The advent of domestic bioterrorism has emphasized the need for enhanced detection of clusters of acute illness. We describe a monitoring system operational in eastern Massachusetts, based on diagnoses obtained from electronic records of ambulatory-care encounters. Within 24 hours, ambulatory and telephone encounters recording patients with diagnoses of interest are identified and merged into major syndrome groups. Counts of new episodes of illness, rates calculated from health insurance records, and estimates of the probability of observing at least this number of new episodes are reported for syndrome surveillance. Census tracts with unusually large counts are identified by comparing observed with expected syndrome frequencies. During 1996–1999, weekly counts of new cases of lower respiratory syndrome were highly correlated with weekly hospital admissions. This system complements emergency room- and hospital-based surveillance by adding the capacity to rapidly identify clusters of illness, including potential bioterrorism events.
An epidemiologic investigation of a gastroenteritis outbreak in December 1994 indicated that salad consumption during lunch was linked with illness on 2 days (5 December: odds ratio [OR]=3.1, 95% confidence interval [CI]=2.0-5.0; 6 December: OR=3.1, 95% CI=1.9-4.9). Single stool or vomitus specimens from ill students and staff (case-patients) were examined for bacterial and viral pathogens. Small round-structured viruses (SRSVs) were detected by electron microscopy in stool specimens from 9 of 19 case-patients and in vomitus specimens from 3 of 5 case-patients. By reverse transcription-polymerase chain reaction (RT-PCR), the SRSVs were shown to be G-2/P2-B type strain. The nucleotide sequences of RT-PCR products from vomitus and stool specimens of ill students were identical to stool specimens from the ill salad chef. These findings suggest that a single SRSV strain was the etiologic agent in the outbreak that was possibly transmitted to students through consumption of contaminated salad. Epidemiologic investigation in conjunction with molecular diagnostics may enable early identification of sources of infection and improve outbreak control.
Invasive meningococcal disease (IMD) reported to the Massachusetts Department of Public Health from 1988 to 2011 was reviewed. The average annual incidence of IMD/100 000 decreased from 1·57 [95% confidence interval (CI) 1·42-1·73] for 1988-1991 to 0·22 (95% CI 0·17-0·29) for 2008-2011. The pattern of decreasing incidence over time differed by age group. There was a decrease in IMD/100 000 in the 0-4 years age group after 1991 from 10·92 (95% CI 8·08-14·70) in 1991 to 5·76 (95% CI 3·78-8·72) in 1992. Incidence in the 0-4 years age group remained below 5/100 000 per year on average thereafter. A substantial reduction in incidence in all age groups was observed between 2000 and 2009, which began before the introduction of conjugate meningococcal vaccine in 2005. Marked reductions in incidence of IMD in Massachusetts, and elsewhere, deserve further investigation with respect to potential factors that go beyond the introduction and deployment of improved meningococcal vaccines.
We report on two outbreaks of Salmonella enteritidis which occurred in 1992; both were associated with Monte Cristo sandwiches. The first outbreak, which occurred in Woods Hole, Massachusetts, was investigated as a case-control study, and involved 74 persons. The second outbreak, investigated as a cohort study, occurred in Brewster, Massachusetts, and involved 32 persons. Monte Cristo sandwiches were strongly implicated in both outbreaks; the odds ratio in the case-control study was 43, and the relative risk in the cohort study was 13. Food-preparation procedures were reviewed and food handlers were educated about safe food-preparation practices. Because of the short grilling time for Monte Cristo sandwiches, (usually several minutes) the eggs used in the preparation may only be partially cooked. As a result, this food should be viewed as high risk for S. enteritidis. Pasteurized eggs should be used to prepare Monte Cristo sandwiches, especially in a commercial setting.
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