mclaughlin_vibrio_globalwarming - The n ew england journal...

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n engl j med 353;14 www.nejm.org october 6, 2005 The new england journal of medicine 1463 original article Outbreak of Vibrio parahaemolyticus Gastroenteritis Associated with Alaskan Oysters Joseph B. McLaughlin, M.D., M.P.H., Angelo DePaola, Ph.D., Cheryl A. Bopp, M.S., Karen A. Martinek, R.N., M.P.H., Nancy P. Napolilli, B.S., Christine G. Allison, B.S., Shelley L. Murray, B.S., Eric C. Thompson, B.S., Michele M. Bird, M.S., and John P. Middaugh, M.D. From the Division of Public Health, Alaska Department of Health and Social Services (J.B.M., K.A.M., J.P.M.); and the Alaska De- partment of Environmental Conservation (N.P.N., C.G.A., S.L.M.) — both in Anchor- age; the Food and Drug Administration, Gulf Coast Seafood Laboratory, Dauphin Island, Ala. (A.D.); the Centers for Disease Control and Prevention, National Center for Infectious Diseases, Atlanta (C.A.B., M.M.B.); and the Washington State De- partment of Health Public Health Labora- tories, Shoreline (E.C.T.). Address reprint requests to Dr. McLaughlin at the Division of Public Health, Alaska Department of Health and Social Services, 3601 C St., Suite 540, Anchorage, AK 99503, or at joe_mclaughlin@health.state.ak.us. N Engl J Med 2005;353:1463-70. Copyright © 2005 Massachusetts Medical Society. background Vibrio parahaemolyticus, the leading cause of seafood-associated gastroenteritis in the United States, typically is associated with the consumption of raw oysters gathered from warm-water estuaries. We describe a recognized outbreak of V. parahaemolyticus infection associated with the consumption of seafood from Alaska. methods After we received reports of the occurrence of gastroenteritis on a cruise ship, we con- ducted a retrospective cohort study among passengers, as well as active surveillance throughout Alaska to identify additional cases, and an environmental study to identify sources of V. parahaemolyticus and contributors to the outbreak. results Of 189 passengers, 132 (70 percent) were interviewed; 22 of the interviewees (17 per- cent) met our case definition of gastroenteritis. In our multiple logistic-regression analy- sis, consumption of raw oysters was the only significant predictor of illness; the attack rate among people who consumed oysters was 29 percent. Active surveillance identi- fied a total of 62 patients with gastroenteritis. V. parahaemolyticus serotype O6:K18 was isolated from the majority of patients tested and from environmental samples of oys- ters. Patterns on pulsed-field gel electrophoresis were highly related across clinical and oyster isolates. All oysters associated with the outbreak were harvested when mean daily water temperatures exceeded 15.0°C (the theorized threshold for the risk of V. para- haemolyticus illness from the consumption of raw oysters). Since 1997, mean water temperatures in July and August at the implicated oyster farm increased 0.21°C per year (P<0.001 by linear regression); 2004 was the only year during which mean daily tem- peratures in July and August at the shellfish farm did not drop below 15.0°C.
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This note was uploaded on 11/07/2010 for the course INTEGBI 118 taught by Professor Shapira during the Fall '10 term at University of California, Berkeley.

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mclaughlin_vibrio_globalwarming - The n ew england journal...

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