Three separate outbreaks of salmonellosis in 2006 were traced back to three individual hatcheries in different states. Each hatchery was identified as the source of Salmonella infections in people who had contact with baby poultry, such as chicks and ducklings, purchased from agricultural feed stores that received birds from the hatcheries. Contact with baby poultry from these hatcheries puts people, especially children and immunocompromised individuals, at risk of salmonellosis. Improved education and preventative measures are needed at hatcheries and feed stores to reduce salmonellosis transmission from baby poultry to humans.
This investigation implicated raw flour as a source of an outbreak of STEC infections. Although it is low-moisture food, raw flour can be a vehicle of foodborne pathogens
PA 513 Lisa Lasker Policy and Evaluation FinalLisa Lasker
The document proposes repealing the 1986 National Childhood Vaccine Injury Act and restructuring the childhood vaccine schedule. This would reduce healthcare costs, return liability to vaccine manufacturers, and increase GDP by improving population health and productivity. Mandating vaccination violates personal rights to refuse medical procedures. Recent evidence suggests current vaccine policies may be harming public health by overloading infants' immune systems and contributing to increased rates of autism and other neurological disorders. Further study of vaccine safety is needed, especially the potential long-term health impacts of ingredients like aluminum and mercury adjuvants.
The document summarizes information about human granulocytic anaplasmosis (HGA), which is caused by the rickettsia Anaplasma phagocytophilum transmitted by ticks. It is an emerging zoonotic disease reported in over 5,000 cases worldwide. Symptoms of HGA include fever, headache, myalgia and patients can experience complications like pneumonia, respiratory failure, and meningitis/encephalitis. Diagnosis involves identifying the morulae in neutrophils on blood smears or through PCR/serology tests. Treatment involves doxycycline which is generally effective.
Jay Cross, a 63-year-old man with a history of heart attacks and other health issues, pays $999 to have his genome sequenced by 23andMe. He is curious about whether his health problems are due to genetics or lifestyle. The results show he has a 20% lower risk of heart attack than average but provide little other useful information. Critics argue direct-to-consumer genetic testing currently offers limited health value given the complexity of gene-disease relationships and lack of expert guidance on interpreting results. As the science progresses, genetic testing may one day provide clearer insights but also raises concerns about overreaction to risk information.
This document summarizes research investigating the source of Liberia's second Ebola virus disease flare-up in June-July 2015. Genomic sequencing revealed that the viruses causing this flare-up were nearly identical to each other and formed a distinct cluster within the Liberian outbreak lineage. Epidemiological evidence linked the flare-up to a previous Ebola virus disease cluster in nearby Barclay Farm in August-September 2014. Two virus genomes from deceased individuals in the earlier cluster differed by only one mutation from viruses in the 2015 flare-up, suggesting this second flare-up originated from reemergence of the virus from a persistently infected person rather than a new introduction.
This review paper analyzes studies on valganciclovir and ganciclovir as treatments for cytomegalovirus (CMV) infection. The paper compares variables across three studies, including treatment length, dosage, sample size, and effectiveness. It finds that valganciclovir is generally the most effective treatment, and that combining oral valganciclovir with intravenous ganciclovir yields the best results. Longer treatment regimens also lead to better outcomes. The review concludes that valganciclovir is the best available preventive treatment for CMV.
This investigation implicated raw flour as a source of an outbreak of STEC infections. Although it is low-moisture food, raw flour can be a vehicle of foodborne pathogens
PA 513 Lisa Lasker Policy and Evaluation FinalLisa Lasker
The document proposes repealing the 1986 National Childhood Vaccine Injury Act and restructuring the childhood vaccine schedule. This would reduce healthcare costs, return liability to vaccine manufacturers, and increase GDP by improving population health and productivity. Mandating vaccination violates personal rights to refuse medical procedures. Recent evidence suggests current vaccine policies may be harming public health by overloading infants' immune systems and contributing to increased rates of autism and other neurological disorders. Further study of vaccine safety is needed, especially the potential long-term health impacts of ingredients like aluminum and mercury adjuvants.
The document summarizes information about human granulocytic anaplasmosis (HGA), which is caused by the rickettsia Anaplasma phagocytophilum transmitted by ticks. It is an emerging zoonotic disease reported in over 5,000 cases worldwide. Symptoms of HGA include fever, headache, myalgia and patients can experience complications like pneumonia, respiratory failure, and meningitis/encephalitis. Diagnosis involves identifying the morulae in neutrophils on blood smears or through PCR/serology tests. Treatment involves doxycycline which is generally effective.
Jay Cross, a 63-year-old man with a history of heart attacks and other health issues, pays $999 to have his genome sequenced by 23andMe. He is curious about whether his health problems are due to genetics or lifestyle. The results show he has a 20% lower risk of heart attack than average but provide little other useful information. Critics argue direct-to-consumer genetic testing currently offers limited health value given the complexity of gene-disease relationships and lack of expert guidance on interpreting results. As the science progresses, genetic testing may one day provide clearer insights but also raises concerns about overreaction to risk information.
This document summarizes research investigating the source of Liberia's second Ebola virus disease flare-up in June-July 2015. Genomic sequencing revealed that the viruses causing this flare-up were nearly identical to each other and formed a distinct cluster within the Liberian outbreak lineage. Epidemiological evidence linked the flare-up to a previous Ebola virus disease cluster in nearby Barclay Farm in August-September 2014. Two virus genomes from deceased individuals in the earlier cluster differed by only one mutation from viruses in the 2015 flare-up, suggesting this second flare-up originated from reemergence of the virus from a persistently infected person rather than a new introduction.
This review paper analyzes studies on valganciclovir and ganciclovir as treatments for cytomegalovirus (CMV) infection. The paper compares variables across three studies, including treatment length, dosage, sample size, and effectiveness. It finds that valganciclovir is generally the most effective treatment, and that combining oral valganciclovir with intravenous ganciclovir yields the best results. Longer treatment regimens also lead to better outcomes. The review concludes that valganciclovir is the best available preventive treatment for CMV.
National Press Foundation - Understanding Vaccines (David Curry, Peg Willingham)Daric Snyder
The document summarizes information presented on vaccines during a webinar series. It discusses the history of vaccines from ancient practices of variolation to modern vaccines. It provides an overview of common vaccines, the vaccine development and approval process, and how vaccines work. It also summarizes information specific to HPV vaccines, including prevalence of HPV strains, how the vaccines were designed to generate an immune response, and recommendations for their use.
This document discusses the paradigm shifts occurring in medicine from omics to precision and system medicine. It notes that traditional medical research focused on the average patient but not differences between individuals. New approaches use large datasets incorporating genetic, clinical, and lifestyle factors to better predict health outcomes for each individual. This enables a shift to precision and system medicine considering an individual's unique biological, psychological and environmental characteristics. The goal is moving beyond a "one-size-fits-all" approach to improve health outcomes.
Historical prevalence and distribution of H7N9 among wild birdsHarm Kiezebrink
CDC Emerging Infectious Diseases published a paper (Volume 19, Number 12—December 2013) on the Historical Prevalence and Distribution of Avian Influenza Virus A(H7N9) among Wild Birds. A very interesting document, it provides a better understanding on transmission of H7N9 under wild birds.
In this paper, the authors reviewed 48 published studies that listed findings of influenza A virus haemagglutin type H7, or neuramonase N9 viruses as well as H9N2. The prevalence was calculated as the number of positive samples divided by the by number tested.
H7N9 has been rarely reported from Delaware (USA), Alberta (Canada), Guatemala, Spain, Egypt, Mongolia and Taiwan but has not been reported from Russia, Japan, South Korea or China from birds sampled between 1976-2012.
The outcome? If you were planning wild bird surveillance to track H7N9 spread in these non-poultry animals, you'll need to sample >30,000 wild birds to find 1 positive for H7N9 (its Asian prevalence was 0.00931%).
That's a rare bird.
This is just a rough gauge of course because it is entirely dependent on when, where and how thoroughly bird populations were sampled, how they were sampled, what they were tested with and how the sequencing methods performed. It also focuses on HA and NA genes, at the expense of other internal influenza gene segments which also have an important role in the assemblage of new viruses.
Source: Posted by Ian M Mackay on Virology Down under
Clinical profile of cholera cases in yavatmal district, maharashtraAlexander Decker
1) The document summarizes a study on cholera cases in Yavatmal District, Maharashtra between June-July 2012.
2) The study found that 13 of 377 cases of acute watery diarrhea were positive for cholera, all caused by the V. cholera 01 El Tor serotype Ogawa strain.
3) Nearly half of cases were children under 5 years old. Living conditions for all patients were poor and involved unsafe water sources, but all cases responded well to treatment.
CDC July 2009 Selected Zoonotic Diseases Conference Callgoa4
This document provides an overview of a conference call on selected zoonotic diseases that took place on July 1, 2009. It lists the speakers on various topics including psittacosis, E. coli sharing between dogs and owners, MRSA and pets, and new ACIP recommendations regarding rabies vaccination. It also summarizes updates to the Compendium of Measures to Control Chlamydophila psittaci Infection Among Humans (Psittacosis) and Pet Birds (Avian Chlamydiosis), including discouraged antibiotic treatment, emphasis on doxycycline treatment, and new testing methodologies.
This document provides information about Chronic Wasting Disease (CWD) in cervids such as deer and elk in Saskatchewan and Alberta. It discusses the history and transmission of CWD, which is similar to mad cow disease. CWD was first discovered in 1967 on a research farm in Colorado. It has since spread to the wild cervid populations in parts of the United States, Saskatchewan, and now Alberta. The document compares the prevalence of CWD in the wild deer populations of Saskatchewan and Wisconsin, finding average infection rates of 0.9% and 0.7% respectively. Provincial governments are implementing herd reduction programs and increased surveillance to monitor and limit the spread of the disease.
Human Genome Project is a worldwide scientific achievement. It was a thirteen-year project initiated in 1990 and completed in 2003. Human Genome Project helped a lot in the identification of diseased genes as DNA is very significant for understanding the diseased gene and their functions. It helped in the identification of disease loci for many diseases and presented their treatment through preventive measures. It identified the gene loci for many diseases like cancer, asthma, high blood pressure, diabetes type 2, obesity, Alzheimer's disease, Down's syndrome, Turner's syndrome, depression and many types of heart diseases including cardiovascular disease and coronary artery disease. This project does not directly treat the diseases but it helps in the identification of disease gene loci and then allows the treatment of disease through its preventive measures before the appearance of symptoms or at the initial stages of the disease through many techniques like gene therapy, pharmacogenomics, and targeted drug therapy. These are the helpful techniques in the diagnoses of the human disease gene locus.
This 3-page curriculum vitae summarizes Jose Giovanny Marte Alcantara's personal and professional experience. It lists his address, languages, education, current position as a research assistant and coordinator at a hospital in Santo Domingo, Dominican Republic, and experience conducting clinical trials for various pharmaceutical companies from 2006 to present. His responsibilities have included quality control, data entry, and general coordination. The CV concludes with a record of his Good Clinical Practice training.
1) In 1946-1948, Dr. John C. Cutler conducted a syphilis experiment in Guatemala sponsored by several US and Guatemalan organizations, including the PHS. Over 600 men in prisons and mental hospitals were deliberately infected with syphilis through prostitutes, inoculation, or spinal taps in order to study the disease and effects of penicillin.
2) Unlike the Tuskegee study where men were not treated, in Guatemala subjects were given penicillin after becoming infected, though it is unclear if all received adequate treatment.
3) The study demonstrated connections between research in developing countries and the US, and helped disprove myths that men in Tuskegee were deliberately infected
Characteristics of pediatric SARS CoV-2 infection and potential evidence for ...Rosmirella Cano Rojas
We report epidemiological and clinical investigations on ten
pediatric SARS-CoV-2 infection cases confirmed by realtime
reverse transcription PCR assay of SARS-CoV-2 RNA.
Symptoms in these cases were nonspecific and no children
required respiratory support or intensive care. Chest X-rays
lacked definite signs of pneumonia, a defining feature of the
infection in adult cases. Notably, eight children persistently
tested positive on rectal swabs even after nasopharyngeal
testing was negative, raising the possibility of fecal–oral
transmission.
1. The study found that exclusive breastfeeding provided strong protection against infant death in Ghana, India, and Peru, where infant mortality from infectious disease is high. However, the risks of death or hospitalization for infants who were predominantly breastfed were not significantly different than for those who were exclusively breastfed.
2. Some experts were concerned that this finding could undermine promotion of exclusive breastfeeding, as the benefits of exclusive breastfeeding over predominant breastfeeding may be greatest in the first months of life when the study's sample sizes were smaller.
