To better quantify the impact of foodborne diseases on health in the United States, we compiled and analyzed information from multiple surveillance systems and other sources. We estimate that foodborne diseases cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Known pathogens account for an estimated 14 million illnesses, 60,000 hospitalizations, and 1,800 deaths. Three pathogens, Salmonella, Listeria, and Toxoplasma, are responsible for 1,500 deaths each year, more than 75% of those caused by known pathogens, while unknown agents account for the remaining 62 million illnesses, 265,000 hospitalizations, and 3,200 deaths. Overall, foodborne diseases appear to cause more illnesses but fewer deaths than previously estimated.

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Food-related illness and death in the United States.

Overwhelming evidence shows the quality of reporting of randomised controlled trials (RCTs) is not optimal. Without transparent reporting, readers cannot judge the reliability and validity of trial findings nor extract information for systematic reviews. Recent methodological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects. Such systematic error is seriously damaging to RCTs, which are considered the gold standard for evaluating interventions because of their ability to minimise or avoid bias. A group of scientists and editors developed the CONSORT (Consolidated Standards of Reporting Trials) statement to improve the quality of reporting of RCTs. It was first published in 1996 and updated in 2001. The statement consists of a checklist and flow diagram that authors can use for reporting an RCT. Many leading medical journals and major international editorial groups have endorsed the CONSORT statement. The statement facilitates critical appraisal and interpretation of RCTs. During the 2001 CONSORT revision, it became clear that explanation and elaboration of the principles underlying the CONSORT statement would help investigators and others to write or appraise trial reports. A CONSORT explanation and elaboration article was published in 2001 alongside the 2001 version of the CONSORT statement. After an expert meeting in January 2007, the CONSORT statement has been further revised and is published as the CONSORT 2010 Statement. This update improves the wording and clarity of the previous checklist and incorporates recommendations related to topics that have only recently received recognition, such as selective outcome reporting bias. This explanatory and elaboration document-intended to enhance the use, understanding, and dissemination of the CONSORT statement-has also been extensively revised. It presents the meaning and rationale for each new and updated checklist item providing examples of good reporting and, where possible, references to relevant empirical studies. Several examples of flow diagrams are included. The CONSORT 2010 Statement, this revised explanatory and elaboration document, and the associated website (www.consort-statement.org) should be helpful resources to improve reporting of randomised trials.

https://www.bmj.com/content/bmj/340/bmj.c869.full.pdf

CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials

Escherichia coli is the predominant nonpathogenic facultative flora of the human intestine. Some E. coli strains, however, have developed the ability to cause disease of the gastrointestinal, urinary, or central nervous system in even the most robust human hosts. Diarrheagenic strains of E. coli can be divided into at least six different categories with corresponding distinct pathogenic schemes. Taken together, these organisms probably represent the most common cause of pediatric diarrhea worldwide. Several distinct clinical syndromes accompany infection with diarrheagenic E. coli categories, including traveler’s diarrhea (enterotoxigenic E. coli), hemorrhagic colitis and hemolytic-uremic syndrome (enterohemorrhagic E. coli), persistent diarrhea (enteroaggregative E. coli), and watery diarrhea of infants (enteropathogenic E. coli). This review discusses the current level of understanding of the pathogenesis of the diarrheagenic E. coli strains and describes how their pathogenic schemes underlie the clinical manifestations, diagnostic approach, and epidemiologic investigation of these important pathogens.

