Search

In October 2017, the Nebraska Department of Health and Human Services (NDHHS) was notified by a local health department of a gastrointestinal illness outbreak among attendees of a wedding reception at facility A, an event center. Shortly thereafter, state and local public health officials began receiving reports of similar gastrointestinal illness among attendees of subsequent facility A events. An investigation was initiated to identify cases, establish the cause, assess possible transmission routes, and provide control recommendations. Overall, 159 cases consistent with norovirus infection (three confirmed and 156 probable) were identified among employees of facility A and attendees of nine facility A events during October 27-November 18, 2017. The investigation revealed a public vomiting episode at the facility on October 27 and at least one employee involved with preparing and serving food who returned to work

In March 2017, the Nebraska Department of Health and Human Services (NDHHS) and the Southwest Nebraska Public Health Department were notified of an apparent cluster of Campylobacter jejuni infections in city A and initiated an investigation. Overall, 39 cases were investigated, including six confirmed and 33 probable. Untreated, unboiled city A tap water (i.e., well water) was the only exposure significantly associated with illness (odds ratio [OR] = 7.84; 95% confidence interval [CI] = 1.69-36.36). City A is served by four untreated wells and an interconnected distribution system. Onsite investigations identified that a center pivot irrigation system intended to pump livestock wastewater from a nearby concentrated animal feeding operation onto adjacent farmland had malfunctioned, allowing excessive runoff to collect in a road ditch near two wells that supplied water to the city. These wells were promptly removed from service, after which no subsequent cases occurred. This coordinated response rapidly identified an important risk to city A's municipal water supply and provided the evidence needed to decommission the affected wells, with plans to build a new well to safely serve this community.

Background: In April 2019, Nebraska Public Health Laboratory identified an NDM-producing Enterobacter cloacae from a urine sample from a rehabilitation inpatient who had recently received care in a specialized unit (unit A) of an acute-care hospital (ACH-A). After additional infections occurred at ACH-A, we conducted a public health investigation to contain spread. Methods: A case was defined as isolation of NDM-producing carbapenem-resistant Enterobacteriaceae (CRE) from a patient with history of admission to ACH-A in 2019. We conducted clinical culture surveillance, and we offered colonization screening for carbapenemase-producing organisms to all patients admitted to unit A since February 2019. We assessed healthcare facility infection control practices in ACH-A and epidemiologically linked facilities by visits from the ICAP (Infection Control Assessment and Promotion) Program. The recent medical histories of case patients were reviewed. Isolates were evaluated by whole-genome sequencing (WGS). Results: Through June 2019, 7 cases were identified from 6 case patients: 4 from clinical cultures and 3 from 258 colonization screens including 1 prior unit A patient detected as an outpatient (Fig. 1). Organisms isolated were Klebsiella pneumoniae (n = 5), E. cloacae (n = 1), and Citrobacter freundii (n = 1); 1 patient had both NDM-producing K. pneumoniae and C. freundii. Also, 5 case patients had overlapping stays in unit A during February–May 2019 (Fig. 2); common exposures in unit A included rooms in close proximity, inhabiting the same room at different times and shared caregivers. One case-patient was not admitted to unit A but shared caregivers, equipment, and devices (including a colonoscope) with other case patients while admitted to other ACH-A units. No case patients reported travel outside the United States. Screening at epidemiologically linked facilities and clinical culture surveillance showed no evidence of transmission beyond ACH-A. Infection control assessments at ACH-A revealed deficiencies in hand hygiene, contact precautions adherence, and incomplete cleaning of shared equipment within and used to transport to/from a treatment room in unit A. Following implementation of recommended infection control interventions, no further cases were identified. Finally, 5 K. pneumoniae of ST-273 were related by WGS including carriage of NDM-5 and IncX3 plasmid supporting transmission of this strain. Further analysis is required to relate IncX3 plasmid carriage and potential transmission to other organisms and sequence types identified in this study. Conclusions: We identified a multiorganism outbreak of NDM-5–producing CRE in an ACH specialty care unit. Transmission was controlled through improved infection control practices and extensive colonization screening to identify asymptomatic case-patients. Multiple species with NDM-5 were identified, highlighting the potential role of genotype-based surveillance.Funding: NoneDisclosures: Muhammad Salman Ashraf reports that he is the principal investigator for a study funded by an investigator-initiated research grant.

