Meat and germs: Cook meat properly as bacteria in meat growing drug resistance

Bacteria in meat show growing drug resistance, FDA says

By Robert Roos

Feb 7, 2013 (CIDRAP News) – An annual report released by the Food and Drug Administration (FDA) this week shows that antibiotic resistance in bacteria found in retail meat and poultry samples is continuing to increase, though not uniformly.

For example, almost 45% of Salmonella isolates found on retail chicken samples were resistant to multiple classes of antimicrobial classes, up slightly from the 2010 level, says the 2011 Retail Meat Report of the National Antimicrobial Monitoring System (NARMS). Also, close to half of Campylobacter isolates in chicken were resistant to tetracyclines.

The report also shows that Campylobacter contamination in general (both susceptible and resistant isolates) increased in chicken and ground turkey samples in 2011, while Salmonella detections were down slightly for both items.

The NARMS retail meat surveillance program is a joint effort of the FDA, the Centers for Disease Control and Prevention (CDC), and health departments in 11 states: California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, Tennessee, and Pennsylvania. Its goals include providing information to promote steps for reducing resistance in foodborne bacteria.

In 2011, each health department bought about 40 retail samples each month—10 each of chicken, ground turkey, ground beef, and pork chops. All the state labs cultured meat and poultry samples for Salmonella, but only poultry samples were cultured for Campylobacter. Four of the states also cultured samples for Enterococcus and Escherichia coli.

The states sent their bacterial isolates to the FDA Center for Veterinary Medicine for identification of serotypes, antimicrobial susceptibility testing, and genetic analysis, the report says.

Resistant Salmonella
The testing revealed that 44.9% of Salmonella isolates in chicken were resistant to at least three antimicrobial classes in 2011, compared with 43.3% in 2010. In ground turkey, 50.3% of isolates showed this level of resistance, up from 33.7% the year before. In addition, 27% of chicken isolates showed resistance to at least five drug classes, which was down from 29% in 2010.

The report also says the percentage of Salmonella isolates with no detected resistance declined in 2011.

The researchers found continuing increases in Salmonella resistance to two specific drug classes. Between 2002 and 2011, resistance to third-generation cephalosporins in chicken isolates climbed from 10% to 33.5%, while such resistance in ground turkey rose from 8.1% to 22.4%. Both increases were significant (P <.05).

Significant increases over that same period were seen for Salmonella resistance to ampicillin: chicken isolates, 16.7% to 40.5%; ground turkey isolates, 16.2% to 58.4%.

On the other hand, all Salmonella isolates were susceptible to nalidixic acid, a member of the quinolone class, the report says.

Campylobacter resistance
More than 90% of Campylobacter isolates come from chicken samples each year, with the rest from ground turkey, the report notes. It says macrolide and fluoroquinolone drugs are used to treat Campylobacterinfections. Fluoroquinolone use in poultry production was banned in 2005.

Macrolide resistance in chicken samples remained low in 2011, at 4.3% for Campylobacter coli and 0.5% for Campylobacter jejuni, the testing showed.

C coli resistance to ciprofloxacin, a fluoroquinolone, peaked at 29.1% in 2005 and has dropped since then, reaching 18.1% in 2011, the report says. However, C jejuni resistance to the drug has continued an upward trend, from 15.2% in 2002 to 22.4% in 2011.

In addition, tetracycline resistance in both Campylobacter species jumped from 2010 to 2011, from 36.3% to 48.4% for C jejuni and from 39.2% to 29.1% for C coli.

Further, gentamicin resistance in C coli reached 18.1% in 2011, a big increase from the 0.7% level seen in 2007 when it was first detected.

On the brighter side, the report says multidrug resistance is rare in Campylobacter: Only 9 of 634 isolates from poultry were resistant to three or more drug classes in 2011.

The report also profiles resistance in Enterococcus species and Escherichia coli found in meat and poultry samples. Among other things, it notes that no Enterococcus isolates were resistant to vancomycin or linezolid, two drug classes that "are critically important in human medicine but are not used in food animal production."

