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Timothy F Jones

Publications and source records attributed to Timothy F Jones.

At least 37 records · Page 2Linked to original sources
PubMed2004

Limitations to successful investigation and reporting of foodborne outbreaks: an analysis of foodborne disease outbreaks in FoodNet catchment areas, 1998-1999.

To better understand factors associated with confirming the etiologic organism and identifying the food vehicle responsible for foodborne-disease outbreaks, we examined data from outbreaks reported in 1998 and 1999 through active surveillance by Foodborne Disease Active Surveillance Network (FoodNet) surveillance areas in 7 states. In 71% of these outbreaks, no confirmed etiology was identified, and in 46%, no suspected food vehicle was identified. Outbreaks involving > or =10 cases were significantly more likely to have their etiology identified than were smaller outbreaks. In two-thirds of outbreaks in which an etiology was not confirmed, no stool specimens were collected for laboratory testing; in 55% of these outbreaks, neither clinical specimens nor food samples were tested. If the etiology of and factors contributing to foodborne-disease outbreaks are to be understood, adequate resources must be available to allow specimens to be collected and tested and epidemiologic investigations to be conducted appropriately.

Disease Outbreaks↗
PubMed2004

Photokeratitis and UV-radiation burns associated with damaged metal halide lamps.

BACKGROUND: Damaged metal halide lamps are known to cause outbreaks of photokeratitis and UV-radiation burns among children and adults, which has prompted the Food and Drug Administration, Rockville, Md, to publish consumer recommendations to prevent such injuries. We investigated 3 outbreaks of photokeratitis and UV-radiation burns in gymnasiums associated with failure to heed these recommendations. OBJECTIVE: To determine the cause of the outbreaks and promote interventions to prevent further injuries. DESIGN AND SETTING: A cohort study of persons exposed to damaged metal halide lamps during the index outbreak in a community gymnasium and a descriptive epidemiologic study of 2 subsequently identified outbreaks in other gymnasiums. PARTICIPANTS: A total of 273 persons potentially exposed during events in 3 gymnasiums. MAIN OUTCOME MEASURE: Photokeratitis with onset within 12 hours of the event. The intensity of UV radiation was measured, and an occupational exposure standard applied. RESULTS: Investigation of the index outbreak identified 18 (approximately 3%) persons who met our case definition for photokeratitis. The median incubation period was 7 hours, and health care visits were reported by 11 persons (61%). Of the 18 patients, 17 (94%) were seated in the back of the gymnasium. Among 37 persons sitting in this high-risk area, the attack rate was 46%. Only 1 (9%) of 11 persons wearing glasses or contact lenses with UV-radiation protection in the high-risk area developed photokeratitis (relative risk, 0.15; P =.01). The safe occupational exposure limit in the high-risk area was 10 to 15 minutes, but exposures of 1 to 3 hours were reported. Prevention recommendations had not been instituted at any of the 3 facilities. CONCLUSIONS: Injuries from metal halide lamps are avoidable, but prevention recommendations may not be widely observed. All facilities using metal halide lamps in areas where children may be exposed should follow the Food and Drug Administration recommendations; amending the National Electric Code may be warranted.

Burns↗
PubMed2004

Restaurant inspection scores and foodborne disease.

Restaurants in the United States are regularly inspected by health departments, but few data exist regarding the effect of restaurant inspections on food safety. We examined statewide inspection records from January 1993 through April 2000. Data were available from 167,574 restaurant inspections. From 1993 to 2000, mean scores rose steadily from 80.2 to 83.8. Mean inspection scores of individual inspectors were 69-92. None of the 12 most commonly cited violations were critical food safety hazards. Establishments scoring <60 had a mean improvement of 16 points on subsequent inspections. Mean scores of restaurants experiencing foodborne disease outbreaks did not differ from restaurants with no reported outbreaks. A variety of factors influence the uniformity of restaurant inspections. The restaurant inspection system should be examined to identify ways to ensure food safety.

Food Handling↗
PubMed2004

Antimicrobial resistance among Campylobacter strains, United States, 1997-2001.

