blood reported of Babesia receipt from cases investigated with during onset reported 2006–2009species. We the understand to measures. control implement and to babesiosis of epidemiology B. microti is transmitted Ixodes by scapularis ticks. Babesiosis can disease result in severe and de

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Aedes canadensis canadensis , and accessory Aedes vectors, La Crosse encephalitis virus (LACV), the most common cause of pediatric cause of encephalitis virus common La Crosse most the (LACV), Despite practicing in a high incidence region, over half of Tennessee half practicing in a high Tennessee over region, of Despite incidence

, are distributed throughout lower-Midwestern states, infection LACV lower-Midwestern , are throughout distributed Rocky Mountain spotted fever, survey, Tennessee, physician physician Tennessee, survey, Rocky Mountain fever, spotted Yi-Chun Lo, S. Patrick, G. Turabelidze, K. Gibney, R. Nasci Chart reviews and family fluid Cerebrospinal conducted. interviews were A cross-sectional survey 8,200 among was conducted with health professionals The male presented with fever, headache, nausea, vomiting, fever, with male presented The and whichwas Of 1139 (14%) completed surveys; responses were analyzed for 588 (60%) analyzed surveys; were responses (60%) 588 completed for (14%) Of 1139 and Aedes albopictus was last in reported Missouri in 2002 in been reported Kansas. and has never In August 2009, meningoencephalitisLACV was suspected in a male aged Missouri, 8 years in northwestern verify to an investigation diagnosis the near conducted Kansas. and examine associated We risk factors.environmental (CSF) was tested at CDC for LACV-neutralizing antibodies. Convalescent serum antibodies. was Convalescent tested LACV-neutralizing was CDC for at tested (CSF) IgM Canyon JamestownIgG, and LACV-specific antibodies for and LACV-neutralizing wasto visited household The virus cross-reactivity). (JCV)-neutralizing exclude antibodies (to characteristicsidentify environmental associated with larvae risk collect and to mosquito for identification. active Tennessee licensure. Tennessee active healthcare providers reported RMSF treatment knowledge that is inconsistent with current with current RMSF reported knowledge that is inconsistent healthcare providers treatment Lack knowledge regarding of recommendations. doxycycline as for a first choice RMSF in children aged years, especially <8 a and family PEs, among demonstrates providers practice regarding targeted recommendations. national for need education meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: 11:35 Infection — Missouri, 2009 Encephalitis Virus Old Face in a New Place: La Crosse resUlTs: meTHoDs: diagnosed as meningoencephalitis. acute infection LACV CSF was confirmedand by positive physicians and 394 (40%) physician extenders (PE [physician’s assistants and advanced practice [physician’s (PE extenders physician (40%) and 394 physicians indicated a primary as who commonly a Doxycycline role. was more practice reported nurses]) to children <8 compared aged (95%) years ≥8 for in agedfirstpersons choice RMSF treatment significantly were likely more Physicians CI=1.9-2.3). 95% Ratio [PR]=2.1, (Prevalence (45%) 95% (PR=1.3, doxycycline choosing than and report in 38%, to children PEs respectively) (50% in likely doxycycline choosing a pediatric report to specialty Providers more were CI=1.1-1.6). RMSF treat to in children than those in a family CI=1.7-2.4). 95% medicine specialty (PR=2.0, likely children treat to with more were working in and academic hospitals centers Providers CI=1.1-1.6). 95% (PR=1.3, doxycycline than practitioners private arboviral encephalitis in the United States, is endemic in upper-Midwestern and mid-Atlantic and mid-Atlantic arboviral in States, upper-Midwestern is endemic encephalitis in United the states. Although Aedes triseriatus natural the vector,

Ravinia Ballroom, 1:30–3:15 p.m......

Emergence of LACV infection LACV near of Missouri-Kansas the increases Emergence border Effective measures exist to prevent healthcare-associated B virushepatitis Effectivemeasures prevent existto La Crosse encephalitis virus, encephalitis La Crosse Missouri General Hospital

s larvae collected a tire. from were Matthew E. Wise, K. Katz, Sharapov, U. S. Marquez, P. Tolan, We reviewed HBV serology and DPH surveillance HBV serology reviewed and classify DPH to records We residents Denise Cardo During June–December 2008, nine (11%) of 81 susceptible residents developed developed residents susceptible 81 of During 2008, June–December nine (11%) larval identified within were 300 habitats, house. Aedes of triseriatus the feet and

as infected, acutely chronically infected, study cohort and immune. susceptible, A retrospective HBV using transmission identify healthcare of data to modes and on potential was conducted behavioral risk abstracted medical factors from charts. observed we infection control Further, practices, interviewed facility and staff, characterizationof performed genetic residents and specimens. HBV DNA concern for changing LACV epidemiology in lower-Midwestern states. Physicians should in should states. Physicians changing for concern in epidemiology LACV lower-Midwestern in LACV differentialclude diagnoses pediatricmeningoencephalitis. for changesEcologic that might facilitate this transmission into be LACV investigated. area expansion of should resUlTs: baCKgroUND: meTHoDs: MODERAtOR: 1:35 aUTHors: CoNClUsioNs: KeyWorDs: 22 APRIL tHURSDAY, SESSION O: serum LACV-neutralizing antibodies, positive serum LACV-specific IgM serum antibodies, IgG,and LACV-specific positive serumnega LACV-neutralizing and while playingbites antibodies. woods mosquito in male The reported the JCV-neutralizing tive and 8 discarded holes tires, tree onset. Fourteen characteristic symptom Aedes before week the triseriatus Aedes albopictu acute HBV infection.acute consulting the podiatrist of Observation highlighted opportunities for residents 24 susceptible of instruments of with blood. Sixcross-contamination (25%) developed A) (Resident chronic infection with receivingHBV podiatricresident care after one had other infected acutely Other residents infectionacute (RR=6.4, 1.4, CI: 29.3). 95% and equipment monitoring glucose A including shared blood exposures Resident possible to sexual All activity. with HBV specimens available three infected for acutely residents infectedcharacterization were with a strain residents A. matching Susceptible Resident that of Healthcare-Associated Illness S. Hathaway, A. Beaton, D. Hu, J. Drobeniuc, J. Perz, N. Thompson, BancroftE. Acute Hepatitis B Virus Infections in a Psychiatric Skilled Nursing Facility — Los Angeles, Facility — Los Infections in a Psychiatric Skilled Nursing Acute Hepatitis B Virus California, 2008 (HBV) transmission, yet outbreaks continue to occur in the United States. occur In 2008, to October in United the continue outbreaks transmission,(HBV) yet of acute HBV a cluster identified Losthe Angeles Public Health of County (DPH) Department a psychiatric skilled of infections residents among facility nursing assist CDC to and invited control. for recommendations and develop with investigation

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, pain clinics, injections outbreaks, epidural infections cause approximately 639,000 U.S. 639,000 aureusStaphylococcus infections cause approximately Infection control breaches during epidural procedures likely during facilitated procedures breaches epidural Infection control Among multiple potential transmission modes identified, transmission modes exposure potential Among multiple

Staphylococcus aureusStaphylococcus

hepatitis B, podiatry, long-term care, B, disease podiatry, hepatitis long-term outbreaks Rachel A. Radcliffe, Meites,E. J. Briscoe, Fosheim,G. McAllister,S. We conducted a cohort study of clinic patients who received injections April injections received who clinic of study patients a cohort conducted We = .02). Clinician all A performed = .02). Specific injections. medications epidural and Eight (7%) of 110 cohort patients were cases; six (75%) were confirmed. were Among cases; six were (75%) patients cohort 110 of Eight (7%) P

