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Current guidelines in the setting of exposures to potentially rabid bats established by the Advisory Committee on Immunization Practices (ACIP) address post-exposure prophylaxis ( PEP) administration in situations where a person may not be aware that a bite or direct contact has occurred and the bat is not available for diagnostic testing. These include instances when a bat is discovered in a room where a person awakens from sleep, is a child without an adult witness, has a mental disability or is intoxicated. The current ACIP guidelines, however, do not address PEP in the setting of multiple persons exposed to a bat or a bat colony, otherwise known as mass bat exposure ( MBE) events. Due to a dearth of recommendations for response to these events, the reported reactions by public health agencies have varied widely. To address this perceived limitation, a survey of 45 state public health agencies was conducted to characterize prior experiences with MBE and practices to mitigate the public health risks. In general, most states (69% of the respondents) felt current ACIP guidelines were unclear in MBE scenarios. Thirty-three of the 45 states reported prior experience with MBE, receiving an average of 16.9 MBE calls per year and an investment of 106.7 person-hours annually on MBE investigations. PEP criteria, investigation methods and the experts recruited in MBE investigations varied between states. These dissimilarities could reflect differences in experience, scenario and resources. The lack of consistency in state responses to potential mass exposures to a highly fatal disease along with the large contingent of states dissatisfied with current ACIP guidance warrants the development of national guidelines in MBE settings. [ABSTRACT FROM AUTHOR]

Rabies prevention and control efforts have been successful in reducing or eliminating virus circulation regionally through vaccination of specific reservoir populations. A notable example of this success is the elimination of canine rabies virus variant from the United States and many other countries. However, increased international travel and trade can pose risks for rapid, long-distance movements of ill or infected persons or animals. Such travel and trade can result in human exposures to rabies virus during travel or transit and could contribute to the re-introduction of canine rabies variant or transmission of other viral variants among animal host populations. We present a review of travel- and trade-associated rabies events that highlight international public health obligations and collaborative opportunities for rabies prevention and control in an age of global travel. Rabies is a fatal disease that warrants proactive coordination among international public health and travel industry partners (such as travel agents, tour companies and airlines) to protect human lives and to prevent the movement of viral variants among host populations. [ABSTRACT FROM AUTHOR]

The article discusses a report on the epidemiology of imported human rabies in the U.S. in 2008, issues by the Centers for Disease Control and Prevention (CDC) in the 2009 issue of Morbidity and Mortality Weekly Report." Human rabies are said to be rare in the U.S., but animal rabies is common. On March 17, 2008, a 16-year-old male who entered the U.S. from Oaxaca, Mexico was confirmed to have rabies contracted from Mexican free-tailed bats. People who have had close contact with the patient received postexposure prophylaxis (PEP). The report noted the difficulties in diagnosing imported human rabies. CDC emphasized the significance of coordinated public health response in addressing imported human rabies.

