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In 2013, Lyme disease was the fifth most common nationally notifiable disease and is endemic in the Northeast. Greenbelt Park, a National Park Service-administered unit, is located in a highly endemic area of Maryland near Washington, D.C. In 2010, the National Park Service and the Maryland Department of Health and Mental Hygiene implemented a park-based knowledge, attitudes, and practices survey for employees, day visitors, and campers to better understand the risk of exposure to ticks. The survey was administered to employees both before (n = 32) and one month after (n = 19) a tick-borne disease training. Day visitors (n = 127) and campers (n = 53) were invited to participate voluntarily in a parallel survey; they did not receive training, but were asked to complete their survey one month after their visit. Many aspects of employee Lyme disease transmission knowledge improved posttraining. Employees with previous Lyme disease were more likely to tuck their pants into socks. However, no other protective measures were significantly changed for employees, day visitors, or campers. Reinforcement of prevention messages, including seasonal education on tick prevention methods as well as signs and symptoms of tickborne diseases, is warranted for all groups at Greenbelt Park and other national parks where tick-borne diseases are endemic. [ABSTRACT FROM AUTHOR]

Objective. Vibriois a naturally occurring waterborne pathogen with potential occupational, recreational, and commercial impacts. During the last 15 years in the U.S. and in Maryland, the incidence of vibriosis has increased. Due to the increase in cases in Maryland, warming water temperatures, and public concern about human health effects resulting from exposure to the Chesapeake Bay, we reviewed cases of vibriosis and evaluated the Vibriosurveillance system in Maryland for timeliness and data quality, attributes necessary for successful outbreak investigation and illness prevention.Methods. The evaluation included (1) informal qualitative surveys of state and local personnel who report and manage Vibriocases and (2) a review of Vibriosurveillance data from 2002 through 2008 for data quality and timeliness of the system.Results. From 2002 to 2008, 188 laboratory-confirmed cases of vibriosis were reported in Maryland with an annual average of 27 cases The species of Vibriothat were most frequently responsible for infection, regardless of clinical presentation, were V. parahaemolyticus(43.6%), V. vulnificus(23.9%), V. alginolyticus(9.6%), and non-toxigenic V. cholerae(9.0%). The case fatality rate fluctuated during the study period, but the number of cases increased.Conclusions. The surveillance system in Maryland is flexible and captures cases of vibriosis where specimens were collected for testing; however, the system may not adequately capture mild, self-limiting infections. Better integration of data collection for clinical, laboratory, and environmental information and improved completion of variables for shellfish harvest or water exposure locations could improve the system. Quarterly meetings comprising surveillance, public health laboratory, and food-control personnel could direct and ensure the success of improvement efforts.

Objectives. To identify cases and determine risk factors for an outbreak of Escherichia coli(E. coli) O157:nonmotile (NM) infections in children attending a summer day care program in California.Methods. The authors conducted a retrospective cohort study; the cohort comprised first and second graders who attended the day care program during the last week in August 1999. Shiga toxin testing and molecular subtyping using pulsed-field gel electrophoresis were performed on isolates. Lake water, lake bottom sediment samples, and waterfowl feces from the lake environs were cultured for E. coliO157.Results. Three cases of Shiga toxin-producing E. coliO157:NM infections with matching pulsed-field gel electrophoresis patterns and four probable cases were found. Children who swallowed more than a mouthful of water had a higher attack rate than those who swallowed less than a mouthful or none at all (43% vs. 10%, relative risk = 4.43, 95% confidence interval 1.12, 17.50).Conclusions. E. coliO157:NM infections were associated with swallowing water from a freshwater lake. Potential sources of contamination include feces from humans, cattle, or deer. This outbreak illustrates the value in screening patients with diarrhea for E. coliO157, submitting isolates to public health laboratories, and using molecular techniques to identify related cases. Outbreaks associated with contaminated freshwater could be averted by prevention and early detection of contamination.

Background:Left ventricular assist devices (LVADs) provide mechanical circulatory support to patients with end-stage heart failure. The use of these devices in the United States has been increasing since the FDA approved the first device in 1994. There are no published studies that have evaluated the relationship between LVAD procedural volume and hospital mortality, despite large variation across hospitals in the volume of LVAD procedures performed. This study sought to explore whether a correlation exists between hospital and surgeon’s procedural volumes and patient outcomes, and also to identify a critical threshold.