Population survey of attitudes and beliefs regarding organic, genetically modified, and irradiated foods.

BACKGROUND: Sales of organic foods are increasing due to public demand, while genetically modified (GM) and irradiated foods are often viewed with suspicion. AIM: The aim of this research was to examine consumer attitudes toward organic, GM and irradiated foods to direct educational efforts regarding their consumption Methods: A telephone survey of 1838 residents in Tennessee, USA was conducted regarding organic, GM, and irradiated foods. RESULTS: Approximately half of respondents (50.4%) purchased organic food during the previous 6 months ('consumers'). The most common beliefs about organic foods by consumers were higher cost (92%), and fewer pesticides (89%). Consumers were more likely than non-consumers to believe organic food tasted better (prevalence ratio 3.6; 95% confidence interval 3.02-4.23). A minority of respondents were familiar with GM foods (33%) and irradiated foods (22%). CONCLUSION: Organic food consumption is common in Tennessee, but knowledge about GM and irradiated foods is less common. Consumer health education should emphasize the benefits of these food options, and the safety of GM and irradiated foods.

Active Bacterial Core Surveillance for Legionellosis - United States, 2011-2013.

During 2000­2011, passive surveillance for legionellosis in the United States demonstrated a 249% increase in crude incidence, although little was known about the clinical course and method of diagnosis. In 2011, a system of active, population-based surveillance for legionellosis was instituted through CDC's Active Bacterial Core surveillance (ABCs) program. Overall disease rates were similar in both the passive and active systems, but more complete demographic information and additional clinical and laboratory data were only available from ABCs. ABCs data during 2011­2013 showed that approximately 44% of patients with legionellosis required intensive care, and 9% died. Disease incidence was higher among blacks than whites and was 10 times higher in New York than California. Laboratory data indicated a reliance on urinary antigen testing, which only detects Legionella pneumophila serogroup 1 (Lp1). ABCs data highlight the severity of the disease, the need to better understand racial and regional differences, and the need for better diagnostic testing to detect infections.

Inadequacy of IgM antibody tests for diagnosis of Rocky Mountain Spotted Fever.

Among 13 suspected Rocky Mountain spotted fever (RMSF) cases identified through an enhanced surveillance program in Tennessee, antibodies to Rickettsia rickettsii were detected in 10 (77%) patients using a standard indirect immunofluorescent antibody (IFA) assay. Immunoglobulin M (IgM) antibodies were observed for 6 of 13 patients (46%) without a corresponding development of IgG, and for 3 of 10 patients (30%) at least 1 year post-onset. However, recent infection with a spotted fever group rickettsiae could not be confirmed for any patient, based on a lack of rising antibody titers in properly timed acute and convalescent serologic specimens, and negative findings by polymerase chain reaction testing. Case definitions used in national surveillance programs lack specificity and may capture cases that do not represent current rickettsial infections. Use of IgM antibodies should be reconsidered as a basis for diagnosis and public health reporting of RMSF and other spotted fever group rickettsiae in the United States.

On-site availability of Legionella testing in acute care hospitals, United States.

We surveyed 399 US acute care hospitals regarding availability of on-site Legionella testing; 300 (75.2%) did not offer Legionella testing on site. Availability varied according to hospital size and geographic location. On-site access to testing may improve detection of Legionnaires disease and inform patient management and prevention efforts.

Environmental investigation following the first human case of babesiosis in Tennessee.

Babesiosis is an emerging tick-borne zoonotic disease in the United States caused by Babesia parasites. In 2009, the first case of babesiosis was documented in Tennessee. Environmental investigation at the reported site of tick exposure included collection of ticks and specimens from eastern cottontail rabbits (Sylvilagus floridanus) and white-tailed deer ( Odocoileus virginianus ) that were tested for piroplasms by molecular and serologic methods. One hundred and sixty-six Ixodes scapularis ticks and biological samples from 8 rabbits and 5 deer were collected. Ixodes scapularis were PCR positive for Babesia odocoilei (n = 7, 4%) and Theileria cervi (n = 24, 14%). Deer were seropositive for B. odocoilei and PCR positive for T. cervi. Rabbits were seropositive for B. odocoilei and Babesia sp. MO1, and 1 rabbit was PCR positive for Babesia sp. MO1. In summary, zoonotic Babesia sp. MO1 infection in rabbits is reported here for the first time in Tennessee as well as infection of deer and I. scapularis ticks with 2 other piroplasms of veterinary importance.

Food worker experiences with and beliefs about working while ill.

Transmission of foodborne pathogens from ill food workers to diners in restaurants is an important cause of foodborne illness outbreaks. The U.S. Food and Drug Administration recommends that food workers with vomiting or diarrhea (symptoms of foodborne illness) be excluded from work. To understand the experiences and characteristics of workers who work while ill, workplace interviews were conducted with 491 food workers from 391 randomly selected restaurants in nine states that participated in the Environmental Health Specialists Network of the Centers for Disease Control and Prevention. Almost 60% of workers recalled working while ill at some time. Twenty percent of workers said that they had worked while ill with vomiting or diarrhea for at least one shift in the previous year. Factors significantly related to workers having said that they had worked while ill with vomiting or diarrhea were worker sex, job responsibilities, years of work experience, concerns about leaving coworkers short staffed, and concerns about job loss. These findings suggest that the decision to work while ill with vomiting or diarrhea is complex and multifactorial.

