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Background. We estimated the vaccine effectiveness (VE) of tetanus-diphtheria-acellular pertussis vaccine (Tdap) for preventing pertussis among adolescents during a statewide outbreak of pertussis in Wisconsin during 2012.Methods. We used the population-based Wisconsin Immunization Registry (WIR) to construct a cohort of Wisconsin residents born during 1998–2000 and collect Tdap vaccination histories. Reports of laboratory-confirmed pertussis with onset during 2012 were matched to WIR clients. Incidence rate ratios (IRRs) of pertussis and Tdap VE estimates [(1 − IRR)*100%], by year of Tdap vaccine receipt and brand (Boostrix/Adacel), were estimated using Poisson regression.Results. Tdap VE decreased with increasing time since receipt, with VEs of 75.3% (95% confidence interval [CI], 55.2%–86.5%) for receipt during 2012, 68.2% (95% CI, 60.9%–74.1%) for receipt during 2011, 34.5% (95% CI, 19.9%–46.4%) for receipt during 2010, and 11.9% (95% CI, −11.1% to 30.1%) for receipt during 2009/2008; point estimates were higher among Boostrix recipients than among Adacel recipients. Among Tdap recipients, increasing time since receipt was associated with increased risk, and receipt of Boostrix (vs Adacel) was associated with decreased risk of pertussis (adjusted IRR, 0.62 [95% CI, .52–.74]).Conclusions. Our results demonstrate waning immunity following vaccination with either Tdap brand. Boostrix was more effective than Adacel in preventing pertussis in our cohort, but these findings may not be generalizable to adolescent cohorts that received different diphtheria-tetanus-acellular pertussis vaccines (DTaP) during childhood and should be further examined in studies that include childhood DTaP history. [ABSTRACT FROM AUTHOR]

Background. Wisconsin was severely affected by pandemic waves of 2009 influenza A H1N1 infection during the period 15 April through 30 August 2009 (wave 1) and 31 August 2009 through 2 January 2010 (wave 2).Methods. To evaluate differences in epidemiologic features and outcomes during these pandemic waves, we examined prospective surveillance data on Wisconsin residents who were hospitalized ≥24 h with or died of pandemic H1N1 infection.Results. Rates of hospitalizations and deaths from pandemic H1N1 infection in Wisconsin increased 4- and 5-fold, respectively, from wave 1 to wave 2; outside Milwaukee, hospitalization and death rates increased 10- and 8-fold, respectively. Hospitalization rates were highest among racial and ethnic minorities and children during wave 1 and increased most during wave 2 among non-Hispanic whites and adults. Times to hospital admission and antiviral treatment improved between waves, but the overall hospital course remained similar, with no change in hospitalization duration, intensive care unit admission, requirement for mechanical ventilation, or mortality.Conclusions. We report broader geographic spread and marked demographic differences during pandemic wave 2, compared with wave 1, although clinical outcomes were similar. Our findings emphasize the importance of using comprehensive surveillance data to detect changing characteristics and impacts during an influenza pandemic and of vigorously promoting influenza vaccination and other prevention efforts. [ABSTRACT FROM PUBLISHER]

Reports on the growing number of outbreaks associated with Salmonella enteriditis infections acquired from contaminated eggs in Wisconsin. Case-control study to determine the risk factors for sporadic infections; Identification of probable sources; Significance of the outbreaks in demonstrating the need for continuing need for quality assurance on egg farms.

An outbreak of Escherichia coli O157:H7 infections occurred after a graduation banquet at a university in Wisconsin. Sixty-one (32%) of 193 banquet attendees developed a gastrointestinal illness; 2 were hospitalized, none developed hemolytic-uremic syndrome or thrombotic thrombocytopenic purpura, and none died. The spectrum of illness was unusually mild, with 61% of ill persons reporting nonbloody diarrhea. A strain of E. coli O157:H7, indistinguishable from the outbreak strain by toxin type, plasmid profile, and pulsed-field gel electrophoresis, was isolated from an unopened package of an uncooked round of beef from the original shipment of meat. An investigation suggested that both undercooked roast beef and salad cross-contaminated with beef were vehicles of transmission. These findings demonstrate that meat from beef cattle may transmit E. coli O157:H7, and such infections among young to middle-aged adults may be mild and may often go undetected. [ABSTRACT FROM PUBLISHER]

