Epidemic Intelligence Service (EIS) Conference: 62 Annual

62nd Annual
Epidemic Intelligence
Service (EIS) Conference
Volume 62 Number 1 April 22–26, 2013
http://www.cdc.gov/eis/conference.html
Regional Digital Imaging Center at The Athenaeum of Philadelphia
Do not go where the path may lead; go instead where there is no path and leave a trail.
—Ralph Waldo Emerson
Crowne Plaza Atlanta Perimeter at Ravinia Ballroom Floor Plan
Name Tags Color Key

EIS Alumni
Current EIS Officers
Incoming EIS Officers
Conference Participants
Conference Staff
Field EIS Alumni
Recruiters
Media
62nd Annual
Epidemic Intelligence Service (EIS)
Conference
April 22–26, 2013
62nd Annual
Epidemic Intelligence Service (EIS) Conference
April 22–26, 2013
Save the Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
In Memoriam, Stephen B. Thacker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Scientific Program Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
EIS Alumni Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2013 EIS Conference Schedule At-a-Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Award Descriptions and Committee Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Awards Presented at the 2012 EIS Conference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Alexander D. Langmuir Lectures, 1972–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Alexander D. Langmuir Prize Manuscripts, 1966–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Philip S.Brachman Awards, 1983–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Distinguished Friend of EIS Awards, 1984–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Iain C. Hardy Awards, 1996–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
J. Virgil Peavy Memorial Awards, 2003–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Donald C. Mackel Memorial Awards, 1987–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Outstanding Poster Presentation Award, 1986–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Paul C. Schnitker International Health Award, 1995–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
James H. Steele Veterinary Public Health Award, 1999–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Mitch Singal Excellence in Occupational and Environmental Health Award, 2010–2012 . . . . . . . . . . . . . . . . . . . . 37
Instructions for Completing Online Conference Evaluations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
2013 Conference Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
SESSION A: Stephen B. Thacker Opening Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
SESSION B: Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
POSTER SESSION 1: Meet the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
SPECIAL SESSION: Dr. James H. Steele’s 100th Birthday Celebration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
SESSION C: Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
SESSION D: Vaccine-Preventable Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
CONCURRENT SESSION E1: Winnable Battles in Chronic Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
CONCURRENT SESSION E2: HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
CONCURRENT SESSION F1: Injury Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
CONCURRENT SESSION F2: Zoonotic Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
SPECIAL SESSION: New Vaccines in the Global Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
SPECIAL SESSION: Chronic Disease Prevention through Healthcare and Public Health Partnerships . . . . . . . . 75
SESSION G: International Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
CONCURRENT SESSION H1: Respiratory Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
CONCURRENT SESSION H2: Occupational Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
CONCURRENT SESSION I1: Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
CONCURRENT SESSION I2: Maternal and Child Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
POSTER SESSION 2: Meet the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
SPECIAL SESSION: Fungal Meningitis Associated with Injection of a Widely Distributed Steroid Product:
Lessons Learned During the Response to the Largest Documented Healthcare-Associated
Outbreak in U.S. History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
SESSION J: Food and Waterborne Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
SESSION K: Alexander D. Langmuir Memorial Lecture and Reception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
SESSION L: International Night (Oral Presentations) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
SESSION M: Donald C. Mackel Award Finalists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
SESSION N: Environmental Health and Preparedness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
SPECIAL SESSION: Stephen B. Thacker Memorial Tribute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
SESSION O: J. Virgil Peavy Memorial Award Finalists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
SESSION P: Money, Math, and Modeling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
SESSION Q: Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
SESSION R: Late-Breaking Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
SESSION S: Healthcare-Associated Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
EIS Officers, Class of 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
EIS Officers, Class of 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Incoming EIS Officers, Class of 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Index of EIS Officer Presenters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
SAVE THE DATE
63rd ANNUAL
EIS CONFERENCE
APRIL 28–MAY 2, 2014
Centers for Disease Control and Prevention

Atlanta, Georgia
www.cdc.gov
6 2013 EIS Conference
Preface
Dear Friends of EIS:
Welcome to the 62nd Annual Epidemic Intelligence Service (EIS) Conference. I am delighted
that you are able to attend our conference, which highlights the professional activities of EIS
officers (EISOs). The scientific program this year includes 95 oral presentations and 31 poster
presentations. In addition, your experience this week will be enriched by International Night, the
EIS satirical revue, the Prediction Run, special award presentations, and other activities that are
longstanding traditions at conference.
For me and for many others, this year‘s conference will be bittersweet. On one hand, we are
welcoming the newest members of the EIS family, a group of incredibly talented persons who
will carry on the EIS legacy. Yet, at the same time, we are saying goodbye to one of the patriarchs
of our EIS family, Dr. Stephen B. Thacker. To honor his legacy, we are dedicating this year’s conference to him. The next page
highlights just a few of his extraordinary contributions to public health and ways that EIS will honor his memory this year and
in perpetuity. We are also featuring Steve in this quarter’s EIS Bulletin (be sure to pick up a copy at the conference). But perhaps
that best way to acknowledge Steve’s legacy is to introduce the newest class of EIS officers.
As always, we extend a special welcome to the incoming EISOs, members of the Class of 2013. We had about a 10% increase in
the number of applications received this year, setting a new record high of 534 complete applications. Although this increases
our initial screening process workload, we also recognize that we have a richer pool of candidates from which to choose the final
class. I’m confident that we selected an excellent group of new officers!
This year’s 81 red tags are a select group of men and women with a broad array of interests and skills. Fifty-seven of the new
officers are women (70%), and 12 are citizens of other nations (15%). Besides the United States, this year’s officers represent
Cambodia, China, Kenya, Mongolia, Nepal, Nigeria [2], Peru, South Korea, Taiwan, Uganda, and the United Kingdom. Among
the 70 U.S. citizens or permanent residents, 20 represent racial and ethnic minority groups (29%). There are 26 PhD-level
scientists (33%), 44 physicians (54%), 9 veterinarians (11%), and 2 nurses (2%). Four of the DVMs, 3 of the MDs, and 1 of the
nurses also hold PhDs. Nine members of the class accepted a prematch assignment in a state/local health department.
This year, we will again run concurrent oral sessions on Tuesday and Wednesday mornings, so please check your program
carefully. There are also several special lunchtime sessions. On Monday, immediately following the Veterinarian’s lunch, there
is a session honoring Dr. James H. Steele’s 100th Birthday Celebration. On Tuesday, there will be concurrent lunchtime special
sessions, New Vaccines in the Global Context and Chronic Disease Prevention Through Healthcare and Public Health Partnerships.
Wednesday’s special session will focus on Fungal Meningitis Associated with Injection of a Widely Distributed Steroid Product:
Lessons Learned During the Response to the Largest Documented Healthcare-Associated Outbreak in U.S. History. On Thursday, we
encourage all attendees to join us for the Stephen B. Thacker Memorial Tribute.
The 2013 Conference provides you the opportunity to hear about many current applications of epidemiology to public health
and prevention by EISOs. I hope you enjoy this exciting series of days and evenings in the EIS experience, and I hope you take
this as an opportunity to learn, meet old and new friends, and welcome the incoming officers. I look forward to seeing you
during the week.
Douglas H. Hamilton, MD, PhD

Director, Epidemic Intelligence Service
Division of Applied Sciences
Scientific Education and Professional Development Program Office
2013 EIS Conference 7
In Memoriam,
Stephen B. Thacker
We dedicate this EIS Conference to the memory of Dr. Stephen B. Thacker (EIS ’76),
who died on February 15, 2013, at age 65. Throughout his nearly 37 years at CDC,
Steve was a preeminent leader of public health science and an ardent advocate for the
professionals who practice such sciences. He held various leadership positions across
the agency, both cross-cutting and in disease-specific areas. All who knew Steve also knew he was an avid reader and lover of literature. In
that vein, we have included famous quotations as complements to the session topics in this year’s program book. We believe Steve would
have appreciated both the humorous and serious sides of these bits of wisdom.
Steve came to CDC in 1976 as an EIS officer and was stationed with the Washington, DC, Health Department. His early claim to fame was
that, on his second day on the job, he was dispatched to Harrisburg to investigate an outbreak of an unknown illness among attendees of
a statewide American Legion convention at the Bellevue-Stratford Hotel in Philadelphia. That now-famous investigation was the first time
Legionnaires’ disease was identified and remains today as a consummate example of the work of EIS officers.
During his tenure at CDC, Steve was a steadfast champion of epidemiology, public health surveillance, and other analytic methods for
public health. He fostered efforts to identify, introduce, and disseminate innovative scientific methods and technology to enhance public
health practice at CDC, nationally, and internationally. His scientific and leadership qualities were recognized through over 40 major awards
and commendations, including the Distinguished Friend of EIS Award (2002) and the Charles C. Shepard Lifetime Scientific Achievement
Award (2009). Steve was one of the most prolific public health scientists, authoring or coauthoring more than 240 papers and textbook
chapters and serving as the editor of scientific papers and journal supplements on a broad range of public health topics (a comprehensive
bibliography is available at http://libguides.phlic.cdc.gov/Thacker).
Steve was an especially dedicated steward of the EIS Program. He was committed to its quality, personally interviewing applicants and
reviewing applications each year, and he ensured expansion of the proportion of women and minorities in each succeeding class. He could
remember the background of every EIS officer admitted during his watch, and he never missed a day of the annual conference. He was
known for his wall of pictures — the photos, names, and positions of current EIS officers and other training program participants displayed
in his office — that demonstrated his commitment to the fellowships and the trainees who are the future of public health. He was also
fiercely committed to documenting the history of EIS, also coediting a supplement to the American Journal of Epidemiology (December
2011) that described the 4,484 Epi-Aid investigations performed throughout the world by CDC’s EIS officers and staff, 1946–2005 (copies of
the supplement are available here at the conference or by contacting C. Kay Smith at [email protected]). The cover graphic and layout design of
this year’s program book is an hommage to the American Journal of Epidemiology, a journal whose issues Steve never failed to read.
CDC has established several traditions in Steve’s name, including an annual Stephen B. Thacker Science for Social Justice Award. The
opening session of the EIS Conference, which was introduced by him for so many years, will hereafter be called the Stephen B. Thacker
Opening Session in recognition of his breadth of scientific knowledge. The 2013 Conference is also the inaugural year for another new
annual honor, the Stephen B. Thacker Excellence in Mentoring Award. After Steve’s posthumous receipt of the award this year, future
recipients will be persons who have been an inspiration to the EIS community and who have exhibited unwavering commitment to the
EIS Program, officers, and alumni through demonstrated excellence in applied epidemiology training, mentoring, and contributions to
building public health capacity. Finally, the CDC Foundation is also honoring Steve’s life and service to public health and the EIS Program at
http://www.cdcfoundation.org/what/program/stephen-b-thacker-fund.
We especially welcome the incoming EIS officers this week because they are the last class who could possibly have experienced the Steve
Thacker interview. We contemplate with deep sadness their and our loss of his direct leadership and guidance. But we know that the legacy
of someone like Steve lives forever. Thus, we hope that through their participation in this year’s conference, especially the Thursday lunch
memorial to him, and perhaps by reading the testimonials posted on the family’s website (http://www.teamthacker.com), they will begin
to get a sense of Steve’s vast knowledge and skills, his quick wit, his joy in seeing public health practice at its best, and his constant refrain,
“Here to serve.” They will continue to experience Steve’s influence throughout their entire 2 years as EIS officers. We all miss you, Steve!!
Denise Koo, MD, MPH (EIS ’91)

Director, Scientific Education and Professional Development Program Office
62nd EIS Conference

Scientific Program Committee
Center for Global Health.................................................................................................Alexandre Macedo de Oliveira, Chair
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention..................................Tracie Gardner, Chair Elect
Center for Global Health.......................................................................................................................................................... Kathrine Tan
National Center on Birth Defects and Developmental Disabilities........................................................................... Daisy Christensen
National Center for Chronic Disease Prevention and Health Promotion................................................... Henraya Davis McGruder
National Center for Emerging and Zoonotic Infectious Disease............................................................. Dianna Blau and Julie Harris
National Center for Environmental Health/Agency for Toxic Substances and Disease Registry....................................Kanta Sircar
National Center for Health Statistics............................................................................................................................................. Brian Kit
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention..................Elizabeth Torrone, Late-Breaker Committee
National Center for Immunization and Respiratory Diseases......................................................................................... Jennifer Verani
National Center for Injury Prevention and Control.................................................................... Kevin Vagi, Late-Breaker Committee
National Institute for Occupational Safety and Health........................................................ Marie DePerio, Late-Breaker Committee
Scientific Education and Professional Development Program Office............ Julie Magri and Randolph Daley, Late-Breaker Chair
Front Row (left to right): Brian Kit, Daisy Christensen, Henraya Davis McGruder, Julie Harris, Marie DePerio
Second Row (left to right): Kevin Vagi, Elizabeth Torrone, Kathrine Tan, Kanta Sircar, Julie Magri, Dianna Blau, Jennifer Verani
Back Row (left to right): Alexandre Macedo de Oliveira, Tracie Gardner
Conference Program Production EIS Program Staff

Rachel Avchen, Anthony Jordan, C. Kay Smith, Julie Magri, Douglas H. Hamilton, Rachel Avchen, Ronald Edwards,
Betsy Lescosky Kathryn Green, Christa Hale, Korwaski Jeter, Anthony
Jordan, Cynthia Kennedy, William Knoll, Sheila Porter,
Deborah Sorgel, Shannon Souvinette, Thuy Nguyen
Acknowledgments/Disclaimer
The EIS Program extends a special thank you to the EIS Alumni Association for sponsoring the breaks at this year’s 62nd Annual EIS Conference. The EIS Program
gratefully acknowledges the valuable assistance and cooperation of the editorial, creative service, and support staff throughout CDC who contribute to the officers’
presentations. Abstracts in this publication were edited and officially cleared by the respective national centers. Therefore, the EIS Program is not responsible for
the content, internal consistency, or editorial quality of this material. Use of trade names throughout this publication is for identification only and does not imply
endorsement by the U.S. Public Health Service or the U.S. Department of Health and Human Services. The findings and conclusions in this report are those of the
author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
The EIS Alumni Association

Founded in the 1960s, the Epidemic Intelligence Service Alumni Association (EISAA) represents more than 3,000 alumni
worldwide. EISAA provides opportunities for alumni to connect with one another and fosters a spirit of loyalty to the EIS
Program through its networking and support activities. EISAA supports a number of awards made during the conference,
including the prestigious Alexander D. Langmuir Award, Distinguished Friend of EIS Award, Donald C. Mackel Memorial
Award, J. Virgil Peavy Memorial Award, and the inaugural Stephen B. Thacker Excellence in Mentoring Award.
Additionally, EISAA provides competitive travel scholarships for prospective applicants to attend the EIS Conference each year.
This year EISAA received 66 applications and awarded 10 scholarships to students. EISAA is also responsible for food and
beverages provided between scientific sessions (identified as “breaks” throughout the program book).
Learn More! All EIS alumni and second-year EIS officers are encouraged to attend the EISAA Annual Meeting that occurs on
Wednesday in the Dunwoody Suites at 5:30 pm.
An enthusiastic and engaged alumni base is crucial to our continued growth and development as an organization. We have
much to gain from staying connected, both personally and professionally. Your support of EISAA will strengthen our network
of EIS alumni in diverse career paths, geographic locations, and interests. It will also ensure a continued cadre of support for
development of future EIS officers!
If you are not already a paid member, consider joining TODAY!
• Membership is easy and relatively inexpensive. Annual dues are $25; a lifetime membership is $350.
• Join Now! You can join at the EISAA table during the conference, during the EISAA Annual meeting, or online at
http://www.cdcfoundation.org/eisaa/eisabout.htm (select Pay Membership Dues).
• Stay Connected! Join the LinkedIn® (http://www.linkedin.com) Epidemic Intelligence Service (EIS) — Alumni and Current
group (more than 700 members and growing)!
We encourage you to get engaged and help us to improve EISAA to better serve all alumni. We hope you enjoy the conference
and that you stop by the EISAA table or the Wednesday meeting to say hello!
Sincerely,
Priti Patel, MD, MPH (EIS ’02) Aimee Ahmed

President, EIS Alumni Association Liaison, EIS Alumni Association
Director of Stewardship
CDC Foundation
General Information
Purpose Statement Speaker Ready Room
The primary purpose of the EIS Conference is to provide a Located in the Dogwood Room, the speaker ready room is
forum for EIS officers to give scientific presentations (oral or available for presenters who need to review or make changes
poster), increase their knowledge of recent investigations and to their presentations. Computers with PowerPoint® software,
the significance to public health, and maintain and increase rewritable CD-ROM drives, and a printer will be available
their skills in determining the appropriateness of epidemiologic Monday–Thursday, 8:00 am–6:00 pm.
methods, presenting and interpreting results clearly, and
developing appropriate conclusions and recommendations. Exhibit Hall
OVERALL CONFERENCE GOALS Open Monday–Thursday, 8:00 am–5:00 pm, in the Preconvene
Area and the Ravinia Ballroom (E, F, and G).
• To provide a forum for EIS officers, alumni, and other
public health professionals to engage in the scientific
exchange of current epidemiologic topics. Environmental Considerations
• To highlight the breadth of epidemiologic investigations Smoking is not permitted in any of the conference sessions,
at CDC. hallways, or meeting rooms. As a courtesy to presenters and all
meeting attendees, please turn off ringers on cellular phones
• To provide a venue for recruitment of EIS graduates during conference sessions. Please limit use of cellular phones
into leadership positions at CDC and state and local to the meeting room foyers and public areas outside the
departments of health. meeting rooms.
Registration and Information Lactation Room

Staff are available at the conference registration desk located Please visit the EIS information table, next to the registration
outside the Ravinia Ballroom. Check-in and onsite registration area, for access to the lactation room. A sign-up schedule
are available Monday–Friday, 7:00 am–5:00 pm. and key will be available at the table Monday–Friday, 7:30 am–
5:00 pm.
Please wear your conference badge at all times during the
conference. Conference staff are wearing purple badges and
are available to assist if you need additional information or
misplace your badge.
Cyber Café/Message Center

To facilitate conference networking, computers with Internet
access are located in the Camellia Room. Preregistered
attendees have immediate access to find, communicate,
and network with other conference participants, speakers,
and staff. LinkedIn® profiles can be uploaded easily to the
conference messaging system, and you can upload a picture of
yourself to facilitate easy identification. If you are not already
registered, please see conference staff for assistance. Please
limit computer time to 10 minutes per session to allow other
conference attendees an opportunity to use the system as well.
2013 EIS Conference Schedule At-a-Glance 11
2013 EIS Conference Schedule At-a-Glance

12 2013 EIS Conference Schedule At-a-Glance
SESSION A: Stephen B. Thacker Opening Session — Ravinia Ballroom 8:15–10:15 am

Award Presentation
Stephen B Thacker Excellence in Mentoring Award
SESSION B: Surveillance — Ravinia Ballroom 10:45–12:10 pm
POSTER SESSION 1: Meet the Authors — Ravinia Ballroom (E, F, and G) 12:30–1:30 pm
MONDAY
SPECIAL SESSION Dr. James H. Steele 100th Birthday Celebration Luncheon — Oakwood Room (A, B) 12:30 pm
SESSION C: Sexually Transmitted Diseases — Ravinia Ballroom 1:30–2:55 pm
SESSION D: Vaccine-Preventable Diseases — Ravinia Ballroom 3:15–5:20 pm
Award Presentation
Iain C Hardy Award
EIS CONFERENCE SOCIAL Conference Preconvene Area 5:20 pm
CONCURRENT SESSION E1: Winnable Battles in Chronic Disease — Ravinia Ballroom 8:30–10:15 am
CONCURRENT SESSION E2: HIV/AIDS — Dunwoody Suites 8:30–10:15 am
CONCURRENT SESSION F1: Injury Prevention — Ravinia Ballroom 10:45 am–12:10 pm
CONCURRENT SESSION F2: Zoonotic Diseases — Dunwoody Suites 10:45 am–12:10 pm
TUESDAY
SPECIAL SESSIONS
CONCURRENT LUNCHTIME SESSION
New Vaccines in the Global Context — Ravinia Ballroom 12:30 pm
CONCURRENT LUNCHTIME SESSION
Chronic Disease Prevention Through Healthcare and Public Health Partnerships — Dunwoody Suites 12:30 pm
Schedule At-a-Glance
SESSION G: International Health — Ravinia Ballroom 1:45–3:50 pm

PREDICTION RUN Liane Levetan at Brook Run Park Pavilion, Dunwoody 6:00 pm
CONCURRENT SESSION H1: Respiratory — Ravinia Ballroom 8:30–10:15 am
CONCURRENT SESSION H2: Occupational Health — Dunwoody Suites 8:30–10:15 am
CONCURRENT SESSION I1: Tuberculosis — Ravinia Ballroom 10:30–11:55 am
CONCURRENT SESSION I2: Maternal and Child Health — Dunwoody Suites 10:30–11:55 am
SPECIAL SESSION Fungal Meningitis Associated with Injection of a Widely Distributed Steroid Product: Lessons Learned During the
Response to the Largest Documented Healthcare-Associated Outbreak in U.S. History — Dunwoody Suites 12:30 pm
WEDNESDAY
POSTER SESSION 2: Meet the Authors — Ravinia Ballroom (E, F, and G) 12:30–1:30 pm
SESSION J: Foodborne and Waterborne Diseases — Ravinia Ballroom 1:30–3:35 pm
SESSION K: Alexander D. Langmuir Memorial Lecture and Reception — Ravinia Ballroom 4:00–5:30 pm
Awards Presentation
Alexander D. Langmuir Prize Manuscript Award
Distinguished Friend of EIS Award
EIS ALUMNI ASSOCIATION MEETING Dunwoody Suites 5:30 pm
SESSION L: International Night — Ravinia Ballroom 5:30–10:00 pm
Poster Session 5:30–6:45 pm
Oral Presentations 7:30–9:45 pm
Award Presentation, 2013 EIS International Night Awards 9:45–10:00 pm
SESSION M: Donald C. Mackel Award Finalists — Ravinia Ballroom 8:30–10:15 am
SESSION N: Environmental Health and Preparedness — Ravinia Ballroom 10:30–11:55 am
THURSDAY
SPECIAL SESSION Stephen B. Thacker Memorial Tribute — Ravinia Ballroom 12:30 pm

SESSION O: J. Virgil Peavy Memorial Award Finalists — Ravinia Ballroom 1:30–3:15 pm
SESSION P: Money, Math, and Modeling — Ravinia Ballroom 3:30–4:55 pm
EIS SATIRIC REVUE Ravinia Ballroom 8:30–11:00 pm
Awards Presentation
Philip S. Brachman Award
SESSION Q: Risk Factors — Ravinia Ballroom 8:30–9:55 am
Awards Presentation — Ravinia Ballroom 10:15 am
Donald C. Mackel Memorial Award
J. Virgil Peavy Memorial Award
FRIDAY
Paul C. Schnitker International Health Award

James H. Steele Veterinary Public Health Award
Outstanding Poster Presentation Award
SESSION R: Late-Breaking Reports — Ravinia Ballroom 10:30–11:55 am
SESSION S: Healthcare-Associated Infections — Ravinia Ballroom 1:30–3:15 pm
CLOSING REMARKS AND ADJOURNMENT 3:15 pm
Monday, April 22, 2013
7:00 REGISTRATION DESK OPENS
8:15 WELCOME AND CALL TO ORDER

Ravinia Ballroom
Thomas R. Frieden, Director, Centers for Disease Control and Prevention
Denise Koo, Director, Scientific Education and Professional Development Program Office
Presentation of the Stephen B. Thacker Excellence in Mentoring Award
8:30 Here to serve. —Stephen B. Thacker

SESSION A: Stephen B. Thacker Opening Session
Ravinia Ballroom
MODERATOR: Denise Koo
8:35 Multi-State Outbreak of Fungal Meningitis and Other Infections Associated with
Contaminated Methylprednisolone Acetate. Anne E. Purfield
8:55 Recurrence of Dracunculiasis (Guinea Worm Disease) After a 10-Year Absence —
Chad, 2012. Nandini Sreenivasan
9:15 Sick and Retired, Prevalence of Pneumoconiosis Among Retired Coal Miners —
3 States, 2012. Cara N. Halldin
9:35 Hantavirus Outbreak Investigation — Yosemite National Park, 2012. Jonathan J. Nunez
9:55 Serogroup A Meningococcal Conjugate Vaccine Coverage After the First National Mass
Immunization Campaign — Burkina Faso, 2011. Sarah A. Meyer
10:15 BREAK Sponsored by the EIS Alumni Association
10:45 There are three kinds of epidemiologists: those who can count and those
who can’t. —Author Unknown (adapted by John M. Cowden)
SESSION B: Surveillance
Ravinia Ballroom
MODERATORS: Christine Casey and Kathleen Gallagher
10:50 High-Risk Use of Prescription Opioids — Tennessee, 2007–2011. Jane A. G. Baumblatt
11:10 BioSense Chief Complaint-Based Syndromic Data as a Near Real-Time Indicator of
Norovirus Disease Activity — United States, 2007–2010. Brian S. Rha
11:30 Communicable Disease Surveillance in New York City Evacuation Shelters After Hurricane
Sandy — November 2012. Alison D. Ridpath
11:50 Burden of Encephalitis-Associated Hospitalizations — United States, 1998–2010.

Neil M. Vora
12:10 LUNCH
12:30 Variety is the spice of life. —William Cowper

POSTER SESSION 1: Meet the Authors
Ravinia Ballroom (E, F and G)
All posters presented during the conference will be on display Monday 9:00 am–Friday 12:00 pm.
The following authors will be present to discuss their studies on Monday, 12:30–1:30 pm.
P1.1 Outpatient Antiviral Therapy for Influenza in Three Healthcare Systems —

United States, 2011–2012. Fiona P. Havers
P1.2 Seroprevalence of Measles and Rubella Antibodies in Pregnant Women — Haiti, 2012.
David L. Fitter
P1.3 Increasing Number and Disproportionate Morbidity and Mortality Associated with
Multistate Foodborne Disease Outbreaks — United States, 1973–2010. Von D. Nguyen
P1.4 No Bones About It: Human Salmonella Infantis Infections Linked to Dry Dog Food —
United States and Canada, 2012. Maho Imanishi
P1.5 Are You Prepared? Visitor Trip Planning and Safety Information Gathering at Zion
National Park — Utah, 2012. Erin M. Parker
P1.6 A Knowledge, Attitudes, and Practices Survey to Inform a Typhoid Fever Intervention
Campaign — Kasese District, Rural Western Uganda, 2012. Jolene H. Nakao
P1.7 Clam-Associated Vibriosis, United States — 1988–2010. Rachel B. Slayton
P1.8 Behaviors Among HIV-Positive Ukrainian Street Youth Associated with a Risk of
Bridging HIV-Infection to Non-Street Youth, 2008. Lina M. Nerlander
P1.9 Findings from the Year of Population-Based Active Surveillance for Legionellosis —
United States, 2011. Kathleen L. Dooling
P1.10 Human Papillomavirus Vaccination Status and Current Contraception Choices in Young
Women with Previous Sexual Experience: Data from the 2006–2010 National Survey of
Family Growth (NSFG). Kenneth B. Quinto
P1.11 Progress in Reducing National Burden of Invasive Methicillin-Resistant Staphylococcus
aureus Infections — United States, 2005–2010. Raymund B. Dantes
P1.12 Multi-District Marburg Hemorrhagic Fever Outbreak — Uganda, 2012. Ilana J. Schafer
P1.13 National Estimates of Sickle Cell Disease with Pediatric Stroke Among African-
Americans — United States, 1997–2009. Charlotte Baker
P1.14 Use of Laboratory Reports as Predictors of West Nile Virus Disease Cases — Texas,
2008–2012. Stephanie J. Yendell
P1.15 A Spicy Catch: Salmonella Bareilly and Salmonella Nchanga Infections Associated with
a Raw Scraped Ground Tuna Product — United States, 2012. W. Thane Hancock
12:30 SPECIAL SESSION: Dr. James H. Steele 100th Birthday Celebration Luncheon
Oakwood Room (A, B)
1:30 I don’t know the question, but sex is definitely the answer. —Woody Allen
SESSION C: Sexually Transmitted Diseases
Ravinia Ballroom
MODERATOR: Gail Bolan
1:35 Extragenital Gonorrhea Infection Among Men Who Have Sex with Men — Sexually
Transmitted Disease Surveillance Network, United States, 2010–2012. Monica E. Patton
1:55 Validating Elimination of Mother-to-Child Transmission of HIV and Congenital
Syphilis — Chile, 2012. Christine E. Ross
2:15 Chlamydia trachomatis Epidemiology and Coinfection Screening Practices — Veterans
Affairs Palo Alto Health Care System, 2008–2011. Alison M. Ludwig
2:35 Using a Mobile Phone Application for Contact Identification of Syphilis Cases Among
Men Who Have Sex with Men — Kansas, 2010–2012. Suparna Bagchi
3:15 Vaccines are the tugboats of preventive health. —William H. Foege

SESSION D: Vaccine-Preventable Diseases
Ravinia Ballroom
MODERATORS: Jane Seward and Stephen Hadler
Presentation of the Iain C. Hardy Award

3:20 Effectiveness of Rotavirus Vaccination Against Severe Childhood Diarrhea —
Guatemala, 2012. Paul A. Gastañaduy
3:40 Duration of Protection Against Hepatitis A for the Current Two-Dose Vaccine
Compared to a Three-Dose Vaccine Schedule in Children — Alaska, 1993–2011.
Gregory A. Raczniak
4:00 Severity of Invasive Pneumococcal Disease in the Era of Pneumococcal Conjugate

Vaccine Introduction. Kathleen L. Dooling
4:20 Rates of Invasive Pneumococcal Disease Among Older Children with
Immunocompromising Conditions — United States, 2007–2009. Aaron M. Harris
4:40 Seroprevalence of Measles, Mumps, Rubella, and Varicella Antibodies in the United
States Population, 2009–2010. Emmaculate Lebo
5:00 Nationwide Measles Outbreak — Democratic Republic of the Congo, 2010–2012.
Heather M. Scobie
5:20 EIS CONFERENCE SOCIAL Sponsored by the EIS Alumni Association

CASH BAR
Conference Preconvene Area
Tuesday, April 23, 2013
8:30 ometimes the questions are complicated, and the answers are simple.
S
—Dr. Seuss
CONCURRENT SESSION E1: Winnable Battles in Chronic Disease
Ravinia Ballroom
MODERATOR: Ursula Bauer
8:35 Relationship Between Two Perceptions About Energy Drinks and the Prevalence of
Energy Drink Use Among Youth — United States, 2011. Gayathri S. Kumar
8:55 Validation of Sodium Intake Estimates Based on 24-hr Dietary Recall Survey with 24-hr
Urine Sodium Excretion Measurements Among Young Adults — Washington DC, 2011.
Carla I. Mercado
9:15 Tobacco Cigarette Smoking Among HIV-Infected Adults in Care in the United States —
Medical Monitoring Project, 2009. Rennatus Mdodo
9:35 Adverse Childhood Experiences and Adult Tobacco Use and Obesity — Nebraska, 2011.
Kristin M. Yeoman
9:55 Environmental Tobacco Smoke (ETS) Exposure and All-Cause Mortality: A Prospective
Cohort Analysis of the Third National Health and Nutrition Examination Survey
(NHANES III). Tala H. I. Fakhouri
8:30 Knowledge is power. —Sir Francis Bacon

CONCURRENT SESSION E2: HIV/AIDS
Dunwoody Suites
MODERATORS: Linda Valleroy and Amy Lansky
8:35 Characteristics of HIV-Positive American Indians — Arizona, 1990–2012. Seema Yasmin

8:55 High HIV Prevalence in Western Equatoria State — Republic of South Sudan, 2012.
E. Kainne Dokubo
9:15 Community-Based Electronic Data Collections for HIV Prevention Research with Black
Men in Rural, Resource-Limited Settings — United States, 2011. Kpandja Djawe
9:35 Did CDC’s 2006 Revised HIV Testing Guidelines Make a Difference? Evaluation of Self-
Reported History of HIV Testing — United States, 2003–2010. Joseph V. Woodring
9:55 Increased HIV Testing Among Men Who Have Sex with Men — National HIV
Behavioral Surveillance System, 20 U.S. Metropolitan Statistical Areas, 2008 and 2011.
Laura A. Cooley
10:45 The best laid schemes of mice and men often go awry.
—adapted from Robert Burns
CONCURRENT SESSION F1: Injury Prevention
Ravinia Ballroom
MODERATOR: James A. Mercy
10:50 Do Adverse Childhood Experiences Add Up to Poor Adult Health? — Results from Ten
U.S. States and the District of Columbia, 2010. Leah K. Gilbert
11:10 Water-Related Unintentional Injuries and Fatalities — Lake Mead National Recreation
Area, Arizona and Nevada, 2007–2011. Carla L. Britton
11:30 Pedestrian Traffic Fatalities — Clark County, Nevada, 2008–2011. Kaci L. Hickox
11:50 Risk Factors for Suicidal Ideation Among Bhutanese Refugees — United States,
2009–2012. Trong T. Ao
10:45 If it looks like a duck and quacks like a duck, we have at least to consider
the possibility that we have a small aquatic bird of the family Anatidae on
our hands. —Douglas Adams
CONCURRENT SESSION F2: Zoonotic Diseases
Dunwoody Suites
MODERATOR: Christopher Paddock
10:50 Lymphocytic Choriomeningitis Virus Outbreak and Risk Assessment — Multiple

States, 2012. Laura S. Edison
11:10 Extreme Rodeo: Results of a Rocky Mountain Spotted Fever Intervention Project —
Eastern Arizona, 2012. Suzanne R. Todd
11:30 Knowledge, Attitudes, and Practices Regarding Dog Ownership and Tick Control on
an American Indian Reservation — Arizona, 2012. Laura E. Adams
11:50 Tularemia: A Potential Public Health Emergency and Contact Investigation —
Virginia, 2011. Jennifer M. Espiritu
12:10 LUNCH
12:30 SPECIAL SESSIONS

CONCURRENT LUNCHTIME SESSION: New Vaccines in the Global Context
Ravinia Ballroom
MODERATOR: Rana Hajjeh
SPEAKERS: Rana Hajjeh, Jacqueline E. Tate, Jennifer Verani, Sema Mandal,
Susan Hariri
12:30 CONCURRENT LUNCHTIME SESSION: Chronic Disease Prevention Through

Healthcare and Public Health Partnerships
Dunwoody Suites
SPEAKERS: Peter Briss, Wayne Giles, Leonard Jack, Kris Ernest
1:45 You must be the change you wish to see in the world. —Mahatma Gandhi
SESSION G: International Health
Ravinia Ballroom
MODERATORS: Pattie Simone and Rita Helfand
1:50 Rapid Surveillance Documents Elevated Mortality Among Blue Nile Conflict
Refugees — South Sudan, 2012. Kevin R. Clarke
2:10 Prevalence of Malaria Parasitemia and Purchase of Artemisinin-Based Combination
Therapies Among Drug Shop Clients — Tanzania, 2012. Melissa A. Briggs
2:30 Changes in Coverage Rates of a Nationwide Micronutrient Powder Distribution
Program — Kyrgyzstan, 2011–2012. Kristie E. Appelgren
2:50 Incidence and Determinants of Adverse Events Following Initiation of First-Line
Antiretroviral Therapy in HIV-Positive Adults — Mozambique, 2004–2007.
Spencer B. Lloyd
3:10 Epidemiology of Hospitalized Influenza Cases from a Population-Based Surveillance

System —Guatemala, 2007–2012. Trong T. Ao
3:30 Cholera Epidemic Associated with Unsafe Drinking Water and Street-Vended Water —
Eastern Freetown, Sierra Leone, 2012. Von D. Nguyen
6:00 PREDICTION RUN

Liane Levetan at Brook Run Park Pavilion, Dunwoody
WEDNESDAY, APRIL 24, 2013
8:30 Remember to breathe. It is, after all, the secret of life. —Gregory Maguire
CONCURRENT SESSION H1: Respiratory Diseases
Ravinia Ballroom
MODERATOR: David Swerdlow
8:35 Respiratory Hospitalizations in Children with Neurologic Disorders — United States,

2010. Fiona P. Havers
8:55 Rates of Pediatric Hospital and Intensive Care Unit Admissions for Lower Respiratory
Tract Infections from MarketScan Data — United States, 2010. Adena H. Greenbaum
9:15 Hispanic Infants Aged <6 Months and Factors Associated with an Increased Risk for
Pertussis — Metropolitan Portland, Oregon, 2010–2012. Kara M. Levri
9:35 Vaccine Effectiveness Among Adolescents Vaccinated with Acellular Pertussis Vaccines,
Washington, 2012. Anna M. Acosta
9:55 Bacterial Pneumonia and Standardized Interpretation of Chest Radiographs in Adults.
Jonathan M. Wortham
8:30 All labor that uplifts humanity has dignity and importance.
—Dr. Martin Luther King, Jr.
CONCURRENT SESSION H2: Occupational Health
Dunwoody Suites
MODERATORS: Henry A. Anderson and Kristin J. Cummings
8:35 Prevalence of Carpal Tunnel Syndrome Among Employees at a Poultry-Processing

Plant — South Carolina, 2012. Kristin M. Musolin
8:55 Salivary Cortisol Response to a High-Protein Challenge and Metabolic Syndrome in
Police Officers — New York, 2004–2009. Penelope J. Baughman
9:15 Self-Reported Gender-Based Violence Among Female Sex Workers — Kampala,
Uganda, 2012. Amee M. Schwitters
9:35 Cancer Screening Non-Compliance Among Females Who Work Alternative Shifts —
United States, 2010. Rebecca J. Tsai
9:55 Inhaled Mercury Exposure from Artisanal Gold Mining and Processing — Nome,
Alaska, 2012. Brian R. Yablon
10:30 I do not cough for my own amusement. —Jane Austen

CONCURRENT SESSION I1: Tuberculosis
Ravinia Ballroom
MODERATOR: Kenneth G. Castro
10:35 Negative Tuberculin Skin Test Result and Increased Risk of Death — United States,
1993–2008. Sara C. Auld
10:55 Relationship Between Cigarette Smoking and Secondhand Smoke Exposure and Latent
Tuberculosis Infection Among U.S. Adults, National Health and Nutrition Examination
Survey, 1999–2000. Eugene Lam
11:15 Enlarged Peripheral Lymph Nodes and Positive Mycobacterium tuberculosis Culture
Among People Living with HIV — Cambodia, Thailand, and Vietnam, September
2006–July 2008. Chimeremma D. Nnadi
11:35 Drinking, Bootlegging, and an Outbreak of Drug-Resistant Tuberculosis — Rural
Kentucky, 2007–2012. Terrence Lo
10:30 ife can only be understood backwards, but it must be lived forwards.
L
—Soren Kierkegaard
CONCURRENT SESSION I2: Maternal and Child Health
Dunwoody Suites
MODERATOR: Wanda Barfield
10:35 Health Hazards Associated with Laundry Detergent Pods — United States,
May–June 2012. Satish K. Pillai
10:55 Discontinuation of Hormonal Contraception Use Among Black Teenage Clients of an
Urban Family Planning Clinic — Atlanta, Georgia, 2012. Michael Lowe
11:15 Evaluation of the Integration of Rapid Syphilis Testing into Routine Antenatal
Services — Nyanza Province, Kenya, 2012. Eleanor B. Fleming
11:35 Relationship Between Use of Labor Pain Medication and Delayed Onset of Lactation —
United States, 2005–2007. Jennifer N. Lind
11:55 LUNCH
12:30 Of course we don’t know what we are doing; that’s why it’s called research.
—Albert Einstein
Ravinia Ballroom (E, F, and G)
All posters presented during the conference will be on display Monday 9:00 am–Friday 12:00 pm.
P2.1 Histoplasmosis Outbreak at a Day Camp — Nebraska, 2012. Kristin M. Yeoman

P2.2 Salmonella enterica Serotype Typhimurium Infection Associated with Cantaloupe —
Kentucky, 2012. Elizabeth S. Russell
P2.3 Assessing Household Preparedness for Radiologic Emergencies — Michigan, 2012.
Mawuli K. Nyaku
P2.4 Cross-Transmission of Ascaris Infection from Pigs to Humans at an Organic Farm —

Coastal Maine, 2012. Leigh Ann Miller
P2.5 Mycobacterium fortuitum Surgical-Site Infections Associated with an Ambulatory Plastic
Surgery Center — Los Angeles County, 2010–2012. Christina A. Mikosz
P2.6 Diversion of Controlled Substances Among Prescription Overdose Deaths —
New Mexico, 2011. Carrie S. McNeil
P2.7 Tri-National Outbreak of Salmonella enterica Serotype Braenderup — The California
Experience, July–September 2012. Rachael H. Joseph
P2.8 Recognizing Laboratory Cross-Contamination: Two False-Positive Cultures of
Mycobacterium tuberculosis — Oklahoma, 2011. Matthew G. Johnson
P2.9 HIV-Related Mortality and Monitored Viral Load, by Zip Code — Cook County,
Illinois, 2010. Yoran T. Grant
P2.10 Animal-Related Unintentional Injury Deaths — Montana, 2003–2011. Abbey J. Canon
P2.11 Central-Line–Associated Bloodstream Infection Reporting Through the CDC National
Healthcare Safety Network — Kansas, January 2011–June 2012. Suparna Bagchi
P2.12 Rapid Response to Escherichia coli O157 Outbreak — New York, 2012. Nina Ahmad
P2.13 Where’s the Beef? Outbreaks of Salmonella Infections Attributed to Beef —
United States, 1975–2011. Alison S. Laufer
P2.14 Prevalence of Obesity in a Nationally Representative Sample of HIV-Infected Adults
Receiving Medical Care in the United States — Medical Monitoring Project, 2009.
Angela M. Thompson-Paul
P2.15 Outbreak of Severe Enterovirus 71 Infections in Children — Cambodia, 2012. Brian Rha
P2.16 Community Experiences, Perceptions, and Exposures to Hydrogen Sulfide and Methane
from Geothermal Venting — Lake County, California, November 2012. Cindy Chiu
12:30 SPECIAL SESSION: Fungal Meningitis Associated with Injection of a Widely

Distributed Steroid Product: Lessons Learned During the Response to the
Largest Documented Healthcare-Associated Outbreak in U.S. History
Dunwoody Suites
MODERATOR: J. Todd Weber
SPEAKERS: Marion Kainer, Benjamin Park, Tom Chiller, Howard Sklamberg
1:30 You won’t be surprised that diseases are innumerable — count the cooks.
—Seneca
SESSION J: Food and Waterborne Diseases
Ravinia Ballroom
MODERATORS: Tim Jones and Ian Williams
1:35 Salmonella enterica Serotype Paratyphi B var. Java Gastroenteritis Outbreak Associated
with Unpasteurized Tempeh — North Carolina, 2012. Stephanie E. Griese
1:55 Outbreak of Listeriosis Associated with Imported and Cross-Contaminated Cheeses —

Multiple States, March–October 2012. Michael Gronostaj
2:15 Salmonella enterica Serotype Typhimurium Gastrointestinal Illness Associated with a
University Microbiology Course — Maryland, 2011. Maria A. Said
2:35 Emergence of GI.6 Norovirus — United States, 2009–2012. Eyal Leshem
2:55 Sonic Salmonellosis: Multistate Outbreak of Human Salmonella Typhimurium Infections
Linked to Pet Hedgehogs — United States, 2012. Tara C. Anderson
3:15 Detecting Hidden Outbreaks of Domestically Acquired Typhoid Fever — United States,
1999–2010. Maho Imanishi
4:00 The suspense is terrible; I hope it lasts. —Willy Wonka

SESSION K: Alexander D. Langmuir Memorial Lecture and Reception
Ravinia Ballroom
SPEAKER: Robert Phillips, MD, MSPH: The Role of EIS in Communities of Solution:
Using GIS and Epidemiology to Activate Health Partnerships.
Presentation of Awards
Alexander D. Langmuir Prize Manuscript Award
Distinguished Friend of EIS Award
This event is cosponsored by the EIS Alumni Association and the Scientific Education and Professional
Development Program Office.
5:30 EIS ALUMNI ASSOCIATION MEETING

Dunwoody Suites
5:30 Best of all possible worlds. —Gottfried Leibniz

SESSION L: International Night
POSTER SESSION
IP1. Target Intervention to Increase Measles Vaccination Coverage by Identifying Low-

Coverage Areas Using Lot Quality-Assurance Sampling — Chennai, India, 2012.
Tony Fredrick
IP2. Predictors of HIV Antiretroviral Treatment Failure Among Patients Attending the
Comprehensive Care Clinic at Rift Valley Provincial General Hospital — Kenya, 2012.
Joyce Njeri Wamicwe
IP3. E-Mail Survey as a Rapid Tool to Confirm Frozen Strawberries as the Vehicle of the
Largest Foodborne Norovirus Outbreak Ever Reported in Germany, 2012.
Sebastian Haller
IP4. Investigation of Outbreak of Cutaneous Anthrax Attributed to Butchering a Sick Cow in
Jiangsu Province, China, 2012. Liangliang Cui
IP5. Outbreak of Conjunctivitis Due to Bacterial Streptococcus pneumoniae —
District Sargodha, Pakistan, 2010. Zafar H. Maken
IP6. Imported Malaria in Guatemalan Soldiers Returning from the Democratic Republic of
the Congo — Guatemala, 2011. Maria L. Müller
IP7. Schistosomiasis Outbreak Investigation, Empandeni Ward, Mangwe District,
Matabeleland South Province, Zimbabwe — June 2012. Pugie T. Chimberengwa
IP8. Case-Control Study for Diphtheria in East Java, Indonesia, 2012. Dimas Panduasa
IP9. Prevalence and Factors Associated with Hypertension and Obesity Among Civil
Servants in Kaduna, Kaduna State — June 2012. Abisola M. Oladimeji
IP10. Risk Factors for Gastric Cancer in Latin America: A Meta-Analysis.
Patricia del Carmen Bonequi Alvarado
IP11. Nested Case-Control Study Among Elementary Students in A Public School on

Firecracker Use During the New Year Celebration — Philippines, 2012.
Alethea R. De Guzman
IP12. Risk Factors of Surgical Site Infection in Hospital A, Bangkok, Thailand, August–
September 2011. Thanawadee Thantithaveewat
IP13. Risk Factors of Underweight Among Under-Five Years Children in Rwanda, 2010.
Alphonse Rukundo
IP14. Factors Affecting the Utilization of Antenatal Care Services Among Pregnant Women —
Ashgabat, Turkmenistan, 2010. Maral Aksakova
IP15. Neisseria meningitids Outbreak — Harenabuluk District, Ethiopia, 2011. Haftom Taame
7:30 ORAL PRESENTATIONS

Ravinia Ballroom
WELCOME: Linda Quick
MODERATORS: Jimmy Kolker and Fadzilah Kamaludin
7:40 Prevalence and Geographic Distribution of Nodding Syndrome — Kilombero and

Ulanga Districts, Tanzania, 2012. Preetha Iyengar
8:00 Outbreak of Bacillus cereus Food-Poisoning with a Fatality After a Feast — Bagli Village,
Bursa Province, Turkey, September 2012. Orhun Kalkan
8:20 Human Cutaneous Anthrax Outbreak Associated with Contact with Livestock —
Georgia, 2012, A Case-Control Study. Archil Navdarashvili
8:45 Outbreak Investigation of Typhoid Fever in Village Kuwardu, District Skardu, Gilgit-
Blatistan (G-B), Pakistan, 2012. Zakir Hussain
9:05 Antiretroviral Therapy Initiating Regimens and Discontinuation Patterns — Medunsa
National Pharmacovigilance Centre Cohort, South Africa, 2004–2011.
Mazvita N. Muropa
9:25 Mumps Attenuated Live Vaccine Effectiveness: 1:1 Matched Case-Control Study —
Zhongshan, China, 2011–2012. Man Wang
Presentation of the 2013 EIS International Night Awards

Dunwoody Suites
International Night is cosponsored by the Center for Global Health (CGH) and the Training Programs
in Epidemiology and Public Health Interventions Network (TEPHINET).
The posters and presentations featured during International Night are from participants in
international programs in applied field epidemiology similar to that of EIS. Some of the programs are
sponsored by CDC, CDC partners, or are independent programs. All conference attendees are invited to
these sessions.
THURSDAY, APRIL 25, 2013
8:30 Extraordinary claims require extraordinary evidence. —Carl Sagan

SESSION M: Donald C. Mackel Memorial Award Finalists
Ravinia Ballroom
MODERATORS: Rachel Kaufmann and Sherif Zaki
8:35 Acute Kidney Injury Associated with Synthetic Cannabinoid Use — Oregon, 2012.
Genevieve L. Buser
8:55 Large Legionnaires’ Disease Outbreak in a Hospital with a Legionella Disinfection

System, Pennsylvania — 2011–2012. Alicia Demirjian
9:15 Soil-Transmitted Helminth Infection in School-Aged and Preschool-Aged Children in
an Urban Slum — Kibera, Nairobi, 2012. Stephanie M. Davis
9:35 Carbapenem-Resistant Klebsiella pneumoniae Producing New Delhi Metallo-Beta-
Lactamase at an Acute-Care Hospital — Denver, Colorado, 2012. Erin E. Epson
9:55 Active Surveillance for Variant Influenza Among Swine, the Environment, and
Employees at Live Animal Markets — Minnesota, 2012. Mary J. Choi

10:30 Prepare for the unknown by studying how others in the past have coped with
the unforeseeable and the unpredictable. —General George S. Patton
SESSION N: Environmental Health and Preparedness
Ravinia Ballroom
MODERATOR: Thomas H. Sinks
10:35 The Perfect Storm: Shelter-Based Surveillance in the Aftermath of Hurricane Sandy —
New Jersey, 2012. Alice M. Shumate
10:55 Assessment of Household Emergency Preparedness Supplies by Housing Type from
a Community Assessment for Public Health Emergency Response (CASPER) —
Michigan, 2012. Michelle Murti
11:15 When Public Health Messaging Still Is Not Enough: Postdisaster Carbon Monoxide
Poisoning Outbreaks, Connecticut’s Experience 1 Year Later — October 2012.
Timothy S. Styles
11:35 Heat Illness: Predictors of Hospital Admissions Among Emergency Department

Visits — Georgia, 2002–2008. Satish K. Pillai
11:55 LUNCH
12:30 SPECIAL SESSION: Stephen B. Thacker Memorial Tribute

Dunwoody Suites
OPEN MICROPHONE: Remarks from the EIS Community
1:30 It is the mark of a truly intelligent person to be moved by statistics.