We summarize antimicrobial resistance surveillance data in human and chicken isolates of Campylobacter. Isolates were from a sentinel county study from 1989 through 1990 and from nine state health departments participating in National Antimicrobial Resistance Monitoring System for enteric bacteria (NARMS) from 1997 through 2001. None of the 297 C. jejuni or C. coli isolates tested from 1989 through 1990 was ciprofloxacin-resistant. From 1997 through 2001, a total of 1,553 human Campylobacter isolates were characterized: 1,471 (95%) were C. jejuni, 63 (4%) were C. coli, and 19 (1%) were other Campylobacter species. The prevalence of ciprofloxacin-resistant Campylobacter was 13% (28 of 217) in 1997 and 19% (75 of 384) in 2001; erythromycin resistance was 2% (4 of 217) in 1997 and 2% (8 of 384) in 2001. Ciprofloxacin-resistant Campylobacter was isolated from 10% of 180 chicken products purchased from grocery stores in three states in 1999. Ciprofloxacin resistance has emerged among Campylobacter since 1990 and has increased in prevalence since 1997.

Animals↗
PubMed2004

Pharmacy data for tuberculosis surveillance and assessment of patient management.

Underreporting tuberculosis (TB) cases can compromise surveillance. We evaluated the contribution of pharmacy data in three different managed-care settings and geographic areas. Persons with more than two anti-TB medications were identified by using pharmacy databases. Active TB was confirmed by using state TB registries, medical record review, or questionnaires from prescribing physicians. We identified 207 active TB cases, including 13 (6%) missed by traditional surveillance. Pharmacy screening identified 80% of persons with TB who had received their medications through health plan-reimbursed sources, but missed those treated solely in public health clinics. The positive predictive value of receiving more than two anti-TB medications was 33%. Pharmacy data also provided useful information about physicians' management of TB and patients' adherence to prescribed therapy. Pharmacy data can help public health officials to find TB cases and assess their management in populations that receive care in the private sector.

Antitubercular Agents↗
PubMed2004

The changing epidemiology of HIV/AIDS in Tennessee.

BACKGROUND: We describe the changing epidemiology of HIV/AIDS in Tennessee to identify opportunities for improved response to the epidemic. METHODS: Health department records of all new cases of HIV/AIDS in Tennessee from January 1992 through December 2001 were examined. Cases were defined according to CDC criteria and classified as HIV or AIDS based on diagnosis in the initial report. RESULTS: During the ten-year study period, 14,278 new cases were reported; 67% were HIV and 33% were AIDS. Incidence in males was three times higher than females. The rate among blacks was seven times higher than whites. From 1992-1996, 17% of cases had a primary risk factor of heterosexual contact, increasing to 26% in 1997-2001 (P<0.01). The proportion of new cases with a diagnosis of AIDS was higher in non-metropolitan than metropolitan areas (35% vs. 21%, P<0.01). CONCLUSIONS: Intervention efforts should include targeting to blacks, females, heterosexual exposure, and persons in non-urban communities.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Epidemiologic investigation of a restaurant-associated outbreak of Pontiac fever.

This case-control study investigated a cluster of respiratory illness among patrons of a restaurant. Of 173 patrons interviewed, 117 (68%) were ill. Symptoms included myalgias (93%), headache (87%), and fatigue (79%). The mean incubation period was 49 h and the mean duration of illness was 71 h. Patrons aged >15 years were more likely to have been ill than younger patrons (odds ratio [OR], 2.96; P=.002); 58% of persons who were ill sat near a large fountain, compared with 18% of respondents who were not ill (OR, 7.5; P=.005). Legionella anisa was cultured from water samples obtained from the fountain pool. Of 22 individuals who were ill, 11 (50%) had a > or =4-fold increase in the titer of antibody to that strain of L. anisa from acute-phase to convalescent-phase serum samples; 3 others (14%) had persistently elevated titers of > or =512; of a group of 20 individuals who had not been exposed to the restaurant, none had titers of >128. Pontiac fever should be considered as a diagnosis during acute outbreaks of influenza-like illness with a high attack rate and no other identified etiology.

