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S B Werner

Publications and source records attributed to S B Werner.

64 records · Page 4Linked to original sources
PubMedDate not supplied

Coccidioidomycosis in Tulare County, California, 1991: reemergence of an endemic disease.

In 1991, 1208 cases of coccidioidomycosis were reported to the California Department of Health Services, compared with an annual average of 450 during 1986-90. We conducted a study in Tulare County to define the epidemiology of the disease and identify risk factors for severe disease, focusing on the epidemic period September 1991-December 1991. To identify cases, we used data from the Coccidioidomycosis Serology Laboratory at the University of California, Davis, other laboratories, and the Tulare County Health Department's coccidioidomycosis reporting system. We compared patients who were hospitalized with those who were not to determine risk factors for severe disease. We identified 128 cases of acute coccidioidomycosis diagnosed between 1 September and 31 December 1991 (attack rate 41/100,000); south central Tulare County had the highest attack rate. Thirty-five (27%) case-patients were hospitalized. Male sex (relative risk (RR) 2.5, 95% confidence interval (CI) 1.2-5.0), black people and Asian races (RR 4.8, 95% CI 2.4-9.6), and age > or = 20 years (RR 8.3, 95% CI 1.2-57.4) were univariately significant and remained independently associated with hospitalization in multivariate analysis. The 1991 Tulare County outbreak of coccidioidomycosis was part of a much larger outbreak that began in California during 1991 and continued through 1993. The outbreak was preceded by an unusually rainy spring. Although dust reduction measures during times of increased coccidioidomycosis incidence can help reduce exposure, definitive control awaits the development of a safe, effective vaccine.

Adult↗
PubMedDate not supplied

High incidence of extra-intestinal infections in a Salmonella Havana outbreak associated with alfalfa sprouts.

OBJECTIVE: To determine a vehicle and point source for an outbreak of Salmonella Havana. METHODS: The authors conducted a case-control study and traceback investigation of 14 residents of California and four from Arizona with onsets of illness from Apr 15, 1998, to June 15, 1998, and Salmonella Havana infections with identical PFGE patterns. RESULTS: Seventeen of 18 patients were women. Seventeen were adults 20-89 years of age. Nine (50%) had diarrheal illness, 6 (33%) had urinary tract infections, 2 (11%) had sepsis, and one had an infected surgical wound after appendectomy. Four patients were hospitalized, and one died. Eating alfalfa sprouts was associated with S. Havana infection (OR = 10.0; 95% confidence interval 1.2, 83.1; P = 0.01). CONCLUSIONS: This outbreak resulted in a high incidence of extra-intestinal infections, especially urinary tract infections, and high morbidity. Raw alfalfa sprouts, often considered a safe "heath food," can be a source of serious foodborne disease outbreaks.

Adult↗
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Influence of host genetics on the severity of coccidioidomycosis.

Coccidioidomycosis, a mild flulike illness in approximately 40% of infected persons, progresses to severe pulmonary or disseminated disease in 1% to 10% of symptomatic cases. We examined host genetic influences on disease severity among class II HLA loci and the ABO blood group. Participants included African-American, Caucasian, and Hispanic persons with mild or severe disseminated coccidioidomycosis from Kern County, California. Among Hispanics, predisposition to symptomatic disease and severe disseminated disease is associated with blood types A and B, respectively. The HLA class II DRB1*1301 allele marks a pre-disposition to severe disseminated disease in each of the three groups. Reduced risk for severe disease is associated with DRB1*0301-DQB1*0201 among Caucasians and Hispanics and with DRB1*1501-DQB1*0602 among African-Americans. These data support the hypothesis that host genes, in particular HLA class II and the ABO blood group, influence susceptibility to severe coccidioidomycosis.

ABO Blood-Group System↗
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A multistate outbreak of Salmonella enterica serotype Baildon associated with domestic raw tomatoes.

