Nebraska Department of Health & Human Services

In 2022, the U.S. Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and state and local public health and regulatory agencies investigated an outbreak of Salmonella Typhimurium infections linked to alfalfa sprouts. A total of 63 ill people were reported in eight states, including ten hospitalizations. Interviews of ill people identified raw alfalfa sprouts as the vehicle of interest. A traceback investigation, including eight points of service in three states, identified a single grower as the source of the alfalfa sprouts. An inspection by FDA and Nebraska Department of Agriculture at the grower identified deviations from food safety standards and violations to FDA's produce safety regulation, including failure to follow the production batch testing requirements. The grower voluntarily recalled four lots of raw alfalfa sprouts. Retail sprout samples collected by state and local officials and sprouts and alfalfa seed samples collected by FDA during inspections at the grower and distributor all tested negative. The epidemiologic, traceback, and inspectional evidence supported the conclusion that alfalfa sprouts from the single grower were the source of illnesses. Whole genome sequencing data from Australian clinical isolates, after the outbreak concluded, supported that contaminated seed was the likely source of sprout contamination. Rapid response and collaborative efforts by federal, state, and local public health officials helped identify the outbreak source and implement the necessary control measures for preventing further illnesses. Established food safety requirements are necessary to reduce foodborne illnesses associated with the production of sprouts for human consumption.

This cross-sectional study aimed to assess the demographic and geographic variations in the visit rate for first-episode psychosis (FEP), identify trends and diagnostic patterns, and explore factors associated with FEP visits in Nebraska. Inpatient and emergency department data spanning 2017-2021 were collected by the Nebraska Hospital Association (NHA). The study focused on Nebraska residents aged 14-35 admitted for FEP, identified through specific ICD-10 codes. The sample was derived using a multi-step process, and the data included patient demographics, Behavioral Health Regions, rural vs. urban residency, and neighborhood characteristics. Mann-Kendall tests were used to test for significant trends over time. T-tests and chi-squared tests were used to assess differences in each of the measures between patients with and without psychotic disorders. The study findings revealed a significant increase in visits related to psychotic disorders from 2017 to 2021. In 2021, the FEP visit rate was 116 per 100,000 individuals, varying considerably by age, gender, and Behavioral Health Region. Schizoaffective disorder bipolar type was the most frequent psychotic disorder. Patients with psychotic disorders tended to be older, predominantly male, and treated in acute care settings. The rising trend underlines the need for continued investment in early intervention programs and highlights challenges in rural areas, necessitating targeted interventions. The findings provide valuable insights to inform planning, advocate for funding, and address the specific needs of diverse populations. Future research should explore additional influencing factors and extend the study period to understand FEP trends comprehensively.

Objective:Expanded public health (PH) antimicrobial stewardship (AS) funding to Healthcare-Associated Infections (HAI)/Antimicrobial Resistance (AR) programs led to hiring of pharmacists with AS expertise in health departments. A PH pharmacists' community of practice (CoP) consisting of pharmacists who work for local, state, and federal PH agencies was initiated to share resources and activities from PH AS interventions and collaborations. The objective of this evaluation was to characterize publications identified by PH pharmacists' CoP that helped advance AS implementation by PH agencies. Methods:In March 2024, a 34-item electronic questionnaire was developed and distributed to the PH pharmacists' CoP requesting nominations of articles that highlight interventions and data sources essential to PH AS practice. Respondents were asked to submit 1-10 scientific articles published from 2014 to 2023 most relevant to their work in PH AS implementation and/or in achieving programmatic deliverables. Articles with ≥ 3 nominations were selected for review. Results:Of 39 PH pharmacists in the CoP, 24 (62%) responded with 106 article nominations. Respondents held state-level positions (83%), had <2 years of PH AS experience (54%), and were often from the southeastern United States (25%). Publications in acute care settings were most frequent (54, 51%), followed by outpatient (47, 44%), and long-term care (45, 42%). A total of eleven articles were selected for review. Conclusions:Scientific publications impactful to AS PH practice can serve as a valuable resource for AS programs and pharmacists in PH. Dissemination of PH AS activities can inform enhancement of AS programs in the PH sector.

Student interview teams provided essential surge capacity for the conduct of routine enteric disease surveillance and outbreak activities during the COVID-19 pandemic response, for states with that resource available. This case study describes how student interview teams based in Colorado and Washington supported enteric disease interviewing for public health agencies in Nebraska, Wyoming, Kansas, and California, and demonstrates the feasibility and value of interstate student interview team work to provide enteric and other communicable disease surge capacity. In collaboration with their respective state health agencies, the Colorado School of Public Health Enteric Disease Interview Team (EDIT) and the University of Washington Student Epidemic Action Leaders (SEAL) team amended scopes of work and procedures for hiring and onboarding, training, work management and engagement, communication, and evaluation to offer enteric disease interviewing support to the Nebraska Department of Health and Human Services, the Wyoming Department of Health, the Kansas Department of Health and Environment, and the California Department of Public Health. EDIT was assigned 467 enteric interviews in Nebraska, 193 in Wyoming, and 33 in Kansas; and the SEAL team was assigned 133 interviews from 26 clusters in California, with response rates of 68%, 79%, 58%, and 53%, respectively. The median time from case assignment to first interview for EDIT interviews was less than or equal to 1 day. The completeness of all interviews was satisfactory. Enteric disease epidemiologists from host state health departments and students reported valuing the interstate work. Establishing interstate student interview team support requires coordination but is possible and can be effective in providing essential surge capacity for states without a student interview team. It also provides intangible benefits such as strengthening relationships between states and affiliated university programs and providing professional experiences and networking opportunities for students.

West Nile virus lineage 1 (WNVL1) has been the only lineage known to circulate within the United States; however, multiple other lineages have been identified around the world. West Nile virus lineage 3 (WNVL3) was previously only isolated from mosquitoes in Czechia, but no human cases had been observed. West Nile virus lineage 3 was identified alongside WNVL1 in 2023 in a severely ill Nebraska patient with no history of international travel. To determine the extent of WNVL3 transmission, 1,199 historical mosquito pools collected from the state of Nebraska from 2012 through 2024 totaling >40,000 Culex spp. mosquitoes were tested. All pools tested negative for WNVL3 RNA. This study suggests that WNVL3 may circulate at very low levels or in alternative vector species in Nebraska.