Adolescent↗
PubMed2003

Outbreak of joint and soft-tissue infections associated with injections from a multiple-dose medication vial.

An outbreak of Staphylococcus aureus joint and soft-tissue infections occurred after therapeutic injections in an outpatient setting. A physician performed intra-articular or soft-tissue injections on 17 patients in August 2001, and 5 (29%) were subsequently hospitalized for infections at the site. S. aureus was isolated from 4 patients, and all 4 isolates were indistinguishable by pulsed-field gel electrophoresis. Of 10 patients injected with lidocaine and triamcinolone, 5 (50%) developed infections, compared with 0 of 7 patients injected with triamcinolone only (P=.04). A multiple-dose vial (MDV) of lidocaine was likely contaminated with S. aureus. A possible contributing factor was refrigeration after the use of MDVs of lidocaine; the manufacturer recommends storage at room temperature. An in vitro study of S. aureus in MDVs of lidocaine revealed prolonged survival at refrigerator temperatures. This outbreak highlights the importance of strict attention to aseptic procedures and carefully following manufacturers' instructions when using MDVs.

Adult↗
PubMed2003

Pseudomonas aeruginosa and Serratia marcescens contamination associated with a manufacturing defect in bronchoscopes.

BACKGROUND: Several outbreaks and pseudo-outbreaks of Pseudomonas aeruginosa and Serratia marcescens infections associated with bronchoscopy have been reported. We conducted an investigation of P. aeruginosa and S. marcescens isolates related to bronchoscopy at a community hospital. METHODS: We reviewed the records of all bronchoscopic procedures at the community hospital from July to October 2001. Environmental samples were obtained. Pulsed-field gel electrophoresis (PFGE) was performed on isolates of P. aeruginosa. RESULTS: From July 1 to October 31, 2001, 66 bronchoscopic procedures were performed in 60 patients, and 43 specimens were obtained for bacterial culture; 20 of the specimens (47 percent) were positive for P. aeruginosa. Six (30 percent) of the specimens that were positive for P. aeruginosa also yielded S. marcescens. All 20 P. aeruginosa isolates were associated with procedures performed with three of four new bronchoscopes from the same manufacturer. Contrary to manufacturing specifications, the biopsy-port caps on all four bronchoscopes were easily removable, and P. aeruginosa was cultured from the biopsy ports of the three implicated bronchoscopes. The PFGE patterns of P. aeruginosa isolates from the bronchoscopes, patients, and two environmental samples were indistinguishable. One patient was hospitalized with P. aeruginosa pneumonia 11 days after bronchoscopy. The manufacturer reported a design change instituted in 1997, and production problems may have resulted in the distribution of bronchoscopes that did not meet specifications. CONCLUSIONS: We documented contamination of bronchoscopes with P. aeruginosa and S. marcescens and possible infection of patients at a community hospital as a result of the inadequate disinfection of bronchoscopes because of a manufacturing defect.

Adult↗
PubMed2003

Increased incidence of the outbreak strain of Mycobacterium tuberculosis in the surrounding community after an outbreak in a jail.

BACKGROUND: Between 1995 and 1997, a tuberculosis outbreak occurred in a large, urban jail. We investigated whether the outbreak strain of Mycobacterium tuberculosis (M. tuberculosis) was circulating in the surrounding community after that outbreak. METHODS: We performed a retrospective cohort study of people with tuberculosis in Shelby County, TN, from January 1998 through August 1999, with molecular fingerprinting of M. tuberculosis strains. RESULTS: From January 1998 through August 1999, 23% of cases in the community involved a strain of M. tuberculosis that was indistinguishable from the previous jail outbreak strain. Twelve people (63%) with that strain had no history of recent incarceration. CONCLUSION: Two years after a tuberculosis outbreak in the jail, the outbreak strain was more prevalent in the surrounding community than it was during the jail outbreak. Jails can be important reservoirs of tuberculosis, which may subsequently circulate outside the institution. If efforts to eliminate tuberculosis are to be successful, the disease must be controlled successfully in such high-risk populations.

