File, Thomas M. Jr MD
From the Summa Health System, Akron, OH.
Correspondence to: Thomas File, MD, MSc, IDCP, Akron, OH. E-mail: email@example.com.
The author has received recent research funding from Pfizer, GlaxoSmithKline, and Gilead. He has been a consultant for Cerexa/Forest, Astellas, Bayer, Cubist, DaiichiSankyo, GlaxoSmithKline, Merck, Nabriva, Pfizer, and Teraphase.
This year’s conference represented the eight in this biennial meeting and was organized by the Centers for Disease Control and Prevention (CDC) and several other organizations with support from more than 30 multidisciplinary partners (including the National Foundation for Infectious Diseases and the Infectious Diseases Society of America). I found this to be a very rich opportunity to better understand infectious disease issues from all over the world—indeed a global health perspective. The following are a few of the abstracts presented at this year’s conference.
21. Toxigenic Vibrio cholera 075 Infections in the US, 2000-2011. AE Newton et al. CDC
From January 2000 to Sept 2011, 28 confirmed cases of cholera were reported to CDC from 10 states; Alabama (3), Florida (7), Georgia (5), Louisiana (3), and Pennsylvania (3) were those with more than one case. All presented with diarrhea, 38% required hospitalization, and none died. Seafood consumption within 7 days before illness was reported in 93% of whom 81% consumed oysters (86% raw). Of those with sufficient information to determine the oyster harvest site, all were from Apalachicola Bay, Fla.
Cholera is not just from outside US and usually associated with ingestion of raw oysters. As I search the Internet, I find that Apalachicola Bay produces more than 90% of Florida’s oysters, so this association may be more of a numbers game rather than a significant association of risk. Furthermore, it seems that “many lovers of oysters will tell you quickly and without doubt that Apalachicola Bay Oysters are absolutely the finest in the world.”
23.Cultivation of Mussels: A Possible Source Of Cryptosporidium Transmitted To Human Beings. TC Bomfim et al. Universidade Federal Rural do Rio de Manerio, Brazil
Using molecular techniques, the investigators identified C parvum from cultivated mussels on Guaiba Island, Brazil. Thus, suggesting this is a potential source of transmission to humans.
So now we may need to be concerned of mussels for more than Vibrio infection!
32.Risk of Infection From the Physical Environment in Bangladeshi Hospitals: Putting Infection Control into Context. NA Rimi et al. International Center for Diarrheal Disease Research, Dhaka, Bangladeshi
Social scientists conducted numerous observations of hygiene status. Some of the observations included the following: overcrowding of hospital environment; soap was uncommonly used and exclusively for staff. Used medical supplies were often discarded in open containers under the beds. At 2 hospitals, waste was later disposed of on the grounds outside the hospital, where people collected them to resell. Mosquitoes and feral cats were commonly observed on the wards.
I was somewhat reluctant to include this as I did not wish to seem disrespectful, but because this was presented, I thought it was of interest to describe conditions at hospitals in other parts of the world. In many ways, this increases my respect and admiration for our colleagues who care for patients under such conditions. Of course, it also calls for improvement of such conditions.
47. An Outbreak of Dengue Fever in Houston, TX, Between 2003 and 2005. KO Murray et al. University of Texas Health Science Center, Houston, TX; 127. Local Dengue in Florida. D Stanek et al. Florida Department of Health; 220. Travel-Associated Cases of Dengue Reported to the Centers for Disease Control and Prevention, 2005-2010. DF Arguello et al. CDC
There were several abstracts concerning Dengue, and I included these three, which reflect the presence of dengue in the United States. In the Houston outbreak, 47 patients were identified; 57% had meningitis/encephalitis and 43% had dengue fever (an unusual ratio, as dengue fever more commonly outnumbers illnesses that are more serious). Of interest, most cases did not have a history of travel to an endemic area, thus supporting local transmission during this study period. In the Florida experience, there were several clusters of dengue virus infection. Most were in areas close to cruise ship ports, suggesting the initial infections came from outside the US but then transmission continued through local mosquito transmission. Of interest, there seemed to be an association with home foreclosures and abandoned dwellings as a source of standing water and mosquito breeding. The surveillance of travelers abstract (#220) indicated that dengue was a common cause of febrile illness in US travelers to dengue endemic areas, especially the Caribbean, South America, and Asia.
