RESUMEN
Current surveillance methods have been useful to document geographic expansion of Lyme disease in the United States and to monitor the increasing incidence of this major public health problem. Nevertheless, these approaches are resource-intensive, generate results that are difficult to compare across jurisdictions, and measure less than the total burden of disease. By adopting more efficient methods, resources could be diverted instead to education of at-risk populations and new approaches to prevention. In this special issue of Zoonoses and Public Health, seven articles are presented that either evaluate traditional Lyme disease surveillance methods or explore alternatives that have the potential to be less costly, more reliable, and sustainable. Twenty-five years have passed since Lyme disease became a notifiable condition - it is time to reevaluate the purpose and goals of national surveillance.
Asunto(s)
Enfermedad de Lyme/epidemiología , Vigilancia de la Población , Borrelia/aislamiento & purificación , Humanos , Estados Unidos/epidemiologíaRESUMEN
In 1999, Connecticut was one of three states in which West Nile (WN) virus actively circulated prior to its recognition. In 2000, prospective surveillance was established, including monitoring bird deaths, testing dead crows, trapping and testing mosquitoes, testing horses and hospitalized humans with neurologic illness, and conducting a human seroprevalence survey. WN virus was first detected in a dead crow found on July 5 in Fairfield County. Ultimately, 1,095 dead crows, 14 mosquito pools, 7 horses, and one mildly symptomatic person were documented with WN virus infection. None of 86 hospitalized persons with neurologic illness (meningitis, encephalitis, Guillain-Barré-like syndrome) and no person in the seroprevalence survey were infected. Spraying in response to positive surveillance findings was minimal. An intense epizootic of WN virus can occur without having an outbreak of severe human disease in the absence of emergency adult mosquito management.
Asunto(s)
Enfermedades de las Aves/virología , Reservorios de Enfermedades/veterinaria , Enfermedades de los Caballos/virología , Vigilancia de la Población , Vigilancia de Guardia/veterinaria , Fiebre del Nilo Occidental/epidemiología , Virus del Nilo Occidental/aislamiento & purificación , Animales , Enfermedades de las Aves/epidemiología , Enfermedades de las Aves/mortalidad , Aves/virología , Connecticut/epidemiología , Culex/virología , Culicidae/virología , Enfermedades de los Caballos/epidemiología , Enfermedades de los Caballos/mortalidad , Caballos/virología , Humanos , Insectos Vectores/virología , Vigilancia de la Población/métodos , Estudios Prospectivos , Factores de Riesgo , Estudios Seroepidemiológicos , Pájaros Cantores , Fiebre del Nilo Occidental/mortalidad , Fiebre del Nilo Occidental/veterinaria , Fiebre del Nilo Occidental/virologíaRESUMEN
In 1999, the U.S. West Nile (WN) virus epidemic was preceded by widespread reports of avian deaths. In 2000, ArboNET, a cooperative WN virus surveillance system, was implemented to monitor the sentinel epizootic that precedes human infection. This report summarizes 2000 surveillance data, documents widespread virus activity in 2000, and demonstrates the utility of monitoring virus activity in animals to identify human risk for infection.
