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Objectives: Injuries resulting from contact with animals are a significant public health concern. This study quantifies and updates nonfatal bite and sting injuries by noncanine sources using the most recent data available (2011-2015) from the National Electronic Injury Surveillance System-All Injury Program with the purpose of using these updates to better understand public health consequences and prevention techniques. Increased rates of bites and stings can be expected in this study's time frame, possibly caused by the increasing human population expanding into animal territories, as well as changes in animal geographic distribution and pet ownership., Methods: The National Electronic Injury Surveillance System-All Injury Program is an ongoing nationally representative surveillance system used to monitor all types and causes of injuries treated in US hospital emergency departments (EDs). Cases were coded by trained hospital coders using information from medical records on animal sources of bite and sting injuries being treated. Data from 2011-2015 were weighted to produce national annualized estimates, percentages, and rates based on the US population., Results: An estimated 1.17 million people visited EDs for noncanine bite and sting injuries annually. This translates to a rate of 371.3/100,000 people. Insects accounted for 71.0% of noncanine bite and sting injuries, followed by arachnids (19.2%) and mammals (7.8%). The estimated annual total lifetime medical and work cost of unintentional noncanine injuries was $5,755,581,000., Conclusions: Various sources of bite and sting injuries had an outsized effect on injury rates and identify potential areas of focus for education and prevention programs to reduce the burden of these injuries on health and healthcare costs. The study describes the diversity of animal exposures based on a national sample of EDs. Noncanine bite and sting injuries significantly affect public health and healthcare resources. Priorities can be focused on animal sources with the most impact on bite and sting injury rates, healthcare costs, and disease burden.

Background: Kissing bugs are common household pests in the Desert Southwest of the United States. These hematophagous bugs enter homes and suck blood from resident humans and pets. They are vectors of Trypanosoma cruzi, an enzootic parasite in small mammals and the cause of Chagas disease in humans. Autochthonous cases of Chagas disease are rare in the United States despite the presence of the vector and parasite. Environmental and biological factors accounting for this phenomenon need studying., Methods: Homeowners in Bisbee and Tucson, Arizona captured kissing bugs inside homes during 2017-2018. Bugs were tested for presence of T. cruzi by polymerase chain reaction. Residents bitten by kissing bugs were tested for Chagas disease by serology. We evaluated invaded homes in the 2 cities., Results: Three species of kissing bugs (n = 521) were collected in or near homes. Triatoma rubida was the most common triatomine in Tucson; T. recurva in Bisbee. T. protracta was uncommon. Seventeen percent of bugs captured in Bisbee and 51.1% in Tucson harbored T. cruzi. Bite victims (n = 105) recalled more than 2200 bites. Reactions to bites were common, including 32 episodes of anaphylaxis in 11 people (10.5%). Tests for Chagas disease (n = 116) were negative. Median age of houses was 91 years in Bisbee and 7 years in Tucson. Bisbee houses had pier and beam foundations. Tucson houses were built on concrete slabs., Conclusions: Kissing bugs harboring T. cruzi readily entered new and old homes. Bites of humans caused severe, life-threatening reactions. There was no serological evidence of Chagas disease among those bitten., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Ants, bees, hornets, wasps, and yellow jackets (insects in Order Hymenoptera) are potentially a serious concern to outdoor workers, as the venom from their stings can cause life-threatening allergic reactions. This study assessed the impacts of Hymenoptera stings and related worker training regimes of forestry workers across the United States (US)., Methods: A survey was distributed to nearly 2,000 outdoor workers in the forestry industry from four US regions (South, West, Northeast, and Midwest)., Results: Ants are a primary concern in the South, with >75% of participants reporting ant stings within the last 5 years. Bees, hornets, wasps, and yellow jackets are a concern for surveyed foresters in all US regions, with 60-70% and 75-93% of participants, respectively, having been stung by bees or hornets/wasps/yellow jackets within the last 5 years. Despite such a large number of participants experiencing stings, nearly 75% of participants were not concerned about being stung or their reaction to stings. Approximately, 70% of participants reported not having received any safety training related to Hymenoptera from their employers., Conclusion: No significant difference was shown in the number of foresters stung at work between safety trained and non-safety trained participants. However, it was significantly more likely for participants to carry a first aid kit if they had received Hymenoptera safety training. Consequently, more comprehensive and frequent training should be considered to help reduce risk of exposure to Hymenoptera.

