A multistate, foodborne outbreak of hepatitis A. National Hepatitis A Investigation Team.
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BACKGROUND: We investigated a large, foodborne outbreak of hepatitis A that occurred in February and March 1997 in Michigan and then extended the investigation to determine whether it was related to sporadic cases reported in other states among persons who had consumed frozen strawberries, the food suspected of causing the outbreak. METHODS: The cases of hepatitis A were serologically confirmed. Epidemiologic studies were conducted in the two states with sufficient numbers of cases, Michigan and Maine. Hepatitis A virus RNA detected in clinical specimens was sequenced to determine the relatedness of the virus from outbreak-related cases and other cases. RESULTS: A total of 213 cases of hepatitis A were reported from 23 schools in Michigan and 29 cases from 13 schools in Maine, with the median rate of attack ranging from 0.2 to 14 percent. Hepatitis A was associated with the consumption of frozen strawberries in a case-control study (odds ratio for the disease, 8.3; 95 percent confidence interval, 2.1 to 33) and a cohort study (relative risk of infection, 7.5; 95 percent confidence interval, 1.1 to 53) in Michigan and in a case-control study in Maine (odds ratio for infection, 3.4; 95 percent confidence interval, 1.0 to 14). The genetic sequences of viruses from 126 patients in Michigan and Maine were identical to one another and to those from 5 patients in Wisconsin and 7 patients in Arizona, all of whom attended schools where frozen strawberries from the same processor had been served, and to those in 2 patients from Louisiana, both of whom had consumed commercially prepared products containing frozen strawberries from the same processor. CONCLUSIONS: We describe a large outbreak of hepatitis A in Michigan that was associated with the consumption of frozen strawberries. We found apparently sporadic cases in other states that could be linked to the same source by viral genetic analysis. (+info)
Cigarette smoking during the last 3 months of pregnancy among women who gave birth to live infants--Maine, 1988-1997.
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Cigarette smoking during pregnancy is associated with adverse birth outcomes (e.g., low birthweight and preterm delivery). The adverse effect of smoking on birthweight occurs primarily during the last trimester of pregnancy. To study smoking prevalence over time among women who gave birth to live infants in Maine, CDC and the Maine Department of Human Services (MDHS) analyzed self-reported data from the Pregnancy Risk Assessment Monitoring System (PRAMS) collected during 1988-1997. This report summarizes the results of this analysis, which indicate that despite the overall decline in smoking prevalence in Maine among women who gave birth to live infants, smoking prevalence remains high during the last 3 months of pregnancy among young women and low-income women, particularly those participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). (+info)
Screening mammography rates by specialty of the usual care physician.
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CONTEXT: Although Medicare began paying for screening mammography in 1991, utilization among enrollees has been low. PRACTICE PATTERN EXAMINED: The relation between the specialty of the usual care physician and the proportion of women 65 years of age and older receiving mammography. DATA SOURCE: 100% Medicare Part B claims for 186,526 female enrollees residing in Maine, New Hampshire, and Vermont during 1993 and 1994. RESULTS: Among women of the target screening age (65 to 69 years), 55.4%, received mammography during the 2-year period. The highest rates of mammography were observed in women whose usual care physician was a gynecologist (77.9%; 95% CI, 75.8 to 79.9), followed by those treated by an internist (67.1%; CI, 66.5 to 67.7), family practitioner (58.1%; CI, 57.4 to 58.9), general practitioner (47.4%; CI, 45.4 to 49.5), and other specialists (41.3%; CI, 40.1 to 42.5). The lowest rates were observed in women who had no physician visits during the 2-year period (9.5%; CI, 8.7 to 10.4). Although screening rates were lower in women aged 70 years and older, a similar pattern was observed. CONCLUSIONS: The probability of a Medicare enrollee's receiving screening mammography is strongly influenced by the specialty of her usual care physician. Covering a preventive service does not guarantee its use. (+info)
Attributes of atmospheric carbon monoxide oxidation by Maine forest soils.