General prevalence
As for the overall prevalence of contamination (susceptible and resistant strains), the project showed that 45.7% of chicken samples in 2011 contained Campylobacter, up from 38.3% in 2010. For ground turkey, the 2011 figure was 2.3%, up from 1.0% in 2010.

For Salmonella, the general prevalence in chicken was 12.0%, down from 13.0% the year before, while the ground turkey figure was 12.3%, down from 15.3% a year earlier. Salmonella was found in less than 1% of ground beef samples both years. For pork chops, the 2011 number was 2.1%, up from 1.5% in 2010.

For E coli (most strains of which are nonpathogenic), prevalence numbers were lower in 2011 than 2010 but remained fairly high: chicken, 71.0%; ground turkey, 76.7%; ground beef, 44.8%; and pork chops, 30.4%.

Congress member reacts
Rep. Louise Slaughter, D-N.Y., a food safety advocate, called the FDA's findings on resistance in meat samples "alarming." In a statement, she cited the high level of ampicillin resistance found in bacteria in ground turkey and the tetracycline resistance seen in Campylobacter from poultry samples.

"The threat of antibiotic-resistant disease is real, it is growing and those most at risk are our seniors and children," Slaughter said. "We can help stop this threat by drastically reducing the overuse of antibiotics in our food supply, and Congress should act swiftly to do so today."

New guidelines for management of thyroid dysfunction in pregnancy launched by the Indian Thyroid Society

2013

Bangalore, Feb 18: The Indian Thyroid Society (ITS) today launched three guidelines for the Management of Thyroid Dysfunction in Pregnancy, Dyslipidemia and Depression at the 10th Annual Conference ‘ITSCON – 2013’. These guidelines are for managing thyroid dysfunction in Pregnancy to safeguard mother and child health, and for patients of Depression and Dyslipidemia to reduce the co-morbidities associated with thyroid disorders. Thyroid disorders in India are characterized by a high prevalence (approx. 11% of adult population), minimal diagnosis, low awareness and low involvement of doctors in treatment.

The guidelines were developed by Elsevier, a global provider of scientific, technical and medical information, and endorsed by the Indian Thyroid Society, Endocrine Society of India [ESI], Federation of Obstetric and Gynaecological Societies of India [FOGSI] and The Association of Physicians of India [API]. Abbott provided financial assistance for the development of these guidelines.

On the launch of the ITS Guidelines, Dr. R. V. Jayakumar, President, Indian Thyroid Society [ITS], Professor of Endocrinology, AIMS, Cochin said, “Conditions such as depression, cardiovascular disorders, high cholesterol, obesity, osteoporosis, infertility and miscarriages are linked to thyroid disorders and these are on the rise in India.. The three independent guidelines for the screening and management of Thyroid Dysfunction will support the medical fraternity in diagnosis and treatment. Timely diagnosis of thyroid disorders in pregnant women is important for a healthy pregnancy and a healthy child. In addition, the guidelines for dyslipidemia and depression offer recommendations to minimize the risk of arising complications.”
Dr. Rakesh Sahay Professor of Endocrinology, Osmania Medical College, Hyderabad said “Thyroid disorders are one of the most under-diagnosed medical conditions and often referred to as the hidden disease. The new guidelines for thyroid disorders associated with pregnancy, dyslipidemia and depression will aid doctors like us to educate the masses about the importance of undergoing a TSH test for the correct diagnosis. Timely treatment of thyroid disorders is the key to preventing health problems.”
The Thyroid Dysfunction and Pregnancy Guidelines recommend screening for hypothyroidism in pregnant women at the 1st antenatal visit by measuring TSH levels. In case overt hypothyroidism is diagnosed then expectant mothers should be treated with a full replacement dose of thyroxine to normalize thyroid function as rapidly as possible. It is also important to understand that; thyroid dysfunction by itself is not an indication for termination of pregnancy.

