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Salmonella is a public health concern, for which a complex interplay between host, agent, and environment exists. An improved understanding of causal processes can be used to better gauge the causes and trajectory of Salmonella in a changing environment. This would be useful in determining the impact of climate change on the New York State (NYS) environment, the effect of climate change on Salmonella in NYS, factors contributing to Salmonella vulnerability in humans, and aspects of climate change and Salmonella which necessitate further research. A systematic review was conducted to study associations between Salmonella and the environment. Using the search criteria, a total of 91 relevant articles were identified from four electronic databases. Key information was abstracted, organized, and synthesized to identify causal processes and linkages between climate change, the environment of NYS, and Salmonella-related outcomes, as well as risk factors to characterize Salmonella vulnerabilities. Three inter-related domains were identified for consideration and application to epidemiological research to confirm and extrapolate disease patterns using climate change scenarios: improved quantification of causal relationships, inclusion of factors linked to sectors not immediately associated with the exposure and outcome, and increased capacity to validate models in diverse settings. This article has been made Open Access thanks to the generous support of a global network of libraries as part of the Knowledge Unlatched Select initiative.

BACKGROUND. Following Haemophilus influenzae serotype b (Hib) conjugate vaccine introduction in the 1980s, Hib disease in young children dramatically decreased, and epidemiology of invasive H. influenzae changed. METHODS. Active surveillance for invasive H. influenzae disease was conducted through Active Bacterial Core surveillance sites. Incidence rates were directly standardized to the age and race distribution of the US population. RESULTS. During 2009–2015, the estimated mean annual incidence of invasive H. influenzae disease was 1.70 cases per 100 000 population. Incidence was highest among adults aged ≥65 years (6.30) and children aged

Background Influenza hospitalizations result in substantial morbidity and mortality each year. Little is known about the association between influenza hospitalization and census tract‐based socioeconomic determinants beyond the effect of individual factors. Objective To evaluate whether census tract‐based determinants such as poverty and household crowding would contribute significantly to the risk of influenza hospitalization above and beyond individual‐level determinants. Methods We analyzed 33 515 laboratory‐confirmed influenza‐associated hospitalizations that occurred during the 2009‐2010 through 2013‐2014 influenza seasons using a population‐based surveillance system at 14 sites across the United States. Results Using a multilevel regression model, we found that individual factors were associated with influenza hospitalization with the highest adjusted odds ratio (AOR) of 9.20 (95% CI 8.72‐9.70) for those ≥65 vs 5‐17 years old. African Americans had an AOR of 1.67 (95% CI 1.60‐1.73) compared to Whites, and Hispanics had an AOR of 1.21 (95% CI 1.16‐1.26) compared to non‐Hispanics. Among census tract‐based determinants, those living in a tract with ≥20% vs

Introduction Previous FluSurv-NET studies found that adult females had a higher incidence of influenza-associated hospitalizations than males. To identify groups of women at higher risk than men, we analyzed data from 14 FluSurv-NET sites that conducted population-based surveillance for laboratory-confirmed influenza-associated hospitalizations among residents of 78 US counties. Methods We analyzed 6292 laboratory-confirmed, geocodable (96%) adult cases collected by FluSurv-NET during the 2010-12 influenza seasons. We used 2010 US Census and 2008-2012 American Community Survey data to calculate overall age-adjusted and age group-specific female:male incidence rate ratios (IRR) by race/ethnicity and census tract-level poverty. We used national 2010 pregnancy rates to estimate denominators for pregnant women aged 18-49. We calculated male:female IRRs excluding them and IRRs for pregnant:non-pregnant women. Results Overall, 55% of laboratory-confirmed influenza cases were female. Female:male IRRs were highest for females aged 18-49 of high neighborhood poverty (IRR 1.50, 95% CI 1.30-1.74) and of Hispanic ethnicity (IRR 1.70, 95% CI 1.34-2.17). These differences disappeared after excluding pregnant women. Overall, 26% of 1083 hospitalized females aged 18-49 were pregnant. Pregnant adult females were more likely to have influenza-associated hospitalizations than their non-pregnant counterparts (relative risk [RR] 5.86, 95% CI 5.12-6.71), but vaccination levels were similar (25.5% vs 27.8%). Conclusions Overall rates of influenza-associated hospitalization were not significantly different for men and women after excluding pregnant women. Among women aged 18-49, pregnancy increased the risk of influenza-associated hospitalization sixfold but did not increase the likelihood of vaccination. Improving vaccination rates in pregnant women should be an influenza vaccination priority.

Foodborne diseases represent a substantial public health concern in the United States. CDC's Foodborne Diseases Active Surveillance Network (FoodNet) monitors cases reported from 10 U.S. sites* of laboratory-diagnosed infections caused by nine enteric pathogens commonly transmitted through food. This report describes preliminary surveillance data for 2016 on the nine pathogens and changes in incidences compared with 2013-2015. In 2016, FoodNet identified 24,029 infections, 5,512 hospitalizations, and 98 deaths caused by these pathogens. The use of culture-independent diagnostic tests (CIDTs) by clinical laboratories to detect enteric pathogens has been steadily increasing since FoodNet began surveying clinical laboratories in 2010 (1). CIDTs complicate the interpretation of FoodNet surveillance data because pathogen detection could be affected by changes in health care provider behaviors or laboratory testing practices (2). Health care providers might be more likely to order CIDTs because these tests are quicker and easier to use than traditional culture methods, a circumstance that could increase pathogen detection (3). Similarly, pathogen detection could also be increasing as clinical laboratories adopt DNA-based syndromic panels, which include pathogens not often included in routine stool culture (4,5). In addition, CIDTs do not yield isolates, which public health officials rely on to distinguish pathogen subtypes, determine antimicrobial resistance, monitor trends, and detect outbreaks. To obtain isolates for infections identified by CIDTs, laboratories must perform reflex culture†; if clinical laboratories do not, the burden of culturing falls to state public health laboratories, which might not be able to absorb that burden as the adoption of these tests increases (2). Strategies are needed to preserve access to bacterial isolates for further characterization and to determine the effect of changing trends in testing practices on surveillance.

Using population-based surveillance data, we analyzed antiviral treatment among hospitalized patients with laboratory-confirmed influenza. Treatment increased after the influenza A(H1N1) 2009 pandemic from 72% in 2010–2011 to 89% in 2014–2015 (P < .001). Overall, treatment was higher in adults (86%) than in children (72%); only 56% of cases received antivirals on the day of admission.

BACKGROUND Sepsis is a serious and often fatal clinical syndrome, resulting from infection. Information on patient demographics, risk factors, and infections leading to sepsis is needed to integrate comprehensive sepsis prevention, early recognition, and treatment strategies. METHODS To describe characteristics of patients with sepsis, CDC and partners conducted a retrospective chart review in four New York hospitals. Random samples of medical records from adult and pediatric patients with administrative codes for severe sepsis or septic shock were reviewed. RESULTS Medical records of 246 adults and 79 children (aged birth to 17 years) were reviewed. Overall, 72% of patients had a health care factor during the 30 days before sepsis admission or a selected chronic condition likely to require frequent medical care. Pneumonia was the most common infection leading to sepsis. The most common pathogens isolated from blood cultures were Escherichia coli in adults aged ≥18 years, Klebsiella spp. in children aged ≥1 year, and Enterococcus spp. in infants aged

