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Background Brucellosis is a severe occupational or foodborne zoonosis throughout much of the world. Although eradicated from domestic cattle in the United States, brucellosis remains a disease risk to people through acquisition and consumption of animal products from endemic countries. Methods Cases of human brucellosis reported through the California public health disease surveillance network were reviewed for 1993 to 2017. Results From 1993 to 2017, 492 cases of brucellosis were reported in California residents. Persons aged >65 years represented less than 20% of cases, but incidence in this age group (0.94 cases per 1 000 000 population per year) was more than twice the incidence in persons aged Conclusions This study underscores the continuing serious health threat of brucellosis for Latinos in California, particularly older men, and the need for targeted public health messaging on preventing the risk presented by importation and consumption of unpasteurized dairy products from outside of the United States, principally Mexico.

In July 2017, fever and sepsis developed in 3 recipients of solid organs (1 heart and 2 kidneys) from a common donor in the United States; 1 of the kidney recipients died. Tularemia was suspected only after blood cultures from the surviving kidney recipient grew Francisella species. The organ donor, a middle-aged man from the southwestern United States, had been hospitalized for acute alcohol withdrawal syndrome, pneumonia, and multiorgan failure. F. tularensis subsp. tularensis (clade A2) was cultured from archived spleen tissue from the donor and blood from both kidney recipients. Whole-genome multilocus sequence typing indicated that the isolated strains were indistinguishable. The heart recipient remained seronegative with negative blood cultures but had been receiving antimicrobial drugs for a medical device infection before transplant. Two lagomorph carcasses collected near the donor's residence were positive by PCR for F. tularensis subsp. tularensis (clade A2). This investigation documents F. tularensis transmission by solid organ transplantation.

The threat of introduction of coronavirus disease 2019 (COVID-19) into the United States with the potential for community transmission prompted U.S. federal officials in February 2020 to screen travelers from China, and later Iran, and collect and transmit their demographic and contact information to states for follow-up. During February 5-March 17, 2020, the California Department of Public Health (CDPH) received and transmitted contact information for 11,574 international travelers to 51 of 61 local health jurisdictions at a cost of 1,694 hours of CDPH personnel time. If resources permitted, local health jurisdictions contacted travelers, interviewed them, and oversaw 14 days of quarantine, self-monitoring, or both, based on CDC risk assessment criteria for COVID-19. Challenges encountered during follow-up included errors in the recording of contact information and variation in the availability of resources in local health jurisdictions to address the substantial workload. Among COVID-19 patients reported to CDPH, three matched persons previously reported as travelers to CDPH. Despite intensive effort, the traveler screening system did not effectively prevent introduction of COVID-19 into California. Effectiveness of COVID-19 screening and monitoring in travelers to California was limited by incomplete traveler information received by federal officials and transmitted to states, the number of travelers needing follow-up, and the potential for presymptomatic and asymptomatic transmission. More efficient methods of collecting and transmitting passenger data, including electronic provision of flight manifests by airlines to federal officials and flexible text-messaging tools, would help local health jurisdictions reach out to all at-risk travelers quickly, thereby facilitating timely testing, case identification, and contact investigations. State and local health departments should weigh the resources needed to implement incoming traveler monitoring against community mitigation activities, understanding that the priorities of each might shift during the COVID-19 pandemic.

Ticks are capable of transmitting numerous pathogens to both humans and their pets. The risks of tick-borne disease risks vary geographically and are determined by the climate, environment, the presence of rodents and other mammal reservoirs, and the species of ticks parasitizing wild and domestic animals. Zoonoses such as Lyme borreliosis, tularemia, and tick-borne rickettsioses can emerge in previously nonendemic areas when circumstances favorable to their maintenance and transmission arise. Tick-borne zoonosis can be prevented by implementation and adoption of an integrated program to reduce the likelihood of tick bites on pets and their owners.

Hantavirus cardiopulmonary syndrome (HCPS) is a frequently fatal viral disease transmitted through rodent secretions and excretions. Working around deer mice can increase risk of infection. This study assessed potential risk of HCPS at facilities occupied by the US Forest Service (USFS) in California. In 2004-2005, 18 USFS facilities in eight National Forests in California were evaluated for evidence of rodent infestation and circulation of hantavirus. Structural deficiencies and evidence of rodent infestation were observed at 18 facilities. Serum antibodies to hantavirus were detected in 50 of 255 deer mice collected from 15 facilities. Seroprevalence was higher at elevations > 1,600 m (22%). Employees at 14 facilities had received training in rodent-borne disease prevention. Risk of HCPS among USFS employees should motivate inclusion of disease prevention information into employee safety training.

