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Salmonella infection causes epidemic death in wild songbirds, with potential to spread to humans. In February 2021, public health officials in Oregon and Washington, USA, isolated a strain of Salmonella enterica serovar Typhimurium from humans and a wild songbird. Investigation by public health partners ultimately identified 30 illnesses in 12 states linked to an epidemic of Salmonella Typhimurium in songbirds. We report a multistate outbreak of human salmonellosis associated with songbirds, resulting from direct handling of sick and dead birds or indirect contact with contaminated birdfeeders. Companion animals might have contributed to the spread of Salmonella between songbirds and patients; the outbreak strain was detected in 1 ill dog, and a cat became ill after contact with a wild bird. This outbreak highlights a One Health issue where actions like regular cleaning of birdfeeders might reduce the health risk to wildlife, companion animals, and humans.

The emergence of Cryptococcus gattii, previously regarded as a predominantly tropical pathogen, in the temperate climate of the North American Pacific Northwest (PNW) in 1999 prompted several questions. The most prevalent among these was the timing of the introduction of this pathogen to this novel environment. Here, we infer tip-dated timing estimates for the three clonal C. gattii populations observed in the PNW, VGIIa, VGIIb, and VGIIc, based on whole-genome sequencing of 134 C. gattii isolates and using Bayesian evolutionary analysis by sampling trees (BEAST). We estimated the nucleotide substitution rate for each lineage (1.59 × 10-8, 1.59 × 10-8, and 2.70 × 10-8, respectively) to be an order of magnitude higher than common neutral fungal mutation rates (2.0 × 10-9), indicating a microevolutionary rate (e.g., successive clonal generations in a laboratory) in comparison to a species' slower, macroevolutionary rate (e.g., when using fossil records). The clonal nature of the PNW C. gattii emergence over a narrow number of years would therefore possibly explain our higher mutation rates. Our results suggest that the mean time to most recent common ancestor for all three sublineages occurred within the last 60 to 100 years. While the cause of C. gattii dispersal to the PNW is still unclear, our research estimates that the arrival is neither ancient nor very recent (i.e.,

Objectives: Although invasive cervical cancer (ICC) rates have declined since the advent of screening, the annual age-adjusted ICC rate in the United States remains 7.5 per 100,000 women. Failure of recommended screening and management often precedes ICC diagnoses. The study aimed to evaluate characteristics of women with incident ICC, including potential barriers to accessing preventive care. Materials and Methods: We abstracted medical records for patients with ICC identified during 2008–2020 in five U.S. population-based surveillance sites covering 1.5 million women. We identified evidence of adverse social and medical conditions, including uninsured/underinsured, language barrier, substance use disorder, incarceration, serious mental illness, severe obesity, or pregnancy at diagnosis. We calculated descriptive frequencies and compared potential barriers by race/ethnicity, and among women with and without symptoms at diagnosis using chi-square tests. Results: Among 1,606 women with ICC (median age: 49 years; non-White: 47.4%; stage I: 54.7%), the majority (68.8%) presented with symptoms. Forty-six percent of women had at least one identified potential barrier; 15% had multiple barriers. The most common potential barriers among all women were being underinsured/uninsured (17.3%), and language (17.1%). Presence of any potential barrier was more frequent among non-White women and women with than without symptoms (p < 0.05). Conclusions: In this population-based descriptive study of women with ICC, we identified adverse circumstances that might have prevented women from seeking screening and treatment to prevent cancer. Interventions to increase appropriate cervical cancer screening and management are critical for reducing cervical cancer rates. [ABSTRACT FROM AUTHOR]

A 4 yr old castrated male greyhound presented with a history of chronic (>3 wk) intermittent diarrhea. Initial fecal analysis identified infection with Ancylostoma caninum. Despite treatment with routine anthelmintics, the dog remained persistently A caninum positive for several months. A novel fecal gastrointestinal real-time polymerase chain reaction (qPCR) parasite panel detected A caninum and the genetic benzimidazole (BZ) F167Y resistance marker in multiple samplings over 48 hr. This finding, together with the dog's clinical signs (diarrhea) and lack of response to routine anthelmintics, prompted treatment with cyclooctadepsipeptide emodepside, a drug currently not registered for dogs in the United States. The dog's clinical signs resolved and post-treatment fecal qPCR testing was negative. However, 5 mo later, retesting with fecal qPCR detected A caninum and concurrent BZ resistance marker, as well as Giardia. A presumptive diagnosis of re-infection was made and the emodepside treatment was continued. The dog again reverted to undetected (A caninum and the 167 resistance marker) on reassessment fecal qPCR. This case report describes the use of a novel fecal qPCR panel for gastrointestinal parasites, persistent hookworm and BZ F167Y resistance marker detection in a dog, and highlights the importance of a stepwise approach to clinical management, treatment, and retesting. [ABSTRACT FROM AUTHOR]

Coccidioidomycosis is a fungal infection caused by inhalation of soil-dwelling Coccidioides spp. organisms. Symptomatic infection occurs in [approximately equal to] 40% of cases and usually presents as a self-limiting, influenza-like [...]