To identify risk factors associated with community- and household-acquired pertussis, we studied 61 households (HHs) with members with culture-positive illnesses and compared their characteristics with 58 neighborhood control-HHs and 62 randomly selected control-HHs. Case-HHs weremore likely than either control group to have members 12–18 y of age (P < .01); these individuals accounted for 34% of all primary cases. A history of exposure outside the home was the most important predictor of community-acquired infection (P < .001), with adolescents being at higher risk than other age-groups (odds ratio, 3.2; P < .001). After known exposure to a culture-positive case in the same HH, the risk of illness was unrelated to age; lengthy delays in initiating erythromycin therapy and prophylaxis were the only factors associated with secondary spread (P < .01). The risk of pertussis may be related more to the likelihood of exposure than to age-related increasesin susceptibility,and the risk can be reduced with appropriate use of erythromycin. [ABSTRACT FROM PUBLISHER]

During a pertussis outbreak in a facility for the developmentally disabled, culture- or direct fluorescent-antibody-confirmed cases were identified in 24 residents and 17 staff members; 38 (93%) were culture positive for Bordetella pertussis. An enzyme-linked immunosorbent assay (ELISA) was used to detect serum IgG and IgA to the filamentous hemagglutinin and lymphocytosis-promoting factor of B. pertussis. Using criteria from ELISA values, we identified an additional 83 residents and 28 staff members as seropositive. Among seropositive persons, antibody levels were elevated by the time of onset of respiratory symptoms and, in three of the four assays, remained elevated for 14 mo. In 44 seropositive persons tested within two weeks of onset of symptoms, 80% were culture positive, compared with 33% of 15 tested two to four weeks after onset (P = .003) and none of 15 tested more than four weeks after onset. The most specific (94%) clinical case definition identified only 41% of seropositive persons. Thus, ELISAs are important tools for individual diagnosis and epidemiological studies of pertussis. [ABSTRACT FROM PUBLISHER]

During an outbreak of pertussis in residents and staff of a facility for the developmentally disabled, 149 persons had laboratory evidence of Bordetella pertussis infection; 130 (87%) reported respiratory illness. Infection rates (IR) in affected wards ranged from 6% to 91%. Most residents were adolescents and adults and had receiveda full course of diphtheria- tetanus toxoids-pertussis (DTP) vaccine; IRs increased with increasing time after the last DTP dose in fully vaccinated residents. The IR was lower in residents on wards where erythromycin treatment/prophylaxis was started two or fewer weeks after the onset of illness in the first case on the ward (IR, 16%), compared with four or more weeks after onset (IR, 75%; P < 10-6) . Respiratory symptoms weremilder in ill residents treated within seven days of onset of illness. Although B. pertussis transmission was substantial, erythromycin treatment of patients and prophylaxis of exposed persons was effective in decreasing transmission and disease severity. Carbamazepine toxicity occurred in seven (19%) of 37 residents when carbamazepine was administered with erythromycin. [ABSTRACT FROM PUBLISHER]

Enzyme immunoassay (EIA), immunodiffusion (ID), and complement fixation (CF) tests for antibody to the A antigen of Blastomyces dermatitidis were assessed in 47 patients in an epidemic of blastomycosis and in 89 control subjects with lower respiratory tract illness. Antibody was detected by EIA, ID, and CF in 77%, 28%, and 9% of the patients, respectively. EIA titers ranged from 1.8–1.512 (median titer, 1.128). Anuoooy oetecteo by ID or CF was always detectable by EIA. Antibody was detected by EIA 13 days after illness onset, and the peak seroprevalence rate and geometric mean titer occurred 50–70 days after onset. Antifungal therapy produced a significant decline in antibody titer by approximately six months after onset. Seven (8%) control subjects had detectable antibody, six had EIA titers of 1:8, and one had a titer of 1:16. The specificities for EIA, ID, and CF were 92%, 100%, and 100%, respectively. The EIA provides a significant advance in serodiagnostic testing for blastomycosis and can be used in an outbreak setting as an epidemiological tool to identify acute B. dermatitidis infection; titers ⩾1:32 strongly support the diagnosis, whereas titers of 1:8 or 1:16 are suggestive. [ABSTRACT FROM PUBLISHER]

