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Article: Outbreak of Foodborne Botulism Associated with a Commercially Produced Multipack Potato Product, Colorado: September 2019

Gayou, Natalia / Plumb, Ian D. / Edwards, Leslie / Pomeroy, Mary / Herlihy, Rachel K. / Johnson, Robin / Pattison, Kimberly / Dykes, Janet / Gómez, Gerardo A. / Jervis, Rachel H.

Foodborne pathogens & disease. 2022 Sept. 23,

2022

Abstract: During September 2019, public health authorities in El Paso County, Colorado, were notified of four patients who had presented to nearby hospitals with clinical features consistent with botulism, a paralytic illness caused by botulinum neurotoxin. One ... ...

Abstract	During September 2019, public health authorities in El Paso County, Colorado, were notified of four patients who had presented to nearby hospitals with clinical features consistent with botulism, a paralytic illness caused by botulinum neurotoxin. One patient died soon after presentation; the other three patients required intensive care but recovered after receiving botulism antitoxin. Botulinum toxin type A was detected in serum from all patients. On further investigation, all four patients had shared a meal that included commercially prepared roasted potatoes from an individual package without refrigeration instructions that had been left unrefrigerated for 15 d. Storage of the product at ambient temperature likely allowed botulism spores to produce botulinum toxin, resulting in severe illness and death. The manufacturer improved labeling in response to this outbreak. Public health officials should consider unrefrigerated potato products as a potential source of botulism; clinicians should consider botulism as a possible cause of paralytic illness.
Keywords	ambient temperature ; antitoxins ; blood serum ; botulinum toxin ; botulism ; death ; disease severity ; patients ; potatoes ; public health ; refrigeration ; Colorado
Language	English
Dates of publication	2022-0923
Publishing place	Mary Ann Liebert, Inc.
Document type	Article
ZDB-ID	2148479-X
ISSN	1556-7125 ; 1535-3141
ISSN (online)	1556-7125
ISSN	1535-3141
DOI	10.1089/fpd.2022.0038
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Article ; Online: Community exposures among Colorado adults who tested positive for SARS-CoV-2 -A case-control study, March-December 2021.

White, Alice E / Tran, Amanda D / Torok, Michelle R / Jervis, Rachel H / Albanese, Bernadette A / Buchwald, Andrea G / Schmoll, Emma / Stringer, Ginger / Herlihy, Rachel K / Scallan Walter, Elaine J

PloS one

2023 Volume 18, Issue 3, Page(s) e0282422

Abstract: Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which causes coronavirus disease 2019 (COVID-19), is spread primarily through exposure to respiratory droplets from close contact with an infected person. To inform ... ...

Abstract	Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which causes coronavirus disease 2019 (COVID-19), is spread primarily through exposure to respiratory droplets from close contact with an infected person. To inform prevention measures, we conducted a case-control study among Colorado adults to assess the risk of SARS-CoV-2 infection from community exposures. Methods: Cases were symptomatic Colorado adults (aged ≥18 years) with a positive SARS-CoV-2 test by reverse transcription-polymerase chain reaction (RT-PCR) reported to Colorado's COVID-19 surveillance system. From March 16 to December 23, 2021, cases were randomly selected from surveillance data ≤12 days after their specimen collection date. Cases were matched on age, zip code (urban areas) or region (rural/frontier areas), and specimen collection date with controls randomly selected among persons with a reported negative SARS-CoV-2 test result. Data on close contact and community exposures were obtained from surveillance and a survey administered online. Results: The most common exposure locations among all cases and controls were place of employment, social events, or gatherings and the most frequently reported exposure relationship was co-worker or friend. Cases were more likely than controls to work outside the home (adjusted odds ratio (aOR) 1.18, 95% confidence interval (CI): 1.09-1.28) in industries and occupations related to accommodation and food services, retail sales, and construction. Cases were also more likely than controls to report contact with a non-household member with confirmed or suspected COVID-19 (aOR 1.16, 95% CI: 1.06-1.27). Conclusions: Understanding the settings and activities associated with a higher risk of SARS-CoV-2 infection is essential for informing prevention measures aimed at reducing the transmission of SARS-CoV-2 and other respiratory diseases. These findings emphasize the risk of community exposure to infected persons and the need for workplace precautions in preventing ongoing transmission.
MeSH term(s)	Adult ; Humans ; Adolescent ; SARS-CoV-2 ; COVID-19/diagnosis ; COVID-19/epidemiology ; Case-Control Studies ; Colorado/epidemiology ; Accommodation, Ocular
Language	English
Publishing date	2023-03-02
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0282422
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Article ; Online: Adult Population Coverage With Influenza Vaccine and Influenza Hospitalization Rates-Is There a Role for Active Outreach to Immunize At-Risk Neighborhoods?