Background: School-located vaccination clinics offer an opportunity to target children for vaccination programs during communicable disease outbreaks. However, children in the United States are primarily vaccinated in the pediatrician's or family physician's office, and the concept of school-located vaccinations may be unfamiliar to some parents and guardians. Physician support could contribute to effective implementation of school-located vaccination clinics during outbreak situations. The primary objective of the study was to assess physician opinion of using school-located vaccination clinics to administer both outbreak-specific and routine vaccines. Methods: A statewide mail and Internet survey was administered to 275 pediatricians and 275 family physicians in Oregon during July and August 2010. Results: Ninety-one percent of physicians supported the use of school-located vaccination clinics as immunization delivery sites during outbreak situations. Sixty percent of physicians supported using school-located vaccination clinics to administer routine vaccinations. Only 575 of physicians had knowledge of school-located vaccination clinic availability to their patients. Conclusions: Pediatricians and family physicians expressed strong support of school vaccination clinics as sites for immunization delivery during outbreak situations but significantly less support for administering routine vaccinations. Increasing physician awareness of school-located vaccination clinic availability and establishing partnerships between physician practices and school vaccination clinics may improve access to immunizations for school-aged children and adolescents, particularly during large-scale communicable disease outbreaks. (Contains 3 tables.)

In August 2013, a man in his 20s from Tonga, Polynesia, who had moved to the United States in June 2010, was examined in a hospital in Portland, Oregon, after [...]

Medscape EDUCATION ACTIVITY Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit. This activity has been [...]

Declines in cervical intraepithelial neoplasia grades 2 to 3 and adenocarcinoma in situ (CIN2+) observed among young women suggest impact from human papillomavirus (HPV) vaccination. To further evaluate vaccine impact including cross‐protection and type replacement, we described high‐risk (HR)‐HPV type‐specific cervical precancer incidence rates among women aged 20 to 39 years, 2008 to 2016. We analyzed cross‐sectional population‐based data on 18 344 cases of CIN2+ from a 5‐site surveillance system. Diagnostic specimens were tested for individual HPV types, including 14 HR‐HPV types (HPV16/18/31/33/35/39/45/51/52/56/58/59/66/68). We estimated age‐specific annual HR‐HPV type‐specific CIN2+ incidence per 100 000 screened women for individual types, vaccine HR‐HPV types (HPV16/18) and nonvaccine HR‐HPV types (non‐HPV16/18). We evaluated trends using average annual percent changes (AAPC) and 95% confidence intervals (CI), and estimated total declines by comparing 2015‐2016 to 2008‐2009 using incidence rate ratios. Among 20‐24‐year‐olds, HPV16/18‐CIN2+ declined from 2008 through 2016 (AAPC: −21.3%, 95% CI: −28.1%, −13.8%), whereas no trend was observed for non‐HPV16/18‐CIN2+ (AAPC: −1.8%, 95% CI: −8.1%, 4.9%). After 2010, CIN2+ among 20‐24‐year‐olds was more often caused by nonvaccine vs vaccine HR‐HPV types. No significant declining trends were observed in older age groups. In 2015‐2016 compared with 2008‐2009, HPV16‐CIN2+ declined 78%, HPV18‐CIN2+ 72% and HPV31‐CIN2+ 51% among 20‐24‐year‐olds; no increases were observed in type‐specific CIN2+ incidence. Among 25‐29‐year‐olds, HPV16‐CIN2+ declined 18%; CIN2+ attributed to seven nonvaccine types increased significantly. No significant declines were observed in older groups. Significant declines in HPV16/18‐CIN2+ in 20‐24‐year‐olds and HPV16‐CIN2+ in 25‐29‐year‐olds corroborate impact of HPV vaccination. A declining trend in HPV31‐CIN2+ is consistent with cross‐protection from vaccination. [ABSTRACT FROM AUTHOR]

Infection with Brucella spp. continues to pose a human health risk in California despite great strides in eradicating the disease from domestic animals. Clustering of human cases in time and [...]

Some chicken meat sold in grocery stores is contaminated with Enterococcus that is resistant to the antibiotic Synercid, according to researchers who analyzed 407 samples of chicken meat taken from 26 stores in four states. Synercid was introduced in 1999 as a treatment for Enterococcus infections that are resistant to vancomycin.

Researchers report the first known outbreak of Salmonella infection in the US that was resistant to a group of antibiotics called fluoroquinolines. The bacterium, called Salmonella enterica serotype Schwarzengrund, was apparently brought to the US by patients who had been hospitalized in the Philippines.

Reptile contact can result in zoonotic non‐typhoidal salmonellosis. In April 2018, Oregon Public Health Division contacted CDC about a cluster of four Salmonella serovar Fluntern (SF) illnesses in four states (OR, CA, IA, NY); patients reported contact with geckos, a popular reptile pet. PulseNet, the national molecular subtyping network of food‐borne disease surveillance, subsequently identified additional SF clinical isolates. Twelve cases in 11 states were identified; median age was 5 years (range: <1–58 years). Three patients were hospitalized; no deaths were reported. Of those with exposure information (n = 10), all reported reptile exposure; 9 (90%) specified contact with leopard geckos. No common source of geckos was identified from reported purchase locations. Los Angeles County (LAC) health officials isolated SF from one patient's leopard gecko. Five reptile/gecko isolates were identified from the USDA National Veterinary Services Laboratories (NVSL) from 2015 to 2018. Five countries responded to an Epidemic Intelligence Information System post by PulseNet; reptile isolate sequence data were received from Czech Republic. A clinical case from England was identified through the National Center for Biotechnology Information pathogen detection pipeline; the patient did not report contact with leopard geckos. Whole genome sequencing analysis revealed substantial genetic diversity between clinical and animal isolates; however, gecko and clinical isolates from LAC were highly related (1 allele difference). This investigation linking SF illnesses to leopard geckos highlights an important public health risk from pets. A better understanding of how geckos are distributed by the pet industry in the United States could improve traceability to points of origin and mitigate Salmonella transmission at gecko breeders. Earlier NVSL reports of SF isolates from geckos suggest the risk of human SF infection from geckos is not new. This investigation demonstrates a need to educate gecko breeders, retailers and gecko owners about the continued Salmonella infection risk from pet geckos. [ABSTRACT FROM AUTHOR]