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CO, one of the most important trace gases, regulates tropospheric methane, hydroxyl radical, and ozone contents. Ten to 25% of the estimated global CO flux may be consumed by soils annually. Depth profiles for (14)CO oxidation and CO concentration indicated that CO oxidation occurred primarily in surface soils and that photooxidation of soil organic matter did not necessarily contribute significantly to CO fluxes. Kinetic analyses revealed that the apparent K(m) was about 18 nM (17 ppm) and the V(max) was 6.9 micromol g (fresh weight)(-1) h(-1); the apparent K(m) was similar to the apparent K(m) for atmospheric methane consumption, but the V(max) was more than 100 times higher. Atmospheric CO oxidation responded sensitively to soil water regimes; decreases in water content in initially saturated soils resulted in increased uptake, and optimum uptake occurred at water contents of 30 to 60%. However, extended drying led to decreased uptake and net CO production. Rewetting could restore CO uptake, albeit with a pronounced hysteresis. The responses to changing temperatures indicated that the optimum temperature for net uptake was between 20 and 25 degrees C and that there was a transition to net production at temperatures above 30 degrees C. The responses to methyl fluoride and acetylene indicated that populations other than ammonia oxidizers and methanotrophs must be involved in forest soils. The response to acetylene was notable, since the strong initial inhibition was reversed after 12 h of incubation; in contrast, methyl fluoride did not have an inhibitory effect. Ammonium did not inhibit CO uptake; the level of nitrite inhibition was initially substantial, but nitrite inhibition was reversible over time. Nitrite inhibition appeared to occur through indirect effects based on abiological formation of NO. (+info)
Pseudomonas dermatitis/folliculitis associated with pools and hot tubs--Colorado and Maine, 1999-2000.
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During 1999-2000, outbreaks of Pseudomonas aeruginosa dermatitis and otitis externa associated with swimming pool and hot tub use occurred in Colorado and Maine. This report summarizes these outbreaks and provides recommendations for swimming pool and hot tub operation and maintenance, particularly when using offsite monitoring of water disinfectant and pH levels or when cyanuric acid is added to pools as a chlorine stabilizer. (+info)
Decreasing incidence of burn injury in a rural state.
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OBJECTIVES: To determine changes in the incidence of burn injury since the regionalization of burn care and intensification of fire prevention initiatives that occurred in Maine during the 1970s. METHODS: Death certificate data from Maine and the United States for deaths due to fire or burns were obtained for 1960-98. Hospitalization and burn registry data were obtained for Maine from 1973-98. Frequencies and incidence rates were compared over time and, where possible, between Maine and the United States. RESULTS: During 1960-79, annual burn mortality in Maine averaged 5.1/100,000, with random variation. After this, the rate declined steadily to an average annual level of 1.4/100,000 during 1993-96. For the entire United States, average annual mortality declined from 4.2/100,000 during 1961-64 to 1.5/100,000 during 1993-96. Reduction in mortality has been principally due to prevention of dwelling fires. Hospitalization for burns in Maine was 34.8/100,000 during 1973-76 and declined to 10.6/100,000 during 1995-98. CONCLUSIONS: Burn prevention measures have dramatically reduced the incidence of death and hospitalization resulting from burns in Maine. (+info)
Enrichment of high-affinity CO oxidizers in Maine forest soil.
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Carboxydotrophic activity in forest soils was enriched by incubation in a flowthrough system with elevated concentrations of headspace CO (40 to 400 ppm). CO uptake increased substantially over time, while the apparent K(m) ((app)K(m)) for uptake remained similar to that of unenriched soils (<10 to 20 ppm). Carboxydotrophic activity was transferred to and further enriched in sterile sand and forest soil. The (app)K(m)s for secondary and tertiary enrichments remained similar to values for unenriched soils. CO uptake by enriched soil and freshly collected forest soil was inhibited at headspace CO concentrations greater than about 1%. A novel isolate, COX1, obtained from the enrichments was inhibited similarly. However, in contrast to extant carboxydotrophs, COX1 consumed CO with an (app)K(m) of about 15 ppm, a value comparable to that of fresh soils. Phylogenetic analysis based on approximately 1,200 bp of its 16S rRNA gene sequence suggested that the isolate is an alpha-proteobacterium most closely related to the genera Pseudaminobacter, Aminobacter, and Chelatobacter (98.1 to 98.3% sequence identity). (+info)
Nosocomial outbreak of Microbacterium species bacteremia among cancer patients.
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To date, only 6 sporadic Microbacterium species (formerly coryneform Centers for Disease Control and Prevention [CDC] groups A-4 and A-5) infections have been reported. The source, mode of transmission, morbidity, mortality, and potential for nosocomial transmission of Microbacterium species remain unknown. From 26 July through 14 August 1997, 8 episodes of coryneform CDC group A-5 symptomatic bacteremia occurred in 6 patients on the oncology ward at the Maine Medical Center. One patient died. All isolates were identified at CDC as Microbacterium species and had identical DNA banding patterns by pulsed-field gel electrophoresis. To assess risk factors for Microbacterium species infection, a retrospective cohort study was conducted. The presence of a central venous catheter was the strongest risk factor (6/6 vs. 22/48; relative risk, 3.2; P<.0001). This outbreak demonstrates significant Microbacterium species-associated morbidity and mortality in immunocompromised populations and confirms the potential for epidemic nosocomial transmission. (+info)