This illustrates that dengue is endemic to certain areas in the United States and includes southern Florida, southern Texas, and Hawaii. Several reports suggest that dengue is the most common cause of febrile illness for travelers from essentially all areas except Africa, where malaria is still king of the febrile illness. In addition, the association of foreclosed residences in Florida as an apparent source of mosquito breeding suggest another ill (no pun intended) consequence of the economic downturn over the past many years.
42.Encouraging Trends in Invasive Infection With MRSA in Connecticut, 2001-2010. S Petit et al. Connecticut Department of Public Health.
Since 2007, hospital-associated, health care-associated, and community-associated methicillin-resistant Staphylococcus aureus have all been decreasing coincident with increased public, public health, and hospital attention.
At least some good news. The authors felt this was due to several factors but included better awareness by the public and health care providers to better prevent transmission and more appropriate management to reduce spread.
E2. Early Success of First Conjugate Serogroup A Vaccination Campaign in Burkina Faso. RT Novak. CDC and Ministere de la Sante, Ouagadougou, Burkina Faso
Seroproup A meningococcus causes major epidemics of meningitis in sub-Sharan Aftrica. In 2010, Burkima Faso became the first country to implement a national preventive campaign vaccinating 11 million individuals aged 1 to 29 years (>90% coverage). The national mean rate decreased by 80% (from 82 cases/100,000 to 16/100,000), with a 62% decrease in mortality from meningitis.
Another great success story of the benefit of vaccines reducing serous disease and saving lives.
180.Risk Factors for Cluster Outbreaks of Avian Influenza A H5N1 Infection, Indonesia. G Samaan et al. Minister of Health, Indonesia and CDC
By July 2009, Indonesia had reported 139 outbreaks of H5N1 infection in humans, the most of any country. Risk factors for clustering (defined as a group of ≥1 cases associated within a specific setting and within 2 weeks of each other) and for secondary cases were assessed. On multivariate analysis, 3 factors were identified: age 5 to 17 years, having direct exposure to sources of H5N1 (eg, birds), and being a first-degree relative of an index case. The finding of first-degree relatives being independently at greater risk suggests there is a genetic basis for susceptibility to infection.
As best as I can tell, this is the largest cohort of cases to be comprehensively evaluated. Investigating teams interviewed cases when possible (but many died before investigation), family members, and key informants within a village. In Indonesia, bird rearing is generally delegated to younger members of the household, which may explain the association with younger age. The association of first-degree relatives for secondary cases adds further evidence that family members who are genetically susceptible are at greater risk of infection from either a specific source or possibly from direct person-to-person transmission. (This report has been now published: Aditama TY et al. Clin Infect Dis. 2011: 53: 1237-1244).
182.Pet Ownership and Animal Interaction in Canadian Households: Zoonotic Disease Implications for Public Health. JW Stull et al. University of Guelph, Canada.
Many human infections are transmitted through contact with animals. More than 50% of homes in most countries have pets, and little is known of the public’s pet contact practices. This study assessed, by a questionnaire, the knowledge of pet owners regarding zoonotic disease and transmission. High-risk practices (eg, feeding raw meat or eggs and failure to wash hands) were regularly reported, and zoonotic disease knowledge was low.
It is apparent that there needs to be better education of pet owners as to the awareness of possible disease, which can be transmitted from their pets. I suggest the reader refer to the excellent commentary in this issue by Joe Myers: The Cat’s Meow . . . and Rash . . . and Lick: Clues to the Zoonotic Puzzle.
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