Electronic nicotine delivery devices such as electronic cigarettes (e-cigarettes) are battery-powered devices that deliver nicotine, flavorings (e.g., fruit, mint, and chocolate), and other chemicals via an inhaled aerosol. E-cigarettes that are marketed without a therapeutic claim by the product manufacturer are currently not regulated by the Food and Drug Administration (FDA). In many states, there are no restrictions on the sale of e-cigarettes to minors. Although e-cigarette use is increasing among U.S. adolescents and adults, its overall impact on public health remains unclear. One area of concern is the potential of e-cigarettes to cause acute nicotine toxicity. To assess the frequency of exposures to e-cigarettes and characterize the reported adverse health effects associated with e-cigarettes, CDC analyzed data on calls to U.S. poison centers (PCs) about human exposures to e-cigarettes (exposure calls) for the period September 2010 (when new, unique codes were added specifically for capturing e-cigarette calls) through February 2014. To provide a comparison to a conventional product with known toxicity, the number and characteristics of e-cigarette exposure calls were compared with those of conventional tobacco cigarette exposure calls.
Characterization of Isolates from an Outbreak of Multidrug-Resistant, ShigaToxin-Producing Escherichia coli O145 in the United States ᰔ Shiga toxin-producing Escherichia coli (STEC) is an important cause of food-borne illness, and several outbreaks of non-O157 serotype infections have been reported recently (10,17).In 2010, a multistate outbreak of STEC O145:NM (nonmotile) infections was investigated and linked to shredded romaine lettuce (4).Twenty-six confirmed and five probable cases were reported from Michigan, New York, Ohio, Pennsylvania, and Tennessee.Eleven (35%) patients required hospitalization, and three (10%) developed hemolytic uremic syndrome (HUS).No deaths were reported.Although antimicrobial treatment for STEC infections is not recommended, some patients receive antimicrobial treatment prior to the diagnosis, and identification of antimicrobial resistance may provide clues about potential sources of these infections (13,14).Therefore, understanding antimicrobial resistance patterns among STEC isolates remains important.Three representative outbreak isolates from ill patients were sent to the National Antimicrobial Resistance Monitoring System (NARMS) at the CDC for antimicrobial susceptibility testing (AST).MICs to 15 antimicrobial drugs were determined by broth microdilution (Sensititre; Trek Diagnostics, Westlake, OH).All three isolates displayed resistance to chloramphenicol, nalidixic acid, streptomycin, sulfisoxazole, and tetracycline and decreased susceptibility to ciprofloxacin (MIC ϭ 0.25 g/ml) (Table 1).Cell lysates were screened for antimicrobial resistance genes by PCR (7).All three isolates contained the floR, strA, strB, sul2, and tetA resistance genes.Sequence analysis confirmed that the gene content and orientation matched those of the floR accessory gene element found in some IncA/C plasmids
In Brief A 2008 multistate food-borne outbreak of Salmonella Saintpaul caused more than 1 400 illnesses in the United States. Although initial investigations suggested tomatoes as the potential vehicle, jalapeño and serrano peppers were subsequently found positive for the outbreak strain. The uncertainty associated with this incident caused government, industry, and the public to question the efficacy of the US food safety system. Examination of the response to this incident exposed breakdowns in several areas. Communication at all levels was lacking, leading to an absence of coordinated actions and conflicting risk communication messages. Variations in resources between local and state health departments created delays in gathering accurate information for epidemiological investigations. Although new laws required increased documentation, rapid and thorough traceback of products remained elusive. Three factors contributed to the difficulty in the Salmonella Saintpaul outbreak, including (1) delayed response due to discrepancies in available resources and expertise at state and local levels, (2) inadequate communication between stakeholders and agencies, and (3) poor traceability capabilities. Future responses to food-borne illness outbreaks may be improved by addressing these three factors. This study focuses on addressing three factors to improve future responses to food-borne illness outbreaks.
Background More smokers report using e-cigarettes to help them quit than FDA-approved pharmacotherapy. Objective To assess the association of e-cigarettes with future abstinence from cigarette and tobacco use. Design Cohort study of US sample, with annual follow-up. Participants US adult (ages 18+) daily cigarette smokers identified at Wave 1 (W1; 2013–14) of the PATH Study, who reported a quit attempt before W2 and completed W3 (n = 2443). Exposures Use of e-cigarettes, pharmacotherapy (including nicotine replacement therapy), or no product for last quit attempt (LQA), and current daily e-cigarette use at W2. Analysis Propensity score matching (PSM) of groups using different methods to quit. Outcome measures 12+ months abstinence at W3 from cigarettes and from all tobacco (including e-cigarettes). 30+ days abstinence at W3 was a secondary outcome. Results Among daily smokers with an LQA, 23.5% used e-cigarettes, 19.3% used pharmacotherapy only (including NRT) and 57.2% used no product. Cigarette abstinence for 12+ months at W3 was ~10% in each group. Half of the cigarette abstainers in the e-cigarette group were using e-cigarettes at W3. Different methods to help quitting had statistically comparable 12+ month cigarette abstinence at W3 (e-cigarettes vs no product: Risk Difference (RD) = 0.01, 95% CI: -0.04 to 0.06; e-cigarettes vs pharmacotherapy: RD = 0.02, 95% CI:-0.04 to 0.09). Likewise, daily e-cigarette users at W2 did not show a cessation benefit over comparable no-e-cigarette users and this finding was robust to sensitivity analyses. Abstinence for 30+ days at W3 was also similar across products. Limitations The frequency of e-cigarette use during the LQA was not assessed, nor was it possible to assess continuous abstinence from the LQA. Conclusion Among US daily smokers who quit cigarettes in 2014–15, use of e-cigarettes in that attempt compared to approved cessation aids or no products showed similar abstinence rates 1–2 years later.
Introduction: Epidemiologic data supporting the role of organochlorine pesticides in pubertal development is limited. Reasons include limited capacity of some studies to show temporal relation between exposure and puberty onset, limited studies on the role of background exposures, and limited availability of covariate data to assess confounding. Evidence on the role of in utero exposures, including organochlorine pesticides, in puberty onset is also limited. We determined the association between in utero exposure to organochlorine pesticides and earlier menarche attainment in a nested case-control study of the population-based Avon Longitudinal Study of Parents and Children (ALSPAC). Methods: Serum collected during pregnancy from mothers of 218 girls who reported early menarche (< 11.5 years) and 230 girls who reported menarche at or after 11.5 years were measured for 9 organochlorine pesticides and metabolites using gas chromatography isotope dilution high resolution mass spectrometry. The association between in utero serum pesticide concentrations and early menarche was analyzed using multivariate logistic regression controlling for mother's age at menarche, mother's prenatal BMI, or child's duration of breastfeeding. Results: Hexachlorobenzene (HCB), β-Hexachlorocyclohexane (β-HCH), 2,2-Bis(4-chlorophenyl)-1,1,1-trichloroethane (p,p'-DDT) and 2,2-Bis(4-chlorophenyl)-1,1-dichloroethene (p,p'-DDE) were detected in more than 50% of the study participants. HCB was the most frequently detected organochlorine (100%) followed by p,p'-DDE (99.8%), β-HCH (98%), and p,p'-DDT (91.4%). Overall, there was no association between in utero exposure to HCB, β-HCH, p,p'-DDT, or p,p'-DDE and early menarche. Conclusions: This is the first study to examine the association between in utero exposure to HCB or β-HCH and early menarche. It appears that in utero exposure to these organochlorine pesticides has little or no role in the timing of menarche in the ALSPAC cohort.