Objective: Injuries resulting from contact with animals and insects are a significant public health concern. This study quantifies nonfatal bite and sting injuries by noncanine sources using data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP)., Methods: The NEISS-AIP is an ongoing nationally representative surveillance system used to monitor all types and causes of injuries treated in US hospital emergency departments (EDs). Cases were coded by trained hospital coders using information from medical records on animal and insect sources of bite and sting injuries being treated. Data were weighted to produce national annualized estimates, percentages, and rates based on the US population., Results: From 2001 to 2010 an estimated 10.1 million people visited EDs for noncanine bite and sting injuries, based on an unweighted case count of 169,010. This translates to a rate of 340.1 per 100,000 people (95% CI, 232.9-447.3). Insects accounted for 67.5% (95% CI, 45.8-89.2) of bite and sting injuries, followed by arachnids 20.8% (95% CI, 13.8-27.9). The estimated number of ED visits for bedbug bite injuries increased more than 7-fold-from 2156 visits in 2007 to 15,945 visits in 2010., Conclusions: This study provides an update of national estimates of noncanine bite and sting injuries and describes the diversity of animal exposures based on a national sample of EDs. Treatment of nonfatal bite and sting injuries are costly to society. Direct medical and work time lost translates to an estimated $7.5 billion annually., (© 2013 Wilderness Medical Society Published by Wilderness Medical Society All rights reserved.)

Background: Although anaphylaxis is recognized as an important life-threatening condition, data are limited regarding its prevalence and characteristics in the general population., Objective: We sought to estimate the lifetime prevalence and overall characteristics of anaphylaxis., Methods: Two nationwide, cross-sectional random-digit-dial surveys were conducted. The public survey included unselected adults, whereas the patient survey captured information from household members reporting a prior reaction to medications, foods, insect stings, or latex and idiopathic reactions in the previous 10 years. In both surveys standardized questionnaires queried anaphylaxis symptoms, treatments, knowledge, and behaviors., Results: The public survey included 1,000 adults, of whom 7.7% (95% CI, 5.7% to 9.7%) reported a prior anaphylactic reaction. Using increasingly stringent criteria, we estimate that 5.1% (95% CI, 3.4% to 6.8%) and 1.6% (95% CI, 0.8% to 2.4%) had probable and very likely anaphylaxis, respectively. The patient survey included 1,059 respondents, of whom 344 reported a history of anaphylaxis. The most common triggers reported were medications (34%), foods (31%), and insect stings (20%). Forty-two percent sought treatment within 15 minutes of onset, 34% went to the hospital, 27% self-treated with antihistamines, 10% called 911, 11% self-administered epinephrine, and 6.4% received no treatment. Although most respondents with anaphylaxis reported 2 or more prior episodes (19% reporting ≥5 episodes), 52% had never received a self-injectable epinephrine prescription, and 60% did not currently have epinephrine available., Conclusions: The prevalence of anaphylaxis in the general population is at least 1.6% and probably higher. Patients do not appear adequately equipped to deal with future episodes, indicating the need for public health initiatives to improve anaphylaxis recognition and treatment., (Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.)