27–May 13, 2009. 13, Confirmeddefined caseswere as 27–May culture-confirmedMSSA from infections defined casesepidural were abscess. fluid,or as Probable blood,clinical cerebrospinal signs of by compared were days afterProportions injection. ≤14 leukocytosis) or fever infection (e.g., assessed. were exact MSSA procedures from isolates test. Clinic infection control using Fisher’s and three clinictwo patients staffnasal genotypedby were pulsed-fieldgel using swabs (PFGE). electrophoresis MSSA transmission from Clinician A to patients. Laboratory and epidemiologic findingsMSSA Clinician transmission from Laboratory and epidemiologic patients. led A to clinic and retrain clinicianthe staff.control procedures infection Followingproper improve to disease settings and transmission is hospitalizations. critical prevent in practices to outpatient to contaminated podiatric instruments was considered the dominant mode of HBV of mode dominant the contaminated podiatricto instruments was considered with care facilities infection compliance transmission in Long-term ensure this should cluster. standards, with healthcare providers. including consultation control CoNClUsioNs: KeyWorDs: resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: CoNClUsioNs: KeyWorDs: 1:55 were offered HBV vaccine by DPH. Infection control recommendations were made to the to made the were recommendations control DPH. Infection by vaccine offered HBV were podiatrist and facility. cases, median patient age was 65 years. Seven (88%) were hospitalized; were allcases, survived. age years. median (88%) was Seven 65 Eight patient (12%) other the of with cases none compared were injections epidural received who patients 69 of ( patients 41 B. Jensen, M. del J. Noble-Wang, Rosario, R. Gupta, J. Hageman, Patel P. Infections Associated with Epidural Injections at a Pain Clinic — Associated with Epidural Infections Staphylococcus aureus 2009 Virginia, West hospitalizations annually. In May 2009, West Virginia of notified annually.hospitalizations health were In departments 2009, May West hospitalized withthree patients methicillin-susceptible S. infections after aureus (MSSA) outbreak the determine to investigated pain clinic. an at receiving outpatient We injections measures. control and implement source underlying conditions were not associated with not case were status. Duringunderlying conditions staff procedures, mask use irregular; were skin syringes access injection and preparations to epidural reused patient were indistinguishable were isolate by vials.shared medication and isolates Clinician Both patient A’s PFGE.

= 0.13). HVR1 cases that four incident showed sequencing = 0.13). P

Enterococci are a leading and infec nosocomial causeEnterococci of colonization Patient-to-patient transmission of HCV occurred HCV of transmission Facility at A and may Patient-to-patient

Hepatitis C virus Hepatitis infection (HCV) affects 3.2 million Americans and disease C, outbreaks, hemodialysis, hepatitis infection control Matthew D. Ritchey, J. Svendsen, A. Kallen, Staggs W. Agam K. Rao, E. Luckman, M. MacCannell, Wise, T. Lin, L. Y. Wilson, We reviewed medical records and HCV antibody (anti-HCV) results for results for and medical (anti-HCV) antibody reviewed HCV records We Of 163 Facility A patients with known HCV status, 56 (34.4%) were previously previously were Facility with known status, HCV A patients 56 (34.4%) Of 163

the 170 Facility A patients treated between Facility January treated A patients 2008 170 the and April 2009. status HCV was and polymerase chain HCV hypervariable the determined using reaction; anti-HCV (HVR1) patient in a relatedness. for A case wasregion was sequenced defined HCV as seroconversion or upon admissionbefore HCV-infected afterwas one admission.infectedpreviously patient A evaluated.2006. were practices Infection control have resulted from observed infection control breaches. Recommendations to correct infection correct to Recommendations breaches. observed from resulted infection control have occurred. and retrain practices facility have control made. No staff were further seroconversions 2:35 aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: 2:15 infected with HCV. Eight incident cases were identified among 107 susceptible patients (attack patients 107 susceptible identified casesamong Eight were incident infected with HCV. shift on treated 1 44 of patients infections susceptible occurred in Incident 1 (2.3%) 7.5%). rate shifts later on ( 61 of vs. 7 (11.4%) were each closely related to one of three previously infected patients (97.2-100% maximum (97.2-100% infected three of previously patients one to each related closely were case-patients incident their related preceded infected Previously patients identity). nucleotide nearby or a sameat dialysisthe station. Lapses shift in hand treatment one by and underwent accesshygiene, cleansing, handling medication documented. and parenteral were G. Xia, J. Drobeniuc, M. Arduino, J. Noble-Wang, N. Thompson,Patel,P. D. Blythe Management of a Vancomycin-Resistant Enterococci Outbreak in a Neonatal Intensive Care Enterococci Outbreak in a Neonatal Intensive Management of a Vancomycin-Resistant Unit — Indiana, 2009 Outbreak of Hepatitis C Virus Infections at an Outpatient Hemodialysis at an Outpatient Infections of Hepatitis C Virus Outbreak Maryland, 2009 Facility — is the leading reason for liver transplantation nationally. HCV transmission in HCV hemodialysis nationally. is leading the transplantation liver for reason facilities has practices. In been associated March 2009, several with infection poor control hemodialysisFacilityin We patients identified among infections HCV were A. incident measures. control and recommend identify to source the an investigation conducted tion among newborns. Enterococcal infection can be further complicated by the presence of of newborns. among infection Enterococcal cantion presence be the further by complicated challenges.strains treatment A (VRE), Hospital which pose considerable vancomycin-resistant Healthnotified of the Indiana during Department that,State January 28–February 24, 2009, surveillancepassive with hadpatients three identified VRE infection neonatalin their intensive

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Oseltamivir and zanamivir are only the licensed antiviral medications Active surveillance Active a of identified high level VRE Intensified colonization.

enterococcus, neonatal intensive care units, vancomycin, infection, outbreak infection, care units, outbreak vancomycin, neonatal intensive enterococcus, We reviewed patients’ medical records and medical interviewed exposed records healthcare patients’ reviewed We We defined a case as culture-confirmedWe PFGEpattern with a colonization, VRE NatalieJ.M. Dailey, A. Rao, L. Chen, J. Duffy,P. Brantley, Wolf, L. E. Lamb, <.05). No additional cases were identified additional identified May cases No after 12. were <.05). Of 93 infants screened, 35 (37.6%) were colonized, with peaks were of in number (37.6%) Of infants 93 35 screened,

