Bat rabies in Washington State: Temporal-spatial trends and risk factors for zoonotic transmission (2000-2017).

BACKGROUND: Rabies is a zoonotic viral disease that can affect all mammals. In the United States, the majority of human rabies cases are caused by bats, which are the only known reservoirs for rabies virus (RABV) in Washington State. We sought to characterize bat RABV epidemiology in Washington among bats submitted by the public for RABV testing. METHODS: We examined temporal and spatial trends in RABV positivity (% positive) for taxonomically identified bats submitted to diagnostic laboratories during 2006-2017. For a subset of Myotis species, we evaluated sensitivity and predictive value positive (PPV) of morphological identification keys, using mitochondrial markers (cytochrome b) as a reference. For bats tested during 2000-2016, we analyzed RABV positivity by circumstances of encounters with humans, cats, and dogs. RESULTS: During 2006-2017, RABV positivity for all bat species was 6.0% (176/2,928). Among species with ≥100 submissions, RABV positivity was 2.0%-11.7% and highest among big brown bats (Eptesicus fuscus). An increasing trend in annual positivity was significant only for big brown bats (P = 0.02), and was circumstantially linked to a geographic cluster. Sensitivity and PPV of morphological identification keys was high for M. evotis but varied for M. lucifugus, M. californicus, M. yumanensis, and M. septentrionalis. A positive RABV result was significantly associated with nonsynanthropic species, abnormal behavior, abnormal hiding, injury, biting, found in a body of water, found alive, found outdoors, and caught by a dog. CONCLUSION: Monitoring passive RABV surveillance trends enables public health authorities to perform more accurate risk assessments. Differences in temporal and spatial trends in RABV positivity by bat species indicate the importance of collecting taxonomic data, although morphological identification can be unreliable for certain Myotis species. Current public health practices for RABV exposures should be maintained as RABV infection in bats can never be excluded without diagnostic testing.

Human Papillomavirus Vaccination in Washington State: Estimated Coverage and Missed Opportunities, 2006-2013.

OBJECTIVE: Human papillomavirus (HPV) causes almost all cervical cancer in women and contributes to vaginal, anal, oropharyngeal, and penile cancer morbidity and mortality. Although vaccines effective in preventing up to nine types of HPV are available, vaccination rates are low nationally. We assessed HPV vaccination coverage by age, sex, and county using Washington State Immunization Information System data. METHODS: We calculated on-time dose coverage by county and statewide among adolescents aged 11-12 years and assessed coverage by age 18 years. We calculated missed opportunities as the number of visits at which doses of other adolescent vaccines were administered without administration of the first dose of HPV vaccine (HPV1). RESULTS: In 2013, HPV vaccination coverage estimates with one, two, and three doses (HPV1-3) for adolescents aged 11-12 years were 48.5%, 32.4%, and 18.3% among girls and 31.2%, 17.1%, and 8.1% among boys. The three-dose HPV vaccine coverage estimate increased to 40.1% among girls by age 18 but was unchanged for boys. Coverage estimates varied by age, sex, and county. One-third of eligible unvaccinated girls and two of five eligible boys aged 11-17 years had at least one missed opportunity to receive HPV1. CONCLUSION: Despite a recommendation to vaccinate adolescents aged 11-12 years, HPV vaccination is often delayed and coverage levels among all age groups are below national target levels. Improved understanding of the variability of HPV vaccination coverage rates by age, sex, and county can inform targeted interventions statewide.

Use of Death Records to Augment Notifiable Conditions Reporting in Washington State.

CONTEXT: Health care providers are required to report newly diagnosed notifiable conditions including the case's vital status according to state regulations, but it is uncertain how many cases remain unreported. Death certificates could potentially serve as a data source for detecting unreported deaths due to notifiable conditions. OBJECTIVE: We sought to evaluate the usefulness of electronic death records to augment notifiable conditions reporting in Washington State. DESIGN: Cross-sectional study. SETTING: All residents of Washington State. PARTICIPANTS: Decedents from 2010-2012. MAIN OUTCOME MEASURES: Total number of fatal cases of acute infectious notifiable conditions in Washington residents estimated by capture-recapture analysis, proportion of estimated fatal cases reported to Washington's notifiable conditions database (Public Health Issue Management System [PHIMS]), and the proportion of estimated fatal cases identified solely from the death records. Information was obtained by searching multiple cause-of death fields on 2010-2012 death records for keywords for acute infectious notifiable conditions. RESULTS: Capture-recapture analysis estimated 317 fatal cases of these conditions could be expected over the 3 years studied (95% CI: 276,358). Public Health Issue Management System alone identified 38% of total estimated cases; using PHIMS and death record data increased identification to 71%. Electronic filing of death records was very timely, with a median of 4 days to visibility. Death record data were highly complete. CONCLUSIONS: Use of death records will augment the notifiable condition reporting system and potentially improve mortality estimates and disease control.