Objective. Transcripts from admission chest radiographs could aid in identification of pneumonia cases for public health surveillance. We assessed the reliability of radiographic data abstraction and performance of radiographic key terms to identify pneumonia in patients hospitalized with laboratory-confirmed influenza virus infection. Methods. We used data on patients hospitalized with laboratory-confirmed influenza virus infection from October 2008 through December 2009 from 10 geographically diverse U.S. study sites participating in the Influenza Hospitalization Surveillance Network (FluSurv-NET). Radiographic key terms (i.e., bronchopneumonia, consolidation, infiltrate, airspace density, and pleural effusion) were abstracted from final impressions of chest radiograph reports. We assessed the reliability of radiographic data abstraction by examining the percent agreement and Cohen's κ statistic between clinicians and surveillance staff members. Using a composite reference standard for presence or absence of pneumonia based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and discharge summary data, we calculated sensitivity, specificity, positive predictive value (PPV), and percent agreement for individual and combined radiographic key terms. Results. For each radiographic key term, the percent agreement between clinicians and surveillance staff members ranged from 89.4% to 98.6% and Cohen's κ ranged from 0.46 (moderate) to 0.84 (almost perfect). The combination of bronchopneumonia or consolidation or infiltrate or airspace density terms had sensitivity of 66.5%, specificity of 89.2%, PPV of 80.4%, and percent agreement of 80.1%. Adding pleural effusion did not result in significant changes in sensitivity, specificity, PPV, or percent agreement. Conclusion. Radiographic key terms abstracted by surveillance staff members from final impressions of chest radiograph reports had moderate to almost perfect reliability and could be used to identify pneumonia among patients hospitalized with laboratory-confirmed influenza virus infection. This method can inform pneumonia surveillance and aid in public health response.

BACKGROUND Invasive group A Streptococcus (GAS) infections are associated with significant morbidity and mortality rates. We report the epidemiology and trends of invasive GAS over 8 years of surveillance. METHODS From January 2005 through December 2012, we collected data from the Centers for Disease Control and Prevention's Active Bacterial Core surveillance, a population-based network of 10 geographically diverse US sites (2012 population, 32.8 million). We defined invasive GAS as isolation of GAS from a normally sterile site or from a wound in a patient with necrotizing fasciitis (NF) or streptococcal toxic shock syndrome (STSS). Available isolates were emm typed. We calculated rates and made age- and race-adjusted national projections using census data. RESULTS We identified 9557 cases (3.8 cases per 100 000 persons per year) with 1116 deaths (case-fatality rate, 11.7%). The case-fatality rates for septic shock, STSS, and NF were 45%, 38%, and 29%, respectively. The annual incidence was highest among persons aged ≥65 years (9.4/100 000) or

To evaluate progress toward prevention of enteric and foodborne illnesses in the United States, the Foodborne Diseases Active Surveillance Network (FoodNet) monitors the incidence of laboratory-confirmed infections caused by nine pathogens transmitted commonly through food in 10 U.S. sites. This report summarizes preliminary 2015 data and describes trends since 2012. In 2015, FoodNet reported 20,107 confirmed cases (defined as culture-confirmed bacterial infections and laboratory-confirmed parasitic infections), 4,531 hospitalizations, and 77 deaths. FoodNet also received reports of 3,112 positive culture-independent diagnostic tests (CIDTs) without culture-confirmation, a number that has markedly increased since 2012. Diagnostic testing practices for enteric pathogens are rapidly moving away from culture-based methods. The continued shift from culture-based methods to CIDTs that do not produce the isolates needed to distinguish between strains and subtypes affects the interpretation of public health surveillance data and ability to monitor progress toward prevention efforts. Expanded case definitions and strategies for obtaining bacterial isolates are crucial during this transition period.

Background Timing of influenza spread across the United States is dependent on factors including local and national travel patterns and climate. Local epidemic intensity may be influenced by social, economic and demographic patterns. Data are needed to better explain how local socioeconomic factors influence both the timing and intensity of influenza seasons to result in national patterns. Methods To determine the spatial and temporal impacts of socioeconomics on influenza hospitalization burden and timing, we used population-based laboratory-confirmed influenza hospitalization surveillance data from the CDC-sponsored Influenza Hospitalization Surveillance Network (FluSurv-NET) at up to 14 sites from the 2009/2010 through 2013/2014 seasons (n = 35,493 hospitalizations). We used a spatial scan statistic and spatiotemporal wavelet analysis, to compare temporal patterns of influenza spread between counties and across the country. Results There were 56 spatial clusters identified in the unadjusted scan statistic analysis using data from the 2010/2011 through the 2013/2014 seasons, with relative risks (RRs) ranging from 0.09 to 4.20. After adjustment for socioeconomic factors, there were five clusters identified with RRs ranging from 0.21 to 1.20. In the wavelet analysis, most sites were in phase synchrony with one another for most years, except for the H1N1 pandemic year (2009–2010), wherein most sites had differential epidemic timing from the referent site in Georgia. Conclusions Socioeconomic factors strongly impact local influenza hospitalization burden. Influenza phase synchrony varies by year and by socioeconomics, but is less influenced by socioeconomics than is disease burden.

IMPORTANCE: Group B Streptococcus (GBS) is an important cause of invasive bacterial disease. Previous studies have shown a substantial and increasing burden of GBS infections among nonpregnant adults, particularly older adults and those with underlying medical conditions. OBJECTIVE: To update trends of invasive GBS disease among US adults using population-based surveillance data. DESIGN, SETTING, AND PARTICIPANTS: In this population-based surveillance study, a case was defined as isolation of GBS from a sterile site between January 1, 2008, and December 31, 2016. Demographic and clinical data were abstracted from medical records. Rates were calculated using US Census data. Antimicrobial susceptibility testing and serotyping were performed on a subset of isolates. Case patients were residents of 1 of 10 catchment areas of the Active Bacterial Core surveillance (ABCs) network, representing approximately 11.5% of the US adult population. Patients were included in the study if they were nonpregnant, were 18 years or older, were residents of an ABCs catchment site, and had a positive GBS culture from a normally sterile body site. MAIN OUTCOMES AND MEASURES: Trends in GBS cases overall and by demographic characteristics (sex, age, and race), underlying clinical conditions of patients, and isolate characteristics are described. RESULTS: The ABCs network detected 21 250 patients with invasive GBS among nonpregnant adults from 2008 through 2016. The GBS incidence in this population increased from 8.1 cases per 100 000 population in 2008 to 10.9 in 2016 (P = .002 for trend). There were 3146 cases reported in 2016 (59% male; median age, 64 years; age range, 18-103 years). The GBS incidence was higher among men than women and among blacks than whites and increased with age. Projected to the US population, an estimated 27 729 cases of invasive disease and 1541 deaths occurred in the United States in 2016. Ninety-five percent of cases in 2016 occurred in someone with at least 1 underlying condition, most commonly obesity (53.9%) and diabetes (53.4%). Resistance to clindamycin increased from 37.0% of isolates in 2011 to 43.2% in 2016 (P = .02). Serotypes Ia, Ib, II, III, and V accounted for 86.4% of isolates in 2016; serotype IV increased from 4.7% in 2008 to 11.3% in 2016 (P

Annual influenza vaccine is recommended for all persons aged ≥6 months in the United States, with recognition that some persons are at risk for more severe disease (1). However, there might be previously unrecognized demographic groups that also experience higher rates of serious influenza-related disease that could benefit from enhanced vaccination efforts. Socioeconomic status (SES) measures that are area-based can be used to define demographic groups when individual SES data are not available (2). Previous surveillance data analyses in limited geographic areas indicated that influenza-related hospitalization incidence was higher for persons residing in census tracts that included a higher percentage of persons living below the federal poverty level (3-5). To determine whether this association occurs elsewhere, influenza hospitalization data collected in 14 FluSurv-NET sites covering 27 million persons during the 2010-11 and 2011-12 influenza seasons were analyzed. The age-adjusted incidence of influenza-related hospitalizations per 100,000 person-years in high poverty (≥20% of persons living below the federal poverty level) census tracts was 21.5 (95% confidence interval [CI]: 20.7-22.4), nearly twice the incidence in low poverty (