—George Bernard Shaw
SESSION O: J. Virgil Peavy Memorial Award Finalists
Ravinia Ballroom
MODERATOR: Maya Sternberg
1:35 Suicides Associated with Home Eviction and Foreclosure — United States, 2005–2010.
Katherine A. Fowler
1:55 Getting Caught in the FoodNet: Determining Regional Profiles of Foodborne Disease
Risk Represented by a Sentinel Surveillance System. Alison S. Laufer
2:15 Transmissibility of Variant Influenza from Swine to Humans: A Modeling Approach.
Karen K. Wong
2:35 Associations of Short-Term Exposure to Ozone and Respiratory Outpatient Clinic Visits
in a Rural Location — Sublette County, Wyoming, 2008–2011. Kerry Pride
2:55 Impact of Aerial Insecticide Spraying on West Nile Virus Disease — North Texas, 2012.
Duke J. Ruktanonchai
3:30 Being approximately right most of the time is better than being precisely right
occasionally. —Author Unknown
SESSION P: Money, Math, and Modeling
Ravinia Ballroom
MODERATORS: Benjamin Park and Barbara Marston
3:35 Cost-Effectiveness of a Screening Program to Prevent Cryptococcal Meningitis Among

HIV-Infected Persons — Vietnam. Rachel M. Smith
3:55 Is Clostridium difficile Strain Type a Predictor of Disease Outcomes? Isaac See
4:15 Economic Impact of a Public Health Response to a Measles Case — New York, 2012.
Nina Ahmad
4:35 Predicting Year of Tuberculosis Elimination Among U.S.-Born Populations, by State.

Courtney M. Yuen
8:30 EIS SATIRIC REVUE

Ravinia Ballroom
Presentation of Philip S. Brachman Award
FRIDAY, APRIL 26, 2013
8:30 Tell me your attributes, and I’ll tell you your chances. —Author Unknown
SESSION Q: RISK FACTORS
Ravinia Ballroom
MODERATOR: Robin Ikeda
8:35 Examining the Relationship Between Food Security and Self-Reported Hypertension
Among White, Black, and Hispanic Adults, Behavioral Risk Factor Surveillance
System — 12 States, 2009. Shalon M. Irving
8:55 Risk Factors for Diarrhea-Associated Death Among Children in Botswana in 2012.
Paul A. Gastañaduy
9:15 Association Between Housing Insecurity and Health Outcomes and Behaviors —
Washington State, 2011. Mandy A. Stahre
9:35 Obesity, Physical Activity, Screen Time, and Sugar-Sweetened Beverage Consumption
Among Adolescents — Utah, 2011. Joanna R. Watson
10:15 Presentation of Awards

Ravinia Ballroom
MODERATOR: Douglas H. Hamilton
Donald C. Mackel Memorial Award
J. Virgil Peavy Memorial Award
Paul C. Schnitker International Health Award
James H. Steele Veterinary Public Health Award
Outstanding Poster Presentation Award
10:30 You just tell me when and where, and not only will I be there, but I’ll also be
late. —Jarod Kintz
SESSION R: Late-Breaking Reports
Ravinia Ballroom
MODERATORS: Douglas H. Hamilton and Randolph Daley
See supplement for presenters and abstracts.
11:55 LUNCH
1:30 A hospital is no place to be sick. —Samuel Goldwyn
SESSION S: Healthcare-Associated Infections

Ravinia Ballroom
MODERATORS: Matthew Kuehnert and Tom Chiller
1:35 Postprocedural Fungal Endophthalmitis Associated with Sterile Products from a Single
Compounding Pharmacy — Multiple States, 2012. Christina A. Mikosz
1:55 Evolution of Clinical Manifestations of Fungal Infections Associated with Contaminated
Steroid Injections — Multistate, 2012. Duc B. Nguyen
2:15 Confirmed Donor-Derived Strongyloidiasis Cluster in Transplant Recipients —
Pennsylvania, 2012. Francisca A. Abanyie
2:35 Clostridium difficile Infection Among Children — United States, 2010–2011.
Joyanna M. Wendt
2:55 Invasive Group A Streptococcus Infections Associated with Outpatient Liposuction —

Multiple States, August–September 2012. Amanda L. Beaudoin
3:15 CLOSING REMARKS AND ADJOURNMENT

Alexandre Macedo de Oliveira, MD, MSc, PhD,
62nd EIS Conference Scientific Program Committee, Chair
28 2013 EIS Conference Awards
Awards
Awards Descriptions and Committee Members
Alexander D . Langmuir Donald C . Mackel Memorial Award
Prize Manuscript Award The Donald C. Mackel Memorial Award, sponsored by the
The Alexander D. Langmuir Prize, established in 1966 by the EIS Alumni Association, recognizes a current EIS officer
EIS Alumni Association, recognizes a current EIS officer or for the oral presentation that best exemplifies the effective
recent alumnus (1 year) for excellence in a written report or application of a combined epidemiology and laboratory
an epidemiologic investigation or study. approach to an investigation or study.
Committee: Priti Patel (Chair), Carol Ciesielski, Committee: Kathrine Tan (Chair), Julu Bhatnagar , Dianna
Mary Kamb, Peter Kerndt, Alexandre Macedo de Oliveira, Blau, Vitaliano Cama, Elizabeth Hall, and Julie Magri
Alexandra Oster, and Katherine Stone
J . Virgil Peavy Memorial Award
Philip S . Brachman Award The J. Virgil Peavy Memorial Award, established in 2003 by
The Philip S. Brachman Award, sponsored by the graduating the EIS Alumni Association, recognizes a current EIS officer
class of EIS officers, recognizes excellence in teaching for the oral presentation that best exemplifies the effective
epidemiology to EIS officers. and innovative application of statistics and epidemiologic
methods in an investigation or study.
Committee: EIS Class of 2011
Committee: Daisy Christensen (Chair), ,
Julie Harris, Steven Leadbetter, Kanta Sircar, and Maya
Distinguished Friend of EIS Award Sternberg
The Distinguished Friend of EIS Award, sponsored by
the EIS Alumni Association, recognizes an individual for Outstanding Poster Presentation Award
contributions to the health, welfare, and happiness of EIS
officers and the EIS Program. The Outstanding Poster Presentation Award is sponsored
by the EIS Alumni Association and is presented by the EIS
Committee: Priti Patel (Chair), Carol Ciesielski, Scientific Program Committee to a current EIS officer for
Mary Kamb, Peter Kerndt, Alexandre Macedo de Oliveira, the poster that best exemplifies scientific content, including
Alexandra Oster, and Katherine Stone originality, study design, and analysis; public health impact;
and presentation effectiveness.
Iain C . Hardy Award Committee: Jennifer Verani (Chair), Henraya Davis
The Iain C. Hardy Award, sponsored by the National Center McGruder, Brian Kit, and Betsy Lescosky
for Immunization and Respiratory Diseases, recognizes a
current EIS officer or alumnus (within 5 years) who has
made an outstanding contribution to the control of vaccine-
preventable diseases.
Committee: David Swerdlow (Chair), John Modlin, William

Schaffner, and Melinda Wharton
2013 EIS Conference Awards 29
Paul C. Schnitker James H. Steele Veterinary

International Health Award Public Health Award
Paul C. Schnitker, MD, died in a plane crash in Nigeria in The James H. Steele Veterinary Public Health Award,
1969. He was en route to serve as a public health officer in sponsored by CDC veterinarians, recognizes a current EIS
the response to famine and other public health problems officer or alumnus (within 5 years) who has made outstanding
resulting from the Biafra Civil War in Nigeria. He is the only contributions in the field of veterinary public health through
person who has died while serving as an EIS officer. outstanding contributions in the investigation, control, or
prevention of zoonotic diseases or other animal-related
The Paul C. Schnitker International Health Award, sponsored human health problems.
by the Schnitker family, recognizes a current EIS officer or
alumnus (1 year) who has made a significant contribution to Committee: Casey Barton Behravesh (Chair),
international public health. Barbara Knust, Adam Langer, Hugh M. Mainzer,
Jennifer McQuiston, and Jennifer Wright
Committee: Douglas H. Hamilton (Chair), Ezra Barzilay,
J. Lyle Conrad, Tom Handzel, Asim Jani, and Donna Jones
Stephen B. Thacker Excellence
Mitch Singal Excellence in Occupational In Mentoring Award
and Environmental Health Award The Stephen B. Thacker Excellence in Mentoring Award,
sponsored by the EIS Alumni Association sponsor, will be
The Mitch Singal Excellence in Occupational Safety awarded each year at the EIS Conference to an individual
and Environmental Health Award, co-sponsored by the who is an inspiration to the EIS community and exhibits
National Institute for Occupational Safety and Health and unwavering commitment to the EIS Program, officers,
the National Center for Environmental Health/Agency for and alumni through demonstrated excellence in applied
Toxic Substances and Disease Registry, established in 2010 epidemiology training, mentoring, and building public health
recognizes a current EIS officer for excellence in an oral capacity.
presentation that best exemplifies the effective application of
public health in the area of occupational or environmental Committee: Priti Patel (Chair), Rachel Avchen, Douglas H.
health to an investigation. Hamilton, Denise Koo, and Alexandre Macedo de Oliveira
Committee: Yulia Iossifova-Carroll (Chair), Diana Bensyl,

David Callahan, Ekta Choudhary, and Renee Funk
Awards Presented at the 2012 EIS Conference

Alexander D . Langmuir Prize Paul C . Schnitker International
Manuscript Award Health Award
Jeffrey T. McCollum Sudhir Bunga and Janelle A. Routh
Donald C . Mackel Memorial Award Iain C . Hardy Award
Danielle E. Buttke Pretta K. Kutty
Outstanding Poster Presentation
Brendan R. Jackson James H . Steele Veterinary Public
Health Award
J . Virgil Peavy Memorial Award Barbara Knust
Noha H. Farag
Mitch Singal Excellence in Occupational
Philip S . Brachman Award
Rachel N. Avchen and Environmental Health Award
Danielle E. Buttke
Distinguished Friend of the EIS Award
Jeffrey P. Davis
Alexander D. Langmuir Lectures, 1986 Hepatitis B Virus and Hepatocellular Carcinoma:

Epidemiologic Considerations.
1972–2012 Robert Palmer Beasley
1972 Prevention of Rheumatic Heart Disease — 1987 Environmental Hazards and the Public Health.
Fact or Fancy. Geoffrey Rose
Charles H. Rammelkamp
1988 Lymphotropic Retroviruses in Immunosuppression.
1973 Cytomegaloviral Disease in Man: Myron E. (Max) Essex
An Ever Developing Problem.
Thomas H. Weller 1989 Aspirin in the Secondary and Primary Prevention of
Cardiovascular Disease.
1974 Hepatitis B Revisited Charles H. Hennekens
(By the Non-Parenteral Route).
Robert W. McCollum 1990 Epidemiology and Global Health.
William H. Foege
1975 Origin, Spread, and Disappearance of Kuru:
Implications of the Epidemic Behavior of a Disease 1991 Public Health Action in a New Domain:
in New Guineans for the Epidemiologic Study of The Epidemiology and Prevention of Violence.
Transmissible Virus Dementias. Garen J. Wintemute
D. Carleton Gajdusek
1992 Helicobacter pylori, Gastritis, Peptic Ulcer Disease,
1976 The Future of Epidemiology in the Hospital. and Gastric Cancer.
Paul F. Wehrle Martin J. Blasér
1977 The Historical Evolution of Epidemiology. 1993 Diet and Health: How Firm Is Our Footing?
Abraham Lilienfeld Walter C. Willett
1978 The Biology of Cancer: 1994 Alexander D. Langmuir: A Tribute to the Man.
An Epidemiological Perspective. Philip S. Brachman and William H. Foege
Sir Richard Doll
1995 Epidemiology and the Elucidation
1979 The Epidemiology of Antibiotic Resistance. of Lyme Disease.
Theodore C. Eickoff Allen C. Steere
1980 Health and Population Growth. 1996 50 Years of Epidemiology at CDC.

Thomas McKeown Jeffrey P. Koplan
1981 The Pathogenesis of Dengue: Molecular 1997 Public Health, Population-Based Medicine,
Epidemiology in Infectious Disease. and Managed Care.
Scott B. Halstead Diana B. Petitti
1982 The Epidemiology of Coronary Heart Disease: 1998 Pandemic Influenza: Again?
Public Health Implications. Robert Couch
Henry W. Blackburn, Jr.
1999 The Evolution of Chemical Epidemiology.
1983 Sexually Transmitted Diseases — Past, Present, and Philip J. Landrigan
Future.
King K. Holmes 2000 Does Chlamydia pneumoniae Cause Atherosclerotic
Cardiovascular Disease? Evaluating the Role of
1984 Poliomyelitis Immunization — Past and Future. Infectious Agents in Chronic Diseases.
Jonas E. Salk Walter E. Stamm
1985 An Epidemiologist’s View of Postmenopausal 2001 Halfway Through a Century of Excellence.

Estrogen Use, or What to Tell Your Mother. J. Donald Millar
Elizabeth Barrett-Connor
2002 Public Health Response to Terrorism: Rising 1968 Salmonellosis from Chicken Prepared
to the Challenge. in Commercial Rotisseries: Report of an Outbreak.
Marcelle Layton Am J Epidemiol 1969;90:429–37.
S.B. Werner, J. Allard, E.A. Ager
2003 Alex Langmuir’s Somewhat Quiet Legacy:
Epidemiology, Sexual Health, and Personal 1969 Outbreak of Tick-Borne Relapsing Fever in Spokane
Choices. Willard (Ward) Cates, Jr. County, Washington. JAMA 1969;210:1045–50.
R.S. Thompson, W. Burgdorfer, R. Russell, B.J. Francis
2004 HIV, Epidemiology, and the CDC.
James W. Curran 1970 Tularemia Epidemic: Vermont, 1968 — Forty-Seven
Cases Linked to Contact with Muskrats. N Engl J
2005 Killin’ Time: Alcohol and Injury. Med 1969;280:1253–60.
Alexander C. Wagenaar L.S. Young, D.S. Bicknell, B.G. Archer, et al.
2006 Measuring Malaria. 1971 Tomato Juice-Associated Gastroenteritis,
Brian Greenwood Washington and Oregon, 1969. Am J Epidemiol
1972;96:219–26.
2007 Implications of Tuberculosis Control on Evidence-
W.H. Barker Jr., V. Runte
Based Public Health Practice.
Thomas R. Frieden 1972 Salmonella Septicemia from Platelet Transfusions:
Study of an Outbreak Traced to a Hematogenous
2008 Physical Activity and Public Health: Does the
Carrier of Salmonella Choleraesuis. Ann Intern Med
Environment Matter?
1973;78:633–41.
Ross C. Brownson
F.S. Rhame, R.K. Root, J.D. MacLowry,
2009 Epidemiology, Public Health, and Public Policy. T.A. Dadisman, J.V. Bennett
Jim Marks
1973 Outbreak of Typhoid Fever in Trinidad in 1971
2010 Community Health Rankings — Epidemiology Traced to a Commercial Ice Cream Product. Am J
in Action. Epidemiol 1974;100:150–7.
Pat Remington A. Taylor Jr., A. Santiago, A.Gonzales-Cortes,
E.J. Gangarosa
2011 Skirmishes, Battles, and Wars: Tracking Infection
Control Success in the Age of Social Networks. 1974 Oyster-Associated Hepatitis: Failure of Shellfish
Robert A. Weinstein Certification Programs To Prevent Outbreaks.
JAMA 1975;233:1065–8.
2012 Prevention of Teen Pregnancy: What Do We Know? B.L. Portnoy, P.A. Mackowiak, C.T. Caraway,
Where Do We Go? J.A. Walker, T.W. McKinley, C.A. Klein Jr.
Robert Blum
1975 Staphylococcal Food Poisoning Aboard
Alexander D. Langmuir Prize a Commercial Aircraft. Lancet 1975;2:595–9.
M.S. Eisenberg, K. Gaarslev, W. Brown, M. Horwitz,
Manuscripts, 1966–2012 D. Hill
1966 Complications of Smallpox Vaccination: I. National 1976 Nursery Outbreak of Peritonitis
Survey in the United States, 1963. N Engl J Med with Pneumoperitoneum Probably Caused
1967;276:125–32. by Thermometer-Induced Rectal Perforation. Am J
J.M. Neff, J.M. Lane, J.H. Pert, R. Moore, J.D. Millar, Epidemiol 1976;104:632–44.
D.A. Henderson M.A. Horwitz, J.V. Bennett
1967 An Outbreak of Neuromyasthenia 1977 Epidemic Yersinia enterocolitica Infection Due
in a Kentucky Factory — The Possible Role of a to Contaminated Chocolate Milk. N Engl J Med
Brief Exposure to Organic Mercury. Am J Epidemiol 1978;298:76–9.
1967;86:756–64. R.E. Black, R.J. Jackson, T. Tsai, et al.
G. Miller, R. Chamberlin, W.M. McCormack
1978 Measles Vaccine Efficacy in Children Previously 1985 The Use and Efficacy of Child-Restraint Devices:
Vaccinated at 12 Months of Age. Pediatrics The Tennessee Experience, 1982 and 1983. JAMA
1978;62:955–60. 1984;252:2571–5.
J.S. Marks, T.J. Halpin, W.A. Orenstein M.D. Decker, M.J. Dewey, R.H. Hutcheson Jr.,
W.S. Schaffner
1979 An Outbreak of Legionnaires’ Disease Associated
with a Contaminated Air-Conditioning Cooling 1986 The Role of Parvovirus B19 in Aplastic Crisis and
Tower. N Engl J Med 1980;302:365–70. Erythema Infectiosum (Fifth Disease). J Infect Dis
T.J. Dondero, Jr., R.C. Rendtorff, G.F. Mallison, 1986;154:383–93.
et al. T.L. Chorba, P. Coccia, R.C. Holman, et al.
and 1987 Oral Contraceptives and Cervical Cancer Risk
Risk of Vascular Disease in Women: Smoking, Oral in Costa Rica: Detection Bias or Causal Association?
Contraceptives, Noncontraceptive Estrogens, and JAMA 1988;259:59–64.
Other Factors. JAMA 1979;242:1150–4. K.L. Irwin, L. Rosero-Bixby, M.W. Oberle, et al.
D.B. Petitti, J.Wingerd, J. Pellegrin, et al.
1988 A Day-Care-Based Case-Control Efficacy Study
1980 Injuries from the Wichita Falls Tornado: of Haemophilus influenzae B Polysaccharide
Implications for Prevention. Science 1980;207: Vaccine. JAMA 1988;260:1413–8.
734–8. L.H. Harrison, C. Broome, A.W. Hightower, et al.
R.I. Glass, R.B. Craven, D.J. Bregman, et al.
1989 Group A Meningococcal Carriage in Travelers
1981 Respiratory Irritation Due to Carpet Shampoo: Two Returning from Saudi Arabia. JAMA 1988;260:
Outbreaks. Environ Int 1982;8:337–41. 2686–9.
K. Kreiss, M.G. Gonzalez, K.L. Conright, A.R. Scheere P.S. Moore, L.H. Harrison, E.E. Telzak, G.W. Ajello,
C.V. Broome
and
and
Toxic-Shock Syndrome in Menstruating Women:
Association with Tampon Use and Staphylococcus Transmission of Plasmodium vivax Malaria in San
aureus and Clinical Features in 52 Cases. N Engl J Diego County, California, 1986. Am J Trop Med
Med 1980;303:1436–42. Hyg 1990;42:3–9.
K.N. Shands, G.P. Schmid, B.B. Dan, et al. Y.A. Maldonado, B.L. Nahlen, R.R. Roberta, et al.
1982 Risk Factors for Heatstroke: A Case-Control Study. 1990 An Outbreak of Surgical Wound Infections Due to
JAMA 1982;247:3332–6. Group A Streptococcus Carried on the Scalp. N Engl
E.M. Kilbourne, K. Choi, T.S. Jones, S.B. Thacker J Med 1990;323:968–72.
T.D. Mastro, T.A. Farley, J.A. Elliott, et al.
1983 Epidemic Listeriosis C — Evidence
for Transmission by Food. N Engl J Med 1991 An Investigation of the Cause of the Eosinophilia-
1983;308:203–6. Myalgia Syndrome Associated with Tryptophan Use.
W.F. Schlech III, P.M. Lavigne, R.A. Bortolussi, N Engl J Med 1990;323:357–65.
et al. E.A. Belongia, C.W. Hedberg, G.J. Gleich, et al.
1984 Unexplained Deaths in a Children’s Hospital: 1992 An Outbreak of Multidrug-Resistant Tuberculosis

An Epidemiologic Assessment. N Engl J Med Among Hospitalized Patients with the Acquired
1985;313:211–6. Immunodeficiency Syndrome. N Engl J Med
J.W. Buehler, L.F. Smith, E.M. Wallace, C.W. Heath, 1992;326:1514–21.
R. Kusiak, J.L. Herndon B.R. Edlin, J.I. Tokars, M.H. Grieco, et al.
and 1993 Comparison of Prevention Strategies for Neonatal

Group B Streptococcal Infection: A Population-
Medication Errors with Inhalant Epinephrine
Based Economic Analysis. JAMA 1993;270:
Mimicking an Epidemic of Neonatal Sepsis.
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N Engl J Med 1984;310:166–70.
J.C. Mohle-Boetani, A. Schuchat, B.D. Plikaytis,
S.L. Solomon, E.M. Wallace, E.L. Ford-Jones, et al.
J.D. Smith, C.V. Broome
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Retrospective Study of the Impact of Lead-Based 2001 Salmonella Typhimurium Infections Transmitted
Hazard Remediation on Children’s Blood Lead by Chlorine-Pretreated Clover Sprout Seeds. Am J
Levels in St. Louis, Missouri. Am J Epidemiol Epidemiol 2001;154:1020–8.
1994;139:1016–26. J.T. Brooks, S. Rowe, P. Shillam, et al.
C. Staes, T. Matte, C.B. Copley, D. Flanders,
S. Binder 2002 Serratia liquefaciens Bloodstream Infections
from Contamination of Epoetin Alfa at a
1994 A Massive Outbreak in Milwaukee Hemodialysis Center. N Engl J Med 2001;344:
of Cryptosporidium Infection Transmitted 1491–7.
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1994;331:161–7.
W.R. Mac Kenzie, N.J. Hoxie, M.E. Proctor, et al. 2003 Transmission of West Nile Virus from an Organ
Donor to Four Transplant Recipients. N Engl J Med
1995 A Multistate Outbreak of Escherichia coli 0157:H7- 2003;348:2196–203.
Associated Bloody Diarrhea and Hemolytic Uremic M. Iwamoto, D.B. Jernigan, A. Guasch, et al., and
Syndrome from Hamburgers: The Washington the West Nile Virus in Transplant Recipients
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Infections Associated with Consumption 349:435–45.
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2006 Case-Control Study of an Acute Aflatoxicosis
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2007 Methamphetamine Use Is Independently Associated
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1998 Suicide After Natural Disasters. N Engl J Med Pregnancy. J Sch Health 2008; 78:641–8.
1998;338:373–8. L.B. Zapata, S.D. Hillis, P.M. Marchbanks,
E.G. Krug, M. Kresnow, J.P. Peddicord, et al. K.M. Curtis, R. Lowry
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— The First Year’s Experience. N Engl J Med Followed-by-Suicide Incidents: National Violent
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A.E. Chin, K. Hedberg, G.K. Higginson, 2005. Am J Epidemiol 2008;168:1056–64.
D.W. Fleming J. Logan, H.A. Hill, A.E. Crosby, D.L. Karch,
J.D. Barnes, K.M. Lubell
2000 Infantile Hypertrophic Pyloric Stenosis
After Pertussis Prophylaxis with Erythromycin: A 2009 Epidemiologic Investigation of Immune-Mediated
Case Review and Cohort Study. Lancet 1999;354: Polyradiculoneuropathy Among Abattoir Workers
2101–5. Exposed to Porcine Brain. PLoS ONE 2009;5:e9782.
M.A. Honein, L.J. Paulozzi, I.M. Himelright, et al. S.M. Holzbauer, A.S. DeVries, J.J. Sejvar, et al.
2010 Increasing Compliance with Mass Drug Distinguished Friend of EIS

Administration Programs for Lymphatic Filariasis in
Orissa, India, 2009 — Impact of an Education and a Awards, 1984–2012
Lymphedema Management Program.
1984 J. Virgil Peavy
PLoS Negl Trop Dis 2010; 4:e728.
1985 Bill Schaffner
P.T. Cantey, J. Rout, G. Rao, J. Williamson, L. M. Fox
1986 Mary Moreman
2011 Effect of Rotavirus Vaccine on Healthcare 1987 James Chin
Utilization for Diarrhea in US Children. N E 1988 Frances H. Porcher
J Med 2011;365;12:1108–17. 1989 Not Awarded
J. Cortes, A. Curns, et al. 1990 J. Lyle Conrad
1991 Alexander D. Langmuir
2012 Multistate Outbreak of Escherichia coli O157:H7 1992 Laurence R. Foster
Infections Associated with In-Store Sampling of a 1993 Kenneth L. Herrmann and William Roper
Raw-Milk Gouda Cheese, 2010 1994 Louise McFarland
J. McCollum, N. Williams, S.W. Beam, et al. 1995 Mike Osterholm
1996 Jim Curran and Larry Schonberger
Philip S. Brachman Awards, 1997 Patsy Bellamy
1998 John Horan
1983–2012 1999 Not Awarded
1983 Philip Brachman 2000 James Hadler
1984 Michael Gregg 2001 Barbara R. Holloway and William R. Jarvis
1985 Howard Ory 2002 Patricia Fleming and Stephen B. Thacker
1986 J. Lyle Conrad 2003 Paul Blake
1987 Andrew G. Dean 2004 David Sencer
1988 Richard C. Dicker 2005 Not Awarded
1989 Carl W. Tyler, Jr. 2006 Robert V. Tauxe and Kashef Ijaz
1990 Richard C. Dicker 2007 Dixie Snider
1991 Richard C. Dicker 2008 Denise Koo
1992 Jeffrey J. Sacks 2009 Arjun Srinivasan
1993 J. Lyle Conrad and Michael Toole 2010 Robert Quick
1994 Willard (Ward) Cates and Robert Breiman 2011 Thomas Peterman
1995 John Horan 2012 Jeffrey P. Davis
1996 Polly Marchbanks
1997 William Mac Kenzie Iain C. Hardy Awards, 1996–2012
1998 Laura A. Coker
1999 Christine Zahniser 1996 Peter Strebel
2000 Jeffrey J. Sacks 1997 D. Rebeca Prevots
2001 Douglas H. Hamilton 1998 Beth P. Bell
2002 Marcelle Layton, Steve Weirsma, James L. Hadler, 1999 Chares R. Vitek
Eddy Bresnitz, Elizabeth Barrett, Robert B. Stroube, 2000 Linda Quick and Nancy Rosenstein
Ross J. Brechner, David S.B. Blythe, Larry Siegel, 2001 Orin S. Levine
Karyn Berry, Sherri Adams, John Eisold, and 2002 Umesh D. Parashar
Greg Martin 2003 Karen A. Hennessey
2003 Deborah W. Gould 2004 Tim Uyeki and Montse Soriano-Gabarro
2004 Jim Alexander 2005 Julie Jacobson-Bell
2005 Julie Magri 2006 Gustavo Dayan
2006 Ralph Henderson 2007 Brendan Flannery
2007 Joshua Mott and Peter Cegielski 2008 Mona Marin
2008 Lisa Pealer 2009 Amanda Cohn and Rosalyn O’Laughlin
2009 C. Kay Smith and Julie Magri 2010 Amy A. Parker Fiebelkorn
2010 Betsy Gunnels 2011 Jacqueline E. Tate
2011 William Schaffner 2012 Preeta Kutty
2012 Rachel N. Avchen
J. Virgil Peavy Memorial Awards, 1996 International Outbreak of Salmonella Infections

Caused by Alfalfa Sprouts Grown
2003–2012 from Contaminated Seed
Barbara E. Mahon
2003 Danice Eaton
2004 Lori A. Pollack and
2005 Andrea Sharma Malassezia pachydermatis Fungemia in Neonatal
2006 Andrea Sharma Intensive Care Unit Patients: There’s a [New] Fungus
2007 Abhijeet Anand and David Lowrance Among Us!
2008 Katherine Ellingson Huan Justina Chang
2009 Michael L. Jackson
2010 Erin Murray 1997 Epidemic of Deaths from Acute Renal Failure
2011 Matthew Willis Among Children in Haiti
2012 Noha H. Farag Katherine L. O’Brien
Donald C. Mackel Memorial 1998 And Weighing in at 25 Million Pounds — A

Multistate Outbreak of Escherichia coli 0157:H7
Awards, 1987–2012 Infections and the Largest Ground Beef Recall
in United States History
1987 Fatal Parathion Poisoning — Sierra Leone M. Kathleen Glynn
Ruth A. Etzel
1999 Clinical Mismanagement of Community Outbreak?
1988 Multistate Outbreak of Legionnaires Disease The Contribution of DNA Finger-Printing to the
Involving Tours to Vermont Analysis of Chronic, Drug-Resistant Tuberculosis in
Margaret Mamolen Buenaventura, Colombia, 1998
1989 Nosocomial Outbreak of Legionnaires Disease Kayla F. Laserson
Associated with Shower Use: Possible Role 2000 Serratia liquefaciens Bloodstream Infections
of Amoebae and Pyrogenic Reactions Associated with
Robert F. Breiman Extrinsically Contaminated Erythropoietin —
1990 Legionnaires Disease Outbreak Associated Colorado
with a Grocery Store Mist Machine Lisa Grohskoph
Frank J. Mahoney 2001 When Beauty Is More Than Skin Deep:
1991 Nosocomial Outbreak of Isoniazid- An Outbreak of Rapidly Growing Mycobacterial
and Streptomycin-Resistant Tuberculosis Furunculosis Associated with a Nail Salon —
Among AIDS Patients, New York City California, 2000
Brian R. Edlin Kevin L. Winthrop
1992 Bacillary Angiomatosis, New Infectious Disease: 2002 Dances with Cows?: A Large Outbreak of E. coli
Epidemiology, Clinical Spectrum, and Diagnostics O157 Infections at Multi-Use Community Facility
Janet C. Mohle-Boetani — Lorain County, Ohio, September 2001
Jay K. Varma
1993 Hepatitis B Virus Transmission Associated
with Thoracic Surgery, Los Angeles 2003 Hepatitis C Virus Transmission from an Antibody-
Rafael Harpaz Negative Organ and Tissue Donor
Barna D. Tugwell
1994 Schistosomiasis and Lake Malawi: A New Site
of Transmission Posing a Serious Risk to Expatriates 2004 Multiple Hepatitis A Outbreaks Associated
and Tourists with Green Onions Among Restaurant Patrons —
Martin S. Cetron Tennessee, Georgia, and North Carolina, 2003
Joseph J. Amon
1995 Use of Urinary Antigen Testing To Detect
an Outbreak of Nosocomial Legionnaires Disease in 2005 Case-Control Study of an Acute Aflatoxicosis
Connecticut, 1994 Outbreak
Lisa A. Lepine E Azziz-Baumgatner
2006 Delayed Onset of Pseudomonas fluorescens Group 1991 Diarrheal Outbreak Associated with a
Bloodstream Infections After Exposure Cyanobacteria (Blue-Green Algae)-Like Body,
to Contaminated Heparin Flush — Michigan and Chicago
South Dakota Philip P. Huang
Mark Gershman
1992 Response to One Dose of Inactivated Poliovirus
2007 Epidemiologic and Molecular Investigation Vaccine after Three Doses of Oral Poliovirus
of an Outbreak of Hepatitis C Viral Infection Vaccine, Abidjan, Cote d’Ivoire
at Hemodialysis Unit — Richmond Virginia, 2006 Bernard J. Moriniere
Nicola Thompson
1993 Cholera Outbreak in Rumonge, Burundi
2008 Multistate Measles Outbreak Associated Maureen E. Birmingham
with an International Youth Sporting Event —
Pennsylvania, Michigan, and Texas, August — 1994 Salivary Testing as an Epidemiologic Tool During an
September 2007 Outbreak of Hepatitis A in an Amish Community in
Tai-Ho Chen Indiana
Edmundo Muniz
2009 Cardiac Events and Deaths in a Dialysis Facility
Associated with Healthcare Provider — Texas, 2008 1995 Longitudinal Predictors of Initiation of Smokeless
Melissa K. Schaefer Tobacco Use
Scott L. Tomar
2010 Fatal Case of Laboratory-Acquired Infection
with an Attenuated Yersinia pestis Strain of Plague 1996 Nonvenomous Animal-Related Fatalities
— Illinois, 2009 in the U.S. Workplace, 1992–1994
Andrew Medina-Marino Constance C. Austin
2011 Outbreak of Nosocomial Listeriosis — Texas, 2010. 1997 Multidrug-Resistant Pneumococcal Meningitis
Noha H. Farag in a Day Care Center — Tennessee
Allen Craig
2012 Pyrrolizidine Alkaloid Toxicity as the Cause of
Unknown Liver Disease — Tigray, Ethiopia, 2007– 1998 Beliefs About the Tobacco Industry and Opinions
2011. About Anti-Tobacco Policies: How Tight Is the
Danielle E. Buttke Link?
Arthur E. Chin
Outstanding Poster Presentation
1999 Cold Breakfast Cereal: A New Vehicle Implicated
Award, 1986–2012 in a Multistate Outbreak of Salmonella Agona
Infections
1986 Gender Gap in the Diaper Set: A Closer Look
Thomas Breuer
at Differences in Sex-Specific Mortality
Ray Yip 2000 Hurricane — Puerto Rico, 1998
Dan O’Leary
1987 Socioeconomic Differences in Smoking Behavior in
Selected States 2001 Counting Crows: Crow Mortality as a Sentinel for
Thomas E. Novotny West Nile Virus Disease in Humans — Northeastern
United States, 2000
1988 Late-Stage Diagnosis of Breast Cancer
Kathleen G. Julian
Among Women in Low Socioeconomic Groups,
Connecticut, 1984–1985 2002 Outbreak of Echovirus 18 Meningitis at a Summer
Thomas A. Farley Camp — Alaska, 2001
Joseph B. McLaughlin
1989 Malaria Infection in Early Infancy, Malawi
Laurence Slutsker 2003 Surveillance for Chlamydia in Women — South
Carolina, 1998–2001
1990 Seroprevalence of Human Immunodeficiency Virus
Wayne A. Duffus
Type I Among College Students, United States
Brian R. Edlin
2004 Hospitalizations Associated with Rotavirus Diarrhea 2006 Kevin Cain

— United States, 1996–2000 2007 Avid Reza
Myrna Charles 2008 Sapna Bamrah and David Lowrence
2009 Rinn Song
2005 Risk of Secondary Transmission from Imported 2010 Andrew Auld
Lassa Fever — New Jersey, 2004 2011 W. Roodly Archer
Ester Tan 2012 Sudhir Bunga and Janell A. Routh
2006 Risk Factors for Helicobacter pylori in a Rural
Community — Montana, 2005
Elizabeth Melius
James H. Steele Veterinary
Public Health Award, 1999–2012
2007 Outbreak of Escherichia coli 0157 Associated
with Packaged Spinach — Wisconsin, 2006 1999 Frederick J. Angulo and Jordan W. Tappero
Authur M. Wendel 2000 David Ashford
2001 Mary Kathleen Glynn
2008 The Power of Combining Routine Molecular 2002 Kirk Smith
Subtyping and Specific Food Exposure Interviews 2003 Michael Bunnin
During Escherichia coli O157:H7 Outbreak — 2004 Jennifer McQuiston
Minnesota, 2007 2005 John Crump
S.M. Holzbauer 2006 Katherine Heldman and James Kile
2009 Seroprevalence of Herpes Simplex 2 — National 2007 Jennifer Wright
Health and Nutritional Examination Surveys, 2008 John R. Dunn
United State, 2005–2006 2009 Casey Barton Behravesh and Stacy Holzbauer
Sara E. Forhan 2010 Kendra Stauffer
2011 Matthew Willis
2010 Travelers’ Impressions of 2009 H1N1 Influenza 2012 Barbara Knust
National Health Messaging Campaign
Emily Jentes Mitch Singal Excellence in
2011 Vibrio mimicus Infection After Consumption Occupational and Environmental
of Crayfish — Spokane, Washington, 2010
Meagan K. Kay
Health Award, 2010–2012
2010 Surveillance and Prevention of Occupational Injury
2012 Associations Between Salmonella Serotypes and
Deaths — Wyoming, 2003–2007
Particular Food Commodities — United States,
Paul Anderson
1998–2008.
Brendan R. Jackson 2011 Unprecedented Outbreak of Acute Childhood Lead
Poisoning — Zamfara State, Nigeria, 2010.
Carrie A. Dooyema
Paul C. Schnitker International
2012 Pyrrolizidine Alkaloid Toxicity as the Cause of
Health Award, 1995–2012 Unknown Liver Disease—Tigray, Ethiopia (2007–
1995 Leslie F. Roberts 2011)
1996 Peter Kilmarx Danielle E. Buttke
1997 Alexander K. Rowe and Eric L. Mouzin
1998 Etienne G. Krug
1999 Kayla F. Laserson
2000 John MacArthur and Peter Salama
2001 Valerie D. Garrett
2002 Robert D. Newman and Lorna E. Thorpe
2003 Puneet Dewan, Lisa Nelson, and Pratima
Raghunathan
2004 Tracey Creek
2005 Oleg Bilukha
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39
2013 EIS Conference Abstracts

40 2013 EIS Conference Abstracts
MONDAY, APRIL 22, 2013
Here to serve.
MONDAY
—Stephen B. Thacker
SESSION A: Stephen B. Thacker Opening Session

8:30–10:15 am
Ravinia Ballroom
8:35 Multi-State Outbreak of Fungal Meningitis and Other Infections Associated

with Contaminated Methylprednisolone Acetate
AUTHORS: Anne E. Purfield, R.M. Smith, M. Schaefer, M. Kainer, M. Wise, J. Finks, J. Duwve, E. Fontaine,
A. Chu, B. Carothers, A. Reilly, J. Fiedler, A. Wiese, C. Feaster, L. Gibson, S.E. Griese, A. Cleveland,
K. Benedict, J. Harris, M. Brandt, D. Blau, J. Jernigan, J. Weber, B. Park, the Multistate Fungal Infection
Outbreak Response Team
BACKGROUND: Outbreaks of fungal meningitis following in 23 states were directly contacted. As of December 3, 541
epidural or spinal injection with contaminated product have case-patients were reported from 19 states; 36 (7%) died.
a reported case-fatality rate of >40%. Starting September Of 386 case-patients with data available, 233 (60%) were
21, 2012, we investigated an outbreak of fungal meningitis female, median age was 64 years (range 16–92), and median
among persons injected with compounded incubation was 20 days (range 0–120). Two-hundred-
methylprednisolone acetate (MPA); our aims were to ninety-two (76%) case-patients had headache; 144 (38%)
characterize the scope of the outbreak, and encourage early had back pain. Thirty-three (9%) case-patients had stroke.
infection recognition and treatment. One-hundred-thirteen (21%) case-patients had laboratory
METHODS: A case was defined as meningitis, stroke due evidence of fungal infection; 102 (90%) had Exserohilum
to presumed meningitis, or spinal, paraspinal or peripheral rostratum, which was also identified from unopened
joint infection in a person injected with implicated MPA. MPA vials.
To promote rapid case-finding, notification of all persons CONCLUSION: This outbreak was primarily due
exposed to implicated MPA was recommended by CDC, to contamination of MPA with E. rostratum. Further
and conducted by public health officials or staff at facilities investigation will determine if the lower case-fatality rate
administering MPA. We collected clinical data using observed in this outbreak, compared with previous similar
standardized case report forms and evaluated isolates and outbreaks, was the result of public health actions, including
clinical specimens for fungal presence using PCR, culture, direct patient notification.
and histopathology. KEYWORDS: central nervous system fungal infections,
RESULTS: By October 19, >99% of 13,502 exposed persons disease outbreaks, product recalls and withdrawals.
2013 EIS Conference Abstracts 41
8:55 Recurrence of Dracunculiasis (Guinea Worm Disease) After a 10-Year

Absence — Chad, 2012
AUTHORS: Nandini Sreenivasan, A . Weiss, J . Djiatsa, F . Toe, N . Djimadoumaji, T . Ayers, M . Eberhard,

E . Ruiz-Tiben, S . Roy
MONDAY
BACKGROUND: Dracunculiasis is a parasitic waterborne RESULTS: We enrolled 19 case-patients and 45 controls.
disease causing pain and disability as the worm emerges Only drinking water-related factors were statistically
from the skin. It prevents patients from working or attending significant. Secondary water sources used outside the home
school, causing financial and social burdens. Dracunculiasis were risk factors (mOR: 38.1; 95% confidence interval
is targeted for global eradication; however, a decade after [CI]: 1.8–805.1), particularly lakes or ponds (mOR: 3.6; CI:
interrupting transmission in Chad, 20 cases occurred during 1.1–12.5) and unprotected wells (mOR: 12.7; CI: 1.9–87.5).
2010 and 2011. Responding to a request from the Chad Primary water sources used daily at home were not associated
Ministry of Public Health, CDC conducted an outbreak with dracunculiasis risk. We were unable to identify any water
investigation in May 2012 to identify risk factors and provide sources linking case-patients between years.
recommendations for outbreak response. CONCLUSION: Although the origin of this outbreak
METHODS: We performed a matched case-control remains uncertain, we identified no unusual modes of
study using a standardized questionnaire focusing on transmission. Prevention efforts should focus on public
demographics, drinking water sources, food and beverages, education about potentially contaminated water sources,
and travel. Case-patients were persons with extracted worms with distribution of water filters and implementation of active
during 2010–2011. Controls were persons without a history surveillance in villages with confirmed local transmission.
of dracunculiasis and were matched to case-patients by age, Widespread advertisement of financial rewards for confirmed
sex, and location. We used conditional logistic regression to cases could supplement surveillance in these villages.
calculate matched odds ratios (mOR). KEYWORDS: dracunculiasis, guinea worm disease, Chad,
water, disease outbreaks
9:15 Sick and Retired, Prevalence of Pneumoconiosis Among Retired

Coal Miners — 3 States, 2012
AUTHORS: Cara N. Halldin, A. Wolfe, A. Laney
BACKGROUND: Inhalation of coal mine dust (CMD) can radiographs; 35 (6.6%) had pneumoconiosis. Three-hundred
cause pneumoconiosis, a chronic, occupational lung disease. retired miners performed spirometry; 106 (35.3%) had
In recent years, coal workers’ pneumoconiosis prevalence and abnormal lung function. Of those with pneumoconiosis
severity have increased among working central Appalachian who performed spirometry, 52% (11/21) had abnormal lung
(Kentucky, Virginia, and West Virginia) miners. Historically, function. Pneumoconiosis prevalence did not significantly
retired miners have not been systematically surveyed differ between retired and working miners (6.6% vs. 5.5%
for pneumoconiosis, therefore little is known about this respectively, PR = 0.8, 95% CI: 0.6–1.1, tenure adjusted).
population. We investigated prevalent lung disease among Abnormal spirometry prevalence was significantly elevated
retired coal miners in central Appalachia. among retired miners (35.2% vs. 14.3%, PR = 2.4, CI: 2.0–2.8,
METHODS: From April to September 2012, we offered tenure and smoking adjusted).
retired coal miners, who were notified through community CONCLUSION: Compared to long-tenured working
outreach, chest radiographs and spirometry. Radiographs miners, pneumoconiosis prevalence in retired miners was
and spirometry were classified according to International slightly elevated and lung function abnormality prevalence
Labour Office standards for pneumoconiosis and American was significantly elevated. Pneumoconiosis is a progressive
Thoracic Society lung function interpretative strategies, disease that can develop or be identified after a miner has left
respectively. We calculated prevalence of pneumoconiosis employment. Fully characterizing the scope of CMD-related
and abnormal lung function, comparing retired miners to respiratory morbidity requires ongoing surveillance of both
a 2005–2009 survey of working central Appalachian coal actively working and retired miners.
miners (n = 6,645), using log binomial regression, adjusting KEYWORDS: pneumoconiosis, coal mining, Appalachian
for confounders. region, respiratory surveillance
RESULTS: We evaluated 527 retired miners’ chest
9:35 Hantavirus Outbreak Investigation — Yosemite National Park, 2012
AUTHORS: Jonathan J. Nunez, and the Hantavirus Outbreak Investigation Team: D. Buttke, B. Enge,
C. Fritz, B. Knust, V. Kramer, S. Messenger, M. Novak, L. Osadebe, P. Rollin, D. Vugia, J. Watt, D. Wong
BACKGROUND: Hantavirus pulmonary syndrome (HPS) years (range: 12–56). One had stayed in an area previously
MONDAY
is a severe, frequently fatal, respiratory disease caused by associated with HPS cases. Nine stayed in Curry Village
inhalation of sin nombre virus (SNV) in aerosolized excreta (CV), an area not previously associated with HPS. All nine
from infected deer mice. During June–August, two cases of had stayed in signature tent cabins (STC), which differ from
HPS among Yosemite National Park (YOSE) visitors were regular tent cabins in having an insulated shell. At CV, nine
reported. Because HPS clusters are rare, we investigated the cases among 8,719 STC lodgers were reported, compared
extent and source of disease. with none among 40,288 regular tent cabin lodgers (P
METHODS: Cases were defined as any febrile illness with <0.001). Rodent infestations were common in STC insulated
SNV antibodies or antigens after lodging at YOSE during spaces. Of 185 traps placed at CV during August, 73 (39%)
June 1–August 28. Patients were located through YOSE visitor successfully trapped deer mice; 14% were SNV-seropositive.
notifications and clinician health alerts. We reviewed clinical CONCLUSION: SNV-infected deer mice were present in
data and YOSE lodging records, and interviewed patients. CV. Infestation of insulated spaces likely increased the risk
We compared the number of cases by lodging type by using for hantavirus transmission in STCs, leading to this outbreak.
Fisher’s exact test. We examined lodging facilities for rodent All STCs were closed indefinitely, and multi-faceted rodent
activity and collected mice for SNV serology. exclusion and control measures were implemented.
RESULTS: Among 10 patients identified, nine experienced KEYWORDS: hantavirus, hantavirus pulmonary syndrome,
respiratory illness and three died. Median age was 44.5 deer mice, sin nombre virus
9:55 Serogroup A Meningococcal Conjugate Vaccine Coverage After the First

National Mass Immunization Campaign — Burkina Faso, 2011
AUTHORS: Sarah A. Meyer, I. Medah, D. Yelbeogo, J. Kambou, J. Goodson, B. Flannery, R. Novak, T. Clark,
N. Messonnier, A. Cohn, K. Wannemuehler
BACKGROUND: Serogroup A meningococcal (MenA) SUDAAN to evaluate adjusted Relative Risks (aRR) of
meningitis epidemics are a devastating cause of death predictors for vaccination.
and disability in Sub-Saharan Africa. In December 2010, RESULTS: Among 6,455 households, 23,890 eligible
MenAfriVac™, a new vaccine designed to eliminate MenA persons were surveyed. National coverage was 95.9% (95%
epidemics, was introduced in Burkina Faso through CI: 95.0%–96.7%): 74.3% by vaccination card and 21.6%
mass vaccination. Subsequent surveillance data revealed by recall. Coverage was >90% in all regions, all target age
near-elimination of MenA disease. Accurate vaccination groups (2–5 years, 6–15 years, 16–30 years), and both
coverage estimates are critical for identification of sexes. Multivariate analysis for all ages demonstrated that
undervaccinated subpopulations and measurement of vaccination was associated with a head of household informed
vaccine impact on disease. of the immunization campaign (aRR:1.31; 95% CI:1.19–1.44)
METHODS: A national coverage survey was conducted in and rural household setting (aRR:1.04; 95% CI:1.01–1.07).
December 2011 using stratified multistage cluster sampling. CONCLUSIONS: High MenAfriVac™ coverage was
In the 13 strata (administrative regions), 25 enumeration achieved in all regions and target age groups in Burkina
areas were selected using probability proportional to size. Faso, including hard-to-reach populations. Maintenance
Twenty households per enumeration area were selected after of population immunity through vaccination of new birth
calculation of a sampling interval. Information on household cohorts will be critical for sustained elimination of MenA
characteristics and vaccination status was collected. epidemics in Burkina Faso.
Vaccination coverage estimates and 95% confidence intervals
(CI), adjusted for the complex survey design, were calculated KEYWORDS: serogroup A meningococcal meningitis,
in SAS 9.3. A multivariable analysis was conducted in meningococcal vaccine, mass vaccination, sampling studies,
Burkina Faso
There are three kinds of epidemiologists:

those who can count and those who can’t.
—Author Unknown (adapted by John M. Cowden)
MONDAY
SESSION B: Surveillance
10:45–12:10 pm
Ravinia Ballroom
MODERATORS: Christine Casey and Kathleen Gallagher
10:50 High-Risk Use of Prescription Opioids — Tennessee, 2007–2011
AUTHORS: Jane A.G. Baumblatt, C. Wiedeman, J.R. Dunn, W. Schaffner, L.J. Paulozzi, T.F. Jones
BACKGROUND: During 2003–2010, in Tennessee, drug million (56%) prescriptions, followed by oxycodone with
overdose deaths increased from 422 to 1,059. More of these 7.3 million (20%) prescriptions. Prescriptions dispensed
deaths involved prescription opioids than heroin and cocaine increased steadily from 6.3 million to 8.5 million/year, with
combined. The Tennessee Controlled Substances Monitoring a corresponding rate increase from 108.3/100 to 142.5/100
Program (TNCSMP) was established in 2006 to monitor population/year. Of persons receiving opioid prescriptions
opioid-prescribing patterns. We analyzed the TNCSMP during 2007–2011, provider shoppers increased from 98,222
data to describe the prevalence of high-risk prescribing and (5.5%) to 130,801 (6.4%); pharmacy shoppers increased
dispensing patterns for opioid analgesics. from 34,979 (1.9%) to 51,188 (2.5%); and high-dosage users
METHODS: We used TNCSMP data regarding patient- increased from 30,349 (1.7%) to 56,993 (2.8%). During 2011,
level opioid analgesic prescriptions during 2007–2011. provider shoppers received 2.1 million prescriptions and 30%
We defined provider shoppers as patients who received of total MMEs dispensed. A total of 5,480 patients received
opioid prescriptions from ≥4 providers/year, pharmacy prescriptions from ≥10 providers and 440 received >1000
shoppers as those who used ≥4 pharmacies/year to fill opioid MMEs/day.
prescriptions, and high-dosage users as those who received CONCLUSIONS: High-risk use of opioids is frequent and
the equivalent of >36,500 mg morphine per year, averaging increasing in Tennessee. TNCSMP data can be an effective
>100 mg morphine equivalents (MMEs)/day. tool for educating medical providers, developing targeted
RESULTS: During 2007–2011, approximately 5.2 preventive interventions, and establishing public health
million Tennesseans received a total of 37.1 million opioid policy.
prescriptions. Of 37.1 million opioid prescriptions dispensed, KEYWORDS: analgesics, opioid; drug prescriptions;
hydrocodone was the most prescribed opioid, with 20.9 epidemiology
11:10 BioSense Chief Complaint-Based Syndromic Data as a Near Real-Time

Indicator of Norovirus Disease Activity — United States, 2007–2010
AUTHORS: Brian S . Rha, S . Burrer, S . Park, U . Parashar, B . Lopman
BACKGROUND: Noroviruses are the leading cause of RESULTS: During the 40-month period, the six states
MONDAY
sporadic and epidemic gastroenteritis in the United States reported 277,433 Diarrhea and 1,165,414 N/V visits, 1,048
(US). Timely monitoring of norovirus activity can rapidly norovirus outbreaks, and 32,455 rotavirus antigen tests (13%
identify norovirus season onset and elevated levels of activity, positive). The proportion of visits due to Diarrhea or N/V
thereby improving prevention and control efforts. We assessed both had strong linear relationships with norovirus outbreaks
whether BioSense, a national-level, near real-time, electronic in each age group (P <0.001), with stronger correlations for
surveillance system that maps emergency department visit Diarrhea (r correlation coefficient: 0.826–0.903) than N/V (r:
data (ICD-9-CM codes and chief complaint text) to 78 sub- 0.552–0.828) for each age group. The proportion of positive
syndromes, can monitor norovirus activity. rotavirus tests significantly improved the Diarrhea model in
METHODS: BioSense chief complaints for “Diarrhea” or the 0–4 year group (P <0.0001).
“Nausea and Vomiting” (N/V) as a monthly proportion of CONCLUSIONS: BioSense Diarrhea chief complaint
all visits were compared with reported norovirus outbreaks syndromic data correlated strongly with reported norovirus
from January 2007 to April 2010. Linear regression models outbreaks, and could provide a near real-time indicator of US
were fitted separately for five age groups (0–4, 5–17, 18–64, norovirus disease activity.
≥65 years, and all ages). For the 0–4 year group, laboratory- KEYWORDS: norovirus, biosurveillance, outbreaks,
reported test data for rotavirus, a major cause of gastroenteritis gastroenteritis, rotavirus
in this age group, were also modeled. We restricted analysis
to six states with uninterrupted (1) BioSense, (2) norovirus
outbreak, and (3) rotavirus antigen test data (≥120 tests/year).
11:30 Communicable Disease Surveillance in New York City Evacuation Shelters

After Hurricane Sandy — November 2012
AUTHORS: Alison D . Ridpath, B . Bregman, L . Jones, V . Reddy, H . Waechter, S . Balter
BACKGROUND: After Hurricane Sandy occurred on RESULTS: Implementation challenges included evacuees’
October 29, 2012, >8,000 New York City (NYC) residents continual movement as shelters closed and consolidated and
required temporary shelter. Six days later, the NYC high turnover of shelter medical staff. The initial telephone
Department of Health and Mental Hygiene (DOHMH) system was unsuccessful, because shelter medical rooms did
learned of 12 persons with gastrointestinal illness at one not have telephones or regular staff and some had no method
shelter. Concern for spread of communicable diseases in for documenting visits; only 75% of sites reported. Under the
congregate settings prompted DOHMH to develop a disease- revised system, completeness of daily reporting increased to
monitoring system in shelters. We describe implementation 100%, and DOHMH received reports of 36 gastrointestinal
of this surveillance system and the data collected. illness cases, one case of fever, and 25 emergency department
METHODS: On November 5, DOHMH began daily calls transfers. Three additional clusters were investigated: rash,
to the 12 shelters for census and number of ill evacuees. conjunctivitis, and gastrointestinal illness. By November 19,
Beginning November 8, a new system was established; all shelters were closed and surveillance ended.
shelter medical staff recorded demographic and symptom CONCLUSIONS: Establishing effective surveillance in
information for patients with gastrointestinal illness, fever, or temporary shelters is challenging and required in-person visits
emergency department transfer on logs that were collected by DOHMH staff to ensure completeness of daily reporting.
daily by visiting DOHMH staff. Shelters were instructed to After establishment, surveillance data were effectively used to
call DOHMH immediately if three or more patients had identify clusters.
similar symptoms. KEYWORDS: cyclonic storms; sentinel surveillance; New
York City; communicable diseases
11:50 Burden of Encephalitis-Associated Hospitalizations — United States,

1998–2010
AUTHORS: Neil M . Vora, R . Holman, J . Mehal, S . Recuenco, J . Blanton
BACKGROUND: Encephalitis is an inflammatory process RESULTS: An estimated 263,352 (SE: + 3017) encephalitis–
MONDAY
of the brain associated with neurologic dysfunction. Illness is associated hospitalizations occurred in the United States
generally severe and often requires hospitalization. Improving during 1998 through 2010. A fatal outcome occurred in
our understanding of the epidemiology of encephalitis could 5.8% (95% CI: 5.5%–6.0%) of all encephalitis–associated
complement clinical management and inform public health hospitalizations and in 10.1% (95% CI: 9.2%–11.2%) and
interventions. We analyzed hospital discharge data to evaluate 17.1% (95% CI: 14.3%–20.4%) of encephalitis–associated
the burden of encephalitis in the United States. hospitalizations in which codes for HIV and tissue/organ
METHODS: Encephalitis–associated hospitalizations during transplant were listed, respectively. The proportion of
1998 through 2010 were analyzed retrospectively using the encephalitis–associated hospitalizations with a known
Nationwide Inpatient Sample, a nationally representative encephalitis cause and those for which the cause was
sample of hospitalizations. An encephalitis–associated unexplained were similar: 50.3% (95% CI: 49.3%–51.2%) and
hospitalization was defined as a hospital discharge record 50.3% (95% CI: 49.4%–51.3%), respectively.
with an International Classification of Diseases, 9th Revision, CONCLUSIONS: Encephalitis is a major public health
Clinical Modification code for encephalitis listed among the concern in the United States and should be monitored.
top 15 diagnoses. Using the Healthcare Cost and Utilization Some of the unexplained encephalitides may be due to novel
Project weighting methodology, robust national estimates of infectious and noninfectious etiologies.
the number of encephalitis–associated hospitalizations were KEYWORDS: encephalitis, hospitalization, United States
calculated. SUDAAN software was used to generate standard
errors (SEs) and 95% confidence intervals (CIs). Etiology
and outcome of encephalitis–associated hospitalizations
were examined.
Variety is the spice of life.

