Biomedical subjects

Ruthanne Marcus

Publications and source records attributed to Ruthanne Marcus.

At least 19 recordsLinked to original sources

PubMed2006

Highly resistant Salmonella Newport-MDRAmpC transmitted through the domestic US food supply: a FoodNet case-control study of sporadic Salmonella Newport infections, 2002-2003.

BACKGROUND: A new multidrug-resistant (MDR) strain of Salmonella serotype Newport, Newport-MDRAmpC, has recently emerged. We sought to identify the medical, behavioral, and dietary risk factors for laboratory-confirmed Salmonella Newport infection, including that with Newport-MDRAmpC. METHODS: A 12-month population-based case-control study was conducted during 2002-2003 in 8 sites of the Foodborne Diseases Active Surveillance Network (FoodNet), with 215 case patients with Salmonella Newport infection and 1154 healthy community control subjects. RESULTS: Case patients with Newport-MDRAmpC infection were more likely than control subjects to have taken an antimicrobial agent to which Newport-MDRAmpC is resistant during the 28 days before the onset of diarrheal illness (odds ratio [OR], 5.0 [95% confidence interval {CI}, 1.6-16]). Case patients with Newport-MDRAmpC infection were also more likely to have eaten uncooked ground beef (OR, 7.8 [95% CI, 1.4-44]) or runny scrambled eggs or omelets prepared in the home (OR, 4.9 [95% CI, 1.3-19]) during the 5 days before the onset of illness. International travel was not a risk factor for Newport-MDRAmpC infection but was a strong risk factor for pansusceptible Salmonella Newport infection (OR, 7.1 [95% CI, 2.0-24]). Case patients with pansusceptible infection were also more likely to have a frog or lizard in their household (OR, 2.9 [95% CI, 1.1-7.7]). CONCLUSIONS: Newport-MDRAmpC infection is acquired through the US food supply, most likely from bovine and, perhaps, poultry sources, particularly among persons already taking antimicrobial agents.

Animals↗

PubMed2005

Food service workers' self-reported food preparation practices: an EHS-Net study.

This study was conducted by the Environmental Health Specialists Network (EHS-Net), a network of environmental health specialists and epidemiologists at federal and state health agencies, whose mission is to improve environmental health practice. One of EHS-Net's primary goals is to improve the understanding of the underlying causes of foodborne illness using a system-based approach. As part of this ongoing effort, EHS-Net analyzed data from a telephone survey of food service workers designed to increase our understanding of food preparation practices (a cause of foodborne illness) in restaurants. Results indicated that risky food preparation practices were commonly reported. Respondents said that at work they did not always wear gloves while touching ready-to-eat (RTE) food (60%), did not always wash their hands or change their gloves between handling raw meat and RTE food (23% and 33%), did not use a thermometer to check food temperatures (53%), and had worked while sick with vomiting or diarrhea (5%). Several factors were associated with safer food preparation practices. Workers responsible for food preparation reported washing their hands and wearing gloves when handling RTE food more often than workers not responsible for food preparation. Workers who cooked reported changing their gloves more often than workers who did not cook. Older workers and managers reported washing their hands more often than younger workers and non-managers. Workers in chain restaurants more frequently reported using thermometers than workers in independently owned restaurants. This study provides valuable information concerning the prevalence of food preparation practices and factors that may impact those practices. Additional research is needed to better understand those factors.

Adult↗

PubMed2005

Beliefs about meals eaten outside the home as sources of gastrointestinal illness.

In a 2002 telephone survey of 16,435 randomly selected U.S. residents, respondents answered several questions about their beliefs concerning sources of gastrointestinal illness. Of those who had experienced vomiting or diarrhea in the month before their telephone interview, 22% believed the source of their gastrointestinal illness was a meal eaten outside the home. I11 respondents who had diarrhea but not vomiting and who did not miss work because of their illness were more likely to believe the illness resulted from a specific outside meal. I11 respondents attributed their illness to a specific outside meal for several reasons, including symptom timing (43%) and illness of their meal companions (6%). Eight percent of ill respondents reported their illness to a health department or the restaurant suspected of causing the illness. Those with vomiting and those who missed work or activities because of their illness were more likely to report their illness. Most respondents (54%) who attributed their illness to a specific outside meal said their illness symptoms began within a short time (5 h) of eating that meal. The foodborne illnesses for which this is a likely time frame typically are associated with vomiting, but respondents with vomiting did not report a shorter symptom onset than respondents without vomiting. These findings suggest that ill respondents may have the misconception that foodborne illness symptoms typically occur shortly after ingestion of contaminated food. Results suggest that education efforts should focus on the nature and timing of foodborne illness symptoms and the importance of reporting suspected foodborne illnesses.