Background We describe the impact of early initiation of influenza antiviral treatment among pregnant women hospitalized with laboratory-confirmed influenza during the 2010-2014 influenza seasons. Methods Severe influenza was defined as illness with ≥1 of the following: intensive care unit admission, need for mechanical ventilation, respiratory failure, pulmonary embolism, sepsis, or death. Within severity stratum, we used parametric survival analysis to compare length of stay by timing of antiviral treatment, adjusting for underlying conditions, influenza vaccination, and pregnancy trimester. Results Among 865 pregnant women, the median age was 27 years (interquartile range [IQR], 23-31 years). Most (68%) were healthy, and 85% received antiviral treatment. Sixty-three women (7%) had severe influenza, and 4 died. Severity was associated with preterm delivery and fetal loss. Women with severe influenza were less likely to be vaccinated than those without severe influenza (14% vs 26%; P = .03). Among women treated with antivirals ≤2 days versus those treated >2 days from illness onset, the median length of stay was 2.2 days (interquartile range [IQR], 0.9-5.8 days; n = 8) versus 7.8 days (IQR, 3.0-20.6 days; n = 7), respectively, for severe influenza (P = .03) and 2.4 days (IQR, 2.3-2.5 days; n = 153) versus 3.1 days (IQR, 2.8-3.5 days; n = 62), respectively, for nonsevere influenza (P Conclusions Early initiation of influenza antiviral treatment to pregnant women hospitalized with influenza may reduce the length of stay, especially among those with severe influenza. Influenza during pregnancy is associated with maternal and infant morbidity, and annual influenza vaccination is warranted.

BACKGROUND: Pertussis is poorly controlled, with the highest rates of morbidity and mortality among infants. Although the source of infant pertussis is often unknown, when identified, mothers have historically been the most common reservoir of transmission. Despite high vaccination coverage, disease incidence has been increasing. We examined whether infant source of infection (SOI) has changed in the United States in light of the changing epidemiology. METHODS: Cases RESULTS: A total of 1306 infant cases were identified; 24.2% were CONCLUSIONS: In contrast to previous studies, our data suggest that the most common source of transmission to infants is now siblings. While continued monitoring of SOIs will optimize pertussis prevention strategies, recommendations for vaccination during pregnancy should directly increase protection of infants, regardless of SOI.

Background Patients hospitalized with influenza may require extended care on discharge. We aimed to explore predictors for extended care needs and the potential mitigating effect of antiviral treatment among community-dwelling adults aged ≥ 65 years hospitalized with influenza. Methods We used laboratory-confirmed influenza hospitalizations from 3 influenza seasons. Extended care was defined as new placement in a skilled nursing home/long-term/rehabilitation facility on hospital discharge. We focused on those treated with antiviral agents to explore the effect of early treatment on extended care and hospital length of stay using logistic regression and competing risk survival analysis, accounting for time from illness onset to hospitalization. Treatment was categorized as early (≤ 4 days) or late (>4 days) in reference to date of illness onset. Results Among 6593 community-dwelling adults aged ≥ 65 years hospitalized for influenza, 18% required extended care at discharge. The need for care increased with age and neurologic disorders, intensive care unit admission, and pneumonia were predictors of care needs. Early treatment reduced the odds of extended care after hospital discharge for those hospitalized ≤ 2 or >2 days from illness onset (adjusted odds ratio, 0.38 [95% confidence interval {CI}, .17-.85] and 0.75 [.56-.97], respectively). Early treatment was also independently associated with reduction in length of stay for those hospitalized ≤ 2 days from illness onset (adjusted hazard ratio, 1.81; 95% CI, 1.43-2.30) or >2 days (1.30; 1.20-1.40). Conclusions Prompt antiviral treatment decreases the impact of influenza on older adults through shorten hospitalization and reduced extended care needs.

Adjusting for diagnostic test sensitivity enables more accurate and timely comparisons over time., Diagnostic test sensitivity affects rate estimates for laboratory-confirmed influenza–associated hospitalizations. We used data from FluSurv-NET, a national population-based surveillance system for laboratory-confirmed influenza hospitalizations, to capture diagnostic test type by patient age and influenza season. We calculated observed rates by age group and adjusted rates by test sensitivity. Test sensitivity was lowest in adults >65 years of age. For all ages, reverse transcription PCR was the most sensitive test, and use increased from 65 years. After 2009, hospitalization rates adjusted by test sensitivity were ≈15% higher for children 65 years of age. Test sensitivity adjustments improve the accuracy of hospitalization rate estimates.

Background We investigated the effect of influenza vaccination on disease severity in adults hospitalized with laboratory-confirmed influenza during 2013-14, a season in which vaccine viruses were antigenically similar to those circulating. Methods We analyzed data from the 2013-14 influenza season and used propensity score matching to account for the probability of vaccination within age strata (18-49, 50-64, and ≥65 years). Death, intensive care unit (ICU) admission, and hospital and ICU lengths of stay (LOS) were outcome measures for severity. Multivariable logistic regression and competing risk models were used to compare disease severity between vaccinated and unvaccinated patients, adjusting for timing of antiviral treatment and time from illness onset to hospitalization. Results Influenza vaccination was associated with a reduction in the odds of in-hospital death among patients aged 18-49 years (adjusted odds ratios [aOR] = 0.21; 95% confidence interval [CI], 0.05 to 0.97), 50-64 years (aOR = 0.48; 95% CI, 0.24 to 0.97), and ≥65 years (aOR = 0.39; 95% CI, 0.17 to 0.66). Vaccination also reduced ICU admission among patients aged 18-49 years (aOR = 0.63; 95% CI, 0.42 to 0.93) and ≥65 years (aOR = 0.63; 95% CI, 0.48 to 0.81), and shortened ICU LOS among those 50-64 years (adjusted relative hazards [aRH] = 1.36; 95% CI, 1.06 to 1.74) and ≥65 years (aRH = 1.34; 95% CI, 1.06 to 1.73), and hospital LOS among 50-64 years (aRH = 1.13; 95% CI, 1.02 to 1.26) and ≥65 years (aRH = 1.24; 95% CI, 1.13 to 1.37). Conclusions Influenza vaccination during 2013-14 influenza season attenuated adverse outcome among adults that were hospitalized with laboratory-confirmed influenza.

Background In 2012, >48000 pertussis cases were reported in the United States. Many cases occurred in vaccinated persons, showing that pertussis vaccination does not prevent all pertussis cases. However, pertussis vaccination may have an impact on disease severity. Methods We analyzed data on probable and confirmed pertussis cases reported through Enhanced Pertussis Surveillance (Emerging Infections Program Network) between 2010 and 2012. Surveillance data were collected through physician and patient interview and vaccine registries. We assessed whether having received an age-appropriate number of pertussis vaccines (AAV) (for persons aged ≥3 months) was associated with reduced odds of posttussive vomiting, a marker of more clinically significant illness, or of severe pertussis (seizure, encephalopathy, pneumonia, and/or hospitalization). Adjusted odds ratios were calculated using multivariable logistic regression. Results Among 9801 pertussis patients aged ≥3 months, 77.6% were AAV. AAV status was associated with a 60% reduction in odds of severe disease in children aged 7 months-6 years in multivariable logistic regression and a 30% reduction in odds of posttussive vomiting in persons aged 19 months-64 years. Conclusions Serious pertussis symptoms and complications are less common among AAV pertussis patients, demonstrating that the positive impact of pertussis vaccination extends beyond decreasing risk of disease.

ObjectivesExternal validity, or generalisability, is the measure of how well results from a study pertain to individuals in the target population. We assessed generalisability, with respect to socioeconomic status, of estimates from a matched case–control study of 13-valent pneumococcal conjugate vaccine effectiveness for the prevention of invasive pneumococcal disease in children in the USA.DesignMatched case–control study.SettingThirteen active surveillance sites for invasive pneumococcal disease in the USA.ParticipantsCases were identified from active surveillance and controls were age and zip code matched.Outcome measuresSocioeconomic status was assessed at the individual level via parent interview (for enrolled individuals only) and birth certificate data (for both enrolled and unenrolled individuals) and at the neighbourhood level by geocoding to the census tract (for both enrolled and unenrolled individuals). Prediction models were used to determine if socioeconomic status was associated with enrolment.ResultsWe enrolled 54.6% of 1211 eligible cases and found a trend toward enrolled cases being more affluent than unenrolled cases. Enrolled cases were slightly more likely to have private insurance at birth (p=0.08) and have mothers with at least some college education (pConclusionsWe conclude that although enrolled cases are somewhat more affluent than unenrolled cases, our estimates are externally valid with respect to socioeconomic status. Our analysis provides evidence that this study design can yield valid estimates and the assessing generalisability of observational data is feasible, even when unenrolled individuals cannot be contacted.

