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1.
Epidemiol Infect ; 141(3): 472-80, 2013 Mar.
Article in English | MEDLINE | ID: mdl-22595455

ABSTRACT

We investigated a possible outbreak of H. pylori in a rural Northern Plains community. In a cross-sectional survey, we randomly sampled 244 households from a geocoded emergency medical system database. We used a complex survey design and global positioning system units to locate houses and randomly selected one eligible household member to administer a questionnaire and a 13C-urea breath test for active H. pylori infection (n = 166). In weighted analyses, active H. pylori infection was detected in 55·0% of the sample. Factors associated with infection on multivariate analysis included using a public drinking-water supply [odds ratio (OR) 12·2, 95% confidence interval (CI) 2·9-50·7] and current cigarette smoking (OR 4·1, 95% CI 1·7-9·6). People who lived in houses with more rooms, a possible indicator of decreased crowding in the home, were less likely to have active H. pylori infections (OR 0·7, 95% CI 0·5-0·9 for each additional room).


Subject(s)
Disease Outbreaks , Health Surveys/methods , Helicobacter Infections/ethnology , Helicobacter pylori , Indians, North American , Rural Population/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Breath Tests , Child , Child, Preschool , Cross-Sectional Studies , Drinking Water , Female , Geographic Information Systems , Helicobacter Infections/microbiology , Humans , Male , Middle Aged , Prevalence , Sampling Studies , United States/epidemiology , Young Adult
2.
Epidemiol Infect ; 141(10): 2068-73, 2013 Oct.
Article in English | MEDLINE | ID: mdl-23228507

ABSTRACT

In 2008, nationwide investigations of a Salmonella serotype Saintpaul outbreak led first to consumer warnings for Roma and red round tomatoes, then later for jalapeño and serrano peppers. In New Mexico, where there were a large number of cases but no restaurant-based clusters, the NM Department of Health and the Indian Health Service participated with CDC in individual-level and household-level case-control studies of infections in New Mexico and the Navajo Nation. No food item was associated in the individual-level study. In the household-level study, households with an ill member were more likely to have had jalapeño peppers present during the exposure period and to have reported ever having serrano peppers in the household. This report illustrates the complexity of this investigation, the limitations of traditional individual-level case-control studies when vehicles of infection are ingredients or commonly eaten with other foods, and the added value of a household-level study.


Subject(s)
Disease Outbreaks/statistics & numerical data , Foodborne Diseases/epidemiology , Salmonella Infections/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Capsicum/microbiology , Child , Child, Preschool , Diet/statistics & numerical data , Epidemiologic Research Design , Family Characteristics , Female , Food Microbiology , Foodborne Diseases/microbiology , Humans , Infant , Solanum lycopersicum/microbiology , Male , Middle Aged , New Mexico/epidemiology , Salmonella/classification , Salmonella/isolation & purification , Salmonella Infections/microbiology
3.
Neurology ; 66(3): 439-41, 2006 Feb 14.
Article in English | MEDLINE | ID: mdl-16476950

ABSTRACT

The occurrence of Creutzfeldt-Jakob disease (CJD) among American Indians and Alaska Natives in the United States was evaluated using national multiple cause-of-death data and medical information obtained from state health departments. Twelve CJD deaths were identified for 1981 through 2002, and the average annual age-adjusted death rate was 0.47 per million population. This rate was significantly lower than that for whites and similar to the rate for African Americans.


Subject(s)
Creutzfeldt-Jakob Syndrome/mortality , Indians, North American/statistics & numerical data , Inuit/statistics & numerical data , Adult , Age Distribution , Aged , Aged, 80 and over , Alaska/epidemiology , Humans , Middle Aged , United States/epidemiology
5.
JAMA ; 286(10): 1201-5, 2001 Sep 12.
Article in English | MEDLINE | ID: mdl-11559265