Background: Stinging insect anaphylaxis (SIA) is a common cause of anaphylaxis and is potentially life-threatening., Objectives: To examine US patients with an emergency department (ED) visit or hospitalization for SIA to evaluate postdischarge follow-up care., Methods: We identified all patients with an ED visit or hospitalization for SIA during 2002-2008 in the MarketScan Database using International Classification of Diseases, Ninth Revision, Clinical Modification codes (index date was the initial ED visit or hospitalization). Patients were required to have continuous full insurance coverage for 1 year or more before and after index. We examined patient factors during the preindex period, characteristics of the index event, and outcomes during the postindex period. Multivariable logistic regression was used to identify independent predictors of receiving preventive anaphylaxis care., Results: We identified 954 patients with an ED visit or hospitalization for SIA (mean [SD] age, 46 [19] years; 41% female). A total of 85% of patients were discharged directly from the ED. For those hospitalized, the mean hospital stay was 1 day, and 50% spent time in the intensive care unit. Cardiorespiratory failure occurred in 27% of those hospitalized. During the postindex period, 69% filled 1 or more epinephrine autoinjector prescription, but only 14% had 1 or more allergist/immunologist visit. Independent factors associated with receiving preventive anaphylaxis care during the postindex period were higher household income, no ED visit (for any reason) in the preindex period, and no cardiorespiratory arrest or failure during the index event., Conclusion: Although two-thirds of patients filled a prescription for an epinephrine autoinjector after an ED visit or hospitalization for SIA, only 14% of patients received follow-up care by an allergist/immunologist. This missed opportunity to provide venom immunotherapy, an essentially curative therapy, unnecessarily places patients at risk for recurrent anaphylaxis., (Copyright © 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Purpose: The history and life cycle of bedbugs, the identification and supportive treatment of bedbug bites, and the eradication and prevention of bedbug infestations are reviewed., Summary: Cimex lectularius, known commonly as the bedbug, is a growing problem in the United States. While the bedbug population declined between the 1950s and the late 20th century, recent increases in international travel and immigration, the banning of dichlorodiphenyltrichloroethane, and insecticide resistance have caused a resurgence of bedbug infestations. Infestations can be identified based on clinical presentation and situational indicators such as housing location and the presence of bedbug fecal smears and nests. Chronic infestation can lead to nervousness, anxiety, and insomnia arising from the inability to identify and eradicate the problem. Scratching at the bite site can lead to a secondary bacterial infection. Because bedbugs continue to bite until the infestation is eradicated, treatment is not accomplished by one strategy alone. A team effort by different health care professionals is necessary. Because bedbugs are hardy insects, eradication can be a daunting task. Proper eradication plans should be in place at all health care facilities, and bedbug infestations should be reported to the state public health department to support the tracking and management of bedbugs., Conclusion: Bedbug infestations are prevalent in locations with high occupant turnover, including hospitals and health systems. Bedbug bites can cause secondary infections and lead to discomfort and anxiety in affected individuals. Pharmacists should work with other health care providers to provide affected patients with supportive treatment and ensure appropriate eradication of the infestation.

Human landing catches (HLCs) are currently the preferred method to determine vector human biting rates (HBRs), which are key determinants of entomologic inoculation rates and important measures for assessing the impact of vector control efforts. Although HLCs are the most direct means of establishing HBRs, they are labor-intensive, and their use is facing increasing ethical concerns. The relationship between Centers for Disease Control (CDC) light traps and HLC collections was evaluated in Macha, Zambia during the 2007-2008 and 2008-2009 rainy seasons. A CDC light trap captured on average 1.91 (95% confidence interval = 1.16-2.28) times as many An. arabiensis per night as an indoor HLC. Additionally, nets treated with deltamethrin did not affect the numbers of An. arabiensis collected. Our results suggest that in regions where use of vector control interventions is high and vector densities are low, CDC light traps can be used to monitor An. arabiensis HBRs.

Vector-borne diseases such as malaria, dengue, and leishmaniasis are a threat to military forces deployed outside of the United States. The availability of specific information on the vector-borne disease threat (e.g., presence or absence of a specific disease agent, temporal and geographic distribution of competent vectors, and vector infection rates) allows for effective implementation of appropriate measures to protect our deployed military forces. Vector diagnostics can provide critical, real-time information crucial to establishing effective vector prevention/control programs. In this article we provide an overview of current vector diagnostic capabilities, evaluate the use of vector diagnostics in Operation Enduring Freedom and Operation Iraqi Freedom, and discuss the concept of operations under which vector diagnostics are employed.