Adult↗

PubMed2004

Chicken consumption is a newly identified risk factor for sporadic Salmonella enterica serotype Enteritidis infections in the United States: a case-control study in FoodNet sites.

The sources of sporadic Salmonella enterica serotype Enteritidis (SE) infections in the United States are unclear. To determine risk factors for sporadic SE infection, we conducted a population-based case-control study in 5 Foodborne Disease Active Surveillance Network surveillance areas. During the 12-month study, 396 cases of SE infection were ascertained. Among the 182 case patients and 345 controls, SE infection was univariately associated with international travel (matched odds ratio [MOR], 61; 95% confidence interval [CI], 8-447), eating undercooked eggs (MOR, 2.2; 95%CI, 1-5), and eating chicken prepared outside of the home (MOR, 2.2; 95% CI, 1.3-3.4). Multivariate analysis revealed that eating chicken outside of the home remained the only significant risk factor for illness (MOR, 2.0; 95% CI, 1.1-3.6). Chicken consumption has not previously been identified in the United States as a risk factor for SE infection. Measures to prevent SE infections include educating consumers and food handlers about food safety and interventions to decrease contamination of eggs and poultry.

Animals↗

PubMed2004

FoodNet estimate of the burden of illness caused by nontyphoidal Salmonella infections in the United States.

To determine the burden of Salmonella infections in the United States, Foodborne Diseases Active Surveillance Network (FoodNet) investigators conducted population-based active surveillance for culture-confirmed Salmonella infections during 1996-1999 at FoodNet laboratories. In addition, all clinical microbiology FoodNet laboratories were surveyed to determine their practices for isolating Salmonella. Telephone interviews were also conducted among residents of the FoodNet sites to determine the proportion of persons with diarrheal illness who sought medical care and the proportion who submitted stool specimens for bacterial culture. Using our model, we estimated that there were 1.4 million nontyphoidal Salmonella infections in the United States, resulting in 168,000 physician office visits per year during 1996-1999. Including both culture-confirmed infections and those not confirmed by culture, we estimated that Salmonella infections resulted in 15,000 hospitalizations and 400 deaths annually. These estimates indicate that salmonellosis presents a major ongoing burden to public health.

Campylobacter Infections↗

PubMed2004

Dramatic decrease in the incidence of Salmonella serotype Enteritidis infections in 5 FoodNet sites: 1996-1999.

Salmonella serotype Enteritidis (SE) emerged as the most common Salmonella serotype among infected persons in the United States during the 1980s and 1990s, with infections reaching a peak in 1995. During the past decade, farm-to-table control measures have been instituted in the United States, particularly in regions with the highest incidence of SE infection. We report trends in the incidence of SE in the 5 original surveillance areas of the Foodborne Diseases Active Surveillance Network during 1996-1999: Minnesota, Oregon, and selected counties in California, Connecticut, and Georgia. Overall, the incidence of SE decreased 46% from 1996 to 1999. The greatest decrease was in Connecticut (71%), followed by northern California (50%), Minnesota (46%), and Oregon (13%). Although SE infection remains an important public health concern, there has been a remarkable decrease in its incidence. This decrease may be a result of targeted interventions, including on-farm control measures, refrigeration, and education efforts.

Female↗

PubMed2004

Invasive Salmonella infections in the United States, FoodNet, 1996-1999: incidence, serotype distribution, and outcome.