ABSTRACT

CONTEXT: Until recently, methicillin-resistant Staphylococcus aureus (MRSA) infections have been acquired primarily in nosocomial settings. Four recent deaths due to MRSA infection in previously healthy children in the Midwest suggest that serious MRSA infections can be acquired in the community in rural as well as urban locations. OBJECTIVES: To document the occurrence of community-acquired MRSA infections and evaluate risk factors for community-acquired MRSA infection compared with methicillin-susceptible S aureus (MSSA) infection. DESIGN: Retrospective cohort study with medical record review. SETTING: Indian Health Service facility in a rural midwestern American Indian community. PATIENTS: Patients whose medical records indicated laboratory-confirmed S aureus infection diagnosed during 1997. MAIN OUTCOME MEASURES: Proportion of MRSA infections classified as community acquired based on standardized criteria; risk factors for community-acquired MRSA infection compared with those for community-acquired MSSA infection; and relatedness of MRSA strains, determined by pulsed-field gel electrophoresis (PFGE). RESULTS: Of 112 S aureus isolates, 62 (55%) were MRSA and 50 (45%) were MSSA. Forty-six (74%) of the 62 MRSA infections were classified as community acquired. Risk factors for community-acquired MRSA infections were not significantly different from those for community-acquired MSSA. Pulsed-field gel electrophoresis subtyping indicated that 34 (89%) of 38 community-acquired MRSA isolates were clonally related and distinct from nosocomial MRSA isolates found in the region. CONCLUSIONS: Community-acquired MRSA may have replaced community-acquired MSSA as the dominant strain in this community. Antimicrobial susceptibility patterns and PFGE subtyping support the finding that MRSA is circulating beyond nosocomial settings in this and possibly other rural US communities.


Subject(s)
Indians, North American , Methicillin Resistance , Staphylococcal Infections/epidemiology , Staphylococcus aureus/drug effects , Community-Acquired Infections/epidemiology , Electrophoresis, Gel, Pulsed-Field , Humans , Midwestern United States/epidemiology , Retrospective Studies , Risk Factors , Rural Population , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Staphylococcus aureus/genetics
6.
Clin Infect Dis ; 33(7): 990-6, 2001 Oct 01.
Article in English | MEDLINE | ID: mdl-11528570

ABSTRACT

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged among patients in the general population who do not have established risk factors for MRSA. Records from 10 Minnesota health facilities were reviewed to identify cases of MRSA infection that occurred during 1996-1998 and to identify which cases were community acquired. Susceptibility testing and pulsed-field gel electrophoresis (PFGE) subtyping were performed on available isolates. A total of 354 patients (median age, 16 years) with community-acquired MRSA (CAMRSA) infection were identified. Most case patients (299 [84%]) had skin infections, and 103 (29%) were hospitalized. More than 90% of isolates were susceptible to all antimicrobial agents tested, with the exception of beta-lactams and erythromycin. Of 334 patients treated with antimicrobial agents, 282 (84%) initially were treated with agents to which their isolates were nonsusceptible. Of 174 Minnesota isolates tested, 150 (86%) belonged to 1 PFGE clonal group. CAMRSA infections were identified throughout Minnesota; although most isolates were genetically related and susceptible to multiple antimicrobials, they were generally nonsusceptible to initial empirical therapy.


Subject(s)
Anti-Bacterial Agents/pharmacology , Methicillin Resistance , Staphylococcal Infections/epidemiology , Staphylococcus aureus , Adolescent , Adult , Aged , Bacterial Typing Techniques , Child , Child, Preschool , Community-Acquired Infections/epidemiology , Community-Acquired Infections/microbiology , Electrophoresis, Gel, Pulsed-Field , Female , Hospitals , Humans , Infant , Male , Microbial Sensitivity Tests , Middle Aged , Minnesota/epidemiology , Staphylococcal Infections/microbiology , Staphylococcus aureus/classification , Staphylococcus aureus/drug effects , Staphylococcus aureus/genetics
8.
Am J Public Health ; 91(3): 425-31, 2001 Mar.
Article in English | MEDLINE | ID: mdl-11236408

