Shiga toxin-producing Escherichia coli O157:H7 outbreak associated with school field trips at a farm animal exhibit-Tennessee, September-October 2023.

Aims: In October 2023, the Tennessee Department of Health identified an outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7 infections among elementary school students who attended school field trips to the same farm animal exhibit. Our aim was to determine STEC source and prevent additional illnesses by initiating epidemiologic, laboratory and environmental investigations.

Methods And Results: We identified cases using laboratory-based surveillance and by surveying caregivers of children who attended the exhibit.

Prevalence of gabapentin in drug overdose postmortem toxicology testing results.

Background: The goal of this study was to establish and compare baseline data on the prevalence of gabapentin identified through postmortem toxicology testing among drug overdose decedents in several geographically diverse states/jurisdictions with differing levels of drug overdose fatality burdens in 2015.

Methods: Death certificates and postmortem toxicology result reports from five U.S.

Comparative effectiveness of antibiotic treatment strategies for pediatric skin and soft-tissue infections.

Objective: To compare the effectiveness of clindamycin, trimethoprim-sulfamethoxazole, and β-lactams for the treatment of pediatric skin and soft-tissue infections (SSTIs).

Methods: A retrospective cohort of children 0 to 17 years of age who were enrolled in Tennessee Medicaid, experienced an incident SSTI between 2004 and 2007, and received treatment with clindamycin (reference), trimethoprim-sulfamethoxazole, or a β-lactam was created. Outcomes included treatment failure and recurrence, defined as an SSTI within 14 days and between 15 and 365 days after the incident SSTI, respectively.

Children with asthma hospitalized with seasonal or pandemic influenza, 2003-2009.

Objective: To describe the characteristics and clinical courses of asthmatic children hospitalized with seasonal or 2009 pandemic H1N1 influenza and compare complications by influenza type.

Methods: During the 2003-2009 influenza seasons and the 2009 pandemic, we conducted surveillance of 5.3 million children aged 17 years or younger for hospitalization with laboratory-confirmed influenza and identified those with asthma (defined as those aged 2-17 years with a history of asthma in their medical record or a discharge code for acute asthma exacerbation or status asthmaticus).

Seasonal and 2009 pandemic influenza A (H1N1) virus infection during pregnancy: a population-based study of hospitalized cases.

We sought to describe characteristics of hospitalized reproductive-aged (15-44 years) women with seasonal (2005/2006 through 2008/2009) and 2009 pandemic influenza A (H1N1) virus infection. We used population-based data from the Emerging Infections Program in 10 US states, and compared characteristics of pregnant (n = 150) and nonpregnant (n = 489) seasonal, and pregnant (n = 489) and nonpregnant (n = 1088) pandemic influenza cases using χ(2) and Fisher's exact tests. Pregnant women represented 23.

Hospitalized patients with 2009 pandemic influenza A (H1N1) virus infection in the United States--September-October 2009.

Given the potential worsening clinical severity of 2009 pandemic influenza A (H1N1) virus (pH1N1) infection from spring to fall 2009, we conducted a clinical case series among patients hospitalized with pH1N1 infection from September through October 2009. A case patient was defined as a hospitalized person who had test results positive for pH1N1 virus by real-time reverse-transcription polymerase chain reaction. Among 255 hospitalized patients, 34% were admitted to an intensive care unit and 8% died.

Adult hospitalizations for laboratory-positive influenza during the 2005-2006 through 2007-2008 seasons in the United States.

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.

Influenza-associated pneumonia in children hospitalized with laboratory-confirmed influenza, 2003-2008.

Background: 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.

Methods: Through Emerging Infections Program Network population based surveillance, children aged <18 years hospitalized with laboratory confirmed influenza with a chest radiograph during hospitalization were identified during the 2003-2008 influenza seasons.

Burden of seasonal influenza hospitalization in children, United States, 2003 to 2008.