Knowledge, attitudes, and practices regarding Rocky Mountain spotted fever among healthcare providers, Tennessee, 2009.

Tennessee has a high incidence of Rocky Mountain spotted fever (RMSF), the most severe tick-borne rickettsial illness in the United States. Some regions in Tennessee have reported increased illness severity and death. Healthcare providers in all regions of Tennessee were surveyed to assess knowledge, attitudes, and perceptions regarding RMSF. Providers were sent a questionnaire regarding knowledge of treatment, diagnosis, and public health reporting awareness. Responses were compared by region of practice within the state, specialty, and degree. A high proportion of respondents were unaware that doxycycline is the treatment of choice in children ≤ 8 years of age. Physicians practicing in emergency medicine, internal medicine, and family medicine; and nurse practitioners, physician assistants, and providers practicing for < 20 years demonstrated less knowledge regarding RMSF. The gaps in knowledge identified between specialties, designations, and years of experience can help target education regarding RMSF.

Rabies epidemiology, risk assessment, and pre- and post exposure vaccination.

Rabies should always be considered in the differential diagnosis of a neurologic disease in a mammal with an unknown vaccination status. Public health veterinarians are available to assist in risk assessment as well as coordination of animal testing. This article discusses the pathogenesis of rabies and clinical presentation in several domestic species. Prevention, North American prevalence and distribution, exposure considerations, and post-exposure prophylaxis are also discussed. Veterinarians in private practice have an integral role in protection of people and domestic animals against rabies.

Factors associated with food workers working while experiencing vomiting or diarrhea.

This study sought to determine the frequency with which food workers said they had worked while experiencing vomiting or diarrhea, and to identify restaurant and worker characteristics associated with this behavior. We conducted interviews with food workers (n=491) and their managers (n=387) in the nine states that participate in the Centers for Disease Control and Prevention's Environmental Health Specialists Network. Restaurant and worker characteristics associated with repeatedly working while experiencing vomiting or diarrhea were analyzed via multivariable regression. Fifty-eight (11.9%) workers said they had worked while suffering vomiting or diarrhea on two or more shifts in the previous year. Factors associated with workers having worked while experiencing vomiting or diarrhea were (i) high volume of meals served, (ii) lack of policies requiring workers to report illness to managers, (iii) lack of on-call workers, (iv) lack of manager experience, and (v) workers of the male gender. Our findings suggest that policies that encourage workers to tell managers when they are ill and that help mitigate pressures to work while ill could reduce the number of food workers who work while experiencing vomiting or diarrhea.

Producer attitudes and practices related to antimicrobial use in beef cattle in Tennessee.

OBJECTIVE: To evaluate knowledge, attitudes, and management practices involving antimicrobial use among Tennessee beef producers. DESIGN: Mail survey. SAMPLE POPULATION: A population-based, stratified random sample of 3,000 beef producers across the state. PROCEDURES: Questionnaires were mailed to beef producers. Questions focused on producer practices related to education, biosecurity, veterinary use, and the purchase and use of antimicrobials. Operation types were categorized as either cow-calf only or multiple operation type (MOT). Associations between various factors and antimicrobial use were evaluated by use of multivariable logistic regression, with the outcome variable being any antimicrobial use (injectable or by mouth) in the past year. RESULTS: Of 3,000 questionnaires mailed, 1,042 (34.7%) were returned. A significantly higher proportion of producers with MOTs reported giving antimicrobials by mouth or by injection than did producers with cow-calf only operations. In addition, higher proportions of producers with MOTs than producers with cow-calf only operations reported treating with macrolides, florfenicol, ceftiofur, and aminoglycosides. In the multivariable analysis, herd size>50 cattle, participation in Beef Quality Assurance or master beef producer certification programs, quarantining of newly purchased animals, use of written instructions for treating disease, and observation of withdrawal times were associated with a higher likelihood of antimicrobial use. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that producers who engaged in more progressive farming practices were also more likely to use antimicrobials. Incorporating training on judicious antimicrobial use into educational programs would likely increase awareness of best management practices regarding antimicrobial use.

Waterborne outbreak of Salmonella I 4,[5],12:i:-.

Salmonella I 4,[5],12:i:- is an emerging serotype, and little information regarding attribution or risk factors for infection has been documented. We investigated an outbreak of Salmonella I 4,[5],12:i:- infections in a rural community and identified the community's private water system as the source of infection. Five people were ill with gastroenteritis. Water testing identified Salmonella. Contamination of the unprotected spring from an environmental source was suspected.

Factors associated with Trypanosoma cruzi exposure among domestic canines in Tennessee.