ABSTRACT

OBJECTIVES: This study sought to describe trends in hospitalizations associated with infectious diseases among American Indians and Alaska Natives. METHODS: Infectious disease hospitalizations and rates among American Indians and Alaska Natives from 1980 through 1994 were examined via Indian Health Service hospital discharge data and compared with published trends for the general US population. RESULTS: Annual hospitalization rates for infectious diseases among American Indians and Alaska Natives decreased by 31.0% between 1980 and 1994. Infectious disease hospitalizations accounted for 16.3% of all hospitalizations in 1980 and 21.2% in 1994, an increase of 30.1%. In 1994, the age-adjusted infectious disease hospitalization rate for American Indians and Alaska Natives was 1863 per 100,000 population, approximately 21% greater than that for the general US population. CONCLUSIONS: Hospitalization trends for infectious diseases show that there has been improvement in the health status of American Indians and Alaska Natives but also indicate that this population has a higher infectious disease burden than the general US population.


Subject(s)
Hospitalization/trends , Indians, North American/statistics & numerical data , Infections/epidemiology , Inuit/statistics & numerical data , Adolescent , Adult , Aged , Alaska/ethnology , Child , Child, Preschool , Female , Hospital Mortality , Humans , Infant , Length of Stay/statistics & numerical data , Male , Middle Aged , United States/epidemiology
9.
Emerg Infect Dis ; 6(3): 238-47, 2000.
Article in English | MEDLINE | ID: mdl-10827113

ABSTRACT

The 1993 U.S. hantavirus pulmonary syndrome (HPS) outbreak was attributed to environmental conditions and increased rodent populations caused by unusual weather in 1991- 92. In a case-control study to test this hypothesis, we estimated precipitation at 28 HPS and 170 control sites during the springs of 1992 and 1993 and compared it with precipitation during the previous 6 years by using rainfall patterns at 196 weather stations. We also used elevation data and Landsat Thematic Mapper satellite imagery collected the year before the outbreak to estimate HPS risk by logistic regression analysis. Rainfall at case sites was not higher during 1992-93 than in previous years. However, elevation, as well as satellite data, showed association between environmental conditions and HPS risk the following year. Repeated analysis using satellite imagery from 1995 showed substantial decrease in medium- to high-risk areas. Only one case of HPS was identified in 1996.


Subject(s)
Hantavirus Pulmonary Syndrome/epidemiology , Satellite Communications , Animals , Case-Control Studies , Disease Outbreaks , Disease Reservoirs , Humans , Image Processing, Computer-Assisted , Logistic Models , Mice , Peromyscus/virology , Rain , Risk Factors , Rodent Diseases/epidemiology , Rodent Diseases/virology , Seasons
10.
Public Health Rep ; 115(5): 469-75, 2000.
Article in English | MEDLINE | ID: mdl-11236019

ABSTRACT

OBJECTIVE: Although the state of Oklahoma has traditionally reported very high incidence rates of Rocky Mountain spotted fever (RMSF) cases, the incidence of RMSF among the American Indian population of the state has not been studied. The authors used data from several sources to estimate the incidence of RMSF among American Indians in Oklahoma. METHODS: The authors retrospectively reviewed an Indian Health Service (IHS) hospital discharge database for 1980-1996 and available medical charts from four IHS hospitals. The authors also reviewed RMSF case report forms submitted to the Centers for Disease Control and Prevention (CDC) for 1981-1996. RESULTS: The study data show that American Indians in the IHS Oklahoma City Area were hospitalized with RMSF at an annual rate of 48.2 per million population, compared with an estimated hospitalization rate of 16.9 per million Oklahoma residents. The majority of cases in the IHS database (69%) were diagnosed based on clinical suspicion rather than laboratory confirmation. The incidence of RMSF for Oklahoma American Indians as reported to the CDC was 37.4 cases per million, compared with 21.6 per million for all Oklahoma residents (RR 1.7, 95% confidence interval [CI] 1.5, 2.1). CONCLUSIONS: Rates derived from the IHS database may not be comparable to state and national rates because of differences in case inclusion criteria. However, an analysis of case report forms indicates that American Indians n Oklahoma have a significantly higher incidence of RMSF than that of the overall Oklahoma population. Oklahoma American Indians may benefit from educationa campaigns emphasizing prevention of tick bites and exposure to tick habitats.