Czaja, Christopher A / Cockburn, Myles G / Colborn, Kathryn / Miller, Lisa / Thomas, Deborah S K / Herlihy, Rachel K / Alden, Nisha / Simões, Eric A F

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2021 Volume 73, Issue 6, Page(s) 1110–1112

Abstract: We evaluated whether Denver neighborhoods with elevated rates of adult hospitalizations for laboratory-confirmed influenza had lower adult coverage with influenza vaccine. Overall vaccine coverage was low. Hospitalization rates were associated with ... ...

Abstract	We evaluated whether Denver neighborhoods with elevated rates of adult hospitalizations for laboratory-confirmed influenza had lower adult coverage with influenza vaccine. Overall vaccine coverage was low. Hospitalization rates were associated with demographic and socioeconomic characteristics. Active immunization of at-risk neighborhoods may be necessary to address disparities in influenza hospitalization rates.
MeSH term(s)	Adult ; Hospitalization ; Humans ; Influenza Vaccines ; Influenza, Human/epidemiology ; Influenza, Human/prevention & control ; Laboratories ; Vaccination
Chemical Substances	Influenza Vaccines
Language	English
Publishing date	2021-03-03
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciab231
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Article ; Online: Health Care Personnel Exposures to Subsequently Laboratory-Confirmed Monkeypox Patients - Colorado, 2022.

Marshall, Kristen E / Barton, Marlee / Nichols, Janell / de Perio, Marie A / Kuhar, David T / Spence-Davizon, Emily / Barnes, Meghan / Herlihy, Rachel K / Czaja, Christopher A

MMWR. Morbidity and mortality weekly report

2022 Volume 71, Issue 38, Page(s) 1216–1219

Abstract: The risk for monkeypox transmission to health care personnel (HCP) caring for symptomatic patients is thought to be low but has not been thoroughly assessed in the context of the current global outbreak (1). Monkeypox typically spreads through close ... ...

Abstract	The risk for monkeypox transmission to health care personnel (HCP) caring for symptomatic patients is thought to be low but has not been thoroughly assessed in the context of the current global outbreak (1). Monkeypox typically spreads through close physical (often skin-to-skin) contact with lesions or scabs, body fluids, or respiratory secretions of a person with an active monkeypox infection. CDC currently recommends that HCP wear a gown, gloves, eye protection, and an N95 (or higher-level) respirator while caring for patients with suspected or confirmed monkeypox to protect themselves from infection
MeSH term(s)	Colorado/epidemiology ; Delivery of Health Care ; Health Personnel ; Humans ; Infectious Disease Transmission, Patient-to-Professional/prevention & control ; Mpox (monkeypox)/diagnosis ; Mpox (monkeypox)/epidemiology ; Personal Protective Equipment
Language	English
Publishing date	2022-09-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	412775-4
ISSN	1545-861X ; 0149-2195
ISSN (online)	1545-861X
ISSN	0149-2195
DOI	10.15585/mmwr.mm7138e2
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Article ; Online: Health care personnel exposures to subsequently laboratory-confirmed monkeypox patients - Colorado, 2022.

Marshall, Kristen E / Barton, Marlee / Nichols, Janell / de Perio, Marie A / Kuhar, David T / Spence-Davizon, Emily / Barnes, Meghan / Herlihy, Rachel K / Czaja, Christopher A

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

2022 Volume 22, Issue 11, Page(s) 2699–2703

MeSH term(s)	Humans ; Mpox (monkeypox)/epidemiology ; Colorado/epidemiology ; Health Personnel ; Delivery of Health Care ; Disease Outbreaks
Language	English
Publishing date	2022-11-07
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2060594-8
ISSN	1600-6143 ; 1600-6135
ISSN (online)	1600-6143
ISSN	1600-6135
DOI	10.1111/ajt.16681
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Article ; Online: Outbreak of Foodborne Botulism Associated with a Commercially Produced Multipack Potato Product, Colorado: September 2019.