As per the Thyroid Dysfunction and Dyslipidemia Guidelines, overt hypothyroidism is associated with the risk of cardio vascular disease as it causes increased levels of LDL cholesterol and hypertension. It is therefore advised that doctors screen patients with dyslipidemia for abnormal thyroid levels and accordingly prescribe treatment.

According to theThyroid Dysfunction and Depression Guidelines one of the co-morbidities associated with thyroid disorders is depression. It is important for doctors who are treating patients for depression to refer them to undergo a TSH test to detect hypothyroidism. This will help in correct diagnosis and treatment to prevent further damage.
Thyroid disorder is a medical condition that impairs the normal functioning of the thyroid gland causing abnormal production of hormones leading to hyperthyroidism or hypothyroidism. Multiple factors such as hereditary, environment and diet can trigger thyroid dysfunction. Thyroid disorders are commonly diagnosed between 20 – 40 years and research has shown that women are more commonly detected with thyroid disorders than men.

Speaking of thyroid disorders in women during pregnancy, Dr. Hema Divakar, President - Federation of Obstetric and Gynaecological Societies of India [FOGSI], Bangalore said “Hypothyroidism is emerging as one of the most common endocrine problem during pregnancy and often goes undetected.

It increases the risk of miscarriage, stillbirth, premature birth and placental abnormalities that adversely affects the overall development of the foetus. In the best interest of the mother and baby, we encourage regular screening for thyroid disorders amongst pregnant women. The guidelines recommend screening at the 1st antenatal visit by measuring TSH levels.”

Often symptoms such as anxiety, mood swings and poor concentration are ignored as signs of stress. These could have been triggered due to abnormal levels of thyroid hormone which can push people into depression.

According to Dr Sarita Bajaj, President Endocrine Society of India (ESI), Allahabad, “Thyroid hormones have a tremendous effect on body processes and can even impact cognitive function. There is little awareness that depression is a co-morbidity associated with hypothyroidism. All patients with depression should preferably be screened for thyroid function tests and be appropriately treated with thyroxine as judged by the physician.”
Dr. Shashank Joshi, President Elect - The Association of Physicians of India [API], Mumbai says "Many hypothyroid patients have underlying lipid abnormalities which get controlled by simple thyroxine therapy. Hypothyroidism needs lifelong thyroxine therapy and if controlled well, the patients can lead a normal life."

Hypothyroidism also leads to a co-morbid condition called dyslipidemia indicated with an increase in serum total cholesterol, low-density lipoprotein (LDL), apolipoprotein B, lipoprotein (a) levels, and possibly triglyceride levels. Dyslipidemia puts a patient at an increased risk for developing cardiovascular diseases, atherosclerosis and coronary artery disease.

The Chairman Organising committee Dr. K. M. Prasanna Kumar confirmed that close to 500 eminent speakers and Key Opinion Leaders from across India were present at the ITSCON-2013 conference. The speakers highlighted various disorders arising from thyroid dysfunctions, the importance of timely screening and recommended treatment to prevent further complications. Till 2012, ITS had screened close to 12 lakh women for thyroid disorders at various diagnostic and education camps throughout India.

Campylobacter infections in Alaska linked to drinking of raw milk

Raw milk suspected in Campylobacter infections in Alaska

At least four people in Alaska's Kenai Peninsula recently suffered Campylobacter infections after drinking raw milk, the Alaska Division of Public Health (DPH) said in a Feb 15 health advisory.

The four people were infected with Campylobacter isolates that were matched by pulsed-field gel electrophoresis. In addition, at least one person with a probable infection also reported drinking raw milk, and an infant in close contact with a confirmed case-patient has a suspected case, the statement said.