personnel (HCP). Resistant viruses were compared using genome sequencing. Respiratory sequencing. Resistant using viruses genome compared were (HCP). personnel areas hospital in and statewide other patients obtained pH1N1 from specimens previously a neuraminidase surveillance mutation H275Y, for pyrosequencing specimens underwent associated with oseltamivir resistance, assess to transmission magnitude. indistinguishable from the initial isolates’, in an infant treated in Hospital A’s NICU during indistinguishable in an initial the infant from A’s in Hospital treated isolates’, policies and compared and infection-control records reviewed 2009. We February 9, 25–June 100 (per surveillance active performance colonization of of and incidence cultures (ASCs) A (February periods using by 25– z-tests. Period between two intervention patient-days) weekly ASCs, included enhanced for cleaningMarch 18) Precautions practices, and Contact twice-weekly included ASCs, rigorous more 9) 19–June B (March Period case-patients. staff. nursing practices, of and cohorting and diaper-handling isolation surveillance associated VRE measures with were a decrease in incident and infection-control VRE when be considered should infections are detected implementation Timely colonization. in NICUs. meTHoDs: meTHoDs: 2:55 aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: meTHoDs: meTHoDs: resUlTs: care unit (NICU). Allcare unit (NICU). clinical had isolates indistinguishable electrophoresis gel pulsed-field measures and assessed their control effects. recommended patterns. We (PFGE) newly identified cases identified newly occurring at beginning the of each period as surveillance effortschanged. surveillanceActive cultures/100 cultures 27.2 versus increased A and B (22.1 between Periods patient-days, cases/100 1.7 versus decreased although (5.0 incidence respectively), patient-days, P respectively; J-M. Maillard,J-M. M. Davies, A. Fleischauer, Deyde, L. C. V. Wolfe, Gubareva, A. Srinivasan, A. Fry, Z. Moore Cluster of Oseltamivir-Resistant 2009 Pandemic Influenza A (H1N1) Infections on a Hospital Pandemic Influenza Cluster of Oseltamivir-Resistant 2009 Among Immunosuppressed Patients — North Carolina, 2009 Ward available to treat 2009 pandemic influenza A (H1N1) virus (pH1N1) infection. rare, Although virus(pH1N1) 2009 treat available to (H1N1) influenza pandemic A During options. 2009,antiviral October because limited of treatment concern is resistance of diagnoses received North Carolina ward of hospital one on patients four immunosuppressed during We thisinvestigated cluster infection identified as oseltamivir-resistant. later pH1N1 virus 2009 resistant of and extent mode determine the transmission. to November

Ravinia Ballroom, 3:30–4:55 p.m.

The spatiotemporal proximity of cases spatiotemporal The and virus homology support Group A streptococcal (GAS) infections range mild from (GAS) A streptococcal pharyngitis Group ......

Cold Case antiviral virus,H1N1 drug resistance, 2009(H1N1) influenza pandemic A Invasive disease was defined by GAS isolation from a normally sterile site (e.g., site sterile normally a from by GAS isolation diseasedefined was Invasive Benjamin J. Silk, Pondo, K. Gershman, T. Cieslak, P. D. Kirschke, Matt Moore The patients, agedpatients, The 43–67 years, Allexperienced illness onsets October 6–11.

Eighty-six emm types were identified among 10,143 (81%) isolates from 12,476 12,476 isolates from (81%) Eighty-six10,143 emm types identified among were

subtype, oseltamivir, immunosuppression blood). We reviewed cases from 10 population-based Active Bacterial Active Surveillance population-based Core cases reviewed 10 from sites We blood). through analyzed 2008. 1995 from emm types We associations with for cellulitis mild and other (STSS), shock syndrome toxic pneumonia,streptococcal severe soft tissue more infections and Logistic infections (PRI). was and used calculate pregnancy-related regression to NF, adjusted conditions). underlying and age, race, (sex, confounders for control and (aORs) ratios odds transmission of oseltamivir-resistant virus; no evidence of transmission beyond the four patients patients four the virus; transmission beyond of evidence no oseltamivir-resistant transmission of precautions droplet of institution was found. Similar prompt by might outbreaks be prevented requiring and by symptoms respiratory them or with fever patients immunosuppressed among use a surgicalto room. the outside mask when meTHoDs: resUlTs: aUTHors: baCKgroUND: KeyWorDs: 22 APRIL tHURSDAY, SESSION P: MODERAtOR: 3:35 Streptococcal Strain Predict the Severity of Invasive Disease? A Does Group CoNClUsioNs: CoNClUsioNs: resUlTs: cases. Although five common emm types (emm1: 22% of total, of 9%,cases. emm12: 22% emm28: emm Although(emm1: common 9%, types five causedlikely halfmore thannot emm3: soft tissue of infections, 8%,were 5%) they emm89: ambulated around the ward while symptomatic. Symptoms inconsistent with influenza-like inconsistent ambulated while Symptoms ward the around symptomatic. days. ≥3 by theseillness patients for isolation diagnosis,(ILI) and droplet delayed treatment, likely the indexcase, patient, Only one was exposed resistant oseltamivir of to detection before viruses. existed homology virus. four patients’ the among genomic Of242 Complete exposed 25, ILI reported 29–November during September interviewed. were Twelve (79%) 190 HCPs, ad no identified specimens hospital state and 174 confirmed. of were Pyrosequencing none but viruses mutation. with H275Y ditional the pH1N1 G. Dumyati, K. Angeles, R. Lynfield, D. Blythe, Farley,M. Petit,S. A. Reingold, D. Stevens, E. Zell, B. Beall, Beneden C. Van for the ABCs Team to life-threateningto illnesses as such fasciitis necrotizing In 2008 (NF). 12,000 cases invasive and vaccines are beingand developed 1,500 deaths States. Multivalent occurred in United the assessed strains disease. include causing GAS severe associationsshould between invasive We syndromesand bacterial strains as manifested emm types, by bacterial the sequences gene specific for individual M serotypes.virulenceprotein Respiratory Illness

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<0.001). One-quarter <0.001). This highlightsoutbreak United measles of occurrences in the continued In the United States, several common emm types were more likely emm types States, several to common more In United the were Although measles transmission has in the been interrupted endemic

<0.01). <0.01). measles, outbreaks, vaccination, travel, health personnel, nosocomial health personnel, measles, travel, outbreaks, vaccination, streptococcus group A, group emm, syndrome, streptococcus severity A case was defined as febrilerash illness of confirmed detection by George S. Han, R. Voorhees, J. Lando, Urdaneta, Lurie, Dato, P. J. Lute, V. V. Four additional measles cases were reported to PADOH; all five were present at present all were PADOH; five to additional measles reported Four cases were

infections measles-specific IgM antibodies. tracingwas Contact exposed for performed persons. Employee measles of evidence serologic for reviewed were exposed personnel of hospital health records immunity. States, which is often attributable to importation and not not recognizedimmediately to and importation States,by clini which isattributable often cians.secondary only five Despite cases,placed a substantial strainprivate on the investigation decrease possibility the measles transmission in of healthcare health To and resources. public and healthcare be immediately, and with isolated rash fever should settings, presenting patients measles immunity. documented have should personnel cause severe GAS disease.cause severe invasive These findingsand further can vaccine development guide understandingour disease of severity. CoNClUsioNs: CoNClUsioNs: KeyWorDs: resUlTs: aUTHors: baCKgroUND: meTHoDs: CoNClUsioNs: CoNClUsioNs: KeyWorDs: 3:55 April 2009 — Pennsylvania, March– Hospital-Associated Measles Outbreak other typesother cause these to infections. was In emm1 associated contrast, with pneumonia syndrome each of severe causing one-third and NF (aOR=1.8), STSS (aOR=1.9), (aOR=1.9), while emm3 P was also associated withSTSS (p≤0.001), (aOR=2.3; (25%) of PRIs were caused by emm28, which more frequently manifested PRIs caused emm28, of by frequently were as a PRI which more than other (25%) P types (aOR=3.0; the ED on March 10. Targeted review of electronic ED records for patients experiencing fever experiencing fever patients for ED records electronic review of Targeted EDthe March 10. on arrived recently childandIndia a school-aged rash from identified who with unknown history;vaccination an child the ED diagnosis received viral of March 10. exanthem on employees hospital confirmedmeasles serum 181 from obtainedPADOH on April 3. Of measles immunity, requiring thus documented had no exposed case, any to (40%) 73 callingdespite simultaneous additional testing identified cases No and vaccination. were >4,000 medical facilities in multiple contacts publicity and and widespread child care centers medical the throughout community and general public. Kutty,P. H. McLean, L. Stockman, Bellini, W. Rota, P. G. Wallace United States, importations continue to occur. On March 28, occur. On to 2009, Pennsylvania the continue States, importations United measles wasof notified in toddler an evaluated Healthunvaccinated of (PADOH) Department focused identifying on Investigation the (ED). department emergency hospital in a children’s and further additional casessource and spread. preventing