Subject(s)
Hospitals, Federal/statistics & numerical data , Indians, North American/statistics & numerical data , Rocky Mountain Spotted Fever/epidemiology , Centers for Disease Control and Prevention, U.S. , Disease Notification , Health Education , Hospitalization/statistics & numerical data , Humans , Incidence , Medical Records , Oklahoma/epidemiology , Population Surveillance , Retrospective Studies , United States/epidemiology , United States Indian Health Service
11.
Pediatrics ; 104(5): e59, 1999 Nov.
Article in English | MEDLINE | ID: mdl-10545585

ABSTRACT

BACKGROUND: Women born in the United States after measles vaccine licensure in 1963 transfer less measles antibody to their infants than do older women. This may result in increased susceptibility to measles among infants. OBJECTIVE: To determine the effect of maternal year of birth on the risk for measles in infants. METHODS: We enrolled 128 unvaccinated infants

Subject(s)
Disease Outbreaks/statistics & numerical data , Measles/epidemiology , Age Distribution , Age Factors , Analysis of Variance , Cohort Studies , Disease Susceptibility , Female , Humans , Immunity, Maternally-Acquired , Infant , Logistic Models , Measles/immunology , Measles Vaccine/administration & dosage , New Jersey/epidemiology , Retrospective Studies , Risk Factors , Seroepidemiologic Studies , Texas/epidemiology , United States/epidemiology
12.
Emerg Infect Dis ; 5(1): 87-94, 1999.
Article in English | MEDLINE | ID: mdl-10081675

ABSTRACT

To investigate climatic, spatial, temporal, and environmental patterns associated with hantavirus pulmonary syndrome (HPS) cases in the Four Corners region, we collected exposure site data for HPS cases that occurred in 1993 to 1995. Cases clustered seasonally and temporally by biome type and geographic location, and exposure sites were most often found in pinyon-juniper woodlands, grasslands, and Great Basin desert scrub lands, at elevations of 1,800 m to 2,500 m. Environmental factors (e.g., the dramatic increase in precipitation associated with the 1992 to 1993 El Niño) may indirectly increase the risk for Sin Nombre virus exposure and therefore may be of value in designing disease prevention campaigns.


Subject(s)
Climate , Ecology , Hantavirus Pulmonary Syndrome/epidemiology , Peromyscus/virology , Animals , Hantavirus Pulmonary Syndrome/etiology , Humans , Population Density , Risk Factors , Seasons , Southwestern United States/epidemiology
14.
Arch Pediatr Adolesc Med ; 149(7): 774-8, 1995 Jul.
Article in English | MEDLINE | ID: mdl-7795768

ABSTRACT

OBJECTIVES: To describe an outbreak and to identify risk factors for mumps occurring in a highly vaccinated high school population. (Note: Highly vaccinated means a population in which more than 95% have been vaccinated.) DESIGN AND PARTICIPANTS: Survey and cohort study of 307 (97%) of 318 students. OUTCOME MEASURES: Mumps was defined as an illness with 2 or more days of parotid swelling. Serologic confirmation of infection was obtained in eight cases, seven of which were evaluated for presence of IgM antibody using immunofluorescent antibodies. Vaccination records were verified for 297 (97%) students. RESULTS: Between October 3 and November 23, 1990, clinical mumps developed in 54 students (attack rate, 18%), 53 of whom had been vaccinated. Most cases (40 [77%] of 52) occurred 12 to 20 days after a school-wide pep rally. Immunofluorescent antibody testing of all seven specimens demonstrated IgM antibody to mumps. Risk factors for clinical mumps identified in multivariate analyses included female gender (odds ratio, 3.0; 95% confidence interval, 1.6 to 5.7) and source of vaccination other than the local public health clinic (students vaccinated by private providers [odds ratio, 3.0; 95% confidence interval, 1.3 to 5.2] or in other districts [odds ratio, 2.4; 95% confidence interval, 1.1 to 5.3]). CONCLUSIONS: The overall attack rate is the highest reported to date (and to our knowledge) for a population demonstrating virtually complete mumps vaccine coverage. Even verified documentation of vaccination may not be an accurate indicator of an individual's protection against mumps. Vaccination failure may play an important role in contemporary mumps outbreaks. We found no evidence to indicate that waning immunity (secondary vaccine failure) contributed significantly to this outbreak. A second dose of mumps vaccine, as recommended using measles-mumps-rubella vaccine, could potentially prevent similar outbreaks in secondary school populations in the future.