Background Reported incidence of surgical site infections (SSIs) in the United States commonly ranges from approximately 0.5–20%. An infection preventionist at a critical access hospital (CAH) notified the Nebraska Department of Health Human Services (NDHHS) Healthcare-Associated Infection (HAI) program of a surgeon with a 6-month SSI rate of 29% (N = 7) and requested assistance. Methods NDHHS HAI program and local health department personnel conducted an investigation. Overall SSI rates were calculated, and seven reported SSI charts were abstracted using the Centers for Disease Control and Prevention’s HAI Outbreak Investigation Form. An additional nine-patient charts with similar characteristics were abstracted and used as the control group. These cases had the same procedures performed at the same facility, by the same surgeon, and during the same period of time but did not develop infections. Results In 2016, of the 452 procedures at this CAH, 17 developed SSIs (rate = 3.8%). SSIs occurred following the most invasive procedures being performed on the sickest patients at this CAH. Of the 17 SSIs, 15 (88.2%) were orthopedic and performed by three surgeons. Surgeon A performed 24 procedures with seven SSIs (rate = 29.2%). Surgeon B performed 171 procedures with five SSIs (rate = 2.9%) and Surgeon C performed 13 procedures with three SSIs (rate = 23.1%). The seven SSIs associated with Surgeon A used different operating room (OR) personnel, rooms, antibiotics, and durations. There were 0 deaths. The seven SSIs and nine controls were evaluated using a stepwise regression model. Using the variables for bone graft, hardware, OR location, and number of people in the OR, the only significant variable was the number of people in the OR. There was an average of 10 people in the OR among cases and seven among controls. Logistic regression yielded an odds ratio of 1.8 (95% CI: 0.99–3.26). Conclusion SSIs occurred primarily after orthopedic procedures, and two of three surgeons were found to have elevated rates. Analysis showed the number of people in the OR was potentially associated with SSIs. After following NDHHS recommendations to limit door openings and OR traffic, there were no additional cases. Additionally, we outlined our methodology in a publically-available response guideline posted to the NDHHS web page. Disclosures All authors: No reported disclosures.

Tularemia is a rare, often serious disease caused by a gram-negative coccobacillus, Francisella tularensis, which infects humans and animals in the Northern Hemisphere. Approximately 125 cases have been reported annually in the United States during the last two decades. As of September 30, a total of 100 tularemia cases were reported in 2015 among residents of Colorado (n = 43), Nebraska (n = 21), South Dakota (n = 20), and Wyoming (n = 16) (Figure). This represents a substantial increase in the annual mean number of four (975% increase), seven (200%), seven (186%) and two (70%) cases, respectively, reported in each state during 2004-2014.

Two children with influenza B-associated encephalitis (IBAE) presented to our hospital during the winter of 2000-2001, both of whom had cases notable for mutism in association with encephalitis. A review of the literature identified 13 additional reports consistent with IBAE that contained sufficient data for analysis. Eleven of 15 reported cases occurred in children aged

Objectives. Yersiniosis, a foodborne infection of zoonotic origin caused by the bacteria Yersinia enterocolitica and Yersinia pseudotuberculosis, is a reportable disease in 38 states. Both sporadic and foodborne outbreaks of yersiniosis have been reported in the U.S., with annual occurrence of an estimated 98,000 episodes of illness, 533 hospitalizations, and 29 deaths. We analyzed surveillance data from nine non-FoodNet-participating U.S. states during the period 2005–2011 to describe the epidemiology of this disease. Methods. As part of a passive surveillance system, laboratory-confirmed cases of yersiniosis were reported to state health departments in Arizona, Illinois, Michigan, Missouri, Nebraska, North Carolina, South Carolina, Washington, and Wisconsin. We calculated overall, age-, and race-specific annual incidence rates per 100,000 population using 2010 Census data as the denominator. We used Poisson regression to examine seasonal variation and annual incidence trends by race, age group, and overall. Results. The average annual incidence of yersiniosis was 0.16 cases per 100,000 population during 2005–2011. We observed a statistically significant decreasing annual trend of yersiniosis incidence among African Americans Conclusion. This multistate analysis revealed differences in the epidemiology of yersiniosis by race/ethnicity that may be useful for future research and prevention efforts. While this study was consistent with the FoodNet report in recognizing the high and declining incidence among African American children and winter seasonality among African Americans, our study also identified April–June seasonality among the white population.