Campylobacter causes an estimated 1.3 million diarrheal illnesses in the United States annually (1). In August 2017, the Florida Department of Health notified CDC of six Campylobacter jejuni infections linked to company A, a national pet store chain based in Ohio. CDC examined whole-genome sequencing (WGS) data and identified six isolates from company A puppies in Florida that were highly related to an isolate from a company A customer in Ohio. This information prompted a multistate investigation by local and state health and agriculture departments and CDC to identify the outbreak source and prevent additional illness. Health officials from six states visited pet stores to collect puppy fecal samples, antibiotic records, and traceback information. Nationally, 118 persons, including 29 pet store employees, in 18 states were identified with illness onset during January 5, 2016-February 4, 2018. In total, six pet store companies were linked to the outbreak. Outbreak isolates were resistant by antibiotic susceptibility testing to all antibiotics commonly used to treat Campylobacter infections, including macrolides and quinolones. Store record reviews revealed that among 149 investigated puppies, 142 (95%) received one or more courses of antibiotics, raising concern that antibiotic use might have led to development of resistance. Public health authorities issued infection prevention recommendations to affected pet stores and recommendations for testing puppies to veterinarians. This outbreak demonstrates that puppies can be a source of multidrug-resistant Campylobacter infections in humans, warranting a closer look at antimicrobial use in the commercial dog industry., Competing Interests: All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Encephalitis produces considerable morbidity in the United States, but morbidity rates among American Indian/Alaska Native (AI/AN) people have not been described. Hospitalization records listing an encephalitis diagnosis were analyzed by using Indian Health Service direct/contract inpatient data. For 1998-2010, there were 436 encephalitis-associated hospitalizations among AI/AN people, an average annual age-adjusted hospitalization rate of 3.1/100,000 population. The rate for infants (11.9) was more than double that for any other age group. Death occurred for 4.1% of hospitalizations. Consistent with reports for the general U.S. population, the rate was high among infants and most (53.9%) hospitalizations were of unexplained etiology. The average annual rate during the study period appeared lower than for the general U.S. population, due particularly to lower rates in the elderly. Future community-based surveillance and mortality studies are needed to confirm these findings and examine reasons underlying the low rates of encephalitis in AI/AN people.

Objective: To estimate the burden of encephalitis-associated hospitalizations in the United States for 1998-2010., Methods: Using the Nationwide Inpatient Sample, a nationally representative database of hospitalizations, estimated numbers and rates of encephalitis-associated hospitalizations for 1998-2010 were calculated. Etiology and outcome of encephalitis-associated hospitalizations were examined, as well as accompanying diagnoses listed along with encephalitis on the discharge records. Total hospital charges (in 2010 US dollars) were assessed., Results: An estimated 263,352 (standard error: 3,017) encephalitis-associated hospitalizations occurred in the United States during 1998-2010, which corresponds to an average of 20,258 (standard error: 232) encephalitis-associated hospitalizations per year. A fatal outcome occurred in 5.8% (95% confidence interval [CI]: 5.6%-6.0%) of all encephalitis-associated hospitalizations and in 10.1% (95% CI: 9.2%-11.2%) and 17.1% (95% CI: 14.6%-20.0%) of encephalitis-associated hospitalizations in which a code for HIV or a tissue or organ transplant was listed, respectively. The proportion of encephalitis-associated hospitalizations in which an etiology for encephalitis was specified was 50.3% (95% CI: 49.6%-51.0%) and that for which the etiology was unspecified was 49.7% (95% CI: 49.0%-50.4%). Total charges for encephalitis-associated hospitalizations in 2010 were an estimated $2.0 billion., Conclusions: Encephalitis remains a major public health concern in the United States. Among the large number of encephalitis-associated hospitalizations for which an etiology is not reported may be novel infectious and noninfectious forms of encephalitis. Associated conditions such as HIV or transplantation increase the risk of a fatal outcome from an encephalitis-associated hospitalization and should be monitored.