—William Cowper
MONDAY

12:30–1:30 pm
Poster 1.1 Outpatient Antiviral Therapy for Influenza in Three Healthcare Systems —
United States, 2011–2012
AUTHORS: Fiona P. Havers, S. Thaker, M. Thompson, A. Fry
BACKGROUND: Influenza causes >200,000 U.S. aged <2 or ≥65 years (n = 551) or with ≥1 chronic medical
hospitalizations annually; persons with chronic medical condition (n = 980). Of those, 29 (2.1%) were prescribed
conditions and those at the extremes of age are at increased antiviral medication; the proportion did not differ among
risk of hospitalization. Early antiviral treatment (≤2 days those without high-risk conditions (50/2113 (2.4%); P =
since illness onset) of influenza reduces the probability of 0.67). Most treated patients (65%) presented to clinic ≤2
hospitalization and is recommended for those with suspected days since illness onset. Four hundred and nineteen (31%)
influenza who are at higher risk for influenza complications. persons with high-risk conditions presented to clinic ≤2 days
We sought to describe outpatient antiviral prescription since illness onset, among whom 14 (3.3%) were prescribed
practices and physician compliance with current guidance. antiviral medication.
METHODS: We analyzed data from three sites participating CONCLUSION: Antiviral treatment was prescribed
in the US Flu Vaccine Effectiveness Network Study during the infrequently among outpatients for whom therapy is
2011–2012 influenza season. Subjects were aged ≥6 months recommended. Efforts to understand the reasons clinicians
and presented to their outpatient provider for an acute do not use antiviral treatment and to better communicate
respiratory illness of ≤7 days duration with fever or cough. the benefits are needed. During the influenza season, high-
Medical history and prescription information was collected risk persons should be encouraged to contact healthcare
by self-report and confirmed with medical record extraction. providers early after symptoms begin.
RESULTS: Of 3,465 enrolled outpatients, 1,352 (39%) were KEYWORDS: influenza, antiviral agents, oseltamivir,
at higher risk for influenza complications, including those outpatients
Poster 1.2 Seroprevalence of Measles and Rubella Antibodies in Pregnant Women —

Haiti, 2012
AUTHORS: David L. Fitter, R. Anselme, B. Flannery, R. Tohme, B. Marston, G. Paluku, G. Rey, M. Griswold,
J. Boncy, J. Tappero, J. Vertefeuille
MONDAY
BACKGROUND: Haiti set a goal to eliminate measles RESULTS: Overall, 696 (94.1%) of 740 sera were seropositive
and rubella (MR), as well as congenital rubella syndrome and 20 (2.7%) were indeterminate for measles IgG; of these
(CRS). A 2007–2008 nationwide MR vaccination campaign 716 (96.8%) sera had evidence of measles immunity. For
reached only 79% of the target population. To assess whether rubella IgG, 691 (93.4%) sera were seropositive and 1 (0.1%)
population immunity was enough to support elimination, we was indeterminate; of these 687 (92.8%) had evidence of
conducted a serosurvey. rubella immunity. Measles seropositivity varied across age
METHODS: We systematically selected 740 serum strata (P = 0.0056); seropositivity increased from 88.6%
specimens from pregnant women enrolled in a 2012 among 15–19 year olds to 98.4% among 30–39 year olds
antenatal HIV sentinel serosurvey across four age strata: (Cochran-Armitage trend test = 0.0006). There were no
15–19, 20–24, 25–29 and 30–39 years. Sera were tested for statistical differences in rubella seropositivity across age
MR immunoglobulin G antibodies (IgG) using commercial strata or measles seropositivity in urban versus rural areas.
enzyme-linked immunosorbent assays. We classified sera as CONCLUSION: Despite previous low vaccination coverage,
seropositive, seronegative or indeterminate per manufacturer’s results from this serosurvey indicate high levels of MR
instructions, and analyzed seroprevalence according to age immunity in pregnant women, and contribute to the evidence
strata, and rural or urban residence. We assessed immunity for MR and CRS elimination from Haiti.
by estimating antibody concentrations (in international units KEYWORDS: measles, rubella, seroprevalence, vaccine,
per milliliter, or IU/mL) for seropositive and indeterminate IgG antibody
sera. Measles IgG concentrations >0.12 IU/mL and rubella
IgG concentrations >10 IU/mL were considered evidence of
immunity.
Poster 1.3 Increasing Number and Disproportionate Morbidity and Mortality

Associated with Multistate Foodborne Disease Outbreaks —
AUTHORS: Von D. Nguyen, S. Bennett, E. Mungai, L. Gieraltowski, L. Gould
BACKGROUND: Approximately 1,000 foodborne disease first five years of the surveillance period to 16.8/year in the
outbreaks are reported in the United States each year. most recent five years. Most multistate outbreaks were caused
Multistate outbreaks are a particularly important source of by Salmonella (49%) and Shiga toxin-producing E. coli
information about foods contaminated during production (STEC, 26%). Among 96 Salmonella outbreaks with a food
and then distributed widely, resulting in broadly dispersed reported, most were attributed to fruits/nuts (24%), vine or
illnesses. We analyzed the trends and characteristics of stalk vegetables (20%), and sprouts (17%). Among 57 STEC
multistate foodborne disease outbreaks. outbreaks, most were attributed to beef (56%) and leafy green
METHODS: We reviewed outbreaks detected and reported vegetables (23%).
to CDC’s Foodborne Disease Outbreak Surveillance System CONCLUSIONS: From 1973–2010, reported multistate
from 1973–2010. Multistate outbreaks were defined as ≥2 outbreaks accounted for an increasing number of foodborne
persons who developed illness after exposure to a common disease outbreaks and contributed a disproportionate share
food in multiple states. Analyses examined the number of of outbreak-associated morbidity and mortality. Knowing the
illnesses, hospitalizations, deaths, implicated foods, and implicated foods and pathogens can help to identify important
etiologic agents. sources of contamination and inform the interventions of
RESULTS: From 1973–2010, multistate foodborne disease regulatory agencies and industry to improve the safety of our
outbreaks accounted for 234 (0.8%) of 27,989 total outbreaks food supply.
and resulted in 3% of all outbreak-associated illnesses, 10% of KEYWORDS: disease outbreak, foodborne diseases, food,
hospitalizations, and 16% of deaths. The number of multistate Salmonella, Escherichia coli
outbreaks increased from an average of 3.4/year during the
Poster 1.4 No Bones About It: Human Salmonella Infantis Infections Linked
to Dry Dog Food — United States and Canada, 2012
AUTHORS: Maho Imanishi, C. Schwensohn, D. Rotstein, K. Arends, A. Hunt, L. Denny, M. Achen, J. Cui,
J. Tataryn, D. Woody, R. Reimschuessel, C. Barton Behravesh
MONDAY
BACKGROUND: Salmonella infections linked to animal Seventy-six percent (28/37) reported dog contact; of 21 case-
contact cause ~130,000 illnesses annually in the United States. patients who remembered the dog food brand, 57% reported
Forty-six million (35%) U.S. households own a dog and many a brand produced at Plant X. The outbreak strain was isolated
feed dry dog food. In April 2012, Salmonella Infantis (SI) from opened and unopened bags of dog food produced at
was detected in an unopened bag of Company X dry dog Plant X, and fecal specimens from dogs that ate Company X
food collected during routine retail surveillance. PulseNet, dog food. Company X recalled >30,000 tons of dry dog and
a national bacterial subtyping network, identified recent cat food produced at Plant X. We identified 37 dog illnesses
human infections of SI with the same genetic fingerprint involving recalled products.
found in the dog food sample (outbreak strain). CONCLUSIONS: One health collaboration on
METHODS: A case was defined as illness in a person epidemiologic, laboratory, and traceback investigations
infected with the outbreak strain of SI occurring between linked dry dog foods produced at Plant X to human and
01/01/12¬–06/30/12. We collected information on exposures dog illnesses. More efforts are needed to increase awareness
including pet foods from case-patients, and cultured animal, among pet owners, healthcare professionals, and the pet food
pet food, and environmental specimens for Salmonella. We industry on risk of illness associated with dry pet food and
conducted traceback investigations, and monitored FDA’s treats.
consumer complaint system for animal illnesses. KEYWORDS: dog, food, outbreaks, pets, salmonellosis,
RESULTS: We identified 52 cases in 21 states and Canada; zoonoses
37% were children aged ≤2 years; 32% were hospitalized.
Poster 1.5 Are You Prepared? Visitor Trip Planning and Safety Information Gathering
at Zion National Park — Utah, 2012
AUTHORS: Erin M. Parker, M.G. Johnson, S. Tarrant, M. Ballesteros, J. Gilchrist, S. Newman, T. Tomlinson,
C. Purcell
BACKGROUND: Injury is the leading cause of death among to plan and 80% of those used the Zion website. Forty-three
Americans aged 1 to 44. Each year approximately 6,000 percent sought out safety information prior to visiting, and
visitors are seriously injured in US National Parks. From 48% sought out safety information at the park. However, 89%
2006–2010, Zion National Park had 13 million visitors and reported exposure to safety information from at least one
responded to 581 injuries, including 15 fatalities, with falls the source at Zion, most commonly the visitor center (60%), park
primary cause. In an effort to improve safety communication rangers (31%), and shuttle stops (28%). The most frequently
to visitors, Zion and the National Park Service invited CDC to recalled in-park safety messages were related to flash flooding,
conduct a survey on how visitors plan their trips and obtain feeding wildlife, and drinking water — the messages depicted
safety information before and during their visits. on the backs of park shuttles.
METHODS: From June 24–July 12, 2012, CDC fellows CONCLUSIONS: Most visitors preplan and use the park
recruited a convenience sample of 500 park visitors aged website, but fewer than half seek out safety information. Zion
18+ at Zion. Respondents completed a self-administered can increase exposure to safety messages by using the website
questionnaire. Data were entered in Epi-Info™ 7 and more strategically. Zion can also expand the use of key safety
descriptive statistics were generated using SAS® 9.2. messaging on shuttle buses, ubiquitous in the park.
RESULTS: Among respondents, 69% decided to visit KEYWORDS: wounds and injuries, safety, recreation,
Zion at least one month prior, with 85% doing pre-trip communication
information gathering. Eighty-one percent used the internet
Poster 1.6 A Knowledge, Attitudes, and Practices Survey to Inform a Typhoid Fever
Intervention Campaign — Kasese District, Rural Western Uganda, 2012
AUTHORS: Jolene H. Nakao, M. Walters, K. Date, A. Blackstock, A. Mubiru, Y. Baseka, E. Mbidde, J. Lule,
J. Sabiiti, B. Nygren, E. Mintz
MONDAY
BACKGROUND: Typhoid fever (TF) causes >21 million boiling or chlorination was associated with knowledge that
illnesses and 216,000 deaths annually worldwide. In these practices prevent TF (OR: 3.25; 95% CI: 1.37–7.68).
Kasese District, Uganda, a persistent outbreak of TF from Almost all respondents (98%) were willing to receive a free
contaminated water resulted in >2,855 suspected cases since TF vaccination, but indicated that before being vaccinated,
January 2008. To inform safe water and vaccine interventions, they would want to know about the vaccine’s purpose (68%)
we conducted a household-level knowledge, attitudes, and and safety (24%). Respondents preferred to receive health
practices survey in five subcounties with high TF incidence. information through radio (62%), worship sites (40%), and
METHODS: Cluster sampling was used to randomly select village health teams (39%), and wanted local leaders (75%),
up to six households from each of 50 randomly chosen village health teams (36%), health facilities (29%), and
villages. An adult in each household was interviewed about religious leaders (27%) to be involved in a vaccine campaign.
TF, vaccinations, water, sanitation and hygiene using a CONCLUSIONS: An intervention in Kasese should include
standardized questionnaire. We calculated frequencies and information on causes, symptoms, and prevention of TF
odds ratios. disseminated through local leaders, health facilities, religious
RESULTS: Of 244 respondents, 194 (81%) had heard of gatherings, and radio. TF education may increase water
TF; however, many of them could not correctly identify one treatment among Kasese residents. Typhoid vaccination is
cause (31%), symptom (28%), or prevention method (26%). acceptable in Kasese and should be strongly considered.
Twenty-nine percent of respondents reported treating their KEYWORDS: typhoid fever; Salmonella Typhi; Uganda;
drinking water within the preceding month; treatment by vaccination; outbreaks; questionnaires
Poster 1.7 Clam-Associated Vibriosis, United States — 1988–2010
AUTHORS: Rachel B. Slayton, A. Newton, A. DePaola, J. Jones, B. Mahon
BACKGROUND: An estimated 80,000 Vibrio illnesses, clams”) of these cases. Among patients who consumed
500 hospitalizations, and 100 deaths occur annually in the “only clams,” V. parahaemolyticus was the most commonly
United States. In 2007, the Council of State and Territorial reported species (72 reports, 77%), followed by V. vulnificus
Epidemiologists made all Vibrio infections nationally (4 reports, 4%). Illnesses may have been more severe in
notifiable. Infections associated with clam consumption patients who consumed “only clams” than “no clams”; for
have been well documented; however, vibriosis prevention V. parahaemolyticus, hospitalization rates were higher (29%
programs have focused largely on risk reduction strategies v. 19%), and for V. vulnificus, both hospitalization (100% v.
for oysters. 92%) and death (50% v. 41%) rates were higher. Implicated
METHODS: We analyzed infections reported to Cholera clams were usually harvested from the Atlantic and eaten
and Other Vibrio Illness Surveillance (COVIS) from 1988 raw. Among 8 investigations of contributing factors, only
through 2010. We categorized domestically acquired, seafood- a single case of improper storage, temperature, or cross-
associated illnesses by whether the patient consumed “no contamination, was reported.
clams” or “any clams” and defined a subset of patients in the CONCLUSION: Clam-associated infections account
“any clam” category who reported “only clams.” We analyzed for a substantial minority of Vibrio infections and may be
demographic, clinical, and microbiological information and more severe than other Vibrio infections. Comprehensive
summarized clam preparation and harvest information. prevention programs must address the risks associated with
RESULTS: Of 3,079 reports analyzed, 2,312 (75%) had clams as well as oysters.
clam consumption information. Clams were associated KEYWORDS: surveillance, foodborne diseases, Bivalvia,
with at least 3% (“only clams”) and as many as 18% (“any Vibrionaceae
Poster 1.8 Behaviors Among HIV-Positive Ukrainian Street Youth Associated

with a Risk of Bridging HIV-Infection to Non-Street Youth, 2008
AUTHORS: Lina M. Nerlander, L. Zapata, R. Yorick, H. Skipalska, R.M. Smith, D. Kissin, D. Jamieson,
C. Vitek, S. Hillis
MONDAY
BACKGROUND: Among HIV-infected street youth More than 35% of boys, orphaned youth, and those on the
(living part- or full-time on the streets) little is known about streets ≤2 years shared needles. In multivariable analysis,
behaviors associated with HIV-transmission to youth not inconsistent condom use was associated with being female
spending time on the streets (non-street youth). We aimed (adjusted prevalence ratio [aPR]: 1.25, 95% CI: 1.09–1.44),
to determine prevalences and predictors of such “bridging working (aPR: 1.18, 95% CI: 1.03–1.36), multiple partners
behaviors”: inconsistent condom use and needle sharing (aPR: 1.37, 95% CI: 1.19–1.58) and “never” (aPR: 1.35 95%
between HIV-positive street youth and non-street youth. CI: 1.14–1.61) or ‘sometimes’ (1.34 95% CI: 1.02–1.76) versus
METHODS: In 2008, 171 street youth in three Ukrainian “always” sleeping on the street. Needle sharing was associated
cites were identified as HIV-infected after testing of eligible with being male (aPR: 1.41, 95% CI: 1.02–1.95), orphaned
participants ages 15–24 following random selection of (aPR: 2.34, 95% CI: 1.82–3.01), and <2 years on the streets
venues. Using data from these youth, we calculated prevalence (aPR 1.76, 95% CI: 1.49–2.09).
estimates of bridging behaviors with non-street youth and CONCLUSIONS: Bridging behaviors between HIV-
assessed predictors using logistic regression. infected street youth and non-street youth are common.
RESULTS: Two-thirds of HIV-infected street youth Efforts are needed to prevent HIV-transmission into the
exhibited bridging behaviors, including 78.3% of girls and general population, including addressing the needs of street
84.2% of those involved in transactional sex. More than youth.
65% of girls, working youth, and youth who “never” or KEYWORDS: homeless, orphan, Ukraine, HIV, social
“sometimes” slept on the streets used condoms inconsistently. networking, needle sharing, unsafe sex, epidemiology
Poster 1.9 Findings from the Year of Population-Based Active Surveillance

for Legionellosis — United States, 2011
AUTHORS: Kathleen L. Dooling, K. Toews, L. Hicks, L. Garrison, R. Carpenter, G. Giambrone, E.M. Parker,
S. Petit, J. Thompson, R. Najera, R. Mansmann, R. Lynfield, B. White, G. Langley
BACKGROUND: Legionella, a bacterium spread via cases; 78% of patients were >50 years old and 63% were male.
inhalation of bacilli in aerosolized water, can cause severe The age-adjusted incidence was 1.4 cases/100,000 population
pneumonia. According to national passive surveillance, — 1.2 cases/100,000 in whites and 2.3 cases/100,000 in
age-adjusted legionellosis incidence increased from 0.4 to blacks. Hospitalization occurred in 473 (98%) cases, ICU
1.3 cases/100,000 population between 2000 and 2011. We admission in 184 (38%) and death in 46 (10%). Blacks were
present the first year of population-based active surveillance not more likely to die from legionellosis than non-blacks
for legionellosis to assess incidence, disease severity and (odds ratio 0.6, 95% CI 0.3–1.3). Most patients (90%) lived in
opportunities for prevention. the community during disease incubation; 22 (5%) resided in
METHODS: We initiated active legionellosis surveillance healthcare settings.
within the Active Bacterial Core surveillance (ABCs)/ CONCLUSION: Legionellosis incidence was similar in
Emerging Infections Program Network. A confirmed case active and passive surveillance. Active surveillance elucidated
of legionellosis is defined as isolation of Legionella from racial disparities in incidence but not case fatality. Prevention
respiratory culture, detection of Legionella antigen in urine or efforts should ensure implementation of recommended
seroconversion. We analyzed 2011 case information collected measures to prevent legionellosis in healthcare settings
from medical chart reviews. We used 2011 postcensal along with studies to understand risks in the community.
estimates for population denominators and to age-adjust The underlying reasons for increasing incidence and racial
incidence rates. We analyzed unadjusted odds of death by disparity require further investigation.
race. KEYWORDS: pneumonia, legionellosis, racial disparity,
RESULTS: The surveillance population was approximately healthcare-associated infection, active surveillance
36 million people in 10 states. ABCs detected 483 confirmed
Poster 1.10 Human Papillomavirus Vaccination Status and Current Contraception

Choices in Young Women with Previous Sexual Experience: Data
from the 2006–2010 National Survey of Family Growth (NSFG)
AUTHORS: Kenneth B. Quinto, K. Schoendorf, S. Lukacs, L. Akinbami
MONDAY
BACKGROUND: Human papillomavirus (HPV) is the RESULTS: Overall, 29.5% of women used a barrier
most common sexually transmitted infection (STI) in the method, 45.3% hormonal methods, and 25.5% reported no
US. Controversy over HPV vaccination includes possible contraception. There was no difference in barrier method
risky sexual behavior due to perceived protection from STIs, use by vaccination status (adjusted odds ratio [aOR]: 0.96;
though research has not supported this theory. No known 95% confidence interval [CI]: 0.6–1.5 for receipt versus not).
studies show whether vaccine receipt affects contraception Women who received the HPV vaccine had increased odds
choices. of hormonal contraception (aOR: 2.09; 95% CI: 1.6–2.8) and
METHODS: Using 2006–2010 NSFG data, we included 1,629 lower odds of no contraception (aOR: 0.59; 95% CI: 0.4–0.8).
women ages 15–24 years who reported knowing their HPV CONCLUSION: HPV vaccinated young women were
vaccination status and ever having sex, were not currently less likely than unvaccinated women to fail to use any
pregnant or seeking pregnancy, and were not postpartum. contraception, were as likely to use a barrier method, and
We assessed the relationship between HPV vaccination status more likely to use hormonal methods. These results suggest
and current contraceptive choices (non mutually exclusive that women who receive HPV vaccine are as likely to use
categories: barrier, hormonal, none). Separate multivariate protection effective against STIs and more likely to use
models (SUDAAN software) for each contraceptive option effective contraception than women without vaccine receipt.
included race; religion; mother’s education; poverty; health KEYWORDS: HPV vaccines, contraception, safe sex,
insurance; STI counseling, testing, or treatment in the past barrier contraception, contraceptive agents
year; age at first intercourse; and number of lifetime male
partners.
Poster 1.11 Progress in Reducing National Burden of Invasive Methicillin-Resistant

Staphylococcus aureus Infections — United States, 2005–2010
AUTHORS: Raymund B. Dantes, Y. Mu, R. Belflower, D. Aragon, G. Dumyati, L. Harrison, F. Lessa,

R. Lynfield, J. Nadle, S. Petit, S. Ray, W. Schaffner, J. Townes, S. Fridkin
BACKGROUND: Methicillin-resistant Staphylococcus Renal Data System data, adjusting for age, race, gender, and
aureus (MRSA) continues to be one of the most common receipt of chronic dialysis.
antimicrobial-resistant pathogens in community and RESULTS: An estimated 82,042 (95% confidence interval
healthcare settings. We describe national estimates of [CI]: 79,718–84,411) invasive MRSA infections occurred
invasive MRSA infections in 2010 and compare them with nationally in 2010 (compared to 111,345 in 2005); of these,
2005 estimates. 13,799 (95% CI: 12,875–14,789) were CA, 51,290 (95% CI:
METHODS: Population-based surveillance for invasive 49,461–53,197) were HACO, and 15,744 (95% CI: 14,758–
MRSA in 9 metropolitan areas with approximately 19 16,796) were HO. Adjusted national estimated incidence
million persons was performed from 2005 through 2010. A rates have decreased since 2005: CA by 20.3% (18.5–22.1%),
case was defined as MRSA cultured from a normally sterile HACO by 22.7% (21.8–23.6%), and HO by 48.3% (47.4–
body site without MRSA culture in the prior 30 days, and 49.4%, P<0.001 for all comparisons).
further classified as hospital-onset (HO, cultured >3 days CONCLUSION: An estimated 29,300 fewer invasive MRSA
after admission), health care-associated community-onset infections occurred in the United States in 2010 compared
(HACO, cultured ≤3 days after admission and/or either to 2005, with greatest declines in hospital-onset infections.
dialysis, hospitalization, surgery, long-term care residence Effective strategies for preventing infections outside acute
in the prior year, or presence of a central vascular catheter care settings will have the greatest impact on reducing the US
within 2 days prior to MRSA culture), or community- national burden of invasive MRSA infections.
associated (CA) if none of the previous criteria were met.
National estimates were calculated using US Census and US KEYWORDS: methicillin-resistant Staphylococcus aureus,
surveillance
Poster 1.12 Multi-District Marburg Hemorrhagic Fever Outbreak — Uganda, 2012
AUTHORS: Ilana J. Schafer, J.F. Wamala, B. Knust, T. Shoemaker, U. Ströher, S. Balinandi, A. Tumusiime,
A. Gibbons, K. Dodd, S. Campbell, L. Nayakarahuka, S. Nichol, P. Rollin
MONDAY
BACKGROUND: On October 18, 2012, an outbreak of convalescent (RT-PCR negative but antibody positive).
Marburg hemorrhagic fever (MHF) was identified in Kabale Among 27 confirmed and probable cases the case fatality rate
district, Uganda. Caused by Marburg virus (family Filoviridae), was 55.6%. Age range was 8 days70 years (median: 26 years)
MHF outbreaks produce devastating losses, with fatality rates and 17 (63.0%) were female. The most common symptoms
reaching 90%. Retrospective and prospective epidemiologic at presentation included fever (92.6%), appetite loss (77.8%),
and laboratory investigations were immediately launched to vomiting (74.1%), headache (70.4%), and fatigue (70.4%).
expeditiously characterize and control the outbreak. Eleven (40.7%) demonstrated hemorrhagic symptoms, which
METHODS: Case report forms detailing epidemiologic and was significantly associated with fatality (OR: 6.7; P = 0.03).
clinical information were completed for patients meeting The last acute case was isolated 11 days after identification of
the case definition. Blood samples were tested by reverse- the outbreak.
transcription polymerase chain reaction (RT-PCR) and CONCLUSIONS: This was the largest MHF outbreak
antigen, immunoglobulin M, and immunoglobulin G serology. in Uganda’s history, and one of three filovirus outbreaks in
Cases were classified based on combined epidemiologic and Uganda over a four month period. The majority of patients
laboratory data and preliminary descriptive analysis was were female and had non-hemorrhagic and non-specific
performed. symptoms. Case fatality was lower than in previous large
RESULTS: Fifteen laboratory confirmed, 12 probable, MHF outbreaks. Prompt investigation and response efforts
and 11 suspect cases were identified across six districts. quickly controlled the outbreak.
Retrospective case finding traced the outbreak origin to KEYWORDS: Marburg hemorrhagic fever, Filoviridae,
July, 2012. Nine (60.0%) confirmed cases demonstrated infectious disease outbreaks, Uganda
acute infections (RT-PCR positive) and six (40.0%) were
Poster 1.13 National Estimates of Sickle Cell Disease with Pediatric Stroke
Among African-Americans — United States, 1997–2009
AUTHORS: Charlotte Baker, A. Grant
BACKGROUND: Sickle cell disease (SCD) is a known risk RESULTS: During the 13-year period, there were 2809
factor for stroke, an important and potentially preventable stroke diagnoses among 2,428,412 discharges for African-
cause of death, disability, and hospitalization among American children. A SCD diagnosis was present in 21% of
children. A child with SCD has a stroke risk 333 times higher stroke discharges overall, 29% of ischemic stroke discharges,
than a child without SCD or heart disease. The literature is and 8% of hemorrhagic stroke discharges. Most (87%) of the
inconsistent, but more than 20% of children with SCD have stroke and SCD cases were ischemic stroke. SCD was the
a stroke and are subject to repeat strokes. The purpose of most common co-existing diagnosis for African-American
this study is to determine the contribution of SCD to stroke children with ischemic stroke and the 7th most common for
among the African-American pediatric population. hemorrhagic stroke.
METHODS: We used data from the Healthcare Cost and CONCLUSIONS: SCD is a leading risk factor for pediatric
Utilization Project (HCUP) Kids’ Inpatient Database (KID) stroke in African-American children. Reducing the number
1997–2009. African-American patients aged 6 months to of strokes among children with SCD would have a significant
18 years with ≥1 ICD-9-CM discharge diagnosis code for impact on the rate of strokes among African-American
ischemic or hemorrhagic stroke were included. Data were children.
weighted to provide national estimates and analyzed using KEYWORDS: stroke; hemorrhagic; ischemic; hospitaliza-
SAS survey procedures. Medical conditions, including SCD, tion; anemia, sickle cell
known to be risk factors for pediatric stroke were ranked
by the frequency in which they appeared as co-existing
diagnoses, first for all strokes and separately for ischemic and
hemorrhagic stroke.
Poster 1.14 Use of Laboratory Reports as Predictors of West Nile Virus Disease
Cases — Texas, 2008–2012
AUTHORS: Stephanie J. Yendell, J. Taylor, B. Biggerstaff, J. Schuermann, D. Hamaker, L. Tabony,

J. Staples, M. Fischer
MONDAY
BACKGROUND: In 2012, Texas reported >1,750 West Nile reports consistent with recent WNV infection and 2,051
virus (WNV) cases, twice that of any previous year. During cases reported to TxDSHS, 1,759 reports were present in
the outbreak, questions arose about numbers of cases that both systems. The laboratory database sensitivity was 86%
had occurred but were not yet reported. We evaluated WNV (1,759/2,051) and PPV was 76% (1,759/2,329); therefore,
laboratory reports as possible early indicators of WNV disease for every 10 positive laboratory reports, we expect 8.8 (95%
cases. confidence interval: 8.4–9.2) cases to be reported. Most (92%)
METHODS: WNV laboratory results reported to Texas laboratory reports preceded case reports with an average
Department of State Health Services (TxDSHS) through the lead time of 7 days (IQR 3–14). Electronic laboratory reports
National Electronic Disease Surveillance System (NEDSS) provided a longer lead time (median: 8 days; IQR: 4–14)
from January 2008–November 2012 were compared to than manually-entered reports (median: 2 days; IQR: 0–4)
confirmed and probable WNV disease cases reported to (P <0.001).
TxDSHS. We calculated sensitivity and positive predictive CONCLUSION: Appropriately filtered laboratory reports
value (PPV) to estimate the number of cases expected for are useful for estimating numbers of WNV disease cases and
each positive laboratory report. We determined medians and might provide more timely information to plan and assess the
interquartile ranges (IQR) for laboratory report lead times utility of public health interventions.
and compared them using Wilcoxon rank sum test. KEYWORDS: West Nile virus, disease outbreaks, public
RESULTS: Of 8,813 WNV laboratory reports, 5,205 (59%) health surveillance, disease notification, medical informatics,
were IgG antibody tests, 864 (10%) were duplicates, and 415 Texas
(5%) were negative results. Of the remaining 2,329 laboratory
Poster 1 .15 A Spicy Catch: Salmonella Bareilly and Salmonella Nchanga

Infections Associated with a Raw Scraped Ground Tuna Product —
United States, 2012
AUTHORS: W . Thane Hancock, T . DeSalvo, L . Gaul, H . Hanson . D . Schoonmaker-Bopp, J . Vostok,

L . Saathoff-Huber, Q . Phan, E . Luckman, T . DuVernoy, W . Culpepper, K . Blickenstaff, J . Cripe, S . Lance,
C . Bailey, I . Williams, K . Neil, for the Salmonella Bareilly Outbreak Investigation Team
BACKGROUND: Salmonella causes ~1.2 million illnesses FoodNet Population Survey. Of the 43 who reported eating
and 400 fatalities annually in the United States; Salmonella sushi, 36 (84%) consumed an item containing “spicy tuna.”
serotypes Bareilly (SBr) and Nchanga (SNc) are uncommon. Traceback investigations implicated frozen raw scraped
In March 2012, states and CDC began investigating a ground tuna from Company A in India. An outbreak strain
multistate outbreak of SBr infections. In April 2012, a was isolated from 67 (92%) of 73 product samples. Company
SNc outbreak was identified with similar demographic, A’s importer recalled 58,828 pounds of raw tuna. FDA placed
geographic, and exposure characteristics as the SBr outbreak; Company A’s products on Import Alert; another contaminated
the investigations were merged. shipment of tuna was identified and denied entry into United
METHODS: A case was defined as infection with the States commerce.
outbreak strains of SBr or SNc occurring during 01/01/2012– CONCLUSIONS: The investigation implicated raw frozen
07/25/2012. Case-patients were interviewed with hypothesis tuna from India as the source of the outbreak. This is the
generating questionnaires. Traceback and environmental first Salmonella outbreak linked to scraped ground tuna, and
investigations were conducted. the first documented outbreak of SNc in the United States.
RESULTS: We identified 425 cases in 28 states and District The recall and Import Alert likely prevented additional
of Columbia. Fifty-five case-patients were hospitalized; none illnesses. The outbreak demonstrates the global aspect of
died. Forty-three (81%) of 53 case-patients interviewed food production and the increasing reliance on food safety
reported eating sushi versus 5% of healthy persons who systems of other countries.
reported eating “sushi, sashimi or ceviche” in the 2006–2007 KEYWORDS: food poisoning, Salmonella, disease outbreaks
MONDAY
PECIAL SESSION: Dr. James H. Steele 100th Birthday

S
Celebration Luncheon
12:30 pm
Oakwood Room (A, B)
Dr. James H. Steele (Honorary EIS ’75) was an early CDC leader and pioneer in the field of veterinary
public health. The veterinarians and EIS alumni of CDC/ATSDR are hosting a special session immediately
after the CDC Veterinarian’s Lunch. Although Dr. Steele is unable to join us in Atlanta, he will share
remarks through a short video presentation. Colleagues and past students will also make remarks about
special memories and Dr. Steele’s contributions to public health science and practice.
Dr. James H. Steele received his Doctor of Veterinary Medicine degree from Michigan State College
in 1941 and a Master’s of Public Health from Harvard University in 1942. He went on to establish the
veterinary division of the Centers for Disease Control and Prevention (CDC) in 1947. He then boldly
introduced the principles of Veterinary Public Health to the U.S. and countries all around the globe.
His outstanding medical achievements have saved countless human and animal lives and has helped
the world to realize higher standards of living through a better understanding of the epidemiology of
diseases shared by animals and man — the zoonoses. As a U.S. Public Health Service officer, he became the first Assistant
Surgeon General for Veterinary Affairs and later was appointed as Deputy Assistant Secretary for Health & Human Services at
the rank of Admiral (two stars). He has received numerous awards over his illustrious career to include the Surgeon General’s
Medallion in 2006, presented by Suregon General Richard H. Carmona. In 2012, Dr. Steele received the OIE (World Animal
Health Organization) Medal of Merit. Through the years, he has been a brilliant veterinary leader and supporter of the philosophy
of One Health, aspiring to improved quality of life for people and animals around the world. Dr. Steele founded the American
Board of Veterinary Public Health in 1950 which later became the American College of Veterinary Preventive Medicine.
Dr. Steele celebrated his 100th birthday on April 3, 2013.
I don’t know the question, but sex is definitely the answer.

—Woody Allen
MONDAY
SESSION C: Sexually Transmitted Diseases
1:30–2:55 pm
Ravinia Ballroom
MODERATOR: Gail Bolan
1:35 Extragenital Gonorrhea Infection Among Men Who Have Sex with Men —
Sexually Transmitted Disease Surveillance Network, United States,
2010–2012
AUTHORS: Monica E. Patton, S. Kidd, M. Stenger, J. Braxton, L. Asbel, K. Bernstein, M. Eaglin,

M. Jespersen, R. Kerani, C. Mettenbrink, M. Mohamed, P. Pathela, C. Schumacher, A. Stirland, J. Stover,
R. Kirkcaldy, H. Weinstock
BACKGROUND: Gonorrhea is the second most commonly clinics that participate in SSuN. Of these, 19,165 (83.2%)
reported notifiable disease in the United States and is associated had been tested for urogenital gonorrhea, 12,696 (55.1%)
with increased risk of HIV transmission. In particular, for pharyngeal gonorrhea, and 9,658 (41.9%) for rectal
rectal gonorrhea is a risk factor for HIV acquisition among gonorrhea at least once during the past year. Of MSM tested,
men who have sex with men (MSM). Because extragenital 11.5% had at least one positive test result for gonorrhea at the
(pharyngeal or rectal) gonorrhea is often asymptomatic, CDC urethra, 7.6% at the pharynx, and 10.1% at the rectum. Of
recommends that MSM be screened annually for gonorrhea MSM tested at the urethra and an extragenital site, 72% with
at exposed urethral, pharyngeal, and rectal sites. We sought to pharyngeal gonorrhea and 73% with rectal gonorrhea tested
describe extragenital gonorrhea testing and infections among negative for uro-genital gonorrhea and would not have been
MSM attending sexually transmitted disease (STD) clinics. treated if treatment were based on urethral testing alone.
METHODS: The STD Surveillance Network (SSuN) collects CONCLUSIONS: Extragenital gonorrhea is common in
standardized data from all patients attending 42 STD MSM tested at STD clinics, but many MSM are not tested.
clinics in 10 states. We examined records of MSM attending Extragenital testing can detect additional infections and may
these clinics during July 2011–June 2012 and assessed help identify MSM at high risk of acquiring or transmitting
the proportion tested for extragenital gonorrhea and the HIV.
positivity of those tests during the preceding 12 months. KEYWORDS: gonorrhea, sexually transmitted diseases,
RESULTS: During our study period, 23,023 MSM attended STDs, extragenital testing
1:55 Validating Elimination of Mother-to-Child Transmission of HIV and Congenital

Syphilis — Chile, 2012
AUTHORS: Christine E. Ross, K. Hoover, A. San Martin, G. Tao, M. Alonso, R. De Aguila, M. Kamb
BACKGROUND: The Pan American Health Organization LB in 2011 and was stable during 2009–2011. Two of 15
MONDAY
(PAHO) has committed to eliminating mother-to-child regions exceeded the CS target (1.12 and 1.26 cases per 1,000
transmission (MTCT) of HIV and congenital syphilis (CS) LB in 2011); one of these regions had an increasing trend
in Latin America and the Caribbean by 2015. In September (P = 0.014). Pediatric HIV incidence was 0.04 cases per
2012, we piloted a method for validating elimination of 1,000 LB in 2011 and was stable during 2009–2011. The HIV
MTCT of HIV and CS in Chile, a country with an established MTCT rate consistently exceeded the target and was 5.1%
elimination program and preliminary reports suggesting in 2011.
elimination had been achieved. CONCLUSIONS: The piloted method was useful in
METHODS: We used PAHO targets: three consecutive validating elimination of MTCT of HIV and CS. Although
years with CS incidence of ≤0.5 cases per 1,000 live births Chile achieved the national CS elimination target, regional
(LB); pediatric HIV incidence of ≤0.3 cases per 1,000 LB; challenges remain. Failure to reach the HIV MTCT target
and HIV MTCT rate of 2% (percentage of infants born to despite a low pediatric HIV incidence suggests that further
HIV-infected mothers and HIV-positive by virologic testing work is needed to address gaps in services for hard-to-reach
or by serologic testing at 18 months). We analyzed Chile’s populations.
national surveillance data for 2009–2011 to calculate target KEYWORDS: HIV, syphilis, infectious disease transmission,
measures and assess their stability, and used linear regression vertical/prevention and control, Pan American Health
to determine trends for one region’s data for 1999–2011. Organization, Chile
RESULTS: National CS incidence was 0.24 cases per 1,000
2:15 Chlamydia trachomatis Epidemiology and Coinfection Screening Practices —

Veterans Affairs Palo Alto Health Care System, 2008–2011
AUTHORS: Alison M. Ludwig, P. Schirmer, C. Lucero-Obusan, R. Ryono, M. Holodniy
BACKGROUND: Chlamydia is the most commonly reported non-Hispanic white; 17 (14%) were non-Hispanic black;
bacterial sexually transmitted disease in the United States and 27 (22%) were Hispanic; and 22 (18%) were other races/
can cause pelvic inflammatory disease, infertility, and ectopic ethnicities. Compared with male Veterans, a significantly
pregnancy. Little is known about chlamydia epidemiology higher proportion of female Veterans were asymptomatic
within the Veterans Affairs Palo Alto Health Care System (women, 62%; men, 32%; P = 0.009). Among Veterans
(VAPAHCS). We described chlamydia epidemiology and eligible for Chlamydia reinfection screening 3–12 months
coinfection screening practices at VAPAHCS. after diagnosis, only 12/91 (13%) were rescreened. Screening
METHODS: We reviewed Chlamydia trachomatis nucleic for coinfection occurred among all patients for gonorrhea,
acid amplification and cultures performed at VAPAHCS 86/133 (65%) for HIV, and 16/44 (36%) for syphilis.
for 2008–2011. We identified positive test results by using CONCLUSION: Although women comprise only 5%
infection control records, diagnostic and procedure code of Veterans served by VAPAHCS, 16% of chlamydia
queries of patient visits, and direct queries of VA electronic cases were among women and 62% were asymptomatic,
medical records. Chart reviews of patient demographics, indicating chlamydia among female Veterans might be
laboratory results, and clinical course were performed. underrecognized. Increased education of clinicians regarding
RESULTS: During 2008–2011, a total of 3,039 chlamydia chlamydia rescreening and screening for coinfection should
tests were performed. A total of 133 (4.4%) tests were positive be considered.
for chlamydia. Among Veterans with chlamydia (median age: KEYWORDS: Clostridium difficile, norovirus, coinfection,
29 years; range: 20–80 years), 21 (16%) were female. Among cross infection
122 veterans with race/ethnicity identified, 56 (46%) were
2:35 Using a Mobile Phone Application for Contact Identification of Syphilis Cases
Among Men Who Have Sex with Men — Kansas, 2010–2012
AUTHORS: Suparna Bagchi, D.C. Hunt, I. Garrison, K. Bisgard, J. Vandevelde
BACKGROUND: During 2000–2010 in United States, RESULTS: Of the 129 MSM–syphilis cases, 42 (32.6%) were
MONDAY
reported syphilis rates increased from 2.1 to 4.5/100,000 reported during enhanced case-finding period. Per MSM–
population, attributed to men who have sex with men syphilis case, the number of social partners contacted during
(MSM) transmission, accounting for 67% of reported cases. enhanced case-finding (median: 6.5; range: 0–57) was higher
MSM anonymous partner-finding often involves using than prior time-period (median: 1.0; range: 0–25; P <0.001)
Grindr,© a mobile device location-based social networking and not different by median number of sexual partners
tool. Disease intervention specialists (DIS) use traditional contacted. Compared with MSM–syphilis cases investigated
investigations (named contact interviews) but often cannot prior to April 15, 2012, the proportion of sexual partners
identify anonymous partners. To augment investigations, on (24.3% versus 44.5%) and social partners (3.9% versus 16.3%)
April 15, 2012, Kansas DIS began using Grindr in addition successfully treated was higher among MSM in the enhanced
to traditional methods. We evaluated the enhanced MSM case-finding period (P <0.001).
syphilis contact identification and management. CONCLUSIONS: The number of sexual and social partners
METHODS: We reviewed all reported MSM-syphilis cases successfully contacted and treated increased by using the
for October 1, 2010–October 31, 2012. After April 15, 2012 Grindr social network. Health departments should consider
(enhanced case-finding period), DIS identified anonymous using social networking tools to enhance MSM-syphilis
contacts by using Grindr user-identification on a mobile investigations.
device. We compared the proportion of social and sexual KEYWORDS: syphilis, prevention and control, Internet,
partners successfully contacted and treated per MSM-syphilis homosexuality
case during enhanced case-finding period to those identified
prior to that date.
Vaccines are the tugboats of preventive health.