In 1993 Sin Nombre virus was recognized as the cause of hantavirus pulmonary syndrome (HPS) and the deer mouse (Peromyscus maniculatus) was identified as the reservoir host. Surveillance by the Centers for Disease Control and Prevention and state health departments includes investigation to determine the likely site(s) and activities that led to infection, an environmental assessment of the home and workplace, and possibly rodent trappings at these sites. As of December 31, 1998, there were 200 confirmed cases from 30 states (43% case-fatality ratio). The national HPS case registry was examined to determine the incubation period of HPS. Review of 11 case-patients with well-defined and isolated exposure to rodents suggests that the incubation period of HPS is 9 to 33 days, with a median of 14-17 days. Case investigations allow a better understanding of the incubation time of HPS and may define high-risk behaviors that can be targeted for intervention.

Hantavirus pulmonary syndrome (HPS) occurs in most infections with Sin Nombre virus and other North American hantaviruses. We report five cases of acute hantavirus infection that did not fit the HPS case definition. The patients had characteristic prodromal symptoms without severe pulmonary involvement. These cases suggest that surveillance for HPS may need to be expanded.

A seroprevalence and risk factor study of emerging tickborne infectious diseases (Lyme disease, ehrlichiosis, and babesiosis) was conducted among 230 residents of a semirural community in Sonoma County, California. Over 50% of residents reported finding a tick on themselves in the preceding 12 months. Samples from 51 (23%) residents were seroreactive to antigens from one or more tickborne disease agents: 1.4% to Borrelia burgdorferi, 0.4% to Ehrlichia equi, 4.6% to Ehrlichia chaffeensis, and 17.8% to the Babesia-like piroplasm WA1. Only 14 (27%) of these seroreactive residents reported one or more symptoms compatible with these diseases. Seroreactivity was significantly associated with younger age (o16 years), longer residence in the community (11 ‐ 20 years), and having had a physician’s diagnosis of Lyme disease. In northern California, the risk of infection with these emerging tickborne diseases, particularly in children, may be greater than previously recognized.

A sample of 244 persons in northern California who provided care for individuals with possible or probable Alzheimer's disease was studied to examine the effect of association with companion animals on three indices of psychological health. 124 caregivers had regular contact with pets; 120 caregivers did not. Men who were attached to dogs scored better on some measures of psychological health than did men who had no pets. Women less than 40 years old who were attached to cats scored better on some measures of psychological health than did the same-age women who had no pets. Women aged 40 to 59 years who were attached to dogs scored worse on measures of life satisfaction and depression than did the same-age women who had no pets. The data suggested a positive indirect effect on caregivers' mental health through interaction between the pet and the patient, but small strata numbers precluded definitive conclusions. Association with pets appeared to temper some of the psychological stress associated with caring for a cognitively impaired adult among young female and male caregivers but not among middle-aged female caregivers.

In September 1994, in response to a reported epidemic of plague in India, the Centers for Disease Control and Prevention (CDC) enhanced surveillance in the United States for imported pneumonic plague. Plague information materials were rapidly developed and distributed to U.S. public health officials by electronic mail, facsimile, and expedited publication. Information was also provided to medical practitioners and the public by recorded telephone messages and facsimile transmission. Existing quarantine protocols were modified to effect active surveillance for imported plague cases at U.S. airports. Private physicians and state and local health departments were relied on in a passive surveillance system to identify travelers with suspected plague not detected at airports. From September 27 to October 27, the surveillance system identified 13 persons with suspected plague; no case was confirmed. This coordinated response to an international health emergency may serve as a model for detecting other emerging diseases and preventing their importation.

Persons who have frequent contact with rodents as part of their occupation may be at increased risk of exposure to rodent-borne viruses such as Sin Nombre virus (SNV), the agent of hantavirus pulmonary syndrome, and Whitewater Arroyo virus (WWA), a New World arena-virus. Eighty-one persons with possible occupational exposure to rodents completed questionnaires and provided specimens for serologic testing. Seventy-two participants reported handling rodents as part of their job. The mean total number of rodents handled during participants' careers was approximately 2200. IgG antibody to lymphocytic choriomeningitis virus was detected in serum from one (1.2%) participant. IgG antibody to SNV, WWA, and Amapari viruses was not detected in any of the serum specimens. Despite considerable exposure to rodents, participants did not have significant serological evidence of exposure to rodent-borne viruses.