Diarrheagenic Escherichia coli

A previously unknown coronavirus was isolated from the sputum of a 60-year-old man who presented with acute pneumonia and subsequent renal failure with a fatal outcome in Saudi Arabia. The virus (called HCoV-EMC) replicated readily in cell culture, producing cytopathic effects of rounding, detachment, and syncytium formation. The virus represents a novel betacoronavirus species. The closest known relatives are bat coronaviruses HKU4 and HKU5. Here, the clinical data, virus isolation, and molecular identification are presented. The clinical picture was remarkably similar to that of the severe acute respiratory syndrome (SARS) outbreak in 2003 and reminds us that animal coronaviruses can cause severe disease in humans.

http://iacld.ir/DL/elm/isolationofanovelcoronavirusfromamanwithpneumoniainsaudiarabia.pdf

Isolation of a Novel Coronavirus from a Man with Pneumonia in Saudi Arabia

background A worldwide outbreak of severe acute respiratory syndrome (SARS) has been associated with exposures originating from a single ill health care worker from Guangdong Province, China. We conducted studies to identify the etiologic agent of this outbreak. methods We received clinical specimens from patients in six countries and tested them, using virus isolation techniques, electron-microscopical and histologic studies, and molecular and serologic assays, in an attempt to identify a wide range of potential pathogens. results No classic respiratory or bacterial respiratory pathogen was consistently identified. However, a novel coronavirus was isolated from patients who met the case definition of SARS. Cytopathological features were noted microscopically in Vero E6 cells inoculated with a throat-swab specimen. Electron-microscopical examination of cultures revealed ultrastructural features characteristic of coronaviruses. Immunohistochemical and immunofluorescence staining revealed reactivity with group I coronavirus polyclonal antibodies. Consensus coronavirus primers designed to amplify a fragment of the polymerase gene by reverse transcription–polymerase chain reaction (RT-PCR) were used to obtain a sequence that clearly identified the isolate as a unique coronavirus only distantly related to previously sequenced coronaviruses. With specific diagnostic RT-PCR primers we identified several identical nucleotide sequences in 12 patients from several locations, a finding consistent with a point source outbreak. Indirect fluorescent antibody tests and enzyme-linked immunosorbent assays made with the new coronavirus isolate have been used to demonstrate a virus-specific serologic response. Preliminary studies suggest that this virus may never before have infected the U.S. population. conclusions A novel coronavirus is associated with this outbreak, and the evidence indicates that this virus has an etiologic role in SARS. The name Urbani SARS-associated coronavirus is proposed for the virus.

/pdf/a-novel-coronavirus-associated-with-severe-acute-respiratory-2xpzga822c.pdf

A novel coronavirus associated with severe acute respiratory syndrome.

A 27-nm particle was observed by immune electron microscopy in an infectious stool filtrate derived from an outbreak in Norwalk, Ohio, of acute infectious nonbacterial gastroenteritis. Both experimentally and naturally infected individuals developed serological evidence of infection; this along with other evidence suggested that the particle was the etiological agent of Norwalk gastroenteritis.

Visualization by Immune Electron Microscopy of a 27-nm Particle Associated with Acute Infectious Nonbacterial Gastroenteritis

An epidemiologic study of altered clinical reactivity to respiratory syncytial (rs) virus infection in children previously vaccinated with an inactivated rs virus vaccine

Spherical 27-nanometer particles were visualized in stools obtained from hepatitis A patients in the acute phase of the disease. The particle was serologically specific for this disease, and every hepatitis A patient tested demonstrated a serologic response to this antigen. The findings suggest that it is the etiologic agent of hepatitis A.

http://science.sciencemag.org/content/sci/182/4116/1026.full.pdf

Hepatitis A: Detection by Immune Electron Microscopy of a Viruslike Antigen Associated with Acute Illness

