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Volume 18, Number 7—July 2012

CME ACTIVITY - Perspective

Assessment of Public Health Events through International Health Regulations, United States, 2007–2011

Katrin S. KohlComments to Author , Ray R. Arthur, Ralph O’Connor, and Jose Fernandez
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K.S. Kohl, R.R. Arthur, R. O’Connor); and Department of Health and Human Services, Washington, DC, USA (J. Fernandez)

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Noninfluenza public health events in the United States, July 2007–December 2011, assessed by WHO as potential public health emergencies of international concern and posted on the IHR secure web portal*

Event by year of assessment (reference) Assessment determination by WHO per IHR criteria†
Description of event at time of assessment
1 2 3 4
Botulism (13) X X X X Four cases associated with a canned food product were identified in 2 states for the first time in 40 y in the United States. The company exported food items to >8 countries.
Salmonella enterica serovar Wandsworth infection (10) X X X Fifty-seven cases were identified in 18 states in the United States. Salmonella spp. can cause serious illness in specific risk groups. Implicated products were sold in the United States and Canada. Other national health authorities are requesting additional information about the outbreak.
Heparin (14) X X X Contaminated heparin products identified in >2 countries were associated with life-threatening clinical events. The United States Food and Drug Administration enacted an Import Alert for the products.
S. enterica serovar Saintpaul infection (11) X X X X Several hundred cases with the same genetic fingerprint have been identified in 40 states, the District of Columbia, and Canada; illness onset was during April–July 2008. This organism was a previously rare cause of salmonellosis in the United States. The implicated food items (raw hot peppers) grown in Mexico were recalled.
Escherichia coli O157:H7 infection (15) X X X A multistate outbreak in 70 persons (25 were hospitalized, 7 showed development of hemolytic uremic syndrome) was associated with eating raw, refrigerated, prepackaged cookie dough that was exported to numerous other countries.
S. enterica serovar Typhimurium infection (12) X X X X Several hundred cases have been reported in 43 states with an onset during September–December 2008. The outbreak was associated with peanut-containing products, an unusual vehicle for this organism. At least 30 countries may have received the products, and a food recall was implemented.
Lassa fever (17) X X Four days after travel on 3 connecting flights involving 3 continents, a patient was hospitalized for sore throat, diarrhea, thrombocytopenia, and given a diagnosis 5 d later. No high-risk contact was identified, but awareness of travel-associated cases is essential.
Oil spill (16) X X An accident at an oil drilling rig off the US coast resulted in an ongoing leak from the well. Modeling suggested that high winds might distribute oil over a wider area, which may potentially affect coastal fisheries and other human activity in other countries.
S. enterica serovar Montevideo infection (8) X X Several hundred cases were identified in 42 states with an onset during July 2009–January 2010. The implicated food item (salami) was exported to 8 countries and was recalled.
Typhoid fever (19) X X X Nine confirmed cases were reported to CDC from 2 states; 7 persons were hospitalized. Consumption of frozen mamey fruit pulp was epidemiologically linked to the outbreak. The pulp was manufactured in Guatemala and shipped throughout the United States and possibly other countries.
Guillain-Barré syndrome (18) X X X Twenty-three suspected cases were clustered in time and place along the United States–Mexico border, possibly associated with Campylobacter jejuni.
S. enterica serovar Enteritidis infection (9) X X X Forty-two cases were reported in 6 states linked to consumption of pine nuts imported from Turkey. The product was recalled.

*WHO, World Health Organization; IHR, International Health Regulations; X, yes; CDC, Centers for Disease Control and Prevention.
†1, Is the public health effect of the event serious?; 2, Is the event unusual or unexpected?; 3, Is there a major risk for international spread?; 4, Is there a major risk for international travel or trade restrictions?

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