Trypanosoma cruzi , the etiologic agent of Chagas' disease, is enzootic in animal populations of the southeastern United States. In the United States, T. cruzi prevalence has been reported for over 20 different wildlife species, and 7 autochthonous human cases have been documented since 1955. Previous canine (Canis familiaris) serosurveys have been limited either by small sample size or confined geographic reporting areas. In this study, we report a seroprevalence of 6.4% among 860 canines from 31 counties and 5 ecoregions throughout Tennessee, using an indirect immunofluorescent assay (IFA). Statistically significant associations between seropositivity and age, weight, and outdoor living were noted. Differences in seropositivity were not seen based on American Kennel Club (AKC) group, sex, habitat, land cover, and ecoregion. Greater attention should be given to possible T. cruzi transmission in Tennessee and veterinarians should consider Chagas' disease as a differential diagnosis with compatible signs.

Methicillin-resistant Staphylococcus aureus and skin infections among personnel at a pediatric clinic.

Ambulatory care visits for methicillin-resistant Staphylococcus aureus (MRSA) infections are increasing dramatically. We investigated a pediatric clinic worker's death caused by MRSA. Among 45 clinic personnel, 16 reported recent skin infections, and 4% were colonized with MRSA. Among 262 patients, 3.4% were colonized with MRSA. Standard precautions were inconsistently applied when treating skin infections. Eight (11%) of 71 environmental swipes contained S aureus. Health care workers in outpatient settings are increasingly exposed to substantial numbers of persons with MRSA, and infection control practices in the ambulatory care setting deserve reemphasis.

Trends in healthcare usage attributable to diarrhea, 1995-2004.

OBJECTIVE: To determine current diarrhea-associated healthcare usage rates and associated sociodemographic factors. These data can be used to determine the impact of the rotavirus vaccine. STUDY DESIGN: Using discharge diagnosis codes, we determined diarrhea-associated visit rates for children aged 0 to 18 years enrolled in Tennessee Medicaid, 1995-2004. Poisson regression compared data across time and within strata. The winter residual excess method estimated the rotavirus burden. RESULTS: Analyzing approximately 500 000 person-years annually, outpatient and hospitalization rates remained stable from 1995 to 2004; emergency department (ED) rates approximately doubled, incidence rate ratio (IRR): 1.92 (1.81-2.04). White children used healthcare at greater rates than black children: outpatient IRR 1.90: (1.85-1.95), ED IRR: 1.69 (1.64-1.74), and inpatient IRR: 1.82 (1.73-1.92); and rural children greater than urban: outpatient IRR 1.66 (1.62-1.70), ED IRR 1.14 (1.11-1.17), inpatient IRR 1.88 (1.80-1.97). Children aged 0 to 35 months experienced 1627 outpatient and 792 ED visits, and 148 hospitalizations per 10 000 child-years; rotavirus may have affected up to 40% of these hospitalizations. CONCLUSIONS: Diarrhea-associated ED visit rates nearly doubled from 1995 to 2004. Future studies could explore factors resulting in increased healthcare usage by white children and those living in rural areas and document the rotavirus vaccine's impact after its release.

Stool cultures and antimicrobial prescriptions related to infectious diarrhea.

Stool cultures can be important in guiding antimicrobial therapy for diarrhea. From among 11.64 million person-years of Tennessee Medicaid enrollment data collected from 1995 through 2004, 315,828 diarrheal episodes were identified. Stool cultures were performed for only 15,820 episodes (5.0%). Antimicrobials were prescribed for 32,949 episodes (10.4%), 89.4% of which were not accompanied by a stool culture. White race and urban residence were associated with higher rates of stool culture. Frequent use of antimicrobials for diarrhea without stool culture may indicate inappropriate antimicrobial use and has critical implications for public health.

Mass distribution of free, intranasally administered influenza vaccine in a public school system.

OBJECTIVE: School-based influenza vaccination programs are a potentially important method of protecting the community against influenza. We evaluated the feasibility and success of a large, school-based influenza vaccination campaign. METHODS: On-site administration of intranasally administered, live attenuated influenza vaccine was offered to all students and staff members in a large, metropolitan public school system in October to December 2005. We evaluated vaccine coverage levels, resources expended, and physician and parent attitudes and knowledge. RESULTS: Of 53,420 public school students, 24,198 were vaccinated with live attenuated influenza vaccine. Of 5841 school staff members, 3626 were vaccinated with live attenuated influenza vaccine or inactivated influenza vaccine. The proportions of students vaccinated were 56% among elementary schools, 45% among middle schools, and 30% among high schools. Schools with larger proportions of black or low-income families had lower vaccine coverage levels. The health department and school system expended 6900 person-hours during the campaign, and various health department clinics were closed for a total of 84 half-days. Community physicians were supportive of the campaign and frequently advised participation for eligible patients. Some physicians had misunderstandings about live attenuated influenza vaccine contraindications. Concern about adverse effects, having asthma, negative physician advice, and nonparticipation in any vaccination program were common reasons for students not participating. CONCLUSIONS: This influenza vaccination campaign in a large public school system achieved relatively high vaccine coverage levels but required a substantial resource commitment from the local health department. This evaluation has critical implications for the ongoing debate regarding immunization policies for school-aged children and preparedness plans for pandemic influenza.