Multistate Outbreak of Escherichia coli O157:H7 Infections Associated with Consumption of Fresh Spinach: United States, 2006.

During September to October, 2006, state and local health departments and the Centers for Disease Control and Prevention investigated a large, multistate outbreak of Escherichia coli O157:H7 infections. Case patients were interviewed regarding specific foods consumed and other possible exposures. E.

The World Health Organization Measles Programmatic Risk Assessment Tool-Pilot Testing in India, 2014.

Measles is a leading cause of child mortality, and reduction of child mortality is a key Millennium Development Goal. In 2014, the World Health Organization and the U.S.

Progress Toward Measles Elimination - Nepal, 2007-2014.

In 2013, the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region (SEAR) established a goal to eliminate measles and to control rubella and congenital rubella syndrome (CRS) in SEAR by 2020. Current recommended measles elimination strategies in the region include 1) achieving and maintaining ≥95% coverage with 2 doses of measles-containing vaccine (MCV) in every district, delivered through the routine immunization program or through supplementary immunization activities (SIAs); 2) developing and sustaining a sensitive and timely measles case-based surveillance system that meets minimum recommended performance indicators; 3) developing and maintaining an accredited measles laboratory network; and 4) achieving timely identification, investigation, and response to measles outbreaks. In 2013, Nepal, one of the 11 SEAR member states, adopted a goal for national measles elimination by 2019.

Hepatitis A Infections Among Food Handlers in the United States, 1993-2011.

We reviewed news reports of hepatitis A virus (HAV)-infected food handlers in the United States from 1993 to 2011 using the LexisNexis® search engine. Using U.S.

Measles Outbreak Associated with Vaccine Failure in Adults--Federated States of Micronesia, February-August 2014.

On May 15, 2014, CDC was notified of two laboratory-confirmed measles cases in the Federated States of Micronesia (FSM), after 20 years with no reported measles. FSM was assisted by the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), and CDC in investigating suspected cases, identify contacts, conduct analyses to guide outbreak vaccination response, and review vaccine cold chain practices. During February–August, three of FSM’s four states reported measles cases: Kosrae (139 cases), Pohnpei (251), and Chuuk (3).

Progress Toward Measles Elimination - South-East Asia Region, 2003-2013.

In 2013, the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region adopted the goal of measles elimination and rubella and congenital rubella syndrome control by 2020 after rigorous prior consultations. The recommended strategies include 1) achieving and maintaining ≥95% coverage with 2 doses of measles- and rubella-containing vaccine in every district through routine or supplementary immunization activities (SIAs); 2) developing and sustaining a sensitive and timely case-based measles surveillance system that meets recommended performance indicators; 3) developing and maintaining an accredited measles laboratory network; and 4) achieving timely identification, investigation, and response to measles outbreaks. This report updates previous reports and summarizes progress toward measles elimination in the South-East Asia Region during 2003-2013.

Patient awareness of need for hepatitis a vaccination (prophylaxis) before international travel.

Introduction: Although hepatitis A virus (HAV) infection is preventable through vaccination, cases associated with international travel continue to occur. The purpose of this study was to examine the frequency of international travel and countries visited among persons infected with HAV and assess reasons why travelers had not received hepatitis A vaccine before traveling.

Methods: Using data from sentinel surveillance for HAV infection in seven US counties during 1996 to 2006, we examined the role of international travel in hepatitis A incidence and the reasons for patients not being vaccinated.

Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States, 2006-2012.

Background: Reports of acute hepatitis C in young persons in the United States have increased. We examined data from national surveillance and supplemental case follow-up at selected jurisdictions to describe the US epidemiology of hepatitis C virus (HCV) infection among young persons (aged ≤30 years).

Methods: We examined trends in incidence of acute hepatitis C among young persons reported to the Centers for Disease Control and Prevention (CDC) during 2006-2012 by state, county, and urbanicity.

Hepatitis B vaccine immunogenicity among adults vaccinated during an outbreak response in an assisted living facility--Virginia, 2010.

Background: Failure to adhere to infection control guidelines, especially during assisted monitoring of blood glucose, has caused multiple hepatitis B outbreaks in assisted living facilities (ALFs). In conjunction with the response to such an outbreak at an ALF ("Facility X") where most residents had neuropsychiatric disorders, we evaluated seroprotection rates conferred by hepatitis B vaccine and assessed the influence of demographic factors on vaccine response.

Methods: Residents were screened for hepatitis B and C infection, and those susceptible were vaccinated against hepatitis A and hepatitis B with one dose of TWINRIX™ (GSK) given at 0, 1, and 7 months.

Laboratory-based surveillance for hepatitis E virus infection, United States, 2005-2012.

To investigate characteristics of hepatitis E cases in the United States, we tested samples from persons seronegative for acute hepatitis A and B whose clinical specimens were referred to the Centers for Disease Control and Prevention during June 2005-March 2012 for hepatitis E virus (HEV) testing. We found that 26 (17%) of 154 persons tested had hepatitis E. Of these, 15 had not recently traveled abroad (nontravelers), and 11 had (travelers).

Outbreak of hepatitis B virus infections associated with assisted monitoring of blood glucose in an assisted living facility-Virginia, 2010.

