International Conference on Emerging Infectious Diseases 2008
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International Conference on Emerging Infectious Diseases 2008 Slide Sessions and Poster Abstracts Emerging Infectious Diseases is providing access to these abstracts on behalf of the ICEID 2008 program committee, which performed peer review. Emerging Infectious Diseases has not edited or proofread these materials and is not responsible for inaccuracies or omissions. All information is subject to change.Comments and corrections should be brought to the attention of the authors. Slide Sessions Monday, March 17 Foodborne & Waterborne Diseases I Outbreaks Associated with Frozen, Stuffed, Pre-browned, Microwaveable Chicken Entrees in Minnesota: Implications for Labeling and Regulation C. Medus1, S. Meyer1, D. Boxrud1, K. Elfering2, C. Braymen2, R. Danila1, K. Smith1; 1Minnesota Department of Health, St. Paul, MN, 2Minnesota Department of Agriculture, St. Paul, MN. Background: In 1998, a Salmonella Typhimurium outbreak (33 cases) associated with eating Brand A chicken Kiev, a frozen, stuffed, pre-browned, microwaveable chicken product occurred in Minnesota (MN). Microwave cooking and consumer perception that the product was pre-cooked were contributing factors. One production date of product that tested positive was recalled. Brand A stuffed chicken product labels were changed to include longer cooking times. During 2005-2006, 3 more Salmonella outbreaks associated with the same type of product were identified in MN. Methods: Outbreaks were identified by routine interviews of all reported Salmonella cases coupled with real-time Page 1 of 262 pulsed-field gel electrophoresis (PFGE) subtyping of all Salmonella isolates. Intact products from case households and retail stores were cultured for Salmonella, and isolates subtyped by PFGE. Results: Four S. Heidelberg cases associated with eating Brand B chicken broccoli and cheese were identified during January-March 2005. Brand B product labels were modified and cooking instructions verified. An S. Enteritidis outbreak resulting in 27 cases in MN and 14 cases in 9 other states occurred during August 2005-July 2006. Cases ate multiple brands of product from 3 manufacturers. One production date of Brand A product was recalled in March 2006. During April-June 2006, different varieties of Brand B product were implicated in a S. Typhimurium outbreak (3 cases). Several product samples tested positive for the outbreak serotype and subtype in all 3 outbreaks. Press releases were issued in all the outbreaks. Most cases in all outbreaks cooked the products in the microwave; none took the internal temperature of the product. Following these outbreaks, the National Advisory Committee for the Microbiological Criteria for Foods issued guidelines for labeling these products: 1) microwaving raw poultry from frozen is not advisable unless instructions ensure the 165ºF endpoint; and, 2) the label’s principal display panel should warn that the product is raw. Conclusions: The cooked appearance of these products, inadequate labeling, and microwave cooking led consumers to undercook the products. Press releases were ineffective. Microwave cooking for these raw products is still allowed; whether the new label requirements will prevent outbreaks is unknown. A Point-Source Outbreak of Guillain Barre Syndrome (GBS) Associated With Consumption of City Water, ShuangYang District, Changchun, Jinlin, China, 2007 R. Feng1, Z. Lei1, L. qun2, M. Huilai1, R. Fontaine3; 1Chinese Field Epidemiology Training Program(CFETP), BeiJing, CHINA, 2Emergency Response Office, Chinese CDC Beijing, China, BeiJing, CHINA, 3Chinese Field Epidemiology Training Program(CFETP);United States Centers for Disease Control and Prevention, Atlanta, GA, USA, BeiJing, CHINA. Background: The acute motor axonal neuropathy (AMAN) type of Gullain Barre Syndrome (GBS) affects hundreds of persons throughout the Far East each year. Campylobacter jejuni (CJ) infection may be a precipitating cause. In July 2007 we investigated a GBS outbreak in ShuangYang District (100,000 population) to identify risk factors of this outbreak and recommend appropriate control measures. Methods: We defined a GBS case as subacute onset from June 1 to July 31 2007 of bilateral flaccid weakness (on neurological examination) or paralysis in a resident of or person working in Shuangyang. We searched for GBS cases in all Changchun hospitals. We selected control persons through a random selection from all households within 100 m of GBS-households. We compared previous diarrhea and exposure to city water of all 36 cases to 165 controls. We also detected CJ infection by culture and serologic testing. Results: We identified 36 GBS (attack rate = 36/100,000) among residents of (33) or visitors to (3) Shuangyang. GBS -patients were widely dispersed throughout Shuangyang. Onset of all GBS occurred from June 21 to July 6 (16 days). On June 11 (from 10 to 35 days earlier) the pumps for the city water system failed and water pressure was restored on June 12 without first flushing the mains. Of GBS-patients 94% reported drinking un-boiled tap water from the city water system compared to 55% of control-persons OR =12 (95%CI=2.7-52). Of GBS-patients 61% reported having diarrhea since June 1 compared to 32% of control persons (OR = 3.4; 95% CI=1.4-8.4). After adjusting for drinking un-boiled water the OR for diarrhea was 2.7 (95%CI=1.2-6.5). CJ with the same PFGE and MLST type was isolated from 1 GBS-patient and 3 of 51 family contacts or neighbors. We found anti-CJ IgG in 61% of GBS-patients and anti-CJ IgM in 27% of GBS-patients. In comparison, 29% of family Page 2 of 262 contacts and neighbors had anti-CJ IgG and 12% had anti CJ IgM. Conclusions: Drinking city water during a failure of the pumping system probably led to this point-source GBS outbreak. The weak association with diarrhea and the low isolation rate of CJ contrast with the high anti-CJ IgG prevalence to suggest that exposure only or asymptomatic infection with CJ initiated the development of GBS. We recommended regular surveillance of the city water supply for standard indicators of drinking water safety. Oyster-associated Vibrio Infections in the United States, 1998–2006 M. Iwamoto, P. Yu, D. Swerdlow, J. Painter; CDC, Atlanta, GA. Background: Several Vibrio species are pathogenic and associated with clinical syndromes including gastroenteritis, wound infection, and septicemia. Foodborne infection usually occurs after eating raw or undercooked seafood, particularly oysters. CDC collects reports of Vibrio infections submitted by health departments. Regulatory efforts to address the threat of seafood-associated vibriosis have focused on prevention and surveillance for V. vulnificus (Vv) and V. parahaemolyticus (Vp) illnesses. Methods: We examined data on non-cholera vibriosis identified during 1998-2006. A case was defined as isolation of Vibrio spp. other than toxigenic V. cholerae from a clinical specimen. Transmission was classified as foodborne based on clinical information, specimen source, and patient exposures. Cases were considered oyster-associated if the case was foodborne and the patient consumed oysters within the 7 days before illness onset. To examine annual trends, we performed Wilcoxon-rank sums tests on year-to- year changes in incidence. Results: Of 4,364 non-cholera Vibrio infections reported from 49 states and territories, 3,090 (71%) were foodborne. Of patients with reported food histories, 1,519 (67%) reported eating oysters in the week before illness; among oyster-eaters, 83% reported eating them raw. Most oyster-associated infections (65%) were caused by Vp; other frequently reported species were Vv (18%), and V. cholerae non-O1, non-O139 (6%). Among oyster-eating patients, 484 (32%) were hospitalized and 139 (9%) died. No significant trends in the incidence of Vp or Vv oyster-associated cases were noted. The annual incidence of Vp varied greatly, with the largest number of cases reported during years coinciding with large outbreaks, most notably 1998 and 2006. Conclusions: Oysters continue to be an important source of foodborne vibriosis and deaths. To date, prevention efforts have been ineffective at reducing oyster-associated vibriosis. Industry and regulatory agencies have recently instituted control measures aimed at reducing the prevalence of vibrios in shellfish. Continued coordinated surveillance is necessary to monitor whether these efforts lead to a reduction in illness. Large Outbreak of Beribéri Possibly Related to Consumption of Mycotoxin-contaminated Rice, Maranhão, Brasil, 2007 H. A. Lima1, E. A. Santana-Porto1, A. F. Santelli1, G. Carmo1, R. S. Alves2, L. R. Queiroga3, S. M. França4, A. A. Siqueira1, J. Sobel5, R. P. Marins6; 1Field Epidemiology Training Program, SVS, Brazilian Ministry of Health, Brasilia, BRAZIL, 2COVEH/SVS, Brazilian Ministry of Health, Brasilia, BRAZIL, 3Department of Heath, Imperatriz -Maranhao, BRAZIL, 4Department of Epidemiologic Surveillance, Imperatriz - Maranhao, BRAZIL, 5Office of Global Health, CDC, Atlanta, GA, 6Division of Transmissible Diseases, SVS, Ministry of Health, Brasilia, BRAZIL. Background: The accepted cause of beriberi is thiamine deficiency. Alcohol consumption, physical activity and high carbohydrate diets are known aggravating factors. Early 20th Century epidemics in Japan were attributed to rice contaminated by citreoviridin (CTV) mycotoxin, which produces a beriberi- Page 3 of 262 like illness in animal models, possibly by disruption of thiamine metabolism. In 2006-7, 471 cases of suspected beriberi were reported from Maranhao State,