Experiments were conducted at 3 US locations (California, Idaho, and Texas) to determine the effects of dietary zilpaterol hydrochloride and duration of zilpaterol feeding on carcass composition and beef palatability. At each site, 160 steers and 160 heifers were stratified within sex by initial BW (study d -1) and assigned randomly within BW strata to 1 of 4 treatments in a randomized complete block design (4 blocks/treatment for each sex). The 4 treatments were arranged in a 2 (no zilpaterol vs. zilpaterol) x 2 (20- or 40-d duration of zilpaterol feeding) factorial. When included in the diet, zilpaterol was supplemented at 8.3 mg/kg (DM basis). Each pen consisted of 10 animals. After slaughter 2 carcasses per pen (n=64 per trial site) were selected. The entire right side of the selected carcasses was collected for dissection and chemical analysis of the soft tissue. Additionally, the left strip loin was collected for Warner-Bratzler shear force determinations and aged to 28 d postmortem. Sensory analysis was conducted on the Idaho trial site samples only. All data were pooled for analyses. Feeding zilpaterol hydrochloride increased carcass muscle deposition (P<0.01) of both steer and heifer carcasses. However, carcass percentage fat of steers and heifers was not affected (P>0.11) by the zilpaterol treatment. In heifer carcasses, carcass moisture percentage was increased (P=0.04) and bone percentage was decreased (P=0.02), whereas in steer carcasses, carcass moisture and bone percentage were not affected (P>0.10). In heifer carcasses, carcass ash percentage was not affected (P=0.61) by zilpaterol, whereas in steer carcasses, carcass ash percentage tended (P=0.07) to be increased. The protein-to-bone ratio was increased (P<0.001) by zilpaterol hydrochloride treatment in both steers and heifers, whereas the protein-to-fat ratio was not affected (P=0.10). Cooking loss of the LM was not affected (P=0.41) by zilpaterol treatment of steers or heifers. However, LM Warner-Bratzler shear force was increased (P=0.003) on average (3.3 vs. 4.0 kg) due to zilpaterol hydrochloride treatment of both steers and heifers. In both steers and heifers, LM sensory panel scores of overall juiciness (6.2 vs. 6.0), tenderness (6.2 vs. 6.0), and flavor intensity (6.2 vs. 6.0) tended (P=0.06) to be decreased in cattle supplemented with zilpaterol. Zilpaterol hydrochloride is a repartitioning agent that seems to affect carcass composition primarily through protein deposition. However, zilpaterol treatment can adversely affect tenderness and other palatability traits.

Because of the Ca dependency of the calpains, oral supplementation of vitamin D3 (VITD) can increase the Ca content of muscle to activate the calpains and improve tenderness. Feedlot steers (n = 142) were arranged in a 4 x 3 factorial arrangement consisting of four levels of VITD (0, 0.5, 1, and 5 million IU/[steer x d]) for eight consecutive days antemortem using three biological types (Bos indicus, Bos taurus-Continental, and Bos taurus-English). Feedlot performance factors of ADG, DMI, and G:F were measured, and carcass quality, yield, and color data were collected. Plasma Ca and P concentrations were measured during d 4 to 6 of supplementation and at exsanguination, and carcass pH and temperature were measured in the LM at 3 and 24 h postmortem. Vitamin D3 treatment at 5 million IU/(steer x d) decreased ADG (P < 0.05) over the supplementation and feed intake for the last 2 d of feeding compared with untreated control steers. Likewise, G:F was decreased (P = 0.03) in steers supplemented with 5 million IU/d compared with controls. Overall, there was a linear decrease (P < 0.01) in ADG and G:F as a result of VITD supplementation. Plasma concentrations of Ca and P were increased (P < 0.05) by VITD concentrations of 1 and 5 million IU/(steer x d). All VITD treatments increased (P < 0.05) LM temperature at 3 h postmortem and pH at 24 h postmortem. Vitamin D3 treatments did not affect (P = 0.07) any other carcass measurements, including USDA yield and quality grade; thus, any improvements in meat tenderness as a result of VITD supplementation can be made without adversely affecting economically important carcass factors. Biological type of cattle did not interact with VITD treatment for any carcass or feedlot performance trait. Although feeding 5 million IU/(steer x d) of VITD for eight consecutive days had negative effects on performance, supplementing VITD at 0.5 million IU/ (steer x d) did not significantly alter feedlot performance.