—William Foege
MONDAY
SESSION D: Vaccine-Preventable Diseases

3:15–5:20 pm
Ravinia Ballroom
MODERATORS: Jane Seward and Stephen Hadler
3:20 Effectiveness of Rotavirus Vaccination Against Severe Childhood Diarrhea —

Guatemala, 2012
AUTHORS: Paul A. Gastañaduy, I. Contreras, J. McCracken, S. Benoit, C. Bernart, B. Chinchilla,

U. Parashar, M. Patel
BACKGROUND: Concerns remain about lower effective- maternal education, and socioeconomic variables.
ness and waning immunity of oral rotavirus vaccines in poor An uncommon G12P[8] strain, heterotypic to the vaccine
populations, where enteric co-infections, co-morbidities, strain, was identified in 90% of rotavirus cases. Effectiveness
malnutrition, and unusual rotavirus strains are common. We of a full vaccine series against severe rotavirus diarrhea was
evaluated vaccine effectiveness against severe rotavirus dis- 75% (95% confidence interval [CI]: 51%–87%) with non-
ease in Guatemala, one of the first low-income countries to diarrhea controls, and 61% (CI: 22%–80%) with rotavirus-
implement routine rotavirus vaccination in 2010. negative controls; partial vaccination (one dose) was 59% (CI:
METHODS: A case-control evaluation was conducted in -58%–89%) and 62% (CI: -1%–86%) effective, respectively.
inpatient and emergency department settings in 4 hospitals No significant differences in effectiveness were observed
during 2012. Card-confirmed vaccine history was compared between infants 6–11 months (61%; CI: -69–91) compared to
between case-patients (children with laboratory-confirmed children ≥12 months of age (78%; CI: 47–91) (P = 0.5).
severe rotavirus diarrhea) and 2 sets of controls: non-diarrhea CONCLUSIONS: Rotavirus vaccination provides sustained
hospital controls (matched by date of birth ±30 days) and protection through 2 years of life against severe rotavirus
rotavirus-negative diarrhea controls (adjusted for birth diarrhea caused by a heterotypic strain among Guatemalan
quarter). Vaccine effectiveness ((1-odds ratio of vaccination) children. This supports broader implementation of rotavirus
x100%) was computed using logistic regression models. vaccination in low-income countries where >90% of the half
RESULTS: We enrolled 190 case-patients, 564 non-diarrhea million annual global deaths from rotavirus occur.
controls, and 243 rotavirus-negative controls. Case-patients KEYWORDS: rotavirus, diarrhea, vaccine effectiveness,
and controls were similar for breastfeeding, birthweight, Guatemala
3:40 Duration of Protection Against Hepatitis A for the Current Two-Dose Vaccine
Compared to a Three-Dose Vaccine Schedule in Children — Alaska,
1993–2011
AUTHORS: Gregory A. Raczniak, L. Bulkow, M. Bruce, S. Negus, M. Snowball, C. Zanis, P. Spradling,

E. Teshale, T. Hennessy, B. McMahon
MONDAY
BACKGROUND: The CDC estimated 17,000 hepatitis variance. A protective level was defined as anti-HAV ≥20
A infections for the United States in 2010. Vaccination for mIU/mL.
hepatitis A is recommended for all US children starting at RESULTS: Throughout the follow-up period, anti-HAV
age 12 months. Protection needs to last into adulthood when protective levels were observed in 24 (100%) of 24 and
symptomatic disease is likely; however, the duration of vaccine 215 (96%) of 225 for the two- and three-dose recipients,
protection and the need for booster doses is unknown. To respectively. No significant differences in GMC were observed
address these questions, we evaluated antibody persistence in between the cohorts at 10 (P = 0.467), 12 (P = 0.496), and
two groups of young adults that were vaccinated in childhood. 14 years (P = 0.175) post-immunization. Protective antibody
METHODS: We determined the geometric mean levels remain for 14 and 17 years for the two- and three-dose
concentration (GMC) of hepatitis A antibody (anti-HAV) cohorts, respectively. GMCs remained stable for both groups
in a cross-sectional convenience sample of 12–24 year-olds for the last 5 years of follow-up.
vaccinated on a two-dose schedule (720 EU/dose) at ages CONCLUSION: The two- and three-dose schedules provide
3–7 years. Results were compared to a cohort that received a protective antibody levels for at least 14 years after vaccination,
three-dose schedule (360 EU/dose) at ages 3–7 years and who indicating a booster dose is not needed. Plateauing anti-HAV
has been followed for 17 years. Anti-HAV levels were log- GMC levels suggest protective antibody levels may persist.
transformed and analyzed using simple (two-dose schedule)
and repeated measures (three-dose schedule) analysis of KEYWORDS: hepatitis A virus, inactivated hepatitis A
vaccine, RNA viruses, enterovirus infections
4:00 Severity of Invasive Pneumococcal Disease in the Era of Pneumococcal

Conjugate Vaccine Introduction
AUTHORS: Kathleen L. Dooling, A. Thomas, W. Schaffner, S. Petit, D. Aragon, A. Reingold, L. Harrison,

M. Nichols, N. Bennett, M. Farley, B. Beall, R. Lynfield, C. Whitney, T. Pilishvili
BACKGROUND: Pneumococcus is a leading cause of whereas CFR was 10.2% pre-vaccine, 13.5% in 2001/02
pneumonia and meningitis deaths. Following 7-valent (P<0.0001) and 10.3% in 2008/09 (P<0.0001 vs. 2001/02).
pneumococcal conjugate vaccine (PCV7) introduction in The proportion of patients with comorbidities increased
the U.S. in 2000, overall invasive pneumococcal disease from 38.2% to 65.5% (P<0.0001). In a model including age
(IPD) incidence and mortality declined, whereas non-PCV7- and time period, comorbidities (odds ratio [OR] 2.2, 95% CI
serotype IPD incidence increased. We evaluated if increases 1.8–2.6) and NVT (OR 1.2, 95% CI 1.0–1.3) were associated
in non-vaccine type IPD led to changes in hospitalization or with increased odds of hospitalization among pediatric case-
case fatality ratio (CFR) during 1998–2009. patients. Likewise, for adult patients, comorbidities (OR 1.3,
METHODS: IPD cases, defined as pneumococcus isolated 95% CI 1.2–1.4) and NVT (OR 1.2, 95% CI 1.1–1.3) were
from a sterile site in a resident of an Active Bacterial Core associated with increased odds of death.
surveillance jurisdiction, were classified as vaccine type (VT) CONCLUSION: Following PCV7 introduction, persons
and non-vaccine type (NVT). Using chi-square, we evaluated with IPD were more likely to have comorbidities, and
changes in CFRs, proportion of case-patients hospitalized, comorbidities were the strongest independent predictor of
and proportion of case-patients with comorbid indications for severe outcomes, especially in children. IPD caused by NVT
pneumococcal vaccination, in two-year periods during 1998– was associated with more severe outcomes than VT IPD.
2009. We evaluated predictors of CFR and hospitalization KEYWORDS: pneumococcus, pneumococcal conjugate
in multivariable logistic regression models separately for vaccine, case fatality ratio, serotype, risk factor
children and adults.
RESULTS: From 1998/99 to 2008/09, hospitalization
among cases increased from 75.6% to 88.1% (P<0.0001),
4:20 Rates of Invasive Pneumococcal Disease Among Older Children

with Immunocompromising Conditions — United States, 2007–2009
AUTHORS: Aaron M. Harris, R. Gierke, A. Payne, R. Link-Gelles, J. King, M. Chen, W. Schaffner, S. Petit,
A. Thomas, N. Bennett, M. Farley, R. Lynfield, D. Aragon, A. Reingold, L. Harrison, M. Nichols, M. Moore,
T. Pilishvili
MONDAY
BACKGROUND: Children with immunocompromising RESULTS: During 2007–2009, 394 IPD cases were identified
conditions (IC) are at highest risk of invasive pneumococcal among 6–18 year–olds; 43 (11%) had IC (24 HM, 14 SCD,
disease (IPD), a leading cause of morbidity and mortality. and 8 HIV/AIDS). IPD rates were higher among children
CDC recommends use of 13–valent pneumococcal conjugate with HM (2,564/100,000 vs. 2.4/100,000; Rate Ratio (RR):
vaccine (PCV13) for all children aged <2 years, and 2–5 years 1068), SCD (148/100,000 vs. 3.4/100,000; RR: 43.5), and HIV/
with IC, including HIV/AIDS, sickle cell disease (SCD), or AIDS (1,265/100,000 vs. 7.9/100,000; RR: 158) compared
hematologic malignancies (HM). We evaluated IPD rates and to those without. IPD case-children with IC had increased
outcomes to help determine whether CDC should extend the hospitalizations (72% vs. 68%; P<0.001) and case-fatality
recommendation for 6–18 year olds with IC. ratios (7% vs. 3%; P=0.017) compared to children without
METHODS: IPD cases, defined as pneumococcus isolation IC. PCV13-types caused 50% (HM), 38% (SCD), 75% (HIV),
from a sterile site, were identified among children with and and 57% (without IC) of IPD.
without IC through the Active Bacterial Core Surveillance CONCLUSION: Children aged 6–18 years with IC are
during 2007–2009, and projected to US population. The at markedly increased risk of IPD and could benefit from
corresponding denominators were estimated using neonatal routine vaccination with PCV13.
screening data for SCD, the National Program of Cancer KEYWORDS: pneumococcal conjugate vaccine, Streptococ-
Registries for HM, and CDC’s HIV surveillance report. We cus pneumoniae, immunocompromsing conditions, HIV/
estimated IPD rates (cases per 100,000 population) among AIDS, sickle cell disease, hematologic malignancies
children 6–18 years for HM and SCD (African-Americans
only), and for <19 years for HIV.
4:40 Seroprevalence of Measles, Mumps, Rubella, and Varicella Antibodies

in the United States Population, 2009–2010
AUTHORS: Emmaculate Lebo, D. Kruszon-Moran, W. Bellini, M. Marin, S. Bialek, G. Wallace, H. McLean
BACKGROUND: The United States documented the higher for all 3 viruses in those aged 6−11 years compared to
elimination of endemic measles in 2000 and endemic rubella other age groups and among non-Hispanic blacks compared
and congenital rubella syndrome (CRS) in 2004. Reported to non-Hispanic whites for measles and rubella (P<0.05).
mumps and varicella cases are at record low levels. It is Measles seroprevalence was lowest in those aged 30−39 years
necessary to monitor population immunity to these diseases (87.9%,CI: 84.8%−90.6%). Mumps seroprevalence was lower
to ensure that measles, rubella, and CRS elimination is in US-born persons compared with non-US born persons
maintained and incidence remains low for mumps and (86.6% vs. 92.3%; P<0.001). Varicella seroprevalence was
varicella. 97.8% (CI: 97.1%−98.3%), and lower in non-US born persons
METHODS: We tested samples collected from persons aged compared with US-born persons (95.6% vs. 98.2%; P<0.01).
6–49 years in the National Health and Nutrition Examination CONCLUSIONS: Seroprevalence was high for all 4 viruses
Survey during 2009–2010. Results from virus specific in the US population during 2009−2010, however, measles
immunoglobulin G (IgG) testing were used to evaluate and mumps seroprevalences were below the estimated
seroprevalence of antibodies to measles, rubella, mumps, and population immunity levels (93%−95% and 90%−92%,
varicella by age, sex, race/ethnicity, and birthplace. respectively) needed for theoretical herd immunity. The lower
RESULTS: Of 5,652 participants, 5,054 (89.4 %) had seroprevalence among some groups suggest that they may
samples for antibody testing. Measles, rubella, and mumps represent populations at increased risk when importations
seroprevalence was 92.0% (95% Confidence Interval [CI]: occur in the U.S.
90.9%−93.0%), 95.3% (CI: 94.3%−96.2%), and 87.6% (CI: KEYWORDS: measles, mumps, rubella, chickenpox,
85.8%−89.2%), respectively. Seroprevalence was significantly seroepidemiologic studies, antibodies
5:00 Nationwide Measles Outbreak — Democratic Republic of the Congo,

2010–2012
AUTHORS: Heather M. Scobie, S. Calixte, E. Pukutu, R. Obama, S. Smit, T. Coulibaly, B. Masresha,

M. Alleman, J. Goodson
MONDAY
BACKGROUND: Measles is a potentially fatal disease, (attack rate: 206 cases/100,000 population). The median
and high population immunity (>93%) is necessary to attack rate was 34 cases/100,000 (range: 7–92) in 5 provinces
prevent transmission. A large measles outbreak began in where SIAs occurred every 2–3 years, compared with 292
the Democratic Republic of the Congo (DRC) in mid- cases/100,000 (range: 34–722) in 6 provinces with a 4–5
2010, despite introducing case-based measles surveillance, year gap between SIAs. Case-based surveillance detected
increasing estimated first dose measles-containing vaccine 5,781 suspected measles cases, among which 2,939 (51%)
(MCV1) coverage from 57% to 71%, and conducting multiple were confirmed. Children aged 9 months–4 years accounted
subnational supplemental immunization activities (SIAs) for 1,750 (60%) confirmed cases; of these, 1,151 (66%) were
to provide a second MCV dose, during 2004–2011. We unvaccinated or had unknown MCV vaccination status.
evaluated surveillance and immunization program data to CONCLUSIONS: Low MCV1 coverage and delays between
identify reasons for the ongoing outbreak. SIAs contributed to DRC’s 2010–2012 measles outbreak.
METHODS: We defined the outbreak period as July 1, 2010– Strengthening case-based surveillance, increasing MCV1
June 30, 2012. We analyzed aggregate and case-based measles coverage and performing high-quality, nation-wide SIAs
surveillance data (including age, vaccination status and every 2–3 years could aid in achieving the 2020 regional
laboratory results), timing and extent of SIAs, and calculated measles elimination goal.
national and subnational cumulative attack rates by dividing KEYWORDS: measles, disease outbreak, measles vaccine,
measles cases reported during the outbreak period (2 years) Democratic Republic of the Congo (DRC)
by the 2011 population.
RESULTS: Overall, 161,217 suspected measles cases were
reported to aggregate surveillance from all 11 provinces
TUESDAY, APRIL 23, 2013
Sometimes the questions are complicated,

and the answers are simple.
—Dr. Seuss
CONCURRENT SESSION E1: Winnable Battles in Chronic Disease

8:30–10:15 am
TUESDAY
Ravinia Ballroom
8:35 Relationship Between Two Perceptions about Energy Drinks

and the Prevalence of Energy Drink Use Among Youth —
United States, 2011
AUTHORS: Gayathri S. Kumar, S. Park, S. Onufrak
BACKGROUND: Energy drinks (EDs), which are popular RESULTS: Overall, 8% of respondents reported consuming
among youth, are often marketed as boosting energy and EDs during the previous week, 19.5% agreed that EDs are
athletic performances. However, because most EDs contain safe drinks, and 12.9% agreed that EDs are a type of sports
high concentrations of caffeine and sugar, they increase risk drink. The proportion who reported consuming EDs during
of dehydration, provide excess calories, and can cause serious the previous week was highest among those aged 16–17
consequences like cardiac arrest. We examined the prevalence (11.4%) and those physically active 3–6 times/week (10.9%).
of ED consumption and its relationship with ED perceptions The likelihood of consuming EDs during the previous week
in youth. was significantly higher among youth who agreed that EDs
METHODS: Using data from the 2011 YouthStyles Survey are safe drinks (odds ratio [OR]: 6.8; 95% confidence interval
of US youth aged 12–17 years (n = 779), we assessed the [CI]: 3.1, 14.8) and those who agreed that they are a type of
prevalence of self-reported ED consumption during the sports drink (OR: 4.5; 95% CI: 2.1, 9.7) than among those
previous 7 days and ED perceptions — both overall and by who did not.
certain sociodemographic and behavioral characteristics — CONCLUSIONS: These findings suggest that many youth
and used multivariate logistic regression analyses to assess have misperceptions about EDs, and efforts to increase
the relationship between consumption and respondents’ awareness among youth about the possible adverse effects of
agreement with two perceptions about EDs: “Energy drinks consuming EDs are needed.
are safe drinks for teens” and “Energy drinks are a type of KEYWORDS: energy drinks, perception, consumption,
sports drink.” youth
8:55 Validation of Sodium Intake Estimates Based on 24-hr Dietary Recall Survey
with 24-hr Urine Sodium Excretion Measurements Among Young Adults —
Washington DC, 2011
AUTHORS: Carla I. Mercado, M. Cogswell, A. Valderrama, C. Wang, C. Loria, A. Moshfegh
BACKGROUND: Mean U.S. sodium intake reduction of higher than 24UE estimates (3,933 mg/d men, 3,431 mg/d
400mg is estimated to prevent 28,000 deaths and save $7 women). Agreement was greater among women (P = 0.23, rr
billion in health care costs annually. Average sodium intake = 1.04 [0.97,1.11], diff = 151.4 [-86.6,389.4], and %diff = 0.18
(3,300 mg/d) is above the Healthy People 2020 target (2,300 [0.09,0.27]) than men (P = 0.17, rr = 1.25 [1.15,1.35], diff =
mg/d). Currently, sodium intake is estimated mostly from 995.6 [636.9,1354.4], and %diff = 0.48 [0.35,0.62]). Estimates
24-hour dietary recalls (24DR), but data on its accuracy is did not vary by race, but agreement was better among obese
limited. Our objective is to assess the accuracy of 24DR for than normal or overweight participants. Results based on
estimating sodium intake. usual intake/excretion estimates were not substantially
METHODS: Using data from a convenience sample of 407 different.
TUESDAY
participants (18–39 years) in a sodium calibration study, CONCLUSION: In this group of young adults, disparities
we estimated mean sodium intake using 24DR and 24-hour in agreement between 24DR and 24UE were greater among
urine sodium excretion (24UE, referent). Agreement between men than women, suggesting gender differences in dietary
measures was assessed by: Spearman’s correlation (P), relative recall. Agreement differences by BMI may contribute to lack
ratio (rr), difference (diff), and percent difference (%diff). of association previously observed between sodium intake
Estimates with 95% confidence intervals were presented and BMI. Analysis examining associations of sodium intake/
stratified by gender, race and BMI. excretion and health outcomes should be stratified by gender
RESULTS: About half of the participants were African- and BMI.
American (48%) and 54% were women. Mean sodium intakes KEYWORDS: sodium, validation studies, diet, biological
from 24DR (4929 mg/d men, 3591 mg/d women) were markers
9:15 Tobacco Cigarette Smoking Among HIV-Infected Adults in Care

in the United States — Medical Monitoring Project, 2009
AUTHORS: Rennatus Mdodo, E. Frazier, C. Mattson, M. Sutton, J. Brooks, J. Skarbinski
BACKGROUND: Among HIV-infected persons, smoking smokers, and 37.3% (CI: 34.9–39.6) had never smoked.
tobacco cigarettes increases risk for HIV-associated and non- Compared with the U.S. population, in which an estimated
HIV-associated morbidity and mortality. Reports suggest 20.6% of adults smoked cigarettes in 2009, HIV-infected
that as many as 40%–70% of HIV-infected persons smoke, adults in care were more than twice as likely to smoke (PR:
but national prevalence estimates are lacking. We report the 2.1; CI: 1.9–2.3). Compared with prevalence in the general
first cigarette smoking prevalence estimates from a nationally population, prevalence of smoking among HIV-infected
representative sample of HIV-infected adults in care. persons was higher among persons aged >65 years (PR: 2.3;
METHODS: Using 2009 data from the Medical Monitoring CI: 1.8–2.7), among women (PR: 2.3; CI: 2.0–2.4), and among
Project, a nationally representative cross-sectional interview Hispanics (PR: 2.4; CI: 2.1–2.5).
survey of 4,317 HIV-infected adults (aged >18 years) in CONCLUSION: The prevalence of cigarette smoking
care, we estimated weighted prevalence of cigarette smoking among U.S. HIV-infected adults is twice the national average.
stratified by demographic and behavioral characteristics. We Reducing cigarette smoking can reduce risk for morbidity
compared these estimates to estimated smoking prevalences and mortality. Providers should take advantage of the
for the general U.S. adult population, using data from the 2009 frequent health care contacts necessitated by HIV infection
National Health Interview Survey to calculate standardized and incorporate smoking cessation into routine care of HIV-
prevalence ratios (PRs). infected adults.
RESULTS: Of the estimated 421,186 HIV-infected adults KEYWORDS: HIV-infected adults, prevalence, cigarette
in care, 42.4% (confidence interval [CI]: 39.7–45.1) were smoking, United States
current cigarette smokers, 20.3% (CI: 18.6–22.1) were former
9:35 Adverse Childhood Experiences and Adult Tobacco Use and Obesity —
Nebraska, 2011
AUTHORS: Kristin M. Yeoman, B. Buss, T. Safranek, B. Cadwell, D. Mannino
BACKGROUND: Adverse childhood experiences (ACEs) by ACE status by using logistic regression with predicted
are associated with risk behaviors and adverse health margins, controlling for age, sex, and education.
outcomes in adulthood. Analysis of state-level ACE data can RESULTS: Prevalence of direct and environmental ACEs
inform policymakers for childhood maltreatment prevention was 32.2% (95% confidence interval [CI]: 30.5%−34.0%)
and well-being programs. We determined ACE prevalence and 44.1% (95% CI: 42.2%−46.0%), respectively; 53%
and association with tobacco use and obesity among Nebraska (95% CI: 51.1%−54.9%) experienced ≥1 ACE. Direct and
adults. environmental ACEs were both associated with current
METHODS: We analyzed data from 9,262 randomly tobacco use (aRR: 1.7; 95% CI: 1.4−2.0 and aRR: 2.1; 95% CI:
selected respondents who completed the state-added optional 1.8−2.5) and obesity (aRR: 1.2; 95% CI: 1.03−1.3 and aRR:
ACE module for Nebraska’s 2011 Behavioral Risk Factor 1.2; 95% CI: 1.05−1.3), respectively. A dose-response relation
TUESDAY
Surveillance System, a telephone survey of a representative existed between total number of individual ACEs per person
sample of noninstitutionalized adults. Direct ACEs were and both outcomes.
defined as reported childhood exposure to physical, sexual, or CONCLUSIONS: ACEs are common and associated with
verbal abuse. Environmental ACEs were defined as reported disease risk factors among Nebraska adults. Strategies to
childhood household exposure to mental illness, substance identify children experiencing ACEs and provide effective
abuse, divorce, or incarceration, or witnessing abuse among interventions during childhood might reduce smoking and
household adults. We estimated ACE prevalence, accounting obesity in adulthood.
for complex survey design, and adjusted relative risk (aRR) of
current tobacco use (lifetime use of ≥100 cigarettes, currently KEYWORDS: tobacco, obesity, child abuse, child of
smoking “some days”) and obesity (body mass index ≥30) impaired parents, domestic violence, Behavioral Risk Factor
Surveillance System
9:55 Environmental Tobacco Smoke (ETS) Exposure and All-Cause Mortality:

A Prospective Cohort Analysis of the Third National Health and Nutrition
Examination Survey (NHANES III)
AUTHORS: Tala H.I. Fakhouri, B. Kit, L. Mirel, D. Brody, C. Ogden, K. Flegal
BACKGROUND: A 2006 report by the U.S. Surgeon all-cause mortality, with adjustments for birth cohort, gender,
General concluded that ETS exposure has adverse health race and ethnicity, income, physical activity, diet, and former
effects. Although the risk of mortality associated with ETS smoking status.
has been previously described, most studies have relied on RESULTS: Median time of follow-up was 14.2 years. After
self-reported ETS exposure and none have been nationally adjusting for potential confounders, the relative risk of all-
representative of the U.S. population. In this study, we sought cause mortality was higher (Hazard Ratio: 1.25, 95% CI
to examine all-cause mortality associated with biomarker- [1.06–1.47]) among ETS exposed participants compared
measured ETS exposure in a nationally representative sample to those not exposed to ETS (P<0.05). Additionally, higher
of U.S. adult nonsmokers. serum cotinine levels were associated with higher risk of all-
METHODS: We prospectively followed a cohort of 6,480 cause mortality (P<0.05 for trend).
nonsmokers in NHANES III from 1988 to 2006. Mortality CONCLUSION: In a nationally representative sample of the
information was based on the results of a probabilistic match U.S. population, environmental tobacco smoke exposure is
between NHANES III and the National Death Index. Analysis associated with all-cause mortality. Interventions designed to
included participants who were ≥40 years of age at baseline. reduce ETS exposure may be informed by these findings.
Because a safe level of ETS exposure may not exist, exposure
was defined as serum cotinine levels ≥0.05 ng/ml, which was KEYWORDS: tobacco smoke pollution, biological markers,
the detection limit for cotinine. We used Cox proportional cotinine, mortality, follow-up studies, prospective studies
hazard regression analysis to determine the relative risk of
Knowledge is power.
—Sir Francis Bacon
CONCURRENT SESSION E2: HIV/AIDS

8:30–10:15 am
TUESDAY
Dunwoody Suites
MODERATORS: Linda Valleroy and Amy Lansky
8:35 Characteristics of HIV-Positive American Indians — Arizona, 1990–2012
AUTHORS: Seema Yasmin, R. Mdodo, H. Huentelman, P. Bloomquist, M. Taylor
BACKGROUND: American Indians (AIs) bear a disparate primary HIV risk factor was heterosexual contact for 34/70
burden of human immunodeficiency virus (HIV) morbidity (48.6%) women and intravenous drug use (IDU) for 24/70
and mortality in the United States, with the third highest HIV (34.3%) women for whom data were available. During the
rate compared with other racial/ethnic groups. Knowledge study period, 184/373 (49.3%) patients with available data
is limited regarding HIV/acquired immunodeficiency were obese; 205/300 (68.3%) reported excessive alcohol
syndrome (AIDS) epidemiology among AIs. We describe the intake; 78/110 (70.9%) had syphilis and 33/110 (30%) had
clinical characteristics of patients at the largest Indian Health gonorrhea. AIDS was diagnosed among 320/461 (69.4%);
Service HIV clinic. 130/461 (28.2%) died (median years from HIV diagnosis to
METHODS: We reviewed comorbidity and risk factor death: 4). Patients with AIDS lived further from the clinic
data for AIs with physician-diagnosed HIV/AIDS during (mean distance: 185 miles versus 125; P = 0.1).
January 1, 1982–November 1, 2012 who received care at the CONCLUSIONS: Findings highlight the prevalence of risk
clinic during January 1, 1990–November 1, 2012. Univariate factors for HIV transmission, including sexually transmitted
analyses were conducted using chi square and Wilcoxon tests. infections and IDU. High rates of comorbidities (e.g., obesity
RESULTS: Records for 468 patients were reviewed; median and excessive alcohol use) and distance to the clinic present
age at entry-to-care was 34 years (range: 18–62 years). challenges in providing care to this population.
Among 448 patients with known sex, 83.9% were male. Men KEYWORDS: Indians, North American, human immu-
having sex with men (MSM) was the primary HIV risk factor nodeficiency virus, acquired immunodeficiency syndrome,
for 257/373 (68.9%) men for whom data were available. The United States Indian Health Service
8:55 High HIV Prevalence in Western Equatoria State — Republic

of South Sudan, 2012
AUTHORS: E. Kainne Dokubo, K.R. Clarke, M. St. Louis, J.J. Neal, S. Cookson, A. Jervase, S.P. Baba
BACKGROUND: The HIV epidemic in Republic of South reported condom use at last sexual intercourse. Limited HIV
Sudan (RSS) threatens to worsen among post-conflict prevention services, most notably availability of condoms
communities. In 2009, estimated HIV prevalence based on and access to HIV testing, limited HIV care and treatment
antenatal clinic (ANC) surveillance data was 3.0% nationally, services, and healthcare worker shortages were observed. Key
and 7.2% in Western Equatoria State (WES). The Ministry informants indicated sexual behavior as the driver of HIV
of Health and CDC aimed to investigate the high HIV transmission; the most common risk factors reported were
prevalence in WES to guide the public health response. multiple concurrent sexual partners, inconsistent condom
METHODS: We abstracted and analyzed HIV testing data use, and early sexual debut.
from three voluntary counseling and testing (VCT) facilities CONCLUSIONS: WES should be prioritized in the
and four ANCs in WES from 2012. HIV services provided national HIV response, with a comprehensive prevention
TUESDAY
were observed and documented for one day. From June strategy including ensured access to condoms; prevention
10–30, 2012, we conducted interviews and focus group interventions focused on at-risk groups, especially young
discussions to identify HIV risk factors using standardized women and their sexual partners; expanded HIV testing
inquiry domains with 75 adult key informants, including and counseling; and strengthened HIV care and treatment
healthcare workers and persons living with HIV. services. Continued surveillance is needed to fully
RESULTS: HIV seropositivity by facility ranged from 6.0% characterize the HIV epidemic in RSS.
to 12.5% among 469 first-visit ANC women and 7.9% to 20.6% KEYWORDS: HIV, South Sudan
among 389 VCT attendees. Only 10.5% of VCT attendees
9:15 Community-Based Electronic Data Collections for HIV Prevention Research

with Black Men in Rural, Resource-Limited Settings — United States, 2011
AUTHORS: Kpandja Djawe, E. Brown, Z. Gaul, M. Sutton
BACKGROUND: Black men are disproportionately affected RESULTS: Of 636 men approached, 586 (92%) responded
by HIV; reducing HIV-related health disparities is a National (median age: 38 years, interquartile range 25–52); 578 (98.6%)
HIV/AIDS Strategy (NHAS) goal. In Florida, the HIV case were heterosexual; 474 (80.9%) had never participated
rate among black men is five times the rate among white in a research study; and 490 (83.6%) had never completed
men. Data regarding sexual behavior, HIV testing, and other a computer survey. Most participants (99.5%) responded
sensitive topics are needed to inform HIV interventions. to questions about HIV testing and sexual behaviors.
However, concerns of trust with traditional public health Respondents reported that ACASI was easy to use (82.3%),
department venues and the sharing of sensitive information enjoyable (82.5%), and adequately protected sensitive
make data collection using face-to-face interviews personal information (84.2%). Respondents, of whom only
challenging. We evaluated the feasibility of using audio 36.8% had regular computer access, would prefer ACASI
computer-assisted self-interview (ACASI) to collect sensitive, compared with face-to-face interviews for future HIV-related
HIV-related information from black men in rural, resource- surveys (OR: 2.26; confidence interval: 1.37–3.71).
limited areas. CONCLUSION: Community-based recruitment and the use
METHODS: During April–October 2011, we conducted of ACASI for data collection are feasible in HIV prevention
community-based recruitment of black men from three rural research in rural, resource-limited settings and are additional
Florida counties. Participants completed ACASI in community tools for informing NHAS disparity-reducing goals.
settings (e.g., parks, barber shops) to report sexual behaviors, KEYWORDS: community survey, data collection, feasibility,
HIV testing history, and data collection preferences. We used HIV, black
logistic regression to estimate associations between ACASI
feasibility and participant characteristics.
9:35 Did CDC’s 2006 Revised HIV Testing Guidelines Make a Difference?
Evaluation of Self-Reported History of HIV Testing — United States,
2003–2010
AUTHORS: Joseph V. Woodring, D. Kruszon-Moran, G. McQuillan
BACKGROUND: Nearly 25% of HIV-positive people in the RESULTS: The overall prevalence of HIV testing increased
U.S. are unaware of their HIV-positivity and subsequently from 39.3% during 2003–2006 to 41.8% during 2007–
transmit over 50% of new HIV infections. Males, African 2010 (P = 0.05). This indicates that approximately 7.9
Americans, and men who have sex with men (MSM) have million more people reported HIV testing after the revised
been disproportionately affected by the HIV epidemic. In recommendation. HIV testing significantly increased among
September 2006, CDC recommended routine HIV screening males (35.3% to 39.4%; P = 0.006); non-Hispanic blacks
for all 13 to 64 year olds in all healthcare settings. This study (53.0% to 59.4%; P = 0.006); 50–64 year olds (28.3% to 34.2%;
examines changes in self-reported history of HIV testing P = 0.004); and those who did not access the healthcare
following the revised guidelines. system in the past year (31.2% to 37.4%; P = 0.008). HIV
testing did not change significantly among MSM (72.3% to
TUESDAY
METHODS: Analysis included 19,375 persons aged 16–64
years who participated in the 2003–2010 National Health and 65.4%; P = 0.3).
Nutrition Examination Survey, a nationally representative CONCLUSIONS: After CDC’s HIV testing
survey. Weighted estimates of persons who reported prior recommendations were revised in 2006, national survey data
HIV testing were produced using SAS and variances were showed some vulnerable subgroups had higher HIV testing
calculated using SUDAAN to account for the complex prevalence, i.e., males and non-Hispanic blacks, while no
survey design. Prevalence of any self-reported HIV testing significant change was shown among MSM.
before and after 2006 was compared using t-tests and further KEYWORDS: HIV, population surveillance, health status
examined by demographic groups, healthcare access and disparities, healthcare disparities, risk factors, Centers for
HIV risk factors. Disease Control and Prevention
9:55 Increased HIV Testing Among Men Who Have Sex with Men —
National HIV Behavioral Surveillance System, 20 U.S. Metropolitan
Statistical Areas, 2008 and 2011
AUTHORS: Laura A. Cooley, A. Oster, C. Wejnert, B. Le, G. Paz-Bailey
BACKGROUND: In 2010, an estimated 29,800 new HIV RESULTS: We included 15,794 MSM (2008: 7,821; 2011:
infections occurred among U.S. men who have sex with 7,973). The proportion recently tested increased from 62.4%
men (MSM); 35.6% were among black MSM. CDC began in 2008 to 66.8% in 2011 (P <0.0001). The proportion of
expanded HIV testing initiatives in 2007, focusing initially black MSM recently tested increased from 61.6% to 69.9%
on African Americans and broadening to include MSM in (P <0.0001). The increase was greater for black than white
2010. HIV testing can lead to engagement in care, treatment, MSM (P <0.001). Adjusted for race/ethnicity, age, education,
and viral suppression, resulting in reduced transmission. We income, and MSA, proportions tested were higher in 2011
assessed changes in HIV testing behavior among MSM. than 2008 (odds ratio: 1.25; confidence interval: 1.17–1.34).
METHODS: We analyzed data from the National HIV CONCLUSIONS: HIV testing increased after
Behavioral Surveillance System. Men in the analysis sample implementation of expanded testing initiatives, and the
were recruited and interviewed in 2008 and 2011 at venues increase was greater among black MSM, a population of
in 20 metropolitan statistical areas (MSAs), were ≥18 years particular interest for prevention. Testing initiatives appear
old, reported at least one male sex partner (past 12 months), to be successful and are an integral part of HIV prevention
and did not report a positive HIV test result. We compared efforts.
the proportions tested recently (past 12 months) and the KEYWORDS: HIV; homosexuality, male; African
temporal changes for black and white MSM (chi-square and Americans; tests, diagnostic
Breslow-Day tests). To determine whether interview year was
associated with HIV testing, we used multivariable logistic
regression.
The best laid schemes of mice and men often go awry.

—adapted from Robert Burns
CONCURRENT SESSION F1: Injury Prevention

10:45 am–12:10 pm
TUESDAY
Ravinia Ballroom
MODERATOR: James A. Mercy
10:50 Do Adverse Childhood Experiences Add Up to Poor Adult Health? —

Results from Ten U.S. States and the District of Columbia, 2010
AUTHORS: Leah K. Gilbert, M. Breiding, S. Dhingra, D. Ford, M. Merrick, W. Thompson
BACKGROUND: Adverse childhood experiences (ACEs), Weighted adjusted odds ratios were calculated examining
which include child abuse and family dysfunction, have eight health outcomes given exposure to 0, 1–3, 4–6, or 7–9
been linked to leading causes of adult morbidity and ACEs after controlling for sociodemographic variables.
mortality. However, prior ACE studies were based on a non- RESULTS: Individuals who experienced 7–9 ACEs were
representative sample of patients from a health maintenance significantly more likely than those who experienced no
organization in Southern California. The objective of ACEs to report: fair/poor health; frequent mental distress;
the current study was to determine if ACE exposure was diabetes; myocardial infarction; heart disease; stroke; asthma;
associated with a range of chronic disease and disability and disability. In addition, evidence for a dose-response effect
outcomes using, for the first time, a large sample of adults was found when examining these health outcomes across all
representative of multiple U.S. states. levels of ACEs.
METHODS: Ten states and the District of Columbia CONCLUSIONS: The results replicate previous findings that
included an optional ACEs module in the 2010 Behavioral ACEs increase the odds of serious chronic health conditions
Risk Factor Surveillance Survey, a national cross-sectional, and disability for the first time using a large, representative
random-digit-dial telephone survey of adults. Respondents sample. These findings underscore the importance of child
were asked about nine ACEs including physical, sexual, and maltreatment prevention as a means to mitigate adult
emotional child abuse as well as house-hold member mental morbidity and mortality.
illness, alcoholism, drug abuse, imprisonment, divorce, and
intimate partner violence. An ACE score was calculated for KEYWORDS: child abuse, domestic violence, chronic
each subject by summing the number of ACE items endorsed. disease, child abuse, sexual
11:10 Water-Related Unintentional Injuries and Fatalities — Lake Mead National

Recreation Area, Arizona and Nevada, 2007–2011
AUTHORS: Carla L. Britton, P. Paul, S. Lam, S. Newman, J. Cheng-Dobson, M. Hinson, J. Gilchrist,

K. Carter
BACKGROUND: During 2007–2011, among 397 National deaths). Motorized boat users experienced 253 (58%) injuries
Park Service units, the highest number of reported visitor (13 [5%] deaths). Swimmers experienced 119 (27%) injuries
fatalities (n = 65; 40 [62%] on water), occurred at Lake Mead (35 [29%] deaths). Among 206 (47%) injuries where alcohol
National Recreation Area (LMNRA). Because the nonfatal or drug use (ADU) status at time of injury was documented,
injury burden was unknown among LMNRA’s approximately ADU was reported in 72 (35%) cases (19 [26%] fatal). The
6.5 million annual visitors, and to inform injury prevention unadjusted PR for ADU-associated fatality was 2.0 (95%
efforts, we characterized fatal and nonfatal water-related confidence interval [CI]: 1.2–3.8); after adjusting for sex and
unintentional injuries and factors associated with fatality. activity at time of injury, only male sex (PR: 6.6; 95% CI:
METHODS: We identified water-related (on, or intended 1.6–27.0) and swimming (PR: 3.6; 95% CI: 1.8–7.3) remained
significant fatality predictors.
TUESDAY
to enter, water) unintentional injuries from LMNRA’s 2007–
2011 emergency medical service records. We matched records CONCLUSIONS: Among injured visitors at LMNRA,
by name, birth date, and incident date to hospital, trauma males and swimmers were at higher risk for fatality;
registry, and U.S. Coast Guard Boating Accident Report public health interventions should target these groups.
Database records. We calculated injury frequencies and ADU documentation on every injury report can improve
compared fatal with nonfatal injuries by using log-binomial assessment of ADU as a risk factor for fatality.
regression to calculate adjusted prevalence ratios (PRs). KEYWORDS: wounds and injuries, drowning, recreation,
RESULTS: We identified 436 total injuries; 53 (12%) lakes, swimming, accident prevention
were fatal. Males experienced 272 (62%) injuries (49 [92%]
11:30 Pedestrian Traffic Fatalities — Clark County, Nevada, 2008–2011
AUTHORS: Kaci L. Hickox, N. Williams, T. Coleman, S. Lyss, J. Fudenberg, B. Robinson, J. Middaugh
BACKGROUND: During 2010, pedestrians represented (71%) were male. Residents’ fatality rate was 1.4/100,000;
~14% of traffic-related fatalities in Nevada. Despite roadway visitors’, 1.1/100,000; and homeless persons’, 30.7/100,000.
engineering and safety campaigns in Clark County, reported Among residents, fatality rate for non-Hispanic blacks was
pedestrian fatalities have remained consistent. We sought 3.0/100,000; for non-Hispanic whites, 1.4/100,000; and
to describe epidemiologic characteristics of Clark County for Hispanics, 0.9/100,000. Visitor pedestrian fatalities
pedestrian traffic fatalities to develop intervention strategies. were concentrated near the Las Vegas Strip; residents’ and
METHODS: We identified pedestrian deaths (on foot, homeless persons’ deaths were more evenly distributed.
wheelchair, or skateboard) hit by motor vehicles in Clark Resident fatality rates increased and visitor rates decreased
County during 2008–2011 by using both coroner’s data and with increasing age. Of homeless deaths, 50% occurred
death certificates, and reconciled results through individual Monday–Friday, 6 pm–midnight, compared with 19% among
case reviews. Demographic information and collision details nonhomeless.
were abstracted from coroner’s case reports. We calculated CONCLUSIONS: Non-Hispanic blacks and homeless
rates by using 2008–2011 Nevada state demographer census persons were at highest risk for pedestrian fatality in Clark
data, 2009 and 2011 homeless census surveys, and 2008–2011 County; interventions should target these demographic
Las Vegas Convention and Visitors Authority profiles. groups. Differences in age-specific rates and geographic
RESULTS: During 2008–2011, a total of 140 pedestrian location among residents and visitors should also influence
traffic fatalities were reported (107 residents, 19 visitors, and prevention efforts.
14 homeless persons). Decedents mean age was 48 years KEYWORDS: accidents, traffic; motor vehicles; walking;
(range: 6–93 years and one intrauterine fetal demise); 100 homeless persons; death
11:50 Risk Factors for Suicidal Ideation Among Bhutanese Refugees —

AUTHORS: Trong T. Ao, E. Lankau, E. Taylor , C. Blanton, S. Shetty, B. Lopes Cardozo
BACKGROUND: Since 2008, >56,000 Bhutanese refugees Median age was 34 years (range = 18–83). Thirteen (3%)
resettled in the United States. Between February 2009 and reported suicidal ideation. Mental illness symptoms
February 2012, 16 suicides among Bhutanese refugees were prevalence was: 19% anxiety (15% men, 23% women; P =
officially reported, prompting an Epi-Aid investigation 0.038); 20% depression (16% men, 26% women; P = 0.008),
to identify risk factors for suicidal ideation (i.e. seriously and 5% PTSD (3% men, 6% women; P = 0.173). Significant
thinking about suicide). Understanding risk factors for associations existed between suicidal ideation and not being
suicidal ideation in this community is critical for future a family provider (OR: 6.6, CI: 1.4–31.9); family conflict (OR:
suicide prevention interventions. 22.6, CI: 5.59–2.6); not finding employment (OR: 11.1, CI:
METHODS: We conducted a cross sectional survey among 2.4–51.5); symptoms of anxiety (OR: 38.1, CI: 7.9–185.1),
randomly selected Bhutanese refugees aged >18 years depression (OR: 11.2, CI: 2.9–42.1), and PTSD (OR: 9.3, CI:
2.1–41.0).
TUESDAY
in Arizona, Georgia, New York, and Texas (N = 423) by

collecting data on: demographics; mental health history; CONCLUSION: High prevalence of mental illness symptoms
post resettlement difficulties; and symptoms of anxiety, indicates potentially under-diagnosed mental illnesses in
depression, and post-traumatic stress disorder (PTSD) using this community, especially among women. Addressing this
standard instruments. Differences between men and women and post resettlement difficulties will be important in a
were assessed using chi-squared test. We estimated odds comprehensive suicide prevention strategy.
ratios (OR) and 95% confidence intervals (CI) for association KEYWORDS: suicidal ideation, refugees, Bhutan, mental
with suicidal ideation using conditional logistic regression. health
RESULTS: Of 423 participants, 221 (52%) were men.
If it looks like a duck and quacks like a duck,

we have at least to consider the possibility that we have
a small aquatic bird of the family Anatidae on our hands.
—Douglas Adams
CONCURRENT SESSION F2: Zoonotic Diseases

10:45 am–12:10 pm
TUESDAY
Dunwoody Suites
MODERATOR: Christopher Paddock
10:50 Lymphocytic Choriomeningitis Virus Outbreak and Risk Assessment —

Multiple States, 2012
AUTHORS: Laura S. Edison, C. Drenzek, J. Gabel, B. Knust, B. Petersen, P. Rollin, U. Stroeher, S. Nichol,
J. House, D. Thoroughman, S. Robeson, K.A. Fowler
BACKGROUND: Lymphocytic choriomeningitis virus LCMV-seropositive, and one experienced aseptic meningitis;
(LCMV), a rodentborne arenavirus, can cause aseptic the one pregnant employee tested negative. Twenty-nine
meningitis, encephalitis, and severe birth defects among (91%) reported wearing gloves, and 13 (41%) using a
humans. In May 2012, four employees of an Indiana rodent- mask. No risk factors were significantly associated with
breeding facility experienced aseptic meningitis caused by seroconversion. Feeder mice bred as reptile food at Facility A
LCMV. An epidemiologic investigation revealed exposure to comingled with wild mice, the presumed source of infection.
LCMV infected mice originating from a Kentucky breeding Among facilities from 21 states that received these mice,
facility (Facility A) as the cause. We investigated Facility A 264/521 (51%) pet stores and 7/11 (64%) distributors still had
to determine the extent of the outbreak and prevent further >500,000 potentially infected mice, which were subsequently
cases. euthanized. Thirty-five pet store employees from six states
METHODS: We performed LCMV serologic testing for tested negative for LCMV.
all Facility A employees and conducted interviews to assess CONCLUSION: LCMV can pose a serious health risk to
their infection control practices and potential risk factors for persons who work with or handle mice. Rodent breeding
seroconversion. We reviewed shipping records and contacted facilities should ensure that wild mice are separated from mice
facilities that had received potentially infected mice to intended for distribution. Personal protective equipment and
encourage euthanization of the mice and assess employees’ education regarding its use should be provided to employees
risk for exposure. Pregnant, sick, or immunocompromised who handle mice.
pet store employees were offered serologic testing. KEYWORDS: mice, humans, lymphocytic choriomeningitis
RESULTS: Among 32 Facility A employees, 11 (34%) were virus, arenavirus, zoonoses, occupational diseases
11:10 Extreme Rodeo: Results of a Rocky Mountain Spotted Fever

Intervention Project — Eastern Arizona, 2012
AUTHORS: Suzanne R. Todd, N. Drexler, A. Brock, F. Dahlgren, L. Adams, E. Weis, T. Shelhamer,

S. Piontkowski, J. Francies, K. Komatsu, M. Miller, J. Gerding, J. McQuiston
BACKGROUND: Rocky Mountain spotted fever (RMSF), Rodeo area decreased to zero at project conclusion, whereas
a tickborne rickettsial disease transmitted by brown dog the non-intervention area experienced increasing numbers
ticks parasitizing free-roaming dogs, is a serious public through August. More (73.8%) RMSF Rodeo dog owners
health problem in Arizona on some tribal lands. The RMSF reported restraining their dogs always or sometimes vs. non-
Rodeo, a pilot intervention project addressing the many intervention dog owners (55.0%, P < 0.001). RMSF Rodeo
causes of RMSF transmission, was implemented in summer dog owners reported some or all of their eligible dogs were
2012 on one reservation. The project included: (1) treating spayed (41.0%) or neutered (30.5%), compared to owners in
community dogs with a long-acting tick collar; (2) applying non-intervention homes (11.4% and 24.7%, P < 0.001 and
pesticide treatments to yards; (3) no-cost spay/neuter clinics; P < 0.001).
and (4) encouraging pet restraint.
TUESDAY
CONCLUSION: The intervention area experienced overall

METHODS: To assess efficacy of the project, we surveyed dramatic decrease in ticks that transmit RMSF. Additionally,
595 households selected through stratified random sampling. we found evidence of an increase in positive dog ownership
Survey data were weighted and compared between RMSF practices which limit free-roaming dogs and aid in reducing
Rodeo and non-intervention houses. Tick counts were ticks and transmission of RMSF. Expanding the intervention
assessed by visual examination of dogs. CO2 traps were project reservation-wide could reduce exposure to ticks in
placed monthly to evaluate environmental tick loads. over 1,000 households.
RESULTS: Almost all dogs (99.2%) at RMSF Rodeo houses KEYWORDS: Rocky Mountain spotted fever, tick, animal
were tick-free compared to dogs in the non-intervention area control
(36.1%). Numbers of trapped brown dog ticks in the RMSF
11:30 Knowledge, Attitudes, and Practices Regarding Dog Ownership

and Tick Control on an American Indian Reservation — Arizona, 2012
AUTHORS: Laura E. Adams, N. Drexler, A. Brock, F. Dahlgren, S.R. Todd, E. Weis, T. Shelhamer, S.
Piontkowski, J. Francies, K. Komatsu, M. Miller, J. Gerding, K. Bisgard, J. McQuiston
BACKGROUND: During 2003–2012, Rocky Mountain The majority of residents (74.5%) stated the number of owned
spotted fever (RMSF), an expanding tickborne disease dogs per person should be limited, with less support (48.2%)
on Arizona American Indian lands, caused >200 human among persons aged 18–25 years, and stronger support
cases and 19 deaths. RMSF ecology is uniquely linked to (80.8%) among persons aged ≥26 years (P < 0.001). Adults
dogs, which carry brown dog ticks that transmit Rickettsia residing with children were more likely to support an animal
rickettsii. Additionally, dog bites injure American Indian control program (89.2%) than those without children (75.8%;
children at a higher rate than other U.S. children. To evaluate P < 0.05). Dog owners rarely reported (9.4%) all their dogs
social behaviors, we assessed the knowledge, attitudes, and being neutered. An animal shelter was supported by 85.1%;
practices influencing dog ownership and tick control among 77.3% supported an animal control program including
residents on one Arizona reservation. euthanasia.
METHODS: We randomly selected 315 households with CONCLUSIONS: On this reservation, the majority of
proportional sampling by housing district of the total residents, including adults who might reside with children,
reservation. We interviewed 1 consenting adult/household. favored increased dog control measures. Combating RMSF
Data were weighted before analysis. and dog bites in this community might include increased dog
RESULTS: Among 234 respondents (response rate: 74.3%), ownership limitations and regulation and requirements to
62.0% owned ≥1 dog; 69.6% of dog owners reported treating restrain dogs.
their dogs for ticks. The majority (61.7%) agreed that all KEYWORDS: Rocky Mountain spotted fever, Rickettsia
dogs should be restrained (e.g., tied, fenced, or kept inside), rickettsii, prevention and control, tick control
although only 28.3% reported always restraining their dog.
11:50 Tularemia: A Potential Public Health Emergency and Contact Investigation —

Virginia, 2011
AUTHORS: Jennifer M . Espiritu, C . Sikorski, M . Tipple
BACKGROUND: Tularemia occurs naturally in many RESULTS: Interviews with the patient and close contacts
species. Caused by the bacterium, Francisella tularensis, it can identified no risk factors besides rabbit exposure while
also be a biological weapon. Cases represent a potential public mowing, a known risk factor for human pulmonary infection.
health emergency requiring prompt investigation. In 2011, a Assessment of healthcare workers identified 27 workers at
military hospital admitted a service member for worsening risk. Eleven were at low risk and instructed to watch for fever
acute respiratory distress after presenting to another military symptoms. Nine were at high risk, interviewed for symptoms,
clinic. Tularemia was not initially suspected and was not and instructed to watch for fever. Seven were at very high risk,
confirmed by Virginia’s public health laboratory until hospital resulting from direct contact with plates during processing,
Day 9. We examined the intentional exposure potential and and received antibiotic prophylaxis.
investigated the healthcare workers’ risk for tularemia. CONCLUSIONS: Bioterrorism was ruled out due to no
METHODS: The patient and close-contacts were interviewed
TUESDAY
unusual risk factors or additional cases, and the patient
to assess the intentional exposure risk. We conducted a cohort recovered. After confirmation, hospital, clinic, and health
study of healthcare workers exposed to the patient’s respiratory department staff promptly responded to assess worker risk
samples from presentation to confirmation because routine and provide prophylaxis, potentially averting more cases.
pathogens are processed on an open bench. Workers at low KEYWORDS: tularemia, occupational exposure, bacterial
risk were those potentially exposed to respiratory secretions, infections, safety
which are not contagious. Those at high risk were present
within 3 feet of isolate processing. Workers at very high risk
handled patient isolate plates.
SPECIAL SESSIONS
CONCURRENT LUNCHTIME SESSION: New Vaccines
in the Global Context
12:30 pm
Ravinia Ballroom
TUESDAY
MODERATOR: Rana Hajjeh

SPONSORS: NCIRD and NCHHSTP
The session will focus on recent progress in the introduction protect against diseases which disproportionately kill people
of new vaccines in resource-poor settings. Historically, in the developing world, and have been introduced in growing
introduction of new and underutilized vaccines in low- and numbers of low- and middle-income countries over the past
middle-income countries has lagged years behind high- few years with support from GAVI and other partners.
income countries. However, in recent years, efforts to promote
the uptake and sustained use of new vaccines in the world’s High-quality epidemiologic and surveillance data, including
poorest countries has resulted in much greater access to life- laboratory data, are crucial for building the evidence base for
saving vaccines among children worldwide. We highlight new vaccines. Data on burden of disease and the impact and
four vaccines to illustrate the progress and challenges in effectiveness of new vaccines in real-world, resource-poor
introducing new vaccines and the role of epidemiologic settings are necessary to guide and monitor policy decisions.
studies/surveillance in guiding decisions about new vaccines The proposed talks will emphasize the role of epidemiologic
in resource-poor settings. studies and surveillance (including some conducted by EIS
officers) in new vaccine introduction and sustained use.
The four highlighted vaccines — rotavirus, pneumococcal
conjugate, meningococcal A conjugate, and human SPEAKERS:
papillomavirus vaccines — have tremendous potential
• Introduction: Use of New Vaccines in Resource-Poor
public health impact to decrease severe disease burden
Settings. Rana Hajjeh
including mortality across the age spectrum. The rotavirus
and pneumococcal conjugate vaccines, which protect against • Rotavirus Vaccine. Jacqueline E. Tate
diarrhea and pneumonia respectively, target the two leading
killers of children worldwide. The meningococcal A vaccine • Pneumococcal Conjugate Vaccine. Jennifer Verani
has the potential to eliminate epidemic meningitis due to
• Meningococcal A Conjugate Vaccine. Sema Mandal
this pathogen in the African meningitis belt. The human
papillomavirus vaccine prevents the second-most common • Human Papillomavirus Vaccine. Susan Hariri
type of cancer among women worldwide. All four vaccines
CONCURRENT LUNCHTIME SESSION: Chronic Disease Prevention

Through Healthcare and Public Health Partnerships
12:30 pm
Dunwoody Suites
TUESDAY
SPONSOR: NCCDPHP
The Affordable Care Act (ACA) prioritizes increasing access in the prevention of cardiovascular disease; (3) partnering
to care, promoting community engagement, preventing with payers to increase the delivery and sustainability of
disease, increasing quality of care and improving population the National Diabetes Prevention Program, an effective and
health. Passage and implementation of the ACA and cost-effective community approach to preventing diabetes
Meaningful Use (MU) regulations have multiple implications among high risk people; (4) efforts to support state public
for public health surveillance, policy, and prevention, all of health departments in promoting clinical and public health
which will be of great interest to epidemiologists. Multiple linkages; (5) promoting policy and systems change to reduce
changes inside and outside of CDC, HHS, and government the burden of chronic disease at the population level through
make it imperative that public health increases its capacity to the Community Transformation Grants.
work with the health care system and healthcare stakeholders
to achieve public health objectives In response to these SPEAKERS:
immense changes, CDC and NCCDPHP must be able
• Millions Hearts Initiative: Clinical and Community
to bridge public health and health care leadership across
Linkages to Prevent Cardiovascular Disease. Peter Briss
topical areas. This special session will focus on current
efforts to reduce chronic disease burden in the U.S. through • Strengthening Chronic Disease Prevention and Health
better linkages between public health, community health, Promotion Programs within State Health Departments.
and health care. Opportunities to link with health care Wayne Giles
systems include engaging key stakeholder partnerships with
regulators, educators, providers, payers, insurers, advocacy • Preventing Chronic Diseases with Policy and System
organizations, and citizens. Change Through the Community Transformation
Grants. Leonard Jack
The presentations will describe (1) current efforts to drive
public health improvements through better linkages between • Public and Private Partnerships Are Preventing
public health and health care; (2) partnering with the Diabetes — The National Diabetes Prevention Program.
healthcare system to promote increased use of electronic Kris Ernest
health records (EHRs), team based care, consistent quality
measurement and other strategies to drive improvements
You must be the change you wish to see in the world.