Salmonella enterica serotype Baildon, a rare serotype, was recovered from 86 persons in eight states; 87% of illnesses began during a 3-week period ending January 9, 1999. Raw restaurant-prepared tomatoes were implicated in multiple case-control studies. Contamination likely occurred on the farm or during packing; more effective disinfection and prevention strategies are needed.

Adolescent↗
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An outbreak of Bacillus cereus food poisoning--are caterers supervised sufficiently.

Bacillus cereus is an uncommonly reported cause of foodborne illness in the United States. In May 1989, an outbreak of B. cereus gastroenteritis occurred among 140 guests who had attended a catered wedding reception in Napa, CA. Investigation established Cornish game hens served at the event as the vehicle for disease transmission (OR = 29, P = 0.0001). Although the spores of B. cereus are ubiquitous, large numbers of toxin-producing organisms (more than 10(5) per gram of food) are required for illness to occur. In the Napa outbreak, bacterial multiplication was facilitated at several points during the preparation and transportation of the food. While a licensed restaurant kitchen was used, the facilities were clearly inadequate for the event. At present, the California Health and Safety Code does not address the scope of catering operations. As caterers increase in number, there will be a growing need for governmental oversight to ensure that food production on a large scale is conducted safely.

Bacillus cereus↗
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Staphylococcal food poisoning associated with an Easter egg hunt.

Staphylococcal contamination of intact, hard-boiled eggs resulted in the food poisoning of an estimated 300 children out of 850 who had participated in an Easter egg hunt. Enterotoxigenic staphylococci that were isolated from the Easter eggs matched that obtained from an infected cook who prepared the eggs three to five days before the hunt and which he left unrefrigerated. Experimental studies demonstrated that heated eggs can absorb 2 mL of contaminated cool water through intact eggshells. When water was inoculated with pathogenic staphylococci at even low contamination levels, rapid growth and enterotoxin production within cooked eggs could be easily duplicated. This is the first large outbreak of its type; safeguards can and should be employed to prevent future ones.

Adolescent↗
PubMedDate not supplied

A cluster of Escherichia coli O157:H7 infections with the hemolytic-uremic syndrome and death in California. A mandate for improved surveillance.

In mid-January 1993, an outbreak of Escherichia coli O157:H7 infections associated with eating hamburger patties at a fast-food restaurant chain (chain A) was reported in Washington State. From mid-December to mid-January, 9 cases of E coli O157:H7-associated bloody diarrhea and the hemolytic-uremic syndrome had been reported in San Diego County, California. A total of 34 persons had bloody diarrhea, the hemolytic-uremic syndrome, or E coli O157:H7 organisms isolated from stool during the period November 15, 1992, through January 31, 1993. Organisms of E coli O157:H7 identified from 6 persons were indistinguishable from those of the Washington outbreak strain. Illness was associated with eating at chain A restaurants in San Diego (odds ratio, 13; 95% confidence interval, 1.7, 99) and with eating regular-sized hamburgers (odds ratio, undefined; lower-limit 95% confidence interval, 1.3). Improved surveillance by mandating laboratory- and physician-based reporting of cases of E coli O157:H7 infection and the hemolytic-uremic syndrome might have alerted health officials to this outbreak sooner, which could have resulted in earlier investigation and the institution of measures to prevent more cases.

Adolescent↗
PubMedDate not supplied

Profile of raw milk consumers in California.

OBJECTIVES: The authors sought to determine the prevalence of raw milk consumption in California--the largest producer of certified raw milk in the United States--and to describe the demographic and behavioral characteristics of raw milk consumers in that state. METHODS: The authors analyzed responses to questions on the 1994 California Behavioral Risk Factor Surveillance System Survey that asked respondents about whether they drank raw milk, the amount consumed, the reason for drinking raw milk, and where raw milk was most often obtained. RESULTS: Among 3999 survey respondents, 3.2% reported drinking raw milk in the previous year. Raw milk drinkers were more likely than nondrinkers to be younger than age 40, male, and Hispanic and to have less than a high school education. CONCLUSIONS: Raw milk continues to be consumed by some residents of California despite the documented hazards associated with this dietary practice.

Adolescent↗