Subject(s)
Disease Outbreaks , Mumps Vaccine/therapeutic use , Mumps/epidemiology , Adolescent , Cohort Studies , Female , Humans , Male , Multivariate Analysis , Mumps/prevention & control , Risk Factors , Schools , Texas/epidemiology , Treatment Failure
15.
Teratology ; 51(5): 311-7, 1995 May.
Article in English | MEDLINE | ID: mdl-7482352

ABSTRACT

The role of folic acid in the primary prevention of neural tube defects (NTDs) is well established. However, questions related to the protective mechanism remain unanswered. To help answer these questions, we designed a case-control study to assess the role of folate- and cobalamin-related metabolites in the pathogenesis of NTDs. Concentrations of folate, cobalamin, and 14 other related metabolites were measured by gas chromatography/mass spectrometry in midtrimester serum specimens from 32 women with an NTD-affected pregnancy and from 132 control women, and in serum specimens from 46 nonpregnant women who had a history of NTD-affected pregnancy and from 43 nonpregnant control women. Log-transformed means of metabolites were compared between case and control women for both the midtrimester and nonpregnant groups. In the pregnant group, serum methylmalonic acid (MMA) concentrations were higher among case women than among control women (130 vs 105 nM). There was a strong dose-response relationship between midtrimester serum MMA level and the risk for an NTD-affected pregnancy, with the relative risk increasing 13-fold for women with MMA levels > 90th percentile. In the nonpregnant group, there was no difference in serum MMA levels between case and control women (140 vs 140 nM). Thus, the serum MMA levels of women in the midtrimester of pregnancies unaffected by NTDs were significantly lower than the levels of nonpregnant women, whereas the levels of women whose pregnancies were affected by NTDs were similar to those of nonpregnant women. The finding of elevated MMA serum concentrations among women in the midtrimester of NTD-affected pregnancies suggests that cobalamin may be involved in the etiology of NTDs. The possible role of cobalamin in relation to the protective effect of folic acid needs further evaluation.


Subject(s)
Methylmalonic Acid/blood , Neural Tube Defects/etiology , Adult , Case-Control Studies , Female , Folic Acid/blood , Gas Chromatography-Mass Spectrometry , Humans , Middle Aged , Odds Ratio , Pregnancy , Pregnancy Trimester, Second , Risk Factors , Vitamin B 12/blood
16.
J Infect Dis ; 171(4): 864-70, 1995 Apr.
Article in English | MEDLINE | ID: mdl-7706812

ABSTRACT

In May 1993, an outbreak of hantavirus pulmonary syndrome (HPS) occurred in the southwestern United States. A case-control study determined risk factors for HPS. Seventeen case-patients were compared with 3 groups of controls: members of case-patient households (household controls), members of neighboring households (near controls), and members of randomly selected households > or = 24 km away (far controls). Investigators trapped more small rodents at case households than at near (P = .03) or far control households (P = .02). After the number of small rodents was controlled for, case-patients were more likely than household controls to hand plow (odds ratio [OR], 12.3; 95% confidence interval [CI], 1.1-143.0) or to clean feed storage areas (OR, 33.4; 95% CI, 1.7-666.0). Case-patients were more likely than near controls to plant (OR, 6.2; 95% CI, 1.1-34.0) and more likely than far controls to clean animal sheds (OR, 11.9; 95% CI, 1.4-103.0). Peridomestic cleaning, agricultural activities, and an increased number of small rodents at the household were associated with HPS.


Subject(s)
Disease Outbreaks , Hantavirus Pulmonary Syndrome/epidemiology , Adolescent , Adult , Aged , Agriculture , Animals , Case-Control Studies , Female , Hantavirus Pulmonary Syndrome/etiology , Humans , Male , Middle Aged , Occupations , Risk Factors , Rodentia/virology , Southwestern United States/epidemiology
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