Thursday, June 9, 2011

QD: News Every Day-Salmonella still a scourge, E. coli could come back

Salmonella food infections continue despite success reducing disease caused by other pathogens, the Centers for Disease Control and Prevention reports.

Salmonella should be targeted because while infection rates have not declined significantly in more than a decade, they are one of the most common, the CDC reports in its latest Vital Signs.

Contaminated food causes approximately 1,000 reported disease outbreaks and an estimated 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths annually in the U.S. Salmonella causes 1 million foodborne infections annually, incurring an estimated $365 million in direct medical costs. Salmonella infections in 2010 increased 10% from 2006-2008.

The same prevention measures that reduced Escherichia coli infections to less than 1 case per 100,000 need to be applied more broadly to reduce Salmonella and other infections, the CDC reports. These measures include:
--cleaner slaughter methods, microbial testing, and better inspections in ground beef processing plants;
--cooking meat thoroughly, and increased awareness in restaurants and homes of the risk of undercooked ground beef;
--vigorously detecting and investigating outbreaks; and
--recalling contaminated food. 234 beef recalls have occurred since the Shiga toxin-producing Escherichia coli (STEC) O157 was declared an adulterant in ground beef in 1994

New national health objectives target a 25% reduction in Salmonella infections by 2020 and 25%-50% reductions for five other infections and hemolytic uremic syndrome. These targets could prevent an estimated 4.6 million illnesses, 68,000 hospitalizations, and 1,470 deaths, and save $421 million in direct medical costs associated with Salmonella infection alone.

But, the U.S. still faces threats from E. coli, Dennis G. Maki, MD, a Master of the American College of Physicians, tells NPR that it's likely the U.S. will see an E. coli outbreak involving travelers returning from Europe. The European outbreak is hospitalizing about a third of its victims, which he called extraordinary.

Food safety practices are described at the CDC, the Food Safety Working Group, at FoodSafety.gov, and at the Partnership for Food Safety Education.

Detailed findings from Vital Signs
The Foodborne Diseases Active Surveillance Network (FoodNet) follows about 15% of the U.S. population for laboratory-confirmed infections with nine common foodborne pathogens. Overall and pathogen-specific changes in incidence were estimated from 1996-1998 to 2010 and from 2006-2008 to 2010.

A total of 19,089 infections, 4,247 hospitalizations, and 68 deaths were reported from FoodNet sites in 2010. Salmonella was the most common infection reported (17.6 illnesses per 100,000 persons) and was associated with the largest number of hospitalizations (2,290) and deaths (29). No significant change Salmonella infections has occurred since the start of surveillance during the period of 1996-1998.

(STEC) O157 infection caused 0.9 illnesses per 100,000 people. Compared with 1996-1998, overall incidence of infection with six key pathogens in 2010 was 23% lower, and pathogen-specific incidence was lower for Campylobacter, Listeria, STEC O157, Shigella, and Yersinia infection, but higher for Vibrio infection. Compared with a more recent period, 2006-2008, incidence in 2010 was lower for STEC O157 and Shigella infection but higher for Vibrio infection.

Among the 7,564 (92%) Salmonella isolates serotyped, the most common were Enteritidis (22%), Newport (14%), and Typhimurium (13%).

For the other pathogens, the number of infections and incidence were: Campylobacter (6,365; 13.6 per 100,000), Shigella (1,780; 3.8 per 100,000), Cryptosporidium (1,290; 2.8 per 100,000), STEC non-O157 (451; 1.0 per 100,000); STEC O157 (442; 0.9 per 100,000), Vibrio (193; 0.4 per 100,000), Yersinia (159; 0.3 per 100,000), Listeria (125; 0.3 per 100,000), and Cyclospora (28; 0.1 per 100,000).

The percentage of patients hospitalized ranged from 0% for Cyclospora to 90% for Listeria infection. Fatalities ranged from 0% for Cyclospora and Shigella to 13% for Listeria infection. Overall, the percentage of patients hospitalized (40%) and killed (1.5%) were highest among those 60 years or older.

The overall incidence for the six key pathogens (Campylobacter, Listeria, Salmonella, STEC O157, Yersinia, and Vibrio) was 23% lower in 2010 than during 1996-1998.

Incidence was significantly lower for Shigella (57% decrease), Yersinia (52%), STEC O157 (44%), Listeria (38% , and Campylobacter (27%) but higher for Vibrio (115% increase). It did not change significantly for Cryptosporidium.

Compared with 2006-2008, overall incidence was not significantly different in 2010. The incidence was significantly lower for STEC O157 (29% decrease) and Shigella (29% decrease) and significantly higher for Vibrio (39% increase). The incidence did not change significantly for Campylobacter, Cryptosporidium, Listeria, and Yersinia.

Labels: infectious disease, public health, QD, salmonella

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Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

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Ves Dimov, MD, ACP Member, is an allergist/immunologist and Assistant Professor of Medicine and Pediatrics at the University of Chicago, where he evaluates and treats both pediatric and adult patients.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

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Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

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Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

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Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

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Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

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Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

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John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

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Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
ACP Member Mike Aref, MD, PhD, ACP Member, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

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William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

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Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

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Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

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Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

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Justin Penn, MD, ACP Associate Member, attended medical school at the University of Washington School of Medicine and trained in internal medicine at the University of Rochester, where he is serving as Chief Resident.

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David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

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Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

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Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

White Coat Underground
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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Thursday, June 9, 2011

QD: News Every Day-Salmonella still a scourge, E. coli could come back

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