Little information is available describing the epidemiology and clinical characteristics of those12 months hospitalized with influenza, particularly at a population level.We used population-based, laboratory-confirmed influenza hospitalization surveillance data from 2003 to 2012 seasons to describe the impact of influenza by age category (3, 3 to6 and 6 to12 months). Logistic regression was used to explore risk factors for intensive care unit (ICU) admission. Adjusted age-specific, influenza-associated hospitalization rates were calculated and applied to the number of US infants to estimate national numbers of hospitalizations.Influenza was associated with an annual average of 6514 infant hospitalizations (range 1842-12,502). Hospitalization rates among infants3 months were substantially higher than the rate in older infants. Most hospitalizations occurred in otherwise healthy infants (75%) among whom up to 10% were admitted to the ICU and up to 4% had respiratory failure. These proportions were 2-3 times higher in infants with high risk conditions. Infants6 months were 40% more likely to be admitted to the ICU than older infants. Lung disease (adjusted odds ratio 1.80; 95% confidence interval 1.22-2.67), cardiovascular disease (adjusted odds ratio: 4.16; 95% confidence interval: 2.65-6.53), and neuromuscular disorder (adjusted odds ratio: 2.99; 95% confidence interval: 1.87-4.78) were risk factors for ICU admission among all infants.The impact of influenza on infants, particularly those very young or with high risk conditions, underscores the importance of influenza vaccination, especially among pregnant women and those in contact with young infants not eligible for vaccination.

Adults hospitalized with 2009 pandemic influenza were younger than those hospitalized in previous influenza seasons and more likely to have lower respiratory tract complications and corresponding indicators of severe illness including intensive care admission, mechanical ventilation, or death., Background. Persons with influenza can develop complications that result in hospitalization and death. These are most commonly respiratory related, but cardiovascular or neurologic complications or exacerbations of underlying chronic medical conditions may also occur. Patterns of complications observed during pandemics may differ from typical influenza seasons, and characterizing variations in influenza-related complications can provide a better understanding of the impact of pandemics and guide appropriate clinical management and planning for the future. Methods. Using a population-based surveillance system, we compared clinical complications using International Classification of Diseases, Ninth Revision (ICD-9) discharge diagnosis codes in adults hospitalized with seasonal influenza (n = 5270) or 2009 pandemic influenza A(H1N1) (H1N1pdm09; n = 4962). Results. Adults hospitalized with H1N1pdm09 were younger (median age, 47 years) than those with seasonal influenza (median age, 68 years; P < .01), and differed in the frequency of certain underlying medical conditions. Whereas there was similar risk for many influenza-associated complications, after controlling for age and type of underlying medical condition, adults hospitalized with H1N1pdm09 were more likely to have lower respiratory tract complications, shock/sepsis, and organ failure than those with seasonal influenza. They were also more likely to be admitted to the intensive care unit, require mechanical ventilation, or die. Young adults, in particular, had 2–4 times the risk of severe outcomes from H1N1pdm09 than persons of the same ages with seasonal influenza. Conclusions. Although H1N1pdm09 was thought of as a relatively mild pandemic, these data highlight the impact of the 2009 pandemic on the risk of severe influenza, especially among younger adults, and the impact this virus may continue to have.

The New York State Department of Health (NYSDOH) collected information about hospitalized patients with Guillain-Barré syndrome (GBS) during October 2009-May 2010, statewide (excluding New York City), to examine a possible relationship with influenza A(H1N1)pdm09 vaccination. NYSDOH established a Clinical Network of neurologists and 150 hospital neurology units. Hospital discharge data from the Statewide Planning and Research Cooperative System (SPARCS) were used to evaluate completeness of reporting from the Clinical Network. A total of 140 confirmed or probable GBS cases were identified: 81 (58%) from both systems, 10 (7%) from Clinical Network only, and 49 (35%) from SPARCS-only. Capture-recapture methods estimated that 6 cases might have been missed by both systems. Clinical Network median reporting time was 12 days versus 131 days for SPARCS. In public health emergencies in New York State, a Clinical Network may provide timely data, but in our study such data were less complete than traditional hospital discharge data.

Objective To examine differences in H1N1 influenza vaccine distribution strategies that may impact the ability to rapidly administer vaccine during a pandemic or public health emergency. Design Retrospective evaluation of immunization data in the New York State Immunization Information System (NYSIIS). Setting Analysis of existing NYSIIS data. Participants Children and adolescents younger than 19 years for whom information on at least 1 H1N1 influenza vaccine was present in NYSIIS. Main outcome measure(s) Median time to administer vaccines to children and adolescents younger than 19 years by December 31, 2009, by county; venue of H1N1 vaccine administration (local health department [LHD] or private medical provider); comparison of immunization-seeking behavior for routine childhood vaccinations and H1N1 vaccine. Results A total of 459 189 first or only doses of H1N1 influenza vaccine were recorded in NYSIIS as being administered to New York State, outside of New York City, children aged less than 19 years, between October 2, 2009, and December 31, 2009. Overall, LHD administered 31% of H1N1 vaccine doses; in counties having population less than 100,000, LHD administered 63% of H1N1 doses compared with 23% in counties having population more than 100,000. Time to median administration was faster for LHD in smaller counties and similar for LHD and private medical providers in larger counties. Children who always received routine childhood immunizations either within or outside of their county of residence often had the same practice for H1N1 vaccine, with 85% of children following these patterns. Children who did not follow these patterns were more likely to receive H1N1 influenza vaccine through LHD. Conclusions Local health departments were able to rapidly administer large quantities of H1N1 influenza vaccine, and patterns of health care seeking relying on increased use of LHD needs to be further studied for future public health emergency planning.

Background. Data on the range and severity of influenza-associated complications among children are limited. We describe the frequency and severity of complications in hospitalized children aged

In 2009, Streptococcus pneumoniae, or pneumococcus, caused approximately 44 000 cases of invasive pneumococcal disease (IPD) and about 5000 deaths in the United States [1]. In addition, pneumococcus is responsible for a considerable burden of respiratory disease globally [2]. Antibiotic nonsusceptibility is a major concern; understanding the dynamics by which pneumococcus develops nonsusceptibility will help maintain the efficacy of these drugs. There are currently over 90 known serotypes of S. pneumoniae, of which only a small proportion account for most invasive disease and most nonsusceptible infections in the United States. Before introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in the United States in 2000, the proportion of penicillin-nonsusceptible and macrolide-nonsusceptible isolates from invasive disease was increasing [3–5]. Previous studies have correlated differential use of antimicrobials with different rates of nonsusceptibility across geographic areas, as well as changing patterns of usage and nonsusceptibility over time [6–11]. When PCV7 was introduced, the 7 serotypes included in the vaccine accounted for 78% of penicillin-nonsusceptible strains [3]. In the decade since, rates of disease caused by these 7 serotypes declined by 99%, and serotypes not included in PCV7 have increased significantly, a phenomenon known as serotype replacement. Some of the replacing serotypes (eg, 19A, 15A, 23A, 35B, 6C) have shown high and/or increasing levels of antimicrobial nonsusceptibility, raising the question of whether antimicrobial use may in part be responsible for the increased prevalence [12–14]. In the pre-PCV7 era, geographic differences in proportions of nonsusceptibility to penicillin and macrolides resulted from geographic variation in selective pressure for nonsusceptibility [10, 15]. In pneumococci, selective pressure may affect nonsusceptibility in 2 ways: by increasing the prevalence of nonsusceptibility within each serotype, and/or by increasing the prevalence of serotypes in which the prevalence of nonsusceptibility is high. The frequencies of pneumococcal serotypes within a population reflect multiple selective pressures imposed by natural and vaccine-induced host immunity [16], and it is in principle possible that selection by antimicrobial use may also affect this pattern. In the pre-PCV7 era, no evidence of such an effect was found; the impact of differences in antimicrobial selective pressure was seen solely in varying prevalence of nonsusceptibility within each serotype, but not in variations in the prevalence of the more nonsusceptible serotypes [15]. Understanding the interplay between antimicrobial use pressures and changing serotype distributions has important policy implications for both antimicrobial stewardship and vaccination programs. In this study, we assessed geographical, serotype, and temporal variation in the frequency of drug nonsusceptibility, with a particular focus on the question of whether, contrary to pre-PCV7 observations, there was evidence that geographic variation in the intensity of selective pressure for nonsusceptibility was reflected in greater prevalence of nonsusceptible serotypes.

