Embed Size (px)
Citation preview
February 3, 2010
Selected Zoonotic Diseases Conference Call
*Proposed
**
February 3, 2010
Selected Zoonotic Diseases Conference Call
Update on Dengue in the United States
+
Christopher J. Gregory, MD, MPH; Epidemic Intelligence Service Officer Dengue Branch, CDC [email protected]
Carina Blackmore, DVM, PhD, Dipl. ACVPMState Public Health Veterinarian Florida Department of [email protected]
Christopher J. Gregory, MD, MPHEIS Officer, Dengue Branch
Centers for Disease Control and Prevention
San Juan, Puerto Rico, USA
Update on Dengue in the United States
February 3, 2010
Dengue Flavivirus – related to WNV, JE, Yellow Fever
Four serotypes: DENV-1, -2, -3, -4 − All cause full spectrum of disease− Infection confers lifelong serotype-specific
immunity
Dengue virus causes an acute febrile illness (called dengue) that is transmitted by bite of infected Aedes mosquito
Dengue Infections Most common mosquito-borne viral disease
40% of world at risk of infection; at least 4 million U.S. citizens live in dengue-endemic areas
50 - 100 million cases of dengue occur annually
− Five fold increase in cases in Americas in 20 years
Leading cause of febrile illness in US travelers returning from Asia, South America, Caribbean
Dengue in the Continental US Transmission in US after a 35 year absence
− Texas: 7 outbreaks since 1980− Hawaii: outbreak in 2001− Key West, FL: outbreak in 2009
Aedes aegypti present in AZ,LA,GA,TX,NM,FL− A. albopictus widespread through south
Increased international travel and immigrant population with ties to endemic country of origin − 2006-08: >1000 travel-associated cases
Dengue Diagnosis and Reporting Clinical Diagnosis alone unreliable
PCR for diagnosis during viremic phase ( ~1st 5 days of illness)
IgM antibodies reliably detectable after day 5
− IgG remains elevated for life, not useful for diagnosis
Dengue added as nationally notifiable condition in June 2009; 32 states currently mandate reporting
− Dengue is not reportable in 7 states that have competent mosquito vectors
Dengue as Public Health Issue Evidence of geographic spread and increased
severity of disease
No effective, sustainable way to eliminate mosquito and breeding sites
No vaccine; although 5 candidates in field studies
Evidence of dengue transmission via receipt of donor organs or tissue, blood transfusions, and occupational exposure in healthcare settings
− Blood donations not currently screened;1 in 600 donations in PR positive for dengue viral RNA in 2007
Contact information:Dengue Branch
Division of Vector-Borne Infectious Disease
Centers for Disease Control and Prevention
1324 Calle Cañada
San Juan, Puerto Rico 00920
Tele: 787.706.2399
Fax: 787.706.2496
E-mail: [email protected]
Human Salmonella Associated with Aquatic Frogs
January 6, 2010
Selected Zoonotic Diseases Conference Call
Shauna L. Mettee, MSNEIS OfficerEnteric Diseases Epidemiology Branch, [email protected]
It’s Not Easy Being Green–A It’s Not Easy Being Green–A Multistate Outbreak of Human Multistate Outbreak of Human
Salmonella Typhimurium Salmonella Typhimurium Infections Associated with Aquatic Infections Associated with Aquatic
Frogs–United States, 2009Frogs–United States, 2009
Outbreak Response and Prevention BranchDivision of Foodborne, Bacterial and Mycotic Diseases
National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention
Shauna L. Mettee, RN, MSN, MPHLTJG, United States Public Health Service
Epidemic Intelligence Officer
OutlineOutline
• Outbreak detection
• Outbreak investigation
• Field investigation
• Recommendations
• Next steps
Outbreak DetectionOutbreak Detection
• April 2009: Utah identified 5 cases of Salmonella Typhimurium in children
• Indistinguishable PFGE pattern identified (outbreak strain)
0
1
2
3
4
5
6
7
8
9
10
3/8
/09
3/1
5/0
93/2
2/0
93/2
9/0
94/5
/09
4/1
2/0
94/1
9/0
94/2
6/0
95/3
/09
5/1
0/0
95/1
7/0
95/2
4/0
95/3
1/0
96/7
/09
6/1
4/0
96/2
1/0
96/2
8/0
97/5
/09
7/1
2/0
97/1
9/0
97/2
6/0
98/2
/09
8/9
/09
8/1
6/0
98/2
3/0
98/3
0/0
99/6
/09
9/1
3/0
99/2
0/0
99/2
7/0
910/4
/09
10/1
1/0
910/1
8/0
910/2
5/0
911/1
/09
11/8
/09
11/1
5/0
911/2
2/0
911/2
9/0
912/6
/09
12/1
3/0
912/2
0/2
009
12/2
7/2
009
Infections with the outbreak strain of Infections with the outbreak strain of Salmonella Salmonella Typhimurium, by week of illness onset (n=83 for whom Typhimurium, by week of illness onset (n=83 for whom information was reported as of 12/31/09)*information was reported as of 12/31/09)*
No. of cases
Week of Illness Onset
*Some illness onset dates have been estimated from other reported information(Estimated onset dates range 4/9 – 12/11; Reported onset dates (n=48) range 5/24 – 11/30)
Illnesses that began during this time may not yet be reported
3-4 Cases
AZ1
CA5
FL1
GA1
ID1
IL5
MD3
MA3
MI4
MO4
NJ2
NY2
OH2
PA4
TN2
TX4
UT14
WA7
More than 4 Cases
Case Counts by States reporting Case Counts by States reporting Salmonella Salmonella Typhimurium cases in Typhimurium cases in cluster 0909MAJPX-1, as of Thursday, December 31, 2009cluster 0909MAJPX-1, as of Thursday, December 31, 2009
MN1
LA1