3. It was also noted that the study only looked at infants older than 6-10 weeks, so the findings may not apply to younger infants, for whom the differences between
This document summarizes a research proposal that aims to test the hypothesis that childhood vaccinations cause autism. The study would examine mercury levels in the urine of children at different age groups and time intervals following the MMR vaccination, to determine if higher mercury is associated with autism. The proposal provides background on autism rates increasing, the discredited Wakefield study linking MMR and autism, and reviews previous studies on thimerosal and mercury that both support and contradict the hypothesized link to vaccinations. The proposed methodology would collect urine samples from 18 children divided into age groups around the time of first MMR vaccination, to measure mercury levels at different time points following vaccination.
Knowledge and Practice of Immunization amongst the care-givers of 12-23 month...iosrjce
IOSR Journal of Pharmacy and Biological Sciences(IOSR-JPBS) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of Pharmacy and Biological Science. The journal welcomes publications of high quality papers on theoretical developments and practical applications in Pharmacy and Biological Science. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Genetic testing analyzes an individual's DNA to identify genotypes and genetic disorders or conditions. It is used diagnostically and for non-medical purposes like forensics. The Human Genome Project mapped all human genes to advance research. Genetic testing can identify hereditary health risks but results are estimates and lifestyle factors also influence health outcomes. While testing provides information, it can also psychologically burden those who see their genes as deterministic of health without considering environmental influences. New research shows epigenetics, beliefs, and lifestyle can influence gene expression beyond what genetic testing indicates.
This document summarizes a research article that investigated the genomic determinants of Mycobacterium tuberculosis transmission. The study identified regions of the M. tuberculosis genome, through analysis of over 200 strains, that were associated with transmission and the occurrence of secondary tuberculosis cases. These regions encoded proteins or influenced immune responses. Specifically, the study found mutations in five genomic regions, including three genes and two intergenic regions, that were statistically associated with transmission. Mutations in two of these genes were found to decrease immune system cytokine production in a way that could influence transmissibility. This research helps further the understanding of the genetic factors that influence the transmissibility of M. tuberculosis strains.
This presentation discusses methods used in molecular biology like pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS) to detect errors in DNA, and their applications in detecting Listeria monocytogenes bacteria. PFGE and WGS analysis of Listeria samples from infected individuals was able to link outbreaks to contaminated apple sources. WGS identified two strains present in both pregnant and non-pregnant infected groups. Maintaining good hygiene practices can help reduce incidence of diseases like Listeriosis.
This document summarizes and reviews several studies that investigated the potential association between autism spectrum disorders (ASD) and socioeconomic status. The review found inconsistent results across studies, with some finding a higher prevalence of ASD among higher social classes and others finding no association. The review concludes that there is likely no consistent association between social class and ASD, though parental education level may be more closely associated with ASD than median family income alone. Ascertainment methods, small sample sizes, and variability in case definitions across studies make drawing definitive conclusions difficult.
Food Assistance and Nutrition Research Small Grants Program ...pleasure16
This document summarizes the key role that child care assistance programs play in helping low-income parents find and maintain employment. It outlines how federal and state funding for these programs grew substantially after welfare reform in 1996, allowing more families to receive assistance. However, funding has declined since 2001 due to budget shortfalls, forcing many states to cut eligibility and create waiting lists. As a result, many low-income working families are struggling without adequate child care support.
Parents can instill good moral values in their children by leading by example in their own behavior, spending quality time with their children, and having open discussions about real-world issues and events. Spending time together helps foster strong relationships where children feel comfortable approaching their parents with questions. It is important for parents to demonstrate good priorities, morality, and beliefs through their own actions rather than just words. Leading by example and engaging children in discussions about societal and world issues provides children with guidance on navigating challenges as they grow into adults.
National Press Foundation - Understanding Vaccines (David Curry, Peg Willingham)Daric Snyder
The document summarizes information presented on vaccines during a webinar series. It discusses the history of vaccines from ancient practices of variolation to modern vaccines. It provides an overview of common vaccines, the vaccine development and approval process, and how vaccines work. It also summarizes information specific to HPV vaccines, including prevalence of HPV strains, how the vaccines were designed to generate an immune response, and recommendations for their use.
This document discusses the paradigm shifts occurring in medicine from omics to precision and system medicine. It notes that traditional medical research focused on the average patient but not differences between individuals. New approaches use large datasets incorporating genetic, clinical, and lifestyle factors to better predict health outcomes for each individual. This enables a shift to precision and system medicine considering an individual's unique biological, psychological and environmental characteristics. The goal is moving beyond a "one-size-fits-all" approach to improve health outcomes.
Historical prevalence and distribution of H7N9 among wild birdsHarm Kiezebrink
CDC Emerging Infectious Diseases published a paper (Volume 19, Number 12—December 2013) on the Historical Prevalence and Distribution of Avian Influenza Virus A(H7N9) among Wild Birds. A very interesting document, it provides a better understanding on transmission of H7N9 under wild birds.
In this paper, the authors reviewed 48 published studies that listed findings of influenza A virus haemagglutin type H7, or neuramonase N9 viruses as well as H9N2. The prevalence was calculated as the number of positive samples divided by the by number tested.
H7N9 has been rarely reported from Delaware (USA), Alberta (Canada), Guatemala, Spain, Egypt, Mongolia and Taiwan but has not been reported from Russia, Japan, South Korea or China from birds sampled between 1976-2012.
The outcome? If you were planning wild bird surveillance to track H7N9 spread in these non-poultry animals, you'll need to sample >30,000 wild birds to find 1 positive for H7N9 (its Asian prevalence was 0.00931%).
That's a rare bird.
This is just a rough gauge of course because it is entirely dependent on when, where and how thoroughly bird populations were sampled, how they were sampled, what they were tested with and how the sequencing methods performed. It also focuses on HA and NA genes, at the expense of other internal influenza gene segments which also have an important role in the assemblage of new viruses.
Source: Posted by Ian M Mackay on Virology Down under
Clinical profile of cholera cases in yavatmal district, maharashtraAlexander Decker
1) The document summarizes a study on cholera cases in Yavatmal District, Maharashtra between June-July 2012.
2) The study found that 13 of 377 cases of acute watery diarrhea were positive for cholera, all caused by the V. cholera 01 El Tor serotype Ogawa strain.
3) Nearly half of cases were children under 5 years old. Living conditions for all patients were poor and involved unsafe water sources, but all cases responded well to treatment.
CDC July 2009 Selected Zoonotic Diseases Conference Callgoa4
This document provides an overview of a conference call on selected zoonotic diseases that took place on July 1, 2009. It lists the speakers on various topics including psittacosis, E. coli sharing between dogs and owners, MRSA and pets, and new ACIP recommendations regarding rabies vaccination. It also summarizes updates to the Compendium of Measures to Control Chlamydophila psittaci Infection Among Humans (Psittacosis) and Pet Birds (Avian Chlamydiosis), including discouraged antibiotic treatment, emphasis on doxycycline treatment, and new testing methodologies.
This document provides information about Chronic Wasting Disease (CWD) in cervids such as deer and elk in Saskatchewan and Alberta. It discusses the history and transmission of CWD, which is similar to mad cow disease. CWD was first discovered in 1967 on a research farm in Colorado. It has since spread to the wild cervid populations in parts of the United States, Saskatchewan, and now Alberta. The document compares the prevalence of CWD in the wild deer populations of Saskatchewan and Wisconsin, finding average infection rates of 0.9% and 0.7% respectively. Provincial governments are implementing herd reduction programs and increased surveillance to monitor and limit the spread of the disease.
Human Genome Project is a worldwide scientific achievement. It was a thirteen-year project initiated in 1990 and completed in 2003. Human Genome Project helped a lot in the identification of diseased genes as DNA is very significant for understanding the diseased gene and their functions. It helped in the identification of disease loci for many diseases and presented their treatment through preventive measures. It identified the gene loci for many diseases like cancer, asthma, high blood pressure, diabetes type 2, obesity, Alzheimer's disease, Down's syndrome, Turner's syndrome, depression and many types of heart diseases including cardiovascular disease and coronary artery disease. This project does not directly treat the diseases but it helps in the identification of disease gene loci and then allows the treatment of disease through its preventive measures before the appearance of symptoms or at the initial stages of the disease through many techniques like gene therapy, pharmacogenomics, and targeted drug therapy. These are the helpful techniques in the diagnoses of the human disease gene locus.
This 3-page curriculum vitae summarizes Jose Giovanny Marte Alcantara's personal and professional experience. It lists his address, languages, education, current position as a research assistant and coordinator at a hospital in Santo Domingo, Dominican Republic, and experience conducting clinical trials for various pharmaceutical companies from 2006 to present. His responsibilities have included quality control, data entry, and general coordination. The CV concludes with a record of his Good Clinical Practice training.
1) In 1946-1948, Dr. John C. Cutler conducted a syphilis experiment in Guatemala sponsored by several US and Guatemalan organizations, including the PHS. Over 600 men in prisons and mental hospitals were deliberately infected with syphilis through prostitutes, inoculation, or spinal taps in order to study the disease and effects of penicillin.
2) Unlike the Tuskegee study where men were not treated, in Guatemala subjects were given penicillin after becoming infected, though it is unclear if all received adequate treatment.
3) The study demonstrated connections between research in developing countries and the US, and helped disprove myths that men in Tuskegee were deliberately infected
Characteristics of pediatric SARS CoV-2 infection and potential evidence for ...Rosmirella Cano Rojas
We report epidemiological and clinical investigations on ten
pediatric SARS-CoV-2 infection cases confirmed by realtime
reverse transcription PCR assay of SARS-CoV-2 RNA.
Symptoms in these cases were nonspecific and no children
required respiratory support or intensive care. Chest X-rays
lacked definite signs of pneumonia, a defining feature of the
infection in adult cases. Notably, eight children persistently
tested positive on rectal swabs even after nasopharyngeal
testing was negative, raising the possibility of fecal–oral
transmission.
1. The study found that exclusive breastfeeding provided strong protection against infant death in Ghana, India, and Peru, where infant mortality from infectious disease is high. However, the risks of death or hospitalization for infants who were predominantly breastfed were not significantly different than for those who were exclusively breastfed.
2. Some experts were concerned that this finding could undermine promotion of exclusive breastfeeding, as the benefits of exclusive breastfeeding over predominant breastfeeding may be greatest in the first months of life when the study's sample sizes were smaller.
3. It was also noted that the study only looked at infants older than 6-10 weeks, so the findings may not apply to younger infants, for whom the differences between
This document summarizes a research proposal that aims to test the hypothesis that childhood vaccinations cause autism. The study would examine mercury levels in the urine of children at different age groups and time intervals following the MMR vaccination, to determine if higher mercury is associated with autism. The proposal provides background on autism rates increasing, the discredited Wakefield study linking MMR and autism, and reviews previous studies on thimerosal and mercury that both support and contradict the hypothesized link to vaccinations. The proposed methodology would collect urine samples from 18 children divided into age groups around the time of first MMR vaccination, to measure mercury levels at different time points following vaccination.
Knowledge and Practice of Immunization amongst the care-givers of 12-23 month...iosrjce
IOSR Journal of Pharmacy and Biological Sciences(IOSR-JPBS) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of Pharmacy and Biological Science. The journal welcomes publications of high quality papers on theoretical developments and practical applications in Pharmacy and Biological Science. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Genetic testing analyzes an individual's DNA to identify genotypes and genetic disorders or conditions. It is used diagnostically and for non-medical purposes like forensics. The Human Genome Project mapped all human genes to advance research. Genetic testing can identify hereditary health risks but results are estimates and lifestyle factors also influence health outcomes. While testing provides information, it can also psychologically burden those who see their genes as deterministic of health without considering environmental influences. New research shows epigenetics, beliefs, and lifestyle can influence gene expression beyond what genetic testing indicates.
This document summarizes a research article that investigated the genomic determinants of Mycobacterium tuberculosis transmission. The study identified regions of the M. tuberculosis genome, through analysis of over 200 strains, that were associated with transmission and the occurrence of secondary tuberculosis cases. These regions encoded proteins or influenced immune responses. Specifically, the study found mutations in five genomic regions, including three genes and two intergenic regions, that were statistically associated with transmission. Mutations in two of these genes were found to decrease immune system cytokine production in a way that could influence transmissibility. This research helps further the understanding of the genetic factors that influence the transmissibility of M. tuberculosis strains.
This presentation discusses methods used in molecular biology like pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS) to detect errors in DNA, and their applications in detecting Listeria monocytogenes bacteria. PFGE and WGS analysis of Listeria samples from infected individuals was able to link outbreaks to contaminated apple sources. WGS identified two strains present in both pregnant and non-pregnant infected groups. Maintaining good hygiene practices can help reduce incidence of diseases like Listeriosis.