Context In 2011, the Food Safety and Modernization Act established Integrated Food Safety Centers of Excellence across the United States to train, educate, and enhance the skill of foodborne illness outbreak investigation teams. To target regional training efforts, the New York Integrated Food Safety Center of Excellence (NYCoE) identified training needs in food safety and foodborne illness investigations among public heath staff in 11 states and 1 large metropolitan area in the Northeast. Objective To identify topics so as to develop training materials relevant to food safety and foodborne disease outbreaks in order to improve and impact foodborne outbreak investigations regionally and nationally. Design Cross-sectional, paper-based survey conducted in January-February 2016. Setting Eleven Northeast and Mid-Atlantic states, and 1 large metropolitan area. Participants Foodborne illness outbreak investigators in the NYCoE region. Main outcome measures Identification of training needs, as self-reported by participants, regarding general foodborne outbreak investigation needs and those specific to epidemiologists, environmental health specialists, and laboratorians. Topics included basic food safety/processing knowledge, communication and metrics, and training formats. Information regarding demographics, utility of the NYCoE, and certificate programs was also collected. Results Surveys returned from 33 respondents (from 10 states and 1 metropolitan area) identified metrics (100%), increasing use of culture-independent diagnostic tests (85%), and guidance on implementation of the Council to Improve Foodborne Outbreak Response (guidelines (89%) as the top training needs. By field, epidemiologists cited training in applying whole genome sequencing (100%), environmental health specialists cited training on the National Outbreak Reporting System (67%), and laboratorians cited training on whole genome sequencing (91%) as important. Short, online, or in-person, 1- to 2-day trainings were the preferred training formats (≥91%). Respondents wanted certificate programs in food safety (73%). Conclusion New diagnostic and molecular techniques are highly desirable topics for trainings, as is understanding national guidelines and outcome measures. Shorter and hands-on training formats, as well as certificate programs, are desirable. The NYCoE used the results of this survey to (i) select training topics for a Food Safety symposium conducted in July 2016 and to (ii) drive other activities.

BACKGROUND The Emerging Infections Programs (EIP) network has conducted population-based surveillance for hospitalizations due to laboratory-confirmed influenza among children since 2003, with the network expanding in 2005 to include adults. METHODS From 15 April 2009 through 30 April 2010, the EIP conducted surveillance among 22.1 million people residing in 10 states. Incidence rates per 100 000 population were calculated using US Census Bureau data. Mean historic rates were calculated on the basis of previously published and unpublished EIP data. RESULTS During the 2009 pandemic of influenza A virus subtype H1N1 infection, rates of hospitalizations due to laboratory-confirmed influenza were 202, 88, 49, 31, 27, 36, 28, and 27 episodes per 100 000 among persons aged

The objective of this study was to identify patient symptoms and case outcomes that were more likely to occur as a result of Salmonella infections caused by bovine-associated subtypes (isolates that matched contemporary bovine isolates from New York by serovar and pulsed-field gel electrophoresis pattern), as compared to salmonellosis caused by non-bovine-associated subtypes. Data were collected in 34 counties of New York that comprise the Foodborne Diseases Active Surveillance Network (FoodNet) catchment area of the Centers for Disease Control and Prevention Emerging Infections Program. Patients with specimen collection dates between March 1, 2008 and March 1, 2010 were included. Symptoms and outcomes of 40 cases infected with bovine-associated Salmonella subtypes were compared to those of 379 control-cases infected with Salmonella isolates that were not bovine-associated. Cases were significantly more likely to have invasive salmonellosis (odds ratio, 3.8; p-value=0.02), after adjusting for age group, gender, and race. In addition, there was a marginal association between case status and the presence of blood in the stool (p-value=0.1) while ill. These findings might have implications for patient management, as a history of consuming undercooked foods of bovine origin or having direct contact with cattle in the few days prior to illness could be useful for suggesting a more proactive diagnostic approach as well as close monitoring for the need to implement more aggressive therapy.

Background. This analysis used data from the most recent Foodborne Diseases Active Surveillance Network (FoodNet) Population Survey (May 2006 through April 2007) to examine differences in the consumption of various types of foods between men and women. Methods. Participants were surveyed by telephone and asked whether or not they had consumed certain foods in the past 7 days, including the following ‘‘high-risk’’ foods commonly associated with foodborne illness: pink hamburger, raw oysters, unpasteurized milk, cheese made from unpasteurized milk, runny eggs, and alfalfa sprouts. Data were weighted to adjust for survey design and to reflect the age and sex distribution of the population under FoodNet surveillance. Results. A total of 14 878 persons $18 years were interviewed, of whom 5688 (38%) were men. A higher proportion of men reported eating meat and certain types of poultry than women, whereas a higher proportion of women ate fruits and vegetables. A higher proportion of men than women reported consuming runny eggs (12% versus 8%), pink hamburger (7% versus 4%), and raw oysters (2% versus 0.4%). A higher proportion of women than men ate alfalfa sprouts (3% versus 2%). No differences by sex were observed for consumption of unpasteurized milk or cheese. Conclusions. Data from the FoodNet Population Surveys can be useful in efforts to design targeted interventions regarding consumption of high-risk foods. Moreover, understanding the background rates of food consumption, stratified by sex, may help investigators identify the kinds of foods likely to be associated with outbreaks in which a preponderance of cases occur among members of one sex.

Influenza antiviral treatment is recommended for all persons hospitalized with influenza virus infection. During the 2010-2011 influenza season, antiviral treatment of children and adults hospitalized with laboratory-confirmed influenza declined significantly compared with treatment during the 2009 pandemic (children, 56% vs 77%; adults, 77% vs 82%; both P < .01).

Background. Foodborne diseases are typically mild and self-limiting but can cause severe illness and death. We describe the epidemiology of deaths associated with bacterial pathogens using data from the Foodborne Diseases Active Surveillance Network (FoodNet) in the United States. Methods. We analyzed FoodNet data from 1996–2005 to determine the numbers and rates of deaths occurring within 7-days of laboratory-confirmation. Results. During 1996–2005, FoodNet ascertained 121,536 cases of laboratory-confirmed bacterial infections, including 552 (.5%) deaths, of which 215 (39%) and 168 (30%) were among persons infected with Salmonella and Listeria, respectively. The highest age-specific average annual population mortality rates were in older adults (R65 years) for all pathogens except Shigella, for which the highest age-specific average annual population mortality rate was in children ,5 years (.2/1 million population). Overall, most deaths (58%; 318) occurred in persons R65 years old. Listeria had the highest case fatality rate overall (16.9%), followed by Vibrio (5.8%), Shiga toxin–producing Escherichia coli O157 (0.8%), Salmonella (0.5%), Campylobacter (0.1%), and Shigella (0.1%). Conclusions. Salmonella and Listeria remain the leading causes of death in the United States due to bacterial pathogens transmitted commonly through food. Most such deaths occurred in persons R65 years old, indicating that this age group could benefit from effective food safety interventions.