Valley fever: finding new places for an old disease: Coccidioides immitis found in Washington State soil associated with recent human infection.

We used real-time polymerase chain reaction and culture to demonstrate persistent colonization of soils by Coccidioides immitis, an agent of valley fever, in Washington State linked to recent human infections and located outside the endemic range. Whole-genome sequencing confirmed genetic identity between isolates from soil and one of the case-patients.

Coccidioides immitis identified in soil outside of its known range - Washington, 2013.

Coccidioidomycosis ("valley fever") is caused by inhaling spores of the soil-dwelling fungi Coccidioides immitis or Coccidioides posadasii. Most infections are subclinical. When clinical manifestations do occur (typically 1-4 weeks after exposure), they are similar to those associated with influenza or community-acquired pneumonia. Disseminated disease is rare. Residual pulmonary nodules can lead to chronic lung disease. Fluconazole or other triazoles often are used for treatment, but mild cases often resolve without specific therapy. A total of 17,802 cases were reported in the United States in 2012.

Coccidioidomycosis acquired in Washington State.

Clinical, laboratory, and epidemiologic evidence suggest that 3 individuals with acute coccidioidomycosis were exposed in Washington State, significantly beyond previously identified endemic areas. Given the patients' lack of recent travel, coccidioidomycosis was not suspected, leading to delays in diagnosis and appropriate therapy. Clinicians should be aware of this possibility and consider the diagnosis.

Acute neuromuscular weakness in a boy with a facial abscess contaminated with Clostridium botulinum.

Wound botulism arising from skin and soft tissue infection is rare in children, most cases being reported in adult intravenous drug users. Cranial nerve palsies are the primary presenting sign, followed by descending neuromuscular weakness. Diagnosis relies on isolation of either toxigenic Clostridium botulinum species or toxin from wound or blood samples. We present an unusual case of wound botulism in a pediatric patient with the intent to inform the reader and improve the time to diagnosis in such cases.

Epidemiology competency development and application to training for local and regional public health practitioners.

In 2002, the Northwest Center for Public Health Practice (NWCPHP) at the University of Washington initiated the Epidemiology Competencies Project, with the goal of developing competency-based epidemiology training for non-epidemiologist public health practitioners in the northwestern United States. An advisory committee consisting of epidemiology faculty and experienced public health practitioners developed the epidemiology competencies. NWCPHP used the competencies to guide the development of in-person trainings, a series of online epidemiology modules, and a Web-based repository of epidemiology teaching materials. The epidemiology competencies provided a framework for collaborative work between NWCPHP and local and regional public health partners to develop trainings that best met the needs of a particular public health organization. Evaluation surveys indicated a high level of satisfaction with the online epidemiology modules developed from the epidemiology competencies. However, measuring the effectiveness of competency-based epidemiology training for expanding epidemiology knowledge and skills of the public health workforce remains a challenge.

Multistate shigellosis outbreak and commercially prepared food, United States.

In 2000, shigellosis traced to a commercially prepared dip developed in 406 persons nationwide. An ill employee may have inadvertently contaminated processing equipment. This outbreak demonstrates the vulnerability of the food supply and how infectious organisms can rapidly disseminate through point-source contamination of a widely distributed food item.

Verotoxigenic Escherichia coli Infection: U.S. Overview †.

Escherichia coli O157:H7 remains a public health problem in the United States despite a dramatic increase in the awareness of, and concern about, foodborne infections since the 1993 multistate E. coli O157:H7 epidemic. Although surveillance data can be difficult to interpret, the incidence of endemic disease caused by this organism is probably not increasing, and might be decreasing, at least in selected populations. With increased recognition of E. coli O157:H7 infection has come the investigation of increasing number of outbreaks, leading to the recognition of many "new" vehicles, including some foods not traditionally associated with enteric infections, such as dry-cured salami and lettuce. Molecular fingerprinting techniques are being used to track the transmission of E. coli O157:H7 through human populations. Analysis of DNA encoding virulence factors and surface antigens suggests that diarrheagenic E. coli have evolved by acquiring large DNA fragments, with subsequent chromosomal recombination. Some Shiga toxin-producing E. coli other than E. coli O157:H7 are no doubt pathogens, but the majority of these toxigenic strains found in food are probably not virulent. More research is needed to define the characteristics that render selected Shiga toxin-producing organisms harmful to humans.