Introduction: In January 2010, the Virginia Department of Health received reports of 2 hepatitis B virus (HBV) infections (1 acute, 1 chronic) among residents of a single assisted living facility (ALF). Both infected residents had diabetes and received assisted monitoring of blood glucose (AMBG) at the facility. An investigation was initiated in response.

Long-term immunogenicity of hepatitis A virus vaccine in Alaska 17 years after initial childhood series.

The Centers for Disease Control and Prevention recommends hepatitis A virus (HAV) vaccination for all children at age 1 year and for high-risk adults. The vaccine is highly effective; however, protection duration is unknown. We report HAV antibody concentrations 17 years after childhood immunization, demonstrating that protective antibody levels remain and have stabilized over the past 7 years.

Transmission of hepatitis B virus from an orthopedic surgeon with a high viral load.

Background: During the evaluation of a needle-stick injury, an orthopedic surgeon was found to be unknowingly infected with hepatitis B virus (HBV) (viral load >17.9 million IU/mL). He had previously completed two 3-dose series of hepatitis B vaccine without achieving a protective level of surface antibody.

Hepatitis B vaccination of susceptible elderly residents of long term care facilities during a hepatitis B outbreak.

Protection of older persons, particularly those with diabetes, against hepatitis B virus (HBV) infection is of growing concern because of increased reports of outbreaks among long-term care facility residents receiving assisted blood glucose monitoring. We evaluated hepatitis B vaccine immunogenicity among residents immunized in response to two such outbreaks in skilled nursing facilities during June 2009-July 2010. One hundred forty-eight (71%) of 209 residents were found to be susceptible to HBV infection.

Persistence of hepatitis A vaccine induced seropositivity in infants and young children by maternal antibody status: 10-year follow-up.

Unlabelled: Persistence of seropositivity conferred by hepatitis A vaccine administered to children <2 years of age is unknown and passively transferred maternal antibodies to hepatitis A virus (maternal anti-HAV) may lower the infant's immune response to the vaccine. One hundred ninety-seven infants and young children were randomized into three groups to receive a two-dose hepatitis A vaccine: group 1 at 6 and 12 months, group 2 at 12 and 18 months, and group 3 at 15 and 21 months of age. Within each group, infants were randomized by maternal anti-HAV status.

Evaluation of hepatitis B vaccine immunogenicity among older adults during an outbreak response in assisted living facilities.

Background: During the past decade, in the United States, an increasing number of hepatitis B outbreaks have been reported in assisted living facilities (ALFs) as a result of breaches in infection control practices. We evaluated the seroprotection rates conferred by hepatitis B vaccine among older adults during a response to an outbreak that occurred in multiple ALFs and assessed the influence of demographic and clinical factors on vaccine response.

Methods: Residents were screened for hepatitis B and C infection prior to vaccination and susceptible residents were vaccinated against hepatitis B with one dose of 20 μg Engerix-B™ (GSK) given at 0, 1, and 4 months.

Outbreak of acute hepatitis B virus infections associated with podiatric care at a psychiatric long-term care facility.

Background: Effective measures exist to prevent health care-associated hepatitis B virus (HBV) transmission, yet outbreaks continue to occur. In 2008, the Los Angeles County Department of Public Health identified an outbreak of HBV infections among psychiatric long-term care facility residents.

Methods: Residents underwent HBV serologic testing and were classified as acutely infected, chronically infected, susceptible, or immune.

Viral hepatitis A, B, and C: grown-up issues.

Viral hepatitis is a major global health problem associated with significant morbidity and mortality. Although there are five major and distinct human hepatitis viruses characterized to date--referred to as hepatitis A, B, C, D, and E, respectively--only hepatitis A, B, and C are epidemiologically and clinically relevant for adolescents in North America. The clinical presentation of acute infection with each of these viruses is similar; thus, diagnosis depends on the use of specific serologic markers and viral nucleic acids.

An outbreak of hepatitis A among primary and secondary contacts of an international adoptee.

The Advisory Committee on Immunization Practices recommends that susceptible people traveling to developing countries receive hepatitis A vaccine or immune globulin prior to departure. Until 2009, the recommendations did not address non-traveling family members or other close contacts of international adoptees. We report an outbreak of hepatitis A in 2008 that occurred in Maine.

Multistate outbreak of Escherichia coli O157:H7 infection associated with consumption of packaged spinach, August-September 2006: the Wisconsin investigation.

Background: Escherichia coli O157:H7 infection often causes hemorrhagic colitis and hemolytic uremic syndrome.

Methods: In 2006, the Wisconsin Division of Public Health and the Wisconsin State Laboratory of Hygiene, in cooperation with other local, state, and federal partners, investigated an outbreak of E. coli O157:H7 infection.

Complete restriction of fluoroquinolone use to control an outbreak of Clostridium difficile infection at a community hospital.

Objective: To review the effect of interventions, including a complete restriction in the use of fluoroquinolones (FQs), used to control an outbreak of hospital-onset Clostridium difficile infection (HO-CDI) caused primarily by the epidemic North American pulsed-field gel electrophoresis type 1 strain.

Design: Retrospective cohort and case-control study of all episodes of HO-CDI both before and after 2 interventions.

Setting: Community hospital; January 1, 2005, through March 31, 2007.