RESUMEN
We describe influenza immunization coverage trends from the New York State (NYS) Department of Health long-term care facility (LTCF) reports. Overall median immunization coverage levels for NYS LTCF residents and employees were 84.0% (range: 81.6%-86.0%) and 37.7% (range: 32.7%-50.0%), respectively. LTCF resident immunization coverage levels in NYS have neared the Healthy People 2020 target of 90% but have not achieved high LTCF employee coverage, suggesting a need for more regulatory interventions.
Asunto(s)
Personal de Salud/estadística & datos numéricos , Hogares para Ancianos/estadística & datos numéricos , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Cuidados a Largo Plazo/estadística & datos numéricos , Casas de Salud/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Encuestas de Atención de la Salud , Humanos , Programas de Inmunización , Control de Infecciones/métodos , Programas Obligatorios , New York , Encuestas y CuestionariosRESUMEN
To help elucidate rabies disease patterns and control issues, a full assessment of a human case of dog-variant rabies was undertaken. In 2000, a 54-year-old man presented to a New York hospital with lower back discomfort four days after arrival from Africa. Rabies was first suspected 8 days after hospitalization based on clinical signs, specimens were collected on the same day, and rabies infection was confirmed the following day (fluorescence antibody testing on nuchal skin biopsy specimen). By the 12(th) day after illness onset, he was unresponsive, and life support was removed on day 15. Subsequently, an African dog variant was confirmed by nucleic acid sequence analysis of rabies viral RNA extracted and amplified from the patient's saliva. Management of human concerns about exposure to the patient kept the number of persons receiving postexposure prophylaxis to 26. With less than half of the U.S. human rabies cases being diagnosed antemortem, this case emphasizes the need to routinely include rabies in the differential diagnosis of any unexplained encephalitis to ensure early confirmation and triage of human contacts to reduce associated healthcare costs.
RESUMEN
The largest reported outbreak of waterborne Escherichia coli O157:H7 in the United States occurred in upstate New York following a county fair in August 1999. Culture methods were used to isolate E. coli O157:H7 from specimens from 128 of 775 patients with suspected infections. Campylobacter jejuni was also isolated from stools of 44 persons who developed diarrheal illness after attending this fair. There was one case of a confirmed coinfection with E. coli O157:H7 and C. jejuni. Molecular detection of stx(1) and stx(2) Shiga toxin genes, immunomagnetic separation (IMS), and selective culture enrichment were utilized to detect and isolate E. coli O157:H7 from an unchlorinated well and its distribution points, a dry well, and a nearby septic tank. PCR for stx(1) and stx(2) was shown to provide a useful screen for toxin-producing E. coli O157:H7, and IMS subculture improved recovery. Pulsed-field gel electrophoresis (PFGE) was used to compare patient and environmental E. coli O157:H7 isolates. Among patient isolates, 117 of 128 (91.5%) were type 1 or 1a (three or fewer bands different). Among the water distribution system isolates, 13 of 19 (68%) were type 1 or 1a. Additionally, PFGE of C. jejuni isolates revealed that 29 of 35 (83%) had indistinguishable PFGE patterns. The PFGE results implicated the water distribution system as the main source of the E. coli O157:H7 outbreak. This investigation demonstrates the potential for outbreaks involving more than one pathogen and the importance of analyzing isolates from multiple patients and environmental samples to develop a better understanding of bacterial transmission during an outbreak.
Asunto(s)
Infecciones por Campylobacter/epidemiología , Campylobacter jejuni/aislamiento & purificación , Brotes de Enfermedades , Infecciones por Escherichia coli/epidemiología , Escherichia coli O157/aislamiento & purificación , Agua Dulce/microbiología , Infecciones por Campylobacter/microbiología , Infecciones por Campylobacter/transmisión , Campylobacter jejuni/genética , Electroforesis en Gel de Campo Pulsado , Infecciones por Escherichia coli/microbiología , Infecciones por Escherichia coli/transmisión , Escherichia coli O157/genética , Humanos , Reacción en Cadena de la Polimerasa , Toxina Shiga I/análisis , Toxina Shiga I/genética , Toxina Shiga II/análisis , Toxina Shiga II/genética , Estados Unidos/epidemiologíaRESUMEN
This report summarizes the spread of a raccoon rabies epizootic into New York in the 1990s, the species of animals affected, and human postexposure treatments (PET). A total of 57,008 specimens were submitted to the state laboratory from 1993 to 1998; 8,858 (16%) animals were confirmed rabid, with raccoons the most common species (75%). After exposure to 11,769 animals, 18,238 (45%) persons received PET, mostly because of contact with saliva or nervous tissue. We analyzed expenditure reports to estimate the cost of rabies prevention activities. An estimated $13.9 million was spent in New York State to prevent rabies from 1993 to 1998. Traditional prevention methods such as vaccinating pets, avoiding wildlife, and verifying an animal's rabies status must be continued to reduce costly PET. To reduce rabid animals, exposures, and costs, oral vaccination of wildlife should also be considered.