=0.047), renal disease or (64% Mycoplasma pneumoniae is U.S. leadingamong the pneumonia cause of Asthma is the most common chronic medical condition among adults among medicalAsthma chronic condition common is most the One-third of adults with asthma hospitalized for pH1N1 experienced experienced adults with of asthma One-third hospitalized pH1N1 for

2009 pandemic influenza A (H1N1), asthma, surveillance, 2009demographics,(H1N1), influenza pandemic risk A We reviewed California Department of Public Health pH1N1 mandatory California reviewed Public Health of pH1N1 Department We Eva Mortensen, J.Louie, C. Pertowski, E. M. Weiss, Acosta, K. Winter, Megin C. Nichols, J. Baumbach, C. Avery, J. Winchell, A. Aragon

>.001). Among 744 adults who were hospitalized or had died from pH1N1, 170 (23%) (23%) 170 hospitalized had died pH1N1, or from were adultsAmong who 744

>.001), chronic neuromuscular disease (52% versus 30%; versus P neuromuscular disease chronic (52% >.001), factors, treatment, outcomes outcomes factors, treatment, case-reports submitted during submitted 2009. Aprilcase-reports defined Cases 23–Augustas were laboratory- 11, either were years who by adultsPCR infection among with ≥18 asthma confirmedpH1N1 aged used identify tests chi-squared to associated factors hospitalized with had died. severe or We death). or stay care unit [ICU] (intensive outcomes severe outcomes. To minimize complications, interventions to encourage vaccination and im vaccination encourage to minimize interventions complications, To outcomes. severe with asthma. early antiviral be targeted patients should for therapy prove 4:35 aUTHors: baCKgroUND: CoNClUsioNs: KeyWorDs: resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: 4:15 for 2009 Pandemic Asthma Hospitalized Adults with of and Outcomes Epidemiology California, 2009 A (H1N1) — Influenza had asthma. Of those, the median age was 43.5 years (range 18-80) and 63% were female.had asthma. were and 63% Of those, median the 18-80) age was years (range 43.5 Asian/Pacific 2% and 11% Islander, black, 18% Hispanic, were 69% white, Thirty-four percent medical additional chronic conditions; more or one had (74%) twenty-five hundred One other. (71%) child-bearing twenty-one of hundred pregnant. One age women were (25%) 51 of 13 had within onset. Overall, (48%) symptom of 48-hours 81 (26%) 45 antiviralreceived therapy, who died 20%and 13% including outcomes, severe experienced (33%) Fifty-four pneumonia. significantlycom were survived.more admission but ICU required outcomes who Severe adults among with also 15%; asthmamon versus were diagnosed who (54% with pneumonia P C. Jean, B. Matyas Modes of transmission and Risk Factors for Mycoplasma pneumoniae During an Outbreak Modes of transmission Center — New Mexico, 2009 Adolescent Residential treatment at a Child and school-age children. are difficultschool-age In July institutions Outbreaks control. in residential to 2009, children for and psychiatric with problems behavior center treatment residential an eight-unit hospitalized for 2009 pandemic influenza A (pH1N1), affecting approximately 28%. We 28%. affectingapproximately hospitalized 2009 for influenza pandemic (pH1N1), A adults among with described and associated factors epidemiology the outcomes with severe in California. hospitalizedasthma died pH1N1 from or were who versus 31%; P 31%; versus

th 59 ANNUAL EIS CONFERENCE: tHURSDAY 142 59th ANNUAL EIS CONFERENCE: FRIDAY 143

Ravinia Ballroom, 8:30–9:55 a.m. >.005). In five of the six of In the five units caseswith >.005). P , outbreak, children, , outbreak, institutions pneumonia, ......

M. pneumoniae caused comingling this Resident outbreak. between units

An 8.3 magnitude earthquake a tsunami by followed devastated American Mycoplasma third Rock from the Sun

We used a modified cluster-sampling method to conduct the CASPER. We We CASPER.the conduct to method used a modified cluster-sampling We A retrospective cohort study was conducted among facility among and staff. was study conducted residents cohort A retrospective Ekta Choudhary, Chen, C. T. Martin, Bayleyegn, T. J. Roth, S. R. Vagi, Noe, Mike McGeehin Nineteen confirmed (10 by PCR) and six probable casessix occurredprobable by and PCR) 77 among (10 confirmed Nineteen

administered a household questionnaire eliciting information about medical about eliciting information and questionnaire administered basic needs a household Oropharyngeal (OP) or nasopharyngeal or were Oropharyngeal swabs collected staff from (NP) residents (OP) and cough or confirmed M. for Amongtested pneumoniae. staffresidents, fever, or casesincluded probable polymerase chain (PCR); positive reaction throat, or andradiographic sore pneumonia pneumonia. throat, cough, without and sore cases fever, included likely in resulted higher staff attack in rates attack a low those units. rate, transmission Despite units isolated likely ill from resulted relatively into staff workingunits. multiple Decreasingin comingling staffingresident and limiting multiple-unit might decreasetransmission during outbreaks.institutional baCKgroUND: meTHoDs: FRIDAY, APRIL 23 APRIL FRIDAY, SESSION q: MODERAtOR: 8:35 aUTHors: CoNClUsioNs: CoNClUsioNs: KeyWorDs: meTHoDs: resUlTs: reported pneumonia among residents. M. age, pneumoniae residents. among was suspected because pneumonia residents’ reported of of transmission, modes confirm riskand to investigated etiology, andsymptoms, setting. We factors. residents (attack rate: 32%). Attack rates were higher Attack in were units rates allowed comingle to than in 32%). rate: (attack residents (alland Three 0%–43%). PCR)confirmed 24 by versus units isolated (67%–100% relatively was residents Attack rate among 14%). (attack rate: cases staff occurred 197 among probable significantly higher ratio=2.4;than(risk staff among Environmental Health M. Kiem, S. Lemusu, A. Wolkin Community Needs Assessment for Public Health Emergency Response Following the Community Needs American Samoa, 2009 — Earthquake and tsunami Samoa on September 29, 2009, resulting in 32 deaths and widespread loss of municipal water, 2009, municipal resulting water, of deaths in loss and 32 widespread 29, September Samoa on services. and sanitation electricity, (ASDOH), The Healthof American Samoa Department Communitywith initial assistance Needs Assessments CDC, from and follow-up conducted and 5 days 3 weeks after tsunami, Publicthe Healthfor Response Emergency (CASPER), CASPER. describe findings follow-up the We from respectively. among residents, staff of illness residents, among allresident Forty-sixillnessonset. staff,preceded onset percent staffand of 98% in the unit units. with multiple the highest attackin worked rate,

Findings assess ASDOH to agencies efforts and helped other response Elevated formaldehyde levels in FEMA-supplied trailers and mobile homes in levels FEMA-supplied trailers homes and mobile Elevated formaldehyde CASPER, needs tsunami assessment, rapid disaster epidemiology, Isabela C. Ribeiro, Kowalski, P. J. Malilay, D. Moffett, Callahan,D. Cross-sectional evaluation of formaldehyde levels in TCs and ≤ 3 years old (new (new and in ≤ 3 years levels old TCs formaldehyde of evaluation Cross-sectional Three weeks after the tsunami, households (N=207) reported increased mosquito reportedweeksThree increased mosquito theafter(N=207) tsunami, households

