On August 19, 2011, a male U.S. Army soldier with progressive right arm and shoulder pain, nausea, vomiting, ataxia, anxiety, and dysphagia was admitted to an emergency department (ED) in New York for suspected rabies. Rabies virus antigens were detected in a nuchal skin biopsy, rabies virus antibodies in serum and cerebrospinal fluid (CSF), and rabies viral RNA in saliva and CSF specimens by state and CDC rabies laboratories. An Afghanistan canine rabies virus variant was identified. The patient underwent an experimental treatment protocol but died on August 31. The patient had described a dog bite while in Afghanistan. However, he had not received effective rabies postexposure prophylaxis (PEP). In total, 29 close contacts and health-care personnel (HCP) received PEP after contact with the patient. This case highlights the continued risks for rabies virus exposure during travel or deployment to rabies-enzootic countries, the need for global canine rabies elimination through vaccination, and the importance of following effective PEP protocols and ensuring global PEP availability.

Introduction. Surveillance for laboratory-confirmed influenza-associated deaths in children is used to monitor the severity of influenza at the population level and to inform influenza prevention and control policies. The goal of this study was to better estimate pediatric influenza mortality in New York state (NYS). Methods. Death certificate data were requested for all passively reported deaths and any pneumonia and influenza (P&I) coded pediatric deaths occurring between October 2004 and April 2010, excluding New York City (NYC) residents. A matching algorithm and capture-recapture analysis were used to estimate the total number of influenza-associated deaths among NYS children. Results. Thirty-four laboratory-confirmed influenza-associated pediatric deaths were reported and 67 death certificates had a P&I coded death; 16 deaths matched. No laboratory-confirmed influenza-associated death had a pneumonia code and no pneumonia coded deaths had laboratory evidence of influenza infection in their medical record. The capture-recapture analysis estimated between 38 and 126 influenza-associated pediatric deaths occurred in NYS during the study period. Conclusion. Passive surveillance for influenza-associated deaths continues to be the gold standard methodology for characterizing influenza mortality in children. Review of death certificates can complement but not replace passive reporting, by providing better estimates and detecting any missed laboratory-confirmed deaths.

OBJECTIVE:To better understand the severity of 2009 H1N1 influenza disease, enhanced surveillance of patients hospitalized with influenza was conducted during the 2009-2010 influenza season in New York State through existing Emerging Infections Program surveillance and a newly established sentinel hospital surveillance program. The 2 surveillance systems were compared to determine consistency across surveillance modalities and reveal the strengths and weaknesses of each to accomplish comprehensive influenza surveillance.DESIGN:Similar variables from the aggregate data collected from each system were compared and differences were analyzed in detail.SETTING:New York State.PARTICIPANTS:Hospitalized adult and pediatric patients detected through 2 influenza surveillance programs.MAIN OUTCOME MEASURES:Significant differences in age distribution, timing of illness onset, illness complications, underlying medical conditions, critical care admissions, use of mechanical ventilation, and illness outcomes.RESULTS:Both surveillance systems saw the highest numbers of confirmed influenza infection among patients hospitalized in early fall 2009, with sharp declines thereafter. Sentinel hospital surveillance continued to detect hospitalizations for influenza-like illness that were not due to 2009 H1N1 influenza well into March 2010. Compared to influenza surveillance conducted through the Emerging Infections Program, the sentinel hospital influenza surveillance program tended to detect a sicker population of children and adults, including a higher rate of critical illness and mechanical ventilation, and among adults, higher rates of some underlying medical conditions. There were no differences in disease outcomes detected between the 2 systems.CONCLUSIONS:Although the 2 surveillance systems were complementary, inherent methodologic variations revealed important differences at season conclusion. The lessons learned should be used to determine the best way to allocate resources to meet the needs of future state and national influenza surveillance efforts.

OBJECTIVESA process evaluation was conducted to evaluate a newly established active influenza surveillance program that utilized 6 sentinel hospitals to collect epidemiologic information for influenza-like illness admissions. Objectives were to determine whether the new system was implemented successfully and met surveillance objectives, including determination of the proportion of patients with 2009 H1N1 influenza, extent of disease severity, and identifying high-risk groups.METHODSTimeliness and data quality were assessed through analysis of electronic case report form completion and timing of specimen collection and submission to public health laboratories for influenza testing. Simplicity and accessibility of the surveillance system were assessed through a survey of hospital-based surveillance staff.RESULTSThe median number of days from admission to initial reporting was 5 days. The completeness of core variables was more than 98%, 96.2% for complications, and 92.6% for underlying medical conditions. Among influenza-like illness admissions, 77.8% had a specimen submitted for confirmatory testing. Eighty-nine percent of survey respondents found guidance provided by New York State Department of Health to be helpful and case report forms easy to use.CONCLUSIONSThis project was implemented within a context of limited time and resources. Certain aspects of planning, such as securing necessary staffing at some hospitals, could not be carried out prior to implementation. Resource limitations necessitated controls on the numbers of specimens submitted each week. Some reporting lags were noted because of delays in data entry. Reporting timeframes allowed for timely data summarization for internal decision making. Maintaining frequent contact with sentinel sites promoted report completeness, timeliness, and consistency across sites. These results highlight the value of sentinel surveillance methodology and challenges of rapidly deploying a new active surveillance system for an emergent disease.