Background: The Asp Caterpillar, Megalopyge opercularis, is endemic to the southern United States and causes hundreds of human envenomations annually. Envenomation from the spines of the caterpillar causes severe pain, burning, swelling, nausea, abdominal distress, and headache. Despite the high prevalence of envenomations, little is known about the caterpillars, their geographical distribution, and the symptoms they engender., Methods: We collected and analyzed 188 case reports of asp caterpillar envenomations over a three-year period., Results: The geographical distribution of the caterpillars is confined to the southeast United States, largely in Texas, Louisiana, and Florida. Symptoms of envenomation vary, but typically include burning pain, swelling, nausea, and itching. The peak months of envenomation are July through November, with few cases reported at other times of year., Discussion: This study sheds light on the caterpillars' distribution and the range of symptoms caused in order to aid in diagnosing puss moth caterpillar envenomation.

Objective: There is not a single data source for information on the extent of nonfatal injuries inflicted by animals. Although individuals bitten or stung by animals may not visit a health care provider, they may call poison control centers (PCCs) for information. These centers are one source of information on the frequency of occurrence of injuries from animals., Methods: The American Association of Poison Control Centers compiles an annual report of exposure calls to various agents, including chemicals, medications, animal bites and stings, plants, and use of antivenoms from their network of PCCs. An estimate of the severity of exposure for each call is also determined. This review examines summary data on different species of animal bites and stings reported by PCCs from 2001 to 2005., Results: From 2001 to 2005 there were 472 760 reports of animal bites and stings, an average of 94,552 per year. There was a trend noted for increasing use of antivenom over this period. Twenty-seven deaths were recorded, most from snakebites., Conclusions: Poison control centers are a source of information for health care workers on management of animal bites and stings. The database maintained by the American Association of Poison Control Centers is another source of information on the magnitude and public health impact of injuries from animals.

Allergic reactions to Hymenoptera stings range from large local reactions to life-threatening anaphylaxis. Over the last 20 years, significant progress has been made using venom extracts in the diagnosis and treatment of Hymenoptera allergy. Despite these advances, there is still room for improvement in increasing the sensitivity of venom allergen skin testing. The venom allergic patient with negative skin tests poses special problems in management. It is important to note their increased risk with a subsequent sting. Guidelines to be used in determining the duration of venom immunotherapy are still evolving. Knowledge of the risks of discontinuing venom immunotherapy and risk factors associated with anaphylaxis with subsequent stings are required to form an individualized approach to treatment.

Background: Anaphylaxis is a severe, life-threatening allergic reaction that affects both children and adults in the United States. However, data regarding the incidence and prevalence of anaphylaxis and the number of deaths caused by it are limited., Objective: To provide a better understanding of the magnitude of the problem of anaphylaxis in the United States., Methods: A thorough review of the current medical literature was conducted to obtain prevalence estimates on each of the 4 major subtypes of anaphylaxis (food, drugs, latex, and insect stings). We calculated an overall estimate of the risk of anaphylaxis by using only estimates that are specifically derived from epidemiologic studies measuring anaphylaxis in the general population., Results: Known rates or cases of anaphylaxis were 0.0004% for food, 0.7% to 10% for penicillin, 0. 22% to 1% for radiocontrast media, and 0.5% to 5% after insect stings. There were 220 cases after latex exposure. Considering the 1999 US population of 272 million, the population at risk for anaphylaxis from food is 1099, from penicillin is 1.9 million to 27. 2 million, from radiocontrast media is 22 000 to 100 000, from latex is 220, and from insect stings is 1.36 million to 13.6 million. These calculations yield a total of 3.29 million to 40.9 million individuals at risk of anaphylaxis., Conclusion: The occurrence of anaphylaxis in the US is not as rare as is generally believed. On the basis of our figures, the problem of anaphylaxis may, in fact, affect 1.21% to 15.04% of the US population.