The strain identified in the cases has not been seen in Alaska before, it said.
Feb 15 Alaska DPH notice

Assocham study reveals the impact of trade union strike on India's GDP

GDP to take Rs 15,000-20,000 crore hit from strike: ASSOCHAM

While sharing some of their concerns like rising prices, ASSOCHAM today appealed to the central trade unions to call off their two-day strike as the country’s economy will take a hit of big hit of Rs 15,000-20,000 crore from the nation-wide disruption in economic activity.
“The national economy, battling slowdown can ill-afford this situation. In fact, the strike would aggravate the price situation because of disruption in the supply line of essential commodities”, said Mr. Rajkumar Dhoot President ASSOCHAM.
Mr. Dhoot further said the strike would cripple mostly the services sector like banking, insurance and transport, besides the industrial production. Even the agriculture would be affected as the movement of vegetables, highly perishable items, would be disrupted.
The ASSOCHAM has estimated the national loss figures based on the daily erosion of about 30-40 per cent to the country’s Gross Domestic Production (GDP) for two days. As per the Advanced estimates of the CSO, the national GDP for the current financial year is projected to be about Rs 95 lakh crore. In other words, it is Rs 26,000 crore per day and Rs 52,000 crore for two days. Of this , the strike would take its toll on at least 30-40 per cent – Rs 15,000 crore-Rs 20, 000 crore.
“Given the nature of the strike and involvement of the all the five major central trade unions, it is going to affect largely the services sector including the banking, financial services, tourism, transportation etc, which are the major contributors to the country’s GDP”, added Mr. Dhoot.

States like West Bengal, Kerala, Maharashtra, Gujarat, Tamil Nadu, Delhi, Haryana, Karnataka and parts of Uttar Pradesh are likely to be affected significantly. Besides, banking operations including the cheque clearances and some segments of the financial markets would take a hit. Moreover, disruption in railways and other public transportation in major cities would hit the movement of the workforce and the cargo operations at the ports.
The cargo operations both at the airport and ports are likely to be affected, the chamber apprehends. 
“Our conservative estimates show that at least 30-40 per cent of the daily GDP would take a hit. For two days, it would be something like Rs 15,000-20,000 crore,” reveals the ASSOCHAM Economic Research (AER) department.
Expressing concerns over the impending strike, the Mr. Dhoot said, it would not be in the interest of the country’s economy to stop work in the crucial sectors. “While we share some of the concerns like rising prices, the solution lies in working together to ensure that the situation is brought under control by raising production and pumping up the supply. The strike, in fact would put further pressure on the price situation as the prices of vegetables etc would immediately go up because of disruption”.

He said the GDP growth is projected to be at a decade low of about five per cent and several sectors like manufacturing are operating at a much lower scale and work disruption would make a big dent on the economic activity.
“Besides, the services sector which has remained backbone of the economy, has also started slowing down,” he said.

As per the chamber estimates, despite global slowdown and difficult domestic conditions, the Indian industry has not really resorted to job trimming and has generally been working in partnership with the labour-force.
“The labour force is a very important stakeholder in the national activity. In fact, it is the human resource which is India’s advantage vis-à-vis several other high cost economies. Thus, welfare of the workforce is on top of the priorities of the industry and ASSOCHAM is fully committed to ensuring their welfare,” added Mr Dhoot.
He appealed to leaders of the all the central unions including CITU, AITUC, INTUC and BMS to engage with the government and find amicable solutions to the issues raised by them. The Industry shares some of the concerns like rising prices, but then “we need to work together to resolve the issue and ensure better supplies which is possible by higher investment and production. The workers’role in this area too is of paramount importance,” he said.
Mr. Dhoot also appealed to the government to immediately engage with the labour unions to find out amicable solutions to the issues raised by them.

More about the breast pump and hygiene

Breast Pump Basics

• Breast shield: Cone-shaped cup that fits over the nipple and surrounding area.
• Pump: Creates the gentle vacuum that expresses milk. The pump may be attached to the breast-shield or have plastic tubing to connect the pump to the breast shield.
• Milk container: Detachable container that fits below the breast shield and collects milk as it is pumped.

These days, many new mothers return to the workplace with a briefcase in one hand—and a breast pump kit in the other.

For those moms working outside the home who are breastfeeding their babies (and those who travel or for other reasons can’t be with their child throughout the day), using a breast pump to “express” (extract) their milk is a must.

The Food and Drug Administration (FDA) oversees the safety and effectiveness of these medical devices.