Invasive Salmonella infections are severe and can be life threatening. We analyzed population-based data collected during 1996-1999 by the Foodborne Diseases Active Surveillance Network (FoodNet), to determine the incidences, infecting serotypes, and outcomes of invasive Salmonella infection. We found that the mean annual incidence of invasive salmonellosis was 0.9 cases/100,000 population and was highest among infants (7.8 cases/100,000). The incidence was higher among men than women (1.2 vs. 0.7 cases/100,000; P<.001) and higher among blacks, Asians, and Hispanics than among whites (2.5, 2.0, and 1.3 cases/100,000 population, respectively, vs. 0.4 cases/100,000; all P<.001). Seventy-four percent of cases were caused by 8 Salmonella serotypes: Typhimurium, Typhi, Enteritidis, Heidelberg, Dublin, Paratyphi A, Choleraesuis, and Schwarzengrund. Of 540 persons with invasive infection, 386 (71%) were hospitalized and 29 (5%) died; 13 (45%) of the deaths were among persons aged > or =60 years. Invasive Salmonella infections are a substantial health problem in the United States and contribute to hospitalizations and deaths.

Disease Progression↗

PubMed2004

Epidemiology of sporadic Campylobacter infection in the United States and declining trend in incidence, FoodNet 1996-1999.

Campylobacter species are a leading cause of foodborne illness in the United States, but few population-based data describing patterns and trends of disease are available. We summarize data on culture-confirmed cases of Campylobacter infection reported during 1996-1999 to the Foodborne Diseases Active Surveillance Network (FoodNet) system. The average annual culture-confirmed incidence was 21.9 cases/100,000 population, with substantial site variation (from 43.8 cases/100,000 population in California to 12.2 cases/100,000 population in Georgia). The incidence among male subjects was consistently higher than that among female subjects in all age groups. The incidence trended downward over the 4 years, with incidences of 23.6, 25.2, 21.4, and 17.5 cases/100,000 population for 1996-1999, respectively--a 26% overall decrease. This trend was sharpest and most consistent in California. Overall, we estimate that ~2 million people were infected with Campylobacter in the United States each year during this time period. Although the number of Campylobacter infections appears to have decreased in the United States during 1996-1999, the disease burden remains significant, which underscores the need to better understand how the disease is transmitted.

Campylobacter↗

PubMed2004

Trends in population-based active surveillance for shigellosis and demographic variability in FoodNet sites, 1996-1999.

Shigella is a common cause of diarrhea in the United States, and accurate surveillance is needed to determine the burden of illness that they cause. Active surveillance for culture-confirmed Shigella infection was done as part of the Foodborne Diseases Active Surveillance Network (FoodNet). A total of 4317 cases of shigellosis were reported during 1996-1999 in the original FoodNet surveillance areas. The average annual incidence was 7.4 cases/100,000 population. The incidence was similar during 1996-1998, but it declined in 1999 to 5.0 cases/100,000 population. State-to-state variability was seen in the incidence of shigellosis. Higher incidence was observed in California and Georgia. Shigella sonnei accounted for 70% of the infections, followed by Shigella flexneri (24%). Compared with other age groups, the incidence was highest among children aged 1-4 years of (36.3 cases/100,000 population). Marked demographic differences were observed between infections with S. sonnei and S. flexneri.

California↗

PubMed2004

Survey of physician diagnostic practices for patients with acute diarrhea: clinical and public health implications.

To understand physician practices regarding the diagnosis of acute diarrheal diseases, we conducted a survey, in 1996, of 2839 physicians in Connecticut, Georgia, Minnesota, Oregon, and California. Bacterial stool culture was requested for samples from the last patient seen for acute diarrhea by 784 (44%; 95% confidence interval, 42%-46%) of 1783 physicians. Physicians were more likely to request a culture for persons with acquired immune deficiency syndrome, bloody stools, travel to a developing country, diarrhea for >3 days, intravenous rehydration, or fever. Substantial geographic and specialty differences in culture-request practices were observed. Twenty-eight percent of physicians did not know whether stool culture included testing for Escherichia coli O157:H7; 40% did not know whether Yersinia or Vibrio species were included. These variabilities suggest a need for clinical diagnostic guidelines for diarrhea. Many physicians could benefit from education to improve their knowledge about tests included in routine stool examinations.

Acute Disease↗

PubMed2004

Physicians as food-safety educators: a practices and perceptions survey.