The first report of pertactin-negative variants of Bordetella pertussis in the United States has raised questions about the role of acellular pertussis vaccines in the recent increase of pertussis cases. Our laboratory utilized a sequence-based method to identify mutations in the pertactin gene responsible for these variants and assessed vaccination status from the associated cases.

To estimate the rates of hospitalization with seasonal influenza in children aged18 years from a large, diverse surveillance area during 2003 to 2008.Through the Emerging Infections Program Network, population-based surveillance for laboratory-confirmed influenza was conducted in 10 states, including 5.3 million children. Hospitalized children were identified retrospectively; clinicians made influenza testing decisions. Data collected from the hospital record included demographics, medical history, and clinical course. Incidence rates were calculated with census data.The highest hospitalization rates occurred in children aged6 months (seasonal range, 9-30/10 000 children), and the lowest rates occurred in children aged 5 to 17 years (0.3-0.8/10 000). Overall, 4015 children were hospitalized, 58% of whom were identified with rapid diagnostic tests alone. Forty percent of the children who were hospitalized had underlying medical conditions; asthma (18%), prematurity (15% of children aged2 years), and developmental delay (7%) were the most common. Severe outcomes included intensive care unit admission (12%), respiratory failure (5%), bacterial coinfection (2%), and death (0.5%).Influenza-associated hospitalization rates varied by season and age and likely underestimate true rates because many hospitalized children are not tested for influenza. The proportion of children with severe outcomes was substantial across seasons. Quantifying incidence of influenza hospitalization and severe outcomes is critical to defining disease burden.

Background Rates of influenza-associated hospitalizations in the United States have been estimated using modeling techniques with data from pneumonia and influenza hospitalization discharge diagnoses, but they have not been directly estimated from laboratory-positive cases. Methods We calculated overall, age-specific, and site-specific rates of laboratory-positive, influenza-associated hospitalization among adults and compared demographic and clinical characteristics and outcomes of hospitalized cases by season with use of data collected by the Emerging Infections Program Network during the 2005-2006 through 2007-2008 influenza seasons. Results Overall rates of adult influenza-associated hospitalization per 100,000 persons were 9.9 during the 2005-2006 season, 4.8 during the 2006-2007 season, and 18.7 during the 2007-2008 season. Rates of hospitalization varied by Emerging Infections Program site and increased with increasing age. Higher overall and age-specific rates of hospitalization were observed during influenza A (H3) predominant seasons and during periods of increased circulation of influenza B. More than 80% of hospitalized persons each season had > or =1 underlying medical condition, including chronic cardiovascular and metabolic diseases. Conclusions Rates varied by season, age, geographic location, and type/subtype of circulating influenza viruses. Influenza-associated hospitalization surveillance is essential for assessing the relative severity of influenza seasons over time and the burden of influenza-associated complications.

An estimated 450,000 cases of shigellosis occur annually in the United States. Outbreaks have been associated with food, water, child daycare centers, and men who have sex with men. However, for sporadic infections, which account for the majority of cases, risk exposures are poorly characterized.Foodborne Diseases Active Surveillance Network (FoodNet) conducts active, laboratory-based shigellosis surveillance in 10 US sites. We interviewed cases with illness onset during 2005 about exposures during the week before symptom onset using a standardized questionnaire. The proportion of patients who denied nonfood risks was used to estimate the burden attributable to foodborne transmission.Overall, 1494 cases were identified. The approximate incidence was 3.9/100,000, with the highest rates among children aged 1-4 years (16.4) and Hispanics (8.4). Of the 929 cases interviewed, 223 (24%) reported international travel in the week before symptom onset. Of the 626 nontraveling cases with complete risk factor information, 298 (48%) reported exposure to daycare or a household member with diarrhea; 99 (16%) reported drinking untreated water or recreational exposure to water; and 16 (3%) reported sexual contact with a person with diarrhea. Two hundred and fifty-nine (41%) denied all nonfood exposures examined.Sporadic shigellosis is most common among young children and Hispanics. Common exposures include international travel and contact with ill persons or daycare. However, more than one-third of US shigellosis cases annually might be due to food consumed in the United States.

Pneumonia is one of the most common complications in children hospitalized with influenza. We describe hospitalized children with influenza-associated pneumonia and associated risk indicators.Through Emerging Infections Program Network population based surveillance, children aged18 years hospitalized with laboratory confirmed influenza with a chest radiograph during hospitalization were identified during the 2003-2008 influenza seasons. A case with radiologically confirmed influenza-associated pneumonia was defined as a child from the surveillance area hospitalized with: (1) laboratory-confirmed influenza and (2) evidence of new pneumonia on chest radiograph during hospitalization. Hospitalized children with pneumonia were compared with those without pneumonia by univariate and multivariate analysis.Overall, 2992 hospitalized children with influenza with a chest radiograph were identified; 1072 (36%) had influenza-associated pneumonia.When compared with children hospitalized with influenza without pneumonia, hospitalized children with influenza-associated pneumonia were more likely to require intensive care unit admission (21% vs. 11%, P0.01), develop respiratory failure (11% versus 3%, P0.01), and die(0.9% vs. 0.3% P 0.01). In multivariate analysis, age 6 to 23 months(adjusted OR: 2.1, CI: 1.6 -2.8), age 2 to 4 years (adjusted OR: 1.7, CI:1.3-2.2), and asthma (adjusted OR: 1.4, CI: 1.1-1.8) were significantly associated with influenza-associated pneumonia.Hospitalized children with influenza-associated pneumonia were more likely to have a severe clinical course than other hospitalized children with influenza, and children aged 6 months to 4 years and those with asthma were more likely to have influenza-associated pneumonia.Identifying children at greater risk for influenza-associated pneumonia will inform prevention and treatment strategies targeting children at risk for influenza complications.

With the emergence of multidrug-resistant nontyphoidal (NT) Salmonella, knowledge of resistance patterns is critical for appropriate presumptive treatment. This report describes the prevalence and trends of NT Salmonella antimicrobial susceptibility within the New York State (NYS) Foodborne Diseases Active Surveillance Network (FoodNet). The NYS Department of Health, Wadsworth Center Public Health Laboratory tested all Salmonella isolates from the NYS FoodNet catchment area between May 2003 and December 2007 for antimicrobial susceptibility to ampicillin, chloramphenicol, streptomycin, sulfisoxazole, tetracycline, nalidixic acid, and ciprofloxacin. Isolate susceptibility results were linked to their corresponding demographic and clinical data and analyzed. Multidrug-resistant isolates were defined as resistant to ampicillin, chloramphenicol, streptomycin, sulfisoxazole, and tetracycline (R-type ACSSuT). Antimicrobial susceptibility for 2189 FoodNet cases (98.5% of total cases) showed 79.6% pansusceptible, 6.9% R-type ACSSuT, and 13.5% resistant to at least one antimicrobial agent but not R-type ACSSuT. Four (0.2%) isolates were resistant to ciprofloxacin. From 2004 to 2007, cases with R-type ACSSuT significantly decreased from 8.7% (37/424) to 4.8% (24/499) (p0.01). Serotypes with the highest proportion of R-type ACSSuT included Salmonella Typhimurium 17.9% (79/444), and Salmonella Newport 29.1% (51/175). Among Salmonella Typhimurium isolates, over 40% of the African-American cases (19/46) had R-type ACSSuT isolates, compared with 15.7% of the Caucasian cases (58/369) (p0.01). R-type ACSSuT Salmonella Typhimurium cases were hospitalized (41.8%) more frequently than pansusceptible Salmonella Typhimurium cases (24.9%), after controlling for age (p0.05). Length of hospitalization was not significantly different. Although R-type ACSSuT NT Salmonella has decreased since 2003 within the NYS FoodNet catchment area, monitoring resistance patterns remains important in identifying emerging resistant strains, vulnerable populations, and determining appropriate presumptive treatment regimens. The higher rate of R-type ACSSuT among the African-American cases requires further study.