Feedlot steers (n = 36) from three biological types (Bos indicus, Bos taurus-Continental, and Bos taurus-English) were used to determine the Ca, P, and vitamin D3 status of feedlot cattle. The USDA yield and quality grade traits were measured at slaughter, and the concentrations of vitamin D3 (VITD) and the metabolites 25-hydroxyvitamin D3 (25-OH D) and 1,25-dihydroxyvitamin D3 (1,25-(OH)2 D) were determined in LM, liver, kidney, and plasma. Plasma and muscle Ca and P concentrations also were determined. Biological type of cattle affected a number of carcass traits. Carcasses from Bos taurus-English cattle had more marbling, resulting in higher quality grades (P < 0.05). Carcasses from Bos taurus-Continental cattle had lower calculated yield grades (P < 0.05) than did carcasses from cattle in the other biological types. In general, differences in carcass traits resulting from biological type were consistent with other reports. Plasma and LM Ca and P concentrations were not affected (P = 0.06) by biological type of cattle, indicating that Ca and P homeostasis is a conserved trait across the different types of cattle. Plasma VITD and 25-OH D concentrations were not affected (P = 0.41) by biological type, whereas plasma 1,25-(OH)2 D concentration was lower (P < 0.05) in Bos taurus-English cattle than in Bos taurus-Continental and Bos indicus cattle. Liver VITD and 25-OH D were not affected by biological type (P = 0.76), but liver 1,25-(OH)2 D concentration was greater (P < 0.05) in Bos indicus cattle than in Bos taurus-Continental cattle. Kidney vitamin D metabolite concentrations were not affected by biological type of cattle (P = 0.21). Muscle VITD concentration was greater (P < 0.05) in Bos taurus-English cattle than in the other two biological types, and muscle 25-OH D concentrations were greater (P < 0.05) in Bos taurus-English cattle than in Bos indicus cattle. Muscle 1,25-(OH)2 D concentration was less (P < 0.05) in the Bos taurus-Continental cattle than in the other two biological types. Cooking eliminated vitamin D metabolite differences among the biological types. Our results suggest that Bos indicus cattle had greater 1,25-(OH)2 D (the biologically active form) in tissues, and greater 1,25-(OH)2 D plasma concentrations than Bos taurus cattle. Thus, the need for VITD supplementation and optimal levels of Ca and P in feedlot diets might differ between Bos indicus and Bos taurus cattle.

The South-Eastern Organ Procurement Foundation presents the first report on a programme to track donors through questionnaires completed at the time of donation, 3 months, 6 months, and yearly thereafter. Donors at participating centres were eligible for an insurance policy with a total benefit of 250,000 US dollars, covering accidental death related to donation, surgery, medical expenses of complications, and disability income. The four participating centres have registered 104 donors. Response rate to the questionnaires was 90.91%. The majority of the donors come from the immediate family (81.62%), either by blood or marriage. The majority of donors are employed full time, with income ranges similar to the national census. Donors rely on employer-provided vacation time and sick leave to recuperate, but the average donor required 12 days of unpaid leave before returning to work. Donors also experienced costs of transportation, lodging, and childcare. Anti-depressants were prescribed to 10.58% of donors, and 4.8% of donors reported they are treated for hypertension. Complications were reported by 37.5% of the donors, but only 7.6% of the complications were serious enough to require hospitalization or surgery. Donors reported higher complication rates than reported by the centres and experience financial burdens afterwards.

Some transplant programs regard hepatitis B antigenemia (HBsAg+) as a contraindication to renal transplantation. We studied the records of 13,287 renal transplant recipients, 781 (5.88%) who were positive for HBsAg, the remainder negative (HBsAg-). Patient survival for HBsAg-recipients is 91.8% at 1 year, 80.6% at 5 years, and 65.8% at 10 years. Patient survival for HBsAg+ recipients was 88.8% at 1 year, 77.6% at 5 years, and 61.6% at 10 years. The difference in patient survival was 3-4%, and graft survival was nearly constant at 3%. The statistical significance for patient survival was p = 0.02 by the log-rank test and p = 0.007 by the Wilcoxon test. There is far more statistical power (p = 0.0001) in other risk factors such as transplant number, recipient race, recipient age, and diabetes. Currently available diagnostic studies may allow better risk stratification of HBsAg+ candidates. We believe that hepatitis antigenemia without added and related risk factors has only a mild effect on graft and patient outcome.