Asunto(s)
Brotes de Enfermedades , Fiebre del Nilo Occidental/epidemiología , Virus del Nilo Occidental , Animales , Enfermedades de las Aves/epidemiología , Enfermedades de las Aves/virología , Culicidae/virología , Ecología , Enfermedades de los Caballos/epidemiología , Enfermedades de los Caballos/virología , Caballos , Humanos , Vigilancia de la Población , Pájaros Cantores/virología , Estados Unidos/epidemiología , Fiebre del Nilo Occidental/veterinaria , Fiebre del Nilo Occidental/virologíaRESUMEN
OBJECTIVE: Non-O157 Shiga toxin-producing Escherichia coli (STEC) have emerged as an important public health problem. Outbreaks attributed to non-O157 STEC rarely are reported. In 1999, follow-up of routine surveillance reports of children with hemolytic- uremic syndrome (HUS) identified a small cluster of 3 cases of HUS, all of whom had spent overlapping time in a Connecticut lake community in the week before onset of symptoms. We conducted an investigation to determine the magnitude and source of the outbreak and to determine risk factors associated with the transmission of illness. METHODS: We conducted a cohort study and an environmental investigation. The study population included all people who were at the lake in a defined geographic area during July 16-25, 1999. This time and area were chosen on the basis of interviews with the 3 HUS case-patients. A case was defined as diarrhea (>/=3 loose stools/d for >/=3 days) in a person who was at the lake during July 16-25, 1999. Stool samples were requested from any lake resident with diarrheal illness. Stools were cultured for Salmonella, Shigella, Campylobacter, and E coli O157. Broth cultures of stools were tested for Shiga toxin. Case-patients were asked to submit a serum specimen for antibody testing to lipopolysaccharides of selected STEC. Environmental samples from sediment, drinking water, lake water, and ice were obtained and cultured for E coli and tested for Shiga toxin. An environmental evaluation of the lake was conducted to identify any septic, water supply system, or other environmental condition that could be related to the outbreak. RESULTS: Information was obtained for 436 people from 165 (78%) households. Eleven (2.5%) people had illnesses that met the case definition, including the 3 children with HUS. The attack rate was highest among those who were younger than 10 years and who swam in the lake on July 17 or 18 (12%; relative risk [RR]: 7.3). Illness was associated with swimming (RR = 8.3) and with swallowing water while swimming (RR = 7.0) on these days. No person who swam only after July 18 developed illness. Clinical characteristics of case-patients included fever (27%), bloody diarrhea (27%), and severe abdominal cramping (73%). Only the 3 children with HUS required hospitalization. No bacterial pathogen was isolated from the stool of any case-patient. Among lake residents outside the study area, E coli O121:H19 was obtained from a Shiga toxin-producing isolate from a toddler who swam in the lake. Serum was obtained from 7 of 11 case-patients. Six of 7 case-patients had E coli O121 antibody titers that ranged from 1:320 to >1:20 480. E coli indicative of fecal contamination was identified from sediment and water samples taken from a storm drain that emptied into the beach area and from a stream bed located between 2 houses, but no Shiga toxin-producing strain was identified. CONCLUSIONS: Our findings are consistent with a transient local beach contamination in mid-July, probably with E coli O121:H19, which seems to be able to cause severe illness. Without HUS surveillance, this outbreak may have gone undetected by public health officials. This outbreak might have been detected sooner if Shiga toxin screening had been conducted routinely in HUS cases. Laboratory testing that relies solely on the inability of an isolate to ferment sorbitol will miss non-O157 STEC, such as E coli O121. Serologic testing can be used as an adjunct in the diagnosis of STEC infections. Lake-specific recommendations included education, frequent water sampling, and alternative means for toddlers to use lake facilities.
Asunto(s)
Escherichia coli/aislamiento & purificación , Agua Dulce/microbiología , Síndrome Hemolítico-Urémico , Síndrome Hemolítico-Urémico/epidemiología , Adolescente , Adulto , Niño , Preescolar , Estudios de Cohortes , Connecticut/epidemiología , Diarrea/diagnóstico , Diarrea/epidemiología , Brotes de Enfermedades/estadística & datos numéricos , Escherichia coli/clasificación , Femenino , Agua Dulce/análisis , Síndrome Hemolítico-Urémico/diagnóstico , Síndrome Hemolítico-Urémico/microbiología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Factores de Riesgo , Toxina Shiga/análisis , Toxina Shiga/química , Natación , Microbiología del Agua , Abastecimiento de Agua/análisisRESUMEN
Human granulocytic ehrlichiosis (HGE) is an emerging tickborne infection, increasingly recognized in areas in which Lyme disease is endemic, but there are few data on the incidence of HGE. Prospective population-based surveillance was conducted in the 12-town area around Lyme, Connecticut, by means of both active and passive methods, from April through November of 1997, 1998, and 1999. Five hundred thirty-seven residents presenting to their primary care provider with an acute febrile illness suggestive of HGE were identified. Of these, 137 (26%) had laboratory evidence (by indirect fluorescent antibody staining or polymerase chain reaction) of HGE; 89 were confirmed cases, and 48 were probable cases. The incidence of confirmed HGE was 31 cases/100,000 in 1997, 51 cases/100,000 in 1998, and 24 cases/100,000 in 1999. A subset of sera was tested by use of immunoblot assays, and results were in agreement with indirect fluorescent antibody methods for 86% of samples analyzed. Thus, HGE is an important cause of morbidity and is now the second most common tickborne infection in southeastern Connecticut.
