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We describe a botulism outbreak involving 4 Middle Eastern men complicated by delayed diagnosis, ambiguous epidemiologic links among patients, and illness onset dates inconsistent with a point-source exposure. Homemade turshi, a fermented vegetable dish, was the likely cause. Patients ate turshi at 2 locations on different days over 1 month., (Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Injectable zinc, a vital component of parenteral nutrition (PN) formulations, has been in short supply in the United States since late 2012. In December 2012, three premature infants with cholestasis hospitalized in Washington, DC, experienced erosive dermatitis in the diaper area and blisters on their extremities, a condition that can be associated with zinc deficiency. All three infants were receiving PN because they had extreme cholestasis and were unable to be fed by mouth or tube. The PN administered to each infant was zinc deficient. Injectable zinc normally is added to PN for premature or medically compromised infants (e.g., those with cholestasis) by the hospital pharmacy because the amount of zinc needed by each patient differs; however, the pharmacy had run out of injectable zinc. No alternatives were available; other preparations of parenteral trace elements either contained insufficient zinc to meet infants' requirements or had the potential to cause trace element toxicity in infants with cholestasis (2). The dermatitis of one infant resolved after the patient was able to take nutrition by mouth. The other two infants were found to have low serum zinc levels. In January 2013, CDC was notified of four additional cases of zinc deficiency among infants with cholestasis who received zinc-deficient PN in a hospital in Houston, Texas. In collaboration with the Food and Drug Administration (FDA), the two hospitals obtained emergency shipments of injectable zinc. No additional cases were reported. Current injectable zinc supplies have been increasing as FDA collaborates with pharmaceutical companies to import emergency supplies. FDA is working to establish temporary backup sources should future shortages occur.

During the 2012 West Nile virus outbreak in Texas, USA, 1,868 cases were reported. Male patients, persons >65 years of age, and minorities were at highest risk for neuroinvasive disease. Fifty-three percent of counties reported a case; 48% of case-patients resided in 4 counties around Dallas/Fort Worth. The economic cost was >$47.6 million.

A jackrabbit die-off near a metropolitan airport was observed by an airport contractor. Further investigation determined that this die-off was probably due to epizootic tularemia. Because of proximity to areas of heavy human traffic and fears of transmission of tularemia to humans, the local health district and department of emergency management organized a multiagency response involving local animal control, environmental health, public health, law enforcement, and airport personnel, in addition to state and federal agencies. The tularemia epizootic subsequently ended, and no cases of human tularemia occurred. In our after-action analysis, we identified several lessons learned: the importance of animal illness surveillance, which can serve as a warning for potential human illness and epidemic; the usefulness of pre-event planning, training, and exercises in facilitating a coordinated response; the usefulness of an effective communication system with the healthcare community; the importance of responders being familiar with Centers for Disease Control and Prevention (CDC) Category A bioterrorism agents when considering a rapid response; and the fact that attempts at environmental control may result in perturbations in animal populations with unintended consequences.