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Volume 11, Number 3—March 2005

Volume 11, Number 3—March 2005   PDF Version [PDF - 9.69 MB - 163 pages]

Perspective

Research

  • Disease Risks from Foods, England and Wales, 1996–2000 PDF Version [PDF - 146 KB - 8 pages]
    G. K. Adak et al.
  • Rapid Identification of Emerging Pathogens: Coronavirus PDF Version [PDF - 333 KB - 7 pages]
    R. Sampath et al.
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    New surveillance approach can analyze >900 polymerase chain reactions per day.

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    We describe a new approach for infectious disease surveillance that facilitates rapid identification of known and emerging pathogens. The process uses broad-range polymerase chain reaction (PCR) to amplify nucleic acid targets from large groupings of organisms, electrospray ionization mass spectrometry for accurate mass measurements of PCR products, and base composition signature analysis to identify organisms in a sample. We demonstrate this principle by using 14 isolates of 9 diverse Coronavirus spp., including the severe acute respiratory syndrome–associated coronavirus (SARS-CoV). We show that this method could identify and distinguish between SARS and other known CoV, including the human CoV 229E and OC43, individually and in a mixture of all 3 human viruses. The sensitivity of detection, measured by using titered SARS-CoV spiked into human serum, was ≈1 PFU/mL. This approach, applicable to the surveillance of bacterial, viral, fungal, or protozoal pathogens, is capable of automated analysis of >900 PCR reactions per day.

  • Antimicrobial Drug Prescribing for Pneumonia in Ambulatory Care PDF Version [PDF - 115 KB - 5 pages]
    C. MacDougall et al.
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    Higher levels of fluoroquinolone use were associated with increasing age and later study year.

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    To determine patterns and predictors of antimicrobial drug use for outpatients with community-acquired pneumonia, we examined office visit and pharmacy claims data of 4 large third-party payer organizations from 2000 to 2002. After patients with coexisting conditions were excluded, 4,538 patients were studied. Despite lack of coexisting conditions, fluoroquinolone use was commonly observed and increased significantly (p < 0.001) from 2000 to 2002 (24%–39%), while macrolide use decreased (55%–44%). Increased age correlated with increased fluoroquinolone use: 18–44 years (22%), 45–64 years (33%), and >65 years (40%) (p < 0.001). Increased use of fluoroquinolones occurred in healthy young and old patients alike, which suggests a lack of selectivity in reserving fluoroquinolones for higher risk patients. Clear and consistent guidelines are needed to address the role of fluoroquinolones in treatment of outpatient community-acquired pneumonia.

  • Ebola Virus Antibody Prevalence in Dogs and Human Risk PDF Version [PDF - 199 KB - 6 pages]
    L. Allela et al.
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    This first report suggests that dogs can be asymptomatically infected with Ebola virus.

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    During the 2001–2002 outbreak in Gabon, we observed that several dogs were highly exposed to Ebola virus by eating infected dead animals. To examine whether these animals became infected with Ebola virus, we sampled 439 dogs and screened them by Ebola virus–specific immunoglobulin (Ig) G assay, antigen detection, and viral polymerase chain reaction amplification. Seven (8.9%) of 79 samples from the 2 main towns, 15 (15.2%) of 14 the 99 samples from Mekambo, and 40 (25.2%) of 159 samples from villages in the Ebola virus–epidemic area had detectable Ebola virus–IgG, compared to only 2 (2%) of 102 samples from France. Among dogs from villages with both infected animal carcasses and human cases, seroprevalence was 31.8%. A significant positive direct association existed between seroprevalence and the distances to the Ebola virus–epidemic area. This study suggests that dogs can be infected by Ebola virus and that the putative infection is asymptomatic.

  • Probable Psittacosis Outbreak Linked to Wild Birds PDF Version [PDF - 114 KB - 7 pages]
    B. L. Telfer et al.
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    Residence in the upper Blue Mountains, age of 50–64 years, direct contact with wild birds, and lawn mowing without a grass catcher were associated with psittacosis.

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    In autumn 2002, an outbreak of probable psittacosis occurred among residents of the Blue Mountains district, Australia. We conducted a case-control study to determine independent risk factors for psittacosis by comparing exposures between hospitalized patients and other residents selected randomly from the telephone directory. Of the 59 case-patients with laboratory results supportive of psittacosis, 48 participated in a case-control study with 310 controls. Independent risk factors were residence in the upper Blue Mountains (odds ratio [OR] = 15.2, 95% confidence interval [CI] 5.6–41.7), age of 50–64 years (OR = 3.9, 95% CI 1.5–10.5), direct contact with wild birds (OR = 7.4, 95% CI 2.5–22), and mowing lawns without a grass catcher (OR = 3.2, 95% CI 1.3–8.0). Protective equipment is recommended for residents in areas frequented by free-ranging birds if contact with birds and their droppings is likely when performing outdoor activities such as lawn mowing.