New mothers may have a host of questions about choosing a breast pump. What type of breast pump should they get? How do they decide ahead of time which pump will fit in best with their daily routines? Are pumps sold “used” safe?
Choosing the Right Pump for You

Kathryn S. Daws-Kopp, an electrical engineer at FDA, explains that all breast pumps consist of a few basic parts: a breast shield that fits over the nipple, a pump that creates a vacuum to express the milk, and a detachable container for collecting the milk.

There are three basic kinds of pump: manual, battery-powered and electric. Mothers can opt for double pumps, which extract milk from both breasts at the same time, or single, which extract milk from one breast at a time.

Daws-Kopp, who reviews breast pumps and other devices for quality and safety, suggests that mothers talk to a lactation consultant, whose expertise is in breastfeeding, or other health care professional about the type of breast pump that will best fit their needs. Questions for new moms to keep in mind include:
How do I plan to use the pump? Will I pump in addition to breastfeeding? Or will I just pump and store the milk?
Where will I use the pump? At work? When I’m traveling?
Do I need a pump that’s easy to transport? If it’s electric, will I have access to an outlet?
Does the breast shield fit me? If not, will the manufacturer let me exchange it?


Should You Buy or Rent?

There’s also the decision of whether to buy or rent a breast pump. Many hospitals, lactation consultants and specialty medical supply stores rent breast pumps for use by multiple users, Daws-Kopp notes.

These pumps are designed to decrease the risk of spreading contamination from one user to the next, she says, and each renter needs to buy a new accessories kit that includes breast-shields and tubing.

“Sometimes these pumps are labeled “hospital grade,” says Daws-Kopp. “But that term is not one FDA recognizes, and there is no consistent definition. Consumers need to know it doesn’t mean the pump is safe or hygienic.”

Daws-Kopp adds that different companies may mean different things when they label a pump with this term, and that FDA encourages manufacturers to instead use the terms “multiple user” and “single user” in their labeling. “If you don’t know for sure whether a pump is meant for a single user or multiple users, it’s safer to just not get it,” she says.

The same precaution should be taken for “used” or second-hand pumps.

Even if a used pump looks really clean, says Michael Cummings, M.D., an obstetrician-gynecologist at FDA, potentially infectious particles may survive in the breast pump and/or its accessories for a surprisingly long time and cause disease in the next baby.
Keeping It Clean

According to FDA’s recently released website on breast pumps, the first place to look for information on keeping the pump clean is in the instructions for use. In general, though, the steps for cleaning include:
Rinse each piece that comes into contact with breast milk in cool water as soon as possible after pumping.
Wash each piece separately using liquid dishwashing soap and plenty of warm water.
Rinse each piece thoroughly with hot water for 10-15 seconds.
Place the pieces on a clean paper towel or in a clean drying rack and allow them to air dry.

If you are renting a multiple user device, ask the person providing the pump to make sure that all components, such as internal tubing, have been cleaned, disinfected, and sterilized according to the manufacturer’s specifications.

Cummings notes that there are many benefits to both child and mother from breastfeeding. “Human milk is recommended as the best and exclusive nutrient source for feeding infants for the first six months, and should be continued with the addition of solid foods after six months, ideally until the child is a year of age,” he says.

The benefits are both short- and long-term. In the short-term, babies can benefit from improved gastrointestinal function and development, and fewer respiratory and urinary tract infections. In the long-term, children who have been breast fed may be less obese and, as adults, have less cardiovascular disease, diabetes, inflammatory bowel disease, allergies, and even some cancers.

Cummings adds that moms and their families benefit by the bonding experience and economically as well, since a reduction in acute and chronic diseases in the baby saves money.

For women considering this option, FDA ‘s website offers resources and information on breast pumps and breastfeeding. These include information on the selection and care of the pumps, in addition to describing signs of an infection or injury related to their use.