Group B streptococcal disease is one of the most common infections in the first week after birth. In 2002, national guidelines recommended universal late antenatal screening of pregnant women for colonization with group B streptococcus to identify candidates for intrapartum chemoprophylaxis.We evaluated the implementation of the guidelines in a multistate, retrospective cohort selected from the Active Bacterial Core surveillance, a 10-state, population-based system that monitors invasive group B streptococcal disease. We abstracted data from the labor and delivery records of a stratified random sample of live births and of all cases in which the newborn had early-onset group B streptococcal disease (i.e., disease in infants7 days of age) in 2003 and 2004. We compared our results with those from a study with a similar design that evaluated screening practices in 1998 and 1999.We abstracted records of 254 births in which the infant had group B streptococcal disease and 7437 births in which the infant did not. The rate of screening for group B streptococcus before delivery increased from 48.1% in 1998-1999 to 85.0% in 2003-2004; the percentage of infants exposed to intrapartum antibiotics increased from 26.8% to 31.7%. Chemoprophylaxis was administered in 87.0% of the women who were positive for group B streptococcus and who delivered at term, but in only 63.4% of women with unknown colonization status who delivered preterm. The overall incidence of early-onset group B streptococcal disease was 0.32 cases per 1000 live births. Preterm infants had a higher incidence of early-onset group B streptococcal disease than did term infants (0.73 vs. 0.26 cases per 1000 live births); however, 74.4% of the cases of group B streptococcal disease (189 of 254) occurred in term infants. Missed screening among mothers who delivered at term accounted for 34 of the 254 cases of group B streptococcal disease (13.4%). A total of 61.4% of the term infants with group B streptococcal disease were born to women who had tested negative for group B streptococcus before delivery.Recommendations for universal screening were rapidly adopted. Improved management of preterm deliveries and improved collection, processing, and reporting of culture results may prevent additional cases of early-onset group B streptococcal disease.

Campylobacter is a leading cause of foodborne illness worldwide. In the United States, changes in the incidence of culture-confirmed Campylobacter infections have been monitored by the Foodborne Diseases Active Surveillance Network (FoodNet) since 1996. In 2006, the incidence of culture-confirmed Campylobacter infection in the FoodNet sites was 12.7 per 100,000 persons. This represents a 30% decline (95% confidence = 35% to 24% decrease) compared to the 1996-1998 illness baseline; however, most of the decline occurred between 1996 and 1999 and the incidence still remains above the national health objective. Important declines were observed in four FoodNet sites (California, Connecticut, Georgia, and Maryland), all age groups, and both sexes. To promote continued progress towards achieving the national health objective, the epidemiology of Campylobacter infections in the United States, including geographic variation and higher incidence among the very young, warrants further study.

BACKGROUND Older adults are at increased risk of influenza-associated complications, including hospitalization, but influenza vaccine effectiveness (VE) data are limited for this population. We conducted a case-control study to estimate VE to prevent laboratory-confirmed influenza hospitalizations among adults aged ≥50 years in 11 US Emerging Infections Program hospitalization surveillance sites. METHODS Cases were influenza infections (confirmed by reverse-transcription polymerase chain reaction) in adults aged ≥50 years hospitalized during the 2010-2011 influenza season, identified through Emerging Infections Program surveillance. Community controls, identified through home telephone lists, were matched by age group (±5 years), county, and month of hospitalization for case patients. Vaccination status was determined by self-report (with location and date) or medical records. Conditional logistic regression models were used to calculate adjusted VE (aVE) estimates (100 × [1 - adjusted odds ratio]), adjusting for sex, race, socioeconomic factors, smoking, chronic medical conditions, recent hospitalization for a respiratory condition, and functional status. RESULTS Among case patients, 205 of 368 (55%) were vaccinated, compared with 489 of 773 controls (63%). Case patients were more likely to be of nonwhite race and more likely to have ≥2 chronic health conditions, a recent hospitalization for a respiratory condition, an income

Summary Background In 2010, 13-valent pneumococcal conjugate vaccine (PCV13) was licensed and recommended in the USA for prevention of invasive pneumococcal disease in children. Licensure was based on immunogenicity data comparing PCV13 with the earlier seven-valent formulation. Because clinical endpoints were not assessed for the new antigens, we did a postlicensure matched case-control study to assess vaccine effectiveness. Methods Cases in children aged 2–59 months were identified through active surveillance in 13 sites. Controls were identified via birth registries and matched to cases by age and postal (zip) code. The primary objective was the vaccine effectiveness of at least one dose against the 13 serotypes included in PCV13. Secondary objectives included vaccine effectiveness against all-cause invasive pneumococcal disease, against antibiotic non-susceptible invasive pneumococcal disease, and among children with and without underlying conditions. Vaccine effectiveness was calculated as (1 – matched odds ratio) × 100%. Findings We enrolled 722 children with invasive pneumococcal disease and 2991 controls; PCV13 serotype cases (217 [30%]) included most commonly serotypes 19A (128 [18%]), 7F (32 [4%]), and 3 (43 [6%]). Vaccine effectiveness against PCV13 serotypes was 86·0% (95% CI 75·5 to 92·3), driven by serotypes 19A and 7F, for which vaccine effectiveness was 85·6% (95% CI 70·6 to 93·5) and 96·5% (82·7 to 100), respectively. We also identified statistically significant effectiveness against serotype 3 (79·5%, 95% CI 30·3 to 94·8) and against antibiotic non-susceptible invasive pneumococcal disease (65·6%, 44·9 to 78·7). Vaccine effectiveness against all-cause invasive pneumococcal disease was 60·2% (95% CI 46·8 to 70·3). Vaccine effectiveness was similar among children with (81·4%, 95% CI 45·4 to 93·6) and without (85·8%, 74·9 to 91·9) underlying conditions. Interpretation PCV13 appears highly effective against invasive pneumococcal disease among children in the USA in the context of routine and catch-up schedules, although some new vaccine antigens could not be assessed. PCV13 immunisation provides a robust strategy for combating pneumococcal antimicrobial resistance. Funding Centers for Disease Control and Prevention.

During 2000–2011, passive surveillance for legionellosis in the United States demonstrated a 249% increase in crude incidence, although little was known about the clinical course and method of diagnosis. In 2011, a system of active, population-based surveillance for legionellosis was instituted through CDC’s Active Bacterial Core surveillance (ABCs) program. Overall disease rates were similar in both the passive and active systems, but more complete demographic information and additional clinical and laboratory data were only available from ABCs. ABCs data during 2011–2013 showed that approximately 44% of patients with legionellosis required intensive care, and 9% died. Disease incidence was higher among blacks than whites and was 10 times higher in New York than California. Laboratory data indicated a reliance on urinary antigen testing, which only detects Legionella pneumophila serogroup 1 (Lp1). ABCs data highlight the severity of the disease, the need to better understand racial and regional differences, and the need for better diagnostic testing to detect infections.

Background. Some studies suggest that influenza vaccination might be protective against severe influenza outcomes in vaccinated persons who become infected. We used data from a large surveillance network to further investigate the effect of influenza vaccination on influenza severity in adults aged ≥50 years who were hospitalized with laboratory-confirmed influenza. Methods. We analyzed influenza vaccination and influenza severity using Influenza Hospitalization Surveillance Network (FluSurv-NET) data for the 2012−2013 influenza season. Intensive care unit (ICU) admission, death, diagnosis of pneumonia, and hospital and ICU lengths of stay served as measures of disease severity. Data were analyzed by multivariable logistic regression, parametric survival models, and propensity score matching (PSM). Results. Overall, no differences in severity were observed in the multivariable logistic regression model. Using PSM, adults aged 50−64 years (but not other age groups) who were vaccinated against influenza had a shorter length of ICU stay than those who were unvaccinated (hazard ratio for discharge, 1.84; 95% confidence interval, 1.12−3.01). Conclusions. Our findings show a modest effect of influenza vaccination on disease severity. Analysis of data from seasons with different predominant strains and higher estimates of vaccine effectiveness are needed.