Five of nine PCs were refurbished units; none had indoor carpeting or HVAC carpeting had indoor refurbished HVAC units; none or nine of PCs were Five

or refurbished) PCs in one school district school PCs in in refurbished) one Georgia,or and day over 2009. May Consecutive and and collected three nine from TCs air PCs. indoor were Teachers samples night continuous facility managers addressing answered a questionnaire characteristics. classrooms’ and identify additional needs. Based these findings, on received funding ASDOH to address and short-term established long- medical repellent, supplies), mosquito community needs (e.g. prevent health to mental programs, programs increase to community andproposed education diseases. vector-borne resUlTs: aUTHors: aUTHors: baCKgroUND: meTHoDs: KeyWorDs: 8:55 resUlTs: CoNClUsioNs: illnesses assess to and efforts, injuries, In health response we andcalcu mental concerns. order medicalbasicof difference the and lated needs in percentages between the initial follow-up and CASPER. units replaced in the past 3 years. Six teachers (50%) considered the classrooms’ environmental environmental classrooms’ the considered inunits past the replaced 3 years. Six (50%) teachers quality turningAC of because adequate,excessive and only two frequently reported off the In and PCs, both formal TCs ppb. overnight ranged levels 7–36 from Formaldehyde noise. and higher than were median day (16 levels respectively) ppb, and 18 median (19 levels dehyde (F)and temperature significantforindoor No found were differences respectively). ppb, 11 breeding sites (49.8%), unsafe housing structure (40.4%), an ill family member (35%), need for for need an ill unsafe family structure housing (35%), (40.4%), member (49.8%), breeding sites were (13%) water and (14%), financial help (26%), Food electricity and (11%). no (28%), clothes healthreported mental concerns increased need. Households greatest identified as self-reported the sleeping: 46.9%; compared We anxiety: (trouble 12.6%; difficulty13%). concentrating: (-16.4%), water CASPER and observedinitial decreases in and electricity follow-up (-40.4%), and an increase in needs; as and well (-6.3%) injuries as illnesses (-4.3%), clothing(-10.2%) was observed. medical care needs (+10.6%) G. Noonan, Garbe, P. S. Moore, S. Metcalf, M. McGeehin Are Formaldehyde Levels in Portable and traditional Classrooms a Cause for Concern? and traditional Are Formaldehyde Levels in Portable Georgia, 2009 used in recent hurricane events have prompted similar in assessments classrooms prompted portable have hurricane events used in recent children significant school-aged spend where in time.(350,000 usein investiga U.S.), This pilot levels that factors affect and could in assessed potential levels tion formaldehyde formaldehyde and traditional classrooms (TCs). (PCs) portable

th 59 ANNUAL EIS CONFERENCE: FRIDAY 144 59th ANNUAL EIS CONFERENCE: FRIDAY 145

=0.03; % exposed [%E] =0.03; % exposed [%E] =0.02; and non mouthing 66.7), %E =0.1; %E 91.7) were associated with were EBLLs in children 91.7) %E =0.1; This study did not identify levels of formaldehyde that are associatedThis identifyof formaldehyde levels not study did The prevalence of EBLLsprevalence Burmeserefugee The among children in Thailand Lead poisoning has permanent neurocognitive sequelae, and its prevalence Lead sequelae, prevalence and poisoning its neurocognitive has permanent indoor airindoor carbon quality, dioxide schools, formaldehyde, lead poisoning, refugees, and anemia, resettlement settlement

Tarissa Mitchell,Tarissa E. Jentes, L. Ortega, Bajcevic, P. Parr, K. Caldwell, V. M. During May– June 2009, During capillary June May– Burmese from refugee blood children in Of 645 children tested, 33 (5.1%) had EBLLs; 65 (10.1%) had undetectable levels. had undetectable had EBLLs; (10.1%) 65 Of children 645 (5.1%) tested, 33

rival, but the prevalence and risk factors for lead poisoning before resettlement have not been not have resettlement and risk lead poisoning before for factors rival, prevalence the but Thailand aged 6 months– 14 yearsThailand14 was analyzed months– agedleadhemoglobin, using 6 portable for instruand were lead levels µg/dL) (<3.3 undetectable or Children (EBLL, withments. elevated µg/dL) 10 determine risk to study factors. inenrolled a case-control was least at 5 times U.S. the Exposures in prevalence. U.S. uncommon children, as such car bat departureTesting before this for difference. status account may nutritional teries, and poorer an U.S. the opportunityfor provided identify to refugee children with EBLLs, lead remediate exposures and alert health officials public Portable lead testingthe inU.S.may be instruments children of evaluation in refugee rapid camps. screening for tools valuable with adverse health effects. However, the observed CO2 levels were found to be elevated to elevated be found were levels observed CO2 the healthwith effects. adverse However, in levels classrooms, the CO2 particularly reduce to in Recommendations TCs. (>1100ppm), been made. have ventilation, improving by CoNClUsioNs: KeyWorDs: meTHoDs: resUlTs: aUTHors: aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: 9:15 — thailand-Burma U.S.-Bound Burmese Refugee Children Lead Poisoning in Border Refugee Camps, May–June 2009 humidity (%) between the two types of classrooms. Carbon Dioxide (CO2) levels ranged levels from between two the types (CO2) classrooms. of humidity Carbon Dioxide (%) and ppm) than during (749 day the higher medians night ppm) at ppm; were (942 509–1405 ppm). than in PCs (710 ppm) higher (1106 in TCs <2 years of age. years of <2 food items (OR18.6; CI 0.95–36.2; CI P (OR18.6; food items Of children <2 years old, 14.4% had EBLLs.Of children years old, 14.4% <2 analyses Multivariate that car battery showed ex P 1.7–57.2; [CI] interval confidence 95% 44.7; [OR] ratio posure (odds 43.6; 1.8–49.4; CI (OR g/dL P <10 hemoglobin 66.7), Brown, J. Painter is approximately 1% among children in the U.S. However, refugee children among children in the resettled U.S. the to 1% However, is approximately screening resettled refugee hadU.S. a higher CDC recommends children prevalence. have after ar determine these Burmese among factors to sought refugee childrendescribed. living We in camps in Thailand. Approximately 500,000Approximately cases poisoning occur pesticide of in develop Case-patients’ clinical presentations, depressed plasma cholinesterase, plasma clinical and depressed Case-patients’ presentations,

