The burden of foodborne disease is not well defined in many countries or regions or on a global level. The World Health Organization (WHO), in conjunction with other national public health agencies, is coordinating a number of international activities designed to assist countries in the strengthening of disease surveillance and to determine the burden of acute gastroenteritis. These data can then be used to estimate the following situations: (1) the burden associated with acute gastroenteritis of foodborne origin, (2) the burden caused by specific pathogens commonly transmitted by food, and (3) the burden caused by specific foods or food groups. Many of the scientists collaborating with the WHO on these activities have been involved in quantifying the burden of acute gastroenteritis on a national basis. This article reviews these key national studies and the international efforts that are providing the necessary information and technical resources to derive national, regional, and global burden of disease estimates.

Many studies have evaluated the role of Cryptosporidium spp. in outbreaks of enteric illness, but few studies have evaluated sporadic cryptosporidiosis in the United States. To assess the risk factors for sporadic cryptosporidiosis among immunocompetent persons, a matched case-control study was conducted in seven sites of the Foodborne Diseases Active Surveillance Network (FoodNet) involving 282 persons with laboratoryidentified cryptosporidiosis and 490 age-matched and geographically matched controls. Risk factors included international travel (odds ratio [OR] ‫؍‬ 7.7; 95% confidence interval [95% CI] ‫؍‬ 2.7 to 22.0), contact with cattle (OR ‫؍‬ 3.5; 95% CI ‫؍‬ 1.8 to 6.8), contact with persons >2 to 11 years of age with diarrhea (OR ‫؍‬ 3.0; 95% CI ‫؍‬ 1.5 to 6.2), and freshwater swimming (OR ‫؍‬ 1.9; 95% CI ‫؍‬ 1.049 to 3.5). Eating raw vegetables was protective (OR ‫؍‬ 0.5; 95% CI ‫؍‬ 0.3 to 0.7). This study underscores the need for ongoing public health education to prevent cryptosporidiosis, particularly among travelers, animal handlers, child caregivers, and swimmers, and the need for further assessment of the role of raw vegetables in cryptosporidiosis.

SCHERICHIA COLI O157, SUCH AS E coli O157:H7, causes approximately 70000 illnesses and 60 deaths annually in the United States. 1 Illness is often characterized by severe bloody diarrhea; renal failure from hemolytic-uremic syndrome (HUS) may occur in 3% to 7% of cases. 2 Healthy cattle are believed to be the most important reservoir of E coli O157. 2 Humans usually become infected from contaminated food or water or from contact with infected animals, infected humans, or either's excreta. 3,4 Because E coli O157 has a low infectious dose and can survive in the environment, environmental contamination with E coli O157 may be an important public health problem. 5,6 Outbreaks have been linked to contamination of surfaces regularly touched by animals, such as the soil of pastures or railings in petting zoos. 7-9 County fairs are popular throughout the United States. 10 Because fairs bring animals and humans into close contact, they are increasingly recognized as a setting for E coli O157 outbreaks. 11 Such outbreaks often affect multiple communities because fairs attract large numbers of individuals, particularly children, and person-toperson transmission may occur after a fair has ended. We describe an investigation of a fair-associated E coli O157 outbreak in which epidemiological and microbiological studies document that infections can be Author Affiliations are listed at the end of this article.

Background: Reproductive coercion (RC), which includes contraceptive sabotage and pregnancy coercion, may help explain known associations between intimate partner violence (IPV) and poor reproductive health outcomes, such as unintended pregnancy. In Kenya, where 40% of ever-married women report IPV and 35% of ever-pregnant women report unintended pregnancy, these experiences are pervasive and co-occurring, yet little research exists on RC experiences among women and adolescent girls. This study seeks to qualitatively describe women's and girls' experiences of RC in Nairobi, Kenya and opportunities for clinical intervention. Methods: Qualitative data were collected as part of the formative research for the adaptation of an evidence-based intervention to address reproductive coercion and IPV in clinical family planning counselling and provision in Nairobi, Kenya in April 2017. Focus group discussions (n = 4, 30 total participants) and in-depth interviews (n = 10) with family planning clients (ages 15-49) were conducted to identify specific forms of reproductive coercion, other partner-specific barriers to successful contraception use, and perceived opportunities for family planning providers to address RC among women and girls seeking family planning services. Additionally, data were collected via semistructured interviews with family planning providers (n = 8) and clinic managers (n = 3) from family planning clinics. Data were coded according to structural and emergent themes, summarized, and illustrative quotes were identified to demonstrate sub-themes. Kenyan family planning providers and administrators informed interpretation. Results: The results of this study identified specific forms of pregnancy coercion and contraceptive sabotage to be common, and often severe, impeding the use of contraceptives among female family planning clients. This study offers important examples of women's strategies for preventing pregnancy despite experiencing reproductive coercion, as well as opportunities for family planning providers to support clients experiencing reproductive coercion in clinical settings.