Human salmonellosis continues to be a major public health issue. Our epidemiologic review of cases from 1989 to 1992 was done to define the current reported rate of infection due to Salmonella species for the state of Arkansas, which might be expected to have higher rates of infection because it is a leading producer of poultry. Results showed that the reported case rate in Arkansas (18.0/100,000) did not differ from that of the United States at large (18.6/100,000). Age-specific rates, however, showed that children less than 1 year of age in Arkansas were infected at a higher rate than those in the remainder of the nation. Salmonella newport and S typhimurium were the most commonly isolated serotypes. Individuals living in a county with poultry processing plants and hatcheries were not more likely to have salmonellosis, and individuals residing in Arkansas do not appear to be at increased risk of salmonellosis because of the poultry industry.
In June and July 1982, a large outbreak of gastroenteritis associated with a barbecue restaurant involved 120 persons in central Arkansas. The illness was characterized by diarrhea, abdominal pain, and vomiting; 23 patients (19%) were hospitalized. Epidemiologic investigation showed that persons who became ill were more likely to have eaten ham or pork sandwiches at the restaurant before their illness than those who remained well. Stool cultures from 19 customers and each of the eight restaurant employees were positive for Salmonella newport. Cultures of a ham slice obtained from the restaurant and a partially consumed pork sandwich obtained from one ill person both grew Salmonella of same serotype.
Elevated blood lead levels (BLLs) in adults can damage the cardiovascular, central nervous, reproductive, hematologic, and renal systems. The majority of cases are workplace-related. U.S. Department of Health and Human Services recommends that BLLs among all adults be reduced to < 25 microg/dL. The highest BLL acceptable by standards of the U.S. Occupational Safety and Health Administration is 40 microg/dL. The mean BLL of adults in the United States is < 3 microg/dL.This report covers cases of adults (aged > or = 16 years) with BLLs > or = 25 microg/dL, as reported by 25 states during 1998-2001.Since 1987, CDC has sponsored the state-based Adult Blood Lead Epidemiology and Surveillance (ABLES) program to track cases of elevated BLLs and provide intervention consultation and other assistance. Overall ABLES program data were last published in 1999 for the years 1994-1997. This report provides an update with data from 25 states reporting for > or = 2 years during 1998-2001. During that period, the ABLES program funded surveillance in 21 states - Alabama, Arizona, Connecticut, Iowa, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Washington, Wisconsin, and Wyoming. Four additional states - California, Nebraska, New Hampshire, and Utah contributed data without CDC funding.During 1998-2001, the overall program's annual mean state prevalence rate for adults with BLLs > or = 25 microg/dL was 13.4/100,000 employed adults. This compares with 15.2/100,000 for 1994-1997. Yearly rates were 13.8 (1998), 12.9 (1999), 14.3 (2000), and 12.5 (2001). For adults with BLLs > or = 40 microg/dL, the overall program's annual mean state prevalence rare during 1998-2001 was 2.9/ 100,000 employed adults. This compares with 3.9/100,000 for 1994-1997. Yearly rates were 3.3 (1998), 2.5 (1999), 2.9 (2000), and 2.8 (2001).Although certain limitations exist, the overall ABLES data indicate a declining trend in elevated BLLs among employed adults.ABLES-funded states increased from 21 to 35 in 2002, and more detailed reporting requirements were put into effect. These, and other improvements, will enable the ABLES program to work more effectively toward its 2010 target of eliminating all cases of BLLs > or = 25 microg/dL in adults caused by workplace exposures.
Journal Article Does the Risk of Tuberculosis Increase in Old Age? Get access William W. Stead, William W. Stead Tuberculosis Program Search for other works by this author on: Oxford Academic PubMed Google Scholar J. P. Lofgren J. P. Lofgren Communicable Disease Division Arkansas Department of Health, Little Rock, Arkansas Search for other works by this author on: Oxford Academic PubMed Google Scholar The Journal of Infectious Diseases, Volume 147, Issue 5, May 1983, Pages 951–955, https://doi.org/10.1093/infdis/147.5.951 Published: 01 May 1983
We studied reactivity to tuberculin skin testing in nearly all nursing home residents in Arkansas. Only 12 per cent of the 12,196 newly admitted residents were tuberculin positive, as compared with 20.8 per cent of the 13,441 residents who were first tested more than a month (mean, 30 months) after admission. The proportion of persons who were positive on initial testing varied greatly with the time spent in the home before testing. Those who were not reactive on initial testing had a 5 per cent rate of conversion for each year spent in a home with a known recent infectious case (within three years) and a 3.5 per cent rate for each year in a home with no recognized recent case. Active tuberculosis developed in only 1 of 534 persons with positive tuberculin tests or previous reactions who were treated with isoniazid, but in 79 (2.4 per cent) of 3270 persons who were not (P<0.001). The disease developed in only 1 (0.16 per cent) of 605 persons whose tests converted to positive and who were treated with isoniazid, as compared with 45 (5.9 per cent) of 757 whose tests converted but who were not treated (P<0.001). We conclude that new infection with tuberculosis is an important risk for nursing home patients and that greater care should be taken to detect and treat new infections before the disease develops and the infection spreads. (N Engl J Med 1985; 312:1483–7.)