unintentional poisoning, unintentional pesticides, cholinergic acute syndrome, carbamate, We conducted a retrospective cohort study of all children ≤10 years old in years both all old of study cohort children ≤10 a retrospective conducted We Ellen E. A. Yard, Siston, E. Gurley, J. Thomas, Hossain,M. M. Rahman, M. Eleven case-patients and 29 non-cases were identified (attack rate=27.5%, case (attackrate=27.5%, identified were non-cases and 29 case-patients Eleven ing countries annually.ing In countries Bangladesh, engages three-quarters in workforce the agricultural of use and increasing. is pesticide widespread practices; In April 2009, Bangladesh health officials illnessof severe onsetof children a cluster sudden with in neighboringidentified two rural vil lages that in resulted three fatalities. and laboratory Bangladesh CDC epidemiologic requested poisoning. pesticide potential investigate to support carbofuran villages. Case-patients were those presenting with ≥2 symptoms characteristic cholinergic with symptoms villages. of ≥2 those presenting were Case-patients Village-specific(RR) riskratios 95% 2-22). and (April period duringinhibition outbreak the calculated.were (CI) intervalsSerumconfidence was collected 7 casesnon-cases 13 from and and carbamate pesticides. organophosphate for and screened serum analyses pesticide suggest carbofuran improved include poisoning. Recommendations regulation, regardingpesticide community safe education usage pesticide and food handling, and further routes. exposureand source confirm to outbreak’s study the KeyWorDs: CoNClUsioNs: meTHoDs: meTHoDs: resUlTs: aUTHors: baCKgroUND: 9:35 April 2009 — Bangladesh, Illness Acute Pesticide-Related of Outbreak fatality rate=27.3%). Case-patients experienced cold skin (90.9%), excessive sweating (81.8%), sweating (81.8%), excessive skin cold experienced (90.9%), Case-patients fatality rate=27.3%). For (63.6%). consciousness of and loss limb weakness (72.7%), oral dischargefrothy (81.8%), ini serial indicated were three that levels case-patients, plasma cholinesterase measurements after de 30 increasedand days.The >20% but symptoms tially presentation, on depressed cholinesterase both pressed suggested carbamate The poisoning with a cholinesterase inhibitor. insecticide carbofuran was following in detected hours two the cases with serum collected <10 eating village, onset. In man included one symptom exposure routes pesticide-related potential goes (RR=undefined, (RR=7.43, all mud cases consuming contact with reported and mangoes) CI=1.0-54.3). 95% Approximate Hussain, J. Schier, A. Chang, D. Birkholz, C.Skinner, A. Wolkin, L. Lewis, C. Martin

th 59 ANNUAL EIS CONFERENCE: FRIDAY 146 59th ANNUAL EIS CONFERENCE: FRIDAY 147

Ravinia Ballroom, 1:30–3:15 p.m. Ravinia Ballroom,

. , well chlorination, pot-chlorinators , well pot-chlorinators chlorination, Pot-chlorinators failed to achieve WHO-recommended FRC levels in levels failed FRC achieve WHO-recommended to Pot-chlorinators Waterborne cholera epidemics are a major public health problem in sub- health problem public are a major epidemics cholera Waterborne Vibrio cholerae Vibrio the Closer the Closer

Thirty wells were randomly selected from six neighborhoods. Pot-chlorinators Thirtysix Pot-chlorinators randomly neighborhoods.wells selected from were Elizabeth C. Cavallaro, J. Harris, J. Santos Barrado, A. Nóbrega, Michael J. Beach Complete post-chlorination data were collected from 26 wells; 15 (58%) were <2 <2 were (58%) collected 26 from wells; data 15 were post-chlorination Complete

as and 24, measured before with compared 48, and afterWHO- and hours placement 72

- bottles filled sand, with gravel, hypochloritecalciumplacedand well.in eachwere granules - w FRC mg/L and 0.2-5mg/L outbreaks in during non-outbreak ≥1 cholera of levels recommended distancesettings. well wells of covers, from latrines, to Presence and rainfall noted. were wells during a cholera outbreak, and conveyed a false security sense of and conveyed Pot- wells outbreak, local during to residents. a cholera disinfection well-water to be discouraged should chlorination approaches and alternative promoted. KeyWorDs: resUlTs: CoNClUsioNs: baCKgroUND: meTHoDs: ...... MODERAtOR: 1:35 aUTHors: FRIDAY, APRIL 23 APRIL FRIDAY, S: SESSION meters deep, with well volumes from 0.6-8.0 m3. Twenty-four (92%) wells had a latrine <30 (92%) 0.6-8.0 from with well deep, volumes meters m3. Twenty-four all on rain days; observation covered fell wells second the on were (15%) Four away. meters and no (4%), one night all at wells. baseline, At wells >0.09 no had mg/L. FRC (15%), Four wells between mg/L 0.2-5 had FRC and 1 (4%) 4 (15%), (62%), mg/L andwells 16 ≥1 had FRC Several families 24, respectively. at stopping 48, reported post-chlorination, and hours 72 after chlorination wells treated pot-chlorinators. with water were household J. Sobel, E. Mintz Evaluation of Pot-Chlorination of Wells During a Cholera Outbreak — Bissau, During of Wells Evaluation of Pot-Chlorination Guinea-Bissau, 2008 Saharan Africa. Guinea-Bissau has experienced five cholera epidemics since 1994.Saharan most The since Africa.epidemics has cholera five Guinea-Bissau experienced occurred in 2008, epidemic cases deaths;recent in and Bissau, 225 causing UNICEF- >14,000 used disinfect to were drinking shallow of wells, source designed pot-chlorinators a common levels achieve free chlorine residual to (FRC) evaluated ability the pot-chlorinators of We water. inactivate cholerae Vibrio in to adequate well water Food- and Waterborne Diseases in the International Setting in the International Diseases Waterborne Food- and

Aflatoxin levels were above the US standard in five of eight commonly- standard US eight of the in five Aflatoxin above were levels In Ethiopia, people living with HIV/AIDS (PLWHA) have an increased have (PLWHA) livingIn Ethiopia, people with HIV/AIDS

Aflatoxin, a toxic metabolite produced by Aspergillus Aflatoxin,produced metabolite spp. toxic fungi, a can cause aflatoxins, Bangladesh, food poultry, We collected human food and poultry in feed in samples threeWe Bangla cities Ethel V. Taylor, A. Bhattarai, Taylor, Ethel V. C.E. O’Reilly, S. Alemayehu, R. Fantu, V. Monika Roy, J. Harris, S. Afreen, Balajee,S. E. Deak, L.Gade, Park,B. Aflatoxin highestwere levels in dates and maximum with groundnuts, levels

desh: Dhaka,desh: poultry of based selected aflatox Chittagong, location on were and Sites Sirajganj. deaths andicosis climatologic data indicating a high risk fungal for Eight contamination. crop red chili dates, betelnut, flour, lentils, wheat powder, ingested (rice, commonly commodities and poultry collected two from main in feed each were sites city. market ginger, groundnuts), quantifiedcommodityAflatoxin of each were subsamples fluorescence using levels in pooled high-performance liquid chromatography. ingested foods tested.elevated effect levels The of aflatoxin in these foods its and association with human health further require investigation. aUTHors: aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: 2:15 meTHoDs: meTHoDs: resUlTs: aUTHors: baCKgroUND: 1:55 of 623 and 423 parts per billion (ppb), respectively (U.S. human food standard, <20 ppb). (U.S. human respectively food standard, and 423 ppb). 623 <20 of parts billion per (ppb), 21.2, range chili 4.8-43 (mean and lentils red 30.6, ppb), ppb), (mean Betelnut range 5.1-63 also had very high ppb) aflatoxinlevels. and flour, Rice, meanginger wheat had (>20 powder (range 0-6 ppb) 3.21 and ppb), (range 0.92-1.6 1.38 aflatoxin(rangeof 0.28levels 0-0.85 ppb), ppb). Mean aflatoxin(range70-77 level in poultry respectively. ppb feedwas ppb, 73 S. Luby, T.Chiller Cuellar, B. Marston, Belayneh, Sewnet, Kebede, Y. T. A. T. Mekonnen, J. Ahmed, R. Quick Changing Water treatment Practices in People Living with HIV/AIDS in Response treatment Changing Water Ethiopia, 2008–2009 to Diarrhea Prevention Programs — Gonder, Rapid Assessment of Aflatoxin Contamination in Food Commodities–Bangladesh, 2009 in Food Commodities–Bangladesh, Contamination Aflatoxin of Assessment Rapid liver failure, liver hepatocellular carcinoma, and death in humans. Inoutbreaks, aflatoxicosis acute animalhuman precede deaths often disease.of reportspoultry to deaths due Recent afla address in this, Bangladeshtoxicosis human potential we exposure. about raised To concern aflatoxin of contamination in burden the investigate to cross-sectional study a rapid performed Bangladeshicommon foods. risk diarrheal of diseases. drinking diarrhea Household risk reduces chlorination in water “WuhuAgar” free locally-produced PLWHA. Several provided organizations have in Ethiopia programs. (ART) in In clients antiretroviral 2009, to chlorination treatment free water for containing WuhuAgar basic care packages of proven and distribution other national (BCP)