(This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products. January 14, 2013)

All about the Kyasanur Forest Disease

Kyasanur Forest Disease, India, 2011–2012

By Gudadappa S. Kasabi and others

To determine the cause of the recent upsurge in Kyasanur Forest disease, we investigated the outbreak that occurred during December 2011–March 2012 in India. Male patients >14 years of age were most commonly affected. Although vaccination is the key strategy for preventing disease, vaccine for boosters was unavailable during 2011, which might be a reason for the increased cases.

Kyasanur Forest disease (KFD), a tick-borne viral disease, was first recognized in 1957 in Shimoga District, India, when an outbreak in monkeys in Kyasanur Forest was followed by an outbreak of hemorrhagic febrile illness in humans. KFD is unique to 5 districts (Shimoga, Chikkamagalore, Uttara Kannada, Dakshina Kannada, and Udupi) of Karnataka State and occurs as seasonal outbreaks during January–June.

Since 1990, vaccination campaigns using formalin-inactivated tissue-culture vaccine have been conducted in the districts to which KFD is endemic (Directorate of Health and Family Welfare Services, Government of Karnataka, Manual on Kyasanur Forest disease. 2005, unpub. data). Earlier studies showed vaccine efficacy of 79.3% with 1 dose and 93.5% with 2 doses. The vaccination program identifies villages reporting KFD activity (laboratory-confirmed cases in monkeys and/or humans, or infected ticks), and all villages within 5 km of the affected location are targeted for vaccination. Two doses are administered to persons 7–65 years of age at 1-month intervals. Because the immunity conferred by vaccination is short-lived, booster doses are administered at 6–9-month intervals consecutively for 5 years after the last reported KFD activity in the area (Directorate of Health and Family Welfare Services, Government of Karnataka, Manual on Kyasanur Forest disease. 2005, unpub. data). If KFD activity is reported where vaccination has been administered during pretransmission seasons, additional vaccination campaigns are conducted.

Thirthahalli Taluka in the Shimoga District, where vaccination campaigns were ongoing, reported 0 cases of KFD during 2007–2010. A vaccination campaign was conducted in the area during October 2010. Because 11 cases were reported from the Thirthahalli Taluka in March 2011, vaccination campaigns were conducted during April–May 2011; however, no booster doses were administered in the affected areas during October–November 2011 because the vaccine was not available. Suspected KFD cases were reported in the area again in December 2011. We investigated this cluster to 1) confirm the etiology, 2) identify risk factors, and 3) propose recommendations for control.

The Study

We defined a suspected KFD case as sudden onset of fever, headache, and myalgia among residents of Shimoga during December 2011–March 2012 (Directorate of Health and Family Welfare Services, Government of Karnataka, Manual on Kyasanur Forest disease, 2005, unpub. data). Health workers conducted door-to-door searches to identify suspected case-patients within 5 km of villages that reported monkey deaths or laboratory-confirmed KFD cases in humans since December 2011. We established stimulated passive surveillance in health facilities in the district to identify suspected case-patients. Health workers collected information about sociodemographic profile, date of onset, and place of residence from all suspected case-patients. We recorded clinical history and vaccination details of laboratory-confirmed case-patients. We analyzed the data to describe the disease by time, place, and person. The investigation was exempted from ethical committee clearance because it was part of the state-level public health response to the outbreak.

Blood specimens were collected from all suspected case-patients. We tested for KFD virus by using nested reverse transcription PCR (RT-PCR) and Taqman-based RT-PCR at the National Institute of Virology (Pune, India) and/or intracerebral injection of the serum into suckling mice at the Virus Diagnostic Laboratory, Shimoga.

We conducted a matched case–control study to identify risk factors for the illness. Persons with laboratory-confirmed infection who were admitted to health facilities were considered case-patients, and healthy persons were used as controls. We recruited 2 controls per case-patient (total 51 cases, 102 controls). Case-patients and controls were matched with age group (±5 years), sex, and locality. We interviewed participants to collect information about any recent exposure to the forest and number of doses of KFD vaccine received in 2011. We conducted conditional logistic regression analysis by using Epi Info software (Centers for Disease Control and Prevention, Atlanta, GA, USA) to identify risk factors. All risk factors evaluated were included in the logistic regression model.