Gayou, Natalia / Plumb, Ian D / Edwards, Leslie / Pomeroy, Mary / Herlihy, Rachel K / Johnson, Robin / Pattison, Kimberly / Dykes, Janet / Gómez, Gerardo A / Jervis, Rachel H

Foodborne pathogens and disease

2022 Volume 19, Issue 10, Page(s) 713–715

Abstract	During September 2019, public health authorities in El Paso County, Colorado, were notified of four patients who had presented to nearby hospitals with clinical features consistent with botulism, a paralytic illness caused by botulinum neurotoxin. One patient died soon after presentation; the other three patients required intensive care but recovered after receiving botulism antitoxin. Botulinum toxin type A was detected in serum from all patients. On further investigation, all four patients had shared a meal that included commercially prepared roasted potatoes from an individual package without refrigeration instructions that had been left unrefrigerated for 15 d. Storage of the product at ambient temperature likely allowed botulism spores to produce botulinum toxin, resulting in severe illness and death. The manufacturer improved labeling in response to this outbreak. Public health officials should consider unrefrigerated potato products as a potential source of botulism; clinicians should consider botulism as a possible cause of paralytic illness.
MeSH term(s)	Humans ; Botulism/diagnosis ; Botulism/epidemiology ; Botulism/etiology ; Botulinum Antitoxin ; Solanum tuberosum ; Clostridium botulinum ; Botulinum Toxins, Type A ; Colorado/epidemiology ; Disease Outbreaks
Chemical Substances	Botulinum Antitoxin ; Botulinum Toxins, Type A (EC 3.4.24.69)
Language	English
Publishing date	2022-09-23
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2148479-X
ISSN	1556-7125 ; 1535-3141
ISSN (online)	1556-7125
ISSN	1535-3141
DOI	10.1089/fpd.2022.0038
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Article ; Online: Evaluation of rates of laboratory-confirmed influenza hospitalization in rural and urban census tracts over eight influenza seasons.

Czaja, Christopher A / Cockburn, Myles G / Colborn, Kathryn / Miller, Lisa / Thomas, Deborah S K / Herlihy, Rachel K / Alden, Nisha / Simões, Eric A F

Preventive medicine

2020 Volume 139, Page(s) 106184

Abstract: The burden of influenza in rural areas is largely unstudied. Rural populations may be vulnerable yet isolated from circulating virus. Laboratory-confirmed influenza hospitalizations in rural Colorado census tracts over eight influenza seasons were ... ...

Abstract	The burden of influenza in rural areas is largely unstudied. Rural populations may be vulnerable yet isolated from circulating virus. Laboratory-confirmed influenza hospitalizations in rural Colorado census tracts over eight influenza seasons were inconsistently distributed across seasons. Rural rates were, on average, lower than urban rates. Race, ethnicity, poverty, health insurance coverage, and distance from a hospital accounted for rate differences. Our interpretation is: 1) influenza regularly circulates in urban areas and inconsistently spreads to rural areas, 2) demographic and socioeconomic factors drive morbidity in exposed populations, and 3) public health interventions targeting high-risk urban census tracts may be beneficial.
MeSH term(s)	Censuses ; Colorado/epidemiology ; Hospitalization ; Humans ; Influenza, Human/diagnosis ; Influenza, Human/epidemiology ; Laboratories ; Rural Population ; Seasons ; Urban Population
Language	English
Publishing date	2020-06-29
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	184600-0
ISSN	1096-0260 ; 0091-7435
ISSN (online)	1096-0260
ISSN	0091-7435
DOI	10.1016/j.ypmed.2020.106184
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Article ; Online: State-level estimates of excess hospitalizations and deaths associated with influenza.