Asunto(s)
Ehrlichiosis/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Anticuerpos Antibacterianos/análisis , Niño , Preescolar , Connecticut/epidemiología , Ehrlichia/inmunología , Ehrlichiosis/complicaciones , Ehrlichiosis/epidemiología , Femenino , Fiebre/complicaciones , Técnica del Anticuerpo Fluorescente Indirecta , Humanos , Insectos Vectores , Ixodes , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Estudios ProspectivosRESUMEN
During October 1996, an outbreak of Escherichia coli O157:H7 infections among Connecticut residents occurred. An epidemiologic investigation included enhanced surveillance and a case-control study. Clinical isolates of Escherichia coli O157:H7 were typed by pulsed-field gel electrophoresis (PFGE). Implicated cider samples were analysed by culture and polymerase chain reaction (PCR). Consumption of implicated cider was associated with illness; (matched odds ratio = undefined, 95 % confidence interval = 3.5-infinity). Ultimately, a total of 14 outbreak-associated patients were identified. All isolates analysed by PFGE yielded the outbreak-associated subtype. Escherichia coli O157:H7 was not cultured from three cider samples; PCR analysis detected DNA fragments consistent with Escherichia coli O157:H7 in one. This outbreak was associated with drinking one brand of unpasteurized apple cider. PFGE subtyping supported the epidemiologic association. PCR analysis detected microbial contaminants in the absence of live organisms. Washing and brushing apples did not prevent cider contamination.
Asunto(s)
Brotes de Enfermedades , Infecciones por Escherichia coli/etiología , Escherichia coli O157 , Microbiología de Alimentos , Frutas/microbiología , Síndrome Hemolítico-Urémico/microbiología , Adolescente , Adulto , Anciano , Bebidas , Estudios de Casos y Controles , Niño , Preescolar , Connecticut/epidemiología , Electroforesis en Gel de Campo Pulsado , Infecciones por Escherichia coli/epidemiología , Femenino , Manipulación de Alimentos , Síndrome Hemolítico-Urémico/epidemiología , Síndrome Hemolítico-Urémico/etiología , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Reacción en Cadena de la PolimerasaRESUMEN
CONTEXT: Few data exist about the long-term outcomes of patients with Lyme disease. OBJECTIVE: To assess the long-term outcomes of patients with Lyme disease. DESIGN: Two-part project including a community-based longitudinal cohort study and a matched cohort study. SETTING AND PARTICIPANTS: Six hundred seventy-eight patients identified from a random sample of all reports of Connecticut residents with suspected Lyme disease submitted to the Connecticut Department of Public Health from 1984-1991 were evaluated in the longitudinal study; for a random subsample of 212 patients from the larger study, 212 age-matched controls without Lyme disease also were enrolled. MAIN OUTCOME MEASURES: Self-reports or parents' reports of symptoms and ability to perform certain daily activities since diagnosis of Lyme disease; scores on the 36-Item Short-Form Health Survey and the Center for Epidemiologic Studies-Depression scale, for adults, by case-definition status and between patients and controls. RESULTS: Of the 678 patients, 51.6% were female, 34.4% were children, and 64.3% met the national surveillance case definition for Lyme disease. Most patients (85.6%) were treated with antimicrobial agents. Interviews were conducted a median of 51 months after diagnosis (range, 15-135 months). An increased frequency of symptoms (eg, pain, fatigue) or of difficulty with daily activities (eg, performing housework, exercising) was reported by 69% of the patients, although few (19%) of these problems were attributed to Lyme disease. Whenever there was a statistically significant difference in the frequencies of either increased symptoms or increased difficulties with typical activities between those who did or did not meet the surveillance case definition, in all instances the greater frequency of problems was in the group that did not meet the case definition. The frequencies of reports of both increased symptoms and increased difficulties with typical activities among patients who had been diagnosed as having Lyme disease were similar to those among age-matched controls without Lyme disease. CONCLUSIONS: In this cohort, although many patients reported increases in symptoms and/or increased difficulties with typical daily activities between 1 and 11 years after diagnosis of Lyme disease, the frequencies of these reports were similar to the frequencies of such reports among age-matched controls without Lyme disease.