This document summarizes and reviews several studies that investigated the potential association between autism spectrum disorders (ASD) and socioeconomic status. The review found inconsistent results across studies, with some finding a higher prevalence of ASD among higher social classes and others finding no association. The review concludes that there is likely no consistent association between social class and ASD, though parental education level may be more closely associated with ASD than median family income alone. Ascertainment methods, small sample sizes, and variability in case definitions across studies make drawing definitive conclusions difficult.
Food Assistance and Nutrition Research Small Grants Program ...pleasure16
This document summarizes the key role that child care assistance programs play in helping low-income parents find and maintain employment. It outlines how federal and state funding for these programs grew substantially after welfare reform in 1996, allowing more families to receive assistance. However, funding has declined since 2001 due to budget shortfalls, forcing many states to cut eligibility and create waiting lists. As a result, many low-income working families are struggling without adequate child care support.
Parents can instill good moral values in their children by leading by example in their own behavior, spending quality time with their children, and having open discussions about real-world issues and events. Spending time together helps foster strong relationships where children feel comfortable approaching their parents with questions. It is important for parents to demonstrate good priorities, morality, and beliefs through their own actions rather than just words. Leading by example and engaging children in discussions about societal and world issues provides children with guidance on navigating challenges as they grow into adults.
RIVERTOWN CHICK CARE SHEET FOR POULTRY/GAMEBIRDSpleasure16
This document provides information and activities about helping ducks find their babies. It includes background information on reproduction and parental care in birds. It describes two downloadable activities - one on attracting mates and one on observing baby animals. It also lists additional follow up activities for students such as pretending to hatch from an egg, investigating nest materials, and observing birds at a wildlife center to compare species, sexes, and ages.
Imagine you are a high school educated single mother with two ...pleasure16
The document outlines several community innovation grants that were funded for various projects. It lists the organization receiving the grant, the project title and description, and the amount of the grant. Some of the projects include strengthening support programs for seniors, providing nutrition education for those living with HIV/AIDS, delivering HIV/AIDS treatment information, providing independent living support for youth, developing educational materials about disabilities, and a mentoring program pairing seniors with children. The grants ranged from $12,000 to $20,000.
City of San Antonio Code: Regulating the Care and Control of Animalspleasure16
The document provides an introduction and overview of a teacher's guide called "Just Hatched" created by the British Columbia Waterfowl Society. The guide includes lesson plans, activities, and materials to teach young children about bird life cycles, different types of nests, and what baby birds need. It covers topics like camouflage, nest types, egg facts, hatching, and the needs of growing baby birds. The guide is intended to support classes visiting a bird sanctuary in the spring to see ducklings, goslings, and young cranes.
February 2010 Selected Zoonotic Diseases Conference Callgoa4
The document summarizes a conference call about dengue and zoonotic diseases. It discusses an update on dengue infections in the United States, including outbreaks in Texas, Hawaii and Florida. It also mentions a multistate outbreak of Salmonella infections linked to contact with aquatic frogs and recommendations provided to the public.
February 2010 Selected Zoonotic Diseases Conference Callgoa4
The document summarizes a conference call about dengue and zoonotic diseases. It discusses an update on dengue infections in the United States, including outbreaks in Texas, Hawaii and Florida. It also mentions a multistate outbreak of Salmonella infections linked to contact with aquatic frogs and recommendations provided to the public.
This study analyzed Trypanosoma cruzi seroprevalence in 520 pregnant women and their newborns in Guanajuato, Mexico. Anti-T. cruzi antibodies were detected in 20 mothers (4%) by ELISA and IHA tests. Four newborn cases tested positive by PCR. Risk factors for T. cruzi infection that were significant (P < 0.050) included building materials of dwellings, presence of pets, and dwellings in rural areas. This constitutes the first systematic study of congenital Chagas disease and associated risk factors in Guanajuato. The results indicate an incidence of 770 cases per 100,000 births in 12 months, with a 0.8%
12 café aula 01 - dr. vicente vaz - novagripeitgfiles
This document summarizes data on the 2009 H1N1 influenza pandemic in England. It reports that an estimated 540,000 cases of H1N1 influenza occurred between June and November 2009, with 138 confirmed deaths, resulting in a case fatality rate of 26 per 100,000. Incidence was highest in children aged 5-14 years, while the case fatality rate was highest in adults aged 65 years and older. Most deaths occurred in individuals with pre-existing medical conditions.
A team of veterinarians and public health students from the U.S. and Uganda worked with Veterinarians Without Borders to study trypanosomiasis (African sleeping sickness) in humans and livestock in Moyo, Uganda. They collected blood samples from over 800 people and 1500 cattle to test for trypanosomiasis and other diseases. Their results found 127 human cases and 98 cattle cases of trypanosomiasis. In 9 households both humans and cattle tested positive, with little difference between male and female cases. While cattle were the only livestock found to be infected, the results were not significant enough to determine relationships between animal and human disease transmission. Improved surveillance, treatment access and t
proposal: Influences of Rhetoric in the Debate of Vaccines and Autism hussein opari
This document summarizes a research paper on the influences of rhetoric in the debate about vaccines and autism. The paper introduces the topic by noting the rising rates of autism diagnoses and the debate around potential links to vaccination. It then outlines the study's justification, research questions, and methodology. The study will analyze medical records and interviews to explore the evidence for links between vaccination, mercury levels, and autism rates in children. It will also review previous literature on both sides of the debate. The goal is to determine if vaccination is conclusively linked to autism or if other environmental factors may play a role.
General Psychology Interpret an instance of behavior (individual .docxlianaalbee2qly
General Psychology
: Interpret an instance of behavior (individual or collective) recently in the news from the point of view of any two of the three schools of thought that became popular when psychology emerged as a discipline. Your response should include specific details including the major theorists and goals of the two selected schools of psychological thought. Your response should be at least 200 words in length. You are required to use at least your textbook as source material for your response. All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying citations. Wade, C., Tavris, C., & Garry, M. (2014). Psychology (11th ed.). Upper Saddle River, NJ: Pearson Education. Must be done in APA format
ONE PAGE /275 WORDS ONE SOURCE BOOK REFERENCE
[1/29/16, 11:29 AM] josphat mungai (
[email protected]
):
Author: R.A. Noe
Employee training and development (6th ed.). New York, NY: McGraw-Hill
2:General Psychology
: A researcher hypothesizes that adults will respond differently to the same baby depending on how the child is dressed. Her colleague, on the other hand, hypothesizes that boys and girls are treated equally and that only temperamental differences lead to differences in their handling. Design a research study to test their hypotheses. Your response should be at least 200 words in length. You are required to use at least your textbook as source material for your response. All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying citations. Wade, C., Tavris, C., & Garry, M. (2014). Psychology (11th ed.). Upper Saddle River, NJ: Pearson Education. Must be done in APA format
ONE PAGE /275 WORDS ONE SOURCE BOOK REFERENCE
[1/29/16, 11:29 AM] josphat mungai (
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Author: R.A. Noe
Employee training and development (6th ed.). New York, NY: McGraw-Hill
Put to the test: as genetic screening gets cheaper and easier, it's raising questions that health-care providers aren't prepared to answer
The American Prospect, November 2010
When my children were born in the mid-1990s, new parents could already see that prenatal genetic testing was altering the terrain of pregnancy and childbirth. Growing numbers of educated women were having children at older ages, with resulting difficulties and risks. More and more parents faced challenging, deeply personal decisions about whether to engage in genetic testing and what to do if they received unfavorable results.
I remember my own anxieties when my wife, Veronica, took a blood test that searched for elevated alpha-fetoproteins, which are associated with diverse ailments ranging from spina bifida to anencephaly. The mere prospect of these rare conditions--and even the choice to undergo the tests--was surprisingly painful. At least genetic counselors and other professionals were available to help guide us.
By that point, amniocentesis had been in wide use for more than t.
This study investigated the association between night work and breast cancer risk using data from a large population-based case-control study in France. The study found that 13% of breast cancer cases and 11% of controls had a history of night shift work, corresponding to a 27% increased risk of breast cancer among night shift workers. The risk was highest for women who worked overnight shifts or had worked night shifts for over 4 years. Notably, women who worked night shifts for over 4 years before their first full-term pregnancy had nearly double the risk of breast cancer compared to those without such a history, suggesting that incompletely differentiated breast tissue may be particularly susceptible to circadian disruption from night work.
The document discusses concerns about the MMR vaccine and a potential link to autism. It provides details on vaccine ingredients including fetal bovine serum and human fetal cells. It summarizes testimony from a Congressional hearing linking vaccines to autism, including findings of measles virus in the gut and autoimmune responses post-vaccination. The document also discusses the history of measles and implications of vaccination and waning immunity over time.
The document discusses the history and effectiveness of measles vaccination programs in the United States and other countries. It notes that measles outbreaks were reported even in fully vaccinated populations in the early 1980s. Some studies found that measles vaccines were not provoking a proper immune response or providing long-lasting immunity. A CDC whistleblower later revealed that a 2004 study had found that the MMR vaccine was linked to a 340% increased risk of autism in African American boys under 3 years old, but this data was covered up by the CDC.
The document discusses the history and effectiveness of measles vaccination programs in the United States and other countries. It notes that measles outbreaks were reported even in fully vaccinated populations in the early 1980s. Some studies found that measles vaccines were not provoking a proper immune response or providing long-lasting immunity. A CDC whistleblower later revealed that a 2004 study had found that the MMR vaccine was linked to a 340% increased risk of autism in African American boys under 3 years old, but this data was covered up by the CDC.
This research article characterized the genetic diversity of Plasmodium vivax and P. falciparum populations from pregnant women in four malaria-endemic countries. Between 2008-2011, nearly 2000 pregnant women were recruited from Brazil, Colombia, India, and Papua New Guinea and followed until delivery, collecting blood samples. Seven P. vivax microsatellite markers were used to genotype 229 P. vivax isolates. P. vivax populations showed moderate to high genetic differentiation between countries and higher diversity than P. falciparum populations from the same areas. Diversity of P. vivax was very high in some settings compared to transmission levels, suggesting stable demographic histories.
Running Head Salmonella in the Caribbean .docxtoltonkendal
Running Head: Salmonella in the Caribbean 1
Salmonella in the Caribbean 4
Angela Brown
Salmonella in the Caribbean
Southern New Hampshire University
The two articles that I have choose to write about is outbreak of multidrug- resistant salmonella infections link to pork – Washington 2015 and outbreak of salmonella Heidelberg infections linked to a single poultry producer- 13 states 2012-2013. After reading about the outbreak of multidrug- resistant salmonella infections link to pork I learned that on the basis of cases investigated before August 2015, a supplemental questionnaire that went into more detail in addressing meat and livestock exposures was developed. Among 80 patients (42% of all confirmed cases) who were interviewed, 59 (74%) reported eating pork during the 7 days preceding illness. This was significantly higher than the most recently published (2007) Foodborne Diseases Active Surveillance Network (FoodNet) population survey of healthy persons, in which 43% reported eating pork in the week before they were interviewed. After reading the outbreak of salmonella Heidelberg infections linked to a single poultry producer I have learned that initial state-based interviews found that chicken was commonly consumed by the persons with infections. A structured questionnaire was developed to collect detailed information on chicken and other exposures noted during initial interviews, and exposures commonly linked to Salmonella Heidelberg, such as eggs. Of 70 patients who responded, 55 (79%) reported consuming chicken in the week before illness onset, a percentage significantly higher than the 64.9% reported in the 2006–2007 foodborne diseases active surveillance network (FoodNet) Population Survey of healthy persons. These resources will be helpful. Plasmids are mobile genetic elements that can be gained or lost relatively easily, which might explain the variable resistance profiles. Resistance to third-generation cephalosporins (e.g., ceftriaxone) is clinically important because extended-spectrum cephalosporins are commonly used for treatment of severe salmonellosis in children. WADOH and PHSKC investigation into the source of pork traced the pork consumed by 35 (59%) of the 59 interviewed patients who reported eating pork back to a U.S. Department of Agriculture’s Food Safety and Inspection Service–inspected pork slaughter establishment in Graham, Washington. This was the largest Salmonella outbreak in Washington in recent history, and highlights that pork is an important source for human Salmonella infections. Best practices in all parts of the pork production industry, from farm to processing plant, can help reduce the risk for future outbreaks. In addition, prevention strategies that incl ...
The number of existing functional somatic syndromes (fs ss) is an important r...Paul Coelho, MD
The study tested the hypothesis that the number of existing functional somatic syndromes (FSSs; e.g. fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome) predicts the development of new FSSs. The study found that the incidence of a new FSS increased with the number of pre-existing (antecedent) FSSs in both cases (women with interstitial cystitis) and controls. Specifically, the risk of a new FSS was highest for individuals with 3 or more antecedent FSSs. Logistic regression showed that the number of antecedent FSSs significantly predicted new FSSs even after accounting for other risk factors. This supports the idea that FSSs are linked
This study examined the spatial distribution of Schistosoma mansoni infection, immunological responses, and exposure risk in Virgem das Graças, Brazil before and after mass drug administration of praziquantel. Before treatment, schistosomiasis prevalence was very high throughout the area, with one community having over 90% prevalence. IgE antibody levels were inversely related to pre-treatment infection levels. After treatment, prevalence and egg counts declined significantly, with only 3% of households having prevalence above pre-treatment levels. However, several distinct spatial patterns remained related to post-treatment IgE levels and water exposure risk.