CO4 KY
1
NM1 MS
1
VA3
WI1
NE1
SD3
AL1
IN1
NV1
1-2 Cases
Demographics for cases of Salmonella Typhimurium cases in cluster 0909MAJPX-1, as of Thursday, December 31, 2009
Demographics n=85Age, range (median)* <1-54 (5)
< 5 years old 42 (50%)< 10 years old 66 (79%)
Gender**, n (%)Female 40 (49%)Male 41 (51%)
*not including 1 without age information
**not including 4 without gender information
Outcomes n=47Hospitalization
n (%) 16 (34%)
Hypothesis Generation Hypothesis Generation Continues…Continues…
• April 2009: Utah identified 5 cases of Salmonella typhimurium in children
• August: CDC identified multistate outbreak predominantly in children
• CDC conducted hypothesis-generating interviews – 3/6 hypotheses identified
Matched Case-Control Study:Matched Case-Control Study:Case DefinitionCase Definition
• Salmonella Typhimurium infection with illness onset on or after April 1, 2009, with – 1) indistinguishable PFGE pattern, the
outbreak strain– 2) MLVA pattern either matching that of the
main outbreak strain, or MLVA unknown
Matched Case-Control Study:Matched Case-Control Study:Control SelectionControl Selection
• Controls were persons with recent infection of Salmonella strains other than the outbreak strain
• Matched to case-patients:– by age– county of residence
Matched Case-Control Study:Matched Case-Control Study:
• 19 cases and 31 age- and geography- matched controls enrolled
• Exposure histories collected – 7 days before illness onset for case-patients – 7 days before interview for controls
Results of Matched Results of Matched Case-Control StudyCase-Control Study
• Illness was significantly associated with exposure to frogs (63% cases vs 3% controls, mOR=24.4, CI=4.0-infinity).
• 6 case-patients knew frog type– All reported African Dwarf Frogs
Results of Results of Environmental SamplingEnvironmental Sampling
• Environmental samples from aquariums containing African Dwarf Frogs in 4 patient homes yielded Salmonella Typhimurium matching the outbreak strain– CO, UT, OH, NM
• Common breeder in California identified– Environmental samples from breeder’s facility yielded
outbreak strain
African Dwarf FrogsAfrican Dwarf Frogs
Lots o’ FrogsLots o’ Frogs
Lots o’ FrogsLots o’ Frogs
Lots o’ FrogsLots o’ Frogs
Lots o’ FrogsLots o’ Frogs
Historical Case Investigation Historical Case Investigation
• Asking states to interview historical cases from Jan 1, 2008 - present with revised case questionnaire
Public Health InterventionsPublic Health Interventions
• Conversations with veterinarians at large pet store chains
• CDC Web updates and media releases
• CDC Podcasts
• MMWR – Jan 8, 2010
• Recommendations to frog breeder regarding animal husbandry, water system and general biosafety practices
Advice to the Public: Advice to the Public: ConsumersConsumers
• Aquatic frogs and all water in the habitat should be considered contaminated
• Hand-washing
• Persons who should avoid contact
• Placement of habitats
Advice to the Public: Advice to the Public: Pet Store OwnersPet Store Owners
• Provide consumers information about the risk of acquiring salmonellosis from amphibians and reptiles
• 2009 Compendium of Measures to Prevent Diseases Associated with Animals in Public Settings
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5805a1.htm
Advice to the Public: Health Care Advice to the Public: Health Care Providers & VeterinariansProviders & Veterinarians
• Provide information to pet owners about risks of acquiring salmonellosis from amphibians and reptiles
• Advise patients on proper hand washing practices
• Veterinarians should teach pet owners how to properly clean the animal habitat
AcknowledgmentsAcknowledgments
• CDC– Samir Sodha, Casey Barton Behravesh, Linda Capewell, Gwen
Ewald, Nancy Garrett, Brenda Le, Leslie Hausman, Ian Williams
• State and Local Health Departments: – Alabama, Arizona, California, Colorado, Florida, Georgia, Idaho,
Indiana, Illinois, Kentucky, Louisiana, Massachusetts, Maryland, Michigan, Minnesota, Missouri, Mississippi, Nebraska, Nevada, New Jersey, New Mexico, New York, Ohio, Pennsylvania, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, and Wisconsin
For more informationFor more information
CDC PodcastsSalmonella Infection and Water Frogs:
http://www2c.cdc.gov/podcasts/player.asp?f=641101
Wash Away Salmonella:
http://www2c.cdc.gov/podcasts/player.asp?f=722515
For Kids:
Water Frogs, Aquariums, and Salmonella -- Oh My!
http://www2c.cdc.gov/podcasts/player.asp?f=442708
Contact: Shauna Mettee , [email protected]
For more informationFor more information
CDC Web Updatehttp://www.cdc.gov/salmonella/typh1209/index.html
MMWR – Jan 8, 2009Multistate Outbreak of Human Salmonella Typhimurium
Infections Associated with Aquatic Frogs — United States, 2009
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5851a1.htm
Contact: Shauna Mettee
Rabies Postexposure Prophylaxis for Animals
January 6, 2010
Selected Zoonotic Diseases Conference Call
Charles Rupprecht, VMD, PhD Poxvirus and Rabies Branch, [email protected]
February 3, 2010
Selected Zoonotic Diseases Conference Call
*Proposed
**