Objectives: To estimate the rates of hospitalization with seasonal influenza in children aged <18 years from a large, diverse surveillance area during 2003 to 2008.

Study Design: Through the Emerging Infections Program Network, population-based surveillance for laboratory-confirmed influenza was conducted in 10 states, including 5.3 million children.

Acute flaccid paralysis: the spectrum of a newly recognized complication of West Nile virus infection.

Objectives: Acute flaccid paralysis (AFP) has recently emerged as a major central nervous system complication associated with West Nile virus (WNV) infection. The spectrum of clinical presentations of AFP in WNV infection and its sequelae have not been well-studied.

Methods: We describe three patients with AFP due to WNV infection and review the clinical presentations of 56 patients with this complication derived from published studies.

Case series: outbreak of conversion disorder among amish adolescent girls.

Objective: Outbreak investigations are challenging in a cross-cultural context, and outbreaks of psychiatric disease are rare in any community. We investigated a cluster of unexplained debilitating illness among Amish girls.

Method: We reviewed the medical records of cases, consulted with health care providers, performed active case finding, administered open-ended and structured interviews, and met with Amish community members.

Photokeratitis and UV-radiation burns associated with damaged metal halide lamps.

Background: Damaged metal halide lamps are known to cause outbreaks of photokeratitis and UV-radiation burns among children and adults, which has prompted the Food and Drug Administration, Rockville, Md, to publish consumer recommendations to prevent such injuries. We investigated 3 outbreaks of photokeratitis and UV-radiation burns in gymnasiums associated with failure to heed these recommendations.

Objective: To determine the cause of the outbreaks and promote interventions to prevent further injuries.

Childhood immunization rates before and after the implementation of Medicaid managed care.

Objective: To evaluate trends in childhood immunization coverage after implementation of Medicaid managed care in Tennessee (TennCare) in 1994.

Design: Before-and-after study using the Tennessee Department of Health annual cross-sectional survey of children aged 24 months.

Patients: A mean of 1663 children per year who were randomly sampled during 1986-1999.

Outbreak of joint and soft-tissue infections associated with injections from a multiple-dose medication vial.

An outbreak of Staphylococcus aureus joint and soft-tissue infections occurred after therapeutic injections in an outpatient setting. A physician performed intra-articular or soft-tissue injections on 17 patients in August 2001, and 5 (29%) were subsequently hospitalized for infections at the site. S.

Pseudomonas aeruginosa and Serratia marcescens contamination associated with a manufacturing defect in bronchoscopes.

Background: Several outbreaks and pseudo-outbreaks of Pseudomonas aeruginosa and Serratia marcescens infections associated with bronchoscopy have been reported. We conducted an investigation of P. aeruginosa and S.

Outbreak of aseptic meningitis associated with echovirus 13.

Background: Before 2001, echovirus 13 accounted for only 65 of approximately 45,000 reported enteroviral isolates in the United States. During spring 2001, several outbreaks of echovirus 13 meningitis occurred, primarily affecting children. We investigated a large outbreak in Shelby County, TN, to determine the characteristics and clinical manifestations of echovirus 13 meningitis.

Bioterrorism-related anthrax surveillance, Connecticut, September-December, 2001.

On November 19, 2001, a case of inhalational anthrax was identified in a 94-year-old Connecticut woman, who later died. We conducted intensive surveillance for additional anthrax cases, which included collecting data from hospitals, emergency departments, private practitioners, death certificates, postal facilities, veterinarians, and the state medical examiner. No additional cases of anthrax were identified.

Fatal inhalational anthrax in a 94-year-old Connecticut woman.

We describe the 11th case of bioterrorism-related inhalational anthrax reported in the United States. The presenting clinical features of this 94-year-old woman were subtle and nondistinctive. The diagnosis was recognized because blood cultures were obtained prior to administration of antibiotics, emphasizing the importance of this diagnostic test in evaluating ill patients who have been exposed to Bacillus anthracis.