Seven patients with vanA-positive VRSA have been identified in the United States. Prompt detection by microbiology laboratories and adherence to recommended infection control measures for multidrug-resistant organisms appear to have prevented transmission to other patients.

This outbreak underscores important challenges in ensuring the safety of compounded pharmaceuticals and demonstrates the potential for substantially delayed infections after exposures to contaminated infusates. Exposures to compounded products should be considered when investigating outbreaks. Patients exposed to contaminated infusates require careful follow-up, because infections can occur long after exposure.

Background: The majority of U.S. disease surveillance systems contain incomplete information regarding socioeconomic status (SES) indicators like household or family income and educational attainment in case reports, which reduces the usefulness of surveillance data for these parameters. We investigated the association between select SES attributes at the neighborhood level and Salmonella infections in the three most populated counties in Michigan using a geographic information system.

Objective To estimate current US herd-level and animal-level prevalence of bovine leukemia virus (BLV) in dairy cows and characterize epidemiologic features. Design Cross-sectional observational study design and survey. Animals 4120 dairy cows from 103 commercial dairy herds in 11 states across the US. Procedures Milk samples were collected from dairy cows through routine commercial sampling and tested for anti-BLV antibodies by antibody capture ELISA. Based on the ELISA results of a sample of an average of 40 cows per herd, within-herd apparent prevalence (AP) was estimated by a directly standardized method and by a lactation-weighted method for each herd. Within-herd AP estimates were summarized to give estimates of US herd-level and animal-level AP. Differences in AP by lactation, region, state, breed, and herd size were examined to characterize basic epidemiologic features of BLV infection. Results 94.2% of herds had at least one BLV antibody positive cow detected. The average within-herd standardized AP was 46.5%. Lactation-specific AP increased with increasing lactation number, from 29.7% in first lactation cows to 58.9% in 4th and greater lactation cows. Significant differences were not observed based on region, state, breed, or herd size. Conclusions and Clinical Relevance These results are consistent with a historical trend of increasing prevalence of BLV among US dairy cattle. Given the findings of other studies on the negative impacts of BLV infection on milk production and cow longevity, these findings are clinically relevant for veterinarians counseling dairy clients on the risks of BLV to their herds.

Mycobacterium bovis is endemic in Michigan's whitetailed deer and has been circulating since 1994. The strain circulating in deer has remained genotypically consistent and was recently detected in 2 humans. We summarize the investigation of these cases and confi rm that recreational exposure to deer is a risk for infection in humans.H istorically, Mycobacterium bovis infection in humans was associated with consumption of unpasteurized milk and dairy products (1,2) and this is still the most important route of exposure in developing countries. US populations are exposed to unpasteurized dairy products imported from countries where M. bovis is prevalent (3,4). M. bovis infection in humans is of concern to health officials in Michigan because of to its endemicity in the state's wild white-tailed deer population and its discovery in several cattle herds. M. bovis in deer represents possible occupational and recreational routes of exposure to humans, especially for hunters, trappers, taxidermists, venison processors, and venison consumers (5).Although M. bovis is a zoonotic agent, surveillance indicates no increase in its incidence in Michigan residents since an outbreak began in 1994. Since 1995, the incidence rate of M. bovis infection in Michigan residents has remained very low, with ≈1 new case per year for a total of 13. No genetic or epidemiologic link to the deer/cattle outbreak strain has been identifi ed among 11 of these human M. bovis cases, based on restriction fragment-length polymorphism analysis, spoligotyping, or mycobacterial interspersed repeat units (MIRU) typing (M. Wilkins, unpub. data,

Vancomycin-resistant Staphylococcus aureus (VRSA) infections, which are always methicillin-resistant, are a rare but serious public health concern. We examined 2 cases in Michigan in 2007. Both patients had underlying illnesses. Isolates were vanA-positive. VRSA was neither transmitted to or from another known VRSA patient nor transmitted from patients to identified contacts.

Salmonellosis is largely a major foodborne disease. However, contact with animals particularly reptiles, has been increasingly recognized as a risk factor for Salmonella infection among children. The major risk factors for salmonellosis in Michigan children have not been assessed. Therefore, we have evaluated the association between Salmonella infections and contact with animals among Michigan children aged ≤ 10 years by conducting a population-based case-control study. A total of 123 children with laboratory-confirmed Salmonella infections and 139 control children, who had not experienced symptoms of gastrointestinal illness during the month prior to the interviews, were enrolled. A multivariable analysis matched on age group revealed that children with Salmonella infections had reported more commonly than controls contact with reptiles [adjusted matched odds ratio (MOR) = 7.90, 95% confidence interval (CI): 1.52-41.01] and cats (MOR = 2.53, 95% CI: 1.14-5.88). Results of this study suggest an association between salmonellosis and contact with cats and reptiles in Michigan children. Additional efforts are needed to educate caretakers of young children about the risk of Salmonella transmission through animal contact.

This study revealed the emergence of S. Newport and the high incidence of the most common Salmonella serotypes among infants, people of African descent, and Hispanics. This information can be used by the state and local health departments of Michigan to enhance salmonellosis prevention efforts by rationalizing the allocation of appropriate public health resources and personnel.