Giardiasis is the most frequently reported diarrheal disease in northern New England. A case-control study of endemic giardiasis and environmental risk factors among residents of New Hampshire involved 273 cases from the state's 1984 disease registry and 375 controls. Giardiasis was associated with a shallow dug well as a residential water source (odds ratio [OR] = 2.4; 95% confidence interval [CI], 1.3-47.0), a recent history of drinking untreated surface water (OR = 3.4; CI, 2.1-5.5), a history of swimming in a lake or pond (OR = 4.6; CI, 2.4-86.0) or swimming in any natural body of fresh water (OR = 4.0; CI, 2.3-70.0), contact with a person thought to have giardiasis (OR = 2.3; CI, 1.4-36.0), and recent contact with a child in day care (OR = 1.5; CI, 1.0-2.1). Multivariate modeling supported these associations. Shallow wells, relatively common in New Hampshire, have not previously been established as important sources of giardiasis.
More than 100 foodborne salmonellosis outbreaks occur each year in the United States. Contaminated food preparation equipment is implicated in approximately 32% of Salmonella outbreaks with a known source. In April 2009, we investigated reported Salmonella infections at a camp in New Hampshire. Camp attendees were contacted to complete a standard questionnaire. The questionnaire asked about foods eaten while at the camp, symptoms of gastrointestinal illness, visits to healthcare providers, and specimen submission for pathogen testing. Laboratory and environmental investigations were conducted, including testing of foods and food preparation equipment. A total of 133 ill persons, including 47 laboratory-confirmed Salmonella Enteritidis infections, were identified during this investigation. A total of 142 (80%) of 178 camp attendees completed a standard questionnaire and 109 cases of gastrointestinal illness and 33 healthy individuals were identified. Statistical analysis of survey data indicated that people who ate pudding were 15 times more likely to become ill with salmonellosis than those who did not eat pudding (risk ratio, 15.2; 95% confidence interval, 2.3-102.3). Salmonella Enteritidis was identified in leftover pudding and in the internal mixing components of the blender used to mix the pudding. All patient, food, and blender isolates exhibited the same pulsed-field gel electrophoresis pattern. This outbreak of Salmonella Enteritidis was caused by a Salmonella-contaminated hand-held immersion blender used to prepare pudding at a camp. A malfunctioning blender shaft seal is suspected to have resulted in contamination of the blender and subsequently pudding prepared using the blender.
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