Asunto(s)
Enfermedad de Lyme/fisiopatología , Adulto , Niño , Femenino , Humanos , Modelos Logísticos , Estudios Longitudinales , Enfermedad de Lyme/tratamiento farmacológico , Masculino , Análisis por Apareamiento , Perfil de Impacto de Enfermedad , Resultado del TratamientoRESUMEN
New meningococcal vaccines are undergoing clinical trials, and changes in the epidemiologic features of meningococcal disease will affect their use. Active laboratory-based, population-based US surveillance for meningococcal disease during 1992-1996 was used to project that 2400 cases of meningococcal disease occurred annually. Incidence was highest in infants; however, 32% of cases occurred in persons >/=30 years of age. Serogroup C caused 35% of cases; serogroup B, 32%; and serogroup Y, 26%. Increasing age (relative risk [RR], 1.01 per year), having an isolate obtained from blood (RR, 4.5), and serogroup C (RR, 1.6) were associated with increased case fatality. Among serogroup B isolates, the most commonly expressed serosubtype was P1.15; 68% of isolates expressed 1 of the 6 most common serosubtypes. Compared with cases occurring in previous years, recent cases are more likely to be caused by serogroup Y and to occur among older age groups. Ongoing surveillance is necessary to determine the stability of serogroup and serosubtype distribution.
Asunto(s)
Infecciones Meningocócicas/epidemiología , Neisseria meningitidis/clasificación , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Electroforesis/métodos , Enzimas/análisis , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Neisseria meningitidis/aislamiento & purificación , Vigilancia de la Población , Prevalencia , Estaciones del Año , Serotipificación , Distribución por Sexo , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To assess state-based surveillance for isolation from a sterile site of vancomycin-resistant enterococci (VRE) in Connecticut. DESIGN: Clinical laboratory reporting (passive surveillance) of VRE isolates to the Connecticut Department of Public Health (CDPH) was followed by state-initiated validation, laboratory proficiency testing, and review of hospital demographic characteristics. SETTINGS: All 45 clinical laboratories and all 37 (36 for 1995 and 1996) acute-care hospitals in Connecticut were included in the study. MAIN OUTCOME MEASURES: The outcome measures included determination of the statewide incidence of VRE and the accuracy of passive reporting, determination of clinical laboratory proficiency in detecting VRE, and analysis of hospital characteristics that might be associated with an increased incidence of VRE. RESULTS: During 1994 through 1996, 29 (78%) of 37 hospital-affiliated clinical laboratories and 1 (11%) of 9 commercial or other laboratories in Connecticut reported to the CDPH the isolation of VRE from sterile sites; 158 isolates were reported for these 3 years. Based on verification, we discovered that these laboratories actually detected 58 VRE isolates in 1994, 104 in 1995, and 104 in 1996 (total, 266). The age-standardized incidence rate of VRE was 14.1 cases per million population in 1994 and 26.8 cases per million population for both 1995 and 1996. Laboratory proficiency testing revealed that high-level vancomycin resistance was identified accurately and that low- and moderate-level resistance was not detected. The incidence of VRE isolates was three times greater in hospitals with over 300 beds compared with categories of hospitals with fewer beds. Increases in the number of VRE isolates were at least twice as likely in hospitals located in areas with a higher population density, or with a residency program or trauma center in the hospital. CONCLUSIONS: Passive reporting of VRE isolates from sterile sites markedly underestimated the actual number of iso lates, as determined in a statewide reporting system. Statewide passive surveillance systems for routine or emerging pathogens must be validated and laboratory proficiency ensured if results are to be accurate and substantial underreporting is to be corrected.