—Mahatma Gandhi
SESSION G: International Health

1:45–3:50 pm
TUESDAY
Ravinia Ballroom
MODERATORS: Pattie Simone and Rita Helfand
1:50 Rapid Surveillance Documents Elevated Mortality Among Blue Nile Conflict
Refugees — South Sudan, 2012
AUTHORS: Kevin R. Clarke, M. Brennan, B. Dineen, C. Navarro-Colorado, J. Ahmed, M. Schilperoord
BACKGROUND: Armed conflict and aerial bombings in four times the emergency threshold of 2/10,000/day during
Sudan’s Blue Nile state increased the refugee population in the first week of surveillance and declined thereafter to
Maban County, South Sudan from 65,000 to 110,000 between 2.0/10,000/day following comprehensive interventions in
March and July, 2012. Recent arrivals were malnourished and health, nutrition, water and sanitation. The CMR declined
the region faced widespread flooding. The United Nations from a peak of 3.2 (three times the emergency threshold of
High Commissioner for Refugees (UNHCR) requested CDC 1/10,000/day) to 1.2 during the same period. The U5MR and
support to implement mortality surveillance. CMR in Jamam camp declined from 1.9 to 0.9 /10,000/day and
METHODS: Deaths were reported weekly from three refugee 1.8 to 1.0/10,000/day, and in Doro camp, fluctuated between
camps. A weekly line list for each camp was compiled from 0.7–2.8/10,000/day and 0.3–0.9/10,000/day, respectively.
data provided by camp health facilities, community leaders, CONCLUSION: Rapidly established mortality surveillance
camp administrators, and a single referral hospital. Duplicates promptly identified high mortality rates in one camp, allowing
were identified and removed. Community health workers targeting of humanitarian aid and a mechanism to monitor
conducted household visits to confirm reported deaths. its impact. Forced migration resulted in a highly vulnerable
Population size was determined using UNHCR registration recent arrival population. Rapid mortality surveillance offers
data which tallies all refugees soon after arrival. The weekly critical real-time data to guide response during humanitarian
crude mortality rate (CMR) and under-five mortality rate emergencies.
(U5MR) were calculated as deaths/10,000 persons/day from KEYWORDS: refugees, mortality, epidemiology, South
July 9–September 2, 2012. Sudan, emergencies
RESULTS: The U5MR in Yusuf Batil camp was 9.3, over
2:10 Prevalence of Malaria Parasitemia and Purchase of Artemisinin-Based

Combination Therapies Among Drug Shop Clients — Tanzania, 2012
AUTHORS: Melissa A. Briggs, A. Kalolella, K. Bruxvoort, G. Lopez, C. Festo, P. Lyaruu, M. Kenani,

S. Abdulla, C. Goodman, S.P. Kachur
BACKGROUND: Malaria is a leading cause of fever RESULTS: Of the 784 drug shop clients, 21% had purchased
and mortality in Africa. Many people seek care for fever ACTs, of which 72% were subsidized. Malaria prevalence was
in private-sector drug shops. In Tanzania, the Affordable 21% in children <5 years, 35% in children 5–14 years, and
Medicines Facility-malaria program subsidized artemisinin- 7% in persons >15 years. Of clients with malaria, only 31%
based combination therapies (ACTs), a first-line antimalarial, purchased ACTs, and only 20% of clients who purchased
to increase their accessibility in the private sector. This study ACTs had malaria. Clients were more likely to have purchased
assessed malaria prevalence and ACT purchase among drug ACTs if the participant was <5 years (adjusted odds ratio
shop clients in the setting of these subsidies. [aOR]: 6.6; 95% confidence interval [95% CI]: 3.7–11.6) or
METHODS: We conducted a cross-sectional survey of their drug shop attendant had >5 years’ experience (aOR:
2.9; 95% CI: 1.3–6.3). Having malaria was only a predictor of
TUESDAY
drug shop attendants and clients purchasing medications
for fever or malaria. Clients were recruited from a stratified ACT purchase in the region with an accreditation program
randomized sample of 73 drug shops in two regions, for drug shops (aOR: 2.9; 95% CI: 1.4–5.8).
one region with a government accreditation program for CONCLUSION: Many drug shop clients have malaria. The
drug shops and one without, during March–May 2012. high proportion of persons with malaria not receiving ACTs,
Malaria testing was performed after medication purchase. and persons without malaria receiving ACTs demonstrates a
We modeled predictors of ACT purchase using multiple need to better target ACTs in the private sector.
logistic regression. KEYWORDS: malaria, artemisinins, private sector, Tanzania
2:30 Changes in Coverage Rates of a Nationwide Micronutrient Powder

Distribution Program — Kyrgyzstan, 2011–2012
AUTHORS: Kristie E. Appelgren, M. Serdula, K. Sullivan, R. Flores-Ayala
BACKGROUND: In 2011, Kyrgyzstan, which has an anemia Nationwide, coverage dropped from 76.0% to 66.8% (P<0.05).
prevalence >50% in children aged 6–23 months, became one The drop was significant in rural areas (from 77.7% to 67.5%,
of the first countries to institute nationwide distribution of P<0.05), but not in urban areas. There was a significant
micronutrient powders (MNPs). Declining coverage in the decrease in 18–23 month age group coverage (from 74.2% to
maintenance phase is a frequent problem for nutritional 62.9%, P<0.05), but not in the 6–11 month or 12–17 month
supplementation programs. This analysis uses monitoring age groups.
data to compare initial MNP coverage rates in 2011 with those CONCLUSIONS: At the end of the program’s first year,
in 2012 in order to inform evidence-based interventions. nationwide coverage had declined by 9.2 percentage points.
METHODS: In each of 48 districts, 24 households with Four times as many districts failed to meet the coverage
a child aged 6–23 months were randomly selected and benchmark in 2012 as compared to 2011; resources to
administered a questionnaire on their child’s current MNP improve coverage will be targeted to these failing districts.
use. On a district level, the coverage benchmark was failed if Nationwide, interventions to increase coverage will be
<14 out of 24 households reported current MNP use. National targeted towards older children and those in the rural areas.
estimates of MNP coverage were calculated by weighting the KEYWORDS: micronutrients, nutritional deficiency, public
results by target population size in each district (SAS 9.3). health surveillance, Kyrgyzstan
RESULTS: In 2011, 4 (8.3%) of 48 districts failed to meet
the coverage benchmark; in 2012, 16 (33.3%) failed to do so.
2:50 Incidence and Determinants of Adverse Events Following Initiation of First-

Line Antiretroviral Therapy in HIV-Positive Adults — Mozambique, 2004–2007
AUTHORS: Spencer B. Lloyd, F. Mbofana, A. Auld, C. Alfredo, L. Nelson, R. Shiraishi, K. Jobarteh,

S. Agolory, T. Spira, T. Ellerbrock
BACKGROUND: In Mozambique, about 1.4 million persons I/II), patients with end-stage disease (stage IV) had higher
are HIV infected and about 74,000 HIV/AIDS deaths occur AE incidence (AHR: 1.53; 95% confidence level (CI): 1.00–
annually. In response, the government has rapidly expanded 2.35). Compared with patients with better immune status
access to life-saving antiretroviral therapy (ART). By 2011, (CD4+ T-cell count >200/µL), patients with severe immune-
over 300,000 persons had started ART. However, little is suppression (CD4+ T-cells <50/µL), had higher AE risk
known about ART-related adverse events (AEs), which can (AHR: 1.25; 95% CI: 1.05–1.48). Most patients (88%) were
significantly decrease ART adherence and increase morbidity prescribed three-drug ART regimens containing stavudine,
and mortality during ART. while zidovudine replaced stavudine in 11% of regimens.
METHODS: We conducted a retrospective cohort study in Compared with patients prescribed stavudine, patients
prescribed zidovudine had 45% lower AE risk (AHR: 0.55;
TUESDAY
Mozambique among a nationally representative sample of

2,596 adults initiating ART during 2004–2007. Incidence of 95% CI: 0.34–0.89).
ART-related AEs (e.g., neuropathy, rash, and diarrhea) and CONCLUSION: Advanced HIV disease and the use of
patient characteristics associated with AE incidence were stavudine-containing regimens were associated with higher
investigated. Adjusted hazard ratios (AHR) were estimated AE incidence. Earlier diagnosis and initiation of ART
using Cox proportional hazards regression models. Missing with non-stavudine-containing regimens could reduce
covariates were imputed via multiple imputation. AE incidence and enhance patient adherence which could
RESULTS: AEs were documented for 475 (18%) of improve HIV morbidity and mortality.
2,596 patients; 11% had neuropathy, 5% rash, and 2% KEYWORDS: HIV, antiretroviral therapy, adverse events,
diarrhea. Compared with ART enrollees with less advanced Mozambique
World Health Organization (WHO) HIV disease stage (stage
3:10 Epidemiology of Hospitalized Influenza Cases from a Population-Based

Surveillance System — Guatemala, 2007–2012
AUTHORS: Trong T. Ao, M.R. Lopez, F. Muñoz, C. Bernart, J. McCracken, J. Bryan, L. Peruski
BACKGROUND: Influenza is a vaccine-preventable disease lab-confirmed influenza; of these, 360 (81%) had influenza
affecting 5–15% of the world population annually. Although A, 82 (18%) had influenza B, and 4 (1%) were co-infected.
a small proportion of all infections, hospitalized influenza Median age was 2 years (QU: 6 years, SR: 2 years, GC:
patients incur substantial health complications and financial 1 year; p<0.01); 254 (57%) were male. Median length of
burden to health systems. We describe the epidemiology of hospitalization was 5 days (range = 0–77). Eighty (19%)
laboratory-confirmed hospitalized influenza infection from a patients required intensive care; 28 (6.3%) died. Overall
facility-based surveillance system in Guatemala. crude incidence rates of hospitalized influenza infection
METHODS: We analyzed surveillance data from 2007 were: QU: 16.9/100,000 (CI: 14.7–19.2); SR: 12.6/100,000 (CI:
to 2012 at three sites (Quetzaltenango [QU], Santa Rosa 11.6–15.8). Age-specific incidence was highest in children <5
[SR], Guatemala City [GC]). Demographic, clinical, and years old: QU: 55.3/100,000 (CI: 45.5–66.6); SR: 49.4/100,000
epidemiological data were collected for enrolled patients (CI: 42.9–64.9).
meeting respiratory syndrome eligibility. Nasopharyngeal CONCLUSION: Influenza is an important cause of
swabs were tested for influenza by real-time reverse- hospitalization in Guatemala, especially among children <5
transcriptase polymerase chain reaction. Patient years old. Pregnant women and children aged >6 months
characteristics were tabulated by site and compared using should be vaccinated for seasonal influenza. Interventions
the chi-squared test for categorical and the Wilcoxon-Mann- to improve clinical management will reduce influenza-
Whitney test for continuous variables. We calculated age- associated morbidity and mortality.
specific hospitalized influenza incidence and 95% confidence KEYWORDS: influenza, Guatemala, hospitalization,
intervals (CI) using Poisson distribution. epidemiology, incidence
RESULTS: Of 6,326 hospitalized patients, 446 (7.0%) had
3:30 Cholera Epidemic Associated with Unsafe Drinking Water and Street-Vended
Water — Eastern Freetown, Sierra Leone, 2012
AUTHORS: Von D. Nguyen, N. Sreenivasan, E. Lam, D. Kargbo, F. Dafae, A. Jambai, W. Alemu, T. Ayers,
S. Stroika, C. Bopp, E. Mintz, R. Quick, J. Brunkard
BACKGROUND: Vibrio cholerae causes an estimated water from improved water sources, such as boreholes and
3 million illnesses and 100,000 deaths annually. During 2012, public taps. Consuming unsafe water (matched odds ratio
Sierra Leone experienced a severe cholera epidemic with [mOR]: 3.4; 95% confidence interval [CI]: 1.1, 11.0), street-
22,252 reported cases and 292 deaths. In August 2012, CDC vended water (mOR: 9.4; 95% CI: 2.0, 43.7) and crab (mOR:
assisted the Ministry of Health and Sanitation (MOHS) in an 3.3; 95% CI: 1.03, 10.6) were significant risk factors for
outbreak investigation. cholera infection. Of 31 stool samples from cases, 13 (42%)
METHODS: We conducted a matched case-control study showed PCR evidence of V. cholerae O1, El Tor. Three isolates
to assess risk factors for cholera. Cases were defined as acute were culture positive. Their PFGE patterns were previously
watery diarrhea requiring IV hydration in persons ≥5 years observed in seven countries.
TUESDAY
old, presenting to a health facility from September 10–21. CONCLUSIONS: Despite near universal access to
Controls were matched by age and neighborhood. Stool improved water sources, consuming unsafe water and street-
samples collected from case-patients were analyzed by culture vended water were risk factors for cholera infection. We
and polymerase chain reaction (PCR) for V. cholerae; isolates recommended that prevention efforts focus on enhancing the
were subtyped by pulsed-field gel electrophoresis (PFGE). microbiologic quality of improved water sources, promoting
Conditional multivariate logistic regression was performed household chlorination, and improving street vendor water
to investigate cholera risk factors. handling practices.
RESULTS: We enrolled 49 cases and 98 matched controls. KEYWORDS: cholera, Vibrio cholerae, water, Sierra Leone
Virtually all cases (96%) and controls (96%) obtained drinking
WEDNESDAY, APRIL 24, 2013
Remember to breathe. It is, after all, the secret of life.

—Gregory Maguire
CONCURRENT SESSION H1: Respiratory Diseases

8:30–10:15 am
Ravinia Ballroom
MODERATOR: David Swerdlow
WEDNESDAY
8:35 Respiratory Hospitalizations in Children with Neurologic Disorders —

United States, 2010
AUTHORS: Fiona P. Havers, A. Fry, J. Chen, D. Christensen, C. Moore, G. Peacock, L. Finelli, C. Reed
BACKGROUND: Children with neurologic disorders disorders, 10,122 hospitalizations were identified; 1,153
are at increased risk for complications from influenza and (11%) were attributed to a respiratory infection (184/10,000
other respiratory infections. Although neurologic disorders person-years). The respiratory infection hospitalization rate
are uncommon, one third of recent influenza-associated was 71/10,000 person-years in 21,325 (32%) children with
pediatric deaths in the United States occurred in this isolated epilepsy; 36/10,000 person-years in 16,035 (24%)
population. The annual hospitalization rate for respiratory children with autism spectrum disorder; 293/10,000 person-
infections for children <15 years of age is approximately years in 10,966 (16%) children with neural tube defects;
50/10,000 children, but rates are unknown in children with and 371/10,000 person-years in 9,738 (15%) children with
neurologic disorders. We sought to characterize respiratory cerebral palsy (CP). Among those with CP, children with
infection hospitalizations in this population. concomitant epilepsy had a rate of 800/10,000 person-years
METHODS: We used data from the Medstat MarketScan versus 202/10,000 person-years in those without epilepsy.
Commercial Claims and Encounters Database, collected CONCLUSION: Children with neurologic disorders are
from U.S. insurance plans. We identified children <18 years at high risk for hospitalization from respiratory infections,
of age as of January 2010 who, in the previous 12 months, had although hospitalization rates vary widely by disorder type
at least one visit with an ICD-9 diagnosis code for a specified and co-morbidities. Optimizing prevention strategies in
neurologic disorder. To determine hospitalization rates, these populations, including improving annual influenza
we identified hospitalizations during January–December vaccination levels, should be aggressively pursued.
2010 with primary or secondary diagnosis codes indicating KEYWORDS: respiratory tract infections, nervous system
respiratory infection. diseases, pediatrics, hospitalization
RESULTS: Among 67,028 children with neurologic
8:55 Rates of Pediatric Hospital and Intensive Care Unit Admissions for Lower
Respiratory Tract Infections from MarketScan Data — United States, 2010
AUTHORS: Adena H. Greenbaum, J. Chen, C. Reed, L. Finelli, A. Fry
BACKGROUND: Lower respiratory tract infections (LRTI) 89, respectively) and decreased with age (1 to <2 years: 677
account for 3–18% of U.S. pediatric hospitalizations and and 58, 2–4 years: 250 and 26, 5–9 years: 91 and 10, 10–18
are the leading cause of infectious disease-related deaths years: 34 and 5, respectively). Median hospital stay was 2
in children. We characterized severe LRTI infections days (interquartile range (IQR) 1,3) and 4 days (IQR 2,7)
among children to inform strategies to reduce LRTI-related for LRTI and LRTI ICU hospitalizations. Among children
morbidity and mortality and assist with pandemic planning. with LRTI and LRTI ICU hospitalization, 34% and 47%
METHODS: We analyzed children enrolled in Medstat had underlying medical conditions (P<0.01). Among LRTI
MarketScan Database, collected from health insurance plans; ICU hospitalizations, respiratory conditions (18%) and
current analysis limited to 2010 (12.5 million children 0–18 complications during gestation (9%) were most common
years). LRTI hospitalizations were identified by a primary among children <1 year.
LRTI discharge code and those with intensive care unit CONCLUSIONS: Infants and young children are at
(ICU) admission were defined as LRTI ICU hospitalizations. greatest risk for LRTI hospitalization and severe LRTI.
Underlying conditions were determined from discharge Pandemic preparedness should consider the high burden of
codes. respiratory disease among children, especially those <5 years.
RESULTS: During 2010, 20,201 LRTI hospitalizations Prevention strategies, including influenza and pneumococcal
(161 per 100,000 person-years) and 2,171 (11%) LRTI vaccination, should be encouraged especially for those with
ICU hospitalizations (11 per 100,000 person-years) were respiratory comorbidities.
identified. Rates of LRTI and LRTI ICU hospitalizations KEYWORDS: respiratory tract infections; intensive care
per 100,000 person-years were highest in infants (809 and units, pediatrics; hospitalization
WEDNESDAY
9:15 Hispanic Infants Aged <6 Months and Factors Associated with an Increased
Risk for Pertussis — Metropolitan Portland, Oregon, 2010–2012
AUTHORS: Kara M . Levri, L . Reynolds, J . Liko, B . Robinson, P . Cieslak
BACKGROUND: During January–November 2012, the year), compared with non-Hispanic infants (465/100,000/
highest number of Bordetella pertussis cases was reported in year); proportion of patients requiring hospitalization was
Oregon since 1950. The greatest morbidity occurred among similar for Hispanics (29.6%) and non-Hispanics (29.2%).
infants aged <6 months, whose pertussis rates were higher Median household size was larger for Hispanic (6.0; range:
among Hispanics than non-Hispanics. To develop hypotheses 3.0–11.0) than for non-Hispanic patients (4.5; range: 2.0–
to explain this disparity, we analyzed enhanced pertussis 14.0; P <0.02). Hispanic and non-Hispanic patients did not
surveillance data. differ significantly by child care attendance (8.0% versus
METHODS: We compared Hispanic with non-Hispanic 4.9%; P = 0.61), up-to-date vaccination status (21.4% versus
pertussis illnesses diagnosed among infants aged <6 months 31.2%; P = 0.50), or age (proportion <8 weeks, 40.7% versus
during January 2010–September 2012 by using Oregon’s 33.3%; P = 0.52).
Metro Area Pertussis Surveillance data. Denominators were CONCLUSION: Hispanic ethnicity is associated with
obtained from Oregon vital statistics data. We evaluated increased risk for pertussis among infants in metropolitan
differences in medians with the Wilcoxon rank-sum test, Portland. Results of this analysis indicate that household size
and differences in proportions with Pearson’s chi-square might contribute to this increased risk. Further research is
test. Infants aged <8 weeks were excluded from up-to-date needed to more fully assess the roles of child care attendance,
vaccination analysis. vaccination status, and age distribution. Multivariable
RESULTS: We identified 77 pertussis cases; 76 (99%) were analysis with multistate data is planned.
laboratory-confirmed. Of 75 patients with known ethnicity, KEYWORDS: Bordetella pertussis, Hispanic, immunization,
27 (36%) were Hispanic, and 48 (64%) non-Hispanic. contacts
Pertussis incidence was higher for Hispanic (1,048/100,000/
9:35 Vaccine Effectiveness Among Adolescents Vaccinated with Acellular

Pertussis Vaccines — Washington, 2012
AUTHORS: Anna M. Acosta, C. DeBolt, M. Lewis, A. Tasslimi, L. Misegades, N. Messonnier, T. Clark,

S. Martin, M. Patel
BACKGROUND: Beginning in 1997, acellular pertussis between cases and controls was calculated using conditional
(aP) vaccines replaced whole-cell vaccines for the entire logistic regression. VE was estimated as (1 − OR) × 100%.
childhood vaccination series. A sixth dose of pertussis- RESULTS: Incidence among 11–14 year olds was
containing vaccine, tetanus toxoid, reduced diphtheria toxoid 235/100,000 in 2012 compared to 55/100,000 in 2011. The
and acellular pertussis (Tdap), was recommended for 11–12 analysis included 93% (466/499) of eligible cases. Tdap receipt
year olds in 2005. In 2012, Washington declared an epidemic or non-receipt status was confirmed in 86% of subjects;
with 4,744 cases reported — the largest number of cases since confirmation is ongoing in the remaining subjects. Excluding
the 1940s. An unexpectedly high incidence was observed unconfirmed subjects, 85% (344/403) of cases and 92%
in young adolescents, the first birth cohort to be vaccinated (1098/1195) of controls received Tdap. Preliminary analysis
exclusively with aP vaccines. showed an overall VE of 57% (95% confidence interval: 34–
METHODS: To assess Tdap vaccine effectiveness (VE), 72%).
we conducted a case-control study in Washington counties CONCLUSIONS: This is the first Tdap VE estimate among
reporting greater than 50 cases. Adolescents aged 11–14 adolescents vaccinated solely with aP vaccines. Despite high
years with reported pertussis according to surveillance case rates of vaccination, Tdap VE in acellular recipients may be
definitions from January 1 to June 30, 2012 were included. lower than previous estimates among whole-cell recipients
Three controls were matched by healthcare provider and birth (65–78%).
year to each case. Vaccination history was obtained through
medical records, the state immunization registry and parent KEYWORDS: whooping cough, diphtheria-tetanusacellular
interviews. The odds ratio (OR) comparing Tdap receipt pertussis vaccines, adolescent, case-control studies, vaccine
WEDNESDAY
effectiveness
9:55 Bacterial Pneumonia and Standardized Interpretation

of Chest Radiographs in Adults
AUTHORS: Jonathan M. Wortham, J. Gray, J. Verani, C. Lucia Contreras, C. Bernart, F. Moscosa,

A. Roldan, J. Moir, J. Hernandez, R. Castellan, W. Arvelo, K. Lindblade, J. McCracken
BACKGROUND: Bacterial pneumonia is a leading infectious CXR plus urine antigen and/or blood culture results; 385
cause of illness and death worldwide, but quantifying (53%) had endpoint consolidation, and 253 (35%) had other
the burden is difficult due to insensitive diagnostics and infiltrate. Bacterial infection was detected in 112 (16%); 12 by
chest radiograph (CXR) interpretations. A World Health blood culture (S. pneumoniae n = 6, Staphylococcus aureus n
Organization (WHO) protocol standardizes pediatric CXR = 5, Klebsiella pneumoniae n = 1), and 100 by S. pneumoniae
interpretation for epidemiologic studies. Because pneumonia urinary antigen. Compared to patients with normal CXRs,
etiologies and radiographic patterns may differ in adults, the bacterial infection was significantly more common among
utility of this protocol on adult CXRs is unknown. those with endpoint consolidation (20% vs. 8%) [Odds Ratio
METHODS: Patients (age ≥15 years) admitted with (OR) = 2.99; 95% Confidence Interval (CI): 1.35–7.94)], but
acute respiratory infections to two Guatemalan hospitals not other infiltrate (20% vs. 12%) (OR = 1.64; CI: 0.70–4.50).
underwent testing for bacterial infections (urine antigen Viral infection was not significantly associated with endpoint
for Streptococcus pneumoniae and/or blood cultures) and consolidation (OR = 1.21; CI: 0.67–2.30).
viral infections (polymerase chain reaction for respiratory CONCLUSIONS: Standardized interpretation of adult
syncytial virus, human metapneumovirus, influenzae A/B, CXRs identified patients with acute respiratory diseases more
parainfluenza virus 1/2/3, adenovirus). CXR were performed likely to have bacterial infections. This approach can help
when clinically indicated, and classified per WHO protocol measure the burden of bacterial pneumonia and impact of
as endpoint consolidation, other infiltrate, or normal. We interventions in adults.
examined associations between end-point consolidation and KEYWORDS: pneumonia, Streptococcus pneumoniae,
bacterial and viral infections. radiography, bacterial pneumonia
RESULTS: During 11/2007–3/2012, 721 patients had
All labor that uplifts humanity has dignity and importance.

—Dr. Martin Luther King, Jr.
CONCURRENT SESSION H2: Occupational Health

8:30–10:15 am
Dunwoody Suites
MODERATORS: Henry A. Anderson and Kristin J. Cummings
WEDNESDAY
8:35 Prevalence of Carpal Tunnel Syndrome Among Employees
at a Poultry-Processing Plant — South Carolina, 2012
AUTHORS: Kristin M. Musolin, J. Gibbins, B. Bernard, J. Ramsey, C. Mueller
BACKGROUND: In 2011, approximately 224,000 U.S. relationship between CTS and exposure group adjusted for
poultry abattoir employees slaughtered approximately nine nonoccupational factors.
billion birds for human consumption. These employees may be RESULTS: A total of 126 (42%) of 300 participants had CTS.
at risk for carpal tunnel syndrome (CTS) from a combination The prevalence of CTS by exposure group was 36% for lower-
of forceful exertions, high repetition, and extreme postures. risk, 43% for moderate-risk, and 48% for higher-risk. In the
Redesigning the work process can prevent illness and early adjusted analysis the higher-risk exposure group had a CTS
intervention and treatment can lead to improved outcomes. prevalence that was significantly higher than the lower-risk
We evaluated the risk of CTS at one poultry-processing plant. exposure group (PR: 1.39; P = 0.01).
METHODS: In August 2012, we undertook a cross-sectional CONCLUSIONS: Increasing levels of force and hand
survey concerning symptoms and occupational risk factors activity were associated with increased CTS prevalence among
among employees. Jobs were grouped into lower, moderate, employees. Recommendations provided to managers and
and higher-risk using the Threshold Limit Value® for Hand employees to reduce these risk factors included increasing the
Activity and forceful exertion categorization. We performed number of line workers, providing appropriate rest breaks;
nerve conduction studies (NCS) to assess median nerve ensuring early medical intervention, and instituting annual
damage in the hand and wrist. A CTS case was defined surveillance of symptoms.
as an employee with (1) self-reported pain, numbness,
burning, or tingling in the hand and wrist of an established KEYWORDS: occupational, poultry, carpal tunnel
frequency, duration, and location, and (2) abnormal NCS syndrome, prevalence
results. We used log-binomial regression to evaluate the
8:55 Salivary Cortisol Response to a High-Protein Challenge and Metabolic

Syndrome in Police Officers — New York, 2004–2009
AUTHORS: Penelope J. Baughman, M. Andrew, C. Burchfiel, D. Fekedulegn, J. Violanti, D. Miller
BACKGROUND: Policing is considered a high-stress mean cortisol response were assessed by MetSyn status using
occupation and officers have elevated cardiovascular morbidity repeated measures analysis of covariance.
and mortality. To investigate this potential connection, we RESULTS: The study included 373 officers (74.0% men)
evaluated the association between salivary cortisol response with a mean age of 41.0 years. Prevalence of MetSyn was
to a standardized challenge and the metabolic syndrome 25.7%. The mean count of MetSyn components decreased
(MetSyn), a subclinical disorder associated with increased (1.89, 1.75, 1.55, 1.37; P < 0.01) across increasing quartiles of
cardiovascular risk. AUC salivary cortisol. The pattern of mean salivary cortisol
METHODS: Cross-sectional data from the Buffalo Cardio- decreased from baseline (5.55, 4.58, 4.47, 4.79, 4.75 nmol/L)
Metabolic Occupational Police Stress Study (2004–2009) in officers with MetSyn and increased (5.08, 5.82, 5.92, 5.82,
were analyzed. MetSyn was defined as three or more of five 5.60 nmol/L) in their counterparts. The test for interaction
components: abdominal obesity, hypertension, elevated between MetSyn status and sample timing was statistically
triglycerides, reduced high-density lipoprotein cholesterol, significant (P < 0.001).
and glucose intolerance. Officers provided five salivary cortisol CONCLUSION: A reduced cortisol response to a high-
samples, one before challenge (ingestion of a lunchtime high- protein meal challenge may be associated with MetSyn.
protein shake) and four at 15-minute intervals thereafter, Future longitudinal studies could provide useful evidence for
where increase represents normal response. Age- and sex- planning intervention studies on cardiovascular risk among
adjusted regression models were used to examine trends in the 794,000 police officers in the United States.
mean number of MetSyn components across quartiles of
area under the curve (AUC) salivary cortisol. Patterns of KEYWORDS: metabolic syndrome, cortisol, cardiovascular
diseases, police
WEDNESDAY
9:15 Self-Reported Gender-Based Violence Among Female Sex Workers —

Kampala, Uganda, 2012
AUTHORS: Amee M. Schwitters, T. Durant, N. Borse, R. Bosa, I. Benech, S. Mital, W. Hladik
BACKGROUND: Gender–based violence (GBV) includes timeframes of 6-months (abuse and rape frequency), lifetime
sexual, physical, and verbal abuse. The 2006 Uganda (rape), and last occurrence (rape perpetrator).
Demographic Health Survey reported 28.2% (lifetime) RESULTS: Among 1,489 FSW respondents, median
and 52.3% (12-months) of Kampala females in the general duration of sex work was two years. Verbal and physical
population experienced sexual and physical abuse, abuse prevalence perpetrated by clients was 77.5% (95%
respectively. Up to 72% of sub-Saharan African female sex CI: 74.7–80.3) and 73.1% (95% CI: 70.0–76.2), respectively.
workers (FSWs) report abuse during their lifetime, but limited Almost half (49.8%; 95% CI: 47.3–52.4) of FSWs reported
research exists on GBV among FSWs in Uganda. Research being raped. Median number of rape occurrences was two
shows FSWs frequently experience GBV perpetrated by (6-months). Rape perpetrators were sex partners (36.3%;
partners, clients, and others. To better understand prevalence 95% CI: 32.8–39.7), strangers (36.1%; 95% CI: 32.6–39.9),
and type of GBV among FSWs in Kampala, we examined and others (27.6%; 95% CI: 21.6–33.6).
behavioral survey data.
CONCLUSIONS: Prevalence of verbal and physical abuse
METHODS: Data from a 2012 Kampala respondent-driven and rape among FSWs in Kampala is frequent. Physical abuse
sampling survey, a probability-based, peer-recruitment is more common among FSWs than among women in the
sampling method, were analyzed. We estimated duration general population. Comprehensive programs, including
of sex work, prevalence and 95% confidence intervals (CI) those targeting cultural norms supporting GBV are needed
for self-reported verbal and physical abuse and rape using to reduce violence among FSWs.
RDSAT, adjusting for the non-random sampling frame.
Participants were >15 years. Interviews utilized recall KEYWORDS: sex workers, female, violence, Uganda
9:35 Cancer Screening Non-Compliance Among Females Who Work Alternative

Shifts — United States, 2010
AUTHORS: Rebecca J. Tsai, S. Luckhaupt, M. Haring Sweeney, G. Calvert
BACKGROUND: Alternative shift work (work hours falling RESULTS: The analyses included 9,009 females. Workers
outside typical daytime shifts) was classified as a probable on alternative shifts, compared to workers on daytime shifts,
human carcinogen by the International Agency for Research were significantly more likely to be non-compliant with
on Cancer in 2007, based primarily on increased breast screening recommendations for breast (34% versus 23%;
cancer risk. Twenty-seven percent of employed females in prevalence ratio [PR] = 1.35; 95% confidence interval [CI]:
the U.S. work alternative shifts (N ≈ 8,700,000). Given the 1.17–1.55) and colorectal cancer (55% versus 48%; PR = 1.10;
effectiveness of certain cancer screening tests to increase CI: 1.00–1.21). Additionally, significant non-compliance with
survival, the associations between alternative shift work screening recommendations for more than one cancer was
and non-compliance with breast, cervical and colon cancer observed for workers on alternative shifts in two industries
screening recommendations issued by the United States (“Manufacturing” and “Accommodation/Food Services”) and
Preventive Services Task Force were investigated. three occupations (“Food Preparation/Serving”, “Personal
METHODS: The 2010 National Health Interview Survey was Care Services” and “Production”), compared to all workers
used to examine these associations. Analyses were restricted to on daytime shifts.
females employed within 12 months of interview. SUDAAN® CONCLUSIONS: The Affordable Care Act eliminates out-
and Poisson regression were used to compare the prevalence of-pocket screening expenses for these three cancers. Greater
of non-compliance with cancer screening recommendations efforts are needed to promote this benefit, particularly among
between females employed on alternative shifts and those female workers with demonstrated non-compliance.
employed on typical daytime shifts. Analyses by 42 industries KEYWORDS: early detection of cancer, industry,
and occupations were also performed. occupation, occupational exposure
WEDNESDAY
9:55 Inhaled Mercury Exposure from Artisanal Gold Mining and Processing —
Nome, Alaska, 2012
AUTHORS: Brian R. Yablon, A. Hamade, D. Fearey, J. McLaughlin
BACKGROUND: Mercury, a potent toxin that can cause from 0.2 to 106.1 µg/g (median: 0.9 µg/g). Subject A, the only
brain and kidney damage, has long been used by miners to participant whose urine mercury concentration exceeded
bind and thus extract gold. Consequently, gold unearthed in the health-risk level, was a processor who heated gold inside
heavily mined areas is commonly amalgamated to mercury, his home 2–3 hours/day. His two neighbors — nonminers
which can be released through heating. In June 2012, we concerned about frequent unpleasant fumes from subject A’s
responded to concerns relayed by Alaska’s Department of home — had the next highest levels (6.4 and 5.4 µg/g). Subject
Environmental Conservation that artisanal miners in Nome A denied symptoms, and his urine mercury level decreased to
were potentially inhaling mercury vapor while heating gold. 50 µg/g after the summer gold-processing season ended. Safe
METHODS: Through press release, radio, and newspaper practice recommendations were distributed to miners and
advertisements, we targeted persons exposed to gold mining posted throughout Nome.
or processing. We surveyed a convenience sample to assess CONCLUSION: Subject A was exposed to potentially
risk factors. We analyzed urine to determine creatinine- toxic mercury levels while heat-processing gold indoors. His
normalized mercury levels, using a literature-derived neighbors were likely exposed through fumes released from
reference (20 µg/g creatinine) to assess potential health risk. his home. Artisanal miners and processors need education
RESULTS: Of 40–50 people approached, 18 participants about safe purification practices to limit personal and
completed surveys and submitted urine. Seventeen (94%) community exposure.
were male; 14 (78%) were miners. No miner heated gold KEYWORDS: mercury poisoning, mining, occupational
≥15 minutes/week. Participants’ urine mercury levels ranged exposure, environmental exposure
I do not cough for my own amusement.

—Jane Austen
CONCURRENT SESSION I1: Tuberculosis

10:30–11:55 am
Ravinia Ballroom
MODERATOR: Kenneth Castro
WEDNESDAY
10:35 Negative Tuberculin Skin Test Result and Increased Risk of Death —
AUTHORS: Sara C . Auld, E . Click, C . Heilig, K . Cain, R Miramontes, G . Bisson, W . MacKenzie
BACKGROUND: Tuberculin skin testing (TST) has RESULTS: Of 36,149 case-patients included in the analysis,
historically been used as a marker of tuberculosis (TB) 5,284 (15%) had a negative TST result, 21,918 (61%) had a
infection and to evaluate risk of progression to active TB. TST result of ≥15 mm and 1,614 (4%) died. Compared to
However, studies suggest that a positive TST result may case-patients with a negative TST result, case-patients with
indicate beneficial immune system response to TB. We a positive result were less likely to die: TST result of 5–9 mm
explored whether a positive TST result was associated with (adjusted odds ratio [aOR]: 0.46; CI: 0.45–0.46); result of 10–
decreased risk of death among case-patients reported with 14 mm (aOR: 0.38; CI: 0.38–0.38); result of ≥15 mm (aOR:
active TB in the United States. 0.31; CI: 0.31–0.31).
METHODS: We analyzed data on TB case-patients reported CONCLUSIONS: Case-patients with active, culture-
to CDC during 1993–2008 who had a positive culture result confirmed TB who have a negative TST result are more likely
and documented susceptibility to first-line drugs and who to die than are patients with TB who have a positive TST
had completed TB therapy or died of any cause after initiating result. Among persons with active TB disease, the TST may
therapy. TST result was categorized by size of induration help identify patients at greater risk for death.
(<5mm [negative], 5–9 mm, 10–14 mm, and ≥15 mm). We KEYWORDS: tuberculosis, tuberculin test, death,
estimated associations between size of TST induration and immunology
death by using logistic regression adjusted for HIV status,
nativity, age, sex, site of disease, and cavitation on radiograph.
10:55 Relationship Between Cigarette Smoking and Secondhand Smoke Exposure

and Latent Tuberculosis Infection Among U .S . Adults, National Health and
Nutrition Examination Survey, 1999–2000
AUTHORS: Eugene Lam, M .L . Pearson, I .V . Rolle, R . Caraballo
BACKGROUND: An estimated 11 million U.S. residents are former smokers, and 51.0% never smokers. Compared with
infected with Mycobacterium tuberculosis (TB). Identifying LTBI prevalence among never smokers, prevalence was
and treating groups with a high prevalence of latent TB significantly higher among current smokers (adjusted odds
infection (LTBI) are essential to TB elimination efforts. ratio [aOR]:3.1; 95% confidence interval [CI]:1.8–5.2), and
Although cigarette smoking has been implicated as a risk former smokers (aOR:2.5; 95% CI:1.0–6.3). Former smokers
factor for active TB disease, limited evidence is available exposed to SHS were more likely to have LTBI compared
regarding the relationship between LTBI and either cigarette to never smokers who were not exposed to SHS (aOR:3.4;
smoking or exposure to secondhand smoke (SHS). 95% CI:1.1–10.9). LTBI was also associated with male sex
METHODS: In multivariable logistic regression analyses, we (aOR:1.7; 95% CI:1.0–3.0), age ≥50 years (aOR:2.3; 95%
used data from the 1999–2000 National Health and Nutrition CI:1.1–4.7), foreign birth (aOR:6.9; 95% CI:3.3–14.6), and
Examination Survey to examine the associations between living in a household with TB disease (aOR:2.8; 95% CI:1.4–
LTBI and smoking status (never, former, or current cigarette 5.7).
smoker based on both self-report and serum cotinine levels) CONCLUSION: Our findings that both smoking and SHS
or SHS exposure among those aged ≥20 years. Participants exposure were associated with LTBI among U.S. adults
with a tuberculin skin test measurement of ≥10 mm were suggest that tobacco control efforts could contribute to U.S.
classified as having LTBI. TB elimination efforts.
RESULTS: Of 3,408 survey participants whose data we KEYWORDS: tobacco, tuberculosis, latent tuberculosis
analyzed, 5.2% had LTBI, 25.9% were current smokers, 23.1% infection (LTBI), cotinine, NHANES
WEDNESDAY
11:15 Enlarged Peripheral Lymph Nodes and Positive Mycobacterium tuberculosis
Culture Among People Living with HIV — Cambodia, Thailand, and Vietnam,
September 2006–July 2008
AUTHORS: Chimeremma D. Nnadi, C. Heilig, P. Moonan, K. McCarthy, J. Varma, K. Cain
BACKGROUND: Tuberculosis (TB) accounts for 25% of all logistic regression to analyze characteristics associated with
HIV deaths. In 2010, 350,000 people died of HIV-associated MTB-positive aspirates.
TB. Diagnosing TB in people living with HIV (PLHIV) can RESULTS: EPLNs were present in 237 (12%) patients.
be difficult: symptoms are often atypical, and some people EPLNs were associated with CD4 <150 cells/mm3, abnormal
cannot produce sputum for examination. Diagnostic delays chest radiograph, self-reported fever, and self-reported weight
contribute to the high mortality rate. PLHIV commonly loss. EPLN culture results were available for 101 patients: 45
have enlarged peripheral lymph nodes (EPLNs). EPLNs can were MTB-positive. In multivariate analysis, positive EPLN
be aspirated for Mycobacterium tuberculosis (MTB) culture, aspirate culture was associated with CD4 <150 cells/mm3
potentially expediting TB diagnosis. We determined factors (adjusted odds ratio [aOR]: 7.0; confidence interval [CI]:
associated with a positive MTB culture among PLHIV with 2.1–22.9), weight loss (aOR: 9.3; CI: 2.1–40.1), and abnormal
EPLNs. chest radiograph (aOR: 5.7; CI: 1.6–19.8).
METHODS: During September 2006–July 2008, 1,988 CONCLUSION: Enlarged peripheral lymphadenopathy
PLHIV attending 8 outpatient facilities in Cambodia, was associated with reduced immune status. Aspiration and
Thailand, and Vietnam underwent an extensive standardized culture of EPLNs may facilitate early TB diagnosis among
TB diagnostic evaluation, including EPLN aspiration for PLHIV, potentially reducing TB morbidity and mortality.
MTB culture. EPLN was defined as a peripheral lymph node
of >1 centimeter or >2 centimeters in the inguinal region. We KEYWORDS: Mycobacterium tuberculosis; HIV; diagnostics;
analyzed clinical characteristics associated with EPLNs. Then, bacteriological techniques; Asia, Southeastern
for patients with EPLN culture results, we used multivariate
11:35 Drinking, Bootlegging, and an Outbreak of Drug-Resistant Tuberculosis —

Rural Kentucky, 2007–2012
AUTHORS: Terrence Lo, E.S. Russell, M. Patterson, E. Johnson, D. Thoroughman, T. Goins, S. Morris
BACKGROUND: Treatment of tuberculosis (TB) is network (i.e., bootlegging). Before 2007, two of these five
generally curative and interrupts transmission by rendering case-patients were not fully evaluated for LTBI. Among all
a case-patient noninfectious. Treatment of drug-resistant case-patients, excessive alcohol use and covert lifestyles
TB is less effective, enabling the spread of Mycobacterium associated with boot-legging hindered TB control efforts.
tuberculosis. Genotyping of M. tuberculosis strains confirmed Of 105 contacts named during the current investigation, 32
an outbreak of drug-resistant TB during January 2007– did not have TST results; 18 (25%) of the 73 with TST results
April 2012 involving six patients in southeastern Kentucky. tested positive.
We investigated these six patients and their contacts to CONCLUSIONS: Epidemiologic and genotypic links to the
recommend control measures. source case of a previous outbreak suggest that the current
METHODS: We reviewed medical records and interviewed outbreak resulted from reactivation of infection acquired in
patients, their proxies, and health department personnel to the distant past. One-quarter of recent contacts were infected,
identify the source of the outbreak, chains of transmission, which, if untreated, could lead to future drug-resistant cases.
and barriers to TB control. Tuberculin skin test (TST) results Given the prevalence of excessive alcohol use and drug
(≥5 mm) were used to estimate prevalence of latent TB resistance among this network, partnerships with alcohol
infection (LTBI) among contacts. treatment programs and increased efforts to complete contact
RESULTS: Of six case-patients, five were culture confirmed. investigations and provide treatment are needed.
Five were contacts to a putative source of an outbreak involving KEYWORDS: tuberculosis; alcohol drinking; tuberculosis,
47 drug-resistant cases beginning in 1988; this patient multidrug-resistant
operated an illegal drinking venue and alcohol distribution
WEDNESDAY
Life can only be understood backwards,

but it must be lived forwards.
—Soren Kierkegaard
CONCURRENT SESSION I2: Maternal and Child Health

10:30–11:55 am
Dunwoody Suites
MODERATOR: Wanda Barfield
WEDNESDAY
10:35 Health Hazards Associated with Laundry Detergent Pods — United States,
May–June 2012
AUTHORS: Satish K. Pillai, M.C. Beuhler, F.M. Henretig, P. Gala, P. Meaney, H. Wolfe, J. Schier, R. Law,
M. Punja, S. Kieszak, L. Lewis
BACKGROUND: Sales of concentrated liquid detergent RESULTS: Of 1,008 laundry detergent exposures, 485
capsules, known as laundry detergent pods (LDPs), are (48%) involved LDPs. LDP exposures were more frequently
increasing in the United States’ (U.S.) detergent market where unintentional (99%) and associated with ingestion (90%)
market share has risen over twofold to 6% in 2012. Concern compared to NPLD exposures (94% and 81%, respectively, P
regarding LDP exposures began in spring 2012 when two < 0.001 for both). Children aged ≤5 years were more likely to
poison centers reported four children with respiratory have a LDP exposure compared to those aged 11–20 years and
distress following ingestion of LDP contents. An investigation 20+ years (P < 0.001 for both). Among children aged ≤5 years,
to elucidate LDP-exposure risk factors and health effects was LDP-exposed individuals more frequently had adverse health
undertaken. events (80%), including vomiting, coughing and lethargy,
METHODS: On May 17, 2012, the American Association of compared to NLPD exposed individuals (63%) (P < 0.001).
Poison Control Centers and CDC developed a code for poison CONCLUSIONS: LDPs represent an emerging public
center (PC) staff to use for LDP exposures. LDP exposures health hazard, potentially resulting in more severe health
were identified in the national PC reporting database, effects in young children compared to NPLD. Laundry
National Poison Data System (NPDS), between May 17–June products should be kept out of sight and reach of children.
17, 2012. Non-pod laundry detergent (NPLD) exposures KEYWORDS: detergent, poisoning, children, risk factor
reported to NPDS during the same timeframe were used as
a comparison group. Statistics for exposure intentionality,
route, age, and adverse health events were calculated using
chi-square or Fisher’s exact test.
10:55 Discontinuation of Hormonal Contraception Use Among Black Teenage