Based on tick specimens accessioned into the U.S. National Tick Collection, the species of ticks recorded as ectoparasites of humans are documented and compared for 49 U.S. states. A total of 44 tick species was recorded as parasites of humans, consisting of 11 species of soft ticks (Argasidae) and 33 species of hard ticks (Ixodidae). Four of the hard tick species are not native to the U.S. and were removed from travelers returning from foreign destinations. Therefore, we record 40 of the 84 species of U.S. ticks as ectoparasites of humans. Predictably, in the southern U.S. and Atlantic states, all active stages of the lone star tick, Amblyomma americanum (L.), were common ectoparasites of humans. Also, in the eastern U.S., adults of the American dog tick, Dermacentor variabilis (Say), and all active stages (especially adults) of the blacklegged tick, Ixodes scapularis (Say), were commonly recorded. In certain Rocky Mountain and western states, all active stages of the Rocky Mountain wood tick, Dermacentor andersoni (Stiles), predominated, whereas, in most far western states, adults of the western blacklegged tick, Ixodes pacificus Cooley and Kohls, were relatively common parasites of humans. Parasitism by Ornithodoros spp. soft ticks was mainly recorded in the western U.S. These findings, together with records of human parasitism by other tick species in the U.S., are briefly discussed with respect to tick-borne disease risk.

Originally associated with forested areas, the transmission cycle of American cutaneous leishmaniasis (ACL) has now adapted to the domestic environment in at least 9 Latin American countries. Several studies have suggested that the domestic dog (Canis familiaris), which is already incriminated as the primary reservoir host of zoonotic visceral leishmaniasis (ZVL), may have a reservoir role in the domestic transmission of human ACL caused by Leishmania braziliensis, L. panamensis, and L. peruviana. This article reviews more than 90 studies reporting ACL infections in dogs, and concludes that as yet there is only circumstantial evidence to support that claim. Almost no data are available on the infectiousness of dogs to sandfly vectors of ACL, and there are few indications that either dog ownership or dog abundance are risk factors for ACL. Nevertheless, it has been proposed that incidence of ACL in humans could be reduced by targeting infected dogs. While this control strategy has been used for many decades against ZVL in Latin America, Europe, and Asia, there is little evidence to demonstrate its effectiveness either in theory or in practice. Particular concerns over the sensitivity and specificity of diagnostic tools, low compliance rates among dog owners, and cost-effectiveness are likely to apply equally to ACL control.

A survey was conducted to determine the effects of biting and stinging arthropods on military personnel, operations, and training. Nearly 70% of respondents reported experiencing problems attributable to arthropods. Arthropods obstructed movement and field position, prevented concealment and cover, disrupted maneuvers, and caused panic. Twenty percent of respondents reported attendance at sick call for treatment of bites or stings, and 4% were hospitalized or assigned to quarters. Median lost time was 2 days. Bee, wasp, and ant stings and spider and chigger bites were the most frequent causes of lost time. Additional training on biting and stinging arthropods, use of repellents and other personal protective measures, first aid for bites and stings, and conditions requiring medical attention is needed in field units to enhance mission performance and reduce time lost because of arthropods. Materials for treatment of bites and stings should be included in first-aid kits issued for field use.

The resurgence of malaria in the Americas has renewed interest in Anopheles biology. Anopheles darlingi, An. albimanus, An. nuneztovai and An. aquasalis are reconfirmed as major malaria vectors and other species are playing important roles in regional malaria transmission. Adult biting activity and larval ecology are discussed in detail. Seasonal abundance and daily biting activity of Anophelines vary considerably among species and geographically for the same species. Anopheles albimanus has the least amount of variation in biting activity over its range and An. darlingi has the greatest. All species studied are more exophilic and exophagic than endophilic and endophagic. Anopheles darlingi is more anthropophilic, endophilic and endophagic than other Anophelines. Larval studies remain more descriptive than comprehensive. Research on Anophelines is becoming more integrated and biologists are using new biochemical techniques and ecological principles to answer critical questions. This "pluralization" will help us understand species complexes, population dynamics and malaria transmission. Integrated control programs will require more regional, in-depth ecological studies.

Sera from 62 patients allergic to Polistes venom were used to study the allergenic relationships among four individual species of Polistes by both direct and inhibition RAST. Both direct and inhibition results showed that the four species' venoms were closely related. The species within the same subgenus were more closely related than those in different subgenera. The Polistes species were more closely related to each other than various yellow jacket (Vespula) species are to each other. The commercial Polistes venom mix appears to contain all of the relevant allergens.