In a retrospective study, the results of tuberculin skin tests done in a nursing home were examined, where most residents admitted during 1972–1981 were tested using purified protein derivative of tuberculin administered intradermally. Of 514 residents who were tested at least once during the study period, results of the admission skin test were available for 254 and follow‐up skin test results were available for 226. On admission, 13 per cent (35/254) were skin‐test positive (≥10 mm induration at 48 hours). Skin test positivity for males was 16 per cent, females, 11 per cent, nonwhites, 19 per cent, and whites, 12 per cent. Highest skin test positivity was for persons received as transfers from other nursing homes (24 per cent) and lowest was for those entering from individual homes (8 per cent, P = 0.016, Fisher's Exact Test). On follow‐up, 38/226 (17 per cent) residents who had been tuberculin‐negative on at least two previous occasions were found to be positive; 24 (63 per cent) of these conversions occurred in a single year (1975) following detection of an infectious patient. The infection rate for persons residing in the nursing home during that year was 28 per cent (28/99) compared with 7.9 per cent (10/127) for persons either discharged before or admitted after 1975 (relative risk = 3.6, P < 0.001). Ten to 15 per cent of new residents are tuberculin‐positive (harbour a dormant tuberculous infection), leaving 85–90 per cent of newly admitted persons who are tuberculin‐negative and thus susceptible to infection if exposed. The study shows that tuberculosis must be considered as a potential nosocomial infection in nursing homes. The source of infection may be a person who has not been recognized as having tuberculosis. Five to 10 per cent of newly infected persons (PPD converters) can be expected to develop tuberculosis if not given preventive therapy with isoniazid (7.2 per cent in a recent study).
Laboratory-acquired infections concern all microbiologists. During ongoing surveillance of laboratory-acquired enteric infections, salmonella infections in the wife and son of a laboratory worker were documented; the first case was fatal. Neither patient had had any contact with the laboratory. The infecting organisms were Salmonella typhi and a multiply resistant strain of Salmonella agona that were being worked within the laboratory; both strains had been received 1 to 2 years previously for proficiency testing exercises. This report documents the transmission of enteric pathogens beyond the confines of the laboratory, with its tragic outcome, and suggests measures to prevent the recurrence of this problem.
In June and July 1982, a large interstate outbreak of Yersinia enterocolitica infections caused by an unusual serotype occurred in Tennessee, Arkansas, and Mississippi. Eighty-six percent of cases had enteritis characterized by fever, abdominal pain, and diarrhea. In three separate case-control studies, drinking milk pasteurized by plant A was statistically associated with illness. In a survey of randomly chosen households, 8.3% of persons who recalled having drunk milk from plant A during the suspect period experienced a yersiniosislike illness. Inspection of the plant and cultures of the available raw and pasteurized milk did not reveal the source or mechanism of contamination or a breach in normal pasteurizing technique. Although outbreaks of enteric disease caused by pasteurized milk are rare in the United States, the ability of Y enterocolitica to grow in milk at refrigeration temperatures makes pasteurized milk a possible vehicle for virulent Y enterocolitica. The extent to which milk is responsible for sporadic cases of yersiniosis is unknown.
The prevalence of tuberculosis among blacks is known to be about twice that among whites. When we looked at infection rates among the initially tuberculin-negative residents of 165 racially integrated nursing homes in Arkansas, we were stimulated to investigate whether this difference could be due in part to racial differences in susceptibility to Mycobacterium tuberculosis infection. A new infection was defined by an increase of ≥12 mm of induration after a tuberculin skin test (5 tuberculin units) administered at least 60 days after a negative two-step test.