  • Effect of Regulation and Education on Reptile-associated Salmonellosis PDF Version [PDF - 230 KB - 6 pages]
    B. de Jong et al.
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    Import restrictions and public awareness campaigns are effective against this common childhood infection.

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    Reptiles have become increasingly common as domestic pets, and with them reptile-associated Salmonella infections in humans. From 1990 to 2000, a total of 339 reptile-associated Salmonella cases were reported in Sweden. In 1996, as part of its efforts to adapt its import regulations to those of the European Union, Sweden no longer required certificates stating that imported animals were free of Salmonella. A subsequent increase was noted in the incidence of reptile-associated cases from 0.15/100,000 in the period 1990–1994 to 0.79/100,000 in 1996 and 1997. After a public education campaign directed toward the general public was begun through the news media, the incidence dropped to 0.46/100,000. Children were the most affected age group among patients (incidence 1.3/100,000). Salmonella enterica serotype Enteritidis was the most frequent serotype (24% of isolates), followed by S. Typhimurium (9% of isolates). Import restrictions and public information campaigns are effective public health measures against reptile-associated salmonellosis.

  • SARS Risk Perceptions in Healthcare Workers, Japan PDF Version [PDF - 134 KB - 7 pages]
    T. Imai et al.
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    In coping with severe acute respiratory syndrome (SARS), infection control measures are a key aspect of protecting healthcare workers. We conducted a survey concerning perception of risk and countermeasures for SARS in 7 tertiary hospitals in Japan from July through September 2003, immediately after the SARS epidemic in neighboring countries. Based on 7,282 respondents out of 9,978 questionnaires administered, we found the perception of risk to be relatively high and the perception of countermeasures at the institutional level to be relatively low. Knowledge of preventive measures, concept of (opinions regarding) institutional measures, and perception of risk differed substantially among the 3 job categories, notably between physicians and nurses. The concept of institutional measures was the most important predictor of individual perception of risk. In view of the potential for future epidemics, planning and implementing institutional measures should be given a high priority.

  • Longitudinally Profiling Neutralizing Antibody Response to SARS Coronavirus with Pseudotypes PDF Version [PDF - 203 KB - 6 pages]
    N. J. Temperton et al.
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    SARS-CoV spike protein pseudotypes are the basis of an in vitro microneutralization assay sensitive and specific for SARS-CoV neutralizing antibodies.

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    The severe acute respiratory syndrome–associated coronavirus (SARS-CoV) spike protein (S) is a major target for neutralizing antibodies. Retroviral SARS-CoV S pseudotypes have been constructed and used to develop an in vitro microneutralization assay that is both sensitive and specific for SARS-CoV neutralizing antibodies. Neutralization titers measured by this assay are highly correlated to those measured by an assay using replication-competent SARS-CoV. No cross-neutralization occurred with human sera known to contain antibodies to coronavirus strains OC43 and 229E. The pseudotype assay was used to profile neutralizing antibody responses against SARS-CoV S in sequential serum samples taken from 41 confirmed SARS patients during the 2003 outbreak in Hong Kong and shows long-lasting immunity in most recovered patients. The pseudotype assay does not require handling live SARS virus; it is a useful tool to determine neutralizing titers during natural infection and the preclinical evaluation of candidate vaccines.

  • SARS-related Perceptions in Hong Kong PDF Version [PDF - 168 KB - 8 pages]
    J. Lau et al.
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    To understand different aspects of community responses related to severe acute respiratory syndrome (SARS), 2 population-based, random telephone surveys were conducted in June 2003 and January 2004 in Hong Kong. More than 70% of respondents would avoid visiting hospitals or mainland China to avoid contracting SARS. Most respondents believed that SARS could be transmitted through droplets, fomites, sewage, and animals. More than 90% believed that public health measures were efficacious means of prevention; 40.4% believed that SARS would resurge in Hong Kong; and ≈70% would then wear masks in public places. High percentages of respondents felt helpless, horrified, and apprehensive because of SARS. Approximately 16% showed signs of posttraumatic symptoms, and ≈40% perceived increased stress in family or work settings. The general public in Hong Kong has been very vigilant about SARS but needs to be more psychologically prepared to face a resurgence of the epidemic.