Comparison of immunity against canine distemper, adenovirus and parvovirus af...Biogal
This study aimed at comparing the immunity of two multivalent vaccines in adult dogs in the city of Uberlândia, Minas Gerais state, Brazil.
VacciCheck was used in the study in order to determine the immunity levels of the dogs.
Unsafe Sleep Practices And An Analysis Of Bedsharing Among Infants Dying Sudd...Biblioteca Virtual
This study analyzed 119 cases of sudden unexpected infant death in the St. Louis area between 1994-1997. The study found that:
1) 61.1% of infants were found prone, 29.4% had their head or face covered by bedding, and 47.1% were sleeping on an adult bed or other non-approved surface.
2) Only 8.4% of infants were found non-prone, with their head and face uncovered.
3) Similar unsafe sleeping practices were seen in cases diagnosed as SIDS, accidental suffocation, and undetermined cause of death, suggesting these diagnoses may overlap.
4) The findings support public health recommendations encouraging supine sleep on firm
H1 n1 influenza a disease information for health professionals lindsey_nejm 2009Ruth Vargas Gonzales
1. A novel H1N1 influenza virus emerged in Mexico and the US in April 2009 that was a triple reassortment of human, avian, and swine influenza viruses.
2. Researchers developed PCR tests to identify confirmed cases of the virus and help track the outbreak. Health authorities worldwide are monitoring and trying to control the outbreak.
3. As of early May 2009, the virus was causing mild to moderate illness in most patients. However, some hospitalized patients developed pneumonia or other complications, and two deaths occurred in high-risk patients. The age distribution and symptoms resembled typical seasonal influenza.
This study compared two methods for screening embryo cells for chromosomal abnormalities: fluorescence in situ hybridization (FISH) and single-nucleotide polymorphism (SNP) microarray analysis. Thirteen arrested embryos were each biopsied into individual cells, with 160 cells total randomized into the two screening methods. Microarray analysis provided interpretable results for more cells (96% vs 83% for FISH) and detected mosaicism (differences between cells of the same embryo) significantly less often than FISH (31% vs 100%). Direct comparison found FISH detected more unique genetic diagnoses per embryo on average. This is the first study to directly compare these two screening methods using paired cells from the same embryos, suggesting FISH may
The document provides information about parking at Metrorail stations, paying fares, accessibility features, and transferring between Metrorail, Metromover, Metrobus, and the South Miami-Dade Busway. Key details include: parking at stations costs $4 daily; fares are $2 with reduced fares of $1; stations have elevators, escalators and stairs for accessibility; and many transfer options exist between rail and bus services.
The document discusses a survey of cell phone recycling programs in New York City. The survey examined compliance with New York state legislation requiring cell phone take-back programs, as well as voluntary programs. Key findings include:
- Only 36% of visited stores had visible take-back signs as required by law. Verizon Wireless stores complied most consistently.
- 28% of stores visited had a visible drop-off box. Boxes were often hidden from view.
- 30% of stores listed on the voluntary RBRC program website did not have drop-off boxes as advertised.
- Employees generally lacked knowledge about their store's recycling program, except at Verizon Wireless stores.
The survey found
Recycling of Cellular Telephones in Mainepleasure16
This document is a memorandum opinion from a United States District Court regarding the government's application for an order authorizing the installation and use of a pen register and caller identification system on two telephone numbers and the production of real-time cell site information. The court initially denied the application, finding the government needed to show probable cause to obtain real-time cell site information. The government then submitted a letter arguing existing statutes allow such information upon less than probable cause. The court examines these statutes and determines they do not authorize access to real-time cell site information without a showing of probable cause.
I n t h e Picture This: Smart Cell Phone Camera Networkspleasure16
This document provides a summary of Maine's first annual report on cell phone recycling efforts in the state as required by Maine law. It finds that in 2008, approximately 54,400 cell phones were recycled in Maine, up from an estimated 1% recycling rate in 2003. This establishes a baseline for measuring the effectiveness of collection efforts going forward. Over 900 cell phone collection sites now exist statewide ensuring convenience for residents. Compliance among retailers was around 73% and most major carriers have developed recycling programs, though some small carriers require further follow up. Continued education efforts are needed to increase consumer awareness and motivation to recycle old phones.
C O N T RO L L I N G E L E C T RO N I C S V I A S M Spleasure16
1) Fort Bragg FCU is collecting school supplies from April 1 to June 30 to send to troops in Afghanistan to help build trust with local communities. Needed supplies include notebooks, pens, pencils, pencil sharpeners, small toys, and healthy treats in ziplock bags.
2) Donations can be dropped off at any FBFCU branch location. Cash donations are also accepted.
3) Interest rates are low, so now is a good time for members to purchase a home and take advantage of a new government tax credit of up to $8,000 for qualified first-time homebuyers.
This document describes a system that allows electrical devices to be remotely controlled via text messaging. It works by using an INSTEON controller connected to a computer to communicate with INSTEON switches. Twitter is used as an SMS gateway so that a phone can send commands to Twitter which are then read by a script on the computer controlling the switches. The script checks Twitter for commands and sends the appropriate signals to the switches via the INSTEON controller.
Job-Hunt FREE 15-Minute Guide to Layoff Self-Defensepleasure16
This document summarizes the results of a survey conducted by the Wisconsin Department of Transportation (WDOT) on cell phone use and motor vehicle crashes from May to October 2002. The survey found that cell phone use by drivers was reported in 1.5% of crashes surveyed. It provides background on bills proposed in the Wisconsin legislature regarding cell phone use and limitations. The report is intended to help legislators and safety officials better understand the issue but notes the limited scope of the study.
AWARENESS OF PERFORMANCE DECREMENTS DUE TO DISTRACTION IN YOUNGER ...pleasure16
This document provides 6 steps to protect yourself if you are at risk of being laid off from your job.
The steps are: 1) Establish private contact channels like a personal email and phone number. 2) Increase external networking through alumni groups and professional organizations. 3) Update your resume privately and collect recommendations. 4) Expand your online presence by registering a domain name. 5) Leave your current job before layoffs start to avoid credibility issues. 6) Take the steps before an actual layoff to prepare without tipping off your employer.
This study examined how well calibrated younger and older drivers were to performance decrements caused by distraction from cell phone use. Forty drivers completed driving tasks on a closed test track while performing a mental math task on a handheld or hands-free phone. Drivers' estimates of performance changes due to distraction were compared to actual changes measured across multiple driving performance measures. The results showed that drivers generally were not well calibrated to the magnitude of distraction effects, with some estimates even showing performance changes in the opposite direction of reality. Younger male drivers in particular tended to underestimate distraction impacts. The findings suggest that lack of awareness of distraction effects could influence drivers' decisions to engage in distracting activities.
Address Book IntegrAtIon wIth Jd edwArds enterprIseone And Jd ...pleasure16
The document provides instructions for installing, configuring, and using Guardian mobile security software. It allows users to enable invisible SMS notifications if an unauthorized SIM is inserted, protect access to apps and data with a password, and purchase upgraded editions for additional features like remote tracking and wiping of a lost phone. Configuration involves setting the notification recipient, secret code, and selecting which apps to password protect. The software comes in Free, Gold, and Platinum editions that can be upgraded by purchasing a registration code.
Cell Phone–Based System Could Improve HIV/AIDS Drug Trackingpleasure16
Address book integration with JD Edwards and other systems can seem simple but is actually quite complex due to various data formats, proliferation of contact information types, and inconsistencies. Magic Software's iBolt is a code-free integration tool that can model the necessary business rules and processes through visual design to facilitate real-time or batch address book integration and information sharing between systems.
2008 DEER HUNTING INFORMATION AND ON-LINE/TOLL FREE TELEPHONE ...pleasure16
1) Researchers at NYU are developing a cell phone-based system called SmartTrack to improve HIV/AIDS drug distribution and patient treatment in Africa.
2) SmartTrack will use cell phone technology to more easily track drug shipments and monitor patient medication adherence and health outcomes.
3) The system aims to address key issues with drug supply chains in Africa like theft and counterfeiting, and help ensure patients follow drug regimens correctly.
This document provides information on deer hunting regulations in Illinois for 2008, including seasons, licenses required, legal firearms, tagging and reporting requirements, and other rules. Key details include:
- Deer hunting seasons include archery, youth firearm, two firearm seasons, muzzleloader, and late-winter antlerless.
- Hunters must report deer harvested within 10 hours via the online or phone check-in system and attach the confirmation number to the tag.
- Legal firearms are shotguns, muzzleloaders, and handguns .30 caliber or larger. Only expanding bullets may be used.
- Hunters must have the proper licenses, permits, and FOID card and follow regulations on tagging, transporting,
The document provides information about recognizing and reporting telephone fraud. It advises consumers to be wary of telemarketing calls and asks questions to determine if a call is legitimate or a scam. Consumers can report fraudulent calls to the FTC and state attorneys general to help law enforcement investigate scams and stop telemarketers. The national Do Not Call registry allows consumers to limit unwanted telemarketing calls by registering their phone numbers.
phone records could track rapist, expert sayspleasure16
Pre-paid phone cards allow users to pay for calling time in advance. However, some cards do not deliver the advertised number of minutes due to hidden fees or charges. Consumers should carefully check rates, expiration dates, and terms and conditions for any additional charges to ensure they get full value for the card. The FTC advises consumers to report any issues with non-working cards.
Bus left you waiting in the cold? Use your cell phone to track it downpleasure16
This article summarizes an expert's opinion that cell phone records could help identify the Northwest Serial Rapist in Columbus, Ohio. The expert, Ben Levitan, believes that by analyzing the cell phone towers that picked up signals from the victims' phones during each attack, police could generate a list of phone numbers near each crime scene and likely identify one phone number common to all the lists, pointing to the rapist. The Columbus police are skeptical but say they will consider any potential leads. They continue to encourage women to take safety precautions.
The Talk-N-Trace is a point-to-point communication and tracing set that allows up to 4 units to communicate hands-free over wired connections. It has a built-in ringer, volume control, and low battery indicator. To use it, the user connects one Talk-N-Trace to each end of the wire pair and presses the on button to power it on and allow conversation or signal the other end by holding the button to ring the other unit.
This report summarizes a comparative accident study between years when a limousine company did and did not allow cell phone use. Survey results from drivers found most believed cell phone use increased distraction and accidents. Accident rates in categories like rear-end collisions and sideswipes decreased from 1998 to 1999 after the company introduced cell phones. However, the decreases were smaller than projections from studies finding 34-400% higher accident risks with cell phone use. The report examines literature on impacts of cell phone use on driving and identifies best practices to reduce risks.
PRLog.Org - Free Web Service Lets You Locate, Track, Sync, Protect ...pleasure16
This free audio tour provides an overview and descriptions of modern outdoor sculptures located at the Getty Center. It includes commentary from sculptors and curators about 27 sculptures by artists such as Henry Moore, Isamu Noguchi, Joan Miró, and others. Visitors can dial a phone number and enter stop codes to listen to details about individual sculptures or get an overall description of the Sculpture Garden.
Aggression - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Understanding of Self - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Covey says most people look for quick fixes. They see a big success and want to know how he did it, believing (and hoping) they can do the same following a quick bullet list.
But real change, the author says, comes not from the outside in, but from the inside out. And the most fundamental way of changing yourself is through a paradigm shift.
That paradigm shift is a new way of looking at the world. The 7 Habits of Highly Effective People presents an approach to effectiveness based on character and principles.
The first three habits indeed deal with yourself because it all starts with you. The first three habits move you from dependence from the world to the independence of making your own world.
Habits 4, 5 and 6 are about people and relationships. The will move you from independence to interdependence. Such, cooperating to achieve more than you could have by yourself.
The last habit, habit number 7, focuses on continuous growth and improvement.