Despite recent advances in tissue culture methodology, only 20 to 35 per cent of adults with acute upper respiratory tract illness yield viruses which can be cultivated by the standard virus recovery techniques.3' 4, 12 Recently, an increase in virus isolation from patients with common colds was achieved by Tyrrell and Bynoe through the use of human embryonic tracheal and nasal organ cultures.9' 20 Viruses were detected in harvests from organ cultures either by the induction of hemadsorption or cytopathic effect (CPE) in subinoculated tissue culture or by the production of colds in volunteers. One virus, strain B814, which was recovered by these techniques and produced colds in volunteers, was of particular interest since it was ether-labile and grew only in human ciliated epithelium. Subsequently, Tyrrell found that this virus resembled in morphology the avian infectious bronchitis virus (IBV), a medium-sized virus which appears to be distinct from the myxoviruses.2, 18 Another newly recognized, medium-sized, ether-labile virus, strain 229E, was recovered from students with colds by Hamre and Procknow using standard tissue culture techniques.5 During a survey of acute upper respiratory illness which was carried out in our laboratory, and in which the standard tissue culture techniques were used, we noted a sharp decrease in the rate of virus isolation during the winter of 1965-66, similar to that reported by others.3' 4 12 Stimulated by the findings of Tyrrell and Bynoe, we used the organ culture technique to study specimens, from this and a previous survey,12 which failed to yield agents in standard tissue cultures. From 23 such specimens 8 agents were recovered, including 6 with an unusual-morphology which resembled that of IBV. The recovery and properties of these 6 viruses form the basis of this report. Materials and Methods.-Collection of specimens and virus isolation attempts in tissue culture: Specimens were obtained from employees of the National Institutes of Health with acute upper respiratory illness on or before the fourth day of illness.12 Two-tenths ml of freshly collected nasopharyngeal wash fluid was inoculated into each of two tubes of the following tissue cultures: HEp-2, primary human embryonic kidney, rhesus monkey kidney, and human diploid cell strains (HDCS) WI-26, WI-38, and AT-39.13 The remaining fluid was stored at -60C. Tissue cultures were obtained from commercial sources, maintained as previously described,' and were incubated at 330C on roller drums. The tubes were observed for cytopathic effect twice weekly. Monkey kidney cultures were tested for hemadsorption at 5to 7-day intervals, and a single blind passage of most human embryonic kidney cultures was made at 21 days. Only those nasopharyngeal washings in which virus could not be detected by these methods were examined by organ culture techniques. Acute phase sera were drawn at the time the washings were collected and convalescent phase sera approximately 3 weeks thereafter. Organ cultures: Human embryonic tracheal organ cultures were prepared and maintained by a modification of the method of Hoorn and Tyrrell.6,7 Tracheas were obtained from fetuses spontaneously aborted at 5-9 months' gestational age. The tissue was excised en bloc by sterile technique and immediately stored in cold Hanks' balanced salt solution with 10% fetal calf serum,

https://www.pnas.org/content/pnas/57/4/933.full.pdf

Recovery in tracheal organ cultures of novel viruses from patients with respiratory disease.

To examine immunity in viral gastroenteritis, we challenged and then rechallenged 12 volunteers with Norwalk agent and evaluated symptoms, jejunal biopsies and serum antibody. With the first challenge, gastroenteritis developed in six volunteers but not in the others. When rechallenged 27 to 42 months later, the six who became ill initially again had gastroenteritis with jejunal lesions; in the six previously immune volunteers illness or jejunal lesions did not develop. Four of five ill volunteers had increases in serum antibody to Norwalk agent after both challenges. Serum antibody did not increase in three immune volunteers after either challenge. Four volunteers who had twice become ill underwent a third challenge four to eight weeks after their second illness. In one gastroenteritis developed; in three, it did not. These findings indicate two forms of immunity for viral gastroenteritis, one of short and the other of long duration. Factors other than serum antibody appear important in immunity to Norwalk gastroenteritis.

https://www.nejm.org/doi/pdf/10.1056/NEJM197707142970204?listPDF=true

Albert Z. Kapikian

Papers

Visualization by Immune Electron Microscopy of a 27-nm Particle Associated with Acute Infectious Nonbacterial Gastroenteritis

An epidemiologic study of altered clinical reactivity to respiratory syncytial (rs) virus infection in children previously vaccinated with an inactivated rs virus vaccine

Hepatitis A: Detection by Immune Electron Microscopy of a Viruslike Antigen Associated with Acute Illness

Recovery in tracheal organ cultures of novel viruses from patients with respiratory disease.

Clinical Immunity in Acute Gastroenteritis Caused by Norwalk Agent