Asunto(s)
Infección Hospitalaria/prevención & control , Notificación de Enfermedades/normas , Enterococcus/aislamiento & purificación , Infecciones por Bacterias Grampositivas/prevención & control , Vigilancia de la Población , Resistencia a la Vancomicina , Adolescente , Adulto , Anciano , Técnicas de Tipificación Bacteriana/normas , Técnicas de Tipificación Bacteriana/estadística & datos numéricos , Niño , Preescolar , Connecticut/epidemiología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Notificación de Enfermedades/estadística & datos numéricos , Enterococcus/clasificación , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/microbiología , Tamaño de las Instituciones de Salud/estadística & datos numéricos , Hospitales/normas , Hospitales/estadística & datos numéricos , Humanos , Incidencia , Lactante , Recién Nacido , Pruebas de Sensibilidad Microbiana/normas , Pruebas de Sensibilidad Microbiana/estadística & datos numéricos , Persona de Mediana Edad , Densidad de Población , Vigilancia de la Población/métodos , Reproducibilidad de los Resultados , Estadística como AsuntoRESUMEN
Hypersensitivity pneumonitis (HP) as a sentinel event implies a remediable exposure and an exposed cohort that require evaluation. A patient with HP convincingly related to her building led to a questionnaire survey in follow-up. Building coworkers demonstrated substantially higher symptom rates than did controls in five other buildings, although no further cases of disease were identified. It is likely that moisture sources in the building included an oversized cooling system and below-grade moisture, but the building met all applicable regulations and standards. Screening investigations for disease are not mandated by law and are often not conducted, in part because cost coverage is unclear. The absence of regulatory or professional standards that adequately address moisture in the built environment forces occupational health professionals to rely on disease documentation strategies to justify intervention.
Asunto(s)
Alveolitis Alérgica Extrínseca/epidemiología , Enfermedades Profesionales/epidemiología , Vigilancia de Guardia , Síndrome del Edificio Enfermo/epidemiología , Femenino , Humanos , Persona de Mediana Edad , AguaRESUMEN
A survey was performed to identify people who were exposed to a rabid pony and determine whether or not they received rabies postexposure prophylaxis (PEP). Sixty-one visitors who came in contact with the rabid pony were identified. These visitors heard about the rabid pony via the news media. Forty-five visitors were exposed during the 2 weeks before the pony died. Thirty-two of these 45 visitors received PEP. Thirty-one visitors had or may have had saliva contact to an open wound or mucosa and all 31 received PEP. Fourteen visitors had no saliva contact to a wound or mucosa and one received PEP. Sixteen visitors were exposed before the pony was potentially shedding rabies virus and one received PEP. No visitor was bitten by the pony. Most of the persons 31/33 (94%) who received PEP had an exposure for which PEP was indicated. Nonbite transmission of rabies is discussed.
