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.
BACKGROUND:Early-onset colorectal cancer (EOCRC) is rising nationally, with South Dakota experiencing a reversal in historical trends. Traditionally, American Indian populations have had higher EOCRC rates attributed to healthcare access disparities and socioeconomic factors. Recent data now reveals that the White population exhibits higher EOCRC incidence in South Dakota. METHODS:We analyzed data from the South Dakota Cancer Registry (2007-2022) to calculate EOCRC incidence rates for American Indian and White populations. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were computed. Behavioral risk factors and insurance coverage were also reviewed. RESULTS:The White population's EOCRC incidence rose to 9.6 per 100,000 in 2018-2022, surpassing the American Indian rate of 7.8 per 100,000 (IRR = 1.27, 95% CI: 1.10-1.45). From 2021 to 2022, insurance coverage improved for both American Indians (46.6% to 55.5%) and Whites (81.5% to 83.4%). However, lifestyle disparities persisted. In 2021, American Indians reported higher fruit but lower vegetable intake than Whites. In 2022, physical activity was lower among American Indians (63.3%) than Whites (77.8%). In 2022-2023, obesity prevalence was significantly higher among American Indians (50.2%) than Whites (34.7%). Binge and heavy drinking percentages were elevated among Whites (30.8% and 10.1%, respectively) compared to American Indians (20.0% and 5.4%). Commercial tobacco use was reported higher among American Indians (45.1%) when compared to Whites (27.0%). CONCLUSION:This shift highlights the success of American Indian-focused interventions and underscores emerging challenges among the White population.
BACKGROUND:Travelers who fly on commercial aircraft while infectious with measles are reported to the US Centers for Disease Control and Prevention (CDC) by health departments. CDC contacts airlines to collect information on potentially exposed travelers. Traveler locating information is shared with health departments to facilitate aircraft contact investigations. In May 2025, CDC was notified of a traveler who flew from Europe to Colorado while infectious with measles, transited through Denver International Airport, then flew from Colorado to North Dakota. This report describes details of the subsequent contact investigations, environmental assessment, and laboratory testing results. METHODS:CDC laboratories conducted testing on a majority of case samples. Data from the CDC laboratory, CDC's Port Health Activity Reporting System, and health department investigations were analyzed to describe the index case, contacts, test results, and travel details. Flight records and visual inspection were used to describe relative locations of index and secondary case-patients at Denver International Airport. RESULTS:The index case was in an unvaccinated adult. Aircraft contact investigations identified 135 exposed domestic travelers. Fifteen secondary cases were identified among people exposed during the international (5) and domestic (3) flights and at the airport (7). Two tertiary case-patients were also identified. Five of the secondary case-patients had at least 1 documented prior measles vaccination. CONCLUSIONS:Measles transmission may occur during travel. Measles vaccination is recommended prior to international travel for all travelers aged 6 months or older. Travelers with fever and other overt signs of transmissible illness, such as coughing or malaise, should be strongly encouraged to delay travel while symptomatic.
As part of the response to the highly pathogenic avian influenza A(H5N1) virus outbreak in U.S. cattle and poultry and the associated human cases, CDC and partners are monitoring influenza A virus levels and detection of the H5 subtype in wastewater. Among 48 states and the District of Columbia that performed influenza A testing of wastewater during May 12-July 13, 2024, a weekly average of 309 sites in 38 states had sufficient data for analysis, and 11 sites in four states reported high levels of influenza A virus. H5 subtype testing was conducted at 203 sites in 41 states, with H5 detections at 24 sites in nine states. For each detection or high level, CDC and state and local health departments evaluated data from other influenza surveillance systems and partnered with wastewater utilities and agriculture departments to investigate potential sources. Among the four states with high influenza A virus levels detected in wastewater, three states had corresponding evidence of human influenza activity from other influenza surveillance systems. Among the 24 sites with H5 detections, 15 identified animal sources within the sewershed or adjacent county, including eight milk-processing inputs. Data from these early investigations can help health officials optimize the use of wastewater surveillance during the upcoming respiratory illness season.
Background To characterize neurodevelopmental abnormalities in children up to 36 months of age with congenital Zika virus exposure. Methods From the U.S. Zika Pregnancy and Infant Registry, a national surveillance system to monitor pregnancies with laboratory evidence of Zika virus infection, pregnancy outcomes and presence of Zika associated birth defects (ZBD) were reported among infants with available information. Neurologic sequelae and developmental delay were reported among children with ≥1 follow-up exam after 14 days of age or with ≥1 visit with development reported, respectively. Results Among 2248 infants, 10.1% were born preterm, and 10.5% were small-for-gestational age. Overall, 122 (5.4%) had any ZBD; 91.8% of infants had brain abnormalities or microcephaly, 23.0% had eye abnormalities, and 14.8% had both. Of 1881 children ≥1 follow-up exam reported, neurologic sequelae were more common among children with ZBD (44.6%) vs. without ZBD (1.5%). Of children with ≥1 visit with development reported, 46.8% (51/109) of children with ZBD and 7.4% (129/1739) of children without ZBD had confirmed or possible developmental delay. Conclusion Understanding the prevalence of developmental delays and healthcare needs of children with congenital Zika virus exposure can inform health systems and planning to ensure services are available for affected families. Impact We characterize pregnancy and infant outcomes and describe neurodevelopmental abnormalities up to 36 months of age by presence of Zika associated birth defects (ZBD). Neurologic sequelae and developmental delays were common among children with ZBD. Children with ZBD had increased frequency of neurologic sequelae and developmental delay compared to children without ZBD. Longitudinal follow-up of infants with Zika virus exposure in utero is important to characterize neurodevelopmental delay not apparent in early infancy, but logistically challenging in surveillance models.