ProSocial Behaviour - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
1. Please note: An erratum has been published for this issue. To view the erratum, please click here.
Morbidity and Mortality Weekly Report
Weekly March 30, 2007 / Vol. 56 / No. 12
Three Outbreaks of Salmonellosis Associated with Baby Poultry
from Three Hatcheries — United States, 2006
During 2006, state health departments notified CDC of exposure. All 21 patients reported diarrhea, and six (29%)
three outbreaks of Salmonella species infections in persons who reported bloody diarrhea. Twelve (57%) patients reported
had been in contact with chicks and other baby poultry (duck- vomiting. Seven (33%) of the 21 ill patients were hospitalized
lings, goslings, and baby turkeys) purchased at agricultural for a median of 4 days (range: 1–9 days); complete data on
feed stores. The feed stores received the poultry from hatcher- recovery status were not available at the time of interview.
ies, and each of the three outbreaks was traced to a single The median age of hospitalized patients was 31 years (range:
hatchery. For decades, baby poultry, particularly chicks and 7 months–79 years). The median age of all patients was
ducklings, have been known to be a source of salmonellosis 18 years (range: 7 months–79 years). Twelve (57%) patients
(1–4). More recently, the source of birds associated with sal- reported exposure to baby poultry in the 7 days before illness
monellosis outbreaks has been traced back to individual hatch- onset; eight of these patients reported purchasing the birds as
eries. Many persons who purchase baby poultry remain a source of meat or eggs, two patients reported purchasing the
unaware that contact with these birds puts them and others birds as family pets, and for two patients, the reason for pur-
who are exposed to the birds, especially children and chase was unknown. The hatchery source of the baby poultry
immunocompromised persons, at risk for salmonellosis. This was determined for eight (67%) of the 12 patients who
report describes the three outbreaks and provides recommen- reported exposure; two patients purchased birds directly from
dations for preventing transmission of Salmonella infection hatchery A in Michigan, and six patients purchased birds from
from birds to humans. five different agricultural feed stores that had all received birds
Hatchery A. In May 2006, during routine surveillance of from hatchery A. This hatchery also was the source of chicks
laboratory results, the public health laboratory at the Michi- and ducklings that caused salmonellosis outbreaks in
gan Department of Community Health detected a cluster of Michigan in 1999 and 2000 (6).
cases that were culture positive for Salmonella serotype Hatchery B. On May 3, 2006, the Nebraska Health and
4,5,12,i:-. Laboratory analysis of the isolates by pulsed-field Human Services System received a report of two children with
gel electrophoresis (PFGE)* yielded an indistinguishable DNA stool-culture–confirmed salmonellosis. The health department
pattern that was later designated as the outbreak strain. Dur- began an investigation on May 4 and learned that the two
ing April–July, the laboratory isolated the outbreak strain from patients both attended the same Nebraska day care center,
a total of 21 clinical samples obtained from ill persons in Michi-
gan. Ill persons were interviewed† by state public health offi-
INSIDE
cials and asked about symptoms and possible sources of
276 Update: Chikungunya Fever Diagnosed Among
International Travelers — United States, 2006
* PFGE provides a DNA pattern for each isolate; closely related or
indistinguishable PFGE patterns suggest a common source and can be used to 278 Progress Toward Poliomyelitis Eradication — Nigeria,
distinguish outbreak cases from concurrent sporadic cases. Persons with 2005–2006
indistinguishable PFGE patterns might be included in the case count, regardless
281 Notices to Readers
of whether exposure to the outbreak source is confirmed.
283 QuickStats
† For all investigations described in this report, if the patient was a young child,
a family member was interviewed.
department of health and human services
department services
Centers for Disease Control and Prevention
2. 274 MMWR March 30, 2007
where they had handled pet chicks brought into the center by
The MMWR series of publications is published by the Coordinating a parent. Additional interviews at the day care center detected
Center for Health Information and Service, Centers for Disease
a total of 10 persons (nine students and one staff member)
Control and Prevention (CDC), U.S. Department of Health and
with diarrhea (three or more loose stools in 24 hours), and
Human Services, Atlanta, GA 30333.
three (30%) with bloody diarrhea. None of the 10 persons
Suggested Citation: Centers for Disease Control and Prevention.
were hospitalized. Stool samples were requested of all persons
[Article title]. MMWR 2007;56:[inclusive page numbers].
with diarrhea. Of the six additional stool samples obtained,
Centers for Disease Control and Prevention
two were positive for Salmonella serotype Montevideo. Of the
Julie L. Gerberding, MD, MPH
four total positive stool samples, all yielded Salmonella sero-
Director
Tanja Popovic, MD, PhD type Montevideo isolates with indistinguishable PFGE DNA
(Acting) Chief Science Officer patterns. Three of the four children had handled the chicks,
James W. Stephens, PhD
and the fourth had the opportunity to do so, although direct
(Acting) Associate Director for Science
contact could not be confirmed.
Steven L. Solomon, MD
During April–June, state public health laboratories identi-
Director, Coordinating Center for Health Information and Service
fied in the national PulseNet database§ the same strain of Sal-
Jay M. Bernhardt, PhD, MPH
monella serotype Montevideo in a total of 56 patients
Director, National Center for Health Marketing
(including those from the Nebraska day care center) from 21
B. Kathleen Skipper, MA
(Acting) Director, Division of Health Information Dissemination (Proposed) states.¶ Forty-eight of these patients were interviewed during
May–July by state public health officials and asked about symp-
Editorial and Production Staff
toms and possible exposures. All interviewed patients reported
Frederic E. Shaw, MD, JD
diarrhea (three or more loose stools in 24 hours), and 25 (52%)
Editor, MMWR Series
reported bloody diarrhea. Eight (17%) patients were hospi-
Suzanne M. Hewitt, MPA
Managing Editor, MMWR Series talized for a median of 2 days (range: 1–7 days), and all fully
Douglas W. Weatherwax recovered; the median age of hospitalized patients was 10
(Acting) Lead Technical Writer-Editor
months (range: 27 days–53 years). The median age of all
Catherine H. Bricker, MS
interviewed patients was 24 months (range: 27 days–82 years).
Jude C. Rutledge
Forty-two (88%) of the 48 interviewed patients reported
Writers-Editors
exposure to baby poultry in the 5 days before illness onset.
Beverly J. Holland
Lead Visual Information Specialist Seventeen (40%) of the interviewed patients purchased the
Lynda G. Cupell birds for meat or eggs, 18 (43%) purchased them as pets, and
Malbea A. LaPete
for seven patients, the reason for purchase was unknown.
Visual Information Specialists
Thirty-seven (88%) of 42 patients with exposure to baby poul-
Quang M. Doan, MBA
try purchased the birds at a store, including at least 14 differ-
Erica R. Shaver
Information Technology Specialists ent agricultural feed stores and one general store; other patients
did not report the facility from which they purchased the birds.
Editorial Board
All 37 patients who purchased baby poultry from a store
William L. Roper, MD, MPH, Chapel Hill, NC, Chairman
were asked whether the store provided information on pre-
Virginia A. Caine, MD, Indianapolis, IN
David W. Fleming, MD, Seattle, WA venting transmission of Salmonella species infection from birds
William E. Halperin, MD, DrPH, MPH, Newark, NJ
to humans; three patients reported receiving this type of
Margaret A. Hamburg, MD, Washington, DC
information. In addition, 31 patients who reported exposure
King K. Holmes, MD, PhD, Seattle, WA
Deborah Holtzman, PhD, Atlanta, GA
John K. Iglehart, Bethesda, MD
Dennis G. Maki, MD, Madison, WI § PulseNet is the molecular subtyping network for foodborne disease surveillance
Sue Mallonee, MPH, Oklahoma City, OK in the United States. Participants are public health laboratories in all 50 states
Stanley A. Plotkin, MD, Doylestown, PA and federal regulatory agency laboratories. PulseNet participants perform
Patricia Quinlisk, MD, MPH, Des Moines, IA standardized molecular subtyping (or “fingerprinting”) of foodborne disease-
Patrick L. Remington, MD, MPH, Madison, WI causing bacteria by PFGE in real time. The results (DNA fingerprints, or
Barbara K. Rimer, DrPH, Chapel Hill, NC patterns) are then submitted electronically to central databases located at CDC,
John V. Rullan, MD, MPH, San Juan, PR which enables rapid comparison of PFGE patterns by public health
Anne Schuchat, MD, Atlanta, GA professionals nationwide (5).
¶ California, Colorado, Iowa, Illinois, Kentucky, Maine, Massachusetts,
Dixie E. Snider, MD, MPH, Atlanta, GA
Minnesota, Missouri, Nebraska, New Jersey, New Mexico, New York, Oregon,
John W. Ward, MD, Atlanta, GA
South Dakota, Texas, Utah, Virginia, Washington, Wisconsin, and Wyoming.
3. Vol. 56 / No. 12 MMWR 275
to baby poultry were asked whether they were aware that they MPH, N Tafoya, P Torres, MS, New Mexico Dept of Health; F Taylor,
DVM, New Mexico Dept of Agriculture. W Keene, PhD, M Plantenga,
could contract salmonellosis from baby poultry; 24 (77%) of
B Progulske, DVM, Oregon Dept of Public Health; R TenEyck, R Rada,
these patients reported being unaware that baby poultry could
L Effinger, MA, Oregon Dept of Agriculture. J Lockett, N Patel, Enteric
be a source of Salmonella species infection. The hatchery source
Disease Laboratory Br; F Angulo, DVM, H Bair-Brake, DVM, Enteric
of the baby poultry was determined for nine (21%) of the 42
Disease Epidemiology Br, Div of Foodborne Bacterial and Mycotic
patients who had been exposed to baby poultry; seven of these
Diseases, National Center for Zoonotic, Vector-Borne, and Enteric
nine patients purchased the baby poultry from three feed stores Diseases; N Gaffga, MD, EIS Officer, CDC.
that all received birds from hatchery B in New Mexico. PFGE
Editorial Note: This report describes three concurrent out-
analysis of isolates from baby poultry and environmental swabs
breaks of salmonellosis that occurred during 2006, the first
from hatchery B yielded a DNA pattern that was indistin-
year during which more than one baby-poultry–associated
guishable from the Salmonella Montevideo outbreak strain in
salmonellosis outbreak has been recognized. These outbreaks
the patients. Hatchery B also had been identified previously
demonstrate that salmonellosis associated with baby poultry
as the source of chicks that caused outbreaks of human
purchased from agricultural feed stores is a source of Salmo-
Salmonella species infections in 2002 and 2005 (New Mexico
nella infection in humans and an ongoing public health
Department of Health, unpublished data, 2007).
problem.
Hatchery C. During March–May 2006, the Oregon State
Each year in the United States, an estimated 1.4 million
Public Health Laboratory identified four patients with Sal-
Salmonella infections result in thousands of hospitalizations
monella serotype Ohio isolates; PFGE analysis yielded
and hundreds of deaths (7). The percentage caused by con-
indistinguishable DNA patterns. All four patients were inter-
tact with baby poultry remains unknown, and few measures
viewed by public health officials and asked whether they had
have been implemented to prevent transmission of
been hospitalized and about possible sources of exposure. The
Salmonella organisms from baby poultry to humans.
median age of patients was 32 years (range: 1–77 years). One
Fewer than 20 hatcheries in the United States provide the
patient was hospitalized.
majority of baby poultry sold in agricultural feed stores in the
All four patients reported exposure to baby poultry in the
nation, and certain hatcheries have been implicated repeat-
days before illness onset. Three of the four patients had pur-
edly as sources of baby-poultry–associated salmonellosis out-
chased chicks from one agricultural feed store; the source for
breaks. Such outbreaks might be prevented by control measures
the fourth patient was unknown. After a review of
at these and other hatcheries and at agricultural feed stores,
invoices from the feed store, the source for the chicks was
where most persons purchase baby poultry. Providing infor-
determined to be hatchery C in neighboring Washington.
mation to customers about the health risks of bird contact
Hatchery C had been identified previously as the source of
and providing adequate handwashing facilities might prevent
chicks that caused outbreaks of salmonellosis in 1995, 1996,
such infections (8). Certain state health departments (e.g., in
2003, 2004, and 2005 (Oregon Department of Public Health,
Washington and Oregon) have urged feed stores to display
unpublished data, 2007).
warnings and provide point-of-sale educational materials to
To assess the prevalence of Salmonella species in chicks at
persons purchasing baby poultry; however, such campaigns
retail stores, the Oregon Department of Agriculture and the
are voluntary and might not be implemented. Increased
Oregon Public Health Division surveyed 16 agricultural feed
emphasis on such point-of-sale educational materials might
stores in western Oregon during February–March 2006.
reduce numbers of infections. Evaluation of the effectiveness
Although the surveys began before the outbreak was detected,
of mandated point-of-sale education in reducing baby-
the data were used to assist in the subsequent outbreak inves-
poultry–associated salmonellosis might help guide future
tigation. Store representatives were asked about conditions
prevention programs.
under which birds were purchased, housed, and sold. In addi-
Although the purchase of baby poultry from agricultural
tion, cloacal swabs from 137 chicks from the 16 stores were
feed stores by persons for meat or eggs or as pets is legal in all
cultured for Salmonella; serotypes Ohio, Montevideo, or
states, a 2005 survey indicated that the sale of chicks to indi-
Tennessee were recovered from 25 (18%) of the chicks from
vidual persons is regulated by law in certain states. For example,
10 of the 16 stores. All agricultural feed stores with chicks
13 states** and the District of Columbia (DC) prohibit the
whose swabs yielded Salmonella Ohio received these chicks
sale of birds that have been dyed. Arkansas, Kentucky,
from hatchery C.