During December 2011–March 2012, we identified 215 suspected case-patients from 80 villages (total population 22,201) in Shimoga (attack rate 9.7 cases/1,000 persons). Of these, 61 (28%) cases were laboratory confirmed (57 by RT-PCR; 4 by suckling mice intracerebral inoculation). Most (92%) laboratory-confirmed case-patients were >14 years of age, and 70% were male. The cases began occurring in the last week of December 2011, peaked during the first 2 weeks of February, and then declined gradually. Of the 215 suspected cases, 166 (77%) occurred in 4 primary health center areas of Thirthahalli Taluka.

Besides fever and myalgia, common clinical manifestations among the 61 laboratory-confirmed case-patients included bleeding (38 [63%] persons), vomiting (28 [46%]), and abdominal pain (26 [42%]). The hemorrhagic manifestations included conjunctival congestion (30 [49%]), hematemesis (5 [8%]), epistaxis (1 [2%]), hematuria (1 [2%]), and rectal bleeding (1 [2%]). One patient died (case-fatality rate 0.5%). Of the 61 laboratory-confirmed case-patients, 20 (33%) had received 2 doses of KFD vaccine, and 2 (3%) received 1 dose; 39 (64%) did not receive any vaccination during April–May 2011. Twelve case-patients were housewives or students; the rest reported multiple occupations requiring frequent visits to the forest, such as cultivator, dry leaf gatherer, agriculture laborer, and cattle grazer.

Behavioral factors, such as handling cattle (adjusted odds ratio [aOR] 5.1, 95% CI 1.3–20.4) and frequent visits to forest for livelihood (aOR 4.8, 95% CI 1.2–20.3) and piles of dry leaves within the compounds of the house (aOR 4.1, 95% CI 1.3–12.3) were independently associated with illness. Of the 51 case-patients, 20 had received 2 doses of vaccine and 2 had received 1 dose. The odds of developing illness did not differ significantly for nonvaccinated case-patients and case-patients who received 2 doses.

Conclusions

Vaccination is the key strategy for preventing KFD in Karnataka. However, during 2011, a booster vaccination campaign was not conducted in the district because of vaccine unavailability, which might be a reason for the upsurge of KFD cases during 2012. Two doses of the vaccine given during April–May 2011 did not confer adequate protection against the disease during December 2011–March 2012, suggesting the possibility of short-lived immunity conferred by 2 doses of vaccine and the need for periodic boosters.

In the affected areas, local villagers stay in and around the forest area, frequently visit the forest for their livelihood, and get infected through tick bites. We identified certain risk factors for the illness, including frequent visits to the forest, handling of cattle, and piles of dry leaves within the compounds. The higher attack rates for male case-patients aged >14 years during this outbreak are consistent with their frequent exposure to the forest. Health authorities advise use of tick repellent; however, it was infrequently used in the area. Educating the community to wear long-sleeved clothing might help reduce exposure to ticks.

Although the transmission cycle of KFD virus is well documented, its control remains challenging. Measures to minimize the human–tick interface are less likely to succeed considering the forest ecosystem and the dependence of local villagers on it. Control of ticks in the forest is far from easy, but health authorities need to continue educating villagers about using tick repellent before visiting the forest, especially during spring and summer, and ensure distribution of tick repellents to them. Health authorities must ensure that vaccination campaigns are initiated on time and completed before November every year. More epidemiologic studies are needed to evaluate the long-term protection offered by booster doses of vaccine. Molecular studies also are needed to understand the phylogenetic relationships of the past and contemporary strains of the virus and to identify possible sources and origins of outbreak strains.

(Dr Kasabi is a senior medical officer with Department of Health and Family Welfare, Government of Karnataka, in Shimoga District. He conducted this outbreak investigation as a part of a Master of Public Health (Epidemiology and Health Systems) course at the National Institute of Epidemiology, Chennai. His research interests include health system research and reemerging infectious diseases.)