Clients of an Urban Family Planning Clinic — Atlanta, Georgia, 2012
AUTHORS: Michael Lowe, M. Whiteman, P. Marchbanks
BACKGROUND: More than 300,000 infants are born to as a reason for discontinuation (55%, DMPA; 33%, OCs).
U.S. teens annually and rates are highest among minorities. Additionally, one-third of respondents discontinuing OCs
Although more than half of sexually active U.S. teens have cited trouble using them. Characteristics independently
used hormonal contraceptives, little is known about factors associated with discontinuing hormonal methods included
associated with their discontinued use of these methods. having ≥4 versus <4 lifetime sexual partners (adjusted odds
METHODS: In 2012, 350 sexually active black female clients ratio [aOR]: 1.7; 95% confidence interval [CI]: 1.0–3.0) and
of an Atlanta family planning clinic responded to a computer- having a mother who did not complete high school (aOR: 2.7;
assisted questionnaire concerning their contraceptive history 95% CI: 1.5–4.9).
and sexual behavior. We used multivariable logistic regression CONCLUSIONS: More than half of respondents who
to examine factors associated with discontinuing hormonal had ever used hormonal contraceptives reported they had
contraceptive methods. discontinued doing so, and many reported using no form
RESULTS: Sixty-six percent of respondents reported having of contraception the last time they had sex. These findings
used some type of hormonal contraception: 47% injectable suggest a need for strategies to improve continuation of
contraception (DMPA), 34% oral contraceptives (OCs), hormonal contraceptives among teens or to encourage
10% the patch, 6% the vaginal ring, and 24% >1 method. Of selection of highly effective user-independent methods, such
those who ever used a hormonal method, 51% reported no as intrauterine devices or implants.
longer using one, and 40% of former users reported using KEYWORDS: family planning methods; oral contraceptives;
no contraceptives the last time they had sex. Respondents contraceptive agents, adverse effects; contraceptive method
frequently cited perceived body or menstrual cycle changes switching; healthcare disparities
WEDNESDAY
11:15 Evaluation of the Integration of Rapid Syphilis Testing into Routine Antenatal
Services — Nyanza Province, Kenya, 2012
AUTHORS: Eleanor B. Fleming, K. O’Connor, I. Sadumah, J. Oremo, S. Kola, S. Oswago, C. Zeh, R. Quick,
M. Kamb
BACKGROUND: Syphilis infection results in perinatal RESULTS: Syphilis testing at first ANC visit increased from
death or disability in approximately 60% of untreated 18% (279 of 1,586 attendees) in the 12 months before the
pregnant women. Nyanza Province has the highest syphilis intervention to 70% (1,123 of 1,614 attendees) during the
burden (2.3% of reproductive-aged women) and the second 12-month intervention period (P <0.001); 35 women (3%)
highest neonatal mortality rate (39 per 1,000 live births) in tested positive during the intervention period compared with
Kenya. We evaluated how integrating rapid syphilis tests 1 (<1%) during the previous 12 months (P <0.001). None of
(RSTs) and penicillin treatment kits into routine antenatal the 8 clinics recorded syphilis treatment according to training
clinic (ANC) services affected syphilis testing, diagnosis, and recommendations. However, 6 of the clinics identified 28
treatment in 2 rural districts in Nyanza. RST-positive women and recorded 34 treatment kits as used
METHODS: In February 2011, nurses from 8 rural clinics (1.2:1 ratio of treatment to positive results).
were trained in using RSTs and documenting test results and CONCLUSIONS: Integrating RSTs into rural ANC services
treatment. During March 2011–February 2012, free RSTs increased syphilis testing and detection. Better record keeping
and treatment kits were provided to clinics for use during the of the treatment of syphilis in RST-positive women is needed.
first ANC visits. We analyzed antenatal registry data during KEYWORDS: congenital syphilis, prenatal care, Kenya,
the 12-month periods before and during RST program female urogenital diseases, pregnancy complications
implementation and used chi-square tests to compare syphilis
testing, diagnosis and treatment during the 2 periods.
11:35 Relationship Between Use of Labor Pain Medication and Delayed Onset
of Lactation — United States, 2005–2007
AUTHORS: Jennifer N. Lind, C. Perrine, R. Li
BACKGROUND: Delayed onset of lactation (DOL) is RESULTS: Among women who initiated breastfeeding (n
associated with early cessation of breastfeeding; shorter = 2,586), 23.6% experienced DOL. Compared with women
breastfeeding duration is associated with a higher risk for who received no labor pain medication, women who received
infections and sudden infant death syndrome in infancy and a spinal/epidural only (adjusted odds ratio [aOR]: 2.10; 95%
for obesity and diabetes later in life. Despite estimates that confidence interval [CI]: 1.47, 3.00), those who received a
86% of mothers in the United States receive pain medications spinal/epidural plus another medication (aOR: 2.31; 95% CI:
during labor/delivery, little research has been done on how 1.55, 3.45), and those who received only labor pain medication
use of these medications affects onset of lactation. other than a spinal/epidural (aOR: 2.25; 95% CI: 1.43, 3.54)
METHODS: In multivariable logistic regression analyses had more than twice the odds of experiencing DOL.
of data from the 2005–2007 Infant Feeding Practices Study CONCLUSIONS: Mothers who received pain medications
II, a longitudinal study of mothers and infants, we assessed during labor/delivery were more likely to experience DOL.
the relationship between mothers’ self-reported use of labor Pregnant women should be informed that use of labor pain
pain medication (classified as none, spinal/epidural only, medications may delay onset of lactation. Interventions
spinal/epidural plus another medication, or only labor pain aimed at providing additional breastfeeding support in the
medication other than a spinal/epidural) and DOL (milk early postpartum period to women who receive labor pain
coming in ≥4 days after delivery). Fully adjusted models medications may help improve breastfeeding outcomes.
controlled for potential confounders identified in bivariate KEYWORDS: breastfeeding, lactation, labor pain, obstetri-
analyses (P<0.05). cal analgesia, obstetrical anesthesia, risk factors
WEDNESDAY
Of course we don’t know what we are doing;

that’s why it’s called research.
—Albert Einstein

12:30–1:30 pm
WEDNESDAY
Poster 2.1 Histoplasmosis Outbreak at a Day Camp — Nebraska, 2012
AUTHORS: Kristin M. Yeoman, B. Buss, T. Safranek, A. O’Keefe, J. Frederick, B. Harmon, B. Cadwell,

B. Park
BACKGROUND: Histoplasma capsulatum, a fungus RESULTS: Among 32 counselors, 19 cases (18 confirmed)
endemic to Nebraska, can cause respiratory illness from occurred; no activities or campsite assignments were
inhaling soil contaminated with bird or bat droppings. On associated with illness. Among 797 children, data were
June 21, Nebraska health authorities were notified of acute obtained for 153; 17 cases (5 confirmed) occurred. Bat
respiratory illnesses among counselors at a children’s day guano was noted on picnic tables and dirt floors at 2 of 12
camp. We investigated the outbreak’s extent and source to campsites. Children assigned to campsites with, or ≤20 yards
prevent further infections. from, guano had 2.4 (95% confidence interval [CI]: 0.5–11.4)
METHODS: We reviewed camp records, administered and 2.2 (95% CI: 0.5−8.2) times the illness odds, respectively.
questionnaires to counselors and attendees’ parents, and Illness odds decreased as distance from guano-affected
inspected the site. A confirmed case was a serum or urine campsites increased (Cochran-Armitage P = 0.04).
test positive for H. capsulatum anytime after camp arrival. A CONCLUSIONS: Campsite contamination by bat guano,
suspected case was illness comprising fever and ≥1 additional which likely became aerosolized during activities, probably
symptom (headache, chest pain, shortness of breath, cough) caused this outbreak. The day camp was relocated; we
≥3 days after camp arrival. A retrospective cohort study identified no further cases. Camp administrators were
evaluated associations between counselor activities, campsite instructed in campsite biohazard mitigation.
assignments, and illness. We compared illnesses among KEYWORDS: histoplasmosis, histoplasma, respiratory tract
children by campsite assignment (campsites with, or ≤20 diseases, logistic models
yards from, guano versus those ≥21 yards away [referent
group]) by using multilevel logistic regression with a random
effect for campsite.
Poster 2.2 S
almonella enterica Serotype Typhimurium Infection Associated
with Cantaloupe — Kentucky, 2012
AUTHORS: Elizabeth S. Russell, T. Sugg, S. Adams, L. Iwig, J. Tobias, W. Grooms, M. Reed, K. Humbaugh,
T. Vaughn, D. Thoroughman
BACKGROUND: In July 2012, the Kentucky Department for patient age was 58 years (range: 3–100 years); 49 (70%)
Public Health identified an increase in reported salmonellosis reported hospitalization, and 3 (4%) died. Among 32 patients
cases >3 times the Kentucky weekly average. These included interviewed, 27 (84%) reported having consumed cantaloupe.
an outbreak of Salmonella Typhimurium with a pulsed- Site visits to grocery stores of interest revealed opportunities
field gel electrophoresis (PFGE) pattern rarely reported in for cross-contamination through use of common surfaces and
Kentucky and that PulseNet matched to cases in other states. utensils for cutting produce. The outbreak strain was isolated
We investigated to identify the vehicle and source of the from two cantaloupes collected from a grocery store with a
Kentucky outbreak and prevent additional cases. single cantaloupe supplier, Farm A, and from cantaloupes
METHODS: We defined a case as laboratory-confirmed sampled from Farm A fields. PulseNet ultimately linked the
Salmonella Typhimurium matching the outbreak PFGE outbreak to 240 illnesses in 20 states.
pattern isolated from a Kentucky resident during July 7– CONCLUSIONS: Epidemiologic and laboratory investi-
September 30, 2012. Telephone interviews provided patient gations traced an outbreak of salmonellosis to a cantaloupe
food histories for 72 hours before illness onset. We visited vehicle and through the supply chain to Farm A. The propor-
grocery stores, collected samples of implicated items, and tion of patients hospitalized was higher than expected for Sal-
performed a traceback investigation. Environmental samples monella Typhimurium, even when considering patients’ age.
for laboratory testing were collected from the farm that grew KEYWORDS: foodborne diseases; Salmonella infections;
sampled cantaloupes. electrophoresis, gel, pulsed-field
RESULTS: We identified 70 matching cases of Salmonella
WEDNESDAY
Typhimurium with illness onsets July 11–August 22. Median
Poster 2.3 Assessing Household Preparedness for Radiologic Emergencies —

Michigan, 2012
AUTHORS: Mawuli K. Nyaku, S. Bies, M. Stanbury, J. McFadden, A. Schnall, A. Wolkin, T. Bayleyegn,

M. Murti
BACKGROUND: Approximately 1 million persons in medication for each person who needed it. Additionally,
Oakland County, Michigan, reside within 50 miles of 66.8% had a carbon monoxide detector, and 51.3% had a
the Fermi Nuclear Power Plant. In support of radiation backup heat source. In response to instructions from public
emergency response plans, we assessed Oakland County health officials, 92.5% of all households would report to a
households’ preparedness for a radiologic emergency by radiation screening center; 94.7% would evacuate; and 90.1%
using a Community Assessment for Public Health Emergency would shelter-in-place. During a radiologic emergency, 55.3%
Response (CASPER) survey. of households indicated their main source of information
METHODS: During September 2012, we used a two-stage would be television, followed by radio (25.0%) and the
cluster sampling design to select 210 representative households Internet (11.4%).
in Oakland County. Through in-person surveys, we assessed CONCLUSION: Oakland County households should be
the proportion of households with essential supplies, how educated to maintain personal emergency stocks of food,
they would respond to public health instructions during a water, and essential medications and access to a backup heat
radiologic emergency, and their main source for information. source for sheltering-in-place. Approximately 90% of county
Data were weighted to account for the complex sampling residents will follow instructions from public health officials,
design. and communication plans should target television, radio,
RESULTS: Among the 210 selected households, 192 (91.4%) and the Internet, with contingency plans for situations where
surveys were completed; 85.6% and 62.5% of households electricity is unavailable.
indicated a 3-day supply of nonperishable food and water, KEYWORDS: disaster planning, needs assessment,
respectively; 96.6% had a 7-day supply of prescription radiologic health, Civil Defense
Poster 2.4 Cross-Transmission of Ascaris Infection from Pigs to Humans

at an Organic Farm — Coastal Maine, 2012
AUTHORS: Leigh Ann Miller, S. Sears, E. McEvoy, P. Carson, B. Mathison, M. de Almeida, A. Dasilva,
H. Bishop, S.P. Montgomery
BACKGROUND: Human infection with Ascaris, a soil- one apprentice provided a worm for testing. Farm pigs were
transmitted roundworm, is rare in the United States but treated with dewormer in July; however, the September
common globally. Adult worms live in the small intestine pooled fecal sample contained Ascaris ova, and when the 10
and can cause intestinal blockages. Pig and human ascarids, pigs were slaughtered in October worms were recovered from
Ascaris suum and Ascaris lumbricoides, respectively, are half of the pigs. Molecular speciation of the apprentice’s and
indistinguishable morphologically. The role of Ascaris cross- pigs’ worms is ongoing. Farm practices reflected industry
transmission from pigs to humans is undetermined. In standards. Dirt was noted on the apprentices’ hands, neither
September 2012, Ascaris infections were reported in two U.S.- wore gloves during pig contact, and pig manure might have
born female apprentices working on an organic vegetable been used for vegetable compost.
farm. We investigated to confirm the cases and determine CONCLUSIONS: The timing of illness at this farm suggests
whether cross-transmission had occurred. that cross-transmission from pigs to humans probably
METHODS: We visited the farm, interviewed the occurred. To prevent further human Ascaris infections, we
apprentices, inspected pig-farming practices, and collected recommended better hand hygiene, excluding pig manure
pooled pig feces and worms from pigs and one apprentice for from compost, growing vegetables away from areas where
analysis. pigs are penned, and thorough washing of vegetables possibly
RESULTS: Farm apprentices had direct daily contact with contaminated by Ascaris ova.
the farm’s 10 pigs, beginning May 2012, and had onset of KEYWORDS: Ascaris suum, Ascaris lumbricoides, organic
nausea and malaise in September. Both women had excreted agriculture, Maine
WEDNESDAY
multiple worms and received anthelminthic treatment; only
Poster 2.5 M
ycobacterium fortuitum Surgical-Site Infections Associated with an
Ambulatory Plastic Surgery Center — Los Angeles County, 2010–2012
AUTHORS: Christina A. Mikosz, M. Kim, C. Tyson, L. Eusebio, H. Rivas, M. Luarca, J. Sturgeon,

C. Landowski, H. O’Connell, T. MacCannell, L. Mascola
BACKGROUND: Mycobacterium fortuitum is a ubiquitous surgical staff, patient order, day of week, or surgery length.
environmental bacterium increasingly associated with PFGE of isolates from case-patients undergoing surgery over
surgical-site infections (SSIs), causing disfiguring infections a 14-month period in this outbreak was indistinguishable,
that require prolonged antibiotic regimens. In October 2011, suggesting a common source. Infection control breaches
an outbreak of five M. fortuitum SSIs was reported among were observed, including medication vials opened with a
patients at a Los Angeles County ambulatory plastic surgery nonsterile tool for wound irrigation and a microwave shared
center (Facility A). We investigated to identify the source and for sterile solutions and food. Approximately 100 specimens
stop transmission. were collected, including water from multiple sources. All
METHODS: Cases were SSIs presenting >30 days after were M. fortuitum culture–negative, except for a sample from
surgery at Facility A during December 2010–October 2012. an upstairs aquarium that had previously leaked into Facility
A case-control study was conducted; control subjects were A’s ceiling; PFGE of this isolate is pending.
well patients selected randomly from months without cases. CONCLUSIONS: Strict adherence to aseptic technique,
Pulsed-field gel electrophoresis (PFGE) was performed on including sterile access of medication vials intended for
available M. fortuitum isolates. Site visits were conducted for wound irrigation and dedication of equipment for surgical
chart review, observation of infection control practices, and use, might have prevented this outbreak. Oversight of
environmental sampling. infection control practices in ambulatory surgical centers,
RESULTS: Seven case-patients were identified, including which differs widely, may prevent outbreaks.
a second cluster that underwent surgery during June–July KEYWORDS: nontuberculous mycobacteria; surgical
2012. Case-patients and control subjects did not differ by wound infection; surgery, plastic; infectious disease outbreaks
Poster 2.6 Diversion of Controlled Substances Among Prescription Overdose

Deaths — New Mexico, 2011
AUTHORS: Carrie S. McNeil, M. Landen, J. Roeber, J. Davis, B. Whorton, S. Lathrop
BACKGROUND: New Mexico has had the highest rate women (63%), Hispanics (55%), and non-Hispanic whites
of drug overdose deaths in the nation. During the past (62%). Diversion was greater among those overdosing on
decade, prescription-drug overdose deaths and opiate benzodiazepines (73%) and combinations of opiates and
sales have increased dramatically. An investigation of New sedative hypnotics (71%) than opiates alone (61%). Diversion
Mexico prescription-drug overdose deaths was conducted to was common among those who died from prescription-
determine how controlled substances had been accessed. drug and alcohol (78%) or prescription-drug and illicit-drug
METHODS: Prescription Monitoring Program data were (71%) combinations or had history of mental illness (63%),
linked by decedent name and birth date to prescription- overdose (57%), and alcohol (67%), illicit-drug (70%), or
drug overdose decedents during 2011, as identified by the prescription-drug (62%) abuse.
Office of the Medical Investigator. Diversion was defined as CONCLUSION: The majority of decedents accessed
lacking a current prescription for any controlled substances controlled substances through diversion. Diversion was most
causing death. For current prescriptions, days of pharmacy- evident among men, American Indians, and decedents who
supplied medication overlapped date of death. We compared had taken benzodiazepines or who had substance abuse
decedents’ characteristics with and without diversion by or mental illness. Future deaths might be averted through
demographics, pharmaceutical category, and substance abuse educating these groups about life-threatening risks of taking
or mental illness history. controlled substances without a prescription or with illicit
RESULTS: Diversion of one or more controlled substances drugs or alcohol.
was identified in 67% of 312 decedents and of all controlled KEYWORDS: prescription drug misuse, substance abuse,
substances in 45%. More men (70%) and American substance abuse detection, controlled substances, medication
WEDNESDAY
Indians (91%) had evidence of diversion, compared with therapy management
Poster 2.7 Tri-National Outbreak of Salmonella enterica Serotype Braenderup —

The California Experience, July–September 2012
AUTHORS: Rachael H. Joseph, A. Kimura, D. Gilliss, J. Lidgard, J. Pringle
BACKGROUND: Salmonella is a leading cause of foodborne illness in a matched case-control study of 37 case-patients
infections and hospitalizations in the United States. An and 46 control patients (odds ratio = 4.6; P value: 0.001).
increasingly globalized food market has led to potential A traceback investigation identified a mango producer in
for multinational outbreaks of Salmonella. In August 2012, Mexico as the source of mangoes consumed by case-patients
the California Department of Public Health, CDC, and in California, other U.S. states, and Canada. These mangoes
Canadian health officials identified clusters of Salmonella were voluntarily recalled by distributers beginning in late
Braenderup infections with indistinguishable pulsed-field gel August and placed on import alert on September 13, 2012.
electrophoresis patterns. CDPH initiated an investigation to Although Salmonella was isolated from recalled mangoes
determine the outbreak source and prevent further illness. tested by the U.S. Food and Drug Administration, the
METHODS: A case was defined as an outbreak strain isolate outbreak strain was not detected.
of Salmonella Braenderup from a California resident on CONCLUSIONS: The epidemiologic investigation con-
or after July 1, 2012. We conducted an age- and ethnicity- ducted in California identified the source of a multistate,
matched case-control study. Control patients were selected trinational outbreak of Salmonella Braenderup. Findings were
from the state Salmonella registry among persons without shared with U.S., Canadian, and Mexican health officials. This
the outbreak strain. Purchase information was collected from investigation highlights the increasing importance of trans-
interview respondents to assist in a traceback investigation. national communication when outbreaks cross borders.
RESULTS: Of 127 cases identified in the United States, 102 KEYWORDS: Salmonella, foodborne diseases, mango, case-
(80%) were California residents; of these, 78% were Hispanic. control studies
Fresh mango was the only food significantly associated with
Poster 2.8 Recognizing Laboratory Cross-Contamination: Two False-Positive

Cultures of Mycobacterium tuberculosis — Oklahoma, 2011
AUTHORS: Matthew G. Johnson, K. Bradley, P. Lindsey, C. Harvey
BACKGROUND: Mycobacterium tuberculosis (MTB) mycobacterial interspersed repetitive unit typing of the three
isolation from clinical specimens is the standard for specimens were indistinguishable. Only liquid media grew
tuberculosis (TB) diagnosis and activates a public health MTB from both questionable specimens; a splash incident
response that can include long-term antibiotic therapy and was suspected, whereby all three liquid media sample lids
extensive contact investigations. Positive MTB cultures are were open during inoculation rather than being opened
rarely questioned, but false-positive culture rates are 2%–4%. one at a time, causing cross-contamination. Also, both
During December 2011, two smear-negative culture-positive questionable specimens were incubated for 2–3 weeks longer
TB cases were reported to the Oklahoma State Department than standard protocol before MTB growth was observed.
of Health (OSDH) in persons without TB signs or symptoms. One of the two patients, an organ transplant recipient, began
We investigated to determine if these were actual TB cases. 4-drug anti-TB therapy, and an investigation was initiated for
METHODS: OSDH TB control staff interviewed physicians transplant-associated TB; both were ultimately discontinued.
and laboratorians, reviewed patient charts, traced epidemio- CONCLUSIONS: Two false-positive MTB cultures resulted
logic links, and ordered microbiologic studies. from laboratory cross-contamination. Adherence to strict
RESULTS: For both patients, TB cultures were ordered laboratory techniques and recognizing the possibility of
without specific clinical suspicion. Both MTB specimens were false-positive MTB cultures, especially when inconsistent
processed on the same day, at the same laboratory, under the with clinical data, are essential in preventing erroneous TB
same hood, and by the same technician sequentially after a diagnoses.
strongly smear-positive TB specimen. No epidemiologic links KEYWORDS: tuberculosis, laboratories, medical errors,
were identified among the three persons. Spoligotyping and case reports
WEDNESDAY
Poster 2.9 HIV-Related Mortality and Monitored Viral Load, by Zip Code —
Cook County, Illinois, 2010
AUTHORS: Yoran T. Grant, F. Ma, A. Satcher Johnson, K. Soyemi
BACKGROUND: Human immunodeficiency virus (HIV)- through December 31, 2009, 403 (2.2%) died in 2010, and
related mortality remains disproportionately high among 4,670 (26%) had ≥1 reported viral load result during 2010.
specific demographic groups despite advances in care. The GMVL was 186 copies/mL (22.5–276,400). The HIV-
Individual quality-of-care measures (e.g., viral load results) specific mortality ratio of zip codes with GMVL >75,000,
aid in predicting mortality risk, but do not explain differences compared with zip codes with lower GMVL, was 1.47 (95%
in mortality between groups in the same geographic region. confidence interval: 0.87–6.73). Validation analysis revealed
By examining a community-level quality-of-care measure, HLM had higher standard errors for parameter estimates
monitored viral load, we assessed correlation between quality than Bayesian analyses.
of care and HIV-related mortality in Cook County, Illinois. CONCLUSIONS: Monitored viral load might be useful for
METHODS: We calculated HIV geometric mean viral load understanding differences in HIV-related mortality; however,
(GMVL) by using viral load results from Illinois’ Enhanced high data completion for viral load results in surveillance data
HIV/AIDS Reporting System (eHARS). We calculated will be necessary. Analyses using community-level markers
HIV-specific mortality rates by zip codes by using 2010 (e.g. GMVL) might aid in targeting interventions to improve
vital statistics data for the numerator and 2010 eHARS HIV care access and antiretroviral adherence to communities at
prevalence data for the denominator. To assess variability in highest risk. Bayesian methods might improve the precision
HIV-related mortality by GMVL, we fit a hierarchical linear of model estimates by reducing error.
model (HLM). For validation, we fit a comparable Bayesian KEYWORDS: HIV, health status disparities, community
model by using 2009 data. health services, viral load
RESULTS: Among the 17,962 persons with HIV reported
Poster 2.10 Animal-Related Unintentional Injury Deaths — Montana, 2003–2011
AUTHORS: Abbey J. Canon, C. Custis, S. Helgerson, R. Nett
BACKGROUND: Agriculture and recreation provide deaths occurred during April–September. Fifty-eight/109
opportunities for human-animal contact and for human (53.2%) animal-related deaths were caused by animal-vehicle
injury and death. In the United States annually during 1991– collisions, with deer causing 38 (65.5%) of those. Horses
2001, excluding animal-vehicle collisions and zoonoses, an caused 30/51 (58.8%) nonvehicular deaths; head injuries
average of 177 deaths (0.06/100,000 population) resulted contributed to 22/29 (75.9%) horse-caused deaths. Venomous
from animal encounters. To develop prevention programs, animals caused two fatalities. Compared with using only
we investigated and characterized animal-related injury ICD-10 codes in ascertaining deaths, keyword searches
deaths in Montana. identified all 58 animal-vehicle collisions and an additional
METHODS: We reviewed death certificates from 24 nonvehicular deaths. For only ICD-10-coded deaths,
unintentional injury deaths in Montana for 2003–2011. the average rate of nonvehicular animal-related deaths was
Vehicular and nonvehicular animal-related deaths were 0.30/100,000 population, and when keywords were included,
identified by using International Classification of Diseases-10 0.57/100,000 population.
(ICD-10) codes and keywords, which were included if animal CONCLUSION: Using both keywords and ICD-10 codes
contact directly or indirectly resulted in death. Zoonoses- allowed a more comprehensive evaluation of animal-
related deaths were excluded. Rates were calculated by using related deaths; compared with prior national estimates, the
2010 Census data. nonvehicular animal-related death rate in Montana was 9.5-
RESULTS: Among 5,349 unintentional injury deaths fold higher. Efforts should focus on equestrian safety and
identified, 109 (2.0%) were animal-related. Median age preventing animal-vehicle collisions in Montana.
of the 109 decedents was 50 (range: 4–89) years. Seventy- KEYWORDS: Montana, wounds and injuries, animals,
one (65.1%) animal-related deaths were among males (rate horses, death certificates, International Classification of
1.59/100,000 population), 1.5 times higher than among Diseases
WEDNESDAY
females (1.06/100,000 population). Eighty-four (77.1%)
Poster 2.11 Central-Line–Associated Bloodstream Infection Reporting

Through the CDC National Healthcare Safety Network — Kansas,
January 2011–June 2012
AUTHORS: Suparna Bagchi, D.C. Hunt, R. Geist, K. Bisgard, J. Scaletta
BACKGROUND: Annually in the United States, 18,000 increased from 50% to 89%. During January 2012–June
central-line–associated bloodstream infections (CLABSIs) 2012, completeness of CLABSI denominator reporting was
occur in hospital intensive care units, with 12%–25% 97%; required data regarding CLABSI reporting forms were
mortality and costing ~$25,000/event. In January 2011, 100% complete, whereas nonrequired data were 20%–40%
voluntary CLABSI reporting was initiated in Kansas by using complete. Eighty (59%) of 136 IPs responded to the survey;
CDC’s Internet-based National Healthcare Safety Network a median of 8 (range: 7–10) data sources were accessed
(NHSN). Because CLABSI surveillance is new in Kansas, we monthly to report CLABSI. NHSN was used by 52 (65%) of
evaluated its attributes. 80 respondents; regarding understanding of CLABSI case
METHODS: We reviewed data for January 2011–June definitions, 62% self-rated “good/excellent,” and 8% self-
2012 from participating acute-care hospitals (ACHs) with rated “somewhat/not at all.” Formal required online training
>25 beds to measure timeliness (proportion of events to meet NHSN enrollment requirements was reported by 34
reported ≤30 days from month’s end) and data quality (data (65%) of 52 IPs.
completeness and denominator reporting). In September CONCLUSIONS: CLABSI reporting through NHSN
2012, we surveyed infection preventionists (IPs) from all is timely but complex. Our survey results indicate that
Kansas hospitals to measure simplicity (data sources accessed additional IP training and CLABSI validation can help
to generate reportable data, understanding of NHSN CLABSI strengthen surveillance.
case definition, and IP training experience). KEYWORDS: cross infection, infection control practitio-
RESULTS: During January 2011–June 2012, CLABSI was ners, prevention and control, Kansas
monitored in 93% (38/41) of ACHs; reporting timeliness
Poster 2.12 Rapid Response to Escherichia coli O157 Outbreak — New York, 2012
AUTHORS: Nina Ahmad, J. Karr, G. Smith, K. Burzlaff, T. Nguyen, L. Gieraltowski, M. Anand, A. Newman,
D. Schoonmaker-Bopp, T. Root, J. Egan, D. Nicholas, N. Dumas, K. Musser, E. Sawyer, J. Luker, T. Quinlan,
T. Halse, C. Hidalgo
BACKGROUND: Shiga-toxin–producing Escherichia coli among the reference population (P = 0.007). Twenty-three
causes ~265,000 illnesses annually in the United States, of cases were identified, all with exposure to prepackaged leafy
which ~96,000 are caused by E. coli O157:H7 (O157). During greens; median patient age was 25 years (range: 6–66 years); 16
October–November 2012, public health officials investigated (70%) were female; and illness onsets occurred October 18–
a cluster of five O157 infections in western New York to November 3. The outbreak strain was recovered from leftover
determine extent of the cluster, identify the source, and prepackaged leafy greens from four patients’ homes. Within
prevent further illness. 8 days of the initial O157 report, Chain A issued a product
METHODS: A case was O157 infection in a New York recall on the basis of initial laboratory and epidemiologic
resident with an isolate having one of two related pulsed-field results plus product package labels from patients revealing
gel electrophoresis (PFGE) patterns. We interviewed the five a common lot code and sell-by date. No further cases were
initial patients with hypothesis-generating questionnaires identified.
and calculated binomial probabilities by using the 2006–2007 CONCLUSIONS: Prompt investigation, close cooperation
FoodNet Population Survey, analyzed shopper card data, between public health authorities and industry, and timely
cultured prepackaged leafy greens from patients’ homes and interventions were successful in controlling this outbreak
grocery stores for E. coli O157, and conducted trace-back associated with prepackaged leafy greens. Investigations of a
investigations. common source for the product are ongoing.
RESULTS: All five initial patients recalled eating grocery KEYWORDS: Escherichia coli O157, foodborne diseases,
store Chain A-brand prepackaged leafy greens; consumption disease outbreaks, electrophoresis, gel, pulsed-field
of prepackaged leafy greens was significantly higher than
WEDNESDAY
Poster 2.13 Where’s the Beef? Outbreaks of Salmonella Infections Attributed

to Beef — United States, 1975–2011
AUTHORS: Alison S. Laufer, J. Grass, L. Gould
BACKGROUND: Salmonella is the most common bacterial beef was implicated in nine of 11 multistate outbreaks. A
cause of foodborne illness in the U.S., estimated to cause higher percentage of case-patients were hospitalized in
>1 million illnesses annually. Although beef is frequently ground beef outbreaks than in all other outbreaks (median:
implicated in outbreaks of salmonellosis, Salmonella is 15% versus 7%) (P = 0.04). Seven (54%) of 13 outbreaks with
not usually considered a beef adulterant. We present the antimicrobial susceptibility data available were caused by
epidemiology of beef-attributed outbreaks of salmonellosis resistant strains; ground beef was the implicated vehicle in all
in the U.S. during 1975–2011. seven. A higher percentage of case-patients were hospitalized
METHODS: We reviewed the Foodborne Disease Outbreak (30%) in outbreaks caused by resistant strains than in
Surveillance System, National Antimicrobial Resistance outbreaks caused by pansusceptible strains (9%) (P = 0.03).
Monitoring System, and literature for outbreaks (≥2 CONCLUSION: Ground beef emerged as an important
cases of similar illness) of salmonellosis attributed to beef vehicle in beef-attributed outbreaks of salmonellosis in the
during 1975–2011. Variables analyzed included geographic 2000s. Ground beef outbreaks had more hospitalizations than
distribution, outbreak size, and antimicrobial susceptibility. other outbreaks, were frequently multistate, and were often
RESULTS: Ninety-five outbreaks were reported, resulting caused by resistant strains. Stronger measures are needed
in 3,643 illnesses, 318 hospitalizations, and five deaths. Of 18 to decrease contamination of ground beef with Salmonella,
beef cuts reported, two predominated, roasts (25 outbreaks; especially resistant strains.
26%) and ground beef (22; 23%). Eighty percent of roast KEYWORDS: Salmonella food poisoning; infectious disease
outbreaks occurred during 1975–1991, whereas 77% of outbreak; food supply; cattle; drug resistance, bacterial
ground beef outbreaks occurred during 2002–2011. Ground
Poster 2.14 Prevalence of Obesity in a Nationally Representative Sample of

HIV-Infected Adults Receiving Medical Care in the United States —
Medical Monitoring Project, 2009
AUTHORS: Angela M. Thompson-Paul, S. Wei, C. Mattson, J. Skarbinski
BACKGROUND: Both obesity and HIV infection are However, obesity prevalence was higher among women aged
associated with increased cardiovascular disease risk, but <40 years in MMP (44.7%, CI: 38.2–51.4) versus NHANES
nationally representative prevalence estimates of obesity (31.9%). In MMP, obesity was twice as likely among women
among HIV-infected persons have not been reported. versus men (adjusted prevalence ratio [aPR]: 2.1; CI: 1.9–
METHODS: We analyzed 2009 data from the Medical 2.4) and 40% more likely among those without a 12th grade
Monitoring Project (MMP), a national probability sample education versus college graduates (aPR: 1.4, CI: 1.1–1.8).
of HIV-infected adults receiving medical care. We included Obesity was 30% less likely among those with AIDS (aPR: 0.7;
participants aged ≥20 years with available body mass index CI: 0.6–0.9). Race/ethnicity, poverty, and viral suppression
(BMI) data (n = 4,013); analyses accounted for complex did not significantly predict obesity.
survey design. Obesity prevalence (BMI >30.0 kg/m2) CONCLUSIONS: Although obesity is less common among
estimated from MMP was age-adjusted and compared with HIV-infected adults than among the general population,
estimated prevalence of obesity in the general population obesity affects nearly 1 in 4 HIV-infected adults in the United
from the National Health and Nutrition Examination Survey States and 45% of HIV-infected women aged <40 years.
(NHANES), 2009–2010. To identify factors associated with Comprehensive HIV care should include prevention and
obesity in MMP data, we performed logistic regression, using treatment of obesity to reduce morbidity and mortality from
predicted marginal means in SUDAAN to calculate adjusted adverse long-term outcomes.
prevalence ratios. KEYWORDS: HIV, obesity, cardiovascular diseases,
RESULTS: Obesity prevalence was lower in MMP (23.0%, morbidity, mortality
WEDNESDAY
confidence interval [CI]: 21.2–24.9 versus NHANES (36%).
Poster 2.15 Outbreak of Severe Enterovirus 71 Infections in Children —

Cambodia, 2012
AUTHORS: Brian S. Rha, G. Abedi, P. Kitsutani, B. Sar, A. Lor, C. Hales, C. Chow, S. Gerber, E. Schneider
BACKGROUND: Outbreaks of enterovirus 71 (EV71) least 8 were intubated, 12 (75%) died. The remaining 13 case-
infections in Southeast Asia have caused disease ranging patients had milder disease and were discharged. The majority
from mild febrile illness to fatal neuropulmonary disease, of case-patients were young (median age: 19 months; range:
but little is known about risk factors for severe disease. From 3 months–9 years), previously healthy (7% with chronic
April–August 2012, 103 children in Cambodia with severe underlying conditions [e.g., asthma], 28% underweight),
neuropulmonary disease were reported. We conducted an and from rural areas (64%) with a median household annual
investigation to generate hypotheses for risk factors and income of $600. Although 85% received treatment prior to
describe severe EV71 disease. hospitalization, 67% received medications they could not
METHODS: Cases were defined as hospitalized, laboratory- identify. No other attributes were identified as potential risk
confirmed EV71-positive children <15 years old with fever, factors for severe disease.
neurological and respiratory signs/symptoms within 7 days CONCLUSIONS: This is the first described outbreak of
of illness onset. From September 11–26, 2012, we conducted severe EV71 disease in Cambodia. Common features of case-
open-ended interviews (case-patient families, medical patients included rural residence and receiving unknown
providers) and medical record reviews for accessible cases. medications prior to hospitalization. Characterizing outpa-
RESULTS: Twenty-nine accessible cases from 12 provinces tient prescribing practices and evaluating sentinel surveil-
were investigated through 22 chart reviews and interviews of lance may be helpful in future efforts to identify risk factors
25 families, 20 clinics/pharmacies, and 7 physicians. Sixteen for severe disease.
case-patients (55%) had significant respiratory distress and/ KEYWORDS: human enterovirus 71, Cambodia, infectious
or died, consistent with severe neuropulmonary disease; at disease outbreaks, sentinel surveillance
Poster 2.16 Community Experiences, Perceptions, and Exposures to Hydrogen

Sulfide and Methane from Geothermal Venting — Lake County, California,
November 2012
AUTHORS: Cindy H. Chiu, M. Lozier, T. Bayleyegn, K. Tait, T. Barreau, L. Copan, R. Roisman, R. Cohen,
S. Smorodinsky, B. Christensen, J. Wilken, R. Kreutzer, S. Vagi, F. Yip, A. Wolkin
BACKGROUND: Hydrogen sulfide and methane gases home, including 23 (14.3%) who noticed a rotten egg smell
from geothermal venting can cause health effects and pose and 11 (6.8%) who saw unusual corrosion on metal surfaces.
risk of explosion. In Lake County, California, a region Fifty-eight (36.0%) had concerns about potential effects;
with geothermal activity, these gases have resulted in 55 (34.2%) were concerned about their family’s health. The
evacuating a mobile home, vacating an office building, and highest hydrogen sulfide reading was 5 parts per billion (ppb);
anecdotal reporting of possible health effects. The objective median readings in the different regions ranged from 0 to 4
of this investigation was to assess Lake County community ppb. Methane levels detected were ≤1% lower explosive limit.
exposures to and perceptions of geothermal gases using CONCLUSIONS: Lake County residents are aware of
the Community Assessment for Public Health Emergency geothermal venting, and some have reported concerns. Both
Response (CASPER). hydrogen sulfide and methane were detected below acute
METHODS: We used a two-stage cluster sampling design health effect levels. We recommend providing geothermal
(7 interviews in 30 clusters) to select 210 households to venting information to the community, documenting
interview regarding geothermal venting. We also measured community concerns, and conducting longer term air
outdoor levels of hydrogen sulfide and methane in 173 monitoring to better understand exposure risks and seasonal
locations in the community. variations. We will also examine the association between
RESULTS: We completed 161 household interviews measured levels and survey responses.
(completion rate: 76.7%). We found that 109 (67.7%) KEYWORDS: hydrogen sulfide, methane, hydrothermal
WEDNESDAY
households were aware of geothermal gases, and 33 (20.5%) vents, environmental health, air pollutants, gases
had experience with geothermal venting in or around their
SPECIAL SESSION: Fungal Meningitis Associated with Injection of

a Widely Distributed Steroid Product: Lessons Learned During the
Response to the Largest Documented Healthcare-Associated Outbreak
in U.S. History
12:30 pm
Dunwoody Suites
MODERATOR: J. Todd Weber
SPONSOR: NCEZID
WEDNESDAY
The 2012–2013 outbreak of fungal infections involved a injections, nearly everyone knew someone who might be at
contaminated product distributed throughout the United risk. Incoming and existing EIS officers and staff would be
States and injected into more than 10,000 patients. Due to exposed to the complexity of responding to such an outbreak,
the serious nature of fungal meningitis, the response, once and the requirement for flexibility and innovation during a
the contaminated product was identified, had to be rapid and situation for which few staff had direct previous experience.
to reach all exposed persons. In addition, CDC needed to
ensure that only one product was contaminated and causing • Introduction to the Outbreak: Lessons Learned in
disease, and generate clinical guidelines in real time based on Outbreak Detection from the State Perspective.
limited data for a previously rarely reported infection. The Marion Kainer
teams responding to the outbreak elected to collect all case
• Lessons Learned in Outbreak Response from the Mycotic
reports from anyone ill who had been exposed to any product
Diseases Branch, CDC. Benjamin Park
from the implicated company, work with FDA to test multiple
products, and collaborate with multiple groups to ensure • Lessons Learned in Development of Clinical Guidelines
direct contact of all exposed persons and collect available for a Previously Unknown Pathogen. Tom Chiller
clinical data to develop treatment guidelines. The scope and
nature of the response to a previously undescribed infection • How Regulation and Oversight of Compounding
were different from other outbreaks, and multiple lessons Pharmacies Changed as a Result of the Outbreak.
were learned that could be applied to outbreaks in the future. Howard Sklamberg
The fungal meningitis outbreak was widely reported and of

interest to many people; because of the commonness of these
You won’t be surprised that

diseases are innumerable — count the cooks.
—Seneca
SESSION J: Food and Waterborne Diseases

1:30–3:35 pm
Ravinia Ballroom
MODERATORS: Tim Jones and Ian Williams
WEDNESDAY
1:35 Salmonella enterica Serotype Paratyphi B var. Java Gastroenteritis Outbreak

Associated with Unpasteurized Tempeh — North Carolina, 2012
AUTHORS: Stephanie E. Griese, A. Fleischauer, J. MacFarquhar, Z. Moore, A. Valiani, S. Morrison,

D. Sweat, J.M. Maillard, D. Griffin, D. Springer, M. Davies, M. Mikoleit, A.E. Newton, B. Jackson, T. Nguyen,
S. Bosch
BACKGROUND: On March 30, 2012, the North Carolina in 5 states with illness onsets during February 29–May 8.
Division of Public Health (NCDPH) was notified by the state Median age was 26 years (range: 4–74 years); 8 (9%) had been
laboratory of five Salmonella enterica serotype Paratyphi B hospitalized; and none died. Eighty-three (93%) reported
var. Java infections among residents of County A with a novel travel to County A. Among 41 patients interviewed, 18
pulsed-field gel electrophoresis (PFGE) pattern. Although (44%) reported consuming unpasteurized Brand A tempeh;
Salmonella is a leading cause of foodborne illness, only 1.1% all reported visiting establishments where Brand A Tempeh,
of Salmonella isolates are serotype Paratyphi B var. Java. originating from a common, local producer, was served. The
We investigated to identify the vehicle and prevent further outbreak strain was identified in samples of Brand A Tempeh
illnesses. and the mold ingredient used for fermentation. We observed
METHODS: We defined a confirmed case as laboratory- inconsistent hand hygiene and preparation of unpasteurized,
confirmed Salmonella Paratyphi B var. Java with the uncooked tempeh on shared surfaces at the implicated
outbreak PFGE pattern (outbreak strain) and a probable restaurants.
case as gastroenteritis in an epidemiologically linked person. CONCLUSIONS: This is the first reported outbreak
We reviewed PulseNet data and 89 case report forms, caused by exposure to contaminated unpasteurized tempeh.
identified frequent exposures, and reinterviewed 41 patients Consistent hand hygiene and separation of uncooked tempeh
for exposure to frequently implicated food items and from ready-to-eat foods should be encouraged.
restaurants. We conducted restaurant site visits and reviewed KEYWORDS: Salmonella Paratyphi B, foodborne diseases,
product invoices.
soy foods, food handling
RESULTS: We identified 89 cases (87 confirmed, 2 probable)
1:55 Outbreak of Listeriosis Associated with Imported and Cross-Contaminated

Cheeses — Multiple States, March–October 2012
AUTHORS: Michael Gronostaj, K.E. Heiman, B. Garalde, M. Adams-Cameron, S. Beam, L. Joseph,

Z. Kucerova, J. Lando, P. LeBlanc, M. Metz, G. Ray, E. Ricotta, A. Sabol, A. Saupe, H. Waechter,
A. Wellman, R. Tauxe, P.M. Griffin, B. Silk
BACKGROUND: Listeriosis causes ~255 U.S. deaths among outbreak-associated than sporadic patients (odds ratio
annually. In July 2012, a case was reported to Allegheny County = 17.3; 95% confidence interval: 2.0–825.7); no specific cheese
(Pennsylvania) Health Department. Listeria monocytogenes was initially reported by ≥2 patients. In follow-up interviews,
was isolated from two different soft cheeses from the patient’s 10/11 (91%) patients reported consuming 10 different cut
refrigerator and one at a retail outlet. PulseNet identified and repackaged soft cheeses. The outbreak strain was isolated
four patient isolates with indistinguishable pulsed-field gel from four cut and repackaged cheeses from wholesale, retail,
electrophoresis (PFGE) patterns. CDC, FDA, and health and residential locations, and from multiple intact wheels of
officials investigated to identify the source and prevent Italian ricotta salata cheese. Fourteen (78%) of 18 patients
further illness. interviewed were linked to ≥1 soft cheese; seven were directly
METHODS: We defined cases as Listeria infection with the linked to the ricotta salata. FDA issued an import alert, and
outbreak strain during March–October 2012. We compared the U.S. distributor recalled the cheese. Four outbreak-related
patients’ food exposures reported on standard questionnaires PFGE subtypes were indistinguishable by MLVA.
with those of patients with sporadic listeriosis reported to CONCLUSIONS: Imported ricotta salata was the outbreak
CDC during 2008–2012. We reviewed retail inventories source. Cross-contamination of cut and repackaged cheeses
to prioritize cheese testing. Isolates were characterized by expanded the outbreak. This first U.S. listeriosis outbreak
using PFGE and multilocus variable-number tandem-repeat associated with cross-contaminated cheeses led to a
analysis (MLVA). multinational recall.
RESULTS: Fourteen states reported 22 cases (4 deaths, 1 fetal KEYWORDS: listeriosis, Listeria, foodborne diseases,
WEDNESDAY
loss). Soft-cheese consumption was reported more commonly cheese
2:15 almonella enterica serotype Typhimurium Gastrointestinal Illness

S
Associated with a University Microbiology Course — Maryland, 2011
AUTHORS: Maria A. Said, S. Smyth, J. Wright-Andoh, R. Myers, J. Razeq, D. Blythe
BACKGROUND: In November 2011, the Maryland the course during 2010. No other common exposures were
Department of Health and Mental Hygiene (DHMH) identi- identified. Salmonella Typhimurium had been removed
fied two Salmonella Typhimurium isolates indistinguishable from use in 2008 because of safety concerns; however,
by pulsed-field gel electrophoresis (PFGE). Both patients testing demonstrated that a culture thought to be Citrobacter
were enrolled in University A’s introductory microbiology freundii was actually Salmonella Typhimurium. Multilocus
laboratory course, which required working with unknown variable-number tandem repeat analysis and PFGE testing
specimens (“mystery broths”) not thought to include Salmo- from the mislabeled Salmonella Typhimurium and the three
nella, a biosafety level 2 (BSL-2) organism. We investigated to patients’ isolates were indistinguishable. These cases were
identify additional cases and exposure source. part of a larger, multistate cluster associated with exposure to
METHODS: Cluster-associated salmonellosis was defined microbiology laboratories.
by gastrointestinal illness and isolation of PFGE-matching CONCLUSION: Organism mislabeling contributed to
Salmonella Typhimurium from a clinical specimen. Patients three salmonellosis cases among University A microbiology
were interviewed using a standard questionnaire, and students. In response, University A implemented enhanced
DHMH case reports since 2002 were reviewed for other cases safety procedures, including removal of all BSL-2 organisms
with laboratory exposures. Health department personnel from mystery broths; CDC issued recommendations
inspected the laboratory, reviewed the course syllabus and to encourage increased laboratory safety. This cluster
procedures, interviewed faculty, and assisted faculty with demonstrates the importance of safe practices in labeling,
organism testing. storage, and manipulation of organisms in academic facilities.
RESULTS: Three indistinguishable isolates were identified KEYWORDS: Salmonella Typhimurium, Salmonella,
with University A exposure, including the two initially microbiology, laboratory infection, molecular typing
identified and a third patient who became ill while taking
2:35 Emergence of GI.6 Norovirus — United States, 2009–2012
AUTHORS: Eyal Leshem, L. Barclay, M. Wikswo, N. Gregoricus, J. Vinjé, U. Parashar, A. Hall
BACKGROUND: Noroviruses are the leading cause of occurred in 26 states and affected >2,908 persons. The most
epidemic gastroenteritis in the United States. Emergence of common mode of transmission was person to person (54%),
new variants has been associated with increased outbreak followed by foodborne (24%). Long-term care facilities were
activity. During 2011–2012, a previously rare genotype the most frequently reported setting (32% of outbreaks).
(GI.6) was associated with an increased number of outbreaks Among reported patients, 64% were female and 50% were
reported to CaliciNet. We describe the characteristics of over 75 years old. Common symptoms included diarrhea
reported GI.6 outbreaks. (60%), fever (45%) and vomiting (43%); 1.1% of patients were
METHODS: We identified all GI.6 outbreaks reported to hospitalized and 0.16% died.
CaliciNet during 2009–2012. Supplemental clinical and CONCLUSION: Emergence of norovirus strains might
demographic data were extracted from the National Outbreak result in increased outbreak activity. While GI.6 viruses
Reporting System (NORS). When data was not available remain responsible for a relatively small proportion of
through NORS, state health departments were queried. all reported norovirus outbreaks there was an increase in
Chi square test for trend was used to assess the increase in GI.6 outbreaks in the United States since 2011. Continued
proportion of outbreaks caused by GI.6 viruses. surveillance for norovirus outbreaks through Calici-Net and
RESULTS: During September 2011–August 2012, 76 NORS will enable further assessment of the public health
(7.4%) of the 1032 norovirus outbreaks reported to Calici- implications and significance of GI.6 noroviruses.
Net were attributed to GI.6 compared with 11 (1.7%) and 24 KEYWORDS: norovirus, gastroenteritis, disease outbreaks,
(3.2%) during September 2009–August 2010 and September public health surveillance, United States
2010–August 2011 respectively (P<0.001). These outbreaks
WEDNESDAY
2:55 Sonic Salmonellosis: Multistate Outbreak of Human Salmonella Typhimurium

Infections Linked to Pet Hedgehogs — United States, 2012
AUTHORS: Tara C. Anderson, N. Marsden-Haug, J. Morris, W. Culpepper, J.K. Adams, S. Bidol, S. Meyer,
J. Schmitz, C. Barton Behravesh
BACKGROUND: Salmonella infections linked to animal were reported. Of the 12 case-patients for which information
contact cause ~130,000 illnesses annually in the United States. was available, 12 (100%) reported direct and/or indirect
Five million (~4%) households own small pet mammals, and pet hedgehog contact in the week before illness began. The
there are ~3,000 hedgehogs in USDA licensed facilities in the outbreak strain was isolated from a MN environmental
U.S. From January to November 2012, PulseNet, a national sample of a container and sink in which a pet hedgehog was
bacterial subtyping network, identified human infections bathed. Hedgehogs were purchased from at least 6 identified
of a historically rare Salmonella Typhimurium (ST) strain hedgehog breeders (5 were USDA licensed) in several
(outbreak strain) that we investigated. geographically distant states. Traceback investigations have
METHODS: A case was defined as illness in a person not revealed a common source of infection.
infected with the outbreak strain of ST identified between CONCLUSIONS: Public and animal health collaboration
01/01/12–11/30/12. We collected information on exposures on epidemiologic, laboratory, and traceback investigations
including animal contact from case-patients, and cultured linked pet hedgehog contact to human infections of ST,
animal and environmental specimens for Salmonella. We highlighting the importance of a One Health investigative
conducted traceback investigations of USDA licensed pet approach. More efforts are needed to increase awareness
hedgehog breeders. among hedgehog breeders, pet owners, and healthcare
RESULTS: We identified 16 cases in 7 states. Illness onset professionals on risk of illness associated with pet hedgehogs.
dates ranged from 12/26/2011–11/02/2012. The median KEYWORDS: hedgehogs, outbreaks, pets, salmonellosis,
patient age was 11 years (range: <1–62 years); 64% were zoonoses
female. Three case-patients were hospitalized; no deaths
3:15 Detecting Hidden Outbreaks of Domestically Acquired Typhoid Fever —

AUTHORS: Maho Imanishi, A . Newton, G . Gonzalez-Aviles, M . Kendall, K . Manikonda, N . Maxwell,

J . Halpin, M . Freeman, T . Ayers, G . Derado, B . Mahon, A . Vieira, E . Mintz
BACKGROUND: Typhoid fever (TF) is transmitted by (common exposure identified), non-outbreaks (common
ingestion of food or water contaminated with Salmonella exposure unlikely), or possible outbreaks (insufficient data).
enterica serotype Typhi (Typhi) from an infected person. RESULTS: DATF accounted for 612 (18%) of 3,346 TF cases
Outbreaks may be caused by asymptomatic carriers who with known travel status during 1999–2010; 71% (413/581)
shed the bacterium sporadically over many years. Detecting were hospitalized. We identified 24 confirmed outbreaks, 14
TF outbreaks among apparently sporadic cases is important non-outbreaks, and 8 possible outbreaks among 46 space-
for public health control of this serious infection. time clusters. Possible outbreaks occurred in five states and
METHODS: Domestically acquired typhoid fever (DATF) had a median duration of eight months (range: 2–25) and size
was defined as a compatible illness in a person with culture- of 2.5 cases (range: 2–5).
confirmed Typhi infection who denied foreign travel in the CONCLUSIONS: DATF cases warrant thorough investiga-
30 days preceding illness onset. We searched the National tion. We are collaborating with state health departments to
Typhoid Fever Surveillance database for DATF cases and identify potential sources for the possible outbreaks. Space-
identified their isolates in PulseNet, the national molecular time scan statistics was a useful and novel screening tool for
subtyping database. Using SaTScan™ software, we performed detecting DATF outbreaks. However, molecular subtyping
space-time scan statistics and identified clusters of ≥2 DATF and shoe-leather epidemiology are still needed to confirm
cases. Based on reports of DATF outbreaks in the literature outbreaks and identify carriers.
and Foodborne Disease Outbreak Surveillance System,
and subtyping and epidemiologic data from state health KEYWORDS: typhoid fever, Salmonella typhi, outbreak,
departments, we classified clusters as confirmed outbreaks space-time clustering
WEDNESDAY
The suspense is terrible;

I hope it lasts.
—Willy Wonka
SESSION K: Alexander D. Langmuir Memorial Lecture and Reception

4:00–5:00 pm
Ravinia Ballroom
WEDNESDAY
The Role of EIS in Communities of Solution: Using GIS and Epidemiology

to Activate Health Partnerships
SPEAKER: Robert Phillips, MD, MSPH
Dr. Robert Phillips is well-known throughout the health of the US Council on Graduate Medical Education, and he
policy community as an effective leader, communicator, continues to advise federal and state governments on health
and investigator. Under his leadership, the Robert Graham education policy. Dr. Phillips’ recent leadership on workforce
Center emerged as an authoritative source of information studies for AHRQ produced primary care workforce estimates
to guide policy, particularly as it relates to primary care embraced by both HRSA and ASPE, and can be reviewed on
and improving the cost-effectiveness of healthcare. In 2012, the AHRQ website. He is currently principal investigator on a
Dr. Phillips moved to the American Board of Family Medicine study of graduate medical education accountability measures,
as Vice President for Research and Policy to contribute to the which will inform issues of stewardship related to $13 billion
research base underpinning primary care improvement and spent on these programs annually.
to continue as a translator of evidence into policy. Dr. Phillips recently completed a month-long consultation
Dr. Phillips has deep experience in designing and to the Australian National University and Australian
implementing health services research pertinent to policy Government on the data systems they need to implement
development and a history of prodigious productivity. His new geographically organized population health systems,
passion for underserved populations stems from growing and he was a Fulbright Specialist to the Netherlands in
up in a rural community that is considered both a “Health 2012 consulting on general practice research translation for
Professions Shortage Area” and “Medically Underserved policy. Dr. Phillips is a graduate of the Missouri University of
Area,” currently served by two Rural Health Clinics. His Science and Technology and the University of Florida College
passion grew from experience working in a Federally Qualified of Medicine. He completed residency training in family
Health Center within a Federal Housing Project. Dr. Phillips medicine, as well as health services research and public health
was selected by the U.S. Secretary of the Department of training, at the University of Missouri. He was elected to the
Health and Human Services to serve on a Federal Negotiated Institute of Medicine of the National Academies of Science
Rule Making Committee for the redesignation of shortage in 2010.
and underservice areas. He also recently served as Vice-Chair
Best of all possible worlds.