Reported by: S Bidol, MPH, M Stobierski, DVM, Michigan Dept of
Community Health. D Leschinsky, Nebraska Health and Human Svcs ** Arkansas, Florida, Illinois, Kentucky, Massachusetts, Michigan, Montana,
System. P Ettestad, DVM, C Smelser, MD, D Sena-Johnson, J Jungk, New Jersey, New York, Pennsylvania, South Carolina, Tennessee, and Vermont.
4. 276 MMWR March 30, 2007
Update: Chikungunya Fever
New York, and Wisconsin have laws establishing a minimum
Diagnosed Among International
number of birds that can be sold to individual persons, and
12 states†† and DC have laws restricting the youngest age at
Travelers — United States, 2006
which birds can be sold. The effectiveness of such legislation
Chikungunya virus (CHIKV) is a mosquitoborne alphavirus
is unknown. None of the hatcheries or stores implicated in
indigenous to tropical Africa and Asia, where it causes
the outbreaks were in violation of state laws related to the sale
endemic and epidemic chikungunya (CHIK) fever, an acute
of baby poultry.
illness characterized by fever, arthralgias, and sometimes
The hatchery B outbreak investigation described in this
arthritis, commonly accompanied by conjunctivitis and rash.
report indicates that persons who purchase baby poultry usu-
Although symptoms of CHIKV infection usually last days to
ally are unaware that Salmonella species infections can be trans-
weeks, joint symptoms and signs usually last for months
mitted from poultry to humans. Although baby birds such as
and occasionally for 1 year or longer; deaths from CHIKV
chicks and ducklings might not appear dirty, they can have
infection are rare (1). No specific antiviral treatment exists for
feces on their feathers and beaks, areas that children are more
CHIKV infection; treatment consists of supportive care,
likely to touch or place in their mouths, possibly resulting in
including analgesics and anti-inflammatory medication for
infection. In addition, all items that have been in contact with
joint symptoms. During 2005–2006, an epidemic of CHIK
birds, such as floors, tables, rugs, sinks, and fingers, can be
fever occurred on islands in the Indian Ocean and in India,
contaminated with a fecal film.
resulting in millions of clinically suspected cases, mainly in
To reduce the risk for illness or death from salmonellosis,
southern India (2,3). In the United States, CHIK fever has
persons should be educated about the risks of contact with
been diagnosed in travelers from abroad. CDC previously
baby poultry, should avoid contact with bird feces, and should
reported 12 imported cases of CHIK fever diagnosed in the
wash their hands with soap and warm water after handling
United States from 2005 through late September 2006,
baby poultry or anything that has been in contact with them.
including 11 with illness onset in 2006 (4). This report of 26
In addition, children aged <5 years should not be allowed to
additional imported cases with onset in 2006 underscores the
handle baby chicks or other baby birds. At the community
importance of recognizing such cases among travelers. Health-
level, hatcheries should provide written information for cus-
care providers are encouraged to suspect CHIKV infection in
tomers at agricultural feed stores and customers who purchase
travelers with fever and arthralgias who have recently returned
directly from hatcheries, recommending ways to prevent trans-
from areas with CHIKV transmission. Acute- and
mission of Salmonella organisms from birds to humans. Ad-
convalescent-phase serum specimens can be submitted to CDC
ditional information regarding health risks posed by contact
for testing through state health departments. Public health
with baby poultry is available at http://www.cdc.gov/
officials and health-care providers are encouraged to be vigi-
healthypets/easter_chicks.htm.
lant for the possibility of indigenous CHIKV transmission in
References
areas of the United States where CHIKV mosquito vectors
1. Anderson AS, Bauer H, Nelson CB. Salmonellosis due to Salmonella
Typhimurium with Easter chicks as likely source. JAMA 1955;158:1153–5. are prevalent.
2. CDC. Salmonella hadar associated with pet ducklings—Connecticut,
Surveillance for CHIK fever in the United States is passive
Maryland, and Pennsylvania, 1991. MMWR 1992;41:185–7.
and laboratory based; the disease is not nationally reportable.
3. CDC. Salmonella serotype Montevideo infections associated with
chicks—Idaho, Washington, and Oregon, spring 1995 and 1996. In the United States in 2006, diagnostic testing for CHIKV
MMWR 1997;46:237–9.
was available at CDC by arrangement through state health
4. CDC. Salmonellosis associated with chicks and ducklings—Michigan
departments. Although clinicians were encouraged to submit
and Missouri, spring 1999. MMWR 2000;49:297–9.
paired acute- and convalescent-phase serum specimens (ide-
5. CDC. PulseNet. Available at http://www.cdc.gov/pulsenet.
6. Wilkins MJ, Bidol SA, Boulton ML, Stobierski MG, Massey JP, ally separated by 2 weeks), paired specimens were not uni-
Robinson-Dunn B. Human salmonellosis associated with young poul-
formly available. All serum samples were tested by
try from a contaminated hatchery in Michigan and the resulting public
immunoglobulin M (IgM)-capture enzyme-linked
health interventions, 1999 and 2000. Epidemiol Infect 2002;129:19–27.
7. Voetsch AC, VanGilder TJ, Angulo FJ, et al. FoodNet estimate of the immunosorbent assay (ELISA) and plaque-reduction neutral-
burden of illness caused by nontyphoidal Salmonella infections in the
ization (PRNT). IgM-negative acute-phase samples were tested
United States. Clin Infect Dis 2004;38(Supp 3):S127–34.
by virus culture. Positive cultures were confirmed by
8. CDC. Compendium of measures to prevent disease associated with ani-
mals in public settings, 2005. National Association of State Public Health polymerase chain reaction.
Veterinarians. MMWR 2005;54(No. RR-4).
†† Alabama, Arkansas, Florida, Kentucky, Massachusetts, Montana, New Jersey,
New York, North Carolina, Pennsylvania, South Carolina, and Wisconsin.
5. Vol. 56 / No. 12 MMWR 277
Including the previously reported cases (4), CDC confirmed The five patients with positive cultures for CHIKV in 2006
a total of 37 cases of CHIK fever with both positive IgM and likely represent a small fraction of CHIKV-viremic travelers
PRNT and/or CHIKV isolation among U.S. travelers with who entered the United States, including many with subclini-
onset in 2006; CHIKV was isolated from the blood of five of cal or milder clinical CHIKV infections that were never docu-
these patients. Patients were from 17 states (four southern mented. Human CHIKV infections typically include transient
states, four northeastern states, five midwestern states, and viremia of sufficient concentration to infect feeding vector
four western states) and the District of Columbia. Median mosquitoes (1), and approximately one fourth of human
age of patients was 49 years (range: 22–78 years), and 54% CHIKV infections are subclinical (5). Thus, despite the
were female. In 25 (68%) of the 37 cases, onset occurred dur- apparent absence of indigenous transmission of CHIKV in
ing June–October 2006 (Figure). The country most commonly the United States or elsewhere in the western hemisphere, the
visited before traveling to the United States was India, reported risk for introduction into local vector mosquito populations
by 32 (86%) of the 37 patients; three patients reported visit- in 2006 was likely higher than previously observed. In 2007,
ing Sri Lanka, and one each had visited Zimbabwe and the the risk likely will continue to be higher than usual, especially
Indian Ocean island of Réunion. An additional seven travel- in tropical and subtropical areas where Aedes aegypti and Aedes
ers returning to the United States in 2006 tested positive for albopictus mosquitoes, the main vectors of CHIKV (6), are
CHIKV antibody by either IgM ELISA or PRNT but not by seasonally abundant.
both. Travelers to tropical areas of Asia and Africa should educate
themselves regarding CHIK fever and follow CDC recom-
Reported by: Div of Vector-Borne Infectious Diseases, National Center
mendations to prevent mosquito bites.* Febrile illness in per-
for Zoonotic, Vector-Borne, and Enteric Diseases; Div Global Migration
sons traveling to the United States from Asia and Africa should
and Quarantine, National Center for Preparedness, Detection, and
Control of Infectious Diseases; E Farnon, EIS Officer, CDC. be reported promptly to local or state public health authori-
ties, and tests for CHIKV infection should be requested (4).
Editorial Note: The 37 imported cases of CHIK fever in 2006
Persons with febrile illness suspected to be caused by CHIKV
were unprecedented in the United States; during the preced-
should avoid mosquito exposure for at least 7 days after ill-
ing 15-year period, 1991–2005, only seven patients had both
ness onset to reduce the likelihood of transmitting CHIKV to
IgM and PRNT antibody to CHIKV detected by tests at CDC,
local mosquitoes, which might then transmit the virus to
and only three of these were known to be returning U.S. trav-
other humans.
elers (CDC, unpublished data, 2006). Factors contributing
References
to the increase in the number of confirmed cases likely
1. Jupp PG, McIntosh BM. Chikungunya virus disease. In: Monath TP,
include an increase in the absolute number of infected travel-
ed. The arboviruses: epidemiology and ecology (vol 2). Boca Raton, FL:
ers and the effects of recent CHIK fever publicity on the fre- CRC Press; 1988:137–57.
quency of clinical diagnosis and submission of samples for 2. Lahariya C, Pradhan SK. Emergence of chikungunya virus in Indian
laboratory testing (4). subcontinent after 32 years: a review. J Vector Borne Dis 2006;43:
151–60.
3. World Health Organization. Outbreak news: chikungunya, India. Wkly
Epidemiol Rec 2006;81:409–10.
4. CDC. Chikungunya fever diagnosed among international travelers—
United States, 2005–2006. MMWR 2006;55:1040–2.
FIGURE. Number (37) of confirmed cases of chikungunya fever,
5. Retuya TJA Jr, Ting DL, Dacula BD, et al. Chikungunya fever outbreak
by month of illness onset — United States, 2006
in an agricultural village in Indang, Cavite, Philippines. Philippine Jour-
9
nal of Microbiology and Infectious Diseases 1998;27:93–6.
8
6. Parola P, de Lamballerie X, Jourdan J, et al. Novel chikungunya virus
variant in travelers returning from Indian Ocean islands. Emerg Infect
7
Dis 2006;12:1493–9.
6
Number
5
4
3
2
1
* Available at http://www.cdc.gov/ncidod/dvbid/chikungunya and http://
0
www.cdc.gov/travel/other/2006/chikungunya_india.htm.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month
6. 278 MMWR March 30, 2007
Progress Toward Poliomyelitis strategy focused on enhancing health-worker training and
Eradication — Nigeria, 2005–2006 supervision and improving outreach at the local ward level.
Four national and two subnational SIA campaigns with triva-
Only four countries (Afghanistan, India, Nigeria, and lent OPV (tOPV) were conducted in 2005; one national cam-
Pakistan) have never experienced interruption of poliovirus paign was conducted in February 2006. Despite these
transmission (1–3). Nigeria had the largest number of cases campaigns, the number of confirmed polio cases in the sec-
in 2006, accounting for 1,129 (56%) of the 2,002 cases ond half of 2005 and early 2006 indicated that a substantial
reported globally. However, major innovations to the national proportion of children had not been immunized and remained
polio-eradication program in Nigeria were initiated in 2006. susceptible to poliovirus infection, especially polio infection
These innovations, if sustained, should advance the Global attributed to WPV1. The National Programme on Immuni-
Polio Eradication Initiative. Nigeria (2006 population: 140 zation began using mOPV1, which is more effective than
million) experienced a resurgence in wild poliovirus (WPV) tOPV against WPV1, during the March 2006 SIAs in 32 of
transmission during 2003–2004 after a loss of public confi- the 37 states (including all northern states). In May 2006, the
dence* in oral polio vaccine (OPV) and suspension of supple- National Programme on Immunization introduced a modi-
mentary immunization activities (SIAs)† in certain northern fied strategy of SIA implementation, called immunization plus
states (4). Subsequently, WPV spread within Nigeria and into days (IPDs), during which OPV and other interventions were
19 polio-free countries (1,5,6). Even after national SIAs delivered using a combination of house-to-house vaccine
recommenced, limited acceptance and ongoing operational delivery and fixed-post vaccination. Four IPD rounds were
problems resulted in low vaccination coverage and continued conducted during May–November 2006 in polio-affected
poliovirus transmission. The number of confirmed polio cases northern states. The May, June, and September IPDs used
in Nigeria attributed to both WPV type 1 (WPV1) and type mOPV1, whereas tOPV was used in the November round to
3 (WPV3) increased from 782 in 2004 to 830 in 2005 and to provide protection against WPV3.