Anecdotal evidence suggests that rabid foxes are more likely to attack humans than are other rabid terrestrial animals. To examine this issue, we analyzed rabies surveillance data (1999-2007) maintained by the New York State Department of Health. Compared to rabid raccoons (Procyon lotor), foxes infected with raccoon variant rabies were more likely to bite during a human exposure incident (P<0.01). Additionally, rabid gray foxes (Urocyon cinereoargenteus) were significantly more likely to bite a human than were rabid red foxes (Vulpes vulpes; P<0.01). Animal control personnel and others who handle wildlife should be educated about the increased risk of bite exposure when dealing with potentially rabid foxes.

"Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel: National Association of State Public Health Veterinarians Veterinary Infection Control Committee 2010" published on 15 Dec 2010 by American Veterinary Medical Association.

This study evaluated characteristics associated with raccoon (Procyon lotor) rabies in New York State (NYS), USA, where this disease has been endemic for the last 15 years. The study included 4448 cases of raccoon rabies in terrestrial mammals reported across 1639 census tracts of NYS during 1997–2003. A Poisson-regression model with census tract-year as the unit of analysis revealed a higher number of raccoon-variant rabies cases per square kilometer in census tracts with each percent increase in the proportion of low-intensity residential areas (those with a lower concentration of housing units) (RR=7.68) and a lack of rivers/lakes (RR=1.20) and major roads (RR=1.10), while the number of cases decreased with each 1-m increase in land elevation (RR=0.998), and each percent increase in the proportion of wetlands (RR=0.01). The model was adjusted for county, ecoregion, and latitude to help control for unknown spatially dependent covariates. The model may be used in prioritizing areas for rabies control based on differential risk, including use of costly intervention methods such as oral rabies vaccine.

BACKGROUND:With the objective of identifying spatial and temporal patterns of enzootic raccoon variant rabies, a spatial scan statistic was utilized to search for significant terrestrial rabies clusters by year in New York State in 1997-2003. Cluster analyses were unadjusted for other factors, adjusted for covariates, and adjusted for covariates and large scale geographic variation (LSGV). Adjustments were intended to identify the unusual aggregations of cases given the expected distribution based on the observed locations. RESULTS:Statistically significant clusters were identified particularly in the Albany, Finger Lakes, and South Hudson areas. The clusters were generally persistent in the Albany area, but demonstrated cyclical changes in rabies activity every few years in the other areas. Cluster adjustments allowed the discussion of possible causes for the high risk raccoon rabies areas identified. CONCLUSION:This study analyzed raccoon variant rabies spatial and temporal patterns in New York that have not been previously described at a focal (census tract) level. Comparisons across the type of spatial analysis performed with various degrees of adjustment allow consideration of the potential influence of geographical factors for raccoon rabies and possible reasons for the highest risk areas (statistically significant clusters).

BACKGROUND:The cost-benefit of raccoon rabies control strategies such as oral rabies vaccination (ORV) are under evaluation. As an initial quantification of the potential cost savings for a control program, the collection of selected rabies cost data was pilot tested for five counties in New York State (NYS) in a three-year period.METHODS:Rabies costs reported to NYS from the study counties were computerized and linked to a human rabies exposure database. Consolidated costs by county and year were averaged and compared.RESULTS:Reported rabies-associated costs for all rabies variants totalled $2.1 million, for human rabies postexposure prophylaxes (PEP) (90.9%), animal specimen preparation/shipment to laboratory (4.7%), and pet vaccination clinics (4.4%). The proportion that may be attributed to raccoon rabies control was 37% ($784,529). Average costs associated with the raccoon variant varied across counties from $440 to $1,885 per PEP, $14 to $44 per specimen, and $0.33 to $15 per pet vaccinated.CONCLUSION:Rabies costs vary widely by county in New York State, and were associated with human population size and methods used by counties to estimate costs. Rabies cost variability must be considered in developing estimates of possible ORV-related cost savings. Costs of PEPs and specimen preparation/shipments, as well as the costs of pet vaccination provided by this study may be valuable for development of more realistic scenarios in economic modelling of ORV costs versus benefits.

A Salmonella enterica serovar Typhimurium outbreak was associated with a veterinary clinic. Confirmed cases were in one cat, two veterinary technicians, four persons associated with clinic patients, and a nurse not linked to the clinic. This outbreak emphasizes the importance of strong public health ties to the animal health community.

After an outbreak of West Nile virus (WNV) infections in people, horses, and wildlife in Staten Island, NY, during the summer of 2000, we surveyed the bird population of the island for evidence of infection. Neutralizing antibodies were detected in 59 of 257 (23.0%) resident birds and none of 96 transient (migrating) birds sampled in early October. Species with the greatest seroprevalence were northern cardinal (Cardinalis cardinalis) (69.2%) and rock dove (Columba livia) (54.5%). House sparrows (Passer domesticus) and chickens (Gallus gallus) had lower than expected seroprevalences, 8.6% and 5.5%, respectively. The geographic distribution of seropositivity suggested focal transmission at several locations on the island. The concentration of seropositive birds among resident bird populations on Staten Island supports the concept that many birds survive WNV infection and that some of these play an important role in the WNV-bird-mosquito transmission cycle.