Czaja, Christopher A / Miller, Lisa / Colborn, Kathryn / Cockburn, Myles G / Alden, Nisha / Herlihy, Rachel K / Simões, Eric A F

Influenza and other respiratory viruses

2019 Volume 14, Issue 2, Page(s) 111–121

Abstract: Background: National estimates of influenza burden may not reflect state-level influenza activity, and local surveillance may not capture the full burden of influenza.: Methods: To provide state-level information about influenza burden, we estimated ... ...

Abstract	Background: National estimates of influenza burden may not reflect state-level influenza activity, and local surveillance may not capture the full burden of influenza. Methods: To provide state-level information about influenza burden, we estimated excess pneumonia and influenza (P&I) and respiratory and circulatory (R&C) hospitalizations and deaths in Colorado from local hospital discharge records, death certificates, and influenza virus surveillance using negative binomial models. Results: From July 2007 to June 2016, influenza was associated with an excess of 17 911 P&I hospitalizations (95%CI: 15 227, 20 354), 30 811 R&C hospitalizations (95%CI: 24 344, 37 176), 1,064 P&I deaths (95%CI: 757, 1298), and 3828 R&C deaths (95%CI: 2060, 5433). There was a large burden of influenza A(H1N1) among persons aged 0-64 years, with high median seasonal rates of excess hospitalization among persons aged 0-4 years. Persons aged ≥65 years experienced the largest numbers and highest median seasonal rates of excess hospitalization and death associated with influenza A (H3N2). The burden of influenza B was generally lower, with elevated median seasonal rates of excess hospitalization among persons aged 0-4 years and ≥65 years. Conclusions: These findings complement existing influenza surveillance. Periodic state-level estimates of influenza disease burden may be useful for setting state public health priorities and planning prevention and control initiatives.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Colorado/epidemiology ; Female ; Hospitalization ; Humans ; Infant ; Infant, Newborn ; Influenza A Virus, H1N1 Subtype/pathogenicity ; Influenza A Virus, H3N2 Subtype/pathogenicity ; Influenza, Human/epidemiology ; Male ; Middle Aged ; Mortality ; Pneumonia/epidemiology ; Population Surveillance ; Public Health ; Young Adult
Language	English
Publishing date	2019-11-07
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2274538-5
ISSN	1750-2659 ; 1750-2640
ISSN (online)	1750-2659
ISSN	1750-2640
DOI	10.1111/irv.12700
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Article ; Online: Symptom Profiles and Progression in Hospitalized and Nonhospitalized Patients with Coronavirus Disease, Colorado, USA, 2020.

Vahey, Grace M / Marshall, Kristen E / McDonald, Emily / Martin, Stacey W / Tate, Jacqueline E / Midgley, Claire M / Killerby, Marie E / Kawasaki, Breanna / Herlihy, Rachel K / Alden, Nisha B / Staples, J Erin

Emerging infectious diseases

2021 Volume 27, Issue 2, Page(s) 385–395

Abstract: To improve recognition of coronavirus disease (COVID-19) and inform clinical and public health guidance, we randomly selected 600 COVID-19 case-patients in Colorado. A telephone questionnaire captured symptoms experienced, when symptoms occurred, and how ...

Abstract	To improve recognition of coronavirus disease (COVID-19) and inform clinical and public health guidance, we randomly selected 600 COVID-19 case-patients in Colorado. A telephone questionnaire captured symptoms experienced, when symptoms occurred, and how long each lasted. Among 128 hospitalized patients, commonly reported symptoms included fever (84%), fatigue (83%), cough (73%), and dyspnea (72%). Among 236 nonhospitalized patients, commonly reported symptoms included fatigue (90%), fever (83%), cough (83%), and myalgia (74%). The most commonly reported initial symptoms were cough (21%-25%) and fever (20%-25%). In multivariable analysis, vomiting, dyspnea, altered mental status, dehydration, and wheezing were significantly associated with hospitalization, whereas rhinorrhea, headache, sore throat, and anosmia or ageusia were significantly associated with nonhospitalization. General symptoms and upper respiratory symptoms occurred earlier in disease, and anosmia, ageusia, lower respiratory symptoms, and gastrointestinal symptoms occurred later. Symptoms should be considered alongside other epidemiologic factors in clinical and public health decisions regarding potential COVID-19 cases.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; COVID-19/complications ; COVID-19/epidemiology ; COVID-19/virology ; Child ; Child, Preschool ; Colorado/epidemiology ; Cough/epidemiology ; Cough/virology ; Disease Progression ; Dyspnea/epidemiology ; Dyspnea/virology ; Fatigue/epidemiology ; Fatigue/virology ; Female ; Fever/epidemiology ; Fever/virology ; Humans ; Infant ; Inpatients/statistics & numerical data ; Male ; Middle Aged ; Myalgia/epidemiology ; Myalgia/virology ; Outpatients/statistics & numerical data ; SARS-CoV-2 ; Symptom Assessment ; Young Adult
Language	English
Publishing date	2021-01-23
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1380686-5
ISSN	1080-6059 ; 1080-6040
ISSN (online)	1080-6059
ISSN	1080-6040
DOI	10.3201/eid2702.203729
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Article ; Online: Assessment of SARS-CoV-2 Seroprevalence by Community Survey and Residual Specimens, Denver, Colorado, July-August 2020.