Background In 2016 all acute care hospitals, inpatient rehab facilities, and PPS-exempt cancer facilities in Nebraska were required to report laboratory identified (LabID) Clostridium difficile infections (CDIs) to the National Healthcare Safety Network (NHSN). Test results indicating CDIs must be reported to the Nebraska Department of Health and Human Services (NDHHS) via the National Electronic Disease Surveillance System (NEDSS). NHSN and NEDSS represent unique sources of CDI reports in Nebraska. Methods The NHSN Nebraska database was queried for CDIs reported in 2016. All lab tests indicating a CDI in 2016 were extracted from NEDSS. These extracts were analyzed to assess descriptive epidemiologic variables and compared for differences. Results In 2016 there were 1,546 CDI LabID events reported to NHSN Nebraska from 28 facilities. There were 249 outpatient CDIs and 1,297 inpatient CDIs. Infections were further characterized as community-onset (N = 773), community-onset, healthcare facility associated (N = 206), and hospital onset (N = 567). An average of 128 CDIs were reported per month (range: 111–155). In 2016 there were 2,177 lab results indicating a CDI reported to NEDSS among Nebraska residents from 42 facilities. Patient ages ranged from 4 months to 104 years (mean = 58 years). An average of 181 CDIs were reported per month (range: 151–218). Comparison of the two data sources found 781 reports among 591 unique patients at 11 facilities that were made to NHSN and were not in NEDSS. Additionally, there were 1,092 reports from 931 unique patients at 12 facilities that were made to NEDSS and should have been made to NHSN but were not. There were 9 shared facilities that accounted for the majority of these discrepancies. Conclusion NHSN and NEDSS represent two unique data sources that allow for a more comprehensive assessment of CDIs. The number and type of facility that report to each system is slightly different but there is some overlap. Therefore, this comparison allows for detection of a greater number of reports overall and also provides an opportunity for data validation. This assessment identified discrepancies in reporting among 9 facilities that can be targeted for further collaborative efforts to improve CDI reporting and management in Nebraska. Disclosures All authors: No reported disclosures.

Background The recent outbreak of M. chimaera has focused attention on NTM species as the potential source of other clusters of infection. Since 2010 NTMs have been reportable in Nebraska. Methods The NEDSS data base for Nebraska was searched for all NTM infections reported from May 1, 2013 through April 30, 2017. These entries were reviewed for species or group type and source of material. All pulmonary isolates were excluded. Results Over 4 years, 421 lab reports of NTMs from non-pulmonary sites were received by the DPH. The most common group isolated was M. avium intracellulare group consisting of 246 specimens. Next was M. chelonae with 57 specimens, followed by M. fortuitum with 32, and M. abscessus and M. gordonae with 17 each. Three or fewer isolates of M. kansasii, M. marinum, M. mucogenicum or M. arupense were reported. Eight isolates were not speciated. The sources of those isolates were included in the report 46% of the time. Source MAI M.chelonae M. fortuitum M. abscessus M. gordonae Source Reported 40% 63% 50% 71% 94% % of those cases reported by site Abscess, wound 26% 14% 25% 33.3% (1 ear) 19% Tissue, mass, skin, or lesion 22 11 (1 sinus) 0 0 12.5 Neck or LN 12 11 0 0 0 Bone or Joint 11 14 19 0 25 Blood 3 22 25 25 0 Fluid Non Specified 24 5.5 12.5 16.7 12.5 Abdomen 0 11 6 0 12.5 Peritoneal fluid 0 3 0 8.3 0 Stool 0 14 6 8.3 CSF 2 0 0 0 0 Other Urine-3 Eye-5.5 Cervix-8.3 Urine 12.5 Conclusion The majority of NTM reported in Nebraska over 4 years came from an abscess, wound, mass, bone, joint or skin source. Interesting results included: the number of cases detected by blood culture (between 15 and 20%) in non-MAI NTMS, the number of abdominal sources or stool (5–10% each) in non-MAI NTM, and the unusual sites discovered such as the CSF (MAI only), peritoneal fluid, ear, eye, and cervix. These results suggest that looking for NTM in the blood or stool could be an effective way of making the diagnosis, that it is important to consider NTM in abdominal infections and infections of peritoneal dialysis fluid of unclear etiology. Lastly, NTM may play a role in infections in unusual sites such as the eye, the ear or cervix. Disclosures All authors: No reported disclosures.

Tularemia is a rare, often serious disease caused by a gram-negative coccobacillus, Francisella tularensis, which infects humans and animals in the Northern Hemisphere. Approximately 125 cases have been reported annually in the United States during the last two decades. As of September 30, a total of 100 tularemia cases were reported in 2015 among residents of Colorado (n = 43), Nebraska (n = 21), South Dakota (n = 20), and Wyoming (n = 16) (Figure). This represents a substantial increase in the annual mean number of four (975% increase), seven (200%), seven (186%) and two (70%) cases, respectively, reported in each state during 2004-2014.

In 2011, the Nebraska DHHS implemented a near-real—time inpatient (IP) surveillance system, to enhance the surveillance of Cardiovascular Disease (CVD). An IP database was created in ESSENCE and algorithms were defined for myocardial infarction (MI) and for the detection of 5 risk factors for CVD. The number of monthly MIs was tracked and the frequency of each risk factor analyzed. Results of this study demonstrate the applicability of ESSENCE for near-real-time monitoring of risk factors and CVD events. Such timely detection holds potential to enhance prospective monitoring of CVD trends in populations and impact efforts towards CVD prevention.