Asunto(s)
Caballos , Rabia/transmisión , Zoonosis/etiología , Animales , Humanos , Rabia/inmunología , Rabia/virología , Virus de la Rabia/aislamiento & purificación , Zoonosis/virologíaRESUMEN
OBJECTIVE: To determine the degree of public awareness of rabies and compliance with cat and dog vaccination laws in Connecticut in 1993. DESIGN: Monthly telephone surveys. SAMPLE POPULATION: 1,810 households. PROCEDURE: A telephone interview was conducted, using rables-related questions contained in the Behavioral Risk Factor Surveillance System, with an adult member from households randomly selected statewide by telephone number. Results of the surveys for the year were aggregated, and weighted data were analyzed. RESULTS: Ninety percent of respondents had heard about rabies during the preceding year, and 84% considered it a problem in Connecticut. Forty-seven percent of households surveyed owned dogs or cats. Ninety-three percent of dogs and 80% of cats were reported to be vaccinated against rabies. Twenty-two percent of households with cats had at least 1 cat that was not current on rabies vaccination. CLINICAL RELEVANCE: In Connecticut, an epizootic of rabies in raccoons was accompanied by a high degree of awareness of rabies and rate of reported vaccination of dogs and cats. However, vaccination of cats was less common than that of dogs. Public education efforts should emphasize the necessity to vaccinate cats and to avoid contact with unknown cats in rabies epizootic or enzootic areas. A surveillance system can be used to help evaluate public health programs.
Asunto(s)
Concienciación , Enfermedades de los Gatos/prevención & control , Conducta Cooperativa , Enfermedades de los Perros/prevención & control , Rabia/veterinaria , Vacunación/veterinaria , Adulto , Animales , Enfermedades de los Gatos/epidemiología , Enfermedades de los Gatos/psicología , Gatos , Niño , Connecticut/epidemiología , Recolección de Datos , Brotes de Enfermedades/veterinaria , Enfermedades de los Perros/epidemiología , Enfermedades de los Perros/psicología , Perros , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rabia/epidemiología , Rabia/prevención & control , Rabia/psicología , Mapaches , Teléfono , Vacunación/psicología , Vacunación/estadística & datos numéricosRESUMEN
The abundance of host-seeking Ixodes scapularis nymphs, the principal vector for the Lyme disease agent, Borrelia burgdorferi, in Old Lyme, Lyme, and East Haddam, Connecticut, was compared with the incidence of reported human Lyme disease in the 12-town area around the Connecticut River and the State of Connecticut for the period 1989 to 1996. Ticks were sampled from lawns and woodlands by dragging flannel over the vegetation and examined for the presence of B. burgdorferi by indirect fluorescent antibody staining. The infection rate of the nymphal ticks by B. burgdorferi during the 9-year period was 14.3% (of 3,866), ranging from 8.6% (1993) to 24.4% (1996). The incidence of Lyme disease was positively correlated with tick abundance in the 12 town area (r = 0.828) and the State of Connecticut (r = 0.741). An entomological risk index based upon the number of I. scapularis ticks infected by B. burgdorferi was highest in 1992, 1994, and 1996 and was highly correlated with the incidence of Lyme disease in Connecticut (r = 0.944). The number of Lyme disease cases has been influenced, in part, by annual changes in population densities of I. scapularis and, presumably, a corresponding change in the risk of contact with infected ticks. Based upon tick activity and spirochetal infection rates, epidemiologically based Lyme disease case reports on a regional scale appear to reflect real trends in disease.
Asunto(s)
Grupo Borrelia Burgdorferi/aislamiento & purificación , Insectos Vectores , Ixodes/microbiología , Enfermedad de Lyme/epidemiología , Animales , Connecticut/epidemiología , Humanos , Prevalencia , Estadística como Asunto , Factores de TiempoRESUMEN
The hypothesis that residence in a uniform medium-density residential development is associated with lower incidence of Lyme disease is tested with data from a rural, 12-town region of south-central Connecticut where the disease is hyperendemic. The residential setting for 424 cases identified by active surveillance from 1993 through 1995 was determined. Cases located within the Eastern Coastal ecologic region, where tick densities are known to be higher than inland and where most of the population in the region resides, were selected for further analysis. Within this region, residence in a homogeneous area of medium-density development at least 30 acres (12 ha) in size was associated with a two- to 10-fold lower level of risk than residence in surrounding less developed areas, depending on the estimate of residential population. Type of residential development may be an important factor to consider, in addition to other environmental variables, in studies of peridomestic vector-borne disease in human populations.