Kugeler, Kiersten J / Podewils, Laura J / Alden, Nisha B / Burket, Tori L / Kawasaki, Breanna / Biggerstaff, Brad J / Biggs, Holly M / Zacks, Rachael / Foster, Monique A / Lim, Travis / McDonald, Emily / Tate, Jacqueline E / Herlihy, Rachel K / Drobeniuc, Jan / Cortese, Margaret M

Public health reports (Washington, D.C. : 1974)

2021 Volume 137, Issue 1, Page(s) 128–136

Abstract: Objectives: The number of SARS-CoV-2 infections is underestimated in surveillance data. Various approaches to assess the seroprevalence of antibodies to SARS-CoV-2 have different resource requirements and generalizability. We estimated the ... ...

Abstract	Objectives: The number of SARS-CoV-2 infections is underestimated in surveillance data. Various approaches to assess the seroprevalence of antibodies to SARS-CoV-2 have different resource requirements and generalizability. We estimated the seroprevalence of antibodies to SARS-CoV-2 in Denver County, Colorado, via a cluster-sampled community survey. Methods: We estimated the overall seroprevalence of antibodies to SARS-CoV-2 via a community seroprevalence survey in Denver County in July 2020, described patterns associated with seroprevalence, and compared results with cumulative COVID-19 incidence as reported to the health department during the same period. In addition, we compared seroprevalence as assessed with a temporally and geographically concordant convenience sample of residual clinical specimens from a commercial laboratory. Results: Based on 404 specimens collected through the community survey, 8.0% (95% CI, 3.9%-15.7%) of Denver County residents had antibodies to SARS-CoV-2, an infection rate of about 7 times that of the 1.1% cumulative reported COVID-19 incidence during this period. The estimated infection-to-reported case ratio was highest among children (34.7; 95% CI, 11.1-91.2) and males (10.8; 95% CI, 5.7-19.3). Seroprevalence was highest among males of Black race or Hispanic ethnicity and was associated with previous COVID-19-compatible illness, a previous positive SARS-CoV-2 test result, and close contact with someone who had confirmed SARS-CoV-2 infection. Testing of 1598 residual clinical specimens yielded a seroprevalence of 6.8% (95% CI, 5.0%-9.2%); the difference between the 2 estimates was 1.2 percentage points (95% CI, -3.6 to 12.2 percentage points). Conclusions: Testing residual clinical specimens provided a similar seroprevalence estimate yet yielded limited insight into the local epidemiology of COVID-19 and might be less representative of the source population than a cluster-sampled community survey. Awareness of the limitations of various sampling strategies is necessary when interpreting findings from seroprevalence assessments.
MeSH term(s)	Adolescent ; Adult ; Age Factors ; Aged ; COVID-19/epidemiology ; COVID-19/immunology ; Child ; Child, Preschool ; Colorado/epidemiology ; Female ; Humans ; Infant ; Male ; Middle Aged ; SARS-CoV-2 ; Seroepidemiologic Studies ; Sex Factors ; Sociodemographic Factors ; Young Adult
Language	English
Publishing date	2021-11-09
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	120953-x
ISSN	1468-2877 ; 0033-3549
ISSN (online)	1468-2877
ISSN	0033-3549
DOI	10.1177/00333549211055137
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