A 27-year-old woman presented to a hospital with symptoms resembling pyelonephritis; respiratory distress did not develop until nearly a day after admission and she subsequently died. The Unexplained Deaths and Critical Illnesses Project of the Centers for Disease Control and Prevention confirmed Sin Nombre virus infection by the results of serological testing and sequencing of the viral genome; staining of Sin Nombre virus antigen in the pulmonary capillaries was relatively weak.

Exposure to cats infected with Yersinia pestis is a recently recognized risk for human plague in the US. Twenty-three cases of cat-associated human plague (5 of which were fatal) occurred in 8 western states from 1977 through 1998, which represent 7.7% of the total 297 cases reported in that period. Bites, scratches, or other contact with infectious materials while handling infected cats resulted in 17 cases of bubonic plague, 1 case of primary septicemic plague, and 5 cases of primary pneumonic plague. The 5 fatal cases were associated with misdiagnosis or delays in seeking treatment, which resulted in overwhelming infection and various manifestations of the systemic inflammatory response syndrome. Unlike infections acquired by flea bites, the occurrence of cat-associated human plague did not increase significantly during summer months. Plague epizootics in rodents also were observed less frequently at exposure sites for cases of cat-associated human plague than at exposure sites for other cases. The risk of cat-associated human plague is likely to increase as residential development continues in areas where plague foci exist in the western US. Enhanced awareness is needed for prompt diagnosis and treatment. Plague is a bacterial zoonosis caused by infection with Yersinia pestis, a gram-negative coccobacillus. Active foci exist in wild rodent and flea populations in many regions of the world, including the western US (where the disease probably was first introduced in 1899‐1900 by rat- and flea-infested ships) [1‐3]. To date, surveillance programs have identified evidence of Y. pestis infection in mammal or flea samples collected from 17 western states (K.L.G., Plague Section, Centers for Disease Control and Prevention [CDC], unpublished data). A total of 297 human cases of plague were identified in 13 of these states from 1977 through 1998.

The incidence of Lyme disease in most endemic areas is unknown but will be an important factor in determining the cost-effectiveness of Lyme disease vaccines in those areas. The authors developed a deterministic model with nine components to estimate the frequency of Ixodes scapularis tick bites and the resulting incidence of Lyme disease in residents of endemic areas. For each component, best point estimates and plausible ranges of values were based on the published literature, unpublished data, expert opinion, or a combination of the above. By using the mean, crude, annual total of 3,827 Lyme disease cases reported from the endemic county of Westchester, New York, in 1991-1994, a mean of 178,889 scapularis bites (20.4 per 100 person-years) and a mean of 10,632 incident Lyme disease cases (1.2 per 100 person-years) were estimated to have occurred per year. Results of a sensitivity analysis that used two different methods suggested that this deterministic model is reasonably robust. In conclusion, according to this model, the incidence of Lyme disease in Westchester County is several-fold higher than suggested by the current passive reporting system. Am J Epidemiol 1998;148:1018-26.

Author(s): Fritz, Curtis L.; Kramer, Vicki L.; Enge, Barryett; Sun, Benjamin | Abstract: Hantavirus Pulmonary Syndrome (HPS), a severe and frequently fatal respiratory disease, was first recognized in 1993 during an outbreak of acute illness in the Four Comers area of the southwestern United States. The etiologic agent, Sin Nombre virus (SNV), was identified as a previously unrecognized member of the Hantavirus genus transmitted by rodents, especially members of the genus Peromyscus, which shed SNV in urine and feces. Since 1993, 16 California residents have been diagnosed with HPS, four of these were identified retrospectively with onset prior to 1993. The median age of case-patients was 42 years, 10 were male, and 8 died. Sites of likely exposure for these cases tended to cluster in the eastern Sierra Nevada range. Serologic surveillance of rodents has been conducted prospectively in California since 1993 and retrospectively for specimens collected back to 1975. To date, serologic evidence of infection with SNV has been recognized in 473 (6.6%) of 7,191 rodents from 18 genera, and in 426 (9.6%) of 4,489 Peromyscus spp. At least one seroreactive Peromyscus sp. specimen has been identified in 40 of 46 counties surveyed.