th 59 ANNUAL EIS CONFERENCE: FRIDAY 148 59th ANNUAL EIS CONFERENCE: FRIDAY 149 <0.01]), <0.01]), P =0.03). =0.03). =0.17). Cholera Cholera =0.17). P =0.02). Among =0.02). <0.01]), and treating <0.01]), P <0.01]). Significant sequential in <0.01]). P <0.001) or IV fluids (76% vs. 55%, P vs. IV(76% or fluids <0.001) Epidemic cholera can fatal, be rapidly cholera in and occurs Cameroon. Epidemic frequently Free distribution of WuhuAgar of use, anddistribution both counseling before proper Free on

HIV/AIDS, safe water, diarrhea, safe diarrheal water, HIV/AIDS, disease

<0.01]) and detection of residual chlorine in stored drinking water (4% to 17% drinking 17% chlorine to residual in of stored and detection (4% water <0.01]) We conducted a retrospective cohort study of cholera mortality cholera interview of by study cohort a retrospective conducted We We surveyed ART clinic clients in the hospital in Gonder, Ethiopia about water water surveyed about Ethiopia ART clinic in in Gonder, hospital the clients We Emily J. Cartwright, M. Patel, R. Djao, Mbopi-Keou, F. E. Mintz, R. Quick P We identified 109 cholera patients, including 29 decedents and 80 survivorsdecedents 29 including patients, in 109 cholera identified We

Survey respondents were predominantly female (72%), 67% had no income, and income, had no 67% female (72%), predominantly were Survey respondents <0.01]) in respondents’ homes. homes. in respondents’ <0.01]) P <0.0001) and receive ORS (91% vs. 55%, P vs. 55%, ORS (91% and receive <0.0001)

=0.0008) and to have lived ≤15 minutes of a health facility (14% vs. 51% P vs. 51% a health of facility minutes (14% =0.0008) lived ≤15 have and to ing cholera survivors and relatives of decedents in villages survivors decedents of ing and survivor relatives cholera and cholera with least at one as wateryacute, defined years onset cholera old ≥2 with diarrhea in a person death. We one 2009.after 31, localAugustIn health facilities,medicalwe abstracted charts and interviewed (HCWs). healthcare workers treatment practices and confirmed WuhuAgarresidual chlo and confirmed practices for water testing by treatment use stored in three in 2008 at time December points: homes rine 1), in 77 among (Survey clients’ clients and in 2009 September 405 among 2), as (Survey clients a baselinedistribution BCP before 2009 3). same the among (Survey 405 following distribution BCP clients’ October-November and during dissemination, BCP significantly of increased drinking behavior treatment water PLWHA. resUlTs: Excess Mortality During Epidemic Cholera — Cameroon, 2009 Excess Mortality During Epidemic Cholera aUTHors: baCKgroUND: meTHoDs: CoNClUsioNs: KeyWorDs: 2:35 meTHoDs: resUlTs: interventions, was initiated. We evaluated changing was initiated. WuhuAgarinterventions, We use to in patterns response these programs. 31% had no education. From Survey increasessequential in Survey per the 1 to were From 3, there education. had no 31% obtaining 28% 100% reported [ to to who free WuhuAgar (3% respondents of centage receiving counseling on proper use of WuhuAgar (22% to 55% to 100% [ to 55% to WuhuAgar use of receiving counseling (22% proper on 28% [ 98% to to withWuhuAgar water (18% their stored alsocreases Survey from were found Survey 1 to WuhuAgar 3 in of to observation bottles (7% [ 95% to 23% 66% [ to 14 villages. The median age was 25 years (range 2-90); 39% were male. Only 3% of cholera villages.male. of cholera were 39%Only3% 14 (rangemedian The 2-90); years 25 agewas ( home at salts survivors (ORS) of used and oral 12.5% rehydration decedents From September-December 2009, cholera caused 717 cases and 85 deaths in Cameroon (case cases deaths (case in and 85 Cameroon caused 717 2009, cholera September-December From be <1%. CFR should cholera the treatment, appropriate With =12%). fatality [CFR] rate those who sought care at a health facility, survivors were more likely to spend the night (91% vs. night the likely care a health sought at (91% spend facility,those who to more survivors were P 33%, decedents were less likely than survivors to have sought care outside the home (69% vs. 95%, (69% less likely home the than were care sought outside survivorsdecedents have to P

=0.006). had Only 44% HCWs of P To reduce cholera mortality, authorities should increase availability the should mortality, authorities of cholera reduce To Preliminary data in analyses diarrhea-specific a substantial reduction show Diarrheal diseases are a leading death in cause in of years children old <5 diarrhea-associated deaths, Health Surveillanceand Demographic System, cholera, diarrhea, cholera, mortality, ORS We examined data KHDSS the and autopsy verbal We socioeconomic demographic, Kashmira A. Date, R. Quick, D. Feikin, K. Laserson, S. Ogwang, M. Hamel From 2003–2007, 532 (12%) of 4,587 of deaths years children old, and among <5 (12%) 532 2003–2007, From

water treatment, population-based population-based treatment, water from 2003–2007. We determined household demographic and socioeconomic characteristics, and socioeconomic demographic determined household We 2003–2007. from and, practices; annual in diarrheal trends treatment including water disease mortality among years old. ≥15 yearschildren and persons <5 mortality Further study products. and a simultaneous increase in treatment utilization water of to contributed have practices treatment water household is determine whether warranted to declining diarrhea mortality rates. ORS in communities, urge those with cholera symptoms to seek care promptly, train HCWs on on train HCWs seekORS care to promptly, symptoms in urge communities, those with cholera supplies. and management, assure rehydration adequate cholera appropriate CoNClUsioNs: KeyWorDs: meTHoDs: resUlTs: aUTHors: baCKgroUND: CoNClUsioNs: CoNClUsioNs: KeyWorDs: 2:55 Five (42%) of 12 health facilities with cholera decedents exhausted rehydration supplies com supplies exhausted health 12 facilities decedents of rehydration with cholera (42%) Five ( nineof facilities decedents pared with without none 307 (4%) of 7,969 deaths among persons ≥15 years old were determined to be diarrhea-specific. determined to were years old ≥15 deaths persons among 7,969 of 307 (4%) During this KDHSS under period, population the surveillance increased 134,990 from to 204,000,1,000deaths and1.4 diarrhea-specific7.6 to per mortality <5 childrendecreased from house years Among old. 65,104 0.2 to years 1.4 old, and from deaths 1,000 per ≥15 persons steadily products data, treatment chlorine use the water of with treatment availableholds water inincreased 4% 2003 from in 27% 2007. to trends in Diarrheal Disease Mortality and Use of Household Water treatment, kisumu kisumu treatment, Water Mortality and Use of Household in Diarrheal Disease trends — Nyanza Province, Surveillance System (kHDSS) Health and Demographic kenya, 2003–2007 Kenya. In campaignKenya. 2003, risk the diarrhea of a nationwide through was reduce initiated to measure this impact the of To treatment. water household for local sale chlorine solution of in diarrhea-associated trends program on mortality in Nyanza and chlorine use products of examined we Kenya, Province, Kisumu data the from Health Surveillance and Demographic a longitudinal, (KHDSS), health system registration andSystem vital population-based event health dynamics and demographic villages indesigned monitor 385 to in in Nyanza province rural Kenya. western received cholera training epidemic. the cholera before received

th 59 ANNUAL EIS CONFERENCE: FRIDAY 150 59th ANNUAL EIS CONFERENCE: FRIDAY 151 Ravinia Ballroom

