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epiTRENDS
Recent CDC Publications
March
2007 Vol. 12, No.
3
Two recent MMWR articles (Morbidity and Mortality Weekly Review) from Centers for Disease Control and Prevention included participation by county health jurisdictions in Washington State. An investigation of an E. coli outbreak originated in Washington State. An investigation of measles involved Washington after another state recognized the disease importation. The MMWR articles are summarized below.
CDC encourages MMWR submissions by local health jurisdictions. LHJ personnel wanting to write up an unusual outbreak or case investigation of a notifiable communicable disease can contact theappropriate epidemiologist with DOH Communicable Disease Epidemiology Section for assistance.
epiTRENDS
P.O. Box 47812
Olympia, WA 98504-7812
Mary C. Selecky
Secretary
Maxine Hayes, MD, MPH
State Health Officer
Jo Hofmann, MD
State Epidemiologist for
Communicable Diseases
Deborah Todd, RN, MPH
Managing Editor
Marcia J. Goldoft, MD, MPH
Scientific Editor
Escherichia coli O157:H7 Infection Associated with Drinking Raw Milk
The Washington outbreak investigation involved Clark County Public Health and Cowlitz County Health Department.. During December 2005, Clark County investigated a cluster of four Escherichia coli O157:H7 cases. All had consumed raw (unpasteurized) milk from a farm in Cowlitz County. The farm was operating a cow-share program, in which persons purchase shares of dairy cows and receive a portion of the milk produced.
Interviews were conducted with 43 of the 45 families with shares in the dairy cows. There were 18 cases of illness identified, eight laboratory confirmed. Five pediatric patients were hospitalized, four with hemolytic uremic syndrome (HUS). E. coli O157:H7 was isolated from both raw milk samples and farm environmental samples.
In Washington, there are up to 150 E. coli O157:H7 cases reported annually with rare deaths. Raw milk is an uncommon but well documented source of exposure to this pathogen. Pasteurization greatly decreases the pathogens in milk. To prevent E. coli O157:H7 and other infections, it is recommended that consumers not drink raw milk or products made from raw milk.
The regulated sale of raw milk is legal in Washington if the dairy is properly licensed by the Washington State Department of Agriculture (WSDA). The Cowlitz County farm was not licensed and it did not follow applicable sanitation and public health safety regulations. As a result of this outbreak, WSDA revised regulations to help ensure that milk producers who sell raw milk through cow-share programs obtain the appropriate state licenses and comply with milk-processing sanitation and public health guidelines.
This article from March 2, 2007 is available at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5608a3.htm
Measles Associated with Adoption of Children in China
On August 15, 2006, the Missouri Department of Health and Senior Services (MDHSS) identified a measles case in a Missouri resident who had recently traveled to China. The patient was part of a group traveling to adopt from orphanages in Guangdong Province. Three cases of measles were eventually identified in adoptive parents including one from Washington State. The Pierce County woman’s febrile rash illness had been attributed to a drug reaction until MDHSS notified Washington State Department of Health (DOH) that she had been a member of the same adoption group as the Missouri measles case. Tacoma Pierce County Health District assisted with the investigation of the case. Subsequent serology confirmed acute measles. She had received one dose of measles containing vaccine.
None of the three patients recalled contact during travel with anyone who appeared ill. All three patients recovered fully, and no secondary cases were identified among family members, other travelers, patients, or medical staff who might have been exposed. Because of delays in diagnoses (the earliest case was identified 2 weeks after rash onset), no control measures (e.g., vaccination of contacts or administration of immunoglobulin) were indicated.
Import-associated measles cases (i.e., imported, import-linked, or imported virus cases) now account for the majority of cases reported in the United States. Imported measles cases among adoptees from China have been reported previously including in Washington State. Though still common in many parts of the world, measles is rare in this country. In the past decade Washington State reported numbers ranging from 15 cases in 2001 to none in 2003. Measles is no longer endemic here in the United States, so cases can almost all be shown to be imported or import-associated.
The Advisory Committee on Immunization Practices (ACIP) recommends measles, mumps, and rubella (MMR) vaccine before travel abroad for persons born during 1957 or later without 1) adequate documentation of immunity by previous vaccination with 2 doses of MCV, 2) laboratory evidence of immunity, or 3) physician-diagnosed measles. The United States Department of State requires that internationally adopted children aged >10 years receive the following vaccines before entry into the United States: measles, mumps, and rubella; polio; tetanus and diphtheria toxoids; pertussis; Haemophilus influenzae type B; hepatitis B; varicella; and pneumococcal. For those aged <10 years, the adopting parents must sign an affidavit promising to provide these vaccinations within 30 days of entry to the United States.
The full article from February 27, 2007 is available at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5607a3.htm
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