Asunto(s)
Ambiente , Enfermedad de Lyme/epidemiología , Densidad de Población , Población Rural , Connecticut/epidemiología , Vivienda , Humanos , Medición de Riesgo , Factores de RiesgoRESUMEN
BACKGROUND: In 1994, a hospital reported an increase in nosocomial legionnaires' disease after implementing use of a rapid urinary antigen test for Legionella pneumophila serogroup 1 (Lp-1). This hospital was the site of a previous nosocomial legionnaires' disease outbreak during 1980 to 1982. METHODS: Infection control records were reviewed to compare rates of nosocomial pneumonia and the proportion of cases attributable to legionnaires' disease during the 1994 outbreak period with those during the same period in 1993. Water samples were collected for Legionella culture from the hospital's potable water system and cooling towers, and isolates were subtyped by monoclonal antibody (MAb) testing and arbitrarily primed polymerase chain reaction (AP-PCR). RESULTS: Nosocomial pneumonia rates were similar from April through October 1993 and April through October 1994: 5.9 and 6.6 per 1,000 admissions, respectively (rate ratio [RR], 1.1; P=.56); however, 3.2% of nosocomial pneumonias were diagnosed as legionnaires' disease in 1993, compared with 23.9% in 1994 (RR, 9.4; P<.001). In 1994, most legionnaires' disease cases were detected by the urinary antigen testing alone. MAb testing and AP-PCR demonstrated identical patterns among Lp-1 isolates recovered from a patient's respiratory secretions, the hospital potable water system, and stored potable water isolates from the 1980 to 1982 outbreak. CONCLUSIONS: There may have been persistent transmission of nosocomial legionnaires' disease at this hospital that went undiscovered for many years because there was no active surveillance for legionnaires' disease. Introduction of a rapid urinary antigen test improved case ascertainment. Legionella species can be established in colonized plumbing systems and may pose a risk for infection over prolonged periods.
Asunto(s)
Infección Hospitalaria/diagnóstico , Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/diagnóstico , Enfermedad de los Legionarios/epidemiología , Microbiología del Agua , Abastecimiento de Agua , Connecticut/epidemiología , Infección Hospitalaria/transmisión , Hospitales Comunitarios , Humanos , Inmunoensayo , Enfermedad de los Legionarios/transmisión , Ingeniería Sanitaria , Orina/microbiologíaRESUMEN
The North American raccoon rabies epizootic continues to expand, now affecting most of New England. In 1990, raccoons became the vertebrate most often reported rabid in the United States. Emergence of this zoonosis poses increasing, but poorly defined risks to humans. This study analyzed various demographic, environmental, and behavioral factors associated with animal infection and human exposure before and during the epizootic in Connecticut. Rabies virus infections among terrestrial vertebrates were analyzed from 1985 through 1994. From March 1991, when the first case was diagnosed, through December 1994, 2,522 of 13,147 animals tested were found positive for rabies viral antigen. Forty-seven percent of the raccoons tested were infected, representing 88.0% of all animals found positive. Domestic animals constituted only 1.7% of positive test results, but 40.6% of the tests performed. The epizootic wave of transmission advanced approximately 30 km/year. Most rabies-positive wild animals were taken from private properties, usually near houses. Possible human exposures involved 939 people on 556 occasions through direct contact (20.7%) or indirectly through another animal (79.3%). Of 3,239 domestic animals exposed to rabies-positive wild animals, 18.4% lacked vaccination. Rabies has become enzootic in Connecticut and risk to humans and animals persists. The public health burden is considerable, yet knowledge is lacking to develop sustainable prevention strategies.
Asunto(s)
Rabia/veterinaria , Mapaches , Animales , Connecticut/epidemiología , Humanos , Rabia/epidemiología , Rabia/transmisión , Agrupamiento Espacio-Temporal , Zoonosis/epidemiologíaRESUMEN
OBJECTIVES: This study examined factors that predispose individuals to protect against Lyme disease. METHODS: Knowledge, attitude, and practice questions concerning Lyme disease prevention were included in the Behavioral Risk Factor Surveillance surveys in Connecticut, Maine, and Montana. A total of 4246 persons were interviewed. RESULTS: Perceived risk of acquiring Lyme disease, knowing anyone with Lyme disease, knowledge about Lyme disease, and believing Lyme disease to be a common problem were significantly associated with prevention practices. CONCLUSIONS: Predisposing factors differ substantially between states and appear related to disease incidence. Personal risk, knowing someone with Lyme disease, and cognizance about Lyme disease and acting on this information are consistent with social learning theories.