...... aboratory Services, CDC

Stephen B. Thacker, Deputy Surveillance, Director for Epidemiology and L 3:15 Closing Remarks and Adjournment and Closing Remarks th 59 ANNUAL EIS CONFERENCE 152

4/14/10 2:23 PM

59 ANNUAL EIS CONFERENCE: INDEX 153

Z P Sharyn: � 40 7, Parks, � Minal:123 16, Patel, 13, Mark: Pendergrast, � 99 57, 9,13, Parvathy: Pillai, � 120 15, Paul: Polkuu, � 56 9, Krista: Powell, � 48 8, Nykiconia: Preacely, R Radcliffe, � Rachel:137 46, 8,17, 19 Jeanette: Rainey, Rao,Agam: � 138 17, 14 Pat: Remington, � 144 19, Isabela:18, Ribeiro, Philip: Ricks, � 55 9, � 138 17, Matthew: Ritchey, Kis: � 91 Robertson, 12, Monika: � 148 19, Roy, S Sanisa: � 118 15, Santayakorn, � 87 12, Erin: Sauber-Schatz, � 140 102, Silk,13,18, Benjamin: Ronald: � 122 15, Skewes-Ramm, Meera: � 95 13, Sreenivasan, 11 David: Swerdlow, T � 112 14, Myduc: Ta, � 148 19, Ethel: Taylor, � 72 10, La'Shan: Taylor, � 71 10, Elizabeth: Torrone, � 100 13, Pritish: Tosh, � 53 8, David: Townes, Crystal: � 83 11, Tyler, V Sara: � 19 Vagi, W Nancy: � 88 12, Williams, � 98 13, Roxanne: Williams, � 62 9, Matthew: Willis, � 136 82, 11,17, Matthew: Wise, Y � 146 Ellen:18, Yard, � 42 8, Catherine: Yen, Zang, � 117 15, Bike: � 37 7, Zheteyeva,Yenlik: O � 44 8, John: Oh, � Eric:127 16, Osoro, Nelson, George: Nelson, � 58 9, Megin: � 142 18, Nichols, � 105 13, Carrie: Nielsen, � 119 15, Stine: Nielsen,

M � 133 Kimberly:47, 8,17, Mace, Roc: Magloire, 19 Sema: � 130 16, Mandal, � 119 15, Ngoni: Mashumba, � 134 17, Kristina: McElroy, � 107 14, Jevon: McFadden, Andrew: � 131 16, Medina-Marino, Elissa: � 45,89 8,12, Meites, � 92 17, 12, Shauna: Mettee, � 145 18, Tarissa: Mitchell, � 65 9, Surbhi: Modi, Diane: � 44 8, Morof, � 142 18, Eva: Mortensen, � 126 16, Pride: Mucheto, � 97 88, Rendi: 12,13, Murphree, � 85 12, Erin: Murray, N Robin: 19 Nandy, � 111 14, Muazzam: S. Nasrullah, � 132 16, Karen: Neil, H � 96 13, Christa: Hale, Lee: � 67 50, 8,10, Hampton, George: Han, � 141 18, Ke: � 124 16, Han, � 38 7, Farah: Husain, I � 74 10, Aybaniz: Ibrahimova, A. Danielle: � 63 9, Iuliano, J � 77 11, Vanessa: Jarquin, Emily: � 51 8, Jentes, K � 121 15, Manar: Kasimzhanova, � 93 69, 10,12, Jessica: Kattan, Meagan: � 106 14, Kay, � 51 8, Keck,James: � 104 13, Erin: Kennedy, � 114 14, Christina: Khaokham, � 78 11, Brian: Kit, � 102 Barbara:92, 12,13, Knust, 17 Erin: Koers, L Molly: � 78 Lamb, 11, William: � 74 10, Lanier, Lee,Soo-Jeong: � 113 14, LiuMingbin:, � 115 15, Lo,Yi-Chun: � 135 17, Anagha: � 90 12, Loharikar, Sara: � 36 7, Lowther, Emily: � 109 14, Lutterloh, � 96 Samuel:13, Graitcer, � 129 16, Christopher: Gregory, � 110 14, Matthew: Groenewold, Presenters

E � 52 Charbel:8, Bcheraoui, El Douglas: � 94 Esposito, 13, F 11 Lyn: Finelli, Mary: � 80 11, Fournier, Brunella: � 40 7, Frammartino, � 59 9, Marie: Anne France, Amy: � 35 7, Freeland, Alicia: 11 Fry, G � 72 10, Tracie: Gardner, � Julia:70 10, Gargano, � Gladwell:116 15, Gathecha, Aimee: � 67 10, Geissler, Saheed: Gidado, � 125 16, Index � 43 8, Bisrat: Abraham, � 64 Simon: 9, Agolory, � 86 12, Teeb: Al-Samarrai, � 76 10, Paul: Anderson, Andria: � 134 17, Apostolou, Roodly: � 66 60, 10, 9, W. Archer, B Danielle: � 39 7, Barradas, � 68 10, Steven: Baty, Bell,Beth: 11 � 111 Thomas:14, Bender, Laura: 17 Bettencourt, � 106 13, Achuyt: Bhattarai, Rama: Bhunia, � 116 15, � 103 13, Dianna: Blau, � 73 Nagesh: 10, Borse, Dita: � 63 Broz, 9, Sherry: � 79 11, Burrer, C Emily: � 149 Cartwright, 19, � 147 19, Elizabeth: Cavallaro, � 36 7, Joseph: Cavanaugh, Chang,Loretta: � 83 11, � 143 47, 8,18, Ekta: Choudhary, � 81 54, 8,11, Eleanor: Click, 19, Susan: Cookson, � 59 9, Jennifer: Cope, � 49 8, Jennifer: Cortes, � 61 Chad: 9, Cox, Andreea: � 84 41, Creanga, 7,12, Rolando: Cruz, � 122 15, D � 139 101, 13,17, Natalie: Dailey, Kashmira: � 150 19, Date, � 55 8, Marie: Perio, de � Dhakal,108 Sanjaya: 14, � 127 Ellen:16, Donnan, � 128 16, Jonathan: Duffy, A

CROWNE PLAZA HOTEL ATLANTA PERIMETER at RAVINIA

59th ANNUAL EIS CONFERENCE 35482_CoverLayout.indd 2 4/14/10 2:22 PM4/14/10 2:23 PM

Annual EIS Conference Annual APRiL 19-23, 2010 CROWNE PLAZA HOTEL – ATLANTA PERimETER AT RAviNiA EPIDEMICINTELLIGENCESERVICE

59 35482_ConferenceCover.indd 1 59th 59th ANNUAL EPIDEMIC INTELLIGENCE SERVICE (EIS) CONFERENCE • APRIL 19–23, 2010 SERVICES HUMAN Prevention AND and HEALTH Control OF

Disease for

A - DEPARTMENT