1,129 in 2006 (as of March 23, 2007). To increase the effec- IPDs offered OPV and other vaccines (e.g., measles vaccine
tiveness of polio-eradication measures and community accep- and diphtheria-tetanus-pertussis vaccine for eligible children
tance of vaccination, in 2006, health authorities in Nigeria and tetanus toxoid vaccine for pregnant women) at fixed vac-
introduced monovalent type 1 OPV (mOPV1) vaccine§ and cination posts, in addition to house-to-house delivery of OPV
changed the way SIAs were implemented. This report sum- (and vitamin A twice in the year). In the targeted northern
marizes these new approaches and overall progress toward polio states, local government areas (LGAs) offered other health
eradication in Nigeria during 2005–2006. interventions when children were brought to vaccination posts.
These interventions included distribution of soap, acetami-
Immunization Activities nophen, oral rehydration salts, anthelminthics, and insecti-
cide-treated bed nets. Additional modifications implemented
In 2005, national reported routine vaccination coverage for
as part of the IPDs were 1) holding community discussions to
3 doses of OPV among infants was 31%. Substantial varia-
educate caregivers and address concerns before each round; 2)
tion was observed in coverage by state (range: 10%–57%),
enhancing detailed SIA planning through involvement of lo-
with lower coverage reported from northern states. In the same
cal community leaders; 3) using qualified local health work-
year, Nigeria adopted a new Reaching Every Ward strategic
approach¶ to improve routine vaccination coverage. This ers on the vaccination teams; and 4) enhancing field
supervision by local, state, and federal authorities and through
partner agencies.**
* Loss of public confidence resulted from rumors regarding OPV safety, including
false allegations that the vaccine could cause sterility or acquired
immunodeficiency syndrome in vaccine recipients. Rumors were promoted,
especially in northern Nigeria, in response to political tensions at national and
state levels. All allegations were refuted on scientific grounds.
† Mass campaigns conducted during a short period (days to weeks) during which
a dose of OPV is administered to all children aged <5 years, regardless of previous
vaccination history. Campaigns can be conducted nationally or in portions of ** National Programme on Immunization of the Nigeria Ministry of Health,
the country. Association of Local Governments of Nigeria, Nigerian state governments,
§ mOPV1 contains polio vaccine against WPV1 only and does not provide World Health Organization, Rotary International, CDC, United Nations
protection against other WPV types. mOPV1 provides greater immunity to a Children’s Fund (UNICEF), European Union, International Federation of
specific WPV type than does the same number of doses of trivalent OPV. Red Cross/Red Crescent, World Bank, the Global Alliance for Vaccine and
mOPV3 is not yet available in Nigeria. Immunization, the Vaccine Fund, and bilateral development agencies of
¶ An adaptation of the World Health Organization Regional Office for Africa Canada, Norway, Japan, the United Kingdom, and the United States (U.S.
and global Reaching Every District initiative. Agency for International Development [USAID]).
7. Vol. 56 / No. 12 MMWR 279
Acute Flaccid Paralysis (AFP) Surveillance This was followed early in 2006 by a substantial increase in
the number of cases compared with the same period in earlier
The Global Polio Eradication Initiative relies on an acute
years. The peak in WPV1 circulation in 2006 occurred in
flaccid paralysis (AFP) surveillance system to identify cases of
March, with a rapid decrease in cases commencing in June
poliomyelitis. Through this system, AFP cases in all children
(Figure 1). The decrease in WPV1 incidence was pronounced
aged <15 years and suspected polio in persons of any age are
in the three states with the highest incidence of poliomyelitis
reported and investigated as possible poliomyelitis. AFP sur-
(Jigawa, Kano, and Katsina) (Figure 2).¶¶ During July–De-
veillance quality is monitored according to World Health
cember 2006, WPV1 incidence for these three states was 63%
Organization (WHO) operational targets.†† In 2005, Nigeria
lower than the same period in 2005 (64 cases in 2006 versus
achieved a national nonpolio AFP detection rate of 7.6 cases
174 cases in 2005). WPV3 circulation did not decrease sub-
per 100,000 population aged <15 years, compared with the
stantially during 2006.
WHO target of two cases, increasing to 7.9 per 100,000 chil-
Of the 830 WPV polio cases with onset in 2005 (580 WPV1
dren in 2006. In 2005, all 37 states and 85% of the 774 LGAs
and 250 WPV3), a total of 224 (27%) were reported from
achieved nonpolio AFP rates of more than two cases per
Kano state (117 WPV1 and 107 WPV3), and 544 (65%)
100,000; in 2006, 90% of LGAs achieved this rate. In 2005,
were reported from nine other high-incidence states (409
adequate stool specimens were collected for 85% of AFP cases
WPV1 and 135 WPV3). Of the 1,129 polio cases with onset
nationally; this percentage increased to 90% in 2006. In 2005,
in 2006 (851 WPV1 and 278 WPV3), 355 (31%) were from
68% of states and 62% of LGAs reached the target of >80%
Kano (303 WPV1 and 52 WPV3) and 718 (64%) were from
AFP cases with adequate stool specimens; in 2006, 86% of
the other nine high-incidence states (504 WPV1 and 214
states and 73% of LGAs reached this target. The proportion
WPV3). Despite the increase in case numbers in 2006, the
of LGAs that reached the target levels for both surveillance
area of transmission decreased, from 21 affected states (57%
indicators increased from 52% in 2005 to 64% in 2006.
of the 37 states in Nigeria) in 2005 to 18 states (49%) in
Vaccination histories of children aged 6–59 months with
2006. No state in southern Nigeria has detected WPV since
nonpolio AFP were used to estimate OPV coverage of the
August 2005.
overall target population. In the 10 states with high polio in-
In 2005, a total of 27 WPV1 and 18 WPV3 genetic virus
cidence,§§ the proportion of nonpolio AFP cases in children
clusters were detected circulating in Nigeria.*** In 2006, fewer
who had never received any OPV decreased from 45% in the
WPV1 and WPV3 genetic clusters were observed; pending
first quarter of 2005 to 31% in the first quarter of 2006 (Table).
completion of genetic analyses and further observation in 2007,
After the introduction and continuation of IPDs, the average
the extent of this decrease is unclear. WPV1 and WPV3 found
proportion of nonpolio AFP cases in children who had
in Cameroon, Chad, and Niger during 2005–2006 were closely
never received any OPV in these states decreased to 18% in
related to viruses found in nearby Nigerian states.
the fourth quarter of 2006.
Reported by: National Programme on Immunization, Federal Ministry
WPV Incidence of Health; Country Office of the World Health Organization, Abuja;
Poliovirus Laboratory, Univ of Ibadan, Ibadan; Poliovirus Laboratory,
Of the 1,959 WPV cases reported during 2005–2006, a Univ of Maidugari Teaching Hospital, Maidugari, Nigeria. African
total of 830 (42%) occurred in children aged <2 years (1,867 Regional Polio Reference Laboratory, National Institute for
[95%] were aged <5 years); 1,483 (76%) of cases were in chil- Communicable Diseases, Johannesburg, South Africa. Vaccine
dren who had received <3 doses of OPV. During the late 1990s Preventable Diseases, World Health Organization Regional Office for
and early 2000s, WPV transmission in Nigeria peaked in July Africa, Brazzaville, Congo. Immunization, Vaccines, and Biologicals
and August during the rainy season and reached its lowest Dept, World Health Organization, Geneva, Switzerland. Div of Viral
Diseases and Global Immunization Div, National Center for
during the dry season (7). In late 2005, the monthly case
Immunization and Respiratory Diseases, CDC.
incidence of WPV1 was atypically high for the dry season.
†† ¶¶
The current WHO operational targets for countries at high risk for polio As of March 23, 2007, with laboratory investigations for January AFP cases
transmission are a nonpolio AFP rate of at least two cases per 100,000 99% complete, 27 cases of confirmed WPV have been reported provisionally
population aged <15 years at each subnational level and adequate stool in the country for January 2007 (seven WPV1 and 20 WPV3), compared
specimen collection for >80% of AFP cases (i.e., two specimens collected >24 with 24 in 2005 (nine WPV1 and 15 WPV3) and 89 in 2006 (80 WPV1
hours apart, both within 14 days of paralysis onset, and shipped on ice or and nine WPV3).
frozen ice packs to a WHO-accredited laboratory and arriving at the laboratory *** All WPVs are sequenced across the interval encoding the major capsid protein
in good condition). (VP1) (approximately 900 nucleotides), and results are analyzed to determine
§§ Bauchi, Borno, Jigawa, Kaduna, Kano, Katsina, Kebbi, Sokoto, Yobe, and the likely origin (by state and LGA) of the virus. Isolates within a cluster
Zamfara. share >95% VP1 nucleotide sequence identity.
8. 280 MMWR March 30, 2007
TABLE. Poliovirus vaccination coverage among children aged 6–59 months with nonpolio acute flaccid paralysis, by quarter and
number of doses administered — 10 states,* Nigeria, 2005 and 2006†
2005 2006
1st quarter§
No. of doses 2nd quarter 3rd quarter 4th quarter 1st quarter 2nd quarter 3rd quarter 4th quarter
0 45% 30% 34% 39% 31% 33% 19% 18%
1–2 31% 37% 27% 33% 35% 36% 40% 39%
>3 21% 31% 36% 25% 31% 28% 34% 37%
Unknown 2% 3% 2% 3% 3% 3% 8% 6%
* Bauchi, Borno, Jigawa, Kaduna, Kano, Katsina, Kebbi, Sokoto, Yobe, and Zamfara.
†
As of March 23, 2007.
§
Analysis for trend across the four 2005 quarters was not statistically significant (chi-square Mantel Haenszel test [χ2mh] = 0.32, p = 0.57), across the four
2006 quarters was significant (χ2mh = 9.99, p = 0.002), and across all eight quarters was significant (χ2mh = 23.99, p<0.0001). Unknowns were combined
with zero doses for this analysis.
2006 have been associated with a
FIGURE 1. Number of confirmed poliomyelitis cases, by wild poliovirus (WPV) type,
month of onset, type of supplementary immunization activity,* and type of vaccine decrease in WPV1 monthly incidence;
administered — Nigeria, 2004–2006†
in 2006, only 22% of 851 WPV1 cases
¶
occurred in the second half of the year.
mOPV1
mOPV1
mOPV1
mOPV1
§
tOPV
tOPV
tOPV
tOPV
tOPV
tOPV
tOPV
tOPV
tOPV
tOPV
tOPV
tOPV
tOPV
An increase in population immunity
against poliovirus infection also is
indicated by the decrease in the propor-
160
tion of nonpolio AFP cases in children
140 WPV type 1 NIDs**
††
WPV type 3 SNIDs
who have received zero doses since the
120 §§
IPDs
introduction of IPDs in May 2006.
100
Number
In 2006, polio-eradication measures
80
were concentrated in the 10 states with
60
the most intense transmission of
40
WPV. Because approximately 50% of
20
the target population remains
0
undervaccinated in high-incidence
Jul Jul Jul
Apr Oct Apr Oct Apr Oct
Jan Jan Jan
2004 2005 2006
states, further improvements in immu-
Month and year
nization levels are needed to interrupt
* Mass campaign conducted during a short period (days to weeks) during which a dose of oral polio-
poliovirus transmission. The continued
virus vaccine (OPV) is administered to all children aged <5 years, regardless of previous vaccina-
involvement of traditional and religious
tion history. Campaigns can be conducted nationally or in portions of the country.
† As of March 23, 2007.
community leaders will be essential to
§ Trivalent OPV.
increase both SIA and routine vaccina-
¶ Monovalent type 1 OPV.
** National immunization days. Nationwide mass campaigns during a short period (days to weeks) tion coverage.
during which a single dose of OPV is administered to all children aged <5 years, regardless of
Although the sensitivity of AFP sur-
previous vaccination history, with an interval of 4–6 weeks between doses.
†† Subnational immunization days. Mass campaigns similar to NIDs but in a smaller area.
veillance and the number of reported
§§ Immunization plus days. OPV and other interventions are delivered using a combination of house-
cases increased in 2006 compared with
to-house vaccine delivery and fixed-post vaccination.
2005, WPV was found in fewer states.
Genetic sequence analysis suggests that
Editorial Note: Although SIAs were resumed in all areas in
several genetic virus clusters have been eliminated in 2006;
Nigeria in mid-2004, they did not sufficiently curtail the
however, by the end of the year, numerous independent chains
resurgence of WPV transmission that began in 2003–2004.
of transmission persisted.