Cohort Studies↗
PubMed2003

From pig to pacifier: chitterling-associated yersiniosis outbreak among black infants.

In this case-control study of Yersinia enterocolitica infections among black infants, chitterling preparation was significantly associated with illness (p<0.001). Of 13 samples of chitterlings tested, 2 were positive for Yersinia intermedia and 5 for Salmonella. Decontamination of chitterlings before sale with methods such as irradiation should be strongly considered.

Black or African American↗
PubMed2003

West Nile virus in Tennessee.

WNV is a mosquito-borne virus that generally causes asymptomatic or mild illness in humans. Less than 1% of infected persons will develop severe disease. Because there is no specific treatment for the disease, mildly ill persons seldom require testing for WNV. Widespread media coverage may contribute to misperceptions about the incidence and severity of the disease, and many patients may benefit from reassurance and information which helps them understand the true risk of WNV compared with many more common but less sensational public health threats. For example, approximately 34,000 Americans die each year from firearms, and 20,000 die from influenza (a vaccine-preventable disease). Common-sense personal protective measures to avoid mosquito bites can substantially reduce an individuals' risk of acquiring WNV.

Animals↗
PubMed2002

La Crosse encephalitis in Eastern Tennessee: clinical, environmental, and entomological characteristics from a blinded cohort study.

A blinded cohort study was conducted in 2000 to better understand the emergence of La Crosse virus infection in eastern Tennessee, with special emphasis on the potential mosquito vector(s). Children with suspected central nervous system infection were enrolled at the time of clinical presentation at a large pediatric referral hospital. Clinical, environmental, and entomological data were collected prior to case confirmation. Sixteen of the 40 children included in the final analysis were confirmed to have La Crosse infection by a fourfold increase in antibody titers between collection of acute- and convalescent-phase sera. Factors significantly associated with La Crosse infection included average number of hours per day spent outdoors (5.9 for La Crosse virus cases vs. 4.0 for noncases, p = 0.049); living in a residence with one or more tree holes within 100 m (relative risk = 3.96 vs. no tree holes within 100 m, p = 0.028); and total burden of Aedes albopictus (number of female and male larvae and adults collected at a site), which was more than three times greater around the residences of La Crosse virus cases versus noncases (p = 0.013). Evidence is accumulating that the newly introduced mosquito species Ae. albopictus may be involved in the emergence of La Crosse virus infection in eastern Tennessee.

Aedes↗
PubMed2002

Neurologic complications including paralysis after a medication error involving implanted intrathecal catheters.

PURPOSE: Long-term continuous intrathecal infusion of medications for chronic medical problems is common. We investigated the cause of a cluster of severe neurologic complications in patients with intrathecal catheters. METHODS: We performed an epidemiologic cohort study of patients who had intrathecal catheters in place in one neurosurgical practice, to assess the presence of new neurologic complications and associated risk factors. RESULTS: The practice included 61 patients who received pain medication through implanted intrathecal catheter pumps, 19 of whom were treated with morphine, either alone or in combination with other medications. None of the 42 patients whose drug regimen did not include morphine developed a complication, whereas 8 of 13 patients who received morphine in refills of their pumps during one 4-week period experienced neurologic complications. Three persons underwent laminectomy for sterile abscesses and were left with new paralysis or leg weakness. Testing of two stock bottles from the involved pharmacy, both labeled as containing pure morphine, revealed the presence of methadone in addition to morphine. One of these bottles also contained trace ethanol. A sample of medication aspirated from the pump of a patient prescribed morphine from the same pharmacy was also found to have contained methadone and methanol. CONCLUSIONS: A variety of severe neurologic complications was associated with inadvertent administration of methadone, and perhaps other unintended substances, by means of implanted intrathecal catheters to a group of patients. Medical errors in an outpatient pharmacy led to this outbreak.

Adult↗