Minnesota Department of Health (MDH) Bug Bytes
October 6, 2005
Vol. 6: No.2
Topics in this Issue:
1. Salad That Makes You Ill
2. Reporting Rule Changes
3. Increases in Syphilis and Quinolone-Resistant Gonorrhea in Gay and Bisexual Men
4. Emerging Infections Annual Conference
5. We Will be Moving to St. Paul
Last Friday, we announced an outbreak of E. coli O157:H7 associated with prepackaged Dole brand lettuce mixes. At that time we had 11 culture-confirmed cases of disease in Minnesota residents with matching PFGE subtypes. Cases had eaten either the Classic Romaine, American Blend, or Greener Selection variety purchased from different Rainbow Foods stores. These mixes share romaine lettuce, red cabbage, and carrots in common. The salad packages had a “Best if Used by 09/23/05” date and a production code beginning with “B250…”. Illness onsets ranged from September 16 to 19. The median age of the cases was 23 years (range, 3-68 years). A case-control study implicated prepackaged lettuce mix (9 of 10 cases vs. 7 of 20 controls; matched odds ratio, 9.9; 95% confidence interval, 1.2-84.0; p =0.035). Among persons who ate prepackaged lettuce salad, illness was associated with Dole brand purchased from Rainbow (8 of 9 cases vs. 0 of 7 controls). The salad mixes were packaged in California.
At the time of this writing, we have 17 confirmed cases including one case of serious hemolytic uremic syndrome in a child. Eight persons have been hospitalized. We also have seen additional six secondary cases in households with a primary case; one person is hospitalized. At least one case purchased their salad mix from a different grocery store chain than Rainbow. E. coli O157:H7 with a matching PFGE has been isolated from an opened bag of lettuce mix obtained from a household that supplied lettuce to two cases; a second opened bag has tested positive for E. coli O157:H7, PFGE results are pending. Additional cases are being reported to us and isolates are being sent to us from laboratories. Two other states have each reported a PFGE-matching case, and one of these two cases reports an identical consumption history from a salad mix purchased in Oregon. We are working closely with the Minnesota Department of Agriculture, CDC, and the U.S. Food and Drug Administration on this ongoing investigation to determine the ultimate source of contamination.
Learn more about: E. coli >>
Effective September 2005, MDH has made changes to the Rules Governing Communicable Disease, Minnesota Rules Parts 4605.7000 to 4605.7900. Complete information is available in the MDH Disease Control Newsletter May/June 2005. The last major revisions had occurred in 1985. Additional diseases have been added, some conditions have been made immediately reportable, and we now require submission of clinical materials when a bacterial or viral isolate has not been obtained.
Learn more about: Reporting Infectious Diseases >>
3. Increases in Syphilis and Quinolone-Resistant Gonorrhea in Gay and Bisexual Men; Watching for Lymphogranuloma Venereum ( LGV)
We recently alerted health care providers about three recent trends among gay and bisexual men: the resurgence of syphilis in Minnesota in 2005; a five-fold increase in quinolone-resistant gonorrhea in Minnesota; and, being on the lookout for LVG since cases have occurred in Europe, Canada, and a few cities in the U.S.
Per CDC guidelines, clinicians are encouraged to assess the sexual risk for all male patients, including gender of their sex partners. The following tests should be performed at least annually for sexually active gay and bisexual men: syphilis serology; urethral culture or nucleic acid amplification test for gonorrhea; urethral or urine test (culture or nucleic acid amplification) for chlamydia in men with a history of insertive oral or anal sex; pharyngeal culture for gonorrhea in men with a history of receptive oral-genital exposure; rectal gonorrhea and chlamydia culture in men who have had receptive anal intercourse; and, HIV serology, if HIV-negative or not previously tested.
Men at higher risk (prior STD history, meeting partners via the Internet, multiple or anonymous sex partners, meth use) should be screened more frequently, at three to six month intervals and counseled on safer sex practices.
For more details and specific guidelines related to these health trends, health providers may call the MDH at (612) 676-5414 or visit their Syphilis website.
Learn more about: Syphilis >>
Our 11 th Annual Emerging Infections in Clinical Practice and Emerging Health Threats Conference will be held November 10 (all day) and November 11 (half day) in downtown Minneapolis. We will have another great conference this year with outstanding speakers. Topics will include STDs, infection control, cutaneous infections, zoonotic diseases, neonatal infections, CA-MRSA, tuberculosis, the HIV pandemic, pandemic influenza, new laboratory tools, vaccines, and more. For the agenda and registration go to Emerging Infections in Clinical Practice and Emerging Health Threats. Attention: non-MDH link.
After 36 years at our present location and over 100 years in Minneapolis, we will be moving to St. Paul. The Minneapolis building will be vacated. The Department of Health was situated in Minneapolis specifically to be aligned with the University of Minnesota. The Infectious Disease Epidemiology, Prevention and Control Division is moving to the Orville L. Freeman Building at 625 Robert Street N. in St. Paul on October 31, 2005. The new phone number will be 651-201-5414. The Public Health Laboratory will be moving to the Minnesota Department of Agriculture/Minnesota Department of Health Lab at 601 Robert Street N. More detailed information on phone numbers and telephones will be provided in the near future. We all agree that we want to retain our close ties with the University and are taking several steps to do so.
Learn more about: MDH Addresses and Locations >>
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