Lymedisease is a tick-borne illness that has been reported from three regions in the United States — the Northeast, Midwest, and West-which correspond to the distribution of the recognized vectors of the disease, Ixodes dammini and Ixodes pacificus. In 1982, a surveillance system designed to define the morbidity and geographic distribution for Lyme disease by using a clinical case definition received information on 491 definite cases and 38 probable cases. Of the definite cases, 489 were acquired in endemic areas of the Northeast or Midwest; one case was acquired in Utah and one in western Pennsylvania, two areas where the illness had not been previously reported. Three states that previously had not reported cases of Lyme disease (Kentucky, Indiana, Montana) reported probable cases. In 37% of the definite cases, the patients had neurological symptoms (most commonly reported was headache with stiff neck, suggestive of meningitis), 10% cardiac symptoms (most commonly reported was palpitations), and 54% arthritic symptoms (most commonly reported in large joints). The occurrence of Lyme disease in areas outside the currently recognized endemic regions, as well as the recent description of Amblyomma americanum as a probable vector, suggest that additional vectors may be described in the future. [ABSTRACT FROM PUBLISHER]

The presence of Staphylococcus aureus producing toxic shock toxin (TST) and the absence of antibody to TST (anti-TST) in acute-phase sera are markers for toxic shock syndrome (TSS). We used radioimmunoassay methods to examine 133 acute-phase and 277 convalescent-phase serum specimens from 181 patients with TSS for anti-TST. Among confirmed menstrual cases, nine (9.5%) of 95 patients had demonstrable anti-TST in acute-phase sera obtained during the first seven days of illness; patients with probable or nonmenstrual TSS had a higher prevalence of anti-TST in acute-phase sera. Five (33.3%) of 15 individuals with confirmed menstrual TSS developed anti-TST as early as seven to nine days after TSS onset; 32 (62.7%) of 51 patients had demonstrable anti-TST in sera obtained more than one year after their episode of TSS. This study demonstrates a gradual rate and low magnitude of development of anti-TST after TSS and supports the diagnostic usefulness of measuring anti-TST levels in sera from patients suspected of having TSS. [ABSTRACT FROM PUBLISHER]

The Wisconsin and Centers for Disease Control (CDC) surveillances for toxic-shock syndrome (TSS)were compared; the distributions of CDC and Wisconsin cases in 1980 by calendar quarter of the initial onset werevirtually identical. Among 131 casesin Wisconsin, 33 of 40 self-reported vs. 16of 91 physician-reportedcaseswere reported during the four-week period (September 18–0ctober 15, 1980) following the CDC announcement of a higher relative risk of TSS among users of Rely® tampons (Procter and Gamble, Cincinnati, Ohio) (P < 0.(01). Of cases with onsets during October 1, 1979–June 30, 1980, eight of 31womenwith physician-reportedcasesvs. nine of 15 with self-reported cases used Rely tampons during their TSS-associated menstrual period (P P < 0.05). Multiple interviews of 22 patients with TSS suggested that patient recall of tampon brand may have been influenced by publicityabout TSS. Passive as compared with partially active surveillance for TSS significantlyfavored self-reporting. In Wisconsin, the volume and source of TSS reporting have been greatly influenced by publicity, and selective reporting of TSS has been influenced by the content of news media reports of TSS. [ABSTRACT FROM PUBLISHER]

The rate of nasal colonization with group B Streptococcus in infants cultured at the time of discharge from the nursery rose significantly during a four-month interval. Investigation of this trend resulted in detection of group B streptococci in the domes of two intrauterine pressure transducers (IPTs). Subsequent routine sterilization of IPT domes after each maternal use was associated with a decline in infant group B streptococcal colonization to the usual endemic rate in the nursery. Retrospective evaluation demonstrated that colonization in infants born to IPT-monitored women had increased significantly during the study interval and that no increase in colonization occurred in infants born to non-IPT-monitored women. From epidemiologic evidence it appears that use of contaminated IPTs during labor was a nosocomial source of group B streptococcal colonization. [ABSTRACT FROM PUBLISHER]