Background Influenza and pneumonia combined are the leading causes of death due to infectious diseases in the United States. We describe factors associated with pneumonia among adults hospitalized with influenza. Methods Through the Emerging Infections Program, we identified adults ≥ 18 years, who were hospitalized with laboratory-confirmed influenza during October 2005 through April 2008, and had a chest radiograph (CXR) performed. Pneumonia was defined as the presence of a CXR infiltrate and either an ICD-9-CM code or discharge summary diagnosis of pneumonia. Results Among 4,765 adults hospitalized with influenza, 1392 (29 %) had pneumonia. In multivariable analysis, factors associated with pneumonia included: age ≥ 75 years, adjusted odds ratio (AOR) 1.27 (95 % confidence interval 1.10–1.46), white race AOR 1.24 (1.03–1.49), nursing home residence AOR 1.37 (1.14–1.66), chronic lung disease AOR 1.37 (1.18–1.59), immunosuppression AOR 1.45 (1.19–1.78), and asthma AOR 0.76 (0.62–0.92). Patients with pneumonia were significantly more likely to require intensive care unit (ICU) admission (27 % vs. 10 %), mechanical ventilation (18 % vs. 5 %), and to die (9 % vs. 2 %). Conclusions Pneumonia was present in nearly one-third of adults hospitalized with influenza and was associated with ICU admission and death. Among patients hospitalized with influenza, older patients and those with certain underlying conditions are more likely to have pneumonia. Pneumonia is common among adults hospitalized with influenza and should be evaluated and treated promptly. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1004-y) contains supplementary material, which is available to authorized users.

Irradiation of fresh meat to control microbial pathogens received approval from the federal government in February 2000. Food irradiation is a useful, albeit underutilized, process that can help protect the public from foodborne illnesses. The objective of this study was to determine consumer knowledge, attitudes, and practices toward irradiated meat products. Data were obtained from a single-stage random-digit dialing telephone survey of residents of the Foodborne Diseases Active Surveillance Network (FoodNet) sites conducted in 2002 to 2003, which included supplemental questions about food safety and irradiated meat for residents of the Connecticut and New York sites. Thirty-seven percent of 3,104 respondents knew that irradiated fresh meat was available for purchase; however, only 2% found the product where they shopped. Knowledge of product availability was significantly influenced by whether a respondent lived in a county with one or more grocery stores operated by chain A, which had actively promoted the sale of irradiated fresh ground beef during the survey period. In a logistic regression model, after adjusting for other factors, respondents living in a county with chain A were more likely to know that irradiated products could be purchased than respondents living in other counties (odds ratio 2.0; 95% confidence interval 1.5 to 2.5). This finding suggests that public education efforts by an individual grocery store chain can have an important effect on knowledge of irradiated food.

Background Campylobacter causes >1 million infections annually in the United States. Fluoroquinolones (e.g., ciprofloxacin) are used to treat Campylobacter infections in adults. Although human infections with ciprofloxacin-resistant Campylobacter have become increasingly common, the human health consequences of such infections are not well described. Methods A case-control study of persons with sporadic Campylobacter infection was conducted within 7 FoodNet sites during 1998-1999. The E-test system (AB Biodisk) was used to test for antimicrobial susceptibility to ciprofloxacin; ciprofloxacin resistance was defined as a ciprofloxacin minimum inhibitory concentration of > or =4 microg/mL. We conducted a case-comparison study of interviewed persons who had an isolate tested. Results Of 858 isolates tested, 94 (11%) were ciprofloxacin resistant. Among 290 persons with Campylobacter infection who did not take antidiarrheal medications, persons with ciprofloxacin-resistant infection had a longer mean duration of diarrhea than did persons with ciprofloxacin-susceptible infection (9 vs. 7 days [P=.04]). This difference was even more pronounced among the 63 persons who did not take antidiarrheal medications or antimicrobial agents (12 vs. 6 days [P=.04]). In a multivariable analysis-of-variance model, the persons with ciprofloxacin-resistant infection had a longer mean duration of diarrhea than did the persons with ciprofloxacin-susceptible infection (P=.01); this effect was independent of foreign travel. The association between ciprofloxacin resistance and prolonged diarrhea is consistent across a variety of analytical approaches. Conclusions Persons with ciprofloxacin-resistant Campylobacter infection have a longer duration of diarrhea than do persons with ciprofloxacin-susceptible Campylobacter infection. Additional efforts are needed to preserve the efficacy of fluoroquinolones.

Many studies have evaluated the role of Cryptosporidium spp. in outbreaks of enteric illness, but few studies have evaluated sporadic cryptosporidiosis in the United States. To assess the risk factors for sporadic cryptosporidiosis among immunocompetent persons, a matched case-control study was conducted in seven sites of the Foodborne Diseases Active Surveillance Network (FoodNet) involving 282 persons with laboratory-identified cryptosporidiosis and 490 age-matched and geographically matched controls. Risk factors included international travel (odds ratio [OR] = 7.7; 95% confidence interval [95% CI] = 2.7 to 22.0), contact with cattle (OR = 3.5; 95% CI = 1.8 to 6.8), contact with persons >2 to 11 years of age with diarrhea (OR = 3.0; 95% CI = 1.5 to 6.2), and freshwater swimming (OR = 1.9; 95% CI = 1.049 to 3.5). Eating raw vegetables was protective (OR = 0.5; 95% CI = 0.3 to 0.7). This study underscores the need for ongoing public health education to prevent cryptosporidiosis, particularly among travelers, animal handlers, child caregivers, and swimmers, and the need for further assessment of the role of raw vegetables in cryptosporidiosis.

In 2000, we surveyed microbiologists in 388 clinical laboratories, which tested an estimated 339,000 stool specimens in 1999, about laboratory methods and policies for the routine testing of stool specimens for Salmonella, Shigella, Campylobacter, and Vibrio species, Yersinia entercolitica, and Escherichia coli O157:H7. The results were compared with those of similar surveys conducted in 1995 and 1997. Although these laboratories reported routinely testing for Salmonella, Shigella, and Campylobacter species, only 57% routinely tested for E. coli O157:H7, 50% for Y. entercolitica, and 50% for Vibrio species. The mean proportions of stool specimens that yielded these pathogens were as follows: Campylobacter, 1.3% of specimens; Salmonella, 0.9%; Shigella, 0.4%; and E. coli O157:H7, 0.3%. The proportion of laboratories that routinely tested for E. coli O157:H7 increased from 59% in 1995 to 68% in 2000; however, the proportion of stool specimens tested decreased from 53% to 46%. E. coli O157:H7 should be routinely sought in stool specimens submitted for microbiologic culture.

Recent antibiotic use is a risk factor for infection or colonization with resistant bacterial pathogens. Demand for antibiotics can be affected by consumers’ knowledge, attitudes, and practices. In 1998–1999, the Foodborne Diseases Active Surveillance Network (FoodNet) conducted a population-based, random-digit dialing telephone survey, including questions regarding respondents’ knowledge, attitudes, and practices of antibiotic use. Twelve percent had recently taken antibiotics; 27% believed that taking antibiotics when they had a cold made them better more quickly, 32% believed that taking antibiotics when they had a cold prevented more serious illness, and 48% expected a prescription for antibiotics when they were ill enough from a cold to seek medical attention. These misguided beliefs and expectations were associated with a lack of awareness of the dangers of antibiotic use; 58% of patients were not aware of the possible health dangers. National educational efforts are needed to address these issues if patient demand for antibiotics is to be reduced.