In the United States and Canada, the most recent documented cases of rabies have been attributed to bat rabies viruses (RABV). We undertook this systematic review in an effort to summarize and enhance understanding of the risk of infection for individuals who have been potentially exposed to a suspect or confirmed rabid bat. United States rabies surveillance summaries documented a total of 41 human bat-rabies virus variant verified non-transplant cases between 1990 and 2015. All cases were fatal. Seven (17.1%) of 41 cases reported a bite from a bat. Ten (24.3%) cases had unprotected physical contact (UPC); these included seven cases that had a bat land or crawl on them (contact with claws) and one case that touched a bat’s teeth. Seven (17.1%) cases had probable UPC. Insectivorous bat teeth are extremely sharp and highly efficient for predation upon arthropod prey. Bats also have sharp claws on the end of their thumbs and feet. One of the most common bat RABV variants has an ability to replicate in non-neural cells. Questioning individuals about unprotected contact with bat teeth and claws (including a bat landing or crawling on a person) may help identify additional exposures.
Campylobacter is regarded as a leading cause of human bacterial gastroenteritis in the United States. We report on a case of laboratory-confirmed Campylobacter jejuni infection in the Commonwealth of Pennsylvania among members of a household living with a laboratory-confirmed but non-speciated Campylobacter-infected puppy. We describe an outbreak of likely dog-associated campylobacteriosis, the risk factors, potential routes of exposure and the clinical features in the exposed family members, which began shortly after exposure to the recently purchased dog. We also provide public health recommendations to prevent Campylobacter infections in veterinary care providers, pet owners and those planning to adopt pets in the future. Finally, this report underscores the importance of the One Health approach when public health responders, human and animal healthcare providers and clinical diagnostic laboratories are tasked with developing effective strategies when investigating, detecting and responding to zoonoses (diseases shared between animals and humans).
Rabid free-ranging cats have been a public health concern in Pennsylvania since raccoon variant rabies first was recognized in the state in the early 1980s. Over the last decade, between 1.5 and 2.5% of cats submitted to Pennsylvania's state laboratories for rabies testing have been positive. In this report, we describe the extent of rabies in free-ranging cats in Pennsylvania. We also present two examples of human exposure to rabid free-ranging cats that occurred in Pennsylvania during 2010-2011 and the public health actions taken to address rabies exposure in the humans and animals. We then describe the concerns surrounding the unvaccinated and free-ranging cat population in Pennsylvania and possible options in managing this public and animal health problem.
repeated, examining education instead of social class. Approval was obtained from the ethics committee, and participants gave written informed consent.Being in the manual social class (26%) was associated with a significantly higher prevalence of calcification (odds ratio = 2.3, 95% confidence interval 1.3 to 5.2, P = 0.04), as was having left full time education before the age of 19 (odds ratio 2.8 (1.2 to 6.3), P = 0.01). Adjusting for age, sex, systolic blood pressure, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglycerides, alcohol consumption, and body mass index either singly or simultaneously attenuated the odds ratios for social class (adjusted odds ratio = 2.0, 95% confidence interval (0.7 to 5.2), P = 0.2) and educational status (adjusted odds ratio 2.2 (0.8 to 6.0), P = 0.1) only slightly, although their significance was reduced. Adjusting for pack years of smoking and physical activity level in those 126 participants on whom these data were available did not alter the odds ratio. In this subgroup the odds ratio for social class was 1.8 and was 3.0 for educational status, both before and after adjustment. CommentThe study shows that socioeconomic differences in coronary artery calcification already exist in men and women in their 30s. A socioeconomic difference in the precursor non-calcified lesions of atherosclerosis may be present even earlier in the life course. Social class differences in coronary risk factors were generally small or non-existent in this cohort (data not given) and explained little of the social class difference in coronary artery calcification.The unequivocal class difference in people in their 30s has important implications. Firstly, interventions aimed at reducing inequalities in heart disease must include young adults and possibly children. Secondly, studies of socioeconomic gradients in coronary heart disease that do not consider the risk factor profiles of participants in their 20s and 30s are unlikely to explain the gradient in full. Thirdly, the paucity of effect of adjusting for established risk factors on class difference emphasises that the biological mechanisms through which social inequalities affect risk for coronary heart disease have yet to be discovered. Finally, electron beam computerised tomography is an important technique for exploring the basis of socioeconomic differences in coronary disease in relatively young cohorts.Contributors: HMC initiated the research, designed the protocol, participated in the data collection, analysed the data, and drafted the paper. She is also the guarantor. MBR helped formulate the hypothesis and study design, advised on the protocol, participated in the data collection, edited the paper, and scored all the electron beam computerised tomography scans. SRU and JHF helped formulate the hypothesis and study design, advised on the protocol, and edited the paper.Funding: Project grant from the British Heart Foundation.Competing interests: None declared.
ObjectiveThe objective of this study was to evaluate the impact of efforts made to improve the completeness of select varicella (chickenpox) case investigation variables.IntroductionRoutine childhood administration of varicella-containing vaccine has resulted in the number of varicella (chickenpox) cases in Pennsylvania falling from nearly 3,000 cases in 2007 to less than 400 cases in 2017. Prior to 2018, the completeness of varicella case investigation data documented in Pennsylvania’s electronic disease surveillance system (PA-NEDSS) was not routinely monitored by Department of Health (DOH) staff. A pilot project was initiated in April 2018 to monitor and improve completeness of select varicella case investigation variables.MethodsVaricella cases reported to PA-NEDSS during MMWR year 2018 (MMWR weeks 1 – 26) in Pennsylvania (excluding Philadelphia County) with a classification status of probable or confirmed were included in the pilot project (n=223). DOH epidemiology staff prioritized 11 key varicella investigation variables and developed a SAS program to identify cases with missing data, which were summarized in weekly reports and provided to DOH immunization staff for follow-up. DOH immunization staff reviewed missing data reports and communicated with case investigators to reconcile missing data. Varicella case data from the project period were compared with a 10-year baseline to evaluate the 11 targeted variables for change in percent completion.ResultsPercent completion of all 11 variables improved during the intervention period, with a median relative increase of 10.2% (range: 4.2% — 25.5%) compared to baseline. All but two variables (pregnancy status and number of days hospitalized) exhibited a statistically significant (p<0.05) improvement in percent completion. In addition, among eight variables that include an unknown response option, only one variable (number of varicella vaccine doses received) measured an increase in the percentage of unknown responses during the project period compared with baseline; however, this increase was not statistically significant (p=0.180).ConclusionsPrioritization of key varicella investigation variables for improved completion was successful and did not result in significant increases of unknown responses. As varicella cases become less common, varicella case investigation data become increasingly important. Increased completeness of these data will enhance DOH communication of varicella surveillance findings, particularly for severe cases. Based on the success of this interagency collaboration, similar efforts are being developed for additional reportable conditions.
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