An estimated 4 million bacterial foodborne illnesses occur in the United States annually. Many of these illnesses can be prevented by educating the public about food-safety practices. We investigated both the role of physicians as food-safety educators and the barriers to providing food-safety information. Participants were randomly selected physicians (n=3117) practicing within the surveillance area of the Foodborne Diseases Active Surveillance Network; 1100 were included in the study. Although only 331 (30%) of 1110 respondents provided food-safety information to their patients, 524 (68%) of 769 who did not provide information expressed interest in doing so. Physicians were more likely to provide food-safety information to patients if they perceived foodborne disease to be a serious problem, perceived food-safety education as their role, felt that patients perceived them as a valuable resource for food-safety advice, or felt comfortable making food-safety recommendations. A national physician education campaign that addresses barriers in food-safety education could improve food-safety education by physicians.

Consumer Product Safety↗

PubMed2004

Egg consumption is the principal risk factor for sporadic Salmonella serotype Heidelberg infections: a case-control study in FoodNet sites.

To determine risk factors for sporadic Salmonella serotype Heidelberg diarrheal disease, we conducted a population-based case-control study in 5 Foodborne Diseases Active Surveillance Network (FoodNet) surveillance areas in 1996-1997. Forty-four case patients and 83 control subjects matched by age and telephone exchange were asked about exposures during the 5-day period before onset of illness in the case patient. Risk factors for infection were evaluated using conditional logistic regression analysis. Eating eggs prepared outside the home remained the only significant risk factor for illness (matched odds ratio [MOR], 6.0; 95% confidence interval [CI], 1.2-29.6). The population-attributable fraction of S. Heidelberg infections associated with eating eggs prepared outside the home was 37%. Eliminating the risk associated with out-of-home egg consumption could substantially reduce the incidence of S. Heidelberg infections. Control measures to prevent S. Heidelberg infection should include advising consumers to avoid eating undercooked eggs and educating food handlers about proper egg handling and cooking.

Adolescent↗

PubMed2004

Reptiles, amphibians, and human Salmonella infection: a population-based, case-control study.

To estimate the burden of reptile- and amphibian-associated Salmonella infections, we conducted 2 case-control studies of human salmonellosis occurring during 1996-1997. The studies took place at 5 Foodborne Diseases Active Surveillance Network (FoodNet) surveillance areas: all of Minnesota and Oregon and selected counties in California, Connecticut, and Georgia. The first study included 463 patients with serogroup B or D Salmonella infection and 7618 population-based controls. The second study involved 38 patients with non-serogroup B or D Salmonella infection and 1429 controls from California only. Patients and controls were interviewed about contact with reptiles and amphibians. Reptile and amphibian contact was associated both with infection with serogroup B or D Salmonella (multivariable odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.2; P<.009) and with infection with non-serogroup B or D Salmonella (OR, 4.2; CI, 1.8-9.7; P<.001). The population attributable fraction for reptile or amphibian contact was 6% for all sporadic Salmonella infections and 11% among persons <21 years old. These data suggest that reptile and amphibian exposure is associated with approximately 74,000 Salmonella infections annually in the United States.

Amphibians↗

PubMed2004

Breast-feeding decreases the risk of sporadic salmonellosis among infants in FoodNet sites.

Among the population of the Foodborne Diseases Active Surveillance Network (FoodNet) surveillance areas ("FoodNet sites") in 1996, children under 12 months of age had the highest incidence of sporadic salmonellosis. We conducted a case-control study in 5 FoodNet sites to identify risk factors for sporadic infant salmonellosis. A case patient was a child under 12 months of age with a laboratory-confirmed, nontyphoidal serogroup B or D Salmonella infection. Twenty-two case patients were matched with 39 control subjects by age and either telephone exchange or vital record birth list. In a multivariate analysis, case patients were more likely to have a liquid diet containing no breast milk than a liquid diet containing only breast milk (matched odds ratio, 44.5; P=.04). Case-patients were more likely to reside in a household where a member had diarrhea (matched odds ratio, 13.2; P=.01). To decrease their infants' risk of salmonellosis, mothers should be encouraged to breast-feed their infants. Caretakers of infants should learn about salmonellosis, hand washing, and safe preparation of formula and solid food.

Breast Feeding↗

PubMed2004

Farm visits and undercooked hamburgers as major risk factors for sporadic Escherichia coli O157:H7 infection: data from a case-control study in 5 FoodNet sites.