The number of cases in northern states increased substantially
Compared with tOPV, mOPV1 is more effective, dose for
in late 2005 and early 2006, particularly WPV1 cases. In
dose, in immunizing children against WPV1; a single dose of
December 2005, the Nigerian government mandated the
mOPV1 has been estimated as the equivalent of 3 doses of
National Programme on Immunization to accelerate polio
tOPV in terms of seroconversion against WPV1 (8). Thus, in
eradication and enhance routine vaccination. The introduc-
2006, the Nigerian Polio Program decided to target preferen-
tion of mOPV1 in March 2006 and improved community
tially WPV1 circulation using mOPV1 for most SIAs.
acceptance in response to the introduction of IPDs in May
9. Vol. 56 / No. 12 MMWR 281
FIGURE 2. Rate* of poliomyelitis attributed to wild poliovirus (WPV) type 1, by state† and semiannual period — Nigeria, 2006§
January–June 2006 July–December 2006
Sokoto Sokoto
Katsina Katsina
Jigawa Yobe Jigawa Yobe
Borno
Kebbi Borno
Kebbi
Zamfara Zamfara
Kano Kano
Gombe
Bauchi Gombe
Kaduna Bauchi
Kaduna
Niger Niger
Adamawa
Plateau Plateau
¶
FCT
Kwara FCT
Nasarawa Nasarawa
Taraba
<1.0
1.1–4.9
5.0–9.9
>10.0
* Annualized rate for each half year per 100,000 children aged <5 years.
† Only states with reported polio cases in each half year in 2006 are labeled.
§ As of March 23, 2007.
¶ Federal Capital Territory.
2. CDC. Progress toward poliomyelitis eradication—Pakistan and Afghani-
Because of its greater transmissibility, WPV1 poses a greater
stan, January 2005–May 2006. MMWR 2006;55:679–82.
threat of wide geographic spread compared with WPV3, as 3. CDC. Progress toward poliomyelitis eradication—India, January 2005–
was observed during the 2003–2004 polio outbreak in June 2006. MMWR 2006;55:772–6.
Nigeria and neighboring countries. Use of tOPV in IPDs in 4. CDC. Progress toward poliomyelitis eradication—Nigeria, January
2004–July 2005. MMWR 2004;54:873–7.
northern states in November 2006 and early 2007 should
5. CDC. Resurgence of wild poliovirus type 1 transmission and conse-
curtail WPV3 transmission. quences of importation—21 countries, 2002–2005. MMWR
For 2007, priority has been given to further improving IPDs 2006;55:145–50.
6. World Health Organization. Outbreak news: poliomyelitis, Kenya. Wkly
planning and supervision in the highest-risk LGAs in the high-
Epidemiol Rec 2006;81:409–16.
incidence states. Communication and health-education 7. CDC. Progress toward interruption of wild poliovirus transmission—
activities will continue to be modified and strengthened Nigeria, 1996–1998. MMWR 1999;48:312–6.
8. Caceres VM, Sutter RW. Sabin monovalent oral polio vaccines: review
according to findings from program monitoring and evalua-
of past experiences and their potential use after polio eradication. Clin
tion. These measures are expected to increase the impact of Infect Dis 2001;33:531–41.
SIAs during the WPV low-transmission season and of SIAs
scheduled for the remainder of the year. Nigeria achieved some
Notice to Readers
key milestones in 2006 toward improving child survival. The
National Public Health Week —
Nigerian government and its immunization partners are com-
mitted to interrupting WPV transmission in Nigeria and to April 2–8, 2007
building sustainable means of enhancing child health. Con-
Since 1995, National Public Health Week has been observed
tinuation and expansion of IPDs and use of mOPV1 is needed
each year during the first week in April. During this year’s
to interrupt WPV1 transmission in Nigeria; periodic use of
observance, April 2–8, 2007, American Public Health Asso-
tOPV will continue to reduce WPV3 circulation.
ciation members and partners will host events throughout the
References
United States, encouraging all persons, especially vulnerable
1. CDC. Progress toward interruption of wild poliovirus transmission—
populations, to “Take the First Step!” toward creating
worldwide, January 2005–March 2006. MMWR 2006;55:458–62.
preparedness plans for public health threats.
10. 282 MMWR March 30, 2007
In conjunction with the observance, CDC’s Coordinating The course will provide practicing public health professionals
Office for Terrorism Preparedness and Emergency Response with the theoretical and practical tools necessary to design,
and Public Health Training Network will host a live satellite implement, and evaluate an effective surveillance program.
broadcast, “Pandemic Influenza: Progress in Planning and Topics include overview and history of surveillance systems;
Exercising: Federal, State, and Local Perspectives,” on April planning considerations; sources and collection of data; analy-
5, from 1 p.m. to 2:30 p.m. EST. A panel will discuss progress sis, interpretation, and communication of data; surveillance
in pandemic influenza planning and exercising and answer systems technology; ethics and legalities; state and local con-
viewers’ questions. The broadcast also will be available as a cerns; and future considerations. Tuition will be charged.
live webcast. Additional information and applications are available from
Additional information regarding the satellite broadcast is Emory University by mail (Hubert Global Health Dept.,
available at http://www2a.cdc.gov/phtn. Additional informa- 1518 Clifton Rd. NE, Rm. 746, Atlanta, GA 30322), by
tion on National Public Health Week is available at telephone (404-727-3485), by fax (404-727-4590), online
http:www.nphw.org. (http://www.sph.emory.edu/epicourses), or by e-mail
(pvaleri@sph.emory.edu).
Notice to Readers
Erratum: Vol. 56, No. 10
Introduction to Public Health
Surveillance Course In the report, “Fruit and Vegetable Consumption Among
Adults—United States, 2005,” on page 215, the second sen-
CDC and Rollins School of Public Health at Emory Uni-
tence in the first complete paragraph should read, “The preva-
versity will cosponsor a course, Introduction to Public Health
lence of consuming fruit two or more times per day was 28.7%
Surveillance, to be held May 7–11, 2007, at Emory Univer-
among men and 36.4% among women.”
sity. The course is designed for state and local public health
professionals.
11. Please note: An erratum has been published for this issue. To view the erratum, please click here.
Vol. 56 / No. 12 MMWR 283
QuickStats
from the national center for health statistics
Percentage of Children with Selected Allergies,* by Age Group —
United States, 2003–2005
16
0–4 yrs
14
5–9 yrs
12 10–17 yrs
Percentage
10
8
6
†
4
2
0
Hay fever Skin allergy Food allergy
Selected allergies
* Based on parental responses to the following survey questions: “During the
past 12 months, has [child's name] had any of the following conditions...Hay
fever? Any kind of food or digestive allergy? Eczema or any kind of skin allergy?”
† 95% confidence interval.
During 2003–2005, the percentage of children with hay fever increased with age; children aged 10–17 years
were nearly three times as likely to have hay fever than children aged 0–4 years. In contrast, the percentage of
children with skin allergies decreased with age, and the percentage of children with food allergies did not vary
with age.
SOURCE: Health data for all ages. National Health Interview Survey, 2003–2005. Hyattsville, MD: US Department
of Health and Human Services, CDC. Available at http://209.217.72.34/hdaa/tableviewer/tableview.aspx?
reportId=186.
12. 284 MMWR March 30, 2007
TABLE I. Provisional cases of infrequently reported notifiable diseases (<1,000 cases reported during the preceding year) — United States,
week ending March 24, 2007 (12th Week)*
5-year
Cum weekly Total cases reported for previous years
Current
2007 average† 2006
Disease week 2005 2004 2003 2002 States reporting cases during current week (No.)
Anthrax — — — 1 — — — 2
Botulism:
foodborne — — 0 19 19 16 20 28
infant — 13 2 95 85 87 76 69
other (wound & unspecified) — 2 1 45 31 30 33 21
Brucellosis — 22 1 119 120 114 104 125
Chancroid — 1 1 34 17 30 54 67
Cholera — — — 6 8 5 2 2
Cyclosporiasis§ 1 10 3 135 543 171 75 156 FL (1)
Diphtheria — — — — — — 1 1
Domestic arboviral diseases§,¶:
California serogroup — — 0 63 80 112 108 164
eastern equine — — — 7 21 6 14 10
Powassan — — — 1 1 1 — 1
St. Louis — — 0 9 13 12 41 28
western equine — — — — — — — —
Ehrlichiosis§:
human granulocytic — 12 1 569 786 537 362 511
human monocytic — 23 1 500 506 338 321 216
human (other & unspecified) — 7 0 226 112 59 44 23
Haemophilus influenzae,**
invasive disease (age <5 yrs):
serotype b — 2 0 9 9 19 32 34
nonserotype b — 10 3 102 135 135 117 144
unknown serotype 4 72 5 247 217 177 227 153 NYC (1), CO (1), AZ (1), OR (1)
Hansen disease§ — 9 2 73 87 105 95 96
Hantavirus pulmonary syndrome§ — 2 0 37 26 24 26 19
Hemolytic uremic syndrome, postdiarrheal§ 1 18 2 272 221 200 178 216 FL (1)
Hepatitis C viral, acute 13 140 22 839 652 713 1,102 1,835 NY (2), OH (1), MI (1), WV (2), NC (4), ID (1), OR (2)
HIV infection, pediatric (age <13 yrs)†† — — 5 52 380 436 504 420
Influenza-associated pediatric mortality§,§§ 4 39 1 41 45 — N N TN (1), IL (2), AZ (1)
Listeriosis 1 89 10 814 896 753 696 665 NY (1)
Measles¶¶ — 2 1 52 66 37 56 44
Meningococcal disease, invasive***:
A, C, Y, & W-135 1 41 6 232 297 — — — TX (1)
serogroup B — 19 4 144 156 — — —
other serogroup — 4 1 25 27 — — —
unknown serogroup 5 155 21 716 765 — — — OH (1), IN (1), MO (1), FL (1), AZ (1)
Mumps 4 175 45 6,541 314 258 231 270 NY (1), FL (1), WA (2)
Plague — — — 16 8 3 1 2
Poliomyelitis, paralytic — — — — 1 — — —
Poliovirus infection, nonparalytic§ — — — N N N N N
Psittacosis§ — 3 0 20 16 12 12 18
Q fever§ 2 27 2 178 136 70 71 61 MO (1), NC (1)
Rabies, human — — 0 3 2 7 2 3
Rubella††† — 7 0 8 11 10 7 18
Rubella, congenital syndrome — — 0 1 1 — 1 1
SARS-CoV§,§§§ — — 0 — — — 8 N
Smallpox§ — — — — — — — —
Streptococcal toxic-shock syndrome§ 1 14 4 101 129 132 161 118 OH (1)
Syphilis, congenital (age <1 yr) 1 35 7 334 329 353 413 412 NC (1)
Tetanus — 1 0 33 27 34 20 25
Toxic-shock syndrome (staphylococcal)§ — 14 3 96 90 95 133 109
Trichinellosis — — 0 14 16 5 6 14
Tularemia — 2 0 89 154 134 129 90
Typhoid fever 1 45 5 317 324 322 356 321 IN (1)
Vancomycin-intermediate Staphylococcus aureus§ — — 0 4 2 — N N
Vancomycin-resistant Staphylococcus aureus§ — — — 1 3 1 N N
Vibriosis (non-cholera Vibrio species infections)§ 1 19 — N N N N N FL (1)
Yellow fever — — — — — — — 1
—: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts.
* Incidence data for reporting years 2006 and 2007 are provisional, whereas data for 2002, 2003, 2004, and 2005 are finalized.
† Calculated by summing the incidence counts for the current week, the 2 weeks preceding the current week, and the 2 weeks following the current week, for a total of 5
preceding years. Additional information is available at http://www.cdc.gov/epo/dphsi/phs/files/5yearweeklyaverage.pdf.
§ Not notifiable in all states. Data from states where the condition is not notifiable are excluded from this table, except in 2007 for the domestic arboviral diseases and influenza-
associated pediatric mortality, and in 2003 for SARS-CoV. Reporting exceptions are available at http://www.cdc.gov/epo/dphsi/phs/infdis.htm.
¶ Includes both neuroinvasive and non-neuroinvasive. Updated weekly from reports to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-
Borne, and Enteric Diseases (proposed) (ArboNET Surveillance). Data for West Nile virus are available in Table II.
** Data for H. influenzae (all ages, all serotypes) are available in Table II.
†† Updated monthly from reports to the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (proposed). Implementation of
HIV reporting influences the number of cases reported. Updates of pediatric HIV data have been temporarily suspended until upgrading of the national HIV/AIDS surveil-
lance data management system is completed. Data for HIV/AIDS, when available, are displayed in Table IV, which appears quarterly.
§§ Updated weekly from reports to the Influenza Division, National Center for Immunization and Respiratory Diseases (proposed). A total of 40 cases were reported for the
2006–07 flu season.
¶¶ No measles cases were reported for the current week.
*** Data for meningococcal disease (all serogroups) are available in Table II.
††† No rubella cases were reported for the current week.
§§§ Updated weekly from reports to the Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases (proposed).