Asunto(s)
Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Enfermedad de Lyme/prevención & control , Adulto , Análisis de Varianza , Causalidad , Connecticut/epidemiología , Femenino , Humanos , Incidencia , Modelos Logísticos , Enfermedad de Lyme/epidemiología , Maine/epidemiología , Masculino , Persona de Mediana Edad , Montana/epidemiología , Proyectos Piloto , Características de la Residencia , Encuestas y CuestionariosRESUMEN
OBJECTIVES: This study was undertaken to determine an accurate vaccination rate and identify factors influencing nonvaccination in a meningococcal vaccination campaign on a Connecticut university campus in May 1993. METHODS: Vaccination and student data were merged to determine demographic factors associated with nonvaccination. A case-control study examined reasons for nonvaccination. RESULTS: The estimated vaccination rate for students returning to the campus was 93%. Lower rates occurred among older students, students living off campus, graduate and nondegree students, and married students. Perceived poor access to the vaccination center was the strongest predictor of nonvaccination. CONCLUSIONS: Higher vaccination rates may be achieved by specifically targeting students who live off campus and by providing multiple vaccination sites with extended hours.
Asunto(s)
Brotes de Enfermedades/prevención & control , Infecciones Meningocócicas/prevención & control , Servicios de Salud para Estudiantes/organización & administración , Negativa del Paciente al Tratamiento , Vacunación/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Estudios de Casos y Controles , Connecticut , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Oportunidad Relativa , Características de la ResidenciaRESUMEN
Between 23 June and 15 July 1994, 21 cases (19 primary and 2 secondary) of Escherichia coli O157:H7 infection were identified in the Bethel, Connecticut, area. Three pulsed-field gel electrophoresis (PFGE) patterns from 15 isolates (I, n = 13; II, n = 2; and III, n = 1) were observed. A case-control study that excluded secondary cases and patients with PFGE II and III patterns (n = 16) demonstrated that consumption of food from one supermarket was associated with illness (15/16 cases vs. 31/47 geographically matched controls, odds ratio [OR] undefined, lower 95% confidence interval OR = 1.45, P = .018). No one food was associated with illness. Inspection of the supermarket revealed deficiencies in hygiene and meat handling practices. The 2 cases with PFGE II ate raw beef and raw lamb from a second supermarket. These outbreaks demonstrate the value of PFGE in supporting epidemiologic investigations and the potential for outbreaks arising from retail outlets.
Asunto(s)
Brotes de Enfermedades , Infecciones por Escherichia coli/epidemiología , Manipulación de Alimentos/instrumentación , Microbiología de Alimentos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Niño , Preescolar , Colitis Ulcerosa/epidemiología , Colitis Ulcerosa/microbiología , Connecticut/epidemiología , Electroforesis en Gel de Campo Pulsado , Escherichia coli/aislamiento & purificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Epidemiología MolecularRESUMEN
To determine the magnitude of underreporting of Lyme disease, a random sample of Connecticut physicians was surveyed in 1993. The magnitude of underreporting was assessed by comparing physician estimates of Lyme disease diagnoses with reports of Lyme disease sent by physicians to the Connecticut Lyme disease surveillance system. Complete questionnaires were returned by 59 percent (412/698) of those surveyed. Of the 224 respondents who indicated that they had made a diagnosis of Lyme disease in 1992, only 56 (25 percent) reported a case of Lyme disease that year. Survey results suggested that, at best, only 16 percent of Lyme disease cases were reported in 1992. Physician underreporting of Lyme disease underestimates the public health impact of Lyme disease.