  • West Nile Virus Risk Assessment and the Bridge Vector Paradigm PDF Version [PDF - 194 KB - 5 pages]
    A. Kilpatrick et al.
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    In the northeast United States, control of West Nile virus (WNV) vectors has been unfocused because of a lack of accurate knowledge about the roles different mosquitoes play in WNV transmission. We analyzed the risk posed by 10 species of mosquitoes for transmitting WNV to humans by using a novel risk-assessment measure that combines information on the abundance, infection prevalence, vector competence, and biting behavior of vectors. This analysis suggests that 2 species (Culex pipiens L. and Cx. restuans Theobald [Diptera: Cilicidae]) not previously considered important in transmitting WNV to humans may be responsible for up to 80% of human WNV infections in this region. This finding suggests that control efforts should be focused on these species which may reduce effects on nontarget wetland organisms. Our risk measure has broad applicability to other regions and diseases and can be adapted for use as a predictive tool of future human WNV infections.

  • Methicillin-resistant Staphylococcus aureus in Horses and Horse Personnel, 2000–2002 PDF Version [PDF - 191 KB - 6 pages]
    J. Weese et al.
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    Methicillin-resistant Staphylococcus aureus was isolated from horses and horse personnel in a pattern suggestive of interspecies transmission of a human-origin clone.

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    Methicillin-resistant Staphylococcus aureus (MRSA) infection was identified in 2 horses treated at a veterinary hospital in 2000, prompting a study of colonization rates of horses and associated persons. Seventy-nine horses and 27 persons colonized or infected with MRSA were identified from October 2000 to November 2002; most isolations occurred in a 3-month period in 2002. Twenty-seven (34%) of the equine isolates were from the veterinary hospital, while 41 (51%) were from 1 thoroughbred farm in Ontario. Seventeen (63%) of 27 human isolates were from the veterinary hospital, and 8 (30%) were from the thoroughbred farm. Thirteen (16%) horses and 1 (4%) person were clinically infected. Ninety-six percent of equine and 93% of human isolates were subtypes of Canadian epidemic MRSA-5, spa type 7 and possessed SCCmecIV. All tested isolates from clinical infections were negative for the Panton-Valentine leukocidin genes. Equine MRSA infection may be an important emerging zoonotic and veterinary disease.

  • Malaria Risk in Travelers PDF Version [PDF - 123 KB - 6 pages]
    H. Askling et al.
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    Malaria risk around the world was assessed by using Swedish surveillance data from 1997 to 2003 with an extensive travel database as denominator.

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    Imported malaria has been an increasing problem in several Western countries in the last 2 decades. To calculate the risk factors of age, sex, and travel destination in Swedish travelers, we used data from the routine reporting system for malaria (mixture of patients with and without adequate prophylaxis), a database on travel patterns, and in-flight or visa data on Swedish travelers of 1997 to 2003. The crude risk for travelers varied from 1 per 100,000 travelers to Central America and the Caribbean to 357 per 100,000 in central Africa. Travelers to East Africa had the highest adjusted odds ratio (OR = 341; 95% confidence intervals [CI] 134–886) for being reported with malaria, closely followed by travelers to central Africa and West Africa. Male travelers as well as children <1–6 years of age had a higher risk of being reported with malaria (OR = 1,7; 95% CI 1.3–2.3 and OR = 4,8; 95%CI 1.5–14.8) than women and other age groups.

Policy Review

  • Notifiable Disease Surveillance and Practicing Physicians PDF Version [PDF - 62 KB - 4 pages]
    G. Krause et al.
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    Surveillance data should be delivered to physicians through occasional nonelectronic reports on current issues of local public health importance.

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    Primary care physicians in Germany are essential participants in infectious disease surveillance through mandatory reporting. Feedback on such surveillance should reflect the needs and attitudes of these physicians. These issues were investigated in a questionnaire survey among 8,550 randomly sampled physicians in Germany in 2001. Of the 1,320 respondents, 59.3% claimed not to have received any feedback on infectious disease surveillance, and 3.7% perceived feedback as not important. Logistic regression analysis showed that physicians in the former East Germany were 2.2 times more likely to have received feedback than those in the former West Germany. Physicians preferred to receive occasional reports (e.g., in case of outbreaks, 31.6%) as opposed to actively having to search for constantly updated information on the Internet (7.8%). The preferred formats were fax (31.7%), mail (30.9%), and the official organ of the German Medical Association (Deutsches Arzteblatt) (30.5%). Feedback of surveillance data to physicians should be delivered through occasional nonelectronic reports on current issues of local public health importance.

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