—Gottfried Leibniz
SESSION L: International Night

5:30–10:00 pm
Poster Presentations
5:30–6:45 pm
Oral Presentations
7:30–9:45 pm
Ravinia Ballroom
MODERATORS: Jimmy Kolker and Fadzilah Kamaludin
See supplement for complete list of presenters and abstracts.
WEDNESDAY
7:40 Prevalence and Geographic Distribution of Nodding Syndrome —
Kilombero and Ulanga Districts, Tanzania, 2012
AUTHORS: Preetha J. Iyengar, J. Maeda, S. Kabamanya, A. Shamte, J. Mghamba, S. Wiersma, E. Farnon,
J. Sejvar
BACKGROUND: Nodding syndrome (NS) is a seizure Head nodding was reported in 226 persons in 211 house-
disorder of unknown etiology resulting in neurological holds, yielding an overall prevalence of 1.8 per 1,000 persons,
deterioration. NS was first described in Mahenge, Tanzania and 0.5 per 1,000 in children 0–15 years. The median age of
during the 1960s. NS epidemics have been recently described possible NS case-patients at interview was 47 years (range,
in Uganda and South Sudan, predominantly affecting children 2–94 years), and 121 (54%) were female. Cases were reported
under age 15 years and clustering in villages. The presence of from 24/25 (96%) villages, with a median of six cases per vil-
NS outside of Mahenge has not been described. lage (range, 0–29); 120 (53%) were reported from five villages.
METHODS: We assessed the prevalence of possible NS cases CONCLUSION: We identified possible NS cases outside
by adding a screening question to the standardized Ifakara of the previously described area in Mahenge, however
Demographic Surveillance System (DSS) survey conducted our survey may have misclassified or overestimated cases.
from October–December 2012. The DSS covers all individuals Possible case median age is older than the typical age range
in 25 villages in two circumscribed areas of Kilombero and reported in South Sudan and Uganda, suggesting differences
Ulanga districts 40 kilometers from Mahenge. A possible in the progression of NS in Tanzania.
case was defined as any person with reported head nodding. KEYWORDS: seizure disorder, Tanzania, prevalence,
The head of household was interviewed and shown a video epidemiologic characteristics
demonstrating NS. Descriptive statistics were performed.
RESULTS: Approximately 127,000 persons (30,000 house-
holds) in 25 villages have been screened as of December 7th.
8:00 Outbreak of Bacillus cereus Food-Poisoning with a Fatality After a Feast —

Bagli Village, Bursa Province, Turkey, September 2012
AUTHORS: Orhun Kalkan, M. Gulay, B. P. Zhu, F. Temel, M. B. Sucakli, M.A. Torunoglu
BACKGROUND: On 11 September 2012, residents of Bagli 9 September; only one course (mixed rice and chicken) was
Village in northwestern Turkey reported a diarrheal disease served. Leftover food stayed at room temperature (range:
outbreak, including one death. We investigated to identify the 13.8-29.5C) overnight and was distributed to village residents
cause and mode of transmission, and to implement control on Monday. The epidemic curve showed a small peak after
measures. Sunday’s meal, followed by a large peak following Monday’s
METHODS: A probable case was onset of diarrhea (≥3 meal. Half (50%) of case-patients vs. 20% of control-persons
episodes/day) plus ≥1 of the following symptoms during 9-12 consumed Sunday’s meals (ORmatched=5.4, 95% CI: 2.0-15);
September: nausea, vomiting, self-reported fever, abdominal 82% of case-patients vs. 2% of control-persons consumed
pain. We reviewed medical records in the village’s two Monday’s leftover food (ORmatched=176, 95% CI: 31-
hospitals for case-finding. In a case-control investigation, we 1689). B. cereus was identified in the leftover food in high
compared exposures of case-patients with control-patients concentration (3.3?108 bacteria/g). Autopsy showed multi-
randomly selected among asymptomatic village residents, organ congestion suggesting sepsis as the cause for child’s
frequency-matched to case-patients by age group. We used death.
the horizontal method for enumerating bacteria in food CONCLUSION: This B. cereus outbreak was likely due
samples for pathogen identification. to consumption of contaminated food stored at room
RESULTS: Of 26 case-patients identified, 23 (including temperature. Village residents were educated on safe food
one child that died) were residents of the village (attack rate: preparation and preservation practices.
5.5%). The main symptoms included diarrhea (100%), self- KEYWORDS: Bacillus cereus, outbreak, foodborne, case-
reported fever (87%), nausea (83%), abdominal pain (83%), control
and vomiting (48%). A village-wide feast occurred on Sunday,
WEDNESDAY
8:20 Case-Control Study of Human Cutaneous Anthrax Outbreak Associated

with Contact of Livestock — Georgia, 2012
AUTHORS: Archil Navdarashvili, T. Doker, A. Folkema, G. Kharod, D. Haberling, M.Geleishvili, T. Rush,

E.Maes, S. Shadomy
BACKGROUND: Georgia’s National Centers for Disease their own farm (OR=3.9; 95%CI 1.5-10.4). Buying meat
Control (NCDC) registered increased human cutaneous from butcher shop was protective (OR=0.4; 95%CI 0.2-0.8).
anthrax in 2011—2012 (81, 143 respectively) compared to 33% of case-patients reported soil-contact, but that was not
2009—2010 (43, 27, respectively). We investigated to detect associated with disease. In 2011 and 2012, 21 and 25 animal
infection source and implement control measures. anthrax cases were reported, respectively.
METHODS: We conducted a 1:2 matched case-control CONCLUSION: Anthrax is an ongoing problem in
study in two high incidence regions, Kvemo Kartli, [KK] and Georgia. It is unclear why the number of cases increased in
Kakheti [Ka]. Cases were identified by disease surveillance 2012, however, several risk factor for disease were identified.
and confirmed by PCR or culture. Two controls, matched by The source of human anthrax was most likely contact
residence (within 250m) and gender were recruited. Matched with a sick animal, slaughtering or disposing of carcass.
analysis and conditional logistic regression were used to We recommended use of personal protective equipment
analyze data. when slaughtering animals, enforcement of regulations to
RESULTS: We interviewed 70 cases and 140 controls. Case- prevent slaughtering and sale of meat from sick animals,
patients were 18—72 years of age(median 40), 87% male; 79% and vaccination of animals against anthrax. Vaccination of
from KK region. 17% disposed of dead animal (OR=20.1; animals against anthrax in KK and KA was conducted in
95%CI 2.6-156); 24% contacted sick animal (OR=14; 95%CI autumn 2012.
3.2-61.5), 43% slaughtered animal (OR=7.3; 95%CI 3-17.9), KEYWORDS: cutaneous anthrax, case-control study,
77% raised animals (OR=6.3; 95%CI 2.6-15.4), 50% contacted outbreak, Georgia
animal products (OR=4.2; 95%CI 2-8.8), 31% ate meat from
8:45 Outbreak Investigation of Typhoid Fever in Village Kuwardu, District Skardu,

Gilgit-Blatistan (G-B) — Pakistan, 2012
AUTHORS: Z. Hussain, J. Ansari, M. Salman, R.J. Asghar
BACKGROUND: On 8th may, 2012, civil dispensary Age group 21-30 years (n= 32, 32.7%) were the most affected
Kuwardu village (5000 population) of district Skardu Gilgit- group. Drinking water from the storage tanks (OR=16.6),
Blatistan (G-B) reported unusual increase in number of cases living in the same house (OR=20.28) were associated with
with high grade fever, abdominal discomfort and anorexia. illness. Six water samples were tested and found unfit for
A team from health department was deputed to investigate human consumption. Multiple logistic regression shows
the outbreak with the objectives to identify the associated risk association of household size (>5 person in room of house)
factors and provide recommendations for control. (OR 7.46), typhoid patients handling and cooking food
METHODS: A Case was defined as a person living in village (OR=13.43) and drinking water from storage tank (OR 12.62)
Kuwardu with fever >38oc and with one of the following with disease.
symptoms; abdominal discomfort, vomiting, diarrhea and CONCLUSION: Awareness campaign was initiated. The
positive Typhidot test (IgM) between 30 April - 27 May, importance of hand-washing practices before cooking and
2012. Cases were enrolled through active case finding. Equal after attending the toilet was highlighted. Developing toilets
numbers of age and sex matched controls were enrolled away from drinking water sources were advocated. Based on
from the neighborhood. Descriptive statistics, univariate and our recommendation Public Health Engineering Department
multivariate analysis was done. Qualitative assessment of the has prioritized setting up treated water system and have sent
environment was also done. request for funds allocation.
RESULTS: A total of 98 cases were identified in which 66% KEYWORDS: waterborne, case control, typhoid, Pakistan
(n= 65) were female. Mean age was 32 years (12-65 years).
WEDNESDAY
9:05 Antiretroviral Therapy Initiating Regimens and Discontinuation Patterns —
Medunsa National Pharmacovigilance Surveillance Cohort, South Africa,
2004–2011
AUTHORS: Mazvita Naome Muropa, RS Summers, NM Dube, LR Kuonza, KS Tint
BACKGROUND: An estimated 1.6million HIV infected discontinued at least once in 103/2979 (3.5%) patients. The
patients are on antiretroviral therapy (ART) in South Africa. highest proportion (25%) of ART discontinuation occurred
ART is life-long and reduces morbidity and mortality in HIV- in patients initiated on non-standard drug regimens. Reasons
infected patients. Discontinuation of ART leads to inferior for ART discontinuation included poor adherence (38.0%),
clinical outcomes and increases the risk of drug resistance. drug-related toxicity (26.1%), non-adherence 12.0%, loss
This study determined ART initiating and discontinuation to follow-up (9.9%) and treatment failure (8.5%). Initiating
patterns in a cohort of patients in South Africa. patients on non-standard drug regimens (Relative risk (RR)
METHODS: Retrospective analysis of Medunsa National =7.42; 95% confidence interval (CI):2.73-20.14), and initiat-
Pharmacovigilance ART surveillance data. ART initiation ing treatment in patients below 26 years of age (RR=7.9 CI:
was defined as “starting an ART naive patient on an ART 1.76-4.78) were associated with ART discontinuation.
drug regimen”, and ART discontinuation was defined as CONCLUSION: Young age at ART initiation and use
“discontinuation of all ART drugs being taken by a patient by of non-standard drug regimens are predictors of ART
a prescribing clinician, at any time in the surveillance period, discontinuation. Clinicians should be encouraged to initiate
for a specified or unspecified reason.” patients on standard ART regimens. Poor and non- adherence
RESULTS: A total of 2979 patients’ data was analysed. Most, accounted for half of the reasons for ART discontinuation.
(68.1%) were females. Mean age at ART initiation was 38.2 Predictors of non-adherence to ART should be investigated.
years (standard deviation: 37.8; 38.5). Most (99.5%) patients KEYWORDS: ART, HIV, surveillance, cohort, ART
were initiated on a standard first line ART regimen. ART was regimens
9:25 Mumps Attenuated Live Vaccine effectiveness: 1:1 Matched Case-Control

Study — Zhongshan, China, 2011-2012
AUTHORS: Man Wang, Hm. Luo, T. Wang
BACKGROUND: Mumps-containing vaccine (MuV) was RESULTS: 435 cases and 435 controls were included for
licensed in the 1990s, and a single dose has been administered data analysis. Among 435 cases, 209 (48.0%) had not been
routinely to children aged 18-24 months since 2008 in China. vaccinated, 183(42.1%) had received 1 dose, and 43 (9.9%)
However, an increased number of mumps cases during 2009- received 2 doses. Among 435 controls, 144(33.1%) had not
2012 in China required evaluation of the effectiveness of been vaccinated, 241 (55.4%) had received 1 dose, and 50
single dose MuV. In 2011, the number of reported mumps (11.5%) received 2 doses. Overall the VE of the MuV against
case in Zhongshan (located at the Pearl River Delta region in clinical mumps in children was 54% (95%CI: 37% 67%). The
south China) reported the highest number cases since 1997, estimated VE for one dose was 53% (95%CI: 34% - 66%), and
with incidence rate 62.9 per 100 000 population. 64% (95%CI: 1% - 87%) for two doses
METHODS: A 1:1 matched case-control study was CONCLUSION: Single dose of MuV is not effective enough
conducted. The reported clinical mumps cases during May to interrupt community transmission of mumps. Adjusting
2011- April 2012 in Zhongshan, born 2003 to 2009, were mumps vaccine strategy is recommended in China.
selected. A control was chosen for each case through the KEYWORDS: mumps attenuated live vaccine, vaccine
vaccination information system, matched by age group, effectiveness, matched case-control study, China
gender and living place. The system was also used to collect
mumps vaccination status for each case and control. VE was
calculated as one minus the adjusted matched odds ratio ×
100%.
WEDNESDAY
THURSDAY, APRIL 25, 2013
Extraordinary claims require

extraordinary evidence.
—Carl Sagan
SESSION M: Donald C. Mackel Award Finalists

8:30–10:15 am
Ravinia Ballroom
MODERATORS: Rachel Kaufmann and Sherif Zaki
8:35 Acute Kidney Injury Associated with Synthetic Cannabinoid Use —

Oregon, 2012
AUTHORS: Genevieve L. Buser, R. Hendrickson, B.Z. Horowitz, R. Gerona, J.H. Moran, K. Vian, S. Su,
R. Leman
THURSDAY
BACKGROUND: Synthetic cannabinoids are illegal drugs RESULTS: We identified nine cases with onset during
that cause adverse neurologic and sympathomimetic effects. April–October 2012. All patients were male, aged 15–27
During 2010, synthetic cannabinoids resulted in >11,000 (median: 18) years, who reported intense nausea and emesis,
U.S. emergency department visits. Synthetic cannabinoids with and without abdominal pain. Peak creatinine levels were
are increasingly popular; nationally, 11.4% of high school 2.6–17.7 (median: 6.6) mg/dL. All patients were hospitalized;
seniors reported smoking them during the previous 12 one required dialysis; none died. Six patients completed
months. In August 2012, clinicians reported acute kidney interviews. They easily purchased synthetic cannabinoids at
injury (AKI) in an adolescent after he smoked a synthetic convenience, tobacco, and adult stores, believing them legal
cannabinoid. Oregon’s Public Health Division and Poison and safe. One clinical and two product samples contained
Center investigated to determine the problem’s scope. evidence of a novel synthetic cannabinoid, XLR-11.
METHODS: Cases were defined as AKI (creatinine >1.3 mg/ CONCLUSIONS: Active case finding, investigation,
dL) treated in Oregon since April 2012 among persons without and state-of-the-art toxicology testing identified a novel
known renal disease and aged 13–40 years who reported epidemiologic link between smoking synthetic cannabinoids
smoking synthetic cannabinoids. We queried poison centers, and AKI. LC-TOF/MS analyses to identify other toxins and
distributed health alerts, contacted nephrologists, and issued animal kidney models to elucidate nephrotoxic mechanisms
a press release. We interviewed patients, collected specimens, are ongoing.
and abstracted medical records. Drug enforcement teams KEYWORDS: cannabinoids; acute kidney injury; substance-
seized implicated products. Toxicology laboratories used related disorders; gas chromatography-mass spectrometry;
liquid chromatography and time-of-flight mass spectrometry spectrometry, mass, electrospray ionization
(LC-TOF/MS) to test clinical and product specimens for
synthetic cannabinoids and metabolites.
8:55 Large Legionnaires’ Disease Outbreak in a Hospital with a Legionella

Disinfection System, Pennsylvania, 2011–2012
AUTHORS: Alicia Demirjian, C. Lucas, L. Garrison, N. Kozak, S. States, E. Brown, J.M. Wortham,
A.L. Beaudoin, M. Casey, C. Marriott, A. Ludwig, L. Hicks
BACKGROUND: Legionnaires’ disease (LD), a preventable RESULTS: We identified five definite and 16 probable
form of pneumonia commonly caused by inhalation of healthcare-associated LD cases during 2011–2012; five case-
Legionella in potable water, is a leading cause of waterborne patients died. Of 44 environmental samples, 29 showed
outbreaks and has a 30% case-fatality rate in healthcare- Legionella growth; twenty-three isolates were MAb2-positive
associated outbreaks. We characterized an outbreak’s extent Legionella pneumophila serogroup 1. Ten were identical to
and evaluated contributing environmental factors in a three available clinical isolates by SBT. Mean concentrations
hospital using copper-silver ionization, a method widely used were 0.32 and 0.23 parts per million (ppm) at five central
to prevent Legionella growth in water. and six peripheral sites, respectively, for copper, and 0.03 and
METHODS: Through medical chart review at Hospital 0.02 ppm for silver, within the manufacturer’s recommended
A in November 2012, we identified patients diagnosed ranges for Legionella control. All 11 samples showed
with LD during 2011–2012. Laboratory-confirmed cases Legionella growth.
were categorized as definite, probable, and not healthcare– CONCLUSION: We identified an LD outbreak linked
associated based on time spent in Hospital A during to a hospital potable water system despite copper-silver
their incubation period. We performed an environmental ionization use. Our data suggest that the recommended
assessment and collected environmental samples for copper and silver concentrations did not prevent Legionella
Legionella culture. Clinical and environmental isolates were growth in this system, which should prompt reassessment of
compared by monoclonal antibody (MAb) and sequence- this technology’s effectiveness elsewhere.
based typing (SBT). Copper and silver concentrations were KEYWORDS: Legionnaires’ disease, Legionella pneumophi-
measured in 11 water samples using inductively coupled la, disease outbreaks, copper, silver
plasma and optical emission spectroscopy.
9:15 Soil-Transmitted Helminth Infection in School-Aged and Preschool-Aged

Children in an Urban Slum — Kibera, Nairobi, 2012
AUTHORS: Stephanie M. Davis, C. Worrell, P. Suchdev, L. Ruth, G. Lopez, R. Wiegand, K.Odero,

L. Cosmas, J. Neatherlin, S. Njenga, J. Montgomery, L. Fox
THURSDAY
BACKGROUND: Soil-transmitted helminth (STH) RESULTS: Infection prevalences were: any STH: PSAC
infections cause anemia, vitamin A deficiency (VAD), 39.0%, SAC 43.6%; Ascaris: PSAC 25.8%, SAC 25.1%;
and malnutrition. Drug-based deworming reduces STH Trichuris: PSAC 21.9%, SAC 30.1%; hookworm <0.1%.
infections and their morbidities. Currently, prevalence and VAD was found in 11.8% of PSAC and was associated with
morbidity studies, and deworming programs, focus on rural Ascaris (adjusted prevalence ratio [aPR]: 2.9; 95% confidence
areas and school-aged children (SAC). Better definition of interval [CI]: 1.23–6.81) and Trichuris (aPR: 2.93; 95% CI:
disease in urban slums, particularly among preschool-aged 1.20–6.73) infections. VAD was found in 4.7% of SAC and
children (PSAC), is needed to inform program design. was associated with Ascaris infection (aPR: 2.46; 95% CI:
METHODS: We studied pediatric STH infection prevalence 1.05–5.78). Malnutrition was found in 29.7% of PSAC, with
and morbidity in the Kibera slum, Nairobi, Kenya. PSAC (6–59 prevalence nonsignificantly increased in subjects with any
months) and SAC (5–14 years) were randomly selected from STH infection (aPR: 1.49; 95% CI: 0.96–2.31).
CDC’s International Emerging Infections Program registry. CONCLUSIONS: STH infection is common in Kibera.
Data included 3 stools tested by the Kato-Katz method for Infection has similar prevalence among PSAC and SAC
STH ova, anthropometry, hemoglobin and micronutrient and is associated with morbidity in each group. Deworming
status. Subjects with ≥1 stool (n = 493 PSAC, 1225 SAC) were programs should include slums and should be expanded to
assessed for STH prevalence and for correlation of infection younger children.
with anemia, VAD and moderate or severe malnutrition by KEYWORDS: helminths, poverty areas, morbidity, devel-
WHO standards, using multivariable regression weighted for oping countries, malnutrition, vitamin A
selection probability and nonresponse.
9:35 Carbapenem-Resistant Klebsiella pneumoniae Producing New Delhi

Metallo-Beta-Lactamase at an Acute-Care Hospital — Denver, Colorado, 2012
AUTHORS: Erin E. Epson, J.M. Wendt, L. Pisney, D. MacCannell, S. Jackson Janelle, B. Kitchel,
H. O’Connell, J. K. Rasheed, B. Limbago, C. Gould, A. Kallen, M. Barron, W. Bamberg
BACKGROUND: Carbapenem-resistant Klebsiella pneu- additional cases. Patients were aged 23–75 years and had
moniae (CRKP) are highly transmissible and cause health resided on 11 different units (median stay: 18 days; range:
care–associated infections with >40% mortality. New Delhi 12–83 days) before case identification; three were treated
metallo-beta-lactamase (NDM)-producing CRKP are rare in for infection; five were asymptomatically colonized, and
the United States. After two patients at a Denver hospital were none died. All isolates were highly related by PFGE. WGS
identified with NDM-producing CRKP during July–August suggested three primary clusters of CRKP. Combining WGS
2012, an investigation was conducted to characterize the out- results with epidemiology identified three units as likely
break and prevent transmission. transmission sites.
METHODS: CDC tested CRKP isolates by polymerase CONCLUSIONS: A 4-month outbreak of NDM-producing
chain reaction for NDM. A case had NDM-producing CRKP CRKP occurred at one hospital, highlighting the risk
isolated from clinical or active surveillance cultures (ASC) of for spread of these organisms. PFGE did not sufficiently
rectal swabs collected during January 1–October 30. Cases differentiate among case isolates, but combining rapid
were identified through microbiology record reviews and six WGS with epidemiologic links indicated transmission
rounds of ASC on units where affected patients had resided. primarily occurred on three units and might be useful for
Medical records were reviewed for epidemiologic links; guiding control measures in real time. ASC, combined with
relatedness of CRKP isolates was evaluated by pulsed-field gel reinforcing infection prevention measures, were required to
electrophoresis (PFGE) and whole-genome sequence analysis control transmission.
(WGS). KEYWORDS: cross infection, drug resistance, microbial,
RESULTS: A third patient, admitted in May, was identified beta-lactamases, sequence analysis, DNA
through microbiology records review. ASC identified five
9:55 Active Surveillance for Variant Influenza Among Swine, the Environment,
and Employees at Live Animal Markets — Minnesota, 2012
AUTHORS: Mary J. Choi, M. Torremorell, J. Bender, D. Her, M. Jhung, T. Uyeki, K.K. Wong, S. Vetter,
D. Boxrud, J. Ertl, J. Nguyen, K. Smith, R. Danila, R. Lynfield
THURSDAY
BACKGROUND: Variant influenza (VI) in humans is RESULTS: IAVs were detected in 10/26 (38%) swine
caused by swine-origin influenza A viruses (IAVs). Because enclosure air samples, 4/16 (25%) swine enclosure railing
swine can support genetic material exchange between avian, samples, 21/27 (78%) swine saliva samples, and 29/70 (41%)
swine, and human IAVs, emergence of variant viruses with swine lungs. Ill swine were observed. Weekly coughing scores
pandemic potential is a serious concern. During 2012, a VI (percent of pigs coughing) ranged from 2% to 18%. IAVs
outbreak linked to agricultural fairs sickened >300 persons were detected in samples from 5/14 (36%) asymptomatic
in the United States. In Minnesota, half of all VI cases from employees. Variant hemagglutinin3 gene segments were
2008–2011, and the first VI cases of the 2012 outbreak, identified in 2/14 (14%) asymptomatic employees.
occurred among live animal market patrons. We initiated CONCLUSIONS: Live animal markets facilitate close
surveillance at two markets to identify factors contributing human-swine contact and represent a venue where
to VI transmission. interspecies IAV transmission can occur. This investigation
METHODS: We collected weekly air samples during confirmed the widespread presence of IAV at live animal
October 8–November 12 from swine enclosures, markets, underscoring the potential for zoonotic transmission
environmental samples from high hand-contact surfaces in this setting. Public health officials, employees, and patrons
(swine enclosure railings, door knobs, and patron sinks), of live animal markets should understand the risk for variant
pooled swine saliva samples, and slaughtered pigs’ lungs. IAV infection and take steps to minimize transmission.
Employees submitted weekly nasal swabs. Real-time reverse- KEYWORDS: influenza A virus, swine, disease outbreaks,
transcription polymerase chain reaction for IAV gene targets sentinel surveillance, zoonoses
was performed on all samples.
Prepare for the unknown by studying

how others in the past have coped
with the unforeseeable and the unpredictable.
—General George S. Patton
SESSION N: Environmental Health and Preparedness

10:30–11:55 am
Ravinia Ballroom
MODERATOR: Thomas H. Sinks
10:35 The Perfect Storm: Shelter-Based Surveillance in the Aftermath of Hurricane

Sandy — New Jersey, 2012
AUTHORS: Alice M. Shumate, E. Yard, M. Casey-Lockyer, A. Schnall, M. Murti, C. Tan, R. Noe, A. Wolkin
BACKGROUND: Hurricane Sandy made landfall in morbidity data in the 21 shelters housing >30 residents
THURSDAY
New Jersey on October 29, 2012, causing widespread overnight. Shelters reported 5,189 health services visits,
infrastructure damage and power outages and prompting which addressed 7,101 health needs. Fifty-two percent of
one of the largest American Red Cross disaster responses to health needs involved acute illness, 32% follow-up care (e.g.,
date. Approximately 7,000 residents were relocated to at least wound care, blood pressure or blood glucose checks, and
thirty Red Cross shelters. CDC and New Jersey Department medication refills), 13% chronic illness exacerbations, and
of Health conducted shelter-based surveillance to track 3% injury. Within 1 week, 100% of shelters transitioned to
morbidity, and designed and implemented sustainable remote reporting, with all but two using smartphones to text
methods for shelter staff to report morbidity data remotely. or e-mail pictures of forms.
METHODS: Red Cross staff recorded demographic data, CONCLUSIONS: Acute care was the most common
primary complaint(s), disposition, and referral data for each need; chronic illness exacerbations and follow-up care
client health visit. Aggregate morbidity tallies of individual were also substantial. We successfully demonstrated timely
interactions for each 24-hour period were compiled, reported capture of standardized morbidity data by using a unique
to CDC daily, and shared with local health departments reporting method. As a result of this response, expanding
for potential follow-up. At each shelter, CDC developed a and institutionalizing smartphone technology for reporting
sustainable method for daily reporting based on available shelter surveillance data is being considered.
technology, which included reporting by e-mail, text message, KEYWORDS: disasters, emergency shelter, population
or fax. surveillance, health services needs
RESULTS: During November 5–21, we collected aggregate
10:55 Assessment of Household Emergency Preparedness Supplies by Housing

Type from a Community Assessment for Public Health Emergency Response
(CASPER) — Michigan, 2012
AUTHORS: Michelle Murti, M. Stanbury, S. Bies, M.K. Nyaku, A. Schnall, T. Bayleyegn, D. Flanders, E. Yard,
A. Wolkin
BACKGROUND: Disaster preparedness plans recommend single-family homes were more likely (P<0.05) than multi-
households have at least 72 hours of emergency supplies. unit dwellings to have copies of important documents, a
Persons in multi-unit dwellings may be disadvantaged way to cook food without utilities, and a backup heat source.
compared to those in single-family homes because of less After adjusting for confounding by cluster, these outcomes
storage or outdoor space; however, little is known about continued to be important, along with owning an emergency
household emergency preparedness by housing type. kit and 72 hours of water (P<0.05). Only the emergency kit
METHODS: We used interview data on household model had intra-cluster correlation (P<0.05), whereas cluster-
emergency preparedness from a two-stage cluster design adjusted estimates changed >10% for six of the nine supplies.
CASPER survey in Oakland County, Michigan, in 2012, CONCLUSIONS: Oakland County multi-unit dwellings had
to estimate the association between housing type and nine fewer recommended emergency supplies than single-family
recommended emergency supplies (e.g., first aid kit). We homes, adjusting for similarities by Census block. Emergency
used three logistic regression models—survey, conditional, planners should consider the influence of household type and
and random effects—to assess the association in the sampled potential strategies for improving preparedness in multi-unit
population, confounding by cluster (Census block), and dwellings. The innovative use of these regression methods to
intra-cluster correlation, respectively. analyze these cluster-sampled data represents an important
RESULTS: Of 192 households interviewed (91% completion development for future CASPER analyses.
rate), 149 (78.9%) were single-family homes and 40 (19.5%) KEYWORDS: emergency preparedness, housing, survey,
were multi-unit dwellings. In survey regression models, logistic models, Michigan
11:15 When Public Health Messaging Still Is Not Enough: Postdisaster Carbon
Monoxide Poisoning Outbreaks, Connecticut’s Experience 1 Year Later —
October 2012
AUTHORS: Timothy S. Styles, P. Przysiecki, G. Archambault, B. Toal, L. Sosa, M. Cartter
BACKGROUND: During October 2011 a large carbon RESULTS: We identified 30 cases from 11 CO exposure
THURSDAY
monoxide (CO) poisoning outbreak (133 cases and 5 deaths) incidents. Median patient age was 40 years (range: 9–92);
occurred in Connecticut following a snowstorm-related 50% were foreign-born; 53% were non-Hispanic white, 37%
power outage. In response, the Connecticut Department Hispanic, and 10% other. One patient had heard CO-warning
of Public Health (CDPH) sought to improve prevention messaging during the previous year; no patients reported
messaging for future storms. On October 29, 2012, Hurricane hearing or seeing warning messaging immediately before or
Sandy caused extensive power outages and another CO during the 2012 storm. Although geographic areas affected
poisoning outbreak in Connecticut. We characterized these by the 2011 and 2012 storms differed, the number of homes
cases. without power and most common CO exposure source
METHODS: On October 26, CDPH launched an enhanced, (portable generators, 91%) were similar.
multimedia CO-warning campaign that continued through CONCLUSIONS: Despite attempts at well-targeted, well-
November 7, including mass-media announcements, timed warning messages and outreach to diverse populations,
Facebook postings, tweets in multiple languages, alerts to postdisaster CO poisonings occurred, albeit with fewer cases
local health departments, posters in high-traffic public areas, and no deaths. Foreign-born persons were disproportionately
and household door hangers. Disaster-related CO poisoning affected. In addition to public health messaging, other
cases were defined as carboxyhemoglobin levels ≥9% (phy- methods of CO poisoning prevention are needed.
sician- and laboratory-reportable in Connecticut) during KEYWORDS: hazardous substances, carbon monoxide,
October 29–November 7, in which CO exposure was poisoning, environmental exposure, communications media,
related to the storm or power outage. We interviewed patients disaster
or proxies with a standardized questionnaire and reviewed
medical records.
11:35 Heat Illness: Predictors of Hospital Admissions Among Emergency

Department Visits — Georgia, 2002–2008
AUTHORS: Satish K. Pillai, R. Noe, M. Murphy, A. Wolkin, A. Vaidyanathan, R. Young, S. Kieszak,

G. Freymann, W. Smith, C. Drenzek, L. Lewis
BACKGROUND: Heat-related illnesses (HRI) are the most identify factors associated with ED-related hospitalization
frequent cause of environmental-exposure related injury versus discharge to home.
treated in U.S. emergency departments (ED). Understanding RESULTS: Among 13,935 ED visits with HRI, there were
factors associated with hospitalization among individuals 12,889 (92.5%) discharges to home and 1,046 (7.5%) hospital
presenting to the ED with HRI can help public health admissions. Controlling for medical comorbidities, men (OR
practitioners identify groups that may benefit from additional 1.26; P = 0.012), African-Americans (OR 1.26; P = 0.029),
outreach efforts. and residents of the Coastal region (OR 1.46; P <0.0001) had
METHODS: ICD9- or E-codes for heat-related disorders a greater odds of admission with HRI compared to women,
from statewide ED and hospital discharge data, collected Whites, and residents of Georgia’s central Piedmont region,
by the Georgia Department of Public Health, were used respectively. Compared to individuals aged 20–29 years, the
to identify cases of HRI occurring during May through highest admission odds admission was among those aged ≥80
September, 2002–2008. Demographic characteristics, county (OR 6.27; P < 0.0001). EHE did not predict hospitalization
of residence and medical comorbidities were identified for (OR 1.14; P = 0.28).
each case. County-level daily temperature information from CONCLUSIONS: Increased educational efforts throughout
CDC’s Environmental Public Health Tracking Network was the summer months targeting the elderly, men, African-
used to determine whether the ED visit occurred during Americans, and Coastal region residents may help reduce
an extreme heat event (EHE), defined as ≥2 consecutive ED-related hospitalizations for HRI in Georgia.
days above the 99th percentile daily maximum temperature.
A multivariate logistic regression model was generated to KEYWORDS: heat illness, hospitalization, disparities,
Georgia
THURSDAY
Never say goodbye because goodbye means going away

and going away means forgetting.
—J.M. Barrie, Peter Pan
SPECIAL SESSION: Stephen B. Thacker Memorial Tribute

12:30 pm
Dunwoody Suites
Moderator: Denise Koo
Sponsor: OSELS/SEPDPO
Please join us and add your voice to ours as we honor the life of Stephen B. Thacker. Stand up and share your memories,
admiration, funny stories, or accolades.
Come share your Steve story!

Although Steve’s legacy to public health science is unquestionable, he also had an uncanny ability to make each person he
encountered feel special. Whether you knew him only because he interviewed you for EIS or if you were lucky enough to work
with him, he treated you with dignity, respect, and regard for your feelings. He encouraged each of us to strive to be our best
whether we were a colleague, a current officer, or an alumnus/alumnae. What impact did he have on you?

For those of us fortunate enough to know and work with Steve, we can safely say that we never met anyone more dedicated to
the continuing success of the EIS Program, to the development of the officers, and to maintaining ties with the alumni. For well
over two decades, he was the rock on which this program has been built. He was a mentor as we faced a changing public health
environment. He was a champion whenever the EIS Program or an individual officer needed one. Above all, he was truly the best
friend of EIS. What did his friendship mean to you?

For those of you who did not have the opportunity to meet or know this extraordinary man, you should join us to learn more
about him and what he meant to so many others. We encourage you to come and connect.
It is all about Steve!

Speakers: Open microphone; remarks will be shared from the EIS community, including brief commentaries by
Philip S. Brachman (EIS ’54), Lyle Conrad (EIS ’65), Douglas Hamilton (EIS ’91), and Stephanie Zaza (EIS ’91)
It is the mark of a truly intelligent person

to be moved by statistics.
—George Bernard Shaw
SESSION O: J. Virgil Peavy Memorial Award Finalists

1:30–3:15 pm
Ravinia Ballroom
MODERATOR: Maya Sternberg
1:35 Suicides Associated with Home Eviction and Foreclosure — United States,
2005–2010
AUTHORS: Katherine A . Fowler, M . Gladden, K . Vagi, J . Barnes, L . Frazier
BACKGROUND: In 2010, suicide was the 10th leading cause the timing of the housing crisis. Most of the decedents were
of death in the United States; 2nd among adults aged 25–34, white (87%), and/or male (79%). The median age was 48.
THURSDAY
and 4th for adults aged 35–54. Suicide is influenced by many Most suicides occurred before the actual housing loss (80%).
factors, including economic crises like the U.S. housing crisis In 37% of cases there was an eviction/foreclosure crisis event
that began in 2007. Although the media has reported suicides < 2 weeks prior to death. Latent class analyses revealed three
associated with eviction/foreclosure, detail about these events subtypes of decedents with differing patterns of risk factors:
is lacking. (1) untreated mental health problems, substance abuse, (2)
METHODS: We used 2005–2010 data from the National mental health problems, treatment, prior suicide attempts,
Violent Death Reporting System (NVDRS) to determine and (3) financial problems only.
the frequency and circumstances of suicide deaths involving CONCLUSIONS: Eviction/foreclosure-related suicides
eviction/foreclosure. We conducted chi-squared tests to increased significantly from 2005–2010. Prevention strategies
determine significance of year-to-year changes, and latent include: support service referrals for those projected to
class analyses to model risk factor profiles. lose homes, intervention prior to the move-out date, and
RESULTS: From 2005–2010, N = 1,023 eviction/foreclosure- recognition that eviction/foreclosure is a crisis event. The
associated suicides were identified. The number of eviction National Strategy for Suicide Prevention recommends training
or foreclosure-associated suicides doubled from 2005–2010 a range of professionals, including financial professionals, to
(2005: n = 88, 2010: n = 176; P < 0.01). Overall, foreclosure- recognize suicidal thoughts and behaviors.
related suicides increased 253% from 2005–2010. Increases KEYWORDS: suicide, economic recession, multivariate
in foreclosure-related suicides began in late 2007, paralleling analysis, surveillance
1:55 Getting Caught in the FoodNet: Determining Regional Profiles of Foodborne

Disease Risk Represented by a Sentinel Surveillance System
AUTHORS: Alison S. Laufer, W. Gu, S. Crim, O. Henao, A. Vieira, D. Cole
BACKGROUND: Approximately 48 million domestically statistical parameters were used to identify the optimal
acquired foodborne illnesses occur annually in the United number of clusters.
States. The Foodborne Diseases Active Surveillance Network RESULTS: The optimal cluster solution consisted of seven
(FoodNet) serves as a sentinel surveillance system for major distinct population profiles, each including 1–13 U.S. states.
foodborne pathogens, tracking illness in ten states. FoodNet Three profiles were each represented by a single FoodNet
covers 15% of the nation’s population, but how well it reflects site (New York, New Mexico, Minnesota); a fourth by two
regional differences in sociodemographic factors associated sites (Georgia, Tennessee); a fifth by the remaining five sites
with enteric disease is unclear. As the first step toward (California, Colorado, Connecticut, Maryland, Oregon).
generating nationally representative foodborne disease Three states (Utah, Louisiana, Mississippi) belonged to
incidence estimates, we used cluster analysis to identify two profiles not represented by a FoodNet site. Based on
groups of states with populations represented by specific clustering, FoodNet represents 96% of the US population.
FoodNet sites.
CONCLUSION: We used cluster analysis to identify states
METHODS: Demographic (age, race, ethnicity), sharing sociodemographic risk profiles represented by
socioeconomic (education, urbanization, poverty), and FoodNet sentinel surveillance. Our results provide a basis for
healthcare access variables describing each FoodNet site and population weighting of FoodNet data to extrapolate national
all 50 states were selected from U.S. Census data and the foodborne disease incidence estimates.
Primary Care Service Area Project. Before cluster analysis,
variable distributions and heat maps were assessed. Variables KEYWORDS: foodborne diseases, sentinel surveillance,
were standardized; disjoint cluster analyses based on the cluster analysis, incidence
k-means method were performed with 2–10 clusters. Four
2:15 Transmissibility of Variant Influenza from Swine to Humans:

A Modeling Approach
AUTHORS: Karen K. Wong, M. Gambhir, L. Finelli, D. Swerdlow, S. Ostroff, C. Reed
BACKGROUND: Respiratory illness was reported among the best-fit transmission probability, we simulated the num-
humans and swine at a 2011 agricultural fair; three human ber of infections among all fairgoers.
THURSDAY
novel influenza A (H3N2) variant [H3N2v] virus infections RESULTS: The best-fit swine-human transmission prob-
were confirmed. The virus had reassorted with the 2009 ability was 0.024 per minute of swine contact. Among
pandemic strain, and its transmissibility was unclear. We 14,910 fairgoers with swine contact, we estimated 80 (95%
sought to estimate H3N2v swine-human transmissibility. confidence interval [CI]: 40–133) H3N2v infections among
METHODS: We developed a population dynamic model persons aged <20 years and 58 (95% CI: 29–96) among per-
(susceptible-exposed-infectious-recovered) of H3N2v trans- son aged ≥20 years.
mission and fit it to observed respiratory illnesses among CONCLUSIONS: Assessing transmission risk can be
an agricultural club cohort at the fair. Assumptions about difficult with few cases, but this model using early data
swine-human contact, age-specific immunity, incubation allowed rapid estimation of the zoonotic transmissibility of
period, and transmission among swine were based on the H3N2v. By showing that cases will likely occur when swine are
epidemiologic investigation or on prior studies. Disease state infectious at highly attended fairs, this model helped inform
transitions were defined by differential equations which were the recommendation that high-risk fair-goers avoid swine
solved for swine-human transmission probability. A stochas- contact and prompted several fairs to enhance screening of
tic model using a Poisson distribution around the best-fit swine for illness. These interventions likely prevented many
transmission probability and a Gaussian distribution around H3N2v illnesses and perhaps deaths.
incubation period was run for 100 simulations to illustrate
possible outcomes around the deterministic estimate. Using KEYWORDS: influenza A virus, zoonoses, swine,
transmission, theoretical models
2:35 Associations of Short-Term Exposure to Ozone and Respiratory Outpatient

Clinic Visits in a Rural Location — Sublette County, Wyoming, 2008–2011
AUTHORS: Kerry Pride, J. Peel, B. Robinson, A. Busacker, F. Yip, J. Grandpre, T. Murphy
BACKGROUND: Ozone is ubiquitous throughout the and 43,285 control-days. Females accounted for 52.7%
atmosphere; elevated levels (≥75 ppb) are common in large (6,717) of the case-days. Median patient age was 28.6 years
urban areas. Exposure to ground-level ozone can result in (range: 4 months–98 years). The median ground-level ozone
respiratory health effects. During 2008–2011, Sublette County concentration was 47 ppb (range: 19–84 ppb). For every
(population ~10,000; 2.1 persons/mile2) had documented 10-ppb ozone increase, during the following day, clinic visits
elevated ground-level ozone; we sought to determine if increased by 4.8% (adjusted odds ratio: 1.048; 95% confidence
ground-level ozone concentrations were associated with interval: 1.003–1.095). Because of the limited sample size, we
respiratory-related clinic visits in Sublette County. were unable to stratify by ozone season or year. We identified
METHODS: Respiratory-related clinic visits were ascer- no other statistically significant interactions.
tained from the only two area clinics’ electronic billing records CONCLUSIONS: Prior studies have not examined
for 2008–2011. The Wyoming Department of Environmental potential health effects of ground-level ozone in nonurban
Quality provided daily ground-level ozone measurements communities. Consistent with extant literature, our results
and weather data. We used a bidirectional (before and after indicate an association between ground-level ozone
event) time-stratified (1-month) case-crossover design (each concentrations and respiratory clinic visits among persons
case serves as its own control), adjusted for temperature and residing in Sublette County. Education efforts can help the
humidity, to investigate associations between ground-level public limit their exposure and understand health effects of
ozone concentrations and respiratory clinic visits. We exam- ozone.
ined interactions by age category and sex. KEYWORDS: ozone, Wyoming, air pollutants, environ-
RESULTS: The final data set included 12,742 case-days mental exposure, respiratory tract diseases
2:55 Impact of Aerial Insecticide Spraying on West Nile Virus Disease —

North Texas, 2012
AUTHORS: Duke J. Ruktanonchai, S.K. Pillai, S. Stonecipher, N. Lindsey, K. Horiuchi, M. Delorey,