In 1996, active surveillance in 5 Foodborne Diseases Active Surveillance Network (FoodNet) sites revealed up to a 9-fold difference in Escherichia coli O157:H7 (O157) infection incidence between sites. A matched case-control study of sporadic O157 cases was conducted in these sites from March 1996 through April 1997. Case subjects were patients with non-outbreak-related diarrheal illness who had O157 isolated from their stool samples. Control subjects were healthy persons matched by age and telephone number exchange. Overall, 196 case patients and 372 controls were enrolled. O157 infections were associated with farm exposure, cattle exposure, eating a pink hamburger (both at home and away from home), eating at a table-service restaurant, using immunosuppressive medication, and obtaining beef through a private slaughter arrangement. Variations in cattle exposures may explain a part of the regional variability of O157 infection incidence. O157 control measures should focus on reducing risks associated with eating undercooked hamburger, dining at table-service restaurants, and farm exposures.

Adolescent↗

PubMed2004

Risk factors for sporadic Campylobacter infection in the United States: A case-control study in FoodNet sites.

Campylobacter is a common cause of gastroenteritis in the United States. We conducted a population-based case-control study to determine risk factors for sporadic Campylobacter infection. During a 12-month study, we enrolled 1316 patients with culture-confirmed Campylobacter infections from 7 states, collecting demographic, clinical, and exposure data using a standardized questionnaire. We interviewed 1 matched control subject for each case patient. Thirteen percent of patients had traveled abroad. In multivariate analysis of persons who had not traveled, the largest population attributable fraction (PAF) of 24% was related to consumption of chicken prepared at a restaurant. The PAF for consumption of nonpoultry meat that was prepared at a restaurant was also large (21%); smaller proportions of illness were associated with other food and nonfood exposures. Efforts to reduce contamination of poultry with Campylobacter should benefit public health. Restaurants should improve food-handling practices, ensure adequate cooking of meat and poultry, and consider purchasing poultry that has been treated to reduce Campylobacter contamination.

Adolescent↗

PubMed2004

Risk factors for sporadic cryptosporidiosis among immunocompetent persons in the United States from 1999 to 2001.

Many studies have evaluated the role of Cryptosporidium spp. in outbreaks of enteric illness, but few studies have evaluated sporadic cryptosporidiosis in the United States. To assess the risk factors for sporadic cryptosporidiosis among immunocompetent persons, a matched case-control study was conducted in seven sites of the Foodborne Diseases Active Surveillance Network (FoodNet) involving 282 persons with laboratory-identified cryptosporidiosis and 490 age-matched and geographically matched controls. Risk factors included international travel (odds ratio [OR] = 7.7; 95% confidence interval [95% CI] = 2.7 to 22.0), contact with cattle (OR = 3.5; 95% CI = 1.8 to 6.8), contact with persons >2 to 11 years of age with diarrhea (OR = 3.0; 95% CI = 1.5 to 6.2), and freshwater swimming (OR = 1.9; 95% CI = 1.049 to 3.5). Eating raw vegetables was protective (OR = 0.5; 95% CI = 0.3 to 0.7). This study underscores the need for ongoing public health education to prevent cryptosporidiosis, particularly among travelers, animal handlers, child caregivers, and swimmers, and the need for further assessment of the role of raw vegetables in cryptosporidiosis.

Adolescent↗

PubMed2003

Consumer attitudes and use of antibiotics.

Recent antibiotic use is a risk factor for infection or colonization with resistant bacterial pathogens. Demand for antibiotics can be affected by consumers' knowledge, attitudes, and practices. In 1998-1999, the Foodborne Diseases Active Surveillance Network (FoodNet( conducted a population-based, random-digit dialing telephone survey, including questions regarding respondents' knowledge, attitudes, and practices of antibiotic use. Twelve percent had recently taken antibiotics; 27% believed that taking antibiotics when they had a cold made them better more quickly, 32% believed that taking antibiotics when they had a cold prevented more serious illness, and 48% expected a prescription for antibiotics when they were ill enough from a cold to seek medical attention. These misguided beliefs and expectations were associated with a lack of awareness of the dangers of antibiotic use; 58% of patients were not aware of the possible health dangers. National educational efforts are needed to address these issues if patient demand for antibiotics is to be reduced.

Adult↗