B. Biggerstaff, T. Sidwa, J. Zoretic, J. McAllister, R. Nasci, M. Fischer, S. Hills
BACKGROUND: West Nile virus (WNV) is the leading spraying’s impact by using the ratio and 95% confidence
THURSDAY
cause of mosquitoborne disease in the United States. During intervals (CIs) of IRRs in treated and untreated areas.
2012, four north Texas counties reported >840 WNV RESULTS: In treated areas, the incidence before and after
cases, six times more than any previous year. In response, spraying was 7.47 and 0.28 per 100,000 persons, respectively;
larviciding and ground-based adulticide spraying were the IRR was 27.00 (95% CI: 12.70–57.41). In untreated areas,
performed variably throughout the area and, for the first time the before and after incidence was 4.80 and 0.45 per 100,000
in north Texas, aerial insecticide spraying was used for WNV persons, respectively; the IRR was 10.57 (95% CI: 6.11–
control with two counties treated in August. We evaluated 18.29). The ratio of these IRRs was 2.55 (95% CI: 1.01–6.49).
aerial spraying’s impact on WNV disease.
CONCLUSIONS: WNV neuroinvasive disease incidence
METHODS: We defined a case as a resident of one of the decreased in the after-spray period in both areas, but the
four counties who, in 2012, had laboratory-confirmed WNV relative change was significantly greater in aerial-sprayed
neuroinvasive disease using the national surveillance case areas. Further studies should assess possible confounding
definition. Patients were categorized as living within or factors (e.g., ground spraying) and evaluate the impact of
outside the aerial-sprayed area. We calculated incidence rate earlier spraying implementation.
ratios (IRRs) in treated and untreated areas by comparing
incidence rates before and after spraying; for unsprayed KEYWORDS: West Nile virus, disease outbreaks, mosquito
areas, before and after periods were defined by using spray control, insecticides
dates from a corresponding sprayed area. We evaluated aerial
Being approximately right most of the time

is better than being precisely right occasionally.
—Author Unknown
SESSION P: Money, Math, and Modeling

3:30–4:55 pm
Ravinia Ballroom
MODERATORS: Benjamin Park and Barbara Marston
3:35 Cost-Effectiveness of a Screening Program to Prevent Cryptococcal

Meningitis Among HIV-Infected Persons — Vietnam
AUTHORS: Rachel M. Smith, T. Nguyen, H. Ha, P. Thang, C. Thuy, L. Truong, H. Bui, T. Le, B. Struminger,
M. McConnell, R. Fanfair, B. Park, J. Harris
BACKGROUND: Approximately 66,000 HIV-associated with an incremental cost/LYG (vs. no intervention) <$6,948.
THURSDAY
cryptococcal meningitis (CM) deaths occur yearly in RESULTS: We tested sera from 226 patients [104 (46%)
South and Southeast Asia; early diagnosis and treatment from northern and 122 (54%) from southern Vietnam].
improves survival. The World Health Organization (WHO) Median CD4 count was 40 (range: 0 – 99) cells/mm3. Nine
recommends screening HIV-infected adults with CD4<100 (4%; 95% confidence interval [CI]: 2–7%) specimens were
cells/mm3 for serum cryptococcal antigen (CrAg), a marker of CrAg-positive; prevalence was similar in southern (6%; 95%
early cryptococcal infection, in areas of high CrAg prevalence. CI: 3–11%) and northern Vietnam (2%; 95% CI: 0–6%) (P =
We evaluated CrAg prevalence and cost-effectiveness of CrAg 0.18). The incremental increases in cost/LYG for screening at
screening in Vietnam. CrAg prevalences of 2%, 4%, and 8% were $190, $137, and
METHODS: HIV-infected, anti-retroviral-naïve patients $119, respectively. At a 4% CrAg prevalence, the number
presenting to care in 12 clinics during 2009–2012 in Hanoi needed to screen to prevent one CM case or death was 228
and Ho Chi Minh City, Vietnam, were prospectively enrolled. and 321, respectively.
Sera from patients with CD4<100 cells/mm3 underwent CrAg CONCLUSIONS: A CrAg screening program is likely to
testing. Cost estimates were obtained from laboratory staff be very cost-effective in Vietnam. Public health officials in
and clinicians in Vietnam; key assumptions, such as mortality Vietnam should consider adding CrAg screening to local
rates, were based on the literature. Cost-effectiveness was HIV care guidelines.
evaluated using cost/life-year gained (LYG); we performed
sensitivity analysis at varying CrAg prevalence levels. WHO KEYWORDS: cryptococcus; meningitis, fungal, cost-
defines a ‘very cost-effective’ intervention in Vietnam as one effectiveness, opportunistic infections
3:55 Is Clostridium difficile Strain Type a Predictor of Disease Outcomes?
AUTHORS: Isaac See, Y . Mu, J . Cohen, Z . Beldavs, L . Winston, G . Dumyati, J . Dunn, M . Farley,
S . Holzbauer, C . Lyons, H . Johnston, E . Phipps, L . Wilson, L . Anderson, F . Lessa
BACKGROUND: An estimated 14,000 deaths/year in the RESULTS: NAP typing results were available for 2,086
United States are attributed to Clostridium difficile infection cases. Severe disease occurred in 403/2,086 (19.3%) cases and
(CDI). Recent increases in CDI morbidity and mortality might death in 81/2,086 (3.9%). NAP1 was the most common strain
be attributed to the emergence of a previously uncommon type (27.9%), followed by NAP4 (10.0%) and NAP11 (9.3%).
strain, North American Pulsed-field gel electrophoresis In univariate analysis, only NAP1 was associated with severe
(NAP) type NAP1. We describe strain types causing CDI and disease (OR: 2.02; P < 0.0001) and death (2.37; P<0.0001).
evaluate their association with patient outcomes. After controlling for age, prior healthcare exposures, and
METHODS: We analyzed data from 10 geographic areas patient comorbidities, NAP1 remained associated with both
participating in active population-based CDI surveillance. severe disease (aOR: 1.62; 95% CI: 1.26–2.09) and death
A case was defined as a positive stool toxin or molecular (aOR: 1.80; 95% CI: 1.12–2.90).
assay for C. difficile during 2009–2012 in a surveillance area CONCLUSION: The NAP1 strain type accounted for over
resident without a positive test in the prior eight weeks. A one quarter of cases and was a predictor for both severe
convenience sample of case isolates underwent pulsed-field disease and death. Strategies to reduce CDI morbidity may
gel electrophoresis typing. Severe disease was defined as need to target strain-specific factors.
ileus, toxic megacolon, pseudomembranous colitis, white KEYWORDS: Clostridium difficile, mortality, risk factors,
blood count ≥15,000, or ICU admission after positive test. We bacterial typing techniques
performed logistic regression to calculate adjusted odds ratios
(aOR) and confidence intervals (CI) for the associations of
strain type with severe disease and death.
4:15 Economic Impact of a Public Health Response to a Measles Case —

New York, 2012
AUTHORS: Nina Ahmad, D. Demeter, J. Nerone, D. Blog, C. Schulte, E. Rausch-Phung, P. Kutty,

I. Ortega-Sanchez
BACKGROUND: Measles is a highly communicable, identified, including 182 (68%) at the school. Among school
vaccine-preventable, viral illness that caused 139,300 deaths contacts, 107 (59%) had no evidence of measles immunity; 34
THURSDAY
worldwide during 2010. In 2000, endemic measles was received measles-containing vaccine as an outbreak control
declared eliminated in the United States; however, prompt measure, and the remaining 73 were excluded for 21 days.
public health response to imported cases remains crucial for During the response, six public health departments, 18 public
preventing spread to susceptible persons. On September 14, health officers, and three laboratories were involved. Public
2012, an unvaccinated male aged 9 years with an imported health personnel expended ~495 person-hours, including
case of measles exposed a highly unvaccinated population at 44 overtime hours. Among response activities, planning
his private school in New York. We assessed the economic and coordination efforts demanded 50% of personnel time.
impact of preventing spread of measles in this community. Preliminary estimated costs to public health were $20,115.
METHODS: We evaluated public health resources and costs No secondary measles cases were identified.
during September 18 (when the case was reported) to October CONCLUSIONS: Extensive public health resources
15 (when control efforts ceased) from the state and local and time were expended to prevent measles spread in an
public health perspective. We used standardized economic unvaccinated setting. These costs emphasize the importance
surveys to calculate personnel hours and associated direct of complying with routine recommended vaccine policy to
costs, including prorated salaries, and costs of materials and decrease the burden on public health.
other response-related expenditures. KEYWORDS: measles, public health, communicable disease
RESULTS: Overall, 269 potentially exposed persons were control, medical economics
4:35 Predicting Year of Tuberculosis Elimination Among U.S.-Born Populations

by State
AUTHORS: Courtney M. Yuen, M. Chen, T. Navin
BACKGROUND: Despite declining tuberculosis (TB) TB elimination in their U.S.-born populations within 50
rates in the United States, nearly 4,000 TB cases in U.S.-born years (median: 30 years; interquartile range: 18–50 years).
persons were reported to CDC in 2011. To determine factors Percentage of cases in correctional institutions at time of
that might affect TB elimination in the U.S.-born population, diagnosis and percentage of cases in Hispanic persons were
we estimated each state’s projected time to TB elimination significantly associated with delay in TB elimination. Time-
and investigated if time-to-elimination was associated with to-elimination was predicted to increase by 5.4 years for each
TB case-patient characteristics. 1% of cases in correctional institutions (P <0.001) and by 0.56
METHODS: We used a piecewise log-linear regression years for each 1% of cases in Hispanic persons (P = 0.004).
model based on annual reported TB case rates during 1994– CONCLUSIONS: We predict that most states will achieve TB
2011 to predict when each state will achieve TB elimination elimination in their U.S.-born populations within the coming
(1 case/1,000,000 population annually), in its U.S.-born decades but expect variation among states. To accelerate
population. We performed multivariate linear regression TB elimination in their U.S.-born populations, states with
to determine ecologic correlations between predicted year high proportions of cases in correctional institutions and in
of elimination for each state and average annual percentage Hispanic persons should consider increasing their efforts to
of case-patients with Hispanic ethnicity, black race, white eliminate TB in these populations.
race, age >64 years, age <15 years, and TB risk factors (e.g., KEYWORDS: tuberculosis, disease elimination, United
residence in a correctional institution). States, epidemiology
RESULTS: Of the states, 75% were predicted to achieve
THURSDAY
FRIDAY, APRIL 26, 2013
Tell me your attributes,

and I’ll tell you your chances.
—Author Unknown
SESSION Q: Risk Factors

8:30–9:55 am
Ravinia Ballroom
MODERATOR: Robin Ikeda
8:35 Examining the Relationship Between Food Security and Self-Reported

Hypertension Among White, Black, and Hispanic Adults, Behavioral Risk
Factor Surveillance System — 12 States, 2009
AUTHORS: Shalon M. Irving, R. Njai, P. Siegel, Y. Liao
BACKGROUND: Food security is a modifiable social RESULTS: Overall, the prevalence of food security was
determinant of health. Lack of food security — which is linked 80.8%, the prevalence of hypertension was 29.4%, and food
with increased stress and in turn the risk of hypertension — security was inversely associated with hypertension after
is inversely associated with socioeconomic status (SES). Our adjustments for SES measures (aPR: 0.84; 95% CI: 0.77–
objective is to examine whether food security is protective 0.91). The relationship differed little by race/ethnicity but
against hypertension independent of SES. was substantially stronger among men than among women
METHODS: We analyzed 2009 data on black, white, and (aPR: 0.76; 95% CI: 0.66–0.86 versus aPR 0.91; CI: 0.82–1.00)
Hispanic adults from 12 states deploying the Behavioral and was strongest among respondents aged 18–34 (aPR: 0.52;
Risk Factor Surveillance System’s Social Context Module 95% CI: 0.39–0.70).
(N = 66,581). Respondents reporting rarely/never being CONCLUSION: Even after adjustments for three SES
worried about having enough money to buy nutritious meals factors, food security remained associated with a decreased
FRIDAY
were defined as food secure; self-reported hypertension was risk for hypertension in all demographic groups assessed.
defined as having been told by a health professional that they These results support the hypothesis that interventions
have high blood pressure. We used logistic regression to intended to increase food security may be effective in
estimate adjusted prevalence ratios (aPR) and 95% confidence reducing participants’ risk for cardiovascular disease without
intervals (CI) for food security in relation to hypertension, modifying their SES.
both overall and by selected demographic characteristic, KEYWORDS: hypertension, food supply, socioeconomic
while adjusting for three measures of SES: education, health status
insurance and poverty-income ratio.
8:55 Risk Factors for Diarrhea-Associated Death Among Children

in Botswana in 2012
AUTHORS: Paul A . Gastañaduy, J . Houston, O . Ratshipa, S . Modi, H . Dale, D . Simpson, M . Patel,

U . Parashar
BACKGROUND: Diarrhea is a leading cause of child RESULTS: Sixty-three case-patients and 126 controls were
mortality in Botswana, a country with high prevalence of enrolled. Among case-patients, 34 (54%) were male, median
childhood malnutrition (~11%) and adult HIV (~25%). For age at death was 4 months (range: 0–18 months), 65% had
HIV-exposed infants (born to an HIV-infected mother), severe dehydration on presentation, and 90% received
formula feeding is recommended. A two-fold increase in intravenous fluids. Compared to controls, children who
reported nationwide childhood diarrheal deaths between died were more likely to be HIV-exposed (97% versus 34%;
January–June 2012 prompted an investigation of risk factors adjusted odds ratio [aOR] = 32; 95% confidence interval [CI]:
to improve prevention and control efforts. 2–530), not exclusively breastfed (94% versus 28%; aOR = 13;
METHODS: A case-control study was conducted at main 95% CI: 2–84), and malnourished (44% versus 2%; aOR = 42;
referral hospitals of 5 districts with the highest diarrhea 95% CI: 4–427).
case-fatality rates. Case-patients (children <5 years who CONCLUSIONS: The vast majority of diarrhea deaths
died with gastroenteritis between January 1–June 30, 2012) in Botswana occur among HIV-exposed infants who were
were compared to age frequency-matched controls (children not exclusively breastfed. Our findings support WHO
presenting to surrounding child welfare clinics [CWC]). recommendations to promote breastfeeding regardless of HIV
CWC cards were reviewed for information on malnutrition exposure status and for effective treatment of malnutrition as
(weight-for-age z-score <-2), HIV exposure, and exclusive key childhood survival interventions, and could contribute to
breastfeeding through 6 months of life. Bivariate and efforts in Botswana to develop similar policies.
multivariate logistic regression were performed to identify KEYWORDS: diarrhea, mortality, HIV, breastfeeding,
risk factors. malnutrition, Botswana
9:15 Association Between Housing Insecurity and Health Outcomes

and Behaviors — Washington State, 2011
AUTHORS: Mandy A . Stahre, J . VanEenwyk, R . Njai, P . Siegel
BACKGROUND: Social determinants of health (e.g., RESULTS: During 2011, among 14,114 WABRFSS partici-
housing insecurity) are a new focus area for Healthy People pants, ~29% reported housing insecurity. Housing insecure
2020. Housing insecurity is associated with stress and residents were twice as likely to report poor or fair health
unhealthy behaviors. Studies establishing this association (16% versus 8%; aPR: 2.05; 95% CI: 1.62–2.59) or that poor
are not population-based and do not attempt to control for health interfered with daily activities (12% versus 6%; aPR:
the effect of socioeconomic status. We sought to examine 2.13; 95% CI: 1.57–2.90). Delay in seeking medical care was
associations between housing insecurity and indicators of 3 times more common among residents who were hous-
poor health or risk behaviors. ing insecure than not (21% versus 6%; aPR: 3.35; 95% CI:
METHODS: Respondents to the 2011 Washington State 2.59–4.33). Housing insecurity was also associated with an
Behavioral Risk Factor Surveillance System (WABRFSS) who increased prevalence of smoking (16% versus 11%; aPR: 1.41;
answered always, usually, or sometimes to how often they 95% CI: 1.11–1.79).
worried about paying their rent or mortgage during the past CONCLUSIONS: The association between housing
FRIDAY
year were classified as housing insecure. We estimated adjusted insecurity and health is substantial even after controlling
prevalence ratios (aPRs) and 95% confidence intervals (CIs), for potential confounders. This information is useful for
adjusting for sex, income, education, insurance coverage, more fully assessing the influence of social policies aimed at
Hispanic ethnicity, marital and veteran status, and adverse improving health.
childhood experiences. All analyses were conducted by using KEYWORDS: housing; socioeconomic factors; health
SUDAAN® to account for weighting of individual responses. behavior; Behavioral Risk Factor Surveillance System
9:35 Obesity, Physical Activity, Screen Time, and Sugar-Sweetened Beverage

Consumption Among Adolescents — Utah, 2011
AUTHORS: Joanna R. Watson, M. Friedrichs
BACKGROUND: Adolescent obesity is associated with Adjusted and unadjusted odds ratios were calculated using
increased cardiovascular disease, diabetes, and all-cause logistic regression. We adjusted for sex, age, race/ethnicity,
mortality during adulthood. To assess obesity risk factors for and parental education.
Utah adolescents, we analyzed 2011 Utah Prevention Needs RESULTS: Obesity prevalence was 7.5% (95% confidence
Assessment (PNA) Survey data. We evaluated three risk interval [CI]: 7.04–7.90). Of Utah adolescents, 81.3% (95%
factors, physical activity, screen time, and sugar-sweetened CI: 80.64–81.88) had <60 minutes/day of physical activity;
beverage (SSB) consumption. 50.0% (95% CI: 49.01–50.90) had >2 hours/day of screen
METHODS: The 2011 Utah PNA was an anonymous time; and 44.4% (95% CI: 43.43–45.31) consumed SSBs >4
survey of 16,667 students weighted to be representative of times/week. Adjusted odds ratios for obesity were as follows:
8th-, 10th-, and 12th-grade Utah public school students. All lack of physical activity, 1.62 (95% CI: 1.30–2.01); >2 hours
data were self-reported and analyses were performed using screen time, 1.57 (95% CI: 1.38–1.77); and SSB consumption
weighted survey methods. Proportions were calculated for >4/week, 1.17 (95% CI: 1.02–1.33).
obesity (≥95th percentile on sex-specific BMI-for-age growth CONCLUSIONS: Lack of physical activity, increased screen
charts), physical activity (≥60 minutes/day with increased time, and SSB consumption were associated with adolescent
heart rate or breathing hard some of the time), screen time obesity. Results support implementation of the Utah Nutrition
(watching television, playing video or computer games, or and Physical Activity Plan 2010–2020.
using a computer for nonschoolwork activities, ≤2 or >2
hours/day) and SSB consumption (glass/can of soda/other KEYWORDS: obesity, exercise, beverages, television, video
sugar-sweetened drink, 0–3 times/week or ≥4 times/week). games, adolescent
FRIDAY
You just tell me when and where,

and not only will I be there, but I’ll also be late.
—Jarod Kintz
SESSION R: Late-Breaking Reports

10:30–11:45 am
Ravinia Ballroom
MODERATORS: Douglas H. Hamilton and Randolph Daley
See supplement for presenters and abstracts.

FRIDAY
A hospital is no place to be sick.

—Samuel Goldwyn
SESSION S: Healthcare-Associated Infections

1:30–3:15 pm
Ravinia Ballroom
MODERATORS: Matthew Kuehnert and Tom Chiller
1:35 Postprocedural Fungal Endophthalmitis Associated with Sterile Products

from a Single Compounding Pharmacy — Multiple States, 2012
AUTHORS: Christina A. Mikosz, R.M. Smith, M. Kim, C. Tyson, K. OYong, K.K. Trivedi, E.H. Lee,
S. Straif-Bourgeois, R. Sowadsky, B. Sun, S. Millay, S. Black, Y.T. Grant, J. Conway, W. Bamberg,
Y. Vasquez, J. Harris, S. Lockhart, T.J. Török, L. Mascola, B.J. Park
BACKGROUND: Fungal endophthalmitis is a rare but Blue-G (BBG) dye during retinal surgery, and 22 had prior
serious infection that can cause vision loss. In March 2012, intravitreal injection of triamcinolone acetonide (TAC). Both
the California and Los Angeles County Departments of BBG and TAC were compounded at Pharmacy X. Fusarium
Public Health were notified of nine fungal endophthalmitis incarnatum-equiseti species complex mold was identified
cases after retinal surgery at a California ambulatory surgical in specimens from BBG-exposed case-patients and from
center. We investigated to identify the source and prevent unopened Pharmacy X BBG vials. Bi-polaris hawaiiensis
additional cases. mold was identified in specimens from TAC-exposed case-
METHODS: Probable cases were defined as ophthalmologist- patients. Of 40 patients with available data, 39 (98%) suffered
diagnosed fungal endophthalmitis after an intraocular vision loss, and 36 (90%) required repeat ophthalmic surgery.
procedure performed after August 23, 2011, the production CDC advised avoidance of Pharmacy X sterile compounded
date of a suspected product. Confirmed cases had fungi products, which were recalled on May 21, 2012.
FRIDAY
identified by culture, histopathology, or polymerase chain CONCLUSIONS: We describe a multistate outbreak of

reaction. Case-finding occurred through Epi-X posts, FDA postprocedural fungal endophthalmitis associated with
MedWatch alerts, e-mails to ClinMicroNet laboratories two compounded products labeled as sterile from a single
and two ophthalmologist professional associations, and compounding pharmacy, resulting in widespread Pharmacy X
sales record review. Microbiologic and genetic testing were product recall. Clinicians should be aware that contamination
performed on patient specimens and available suspected of sterile compounded products can occur.
product. Patient charts were reviewed. KEYWORDS: eye infections, fungal; endophthalmitis;
RESULTS: We identified 43 confirmed and probable disease outbreaks; epidemiology; drug compounding
cases in nine states; 21 had prior exposure to Brilliant
1:55 Evolution of Clinical Manifestations of Fungal Infections Associated

with Contaminated Steroid Injections, Multistate, 2012
AUTHORS: Duc B. Nguyen and members of the Fungal Infection Outbreak Clinical Team
BACKGROUND: Fungal infections are a rare complication to symptom onset. Meningitis, parameningeal infections
of steroid injections to treat chronic back pain, and the (e.g., epidural abscess) and stroke occurred in 249 (73.0%),
clinical course of disease is largely unknown. In September 111 (32.6%), and 34 (10.0%) cases, respectively. Majority of
2012, we investigated an outbreak of fungal infections meningitis (89.2%) and strokes (94.1%) occurred in the first 5
associated with injections of contaminated preservative- weeks of the outbreak, whereas the majority of parameningeal
free methylprednisolone acetate (MPA) produced by a infections (65.8%) occurred later. Ninety percent of case-
single compounding pharmacy. We describe the clinical patients (n = 308) received antifungal therapy. Twenty-eight
presentations and outcomes of infected patients. (11.2%) and 16 (6.4%) meningitis case-patients subsequently
METHODS: Probable cases were defined as meningitis, developed parameningeal infections and stroke, respectively.
stroke, and/or parameningeal infections in persons exposed Twenty-six (7.6%) case-patients died; deaths occurred more
to implicated MPA after May 21, 2012. Confirmed cases met frequently among confirmed than probable cases (14.0% vs.
the probable case definition and had laboratory evidence 5.0%, P = 0.004).
of Exserohilum rostratum or Aspergillus fumigatus. We CONCLUSIONS: Clinical presentations evolved during
abstracted detailed information from medical records of a the outbreak, reflecting possible variation in pathogenic
subset of case-patients in Florida, Indiana, Michigan, New mechanisms. Current emphasis should be on appropriate
Jersey, Tennessee, and Virginia to better characterize clinical spinal imaging to detect and treat parameningeal infections.
features. Continued close follow-up is needed in light of these dynamic
RESULTS: As of November 19, 2012, data from 341 cases clinical manifestations.
(100 [29.3%] confirmed) were available. Median incubation KEYWORDS: fungal infection, contaminated steroid injec-
period was 19 days (range: 0–86 days) from last injection tions
2:15 Confirmed Donor-Derived Strongyloidiasis Cluster in Transplant

Recipients — Pennsylvania, 2012
AUTHORS: Francisca A. Abanyie, E. Bosserman, S. Montgomery
BACKGROUND: Transplant-associated Strongyloides ster- endoscopy. The fourth had no evidence of strongyloidiasis.
coralis infection is an emerging public health concern among There was no known history of illness compatible with
solid-organ transplant recipients. The source of infection in prior infection with Strongyloides in the donor or recipients.
these patients is not always apparent and may have implica- Banked donor serum testing results were positive (13.68
tions for the establishment of screening guidelines. We inves- units/uL). Pre-transplant serum samples obtained from all
tigated a cluster of patients infected with Strongyloides who four recipients were negative. Two recipients expired due to
received solid-organ transplants from a single donor to deter- pulmonary complications unrelated to strongyloidiasis; the
mine the source of infection. remaining two were successfully treated with albendazole
METHODS: We examined details of the procurement and and ivermectin.
transplantation of solid-organs for recipients who developed CONCLUSIONS: We identified the source of Strongyloides
strongyloidiasis post-transplant and determined the donor infection as donor-derived based on EIA testing of the
and recipients’ risk of Strongyloides infection by reviewing donor and recipients’ serum samples. This cluster is one
FRIDAY
medical and laboratory records. Pre-transplant serum from of four clusters of donor-derived strongyloidiasis in 2012,
each recipient and banked donor serum samples were tested highlighting the emergence of this public health concern.
at CDC’s Parasitic Diseases Reference Laboratory via enzyme Organ procurement organizations and transplant medicine
immunoassay (EIA) to determine if strongyloidiasis was physicians should consider testing to assess risk of donors
donor-derived infection or reactivation of chronic infection from endemic areas to improve transplant safety.
in the recipients. KEYWORDS: Strongyloides infection, strongyloidiasis,
RESULTS: Of four recipients, three were confirmed to have solid-organ transplant, transplant-associated infections,
evidence of strongyloidiasis by detection of parasite larvae on screening guidelines
2:35 Clostridium difficile Infection Among Children — United States, 2010–2011
AUTHORS: Joyanna M. Wendt, J. Cohen, Y. Mu, G. Dumyati, J. Dunn, S. Holzbauer, L. Winston,

W. Bamberg, J. Meek, M. Farley, L. Wilson, E. Phipps, Z. Beldavs, C. Gould, F. Lessa
BACKGROUND: Clostridium difficile infections (CDI) RESULTS: Of 944 CDI cases identified, 71% were CA.
are an increasing public health threat; however, little is Incidences per 100,000 were 70.6 (age 1 year), 34.2 (2–3 years),
known about the epidemiology among children including 15.4 (4–9 years), and 16.6 (10–17 years). Older cases (10–17
those <3 years of age in whom colonization is common years) more frequently had underlying medical conditions
and pathogenicity less certain. We used active surveillance (P=0.003) but the proportion of cases with diarrhea (72%),
data to describe CDI incidence, exposures, and clinical severe disease (8%), or co-infection with another enteric
characteristics among children. pathogen (4%) was similar across age groups; none died.
METHODS: We analyzed population-based CDI data for Among the 95 CA cases interviewed, 83% reported a doctor’s
children aged 1–17 years from 10 U.S. geographic areas office visit and 72% used antibiotics during the prior 12 weeks.
participating in the Emerging Infections Program during CONCLUSIONS: Similar clinical severity across age groups
2010–2011. A case was defined as C. difficile-positive stool suggests an etiologic role for C. difficile in the high rates
without a positive test in the prior 8 weeks. Community- observed in younger children. Targeting prevention efforts to
associated (CA) cases had stool collected as an outpatient or reduce antimicrobial use among young children in outpatient
≤3 days after hospital admission and no overnight healthcare settings should be prioritized for prevention.
facility stay in the prior 12 weeks. Demographic, exposure, KEYWORDS: Clostridium difficile, pediatrics, surveillance
and clinical data were collected. A convenience sample of CA
cases was interviewed. Age-stratified incidence was calculated
using U.S. census. Chi-square test was used for comparisons.
2:55 Invasive Group A Streptococcus Infections Associated with Outpatient

Liposuction — Multiple States, August–September 2012
AUTHORS: Amanda L. Beaudoin, L. Torso, M.A. Said, K. Richards, L. Wilson, K.L. Dooling, J.M. Wendt,
M. Wise, A. Longenberger, M. Moll, P. Eggers, S. Ostroff
BACKGROUND: Group A Streptococcus (GAS) causes linked to Facility A and one to Facility B. An additional GAS
10,700–12,500 invasive infections annually among U.S. infection was identified in a household contact of a patient.
residents. In September 2012, the Maryland Department of GAS was isolated from two HCP who performed all four
Health and Mental Hygiene was notified of invasive GAS liposuction procedures; emm type (emm28) matched all three
infections in three persons who had undergone liposuction available case isolates. HCP received antimicrobial treatment
at an unregulated outpatient cosmetic surgery “medspa” to eradicate GAS carriage. Both facilities lacked infection
(Facility A). Health care personnel (HCP) at Facility A also control policies and equipment sterilization records. State
performed liposuction in Pennsylvania (Facility B). State health departments closed Facility A and suspended
health departments investigated both facilities to identify liposuction at Facility B.
additional cases and potential GAS sources. CONCLUSIONS: GAS was likely transmitted by HCP
METHODS: We contacted 53 liposuction patients from during liposuction performed at facilities with deficient
Facilities A and B during July 1–September 15, 2012. infection control practices and policies. These outpatient
FRIDAY
Confirmed cases had GAS isolated from a normally sterile facilities typically are not regulated as ambulatory surgical
site or wound after liposuction. We reviewed infection centers. This investigation highlights the need for oversight
control practices at both facilities. HCP were interviewed and of such outpatient facilities to reduce the incidence of life-
screened for GAS carriage. GAS isolates were emm-typed. threatening health care-associated infections.
RESULTS: We identified four confirmed invasive GAS cases, KEYWORDS: Streptococcus; lipectomy; infection control;
including one death. All patients (Maryland=3, Delaware=1) ambulatory surgical procedures; quality assurance, health
had been hospitalized in intensive care. Three cases were care
EIS Officers, Class of 2011

Acosta, Anna* – NCIRD
Ailes, Elizabeth C. – NCBDDD
Ao, Trong (Tony)* – CGH
Appelgren, Kristie* – NCCDPHP
Auld, Sara* – NCHHSTP
Baker, Charlotte* – NCBDDD
Baughman, Penelope* – NIOSH

Baumblatt, Jane A.G.* – SEPDPO
Behbod, Behrooz – NCEH
Briggs, Melissa A.* – CGH
Britton, Carla* – SEPDPO
Buser, Genevieve L.* – SEPDPO
Chiu, Cindy H.* – NCEH

Clarke, Kevin* – CGH
Dantes, Raymund B.* – NCEZID
Davis, Stephanie* – CGH
Dokubo, E. Kainne* – CGH
Dooling, Kathleen L.* – NCIRD
Espiritu, Jennifer* – SEPDPO

Fakhouri, Tala H. I.* – NCHS
Fitter, David* – CGH
Fleming, Eleanor B.* – NCHHSTP
Fowler, Katherine A.* – NCIPC
Garrett, Tiana A. – SEPDPO
Gastañaduy, Paul A.* – NCIRD

Ghaji, Nafisa – NCBDDD
Grant, Yoran T.* – SEPDPO
Greenbaum, Adena H.* – NCIRD
Griese, Stephanie E.* – SEPDPO
Gronostaj, Michael* – SEPDPO
Halldin, Cara N.* – NIOSH

Hancock, William* – NCEZID
Hoots, Brooke E. – NCHHSTP
Houston, James C. – CGH
Houston, Keisha A. – NCCDPHP
Imanishi, Maho* – NCEZID
Introcaso, Camille E. – NCHHSTP

Johnson, Matthew G.* – SEPDPO
Joseph, Rachael* – SEPDPO
Kinzer, Michael H. – SEPDPO
Lam, Eugene* – NCCDPHP
Lankau, Emily – NCEZID
Laufer, Alison S.* – NCEZID

Lo, Terrence* – NCHHSTP
Ludwig, Alison* – SEPDPO
Mahajan, Reena – NCHHSTP
Mdodo, Rennatus* – NCHHSTP
Meyer, Sarah A.* – NCIRD
Mikosz, Christina A.* – SEPDPO

Musolin, Kristin* – NIOSH
Nerlander, Lina* – NCCDPHP
Nguyen, Duc B.* – NCEZID
Nunez, Jonathan J.* – SEPDPO
Parker, Erin M.* – NCIPC
2013 EIS Conference EIS Officers 137
Paul, Prabasaj – NCCDPHP

Pillai, Satish .K.* – NCEH
Pride, Kerry R.* – SEPDPO
Raczniak, Gregory* – NCEZID
Said, Maria A.* – SEPDPO
Scobie, Heather M.* – CGH
See, Isaac* – NCEZID

Slayton, Rachel B.* – NCEZID
Smith, Rachel M.* – NCEZID
Sreenivasan, Nandini* – NCEZID
Styles, Timothy S.* – SEPDPO
Taylor, Eboni M. – NCEZID
Tian, Niu – NCCDPHP

Toprani, Amita – SEPDPO
Tsai, Rebecca* – NIOSH
Walters, Maroya S. – NCEZID
Wendt, Joyanna M.* – NCEZID
Wong, Karen K.* – NCIRD
Worthham, Jonathan M.* – NCIRD

Yasmin, Seema* – SEPDPO
Yendell, Stephanie* – NCEZID
Yeoman, Kristin M.* – SEPDPO
* Presenting EIS Officers

138 2013 EIS Conference EIS Officers
EIS Officers, Class of 2012

Abanyie, Francisca A.* – CGH
Adams, Laura E.* – SEPDPO
Agaku, Israel – NCCDPHP
Ahmad, Nina* – SEPDPO
Alami, Negar (Nikki) – NCHHSTP
Anderson, Tara C.* – NCEZID
Bagchi, Suparna* – SEPDPO

Beaudoin, Amanda L.* – SEPDPO
Brinker, Kimberly – NIOSH
Canon, Abbey J.* – SEPDPO
Choi, Mary* – SEPDPO
Cooley, Laura A.* – NCHHSTP
Demirijian, Alicia* – NCIRD

Djawe, Kpandja* – NCHHSTP
Doker, Thomas – NCEZID
Durand, Lizette NCIRD
Edison, Laura S.* – SEPDPO
Ellis, Esther – NCEZID
Epson, Erin* – SEPDPO

Geller, Andrew – NCEZID
Gerbi, Gemechu – NCHHSTP
Gilbert, Leah K.* – NCIPC
Gunnala, Rajni – NCCDPHP
Harris, Aaron M.* – NCIRD
Havers, Fiona P.* – NCIRD

Hickox, Kaci L.* – SEPDPO
Idowu, Rachel – CGH
Irving, Shalon M.* – NCCDPHP
Iyengar, Preetha* – CGH
Johnson, Candice – NIOSH
Johnson, Jonetta – NCCDPHP

Kamiya, Hajime – NCIRD
Ko, Stephen – NCHHSTP
Kumar, Gayathri S.* – NCCDPHP
Landman, Keren – CGH
Lebo, Emmaculate* – NCIRD
Lederer, Philip – CGH

Leshem, Eyal* – NCIRD
Levri, Kara M.* – SEPDPO
Lind, Jennifer N.* – NCCDPHP
Lloyd, Spencer B.* – CGH
Lowe, Michael* – NCCDPHP
Lozier, Matthew – NCEH

McCague, Anna-Binney – NIOSH
McNeil, Carrie S.* – SEPDPO
Mercado, Carla I.* – NCCDPHP
Miller, Leigh Ann* – SEPDPO
Morris, Jamae – NCEZID
Murti, Michelle* – NCEH/ATSDR

Nakao, Jolene H.* – NCEZID
Nguyen, Von D.* – NCEZID
Nnadi, Chimeremma D.* – NCHHSTP
Nyaku, Mawuli K.* – SEPDPO
Osadebe, Lynda – NCEZID
2013 EIS Conference EIS Officers 139
Patton, Monica E.* – NCHHSTP

Plucinski, Mateusz – CGH
Purfield, Anne E.* – NCEZID
Quinn, Celia – SEPDPO
Quinto, Kenneth B.* – NCHS
Rha, Brian S.* – NCIRD
Ridpath, Alison D.* – SEPDPO

Ross, Christine E.* – NCHHSTP
Ruktanonchai, Duke J.* – SEPDPO
Russell, Elizabeth S.* – SEPDPO
Salyer, Stephanie – CGH
Schafer, Ilana J.* – NCEZID
Schwitters, Amee M.* – CGH

Sein, Carolyn – CGH
Shiferaw, Miriam – CGH
Shumate, Alice M.* – SEPDPO
Stahre, Mandy A.* – SEPDPO
Thomas, Dana – NCEZID
Thompson-Paul, Angela M.* – NCHHSTP

Todd, Suzanne R.* – NCEZID
Vora, Neil M.* – NCEZID
Wallace, Ryan – NCEZID
Watson, Joanna R.* – SEPDPO
Wilken, Jason – SEPDPO
Woodring, Joseph V.* – NCHS

Yablon, Brian R.* – SEPDPO
Yuen, Courtney M.* – NCHHSTP
* Presenting EIS Officers

140 2013 EIS Conference EIS Officers
Incoming EIS Officers, Class of 2013

Adam, Jessica MD, MPH Mcnamara, Lucy PhD, MS
Apata, Ibironke MD Meiman, Jonathan MD
Arriola, Carmen DVM, PhD, MHS Mercado Crespo, Melissa MSc, MA, PhD
Arwady, Mary MPH, MD Merrill, Rebecca MHS, PhD
Ayscue, Patrick PhD, DVM Millman, Alexander MD
Basler, Colin DVM, MPH Mirkovic, Kelsey PhD
Biggs, Holly MD, MPH Moturi, Edna MBChB, MPH
Blackley, David MPH, DrPH Mullins, Jocelyn DVM, MPH, PhD
Bowen, Virginia MHS, PhD Nolen, Leisha MD, PhD
Breakwell, Lucy MSc, PhD Nyakaana, Nyangoma Edith MBChB, MPH
Calles, Dinorah MPH, PhD Oboho, Ikwo MD, PhD, ScM
Chatham-Stephens, Kevin MD, MPH Ogunmoyero, Oluwatosin (Tosin) MBChB, MSc
Chea, Nora MD, MSc Olayinka, Olaniyi MBChB, MPH
Chevalier, Michelle MPH, MD Paczkowski, Magdalena PhD, MPH
Clayton, Joshua L MPH, PhD Painter, Julia MPH, PhD
Dahl Thomasson, Erica MPH, PhD Pastula, Daniel MD, MHSc
Desilva, Malini MPH, MD Perkins, Kiran MPH, MD
Dixon, Meredith MD Petersen, Emily MD
Dynes, Michelle MSN, MPH, PhD Petrosky, Emiko MD, MPH
Epstein, Lauren MD, MSc Phillips, Raina MD
Fechter-Leggett, Ethan DVM, MPVM Pringle, Kimberly MD
Forrester, Joseph MD, MSc, MSc Puckett, Mary PhD
Francois, Louise MD, MPH Reaves, Erik DO, MTM&H
Harris, Jennifer MPH, PhD Rhea, Sarah DVM, MPH, PhD
Harvey, Robert DVM, MPH Rosenthal, MPH, PhD, PhD
Hastings, Deborah MS, MD Schnabel, David MD, MPH
Hsu, Joy MD, MSc Sharma, Aditya MD
Hunter, Jennifer MPH, DrPH Socias, Christina MPH, DrPH
Jacobs Slifka, Kara MD, MPH Sumner, Steven MD, MSc
Kiebler, Craig MS, MPH, DVM Taylor, Allison MPH, PhD, PhD
Koirala, Samir MBBS, MSc Tomczyk, Sara MSc
Lee-Kwan, Seung MS, PhD Vallabhaneni, Snigdha MD, MPH
Lester, Laura DVM Volkmann, Tyson MPH, PhD
Levy, Benjamin Aaron MD Wells, Natalie MD, MPH
Lin, Xia (Michelle) MS, PhD, MSPH Wendorf, Kristen MD, MS
Luvsansharav, Ulzii-Orshikh MD, MSc, PhD Whitfield, Geoffrey MEd, PhD
Maenner, Matthew PhD Williams, Candice MD, MPH
Marcewicz, Lauren MD Wilson, Nana MPH, PhD, MSc
Marcinkevage, Jessica MSPH, PhD Wu, Hsiu MD
Matanock, Almea MD Yacisin, Kari MD, MSc
Mcgee, Sasha PhD, MPH, MPH
Index of EIS Officer Presenters

Abanyie, Francisca.............................................................................134 Lloyd, Spencer......................................................................................78
Acosta, Anna........................................................................................82 Lo, Terrence..........................................................................................88
Adams, Laura.......................................................................................72 Lowe, Michael......................................................................................90
Ahmad, Nina............................................................................... 98, 127 Ludwig, Alison.....................................................................................56
Anderson, Tara..................................................................................104 McNeil, Carrie.....................................................................................95
Ao, Trong........................................................................................70, 78 Mdodo, Rennatus................................................................................63
Appelgren, Kristie...............................................................................77 Mercado, Carla.....................................................................................63
Auld, Sara.............................................................................................86 Meyer, Sarah.........................................................................................42
Bagchi, Suparna.............................................................................57, 97 Mikosz, Christina....................................................................... 94, 133
Baker, Charlotte...................................................................................52 Miller, Leigh Ann................................................................................94
Baughman, Penelope...........................................................................84 Murti, Michelle..................................................................................115
Baumblatt, Jane....................................................................................43 Musolin, Kristin...................................................................................83
Beaudoin, Amanda............................................................................135 Nakao, Jolene.......................................................................................49
Briggs, Melissa.....................................................................................77 Nerlander, Lina....................................................................................50
Britton, Carla.......................................................................................69 Nguyen, Von...................................................................................47, 79
Buser, Genevieve................................................................................111 Nguyen, Duc......................................................................................134
Canon, Abbey......................................................................................97 Nnadi, Chimeremma..........................................................................87
Chiu, Cindy........................................................................................100 Nunez, Jonathan..................................................................................42
Choi, Mary.........................................................................................113 Nyaku, Mawuli.....................................................................................93
Clarke, Kevin........................................................................................76 Parker, Erin...........................................................................................48
Cooley, Laura.......................................................................................67 Patton, Monica.....................................................................................55
Dantes, Raymund................................................................................51 Pillai, Satish................................................................................. 89, 116
Davis, Stephanie................................................................................112 Pride, Kerry........................................................................................125
Demirjian, Alicia...............................................................................112 Purfield, Anne......................................................................................40
Djawe, Kpandja....................................................................................66 Quinto, Kenneth..................................................................................51
Dokubo, Kainne...................................................................................66 Raczniak, Gregory...............................................................................59
Dooling, Kathleen.........................................................................50, 59 Rha, Brian.......................................................................................44, 99
Edison, Laura.......................................................................................71 Ridpath, Alison....................................................................................44
Epson, Erin.........................................................................................113 Ross, Christine.....................................................................................56
Espiritu, Jennifer..................................................................................73 Ruktanonchai, Duke.........................................................................125
Fakhouri, Tala......................................................................................64 Russell, Elizabeth.................................................................................93
Fitter, David..........................................................................................47 Said, Maria..........................................................................................103
Fleming, Eleanor.................................................................................90 Schafer, Ilana........................................................................................52
Fowler, Katherine..............................................................................123 Schwitters, Amee.................................................................................84
Gastañaduy, Paul........................................................................ 58, 130 Scobie, Heather....................................................................................61
Gilbert, Leah........................................................................................68 See, Isaac.............................................................................................127
Grant, Yoran.........................................................................................96 Shumate, Alice...................................................................................114
Greenbaum, Adena.............................................................................81 Slayton, Rachel.....................................................................................49
Griese, Stephanie...............................................................................102 Smith, Rachel.....................................................................................126
Gronostaj, Michael............................................................................103 Sreenivasan, Nandini..........................................................................41
Halldin, Cara........................................................................................41 Stahre, Mandy....................................................................................130
Hancock, W. Thane.............................................................................53 Styles, Timothy..................................................................................115
Harris, Aaron.......................................................................................60 Thompson-Paul, Angela.....................................................................99
Havers, Fiona.................................................................................46, 80 Todd, Suzanne......................................................................................72
Hickox, Kaci.........................................................................................69 Tsai, Rebecca........................................................................................85
Imanishi, Maho........................................................................... 48, 105 Vora, Neil..............................................................................................45
Irving, Shalon.....................................................................................129 Watson, Joanna..................................................................................131
Iyengar, Preetha.................................................................................107 Wendt, Joyanna..................................................................................135
Johnson, Matthew...............................................................................96 Wong, Karen......................................................................................124
Joseph, Rachael....................................................................................95 Woodring, Joseph................................................................................67
Kumar, Gayathri..................................................................................62 Wortham, Jonathan.............................................................................82
Lam, Eugene.........................................................................................87 Yablon, Brian........................................................................................85
Laufer, Alison.............................................................................. 98, 124 Yasmin, Seema.....................................................................................65
Lebo, Emmaculate...............................................................................60 Yendell, Stephanie................................................................................53
Leshem, Eyal......................................................................................104 Yeoman, Kristin.............................................................................64, 92
Levri, Kara............................................................................................81 Yuen, Courtney..................................................................................128
Lind, Jennifer.......................................................................................91
Dr. Stephen B. Thacker
contributed to
21 publications
published in the
American Journal of
Epidemiology.
The design of this
62nd Annual EIS
Conference book
acknowledges
the style and graphical
treatment of one of
Dr. Thacker’s
favorite journals.
CS237745-B

Epidemic Intelligence Service (EIS) Conference: 62 Annual

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62nd Annual

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Current EIS Officers

Incoming EIS Officers

Field EIS Alumni

Save the Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Centers for Disease Control and Prevention

Douglas H. Hamilton, MD, PhD

Denise Koo, MD, MPH (EIS ’91)

62nd EIS Conference

Conference Program Production EIS Program Staff

The EIS Alumni Association

If you are not already a paid member, consider joining TODAY!

Priti Patel, MD, MPH (EIS ’02) Aimee Ahmed

Registration and Information Lactation Room

Cyber Café/Message Center

2013 EIS Conference Schedule At-a-Glance

SESSION A: Stephen B. Thacker Opening Session — Ravinia Ballroom 8:15–10:15 am

SESSION G: International Health — Ravinia Ballroom 1:45–3:50 pm

SPECIAL SESSION Stephen B. Thacker Memorial Tribute — Ravinia Ballroom 12:30 pm

Paul C. Schnitker International Health Award

Monday, April 22, 2013

7:00 REGISTRATION DESK OPENS

8:15 WELCOME AND CALL TO ORDER

Presentation of the Stephen B. Thacker Excellence in Mentoring Award

8:30 Here to serve. —Stephen B. Thacker

10:15 BREAK Sponsored by the EIS Alumni Association

11:50 Burden of Encephalitis-Associated Hospitalizations — United States, 1998–2010.

12:30 Variety is the spice of life. —William Cowper

P1.1 Outpatient Antiviral Therapy for Influenza in Three Healthcare Systems —

2:55 BREAK Sponsored by the EIS Alumni Association

3:15 Vaccines are the tugboats of preventive health. —William H. Foege

Presentation of the Iain C. Hardy Award

4:00 Severity of Invasive Pneumococcal Disease in the Era of Pneumococcal Conjugate

5:20 EIS CONFERENCE SOCIAL Sponsored by the EIS Alumni Association

Tuesday, April 23, 2013

8:30 Knowledge is power. —Sir Francis Bacon

8:35 Characteristics of HIV-Positive American Indians — Arizona, 1990–2012. Seema Yasmin

10:15 BREAK Sponsored by the EIS Alumni Association

10:50 Lymphocytic Choriomeningitis Virus Outbreak and Risk Assessment — Multiple

12:30 SPECIAL SESSIONS

12:30 CONCURRENT LUNCHTIME SESSION: Chronic Disease Prevention Through

3:10 Epidemiology of Hospitalized Influenza Cases from a Population-Based Surveillance

3:50 BREAK Sponsored by the EIS Alumni Association

6:00 PREDICTION RUN

WEDNESDAY, APRIL 24, 2013

8:35 Respiratory Hospitalizations in Children with Neurologic Disorders — United States,

8:35 Prevalence of Carpal Tunnel Syndrome Among Employees at a Poultry-Processing

10:15 BREAK Sponsored by the EIS Alumni Association

10:30 I do not cough for my own amusement. —Jane Austen

MODERATOR: Kenneth G. Castro

P2.1 Histoplasmosis Outbreak at a Day Camp — Nebraska, 2012. Kristin M. Yeoman

P2.4 Cross-Transmission of Ascaris Infection from Pigs to Humans at an Organic Farm —

12:30 SPECIAL SESSION: Fungal Meningitis Associated with Injection of a Widely

1:55 Outbreak of Listeriosis Associated with Imported and Cross-Contaminated Cheeses —

3:35 BREAK Sponsored by the EIS Alumni Association

4:00 The suspense is terrible; I hope it lasts. —Willy Wonka

5:30 EIS ALUMNI ASSOCIATION MEETING

5:30 Best of all possible worlds. —Gottfried Leibniz

8:15 WELCOME AND CALL TO ORDER

3:15 Vaccines are the tugboats of preventive health. —William H. Foege

12:30 CONCURRENT LUNCHTIME SESSION: Chronic Disease Prevention Through

6:00 PREDICTION RUN

12:30 SPECIAL SESSION: Fungal Meningitis Associated with Injection of a Widely

5:30 EIS ALUMNI ASSOCIATION MEETING

7:30 ORAL PRESENTATIONS

Presentation of the 2013 EIS International Night Awards

12:30 SPECIAL SESSION: Stephen B. Thacker Memorial Tribute

1:30 It is the mark of a truly intelligent person to be moved by statistics.

8:30 EIS SATIRIC REVUE

10:15 Presentation of Awards

8:35 Multi-State Outbreak of Fungal Meningitis and Other Infections Associated

9:15 Sick and Retired, Prevalence of Pneumoconiosis Among Retired

9:55 Serogroup A Meningococcal Conjugate Vaccine Coverage After the First

Poster 1.2 Seroprevalence of Measles and Rubella Antibodies in Pregnant Women —

Poster 1.3 Increasing Number and Disproportionate Morbidity and Mortality

Poster 1.8 Behaviors Among HIV-Positive Ukrainian Street Youth Associated

Poster 1.9 Findings from the Year of Population-Based Active Surveillance

Poster 1.10 Human Papillomavirus Vaccination Status and Current Contraception

Poster 1.11 Progress in Reducing National Burden of Invasive Methicillin-Resistant